Many homeowners and business owners find themselves disagreeing with their insurance company’s analysis of their insurance claim. However, most are unaware that they can dispute the insurance company’s findings via the Insurance Appraisal Clause! Find out the steps you can take to dispute your insurance claim settlement.
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Many homeowners and business owners find themselves disagreeing with their insurance company’s analysis of their insurance claim. However,Insurance Appraisal Clause… A Policyholders Best Chance to Resolve an Insurance Claim Dispute! Articles most are unaware that they can dispute the insurance company’s findings via the Insurance Appraisal Clause! Even though the policyholder (you) submits a contractor’s estimate, receipts for repairs or materials, or even photos showing damages that the insurance company did not include for repairs… they still won’t budge.
Most policyholders are unaware of how to dispute and resolve their claim with the insurance company. Policyholders have a choice and a voice within their policy for this very purpose. It’s called The Appraisal Clause – also know as The Appraisal Provision. Now, don’t let this scare you. It may seem like a fancy clause that would take a law degree to understand. However, a simple way to understand the clause is that it’s the insurance industry’s version of arbitration. Although similar, the Appraisal Clause is NOT an arbitration or mediation and the umpire is not an arbitrator, mediator, or judge. Insurance Appraisal, Mediation, and Arbitration are separate things.
In short; Arbitration requires attorneys and a legal process, where Insurance Appraisal does not require attorneys or a legal process. Arbitration is a dispute between two parties for any reason, where as, the Insurance Appraisal Clause is a for disputes between the “value,” of property only – bee it an automobile, plane, train, couch, house, commercial building, etc.
Most Policies Have the Appraisal Clause.
If you feel you’re at a dead end with your insurance company and want to resolve your claim you’ll need to check your policy for the Appraisal Clause. Most policies will have the provision listed under the “What to do after a loss,” section or the “Conditions” section of the policy. Below, you will find a sample of a typical Insurance Appraisal Clause included in most policies. Keep in mind that policies can be different in each state. Therefore, you should read your own policy to see if this clause exists. It will say something similar to the following ;
“APPRAISAL – If you and we fail to agree on the amount of loss, either one can demand that the amount of the loss be set by appraisal. If either makes a written demand for appraisal, each shall select a competent, independent appraiser. Each shall notify the other of the appraiser’s identity within 20 days of receipt of the written demand. The two appraisers shall then select a competent, impartial umpire. If the two appraisers are unable to agree upon an umpire within 15 days, you or we can ask a judge of a court of record in the state where the residence premises is located to select an umpire. The appraisers shall then set the amount of the loss. If the appraisers fail to agree within a reasonable time, they shall submit their differences to the umpire. Written agreement signed by any two of these three shall set the amount of the loss.”
OK, But How Does The Insurance Appraisal Clause Work?
The Appraisal Clause allows the policyholder (you) to hire an independent appraiser to determine the value of their damages. In turn, the insurance company will also hire their own independent appraiser. The two appraisers will then get together and select an umpire. The umpire is basically the arbitrator, or what you might call the judge. If a disagreement between the two appraisers arises, they can present their differences to the umpire who will make a ruling.
OK; so far so good, the basics of the insurance appraisal process are beginning to come together. We have an independent appraiser for the policyholder. We have an independent appraiser for the insurance company. Finally, there is an Umpire. These three individuals are known as The Appraisal Panel. The object of the Appraisal Panel is to set or determine The Amount of Loss. The Amount of Loss is the total dollar amount needed to return the damaged property back to its original condition, either by repair or replacement.
Once the Appraisal Panel is set, the policyholder’s chosen appraiser and the insurance company’s chosen appraiser will review the documents, estimates, and differences between them. The two independent appraisers will try to discuss and resolve the differences in damage and in cost. For example; the insurance company may determine that brick on a home does not need to be replaced. Where as, the contractor or appraiser for the policyholder says that it does have to be replaced. The two appraisers will discuss their reasons for their position and try to come to an agreement, first if it should be repaired or replaced, and secondly the cost to return the brick back to it’s original condition prior to the loss.
One benefit of this process is that the two independent appraisers have not been subject to the bickering and anger between the policyholder and the insurance company. Basically, it’s the hope that cooler heads will prevail. All the appraisers really have is the amount of the damage and the difference between the two estimate numbers. They do not have the previous baggage or anger that led up to the Appraisal. The process was designed so that these two individuals, who have no interest in the outcome, could discuss a settlement based on the facts presented to them.
Sometimes issues arrive where the two independent appraisers can’t agree on certain items. In this event, the two appraisers will submit their differences to the chosen umpire. The three will discuss the issues and try to reach an agreed settlement of the differences. As stated above; the settlement or final number is called The Amount of Loss. The final amount is known as the Appraisal Award. The Award is signed by the individuals who agree on The Amount of Loss. However, only TWO of the three individuals need to agree. (An agreement between the two independent appraisers, or the umpire and either appraiser) Once any TWO of the three individuals on the Appraisal Panel sign the award… the dispute is over! The amount on the Award binding and is paid by the insurance company, to the policyholder.
Can I Use An Insurance Attorney To Dispute My Claim?
