I don’t know how I forgot I had it, 85 pages of the most riveting claims adjusting procedures a policyholder lawyer could want courtesy of your hosts Sop and Nowdy. I also put it on Scribd:
[scribd id=19263355 key=key-14lpcdl1m4tjvsayv2gv]
A reader sent in a short synopysis of some points that stood out – it shows that the industry does indeed know established law when it comes to adjusting claims. Maybe someone can get this to Judges Engelhardt and Berrigan in NOLA:
1) p. 29 the sub-section titled “Burden of Proof” under the section titled “General”
An insured with an “all risks” (open perils) policy only needs to prove that a loss occurred and is not expected or required to establish the cause of the loss. This is far less involved for the insured as he or she must simply establish that the property is damaged. Since the insurer covers all risks not otherwise excluded, the burden of proof is on the insurer to determine the claim is excluded from coverage. In the case of “Losses Insured”, the insurer must show that the loss was proximately caused by an excluded event.
The burden of proof greatly affects the adjuster investigating the loss, for after all, it is the role of the adjuster to fulfill actions and duties of the insurer in the investigation, evaluation and conclusion of a loss. “All-risks” or “open peril” policies place a heavy burden on the adjuster to prove that there is no coverage for the cause of the damage. When the insurer and therefore, the adjuster, has the burden of proof and cannot prove what caused the loss, an exclusion defense cannot be utilized and coverage will apply.
2) p. 23 under the section titled “General” the following is stated:
The adjuster is the foundation upon which an insurer is built…. if the adjuster does not provide the service promised by the insurer, the promise made by the policy is broken and the insurer will lose customers and fail.
The property adjuster has a duty to help the insured to (1) prove the loss to the insurer and (2) understand the terms and conditions of the policy.
3) p. 30 under the sub-section “Types of Catastrophes” within the section titled “General” the following is stated:
Most structures can withstand with minor damage a relatively low-velocity hurricane with winds between 75 and 90 mph. However, as wind speeds increase, hurricane destruction becomes severe. In August, 1992 Hurricane Andrew crossed southern Florida with sustained wnds in excess of 130 mph, obliterating homes and essntially causing the same damage as a thirty mile wide tornado.
4) p. 33 under the sub-section “Interruption or Shortage of Services” within the section titled “General” the following is states:
Building supplies are often unavailable immediately following a catastrophe. Supplies usally become available within a few weeks, but prices remain high and remain so for months. Adjusters preparing estimates in catastrophe environments must be aware of prevailing prices. Estimating losses based on prices that prevail only during normal times is unrealistic.