Loss Adjusters - Are they biased?

Archie2107

Good afternoon,

I'm here to plead for some help! I was wondering if anyone has had the same experience as I with regards to an insurance claim and the opinions of a loss adjuster?

On April 2nd, the mains water pipe in the ensuite bathroom burst and water escaped for at least a period of 4 hours, damaging the bathroom and lounge on the floor below. I would like to add that I own the property with a friend and we have both had to vacate on the grounds that we feel it is uninhabitable.

To cut a very long story short, I have had a huge issue with the loss adjuster appointed by the insurance company. The issues started when (after a week of chasing up both the insurers and the loss adjusters) they finally organised for a loss adjuster to come and view the apartment. This was on the 19th April - a whole 17 days after the initial damage had happened in which I, myself, had to arrange for a local company to carry out emergency repairs and install 2 industrial dehumidifiers making the apartment essentially uninhabitable.

In the meantime, I felt I had to vacate the apartment - with my puppy - and find somewhere to live whilst the essential repairs (which, have not even been agreed by the loss adjuster or started yet!) are taking place. Now my issue here is not with the actual quote for the works - which are substantial - instead it is with the loss adjuster's opinion that the apartment is (laughably) habitable! As you could imagine this came as a shock as I have arranged for alternative accommodation and have been told that this is at my own expense. This is a huge sticking point for me as I feel that I should not have to argue my case with the insurers but they fail to acknowledge the fact that the apartment is not habitable due to the loss adjuster's opinion.

The reasoning for this decision is due to a few basic facts:
- We have 3 bedrooms (one of which is damaged and the ceiling to the lounge has been torn down underneath it; making it unsafe),
- We have showering facilities (the door of which does not close due to the damage - making privacy very difficult),
- We have a working kitchen (of which all of our lounge furniture including couches is currently being stored).
Whilst I understand that, to the loss adjuster, this may seem like it is an uncomfortable (at most) living situation but I have to strongly disagree for the following reasons:
- The kitchen is inoperable due to the storage of our lounge furniture on the same floor - something the loss adjuster seems to think is remedied by simply moving the furniture upstairs into the spare room.
- this leads me nicely into my second point - should the spare room have our lounge furniture stored, this would mean that i would have to share the remaining bedroom with my flat mate, again removing any privacy and essentially making it inappropriate.
- The contractor, thinking about the safety of his staff as well as the two of us residing in the apartment, has strongly recommended we not live in the apartment whilst works are being done. He has stated that walls will be removed, dust will become an issue and that wires and cabling will be exposed during repairs.
I fear that I will be living in a building site and the stress caused to myself and the puppy would be extensive.

Am I being unreasonable?

I would also like to add that I am not taking advantage and checking myself into a 5 star hotel or a lavish spa retreat but instead I am currently renting a room from a local resident which, living in Jersey, is not cheap. I would rather stay in my own home - It is inconvenient for me to have moved out but I had no other option - if the apartment was habitable then it would've been more convenient to stay.

My formal complaint is in it's 6th week of the insurers 8 week process but I sense that they will respond just as they have done during the last couple of months.

I have contacted the insurers today and asked them if they would be willing to appoint a local loss adjuster who is aware of the very old buildings on the island and the laws in place over here (which are pretty similar to those in the UK I hasten to add). They have informed me that, due to a contract they have with the loss adjuster company, they are unable to appoint any other loss adjusters to see the apartment. Is this correct? Surely the job of a loss adjuster is to impartially assess the damage and agree on the works to be carried out? Now I know there will be some form of bias - with loss adjuster essentially preventing any extravagant and fraudulent claims but this relationship stinks of a new level of bias between the two companies and does not sit well with me. Who else will this affect if the loss adjusters are only there to make claims difficult for their loyal (and helpless) customers!?

As it stands, the works are yet to commence, with the loss adjuster picking up every item in the contractors quote of works therefore hindering the process. The insurers have agreed to request a new loss adjuster deal with the claim BUT this is an adjuster within the same company that they have a contract with - what is stopping them from having the same bias? I am currently paying the mortgage for the apartment and am haemorrhaging my savings on alternative accommodation on an island that has the comparable expense of living as inner city London.

Can someone help? I feel like I have been banging my head against a brick wall (excuse the pun) for sometime now!

