In the event that an insurance company and policyholder disagree on the amount of damage caused by a covered event - and/or the amount of payment to settle a claim - then what is the next step?
For many claims the only available option to resolve a dispute may be a clause buried in the "Conditions" and/or "What to do after a loss," sections of the policy. It's called The Appraisal Clause - also know as The Appraisal Provision.
Usually the insurance company invokes the Insurance Appraisal Clause more often than policyholders do. Simply because they have a more educated understanding of the terms and conditions of their policies. However, policyholders can invoke the appraisal clause as well. If the insurance company has invoked the Insurance Appraisal Clause on your claim or you wish to do something about your disagreement with them, you're in the right place. It may seem difficult at first to understand. The simplest way to explain is that it's similar to arbitration. However, it's not actually an arbitration. Without getting into to much legal mumbo-jumbo, an arbitration is more like a formal legal proceeding that takes place out of a coatroom, where the appraisal process is less formal and does not require attorneys or legal type processes.
Below, you will find a typical Insurance Appraisal Clause included in most policies. As stated earlier; The appraisal clause is usually found in the "Conditions" and/or "What to do after a loss," sections of the policy. Keep in mind that policies are different in each state. Therefore, you should refer to your own policy to see if the Insurance Appraisal Clause exists or is worded differently. In most policies the Insurance Appraisal Clause will state something close to this:
|APPRAISAL - If you and we fail to agree on the amount of loss, either one can demand that the amount of the loss be set by appraisal. If either makes a written demand for appraisal, each shall select a competent, independent appraiser. Each shall notify the other of the appraiser's identity within 20 days of receipt of the written demand. The two appraisers shall then select a competent, impartial umpire. If the two appraisers are unable to agree upon an umpire within 15 days, you or we can ask a judge of a court of record in the state where the residence premises is located to select an umpire. The appraisers shall then set the amount of the loss. If the appraisers fail to agree within a reasonable time, they shall submit their differences to the umpire. Written agreement signed by any two of these three shall set the amount of the loss.
An Important Note: The insurance company must make every effort to settle a claim in a timely manner. After a policyholder advises the insurance company that they disagree with their findings, the company cannot immediately invoke the Insurance Appraisal Clause. They need to make every effort with the insured to resolve the claim. They can re-inspect the property, meet with contractors, or even have an engineer inspect the damages. Policyholders however, don't have to wait until they feel hopelessly deadlocked with the adjuster or insurance company to invoke the Insurance Appraisal Clause. The policyholder can do it any time.
Use the information here to educate yourself on the Insurance Appraisal Clause, it's advantages and disadvantages, as well as steps to take if your involved with an insurance dispute, settlement dispute, or are in need of hiring an Settlement Dispute Appraiser or an Insurance Appraisal Umpire.
Wish to speak with someone?
Confused? Have questions? How do you know unless you ask? Please feel free to contact us to have your Insurance Appraisal Clause questions answered. Or, call us directly at (919) 669-9111. We will be happy to assist you in any way we can.
We provide insurance appraisal services in North Carolina (NC), South Carolina
(SC), Georgia (GA), Florida (FL), Alabama (AL), Mississippi
(MS), Louisiana (LA), Texas (TX), Virginia (VA), Maryland
(MD), Delaware (DE), Washington DC, Pennsylvania (PA), New Jersey (NJ), New York (NY),
Ohio (OH), Kentucky (KY), Indiana (IN), and Oklahoma (OK). If you are in need of any type of Insurance Appraisal Services as outlined; please do not hesitate to contact us. We are here
to help you in any way we can.