Questions Commonly Asked to Our Public Adjusters

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What is a Public Adjuster?

A Public Adjuster is a professional claim advocate representing the policyholder in negotiation and appraising your insurance claim. 

A Public Adjuster is a professional claim advocate representing the policyholder in negotiation and appraising your insurance claim. A licensed public adjuster or an attorney are the only two types of individuals representing policyholders for a property damage claim. A public adjuster must meet strict educational, background, and ethical criteria required by the state government to work as a public adjuster.

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Who Determines Repair vs. Replace?

As a public insurance adjuster, our job is to ensure our clients receive a fair and accurate settlement for damages sustained by a covered loss.

For example; If a fire breaks out in the kitchen, it sends smoke throughout the building, including a/c ductwork. Can the ductwork be cleaned of the smoke to ensure the insured does not suffer ill health effects months later because the ductwork wasn’t properly decontaminated? Depending on the extent of the smoke damage under this scenario, we would normally demand that the ductwork be replaced.

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How Does Arbitration Work?

Arbitration is a form of alternative dispute resolution (ADR), used in place of litigation (going to court) in the hope of settling a dispute without the cost and time of a court case.

Litigation is a court-based process that involves a decision that is binding on both parties and a method of appealing the decision. 

The differences between arbitration and litigation involve the processes themselves and the result of decisions on the disputes. Both are formal processes, but arbitration can be less costly and results in shorter settlement times.

Commercial arbitration is a means of settling disputes by referring them to a neutral person, an arbitrator, selected by the parties for a decision based on the evidence and arguments presented to the arbitration hearing. The parties agree in advance that the decision will be accepted as final and binding.

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What is Mitigation?

Mitigation means reducing the risk of loss from the occurrence of any undesirable event.

Mitigation is an essential element for any insurance business to avoid unnecessary or additional losses. 

In general, mitigation means to minimize the degree of any loss or harm, employing efforts to keep damages from getting worse. In insurance contracts, various clauses and conditions are specified to ensure minimum losses to the insurer. One of the duties of the insured is that you are required to protect the property from further damage or loss by taking reasonable and necessary temporary repairs required to protect the property and reasonable and necessary actions to preserve and retain any damaged property.  For example, if a storm causes a window to be broken then it is up to the policyholder to temporarily board up the window until it can be properly replaced.

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Do you Handle Liability Claims?

No, they are legally only handled by Attorneys.

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What Is the Difference Between a COA (Condominium Owners Association) and an HOA (Home Owners Association)?

One of the main differences between condominium owner associations (COAs) and homeowner associations (HOAs) is how the association itself administers property development.

Usually, an HOA oversees single-family homes in planned developments, usually made up of individual lots and homes. In contrast, condo associations manage common structures with multiple units, much like apartments and townhomes.

  • When it comes to maintenance and repair issues, this is when things get down to the nitty-gritty. Condominium associations are responsible for all the general common elements (GCEs), such as lobbies, common hallways, sidewalks, roofs, elevators, swimming pools, and parking lots. Since it’s a community-based association, COAs typically outline their services to those in common areas. A unit owner is ordinarily responsible for maintaining their HVAC system; however in the event of an insurable loss the responsibility shifts to the association’s master policy.

For HOAs, they are responsible for maintaining, repairing, and replacing common areas, much like COAs, but with some differences jutted in. Things like sidewalks, green spaces and playgrounds are all under the purview of an HOA, as well as some landscaping of individual lots.

Condo unit owners COA’s,  while allowed to run the condominium, still elect a board of directors to carry out most of the powers of a condo association. This is where something like condo associations insurance is a must-have for those who serve. Options like an umbrella policy, directors and officers liability and crime insurance are available to provide financial coverage in the event of litigation.

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What Repairs Are the Condo Association Responsible for in FL?

Under the Florida condominium statute, associations are generally responsible for repairing and replacing the drywall within the condominium units.

According to Florida Statute §718.111(11)(f), the association’s policy of hazard insurance covers “all portions of the condominium property as originally installed or replacement of like kind and quality, in accordance with the original plans and specifications,” except “all personal property within the unit or limited common elements, and floor, wall, and ceiling coverings, electrical fixtures, appliances, water heaters, water filters, built-in cabinets and countertops, and window treatments, including curtains, drapes, blinds, hardware, and similar window treatment components, or replacements of any of the preceding.  If a covered loss occurs, the condominium association would also be responsible for HVAC systems, roofing, exterior painting, doors, and windows.

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What is the Difference Between Personal Liability Coverage and Personal Property Coverage?

Personal Liability Coverage — Coverage that protects you in the event that others make a claim or bring a suit against you for physical injuries, bodily injury, or property damage for which you are responsible.

