By SPJ Adjusting Services | Insurance Appraisals
Insurance Appraisal Coverage Disputes: One of the most frustrating surprises to both homeowners and commercial policyholders in Texas and Louisiana property claims has to do with the fact that an appraisal cannot begin until certain “coverage questions” are sorted out. The feeling of many insureds is that appraisal solves everything instantly. However, when an insurer pushes coverage disagreements to the forefront, the whole process can stall.
At SPJ Adjusting, we repeatedly find ourselves assisting Louisiana policyholders from Lake Charles to Baton Rouge due to the carrier’s insistence that coverage must first be litigated. Understanding how this works can save months of unnecessary frustration.
Appraisal vs. Coverage: Two Different Trains That Sometime Collide
Appraisal is a process to determine the amount of loss and not whether the loss is covered.
On the other hand, coverage concerns what the policy in fact pays for, as in:
Whether the roof damage resulted from a covered peril, such as hail or wind.
Was there any preexisting degeneration?
Does the interior damage have a relation to storm-created openings?
Insurers in states like Texas and Louisiana commonly argue that coverage issues must be resolved before appraisal, while policyholders commonly argue that appraisal must be conducted forthwith. That can create the sort of tug-of-war that will continue several months.
How Insureds Can Work to Steer Clear of Appraisal Delays
Insurance Appraisal Coverage Disputes: While coverage disputes will no doubt cause delays in the appraisal process, proactive steps on behalf of policyholders often reduce unnecessary delays in reaching an appraisal. Documenting all damage immediately after a loss, maintaining clear records of contractor reports, photographs, and communications with the insurer, and knowing the policy language go a long way toward facilitating speed in the appraisal process New Orleans, Louisiana.
Policyholders must call for early engagement of appraisers and, where possible, work with their insurer to ensure that questions about coverage are reduced. Working with a knowledgeable public adjuster or an expert in appraisal, such as SPJ Adjusting, helps ensure that claims move along expeditiously, and the carriers cannot use coverage disputes as a stalling tactic.
Insurance Appraisal Coverage Disputes: How They Delay Property Claims
Both states allow appraisal, but the courts have different approaches depending on circumstances.
- Where the loss is expressly covered
The courts, in most instances, order appraisals first.
This is common after hurricanes or large Gulf Coast hailstorms where coverage is not seriously disputed.
- In case the insurer denies causation
For example:
“Your roof damage was old. It wasn’t caused by the storm.”
The courts can stay appraisal until the issue of causation has been determined.
- Coverage questions are small.
The courts normally grant motions to compel an appraisal in order to proceed with the process.
To Louisianans trying to rebuild after Hurricane Ida or multiple hailstorms, the difference is very real. A wait for a judge to decide on coverage can equate to months or an entire year lost before an appraiser ever steps foot on the property.
Why Delays are Advantageous for a Carrier
For every month wasted wrangling over coverage:
The insurer retains the money for a longer period of time
It is more costly to perform repairs.
It accelerates the deterioration of structures.
Insurance policyholders continue to face economic hardship.
Appraisal was devised as a summary process. The very advantage of such a process is lost when issues of coverage propel the matter into litigation limbo.
Why Many Louisiana Claimants Choose SPJ
SPJ Adjustment Services can assist the policyholder in a number of ways, including
Assist in preparing clean, well-documented claims.
Steer disputes into the appropriate appraisal process.
Serving as expert appraisers or umpires when the parties cannot agree.
And to ensure that the carrier does not abuse coverage disputes for purposes of delaying payment.
Insurance Appraisal Coverage Disputes From hail and hurricane losses to commercial property losses, our team has been privileged to work day in and day out with Texas and Louisiana claimants. When the insurers try to delay, SPJ helps move things forward.
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