Frequently Asked Questions

Terms To Know

a)When the damage to property is economically repairable, actual cash value means the cost of repairing the damage, less reasonable deduction for wear and tear, deterioration and obsolescence, b) When the loss or damage to property creates a total loss, actual cash value means the market value of property in a used condition equal to that of the destroyed property, if reasonably available on the used market, c)Otherwise, actual cash value means the market value of new, identical, or nearly identical property, less reasonable deduction for wear and tear, deterioration, and obsolescence.

An antique is an object created or produced 100 or more years ago.

If you and your insurance company fail to agree on the amount of actual cash value or amount of loss, either one can demand a determination by appraisal. Each shall select a competent, independent appraiser and notify the other of the appraiser’s identity. The appraisers then select an umpire. The appraiser shall then set the amount of the actual cash value and loss to each item. The umpire settles any disagreement between the appraisers about the value of any item. You are responsible for the cost of your own appraiser. The cost for the umpire is split between you and your insurance company.

A competent, independent, and impartial person who estimates the value of something, such as real estate, jewelry, or rare books. For purposes of insurance appraisal, an appraiser is competent, independent, and disinterested.

A collectible is an object suitable for a collection, originally a work of fine art or an antique, items can be collected as a hobby, for display, or as an investment whose value may appreciate. A collection of items whose value does not appreciate is considered only a collection.

This is referring to the exact date your insurance loss took place.

The Declarations Page of your insurance policy contains all of the critical information about YOUR particular insurance policy. It is the page that tells WHO is the named insured, WHAT is being insured (property address, automobile identification, description of property, etc.), HOW MUCH it is being insured for (policy limits), WHEN the insurance policy is in force (inception and expiration dates), WHO ELSE is named on your policy (mortgage information, additional insureds, etc.), DEDUCTIBLES, COVERAGES, and lots of other information that determine what the actual insurance policy covers.

The reduction in value due to use, obsolescence, age, etc.

Free from bias, prejudice, or partiality; not having a pecuniary interest.

An insurer shall furnish, upon request of any person claiming to have a loss under any insurance contract, forms of proof of loss for completion by such person. But such insurer shall not, by reason of the requirement to furnish forms, have any responsibility for or with reference to the completion of such proof or the manner of any such completion or attempted completion. If a person makes a claim under a policy of insurance, the insurer may require that the person be examined under an oath administered by a person authorized by state or federal law to administer oaths. This provision is included in most insurance policies, although some of the specific wording may vary depending upon the insurance company and/or policy of insurance.

An act or instance of deception. If it is proven that you committed fraud during the claims process, your entire claim can be denied.  As the Washington State Office of the Insurance Commissioner says, “It is a crime…” per:  RCW 48.30.230 False claims or proof —Penalty. (1) It is unlawful for any person, knowing it to be such, to: (a) Present, or cause to be presented, a false or fraudulent claim, or any proof in support of such a claim, for the payment of a loss under a contract of insurance; or (b) Prepare, make, or subscribe any false or fraudulent account, certificate, affidavit, or proof of loss, or other document or writing, with intent that it be presented or used in support of such a claim.(2)(a) Except as provided in (b) of this subsection, a violation of this section is a gross misdemeanor. (b) If the claim is in excess of one thousand five hundred dollars, the violation is a class C felony punishable according to chapter 9A.20 RCW.

You and, if a resident of your household: a) any relative; and b) any person under the age of 21 in your care.

Suit Against Us. No action shall be brought unless there has been full compliance with all of the policy provisions and the action is started within one year after inception of the loss or damage. This provision is included in most insurance policies, although some of the specific wording may vary depending upon the insurance company and/or policy of insurance. Some policies allow two-year deadlines.

This includes coverage for your furnishings and personal items.

The Proof of Loss is the form upon which you formally submit your claim to the insurance company. Your Proof of Loss will tell the insurance company how much you are asking them to pay you for your loss. Along with your Proof of Loss, you will attach any repair estimates, contents inventories, summaries of expenses, and any other documents that help prove your claim. By filing a Proof of Loss you are telling the insurance company that you expect to be paid for your loss. Your Sworn Statement in Proof of Loss is exactly that – a sworn statement that your claim is legitimate. (Anything less than legitimate could be considered fraud, and defrauding an insurance company is a crime.)

Physical injury to, destruction of, or loss of use of tangible property, including loss of its use resulting from such physical injury or destruction.

In case of loss or damage to personal property, replacement cost means the cost, at the time of loss, of a new article identical to the one damaged, destroyed, or stolen. When the identical article is no longer manufactured or is not available, replacement cost means the cost of a new article similar to the one damaged or destroyed and that is of comparable quality and usefulness, without deduction for depreciation.

Special investigation units (SIU) are a division of insurance companies and offices of the insurance commissioner for the purpose of investigating unusual, questionable, and/or suspicious claims, claimants,and/or service providers. See also, National Insurance Crime Bureau (NICB).
An impartial person appointed to make an award or a final decision usually when a matter has been submitted to Arbitrators who have failed to agree. An arbitral submission may provide for the appointment of the umpire.

