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Frequently Asked Questions About Wisconsin Insurance Claims

Wisconsin Insurance Claims

When your home or property is damaged it can be devastating and difficult to recover from.  In most cases, people and business have insurance to help them recover after a loss.  This article is intended to provide guidance to policyholders and answer frequently asked questions about Wisconsin Insurance Claims and how to maximize your recovery after a loss.

What does my homeowner’s policy cover?

Your homeowner’s policy generally provides coverage for physical damage to your home, personal property, and other structures such as fences, garages, barns, and sheds.  Many insurance policies will also provide some coverage for landscaping such as damage to trees. For specific coverage, you will need to review the policy declarations.  Depending on your policy, you may have coverage under an all risk grant of coverage or coverage may be limited to losses that were caused by specific risks. Murdock Law has prepared an informational guide about how to read and understand your policy here

All-Risk Coverage

The most common grant of coverage for property coverage provides coverage for all risks of loss unless the policy contains a specific provision expressly excluding loss from coverage.  An example of such a provision would be as follows:

We cover You against all risks of direct physical loss . . . subject to the provisions and stipulations herein

Under this grant of coverage, the starting point is that the loss is covered and then the insurance company would have the burden to show that an exclusion would otherwise apply.

Specified Peril Coverage

Some policies such as the ISO HO-2 form limit coverage to specific risks. This type of policy only provides coverage for the listed risks, such as fire, windstorm, vandalism among others. An example of such a provision would be as follows:

We insure for direct physical loss to the property …by a peril listed below, unless the loss is excluded…

Under this grant of coverage, the policyholder would need to establish that the damage was caused by one of the listed risks.  There still may be exclusions that would limited coverage.  The insurance company would have the burden to establish that an exclusion applies.

The differences in coverage can be substantial.  For example, assume damage was caused by a deer crashing through a window.  Under an all-risk policy, the property owner would be covered but there would not be covered under a specific peril policy.

Personal Property (Contents Coverage)

Property insurance coverage also provides coverage for your personal property.  The majority of policies, however, limit personal property coverage to specific peril coverage. In addition, most policies generally limit o how much you may recover for your personal property that was damaged or destroyed when you away from home, or limit or exclude coverage for high-priced items like jewelry, antiques, art,  collectibles, business property and some electronics.

Additional Living Expense

Coverage is also provided for Additional Living Expense (“ALE”), which should pay for costs above your normal living expenses when covered loss forces you to temporarily move away from your home.  For example, many policies would provide payments for the costs of staying in a motel and the expense of eating at a restaurant if your home is destroyed by a tornado.  There may be limits on the duration you will be compensated for ALEs, and there may be limits on the dollar amounts you will receive for your ALE.

Can My Insurance Company Deny Coverage?

Yes.  An insurance company may deny claims that are not covered under the policy or excluded under the policy. In addition, or where the policyholder breached his or her own obligations under the policy.  For example, your insurance company will deny coverage if you committed arson.  That being said, many times insurance companies will wrongly deny coverage.  If you believe that coverage was wrongfully denied, it is a good idea to get legal advice. Murdock law regularly consults with policyholders who have suffered losses and has obtained coverage for losses that were wrongfully denied.  We would be happy to talk with you to determine whether you have a case. You can reach us here: 844-744-7529.

How Are Losses Paid?

There are several methods that  insurance companies use to  assign a value Wisconsin Insurance Claims:

  • Replacement Cost (“RCV”) – RCV is used as the starting point for every claim. It is this type of coverage pays what it costs to rebuild or replace your property today with materials of like kind and quality.  To obtain RCB you must actually repair or replace the damaged property

 

  • Actual Cash Value (“ACV”)– ACV pays RCV less depreciation. The idea with ACV is that you will receive compensation for the fair market value of the damaged property at the time of the loss.  For example, a roof that was 15 years old would have depreciated more than a roof that was only five years old. ACV was designed by insurance companies because they were paying for losses and the policyholders were taking the money and not repairing the proper

 

  • Guaranteed Replacement Cost (sometimes called extended replacement cost) – this coverage pays to replace your home even if it costs more than the policy limit, which is common due to inflation.  Many policies limit this coverage to a certain percentage of the cost above the policy limits.
Can I Obtain Emergency Financial Assistance after A Covered Loss?

Typically, yes. We find that this commonly occurs after fire losses and other major disaster claims where the homeowners are unable to live in their home. Most homeowners policies provide payments for your living expenses following a loss.  These payments are usually part of your homeowner’s policy coverage for ALEs. Most policies provide payments for your costs to stay in a hotel or a temporary apartment immediately following the loss. Many insurance companies will provide emergency expense coverage money to purchase lost property or make emergency repairs to your home. You will need to document your expenses. So keep your receipts!

