Seitlin Was Awarded Top Insurance Firm in South Florida by Business Leader Media

Seitlin was awarded the "2011 Best Insurance Firm" award by Business Leader Media. The annual industry awards dinner were held in May in Miami with over 400 attendees.  Other industry winners included Perry Ellis, Greenberg Traurig, the University of Miami and Blue Cross and Blue Shield.  This was a great honor for Seitlin and is reflective of the dedication and professionalism of our 125 associates in South Florida.

CLAIMS: The Insurer’s Obligations, the Agent’s Role

[For Claim Reporting contacts, visit Seitlin.com]

Insurance policies are contracts. Both parties to the contract [the insured and the insurer] have rights and duties [obligations] pursuant to the contract.

We discussed some of the insured’s most important claim-related obligations in the preceding document AFTER THE STORM –MAXIMIZING YOUR CLAIM RECOVERY. What about the insurer; what are its claim-related obligations?

First, the insurer is obligated to pay for loss or damage as more fully described and limited in the insurance policy. For example, the ISO Commercial Property Building and Personal Property Coverage Form states:

“We [the insurer] will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss.”

Second, the insurer must comply with relevant principles of contract law and applicable Florida State Statute.Most important here is Florida Statute 626.9541:

"(1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE ACTS.

(i) Unfair claim settlement practices

3. Committing or performing with such frequency as to indicate a general business practice any of the following:

a. Failing to adopt and implement standards for the proper investigation of claims;

b. Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue;

c. Failing to acknowledge and act promptly upon communications with respect to claims;

d. Denying claims without conducting reasonable investigations based upon available information;

e. Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed;

f. Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement;

g. Failing to promptly notify the insured of any additional information necessary for the processing of a claim; or

h. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.”

Third, the insurer has to be wary of Florida Statute 624.155. Essentially, 624.155 gives the insured a “hammer” as follows:

“(1)Any person may bring a civil action against an insurer when such person is damaged:

(a)By a violation of any of the following provisions by the insurer:

1.Section 626.9541(1) (i)

(b) By the commission of any of the following acts by the insurer:

1. Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests;

2.Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made; or

 

3. Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage. Notwithstanding the provisions of the above to the contrary, a person pursuing a remedy under this section need not prove that such act was committed or performed with such frequency as to indicate a general business practice.”

 

In summary, given all of the above, the insurer must investigate, adjust and settle with its insured as required by the insurance contract and the law.

 

Seitlin’s role

 

Generally, independent insurance agents lack contractual or legal authority to:

• Conclusively construe insuring agreements and other policy terms and condition
• Investigate and pay claims
• Commit the insurer to any course of action

Specifically, our contracts with various insurers are in line with the foregoing and, while holding us to certain basic standards of performance, e.g. provide accurate information to the insurer, are expressly drafted by the insurers to recognize Seitlin as the insured’s representative.

Given these limitations, we function as our client’s troubleshooter and advocate, doing whatever we reasonably can to compel insurers to live up to their contractual and statutory obligation to adjust and settle claims.

How do we accomplish that?

• Maintain a staff of experienced Claim Consultants who understand the claims process from beginning to end;
• Focus on problem cases, becoming involved as soon as a client makes us aware that the insurer is not performing as required;
• Develop an in-depth understanding of the critical issues by communicating with adjusters, claim managers, executive management and attorneys;
• Devise and work to implement alternative claim management strategies as dictated by the facts;
• Realizing that coverage is the major factor in many claim-based disputes, remain current with Florida law as it relates to insurance coverage and approach coverage from a law of contracts perspective, using rules of policy analysis and interpretation to the client’s benefit where possible;
• Explain claim and legal issues to client personnel as needed to help them navigate through the claim process as easily as possible

Conclusion

We’ve reviewed the claims landscape from MAXIMIZING YOUR CLAIM RECOVERY; PRE-LOSS STRATEGIES to AFTER THE STORM –MAXIMIZING YOUR CLAIM RECOVERY, all in light of THE INSURER’S OBLIGATIONS, THE AGENT’S ROLE.

