When was the last time you read your insurance policy? Terms like “stretch coverage,” “actual cash value,” “recoverable depreciation” or “Ordinance and Law” can mean very little to the average person, but can mean a lot in terms of sizable out-of-pocket expenses or money left on the table to an insured facing a building loss. The last thing anyone needs is the added pressure of becoming an expert on insurance terminology when faced with a loss.

Having a Public Adjuster on your side of the table who is as well-versed in the language of insurance policies as the insurance companies (and their adjusters) levels the playing field in any discussion. PLA’s Public Adjusters meticulously document each claim as they review each policy line-by-line to uncover hidden coverages to increase payouts for our clients.

To help underscore this point, we thought we would share a recent example of how our knowledge of industry terminology saved our client significant amounts of money, as well as helped get their business back up and running quickly. Professional Loss Adjusters’ Maine office received a call from a local nursing home for a water damage claim. When P3100005_LR.jpgwe arrived, there was significant water damage: approximately one third (7,000-square-feet) of the 23,000-square-foot facility was impacted. A “dry sprinkler system” had been installed above the ceiling and was thought to be safe in northern climates. The cause of the water damage was due to condensation building up within the sprinkler piping that could not be properly drained during annual inspections. A dip had formed in the piping where undetected water collected. This portion of the piping was located near an eave that sustained several days of subzero winds and temperatures.  No one knew that this fully functioning sprinkler system could not be thoroughly drained. As a result, the pipe froze, then thawed and burst, flooding eight rooms in a specialized wing within the nursing facility.

When our adjuster, Bruce Knowlton, reviewed the client’s insurance policy, he discovered they had “Ordinance and Law” coverage. “Ordinance and Law” Coverage (Part A) states that, if your building is partially damaged by a covered loss (in this case, water damage), and the local building inspector or fire marshal requires you to demolish the undamaged portion and reconstruct it to bring it up to a higher standard, that demolition and reconstruction would be covered under the policy.

P3100040_LR.jpgIn this case, although the sprinkler system was not outdated, it was found to have several deficiencies.  Engineers representing both the insured and the insurance company agreed that the most cost effective plan was to replace the entire system rather than try to repair it.

Although the insured had to spend the money first in order to be reimbursed for this coverage, it alleviated the final burden of having to pay for this major system upgrade out of pocket. Our client did not realize that “Ordinance and Law” was part of their coverage until Bruce told them. This allowed the insured to receive a fair settlement: triple the amount of the initial insurance company settlement, as well as a new sprinkler system for the entire facility.

Bruce was beneficial in not only finding and convincing the insurance company to grant coverage for what the policyholder was entitled to, but as a liaison for mediation—working on behalf of the nursing home while negotiating with the insurance company. 

Hiring a Public Adjuster to represent you during a claim—whether you have a loss in your business or your home—can, and often does, result in the client being able to fully restore their property...quickly and effectively.

Do you have questions about an insurance claim or the claims process? In Maine or New Hampshire, contact Bruce Knowlton at bknowlton@pla-us.com or call 207.838.5912.


About Professional Loss Adjusters

For most, the preparation of an insurance claim is unfamiliar and rough terrain. What is covered? What is not covered? What does this terminology mean? Will my insurance company pay me enough so that I can rebuild?

Following a loss, you are legally responsible to prepare and prove your claim to the insurance company. Where do you start?

PLA represents homeowners and business owners in the preparation and substantiation of insurance losses as a result of fire, flood, hurricane, windstorm, collapse, theft, and/or vandalism. We are your advocates—working to settle your claim and obtain everything you are owed by your insurance company. 

We understand insurance policies. Some of our team members have worked for major insurance companies and understand how they operate. We know how to mine your policy and to identify specific coverage, so that we can obtain the highest possible settlement on your behalf—much higher than you would be able to achieve on your own.

Have a question? Give us a call at 888.747.8260 or email us at claims@pla-us.com or visit our FAQ page.


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