 How can I preserve my Wisconsin Insurance Claim?

The first thing that an Insurance Dispute Lawyer will request is a copy of your policy.  Whether you are working with a lawyer, public adjuster, or doing it on your own, you should obtain a full copy of your policy and not just the policy declarations.  Read the policy as you may need to get into the nuances of the policy language when reporting the claim and negotiating for full compensation for the loss.

Document, document, document! Save your receipts for any expenses. Take photographs of the damage as soon as possible.  Sometimes insurance companies will dispute your claim and the conditions of the loss may have changed.  For example, in Hail damage claims the hail stones will melt shortly after the loss. Murdock Law was able to help  a Condominium Association obtain a recovery for their roofs for hail damage where the insurance company initially took the position that the dents where not caused by hail because the hail wasn’t big enough to cause that damage.  Fortunately, a resident had taken photos of the hail, which clearly demonstrated that the hail stones were large enough to cause the damage. We then provided a legal response, which included the photographs and forced the insurance company to change their position.  The existence of those photographs dramatically shortened the length of the dispute and avoided the need for the Association to obtain expensive expert reports to rebut the insurance company’s position.

Prompt Notification is Required

You will need to promptly report the claim in the manner specified by your policy because there may be obligations to contact your insurer within a given amount of time under your policy. If you do not act quickly, you could be hampering your ability to receive needed money as quickly as you would like it. Sometimes you may call your agent but other policies will direct you to report the claim directly to the company.

If you have an inventory of your personal property, you should provide this information to your insurer as soon as you are able to.  This will maximize your ability to receive prompt payment to repair or replace these items

What if I live in a condominium?

If you live in a condominium that is affected by a disaster, then you will have to consider two different policies.  The first will be the association policy, which typically covers the exterior and common areas of the condominium. The second is your personal condominium property policy that covers the interior of the unit as well as personal property. The typical condominium policy provides coverage that is similar to the typical homeowner’s policy,  however, the condominium association will need to present the claim for damage to the common elements of the property.

What I Live in An Apartment?

If you live in an apartment, your landlord’s policy typically coverers damage to the property.  However, you are likely more concerned about your personal property, which is generally not covered under your landlord’s policy. To obtain coverage for your personal property you will need to obtain renter’s insurance.

How do I Get an Insurance Adjuster out to My Home to Inspect the damage?

You should contact your insurance company and notify them about the loss as soon as you are able to.  If your insurance company is not responsive and does not send an adjuster to work on your claim, you may need to consult a Wisconsin Insurance Claims lawyer. If the insurance company does not appoint an adjuster to your claim, then you should request one and follow up with a written request using certified mail.

What can I do to Prepare for the Insurance Adjuster’s Inspection?

To prepare for an adjuster to come out and evaluate your property damage, you should get as much information together as you are able to.  You should also do your own investigation to determine where you believe there is damage to your property.  If possible, you should attempt to obtain cost of repair estimates in advance of the inspection.  Some insurance adjusters will try to reduce the scope of the damage by attempting

 Damage To Real Property

The first step that you should undertake is to catalog and photograph all of the areas of obvious damages to all of the structures on your property.  This will include taking pictures not only of your home, and the rooms in your home, but also outbuildings, sheds, and barns where appropriate.  It is best to have a list of areas where you know there is damage before the adjuster arrives. Insurance adjusters are not experts in evaluating whether there is structural damage to your property and they are not interested in maximizing the amount of money they authorize their company to pay. So please don’t accept their conclusions at face value.

In addition, there may also be latent damage to your property. On many losses it is advisable to work with your own contractors and experts to evaluate your property for structural damages. If your insurance company will not perform an evaluation, or if you want a separate investigation (which is your right), then you should have one performed by an independent expert. The costs of such an investigation may be covered by your policy.

In addition to investigating the structural elements of the property, you should also have systems such as the electrical and plumbing systems inspected in order to determine the extent to which they have been damaged by the disaster.  This is particularly important because many insurance policies provide coverage for damage to systems even if there is limited or excluded coverage in other areas. Most insurers will pay for such inspections and may help facilitate such inspections.  If you are having difficulties with your property insurer conducting an inspection, you should consider working with a Insurance Dispute Lawyer to facilitate a proper inspection.

Personal Property Losses

To prepare for a meeting with the adjuster is to keep an inventory of all of your possessions prior the disaster occurring. This is the best way to ensure that you have basic information to provide to the insurance adjuster about what losses you have suffered. The Wisconsin OCI has a Personal Property Home Inventory worksheet on its website that you can download here.  You should make an inventory and then update it as you acquire and get rid of certain possessions. The ideal inventory would have pictures of all of your possessions and a record of the brand name and model number of items where appropriate.  That being said, cataloging personal property does not rank very high on most people’s to-do lists and more than likely you will need to do this after the loss.  This means that you will have to attempt to substantiate your losses based on the damaged property, old receipts, bank statements, or other documentation of your personal property losses. Take photographs as you are doing this process.

