SoCal 2007 Wildfire Roadmap to Recovery: Legal Issues & Scopes of Loss December 12, 2007 Rancho Bernardo Community Presbyt...
Disclaimer: <ul><li>The information provided here is intended for general educational purposes  and should not be construe...
Underinsurance 101 <ul><li>If the dollar limits in your policy will not cover the cost of putting you back where you were ...
Underinsurance is a challenging problem and there is no “one size fits all” solution <ul><li>It is such a common problem a...
Your policy is a legal contract  <ul><li>It gives you and your insurance company rights  and  responsibilities </li></ul><...
Your goal is to be effective in claim settlement negotiations <ul><li>Insurance policies are contracts written by insuranc...
Pace yourself and resist being rushed or pressured <ul><li>Insurers frequently extend policy deadlines and relax requireme...
Create a paper trail, even if it’s not your normal “m.o.” <ul><li>Confirm representations and agreements in writing despit...
Go up the chain of command <ul><li>Write letters to your adjusters’ supervisors, their supervisors, and even the President...
Scope of Loss <ul><li>WHAT :  Defines, describes, details “as it was” dwelling loss </li></ul><ul><li>WHY :  A foundation ...
Get independent estimates and opinions on repairs <ul><li>If insurance company adjusters or contractors offer to settle ba...
Xactimate:  Machine vs. Man <ul><li>Most adjusters use Xactimate to generate dwelling loss estimates and settlement offers...
Our heartfelt thanks to: <ul><li>Tonight’s speakers </li></ul><ul><li>UP Mentors and Sponsors </li></ul><ul><li>The Rancho...
Reserve slides
Did you know? <ul><li>Under CA. law, your insurance company cannot require you to use a specific professional to repair/re...
Contractor scams are very common after disasters <ul><li>Before you hire a contractor, check their customer references and...
Six basic steps if you suspect or know that you're underinsured:  <ul><li>Step One :   Calculate  the total scope and amou...
Underinsurance RX “to do” recap: <ul><li>Network with others insured with your same company </li></ul><ul><li>Visit “Under...
Introduction to Gafcon Wildfire Presentation
Competitive Bid Estimating Litigation Support Estimating
Preparing a Scope of Loss  Estimate and Why
Documentation
Check List of Finishes for a Single Family Residence EXTERIOR FINISH Did/Does the exterior of the home have any siding?  I...
Quantity Survey
Develop Unit Costs
Smith Residence Date:  January 1, 2008 1234 Front Street  Estimated Cost of Replacement Description QTY Unit Unit Cost Tot...
Smith Residence Date:  January 1, 2008 1234 Front Street  Estimated Cost of Replacement Description QTY Unit Unit Cost Tot...
General Requirements
Smith Residence Date:  January 1, 2008 1234 Front Street Estimated Cost of Replacement Description QTY Unit Unit Cost Tota...
Overhead Profit
Building Plan Check and Permit Fees  Architectural and Engineering Fee
The American Society of Professional Estimators - ASPE Forensic Expert Witness Association - FEWA Forensic Consultants Ass...
www.gafcon.com SAN DIEGO     IRVINE     LOS ANGELES 701 B Street, Suite 1600     San Diego, CA 92101 Contact Maryssa Pt...
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Meeting 2: Legal Issues and Scopes of Laws

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Meeting 2: Legal Issues and Scopes of Laws

  1. 1. SoCal 2007 Wildfire Roadmap to Recovery: Legal Issues & Scopes of Loss December 12, 2007 Rancho Bernardo Community Presbyterian Church www.unitedpolicyholders.org
  2. 2. Disclaimer: <ul><li>The information provided here is intended for general educational purposes and should not be construed as legal advice . </li></ul><ul><li>Today’s speakers are invited speakers volunteering their time as educators. </li></ul><ul><li>Neither United Policyholders nor the Rancho Bernardo Community Presbyterian Church endorse or warrant the presentations or services of any volunteer speakers. </li></ul>
  3. 3. Underinsurance 101 <ul><li>If the dollar limits in your policy will not cover the cost of putting you back where you were before a loss, you are underinsured . </li></ul><ul><li>As many as 90% of those who suffered loss in Firestorm 2007 may be underinsured in one or more categories (dwelling, contents, ALE, other structures, etc.) </li></ul><ul><li>Strategic negotiation and litigation are your two main options. </li></ul>
  4. 4. Underinsurance is a challenging problem and there is no “one size fits all” solution <ul><li>It is such a common problem after large- scale disasters that UP has an entire section of our website devoted to the subject.    </li></ul><ul><li>UP’s Executive Director is in active discussions with the CA. Ins. Comm’r, private attorneys and insurer representatives to help 2007 wildfire survivors who are underinsured. </li></ul><ul><li>Go to the &quot;Claims Tips“ section at www.uphelp.org and find &quot;Underinsurance Help“ </li></ul>
