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Your Rights and Duties Under the Policy

Updated: Feb 19


Your right to have your own representative


I often have insureds ask me if the insurance company will be retaliatory if they hire a company or Public Insurance Adjuster to represent them. Although I would like to say no, that is often not true. I see the opposite and not always because a Public Adjuster was hired, but because they filed a claim. What I tell the insured looking for assistance is that they are entitled to representation and as long as their claim is legitimate, there should be no harmful repercussions by doing so. Texas Department of insurance puts out a document that comes yearly with your policy premium renewal notice. This document is important and you should read it carefully. It is called the Consumer Bill of Rights. The following is an excerpt taken from the Consumer Bill of Rights-Homeowners, Dwelling and Renters Insurance put out by Texas Department of Insurance.


PROPERTY CONDITION. Voluntary Inspection Program: You have the right to

have an independent inspection of your property by any person authorized by the

Commissioner of Insurance to perform inspections. Once the inspector determines that

Your property meets certain minimum requirements and issues you an inspection

certificate, no insurer may deny coverage based on property conditions without

reinspecting your property. If an insurer then denies coverage, the insurer must identify,

in writing, the specific problem(s) that makes your property uninsurable, You can find a list of available inspectors on the TDI website at ww.tdi.texas.gov/company/vipagnt.html or you can contact TDI) for the list directly at

I-8OO-252-3439


Property Conditions may affect your insurability


Under your policy, you are required to maintain your property. For example, many of my clients have no idea that their roofs need maintenance and by a licensed Roofer/contractor. Not everyone who is doing work on properties is qualified or understands all the complexities required to keep the elements out of your home. For example, in El Paso, many residential properties have roof wall intersections where the roof and the wall meets. These areas need to be flashed properly. Without proper flashing many properties leak. It is equally important to replace flashing with new flashing with each re-roof. I often hear it is not necessary and flashing can be reused but how do you ensure that you are going to put the roofing nails back in the same holes? Do you want to take that chance? Did you know that your policy covers all flashing to be replaced during a re-roof? Did you know that the International code minimum requirements state flashing needs to be replaced? What we see during our inspections is a lot of tar and granules used to hide the missing flashing, counterflashing or weep screed required to be applied to stucco at roof wall intersections. We see termination bars used improperly on parapet walls where parapet wall flashing should be brought over the outer edge of the parapet wall and stucco removed and replaced.

Putting termination bars instead of installing parapet wall flashing of materials over the whole parapet wall and over 2" is not doing the insured justice and creating a problem and future maintenance requirements of having to apply epoxy etc.




Photo above is an example of roof wall intersections that require flashing such as step, L flashing, kick out diverters & counterflashing.


INSPECTION OF YOUR PROPERTY:

Your insurance company has the right to inspect your property. They must let you know and schedule with you. It is not appropriate for them to show up without notice. The following is also the case. If the insurance company reduces your coverage, they must do the following. This is an excerpt from the Consumer Bill of Rights;


NOTICE OF REDUCED COVERAGE. If an insurer uses an endorsement to

reduce the amount of coverage provided by your policy, the insurer must give you a

written explanation of the change made by the endorsement. The insurer must provide

the explanation not later than the 30th day before the effective date of the new or renewal

policy. An insurance company cannot reduce coverage during the policy period unless

you request the change. If you request the change, the company is not required to

provide notice.


Cancellation, Non Renewal or to Determine Renewal Premiums


USE OF CLAIMS HISTORY TO NONRENEW OR DETERMINE RENEWAL

PREMIUM. Your insurance company cannot use claims you filed as a basis to

nonrenew your policy unless:

• you file three or more claims in any 3 year period: and

• your insurer notified you in writing after the second claim that filing a third claim

could result in nonrenewal of your policy

Your insurance company cannot use the following types of claims to determine the

number of claims you have filed or to determine your premium if your policy is renew ed:

• claims for damage from natural causes, including weather-related damage:

appliance-related water damage claims where the repairs have been inspected and certified: or

claims filed but not paid or payable under the policy.

NOTE: An insurance company can count appliance-related claims if three or more such claims are filed and paid within a 3-year period.


Property Inspections (during claims):

During property inspections, after a claim is filed, the following are conditions that may trigger underwriting to evaluate your insurability;

  • house or property has been left untidy, dirty or in a bad state of repair.

  • you failed to mitigate your damage. ie. tarp where shingles are missing

  • failed to stop the leak from continuing

  • failed to call a mitigation company to evaluate and minimize damage.

  • hazardous situations that cause increase in liability. ie. aggressive dogs, exposed wires etc.

Below are examples of what can cause non renewal or cancellation of policies.


Add a Closing


Insurance coverage has become more convoluted with coverages that have diminished over time and premiums as well as deductibles that are rising.


By this point it should be very apparent that having your own representative or advocate is a necessity if not a wise step to take when it comes to insurance claims handling. If you think you need someone to assess your situation and are not sure if you should file a claim, then using a Public Adjuster is a no brainer as we will review your prior claims, inspect your property and make recommendations if there are maintenance issues. We will file the claim for you if your have a legitimate claim to pursue. If not, we will give you feedback and our recommendations and you will owe us nothing. Public Adjusters work contingency. Our value far outweighs the small fee that they charge. If you feel you have been underpaid, denied inappropriately or need a second opinion. Please call us at our number on the front of our website and we will be happy to assist you if we can. 1-800-517-8006


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