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robby
USA
7 Posts |
 Posted - 05/04/2003 : 08:23:52
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I have a HO-A+ policy in Texas. We have gone to Apparisal under the policy. We picked the umpire and gave the paperwork to the umpire and asked that a decision be given on the dispute.
We were the only ones that paid the umpire up front with the deliver of the paperwork to the umpire.
The umpire waited about 10 days and still no payment from the other side. The umpire returned both parties paperwork and the one payment and said he was withdrawing as the umpire.
Reason being none payment by one side and to much work had been done for him to make a determination of what was damaged. 60 photos and video tape provided to umpire.
What do we do now? I have been handling claims for 25 years and never had this come up. Any ideas? |
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CCarr
Canada
1200 Posts |
Posted - 05/04/2003 : 08:44:57
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Robby, please clarify that you are the adjuster for the carrier in this situation, and not the appraiser representing the carrier.
However, the Appraisal provision of the policy is an option, that may be demanded by either side. Who invoked this policy provision?
That is important when considering the "Suit Against Us" policy provision wording.
It is important to remember that a decision "by any two" (both apprsaiers, or one appraiser and the ump) will set the amount of loss.
What efforts were made by the two appraisers to find agreement?
Your comments on the above, could create a clearer picture from which to suggest; "what do we do now?". |
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katadj
USA
315 Posts |
Posted - 05/04/2003 : 10:51:45
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First: Was the umpire selected by the appraisers, or was the umpire appointed "ex parte"?
Second: The umpires fees are not due and payable unless and until the decision is made. AT which time the umpire can request payment before issing the award letter.
Third: What issues were presented to the umpire for decision. The entire loss, as a disagreement, or specific items, (as the umpire has only to decide the disposition of the differences of the 2 appraisers)
Forth: Was the umpire interviewed by the appraisers prior to acceptance?
Fifth: In the event that the umpire has withdrawn, (there must be justifible cause, and non-receipt of payment is not normally an acceptable reason, unless that was listed and requested, and agreed to by all parties), you now can agree on another umpire or request that the court of jurisdiction appoint an umpire.
Sixth: The umpire's suggestion that too much work has been done, is not always relavent. The umpire , like a judge, does not even have to inspect the loss, they can make the decision based on the evidence presented, as in a trial.
It appear's that the parties involved are not totally familiar with the appraisal process and the rulings issued heretofore. Perhaps some need to go back to school before they enter into this arena.
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Edited by - katadj on 05/04/2003 15:37:52 |
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robby
USA
7 Posts |
Posted - 05/04/2003 : 14:25:43
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To:C Carr:
I am working for the insured. We asked for the apparisal.
The company adjuster and us agreed to disagreed and send to the umpire. Who we both agreed upon as the umpire.
The umpire said he became basied on the carrier for not making the payment timley.
Katadj:
1st.Agreed upon by both parties. 2nd Payment was agreed to as being due upon the time the two files were presented to the umpire. 14 days later the umpire pulls out.3rd The items in question was the damage to the insured risk only. Not ALE. or Contents. 4th The umpire agreed to the job. 5th umpire said none payment. 6th we have presented that issue with the umpire. 7th. where is there a school on this issue. I have adjusted for 23 years and not seen anything training guide lines on this part of the policy. I have been to carrier schools and CE classes without any mention. |
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CCarr
Canada
1200 Posts |
Posted - 05/04/2003 : 15:24:58
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Robby, are you saying that the carrier adjuster was acting as the appraiser for the carrier?
Regarding "Appraisal school", do a Google search, and it will turn up more than enough information to steer you in the right direction for training in dispute resolution and the appraisal process.
Since you have made it clear that the insured invoked the appraisal provision, you now have a number of options.
1st - withdraw from this process and instruct your client (insured) to obtain a qualified appraiser.
2nd - tell the carrier adjuster to appoint a qualified appraiser (not the adjuster handling the file)
3rd - then attempt to start the process all over again (between the two qualified appraisers)
4th - if the 3rd item fails, then invoke the umpire condition as per the policy wording.
5th - The insured could seek legal counsel and consider his position relative to "Suit Against Us" provision of the policy.
The mess you are in, and that of your client insured, is from your own doing; with no malice intended. It is absolutely silly for the handling adjuster to be the appraisal rep on his own file, or for the other appraiser not to object professionally about this for very valid reasons relative to the appraisal process. What has happened goes against the principal grain of what the appraisal process is all about. Neither of you are familiar with the concept of appraisal, and the handling adjuster will not change his attitude and outlook just because he wears a different hat for a day.
