Fire Insurance Claims and Recovery Guide
Filing an insurance claim after your home has been damaged by fire is no easy task. You can expect to face an overwhelming amount of paperwork and documentation that is difficult to understand and/or complete. This guide is designed to help you navigate the insurance claims process after a fire. It will explain the different parts of a claim, who is involved, and how a settlement may be calculated.
This guide will cover a broad range of topics, including:
Essential information such as what to do immediately after a fire and what homeowners insurance covers;
More detailed information about coverage types and limits, and how to make sure you receive a fair settlement;
Advice for the First Hours After a Fire
The first few hours after a fire are tough. Paperwork will probably be the last thing on your mind. However, once your family is safe and sheltered, your next steps can have a big impact on your insurance claim. By considering the following tips, you can help ensure the resolution of your claim is as fair as possible.
At Virani Law, we have lived through a tragic house fire and understand what you are going through. Get in touch to see how we can help you understand your claim.
1. Notify Your Insurer and Mortgage Lender
Call or email your insurer and your mortgage lender to inform them that a loss has happened and that youwill be initiating an insurance claim. Your mortgage lender has a stake in your insurance claim and they might also offer a payment deferral.
2. Initiate Your Claim in Writing
Inform the insurer of your loss in writing to initiate your claim. Describe the nature of the loss and, to the best of your ability, the circumstances around the loss.
3. Request Your Long-Form Policy
Once an adjuster has been assigned to your claim, ask them for a copy of your long-form policy. This is your complete insurance policy wordings and terms, including the declaration page. The declaration page will show you the monetary limits of your policy, and should indicate which coverages you have available to you.
4. Take and Organize Photosv
Once the authorities have cleared the site for access, begin taking photos of the damage and organize them in a binder or digital folder. You can also begin organizing photos of your home pre-loss by using photo albums (if any survived the fire), cell phone libraries, and social media. These pre-loss photos will be helpful as a comparison or as a baseline for determining what kind of repair work is necessary.
5. Remove Valuable and Sentimental Items
You should only remove items from your home if they have sentimental value or could be stolen or further damaged. Document all surviving items before removal by taking photos. Inform the adjuster that you have removed these items and let them know if you plan to take any steps towards restoring them.
6. Secure the Site
Talk to your insurance company about steps that can be taken to secure the site. They should take measures to prevent further damage and discourage looting by boarding the windows, placing tarps over the roof, or erecting a fence.
7. Track Your Expenses
Learn what types of expenses can be covered by your homeowners insurance and how much coverage you have. Keep all of your receipts and organize them in a folder for reimbursement later. If you have the time and ability to start a digital spreadsheet it will save you and/or your adjuster time when it comes to reconciling those receipts.
8. Request a Cash Advance
A cash advance can be used to help pay for some of your Additional Living Expenses. These increased expenses are incurred because you don’t have the use of your home, such as extra rental costs, hotel stays, the increased cost of takeout over groceries, increased gas, etc. You can request a cash advance to cover these costs up front, and it will be reconciled when you submit the receipts later.
What You Need to Know About Your Claim
Additional Living Expenses
Who Does What in the Fire Insurance Claim Process?
Your insurer will assign an insurance adjuster to your claim. They may be an in-house employee or an independent insurance adjuster. They work for the insurer, review your receipts, work with contractors or engineers to estimate the cost of repairs to your home, and calculate the cost of replacing your lost belongings.
You can represent yourself, or if you’d like a professional involved, you can hire a public adjuster or insurance lawyer, such as Virani Law. They will review your insurance policy, navigate the claim process, and negotiate with the insurer to improve the value of your claim. Get in touch, or call us at (519)-515-0010.
Throughout the claims process, the insurer may bring in an appraiser to determine the replacement cost of valuable goods; a contractor or engineer to generate a Scope of Work and quote for repairs; restoration experts; and other professionals involved in estimating, valuing, inspecting, or repairing.
The Claims Process
The insurance adjuster or third-party adjuster will identify the cause of loss if possible.
The adjuster will review and calculate the Scope of the Loss. They will work with a builder, contractor, or engineer to create a Scope of Work for structural repairs and they may work with an appraiser or content specialist to create a “contents inventory,” which is simply a list of lost or damaged personal belongings.
The adjuster works with experts to quantify the loss. They generate an estimate using the structural Scope of Work, and they use the contents inventory to generate a Schedule of Loss, which includes additional information such as age and value.
