Little-known public insurance adjusters help with claims

01/29/2007

Steve Higgins , Register Business Editor

NORTH HAVEN — Houses burn down. They also get damaged by water, cold weather, vandalism and falling trees. So, you call your insurance company and they send over an adjuster, who gauges the extent of the damage and makes a recommendation based on your policy.

For most people, that’s the end of it. The insurance company pays what they pay, and the homeowner uses the funds to rebuild or to replace lost items.

But how does a homeowner know if they were fully reimbursed? How many homeowners understand their own insurance policies? How can they make sure they got all that was coming to them?

That’s where public insurance adjusters step in. People who suffer losses covered by insurance policies may hire public insurance adjusters to represent their interests during negotiations over payments.

Public insurance adjusters do not work for insurance companies. They are independent consultants who help policyholders submit proper insurance claims and negotiate with insurance companies on their clients’ behalf.

Public insurance adjusters can obtain higher settlements for policyholders in some cases, yet most people are unaware they exist.

"The way we look at it, insurance companies have their own adjusters and so should the policyholders," said David Biller, president of Biller Associates Tri-State LLC, at 154 State St. in North Haven. "Many people don’t even realize they can hire their own adjuster. As such, they often find that, due to inexperience, they are not fully compensated for their losses."

Susan Giacalone, counsel for the Insurance Association of Connecticut in Hartford, said the vast majority of claims are settled without dispute and she denied that insurance companies sell policyholders short. She said insurance company adjusters are licensed and regulated by the state, and under state law they are required to negotiate claims in a manner that is fair to consumers.

Failing to fully reimburse consumers who suffer losses "is a violation of the law, and it’s not to our benefit. It’s to our benefit to keep our customers happy," Giacalone said.

Public insurance adjusters can be helpful to consumers involved in complex cases with large losses, she said, since they will do much of the legwork for the policyholder. But Giacalone said consumers should be aware they will pay the cost of the public adjuster’s work out of their own pocket.

Public insurance adjusters offer a wide variety of services to people who suffer property losses. They will secure the property after a fire, help people find temporary housing, report the claim to the insurance company, prepare estimates and inventories, evaluate insurance coverage, and negotiate claims.

"People often do not realize that they carry the burden of submitting estimates, sifting through their damaged personal property and presenting and proving their claims," said Biller. "Having a good insurance policy is not enough. The average person has not read their insurance policy. They don’t realize there are limitations, exclusions and obligations."

Biller, 33, of Wallingford, runs Biller Associates with his father, Meyer Biller, 82, of East Haven. Meyer Biller started the company in 1959 and claims to have been the state’s first public insurance adjuster. Today the firm employs 12 people.

After serving in the U.S. Army in World War II, Meyer Biller became a builder in his native New York, then relocated to North Haven and later Hamden. After a kitchen fire damaged an apartment building he was constructing in New Haven, Biller’s insurance company offered him $500 to repair the $3,200 kitchen.

After that experience, Biller researched public insurance adjusters in other states and took a home-study course to become one in Connecticut. He charged clients 10 percent of the settlement as his fee, and state regulators later adopted that fee structure in regulating and licensing the fledgling industry, he said.

If a policyholder cannot come to a settlement with his or her insurance industry, the case usually goes to arbitration and is decided by a third party selected by a judge. Occasionally such cases wind up in court, if the dispute is over more than just a dollar amount, i.e., charges of "bad faith" or "unfair trade practices" surface.

Meyer Biller said claims can get complicated. He’s involved in a case currently, for instance, involving a public gym floor. The owners cleaned up after a major water spill and didn’t file a claim, not realizing that moisture under the floor would later cause it to buckle. "The insurance company refused to pay because they didn’t report it earlier," he said.

Policyholders are often unaware that policies require them to take certain preventive actions, such as preparing for potential winter damage, and boarding up broken windows to protect a home from further damage.

David Biller said it’s vital for homeowners to read and understand their policies, because they include so many unknown items.

For instance, he said, few people realize that damage to a gravestone in a cemetery is often covered in a homeowners’ policy.

Steve Higgins can be reached at business@nhregister.comor 789-5752.