Appraisals

In property insurance, the terms “appraisal” and “appraisement” refer to a private adjudicatory process created in an insurance policy by which disputes over the amount of a loss are resolved by competent and disinterested appraisers. The purpose of an appraisal provision is to provide a determination of the extent of the loss. When triggered, the appraisal process is mandatory unless the other party agrees to waive its right to appraisal.
Although the language varies a little from policy to policy, appraisal provisions usually have the same general features:
  • There must be a disagreement about the “amount” of the loss.
  • Either the insurance company, the policyholder, or both may decide to trigger  appraisal. It only takes one to put a claim into appraisal.
  • Once appraisal is triggered, the policyholder and the insurance company must each appoint an appraiser, usually within 20 days.
  • Each appraiser must be competent and disinterested.
  • The appraisers choose an umpire to break a tie. If the appraisers cannot agree on an umpire, a court in the applicable jurisdiction can appoint the umpire.
  • A written agreement by two of the three will establish the amount of the loss.
  • Some appraisal provisions state that the appraisers should select an umpire at the outset of the process. Others allow the appraisers to decide on an umpire if and when they disagree on the amount of a loss.
  • The policyholder and the insurance company each have to pay the appraiser that it selected. For all other costs relating to the appraisal – including the cost of the umpire – the policyholder and the insurance company divide the responsibility equally.
Appraisal is not for determining coverage issues. Appraisal is only designed to determine the amount of a loss. Therefore, policyholders should also be careful to understand exactly what “loss” is being submitted to the appraisers. Often, an insurer will send the structural portion of the loss to appraisal but not the contents or alternative-living-expense portions of the claim to appraisal. To avoid surprises, it is always better to identify at the beginning all of the “losses” that will be considered in the appraisal.
The disinterestedness requirement is by far the most important part of an appraisal. Discovery in some of our cases has revealed that the insurance company dictated how the appraiser should conduct the appraisal, what evidence to consider, and even how to vote. In such cases, we have shown that the appraiser abdicated the requisite independence and that the insurance company deprived the policyholder of the valuable right to an efficient resolution of the loss by neutral appraisers.

Appraisal is a time for advocacy. Counsel for policyholders should help select an experienced appraiser who will be fair to both sides. Then, counsel should advocate for the type of appraisal hearing that should occur – it will vary depending on the claim – and help gather evidence that supports the policyholder’s position. The point is that appraisal is not a passive process.

The insurance company must conduct a good-faith investigation before requiring a policyholder to undergo appraisal. This is based on the laws:

  • An insurance company cannot simply skip its obligation to conduct a full and fair investigation by invoking appraisal. With respect to their policyholders, insurance companies always have a duty of good faith, and they always have a duty to investigate. WAC 284-0-30-330(4)
  • The claims-handling regulations make insurance companies responsible for the accuracy of actual-cash-value evaluations. WAC 284-30-380(7)
  • Moreover, it is unlawful for an insurance company to compel “a first party claimant to initiate or submit to litigation, arbitration, or appraisal to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in such actions or proceedings.”  WAC 284-30-330(7)

Contents Inventory

The entire inventory process from start to finish will require three weeks to six months depending upon the circumstances of your claim.

This is your contents claim, and your involvement contributes to the accuracy of your inventory. We prefer that you at least review, age, and sign off on your contents inventory before it is submitted to the insurance company for consideration.

CDR offers a range of contents inventory services, and without knowing the extent of your loss and/or the circumstances of your claim, we cannot quote a specific price. However, you may contact CDR directly to schedule an appointment or teleconference with our claims manager,

Brandi Hollibaugh, to get an estimate of cost for the specific inventory services you need.

You, the policyholder, are responsible for submitting your contents claim, so the CDR costs are your responsibility. However, you may want to check with the insurance company claim representative to see if they will cover this cost as a claim expense or under other policy coverages for claim preparation.

The age of a contents item is one of several factors which might be taken into account in the determination of actual cash value. Actual cash value can be calculated as replacement cost less depreciation, so a five-year-old sofa would be depreciated more than the same sofa that’s brand new.

It depends on the insurance company. The CDR valuations are based on independent verification and our decades of experience in the business of evaluating contents inventories. The valuations we provide are fair, reasonable, and arguable.

You have to replace the item in order to collect the withheld depreciation. Save your purchase receipts, match each item to the inventory line item number, and submit the receipts to your insurance company. You have 180 days after the ACV has been issued to make a claim for withheld depreciation.

The insurance policy cites a provision for resolving disputes over loss, damage, and/or valuation. Please click here to learn more about the appraisal provision.

Public Adjuster

Public Adjusters are engaged exclusively by you, the policyholder, and not by the insurance companies.

Yes. Most companies actually prefer to work with an experienced claimant. It is in the best interests of all concerned that a fair and prompt settlement be made.

The insurance company adjuster or independent adjuster is employed exclusively by the insurance company and must try to strike a balance between your interest and those of the insurance company. Public Adjusters are working for your best interests exclusively.

The agent or broker serves you at all times in connection with your insurance coverages. They generally do not have the time, training, license, or facilities to render the highly specialized service of insurance adjusting and inventory documentation.

No. It stands to reason that Public Adjusters who professionally handle and prepare claims every day, can do it more competently and efficiently than the average insured, who may have only one loss in a lifetime.

Yes. Public Adjusters will assist you in any claims of loss against any insurance company under the fire coverage and allied lines. These include windstorm, explosion, snow, hail, smoke, motor vehicle damage losses, inland marine, use and occupancy, rentals, improvements and betterment, commission and profit, report forms, and other.

Do you really know what is rightfully due to you? A Public Adjuster does. Public Adjusters are your representative exclusively. With the Public Adjuster’s experience and knowledge, they are far more capable of bringing about a favorable and satisfactory adjustment.

RESOLUTIONS

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