Insurance Umpire Services to Resolve Claim Disputes

Stone Claims Group employs a team of IAUA and Windstorm Network Certified Insurance Umpires that has experience working for the insurance companies, for policyholders, and contracting companies. Our wide range of past work experience combined with our skills in large loss adjusting makes Stone Claims Group an attractive choice for both parties.

Our Promise If Appointed As Your Umpire

  • We promise to be fair and impartial.

  • We promise to make our decision based only on the facts presented and not to let bias affect our decisions.

  • We promise to review and address all pertinent facts.

  • We promise not to consider pleasing any particular party, but to award the fair value of the claim.

  • We promise to keep you updated on each state's property claim laws and jurisdictional issues in the state in which the loss occurred.

  • We promise to physically inspect the damaged property including the roofs.

  • We promise to produce a written report or estimate for any property damages that distinguishes between Replacement Cost Value, Actual Cash Value and delineates lines of coverage.

Commonly Asked Questions for Umpires

How does the court appoint an umpire?

If after 15 days, the two appraisers cannot agree on a choice of an umpire, most policies state that either party may request that the choice be made by a judge of a court of record in the state where the described location is located. Notice the policy may request that the choice be made by a judge. If the two appraisers want to continue to attempt to choose an umpire, there is nothing in the policy that would forbid it.

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How do I choose an umpire for an insurance appraisal?

An umpire is selected and agreed upon by the two Appraisers and not by the Insurance Carrier or Insured.

A qualified umpire is a competent, disinterested, impartial individual chosen by the two appraisers or appointed by a judge and charged with the responsibility of evaluating the differences in the amount of the loss set by the two appraisers.

The two appraisers should attempt to agree on an umpire no later than 35 days after the initial demand of appraisal is received, or 15 days after the appraisers first begin the umpire selection process. Usually, both appraisers start this process by submitting a list of candidates they consider qualified. If one appraiser agrees to use an umpire off of the other appraiser’s list, the choice of umpire is usually set. I say usually because courts have ruled that the umpire must be competent and disinterested. It is commonly understood that the umpire has the responsibility to reveal to the two appraisers whether he is either partial or biased toward either the insurer, insured, or one of the appraisers. He should be transparent in revealing any past business dealings, employments, or on-going dealings with any of these named parties. If the umpire fails to make the appropriate disclosure and he/she is later accused of showing partiality during the appraisal process, it is possible that the appraisal process be brought under suspicion and the award overturned by the court.

If after 15 days, the two appraisers cannot agree on a choice of umpire, most policies state that either party may request that the choice be made by a judge of a court of record in the state of the described location. Notice the policies says “may request that the choice be made by a judge;” meaning that if the two appraisers want to continue to attempt to choose an umpire, there is nothing in the policy that would forbid it.

If the appraisers agree on selecting an umpire, it is expected that a Declaration of Appraisal, DOA, will be executed. This document will state who the appraisers chose for their umpire and sign their names and attest to the same. After the Declaration is signed, this document should then be sent to the umpire of choice. It is understood, that the umpire should then declare if he is not suitable to act in this capacity due to bias, perceived bias, or incompetence. If the umpire agrees to serve in this capacity, he will sign the DOA and return the signed copy to both parties. Once this process is finished, the two appraisers will schedule their joint inspection.

Referenced https://www.aafpaa.com/choosing-an-umpire.html

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Can I appeal the umpire decision?

In most states, after a party receives notice of an appraisal award, the party may make a motion to the court to confirm the award. At this time, the court shall issue a confirming order unless the award is modified or corrected.

If within fifteen (15) days from the date of the notice of challenge, all Parties do not agree to the challenge or the challenged umpire does not withdraw, the Party making the challenge may elect to pursue it if the challenge is based on: (1) the failure of the umpire to meet the requirements for umpire set forth in the relevant contract(s); (2) the failure of the umpire to meet the Neutral Criteria listed in 6.3(a) – 6.3(d) above; (3) a violation of the standards set forth in Comment 3 to Canon 1 of the ARIAS•U.S. Code of Conduct; or (4) the alleged failure to make adequate disclosures as required by Canon IV of the ARIAS•U.S. Code of Conduct. In that case, within fifteen (15) days of the notice of challenge, the Party making the challenge shall seek a decision on the challenge from a neutral three-member sub-committee made up exclusively of members of the ARIAS Ethics Committee and the Board of Directors (the “Sub-Committee”). The Party seeking such a decision shall do so by notifying the Executive Director, in writing, of its intention to seek a decision on the challenge from the Sub-Committee”.

