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Answers to Your Questions about Hurricane Insurance Claims Part 2

If it’s not and they need to pack it out and store it, that comes out of coverage C. And then D you’re alternative living expenses, ALE, they’re gonna have to put you up in a similar home and they need to pay those expenses also.

In addition you’ve got additional coverages for debris removal, additional coverage for law in ordinates. You just gotta make sure that they’re paying not just the A policy limits, but all of the policy limits. Not if it’s a total loss, not if it’s a total loss.

There was a case that came out after Ivan that talked about how much they owned under this valued policy law if the estimate is lower. And then the legislature changed the statute slightly to say it’s the higher of, or the lower of the policy limits or the rebuild estimate. But if you read it carefully that’s only if there are multiple causes of loss for that loss. So let’s say it’s wind and flood. In that case it will the lower of the estimate or the policy limits. In your case, if it’s wind, that doesn’t apply. Excellent question, if you had to some work yourself to prevent further damage, what does the insurance, how does the insurance company compensate for that and if so what rate.

You do have coverage, and in fact you have a duty under your policy to perform repairs to prevent further damage. And a lot of policies that’s an additional coverage with the debris removal and the law in ordinates. And so make sure that they are paying you cause you have a duty to do that. And so the question is how. And you would be, if you have a license, let’s say you’re a licensed contractor, you’re just doing the work. They’ve gotta pay a reasonable rate for that. – [Man 2] Do they use the federal standard? – No there ain’t gonna be a federal standard. They’re gonna use usually a program called Xactimate to give us what the labor rates are for that, usually. And sometimes, well not sometimes, almost always after a disaster like this, the Xactimate rates, our contractor will tell you this, are gonna be too low because the labor rates have gone up here right.

It’s a bidding war. If you’ve got a hammer and a jig saw, it’s a bidding war. And people are paying a lot to get good labor in. And so the Xactimate rates are really out the window because you can’t get the job done for what they’re saying. So you just gotta find out from a contractor what is the labor rate to do that. So it’d be the materials plus the labor. Yeah there isn’t like here’s the, what we look at, one thing, it’s a reasonable amount. And if it would have been what do they gotta get somebody a handyman in to do that work for.

Yes sir, after it. And they’re gonna try to stick people with, I’m seeing it already, where they’re using Xactimate but the rates are this and you can’t get the job done for that. Because the rate they’re giving people are, materials have gone up and labor rates have gone up.

– [Man 3] So how would you circumvent that problem? – I get my contractor and find out what the rates are that he’s charging, if he’s bidding it out, what are the bids. But if I’m going to trial thought what I’m gonna do is going to several contractors and sort of get from them a conglomerate of what it is everybody’s paying, and then I’ll have an economist come in and talk about those rates. I cannot tell you how many times the adjuster who’s in the field says something to the homeowner who’s just flat out wrong or contradicted later. So did you look at your policy at all or do you have it?

– [Man 4] I don’t have a (mumbles). – You don’t what?

– [Man 4] Have a (mumbles). – Ah no I understand. But I’ll take a look at that for you and see if you have coverage for, it’s other structures. But usually if it’s not connected to the house you’re gonna have problem under the flood coverage. If it’s touching and there’s a connection, let’s say a bolt, then it’s usually gonna be under the coverage A dwelling. That’s usually gonna go under the dwelling coverage. Now I’d wanna look at it a little bit closer.

A lot of time your coverage A dwelling coverage is gone, you don’t have any more limits and you do have coverage B limits and so I look real close at the policy and the terms in there to see which bucket I’m gonna put that part of the claim in. Flood versus wind, how do we prove what it is. Well, the best thing that I’ve had is my client, the last thing he did before he left the house after Matthew is, he turned on a video camera and pointed it at the ocean. It actually ended up on CNN. And I knew exactly what happened with the flood, because we had a videotape of when the flood came and what it did. I’m betting you don’t have that right.

– [Man 4] We have historical when it comes to weather, weather forecasts and. – Oh yeah.

– [Man 4] The event of that.