We hope some or all of this information will be of benefit to you, ultimately helping to put more money in your pocket if a loss occurs. If you have any questions, concerns, comments or suggestions, please contact Seitlin.

Maximize Your Claim Recovery: After the Storm

[For Claim Reporting contacts, visit Seitlin.com]

You’ve sustained a major loss, perhaps as a result of a fire or hurricane. Now what?

1. The typical Commercial Building and Personal Property Coverage Formimposes a number of Duties in The Event Of Loss or Damageon the insured, including:

“Give us [the insurer] prompt notice of the loss or damage. Include a description of the property involved.”

Simply stated, one of your first calls after the loss occurs should be a report of claim to the insurer, either direct to the insurer or via Seitlin. Don’t wait for perfect information; the insurer will work with you to fill in any gaps. Instead, report what you know now.

2. Here’s another Duty imposed by the policy:

“As soon as possible, give us a description of how, when and where the loss or damage occurred.”

This information can be provided as part of the first report if available, or as it becomes available. Again, the key is to get the information to the insurer as soon as you can.

3. The policy also requires the insured to try to prevent further loss or damage:

“Take all reasonable steps to protect the Covered Property from further damage, and keep a record of your expenses necessary to protect the Covered Property, for consideration in the settlement of the claim.”

In a nutshell, you must do what you reasonably can, as quickly as you can, to protect the property from further damage. This might include temporary repairs, e.g. boarding up broken windows, or beginning cleanup, e.g. drying out wet carpet and drywall, or moving undamaged property to a secure location out of harm’s way. DO NOT make permanent repairs to your damaged property unless the adjuster has reviewed your claim and given you permission to proceed.

Recall this excerpt from the first document in this series, MAXIMIZING YOUR CLAIM RECOVERY; PRE-LOSS STRATEGIES:

Have you identified and made arrangements with localcontractors, including restoration contractors,tobegin cleanup, make temporary repairs, andsalvage equipment and other propertythat can be saved? This could include "drying out" the premises, moving salvageable property to another location, and separating out property that is a total loss.

To reiterate: do what you can prior to the loss to be prepared to discharge your duties after the loss.

Remember too that Insurers tend to pay these post-loss, mitigation-related expenses as incurred as long as they aren’t exorbitant in light of the circumstances. Keep good records of your expenditures and present them to the insurer early on. An “advance payment” in reimbursement of the expenses is likely.

4. As an adjunct to the protection of covered property and minimization of the loss, the policy also requires the following:

“Also, if feasible, set the damaged property aside and in the best possible order for examination.”

In addition, take photographs of all damaged property, real and personal, right after the loss to the extent possible with safety foremost in mind. This will enhance the presentation of your claim and assist the adjuster in his or her investigation.

 

5. Generally, an insured has the burden to establish coverage under the policy and the amount of the covered loss. Seitlin personnel will help you to establish coverage but providing sufficient documentation in support of the claim is something the insured should be prepared to do. This will likely be the most time consuming and difficult part of the process.

 

The insurer will work with you to establish the amount of the loss but the policy imposes several Duties in this context:

 

“At our request, give us complete inventories of the damaged and undamaged property, including quantities, costs, values and amount of loss claimed.”

 

“As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records.”

 

“Also permit us to take samples of damaged and undamaged property for inspection, testing and analysis, and permit us to make copies from your books and records.”

 

Returning again to MAXIMIZING YOUR CLAIM RECOVERY; PRE-LOSS STRATEGIES, we posed these questions:

 

6. Do you maintain a continuously updated inventory of all your business personal property, including documentation [receipts, photos] to prove the existence of the property?

 

7. Do youback up data,including business and accounting records,regularly and maintain the back up data in a secure offsite location?

