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Hurricane Claim Process

Claim How hurricane guide

Utilizing my claim experience as an adjuster we have created this step-by-step hurricane claim guide to help you bring your home back to it’s pre-loss condition. This guide will help you navigate your property claim in chronological order with a bulleted format of basic to detail information as it relates to your claim.

A Directory of Insurance Qualified Vendors is provided for your convenience. These hurricane claim professionals are familiar with communicating responsible pricing. They bring access to a network of skilled labor and are knowledgeable in working with the insurance carriers’ requirements to bring you back to pre-loss conditions!

See section 5 & 9 below.

 6 Steps to safety:

  1. Only do activities that are safe for you to perform.
  2. Make sure your family and animals are safe.
  3. DO NOT GO NEAR downed power lines or flooded areas.
  4. If you have flooding in your home (insulate yourself) turn off the power at the breaker box.
  5. Call your insurance carrier immediately to start your claim! The phones will be busy with others calling in at the same time you are. Remember patience is a virtue, claim dispatch has taken time away from their families to record and dispatch your claim.
  6. If using a generator: (Read the instructions before operation)
    1. Do not operate it inside or immediately outside the door or window.
    2. Carbon monoxide is created by the exhaust and is deadly.
    3. Utilize a Carbon Monoxide detector (similar to a smoke detector in design) to alert you in the event carbon monoxide comes into your home.
    4. Make sure the generator has a grounding rod (this is usually a copper rod that is driven into the ground that is attached by a ground wire to your generator).

Note: A Claim Examiner at the carrier will be assigned your claim, this name will likely change throughout the process as new claims come into the call center, this allows the overall process to move quicker. Your conversations and documents will be saved to your specific file.

Very Important:

Following a catastrophic event, things are chaotic to say the least, it’s more like organized chaos! Hurricanes pass as slowly as they arrive. While dealing in the aftermath of a catastrophic event people may arrive at your home offering their services. You have options:

  • Were they sent by your insurance carrier?
    • If yes, they should provide a claim number that was also provided to you when placing the claim. These vendors may or may not be from your area but may be legitimate.
  • If they were not sent by your insurance carrier.
    • Make sure they provide you with proper credentials that legitimize their services.

The field adjuster or desk adjuster can provide clear direction on this. Be careful about what contracts you are asked to sign.

There are honest vendors out there who will truly help you. See Choosing a Vendor below.

Mediation “Florida”: Upon completion of your claim, if you have a claim dispute you can review “Mediation and Neutral Evaluation” material for more information about filing a claim.

NOTICE:  Section 817.234 of Florida Statutes provides in part: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

WHAT TO DO FOLLOWING A HURRICANE:

  • If you smoke do not light-up or create any sparks due to potential gas leaks!
  • Take photos before moving anything to document your damages.
  • Before the storm hits take photos or videos of the contents in your home.
  • If a tree is on the power line and/or the power lines are down:
  • Stay clear of the area – lines may still be live – avoid electrocution!
  • Allow the power company to remove trees from power lines.
  • Do not move or touch power lines with any objects – avoid electrocution!
  • If a large transmission line is down: A greater distance of safety is necessary – electricity can travel across the ground – avoid electrocution!
  • If a tree is on the roof:
  • Remove and tarp/board-up roof and/or walls.
  • If water damage has occurred see use our Water Claim Process. Restoration may be required to remove and rebuild the damaged area.
  • Turn the Gas, fuel, AC/Heat and/or electric off to the area that has been damaged.
  • Prepare to remove your prescriptions and food from the refrigerator and freezer based on your power service options.
  • Moving contents: If you need to protect contents from further damage, take some quick overview photos of the room before moving them.
  • The adjuster will need to view the rooms and/or review your photos for the location of items to properly document your loss.
  • If possible, avoid moving contents before you have met with your adjuster for instruction.
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Be sure to provide the best phone number/’s and email address to reach you at, provide your cell number as home phones and electric may not be available. Share an alternative contact name and number of a family member or friend outside the damage zone possibly due to limited utilities or access.  Share exactly what happened to the best of your knowledge as this will aid the triage process in responding to your needs and if there is limited access to your dwelling.

