INSURANCE CLAIMS FAQ
Why do I need a lawyer?
The insurance companies already have teams of lawyers all over the country representing their interests—The question really is why would you want to go up against them alone?
I have considered that, but the insurance representative told me I don’t need a lawyer and that they will pay my claim without a lawyer.
Consider this, why do the insurance companies want to talk you out of getting a lawyer?
Because they know that if you hire a good lawyer, they will have to pay you what they owe.
In additions to teams of lawyers working to help insurance companies pay what they owe, they have trained adjusters whose only job is to pay you as little as possible.
The insurance company does not care about you. They will pay for a few damages and then give you a minimum settlement to go away. Once you are stuck with property damages and not enough money to repair, it may be too late to seek the services of a lawyer. The last thing an insurance company wants is for you to have a lawyer looking out for you.
What does homeowner's insurance cover?
Generally, you’ll find that homeowners insurance covers damage or destruction to a home’s interior and exterior, loss or theft of personal possessions, as well as protect you against personal liability for any harm to others. A standard homeowner’s insurance policy will cover things like:
Dwelling: The most basic coverage you find in a policy is for protection of your dwelling which covers the structure of the home (foundation, walls, and roof), as well as certain structures that are attached to the home like the garage or deck.
Other Structures: Standard insurance policies generally cover other structures on your property that are separate from your dwelling, such as a fence, detached garage, or tool shed.
Personal Property: This provides coverage for your personal belongings such as clothing, furniture, electronics, appliances, and other items if they are stolen or destroyed by an insured peril.
Liability: This type of protection covers you in the event there is a lawsuit for bodily injury or property damages caused by you, a family member, or a pet to other people.
Additional Living Expenses (ALE): The additional costs you accrue living away from home in the event it becomes uninhabitable from an insured disaster (such as rent, hotel stay, restaurant meals, storage fees, and other types of expenses you would not have had had the event never occurred.)
Medical Payments: Covers medical expenses of someone injured on your property regardless of who is at fault. It also covers medical expenses if you, a family member, or your pet injures someone off of your property.
How can Galindo Law help?
For over 21 years, we have been protecting the rights of home and business owners on their property damage insurance claims. We have the knowledge and dedication to fight the insurance companies all the way. Most claims settle before reaching the court room because we know how to stand up to insurance companies.
Sometimes the insurance companies won’t listen to reason. When this is the case, Galindo Law has a proven track record of going to trial and winning.
We secure millions of dollars in settlements and verdicts for our clients every year.
What damages are typically covered on a homeowner's insurance policy?
Although there can be variations depending on the policy type and the insurance carrier (as well as certain limitations or exclusions of coverage) most standard homeowners insurance cover perils like:
* Fire or Lightning
* Smoke
* Hail or windstorms
* Vandalism
* Theft
* Explosions
* Falling objects
* Riots or civil disturbances
* Volcanic eruptions
* Damage caused by vehicles or aircraft
* Weight of ice or snow
* Sudden damage from a power surge
* Overflow or accidental discharge of water or steam from household systems such as plumbing, air conditioning, heating, fire-protective sprinkler systems, or other household appliance
* Sudden or accidental tearing, cracking, bulging, or burning of a hot water, steam, air conditioning, or fire protective system
* Freezing of a plumbing, air conditioning, heating, fire-protective sprinkler systems or household appliance
What is generally NOT covered by homeowner's insurance?
Acts by the Government: Homeowners insurance will not cover damages to your property or personal belongings if a governmental or public authority is responsible which includes seizure and eminent domain.
Acts of War: If the Government officially declares an event as an act of war, damages to the home will not be covered by insurance. Terrorist attacks may not be specifically referenced in a policy but damages to property due to explosions, fire, smoke, and acts of vandalism are typically covered.
Business-Related: If you are doing business in or out of your home (even small business), its best to talk to someone about business insurance because standard home insurance policies do not cover business-related claims.
Dog Breeds: Certain dog breeds are considered aggressive and denied coverage by certain carriers.
Earth Movement: Perils such as earthquakes, sinkholes, or mudflows are typically not covered or are required as an add-on to your policy to be covered.
Intentional Damage: Intent to cause damage to your own property is not included, although vandalism or criminal acts by another are usually covered.
Flooding Damage: Flood damages usually require a flood insurance policy to be covered.
