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2020 CA Wildfires
How to Read and Understand Your Homeowners Insurance Policy
September 24, 2020Virtual Workshop/Webinarwww.uphelp.org/2020wildfires
Esta reunión cuenta con interpretación al español
Para activar la interpretación, vaya a la parte baja a la derecha de su pantalla y haga clic en el icono o símbolo global titulado Interpretación/Interpreting.
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Gracias
2020 CA Wildfires
How to Read and Understand Your Homeowners Insurance Policy
September 24, 2020Virtual Workshop/Webinarwww.uphelp.org/2020wildfires
Emily Rogan
• Senior Program Officer, United Policyholders
• 12+ years experience in disaster recovery
• Board Member, NorCal VOAD
• Board Member, San Francisco VOAD
• Former Board Member, CDI Curriculum Board
• NERT Volunteer
Housekeeping• Welcome• We are recording this educational webinar• Questions:
– Use Q&A feature for clarification– For Questions UP Roadmap to Recovery
Q&A Wednesday, September 30th at 5:30pmRegister at: www.uphelp.org/webinar_sept30
Copyright 2020. United Policyholders. All rights reserved.
About United Policyholders• 501(c)3 not-for-profit charitable organization
• A voice and an information resource for consumers in all 50 states
• A 29+ year track-record and subject matter expertise in insurance and disaster recovery
• Not for profit…not for sale
• Funded by donations and grants
• A volunteer corps with personal and/or professional expertise in disaster recovery and insurance
Copyright 2020. United Policyholders. All rights reserved.
Our Three Programs
• Roadmap to RecoveryTM
– Guidance on maximizing insurance funds, making decisions and getting back home after a catastrophic loss
• Roadmap to Preparedness– Helping households and communities reduce risk and be
resilient to disasters and adversity
• Advocacy and Action– Fighting for insurance consumer rights and protections
Copyright 2020. United Policyholders. All rights reserved.
Team UP
• Professional staff• Government and nonprofit partners• Volunteers
– Previous catastrophic loss survivors– Consumer-oriented professionals
• Lawyers• Claim Adjusters• Tax and Financial Planning experts• Construction and real Estate professionals
Copyright 2020. United Policyholders. All rights reserved.
THANK YOUFUNDERS AND PARTNERS
The Fine Print• This workshop is intended to be general
guidance only, not legal advice.• If you have a specific legal question, we
recommend you consult an experienced attorney.
• We do not endorse or warrant any of the sponsors listed at www.uphelp.org or speakers at our workshops.
Copyright 2020. United Policyholders. All rights reserved.
Today’s Topics
Copyright 2020. United Policyholders. All rights reserved.
How to Read and Understand Your Policy:
How to read your insurance policy
Determining all available benefits
Understanding lingo and claim rules
Depreciation, code upgrades, extended benefits
Best Practices
Get it in WRITING!
If not, put it in writing, back to them confirming your understanding.
Keep it professional.
Be concise and to the point.
Bold or bullet point your requests.
Use proper grammar and punctuation.
Promptly respond to letters and reasonable requests.
Avoid venting frustrations and emotions to your adjuster.Copyright 2020. United Policyholders.
All rights reserved.
Start a Claim Diary• Your claim diary will help you stay organized
and keep moving forward.• It is very likely that the first adjuster assigned to
your claim will be replaced and you’ll be dealing with others over time.
• Creating a written record prevents delays and frustration and is a paper trail of how the insurer is handling your claim.
Copyright 2020. United Policyholders. All rights reserved.
Speak “UP”• Present your requests clearly and in writing• Explain what you need, when you need it, and
why you are entitled to it• Keep a Claim Diary
– Take notes on who you talked to, the number you called, date and time, what was said. Keep all of your paperwork organized and together
• Use your “working copy” of the policy– “Can you show me where it says that in my policy?”
Copyright 2020. United Policyholders. All rights reserved.
Sandra Watts• Project Coordinator and Instructor,
Roadmap to Recovery
• 30+ years experience in Insurance claims and claims management
• Appointed Member, CA DOI Curriculum Board
• IICRC Certified Fire & Smoke and Water Restoration Technician (FSRT and WRT)
• CPIA - Certified Property Insurance Appraiser
• CPIU - Certified Property Insurance Umpire
Copyright 2020. United Policyholders. All rights reserved.