Personal Property Coverage — This coverage may help to repair or replace your personal belongings, such as electronics or furniture, in the event that they are stolen or damaged in a covered claim.

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What is the Difference Between the Condo Unit Owner Policy and the Condo Master Policy?

The Master Condo Policy or Condominium Association Insurance policy is the insurance policy that is held by the homeowners or condominium association.

An individual condominium insurance policy, or a unit owner’s policy, is the insurance policy you are responsible for as a condominium unit owner. This is essential because this policy protects your personal belongings and offers liability protection in case of an accident within your unit’s walls.

The Master Condo Policy or Condominium Association Insurance policy is the insurance policy that is held by the homeowners or condominium association. Its premium comes out of your maintenance fees or association dues. The Master Condo Policy is responsible for covering two main areas of risk — general liability for the association and property damage coverage for common areas. Common areas are generally defined as the roof and exterior walls, stairways, recreation rooms, elevators, common hallways, and grounds. The specifics of these policy differences and coverages will depend on the specifics of your Association Policy language.

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What Information Does the Policy Require to Prove Your Claim?

Burden of Proof is the obligation to prove what is alleged. This requirement can be completed by the insured in many ways.

To meet your ‘Burden of Proof,’ you may need all or part of the following:

  • Detailed unit cost appraisal estimate prepared using the universal Xactimate software for any building damage replacements and repairs.
  • Detailed, line by line appraisal, with pricing support of physical inventory and damage of all furniture, fixtures, equipment, and stock.
  • Identification and evaluation of any insurable interests in any of the betterments and improvements.
  • Valuation and appraisal needed for any co-insurance requirements.
  • Determination of salvage disposal.
  • Physical depreciation schedules for all property.
  • Income loss analysis for any business interruption claim.
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What is Actual Cash Value?

Actual Cash Value is the fair and reasonable cash price which the property could be sold for in the market, in the ordinary course of business and not at a forced sale.

The method your carrier adjusters use to reach ACV settlement figures relies on depreciation tables and programs that calculate average life expectancy. If your property doesn’t fit neatly into an “average” category, your settlement may be unreasonably low. Fortunately, Stone Claims Group can use documentation and facts to dispute an unacceptably low offer.

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Do You Also Handle my Damaged Content Items?

Stone Claims Group will assist by assessing and creating an accurate content schedule with your damaged property’s valuation and documentation in a format that conforms to your policy language.

Yes, as the insured, you are required under the insurance policy to conform to the “Your Duties After A Loss” provision contained in your policy. In short, it is your duty to provide detailed documentation of your loss. Stone Claims Group will assist by assessing and creating an accurate content schedule with your damaged property’s valuation and documentation in a format that conforms to your policy language. Unique damaged contents may require the expertise of a content specialist in this field, which we can arrange.

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Can I Claim Business Interruption?

Business Interruption or Business Income Coverage pays continuing “normal” business expenses, due to direct physical loss or damage, such as one which might be caused by a fire or a natural disaster.

This type of insurance also covers operating expenses, a move to a temporary location if necessary, payroll, taxes, and loan payments. In rare cases, business interruption insurance can apply if a civil authority shuts down a business due to physical damage to a nearby business, resulting in a firm’s loss.

Standard business interruption insurance may not reimburse policyholders if the business is closed due to a pandemic. Even some all-risk insurance plans have specific exclusions for losses due to viruses or bacteria.

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How Do You Handle Insurance Coverage Issues?

One of the important benefits of hiring a public adjuster is that you have an ally with the knowledge to recognize coverage issues as they develop and the expertise to work through them before they spin out of control.

When you’re dealing with an experienced commercial insurance adjuster, you might not realize that a coverage issue exists until you receive a reservation of rights letter or denial of coverage. One of the important benefits of hiring a public adjuster is that you have an ally with the knowledge to recognize coverage issues as they develop and the expertise to work through them before they spin out of control.

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How Long Do I Have to Contract with Stone Claims After the Date of the Storm?

In Florida, you have four years from the date of your property damage to file a claim against the at-fault party. 

If the insurance company is not dealing with you fairly, you have five years from the unfair claim incident to bring a claim against the insurance company. ( Section 95.11(2)(e)) These periods differ from state to state. 

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How Do You Handle Storm Damages That Are Uncovered During the Repair Process but Were Unknown Before?

If you find additional damage after the settlement or during the repair process, you can “reopen” the claim and file for an additional amount.

Any additional unknown damage must be properly documented and presented to the insurance company. Most policies require claims to be filed within one year from the date of the disaster. Check with your state department of insurance.

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My Flat Roof Installation is Unique. How can I determine if it is Repairable?

Commercial roofing has many different applications; Modified Bitumen, Built-Up-Roofing, Single-Ply Membranes, Cold/Hot Fluid Applied Systems, Metal, Clay/Concrete Tile, Asphalt Shingles, as well as Spray Applied Polyurethane Foam and Coating System.