Examples:

  • A tree fell on your roof.
  • A tree fell on my home, breaking trusses…. and is still on my home.
  • Service Line was pulled off the side of our home.
  • Winds blew my shingles off.
  • My home is flooded.
  • The neighbor’s boat is on my roof…
  • Your claim is important, the adjuster will reach out to you as quickly as possible for scheduling.
  • Please be available at the appointed time, share any receipts, invoices or paperwork you have received as the result of this event.
  • Depending on the size of this event, it may take several days before you hear from your adjuster. A catastrophic event can overwhelm the support system.
  • Please be mindful of the adjuster’s requested time frame, as he/she is working long diligent hours to meet and file a report/estimate for many insureds.

Please understand, the adjuster will be working with some insureds that may have been flooded out of their home or a tree has fallen onto their home crushing the walls now laying on the foundation and displacing the occupants. In either case, the adjuster and carrier know each claim is important as the next, they want to be on-site as soon as humanly possible.

Additional Information:

The following may be directed by the field adjuster or the carrier desk adjuster:

  • Contractor – Board-Ups (cover & tarp openings in a structure)
  • Contractor – Restoration, to rebuild the structure.
  • Mitigation company – Evacuate smoke and/or remove water.
  • Mitigation and/or Restoration company – Clean and inventory contents damaged by fire, smoke and water. This allows your contents coverage to work for you by minimizing your cost of content replacement.

Most insurance carriers use qualified vendors; however, they allow the insured to choose vendors in addition to the preferred vendor’s list.

Secure your properties damaged areas by boarding or tarping roof, doors, windows, and other openings to protect your property from further damage. This is sometimes provided by a 3rd party.

Important: The carrier must be allowed the “right to inspect” the damage for cause and origin as soon as possible. A delayed inspection may result in a denial of the claim.

The insured (per policy) is permitted to protect damaged and undamaged property from further damage.

  • If you must move something, please take photos before disturbing the area!
  • Photos: Should be a wide overview AND close-up of damage if possible.
  • The photo should capture the entire tree, not just the 3’ limb that pierced the roof.
  • When a tree has been removed from the roof, a photo should capture what the roof looks like without the tree before it is tarped.
    • Board Up will be conducted to secure and protect your property if
    • Please keep all receipts to submit to the adjuster/carrier for board up and or tarping even if you have conducted this yourself instead of another party.

Note: Board up is to secure your property by boarding up the roof, doors, windows, and other openings to protect your property from further damage.

A WATER MITIGATION Vendor may arrive immediately for dry-out if required.

DO NOT MOVE ANYTHING!

Conducted by the Adjuster – he/she will:

  • Photograph damaged and surrounding area to include all rooms.
  • Measure and document immediate and surrounding areas.
  • Conduct an interview with insured regarding the loss
  • Photograph all exterior elevations, and all interior rooms.

The Adjuster will discuss the scope of work required for repair with the contractor if involved. Each will submit an estimate to the carrier regarding the scope of work to replace and/or repair damage caused to your structure by this peril.

Note: In addition to the adjuster, a contractor may be involved depending on the damage.

Water Mitigation, Restoration Contractor, etc.

This may be multiple vendors or an individual vendor providing a combination of services.

Water Mitigation Vendor – This is a rapid response to mitigate (minimize, stop and dry) water and/or smoke damage within hours of the loss.

Restoration Contractor Vendor – Removes the damaged materials, rebuilds and/or repairs damage.

Florida Contractor License Search: Utilizing an insurance experienced vendor can make your task more seamless.

There are insurance Preferred/Qualified vendors familiar with communicating a written itemized estimate and providing timely service to brining the insured back to whole.

Since each contractor is looking at the same scope of work, the pricing should also be the same between these vendors, it boils down to who you feel comfortable with completing the task.

    • Preferred/Qualified Vendors are a courtesy recommendation by the insurance carrier, you can also refer to the attached list of Qualified vendors near you.
    • Review and read all paperwork before signing, the carrier and/or adjuster can provide further insight if needed.

Avoid signing agreements that give the contractor the right to act on your behalf. Protect yourself; DO NOT sign any contracts that use “Assignment of Benefits” language without fully understanding what an AOB is. 

