Public insurance adjusting

Public insurance adjusters help policy holders receive payment from insurance companies. Public adjusters represent the policyholder for a small percentage of the resulting settlement money from the insurance claim.

What they do

This page on Public Adjusters in incomplete. Please see: https://en.wikipedia.org/wiki/Public_adjuster

Public insurance adjusters represent the policyholder during the insurance claims process. They enforce insurance policies, using State statutes, policy language, and state legislation. These individuals or companies can inspect property damage, but in general they cannot practice law or give legal advice. While public adjusters are usually not lawyers (while some are), there are exceptions to the applications of laws. In most states where public adjusters are licensed, they are issued licensure by a state's insurance commissioner's office to practice insurance, and insurance is based on law and incorporates law, and also operates based on legal principles and protocols. Absent a person having a law license, there are numerous professions that are permitted to practice specific, limited applications of law such as real estate, tax accounting, and insurance. Think of it as lawyers being able to practice any law, while public adjusters are able to practice insurance law, but only in a smaller portion; To add an analogy if an Attorney is a "Doctor" then the Public Adjuster would be the "PA or physicians assistant" where they are still able to practice medicine and make a diagnosis under supervision but not to the degree of a Doctor. Public Adjusters typically charge a lower percentage than Attorneys Usually 10 to 20 percent of the claim settlement. When Attorneys charge upwards of 30 percent or more. Public Adjusters are known to recover more money in many instances, taking a smaller commission while getting the same job done, and leaving the policyholder with more money in their pocket and more satisfaction in the end. The process changes if the Public Adjuster needs to file a lawsuit. Then the Public Adjuster becomes the eyes and ears of Attorneys when the case goes into litigation when the claim is denied or underpaid with a lowball offer and the Insurance Company stands firmly on its position. If the public adjuster has done all he can to negotiate with the insurance company and reaches an impasse, and the Public Adjuster cannot recover a full settlement without filing a lawsuit because the Insurance company is not cooperating. Due to the Insurance Company being negligent toward the policyholder, underpaying the claim, and or acting in Bad Faith. Those are all three valid reasons to file a lawsuit. Or else the claim/case will not have merit and will get thrown out. In this event, the claim needs to go to litigation for a successful settlement recovery. The Public Adjuster is usually the one who tells the Attorney the total dollar amount to sue for. The Attorney is essentially blind without the Public Adjuster's knowledge of the claim.

The Public Adjuster unlike a construction consultant or contractor, writes specialized re-construction estimates specifically pertaining to the terms and conditions of the Insurance policy language. Contractors are not allowed to read your policy in the State of Florida or discuss policy terms with the homeowner/policyholder or negotiate or "Adjust" the claim settlement dollar amount with an Insurance Company. This is so you understand the distinct difference between a contractor quote, and a comprehensive Public Adjuster Estimate addressing all coverages of the policy after a thorough investigation of the entire property and addressing all coverages. As a homeowner policy will have the typically following coverages. Coverage A "the dwelling", Coverage B "Other Structures" (such as fencing or a garage, barn, or shed, not directly connected to the dwelling), Coverage C which is personal property or contents, Coverage D & E which is either "loss of use" (if you cannot rent your home or have to shut your business down temporarily the insurance company offers to pay your tenant's lease payments or pay for you to live somewhere else while you pay our mortgage because you home is deemed uninhabitable living conditions. Which is E or "additional living expenses". Contractors do not address all of the coverages and are not allowed to. They typically only fix your roof, and leave all sorts of items you are entitled to off of the table. Here's an example, a roofing company offers to get your roof "paid for through your insurance". Even though they cannot advocate for you, they hope you file a claim and wish the insurance company will pay for your roof so they can get the roof job. However, you most likely will have interior water damage, mold damage, and hidden damage behind the walls left unacknowledged and unaddressed, leaving tens and thousands of dollars on the table that directly affect your quality of life and well-being. Especially if you have bad roof and ceiling water stains. Under proper procedure, you need an air quality hygenist to come and test for black mold and hundreds of contaminants that can become aerosolized in the air of your home causing physical harm to the respiratory system as well as psychological harm to the brain such as brain fog.

These details go unaddressed if you use a contractor to help with your claim, as contractors Legally in the State of Florida absolutely cannot speak or negotiate with the insurance company, at best they can only call to discuss a bid for work that needs to be done, not pertaining to the policy. It is highly recommended to consult with a Public Adjuster first and have them recover a settlement, then a contractor after you receive your cash settlement so you have the settlement cash to negotiate with contractors. Not the other way around. If you sign an "Assignment of Benefits" documentation or a "Direction to Pay" document with a licensed contractor you can be locked into using their company and held liable if you do not use their company once you receive your settlement. Meaning you will absolutely not have control over your settlement budget or the freedom to shop around for the best contractor prices. On the other hand, the best choice is to hire a Public Adjuster to recover a settlement for you without you paying a dollar until the Public Adjuster recovers a settlement and the check is deposited into your bank account and cleared. You then pay the Public Adjuster a percentage of your settlement and you typically do not come out of pocket doing this. You will need to sign a letter of representation allowing the Public Adjuster to speak on your behalf, as well as have the Public Adjusting company named on the check to ensure their contingency fee is paid, that is the best deal out there, as I said they are able to recover settlements even higher than an Attorney in less time, and charge a lower commission, ultimately leaving you with thousands of more dollars directly in your pocket for you to spend on damages.

