Case Study: The Disputed Mold Damage Claim After Hurricane Ian

Background

Jane Doe, a homeowner in Tampa, Florida, faced extensive mold damage in her home caused by flooding during Hurricane Ian. She lodged a claim with her insurance company, expecting the damages to be fully covered by her homeowner's insurance policy.

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Initial Assessment

Her insurance company dispatched an adjuster who estimated the damage repair costs to be $15,000. This amount was intended for water extraction and partial repairs, which the adjuster believed to be sufficient.

The Dispute

Jane Doe disagreed with this assessment, knowing that the extent of the mold required comprehensive remediation. She felt the initial estimate was grossly inadequate for the scale of the damage.

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Legal Representation

Realizing the complexity of her claim, Jane Doe decided to hire a lawyer who specialized in insurance disputes. Her lawyer recommended that she obtain comparative estimates from independent contractors to challenge her insurance company’s assessment.

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Comparative Estimate

Independent Contractors‍

Following her lawyer’s advice, Jane Doe procured two independent estimates, both of which quoted around $30,000 for full mold remediation and restoration of the damaged lower level of her home.

Submission to Insurer‍

Her lawyer presented these estimates to the insurance company, along with a comprehensive mold assessment from a certified hygienist.

Insurer's Counteroffer‍

After reviewing the submissions, the insurance company slightly increased their compensation offer to $18,000 but stood firm on their assessment that a full remediation was excessive.

Invoking the Appraisal Clause

With an impasse reached, Jane Doe’s lawyer advised her to invoke the appraisal clause of her policy. The insurance company agreed, initiating the appraisal process.

Appraisal Process

Appraiser Selection

Each party chose an independent appraiser. However, the appraisers reached a deadlock, unable to agree on the cost of the necessary repairs.

Engaging an Umpire‍

To break the stalemate, her lawyer took the lead in selecting a qualified umpire, particularly one with years of experience completing restoration repairs. He approached Mr. Tony Allogia, a known umpire and licensed general contractor.  Tony’s expertise stems from his extensive and multi-faceted career dedicated to the fields of insurance, insurance adjusting, construction, restoration and repairs, consulting, umpiring, and serving as an expert witness. Known for his impartiality, Tony evaluates damages as if he himself were giving the estimate to complete the repairs himself. In some instances, upon reaching a decision, Tony is requested to implement the final solution he has determined. This is a very healthy pressure that Tony enjoys which many other consultants simply don’t as they lack the practical experience to also implement the solution.

Umpire's Evaluation and Decision

Mr. Allogia reviewed the case thoroughly, evaluating the damages himself, considering the appraisers' reports, the contractors' comparative estimates, the environmental hygienist's mold report, and the terms of the insurance policy. His investigation concluded that the damage warranted complete remediation due to the health risks associated with mold and the extensive nature of the damage caused by the hurricane.

Outcome

Tony Allogia, the designated umpire, ruled in favor of the $30,000 estimate for full mold remediation and restoration. Mr. Allogia reached this conclusion by adeptly utilizing modern estimating software and drawing upon his practical knowledge gained through extensive experience in construction, restoration, adjusting, and insurance fields. The insurance company, bound by the umpire's decision according to the policy's appraisal clause, agreed to pay the claim at the assessed value.

Conclusion

Jane Doe’s case illustrates the efficacy of an umpire’s intervention and the appraisal process in resolving complex insurance disputes. With her lawyer’s guidance and the umpire's decisive ruling, Jane Doe successfully secured the funds required for the necessary repairs to fully restore the damage caused by Hurricane Ian, as stipulated in her insurance policy.

Lessons Learned

An umpire’s expertise can be invaluable in navigating disputed insurance claims. Comparative estimates are crucial in supporting a policyholder's claim of underestimation by an insurer. The appraisal process serves as an effective resolution mechanism and can be expedited with professional assistance. An umpire's binding decision helps to ensure a fair settlement and is a vital component of the insurance dispute resolution process.

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Call to Action

Bearing this case in mind, as an insurance defense lawyer it can be difficult to find an impartial umpire candidate with the proper qualifications. All Claims distinguishes itself from other umpires by maintaining a team of consultants with both technical expertise and real-world construction experience. This unique combination enables them to comprehend disputes at a depth that technical-only or non-construction consultants and umpires simply cannot match. As a mold certified (MRSR299, MRSA687), state licensed general contractor (CGC1517916), All Claims Consulting has served as an impartial consultant and handled 7,658 cases for our 623 clients. Our staff of consultants averages decades of experience conducting appraisals, expert witness testimony, mediation, and umpire assignments. If you find yourself with questions or would like to discuss any aspect of the insurance appraisal dispute process, reach out to Tony Allogia at tony@allclaimsrepairs.com.