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 through the Insurance Appraisal Process! Even though the policyholder (you) submits a contractor's estimate, receipts for repairs or materials, or documented the damage by photos showing damage 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 at this point. Policyholders have a choice through a clause within their policy for this very reason. The Appraisal Clause - also known as The Appraisal Provision. It may seem like a fancy clause that would take a law degree to understand. However, a simple way to understand it is that it's the insurance industry's version of arbitration. Although similar, the Appraisal Process is NOT an arbitration or mediation and the umpire is not an arbitrator, mediator, or judge. Insurance Appraisal, Mediation, and Arbitration are separate things.
Most Policies Have the Insurance Appraisal Clause
If you feel your at a dead end with your insurance claim and want to resolve it you need to contact United States Adjusters now. We will 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 see 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.
How Does the Insurance Appraisal Process Work?
The Appraisal Provision allows the policyholder (you) to hire an independent appraiser (United States Adjusters) 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 on the total 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 Appraisal is is filed, the policyholder's chosen appraiser (United States Adjusters) and the insurance company's chosen appraiser will review the documents, estimates, and differences between them. The two appraisers will try to discuss and resolve the differences in damage and in cost. For example; the insurance company may determine that continuous tile floor of the 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 the Insurance Appraisal 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.
How Do I know if the Insurance Appraisal Process 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 Process 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 floods. Flood policies are purchased separately. So, if there is no coverage for the flood damages then the Appraisal Process is not an option.
Simply put, the Insurance Appraisal Process 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 Process may not be the best option. The Appraisal 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 several contractors of $200,000 or more, its time to invoke the appraisal clause.
There are GREAT advantages with going to appraisal
There are several advantages to the Insurance Appraisal Process. The most obvious is costs. Insurance Attorney's will usually charge 30% to 45% of the total award. On 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 Process was designed to keep these disputes out of the courtroom.
The advantage of invoking appraisal 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 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 Demand Appraisal?
When the dispute is real and the damages are real, the policyholder usually see's 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, the Appraisal Process 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 appraisal on your claim you should consult an insurance claim expert to see if it's worth your time and effort.
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 Process, so that...
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