Insurance Company Requirements for Restoration Damage Claims

 

Are you experiencing a flood, water, sewage, fire, or mold damage claimrestoration company insurance claim help to your home and deciding to or have already made a claim on your insurance?

  • Maybe you just had one and do not know your insurance claim rights?
  • Maybe you are happy with the claims process but are weary if you will be treated correctly and want insurance claim help?
  • Maybe you are having problems with getting your claim paid correctly or you insurance carrier is not paying you enough money and want to know the insurance claim laws?
  • Possibly your insurance company is not following your homeowner’s insurance policy correctly or not responding to you in a timely manner?
  • Maybe you have questions about what is covered vs what is not a covered loss but your carrier is not giving you the information?
  • Maybe there is a portion of your claim that you think should be covered but your insurance carrier is not paying for it yet you don’t know the insurance regulations to back it up?

These are all example questions and concerns that we have seen from past customers for insurance claim help and the requirements for many like these are outlined below.

 

The board of regulators in the State of CA for governing homeowners and disaster insurance (among other type of insurance) is the California Department of Insurance and two of the most pertinent codes and regulations set forth by them are:

  • California Code of Regulations
  • California Insurance Code

 

Here are some pertinent, paraphrased state insurance laws and regulations from the California Department of Insurance Code of Regulations:

CA Code of Regs 2695.9

(c) Insurance companies cannot require a homeowner to use a specific entity or individual to work on the property, both on the emergency water, fire, and mold remediation side and on the reconstruction side. [This leaves the option of who to choose as the contractor up to the homeowner / policyholder].

(d) It is against insurance regulations for an insurance company (including their adjuster representatives) to suggest or even recommend that a property be worked on by a specific entity unless very specific measures are met:

(1) the policyholder (homeowner) expressly request a referral from the insurance company; or

(2) the policy holder has been given, in writing, that they have the right to choose whomever they desire to work on their home and that the insurance carrier will be required to bring the property back to pre-loss conditions using acceptable standards for good workmanlike practices.

CA Code of Regs 2695.9

(e) ….[Insurance Carriers are required] to bring the property / home back to pre-loss conditions and allow the use of a contractor that can meet “acceptable standards for good and workman like construction.” The insurance carrier must use costs for paying for the work that are “accurate and representative of costs in the local market area.”

 

And paraphrased from the California Insurance Code Section 790 – 790.15:

790.02 Insurance carriers and their representatives shall not engage in any “method of competition or an unfair or deceptive act or practice in the business of insurance.”

790.03 This section defines a “method of competition or an unfair or deceptive act or practice in the business of insurance” as:

(h) Committing or consciously participating in any of the following unfair practices when settling claims:

(6) Forcing a policyholder to collect money due for a claim themselves when it is clear that it is a covered loss. An example of this could be when a homeowner chooses a competent and licensed contractor to do work for a covered loss and the contractor uses fair pricing (e.g. using software such as Xactimate that pinpoints specific costs to different zip codes) yet the insurance company pays less. The difference in price would still be due to the contractor. But this amount is unfair to be required to be recovered by the policy holder. It is the insurance carrier’s responsibility to pay the difference in a reasonable time frame.

(12) Not settling claims promptly for a covered loss under one portion of the insurance policy coverage in hopes of influencing another portion(s) of the insurance policy coverage. An example of this could be for a flood damaged home where there are dryout needs and reconstruction needs. If the insurance carrier holds back from paying for the reconstruction in order to influence (i.e. lower) the dryout costs, this could be seen as unfair and, therefore, not allowed.

790.035 Any representative of an insurance carrier that takes part in “any unfair or deceptive act or practice defined in section 790.03” is liable to the State of California a civil penalty set by the commissioner, which can be up to five-thousand dollars ($5,000) for every infraction, or, if the practice was willful, liable a civil penalty up to ten-thousand dollars ($10,000) for every infraction. It is up to the commissioner what constitutes an infraction.

 

If you are experiencing a flood, water, sewage, fire, or mold damage restoration need and want help with your insurance claim so that your home and family are taken care of correctly, call us at 619.597.2003. We meet and guarantee all of the following:

  • Available 24/7 and can be on-site in less than one hour
  • Experienced since 2006 to get your claim paid correctly
  • Work with all insurance carriers
  • Use representative costs approved by all insurance carriers
  • Licensed General Contractor
  • IICRC (Institute of Inspection Cleaning and Restoration Certification) Certified
  • Bonded and Insured
  • Excellent standing with the BBB
  • Guarantee our work

We have found that the majority of insurance carriers follow these regulations very closely. We do, however, see instances of insurance carriers trying to “walk the line” between paying the right amount for a claim and trying to reduce the cost. We have also seen many instances where insurance carriers try to push their “approved” contractors onto a job. These are both, by definition, unfair or deceptive acts in the business of insurance and break the legal duty of insurance carriers.

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