When the Insurance Company (Insurer) sends their Insurance Adjuster to represent them, “ONE QUESTION”, Who is representing the policyholder (Insured)?
*** When the Insurance Adjuster arrives, “ask” the Insurance Adjuster if they are licensed to represent the policyholder.
There are only (3) people that can represent the policyholder and negotiate a fair settlement in the best interest of the policyholder:
- The Policyholder (Power of Attorney)
- A Licensed Public Insurance Adjuster
- An Attorney
TIC 4102.163. CERTAIN CONTRACTOR BUSINESS PROHIBITED. (a) A contractor may not act as a Public Insurance Adjuster or advertise to adjust claims for any property for which the contractor is providing or may provide contracting services, regardless of whether the contractor: (1) holds a license under this chapter; or (2) is authorized to act on behalf of the insured under a “POWER OF ATTORNEY” or other agreement. (b) The commissioner shall adopt rules necessary to implement and enforce this section.
***Becareful with signing any contracts that state “POWER OF ATTORNEY” or “CONTINGENCY BASED”, contractors should be experienced enough to provide you a preliminary or detailed estimate without waiting for the the insurance companie’s offer.
What is a Public Insurance Adjuster?
Eric Ramirez is a licensed Public Insurance Adjuster in Texas, and Puerto Rico. Representing Policyholder’s (insured) in negotiating fair settlements against the Insurance Company.
The Policyholder can be “Pro-Active” and call for a “Free Inspection & Estimate” and not sign a contract till they receive both (LAPIA & Insurer) estimates. In many cases the Insurance Company may offer you “Substantially Less”. In order to maximize your settlement, without costly litigation, your wisest move is to hire a Public Insurance Adjuster. A Public Insurance Adjuster will EVEN assist you through the entire Appraisal Process (as stated in the policy).
Public Insurance Adjusters should be monitoring the Insurance Adjusters for violations under TIC 4102.57
- Insurance Company misrepresenting material facts or policy provisions.
- Failing to attempt in good faith, prompt, fair, and equitable settlement.
- Failing to provide a reasonable explanation in the policy, facts or law or failing to adopt and implement reasonable standards for prompt investigation.
- Failing within a reasonable time to affirm or deny coverage or Reservation of Rights (coverage or no coverage) without attempting in good faith to effect a prompt, fair and equitable settlement.
- Refusing, failing, or unreasonable delay settlement.
- Undertaking to enforce a full and final release of a claim for policyholder when only a partial payment has been made.
- Refusing to pay a claim without conducting a reasonable investigation.
- Delaying or refuse settlement of a claim.
- As the condition of the settlement, the insureds must produce federal income tax return for examination or investigation, unless court order, fire loss, or profits or income loss.
Another area of our codes we are required to know:
- Receipt of Notice of Claim
- Acceptance or Rejection of Claim
- Payment of Claim
- Delay in Payment of Claim
- Extension of Deadlines
What Mr. Ramirez has found many “out of state” insurance companies (TIC 4101) may have a license with the Department of Insurance, but not registered with the Secretary of State or Comptroller of Public Accounts, leaving the question “are they paying TEXAS taxes” and “performing legally”? Mr. Ramirez investigates every adjuster and appraiser to ensure that there is not any conflict of interest, and if so, how should they be handled. Does he wait until no more offers or award has been rendered or have them removed ASAP? This information is good to know in litigation if the Insurance Company / Claims Appraiser has denied, delayed or offered substantially less while performing illegally in Texas in bad faith.
The standard fee for Public Insurance Adjusters is 10% of the “Total Amount Paid” (including prior payments) – deducible by the Insurer to resolve a claim (TIC 4102.104). Public Insurance Adjusters normally work on a “Contingency Base”, NO Fees Upfront!
What happens if the insurance company doesn’t want to pay more, does the policyholder have to hire an attorney?
