Who represents the interest of the Association in an insurance claim?
Understand who represents the interest of the Association in an insurance claim
Throughout the insurance claim process many people are involved, from the frontlines to the back office. Believe it or not, not a single person that works for the Insurance Company is there to represent the Association’s interest. A quick breakdown of the people Association may encounter during an insurance claim:
Independent Adjuster
Independent Adjuster is any person who is self-employed or is associated with or employed by an independent adjusting firm or other independent adjuster, and who undertakes on behalf of an insurer to ascertain and determine the amount of any insurance claim, loss, or damage payable under an insurance contract or undertakes to effect settlement of such insurance claim, loss, or damage.
Company Adjuster
Company Adjuster is a person employed on an insurer’s staff of adjusters or a wholly owned subsidiary of the insurer, and who undertakes on behalf of such insurer or other insurers under common control or ownership to ascertain and determine the amount of any insurance claim, loss, or damage payable under a contract of insurance, or undertakes to effect settlement of such insurance claim, loss, or damage.
Therefore, both the Independent Adjuster and Company Adjuster undertake on behalf of the Association’s insurance company, to ascertain and determine the amount of any insurance claim, loss or damage payable under your policy.
Public Adjuster
However, for a Public Adjuster is any person who, for money, commission, or any other thing of value, prepares, completes, or files an insurance claim form for an insured or third-party claimant or who, for money, commission, or any other thing of value, acts on behalf of, or aids an insured or third-party claimant in negotiating for or effecting the settlement of a insurance claim or insurance claims for loss or damage covered by an insurance contract or who advertises for employment as an adjuster of such insurance claims. The term also includes any person who, for money, commission, or any other thing of value, solicits, investigates, or adjusts such insurance claims on behalf of a public adjuster.
According to the OPPAGA Study published by the Florida Insurance Council, “ ‘The typical payment to a policyholder represented by a public adjuster was $22,266 for insurance claims filed in 2008 and 2009 related to the 2004 hurricanes. In contrast, policyholders who did not use a public adjuster received typical payments of $18,659.’ The report also notes that the difference in payments was even larger for insurance insurance claims related to the 2005 hurricanes, ‘with public adjuster insurance claims resulting in payments that were 747% higher.’ ”
Loss Consultant
If the Association is not comfortable assigning a percentage of their loss to a Public Adjuster, consider the retention of a Loss Consultant. Typically, paid hourly or on a flat fee basis, these professionals with the right background and training can effectively and properly advise you and your client throughout the insurance claim process. The services can range from simple advising to all of the services a Public Adjuster may provide. In States like Alabama where Public Adjusters are not prevalent due to laws restricting the practice, this may be a cost effective alternative to ensure your client’s rights are protected and that they adequately recover from a loss. Also, consider that if a Lawyer does retain this professional they can act as an expert in any action against an Insurance Company or third party.
Claims Examiner
More recently, the Claims Examiner holds the keys to the Association’s insurance claim, regardless of the opinions of the Independent or Company Adjuster tasked with investigating the loss in the field. These Claims Examiners routinely review the work of the Adjusters and interpret policy coverage and insurance insurance claims handling manuals. Although, these individual’s make the ultimate insurance claim decision on coverage and amount paid they will rarely, if ever, actually go out to the loss location.
