FOX 11 Investigates: Getting the most out of your insurance claim

    Appleton house fire, May 21, 2015

    As homeowners we pay good money to insure our property, while hoping we never have to file claim. When disaster strikes you expect the insurance companies to have your back. But FOX 11 Investigates found some property owners fighting to get the settlement they felt they were owed.

    A contractor's torch touched off a fire at Amanda Wood's home in Appleton last Spring, according to fire officials. They believe smoldering embers made their way to the attic, igniting flames from there.

    FOX 11 News reported on the fire and damage to the home.

    "I found out from the FOX 11 report was the first time I heard the estimated damage which they put at $100,000 at the time," said Wood.

    The actual costs would climb.

    After assessing the fire, smoke and water damage throughout the 3-bedroom home, Wood says American Family Insurance told her she would need to pay between $8,000 and $11,000 up front.

    An email from American Family indicates the money was needed to first remove asbestos from the damaged home before repairs could begin. The claim manager indicating such removal was not covered in her policy.

    An American Family spokesperson tells FOX 11 Investigates, its staff was "following procedure."

    "I was shocked because I didn't start my house on fire so I couldn't figure out why I had to take $11,000 of my own money to get the process started," said Wood.

    Wood says the insurance company's adjuster indicated there were tens of thousands of dollars in repairs that needed to be made to the home that were not covered in her policy. Email exchanges suggest the company claimed there were pre-existing conditions. Wood was left devastated, frustrated and confused. She thought she was completely covered by insurance.

    "Were you feeling victimized at that point?" asked FOX 11 Investigates.

    "Absolutely, and that's why I think it's so important to get the word out to everybody. Know your policy," said Wood.

    In a written statement American Family Insurance told FOX 11 Investigates-- "We pride ourselves on working with every customer to help them understand the claim process."

    But that wasn't enough for Wood. She turned to David Miller, with Miller Public Adjusters, an expert in reading insurance policies and construction.

    Realizing the extent of the damage, Miller got the city of Appleton's building inspector involved. The property was ultimately deemed uninhabitable and ordered torn down by the city. Further negotiations with American Family led to an insurance settlement estimated to be well over $200,000, topping out at Wood's policy maximum.

    With negotiations and delays the claim process took months. Going on nine months after the fire, Wood's new home is finally nearing completion.

    And Wood never had to pay for the asbestos removal.

    "I never paid that $11,000. I refused to," stated Wood.

    "Without proper representation there may be some additional coverages or things you may not understand you're entitled to in order to rebuild or repair your property," said Miller.

    American Family Insurance declined an on-camera interview but in a statement told me: "In this situation, the amount of American Family's initial claim payment to our customer was for a repair to her home, which was in line with the recommendation from the customer's own contractor, two other independent contractors and reflects our company policy. It was when an Appleton city building inspector ordered the house be torn down, and not repaired, that we immediately offered to pay the amount covered in the customer's insurance policy to rebuild the home."

    American Family went on to say: "We are always willing to consider new information and if needed adjust our approach for the customer, which is what we did in this situation."

    "Have there been people who probably should have received more money but didn't know they could take it a step further?" FOX 11 Investigates asked Miller.

    "Yes," confirmed Miller. "We get calls at any stage of the claim and a lot of times we get called at the later end of the claims and when that happens the policy holders don't realize that they had so much money left on the table that they were able to recover."

    Miller battled an insurance company four years ago, after his home caught fire. He says his insurance company's adjuster offered what he believed to be a low estimate of repairing the damages. Miller knew better having worked in construction for years. His fight with his own insurance company prompted him to get his public adjuster's license and start his own public adjusters company four years ago.

    "I don't want to go on knowing that other people are getting short-changed like I did or I was getting," said Miller.

    American Family Insurance should not be singled out.

    The Wisconsin Office of the Commissioner of Insurance confirms that low claim offers are the most common complaint from policy holders it receives regarding property and casualty claims. Property and casualty claim complaints totaled 966 against all insurers in Wisconsin in 2014.

    This fire in 2014 gutted the Timbuktu bar in Oshkosh. The owner says with the initial insurance offer she would have lost everything. Miller was hired and the owner confirms she was able to get an insurance settlement four times higher. An exact figure could not be released as part of a non-disclosure agreement.

    The job of a public adjuster is relatively new in Wisconsin and pretty much the midwest. Miller says that's in part to our 'midwest values' of trust that the insurance companies have our best interests at heart. But on the west, east and Gulf coasts, public adjusters are more commonplace in representing homeowners.

    In Madison, the Office of the Commissioner of Insurance does not regulate private public adjusters. The office recommends as a homeowner you do your homework before signing any agreement.

    David Day has been an adjuster for more than 20 years. He started out as an adjuster for an insurance company--the other side.

    "I think what the mindset is at the insurance companies is, we want to pay the least amount of money that we can," said Day.

    Day says there is no right or wrong settlement number. He adds the value of the claim is what both sides agree to in the end.

    But FOX 11 Investigates asked specifically about the claims he has taken on as a private adjuster.

    "How many did you add value to?" FOX 11 asked.

    "I'd say 100 percent," said Day.

    As for Amanda Wood, she feels hiring a public adjuster was worth it. And she has a message for other homeowners.

    "Go home and read through your policy and see how much you're confused about, because there's a lot in there that could easily be swung two different ways," said Wood.

    Do you need to hire a public adjuster? No. Especially if you're able to decifer the technical wording of your insurance policy, and you have the time and patience to negotiate with your insurance company.

    Some people hire attorneys, who may in turn go to someone like Miller for their expertise.

    As for Miller, he charges on average 10 percent of the claim payment. If he doesn't get you anything there's no charge.

    The Wisconsin Officer of the Commission or Insurance has some tips for insurance policy holders on what to be aware of regarding insurance coverage.

    Read a few tips to avoid problems with insurance claims from the Wisconsin Office of the Commissioner of Insurance.

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