  5. 5. Your policy is a legal contract <ul><li>It gives you and your insurance company rights and responsibilities </li></ul><ul><li>Cooperation, documentation, investigation </li></ul><ul><li>Do not do any of the following without first checking with an attorney who has experience representing policyholders: </li></ul><ul><ul><li>Sign &quot;releases&quot; or waivers </li></ul></ul><ul><ul><li>Give a recorded statement </li></ul></ul><ul><ul><li>Submit to an Examination Under Oath </li></ul></ul>
  6. 6. Your goal is to be effective in claim settlement negotiations <ul><li>Insurance policies are contracts written by insurance company lawyers.  </li></ul><ul><li>Legal arguments can strengthen your negotiating position.  </li></ul><ul><li>Read the CA. Fair Claims Regulations and/or consult with a lawyer to develop a strategy , and then use legal advice and arguments to convince your insurance company to change its position without getting involved in a lawsuit. </li></ul>
  7. 7. Pace yourself and resist being rushed or pressured <ul><li>Insurers frequently extend policy deadlines and relax requirements for proofs of loss </li></ul><ul><li>By law you have up to 24 months of ALE (LOU) benefits </li></ul><ul><li>The CDI may help you get time extensions if your insurer unreasonably refuses </li></ul><ul><li>You may feel frustrated and powerless at times, but you are NOT. The laws that protect you give you power. </li></ul><ul><li>A catastrophic insurance claim can take two plus years to get fully and fairly settled </li></ul>
  8. 8. Create a paper trail, even if it’s not your normal “m.o.” <ul><li>Confirm representations and agreements in writing despite the hassle </li></ul><ul><li>Use your insurance CLAIM DIARY. Record everything between you and the insurance company.  </li></ul><ul><li>Write short, to-the-point letters to your adjuster outlining issues that need to be resolved that are delaying settlement of your claim.  </li></ul><ul><li>Put reasonable deadlines in your letters telling the insurance company when you expect a reply.  (i.e., “Please respond no later than fourteen business days from the date on this letter).  </li></ul><ul><li>Refer to the CA. Fair Claim Settlement Practice regulations as often as they apply </li></ul><ul><li>  </li></ul>
  9. 9. Go up the chain of command <ul><li>Write letters to your adjusters’ supervisors, their supervisors, and even the President or CEO of the insurance company.   Follow up by phone. </li></ul><ul><li>Read the wording of the specific exclusions or limitations that the insurance company is relying on.  </li></ul><ul><li>Read the whole policy and whatever brochures or sales materials you can get your hands on.  You may find words that show they promised or owe more benefits than they’re offering.  </li></ul>
  10. 10. Scope of Loss <ul><li>WHAT : Defines, describes, details “as it was” dwelling loss </li></ul><ul><li>WHY : A foundation for settling dwelling claim </li></ul><ul><li>HOW : Should be independent/objective </li></ul><ul><li>A scope of loss is not the same as an estimate </li></ul><ul><li>A scope of loss should allow estimates to be prepared and compared “apples to apples” </li></ul><ul><li>A scope of loss is the basis for an independent, credible repair/replacement estimate </li></ul>
  11. 11. Get independent estimates and opinions on repairs <ul><li>If insurance company adjusters or contractors offer to settle based on computer-generated or “lowball” estimates, get independent estimates from qualified local builders or construction professionals and read our FAQs. </li></ul><ul><li>Aim for estimates that can be compared side by side with your insurers’ estimates. </li></ul>
  12. 12. Xactimate: Machine vs. Man <ul><li>Most adjusters use Xactimate to generate dwelling loss estimates and settlement offers </li></ul><ul><li>Pricing often low, too generic </li></ul><ul><li>Estimates look good on paper but are often inaccurate </li></ul><ul><li>Computers don’t build houses </li></ul>
  13. 13. Our heartfelt thanks to: <ul><li>Tonight’s speakers </li></ul><ul><li>UP Mentors and Sponsors </li></ul><ul><li>The Rancho Bernardo Community Presbyterian Church </li></ul>
  14. 14. Reserve slides
  15. 15. Did you know? <ul><li>Under CA. law, your insurance company cannot require you to use a specific professional to repair/replace your property? Reg. 2695.9 </li></ul><ul><li>Under CA. law your insurance company must give you copies of estimates and other documents in your claim file? Ins. Code sec. 2071 and Reg. 2695.9 (d) </li></ul><ul><li>Under CA. law your insurance company must respond to your calls and letters within 15 days? Reg. 2695.5 </li></ul>
  16. 16. Contractor scams are very common after disasters <ul><li>Before you hire a contractor, check their customer references and their license status online with the Contractors State Licensing Board www.cslb.ca.gov </li></ul><ul><li>or call: 1-800-321-CSLB (2752) </li></ul>
