In March of 2020 the world began to turn upside down with news of COVID 19 becoming a worldwide pandemic. However, for this particular homeowner life became more difficult than others when an electrical fire destroyed his property.

In the early morning hours of March, 2020, the homeowner (now residing out of state) received a call notifying him that his home caught fire destroying everything. After confirming that his ex and his son were safe, the insured notified his insurance company of the fire loss. While filing the claim the homeowner was asked a few basic questions that apparently raised a red flag with the insurer. Three days later he received a Reservation of Rights (ROR) letter. The ROR letter is used to notify a policyholder that the insurance carrier is investigating the claim and is issued to reserve the insurance company’s right and or preserve any timelines of state statutes to deny a claim at the conclusion of the investigation. The letter stated that “the investigation has revealed that you were not occupying the residence premises at the time of the above noted loss.” It was obvious the insurance company was making an issue of this as a reason to deny the claim.

Realizing he had never been issued a complete copy of his insurance policy (as most people are not), the homeowner requested his insurance agent provide a copy to review the issue at hand. After some back and forth with the agent, he was finally able to receive what he thought was a full copy of his insurance policy. Unfortunately, if you are not familiar with the terms and conditions of the insurance policy, trying to read coverages can become tedious and confusing. Thus, the homeowner was unable to locate the issues referenced in the ROR letter.

A few weeks pass with no communication regarding the status of his insurance claim and no funds issued for the family who lost everything. Realizing he was at a disadvantage while the insurance company investigated his claim, the homeowner contacted Public Adjuster Zach Flora with Tutwiler & Associates Public Adjusters. The homeowner explained the situation that he currently lives out of state and owns the insured home in Pittsburgh that he purchased for a past significant other and his son to live in.

Since this situation could be a potential coverage issue, the first thing Mr. Flora did was request a full copy of the insurance policy listing all the forms and endorsements. This is standard practice for public adjusters on every claim since the policy is your contract with the insurance company. In return for receiving your premium they give you the coverages listed in the policy terms and conditions.

Upon review of the homeowner’s policy, Mr. Flora noted the definitions section that “YOU” and “YOUR” refer to the named insured shown in the policy who resides at the residence premises. These terms also mean your spouse who resides at the same residence premises: your relatives and any other person under the age of 21 and in the care of you or your relatives. Mr. Flora reached out to the homeowner who confirmed that his son was 13 years old.

Since the homeowner’s son was 13 and the homeowner was providing the home, clothing, funds for food etc. (doing what any other father does) he was considered in the care of the named insured on the insurance policy. Therefore, this classified him within the policy definitions as a named insured of the property.

To clarify the issue with the insurance company, Mr. Flora documented the facts and put them in a detailed letter that was sent to the insurance company. With a couple of additional phone calls and a bit of negotiation, the insurance company agreed to full coverage of the homeowner’s claim. All the while Mr. Flora had assembled a full repair estimate of the fire damaged Dwelling and Personal Property form that he sent to the insurance company. The attention to detail and accuracy of his estimate resulted in a full policy limits settlement on the home, the full amount presented on personal property, and policy limits for additional living expenses (ALE) which included housing and any back expenses incurred from the insurance company investigation.

In this case, having a Public Adjuster on the homeowner’s side who did a thorough review of the policy, was able to clear up an issue that could have delayed the claim. Properly documenting the loss and presenting the claim in a professional manner to the insurance company yielded a settlement that allowed the homeowner to rebuild his property.