By Joe Brennan
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 on how to resolve an insurance claim dispute via the insurance appraisal clause and dispute your insurance claim settlement.
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! 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 known 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, whereas, 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. So before you think of how to resolve an insurance claim dispute via the insurance appraisal clause, ensure that you had coverage for the loss.
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
One of the important ways of how to resolve an insurance claim dispute via the insurance appraisal clause is 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, engineers, and other experts to consult with about mold, demolition, cost associated with contents, and in some cases, additional living expenses, does not sound like a good candidate. You should choose your Independent Appraiser wisely. Look for and interview someone with experience of the type of damage you have and with the type of property damaged, as well as a specialist when it comes to the Insurance Appraisal Clause and process, and also Insurance Claims Handling.
Many people confuse the words Independent Appraiser with that of a real estate appraiser. As you can see, a real estate appraiser is far from what is needed for an Insurance Appraisal. An Independent “Insurance,” Appraiser is an insurance claims expert on costs and processes to repair or replace damaged property. The next question is, “Who will have such knowledge?” People requesting assistance in the past have asked if the following experts with the following backgrounds are good choices:
Structural Engineers: This person may be a structural expert and could probably provide a good estimate to replace a building, but what about the contents (furniture, food, etc.) damage? Do they know anything about the insurance policy, the claims process, the software used by insurance companies, the Appraisal Clause and process?
Construction Attorney: A Construction Attorney most likely has knowledge of construction contracts and issues that building contractors have. Do they know anything about the insurance policy, the claims process, the software used by insurance companies, the Appraisal Clause and process, the contents damaged? (NOTE: If you retain an attorney as Appraiser, remember, there is NO attorney/client privilege because the attorney is being hired as an Appraiser, not as an attorney.)
Construction Superintendent or General Contractor: Again, excellent choice for generating a structural estimate, but is most likely not familiar with insurance claims… and even more importantly, the Insurance Appraisal Clause and process.
Insurance Claim Attorney/Lawyer: Keep in mind that the clause was designed to keep these types of disputes out of court. You can surely use an attorney as your appraiser; however, the fees can exhaust your reward. Attorney’s fees range between 30% and 40% of the amount collected. This will dig deep into the net amount you receive. An Insurance Attorney will also have expert knowledge of the policy. However, the Appraisal Provision clearly notes that no policy provisions will apply. Has the attorney represented their clients in many appraisals or mostly in court cases? How familiar are they with the process of Appraisal, building costs, construction practices, the contents damaged? Does the attorney know anything about the software used by insurance companies? (NOTE: If you retain an attorney as Appraiser, remember, there is NO attorney/client privilege because the attorney is being hired as an Appraiser, not as an attorney.)
Independent Insurance Appraiser: Doesn’t it make sense to hire an individual who is an expert of the process in which you are about to engage? You’ve heard the expression, “Would you go to your auto mechanic if you needed brain surgery?” It is highly recommended to use a qualified, professional, Insurance Appraiser. This professional will already know the Insurance Appraisal Process. They will also have qualified professionals (engineers, contractors, inspectors, etc.) at there disposal to back up their analysis.
Regardless of background, an Independent Appraiser will also require good communication skills and agree with the position they are defending. They should know about the insurance policy, the claims process, the software used by insurance companies, the Appraisal Clause, the process of Appraisal, contents damage, structural damages, building costs and processes, as well as materials and building codes. Makes sense, right?
Advantages to the Appraisal Clause and Process
There are several advantages to the Insurance Appraisal Clause. The most obvious is costs. Insurance Attorney’s will usually charge 30% to 45% of the total award. This means that a $200,000 claim, the attorney’s fee would be in the range of Sixty to Ninety-thousand dollars ($60,000 to $90,000). That can hurt a policyholder trying to rebuild their life. Remember, the Insurance Appraisal Clause was designed to keep these disputes out of the courtroom.
The advantage of invoking the Appraisal Clause allows for a less formal or no-legal proceeding. An Independent Appraiser usually charges in the range of $125 to $200 per hour. Using the same example above with an award of $200,000; if the dispute took 25 to 50 hours, the cost would be in the range of Five Thousand to Ten Thousand dollars ($5,000 to $10,000). This can be a significant difference.
Another advantage is time. The courtroom can delay an insurance claim dispute for years, where the Appraisal Clause and process usually only takes a few months. Sometimes it can last longer depending on the complexity of the claim. However, the courtroom will most certainly be longer. The result of less time and less cost becomes a less of a burden for both sides of the dispute.
Once an award is signed the insurance company has 30 to 60-days (depending on state) to settle the award.
Should I Invoke The Appraisal Clause on My Claim?
When the dispute is real and the damages are real, the policyholder usually sees a greater return at the end of the appraisal. If the policyholder’s claim is supported by an Insurance Claims Expert, building or repair contractors, or an engineer – and the amount of money between the two estimates is large, invoking the Appraisal Clause is a no-brainer. However, if a contractor or Public Adjuster is trying to beef-up the damages for their own benefit, then it’s the policyholder that pays dearly for it. If you’re considering invoking the Appraisal Clause on your claim you should consult an insurance claim expert to see if it’s worth your time and effort. This is how to resolve an insurance claim dispute via the insurance appraisal clause.
Being that the Appraisal Award is binding the policyholder should be sure before they cost themselves unwanted anguish. If the outcome of your Appraisal Award is not what was to be expected, both parties must live with the result. As stated, the Appraisal Award is binding on “both parties.”
At the end of the day nothing is risk free. There are no promises or guarantees with the outcome of any Appraisal. However, if you have a dispute over $20,000 you’re more than likely to have a result you can live with. Do your homework and remember to choose an Independent Appraiser that is educated and experienced with the type of damages you have, what caused the damage, and the type of property damaged. Keep in mind that this is “YOUR,” property and “YOUR,” insurance policy. Your policy protects you with the Insurance Appraisal Clause, so that the Playing Field Remains Level, and The Process Works Fairly For Both Parties…Not Just The Insurance Companies. I hope this article has given you valuable insight on how to resolve an insurance claim dispute via the insurance appraisal clause.
Copyright of Insurance Claims Group, Inc. & Joseph P. Brennan: Joe Brennan is President and owner/operator of Insurance Claims Group, Inc., a national independent adjusting, appraisal, and umpiring firm. Joe has been in the property loss business for more than 24-years. Mr. Brennan is highly educated with the appraisal process and has acted as an appraiser and umpire on dozens of claims. Mr. Brennan can be reached at;
Insurance Claims Group, Inc.
2054 Kildaire Farm Rd., Suite # 426
Cary, NC 27518
Web: http://www.insuranceclaimsgroup.com/ & http://www.insurance-appraisal-servies.com/