Under Article 12 of the UNCITRAL Arbitration Rules, “any arbitrator may be challenged if circumstances exist which give rise to justifiable doubts as to the arbitrator’s impartiality or independence”. Here, the grounds for challenging an umpire through the protocol are limited to those enumerated in Rule 16.9(d).

The first two grounds involve failure of the umpire to meet the requirements set forth in the relevant contract or under the Neutral Criteria.

The third ground requires reference to Comment 3 to Canon 1 of the ARIAS-US Code of Conduct. As set forth in Comment 3, “The parties’ confidence in the arbitrator’s ability to render a just decision is influenced by many factors, which arbitrators must consider prior to their service. There are certain circumstances where a candidate for appointment as an arbitrator must refuse to serve…”. An example of such a circumstance, per Comment 3(a), is “where the candidate has a material financial interest in a party…”

The fourth ground is the failure to make adequate disclosures as required by Canon IV of the ARIAS-US Code of Conduct. Per Canon IV, “Candidates for appointment as arbitrators should disclose any interest or relationship likely to affect their judgment. Any doubt should be resolved in favor of disclosure”. Per Comment 2 to Canon IV, required disclosures include but are not limited to relevant positions taken in published works or in expert testimony, the extent of previous appointments as an arbitrator by either party, and any past or present involvement with the contracts or claims at issue.

The Potential Results of a Challenge

There are three likely outcomes that will result from a challenge – (1) the challenging party will prevail resulting in the replacement of the umpire; (2) the challenging party’s challenge will not be accepted, or; (3) the umpire will withdraw.

In terms of the mechanics of the challenge, Rule 16.9(e) of the Insurance Rules provides that a three-person Sub-Committee will be chosen at random by the Executive Director exclusively from the members of the ARIAS Ethics Committee and Board of Directors.

For a hearing on the papers, the associated fee is $5,000. If an in-person hearing is determined to be required, the associated fee is a daily rate of $2,400 plus reasonable costs and expenses. The Sub-Committee has discretion in how it decides the challenge. But it is charged with rendering a decision on the challenge within thirty (30) days of receiving the papers or completing a hearing on the merits.

Rules 16.9(i) and 16.9(j) of the Insurance Rules suggest that the three scenarios set forth above will be resolved as follows:

  1. Where the challenger prevails, the challenging party shall be awarded its fees and costs, and the second-highest ranked umpire candidate will serve as the replacement umpire;

  2. Where the challenger fails, the party opposing the challenge shall be awarded its fees and costs, and the umpire will remain in place; and

  3. Where the umpire withdraws, the second-highest ranked umpire candidate will serve as the replacement arbitrator.

The Challenge of Challenges

The drafting of the challenge provision was an attempt to provide parties acting in good faith with a fair and efficient challenge process while at the same time deterring mischievous parties from using frivolous challenges as a tool for obstruction and delay. While actual challenges under the Insurance Rules will undoubtedly test the procedure, its mere presence advances the Insurance Rules as a valuable tool for the resolution of direct insurance and insurance-related contract disputes.

Referenced from http://arbitrationblog.kluwerarbitration.com/author/peter-halprin/

However, there are a few exceptions to note. In most states, an appraisal award can be voided in the event of any of the following circumstances:

  • The appraisal award was made without the proper authority

  • The appraisal award did not comply with the requirements of the insurance policy

  • The appraisal award was made as a result of a mistake, accident or fraud

Thus, if your appraisal award seems off, it is important you collect as much information as possible and how the panel decided on the value it did. This can be easier said than done, as appraisal panels are not always transparent in their methods. However, if your appraiser has any notes on the deliberations made by the panel or any other correspondence that could be useful to you, reach out and see if you can make use of it.

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Is the umpire decision final?

That is the intent. The general rule is that once the umpire has issued a final award, the umpire lacks any continuing power to revise the award or issue a new one. The Umpire’s decision becomes binding only by a majority agreement (2 of 3).

