Understanding the Claims Representation Process & How it Works
A loss to your commercial property or home creates an unfamiliar environment and poses excessive demands on your time. Decisions involving thousands and sometimes millions of dollars must be made and often made quickly with little margin for error. A decision must be made early on whether this process is to be undertaken by the policyholder or whether the professional expertise of a public adjuster should be brought in. Time and again it has been demonstrated that when dealing in an area that is unfamiliar, the end result can be a loss in valuable time and money.
Large or small, commercial or residential, properly handling a claim involves a structured process that when followed, will ensure it is processed properly and given the best chance of being honored and paid by your insurance carrier. The main services an adjuster will perform for you include:
Analyze your policy to get the maximum claim coverage.Inspect the property damage and estimate all losses with our computerized system.Notify the insurance company of your loss and ensure they have proper documentation.Set all appointments with insurance company staff and provide them with preliminary estimates for building and contents damage and loss of business accounting figures.Negotiate with insurance company for a fair and equitable settlement.Prepare all documents in order to obtain payment.Provide a list of trusted professionals for reconstruction if required.
The following explanation below is a more detailed explanation of the process used by Tutwiler & Associates and what to expect when dealing with a property damage insurance claim.
Stage 1: Initial Contact - Whether you contact us via phone (305) 956 3666, email, or our free Claims Evaluation Form, we will respond to you as quickly as possible. The more information you can provide us the better we can answer your questions and concerns. Upon review of your information we will call you to answer any additional questions and then schedule a meeting to inspect your damage. For the initial inspection we should schedule a time when you can be present.
During the meeting we will review your insurance policy to understand the coverage’s we have to work with. It’s of critical importance to have a plan in place based on the loss and the coverages. As an example: Are there enough limits available to hire a restoration company or are items and building components damaged to the extent that paying for the loss will use up your policy limits? There are a number of decisions that need to be made following a loss. These decisions will have a big impact on the outcome of your claim and your recovery. Our initial contact and the steps we recommend based on the facts of your loss and your policy coverage are going to be vital and critical to your recovery.
After the initial consultation, we hope you will realize the value of having a professional on your side. In order for us to be your representative and file your claim, you must appoint PICC as your public adjuster. Thus we will ask you to sign an authorization form allowing us to notify the insurance company. Our professional fee structure will be worked out with you based on your needs and coverages and is generally based upon what we are able to negotiate for you. That means that we are highly motivated to do all we can to make sure you are fairly compensated in your insurance settlements with consideration to your coverage and insurance policy limits.
Typically, fees run in the 5%-20% range and are highly dependent upon the type of claim, size of the claim and circumstances of the loss allowing us to gauge the amount of time a claim is likely to take. In Florida when a disaster is declared (such as in the aftermath of a Hurricane) Public Adjuster fees are capped at 10% per State law. One of the things we pride ourselves on is making sure fees and related expenses are understood upfront so there are no surprises.
Stage 2: Investigation – Once we become your authorized public adjuster, the first step is the analysis of your policy provisions and stipulations as they relate to your loss. This in-depth review is used to determine the coverage, limits, exclusions, and other forms that may apply to your particular loss. In investigating and planning for the loss and damages documentation and presentation, an understanding of recent court cases, decisions from the Insurance Commissioner's office, industry technical articles and opinions, and other factors that are likely to influence your standard insurance policy are all used to map a claims strategy.
In many cases we have found the printed policy forms are contradictory to current practices and procedures of insurance adjusting in your area. Keep in mind that your insurance policy is a contract. While we do not dispense legal advice, given the nature of insurance disputes, we have seen instances where over the year’s court rulings may have an effect on the practice and procedures of adjusting property claims in your state.
Thus what’s in a standard generic insurance policy may not be what the law of the land is where the loss occurred. We pride ourselves on staying current and in compliance with all issues that effect our profession through updated and current continuing education requirements required by the State regulators where we hold our professional licenses.
Stage 3: Documentation of the Claim – As the insured, you are required under the insurance policy to conform to the "Your Duties After A Loss" provision contained in your policy. This can be an involved and detailed process requiring time and expense to meet the requirements. As your claim representative, your PICC public adjuster will create an exact profile of your property so it reflects its true value and conforms to your insurance policy language.
This in-depth process includes:
1) detailed construction estimates with supporting engineering documents if necessary;
2) detailed and verified inventory and contents schedules with correct valuation and supporting documentation;
3) in-depth business interruption coverage analysis which includes projections and forecasts;
and 4) the required technical and supporting documentation showing the current industry publications and authoritative papers supporting positions taken in the claim adjustment process.
Stage 4: Presentation of the Claim - After the full extent of the loss has been determined and documented a schedule of losses is prepared and undergoes a complete review by our staff. The claim is then segregated into the separate categories which conform to the various policy provisions that apply. A thorough review of the documents is made with the client and, with final approval the property insurance claim is submitted to the insurance carrier.
Stage 5: Negotiations and Settlement - Upon approval and submission, we initiate claims status follow-up on the insured’s behalf to expedite the processing of the claim. We also make ourselves available to answer any claim clarification requests posed by the insurance company which sometimes uses these as delay tactics.
It is typical that there may be some negotiations regarding the claim, which many times boils down to justifying the value and legitimacy of the claim components. A well-defined position that is professionally documented should gain the respect of the insurance company representative.
At PICC, our expertise and qualifications in fielding any questions should lead to a fair settlement of your claim. It should be noted that no claim is settled without prior approval from the client who will be kept abreast of all negotiations as they proceed. We are also mindful of the negative financial impact of a loss to your property and we pledge to work diligently in resolving your claim in a timely manner.
If your home or your business has suffered a loss, please call our experts at (305) 956-3666 or visit www.piccfla.com for a FREE claim analysis with PICC.
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