第三案例報告 - (Public Insurance Adjuster) PART 2

This PA reported the opinion to the homeowner as above, and a few days later the insurance agent contacted me. The agent told me that the homeowner said, “The cost of leak detection (about $400) is too much, so just file the claim with the insurance company without the leak-detection process. The water leakage is obvious. What else needs to be checked?” As a result, this PA received the related insurance contract from the insurance agent and reviewed it.

This PA specifically pointed out the related clauses where the payment of compensation might be denied.

I also reminded the agent about the similar case involving a house in Fontana, which the agent once consulted me about. Now the agent was aware of the situation correctly. Since that day, there was no further contact with this PA about the case, so I believe the homeowner handled the case well according to the agent's advice.

If the homeowner receives a notice of payment rejection (denial of coverage letter) from the insurance company after filing a claim according to the homeowner’s will, with such notice the insurance company may ask the homeowner, who is the insurance policy holder, to repair the part of the problem at his or her expense within 90 days (change order letter). At this point, the homeowner has to secure proof, including repair expenses paid and photos before and after the repair. In some cases, the insurance company wants to check whether the homeowner fixed the problem. Such a case of payment rejection will be kept as a record for minimum three years by the related insurance companies and the Insurance Association Records Administration. If the site isn't repaired but the homeowner switches to another insurance company and files a claim for the same issue, it may becomes an issue of insurance fraud based on mis-representation,or concelment and the person will be in a very awkward position. Please don’t forget that the insurance companies share adverse information with other insurance companies.

Through this case, I saw a true professional--a wise insurance agent,try his best to protect his customer.

Jae Park, AIC
Public Insurance Adjuster
Ex- Insurance Carrier's large & complex property loss claim adjuster
IICRC/Clean Trust- WRT, AMRT, FSRT
Jae Park & Associates, Inc.
3255 Wilshire Blvd Suite # 1414
Los Angeles, CA 90010
Business Cell # 213-572-7379
Fax# 877-277-9752
E-mail: jae.park.assc@gmail.com
Website: www.Jpadjusters.com