For an insurance carrier to accept responsibility for a loss, it must classify as a “covered peril” under an HO3 policy. Most policies cover: fire or lightning; windstorm or hail; an explosion; riot or civil commotion; damaged caused by aircraft; damage caused by vehicles; smoke; vandalism or malicious mischief; theft; volcanic eruption; falling objects; weight of ice, snow or sleet; accidental overflow of water from within a plumbing, heating air conditioning or automatic fire protection system; sudden and accidental tearing apart, cracking, burning or bulging of a steam system, heating system, air conditioning or automatic fire protection system; freezing of plumbing and other systems; and damages from artificially generated electrical currents. An “all other peril” loss is a covered peril other than hurricane/windstorm damage. Think of your homeowner’s policy as coverage for a one-time, sudden event that financially impacts your property; it is not a maintenance policy.
There are several exclusions to homeowners’ insurance: neglect or failure to make repairs, wear and tear, corrosion and rust, contamination, animals and pests, fungi, nuclear hazards, power failure, government actions and war. Another common exclusion is flood (flood water is rising water as opposed to falling water).
If the carrier classifies the loss as a covered peril, they “extend coverage” meaning they are responsible for providing an estimate and possible payment to the insured to put the property back into pre-loss condition (like kind and quality) to before the loss occurred. A payment will be issued if the carrier estimate is above the deductible amount. The deductible for an all other peril claim is usually a set dollar amount, either $1,000 or $2,500.
The claim process begins with the filing of a claim. The carrier then assigns both a desk adjuster as well as a field adjuster. The desk adjuster is just that, an individual within the carrier that adjusts the claim from their desk. Their eyes and ears on the claim is the field adjuster. The field adjuster is the person that physically goes to the property, takes photos, inspects the loss, creates an estimate, and reports it beck to the desk adjuster. The desk adjuster is the one who assesses the loss and makes claim determinations. Under some circumstances, the desk adjuster may assign another professional such as an engineer to visit the property to do a further investigation.
The insured, from the start of the claim, is responsible for preserving the property for inspection as well as preventing further damage from occurring. If you have any questions, call/text Irene from Recovery Insurance Adjusters at 772-285-4515