By signing an AOB you surrender your rights to the vendor. They can then receive a check directly from the carrier without performing any work, they can also hold your job hostage demanding more monies above the actual scope of work. This can snowball into a real tangled mess leaving the insured to pay out of pocket.

    • What is a “Work Authorization or Service Authorization”? This Is required to begin work, this is a normal business practice so that all parties are in agreement to the terms of service offered. Typically, this agreement gives your vendor permission to provide services immediately accessing your property to make needed repairs and continue the project to completion following collaboration through the Adjuster or insurance carrier Desk Adjuster. This agreement also confirms the insured’s responsibility for services conducted outside of the coverage amount.
    • What is a “Direction to Pay”? This gives authorization for the carrier to pay the contractor directly following completion of the work. Many carriers stipulate specific requirements before submitting payment to the vendor such as “Certificate of Completion”.

Example: Sample Contract Wording: To start our emergency and restoration service, you must sign the “Service Authorization Form.” This allows mitigation/restoration company to act immediately. We do not know your insurance coverage; therefore, we can’t know exactly what your insurance will cover. It is important to understand you are financially responsible for our services. Your deductible is payable before we start work. If for any reason insurance coverage cannot be verified at the time of our emergency service, an additional deposit may be required.

WATER MITIGATION: It is important to dry out your property as soon as possible, this may take 3 to 5 days by an IICRC, WRT Certified Technician.

    • There is a science to drying out different types of material, some items will not be salvageable.
    • Long term health issues can be averted by having your property professionally dried out to prevent Mold and Mildew issues that can ultimately affect your respiratory system.
    • What is a “Peer Review”? Sometimes the carrier will request a Peer Review; This process is when another knowledgeable company for example: will duplicate the Water Mitigation process through measurements and dry out log sheets (from the original mitigation company) to determine the appropriate equipment was used in the drying process of your property. There is a science to this process!

Restoration contractors are licensed contractor specialists in their field; in addition to knowing the requirements to conduct the appropriate repair they also understand the insurance format requirements such as documenting, “Scope of Work” and “Line Items”.

    • They will discuss the “Scope of Work” with the adjuster and provide a “Line Item” estimate to the carrier reflecting the removal and replacement to effectuate the damaged area to pre-loss conditions
    • Please understand – Not every licensed contractor is familiar with the insurance environment  as it relates to your coverage!
    • Estimates recognized in this industry are based on-line items; utilizing linear feet, square feet, and item count and/or squares
    • What is a Line Item? A specific price applied to a unit of measurement. It is similar to Procedure Codes in the US Health Care System.
    • Written Estimate: A summary of each effected room in the dwelling and/or Other Structure-Fence, Workshop, Shed, Barn, etc., will be grouped separately; each reflecting a unit of measurements representing labor and materials as it applies to the repair or replacement of a covered item, which is summarized in a “Line Item”; additional Line Items may include service hours and dry-out equipment. Estimates are created from 3rd party software such as Xactimate, Symbility, Simsol, etc…

Excerpt from Estimate:

Any upgrades and improvements will be at an additional cost to the insured and worked out between you and the contractor.

 SUPPLEMENT: The restoration company knows how to document and file for a supplement if needed, saving you tremendous time in the process!

Important: If the estimate received from the contractor is higher than the settlement amount, you should notify your carrier before work begins. The carrier must have the opportunity to review and/or view the additional proposed damages.

See #9 below: Contractor – Working with the restoration contractor and qualified vendors.

Download our Contents Worksheet here.

Avoid moving items from the place they were damaged unless it is necessary to protect from further damage. If applicable photograph and start making a list of items damaged by this event.

    • Content sheets will be provided by the field or desk adjuster, whether you have a mitigation company coming in or not.
    • List the items with the required information to the best of your knowledge.
    • If there are multiple content items damaged, you will likely be contacted by another vendor that will record your contents inventory.

Note: When restoration begins with contents it is always good to be on site for any questions and directions regarding inventorying of contents.

