On February 28, 2013 a massive fire broke-out in this upscale waterfront home located in Tierra Verde, Florida burning off the roof and causing significant fire, water, and smoke damage to the rest of the building structure, custom furniture, and personal belongings.  As is typical with all fires, which become public record when the fire department gets called, the homeowner was “assaulted” (his words) by emergency service restoration contractors and public adjuster chasers who came from all over the State of Florida to give their sales pitch.  Unfortunately, this property owner fell victim and signed with a restoration company who provided an estimate with a “not to exceed” agreement. But when the contractor sent the invoice for services performed, it was triple the amount!  The insurance company was just as surprised and refused to pay an obviously exorbitant amount. The contractor’s response was to place a lien on the property until the situation could be resolved.

The homeowner also wanted to give his insurance company the chance to fully pay the insurance claim based on the repair estimates. After all, he had been paying his premiums for many years. So why shouldn’t they live up to their end of the bargain?  Sadly, he later learned that trusting this particular insurance company was not in his best interest besides signing with a fly by night contractor who scammed him.  

The property damages for this claim were so great, that the insurance company and their hired “expert adjusters” seemingly had no clue where to begin to unravel such a complicated claim.  This led to several delays and serious repair underpayments.  For example, the insurance company sent out one of their preferred engineers who miscounted the amount of charred trusses and advised the insurance company to not pay for the replacement of the entire roof under Florida’s 25% Roof Replacement rule that is specifically outlined in the current Florida Building Code Existing Building Section 611.1.1 which mandates “that if more than 25% of a non-conforming roof section is to be repaired, replaced, or recovered, the entire affected roof section must be repaired, replaced, or recovered to meet the current Florida Building Code requirements.”  

So how many charred roof trusses did this engineer miscount?  They counted only nine charred trusses when in fact there were twenty! Their report they recommended to “sister the charred trusses.”  While I am not sure how sistering charred trusses puts the insured back to their pre-loss condition, one must consider how the owner would explain that to a potential buyer if he chose to sell the home.  It sure doesn’t look or smell good!   

Things got a little more interesting when the insurance company changed the adjusters handling this claim three different times.  Besides the obvious of starting over eight months into the claim, changing adjusters can have other negative impacts. For  example: In order for the homeowner to prevent any further damage from occurring (mitigation) he had to tarp his roof.  Now anyone who lives in Florida knows that with each passing thunderstorm comes wind that can blow off a roof tarp.  During this timeframe, the City also required the property owner to replace his roof.  When the newly assigned adjuster arrived for yet another inspection, he was of the “opinion” that the owner only replaced 4 roof trusses and not the entire roof.  Folks, this is about as bad as it gets especially when we provided photographs of the clear blue sky from inside living room.  As this point, it became very clear that there were some serious issues with the way the claim was being handled and the owner hired our firm. This allowed the property owner to return to running his growing business and leave the insurance issues to an expert that could restore some sanity to this claim.    

We immediately brought in a local engineering firm to help confirm the structural damage issues, roof replacement, and other code issues required by the City. Shortly thereafter, a properly documented claim was presented to the insurance company.  In response, the insurance company retained yet another adjuster.  After some back and forth claims negotiation, we were able to get the claim turned around and the insurance company finally agreed to a fair settlement. In total, the insurance company agreed to pay $538,596 including an extra $95,000 so the owner would not take legal action!  

Even simple fires can turn into complicated claims. In this case a major fire turned into a 3 ring claims processing circus. Public adjusters were created to be insurance claim experts that advocate for the policyholder. We love these types of claims because they validate our value. We hope more people utilize this expertise.