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Umpire and Appraiser qualification requirements.

There are no official requirements for these positions. There are Certification and Credential programs for Umpires and Appraisers. Still, their selection is primarily based on prior Umpire and Appraiser experience and their knowledge about the type of property damages in dispute. The use of appraisal to resolve insurance disputes has grown extensively. Persons who act as Umpires, therefore, undertake serious responsibilities to the public, as well as to the parties. Those responsibilities include important ethical obligations.

ETHICAL RULES FOR UMPIRES IN INSURANCE APPRAISALS

These ethical rules shall be effective as of February 5, 2020.

The Windstorm Insurance Network has committed to upholding the highest ethical standards for professionals in the insurance industry, hereby adopts the following ethical rules for umpires who have completed the Wind Umpire Certification course and who actively engage in the appraisal process as an umpire.

An Umpire shall:

  1. Be a neutral party.

  2. Have no financial interest in any involved property or the outcome of the appraisal.

  3. Disclose any previous business relationship with any party, appraiser, or attorney retained by a party.

  4. Promptly disclose any potential conflict of interest before accepting an assignment as an umpire, and notify the parties immediately if a conflict or potential conflict arises during the appraisal proceedings.

  5. Not accept any assignment that he or she is not certain he or she is qualified to handle.

  6. Confirm any fee arrangement with the parties in writing.

  7. Confirm the issues to be addressed in the appraisal in writing with the parties.

  8. Agree to inspect the property if requested to do so by either appraiser.

  9. Maintain impartiality and neutrality throughout the appraisal process and uphold the integrity of the proceedings.

  10. Share all communications with all members of the appraisal panel throughout the appraisal proceedings.

  11. Be responsible to proceed diligently to conclude the appraisal proceedings.

  12. Retain only unbiased, qualified, and impartial experts.

  13. Inquire of any retained expert as to any potential conflict of the expert.

  14. Evaluate completely all presented facts and claims.

  15. To the best of his or her ability, follow the law of the jurisdiction of the property.

  16. Withdraw from the proceedings if a conflict arises, and the conflict is not waived in writing by all parties after notice to the parties of the conflict.

  17. Not withhold signature on any appraisal award until payment for services is received.

  18. Maintain records in good order during the appraisal process in accordance with any applicable rules or guidelines for preservation once the matter is concluded.

  19. Keep true and accurate records of time, expense, and fee billings.

  20. Keep an updated list of all properties and parties for which he or she served as an umpire for a period of seven (7) years.

  21. Maintain and keep current all applicable professional licenses and continuing education requirements.

  22. Be truthful and accurate in all marketing or advertising activities.

Copyright ® Windstorm Insurance Network, Inc.

Umpire Certification

CHAPTER I: AN UMPIRE SHOULD UPHOLD THE INTEGRITY AND FAIRNESS OF THE APPRAISAL PROCESS.

A. An Umpire has a responsibility not only to the parties but also to the process of the appraisal itself. They must observe high standards of conduct so that the process’s integrity and fairness will be preserved. Accordingly, an Umpire should recognize a responsibility to the public, to the parties whose rights will be decided, and to all other participants in the proceeding.

B. One should accept appointment as an umpire only if fully satisfied:

(1) that he or she can serve impartially;

(2) that he or she can serve independently from the parties, potential witnesses, and the appraisers;

(3) that he or she is competent to serve; and

(4) that he or she can be available to commence the appraisal in accordance with the requirements of the proceeding and thereafter to devote the time and attention to its completion that the parties are reasonably entitled to expect.

C. After accepting an appointment and while serving as an Umpire, a person should avoid entering into any business, professional, or personal relationship, or acquiring any financial or personal interest, which is likely to affect impartiality or which might reasonably create the appearance of partiality. For a reasonable period of time after the decision of a case, persons who have served as Umpires should avoid entering into any such relationship, or acquiring any such interest, in circumstances which might reasonably create the appearance that they had been influenced in the appraisal by the anticipation or expectation of the relationship or interest. Existence of any of the matters or circumstances described in his paragraph C does not render it unethical for one to serve as an Umpire where the parties have consented to the Umpire’s appointment or continued services following full disclosure of the relevant facts in accordance with Chapter II.

