Home Insurance from Storm Sandy

I need some advice. I’ll keep it short. I hired an Insurance Adjuster to represent me with State Farm Insurance. The Engineers report is well done and it itemizes damages of 300K+, more than the policy limit of 300K. State Farm’s Engineer says 23K. Isn’t this report supposed to be based on facts, and not entirely an opinion?

The insurance check barely covers the cost of the tree removal. The house is completely destroyed. What options do I have to pursue next?

Anyone work in the Insurance Industry?

Is there a Consumer Organization I can talk to?

Update: The house has been condemned. I can’t even go inside or live there anymore!

Superstorm Sandy National Disaster Legal Aid Hotline: 1-800-699-5636.

NY State Hotline specific to insurance issues: 1-800-339-1759

I work in insurance (not at State Farm) taking claims by phone. I’m not a licensed adjuster. I also do not live or work in your state. Additionally, I rarely have an opportunity to look at property claims, although I DID take several claims for Sandy because we were so busy. I’ve picked up a lot of general insurance knowledge as well, from reading adjuster notes every day for years.

Now then. In your situation, I would start by calling your State Farm adjuster. Be polite, be composed, and be firm. *Do not *lose your temper. I know it’s a stressful situation. But if you are rude, yelling, or cursing, the adjuster will hang up on you and tell you to call back when you’re calmer.

The first thing you should do is ask to be sure they have received a copy of your independent assessment. It’s a big company, and paperwork can get misdirected or misplaced. If they have received it, ask them why they’re denying such a large portion of your claim. My *guess *is that they’re going to point to an exclusion on your policy. By any chance, was the preponderance of your damage caused by floodwaters? One nearly-universal exclusion on homeowner’s policies is water damage caused by flooding. If that is the case, State Farm is only obligated to pay for the damage caused by wind. Like if the wind knocked down a tree that ripped a hole in the side of your house and rainwater fell into that room, causing water damage? That would be covered. But devastating water damage on your first floor due to water rising up and coming through the doors and windows? Wouldn’t be covered, no matter how bad it is, because it’s a flood. You would only be covered for flood damage if you had previously purchased a national flood insurance program policy in addition to your regular homeowner’s policy. Or if you purchased a “flood rider” through State Farm (not available everywhere, and not every insurance company offers them).

If your damage is NOT from rising water or flood, though, ask why there’s such a large discrepancy between your list and the check they issued. If they hem and haw and don’t point to anything specific, ask for the itemized list they based the check on. Compare the lists and call/write back to dispute it. If that doesn’t get you anywhere (which I can’t imagine), ask to speak to the adjuster’s supervisor. If you adjuster is dealing unfairly with you, their supervisor will intervene.

The chances they are dealing in bad faith with you are very, very low. State Farm’s not a fly-by-night company. However, if you’re still not satisfied with their decision, you can apply for third-party mediation by the American Arbitration Association. This information ONLY applies to New York claims, and ONLY if one or more of these criteria are met:

  1. Damage dispute to the tune of $1,000+.
  2. 45-day (or more) delay in claim processing after your documents proving the claim were received.
  3. Claim was denied in part or in full.

If any of those criteria apply to you (and from your description, two of them do), then you can request free mediation through a company that New York selected to handle Sandy mediation statewide:

In writing:
American Arbitration Association
Storm Sandy Mediation Claims
120 Broadway – 15th Floor
New York, NY 10271

By phone: 855-366-9767, 855-366-9768, or 917-438-1660
By fax: 646-845-1958 or 917-438-1600
By email: [EMAIL=“StormSandyNY@adr.org”]StormSandyNY@adr.org

Even if your claim gets denied as a result of a specific exclusion on your policy, you should apply for mediation. It doesn’t hurt to try! You should also consider applying for disaster relief through FEMA’s website if you haven’t already.

Thanks for your suggestions! There was no water damage I was there to stop it. The house is in PA if you can provide more numbers specific to that state. This is the place to go for answers!

Seems like all the phone numbers above are specifically for NY. I’m in PA.

Sorry for some reason I did assume you were in NY. Sidebars on the side of the first link indicate sister hotlines for NJ, CT, and MD… But not PA. Id still give them a call and see if they can refer you. It’s free after all. :slight_smile:

I’m sorry, I didn’t know where you were from and I assumed Hello Again did. In that case, you’ll still want to go through all the steps I listed (minus the arbitration bit). You need to figure out WHY they are denying such a large portion of your claim. They can’t just arbitrarily reduce a settlement of a total loss, there are many *many *state-specific guidelines in place to prevent this. But an exclusion would allow them to reduce the value of your claim. Seriously, just call your adjuster and figure it out. Once you are armed with that information, you can make an attack plan. Until then, though, there are way too many possibilities to even begin speculating on.

If you can’t get the information you need because the adjuster and their supervisor are continually stonewalling (or ignoring) you, you might consider attorney representation as a last resort. You can try to request they participate in third-party arbitration, but I don’t think the insurance company would do it without some legal pressure from your side of the table.