Law or Ordinance: Upgrades or damages resulting from an area of your home that is not up to standard building codes or regulations.
Luxury Items: There are often high-valued collector’s items, such as jewelry or artwork, that are not covered in a standard policy’s limits and take a separate policy to be covered.
Mold Damage: Mold is considered to be something that is preventable and grows over time before it affects your health or home, therefore is generally not covered.
Natural Disasters: Depending on your geographic location, certain natural disasters such as Earthquakes, Wildfires, Hurricanes, etc. are not included in a policy or require you to purchase coverage in a separate policy.
Negligence: If you neglect or fail to properly maintain the repairs or upgrades to your property.
Nuclear Accidents: Insurance does not cover any type of nuclear hazard, accident, or disaster.
Normal Wear and Tear: Since insurance is typically designed to cover sudden events and accidents, it wouldn’t typically cover normal wear and tear.
Power Failure: It is typical to find that damages or loss relating to a power outage would not be covered.
Swimming Pools, Diving Boards, Hot Tubs, Tree Houses or Trampolines: Considered to frequently cause injuries, these high-risk factors are often excluded or require you to purchase additional coverage.
Termites, Bedbugs and Other Infestations: Some infestations are considered preventable, others are considered to be brought into the home and are normally excluded.
Watercraft: Oftentimes there are very limited or strict conditions for watercraft to be covered so you would have to consider additional boat or watercraft coverage.
Water Damage: Damages that result from things like water or sewer backup, sump overflow or discharge, are usually offered as add-ons to a standard policy. Some damages caused from things like a burst pipe could be covered, so it is good to understand exactly what your policy covers.
What should I do if I have to file an insurance claim?
1. Notify the Insurance Company Immediately
It is extremely important to contact the insurance company as soon as possible for multiple reasons. First, the insurance provider could have a time limit on accepting claims after a damage occurs (24-48 hours is not uncommon). Secondly, once you’ve notified the insurance company, it triggers deadlines that your carrier must follow to stay compliant with the law. They must acknowledge your claim and begin the investigation process.
2. Document, Document, Document
Although the storm was hard enough to go through and adding any added burden could be a struggle at this time, we cannot stress this point enough. Documenting everything that happens with your claim is extremely crucial. Having excellent or incomplete records can absolutely make or break your claim. We’ll list some key areas that will help build your case:
* Fully inspect all areas of your property including commonly hidden areas (such as the attic or crawl spaces) for damage or moisture. See our list of common hidden storm damages.
* Take photos and video of your damages, even if minimal.
* Begin a journal or log of everything that happens, including dates and times, contacts you speak to, summaries of what happened or what was said, etc.
* Start a file and keep any printed correspondence (such as letters, emails, or reports from the insurance company, repair/service quotes, etc.) as well as any purchase receipts for repairs all together in that same file.
* If any of the contents of your home were damaged, make an inventory list of those items and include any purchase receipts you have saved for them (such as computers, TVs, appliances, furniture, etc.)
* Get quotes on repairs from trusted contractors and service professionals which can be used to calculate your claim
* Gather together invoices, purchase orders, policies, and other key documents that will be included in your claim
* Send a follow up email with a brief summary of any verbal communication you had in-person or by phone
3. Cooperate with your Insurance
Once you’ve notified the insurance company of your claim, it is your responsibility to continue to cooperate with them by providing any necessary and reasonable documentation they request as they investigate your claim. Be present and make your property available for the adjuster that will be inspecting the damages. Provide the adjuster with information they need to perform their inspection, and make sure to point out any and all areas that sustained damages. Have the adjuster inspect all damages, even in tight areas like attics or crawl spaces. Be polite and courteous with the adjuster and do your best to answer questions, return phone calls, and send all documentation and pictures of damages to your property. Again, it is always best to send a polite summary email to the adjuster and to log your in-person communication as a brief record of what happened on the visit.
4. Your Rights in the Processing of your Claim
Insurance companies must follow the law and insurance codes to acknowledge, investigate, and process your claim. Deadlines are usually within 15 calendar days to acknowledge your claim and request documentation from you. Generally, they must approve or deny your claim, in writing, 15 calendar days after they receive your requested documentation. Once approved, the insurance company should process a payment to you within 5 days.