WHERE TO START? Request policy in writing - ask for a “certified” copy to be
sure it is both current and correct However, your insurer is only legally required to provide
a ”complete and accurate” copy, so accept if they send. Then CHECK IT! We are going to show you how.
Modify UP Sample letter to request your policy (Law: insurer has 30 days to provide) CDI can help if you have issues.
Make a working copy so you can highlight and write notes .
Copyright 2020. United Policyholders. All rights reserved.
UP Resources
• Sample Letter-Requesting a Copy of Your Insurance Policy
Uphelp.org/samples
• A Simplified Guide to Your Insurance Policy
Copyright 2020. United Policyholders. All rights reserved.
Mobile/Manufactured Homes
• Similar language as HO policies
• Use the same method to determine coverage
• Generally have the same 4 “buckets” of coverage (A, B, C, D)
• Valuation of damaged or destroyed home is often difficult (RC versus ACV)
• Sometimes issues over title to home
Copyright 2020. United Policyholders. All rights reserved.
Renter’s Policies• Very similar language to HO policies• Do NOT cover the structure, or exterior, of your
home• Obligation to clean and repair the structure is the
landlord’s responsibility• Coordinate with them to have building cleaned
first, then your contents, or hire same remediation firm to do at the same time.
• Remind your adjuster that the time to repair the structure is out of your control – you need ALE!
Copyright 2020. United Policyholders. All rights reserved.
A “complete copy” has:
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• Declarations Page* – showing the name of the insured, location of property, effective date, all coverage forms and limits in force for that time
• CA Residential Property Insurance Disclosure • CA Residential Property Bill of Rights• Policy form*• All Endorsements* attached (also called “riders”)• Other “Notice/compliance” pages
(*These also apply to Renter’s & Manufactured Home Policies)
DECLARATIONS• The “key” to all your insurance payments• Not all declarations look the same• They should all contain:
– Name of Insured– Location of insured property– Effective date- also called policy period– Major coverages and their limits of liability– Policy forms and endorsement forms– Deductibles (or deductibles)– Mortgagee information
Copyright 2020. United Policyholders. All rights reserved.
Copyright 2020. United Policyholders. All rights reserved.
Copyright 2020. United Policyholders. All rights reserved.
Copyright 2020. United Policyholders. All rights reserved.
Do I have ERC & Code Upgrade?
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YES
MAYBE
NO IDEA?!
CA Residential Property Insurance Bill of Rights
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A consumer is entitled to receive information regarding residential property insurance. The following is a limited overview of information that your insurance company can provide:
•The insurance company’s customer service telephone number forunderwriting, rating, and claims inquiries.
•A written explanation for any cancellation or nonrenewal of your policy.
•A copy of the insurance policy.
•An explanation of how your policy limits were established.
•In the event of a claim, an itemized, written scope of loss report preparedby the insurer or its adjuster within a reasonable time period.
•In the event of a claim, a copy of the Unfair Practices Act and, if requested,a copy of the Fair Claims Settlement Practices Regulations.
•In the event of a claim, notification of a consumer’s rights with respect tothe appraisal process for resolving claims disputes.
•An offer of coverage and premium quote for earthquake coverage, if eligible.
A consumer is also entitled to select a licensed contractor or vendor to repair, replace, or rebuild damaged property covered by the insurance policy.
Dec Page plus policy wording = your max available benefits
Copyright 2020. United Policyholders. All rights reserved.
ANATOMY OF A
POLICY
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Definitions
Coverages
Additional Coverages
Losses Insured
Losses Not Insured (Exclusions)
Loss Settlement Provisions
Conditions
DEFINITIONS• Tells us what certain words mean• If not otherwise defined, use the “common
meaning” usually found in dictionary• Some policies bold defined words• Some policies use “quotes” to identify • Some important terms: , “insured”,
“building structure” “actual cash value” and “property damage.”
Copyright 2020. United Policyholders. All rights reserved.
Definitions- Examples
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State Farm
CSAA
Nationwide
COVERAGES• Tells us what specifically is covered.• Very broad language• The letters (A, B, C, D) differ by company• Usually consists of:
– COVERAGE A – Dwelling – COVERAGE B – Dwelling Extension– COVERAGE C – Personal Property– COVERAGE D – Loss of Use (ALE)(Renter’s policies the same without Coverage A included)
Copyright 2020. United Policyholders. All rights reserved.
