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My Claim Number
Date:
The field adjuster just inspected your property and you’re wondering what comes next. There are many steps TWIA takes to see your claim through to completion, but there are also steps you can take to help make it go smoothly. Use this brochure to learn about the claims process and use the helpful checklist on the back to mark off tasks when you complete them.
It Starts with You We rely on you to show and tell us about the damage you have suffered. Telling us about the damage you see, along with what our field adjuster finds, will help us understand your claim. The estimate we get from the field adjuster is just a starting point, and can change based on any additional information you provide us.
Understanding Your PolicyUnderstanding your policy will help you make informed decisions and better prepare you to navigate the claims process. Knowing the amount of your deductible and which endorsements you have are especially helpful. Your agent can be a valuable resource to help you understand your insurance policy coverage. For example, while our policies allow us to pay to remove trees fallen on covered structures, it does not allow us to pay for downed trees that did not fall onto covered structures.
The Next Step
After the Check Arrives
Cash Your CheckEven if you believe your claim payment is not enough to pay for covered repairs, you should go ahead and cash the initial check right away. Cashing your check does not mean you agree that the amount is final. Any additional claim payments will be mailed to you as a supplement to your first payment. If you are satisfied with the payment you have received, you may then proceed with the repair process.
Mortgage CompanyMortgage companies generally require homeowners to carry property insurance. Due to their financial interest in an insured property they may require to be included on the policy. As a result, the mortgage company may be named on your claim payment check. Every mortgage company follows different guidelines on how to process these checks, so contact your mortgage company right away to find out how to endorse and process your claim payment check.
Certificates of Compliance (TDI will take over WPI-8-C certification responsibilities beginning June 1, 2020.) Many property repairs will require a Windstorm Certificate of Compliance (WPI-8 or WPI-8-C) to remain eligible for TWIA coverage. The Texas Department of Insurance (TDI) oversees the Windstorm Certification program and, at no cost to you, they certify ongoing repairs or improvements (WPI-8). For repairs that have already been completed, you will hire a Texas-licensed engineer to certify compliance with the building code. The engineer will apply for a certificate of compliance for a completed improvement (WPI-8-C) and TWIA will issue the certificate. To find out if your repairs or improvements require an inspection for either a WPI-8 or a WPI-8-C, and before any repairs are started, call TDI (800) 248-6032.
To-Do List: Actions you can take for your claim
Read your entire notice letter carefully
Select contractors suited for the repairs you need
Request detailed estimates from contractors
Take an inventory of your damaged personal property
Upload your contractor estimates and any additional documentation online at www.twia.org/claimscenter
Check with your contractor for necessary building permits
Your mortgage company may be included on your policy, check to see if yours is listed and if it is the correct company
If it isn’t correct, talk to your agent to get it changed
Document additional living expenses, saving all receipts
Learn about how to protect yourself from insurance fraud on our website at www.twia.org/insurance-fraud
Contact UsVisit us online:
www.twia.org
Register to use Claims Center:www.twia.org/claimscenter
Call us:(800) 788-8247
Email us: [email protected]
Mailing address:P.O. Box 99090
Austin, TX 78709-9090
Follow us:www.facebook.com/
TexasWindstormInsurance
May 23, 2019 - Version 1Disclaimer:This document is intended for educational purposes only and does not supersede your policy contract. Every claim is evaluated on its own merits and it is possible your particular claim could be handled differently.
TWIA inspected my property What’s next?
4
:
3
It is important to understand the deadlines related to the appraisal process even if you are still working with TWIA to resolve disagreements about your claim.
Talk with TWIA Please contact TWIA if you believe your claim payment is not enough to pay for covered repairs. We will work with you to address any unmet needs you have and try to provide a timely resolution. We will also try to prevent you from incurring any out-of-pocket or additional costs. Contact TWIA so we may consider any new information that could support additional payments.
Demand Appraisal Appraisal is a formal process to handle disputes about the amount TWIA will pay for your claim. Unless otherwise stated by TWIA or the Texas Department of Insurance (TDI), the deadline to demand appraisal is 60 days from the date you receive your notice letter. To demand appraisal you can use the form provided by TWIA in the notice letter, write a letter to TWIA, call your claims examiner, or send an email to [email protected]. Include your claim number and indicate that you are demanding appraisal. Keep a copy for your records.