These are details that general contractors do not address and miss because they only want the roof portion of the claim, leaving you stranded with tons of mold damages, and in an unhealthy house without you even knowing. This is why it's extraordinarily highly recommended to use a Public Adjuster to conduct an adequate full and thorough investigation of the entire property from the slab up to the roof chimney from head to toe inside and out. By the Public Adjuster conducting a physical inspection and investigation of the property and damages. The Public Adjuster walks the property and collects physical evidence, with camera pictures, and thermal imaging to show water damage hidden in materials or behind walls, or underneath flooring, or roofing. The Public Adjuster then takes measurements to calculate the square footage of the areas of materials affected. They write a re-construction estimate (usually in Xactimate, the same software insurance companies use, Xactimate is the industry standard estimating software so the Public Adjuster and Insurance Company can see eye to eye.) The estimate reflects how much materials and labor will be needed to fix the damages that occurred to the dwelling, building, boat, tractor-trailer, or farm crops, during a hailstorm, windstorm, hurricane, or tornado. These are typically covered perils in an insurance policy. A peril is an event or occurrence that causes property damage that is covered by an insurance policy. A reconstitution estimate can amount to a few thousand dollars worth of damages to millions of dollars worth of damages. The Insurance Company and policy are responsible for top pay for covered perils up to the policy limits they have provided. So the Public Adjusters use the evidence they have gathered to write a comprehensive re-construction estimate, based on how much the damages will cost to re-construct the property back to Pre-loss condition.

Pre-loss condition is the condition the home was in before any damages occurred. If you have an RCV policy the insurance company is responsible for paying to fix your house back to pre-loss condition including any increased pricing or inflation of current market prices of materials. For instance, if you got your roof done for $15,000.00 ten years ago, and now the same roof materials and labor cost $20,000.00 due to inflation of labor and materials cost. The RCV or "Replacement Cost Value" policy is responsible for that difference in price reflecting today's market values. The line items in the reconstruction estimate are very important representing the total dollar amount of material quantities, square footage of materials, or items needed to bring the property back to brand new or pre-loss condition. The dollar amount of the estimated will reflect the settlement amount needed to fix the property. All items, quantities, and materials need to be justified per the Insurance Policy terms. This is why the Public Adjuster plays the key role in the claims process either settling the claim by negotiating with the Insurance company or ultimately providing the Attorney with a total dollar amount to sue for in the event the Insurance Company does not cooperate or communicate.

The fact is that for most claims, most consumers don’t need more than an assister like a public adjuster, because adjusting a claim is not complex litigation where an attorney is mandatory). But, it's still the practice of law -- there is no way to avoid law in insurance, and contrarily law is taught as an integral part of insurance to ensure protection and fairness for society. While a person might be a real estate agent and not a real estate attorney, or a certified public accountant and not a tax attorney, or being an adjuster instead of being either a plaintiff’s counsel or a defense counsel, these non-attorneys who practice these professions actually practice law applications but to a limited degree as authorized by the state. For example, an insurance claims adjuster can execute legal forms for consumers such as sworn statements and releases, and invoke contractual compliances and restrictions. Doing so is actually practicing law, but adjusters are licensed for just such authority. Without such licensure, then such limited legal practices are prohibited, hence the government-issued licensure. A license validates the basic competency to practice law-related principles and practices needed to service consumers (be it real estate, accounting, insurance, or other). Adjusters are taught and in many cases that they must master certain legal doctrines in order to do the work of claims processing, adjusting, and advising, in a manner that is fair and protective of the parties involved. This is the practice of law on a restricted basis. This licensure authorizes public adjusters to practice that limited portion of the law that applies to insurance claims and only insurance claims. Any advice exceeding the claim that involves legal interpretation or defining of it would more so escape the restrictions of the licensure and begin to cross into the practice of law. (However, be advised that many consumers mistake an attorney’s knowledge of insurance to be equal to or greater than a public adjuster, while this is grossly false. The fact is that for consumer property claims, most attorneys need to seek and obtain the assistance of public adjusters who actually possess superior claims knowledge. Virtually all attorneys need to hire specialists and/or experts to support their cases, and a public adjuster can be either one or both. Attorneys are usually not subject matter experts themselves despite many people assuming otherwise).

