Jason Cieri | Property Insurance Coverage Law Blog | June 2, 2015
Starting on May 18th and over the following weeks, policyholders that had flood insurance through a WYO carrier or a FEMA direct policy that submitted claims for Superstorm Sandy will receive a letter in the mail asking if they want to reopen their claim for review. This “claims review process”—created by FEMA—will give policyholders who felt they were shortchanged on their property damage claim an opportunity to be reviewed by another “highly skilled NFIP-certified insurance adjuster.”
What should I do when I get the letter? If you have already hired an attorney or a public adjuster, call them and see if they will handle the claims review process for you. Don’t assume they will be aware of the process for your claim. The letters will only be sent to the policyholder, not their representatives, regardless if they are already represented.
If you choose to represent yourself during the Sandy Claims Review process, you have 90 days to opt in to review your claim by either phone or email. Whether you call or email your opt in, please have the following information with you:
flood insurance carrier name;
policy number at the date of loss;
date of loss; (Sandy was October 29, 2012)
address of property that was damaged; and
current mailing address and telephone number
Once you opt in, you will be assigned a case worker that will have a “buddy backup” caseworker in situations where your assigned caseworker is unavailable. The review process will ideally last 90 days. The certified insurance adjuster will use these 90 days to build a file, figure out if you are owed money and be able to explain to you whether you are entitled to or not entitled to additional monies. From the time you opt in, you have 14 days to submit additional paperwork to FEMA besides the file already created through your existing claim file.
Who are these certified insurance adjusters? FEMA has not disclosed which adjusting firm they are using for this process. They are said to be highly trained and should work in “the best interest of the policyholder”.
What if I don’t like the result of the review, do I have any recourse? Yes, if you do not like the result of your claims review, you can seek mediation through a neutral 3rd party. FEMA hasn’t disclosed who this neutral 3rd party will be but they should also have the “best interest of the policyholder.”
A few quick notes:
The claims review does not extend or affect your ability to file a lawsuit. If you have already missed the date to file a lawsuit, this review will not extend the time for you to file. Therefore, if you are still unsatisfied after a 3rd party neutral there is no additional recourse to recover additional monies.
If you are still within the one-year limitations period from the date of the denial letter and you want to dispute your claim, seek an attorney immediately so they can file a law suit and preserve your ability to sue under the policy.
While the certified NFIP-trained adjusters and the neutral 3rd party mediators are supposed to have the best interest of the policyholder, this is still adversarial proceeding so it is best to have either an attorney or a public adjuster handling the process for you to ensure you are being treated fairly and to meet the various deadlines to submit documents or other information.