In appraisal, you and TWIA each hire a competent and independent person to determine the amount of the loss owed under the policy. If there are still disagreements between the two appraisers, the appraisers will submit to an umpire they choose. The final appraisal decision is binding on you and TWIA. You can only appeal the appraisal decision based on specific conditions outlined in your policy. Please note, the appraisal process is used to resolve only the part of the damage covered by TWIA. The appraisal process cannot be used to dispute damage not covered under the policy.
Do BothTWIA will always try to address any unmet needs you have, and working directly with TWIA can prevent out-of-pocket costs from the appraisal process. However, if you do not demand appraisal before the deadline, you will lose the right to challenge the amount TWIA estimated for your covered damage. If you are still not satisfied with your payment after discussing it with TWIA, you must demand appraisal before the deadline indicated in your policy and notice letters to preserve your rights. You may want to do both.
What to Expect from TWIA
The TWIA claims examiner is a trained professional licensed by the state of Texas. The claims examiner works in our offices and manages your claim. The claims examiner is your primary TWIA contact for the life of your claim.
The TWIA claims examiner reviews the field adjuster’s report and estimate along with weather reports and any additional documents. It is the claims examiner’s job to determine what is and what is not covered by the policy. They will be the
person determining if the property is a total loss. Your claims examiner will contact you to discuss your claim, issue any payment due, and answer any of your questions.
You may work with more than one claims examiner because our staff works as a team to help your claim move quickly. If you are unhappy with or have difficulty reaching your claims examiner please email [email protected] so we may find a solution that works for you.
Claims Examiners: Your primary person of contact for your claim
Field Adjusters: Inspect your property and create reports and estimates for TWIA
Within 60 days of receiving your claim, TWIA is generally required to make a determination on your claim and send you a letter stating the decision. The amount of time it takes us to complete this process depends on how much information we have available to us. We do this as quickly as possible and you can typically see a result sooner than 30 days. The notice letter we send to you will be titled either: Notice of Claim Acceptance, Notice of Claim Denial, or Notice of Claim Acceptance in Part and Denial in Part. Read this letter in full as it explains how TWIA reached its decision.
Your claims examiner will reach out to you and let you know of TWIA’s decision on your claim. If TWIA determines you have damage covered by your windstorm policy, you will either receive a check from TWIA or a notification that the loss is less than your deductible and there will be no payment.
Estimates and Documentation
Even though the field adjuster prepared an estimate on the cost to repair your property, it is still important to request your own estimates. Talk to qualified contractors who are willing to perform your repairs and ask them to provide you with a detailed estimate. You can even provide them with the estimate you receive from TWIA. Send us any estimates you receive for review. This will help TWIA resolve any discrepancies between your submitted estimates and the estimates provided by the field adjuster.
Before any repair work begins, walk around your property and take photos of the damage. Sometimes you may find something that you weren’t aware of before, and it helps us process your claim more quickly if we see your documentation. It also helps to take a personal property inventory - write down what you have and what is damaged. You can find a form to use online at www.twia.org/ppif. Do NOT repair, replace, or dispose of any damaged items
before discussing it with your claims examiner. You can upload your detailed estimates from contractors and any additional documentation to our online Claims Center or email them to [email protected].
Additional Living Expenses (ALE)ALE is additional coverage you can purchase. If you are not able to live in your house because of damage caused by wind or hail, ALE reimburses you for additional necessary and reasonable costs for housing and other needs. The ALE endorsement helps you maintain a normal standard of living. This coverage is only available for your primary residence.
You Only Need One ClaimIf you find additional damage, contact us. You do not need to open a new claim. If you have already filed a claim with us we will add the newly discovered damage to the claim we are currently working on.
If You Disagree with TWIA’s Claim Decision
Field adjusters are not authorized to: Confirm or deny coverageDeclare total losses Recommend contractors for temporary or permanent repairs
Who You Will Work With
Field adjusters are authorized to: Inspect, document, and photograph your propertyCreate reports and estimates for TWIA
The TWIA field adjuster is a state-licensed property adjuster who has also received TWIA training. They will inspect your property and take photos of damaged and undamaged areas. Based off their documentation, they will prepare damage estimates and send those reports to TWIA. They are only there to obtain information about your property’s damage. They cannot make any decisions on your claim. Any questions about your claim should be directed to your claims examiner.
Other Experts We may also send engineers or other experts to inspect your property. These experts help us answer more complicated questions about the damage and repairs to your property. The experts provide us with facts about what caused the damage, the extent of the damage, and the cost to repair it. This helps us determine what damage is and isn’t covered and how much the repairs will cost.