    • Working with Mitigation and/or Restoration company – To clean and inventory contents damaged. Often, many items can be saved (including smoke-stained wedding dresses). This allows your contents coverage to work for you by minimizing your cost of content replacement.
      • DO NOT ATTEMPT TO CLEAN ANYTHING ON YOUR OWN if it is fire-related.
      • You may be asked how you want your contents sorted. This choice can save you wasted coverage for other items.
      • Clean and salvage
      • Inventory Only – Do not clean or salvage
      • An inventory will be made of clothing and other textile items.
      • Drying techniques are conducted to protect Electronics, artwork, appliances, drapes, blinds, furniture, etc. require specific methods of cleaning.
      • Timeliness is essential to protecting and cleaning surfaces.

Ozone and deodorizing process are commonly used for removing odors.

A deductible applies to every policy. Policy language follows individual State Statutes. Most states consider it a Felony if a vendor offers to pay your deductible.

Single deductible (non-hurricane related claim)

Hurricane Deductible – Hurricane related  

In Florida this is usually 2% of coverage A, this deductible is a calendar year deductible; if the insured has qualified in paying out the full deductible within a calendar year, any additional hurricane claim within that calendar year will have met the deductible amount, insured will not be required to pay an additional deductible during the same year.

Read more from Florida’s CFO about Florida’s hurricane deductible. 

The following information may not apply to this loss.

ALE is additional costs incurred by the policyholder if you are temporarily displaced and required to be out of your home residence. During a catastrophic event other housing options may be limited and not available in your immediate area.

  • To qualify – The property must meet specific attributes to render the home unlivable.
  • Most carriers utilize a housing location service.
    • Their goal is to find a location comparable to your current housing.
    • Please understand this is not a vacation plan.
    • Depending on each circumstance; You may be relocated to an Extended Stay with a kitchen or rental home if repairs will be ongoing for multiple months.
    • Notify your carrier of any special needs/medical needs you may have and/or if pet boarding is required.
    • Based on your circumstance it may be necessary for you to stay in a hotel before the carrier can respond; in this case, your receipts can be submitted as incurred costs.

Incurred expenses: is when the policyholder pays for food and lodging known as the upfront cost to the policyholder and then submits for reimbursement per policy guidelines. These are out-of-pocket costs considered for reimbursement.

Food Expense/Receipts:

  • Reimbursement of food
  • Save your ITEMIZED receipts from eating out.
  • Alcoholic beverages are not permitted.
  • Credit Card Statements are not acceptable as they do not show detail.
  • Label your recipes, Breakfast, Lunch or Dinner.
  • Receipts are only applicable to the area of your home policy address (if you are going on vacation or a business trip you would be eating out anyway). These receipts would not be permitted.
  • Expenses for snacks, coffee, breaks, and meals during your workday are not considered additional expenses.

Download your Additional Living Expenses worksheet

Important: There is a limit to your ALE coverage, I have seen a few people spend their entire coverage before they were able to get back into their home. Yes, they had to stay with other family members.

Choosing a contractor who understands the insurance process can save you time and frustration, you will be required to sign a “Work Authorization” for them to begin work.  Always remember to read before you sign!

Restoration vendors know how to submit accurate line-item pricing, so the insured receives the appropriate coverage for their damages.

    • After the contractor and adjuster discuss the scope of work (damaged items and quantity) they each will provide an estimate to the carrier for review of coverage as it relates to the policy you purchased.
    • If the estimate received from the contractor is higher than the settlement amount, you should notify your carrier before work begins. The carrier must have the opportunity to review and/or view the additional proposed damages.
    • Once your contractor is finished, they will provide a “Certificate of Completion” to the carrier triggering “Recoverable Depreciation” based on your specific policy type (See Recoverable Depreciation under “Estimate” section below).

It is important to hire a contractor that understands insurance industry practices such as line items. (A Line-Item places a standard in value as it relates to the repair process; for example, replacing Drywall).

A DRAW may be required by the contractor if the job exceeds $10,000.00 this helps cover initial expenses such as permitting, dry-out, storage cost, restoration, materials, and labor.

    • A settlement check or advance may come with all insurable interest names (required by law) printed on the check including your financial institution.
    • A Loss draft from the Mortgage company will provide multiple releases during the project based on the levels of completion.

If you have a mortgage and/or an additional insured listed on your policy; your settlement check will be sent with all insureds and additional insureds name printed as Pay To.