COVERAGE A- Examples
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In general, covers the main house, and most pay for construction materials on the premises. Some cover other attached structures, and some do not.
COVERAGE B- Other Structures• Also called “Dwelling Extension”• Usually limited to 10% of Coverage A limit• Some companies let you increase this $• What qualifies varies quite a bit by
company• Some items that are “other structures”
under one policy, might be landscaping under another policy.
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Coverage B - Examples
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Remember the definitions? Here’s when you need them! (Farmer’s Smart HO)
Combining Coverages in CA - NEW LAW!• 10103.7. In the event of a covered loss relating to a state of emergency,
as defined in Section 8558 of the Government Code, an insured under a residential property insurance policy shall be permitted to combine payments for claims for losses up to the policy limits for the primary dwelling and other structures, for any of the covered expenses reasonably necessary to rebuild or replace the damaged or destroyed dwelling, if the policy limits for coverage to rebuild or replace the primary dwelling are insufficient. Any claims payments for losses pursuant to this subdivision for which replacement cost coverage is applicable shall be for the full replacement value of the loss without requiring actual replacement of the other structures or contents. Claims payments for other structures in excess of the amount applied towards the necessary cost to rebuild or replace the damaged or destroyed dwelling shall be paid according to the terms of the policy.
• (Added by Stats. 2018, Ch. 618, Sec. 3. (SB 894) Effective January 1, 2019.)
Copyright 2020. United Policyholders. All rights reserved.
Coverage C – Contents
• Covers personal property owned by the insured while it is anywhere in the world
• In general, if you imagine taking the roof off and shaking your house, what falls out is personal property.
• Check your policy for any “off premises” coverage and/or limits
• May cover guest’s property if destroyed at your home
• Many items subject to specific coverage limitsCopyright 2020. United Policyholders.
All rights reserved.
Coverage C – Example
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Contents – Special LimitsSome common contents limits include:• Money - $150 - $500 • Securities - $1,000• Business Property - $500- $2,500• Watercraft - $1,000• Trailers - $1,000• Computers/Electronic Equipment - $5,000Other items (jewelry, firearms) have special theft limits that don’t apply
to fire.Copyright 2020. United Policyholders.
All rights reserved.
Contents – Property Not Covered • Items that are specifically insured
elsewhere (i.e. jewelry, art w/own coverage)
• Animals, birds, and fish • Property of tenants, roomers or boarders• Motor vehicles (exceptions for certain
vehicles not registered for use on roads and/or for handicapped assistance.)
• Recreational vehiclesCopyright 2020. United Policyholders.
All rights reserved.
COVERAGE D – ALE/LOSS OF USE• Coverage and limits vary by company• Check your declarations page for limits:
– “Actual Loss Sustained”– Money limit– Time limit– Money & time limit
• Check the policy for coverages:• Additional Living Expenses• Fair Rental Value• Prohibited Use / Civil Authority
Copyright 2020. United Policyholders. All rights reserved.
Coverage D – Loss of Use
Note: California law provides that for a Governor’s declared disaster your insurer must give you at least 36 months to use yourALE benefits. It does not increase the coverage limit.
Declarations + Policy = Coverage
Copyright 2020 United Policyholders All Rights Reserved
STATE FARM SAMPLE
-Actual Loss Sustained(means no $ limit!)
- To maintain YOUR standard of living.
- Standard Policy says 24 months. State Law and ENDORSEMENT extend this to 36 mo.
Farmer’s Sample Language
Copyright 2020. United Policyholders. All rights reserved.
Farmer’s Sells Several Policies, so review YOURS!
This one has both a money and a time limit. AND the damage must be to the dwelling, not off site.
ALE OR Fair Rental Value
CSAA**
YOUR OPTION
**
Copyright 2020 United Policyholders All Rights Reserved
ALE vs. FAIR
RENTAL VALUE
ALE – Actual additional costs incurred to maintain your standard of living
FRV – A negotiated amount, based upon the fair rental value of the home you lost
Check your policy to see which applies
If you don’t have FRV, you can always ASK for it – the worst is “no”
BREAK DOWN ALE LANGUAGE
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(Some policies say that it has to be YOUR property damaged – others don’t!)
