Help with insurance claim

do not trust your insurance company


THE CLAIMS PROCESS


LRG, or the Policyholder, notifies the insurance company a loss has occurred. This step is often called "filing a claim" or "making a claim." It's important to notify the insurer as soon as possible, as many policies have time limits for reporting claims. Often times, the Insured will first contact LRG, and we take care of filing the claim on their behalf.

LRG will review the insurance policy to determine applicable coverage, deductibles, and how other policy conditions may apply. Details regarding application coverage are often discussed with the Policyholder to ensure they have a clear understanding of how the policy works.

When LRG is retained immediately following a loss, we often inspect before the adjuster working on behalf of the insurance company. Otherwise, the insurance company will inspect for covered damage and determine how much money, if any at all, you are due. LRG inspections include detailed documentation of damage, which may include, but is not limited to thermal imaging, moisture readings, photo documentation, material identification, dimensioning, and expert reports. 

LRG utilizes the same estimating software that most insurance companies use. In creating our own estimate, we strive to make sure all relevant items are included. LRG estimates are extremely thorough, and provide a more detailed breakdown than those of insurance companies. This helps ensure that LRG clients are paid for everything. That is always our goal.

Once estimates are completed, all supporting documentation, and estimates are presented to the insurance companies for payment of the covered loss. 

Even though LRG will have provided substantial documentation of the loss, often the insurance companies will not be in full agreement. LRG will continue negotiating on behalf of the Insured from start to finish. It is the duty of the Policyholder to prove the damage being claimed. LRG relieves you of this task.

Settlement is contingent on the Insured and Insurer reaching a final agreement. While LRG will advise, offer input, and recommendations relating to settlement, the final decision ALWAYS belongs to you, the Policyholder.

COMMON QUESTIONS


This question is probably asked more than any other. Unfortunately, there is no set standard as this often depends on your insurance company. If you are willing to accept a lot less money than you are due, the process would be faster. Why? Because this would be a huge benefit to the insurance company. The problem is this; when you present a well documented claim for damages, it often is much more than the insurance company wants to pay. They will often spend a lot of time trying to save their company money.

Every state has their own laws that apply. The following is from the TEXAS INSURANCE CODE.

Sec. 542.055. RECEIPT OF NOTICE OF CLAIM. (a) Not later than the 15th day or, if the insurer is an eligible surplus lines insurer, the 30th business day after the date an insurer receives notice of a claim, the insurer shall:

(1) acknowledge receipt of the claim;

(2) commence any investigation of the claim; and

(3) request from the claimant all items, statements, and forms that the insurer reasonably believes, at that time, will be required from the claimant.

(b) An insurer may make additional requests for information if during the investigation of the claim the additional requests are necessary.

(c) If the acknowledgment of receipt of a claim is not made in writing, the insurer shall make a record of the date, manner, and content of the acknowledgment.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.

Sec. 542.056. NOTICE OF ACCEPTANCE OR REJECTION OF CLAIM. (a) Except as provided by Subsection (b) or (d), an insurer shall notify a claimant in writing of the acceptance or rejection of a claim not later than the 15th business day after the date the insurer receives all items, statements, and forms required by the insurer to secure final proof of loss.

(b) If an insurer has a reasonable basis to believe that a loss resulted from arson, the insurer shall notify the claimant in writing of the acceptance or rejection of the claim not later than the 30th day after the date the insurer receives all items, statements, and forms required by the insurer.

(c) If the insurer rejects the claim, the notice required by Subsection (a) or (b) must state the reasons for the rejection.

(d) If the insurer is unable to accept or reject the claim within the period specified by Subsection (a) or (b), the insurer, within that same period, shall notify the claimant of the reasons that the insurer needs additional time. The insurer shall accept or reject the claim not later than the 45th day after the date the insurer notifies a claimant under this subsection.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.

Sec. 542.057. PAYMENT OF CLAIM. (a) Except as otherwise provided by this section, if an insurer notifies a claimant under Section 542.056 that the insurer will pay a claim or part of a claim, the insurer shall pay the claim not later than the fifth business day after the date notice is made.

(b) If payment of the claim or part of the claim is conditioned on the performance of an act by the claimant, the insurer shall pay the claim not later than the fifth business day after the date the act is performed.

(c) If the insurer is an eligible surplus lines insurer, the insurer shall pay the claim not later than the 20th business day after the notice or the date the act is performed, as applicable.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.

There is no accurate answer. People are dropped by their insurance companies on a regular basis. The good news is that there are plenty of companies that will be waiting in line to offer coverage.

When is the last time you realized a decrease in premiums? The truth is that insurance premiums are constantly increasing regardless of your individual claim history. You are paying for their promise to protect your property; don't be afraid to use the product you purchased from them. Otherwise, what good does it to have insurance at all?

In most cases, no; you do not need their approval. The terms and conditions of your policy give you the right to do so.

As a matter of fact, almost every single insurance policy has a condition stipulating the Insured has a duty to mitigate. Remember......the policy is what determines coverage; not the insurance adjuster sent out to inspect your property.

Yes...you have the right to choose your own contractor. You are not obligated to use anyone provided by the insurance company.

It depends on the conditions of your policy and applicable state law. Usually 2-3 years.

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