  • All payees on a claim check must endorse it before deposit.
  • You will need to contact your financial institution for instructions on depositing (cashing the check) with other party names listed.
  • Accepting/cashing/signing of the check does not release or surrender your rights as the named insured.

Note: A separate check will be issued for each Coverage Category:

            Coverage A – Dwelling

            Coverage B – Other Structures

            Coverage C – Contents

            Coverage D – (ALE) Additional Living Expense

Example: ABC Contracting and John & Mary Smith. The contractor may have you (the insured) sign the check so he can deposit funds for his company to do the work. The insurance carrier can provide more detail and suggestions for this process.

Example: Bentworth Mortgage, Inc and ABC Contracting and John & Mary Smith.

Every financial institution has specific guidelines. You will want to contact your mortgage company for specific instructions on depositing the check and how the funds will be distributed.

Understanding the estimate and how Recoverable Depreciation is applied. (Recoverable Depreciation may not apply to some policies and/or specific coverages).

  • When the adjuster and contractor have an agreed-upon scope of work; each will provide a separate estimate to the desk adjuster for review. The estimates will be reviewed by the carrier examiner and considered with your policy for coverages.
  • A line-item estimate will be provided with your Settlement Check from the carrier.
  • Every line item describes a cost factor based on “unit of measurement”; Square Feet, Lineal Feet, Square or individual item. This process reflects the costs incurred to bring you back to pre-loss conditions.
  • The estimating software used is provided by a 3rd party, who gathers regional labor and material pricing. They operate independently and are not controlled by the insurance carriers.
  • A policy will either be an RCV – Replacement Cost Value or ACV – Actual Cash Value.
  • If your policy states RCV Recoverable Depreciation will likely apply.
    • This means a depreciated amount will be withheld from the original settlement, upon completion of work the depreciated amount is recoverable to the insured.

Example: The contractor submits the “Certificate of Completion” to the carrier, the carrier sends the remaining settlement check. (Insured will receive the remaining “Recoverable Depreciation” check made out to Insured and/or other insurable interests listed on the policy or work agreement.)

 

  • If your policy states ACV “Actual Cash Value” – Depreciation will apply and is not recoverable. (You will receive no additional monies.)

Note: Some items may be ACV only, based on the individual policy.

Special Note: If the rebuild cost is less than the original estimate. The final check will reflect the difference (as the insured is not permitted to profit from a loss).

 

If your policy states ACV “Actual Cash Value” – Depreciation will apply and is not recoverable. (You will receive no additional monies.)

Sometimes ACV only applies to specific line items within an estimate.

Request for settlement to carrier/adjuster for additional damage not previously discovered regarding the same loss, that was not addressed on the prior estimate.

  • Supplement considerations:
    • Newly discovered damage relating to this claim that was not considered in the original estimate.
    • Incurred cost is an expense you have to pay-out on before it is considered for coverage such as permits.

The vendor should follow a Line-Item format for Invoicing to submit a tree invoice for reimbursement.

    • How do I submit a tree invoice for reimbursement?
    • Invoice Line items should have debris removal (from the Dwelling or Other Structure) listed separately from (haul to the curb).
    • Add Claim Number to invoice.

 

The repair invoice plays an important part in a water claim process. If a plumber is required; have them provide an itemized Invoice of services provided.

  • Photograph area prior to opening or repairing any ceilings, walls, floors, tile or panels
  • Separate the damaged item on the invoice.
  • Retain the damaged/faulty part/s (fitting, pipe, valve, hose, etc. to provide to the adjuster).
  • Add Claim Number to invoice.

What is FAILURE TO REPAIR?

The term is specific to the cause; if the insured has received a settlement for repair or replacement and not effectuated the completion for which you received coverage; the carrier can deny any future claims that may be related regarding the failure to repair.

Read more…

Example: Named insured receives settlement to replace or repair the roof shingles and chooses for whatever reason to NOT replace roof shingles and additional damage occurs, the carrier has no responsibility to place coverage for additional damages that occur, as the insured did not provide due diligence in protecting the property with timely repair or replacement.

Example: Failure to Repair because insured chose $2,500.00 deductible and damages total $2,600.00.

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