Welcome to the first edition of The Adjuster's Advantage!
We aim to address legal and practical issues that Public Adjusters confront in adjusting losses on behalf of insureds. As an attorney with more than 30 years experience in first-party property insurance, including significant representation of insurers, I can offer insights from both sides of the aisle.
Let's begin by going back to basics and take a few minutes to think about something elementary - the policy. I consider this document to consist of two parts: (1) the Declarations Page(s) and (2) the actual policy forms. The policy provides the roadmap for the adjustment but is rarely presented by the insured at a first meeting. One of the first orders of business accordingly should be to obtain and review a complete copy of the policy, not just the Declarations pages. Why?
First of all, you want to find all the available coverages including those that may be hiding in the forms. The insurer, on the other hand, will focus on conditions, limitations and exclusions (including the "hidden pitfalls" that are still present in most policies). This is like a chess match. You need to know what they know and determine where they could be heading.
I suggest that you first verify that you have received the correct forms. Somewhere in the Declarations, perhaps even on a Supplemental Declarations page, you will find a list of the forms by number and edition date. Take the few minutes necessary to compare the forms presented to you with the list to verify that you have the correct forms with the correct edition dates. This is important, especially in the situation where the insured has been with the insurer for some time. The complete policy may be spread over several years, with only new endorsements presented at renewal, and may be impossible for the insured to reconstruct, even without a catastrophic loss. In the event of litigation, the insured will need to prove the policy. Getting a complete copy at the outset, from the insurer if necessary, before battle lines are drawn, is the easiest way to accomplish this.
Moreover, while the insurer's adjuster will be conversant with the current forms, the policy may refer to some older, now outdated forms that may provide broader coverage. You want to know this! Indeed, the forms may also provide a way around exclusions, limitations and conditions. I well remember one case in which the carrier printed the statutory 165 line policy language on the reverse side of the Declarations page in gray ink that was so light as to be almost invisible. The Court refused to enforce the terms of the statutory policy on a motion for summary judgment reasoning that the carrier could not take advantage of any provision of the policy that it did not make easily findable and readable by the insured!
I am sure you all have "war stories" on these issues and I would be happy to hear them and possibly share them with the Public Adjuster universe in future installments. If you have current issues that you would like discussed, please let us know. You can contact me by telephone (973-538-4100) or email (email@example.com). If we can help on any given case, please feel free to call.