Indemnification is the most important word in insurance. The following is something I COPIED YEARS AGO
First, what is Insurance
Of all the billions of dollars that are spent on insurance policies every year, hardly anyone could define what it is or how it works. It is rare when we meet someone that has ever bothered to read even one of the several insurance policies that they own. This is regrettable, because consumers are paying a lot of money for something, and they assume they know what they’re getting – but unfortunately, they actually have no clue. Consumers expect the adjuster, the claims professional, to be the expert regarding their insurance-related issues
Insurance is coverage (by a contract) where one party (the insurance company) undertakes to indemnify or guarantee another (the policyholder) against loss caused by a specified contingency or peril (event). The very word “Insurance” comes from the Latin word for “Security”. The word “Policy” comes from the Italian language meaning “Promise.” So, a property policy is a contract where an insurance company (carrier) promises to indemnify insureds (policyholders). It’s nothing more than a promise. That is why carriers acting in good faith is so critical. More on that in a moment.
A simple analogy here is helpful. At its most basic, insurance is nothing but a transfer of risk. Imagine a quarterback passing a football to a receiver downfield. In this analogy, the consumer is the quarterback, the football is the risk of a financial loss from some event occurring (house fire, storm damaging your roof, an auto collision, etc…) and you are passing the football – transferring the ‘risk’ of a financial calamity happening to another – to your insurance carrier (the receiver). The receiver (your carrier), promises to catch the ball and carry it downfield (protecting you from potential financial ruin).
Simply stated, Insurance is a societal mechanism for spreading the chance of financial loss among a large number of people. By purchasing insurance, a person/entity shares risk with a group of others, reducing the individual’s potential for disastrous financial losses. Let’s take the expansive definition of insurance we gave in the introduction and break it down: A system of indemnification creating a hedge of protection against the potential risk of financial loss (for a sudden & accidental, covered loss) from a named peril using a legal contract purchased by an insured (policyholder who has an insurable interest) from an insurer (insurance company), that transfers said risk from the inured to the insurer (carrier) and ultimately to a large group (policyholders), who agree to share the financial losses in the form of premium payments in exchange for said premium and a duty of care.
That’s certainly a mouthful. Let’s break it down:
Indemnification: Indemnification is the basis and foundation of insurance coverage. The objective is that the insured should neither reap economic gain nor incur a loss if adequately insured. This objective requires that in the event of a covered loss, the insured receives a payment equal to that of the covered loss (minus deductible) so that the insured will be restored to the same financial position after the covered loss as before the loss.
Who is covered? Good question – the Insured is obviously covered, but other Insured’s may become covered depending on definitions in the policy or circumstances. On property losses, the Insured will be named on the declarations page in the policy or in the definitions. Regular resident’s are typically considered an insured. In liability claims, other individuals other than named Insureds, may be covered as specified in the policy language.
covered for what type of loss? If you are handling property losses, physical damage to covered property will be the covered loss. In liability claims here someone is suing the insured due to their negligence; the loss can be both property damage and/or bodily injury.
because of what? It may be a storm, fire, lightning, explosion, or number of other named, covered perils. In auto policies, the covered loss is either a collision or an other-than-collision incident (i.e., tree falls on auto).
up to how much money? The covered loss is limited to the dollar amount specified in the policy limits with the exception of automobile physical damage and workers compensation claims. Under no circumstances, does a policy pay more than the policy limits, barring suit.
how is the amount determined? The policy language will dictate how to calculate the value of the covered loss. Some policies pay replacement cost, some actual cash value, while others pay the stated value of the loss. Read the ‘Loss Settlement’ provision
What conditions must exist for a loss to be a covered loss? As one might expect, not all losses are covered losses. If you are adjusting claims long enough, you will encounter a situation where no coverage exists. In such cases, we must recommend to the carrier that they deny the claim. Let’s face it, either the loss is a covered loss, or it is not – as simple as that!
What the Heck is an Adjuster Anyway? In general, all claims adjusters take care of the part of insurance that customers really care about – getting paid when they have a claim. Many people come into CAT adjusting from a construction, remodeling, or contracting background. These are excellent backgrounds for CAT adjusting. The reason for the term adjuster is that when an insured makes a compelling argument that your estimate be increased to pay for legitimate and reasonable items, that you adjust your estimate accordingly.
If your insurance company denied your property claim, we are here to help. We fight for our clients to maximize your insurance claim so that you can get the repairs completed on your home or business.
KNOW YOU LOCAL BUILDING CODES
Carriers can often miss items or omit them due to lack of knowledge when it comes to what is required by your local building codes. So many Contractors end up doing the required work for free because they don’t request the Carrier pay for these items or maybe the Contractor is unaware of what is allowed.
Ordinance or Law Coverage – coverage for loss caused by enforcement of ordinances or laws regulating construction and repair of damaged buildings. Standard Homeowners policies include a provision granting a limited amount of building ordinance coverage; this amount can be increased by endorsement. Also referred to as building ordinance coverage.
When an Insurance policy includes Ordinance and Law coverage, the Carrier is required to allow repairs to be performed to the building code requirements adopted by the city, county or state the property is located in. Items such as ice and water, drip edge, house wrap, flashings etc. can often be excluded from the Carriers estimate, yet Contractors are required to install or replace them.
Taking the time to research building codes, Manufacturer requirements, or asking your local Building Inspectors questions will pay dividends when requesting the Carrier to pay for what is owed.
Also, it is wise to review your personal policy to see if you have Ordinance or Law coverage included. Not having Ordinance or Law coverage could result in costly out of pocket expenses or could be the difference between a full replacement of a roof or siding and an unsightly repair. Reach out to your Insurance Agents to add this to your policy if you don’t already have it.
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