CLAIM FILING AFTER A DISASTER

What to do after a disaster.
How to determine the settlement amount.
What's covered by a typical homeowners policy.
How the payment process works.
What to do if you don't agree with the settlement.
When the claim filing process is complete.
WHAT TO DO AFTER A DISASTER

1. Make temporary repairs.

Make temporary repairs to prevent further weather related damage. Cover holes in the roof, walls, doors and windows with plastic or boards. Be careful not to risk your own safety in making the repairs.

Save receipts for any material you buy. Your insurance company will reimburse you for the cost.

Beware of building contractors that encourage you to spend a lot of money on temporary repairs. Remember that payments for temporary repairs are part of the total settlement. If you pay a contractor a large sum for a temporary repair job, you may not have enough money for permanent repairs.

Don't make extensive permanent repairs until after the claims adjuster has been to your home and assessed the damage.

Avoid using electrical appliances, including stereos and television sets, that have been exposed to water unless they've been checked by a technician.

2. Call your insurance agent or insurance company.

Report the damage to your insurance agent or insurance company representative. Ask questions such as: Am I covered? Does my claim exceed my deductible? (Your deductible is the amount of loss you agree to pay yourself when you buy a policy.) How long will it take to process my claim? Will I need to obtain estimates for repairs to structural damage?

3. Save receipts for additional living expenses.

Most homeowners policies cover additional living expenses such as food and housing costs, telephone or utility installation costs in a temporary residence, extra transportation costs to and from work or school, relocation and storage expenses and furniture rental for a temporary residence. Your insurance company will usually advance you money for these expenses. The payments will be part of the final claim settlement. Let your insurance company know where you can be reached so that the claims adjuster can give you a check.

The maximum amount available to pay for such expenses is generally equal to 20 percent of the insurance on your home. So on a home insured for $100,000, up to $20,000 would be available. This amount is in addition to the $100,000 to pay for repairs or to rebuild your home. Some insurance companies pay more than 20 percent. Others limit additional living expenses to the amount actually spent during a certain period of time, such as 12 months, instead of a maximum percentage of the policy limit.

4. Preparing for the adjuster's visit.

The claims process may begin in one of two ways.

  1. Your insurance company may send you a claim form, known as a "proof of loss form," to complete.
  2. An adjuster may visit your home first, before you're asked to fill out any forms. (An adjuster is a person professionally trained to assess the damage.) Usually, the more information you have about your damaged home and belongings the faster your claim can be settled.

Major disasters make enormous demands on insurance company personnel. Your adjuster generally will come prepared to do a thorough and complete study of the damage to your home. However, the large number of claims may place time restrictions on adjusters forcing them to "scope the loss." If your adjuster doesn't make a complete evaluation of the loss on the first visit, try to set up an appointment for a second visit.

Be sure to keep copies of lists and other documents you submit to your insurance company. Also keep copies of whatever paperwork your insurance company gives you.

Personal Belongings

  1. Make lists of the damaged items. Include the brand names and model numbers of appliances and electronic equipment. If possible, take photographs of the damage. Don't forget to list items such as clothing, sports equipment, tools, china, linens, outside furniture, holiday decorations and hobby materials.
  2. Use your home inventory or put together a set of records - old receipts, bills and photographs - to help establish the price and age of everything that needs to be replaced or repaired.
  3. If your property was destroyed or you no longer have any records, you will have to work from memory. Try to picture the contents of every room and then write a description of what was there. Try also to remember where and when you bought each piece and about how much you paid.
  4. Don't throw out damaged furniture and other expensive items because the adjuster will want to see them.

Structure of Your Home

  1. Identify the structural damage to your home and other buildings on your premises, like a garage, toolshed or in-ground swimming pool.
  2. Make a list of everything you would like to show the adjuster when he or she arrives. This should include cracks in the walls, damage to the floor or ceiling and missing roof tiles. If structural damage is likely even though you can't see any signs of it, discuss this with your adjuster. In some cases, the adjuster may recommend hiring a licensed engineer or architect to inspect the property.
  3. Have the electrical system checked. Most insurance companies pay for such inspections.
  4. Get written bids from reliable, licensed contractors on the repair work. The bids should include details of the materials to be used and prices on a line-by-line basis.

