Harsher policy terms mean damages might not be covered Honored to have been asked to contribute to this article.

Jean Eaglesham is a topnotch reporter and very knowledgeable at all levels of the insurance industry. I suggest you follow her on the WSJ.

https://www.wsj.com/finance/homeowners-hit-by-helene-are-in-for-an-insurance-claim-shock-60ae5519?st=fpHroy&reflink=desktopwebshare_permalink

Q. We moved into our new house and within a few weeks, the sewer backed up into the shower and leaked out of the shower pan all over the downstairs area (very stinky!). Everyone agrees this is considered a "Category 3" leak. Remediation company came and took out the tile, flooring, a lot of drywall and dried everything out. Insurance company has no problem paying them for everything they did (they seem to work together a lot). Insurance adjuster is saying that the tile and shower pan are part of the plumbing and are not covered, but is saying that they will pay for the cement board behind the tile in the shower. They are also only planning to pay an amount roughly equal to the cost of the remediation for reconstruction (which is roughly equal to the estimate from the remediation company....because they provide reconstruction services as well). It seems ludicrous that reconstruction would cost the same as remediation. To rip stuff out and dry it out is a lower level of skill and doesn't require any materials.....but the adjuster is saying we are lucky that he is covering what he is covering. The remediation company isn't even available to do the job. We have 3 bids from other quality contractors that actually have availability and they are double the price.

Q. In my case, the insurance adjuster added $10,300.00 to my Irma hurricane claim to cover Overhead & Profit. This amount and the ACV were paid to me by Frontline upfront under my Replacement Value hurricane policy. The recoverable depreciation was held back until the work was completed. I required six trades to complete the work...roofer, painter, solar system, plumber, gutters and garage door. I did not hire a general contractor. I dealt with each trade directly. After the roof and painting were completed this past April (2019), I filed my claim for about $1,700.00 additional expenses relating to the roof and painting, plus the recoverable depreciation relating to the roof and painting (approx. $7300.00 RD). There was no dispute with respect to the $1,700.00 add'l expenses. The balance of the work (gutters, garage door, etc.) will be completed this winter/spring. My out of pocket expenses paid to the roofer and painter was only about $400.00 more than the ACV plus recoverable depreciation. Frontline clawed back almost all of my Overhead & Profit recovery relating to the roof and painting and offset it against the Recoverable Depreciation. The result was that I received a check for about $400.00, rather than a check for $9000.00 that I expected ($1,700 add'l expenses plus $7300 recoverable depreciation). Frontline's explanation is that I am only entitled to receive the amount of my out of pocket expenses so, to achieve this result, they can claw back some, or all, of the Overhead & Profit amount previously paid. The effect of this is that older homes with higher depreciation such as our 45 year old bungalow will have almost all, if not all, of the previously paid O & P clawed back, while a newer home with lower depreciation, like my neighbor's 4 year old home, will have very little of the O & P clawed back. In both cases we have acted as our own general contractor. Has my recoverable depreciation claim been properly handled? My home is in Florida. Thank you

This is a frequent question we get after a policyholder has tried to handle their own claim and learns the settlement amount will not return their property to its prior condition.

Q. Does a public adjuster get paid on the full amount of the claim or just the disputed amount?

A. If a prior payment was made before the PA was hired, the PA should not be paid a fee on that amount. Basically, a PA should only be paid on new money they were able to recover after they were hired.

A policyholder wrote in and recently asked:

Q. I’m hoping you can help me with an answer to a quick question. I hired a public adjuster to do an insurance appraisal because the insurance company has been jerking me around. The public adjuster will not share the dollar amount of his appraisal with me. Is that standard practice? He is stating that there is a clause in my policy that requires the appraiser to be independent and impartial, which then prohibits him from sharing his appraisal value with me. I think he is incorrect and is simply waiting for the insurance company’s appraiser to submit his value before writing up his own. Can you please advise? Thank you.

When a homeowner files an insurance claim, the last thing they expect is having to include their mortgage holder on the check. But this is usually the case and cause settlement delays and confusion depending on how the mortgage holder processes the settlement. The following is a related insurance claim question we answered submitted by a policyholder.

Q. I have a VA loan through TD Bank whose main office is in Lewiston, Maine. I live in Florida and retained a public adjuster to help me deal with my insurance claim. I suffered severe damage from Hurricane Michael on 10/10/18. Do you think I will have any problems with the bank releasing insurance proceeds directly to me seeing as it could be an inconvenience for the bank with me living so far away? Also, what records will the insurance company require if I do some of the work myself and have others help me?

Q. I serve on a COA Board and we recently had a fire. Our property manager is telling us the contractor will handle everything, while some of us want to talk to a public adjuster. What is your perspective?

As Hurricane Michael damage recovery moves into the new year, we continue get deluged with property insurance claim questions from frustrated policyholders. Right now, we seem to be at the stage where policyholders have received settlement offers they feel are too low to fix their damage or where property owners feel their insurance company is not being responsive. This is especially true with commercial claims and the business community in the Panhandle as evidence in this article Local Businesses Say Insurance is Taking Too Long on Claims. Now there’s a good way to kill off the small business community!

If your Florida home was severely damaged by Hurricane Michael to the extent that it is uninhabitable to live in, most insurance policies provide a coverage called “Additional Living Expense” or “A.L.E.” if it is a covered loss. Under the Additional Living Expense coverage, you and your family may be entitled to rent another home of the same size, like kind and quality as well as be reimbursed for any extra expenses you incur such as food and temporary lodging.

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

Q. We are survivors of Hurricane Maria. Our property sustained severe damages from the wind and rain. The insurance company´s adjuster reports damages amounting to $36,000. But they are only offering $10,000 arguing that we failed to reassess the property in recent years. As a result, when they apply the per square foot construction cost mandated by the local insurance industry regulator, our property comes out as severely underinsured. We had purchased the property for $125,000 nearly 20 years ago and its value nowadays is below that amount owing to the economic recession.  (Of the $125,000 we paid, the appraisal back then estimated the structure value at $40,000 and the land at $100,000) We are filing a second appeal and are wondering if this is an industry practice.  Any suggestions?