The Appraisal Clause was initiated to lower the number of lawsuits filed against insurance companies. The courts found that many lawsuits were entering the legal system where the cost to repair or replace damaged property was being disputed. In many cases the suites were being resolved when professional engineers and contractors could address the issues. The Appraisal Clause was created to get such individuals together and keep these disputes out of the courtroom. Assuming you acquired an estimate of repair to your property for $100,000, from a contractor or insurance claims expert. Your insurance company has created an estimate for $30,000. This would be a clear dispute between the amounts of damage. This type of dispute is exactly what the Appraisal Clause was developed to resolve.
The clause allows parties on both sides of the insurance policy to dispute their differences using this less costly provision. Let’s face it; the courts are filled with lawsuits. The Insurance Appraisal Clause and process allows for the dispute to be settled out of court. Using Insurance Attorneys and lawsuits can have insurance claims tied up in court for years. The Appraisal Provision was designed to keep these disputes out of court for a less costly and timelier resolution.
Insurance Claim Attorneys will usually represent policyholders for bad faith practices. Bad Faith is a whole other issue and sometimes happens after the Appraisal Process has been completed. Bad Faith claims are for much larger suites against insurance companies when it is alleged that they did not act in good faith of the policy they sold to the policyholder. In summary; disputes between the amount of damages and repairs will follow the Appraisal Clause before entering into the legal system. Many Insurance Attorneys will also advise the policyholder to engage in the Appraisal Process before any lawsuits will begin.
How Do I know if the Insurance Appraisal Clause is a Good Option for My Claim?
If the Appraisal Clause is in your policy then it is always an option. However, it’s wise to point out that Appraisal is usually an option when there is a substantial difference in the amount between the two estimate totals. For example; let’s say a fire completely destroys a house and the homeowner’s personal property within it (Know as the Contents). The differences between what the insurance company wants to pay and what you wish to receive is $5,000. In this situation, the Appraisal Clause is not the best idea. After paying the fees involved for the appraisal, you may not end up with much of the $5,000 being disputed.
Now, if we take the same fire that destroys the property and the dispute between the policyholder and the insurance company is $40,000, appraisal should be considered. The policyholder now has a chance to recover substantially more money than originally offered.
Also, the Appraisal Clause is only applicable if a dispute arises from a covered loss. If the insurance company denied the claim as something not covered then this is not a dispute on the amount to repair, but rather a dispute on coverage. For example; homeowners and business policies due not cover damages from flooding. Flood policies are purchased separately. So, if there is no coverage for the flood damage then the Appraisal Clause is not an option.
Simply put, the Insurance Appraisal Clause is to determine the “amount of loss,” to property only. The Appraisal Panel is not to determine coverage, policy provisions, deductibles, how much was previously paid on the claim, etc. Let’s say there was an appraisal for a grand piano that fell off a delivery truck on the highway. The Appraisal Panel’s job is not to determine who’s at fault, the policy coverage limit, if the truck had a registration, or anything other than “How Much is the Piano Worth.”
As with our example earlier, if the insurance company offers a settlement of $10,000 to repair a roof and the policyholder has contractor bids for $15,000, then the Appraisal Clause may not be the best option. The process may cost more than the $5,000 that’s being disputed. Unfortunately, the differences in repair/replacement costs are usually much greater. When an insurance company generates an estimate for a claim of $75,000 and the policyholder has acquired professional bids from several contractors of $200,000 or more, its time to invoke the appraisal clause.
Beginning The Appraisal Process.
Either party associated with the policy can invoke the Appraisal Clause. However, such a request must be made in writing. Each policy will have a time limit of when this can take place. Even if a claim has been closed for many years, either party can still dispute the claim and reopen for review. It’s recommended that the request to invoke appraisal be sent via certified mail. Once the request to invoke the Appraisal Clause has been initiated, as explained earlier, each party, the insurance company and policyholder, appoints an Independent Appraiser. (If you wish to invoke the appraisal clause in your policy you need to submit a letter to your insurance company. Find more information at http://www.insurance-appraisal-services.com/invoke-appraisal.html )
Choosing An Independent Appraiser.
It’s important to select an Independent Appraiser that has experience with the damages being disputed in the claim. A person with expert knowledge of insurance claims handling, firsthand knowledge of the damaged property, and its replacement cost. For example; a person with expert knowledge of insurance claims handling and with expert knowledge of the Appraisal Clause and process, with little experience on the costs to replace an antique grand piano may not be the best choice. In the case of a home or building fire; a good Independent Appraiser is someone who can generate their own line-item detailed estimate to repair or replace the damaged property, can secure multiple bids from reputable contractors to back up their findings, knows building codes, and can articulate unforeseen costs of repairs. If a building has historic features with materials like, solid Adler doors, large detailed moldings, and custom cabinets, a great amount of research with a salvager may be needed. The Appraiser should have experience with building procedures, materials and the cost of such terms to create an accurate “amount of loss,” to return the property to its original condition prior to the loss.
See, the policy provides coverage to replace the damaged property with those of like kind and quality. An Independent Appraiser that is not familiar with, or that does not have experienced contractors, enginee