Oh, and if it’s not too much to ask, please post back when you figure out why they shortchanged your settlement so much. I’d also love to know how your claim wraps up, although that could take weeks or months.

It has to do with depreciation and deductibles and Contractors overhead and profit. All those numbers add up. The Engineering report itemizes all the costs starting with 40k down to 23k. My Engineering report starts around 300k itemizing the costs needed to repair the structure and pass inspections to meet modern code requirements. That’s where the difference is. The Engineering report. It’s supposed to be based on the facts you can see during the inspection. Yet the 2 conclusions couldn’t be more different. I did not see the word Exclusion used in any of the paperwork. I wish we could go thru my items one at a time and have them explain why they are NOT in need of repair. It would be even better in person while looking at them. I have not yet talked to State Farm. I thought that was the adjusters job. They appear to have written a complete and professional Engineers report. Which was ignored. All the references to it in their report are invalid criticism based on the way it LOOKED with dirt and mildew. There are many errors in the SF report while it claims mine is wrong. Untrue. I’m not a qualified structural engineer, but the guy who wrote it is. Why can’t they get together and resolve the differences? These are facts we’re dealing with, not opinions. Either the wall is cracked or it’s not. The roof is missing. The structure obviously shifted. This seems relevant to me and the Engineer. How do I ask for this:

Please list all the items in my report that are clearly false, based on the facts that we can observe together at the house?

The person you hired is an independent adjuster, or IA. Hiring your own adjuster is like getting a second opinion–it’s not a substitute for the adjuster State Farm assigned to your case. IAs do not have the ability to force State Farm to increase the amount of your claim. State Farm’s adjuster is the one who’ll actually be approving and issuing your checks. That is the **only **person who can approve your claim. And they will conduct their own adjustments and estimates as part of the claim resolution process. If there is a discrepancy, it ultimately falls on the policyholder to figure out why. The independent adjuster you hired may not be advocating for you as hard as they should be. They probably have a very large caseload. And, at the end of the day, it’s your stuff and your money at stake. Nobody else–not even a lawyer–will advocate for your stuff as hard as you will.

There may also be time delays (often *very *significant ones) if you wait for a third party to shuffle information back and forth between you and your insurance company. Why wait when you can contact State Farm directly? How can you be sure State Farm is aware you’re dissatisfied with their damage estimate if you haven’t even asked them yourself? My advice is to contact the State Farm claim rep and ask him or her directly why their estimate of damage differs from the one your IA prepared. Tell them you’ve never dealt with a claim before, and you’re really really confused and could use some guidance. Adjusters (unless you get a mega-asshole, which does happen) generally want to work WITH you to repair your home to its pre-loss condition as quickly as possible. And if that cannot happen, then they should help you rebuild it. Stop relying on the middleman, IMO.

Now, if you hired a lawyer, the State Farm adjuster would generally be barred from communicating directly with you. But when hiring an IA, no such prohibition exists. You can ask the internet for advice all day long, but without knowledge of your case, we can only speculate. I can ASSURE you that your State Farm adjuster has the answers to all of your questions. So call them!

I cannot find any resources in PA like there are in NY and NJ. I called all the numbers and they only sent me to www.mediate.com Not very helpful…

Please help? Anyone? I’m homeless…

For clarity, can you respond to Rachellelogram’s post? Can’t help ya if we don’t know the basics. So far we have you with a wrecked house, and two significantly different numbers to get things put right.

I’m not hip to how house insurance claims work, let alone how storm disasters are handled but SF has their own claims folks–what moved you to hire an independent? And have you discussed the matter with SF’s claims folks? And if they gave you nothing, have you tried firing up your agent? They don’t have to say what you want to hear, but you ARE entitled to answers/decisions/explanations.

That makes sense; State Farm probably wants to simply repair damage, while your engineering guy may be specifying extra stuff to bring things up to code that weren’t strictly damaged by the storm.

For example, in my house, if there was to be tornado damage, the insurance company might choose to pay for any wiring damage, and bring that part up to code.

However, they would almost certainly balk at paying for a new breaker panel and re-wiring the house with copper, which would be needed to bring the house up to modern day code (the panel’s 1969-vintage, and about 1/2 the wiring is aluminum).

From what your post says, it sounds like that’s what may be happening.

Still no progress. Here’s an update.

Who can I call to get help?

The settlement amount was determined and check cut before the site inspection!

You’d never know the damage without exposing the structure.
We verified it later when it was torn down.
The corner was obviously compromised.
You couldn’t know this for certain without a destructive inspection.
How could we have afforded to repair the damage to make it safe again?

The house was involuntarily Condemned and torn down…

I’ve had many long discussions with SF after the claim was closed, which was months ago. Each time I get a new adjuster. Another representative. No good answers. I’m getting the run around. The house is gone. I didn’t have any other choice. At least this way I could see the damage to the structure which was obvious but impossible to prove because it was hidden by the cracked plaster. At least this way it is possible to sell the land. After paying the tree guy, no money was left over to repair the condemned and destroyed house. Here’s the irony:

I didn’t have enough money from the settlement to tear it down!