2
✓✓
xxx
3
It is important to understand the deadlines related to the appraisal process even if you are still working with TWIA to resolve disagreements about your claim.
Talk with TWIA Please contact TWIA if you believe your claim payment is not enough to pay for covered repairs. We will work with you to address any unmet needs you have and try to provide a timely resolution. We will also try to prevent you from incurring any out-of-pocket or additional costs. Contact TWIA so we may consider any new information that could support additional payments.
Demand Appraisal Appraisal is a formal process to handle disputes about the amount TWIA will pay for your claim. Unless otherwise stated by TWIA or the Texas Department of Insurance (TDI), the deadline to demand appraisal is 60 days from the date you receive your notice letter. To demand appraisal you can use the form provided by TWIA in the notice letter, write a letter to TWIA, call your claims examiner, or send an email to [email protected]. Include your claim number and indicate that you are demanding appraisal. Keep a copy for your records.
In appraisal, you and TWIA each hire a competent and independent person to determine the amount of the loss owed under the policy. If there are still disagreements between the two appraisers, the appraisers will submit to an umpire they choose. The final appraisal decision is binding on you and TWIA. You can only appeal the appraisal decision based on specific conditions outlined in your policy. Please note, the appraisal process is used to resolve only the part of the damage covered by TWIA. The appraisal process cannot be used to dispute damage not covered under the policy.
Do BothTWIA will always try to address any unmet needs you have, and working directly with TWIA can prevent out-of-pocket costs from the appraisal process. However, if you do not demand appraisal before the deadline, you will lose the right to challenge the amount TWIA estimated for your covered damage. If you are still not satisfied with your payment after discussing it with TWIA, you must demand appraisal before the deadline indicated in your policy and notice letters to preserve your rights. You may want to do both.
What to Expect from TWIA
The TWIA claims examiner is a trained professional licensed by the state of Texas. The claims examiner works in our offices and manages your claim. The claims examiner is your primary TWIA contact for the life of your claim.
The TWIA claims examiner reviews the field adjuster’s report and estimate along with weather reports and any additional documents. It is the claims examiner’s job to determine what is and what is not covered by the policy. They will be the
person determining if the property is a total loss. Your claims examiner will contact you to discuss your claim, issue any payment due, and answer any of your questions.
You may work with more than one claims examiner because our staff works as a team to help your claim move quickly. If you are unhappy with or have difficulty reaching your claims examiner please email [email protected] so we may find a solution that works for you.
Claims Examiners: Your primary person of contact for your claim
Field Adjusters: Inspect your property and create reports and estimates for TWIA
Within 60 days of receiving your claim, TWIA is generally required to make a determination on your claim and send you a letter stating the decision. The amount of time it takes us to complete this process depends on how much information we have available to us. We do this as quickly as possible and you can typically see a result sooner than 30 days. The notice letter we send to you will be titled either: Notice of Claim Acceptance, Notice of Claim Denial, or Notice of Claim Acceptance in Part and Denial in Part. Read this letter in full as it explains how TWIA reached its decision.
Your claims examiner will reach out to you and let you know of TWIA’s decision on your claim. If TWIA determines you have damage covered by your windstorm policy, you will either receive a check from TWIA or a notification that the loss is less than your deductible and there will be no payment.
Estimates and Documentation
Even though the field adjuster prepared an estimate on the cost to repair your property, it is still important to request your own estimates. Talk to qualified contractors who are willing to perform your repairs and ask them to provide you with a detailed estimate. You can even provide them with the estimate you receive from TWIA. Send us any estimates you receive for review. This will help TWIA resolve any discrepancies between your submitted estimates and the estimates provided by the field adjuster.
Before any repair work begins, walk around your property and take photos of the damage. Sometimes you may find something that you weren’t aware of before, and it helps us process your claim more quickly if we see your documentation. It also helps to take a personal property inventory - write down what you have and what is damaged. You can find a form to use online at www.twia.org/ppif. Do NOT repair, replace, or dispose of any damaged items
before discussing it with your claims examiner. You can upload your detailed estimates from contractors and any additional documentation to our online Claims Center or email them to [email protected].
Additional Living Expenses (ALE)ALE is additional coverage you can purchase. If you are not able to live in your house because of damage caused by wind or hail, ALE reimburses you for additional necessary and reasonable costs for housing and other needs. The ALE endorsement helps you maintain a normal standard of living. This coverage is only available for your primary residence.