The homeowner determines a recovery plan using the Scopes of Loss. You decide if you are repairing your home according to the structural Scope of Work, or if you’d prefer to cash out and then manage the process yourself. The insurer may want to put out a tender to a list of preferred contractors and you have the option to choose your own contractor as well, but know that in either situation the value approved for the repairs or rebuild will be pre-determined by the initial estimates. You also determine if you are replacing contents, cashing out, or a mix of the two. Consider unanticipated costs when deciding what to do with contents, as replacing contents before your home is repaired can result in higher storage costs. For advice and to help with your insurance claim, get in touch or schedule a free claim review.
Negotiate your settlement if you believe you’re entitled to more than the insurer’s offer. Insurers may undervalue lost contents or structural repairs. At this stage in the claims process you can also proceed with repairs. Keep the receipts and invoices for all work done on your home.
Pay your deductibles. Often this is deducted from your Contents or Additional Living Expenses settlement at the end of your claim.
Keep track of everyday living expenses. Keep and organize your receipts and submit them to the insurer for reimbursement of expenses incurred beyond your normal monthly budget due to having to live outside your home.
What Types of Loss Does Your Home Insurance Cover?
Whether and to what extent your insurance policy covers the loss of your home or belongings depends on the types of coverage included in your policy. Many perils or causes of loss are covered in standard insurance policies, but not all policies are the same. Your specific policy may include some specified perils, but exclude others; or you may need premium coverage for certain causes of loss.
Fire is one of the most common causes of residential and commercial damage. Home insurance policies usually include coverage for damage caused by a fire that originated on the property, a neighbouring property, or resulting from natural disasters such as wildfire or lightning.
Most policies provide coverage for break-and-enters and theft, although coverage may be subject to strict limits when it comes to high-value items if you did not opt for additional insurance. Theft coverage and those special limits may become a concern in fire losses if valuables are looted from the home after the fire.
Water damage in most home insurance policies does not include what we would commonly think of as flood insurance (water damage from overland sources). Water damage may also be excluded if it is caused by neglected maintenance, such as leaking pipes, ground seepage, or sewer pipe backups. While each case is different, this coverage usually includes water damage caused by rain or snow, burst or frozen pipes, extinguishing a fire, accidental overflow of an appliance, etc.
If someone is injured on your property, liability coverage protects you from paying for their damages out-of-pocket if they take legal action against you. This may also apply if a contractor is injured while doing repairs on your property.
There may be additional or premium coverage options available in your area that will cover other types of loss. Some premium coverage options include traditional flooding, earthquake, sewer back-up, and ground water protection. If you run a home-based business such as a home office or short-term rental, you can and should consider coverage for business content and losses.
Damage Not Usually Covered
It can be difficult to find coverage for certain types of damage including repeated water leaks, seepage, landslides, and subsidence.
Contents coverage is responsible for a significant portion of a fire insurance claim. This area of coverage goes towards the costs of replacing the personal belongings lost or damaged by the fire. Below are some helpful tips you can use to prepare your Contents claim and make sure you receive a fair settlement. As Virani Law, we ensure your contest are not be undervalued or over-depreciated and we negotiate with your insurer to maximize your settlement. Get in touch or call us at (519)-515-0010.
Tips to Create Your Schedule of Loss
A Schedule of Loss is a comprehensive list of personal belongings in your home that were damaged or destroyed by the fire, smoke damage, or in efforts to put out the fire. This list includes information such as age and valuation, and any cash advance or settlement will be based on these figures. Following these steps can help you make sure you fulfill your insurer’s expectations and complete a comprehensive Schedule of Loss.
Confirm Your Responsibilities
Ask the insurance adjuster if they require you to compile your Schedule of Loss. In some cases, the adjuster may compile your Schedule of Loss for you, or they may hire a specialist to do so, but you should still review it to confirm that it is accurate and complete.
Use Photos and Documents
A Schedule of Loss is can be incredibly extensive and it can be a challenge to remember everything you had in your home. Use photos of your home, receipts, and bank or credit card statements to help recall belongings that were damaged or destroyed.
Be Strategic When Creating Your List
There are several strategies you can use to help you create the most complete list of contents. Start by going from room to room. You can also visit stores and websites where you’ve shopped in the past to refresh your memory. Ask family members or regular guests for help generating lists. For example, teenagers will likely have a much better idea of what they had in their closets and rooms than you do.
Include Every Detail in Your SOL
The more details you can include in your SOL, the more accurate its appraisal should be. Include details such as current price, brand, how long you had owned it, and where you purchased it.