Their are many ways to negotiate a claim as a Public Insurance Adjuster. Eric Ramirez has performed as an Insurance Appraiser for over 500 Appraisals, with the majority of them Court Appointed Umpires. This is not your typical insurance adjusting. When handling meetings with repeated Judges, Attorneys, etc., Eric’s wealth of knowledge really shines. Many Umpires might act like a “Mediator” or “Arbitrator”, or PIA’s, IA, Contractors making jesters during our inspection “I gave it to you last time, this time I will be the other side” which is “not” making the insured “whole” or what happens if the award gets set aside. Mr. Ramirez heard that an award cannot get set aside by Attorney, Insurance Adjusters, etc., Mr. Ramirez totally disagree with his experience, he has around (6) of his awards set aside out of 500+ Insurance Appraisal.
These are some of the biggest reasons why you need an experienced license Public Insurance Adjuster or Attorney on your side to walk you through the Adjusting and Appraisal process. As a Public Insurance Adjuster, one of our clients went through the appraisal process, and the insurance company withheld her money, after Hurricane Harvey winds blow a tree branch and poked a hole on their 3rd floor trickling down to the 1st floor, need to say, that the Appraisal Award got set aside, as the Public Insurance Adjuster, Mr. Ramirez was able to get the dwelling amount of $156,896.73 released (savings the insured on Atty. Fees), and the remaining ALE, Content and O&L, to hire an attorney.
Mr. Ramirez’s goal is to avoid litigation at all cost and lengthy litigation time. Many Public Insurance Adjuster do not know how to handle the Appraisal Process as it is “binding” and send them to the Attorneys, and then many Attorneys turn around and hired Mr.Ramirez as the insured’s Insurance Appraiser. Mr. Ramirez rather suggest to let him walk you though the “Appraisal Process” in order to establish the “Amount of Damages” and then, if you choose to file lawsuit after the Appraisal Process for additional damages you would have all rights to under the Consumer Home Bill of Right (#42) – “RIGHT TO SUE. If an insurance company violates our rights, you may be able to sue that company in court, including small claims court, wit or without an attorney.”
Eric Ramirez welcomes both sides (insured & insurer) for services as an impartial Insurance Appraiser, give him a call, his prices hasn’t changed ($1 per SF), but as of today, the “insurance company” or “defensive council” has not hired Mr. Ramirez as their Insurance Appraiser.
Be-careful of Contractor and Public Insurance Adjuster quickly pushing litigation, this may be called “Barratry”, if they are directing you to a single attorney. Mr. Ramirez has a list of attorneys who are active in the field of Property Insurance Claim Disputes & Breach of Contracts, which he shares with all his clients upon their request.
PLEASE NOTE: Due to the high demand of the “Houston Explosion”, Eric Ramirez services as an Insurance Appraiser has stopped to ensure that operation “Houston Explosion” will go smoothly. He write his estimate by the books, like if he was going to trial. If he don’t have evidence, it’s normally excluded in his reports. While some insurance adjusters and engineers focuses on NON-COVERED items, Eric Ramirez focuses on COVERED items.
Although there are damages beyond Eric Ramirez negotiating a fair settlement as a Public Insurance Adjuster with the Insurance Company, many have asked if they have “rights” to file suit against on who is at fault for their damages or against the insurance company for Bad Faith, Deceptive Trade Practices, Unfair Settlement Practices, etc. – (TIC 4102.057)
Yes, under the Texas Consumer Bill of Rights #31. TIME-FRAMES FOR CLAIM PROCESSING AND PAYMENT. When you file a claim on your policy, you have the right to have our claim processed and paid promptly. If the insurance company fails to meet required claims processing and payment deadlines as stated Texas Insurance Code 542, you have the right to file a lawsuit, which normally Public Insurance Adjuster should be monitoring every step to ensure that you are treated fairly.
In other cases that are beyond the insurance company who was at fault, could be another reason
TIC 4102.158 – CONFLICTS OF INTEREST PROHIBITED. (a) A license holder may not: (1) participate directly or indirectly in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the license holder; or (2) engage in any other activities that may reasonably be construed as presenting a conflict of interest, including soliciting or accepting an remuneration from, having a financial interest in, or deriving any direct or indirect financial benefit from, any salvage firm, repair firm, construction firm, or other firm that obtains business in connection with any claim the licenses holder has a contract or agreement to adjust.
SEARCH THE DEPARTMENT’S WEBSITE FOR LICENSING VERIFICATION
Puerto Rico Office of the Commissioner of Insurance – (The list is outdated but can call to verify or National Associations of Insurance Commissioners)
