Insurance Law

APPRAISAL

When a policyholder makes a claim for damage or loss to their property, the insurance company will typically send out an insurance adjuster to assess the value of the damaged or lost property. However, sometimes there can be disagreements between the policyholder and the insurance company about the value of the property, and this is where the appraisal provision comes into play.

The appraisal provision allows for a disinterested and competent appraiser to be brought in to determine the value of the property in question. This appraiser is not affiliated with either the policyholder or the insurance company and is considered neutral. If the policyholder and the insurance company's appraisers disagree on the value of the property, the policy will often provide for the appointment of an impartial umpire to make a final determination.

It is important to note that these appraisals are typically binding, meaning that the policyholder cannot contest the appraisal award if they disagree with it. There are some exceptions, such as if the appraiser was not qualified or if there was fraud involved in the appraisal process. Also the process can be complicated and easily manipulated by insurance companies or their appraisers, leading to a bad appraisal award that does not adequately compensate the policyholder.

For this reason, it is important to have an experienced appraiser like Faber Adjusting who has been helping clients navigate these types of claims for many years and can provide guidance throughout the process or represent you as your appraiser.

UNDERSTANDING INSURANCE COVERAGE AND CLAIMS

Insurance policies and the majority of other paperwork pertaining to insurance coverage are complex contracts that are challenging to read and comprehend. Many people erroneously believe that all insurance policies are fundamentally the same and count on their agent to look out for their interests and secure the "standard" coverage. The phrase " full coverage" insurance policy is commonly used, but it is important to note that this terminology is no longer accurate or commonly used. It is crucial to understand the specific coverage provided by your policy, including the range of adverse events and perils that it covers, the types of benefits it provides, the limits on what the insurance company will pay and/or provide, the types of claims that are included and excluded from coverage, and any specific deadlines that must be met. Additionally, it is important to understand your obligations as a policyholder. Failing to understand your insurance coverage can lead to common problems such as claim denials and refusal to defend you in litigation. It is essential to consult with an experienced public insurance adjuster attorney who can help you navigate the complex world of insurance coverage and protect your rights and interests. Therefore it's imperative to comprehend your insurance coverage and get straightforward answers to inquiries like:

1. What specific coverage does the policy provide?

2. Is it a Replacement Cost policy or Actual Cash Value policy?

3. Does it protect me against the range of adverse events and perils that can occur?

4. What are the limits on what my insurance will pay and/or provide?

5. What sorts of benefits does my policy provide?

6. What types of claims are included and excluded from my coverage?

7. What specific deadlines are there that must be met?

8. What obligations do I have as a insured claimant?

9. Do I have to pay my deductible?

10. How much are my deductibles?

INSURANCE CLAIM PITFALLS

The 10 of the most common and serious problems you encounter with insurance coverage and claims are: 

1. Denials or delays in payment of your claim

2. Your insurance company denies your claim, arguing that your policy was cancelled before the covered loss event occurred

3. Your insurance company rescinds your coverage due to an alleged act of misrepresentation by you

4. Your insurance company refuses to defend you in a lawsuit, claiming that you do not have coverage for what you are being sued for

5. Policy limits that are not sufficient to cover the extent of your damages

6. Lack of clear understanding of the policy's coverage and exclusions

7. Policy language that is difficult to understand and interpret

8. Complex claims processes that can be confusing and difficult to navigate

9. Denials of benefits and coverage based on technicalities and fine print

10. Limited timeframes for filing claims and disputes, which can be missed if not properly monitored.

REPLACMENT COST, ACTUAL CASH VALUE, AND DEPRECIATION

In addition to RCV and ACV, it is important to understand the concept of depreciation. Depreciation is calculated based on the age and condition of the property at the time of loss. Depreciation can significantly impact the reimbursement amount, as it is subtracted from the RCV to determine the ACV. This is why it is particularly important for policyholders to negotiate the lowest possible depreciation in order to maximize their reimbursement. This is particularly important when it comes to private and business. This is due to the fact that business practices, and personal lifestyles change dramatically after a devastating property loss, type of personal property needs and purchases change, preventing recovery of depreciation on some new personal property purchases. 

COMMON INSURANCE TERMS

1. Policyholder: The person or entity that holds the insurance policy.

2. Coverage: The specific types of risks or losses that are covered by the insurance policy.

3. Deductible: The amount of money that the policyholder must pay before the insurance company will begin paying for losses or damages.

4. Liability Coverage: Protection for the policyholder against financial loss if they are found to be legally responsible for damages or injuries to another person or their property.

5. Perils: The types of risks or events that are covered by the insurance policy.

6. Endorsement: An amendment to an insurance policy that adds or removes coverage.

7. Loss: Damage or destruction to property covered by an insurance policy.

8. Claims Adjuster: A professional who evaluates insurance claims and determines the amount to be paid out to the policyholder.

9. Actual Cash Value: The replacement cost of property minus depreciation.

10. Subrogation: The process in which an insurance company seeks reimbursement from a third party for losses they have paid out to the policyholder.

11. Underwriting: The process of evaluating risk and determining the cost of insurance.

12. Premium: The amount of money paid by the policyholder to the insurance company for coverage.

13. Exclusion: A specific type of loss or risk that is not covered by the insurance policy.

14. Indemnification: The process of compensating the policyholder for their loss.

15. Cancellation: The termination of an insurance policy before its expiration date.

16. Renewal: The extension of an insurance policy for an additional term.

17. Policy: The legal contract between the insurance company and the policyholder that outlines the terms and conditions of the coverage.

18. Appraisal: A professional assessment of the value of property.

19. Insurance Fraud: The act of making false or misleading statements in order to collect insurance benefits.

20. Umbrella Policy: An additional insurance policy that provides additional liability coverage above and beyond the limits of other policies.