Stay Up to Date on Your Insurer’s Plans
Find out what your insurer intends to do with your belongings. They may intend to have you replace many of them, but they may also plan to take efforts to have belongings restored and/or cleaned of smoke damage. The funds for these restoration attempts will come from your Contents coverage, reducing the pool you have available for replacing other items. It is important that you consider your pool of coverage and know whether you might run the risk of hitting your limit. In any event, it’s important to know that the insurer is moving ahead wisely, meaning that they are not trying to clean items that are objectively damaged or uncleanable. You should have the power of oversight before restoration attempts are made and you might not have to pay for failed restoration efforts if doing so would impact your ability to recover other items.
Share a Provisional SOL
Your Schedule of Loss doesn’t have to be complete before you share it with your insurer. If you need an advance and your insurer wants to appreciate the overall quantum of the loss first, just make sure it is clear that you’re submitting a provisional Schedule of Loss and reserving the right to add to it as you remember more details. This is a good way to get your Contents claim started while reducing the risk that you’ve forgotten something.
Add to Your SOL
You do not have to sign off on your Schedule of Loss until you are confident that you have included all of the belongings lost in the fire.
Negotiate the Value of Lost Contents
If you’re not interested in replacing every item, the final step before settling your claim outright will be negotiating the value of your lost contents with your insurer. You do not have to accept the insurer’s values if they have over-depreciated or devalued items.
Replacement Cost vs. Actual Cash Value
Insurance policies offer two types of coverage for contents. When you review your long-form policy and declaration pages check the basis for settling the claim. Your policy will say whether the insurer will cover the Replacement Cost of lost contents or their Actual Cash Value. The difference this coverage makes to a settlement can be substantial, and many homeowners are surprised to find that they only have Actual Cash Value coverage. If you do have Actual Cash Value coverage, that makes it all the more important to create a comprehensive Schedule of Loss and review the insurer’s valuation of your belongings closely.
Replacement Cost coverage provides you with the money it would cost to replace your belongings with the same or comparable items at today’s prices. Some goods may no longer cost as much as they did at the time of purchase, such as electronics, but the settlement should allow you to replace all or most of your belongings depending on limits and deductibles.
Your policy may give you a limited time to seek Replacement Cost coverage. Going over this special deadline could leave you with only Actual Cash Value coverage. This type of deadline is an important red flag in your policy, and you should be looking for it as soon as you determine that you have Replacement Cost Coverage in the first place.
There are generally two types of time limitation you should look out for:
• A limitation or proscription period to finalize your claim. The language may be found in the statutory conditions included in the policy.
• A Replacement Cost limiting clause, which might be 180-days, 1-year, or something more specific.
Actual Cost Value
Actual Cash Value coverage provides you with a settlement equal to what your belongings would have been worth had you sold them at the time of loss. The insurer will calculate their Replacement Cost and then subtract depreciation. Depreciation is the value an item loses over the period of ownership due to the passage of time, damage, and wear-and-tear. For example, you may have spent $1,000 on your couch, but after five years of ownership the fabric is dulled, the springs begin to sag, and the legs may be damaged from movement, meaning it’s only worth $500. The insurer would pay you out using the $500.
Homeowners may be surprised to find out how much insurers have depreciated their belongings. With Actual Cash Value coverage, you will have to be vigilant against potential over-depreciation of your items. You should review the Schedule of Loss to ensure that depreciation is accurately calculated based on the item’s age and condition.
Additional Living Expenses
Your Additional Living Expenses claim is critical for the recovery of extra costs incurred by you when you have to move out of your home. Use this information to put together your ALE claim and make sure you get the most out of your settlement.
Request an Advance for ALEs
Your family faces immediate expenses in the wake of a fire. You may have to rent rooms in a hotel or motel for the immediate future, and as you settle your insurance claim and repairs begin, you may need an apartment or rental home. Until you get settled in a rental with a kitchen, you will likely rely on takeout and if the temporary accommodation is out of town, you may potentially be paying more for gas and transportation.
Your fire insurance claim can take time and it’s not in your best interest to rush the process. You can take some of the financial pressure off by requesting an advance for Additional Living Expenses. This will put money in your pocket right away, giving you breathing room to be thorough with your claim. Make sure you keep receipts and manage the funds though, because you will have to reconcile the advance later or it will be deducted from additional costs later on.