The exterior shell of your building is called the building envelope, which includes: waterproofing, cladding, glazing, and roofing is the number one concern after a storm event.  Roof damages, many not visible during an inspection, can lead to additional interior damage and energy loss.  

Commercial roofing has many different applications; Modified Bitumen, Built-Up-Roofing, Single-Ply Membranes, Cold/Hot Fluid Applied Systems, Metal, Clay/Concrete Tile, Asphalt Shingles, as well as Spray Applied Polyurethane Foam and Coating System. We analyze each roof system to determine the repairability to ensure a watertight roof system and envelope integrity for Building Owners and Property Managers. If necessary, we will use thermal imaging cameras and other testing devices to find hidden damage.

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How is Your Damage Estimate Prepared?

After a thorough inspection, possibly several inspections with contractors and experts as necessary, Stone Claims completes a comprehensive estimate in the software used by your insurance carrier for compatibility and clarity.

The estimate details each damaged item. Each item’s repair cost – area by area, reflects the real total repair costs, and this estimate, must conform to the coverages provided in your policy language. Our estimates will include repair costs and additional required items such as OSHA regulations, any law or ordinance issues, and increased costs of construction, to name just a few.

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My Carrier Told Me My Claim Repairs Will Not Exceed my Deductible.

Damages may initially be overlooked. We can commit an entire team of experts to each case: licensed public adjusters, building engineers, construction and contents specialists, lawyers, and others if necessary to document the complete scope of damage repairs necessary.

Typically, a carrier property insurance adjuster will investigate and evaluate your claim quickly after the claim is established. It’s usually intended to settle quickly, save claim dollars, and move on to the next insured. Stone Claims has settled numerous insurance claims where the carrier adjuster said the claim would not exceed the deductible only to settle with us for thousands and even millions of dollars. We would be happy to provide references of former clients who went through this exact scenario.

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How Can We Get Started?

A consultation is free and without obligation. Please feel free to call us at 1-800-892-1116 and set-up an appointment to discuss your claim. 

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Why Do You Specialize in Commercial Losses?

Stone Claims Group is best suited for the complexity of commercial property insurance losses.

Commercial property claims are complicated, so insurance companies send out their most experienced adjusters to handle them. It is only fair to have an experienced public adjuster handling your claim, to level the playing field. We apply a team effort to every phase: investigation, estimating, negotiation to arrive at the final settlement.

 

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What Type of Losses Do You Handle?

Stone Claims Group specializes in commercial first-party insurance claims.

Damages from hail, wind, hurricane, tornado, fire, water damage and vandalism are just a few of the most common types of claims we handle. Call Stone Claims Group to discuss your loss: 800-892-1116.

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What Should I Expect With the Stone Claims Group Representation Process?

Expect: professionalism, personal attention, expertise, and the best possible outcome.

No two claims follow the same path. Part of the expertise of Stone Claims is knowing how to control and direct the claim to the best conclusion. Claims can include building damage, personal property damage, and business interruption. Regular conferences are held with you in person, by zoom, or by telephone. All claims are thoroughly documented, archived, and reviewed with you before submitting to the insurance company. A typical claim scenario flow:

  • Initial contact.
  • Contract.
  • Investigation.
  • Documentation of your loss.
  • Meeting with your Carrier Adjuster, Carrier experts.
  • Negotiations with additional experts if and as needed.
  • Client review of all claim documentation and values submission.
  • Submission to Carrier for settlement for repair costs as agreed.
  • Negotiating the best settlement.

Decisions involving thousands and sometimes millions of dollars must be made and often made quickly with little margin for error. You must decide early on whether this process is to be undertaken by the policyholder/board of directors, risk manager, or whether the expertise of a Public Adjuster should be brought in. Time and again, it has been demonstrated that when dealing in an unfamiliar area, the result can be a loss of invaluable time and money.

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How is Stone Claims Group Different?

We are much more rare than different. Stone Claims Group is part of an elite set of professional public adjusting firms specializing in large losses and commercial claims.

We are field-tested. We have the staff, experience, and expertise to handle your claim to the best possible outcome. We are the ‘Guardians of your Interests.’

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How Does the Public Adjuster Get Paid?

Public adjusters work exclusively for the best interest of the policyholder – not the insurance company. For this reason, we only get paid if you get paid, and the fees for services are generally a small percentage of the insurance settlement.

Most of our past clients have seen such significant success with the increased settlements that the fee becomes inconsequential.

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How Do I Select the Best Public Adjuster?

Experience, expertise, professionalism, integrity, and licensing.

