Dealing with insurance adjusters

[trader4]

And with ice damming material they aren't? Exact same thing.

[dpb]

The unknown here in all these is what the policies actually state--in the lender-mandated coverage case one presumes they probably required the 'law & covenant' rider be included. It is highly unlikely the ins-co voluntarily spent more than were obligated for in any large amount, anyway.

As noted earlier, it's also been my observation that one generally gets better cooperation/settlement in the case of a "one-off" incident than likely to get in widespread disaster as well simply because in the one case it doesn't show up as much an in the latter the corporate impact is clearly very large and immediate so there's more pressure to hold adjusters to the lowest limits possible. Also, in those cases you're likely working w/ itinerant contract adjustors who may be paid w/ incentives for how much they can "save".

So, as I've said innumerable times, you need to find out the specific details within your policy's exclusions in the actual fine print language--it will control not your perception of what you think it _should_ cover nor even the summary description of coverage supplied that will, in fact, have a disclaimer that it is not the actual policy.

[dpb]

Yeah, that one... :)

What you've not provided is any specific details on the policy, your relationship w/ and support (or lack thereof) of the agent, etc., etc., only your (understandable) frustration based on what you believe should be.

There's been much good advice given but little sign of follow-up (or at least relating the results of any).

I'd reiterate what I've said earlier and then look into the independent adjustor as others have suggested. Do you know how this adjustor got assigned? Is he/she as I suspected an out-of-area itinerant specializing in disaster-area adjusting? They show up here in hordes like locusts after large hails and are, indeed, a plague I will agree.

The thing is that you need to get factual first on what your policy does indeed say rather than just repeating that what it is that you think it _should_ say. I know I'm repeating myself but it doesn't seem to be getting through...

[bob haller]

OP should call his states insurance commisioners office with a simple question, do insurance paid for repairs need to meet current building code?

My experience says it does.....

[dpb]

He's been told that innumerable times to check and see what is in place in his jurisdiction, yes. So far, no indication he's done so.

But, in the end, it will be what his specific policy terms are that will have final say-so, I expect.

Your experience is dated. See earlier posted links and DAGS on 'law and ordinance' rider/policies.

As pointed out there and AFAIK at this time in the US only FL has state law that mandates that new policies contain the clause/coverage by default. If it's been incorporated into statute/regulation elsewhere, it's recently.

And, as noted, it seems it started being a tactic after the spate of gulf coast disasters and it's only after that that FL instituted their reg's/laws. I'm pretty sure one eventual side-effect of Sandy will be to cause such to happen in the NE as well.

[dpb]

...

Again, yeah, that one.... :)

One other comment intended to make on the above point.

Be completely clear there are two different issues here--lowball rates for covered repairs will be much more easily contested and while I understand it's irritating and frustrating, don't get too bent out of shape too soon over them. That's the kind of the thing independent adjustors or tradesmen can help with and do all the time successfully.

The larger issue that has been the subject of the sidebar discussion is one of what is/isn't covered. That's the one that is strictly going to be a legal issue first and that you really need to get factual into the nitty-gritty of the _specific_ language of your _specific_ policy and any riders attached thereto.

[trader4]

the cost of

See

Uh, no....

"Defendant moved for summary judgment, arguing that the policy unambiguously excludes coverage for required building code upgrades and provides only for the cost of returning the house to its prefire condition, building code violations notwithstanding. "

It did have the exclusion. And the court agreed with my iterpretation:

?Exclusionary language that conflicts with the objectively reasonab le expectations of the insured is not enforceable, even if a ?painstak ing study of the policy provisions would have negated those expectations. ? ?Tepe v. Rocky Mountain Hosp. & Med. Servs., 893 P.2d 132

3, 1328 (Colo.App.1994)(quoting State Farm Mut. Auto. Ins. Co. v. Nissen, 851 P.2d 165, 168 (Colo.1993)).

 As always, in law, the particular facts will

Yes, I hear what you're saying. And if you go back to how this all started here, I listed a number of things where the insurance company is low balling and trying to weasel away. Not paying for ice damming material was just one example. And in this case, it's not worth fighting over, because it doesn't amount to that much of the total claim. It's probably $400 or so. That's real world price, could be $200 in their pricing.

I'll give you another example. I had an old couch up in the loft. It got some water on it, and there are stains that won't come out. I do have replacement cost coverage, right? They gave me $200 for a 16ft sofa.

[Ed Pawlowski]

Of course they have to meet code. But that does not mean they have to pay for all of it. They only pay what is covered. Did you read the policy? No one here has so anything we say is speculation.

[bob haller]

Ultimately the adjusters job is to settle claims as cheaply and quickly as possible for the company...

I have delt with some, they like fast and cheap/

I still believe they MUST meet and pay for code requirement upgrdes,,

[trader4]

I'm not going to fight each issue one at a time. I'm waiting until I can address them all with them at the same time, as a final settlement.

I looked into it a bit. Big problem is that the whole claim is up to $10K. So, it's not a big enticement for any adjuster. I called the two local ones that I could find and both are not taking any new clients. The person on the phone at one of them gave me advice along the lines that I'm probably better off dealing with the insurance company myself. Sounded like they were not having a lot of luck with the insurance companies themselves.

 >Do you know how this adjustor got

Allstate picked them. What their internal process is, who knows.