If this is met, you will be owed ALE under most policies.
To become uninhabitable (unfit to live in)
Causes the residence premises (your house)
When a Loss Insured (FIRE!)
WHAT ARE YOU OWED?• INCREASED COST - over and above what you NORMALLY spend.• EXAMPLES:
– If you own your home, you must continue to pay your mortgage. Thus, rent on your temporary home is an increased cost.
– If you usually rent, and pay $1,500 per month, but now pay $2,000, the additional $500 is an increased cost
– If your monthly food costs are $500, and now you have to eat out, and your costs are $1,000, then the additional $500 is an increased cost.
– If your utility bill was $150/month, but is now included with your rent, then your insurer might deduct that since you are saving
– Your insurer will ask you to provide an estimate of the amounts you spend monthly on certain items.
Copyright 2020 United Policyholders All Rights Reserved
WHAT ARE YOU OWED?
• MAINTAIN YOUR STANDARD OF LIVING – you are entitled under the terms of your policy to live at the same standard as before the loss.
• EXAMPLES:– Single family home, condominium or townhouse, same number
of bedrooms, bathrooms, amenities, air conditioning, even a swimming pool, if you had one before!
– Same standard type of neighborhood – i.e. gated community, rural with some land, high rise, etc.
• HOW LONG?– shortest time to repair, replace or for your household to settle elsewhere. CA state law gives 24 months, with ability to have 36 months, but it is NOT automatic.
Copyright 2020 United Policyholders All Rights Reserved
WHAT QUALIFIES?• Rent for temporary housing• Renters insurance policy • Extra miles• New Account “Set up” fees at temp. housing• Photo copies and mailing expenses related to
claim• Moving costs• Pet boarding costs• Ask for their list
Copyright 2020 United Policyholders All Rights Reserved
ALE – Be Creative• ALE creativity comes into play when you are concerned
that your dollar limit won’t last the entire length of you• Beware that if you have an “Actual Loss Incurred” policy
(no $ limit) negotiations can leave you with LESS!• Ask for FRV versus “as incurred”• Negotiate a lump sum• 5th wheel or recreational vehicle• Tiny home• Other home you own • If you don’t ask, you won’t get. The worst that can
happen is they say no.
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ADDITIONAL COVERAGES
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Debris removal
Trees/Plants/Shrubs
Temporary Repairs
Refrigerated Products
DEBRIS REMOVAL• Commonly adds an additional 5% to each coverage, once the
underlying limit is exhausted (some include in limit, some higher %)• Debris removal costs are included in the estimate, until limit
reached, then it is applied• Can use private contractor, or consolidated FEMA program, at your
choice• Make sure private firm can comply with County requirements for
removal & disposal of toxic substances• Additional 5% for contents debris is often overlooked• Usually does not include any coverage for Trees/Shrubs/Plants
(unless they hit the house)• Photograph debris before it gets taken away, but be safe if sifting• Try to target still-recognizable items in photos• Save the photos where you’ll be able to find them later
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DEBRIS REMOVAL
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SAMPLE LANGUAGE:State Farm and Farmers
TREES, PLANTS
& SHRUBS
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Covers specified landscaping damaged or destroyed
Usually only covers specific perils – i.e. fire
Generally adds an additional 5% of coverage
Includes debris removal for trees
Cross reference with Debris Cov
TREES, PLANTS & SHRUBS• EXAMPLES – Liberty Mutual & Farmers
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Refrigerated Products/Food Spoilage
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If your adjuster is limiting your food loss claims based upon one of these – remind him that your loss was caused by FIRE, not by power interruption! CA is a “predominant cause” state- means they must look at whether the “most important” cause is covered.
LOSSES INSURED• Identifies what types of losses are covered• Two major methods:
1) “All Risk” or “Broad Form”All accidental, direct losses are covered, unless
specifically excluded2) “Named Peril” Lists specific “events” that are covered. Usually 16. different perilsExclusions still apply
Cov. A, B & C could use different methods- check!Copyright 2020. United Policyholders.
All rights reserved.
