MOST IMPORTANT RECOMMENDATION:
READ & UNDERSTAND THE DUTIES AND OBLIGATIONS OF THE INSURED in the insurance policy:

GET YOUR FILE TO THE TOP OF THE CLAIMS ADJUSTER’S PILE:

Here are six key action points from a career property and casualty claims adjuster. This is how it really happens in the real world of claims adjusting investigations: 

The Duties of the Insured in Event of Loss – These are your contractual duties which you will be required to fulfill in order to gain full settlement and recovery. These stipulations are usually placed in the “General Conditions” section of the commercial insurance policy – be prepared for them – failure to plan is planning to fail. This policy is typically your only asset for recovery. Know it well.

Your Policy Design  – This is your policy Schedule of Covered Property accurate? Can you validate with your leadership, and certainly each year with your agent, that your building locations, values, and address descriptions, types of construction, etc., are accurate and match up correctly with your policy documents. These

errors could negatively impact any future recovery, substantially delay the loss investigation, and may reduce the final loss settlement. 

Replacement Cost – You must accurately maintain your RCV (Replacement Cost Valuation) on each covered building. Again, this is your contractual obligation
– not the agent‘s. You, and only you, are the insured. These key policy design components are typically the first points of scrutiny in the claims adjusting
process. 

Coinsurance Penalties – Again, we emphasize, maintaining the minimum 80% coinsurance limit of coverage for any building you desire to purchase replacement
cost on, is your contractual duty. In the adjusting process, this valuation standard is many times the first “structural analysis of coverage” in the adjusting
drama. If there is “underinsured” flaws noted, then the coinsurance penalty is applied – trust me, it’s not a happy moment. The penalty that is computed is
applied against your loss totals before the wind deductible or standard policy deductible is applied.

Preparation vs. Reaction  – Sadly, many severe property loss cases in Florida, and especially those with fiduciary responsibilities as seen with associations, tragically fall short in the adequate preparation for the bare essentials of meeting the claims adjusting strategies of the insurance company. You must know how they come to play! Your full recovery could be compromised by the following events:

1. Examinations Under Oath of the board members / officers (one at a time, and behind closed doors with a Court Reporter).
2. The carrier’s right to review seven (7) years worth of financial and property maintenance records…and yours are stored where?
3. Inadequate or faulty Proof of Loss one of most crucial documents you will be asked to officially sign and witness to as to accuracy of loss and or potential
supplemental loss recoveries. It is a legal document – don’t mess it up.

Documents Digitally Prepared Claims adjusters are rarely greeted by an association/commercial officer/owner with a flash drive or CD that contains all the
building and past property damage histories, including current digital color photographs of general property conditions – taken at least 90-days before hurricane season begins. If just these minimum loss adjusting materials were quickly given to the claims adjuster – you would smartly benefit in getting your file to the top of his pile – ready for processing upstairs to the claims department for the final victory you want to experience – a settlement payment.

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For purposes of this article I have taken the liberty to quote the Claims Administration section of the Florida Insurance Contract Statute:
Title XXXVII
INSURANCE Chapter 627
INSURANCE RATES AND CONTRACTS
627.426 Claims administration.—

(1) Without limitation of any right or defense of an insurer otherwise, none of the following acts by or on behalf of an insurer shall be deemed to constitute a waiver of any provision of a policy or of any defense of the insurer thereunder:

(a) Acknowledgment of the receipt of notice of loss or claim under the policy.
(b) Furnishing forms for reporting a loss or claim, for giving information relative thereto,
or for making proof of loss, or receiving or acknowledging receipt of any such forms or
proofs completed or uncompleted.
(c) Investigating any loss or claim under any policy or engaging in negotiations looking
toward a possible settlement of any such loss or claim.

(2) A liability insurer shall not be permitted to deny coverage based on a particular coverage defense unless:

(a) Within 30 days after the liability insurer knew or should have known of the coverage defense, written notice of reservation of rights to assert a coverage defense is given to the named insured by registered or certified mail sent to the last known address of the insured or by hand delivery; and (b) Within 60 days of compliance with paragraph (a) or receipt of a summons and complaint naming the insured as a defendant, whichever is later, but in no case later than 30 days before trial, the insurer:

1. Gives written notice to the named insured by registered or certified mail of its refusal
to defend the insured;

2. Obtains from the insured a Non-waiver Agreement following full disclosure of the specific facts and policy provisions upon which the coverage defense is asserted and the duties, obligations, and liabilities of the insurer during and following the pendency of the subject litigation; or 3. Retains independent counsel which is mutually agreeable to the parties. Reasonable fees for the counsel may be agreed upon between the parties or, if no agreement is reached, shall be set by the court.

History.—s. 475, ch. 59-205; s. 3, ch. 76-168; s. 1, ch. 77-457; ss. 2, 3, ch. 81-318; ss. 375(1st), 377, 809(2nd), ch. 82-243; ss. 53, 79, ch. 82-386; s. 97, ch. 83-216; s. 114, ch. 92-318.