Yes, from TN. And that I think is part of the problem. An adjuster that lives in the NYC/NJ area has a better understanding of what things cost. I'm sure they still have the same per sq ft costs loaded, but if they see a paint job comes out to $1100 and they know from personal experience there is no way in hell it can be done for that, I think they are far more likely to go back and do some fiddling with line items within their control to make it come out right. After a lot of complaining, I finally did get the adjuster to pay for two coats, after insisting all along that they never would. Even with that, it's still $1000 less than the lowest quote and I've gotten about 6 now.

One problem with that is that I can't find the damn thing at the moment. But it doesn't matter at the moment, because my strategy right now is to address all the remaining issues at once, later.

[trader4]

Bob, I agree with you in concept. The way you and I see it, if you're paying for replacement cost coverage and your bedroom burns down, the insurance company should be responsible for paying for a new bedroom that is the same size, same functionality as the old one. That code now requires arc fault, more insulation, ice damming on the lower roof, etc, is their problem. You paid for replacement of a bedroom, they have to replace it.

But DPB is right that the clever insurance companies have exclusions in most policies that say they don't have to pay for it. Or at least they think it means they don't have to pay for it. Did you see that Colorado case I posted the link to? The policy in that case had exactly that, an exclusion. The house burned down and Allstate said they were not required to pay for things now required by code. The lower court agreed with the insurance company. On appeal, it was reversed, because the appellate court cited case law where if the overwhelming verbage of the policy would lead a reasonable person to believe that it was covered, tricky exclusions can be ignored. They said the overall policy was clearly to put the homeowner back in the position they were in pre-fire. That means they had a bedroom then, they are entitled to a bedroom now. The fact that some code changes mean it costs more does not mean the homeowner winds up in any better position than they were pre-fire. They still only have a min code bedroom. That was the essence of the finding.

And following that, they probably crafted the policies better so as to still be able to deny it. In short, at best it's a grey area and could vary from state to state depending on the laws there, the court rulings, etc. And in my case it's a couple hundred buck, if the insurance company won't cover it, it's not worth a big fight. BUT, I think it is worthy of discussion for two reasons:

1 - I don't think it's right 2 - Anyone that has replacement cost coverage should be aware of this. Worst case, let's say you have a house that you've been paying for replacement cost on for 25 years. It covers the house to $300K. The house burns down. The insurance company could total up what they say it takes to build a new one, that isn't up to code. Suppose that can be done for $250K. So, even though the policy says they will pay to replace the house, they give you a check for $250K and refuse to pay the other $50k, because that is for code required items that were not required when the original house was built.

[dpb]

On 3/26/2013 8:09 AM, [e-mail] wrote: ...

...

The agent certainly should be able to furnish one in a heartbeat.

I'd forgotten the carrier; I've never dealt w/ Allstate but my sense is they're one of the PITA outfits. Our carrier has always been the Farm Bureau in the state of current residence and while they may be a little higher premiums, I've never had any difficulty in the claims process. But, you've got to be able to qualify as member in the Farm Bureau in most states for them to underwrite which is generally not possible for urban dwellings. Not that any of that helps your current problem, just an aside...

I looked at the State Farm web site for catastrophe adjustment and there are a couple of interesting things at the following page--nothing I found specifically covered the question of coverage re: code-mandated upgrades but the question of the depreciated estimate and replacement coverage for personal property was...says they'll make an additional restitution on the actual replacement cost when you supply your cost documentation for the repair or replacement of the item.

Seems like a reasonable approach to work it out in the end--they do have a generic paragraph about the difference between contractor estimate and adjustment as well...they (of course) claim they have "local rates" built into their software but rates for whom--the illegals gathered in front of the Lowes every morning, maybe? :)

I didn't find any mention as noted on the Code or the 'law and regulation' rider issue. I don't recall whether you said NJ or NY so didn't look at state sites to see what they're saying.

I'd be on the agent, though to get on my side to at least reach the minimum reputable contractor estimates for the physical repair work...

[dpb]

...

I had missed the end result in the CO case before indeed...that's interesting that the court did strike the exclusion down owing to the preponderance of implied coverage to make whole. If undoubtedly help the insured in that case to have been in what is now a very liberal-leaning State in making the appeal.

As noted, I'm sure the underwriters' lawyers have studied that (and any similar) decisions _very_ carefully and have wordsmithed the language to try to ensure it will be enforceable in the future.

As you, I think it's a despicable ploy; nothing I've written previously should be interpreted as being supportive of the idea; only that it's definitely not a given that coverage will be automatically given to cover additional Code or other occupancy reg's in place since the time the original structure was built.

As noted earlier, I think there was a big problem in the casualty models used in setting rates for catastrophic losses in that they forgot about/essentially ignored common-cause and the magnitude of the possible damage area affected by these events as the population and particularly evaluations in these coastal areas grew exponentially over the years w/o any major events. After that, they were left with such massive losses they've resorted to whatever could to try to limit liability.

Also as I noted before, I believe one upshot of Sandy will be that FL-like legislation will follow in the NE and along all the Atlantic coastal areas w/ time that will mandate that policies include the rider by default and homeowners will have to explicitly decline it if choose to not pay the additional premiums that it will entail. And, of course, while it will provide coverage, "there is no free lunch" and rates will rise to cover it. Of course, they're rising anyway to cover the problems the last few years have uncovered in the actuarial rates were using, anyway...

[TomR]

Here's a website link that I just found today that I think will be of interest to you:

.

And, you guessed it, Allstate ranks Number 1 on their list.