I'm not sure of the current statistical number, but I do know that the majority of appraisals undertaken as a result of the policy provision are settled at the appraiser level; hence without the need to hire an umpire.
When an umpire is engaged, that person is normally an "old salt" retired litigator or appraisal veteran; who has participated in many such cases agreed at the appraiser level. |
Edited by - CCarr on 05/04/2003 15:27:45 |
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katadj
USA
315 Posts |
Posted - 05/04/2003 : 15:30:17
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Robby,
Unfortunately , there are no schools on the appraisal process that I am aware of.
This segment of the policy has long been ignored due to the inability of most to comprehend the duties and responsibilities of each of the parties to the process. The process as written is to provide a timely resolution to the claim and to deter litigation.
The process MUST be followed to completion, prior to either party bringing suit against the other. You can file suit, but not bring suit, until this process is completed.
In your case: If in fact, the Umpire insisted on payment and that was a part of the agreement, and he was not compensated as agreed, then he had justification to withdraw. (His reasoning being bias.)
While , personally, I have NEVER heard of this type of action, not much surprise's me, anymore. Sounds very UNPROFESSIONAL. How one can establish a cost without knowing the amount of involvement baffles this individuals mind.
Some Umpire work can take a year or more to properly resolve. Granted most are done in a much more expedious manner, but still, there are suspect issues as to the financial arrangement in this case.
The umpire is also a disinterested third party to the loss and is only intended to be used to resolve any disputes, as you are aware.
In this instant case, perhaps you and the other appraiser should attempt to resolve the issue forthwith. Failing that, you should both agree on another umpire within 15 days, and if you cannot agree, appeal to the court for an appointment of an umpire.
Make sure you obtain a written letter of withdrawal from the initial umpire. (Keeps things neat) |
Edited by - katadj on 05/04/2003 15:36:24 |
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CCarr
Canada
1200 Posts |
Posted - 05/05/2003 : 00:29:31
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Neither the interpretation or the 'mechanics' of the "Appraisal" provision of an insurance policy is 'rocket science'.
It all boils down to each party having a proper appraiser, and each appraiser being provided with complete documentation to deal with the issue at hand.
A "proper appraiser" does not have to be an insurance 'master', nor a construction 'guru'; but must understand dispute resolution principals and be of a proper mindset to allow the appraisal process to work.
The appraisal process, whether for insurance policy provisions or any other type of dispute, is just a form of "alternative dispute resolution" (ADR).
Again I suggest, you do a Google search for "dispute resolution appraisal training", and you will get more than enough information to guide you further in being trained at this function.
One link of note which provides a good primer for a better understanding of the basics is;
http://www.cs.state.ny.us/pio/hearingofficermanual/chapter07-adr.htm |
Edited by - CCarr on 05/05/2003 00:35:14 |
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Jim Lakes
USA
37 Posts |
Posted - 05/05/2003 : 22:14:41
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Robby,
Clayton is right.
The reason and background behind this provision is that when the insured and the carrier cannot come to an agreement as to damages, (only, not coverage) and when either party invokes the appraisal clause, both parties are to appoint a non-partial person to present their case to an umpire. It is HIGHLY recommended that neither party for the insured or the carrier should have been involved in any process of the adjustment of the claim, so as to have total impartiality that could/would bias their case.
This does not always happen and when someone that was involved in the adjustment of the loss is also appointed as the appraiser; this dilutes the impartiality of the appraiser.
I am involved in just such a case at this time and one of the appraisers is a PA and the other is the adjuster that handled the case. I recommended highly to the PA that he object to the adjuster and he had no problem with him as the appraiser. In this case the PA has no right now to complain of bias on the adjusters part and this umpire would entertain no consideration if the PA brought up this subject.
Concerning the payment issue to the umpire. This mess could have been avoided by all if the umpire would have informed both parties of his rate per hour and that he demanded payment at the same time from both parties prior to handing them his letter of judgment. I have seen to many cases where the umpire was not paid by the losing party. I would never hand down a judgment without first being paid by both parties and both parties would be aware of this at the time that both parties agreed to appoint me as the umpire.
Jim Lakes, RPA
VP RAC Catastrophe Services, Inc.
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robby
USA
7 Posts |
Posted - 05/06/2003 : 06:32:07
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| Jim thanks for your comments. I learn something each time I check out the catadjuster site. |
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robby
USA
7 Posts |
Posted - 05/07/2003 : 07:43:34
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The umpire came back!! Problem solved. Thanks for the help.
Robby |
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UMPIRE
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