You Only Need One ClaimIf you find additional damage, contact us. You do not need to open a new claim. If you have already filed a claim with us we will add the newly discovered damage to the claim we are currently working on.
If You Disagree with TWIA’s Claim Decision
Field adjusters are not authorized to: Confirm or deny coverageDeclare total losses Recommend contractors for temporary or permanent repairs
Who You Will Work With
Field adjusters are authorized to: Inspect, document, and photograph your propertyCreate reports and estimates for TWIA
The TWIA field adjuster is a state-licensed property adjuster who has also received TWIA training. They will inspect your property and take photos of damaged and undamaged areas. Based off their documentation, they will prepare damage estimates and send those reports to TWIA. They are only there to obtain information about your property’s damage. They cannot make any decisions on your claim. Any questions about your claim should be directed to your claims examiner.
Other Experts We may also send engineers or other experts to inspect your property. These experts help us answer more complicated questions about the damage and repairs to your property. The experts provide us with facts about what caused the damage, the extent of the damage, and the cost to repair it. This helps us determine what damage is and isn’t covered and how much the repairs will cost.
2
✓✓
xxx
My Claim Number
Date:
The field adjuster just inspected your property and you’re wondering what comes next. There are many steps TWIA takes to see your claim through to completion, but there are also steps you can take to help make it go smoothly. Use this brochure to learn about the claims process and use the helpful checklist on the back to mark off tasks when you complete them.
It Starts with You We rely on you to show and tell us about the damage you have suffered. Telling us about the damage you see, along with what our field adjuster finds, will help us understand your claim. The estimate we get from the field adjuster is just a starting point, and can change based on any additional information you provide us.
Understanding Your PolicyUnderstanding your policy will help you make informed decisions and better prepare you to navigate the claims process. Knowing the amount of your deductible and which endorsements you have are especially helpful. Your agent can be a valuable resource to help you understand your insurance policy coverage. For example, while our policies allow us to pay to remove trees fallen on covered structures, it does not allow us to pay for downed trees that did not fall onto covered structures.
The Next Step
After the Check Arrives
Cash Your CheckEven if you believe your claim payment is not enough to pay for covered repairs, you should go ahead and cash the initial check right away. Cashing your check does not mean you agree that the amount is final. Any additional claim payments will be mailed to you as a supplement to your first payment. If you are satisfied with the payment you have received, you may then proceed with the repair process.
Mortgage CompanyMortgage companies generally require homeowners to carry property insurance. Due to their financial interest in an insured property they may require to be included on the policy. As a result, the mortgage company may be named on your claim payment check. Every mortgage company follows different guidelines on how to process these checks, so contact your mortgage company right away to find out how to endorse and process your claim payment check.
Certificates of Compliance (TDI will take over WPI-8-C certification responsibilities beginning June 1, 2020.) Many property repairs will require a Windstorm Certificate of Compliance (WPI-8 or WPI-8-C) to remain eligible for TWIA coverage. The Texas Department of Insurance (TDI) oversees the Windstorm Certification program and, at no cost to you, they certify ongoing repairs or improvements (WPI-8). For repairs that have already been completed, you will hire a Texas-licensed engineer to certify compliance with the building code. The engineer will apply for a certificate of compliance for a completed improvement (WPI-8-C) and TWIA will issue the certificate. To find out if your repairs or improvements require an inspection for either a WPI-8 or a WPI-8-C, and before any repairs are started, call TDI (800) 248-6032.
To-Do List: Actions you can take for your claim
Read your entire notice letter carefully
Select contractors suited for the repairs you need
Request detailed estimates from contractors
Take an inventory of your damaged personal property
Upload your contractor estimates and any additional documentation online at www.twia.org/claimscenter
Check with your contractor for necessary building permits
Your mortgage company may be included on your policy, check to see if yours is listed and if it is the correct company
If it isn’t correct, talk to your agent to get it changed
Document additional living expenses, saving all receipts
Learn about how to protect yourself from insurance fraud on our website at www.twia.org/insurance-fraud
Contact UsVisit us online:
www.twia.org
Register to use Claims Center:www.twia.org/claimscenter
Call us:(800) 788-8247
Email us: [email protected]
Mailing address:P.O. Box 99090
Austin, TX 78709-9090
Follow us:www.facebook.com/
TexasWindstormInsurance
May 23, 2019 - Version 1Disclaimer:This document is intended for educational purposes only and does not supersede your policy contract. Every claim is evaluated on its own merits and it is possible your particular claim could be handled differently.
TWIA inspected my property What’s next?
4
:
