Insurance claims are an adversarial process between the insurance company and the insured party. Do not be fooled, each party will be looking out, or should be looking out for its own interests. Therefore, its a good idea to know some general information regarding your rights, be familiar with the claims process and take note of the following:
Property Insurance Claims
When filing a claim do the following
- File a written claim to the insuring agency/company directly or thru an authorized representative
- File the claim as soon as possible
- Provide the insured party’s name
- Provide insurance policy number
- Provide a list of the damages suffered by your property.
- If multiple buildings or areas are insured under a single policy, enumerate damages by building or areas
- Additional/not reported damage can be included later, you have until a release has been signed and/or claim award has been cashed.
- *Request written proof of claim receipt*
- *Request claim or case number*
- *Request a copy of the entire insurance policy* including coverage and exclusion booklet
- Follow up your claim directly with the insurer by phone or if necessary by personal visits
Performing Repairs or Clean Ups
If you’ll be performing cleanup or emergency repairs prior to receiving insurance claim payment do the following:
- Maintain adequate records of invoices and payments made.
- If paying in cash, request a receipt.
- Document repairs and/or cleanup with photos.
- Keep a log of activities performed
- If possible, store all removed material and or equipment until insurance adjuster authorizes disposal.
Substantiating Your Claim
Remember that the insurance company sends either an in house adjuster or external adjusters (contractors), that will verify and substantiate your claim in order to safeguard its interests. Therefore, you should take steps to safeguard your own. Some safeguards can be covered by the insurance company as part of your claim. See below:
- Hire a public adjuster. The Public Adjuster must be licensed in Puerto Rico or have a waiver to practice in Puerto Rico. Always request the adjuster’s credentials and make sure they’re up to date. This type of professional will usually enter into a contingency based contract fee with the insured. The contingency amount will depend on the amount awarded for the claim, as it is a percentage agreed upon by the parties (insured and public adjuster).
- Hire a licensed professional (engineer, architect) to perform a certified damage assessment and repair quote. From our experience, these assessments and quotes provides a more robust substantiation to your claim. Always request the professional’s credentials and make sure they’re up to date. All certified reports must include the licensed professional’s stamp and the CIAPR or CAAPPR stamp adhered to the report, if not, it will not be considered as certified. This type of professionals will request a one time fee or a per hour fee that can range from $90/hr to $140/hr. Usually these fees can be recovered and or be included in the damage claim itself. These reports only consider the damages suffered by the property and will not make an adjustment as to insurance policy coverage.
- Request a quote from a licensed contractor in order to repair the damages. If you had to pay for the quote, the fees could be included in the damages claim.
The Insurance Claim Process
- Suffer an alleged damage
- File a claim to the insurance company or its authorized representative
- Claim is received by the insurance company and a claim number is assigned (Some companies may use the insurance policy number)
- Case is assigned to internal adjuster and/or external adjuster (contractor)
- The internal adjuster and/or external adjuster, visits the property and performs a damage assessment. The assessment includes an interview of the insured or authorized representative, prepares a list of all damages, takes pictures of the damages and prepares a small plot plan sketch. Any information can and should be provided to the adjuster, including any quote or professionally certified report.
- The internal adjuster and/or external adjuster prepares a quote of the damages.
- The internal adjuster and/or external adjuster adjusts the claim according to insurance policy coverage and exclusions, and prepares a report.
- Insurance company notifies client of claims amount to be awarded according to adjuster’s report.
- Insured party can accept or request a reconsideration of the award amount.
- If the insured accepts the awarded amount, a payment will be issued via check and a signed release will be requested of him. Cashing the check can constitute a release.
- If the insured requests a reconsideration process, the internal adjuster and/or external adjuster will review the report and determine if the amount awarded should be amended.
- A final decision will be communicated to the insured.
- If the insured does not agree with the amount awarded, he can file a judicial claim.
In Puerto Rico, insurance companies are required to acknowledge a written claim and start its investigation within 15 days, according to Article 27.150 of Puerto Rico’s Insurance Code (26 L.P.R.A. §2714). The investigation, adjustment and resolution of the claim must be performed in the “shortest reasonable period of time”, not to exceed 90 days from the claim filing, according to Article 27.150 of Puerto Rico’s Insurance Code 26 L.P.R.A. §2716b. Hence an insured party has a right to get a resolution on its claim in 90 days, be it a payment or a written justified denial.
Things to Remember
- Insurance companies and their adjusters will quote damages in order to repair to a similar or equal condition, prior to suffering the damage
- Always read your policy coverage and exclusions. Do not rely on word of mouth interpretations of what’s covered or not, be dubious of any professional or insurance company agent that does not cite the specific term in the policy that excludes your claim
- Always make sure the adjuster or licensed professional includes, demolition, removal and cleanup in its quote
- Always make sure the adjuster or licensed professional includes any design fees and permit costs required to perform the repairs
- Always make sure the adjuster or licensed professional includes any taxes, municipal patents, permit fees taxes, insurance costs etc.
- Always remember that the deductible will be subtracted from the total amount of the adjusted loss
We stress that you get adequate counseling from a knowledgeable professional in this field regarding your insurance claim. If you have any questions please contact us. We’ll be glad to assist you.