On September, 2016 a property owner who owns a significant amount of property in the Wilmerding area of Pittsburgh all insured with one particular insurance company for close to 27 years, reported a claim after noticing the exterior brick on one of her apartment buildings were beginning to fall.
Her insurance company replied that they were sending out one of their trusted engineers to view the property and inspect the structural integrity of the wall. Upon meeting with the policyholder’s contractor and inspecting the building, the engineer informed the woman and her contractor that the wall (in his opinion) was safe. Some time passed after the inspection and the property owner received a letter from her insurance company stating that their engineer had confirmed no real damage had occurred to the building, therefore the claim is denied. In this letter was a report written by the engineer stating his findings along with a proposed repair method.
After a few phone calls asking for further direction and left with little to no response from her insurance company the woman decided to begin the recommended repairs to her building to ensure its longevity and safety of her tenants. However, at this point in time the weather did not permit the repairs to begin. Luckily, with a mild winter only a few months pass which allows the contractor to free up and schedule the work to be done.
On February, 2017 the contractor set up scaffolding to begin the repair that the insurance company engineer recommended. Within moments of the repair to tie the brick to the building, the contractor began to hear cracking. He immediately started his descent from the scaffolding but the wall collapsed on top of him and another worker. Once the dust settled, neighbors and passersby came to the rescue. Luckily, the two gentleman escaped with only minor injuries from the 3 stories of brick that came down on top of them.
Confusion set-in. The women not knowing what to do based on her insurance company’s recommendation, once again turned to them for help. Upon getting notice of the claim the insurance company sent a Reservation Of Rights letter (ROR) stating that once again there may not be coverage for the damage and they must investigate. This time, a different engineer was sent out who investigated the loss unassisted by any representative of the property owner.
Seeing the red flags and to protect her interests, the woman did her research and in March, 2017 she hired Public Adjuster Zach Flora of Tutwiler and Associates. As required Mr. Flora notified the insurance company of his representation, requesting a certified copy of the insurance policy that relates to the damaged building. It is always important to know the policy or contract language as it relates to any loss.
First things first. Mr. Flora arranged to secure the building since it is on a relatively busy road, getting fences put up and arranging for the bricks to be cleaned off the street. Next began the battle due to the Reservation Of Rights letter the insurance company was leaning on to say their investigation is continuing. Repeated requests for a copy of a policy along with the engineer’s report went unanswered for months causing great delay and affecting the property owners income. Even worse, the city started beginning to fine her daily.
Four months into the claim, after continuous emails, phone calls, and requests for onsite inspections by Mr. Flora and explanations regarding why this claim is covered, the engineer’s report along with the policy was released including a letter awarding coverage. Upon receipt of the policy, claim adjuster Flora did his review, breaking down coverages and how they apply. Upon review of the engineers report. He immediately noticed that the report only addresses the west exterior wall, the wall that collapsed. Like taking pieces from a puzzle and drawing upon his adjusters training, if one wall was affected, the others may shift due to all being tied together. Additionally, there was no inspection for interior damage. When asked why, the answer was that he could not gain access. The reason he could not gain access is that he did not coordinate with the property owner a date or time to arrange to do so.
With some back and forth a time was set with Mr. Flora and the insurance company consultant, another hired vendor to inspect the property. The two started with the exterior since it was the area of most concern. When Mr. Flora began to talk about the interior, the consultant replied that he was there only to examine exterior damage and was told nothing of interior issues and leaves.
The battles continued after the inspection for the entire loss to be examined. In the meantime, Mr. Flora got the insured’s loss of income paid at policy limits along with the mitigation costs. Further, as he continued to push for a full inspection, the cost of repair for the exterior wall was negotiated. The insurance company now decided to depreciate the repair cost by close to 70% leaving the property owner with pennies on the dollar to repair her building.
Finally, in October, an interior inspection was set. But once again there was not a full inspection to Mr. Flora’s satisfaction. The consultant advised that he was to only document certain parts of the building, not examine the extent of damage in its entirety. Shortly after the inspection, $10,000 (a small amount) was issued for repairs to the interior damage.
This trend repeated itself for close to 2 years until Mr. Flora with the help of some legal colleagues were able to finally settle this originally denied claim with a recovery upwards of $200,000 for the policyholder.