REPRINT FROM THE INTEGRAL NEWSLETTER
INTEGRAL often receives questions because of our website and newsletter. The majority of the questions are from the consumer. Today the consumer is very educated and we typically receive each week at least one of the following questions:
Why should an independent damage report be obtained when the approved restoration contractor is providing one?
Today insurers are walking a fine line between “Bad Service” and “Bad Faith” and are creating concerns with the insurance consumer. The typical consumer simply does not understand their rights, or the responsibilities of the insurer to them. Current statistics indicate fewer than five percent actually read their insurance policy.
Bad faith on the part of the insurers can be described as any blatant action taken by the insurer or their representative that undermines the terms and conditions of the policy. This could include bad service. Even legitimate damages to which the insured may be legally entitled can simply be denied by the insurer. The claim will not be paid and the file closed because the consumer will accept the decision of the insurer and not challenge the process any further.
Some insurers will only respond to litigation which is an expensive method that usually results in long delays before reaching any type of conclusion. There are alternatives available at a fraction of the cost to the consumer which are viable options.
As a property loss consultant, INTEGRAL investigates the loss by determining the quality and quantity of damaged property and will produce a report outlining the cause, circumstances surrounding the cause, description of property, scope of damage, and assessment of restoration. Once the report has been produced, the consumer can make certain that all the facts surrounding the loss have been determined. This includes the handling of the claim by the insurer or their representative and therefore produces a reasonable, sufficient proof of loss for the consumer to file with the insurer. We have a network of consultants specialized in building restoration that are available to provide their expertise.
The INTEGRAL method is
- To provide an objective independent damage report.
- To limit liability and risk by applying the rules of accepted appraisal practices.
- To identify all damaged items that have not been damaged by the insured peril that are included in the report.
- To identify costs that exceed industry standards.
- To identify conditions that have a bearing on the cost of repairs.
- To identify delays and errors which has escalated the cost of the repairs.
- To identify interpreted quality and quantity differences.
- To clearly define the work to be completed.
- To clearly assign a dollar value to each task.
- To clearly write reports in layman’s terms for clearer understanding by everyone.
- To have our reports supported by trades and/or suppliers willing to provide their services and/or products required.
My strata complex that suffered a fire on the top floor is a 3 story building with 30 units in it. Water poured down into my suite on the ground floor and my insurance company denied my claim yet other owners in the building are having their claims covered. I have a comprehensive policy. Why?
It appears that the fire destroyed the top floor of the building and to extinguish the fire on the top floor it sent water down two stories into the units below.
It is becoming more and more common for insurance companies to deny claims or find alternative solutions that are less expensive. However these solutions do not necessarily produce the results required. The first step is to discuss the situation with the broker of record and determine whether it is the broker’s opinion that the loss is not excluded. Then potentially seek other professional advice if the insurer stands by their declination of coverage.
As a Restoration Manager, INTEGRAL photographs the building, makes a diagram of the building, completes a Scope of Damage, and completes an Assessment of Damage in the form of a Damage Appraisal Report. The assessment of damage is priced on a replacement cost basis using qualified trades people. If the loss involves strata owners improvements or leasehold improvements, these improvements are incorporated into the total report. The report will be sent to the adjusters for the building insurer as well as the unit owner’s or tenant’s insurer. It is the job of these two adjusters to determine who is responsible for what damage because INTEGRAL is not an adjusting firm, rather an appraisal company.
After the adjusters have determined coverage, amounts, etc. INTEGRAL can then manage the restoration process. Once the value or budget has been determined INTEGRAL will continue to work with you until the restoration process is complete and to your satisfaction.
INTEGRAL is not a restoration contractor, but rather a restoration manager. We have no vested interest in the work to be performed because we are paid fees on a report and management basis. We manage the scheduling and services of separate qualified sub-contractors who may not be approved contractors of the insurance company.
The insurance adjuster is not considering all of my fire damage and says there is nothing wrong with finishes in the second bedroom. There is approximately $ 7,500 damage in this room from smoke and water. I have talked to several people who advised that I seek a public adjuster, or a lawyer, or an advocate. Who should I talk to?
There are several components to this excellent question. So let’s take them in order.
A public adjuster is a licensed insurance adjuster who works on behalf of the consumer or the insured. In accordance with the Financial Institutions Act anyone working for a consumer as an adjuster must be licensed (there are a few exceptions) if they are doing it for remuneration. The public adjuster works on a percentage of the loss paid and in this case the amount of damage ($7500) will preclude the public adjuster taking on your case. The amount of damage would have to be much higher to take to a public adjuster, a starting amount is typically $50,000.
A lawyer is exempt from having to have an adjuster’s license under the Financial Institutions Act. In this case their hourly fee of $ 150 or more would soon use up the $ 7,500. A lawyer would probably advise you that it isn’t worth pursuing.
The term advocate is interesting, as it really is a general term. The public adjuster is an advocate. The lawyer is an advocate. Your broker can even be an advocate. However, the term advocate is typically accepted as the insurance buyer’s representative or risk manager . The advocate is virtually considered an employee of the insured (the insurance buyer) and is therefore considered as part of the insured. Unfortunately the advocate position in the past would typically be found with respect to commercial, agriculture, institutional and industrial risks, not residential. However today the advocate position is available for residential risks as well.
There is a fourth option. Today it is possible for the insured to present their own case for coverage by obtaining an independent Damage Appraisal and/or Contents Appraisal. It is up to the insured to prove their loss and these reports are accepted by the claims industry as the proof. The cost of these reports would be necessary even if a public adjuster or lawyer should subsequently be retained.
Damage Appraisals and/or Contents Appraisals are available through INTEGRAL on a packaged fee basis.