Public Adjusters

  1. Your insurance company provides an adjuster at no charge to you. You also may be contacted by adjusters who have no relationship with your insurance company and charge a fee for their services. These are known as public adjusters. You may use a public adjuster to help you in settling your claim.
  2. Public adjusters may charge you as much as 15 percent of the total value of your settlement for his or her services. The fee isn't covered by your insurance policy. Sometimes after a disaster, the percentage that public adjusters may charge is set by the insurance department.
  3. If you decide to use a public adjuster, first check his or her qualifications by calling your state insurance department. Ask your agent, a lawyer or friends and associates for the name of a professional adjuster they can recommend. Avoid individuals who go from door to door after a major disaster unless you are sure they are qualified.

HOW TO DETERMINE THE
SETTLEMENT AMOUNT

The settlement amount depends on which type of policy you have.   Having inadequate insurance can affect the settlement amount.

1. The Difference between Replacement Cost and Actual Cash Value
Replacement cost is the dollar amount needed to replace a damaged item with one of similar kind and quality without deducting for depreciation - the decrease in value due to age, wear and tear and other factors. An actual cash value policy pays the amount needed to replace the item minus depreciation.

Suppose, for example, a tree fell through the roof onto your eight-year-old washing machine. If you had a replacement cost policy for the contents of your home, the insurance company would pay to replace the old machine with a new one. If you had an actual cash value policy, the company would pay only a percentage of the cost of a new washing machine because a machine that has been used for eight years would be worth less than its original cost. Suppose, also, that the tree damaged your 15-year-old roof so badly that it had to be completely replaced. If you had a replacement cost policy, the insurance company would pay the full cost of installing a new roof. If you had an actual cash value policy, it would pay a smaller percentage of the cost of replacing it.

2. Extended and Guaranteed Replacement Cost
Extended Replacement Cost: If your home was damaged beyond repair, a typical homeowners policy will pay to replace your home up to the limit of the policy.  Where the value of your insurance policy has kept up with increases in local building costs, a dwelling like the one that was destroyed generally can be rebuilt for an amount that's within the policy limit.  However, some insurance companies offer a replacement cost policy that will pay a certain percentage over the limit to rebuild your home - 20 percent or more, depending on the insurer - so that if building costs go up unexpectedly, you will have extra funds to cover the bill. 

Guaranteed Replacement Cost: Sometimes after a widespread disaster, a large demand for construction workers and materials drives up prices.  A few insurance companies still offer a guaranteed replacement cost policy that pays whatever it costs to rebuild your home as it was before the disaster.  But neither a guaranteed or extended replacement cost policy will pay for a house that's better than the one that was destroyed.

3. Mobile Home Policies
If you own a mobile home, you may have a policy based on replacement cost, actual cash value or, in a few cases, a "stated amount." With a stated amount policy, the maximum amount you receive if your home is destroyed is the amount you agreed to when the policy was issued.  The depreciation in the value of your home is not considered in the settlement.

WHAT'S COVERED BY A TYPICAL HOMEOWNERS POLICY

The following are general topics regarding insurance coverage:

1. Trees and Shrubbery

Most insurance companies will pay for the removal of trees that have fallen on your home. They may pay to remove the trees that have fallen and haven't caused damage to your home or other insured structure. They usually won't pay to replace trees or shrubbery that have been damaged in a storm.

2. Water Damage

Homeowners policies don't cover flood damage but they do cover other kinds of water damage. For example, they would generally pay for damage from rain coming through a hole in the roof or a broken window as long as the hole was caused by a hurricane or other disaster covered by the policy. If there is water damage, check with your agent or insurance company representative as to whether it is covered.

3. Compliance with Current Building Codes:

Building codes require structures to be built to certain minimum standards. In areas likely to be hit by hurricanes, for example, buildings must be able to withstand high winds to reduce the risk of hurricane damage. If your home was damaged and it was not in compliance with current local building codes, you may have to rebuild the damaged sections according to current codes. In some cases, complying with the code may require a change in design or building materials and may cost more. If you live in an area likely to be flooded, you may have to comply with federal codes which require buildings to be raised above flood level. Generally, homeowners insurance policies won't pay for these extra costs.  However,  some insurance companies offer an endorsement that pays for these extra costs while some insurance companies offer an endorsement that pays a specified amount toward such changes. (An endorsement is a form attached to an insurance policy that changes what the policy covers.)

For more information about the coverage provided by a typical homeowners insurance policy...

HOW THE PAYMENT PROCESS WORKS

The first check you get from your insurance company is often an advance, not a final payment.

If you're offered an on-the-spot settlement, you can accept the check right away. Later on, if you find other damage, you can "reopen" the claim and file for an additional amount. Most policies require claims to be filed within one year from the date of disaster.

When both the structure of your home and your personal belongings are damaged, you generally get two separate checks from your insurance company. You should also receive a separate check for additional living expenses.

