WHAT TO DO WHEN AN INSURANCE COMPANY WILL NOT APPRAISE

Insurance companies can be stubborn and refuse to appraise the scope of a loss.  In my experience, there are three reasons for this position:

  • The insurer claims no event occurred that could cause damage (i.e., no wind storm at all);
  • There is no coverage for the alleged loss event; and
  • The deadline to repair property, or bring a claim, has expired.

Is it the insurer’s right to take these positions?  Consider the following when a claim stalls and an insurer refuses to appraise.

NO LOSS EVENT

In all states where I practice, there are competing legal principles that apply to instances where insurance companies refuse to appraise.  One principle is that both insurers and insureds have a right to appraise and not litigate the scope of loss when there is observed damage.  The second principle is that insureds must first prove in court there is an “occurrence,” or coverage under the policy, before any right to appraisal.

How these principles play out is highly dependent on state law, which varies by state.  Some states are very strong on the right to appraisal and denying the insurer the right to simply say “no loss occurred” and avoid appraisal.  Other states lean in the opposite direction.  Given these competing principles, it is always helpful if the insurance company admits to seeing some damage that could be an insured loss.  In these circumstances, the property owner is in a better position to obtain a court order compelling appraisal.

THERE IS NO COVERAGE FOR THE ALLEGED LOSS EVENT

Insurers will often deny all coverage, even if an alleged loss event happened and caused damage.  The reason is that the event may be excluded by the terms of the insurer’s policy.  One example is the property owner that claims water damage due to leaking and seepage over time.  Many insurance policies specifically exclude leakage and seepage over time.  In this instance, appraisal is indeed futile because the amount of loss set in appraisal won’t be covered anyway.

Yet insured property owners are entitled to dispute the facts that would trigger an exclusion.  Some insurers declare “no coverage” by deciding how a fact occurred.   For example, an insurer may say, “that is old hail damage” and declare no right to appraisal.  If a property owner objects to this fact the dispute is factual – what actually occurred on the ground – not an interpretation of an insurance policy.  Such a dispute ought to be decided in appraisal because if an insurer could simply made such a declaration the right to appraisal is lost.

Best practice is for property owners to determine the cause of loss and then read their policy to see if that specific cause is covered or excluded.  Only then should they consider whether to demand appraisal.

A DEADLINE EXPIRED

Insurers will often deny appraisal if a deadline has expired.  They are right to do so if the statute of limitations has expired.  If the statute of limitations has expired, the entire claim has expired, thus appraisal of the claim is futile.

Insurers will deny appraisal if a deadline to complete repairs and recover replacement cost benefits has expired.  I question whether such deadlines that, in practice, operate to reduce an otherwise short statute of limitations can be enforced.  State law writes a portion of each insurance policy in the three states where I practice.  The deadline to pursue a claim is truly a deadline from the Legislature.  Another deadline from an insurer on top of the Legislature’s deadline that acts to reduce part of the claim seems like and end-run around the Legislature. When insurers try to impose a deadline to complete repairs, I think it is wise to thoughtfully address that claim.

Contact me if you need any help when an insurer will not appraise.