Losses Insured – All Risk Examples
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Losses Insured – Named Peril Example
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1. Fire or lightning2. Windstorm or hail3. Explosion4. Riot or civil commotion5. Aircraft6. Vehicles7. Smoke8. Vandalism & malicious mischief9. Theft10. Falling Objects11. Weight of ice, snow or sleet12. Accidental discharge of
water/steam13. Sudden burst of steam boiler14. Freezing15. Sudden and accidental ‘power
surge”16. Volcanic eruption
LOSSES NOT INSURED = EXCLUSIONS
• Amazingly complicated to analyze and apply in many cases- try not to get in too deep!
• Note that many policies exclude things (like code upgrades) in order to add back limited coverage somewhere else
• CA is a “predominant cause” (most important cause) state, so if that cause is covered then generally all ensuing losses that arise from it are covered – FIRE!
Copyright 2020. United Policyholders. All rights reserved.
Exclusion - Example
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LOSS SETTLEMENT PROVISIONS• Determines how your loss is to be settled• Major points are:
– Replacement Cost– Actual Cash Value
• Loss Settlement Provisions are OFTEN modified by Endorsements, so always check!
• Most policies contain language that allow reimbursement for amounts actually and necessarily spent for covered repairs, up to the policy limits.
Copyright 2020. United Policyholders. All rights reserved.
Example – Actual Cash Value
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If you see this, LOOK for an endorsement that adds replacement cost back in!Certain policies are only ACV, especially manufactured home policies.
ACV with RC paid when repairs completed –Most common
Copyright 2020. United Policyholders. All rights reserved.
POLICY ENDORSEMENTS
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When listed, become part of your policy
VERY important to have and read
Modify and/or clarify provisions
Can add or remove coverages
Can limit or expand coverages
Sometimes conflict with provisions
Ask for clarification, if it doesn’t make sense
Example – Replacement Cost
Copyright 2020. United Policyholders. All rights reserved.
State Farm FE-3422 2010
Same ACV Policy + Endorsement
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EXTENDED REPLACEMENT COVERAGE• Most HO policies sold today have “extended
replacement” provisions• These provide additional funds to replace your home
when your Coverage A limits are inadequate to repair/replace your dwelling.
• Most language is included in the Loss Settlement section, or are added by Endorsement
• The naming varies, look for “extended” “replacement”• Limits vary from 10% to 200% • Most policies apply the extended benefits only to
Coverage A.• Some policies apply ERC to A, B and C.
Copyright 2020. United Policyholders. All rights reserved.
ERC Examples
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CODE UPGRADE COVERAGE
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• Most HO Policies, but not all have some (usually 10%) coverage for CODE UPGRADES
• Some add it as an extra limit, some do not• You can purchase more (20%-50% or more)– more
important for an older home that has not been updated• Pays for upgrades to your home that you are required to
add, based upon a building ordinance or law, to bring THE HOME YOU LOST up to current codes
• Check endorsements, as policy is often modified• In CA – Insurance Code 2051.5 allows you to use this
amount to rebuild elsewhere or buy a replacement home, even if the policy says otherwise.
Code Upgrade/Ordinance & Law
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Look for words “additional amount of insurance”
Sample Endorsement- Code
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Sample Endorsement - ERC
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Sample Endorsement
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INSURANCE CODE 2051.5• Effective September 21, 2018• Sets “measure of indemnity” (what your insurer
owes you) as the cost to repair or replace the thing you lost, up to policy limits
• Expands time to collect RC to 36 months for declared emergencies
• Allows for ALE to 36 months for emergencies• Allows you to use ALL of your insurance
coverages to rebuild elsewhere or to buy a replacement home
Copyright 2020. United Policyholders. All rights reserved.
Dwelling Coverage
These are the “big ticket” items in your policy
Do the math to know your limits! – Coverage A - limits for main
dwelling– Extended Replacement?
(commonly 25%, 50% or 100%)– Debris Removal - Usually 5%
PER coverage– Code Upgrade Coverage
(Ordinance & Law)– Trees, Shrubs and Plants -
Usually 5%– Inflation Coverage to increase
all?
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INFLATION COVERAGE
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Inflation protection is not included in every policy, and when it is, is applied differently.
