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Policyholder Question – Refusal to Pay Insurance Claim and Withholding Appraisal Award Check

Policyholder Question – Refusal to Pay Insurance Claim and Withholding Appraisal Award Check

The following is an insurance claim question we answered for a policyholder through the United Policyholders Ask an Expert Forum.

Q. I live in Florida and have had an extensive water damage/mold claim that I hired a public adjuster to handle. The insurance company invoked appraisal and the out-of-state umpire determined that mold was accountable for $15,000 of damage although our mold remediation bill totaled $9,500 (we have a mold cap of $10,000 per claim). Secondly, the bathroom tile floor was damaged during remediation and was included as part of the umpire's award. However, the insurance company is refusing to pay the $4,300 floor tile repair portion of the award stating that I must abrogate against the mold remediation company to recoup that loss. Third, my public adjuster is holding the check issued by the insurance company hostage, insisting that I pay his fee prior to endorsing it over to the mortgage company. Please help!

A. Thank you for your question. Did you receive a copy of the appraisal award?  If the award stated the mold loss was over the policy limits for mold the insurance company should pay you the $10,000 or in your case the policy limits. Appraisal awards are extremely hard to overturn. So unless there is fraud or the award has items not covered by the policy, the award will be binding. As to the loss caused by the remediation folks, if you have an all risk policy this loss should be covered unless you have some exclusion for this type of event. The insurance company can then subrogate to get their money back from the remediation company or its insurance carrier.

As to the public adjuster withholding your check, this is a very bad practice, one that has been dealt with severely in the past by the Florida Office of Insurance Regulation. Typically, you can file a complaint with the appropriate department in Tallahassee and they will likely bring an administrative action against the public adjuster. I suggest you send a certified letter to the public adjuster advising them if they do not release your check you will take action with the OIR in Tallahassee.

If you have questions regarding any property insurance claim related issues please call 800.321.4488 or contact us to submit a question to one of our public adjuster insurance claim experts.

Total: 1 Comments
Shirley Heflin Peterson
  Greetings! I feel for the Policyholder asking the questions in this post. Not only has the INSURER made the INSURED jump through many hoops to get a valid claim paid, now their Public Adjuster is holding an insurance draft HOSTAGE! This is in very poor taste, to say the least. Of course the Public Adjusting fee should be paid (according to the pertinent Contract), but the minute the P.A. makes the fee issue another battle for the INSURED to fight, an adversarial relationship is born. Respectfully, SHIRLEY HEFLIN PETERSON
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