Some months back I received a call from a physician who was referred to me by an engineering firm we had worked with on a large project in Longboat Key, Florida that resulted in a multi-million dollar settlement. Not only was the client pleased with our work, but their engineer apparently was equally impressed given the kind words he shared with this physician about our work and the results we were able to achieve with previous claim.

During my initial discussion with the physician on the phone, I told him it was unlikely we could prevail on his insurance claim based on the damages he described to me. The insurance industry had changed most policies to take away coverage that was previously available for what sounded to me like a collapse claim.  After a more in-depth discussion, I agreed to inspect the loss and look at his policy. In the meantime he had reported the loss to his homeowner’s insurance carrier who incorrectly had listed the cause of the loss as a sinkhole.  A quick inspection of the loss by an independent adjuster sent out by the insurance company resulted in a denial letter stating there was no sinkhole activity based on their engineer’s inspection.

When I first arrived at the property, I have to say I was impressed. This was a three story mansion right on the Gulf of Mexico located in a very private and exclusive community which was unlike anything I have seen before!  Unfortunately, just as this homeowner had described, there were structural damages that had to be fixed. Some of the stucco on the Gulf side had been removed and it was apparent there was hidden damage to plywood sub-floor and supporting beams that help to hold up the building. From all indications, water had intruded into the building causing hidden damages. What happened to this home and what needed to be done  to repair it was like many other projects I had worked on over the years when collapse coverage was favorable to the policyholder.

So while I knew the protocol for a loss like his, the big unknown was the policy language for this risk.  At this point, I agreed to look into the claim with no guarantees on a successful outcome.  A follow-up meeting was arranged with his engineer, an architect and contractors.

While putting things into action, I made a request for a certified copy of the insurance policy to make sure we had a true and correct copy of the policy and all endorsements. When the policy arrived and I reviewed it, to my complete astonishment, the underwriters had in place what I refer to as the good language for collapse. If other thresholds were met, this loss had a good chance to be covered.  While this was good news, we were a long way from a settlement given the nature of the damages, building code issues and the actual repair process that had to be undertaken.

So we filed a claim with a proof of loss and off we went to negotiate with the insurance carrier on coverage and damage issues. At some point in the negotiation process I could tell we had all coverage issues settled since all threshold issues were met. My sense was that all that needed to be resolved was the amount of damages. Clearly determining damages to building components that are hidden are problematic. Since repair activity was a work in progress, the insurance carrier wanted to make a payment based on their contractor’s estimate. Our client had already secured a contractor and signed a contract with a deposit, for a repair amount which not surprisingly was in excess of the insurance companies computer estimate.  

What followed was a lot of work, negotiations and mediation. While the mediation resulted in an initial impasse, we all kept working and talking until a final settlement was reached.  Are my clients happy? You bet they are. While the insurance company, may not feel the same, to their credit they stepped up and paid for a loss that was covered after we showed them the way.

So as I wrote in the beginning, whomever you are dealing with, make sure they read and understand your insurance policy and coverage!  You never know what you may find. In this case, while not literally a pot of gold, it was nonetheless a golden settlement for this family. 

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.