D. Umpires should conduct themselves in a way that is fair to all parties and should not be swayed by outside pressure, public clamor, and fear of criticism or self-interest. They should avoid conduct and statements that give the appearance of partiality toward or against any party.

E. An Umpire should conduct the appraisal process so as to advance the fair and efficient resolution of the matters submitted for decision. An Umpire should make all reasonable efforts to prevent delaying tactics, harassment of parties or other participants, or other abuse or disruption of the appraisal process.

F. Once an Umpire has accepted an appointment, the umpire should not withdraw or abandon the appointment unless compelled to do so by unanticipated circumstances that would render it impossible or impracticable to continue. When an Umpire is to be compensated for his or her services, the Umpire may withdraw if the parties fail or refuse to provide for payment of the compensation as agreed. Umpires do not contravene this Chapter if, by virtue of such experience or expertise, they have views on certain general issues likely to arise in the appraisal, but an Umpire may not have prejudged any of the specific factual determinations to be addressed during the appraisal. During an appraisal, the Umpire may engage in discourse with the parties or their counsel, draw out arguments or contentions, comment on the law or evidence, make interim rulings, and otherwise control or direct the appraisal. These activities are integral parts of an appraisal.

 

CHAPTER II: AN UMPIRE SHOULD DISCLOSE ANY INTEREST OR RELATIONSHIP LIKELY TO AFFECT IMPARTIALITY OR WHICH MIGHT CREATE AN APPEARANCE OF PARTIALITY.

A. Persons who are requested to serve as Umpires should, before accepting, disclose:

(1) any known direct or indirect financial or personal interest in the outcome of the appraisal;

(2) any other matters, relationships, or interests which they are obligated to disclose by the agreement of the parties, the rules or practices of an institution, or applicable law regulating umpire disclosures.

B. Persons who are requested to accept appointment as Umpire should make a reasonable effort to inform themselves of any interests or relationships described in paragraph A.

C. The obligation to disclose interests or relationships described in paragraph A is a continuing duty which requires a person who accepts appointment as an arbitrator to disclose, as soon as practicable, at any stage of the appraisal, any such interests or relationships which may arise, or which are recalled or discovered.

D. Disclosure should be made to all parties unless other procedures for disclosure are provided in the agreement of the parties, applicable rules or practices of an institution or by law.

 

CHAPTER III: AN UMPIRE SHOULD AVOID IMPROPRIETY OR THE APPEARANCE OF IMPROPRIETY IN COMMUNICATING WITH PARTIES.

A. An Umpire or prospective Umpire should not discuss a proceeding with any party in the absence of any other party, except in any of the following circumstances:

(1) When the appointment of a prospective Umpire is being considered, the prospective Umpire:

(a) may ask about the identities of the parties, counsel, or witnesses and the general nature of the case;

(b) may respond to inquiries from a party or its counsel designed to determine his or her suitability and availability for the appointment. In any such dialogue, the prospective Umpire may receive information from a party or its counsel disclosing the general nature of the dispute, but should not permit them to discuss the merits of the case.

B. Unless otherwise provided in this Chapter, in applicable arbitration rules or in an agreement of the parties, whenever an Umpire communicates in writing with one Appraiser, the Umpire should simultaneously send a copy of the communication to other Appraisers.

 

CHAPTER IV: AN UMPIRE SHOULD CONDUCT THE PROCEEDINGS FAIRLY AND DILIGENTLY.

A. The Umpire should allow each Appraiser a fair opportunity to present its evidence and arguments.

B. An Umpire should conduct the proceedings in an even-handed manner. The Umpire should be patient and courteous to the parties, their representatives, and the witnesses; and he or she should always encourage similar conduct by all participants.

C. When the Umpire determines that more information than has been presented by the parties is required to decide the case, it is not improper for the Umpire to ask questions, call witnesses, and request documents or other evidence, including expert testimony.

D. Upon the request of either or both Appraisers, the Umpire should personally inspect any available damaged property.

 

CHAPTER V: AN UMPIRE SHOULD MAKE DECISIONS IN A JUST, INDEPENDENT AND DELIBERATE MANNER.

A. The Umpire should, after careful deliberation, decide all issues submitted.

B. An Umpire should not delegate the duty to decide to any other person.

C. An Umpire should decide all matters justly, exercising independent judgment, and should not permit outside pressure to affect the decision.