 

It should now be clear that your business records will be invaluable in expediting the settlement of your claim. Spending some time before a loss occurs with your post-loss Duties in mind will facilitate the discharge of those duties.

 

8. Finally, keep this Duty in mind:

 

“Cooperate with us in the investigation or settlement of the claim.”

You must cooperate with the insurer, e.g. by providing the documentation and access they are entitled to. If you don’t, the settlement process will grind to a halt. The vast majority of insurers want to work with their insuredsto arrive at a fair settlement as quickly as possible. However, insurers are very willing to wait indefinitely to get information they are reasonably entitled to.

We encourage our clients to take the path of least resistance, i.e. work with, not against the insurer. However, disputes can and do arise. In that case, it’s important to understand two things:

1. What are the insurer’s obligations to its insured in a claim context? And,

2. What is Seitlin’srole?

For an in-depth analysis of these issues, please proceed to the final document in the series, THE CLAIM PROCESS; THE INSURER’S OBLIGATIONS AND THE AGENT’S ROLE.

Maximize Your Claim Recovery: Pre-Loss Strategies

[For Claim Reporting contacts, visit Seitlin.com]

A prompt, fair settlement of a first party property insurance claim primarily depends on two things; sufficient insurance coverage and sufficient documentation to establish the amount of the loss.

Coverage is fixed; there is nothing you can do to change it to your benefit after a loss occurs. Therefore, you should focus on the things you can influence or control, e.g. avoidance, mitigation and documentation as more fully described below, to enhance the final outcome after a claim is submitted.

It’s especially important to do what you can “pre-loss” to be prepared to move forward quickly after a loss occurs, including discharge of your duties under the policy; see the next document in the series AFTER THE STORM –MAXIMIZING YOUR CLAIM RECOVERYfor more on this issue.

Are you prepared to move forward in the optimal manner after a loss? The answers to the following questions may help you to determine your state of readiness. “No” answers are not the ideal and may indicate a “preparedness gap.” We recommend taking action as follows to close the gap before a loss occurs.

1. Avoiding a loss is the best strategy. Have you done everything you can do to avoid or minimize a loss, e.g. alarms, sprinklers,hurricane shutters orimpact resistant glass, upgrading structures to meet the current building code?

2. Do your contracts include aclause that shields you from liability for damages if you are unable to perform your contractual obligations as a result of events or forces beyond your control?

3. Have you assigned internal responsibility for handling the claim with the insurer and communicating with corporate management, especially if multiple locations are involved?

4. Do you keep a list of relevant insurance policies and related information including:

• Contact information for your Seitlin agent
• Insurer names, policy numbers, policy periods, deductibles and coverage limits
• Instructions for contacting insurers directly if your Seitlin agent is unavailable

You should keep a copy of your completed list both on and off premises.In addition, provide your Seitlin agent with contact information for your key personnel.

5.  Do you have contingency plansfor securing essential services at your current location if services are disrupted? Will a generator be available? Can you obtain internet and phone service by satellite or other means? Have you secured access to fuel for your fleet?

6. Assuming you can't continue operating at your current location,have you made arrangements to operateatanother location?

7. Haveyou identifiedequipment dealers or leasing companieswho can providenecessary equipment to keep your business going in the short term and provide replacement equipment going forward?

8. Have you identified and made arrangements with local contractors, including restoration contractors,tobegin cleanup, make temporary repairs, and salvage equipment and other propertythat can be saved? This could include "drying out" the premises to avoid mold, moving salvageable property to another location, and separating out property that is atotal loss.

9. Do you maintain a continuously updated inventory of all your business personal property, including documentation [receipts, photos, video records] to prove the existence of the property?

10. Have you identified the best sources for replacement of your business personal property?

11. Do you back up data,including business and accounting records,regularly and maintain the back up data in a secure offsite location?

Seitlin personnel are ready to assist you with pre-loss preparation. Please contact Seitlin with any questions or concerns you may have.