Important Note: When the Department of Insurance declares a weather-related event as a catastrophe or natural disaster, they offer deadline extensions of up to 45 days for the insurance providers to approve or deny your claim, and an additional 15 days to make payment to you – provided they notify you and give reason for the extension. This could mean longer wait times for an adjuster, claim acceptance, claim denial, or payment.
If an insurance company does not comply with the law, they can be held liable for statutory interest penalties.
What if your claim is delayed, denied, or underpaid?
Often many property owners find they have little trouble filing an insurance claim for their damages. Other times - usually when the stakes are much higher and the damages are more extensive - there is a greater chance for dispute. If you disagree with the amount of money the insurance is offering you, or you were denied coverage, you have a few options available.
1. You can provide a bid or quote for your repair from a reputable contractor or service company, and ask for the insurance company to reevaluate your claim. Sometimes an insurer will adjust the amount of your claim with valid quotes for the repair of your damages.
2. Another option is to hire a public claims adjuster. Public adjusters can be very valuable to help assess the full extent of your damages and negotiate for a higher settlement with your insurance company, but it is fair to note that they have no position of authority or legal power over the insurance company. Therefore, insurance companies have no legal obligation to accept a public adjuster’s report, and oftentimes disputes can still arise.
3. You could also contact an insurance claims attorney to review your case. An attorney can examine your policy, documentation, and insurance estimate to evaluate your options. They can send a letter to the insurance company to represent you on your claim, as well as generate a demand letter for the maximum settlement. They collect all important evidence, calculate accuracy in your damages, and will negotiate on your behalf.
Most attorneys and public adjusters work on a contingency-basis, which means there are no upfront, out-of-pocket costs and any fees that are generated would be paid out of a settlement that is won for you (which would NOT include any original payment that was sent by your insurance company.) No win, no fees. This gives property owners a chance to understand their rights, and to pursue legal options to get a fair settlement on their claim without upfront or premium hourly attorney rates.
Why hire an attorney vs. a public adjuster?
What’s the key difference between a Public Adjuster and an Insurance Attorney?
The short and sweet of it is - negotiating power. Public Adjusters can be very valuable to help assess the full extent of your damages and negotiate for a higher settlement with your insurance company, but they have no position of authority or legal power over the insurance company. Therefore, insurance companies have no legal obligation to accept a public adjuster’s report, and oftentimes disputes will arise. Attorneys represent their clients inside and out of court and have the litigation power against the insurance company to maximize their claim. Public adjusters are usually in the range of 10% - 20% in their fee arrangements, and attorneys are generally in the range of 33-40%. They both assume much risk up front and have full intent to try and win the highest settlement for your claim, but attorneys can pursue legal action and other awards for damages where a public adjuster cannot.
How are Public Adjusters and Insurance Attorneys similar?
Both public adjusters and insurance attorneys work for you. They can be hired with no upfront costs and usually do not charge any fees on any money you have already received from the insurance company. They work on a contingency basis meaning their fees will only be paid from any further money they are able to win for you.
For example, the insurance company sends you a payment for your claim for $10,000. When a public adjuster or attorney is hired, that $10,000 payment would not be considered in their fees. If a public adjuster or attorney were then able to negotiate for $40,000 more from the insurance company, the $40,000 is the amount they would base their fee percentage on. The total amount in the claim from the insurance company would be $50,000, but the fees are only on the $40,000 they were able to recover for you which would be in the vicinity of $10,000 – $16,000 from your settlement offer. Out of $50,000, you would have received a total between $34,000 - $40,000, where originally you had only started with $10,000. Every case is different, but this is an example to give you an overall idea.
Getting the Most for your Claim
In many cases, hiring a public adjuster is a good option for your situation. They can help you understand your policy coverages, calculate your property damages, and re-file a claim to the insurance company to help negotiate a higher settlement, acting as your representative in what can feel like a nightmare process.
On the other hand, many cases are best to start with an experienced insurance attorney. An attorney can be a valuable asset in fighting the legal battles to get you everything you deserve in your claim, especially on more complicated or severe cases where the property damages are extensive and the insurance company is not acting in good faith. You should consider contacting an attorney versus a public adjuster when:
* You have questions regarding your policy coverages
* The insurance adjuster’s estimate is lower than expected
* Damages are extensive and claims are more complex
* Claims are delayed or denied