D. In the event that both appraisers agree upon a settlement of issues in dispute and request the umpire to embody that agreement in an award, the umpire may do so.

 

CHAPTER VI: AN UMPIRE SHOULD BE FAITHFUL TO THE RELATIONSHIP OF TRUST AND CONFIDENTIALITY INHERENT IN THAT OFFICE.

A. An Umpire is in a relationship of trust to the parties and should not, at any time, use confidential information acquired during the Appraisal process to gain personal advantage or advantage for others, or to adversely affect the interest of another.

B. The Umpire should keep confidential all matters relating to the Appraisal process and decision. An Umpire may obtain help from an associate, a research assistant or other persons in connection with reaching his or her decision.

C. It is not proper at any time for an Umpire to inform anyone of any decision in advance of the time it is given to all parties. It is not proper for the Umpire to inform anyone about the substance of the deliberations of the Appraisers. After an appraisal award has been made, it is not proper for an umpire to assist in proceedings to enforce or challenge the award.

 

CHAPTER VII: AN UMPIRE SHOULD ADHERE TO STANDARDS OF INTEGRITY AND FAIRNESS WHEN MAKING ARRANGEMENTS FOR COMPENSATION AND REIMBURSEMENT OF EXPENSES.

A. Certain practices relating to payments are generally recognized as tending to preserve the integrity and fairness of the arbitration process. These practices include:

(1) Before the Umpire finally accepts appointment, the basis of payment, including any cancellation fee, compensation in the event of withdrawal and compensation for study and preparation time, and all other charges, should be established.

(2) Umpires should not, absent extraordinary circumstances, request increases on the basis of their compensation during the course of a proceeding.

(3) Umpires should not withhold any decision or award pending payment by any or either party for the services of the umpire.

 

I urge any person interested in becoming an Umpire to take the certification course and then get listed in the Wind Umpire Directory.

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When does the umpire get involved in the appraisal process?

The umpire is the arbitrator, and if disagreements between the two appraisers can’t be resolved, the umpire makes the ultimate decision.

The three-person team in Appraisal:

An appraisal is concluded in an informal dispute resolution process to establish the amount of damages for an insurance claim. The availability of the appraisal process for your claim depends on your insurance policy’s terms and conditions. In short, you will need to review your insurance policy to determine if the appraisal is available and how to invoke it for your claim.

Typically, each party selects its own appraiser. Often the parties will select the adjusters they are working with. That means the insurance company will select its independent insurance adjuster, and the homeowner will select its public adjuster. If the two appraisers are unable to agree on the amount of damages, they will need to agree on a third party to serve as an umpire. In the unlikely event when the appraisers cannot agree on an umpire, a petition will need to be filed in Court for a judge to select a neutral umpire.

The Appraisal Umpire

To reach this decision, the umpire can often visit the property to see the damages, review repair estimates, and speak with the property owners, experts, or repair personnel. The umpire’s appraisal award must be signed by at least one of the appraisers to be final. Absent a showing of fraud or collusion, the umpire’s final decision will set the amount of loss.

The integrity of the Appraisal Process

As you can see, the umpire is an essential participant in the appraisal process. Given the importance, it is crucial to select the right umpire for your appraisal. Retired judges often serve as umpires for insurance appraisals. In any case, you will want to have an umpire that is familiar with the unique issues that your insurance claim presents and being a person of unquestioned ethics and honesty.

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Who chooses the umpire during an insurance appraisal process?

The two appraisers.

Most commercial policies contain language similar to the following:

If you and we fail to agree on the amount of loss, either may demand an appraisal of the loss. In this event, each party will choose a competent and impartial appraiser within 20 days after receiving a written request from the other. The two appraisers will choose an umpire. If they cannot agree upon an umpire within 15 days, you or we may request that a judge make the choice of a court of record in the state where the “premises” is located.

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How are umpires paid?

Each party will bear the other expenses of the appraisal and umpire equally.

In other words, your insurance company will hire its own appraiser, and you will engage your own appraiser. All additional costs – including the cost of the umpire – are split equally.

Payment

  • Each appraiser shall be paid by the party selecting him or her.

  • Expenses of appraisal shall be paid by the parties equally.

  • The Umpire shall be paid by the parties equally.

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