Remember that all of your belongings have a cost. If you lose all of your possessions in a fire, tornado, or other disaster replacing all of those items can add up to a significant amount of money. Thus, it is imperative to have a complete list so you have the ability to recover for the loss of all your personal property.

Can I hire someone to make emergency repairs?

You can hire someone to make emergency repairs but often the insurance company will provide recommendations.  Please be advised that even if you hire the insurance company’s recommended emergency repair company, you are liable directly to that company should the insurance company deny your claim. Please review the emergency repair contracts very carefully as this is an industry that is rife with problems.

While emergency repairs are typically available to mitigate damages from the loss, most policies do not allow you to make permanent fixes to your property until after an  insurance adjuster has had an opportunity to review the damages. The adjuster may also need to evaluate the damage in conjunction with an expert to determine what repairs are even required.

What if the insurance company offers to settle my Wisconsin Insurance Claims?

Insurance companies usually separate your claims into the various categories of coverage under the policy (1) property damage to your home; (2) damage to personal property; (3) additional living expenses; and (4) emergency repairs.  The allocation is important because the payment scheme is different between the two coverages.  The check for your coverage for personal property damage will typically be made out to you, while the payment for damages to your home may be made to your lender if there is a mortgage on your house.

If you have received an advance check immediately after the disaster to cover ALEs and items such as clothing, it is vital to keep all of the receipts for these monies because they will likely be deducted from the final settlement with the insurance company.

Final Payment

If you have forgotten something on your claim you should not accept any check that is for “final payment” for your claim.  Wisconsin law does not permit any check to indicate final payment unless the policy limits have been paid or the claim is being disputed.  There are also instances where your insurer will be obligated to pay the policy limits on your behalf.  If you have forgotten an item but already accepted a check, then you should contact your insurance agent.  The insurance company should continue to pay for these items up to the policy limit.  Although it is possible for an insurance company to reopen a claim for additional payment, it is advisable to avoid this situation by filing as accurate a claim as possible based on an inventory and accurate assessment of your property losses.

Before you sign any release or waiver and before cashing any check from an insurance company, which purports to be full and complete payment of your claim, you may want to consult an attorney.  You should be aware that there are specific statutory criteria in order for there to be a final settlement of your claims, including time that payment is due by your insurer.  If you have questions, you should consult an Wisconsin Insurance Claims Lawyer. Working with an attorney can give you guidance about maximizing the value of your claim before you enter into a settlement with your insurer. The Wisconsin OCI may also be able to assist you if you have complaints against your insurance company.

 What if the Insurance Company Denies or Underpays my claim?

If you have a Wisconsin Insurance Dispute, the first step to ensure to get the insurance company’s reason in writing.  Do not accept the adjuster’s oral statement that there is no coverage.  Under Wisconsin law, insurance companies are obligated to provide a written explanation of the basis for their coverage denial.  If you are unable to resolve your dispute, you should consult a Wisconsin Insurance Claims attorney. You should also be aware that you have a limited time to bring a suit against your insurer. Unless stated otherwise in the policy, the statute of limitation is just one year from the date of the loss to bring a claim under Wisconsin law.

 What is Insurance Bad Faith?

Bad faith is the refusal to timely pay a claim or without a reasonable basis and with knowledge of or disrespect even if insurer has a reasonable basis for denial, failing to properly investigate the claim. In other words, Bad faith requires an insurance company to not only be wrong, but that the insurance company should have known it was wrong.

Bad faith claims are popular because an insurance company acts in bad faith is liable for extra-contractual damages including attorneys fees. Although commonly alleged, few Wisconsin attorneys have tried bad faith claim because the claims are procedurally difficult and are often settled well-before that they would be tried because they are typically resolved after Wisconsin Insurance Claims when litigated to completion. In this regard, Murdock Law is different, when we assert a bad faith claim we are prepared to see it all the way through and we won bad faith claims at the highest levels.

More information on insurance bad faith can be found here.

Other Resources

The Murdock Law Blog address many insurance topics and is a great resource for policyholders.  In addition, we also recommend the policyholders check out the  United Policyholders of America, which is another great resource for consumers and also provides topic specific answers for many common (and many uncommon) questions.  The Wisconsin Office of the Commissioner of Insurance (“OCI”) offers practical advice for Wisconsin Insurance Claims and is available to assist you with complaints or difficulties that you have with your insurer.  You can see the information on the web at http://oci.wi.gov.

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