Nov

28

Filing an Appeal to a Flood Claim Settlement

Tagged Under : Claim Settlement, Settlement

The third in a series of articles on appealing a National Flood Insurance Program claim settlement

In the two previous articles of this series we have looked at whether you can file an appeal on a flood insurance claim without the aid of a lawyer or public adjuster and how to begin the process. If you are just joining, it may be preferable to review the first two articles now:

  • Article One: Do I Need a Public Adjuster to Appeal My Flood Insurance Claim?
  • Article Two: Preparing to Appeal a Flood Insurance Adjuster’s Damage Estimate.

The estimate of flood damages presented you by the flood insurance adjuster simply is not enough to cover the repairs you must make. You are certain of that, at least certain enough to feel you should fight for more funds. You have discussed the shortfalls with the IA, as the independent adjuster contracting with the insurance company is known. Your case for more funds has fallen on deaf ears, or at the least you have received unsatisfactory explanations regarding the estimate.

After following the steps outlined in article two of this series, noted above, you are ready to file a formal appeal to FEMA. Take heart, you may rest assured you will get someone’s attention. As a federal program, the National Flood Insurance Program (NFIP) is mandated to respond to appeals that go to FEMA or your Congressman. It may take a little time, but when you have submitted your appeal in the manner outlined by the program, you will always get results. You might not receive the additional funds you request, depending on coverage and other details of your situation, but you will receive attention and an answer.

The following information is taken from the Claims Handbook, published by FEMA and available at http://www.floodsmart.gov. In your letter of appeal to FEMA, include the following items:

  • Your policy number shown on the declarations page of your policy
  • The policyholder’s name, shown as the Named Insured on the Declarations Page
  • The address of the insured property
  • Contact numbers if you are displaced from your home
  • Details of your concerns
  • Dates of contact and details of contact for everyone you have spoken with in attempting to resolve your concerns prior to filing this appeal (see article two).

Write your letter formally, leaving the emotion out and being sure to state clearly what you are appealing. You are going to need to support everything you ask for with documentation, so be on solid ground. Don’t ask for things that are excluded in the policy (hot tubs, say), and be specific about items and prices.

Outline what the IA submitted in his estimate and show why that is inadequate. Your letter is only the beginning of this process, but look on it as the first impression you will make on a judge who is trying your case. Be professional, courteous and knowledgeable.

I suggest that you do enough study in the policy, which can be downloaded from the web site mentioned above, to be sure you’re on solid ground in the things you are requesting. It also is a good idea, unless you’re a strong writer, to have someone with good writing skills review and edit your letter for clarity and correctness.

When you feel you have made a strong outline of your case, round up your supporting documentation. This includes everything that pertains to the disputed areas of your loss. If you have photographs that portray the damages in question, by all means include them in some form, the more the better.

If you have reached the point of appeal, you probably have a contractor’s estimate that differs significantly from that of the adjuster. Include the estimate and any information on the contractor that would lend credibility to his opinion: how many years in business; references, areas of expertise. A letter from the contractor to FEMA is not a bad idea, too, if he or she can briefly outline the main difficulties they would face in trying to make repairs with the funds recommended by the adjuster.

The documentation you need will depend on the specifics of your appeal. Send only those things that pertain to the dispute. Receipts are always strong documentation. The policy states that you are entitled to replacement of damaged property in like kind and quality.

It does not specify prices, which are dependent upon local conditions, among other factors. This means that if the IA has recommended replacing your doors for $130 each but you have already spent $180 each, you can probably collect the greater amount if the new door does not represent an upgrade and you have receipts to show the actual cost.

Receipts are the single most effective form of documentation you can provide. Unless you are replacing vinyl floor covering with ceramic tile, say, which would be an upgrade that is not covered, a receipt for funds paid is almost bullet-proof.

You might also want to consider other cases similar to yours in presenting your appeal. If there are neighbors who have similar homes and received about the same amount of damage, their estimates might—and I repeat, might—be relevant. Worth considering, anyway.

FEMA will likely want to send an NFIP General Adjuster to re-inspect your property after receiving your appeal. You must cooperate in this process, and remember, the General Adjuster is the person who will make the decision on whether your appeal has merit, so courtesy is never a bad idea.

Once the General Adjuster has submitted his report to FEMA, it will run through a series of reviews and considerations before a decision is issued to the insurance company, who will notify you.

Several restriction on appeals exist, including that if you have sued the insurance company, you have lost the ability to file an appeal. These restrictions are outlined in the Claims Handbook mentioned above and I strongly recommend reading it.

Should you be dissatisfied with the results of the appeal and still believe you are in the right, a lawsuit is not prevented by having filed an appeal. You must file any such suit within one year of the time you received the insurance company’s denial letter and the appeal process does not extend that one-year period.

Filing an appeal to your flood claim might not get you everything you request. But it will clearly lay out why you are not getting it and you will at the least ease the anger of feeling as though no one is considering your side.

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