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Is Your Home Insurance Company Misrepresenting Your Policy Terms?

Home Insurance Company Misrepresenting Your Policy Terms

How would you feel if your Insurance Company misrepresented your policy terms and conditions which meant you weren’t entitled to an additional $117,980.20?

For background, our firm, United Public Adjusters & Appraisers, Inc. was retained by the building owner to handle the claim reporting, damage assessments, and negotiating a fair settlement in the shortest period of time.

To list the many obstacles, we’ll start with the insurance company, TPA, stating they couldn’t find the policy. Of course, this didn’t make any sense, as we had a physical copy of an active insurance policy. We then reached out to the P & C wholesaler who then contacted the insurance carrier TPA to further state the Policy was valid.

Now that the home insurance policy was established as being Active, TPA assigned a field adjuster to meet our firm. Like any other industry, you tend to recognize who the insurance company’s assigned public adjusters are as it’s a small industry in one of the largest cities in the US. For this property damage claim, we never negotiated a claim with this specific adjuster. When we met the carrier assigned adjuster, he was polite, but we could tell he seemed overwhelmed. The telling signs were when he was trying to sketch the floor plan and kept going inside and outside of the building to understand where he was. As we called out building materials and discussed how smoke traveled,  he said, “interesting, I didn’t know that.”  Then all of a sudden, he opened up and said, “this is my first fire claim.” Our first reaction was his boss should have shadowed him and that we better take our time with him. In short, how could we be upset, as he was being honest and wanted guidance. Knowing this, we slowly educated him while hoping he would use his own common sense and judgment when drafting his estimate. Can you imagine a building owner doing this on their own?

30 days later, we received a building offer. Of course, nothing goes smoothly, as the insurance company applied over 60% in depreciation which meant the insured wouldn’t receive enough money to even start the job.

After speaking to the TPA inside adjuster, they sent our firm a revised repair estimate which reduced their depreciation, BUT they wanted to hold back $117,980.25 (additional 25%). The carrier adjuster stated “the 25% for the repair endorsement is reimbursable upon completed repairs and incurred cost.” We quickly replied with, “your interpretation of the policy form doesn’t reflect the actual policy language, as the form states the insurer won’t pay more than the actual cash value (ACV) amount until the repair/replacement is completed.” Due to this clear dispute, the carrier reached out to their coverage counsel. Not long after, they stated, “coverage counsel reviewed the endorsement and we are in agreement with releasing the remaining dwelling funds for the additional endorsement over and above policy limits.”

As you can see in this case study, our experienced Public Adjusters never gave up and ensured our client was fully compensated!

Have questions on a property damage claim? Contact United Public Adjusters & Appraisers, Inc. at 1-800-718-5677 to schedule a consultation.



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