Public Adjusters cannot provide homeowners with legal advice, but public adjusters can advise homeowners with insurance advice, of questions of the insurance contract, documentation, and engage in regulatory requirements, and effect compliance with state statutes applying to their profession (which is required), while all of these functions include law. If a licensed public adjuster explains to a policyholder/insured that in a particular jurisdiction that the term actual cash value means the current market rate as is defined by the courts in that local, then that is not giving legal advice or engaging in the unauthorized practice of law. In this case, the insurance term is actual cash value, which is also a legal term. To say that actual cash value means market rates is qualifying an insurance concept by interpreting it by the definition in law. In this event, law is being practiced, but is being done within the confinement of an insurance licensure. For an adjuster to advise a policyholder/insured on laws that are not directly related to the concepts of insurance practice or the insurance contract would be more so legal advice than insurance advice. Professionals who are licensed are authorized to practice the rules. For example, to read, interpret, and define an insurance policy, which is an authorized but limited form of legal application. However, there just a few states which prohibit public adjusters from contract (the policy) interpretation and advisement to policyholders and those insured, because their judicial system has determined that such contract defining for some other person is the practice of law. Contrary to the examples above, which are historically and traditionally practice, there are some jurisdictions where such practices are considered only law, and even licensed persons having expertise cannot engage in contract applications as an insurance policy is in fact a contract. These jurisdictions consider that: 1) contracts can only be interpreted by lawyers, and 2) to represent someone else in a business transaction is the practice of law. Alabama does not license public adjusters at all, because that state considers insurance claims to be all law. However, in most states it is considered that such a limited practice of law, confined to only restricted parameters, is not only the intent of the government to serve the needs of the public without requiring a lawyer (being why public adjusting was created over a hundred years ago), but such subject matter is basis of insurance claims practices.

However, in South Carolina for example, the courts have ruled that for a public adjuster to advise a policyholder/insured on what coverage that policy provides is actually practicing law, and that coverage advice is reserved only for attorneys. This actually makes no sense, defeats the purpose of licensing a person to practice insurance (of which insurance is based on generations of law practice, court rulings, and government regulations), while virtually all other states do not agree with South Carolina's elimination of traditional authority. The fact is that the very reason that public adjusters are adjusters is to practice insurance, which is based on law, includes law, is defined by law, interpreted by law, and according is the very reason for requiring licensure of its practitioners. There is no benefit to the public to avoid the cost and complexity of law practices by attorneys when licensing insurance practitioners for a single function - claims practicing - and then also prohibit any claim practicing (other than estimating costs, which is estimating, not claims practicing). Instead, South Carolina limits public adjusting to only determining values, such as in writing an estimate of the loss and damage. However, not only can any qualified construction contractor prepare such estimates, but being restricted to values determinations alone is the function of appraisal, where appraisers and umpires resolve estimating disagreements - an adjuster is not needed (but in South Carolina, public adjusters can only estimate, cannot represent a consumer, and is relegated to being only a cost advisor to consumers just like any construction contractor would be). Insurance claims appraisals is an alternative dispute resolution method in virtually all policy contracts that is designed to resolve cost disputes without any policy interpretation. Therefore, in effect, when South Carolina relegates only values determinations to the practice of public adjusting, it reduces an insurance claim’s competent professional on the subject matter of coverages, exclusions, and the like to really being just an appraiser or a construction estimator. In such a case, a policyholder/insured would not need a public adjuster, and can just hire a contractor or an appraiser. So, the function of a public adjuster in a state like South Carolina which restricts the practice of public adjusting to that of contractor-estimating or cost-appraising has instead has only nullified the traditional and historical service of public adjusting to serve consumers.

The purpose of licensing persons as claims professionals is to allow them to apply legal concepts that are restricted to a single function, while not allowing any activities greater than those specific regulations. Otherwise, consumers are forced to hire attorneys at triple or greater the cost, and because they practice law and not exclusively insurance, then these attorneys often don't possess the equivalent competency as a public adjuster who has much greater exposure to the volume of claims experiences. Public adjusters also help in building the case that is argued against the insurance company in permissible jurisdictions unlike Alabama or South Carolina. Adjusters mostly represent clients who have been victim to property damage or loss. Most cases involve disasters including: fires, floods, hurricanes, frost damages, burglaries, and earthquakes.[3]

Licensing

Most American states require public insurance adjusters to be licensed with a professional body before they can practice.

National body

A large collaboration of public insurance adjusters is the National Association of Public Insurance Adjusters, which helps to coordinate claims and make the business environment open to adjusters.

See also

• Public adjuster

References

This article "Public insurance adjusting" is from Wikipedia. The list of its authors can be seen in its historical and/or the page Edithistory:Public insurance adjusting. Articles copied from Draft Namespace on Wikipedia could be seen on the Draft Namespace of Wikipedia and not main one.

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