1. Structure

If your home is mortgaged, the check for home repairs will generally be made out to you and the mortgage lender. As a condition of granting a mortgage, lenders usually require that they are named in the homeowners policy and that they are a party to any insurance payments related to the structure. The lender gets equal rights to the insurance check to ensure that the necessary repairs are made to the property in which it has a significant financial interest.

This means that the mortgage company or bank will have to endorse the check. Lenders generally put the money in an escrow account and pay for the repairs as the work is completed. You should show the mortgage lender your contractor's bid and let them know how much the contractor wants up front to start the job. Your mortgage company may want to inspect the finished job before releasing the funds for payment.

Some construction firms require you to sign a form that allows your insurance company to pay the firm directly. Make certain that you're completely satisfied with the repair work and that the job has been completed before signing any forms. Remember, you won't receive a check for the repair job. The firm will bill your insurance company directly and attach the "direction to pay" form you signed.

2. Personal Belongings

If you don't get a separate check from your insurance company for the contents of your home, the lender should release the insurance payments that don't relate to the dwelling. It should also release funds that exceed the balance of the mortgage.

State bank regulators often publish guidelines for banks to follow after a major disaster, setting out how these and other matters should be handled. Contact state offices to find out what these guidelines are.

If you have a replacement cost policy for your possessions, you normally need to replace the damaged items before your insurance company will pay you the replacement cost.

If you decide not to replace some items, you will be paid their actual cash value. You don't have to decide what to do immediately. Your insurance company will generally allow you several months from the date of the cash value payment to replace the item. Find out how many months you are allowed. Some insurance companies supply lists of vendors that can help replace your property.

3. Additional Living Expenses

Make sure the check for additional living expenses is made out to you and not your bank or mortgage lender. This money has nothing to do with repairs to your home and you may have difficulty depositing or cashing the check if you can't get the mortgage lender's signature.

4. What If I Don't Rebuild ?

If your home was destroyed, you have several options:

  1. Rebuild your home on the same site.
  2. Sell the land your old home was built on and build in a different place.
  3. Rent a home rather than rebuild the one that was destroyed.

If you decide not to rebuild, the settlement amount depends on state law, what the courts have said about this matter and the kind of policy you have. Read your policy carefully if you decide not to rebuild and find out from your insurance agent or company representative what the settlement amount will be based on.

A similar rule applies to repairs. Suppose you decide to change the kitchen flooring materials when you rebuild. If you replace your expensive floor with materials that are cheaper but more practical, you are not entitled to the difference in cash. Unless the cost of repairs is a small amount, your insurance company may initially pay you a sum equal to the actual cash value. It will withhold the balance of the full replacement cost amount until after the repairs are completed.

WHAT TO DO IF YOU DON'T AGREE WITH THE SETTLEMENT

1. Talk to your agent or the claims manager at your insurance company.

Explain your side of the matter. Provide copies of supporting documents. Also, send a letter and documents to the claims executive at the insurance company's headquarters whose address is usually found on the first page of the policy.

2. Call the National Insurance Consumer Helpline.

If after hearing from your insurance company's claims executive, you still feel your claim hasn't been handled properly, call 800-942-4242. It is a toll-free consumer information telephone service sponsored by the insurance industry. Trained personnel and licensed agents are available to assist consumers who have complaints. The Helpline operates Monday - Friday, 8:00 a.m. - 8:00 p.m. ET.

3. Contact your state insurance department.

Explain the reasons for the disagreement to a consumer services representative at the department. He or she will discuss the matter with your insurer and help to resolve any difference so the claim can be settled.

4. Consult an attorney.

The American Bar Association notes that many situations involving legal matters can be handled by consumers on their own, without a lawyer. If you do hire an attorney, provide them with a copy of your insurance policy and all other relevant documents. If the insurance company has made a settlement offer, tell your attorney about it and ask if he or she believes that a lawsuit will help you get a larger settlement, net of the attorney's fees. Attorneys usually work on an hourly rate, but with cases involving injuries, they generally work on a contingency basis. Get your attorney's fee structure in writing before you decide to pursue the case. If you hire an attorney, you will no longer talk directly with the insurance company. You can remain current on the progress of your claim by insisting that you receive copies from your attorney of all correspondence involving your case. Your attorney must have your agreement before committing to any settlement.

WHEN THE CLAIMS FILING PROCESS IS COMPLETE

After your claim has been settled, take time to re-evaluate your homeowners insurance coverage to make sure you have adequate protection.

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