Main MenuWhen policyholders encounter a property claim denial, or claim determination that they feel to be inconsistent with their expectations of coverage, they generally believe their only option is to turn to an attorney to resolve the issues. In my experience, this is generally a result of policyholder’s lack of awareness of the existence of Licensed Public Insurance Adjusters, and the role they serve in the claims process.
I commonly am asked whether a policyholder should hire a Public Adjuster as opposed to a Lawyer. In the coming days we will post a more in-depth post about the differences between representation by a Public Adjuster vs. a Lawyer in a property claim. But this post will provide some insight as to why a policyholder may want to discuss their denied claim with a Licensed Public Adjuster prior to the enlistment of a lawyer.
The decision of which professional is right for a policyholder is largely dependent upon the specifics of a claim and the disputes or issues that have arisen. In our opinion, both professionals have their specific roles and given that no two claims are the same, consideration should be given to numerous factors when determining which professional may best meet the needs of your case.
One of the main things to consider when seeking the right professional for your claim, is what the dispute is over. There are generally speaking two basic hurdles a policyholder must overcome in order to arrive at a settlement of their property claim, “coverage” and the determination of the “amount of loss”. The coverage hurdle, generally speaking, is overcome upon the acknowledgement by an Insurer that a loss caused by a covered peril occurred within the policy period. The “amount of loss” generally speaking is the determinations of what was damaged, the extent of the damages, and the costs to repair the damaged property.
When the coverage hurdle cannot ultimately be overcome, the only option to resolve for resolving a true coverage issue is to file a lawsuit and have the appropriate court determine the matter, which a lawyer would be required for. In disagreements over the “amount of loss”, other alternative dispute resolution methods exist in most policies, which may not require the enlistment of an attorney.
While these issues are going to be case by case specific, one thing to consider when facing a denied claim is whether the denial can be overcome without ensuing litigation. Our firm has been retained in cases that started with a denial of coverage, that were later shown to in fact be covered losses, and did not require litigation to overcome. While this may not always be possible, it warrants considerations by a policyholder on the facts of their insurers position. In many situations a competent Public Adjuster will be able to evaluate the insurers position and determine if the position is accurate, reasonable, factually supported and/or justifiable. In many cases where our firm has determined that not to be the case, our investigation combined with sound independent exerts analysis, has been able to convince the insurers of the merits of their insured’s claim. Had our clients not taken this path, opting to utilize the services of an attorney, they would likely have been subjected to a potentially lengthy litigation process and significantly more professional fees to an attorney, than they paid to our firm.
Now turning to situations where our firm was unable to overcome a complete denial of a claims; our client’s retained attorneys have benefited greatly in their litigation efforts through the use of our thorough and factually supported investigation and claims presentation, expert opinions and factual witness accounts of the investigation and claims adjusting process. Many of these cases, combining the efforts and experience of a competent Public Adjuster and specialized property and casualty lawyer, has served to synergistically leverage both professionals expertise and capabilities to deliver the best outcome for our mutual clients.
While each case may not require, or benefit, from the retention of a Licensed Public Insurance Adjuster, when faced with a denied property insurance claim, a policyholder may be well served to obtain the opinion of a highly experience Public Adjuster to evaluate the possibility of overcoming the insurers coverage position prior to engaging in litigation over the issues.
We hope this information is helpful in your claims pursuits, and as always, we are here to help and educate, so do not hesitate to call with your questions.