Select a Public Adjuster specializing in the type of peril, type of policy, and type of building damaged. Always ask the Public Adjuster to see a list of references. Any public insurance claim adjuster you choose to work with should have years of experience handling a similar type and size of claim, and should have their own team of dedicated staff – including adjusters, building estimators, experts, contents appraisers, certified public accountants, and attorneys. Large claims require a more prepared Public Adjusting firm, like Stone Claims Group.

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If My Claim was Closed by the Insurance Company, is it Too Late to Hire a Public Adjuster?

Usually, it is not too late.

Most state laws allow a few years to file a supplemental claim from the date of loss. If you believe you were not paid the right amount and would like us to review your claim, please contact us at 1-800-892-1116. We will carefully audit and analyze your claim and provide our professional opinion.

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When Should I Call a Public Adjuster?

You should call us at  1-800-892-1116 immediately after a loss. It is most beneficial for all parties when Stone Claims Group is involved at the beginning of the claim development to set the tone for the entire claim & settlement process.

Typically a carrier property insurance adjuster will investigate and evaluate your claim quickly after the claim is established, it’s usually with the intention of settling quickly, saving claim dollars, and moving on to the next insured. It is important to let the insurance company know the estimated amount of the loss at the beginning of the claim to properly set the reserve funds. Once an insurance company adjuster sets his or her reserve amount it is much harder to get them to change their minds and add to the amount.

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Why Shouldn’t I try to Handle the Claim Myself?

Policies are intentionally drafted vaguely, leaving them open to interpretation by your insurance company – most often in their favor.

Not many people take the time to read and understand their entire insurance policy. Insurance policies, just like all legal documents, should be reviewed only by attorneys and adjusters trained in property insurance policies. Policies are intentionally drafted vaguely, leaving them open to interpretation by your insurance company – most often in their favor. The policy is the roadmap that dictates how and how much a claim may be settled for. Suppose you are not an expert in property policies. In that case, it is almost certain that you will badly compromise your claim by failing to recognize coverages that exist or by failing to convince a skilled adjuster, who has been hired by the carrier to represent its interests, as to your interpretation of the policy. Furthermore, it will be nearly impossible for you to meet your burden of proof of damages without a detailed, line by line itemization of damages to your building, contents, or business loss.

To properly document an insurance claim and present it to the insurance company is a time consuming and emotional ordeal. After a loss, your whole life can be turned upside down. We will allow you to pursue your livelihood while we deal with the insurance company and prepare the claim for you. A property manager is not an insurance adjuster and does not have the expertise in claim documentation. Just as public adjusters are not trained in property management, we feel it is best to let a real professional work for your best interests.

Without a policy expert on your side, you are almost certain to compromise your claim potential and not have your settlement and coverage interpretation in your best interest.You don’t want to accept a settlement that falls short of restoring the loss’s full amount.

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What to Consider When Choosing a Professional Public Adjusting Firm?

 No Public Adjuster should make any promises of what they can do without knowing your specific insurance policy and carefully examining the loss/claim.

When hiring a Public Adjuster, don’t hire the first one that comes along. Always make sure your Public Adjuster is experienced in his/her field and obey the law. No Public Adjuster should make any promises of what they can do without knowing your specific insurance policy and carefully examining the loss/claim. One of the best ways to determine if a public adjuster is qualified to handle your request is by their former clients’ references.

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What Are the Benefits of Hiring a Public Adjusting Firm?

A few of the benefits of hiring a Public Adjusting firm include helping a policyholder understand and interpret their policy, resolve the claim faster, ensure fair value for the claim, and protect the policyholder’s rights.

A few of the benefits of hiring a Public Adjusting firm include helping a policyholder understand and interpret their policy, resolve the claim faster, ensure fair value for the claim, and protect the policyholder’s rights. It is not the job, duty, or responsibility of your insurance company to discover the full extent of your loss. That responsibility is the policyholders’. A good public adjuster is essential to determine the fair repair amount of the loss.

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What is The Difference Between a Public Adjuster, a Company Adjuster, and an Independent Adjuster?

Public adjusters work exclusively for the policyholder. A public adjuster’s goal is to help the policyholder/claimant with the insurance claim process’s ins and outs.

Many people think independent adjusters and Public Adjusters are the same things; that is just not true.

Many people think Independent Adjusters and Public Adjusters are the same, which is not true. A public adjuster’s goal is to help the policyholder/claimant with the insurance claim process’s ins and outs. Public Adjusters are experts in reading and understanding insurance policies. Experienced public adjusters will ensure you’re getting the exact amount of compensation you’re owed based on the terms of your insurance policy.

An Independent Adjuster represents the insurance carrier. When you make a claim with your insurance company, it assigns its own adjuster to your claim. Independent adjusters can work for multiple carriers, but can only represent carriers. 

The last type of adjuster is a company adjuster. A company adjuster works directly for one insurance company. They work for the carrier while we work for you.

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