• Maria Shalack

Appraisal vs. Litigation

Appraisal is an alternative dispute resolution that most insurance policies have, in which the policyholder or the insurance company can invoke, to try to agree in the amount of the loss. If the appraisers do not get to an agreement, then a neutral person, called the umpire makes the decision. It is a binding process and it is only recommended when there is a dispute on the amount of the loss, and coverage has been determined already, either by a payment made on the claim or if the damages were under the deductible.

When Appraisal is demanded, the policyholder needs an “Appraiser” to represent them in the loss, this person can be the Public Adjuster, who is very familiar with the claim. If the insurance company requests a competent or disinterested party, it is recommended you hire someone who has experience on insurance claims and that has your best interest in mind. For example, many times we are called to be appraisers in cases where the homeowner does not have a Public Adjuster in place.

I do not suggest going to appraisal if the insurance company has said that the roof is not covered but the interior damage is. Because once you go to appraisal, the outcome is binding and it is very difficult to challenge even in a court of law. Appraisal is usually faster than Litigation and the cost is minimal, so it is a good remedy when coverage is not in dispute. Be certain you hire someone who knows the process of appraisals and has experience in the industry.

Litigation is recommended when the claim has been denied or there is a coverage issue, such as the roof not being covered. The only way and the right time to get an attorney is when you are going to sue the insurance company. The attorneys can file suit and litigate the case, argue the language of the policy and attempt to hold the insurance company accountable to your claim. If the attorney is successful in getting your claim paid, in Florida the legal fees do not come out of your awarded amount. The attorney fees are paid by the insurance company separately. Oftentimes the insurance companies will settle with the lawyers at the last minute to avoid a lengthy and expensive trial.

You need to make sure the attorney has built the file and has the appropriate estimates, reports and evidence to support the claim and that all conditions of the policy have been met (for example, the Proof of Loss).

Remember that the burden of proof rest on the insured, YOU, and that is why a Public Adjuster can help you as an expert witness on the claim. When you have a Public Adjuster representing you, they are supposed to document the claim in case it ends up in litigation. Attorneys are very effective when Litigating the case if it has been properly prepared by a Public Adjuster; but, the process can be lengthy.

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