Many thanks for taking the time to read this long winded nightmare,

Yours,
Helpless and homeless.

Quentin

Whenever you are unhappy with your insurer then you make a formal complaint


You say you did so 6 weeks ago


If they ignore you for 8 weeks or you are unhappy with their reply if it comes before then you can escalate to the fos for their adjudication at no cost to you


And keep on complaining in the meantime!

BoGoF

Does the FOS cover Jersey complaints?

Archie2107

I think it may cover this complaint as the company is a UK company?

theoretica

Whether the house is habitable now, and whether it would be habitable during the building works are surely separate. The insurers might, reasonably, argue that putting your furniture into storage would be a cheaper solution than moving out until the work starts. But if your builders advise they cannot keep the property safe for residents during the works that is a strong case to present to the insurers.

Zorillo

Loss adjuster's aren't biased, but they are sometimes wrong. It doesn't sound like you're being unreasonable, based on the facts you've presented.

Quentin

If there was no issue with Loss Adjusters bias there would be no work and no need for Loss Assessors!

Archie2107

Thank you for your comments everyone.

I don't have a problem with the fact that a loss adjuster needs to be involved - if anything, I encourage it! My issue here is the fact that the insurers have a contract with the loss adjusters meaning that no other firm is able to be appointed by them. Surely loss adjusters should be impartial and provide a realistic evaluation for the customers that the insurers should be looking after?

Quentin

In the circs you mention you might want to consider your own Loss Assessor to represent you.

Chickenlips

Most loss adjusters aren't biased, but many loss assessors will tell you they are.

I would advise against appointing a loss assessor and I'll explain why. The assessor makes their money by taking a cut from your claim. Your adjuster will settle your claim based on the insured loss - and most adjusters will offer no more or no less than a reasonable figure for the insured damage. Assessors typically submit over inflated prices (Because if your claim was settled at what it was worth, by the time they've had their cut their isn't enough to cover the works). This means that the assessor and adjuster can spend weeks going back and forth trying to agree a settlement figure.

Concerning alternative accommodation: each insurer has their own definition as to what will trigger a successful claim - the adjuster will be acting in accordance with your insurers definition of uninhabitable. The cheaper the policy, the more likely you are to find that alternative accommodation will only be considered when the all bathrooms and the kitchen are out of action (and potentially several other rooms too). Most insurers will consider alternative accommodation if you have an existing health condition that will be made worse by the insured event.

My recommendations:

1- if the shower door is damaged due to the insured event, ask the adjuster if you can get this repaired by a local tradesman and submit the bill. This will alleviate any privacy issues.

2- Contents in the kitchen. Can these be stored in the garage? If not, ask the adjuster to have them taken into storage so that you are able to remain at home.

3- Flat mate. Are your insurers aware that you have a flat mate? If they are not a relative, be careful with what you say to insurers. Some will not offer cover if you let out part of your home to a non-family member. Others may apply warranties. If the insurer can demonstrate that yours is a risk their underwriters don't insure (and some won't offer cover to those letting our part of their home), they may be able to avoid your policy.

The adjuster will be audited and some insurers now do live audits on claims (I.e. send a second adjuster part way through a claim to check the first is going their job correctly). This means that the loss adjuster has to check the extent of any scope provided. The value the claim is settled at may have an impact on your premiums next year.

Depending on the value of the claim, you might be able to get the adjuster to appoint a surveyor, which may speed things up. Alternatively, you could obtain a second quotation from a local contractor - again, may speed things up.

Full disclosure: I work for an adjusting company.

(Text removed by MSE Forum Team)

Marius_de_Jess

It is the fact that adjusters working for the insurance company have the intention to exert their most effective efforts as to save as much money for the insurance company as they can achieve.

And it is the fact the loss assessors have the intention of making the insurance company pay as much as they can achieve, by overwhelming the arguments of the insurance company hired adjusters.

To save yourself time and trouble and money, better to share your indemnity payment with the loss assessors: because they are more self-motivated, self-driven to overwhelm the arguments of the loss adjusters hired by the insurance company.

Why? Because loss assessors only get to make money if and when they overwhelm the arguments of the insurance company hired loss adjusters.

It's plain simple psychology.