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AJC Watchdog: First Alert

Keeping watch on those who hold the public trust and money

Are insurers stalling on Irma claims?

Insurance regulators should publish running tallies on claims related to Hurricane Irma and Hurricane Harvey so that consumers can determine if their insurer is doing its job, a leading consumer advocate says.

However, it appears that Georgia consumers won't have access to such information.

The Atlanta Journal-Constitution reported this weekend that many victims of the recent storms may face difficulty getting their damages covered by insurers. That's because insurers exclude certain types of damage -- such as flooding -- from a typical homeowners policy. And the fine print in some policies may make it difficult to collect on other types of storm damage, the AJC found. Read the story by clicking here:

J. Robert Hunter, director of insurance at the Consumer Federation of America, says insurance regulators in the states hit hard by the recent storms should require insurers to send in daily updates on claims and how they're being handled. He is also calling on the Federal Emergency Management Agency to require similar reports for the processing of flood insurance claims.

Hunter said the regulators should require insurers to report the number of claims filed, the number closed with and without payment, the number denied and the number disputed in lawsuits. Hunter said the regulators should also require reports on how much they have paid out in disaster claims.

Regulators should then publish this information, in a running tally, on their websites to allow consumers to see how well insurers are doing at paying out claims to the hundreds of thousands of people whose property was damages by the winds and flooding of the recent storms.

“This action will hold insurance companies accountable to the public and allow consumers to see the performance of their insurance company compared to other companies,” Hunter said.

The Georgia Department of Insurance said it planned to issue a "data call" on Monday requiring the state's insurers to report claims and damage tallies to the department. The state required similar updates after other large storm events, including last year's Hurricane Matthew when it collected information every week on the number of claims reported, the number open, the number closed, the total claims paid and total amount of incurred losses. Flood insurance claims would be included in the data calls, the department said.

However, under Georgia law, the information is confidential and can't be released for public scrutiny. That's because data calls to insurers are made under the commissioner's "examination authority," the department said. State law says responses  to examinations remain confidential. That's unlike many other reports insurers file with the state that are open to public inspection.

The insurance department said Monday that it will provide the public with aggregate numbers resulting from the data call.

Georgia Insurance Commissioner Ralph Hudgens issued a directive to insurers after Irma hit to promptly identify, evaluate and resolve each claim. The insurance department on Monday also opened its first "claims village" in Brunswick to help Georgia consumers meet with their insurers, who will have company representatives ready to meet with policy holders at the village. The state will also be convening insurers at a "claims village" in Savannah later this week.

Hunter said regulators should seek pledges from insurance executives promising that their companies will provide prompt service on claims.

“As families rebuild, they deserve a public commitment from the nation’s insurance companies to hold up their end of the insurance bargain and pay claims quickly and fairly,” said Hunter, a former administrator of the National Flood Insurance Program and Texas Insurance Commissioner.

If an insurer denies a claim or offers a settlement that seems too low, Hunter offers this advice:

  • Demand that the insurer show you the detailed language in the policy that served as the basis for their offer. This might let a consumer know that the insurer is right: for example your damage is less than your deductible.
  • It might also reveal that the company slipped new limits into a policy without informing you. If you feel you have been misled, it might be time to talk to a lawyer, Hunter said. Some changes could include "percentage deductibles" that shift more of the damage on to a property owner's responsibility.

  • Some property owners may be low-balled because of a restriction that limits replacement cost payments, which could come into play if a home is destroyed. This creates problems when construction costs rise after big storm events.
  • Another problem in the fine print: Insurers may not longer pay the additional costs of bringing a cost up to code. So, a local government may require that a new home be elevated to avoid flood risk, but the insurance policy will only pay for a home like the old one, which wasn't elevated.
  • Hunter warned consumers that about something the AJC wrote about in its Sunday story: if you have both wind and water damage, some insurers have a provision that if you have an insured event (wind damage) and also an uninsured event (flooding) they will cover neither. "Regulators should protect consumers from such egregious abuse where a stated coverage like wind falls out of your policy due to tricky language creating a trap door hidden in the recesses of policy language for the coverage to drop through," Hunter said.

If after reading the policy you believe the offer is too low or a denial is wrong, Hunter said the next steps are:

What if it's a claim on a flood insurance policy?

Hunter says that changes the process slightly. The federal government underwrites flood insurance, although insurance companies are under contract to service the claims. That means consumers should direct complaints to the Federal Emergency Management Agency, which runs the flood program. FEMA's tips on claims can be found here.

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About the Author

Carrie Teegardin is on the investigative team. She is a graduate of Duke University and has won numerous national journalism awards.