– Well and I’ve got a forensic meteorologist and we’d look at all of that. And so the question is how do we distinguish between the two if you don’t hand me a video of what happened. And that is through a forensic meteorologist, and then also through forensic examination of the property. We look at what the damage is. I know what damage flood causes versus water, one. Two, the insurance companies have the burden of prove in the case. They have to prove, let’s say it’s the wind carrier, the wind carrier has to prove that the damage was caused by flood. And many times they cannot do that.

They don’t tell you that they have the burden to prove. They make you think you’ve gotta prove all this stuff. All you’ve gotta prove, there are three questions on the verdict form. Did we prove stuff got damaged, yes. If we prove that, question two is did the insurance company prove that it’s excluded. And a lot of times they cannot do that because they can’t distinguish between flood and wind, they’re just saying it.

Well saying it’s one thing. But proving it by the greater weight of the evidence is something totally different. They have to prove it by the more persuasive and convincing force and effect of the entire evidence in the whole case and they can’t do it. And so what I do is show the jury all the reasons why they cannot carry their burden of prove. Please do not, I was talking, you look at this stuff, it will drive you crazy trying to figure out how do I. Don’t do it. Just get their decision, both of them, and let me look at them. And I’ll tell you if they’re doing the right thing or not. But this stuff will drive you nuts if you try to go and figure it out. And I’m telling you don’t do it. I’ll look at it for free for you. As a home owner don’t be telling the adjusters what caused the loss. Do you know what I need to win the case?

There’s one thing, there is one thing I gotta have to win the case. They gotta say no. That’s the one thing I’ve had in every case I’ve ever won. They all started with no. And so don’t be afraid of letting them do their job.

I have a section in the book that talks about stop helping me, right, clients. Stop helping, and this is what it means. Don’t be telling the adjuster yeah I think it was the flood. You don’t know. Let ’em do their thing, let ’em just go do whatever it is they’re going to do. Because if you tell them yeah I think it was the flood or I think it was the wind. They’ll put that in the report and then I gotta deal with it. Just say you’re the professional, you tell me. And let ’em do it.

I don’t care what they decide, I just need to get their documents and then I’ll let you know what I can do for you. And don’t let it drive you crazy cause it will. People stay up late at night and then you’re gonna have to go to the psychologist. And I couldn’t more highly recommend it but you probably have bigger problems to worry about than reading an insurance policy. Citizens depopulates and shifts some policies each year over to carriers that are not related to the state. And that’s common, you gotta do it, you can’t stay with Citizens if they’re doing that. And then people have a concern, well I’ve never heard of this insurance company, what if they go under.

Don’t worry about it, we do have in Florida FIGA. The Florida Insurance Guarantee Association. And so FIGA, if your insurance company goes under. How many people here have Homeowners choice?

Okay. So Homeowners Choice, their predecessor before them had problems and then it shifted over and Homeowners Choice picked up those policies. So two things happen if an insurer goes under. Sometimes another insurer like Homeowners Choice will come in and pick ’em up and say we’ll handle those claims, we will accept those claims and we’ll pay those claims as if we were the insurer.

And sometimes nobody comes in because it’s just a mess and the state takes them over. And they cover up to $300,000. So the state will cover you up to $300,000 and so you’ve got that protection. Hopefully that helps you but there’s nothing you can do to stop it.

– [Lady 2] If I’m in the middle of a claim dispute with Citizens. – Oh it doesn’t matter. Unless this new insurer says we’re gonna assume all those old claims too and they usually aren’t gonna do that. They’re gonna say this is our cut off date, any old dates of loss that occur prior to X day are gonna be on Citizens, after X, we’re gonna assume. Don’t let it, again great question, don’t let it drive you crazy. Just let ’em do whatever they’re gonna do.

And if they pay it good, if they don’t, you let me know. I got a stack of verdict forms and jury instructions that I’ve had approved by the district courts of appeal throughout the state of Florida that I take with me in every case. There are three questions on the verdict form. Did the insurer prove by the greater way of the evidence that during the policy period they proved that the home sustained direct physical loss. Yes or no. If your answer is yes, go to question two.

