Insurance shooting down their own adjustors

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PostPosted: Wed Aug 17, 2011 6:39 pm   Post subject:   

So we called the S.E. early this week who said they had amended the report (to say what we have no idea) and submitted it back up to the insurance company. I called the ins co and they stated they had not received the report, but it could just be held up. I'm OK with this, if it takes a day or so, by all means, I don't want to rush anyone.

Depending on what the report says, either the adjustor will be sent back out. If we were still unhappy at that point it would go to arbitration (according to our claims handler). Seems the appraisal clause would come first, but there might be a certain advantage to not mentioning this to us. As anyone who visits the property believes it's a loss. Anyway there was some weirdness to the conversation that I love to hear more about if anyone has info.

The first S.E. report we received had no dollar amount attached to any of the points it mentioned. However our claims handler mentioned that it did. I think she must be mistaken right? The insurance company gets the report and their internal engineers assign the dollar amount not the outside engineer, correct? Then the adjustor writes up the claim and it has to jive with this number (in our case it did not...multiple times). I guess what I'm asking is who assigns a dollar amount to this report? I know the adjustor is the one who actually works up the bid, but there must be some internal amount that dictates where the adjustor's numbers should be. Is this number decided by the outside engineering firm, or within the ins co based on the report?

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PostPosted: Wed Aug 17, 2011 6:55 pm   Post subject:   

I think this post goes to another thread that you already started.

If I recall the situation correctly the problem is that an independent appraiser that the insurance company sent out came up with certain damages and the insurance company disagreed.

The independent appraiser probably should not have given you any information as usually they don't have the authority to determine or explain coverage. They are only there to write up a report for the insurance company. I think part of the "problem" is that the appraiser went over some information with you. The appraisers I hire I specifically tell not to go over anything (as the carrier that I work for has unique policies).

The appraiser would submit his/her report to the insurance company and this report would have dollar amounts. But then the adjuster needs to review the damages and determine what is covered under the policy and to what extent. The appraiser might need to work up new figures based on this. Ultimately its the insurance company that determines the amount payable under the policy.
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PostPosted: Wed Aug 17, 2011 7:48 pm   Post subject:   

No, I think you might be confusing my post with another. We haven't invoked our appraisal clause yet. No appraiser has visited our home.
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PostPosted: Wed Aug 17, 2011 8:00 pm   Post subject:   

I don't know why but this looked like a new thread. Its been a long week.

Who is "SE"? I though this was the appraiser that came out to look at the property.

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PostPosted: Wed Aug 17, 2011 8:40 pm   Post subject:   

Ha, sorry I'm getting tired of typing it out, SE = structural engineer.

The last visit we had was from a SE we hired. He stated that the original SE was spot on, but he missed a major issue dealing with the structural integrity of the home. Unless this was addressed, the home could not be deem "safe".

I've really tried to keep this "anonymous" and be vague on a few things for a couple of reasons. First I don't want to turn this into a bashing thread about my ins co. I'm here for some advice and suggestions, not to vent about my ins co. Secondly I don't want to be identifiable, it just seems best to keep specifics under wraps until this is resolved. However, I'm finding myself in a position where I don't know if I can really relay the problem, without discussing the specifics. Perhaps I'm being over cautious at the cost of not doing a good job of describing the problem.

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PostPosted: Tue Aug 30, 2011 6:41 pm   Post subject:   

Well it appears the original engineer will not be making any drastic changes to his report. That said, the co is still sending out another adjustor, I have no clue why. Long story short, I feel we have exhausted our options. We will be hiring an lawyer, invoking our appraisal clause, or hiring a PA. Not sure which yet, but we need to pass the job on, we just can't keep this up. It's taken too much of a toll on our lives. Sure would be nice if they would listen to their adjustors and our contractor and simply pay what they suggest.
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PostPosted: Wed Nov 16, 2011 6:29 pm   Post subject:   

Well this is how insurance adjusters work. It is their job to work in favor of the insurance companies. But why are you not willing to hire a public adjuster?

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