DO THE MATH! EXAMPLECoverage A - $500,000Inflation adjustment is 3% per year Increases limits by $15,000/ year, or $41.09/dayIf loss occurs after 180 days ($41.09 x 180) Increase is $7,397.26Adjusted Coverage A is $507,397
Extended Replacement Coverage = 25%Coverage A $507,397 x 25 % = $126,849TOTAL DWELLING Coverage Available (A + ERC) = $634,246
Debris removal is 5% of Coverage A*Coverage A is $507,397 x 5% = $25,369.85 Debris may (or may not) apply separately to each coverage – A, B, C
*To trigger the additional 5%, the base limit must be exhausted
Copyright 2020. United Policyholders. All rights reserved.
Make a chart of your max limits
Copyright 2020. United Policyholders. All rights reserved.
Claim Handling
Standards
California Fair Claims Settlement Practices Act
– 15 days to respond to communications• Email, letter, phone call
– 40 days to pay or deny claim– If unable to make decision
must send letter• What they need to make a
decision• How long they need to
make the decision• Send letter every 30 days
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Voluntary Claim Handling Reforms• If your adjuster is from out of State, they
may not know about CA laws, regulations and bulletins
• Ask if they have been trained in CA Fair Claims Settlement Practices Regulations
• Ask for an advance (in writing):- Advance of 25% of Contents Coverage- 4 months advance of Additional Living
Expense Coverage
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The flow of insurance
funds
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Advances
ACV payments when values are set
RCV payments upon proof of expenditures, replacement, repairs completed
CONSIDER:• Opening a separate bank account• Keep track insurance funds collected and
paid out• What “bucket” of coverage does each
check come out of?• Example of Insurance Accounting
Spreadsheet and ALE Drawdown Spreadsheet at: www.uphelp.org/samples
Copyright 2020. United Policyholders. All rights reserved.
Best Practices
Get it in WRITING!
If not, put it in writing, back to them confirming your understanding.
Keep it professional.
Be concise and to the point.
Bold or bullet point your requests.
Use proper grammar and punctuation.
Promptly respond to letters and reasonable requests.
Avoid venting frustrations and emotions to your adjuster.Copyright 2020. United Policyholders.
All rights reserved.
Stay Connected to Other Disaster Survivors
• Great source of information about:– Insurance– Rebuilding– Negotiation and Financial strategies– Referrals and warnings re: professionals
• Important source of emotional support– No one else understands your challenges and
emotions like another survivor
Copyright 2020. United Policyholders. All rights reserved.
Here for the long haul• UP is here to offer guidance to help you
put one foot in front of the other on YOUR path to recovery– Common Obstacles addressed in Roadmap
to Recovery Program:• Underinsurance• Lowballing • Buy vs. Rebuild• Home Inventory
Copyright 2020. United Policyholders. All rights reserved.
CALIFORNIA DEPARTMENT OF
INSURANCE
FOR FREE, PERSONAL ASSISTANCE WITH YOUR CLAIMS OR UNDERINSURANCE ISSUES
CALL US AT: 1 800 927 4357OR GO ONLINE: insurance.ca.gov
24/7 help on the web: www.uphelp.org/2020Wildfires
Claim Help for Disaster Survivorswww.uphelp.org/2020Wildfires
Links to pro-consumer Professional help: www.uphelp.org/findhelp
Sample Letters & Claim Formswww.uphelp.org/samples
“Survivor’s Speak” Tips from past disasterswww.uphelp.org/SurvivorsSpeak
Upcoming workshops and resources www.uphelp.org/2020wildfires
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Copyright 2020. United Policyholders. All rights reserved.
Stay informed
Encourage friends to sign up:www.uphelp.org/signup
• To be added to our mailing list for notices of future events and updated guidance
• To request a copy of today’s Power Point/Recording, email [email protected]
THANK YOUFUNDERS AND PARTNERS
UPCOMING WEBINARS: www.uphelp.org/2020wildfires
Roadmap to Recovery Q&A – 2020 CA WildfiresSeptember 30th @ 5:30 p.m.
Roadmap to Recovery for RentersThursday, October 1st
Navigating your Partial Loss/Smoke Loss ClaimWednesday, October 7 @ 5:30 p.m.
Navigating the “Dwelling” Portion of Your ClaimThursday, October 8th
Thank you!www.uphelp.org/signup
• To be added to our mailing list for notices of future events and updated guidance
• To request a copy of today’s Power Point/Recording, email [email protected]
R2R Guidance and Tools
“The Little Yellow Book”
email: [email protected]
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