Tips for Keeping Track of Your Expenses
Make filing your claim simple and keep close track of all of your expenses while your home is unusable. Here are a few tips for keeping track of expenses and organizing them for your claim:
Hold onto all of your receipts for expenses and sort out which ones are covered by your insurance policy later rather than making a split-second decision to keep the receipt every time you make a purchase;
Organize receipts for all expenses in a physical folder, three-ring binder, or in a digital folder;
Prepare evidence of your normal expenses for comparison in case the insurance company questions them.
Keeping track of your expenses will also help you follow how much you’re spending on Additional Living Expenses. Most policies include limits on how much you will be reimbursed for ALEs, after which you will have to start paying out of pocket. It may prove difficult to stretch that policy limit if your home is being completely rebuilt or settling your claim takes a long time. Making and sticking to a budget is a must, even if you’ve been comfortable with monthly spending in the past.
What Costs Get Reimbursed?
The purpose of Additional Living Expenses coverage is to help your family maintain your standard of living while your insurance claim is resolved and your home is restored. ALE coverage extends to costs such as:
• Temporary accommodations, including short-term hotel stays and longer-term apartment or house rentals;
• Food above your usual expenditure, including takeout and restaurant costs but not alcohol;
• Moving costs;
• Travel and transportation costs;
• Storage costs.
The insurer will only reimburse you for costs above and beyond your normal household expenditure. The insurer will likely ask to see bank statements to determine your average weekly costs for food and gas. They will generally cover the whole cost of your accommodations if you owned the home, since you were not incurring any “rent” before the loss, but they will still have to continue making mortgage payments and paying property taxes after the loss.
Mass Evacuation Coverage vs. Additional Living Expenses
If you have had to leave your home due to a mass evacuation order in the event of a wildfire, tornado, or mass flooding, Mass Evacuation coverage can reimburse those emergency expenses above and beyond your normal household expenditures. Many of the costs associated with Mass Evacuation are similar to those in Additional Living Expenses coverage, such as temporary accommodations, gas and mileage, as well as additional expenses such as emergency clothing, toiletries, and medication.
Once a mass evacuation order has been lifted coverage may terminate. If you return to find your home was spared by the event and is livable immediately, all living expense coverage ceases. If, however, you return to find your home unlivable due to damage, temporary accommodation, food, and gas costs switch to Additional Living Expenses coverage. You can organize receipts for those costs separately to make your claim easier.
Structural Repair and Rebuilding
The structural damage done to your home is often the most expensive element of a fire insurance claim. In some cases, fire damage is so extensive that the home is a total loss and needs to be rebuilt completely. At Virani Law, we will have unbiased experts in the construction field look at the damages to your property to make sure all the damages have been documented and quantified appropriately.
The Scope of Work
The rebuilding or repair process begins with the insurer preparing a Scope of Work. This is an outline of all the repair or rebuilding work that needs to be accomplished to restore your home to its pre-loss condition.
A Scope of Work should be very detailed, including measurements and recommended building materials. Once the Scope of Work is completed, the insurer will send that to contractors to be used in the creation of estimates of the cost of those repairs. The insurer will request estimates or “bids” from their preferred contractors, but you can have an independent company submit an estimate or bid as well. The insurer will most likely use the lowest bid as the “cost” of the repairs. This “cost” is used as a maximum payout to which ever contractor actually completes the work and can also be used to calculate a payout if you prefer to organize everything yourself. There is some pressure on the part of the homeowner to become part of this process before a low baseline figure is determined.
Disagreements may arise between your vision for the repair/rebuild of your home or business, and the Insurance Company’s plans. At Virani Law, we represent your interests to achieve what you deserve from your policy. For details, call us at (519)-515-0010 or schedule a free claim review.
There are a few things you should know to help you navigate your Structure claim:
This will vary depending on your adjuster, your Insurance Company, and the terms of your policy. Most insurers have a list of “preferred vendors” who they will hire directly or heavily suggest that you hire. However, you are entitled to some say in this selection, especially if you’re the one signing the contract.
Your insurance policy will generally require that your home be repaired or rebuilt as closely as possible to the state it was in before the loss. However, the current building code may require some changes (see bylaw or upgrade coverage below). Additionally, any renovations you did prior to the loss which were not disclosed to the insurer may not be covered (see renovations below).
Anytime you contemplate or begin renovations on your home, your Insurance Company should be notified. Some policies even have terms requiring notice within specific timeframes. Any renovation you failed to disclose to the insurer may not be covered in the cost to repair after a loss. This means that the undisclosed improvements you made will have to be made again at your expense.
