While looking for some information in my office library yesterday, I pulled a book from a shelf titled The Policyholder Advisor authored by Eugene R. Anderson, William G. Passannante, and Robert M. Horkovich. These three gentlemen, all attorneys, and at the time of publishing in 2002, shareholders at Anderson Kill & Olick P.C. now Anderson Kill P.C. one of the nation’s leading law firms for policyholders. The book jacket noted that the book is a collection of articles published in the firm’s newsletter, “The Policyholder Advisor.”

It was a little uncanny when I opened the book, and it opened to page 181 and the chapter title was “Insurance Coverage Available for Property Losses from The Blizzard of 96.” While no two storms are ever the same, there sure are a lot of similarities between the 1996 blizzard and the current polar vortex malaise of 2014; especially when it comes to insurance coverage issues and disputes with insurance carriers.

Yesterday, I was on a flight to sunny South Florida to meet with a client, and ran into a large loss adjuster who works for one of the major insurance carriers heading the same way. When you meet a fellow adjuster or colleagues who are in the business, usually the first question is to ask if you are busy. This seasoned adjuster side tells me the claims are rolling in from the areas that were affected in the big freeze caused by the “polar vortex” last week. It seems his company is so overwhelmed, that they have staffed call centers with independent adjusters just to handle the call volume.

First a little background, an umpire in the insurance property world has nothing to do with baseball except that a baseball umpire and an umpire in a property insurance dispute have one thing in common--both have to make a decision. The baseball umpire will have to make a decision quickly, where as an umpire in the appraisal dispute resolution forum should take as much time as needed to make a decision based on all the facts. A good umpire will thoroughly review of all the materials provided to him or her by the two appraisers (representing each side of the dispute) who agreed to his or her appointment. This can and often should include a visit to the loss site (if the property in question is still standing) along with the two appraisers and the policyholder if they want to understand the opinions as to why the initial adjustment was wrong.

It’s been an eventful year for public adjusters and the insurance claims industry. So I want to share my 2014 News Year’s Wish List for the property insurance industry.

1. I wish Congress would fix the Biggert-Waters 2012 National Flood Insurance Reform Act. This extremely ill-conceived act of Congress is causing great harm to homeowners all across this country. Remember, an affordability study was supposed to have been commissioned with this legislation but is now two years away according to some accounts in the media. Meanwhile, policyholders who have been in their homes for years (and I am not just talking about high priced homeowners) are hurting because of premium increases and no buyers for their property. Shame on Congress for this!

Q. My tenant reported mold in a house that is 6 years old. We had a company test and they said the mold was caused by the a/c, due to a low refrigerant level, which caused high humidity levels in the house. At first, the insurance company said we were covered. But when the tenants request reimbursement for a medical x-ray, which showed a spot on the lung, the insurance said we were not covered. They said it was not a covered peril. They said that the a/c caused the 70% humidity which caused the mold. The remediation estimates are in excess of $30k and it appears there will be a medical claim. There were 69 days involved from the time the tenants first noticed the mold until they vacated the house. Also, the tenants’ personal items are supposed to be discarded. Am I responsible for that? The lease required them to have renters insurance but this is the second year of the lease and they did not renew it after the first year. Also, I have seen web ads for a mold bomb fogger that is supposed to be approved by the EPA. It is from Biocide Labs. Has anyone ever used it?

Q. I have a friend that lives in a retirement condominium community. They have a condo policy that covers all 8 buildings in the community. The insurance has paid to replace between 98-160 shingles per roof due to hail damage. The HOA by-laws state that the roof color must be the same on all roofs. After 17 years it will not be possible to match that many shingles on each roof. They have ordinance and law coverage in their policy for replacement cost. Would this apply in this situation? Should the insurance have to pay for a full replacement of the shingle roofs?

A policyholder in South Carolina recently wrote us about a fire claim turned nightmare. When notified of a claim, insurance companies will sometimes send out their preferred vendor as a way to provide fast service but also to control costs and prevent the policyholder from hiring their own vendor, since they have contracted reduced rates with these vendors.