  17. 17. Six basic steps if you suspect or know that you're underinsured: <ul><li>Step One :  Calculate the total scope and amount of your losses in each major category: (Dwelling, Contents, ALE, Other Structures, and Debris Removal).  If your insurer sold you a “replacement cost” policy, your total losses are what your coverage limits should have been.   </li></ul><ul><li>Step Two :  Remember and reconstruct as best you can the history of how your limits were set. </li></ul><ul><li>  </li></ul><ul><li>Step Three :  Consult with previous disaster survivors and at least one experienced policyholder attorney with the goal of getting a realistic assessment of your chances of convincing your insurer to pay more than your stated policy limits.   </li></ul><ul><li>Step Four: Choose your words carefully. Consult with an experienced policyholder attorney before allowing your insurer to interview you, take your recorded statement or examine you under oath.  Your own words can unintentionally harm your chances of getting paid in full.  Go to &quot;Find Help&quot; at www.unitedpolicyholders.org as a starting point to find the right lawyer. </li></ul><ul><li>Step Five: Make a clear, written demand that your insurance company honor the promises it made to put you back where you were before a loss.   </li></ul><ul><li>Step Six: Go on record.  File a complaint with the California Department of Insurance.  Keep your complaint simple and general.  Don't go into specifics about your dealings with the agent/broker/insurance company.  Identify your company and the approximate amount of the shortfall. </li></ul>
  18. 18. Underinsurance RX “to do” recap: <ul><li>Network with others insured with your same company </li></ul><ul><li>Visit “Underinsurance Help” at www.uphelp.org </li></ul><ul><li>Start at the “Find Help” section of www.uphelp.org to find qualified professional help </li></ul><ul><li>Pursue all avenues to get the insurance company to cooperate informally </li></ul><ul><li>If you have a strong case, use our civil justice system – it’s a cornerstone of our democratic system. </li></ul><ul><li>If you do not have a strong case, pursue alternatives </li></ul><ul><li>  </li></ul>
  19. 19. Introduction to Gafcon Wildfire Presentation
  20. 20. Competitive Bid Estimating Litigation Support Estimating
  21. 21. Preparing a Scope of Loss Estimate and Why
  22. 22. Documentation
  23. 23. Check List of Finishes for a Single Family Residence EXTERIOR FINISH Did/Does the exterior of the home have any siding? If yes, what locations? If yes, what species or composite (Wood composite, Cementitious, redwood, cedar or spruce)? If yes, what style of siding (Totem, tongue and grove or lap siding? Did the exterior of the home have stucco? If yes, what locations and dimensions per elevation? Did/Does the exterior of the home have any veneer installed over stucco? If yes, what type - Brick, Stone, other? If yes, what locations? Does the exterior of the home have any wood trim? If yes, what widths and lengths? If yes, is the wood trim over stucco or siding, is it around windows and doors etc?
  24. 24. Quantity Survey
  25. 25. Develop Unit Costs
  26. 26. Smith Residence Date: January 1, 2008 1234 Front Street Estimated Cost of Replacement Description QTY Unit Unit Cost Total Wall Framing 2&quot; x 4&quot; Wood stud wall, exterior 2,750 SFSA $1.95 $5,363 2&quot; x 4&quot; Wood stud wall, interior 1,845 SFSA $1.95 $3,598 Blocking 4,595 SFSA $0.25 $1,149 1/2&quot; CDX Sheathing with shear nailing 2,750 SF $1.30 $3,576 8&quot; x 8&quot; Exterior post 10 LF $15.25 $153 Subtotal-Wall Framing 2,731 SF $5.07 $13,839
  27. 27. Smith Residence Date: January 1, 2008 1234 Front Street Estimated Cost of Replacement Description QTY Unit Unit Cost Total Landscaping Amendments/Top soil 2,500 SF $0.60 $1,500 Ground Cover 500 SF $1.25 $625 Sod 2,000 SF $0.70 $1,400 1 gallon trees/scrubs 1 EA $15 $15 5 gallon trees/scrubs 100 EA $30 $3,000 15 gallon trees/scrubs 4 EA $125 $500 Specimen trees, 24” box 11 EA $300 $3,300 Specimen trees, 36” box 3 EA $750 $2,250 Specimen trees, 48” box 4 EA $1,500 $6,000 Sub-Landscaping $18,590
  28. 28. General Requirements
  29. 29. Smith Residence Date: January 1, 2008 1234 Front Street Estimated Cost of Replacement Description QTY Unit Unit Cost Total General Requirements Supervision Superintendent, part time 5 MO $3,250 $16,250 Safety & Fire Control First aid locker 1 EA $75 $75 Safety equipment & supplies 5 MO $50 $250 Fire extinguishers 2 EA $150 $300 Subtotal - Safety & Fire Control $625 Temporary Utilities Temporary electricity 5 MO $150 $750 Temporary telephone 5 MO $200 $1,000 Temporary construction water 5 MO $100 $500 Temporary Toilet 5 MO $175 $875 Temporary hand washing station 5 MO $200 $1,000 Sub-Total Temporary Utilities $4,125
  30. 30. Overhead Profit
  31. 31. Building Plan Check and Permit Fees Architectural and Engineering Fee
  32. 32. The American Society of Professional Estimators - ASPE Forensic Expert Witness Association - FEWA Forensic Consultants Association - FCA American Association of Cost Engineers - AACE
  33. 33. www.gafcon.com SAN DIEGO  IRVINE  LOS ANGELES 701 B Street, Suite 1600  San Diego, CA 92101 Contact Maryssa Ptacnik with any questions at 619.231.6100 ext 1251 or email at mptacnik@gafcon.com

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