When a home is in need of repair it often cannot be rebuilt exactly as it was because some of the original building aspects would be against current building codes. Changes will have to be made so that the new work conforms with current codes. If making the changes results in increased costs, coverage amounts may be limited by the terms of your policy.
Generally, no, the home should be built as closely as possible to the state it was in before the loss. However, out-of-date finishes may need to be modernized, and some policies or endorsements allow the insurer to use the most common industry finishes instead of exact replacements.
An agreement with the insurer to accept a lump sum of cash for settlement of one or more aspects of the claim. This lump sum transfers the responsibility for rectifying those concerns to the homeowner. In other words, if you accept a global cash settlement on your structural coverage, it is then your responsibility to budget for the rebuild. If you go over budget and cannot complete the repairs, the Insurer will not provide additional funds. The same can be said for the global cash settlements for content replacement or additional living expenses.
Complications can happen as part of your fire insurance claim. The loss adjuster does not necessarily know everything about your policy, your home, or your belongings. Meanwhile, the stress and confusion of filing a claim can lead to mistakes on the part of the homeowner. The following section will examine some of the most common complications in fire insurance claims.
Common Problems with Insurance Claims
Homeowners may disagree with the adjuster over how their personal belongings have been valued. Adjusters may over-depreciate and devalue personal property.
The insurer may undervalue repairs or rebuilding costs. Adjusters base the compensation they will provide for Structural repairs or rebuilds on the lowest bid they receive, meaning repairs may actually cost more than the insurer says if the lowest bidder is not the one ultimately completing the work.
Additional Living Expenses
Disagreements over the legitimacy of costs may result in genuine additional or increased costs being denied or discounted in reimbursement calculations.
Homeowners Not Knowing Their Rights
Not knowing your rights means you are at a greater risk of agreeing to things under the insurer’s pressure, and/or failing to pursue fulsome claims and fair compensation.
Subrogation: What Happens When the Fire Started Next Door?
Your home has been damaged by a fire, but the fire started next door. Who’s responsible for compensating you for your losses and covering the costs of repairing your home? Do things still flow through your own insurer, or will they be shifted to your neighbor and their insurer?
When your home is damaged due to a fire that started on another property, your insurer still compensates you for the loss through a normal claim; but they can then seek repayment of that coverage from the third party who is liable for the damage. The third party’s insurance company covers the costs of this liability up to their limits for that coverage. This process is called subrogation.
The process of claiming normally and allowing your insurer to pursue subrogation is the most preferable option available to you, and it is often faster and easier than alternatives such as litigation. Allowing your insurer to manage any resulting subrogation ensures that you streamline the process, achieve a fair result, and save yourself the heightened costs and frustrations of litigation.
But what if you didn’t have insurance, or if you were underinsured and are left out-of-pocket for repairs? Coverage shortfalls due to policy limits and costs that were not insured at all can be recouped through more formalized legal action. You can enter into litigation to collect damages directly from the third party (and/or their insurance company). There will be added requirements (such as establishing liability) that are avoided by a traditional insurance claim, and it can take years before you see the proceeds.
What Not to Do in Your Fire Insurance Claim
As the homeowner, avoiding these mistakes can make your fire insurance claim easier and cut down on unnecessary complications. Acting in good faith and providing the insurer with the information they need is not only necessary, but it also puts you in a better position to negotiate a fair settlement. Insisting on exploring the full extent of your rights and receiving the compensation you are entitled to under your insurance policy is equally important. Below is a list of common mistakes homeowners make when filing a fire insurance claim:
Once you sign off on your Schedule of Loss, you may not be able to claim any additional items that were inadvertently missed. You can submit a provisional Schedule of Loss to keep the process moving, but then sign off once you are confident it is complete. See our Schedule of Loss To Do List for more information.
If you exaggerate, mislead, or outright lie in your claim, it can be denied outright and your policy can be voided. This includes claiming possessions you didn’t own, mischaracterizing the age or quality of your contents, etc. You owe the insurer a duty of utmost good faith, meaning you are under a clear obligation to be fair and honest, and if you fail to meet that duty you void your policy. You risk receiving no compensation at all, even for legitimate expenses. You may also struggle to find new home insurance in the future. Exaggerating or over-inflating your claim is never a good idea.