Question two, did the insurance company prove by the greater way of the evidence that all of the damage claimed by the plaintiff is excluded by the specific terms of the policy, yes or no. If your answer is no, your verdict is for the homeowner. Third question is how much. Yeah because, here I’ll tell you how you could be hurting yourself. I had a case two years ago. My client said you know what they told me to go get a engineer so I went and got a engineer.

And I said do you know you’ve hired their favorite engineer? Do you know that they had paid that company six million dollars in the last three years? No here’s the question. Sir, didn’t you feel awkward walking around the house with my client, knowing that that company right there has paid your company six million dollars and you didn’t even tell her. You didn’t feel awkward at all keeping that to yourself. Well no, I didn’t think about it. Well did you think to tell them that when you went back to your office that day after inspecting the house, did you think to tell her that you had case with that guy right there?

That lawyer. No I didn’t think to tell him that either. So you can harm yourself, I won that case, as you might imagine cause the jury says yeah we understand what’s going on. So you can, you need to ask the question. Do you do work for the insurance companies. They usually if you ask them that come, I do some. Well what’s some, like 98%, or 1% of your work’s on behalf of insurance companies. Let me get my engineer out there because I don’t want an engineer.

If you hire the engineer and he goes and goes I don’t know. That plays into their scenario a little bit. I’d rather have my forensic engineer go out there and say you know what, the cracks start at the top of the wall, that means it’s wind damage. Cracks that start at the foundation means there’s foundation movement and it’s foundation so that’s probably flood. That may be one of the things we look at. However, do you have sink hole coverage?

On your policy, do you know. When the flood waters recede, what happens a lot of the time is we have classic sink hole activity. Not sink holes, big hole with a house in the ground, but we have sink hold activity which is defined as a weakening of the earth supporting the foundation and it causes cracks in the foundation working their way up. That’s covered even if it was caused by flood under the wind policy. All I need to know to get started on case so I need to get a look at that.

Yeah and don’t get too put upon about that because everybody, whenever these happen, everybody gets sort of pushed back. But for a roof replacement, we don’t need to have water coming into the house to require the insurance company to replace the roof.

What I want them to look at is the ceiling strip underneath the shingle. The shingles lay on top of each other, there’s a ceiling strip. If that ceiling strip was, if the wind was strong enough to knock the ridge vent off, it was more than strong enough to lift up the shingles. Do you have architectural or?

– [Lady 3] It’s a metal roof.

– [Man 5] Tin roof.

– It’s a metal roof, all right. Well we need to look and see if it was, got up under between the fascia and there and see if it’s lifted. Cause here’s what happens. It lifts it and it sets down, it’s doing this throughout the storm. It’s doing this. If I was to pull a nail out with my hand, what would be the best way for me to pull the nail out? Like that, wiggle it right, wiggle it a little bit. Guess what the wind’s doing.

It’s moving this up and down, moving it up and down. And it’s loosening the nail and ob longing the hole that the nail’s in, your nails are now loose. They’ve gotta replace that. It does but the only, and the questions is if you have, in your policy you do have coverage where civil authorities have either prohibited you from being there or mandatory evacuation. It even includes if you got damage and a cop says you can’t come back.

Any of that, civil authority. I assure you I used to be a cop. So a man with a badge, and a gun, and arrest authority saying you can’t go there is a civil authority saying that you’re not allowed to go. Don’t go. So yes, but the only thing that that’s gonna get you is these living expenses while the evacuation is in force. But then we’re gonna have a little fight with the insurance company about when that begins because if there’s no damage to the house, then their gonna say it doesn’t cover and I’d have to look at the policy.

– [Man 6] Exactly. – Yeah but only from the point of damage onward they’re gonna say, let’s say it got damaged on the tenth. Let’s say it got damaged on the tenth. Then the living expenses from the tenth until the civil. – [Man 6] Yeah they kept us out for a week.

– You should be at the alternative living expenses, additional living expenses during that time. If you have a business policy and the same thing happens, you can get business interruption coverage. Alright, so we got a great point, I’m gonna stay here. We’re gonna let our employees sort of wrap this up. If anybody’s got questions, let’s bring them up front. Thanks for coming.