THINGS YOU NEED TO KNOW ABOUT INSURANCE:

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Insurance policies are considered legal “contracts” between you and your insurance company, and they are NOT simple documents to read and understand. Commonly, upon receipt, home and business owners rarely read their policies, and simply trust their insurance company to cover them for all perils under all conditions. After a damage claim arises, it is too late, all the insurance provisions are “set in stone Regarding the insurance contract, do you know the meaning of the following terms: “under insured”, “80% co-insurance clause”, “appraisal”, “matching”, “ACV”, “depreciation withholding”, “cosmetic damages”, “dwelling”, “other structures”, “exclusions”, “loss of use”? Norm Jones, of our business “LoneStar Pro Adjusters, has been involved in the insurance claims business since September 17, 1989 when a category 4 hurricane by the name “Hugo”, devastated St. Croix, US Virgin Islands. Norm assisted about 50 of his law clients in processing huge claims for damages for their homes and businesses. Since then, he worked for insurance companies for many years and, among other things, gave legal opinions regarding insurance policy coverage. Although Norm retired after 50 years of law practice and can only represent you as a Public Insurance Adjuster, he brings all of his legal knowledge to the table when representing you. If you do not understand all of the insurance terms listed above, then you would be well advised to hire us to interpret such terms and assist you in processing your claims for damages.

The insurance companies hire “independentinsurance adjusters’ to assess the damages to your home or business caused by insured perils, such as fire, tornados, flood, etc. Whereas “public insurance adjusters” are hired by insured home and business owners, to stand in your corner, so to speak, and advocate for your benefit. As Public Insurance Adjusters, we first review and analyze your insurance policy(s) to be certain that each and every coverage term is being considered in the ultimate damage award. We want you to collect every dollar to which you are entitled. Afterall, the insurance companies expect you to pay all of their required premiums, so you should expect to receive all of the benefits of your insurance policy.

Most insurance policies require you, the home or business owner, to mitigate damages as soon as possible after a storm or whatever peril caused the damage. For example, if a hailstorm causes your roof to leak and water is entering the inside of your home or business, you are required to put a tarp or other waterproof material over the leak to stop water from entering. Under your policy, you should be able to be reimbursed for such expenses. Secondly, you are required to file a Notice of Claim with the insurance company as soon as possible. Be aware that if you allow an inordinate amount of time to pass before filing your notice of claim, it is possible that your claim could be denied.

Thirdly, you have a duty to allow the insurance company’s independent adjuster or other inspector to have full access to your home or business for inspection. 

Upon receipt of your Notice of Claim, the insurance company should promptly have its independent adjuster and/or inspector visit your property to make a detailed account of the damage. Almost all insurance companies implement the software “Xactimate”, to input the data accumulated by its inspectors in order to arrive at an initial award of damages. Gilbert Esparza of our business “LoneStar Pro Adjusters” taught courses in Xactimate at the Adjuster Academy of Texas, so he is an expert in the software and can expertly interpret what the insurance company produces and will implement our own Xactimate version of damages from our own damage assessment. But that is not where it ends. When we assess damage and input data into our software, we are mindful that you, the home or business owner, MUST be able to rebuild or make repairs with the amount of money paid to you by the insurance company. Often, that is not the case, and that is when you need our help! 

In the event the amount of money the insurance company decides to pay you is not sufficient to replace or repair the damage to your home or business, then you can try to argue for more money, or you can hire us to make the arguments in your behalf. Of course, you must factor in the amount of the deductible, which will take a bite out of the funds you receive from the insurance company. Generally, we are very successful in increasing the damage award, but sometimes the insurance company is too entrenched in their decision to move upward. At such point, there may be other methods for dispute resolution, such as mediation (Norm has been a certified mediator since 1994), or arbitration, or appraisal, or as a last resort litigation. Most insurance policies contain a provision for “appraisal” as a method to settle disputed claims or amounts of the claims. The provision extends such a remedy to either the insurance company or the insured home or business owner, or both, if either or both are not satisfied with the damage award. The insurance appraisal method has nothing to do with the market value of your property. Rather it is a process by which each party will choose an appraiser to advocate for him/her, and the two appraisers will select an umpire who would break the tie if the appraisers could not decide the amount of the damage award. Each party would pay the fee to their appraiser and one-half the cost of the umpire.

Sometimes, after a damage award is paid and accepted by the home or business owner, further damage appears. In such cases, a home or business owner is allowed to file a supplemental claim and has a right to payment of a supplemental award if the damage is covered by the insurance policy.

Sometimes, retaining the services of a public insurance adjuster after you have filed the claim for an award of damages is like “closing the barn door after the cows are out”. For many reasons, the hiring of a public insurance adjuster immediately after the occurrence of damage to your home or business is much preferred. For starters, we can and will do everything “from A to double ZZ” that is necessary to obtain a just award of damage. You will not be required to do anything, including the filing of a notice of damage claim.

We are available 24 hours a day, 7 days a week, and will make every effort to be at your location no later than the day after the occurrence of damages. Just call 1-512-753-9595 at any time on any day.