If your insurer presents you with an offer that seems too low, you can push back. Get help negotiating your claim if you are not sure where to start or how to get better results. If you feel pressured into accepting an offer because of cash-flow and finances, request a cash advance for Additional Living Expenses or Personal Contents, and use that for the necessary costs and replacements while you negotiate the remainder of the claim.
This goes beyond simply rushing to accept the insurer’s offer. There are many things the insurer may want to do that you still have some say in, such as using one of their preferred contractors for the repairs or attempting to restore smoke-damaged belongings instead of replacing them.
You need to become an expert in your policy. The loss adjuster may not identify or recommend everything that you are entitled to. There may be cases where you need to be your own advocate, and knowing the details of your policy will help you push back where you’re entitled to more.
When Should You Work with Virani Law?
A major red flag is not hearing from your insurer about where your claim is going next, when work is going to happen, or why there have been delays. Struggling to get information from your insurer adds to the stress you’re already going through. This can be especially frustrating when the insurer makes an effort to document any delays you cause or require and use them to pressure a settlement; but no one is holding them accountable for theirs.
You Feel You Have Not Received a Fair Offer
When you receive the insurer’s offer of settlement or proposal for action you can still negotiate for more or alternative considerations. If you feel as though the insurer has devalued your Contents claim or undervalued the structural repairs, it helps to have a professional review their offer. Professionals are able to identify problematic behaviours and troubling tactics that may not be immediately obvious to a normal homeowner. They can find the areas where you deserve to receive more, and they know how to most efficiently achieve those results.
Total Loss or Substantial Claim
The size of your claim is another factor to consider. In the case of a total or substantial loss, the difference between getting help and completing your claim on your own can be significant. Keep in mind the time and effort needed to present and finalize the claim, the stress of balancing emotional recovery with financial recovery, and the desire to get back to normal, not to mention the heightened financial considerations that come with larger claims.
Fire insurance claims are stressful. You are already dealing with the emotional impact of losing your home and belongings and getting your family settled into new living arrangements. Fire insurance claims involve an overwhelming amount of paperwork, review, and support; not to mention language and practices that may be difficult to understand. An insurance lawyer explains the jargon that the loss adjuster may use and handles much of the process for you. Having a professional manage the process can save you from much of the stress that comes with filing a claim.
You Want a Representative Acting in Your Best Interest
It can’t be understated how important your claim is to you and your family. If the insurer’s offer is not enough to cover the costs of rebuilding your home or replacing your belongings, you have to make up the difference out-of-pocket. It can be comforting to know that any under-coverage could not be avoided, as opposed to constantly wondering if you settled for less than you deserved. Many homeowners feel more confident when their claim is handled by someone who deals with insurance claims every day. Just as the loss adjuster acts in the best interest of the insurer, an insurance lawyer will act in your best interest. It can put you on a more equal footing with the insurer.
What Happens If You and Your Insurer Cannot Agree?
There are some cases where the homeowner and insurer cannot agree on issues such as the extent of repairs needed, the adequacy of repairs already completed, or the value of contents that need to be replaced. In these cases, the Dispute Resolution process can resolve a fire insurance claim without resorting to traditional litigation.
Dispute Resolution Step-by-Step
Complete Proof of Loss Forms
As the homeowner, you must complete all Proof of Loss forms required by the insurer, including a Final Proof of Loss.
Deliver (or Receive) a Demand Letter
You must deliver (or receive from the insurer) a written letter demanding that the file be moved to the Dispute Resolution process. The letter includes the demand, identifies the initiating party’s representative or “appraiser”, and requests that the other party identify their representative within 7 days.
Select a Representative
public insurance adjuster as their representative for the Dispute Resolution process. The party receiving the demand letter has 7 days to identify a representative, or else one may be appointed.
Representatives Select an Umpire
The representatives for each party then have 15 days to select an umpire. Umpires tend to be people with experience in insurance negotiations, the law, or construction. They must be impartial.
Representatives Negotiate Each Issue
The two representatives will identify the issues that led to the dispute and negotiate each one individually to find a mutually acceptable compromise.
Unresolved Issues Are Submitted to the Umpire
Any issues that remain unresolved after negotiation are submitted to the umpire. The umpire conducts a mediation-like session in which both representatives and the umpire put forth decisions on each issue. Wherever two of the three agree, the decision becomes final.
The Written Determination
Final decisions are released in a Written Determination (sometimes known as the Award Document). This document determines what the insurer must pay out to the homeowner. It is binding on both parties, meaning once the Dispute Resolution process is complete, you most likely will not be able to change the outcome.