MAKING YOUR INSURANCE CLAIM:HOW TO NAVIGATE COMPLEX INSURANCE CLAIMS TO ACHIEVE OPTIMUM RESOLUTION

Prepared for Residents of Fort McMurrayPrepared By: Higgerty LawFebruary 2017

AGENDA• Introduction

• Insurance Basics

• Policy Wording

• Policy Coverages

• Policy Limits

• Specific Considerations

• Insurance Company Tactics and Claim Hurdles

• Recommended Approach

• Making a Claim - The Process

• Plan of Action

• How We Can Help

•Why Higgerty Law?

• Structure of Proposed Representation

•What Next?

• Conclusion

•Questions

HIGGERTY LAW - ABOUT USHiggerty Law is a technology-driven, broad-service law firm dedicated to helping

individuals and businesses. Located in Calgary, Alberta, we serve our clients across a wide range of legal practice areas. With senior counsel who have over 70

collective years of experience dealing with insurance law, our firm is adept at navigating the ups and downs that are associated with complex or large insurance

claims.

Our progressive approach to technology integration - coupled with our expertise and proven track record - enables us to help our clients in the most efficient,

convenient, and competent manner possible.

INSURANCE BASICS: Policy Wording

• Two forms of compensation means:

• Replacement Costs - the lesser of either the cost to repair or replace the

damages with materials of similar kind or quality.

• Actual Cash Value (A.C.V.) - the cost of repairs less depreciation.

• Dwelling: the property and its fixtures as described in the insurance policy

and being used as the primary residence.

• Uninsured Perils: Uninsured events which are not covered by the policy.

• Additional Living Expenses: Payment of moving costs, property storage costs,

and increased living expenses for a reasonable period while repairing or

replacing the damaged property.

INSURANCE BASICS: Policy Limits• Insurance policies can have several limitations included in them, which can vary from

policy-to-policy.

• It is critical that homeowners are aware of their policy limits, as these limits can have an impact on a claim.

• These limits can include:• Individual Coverage Limits;• Global Policy Limits;

• Guaranteed Replacement Cost Limits.

Higgerty Law will identify the limits included in your policy, in order to protect your rights.

INSURANCE BASICS: Potential Coverages

• Typical Fire Insurance Policies Cover:• The structural dwelling or residence;

• Contents of the dwelling;

• Additional buildings on the property;

• Additional Living Expenses (A.L.E.);

• Vehicles and recreational vehicles;

• Incidentals (such as yard clean-up, etc.); and,

• Others (as determined by the individual policies).

Higgerty Law is positioned to be able to identify and assess the coverages that are available to homeowners, in order to maximize the potential recoveries from

insurance companies.

SPECIFIC CONSIDERATIONS

• Insurance Companies may attempt to implement a 20% deduction for contractor profit and overhead in those situations where the homeowner is acting as the general contractor. This does not take into consideration costs such as:

• Time spent;• Loss of revenue from other sources;• Equipment rental; and,• Other costs.

Higgerty Law will take the position that this deduction is inappropriate, and will fight to have it excluded.

INSURANCE COMPANY TACTICS AND CLAIM HURDLES

• Insurance Companies use many tactics to delay claims, discourage claimants, and benefit the insurance company's interests.

• Tactics that are typically utilized can include:• Continual Negotiations;• Multiple Adjusters and Changing Adjusters Mid-Claim;• Unfulfilled Promises;• Non-Responsiveness and “Going Dark”;• Client “Run Around”;• Continual Delays.

• Remember: Claims Delayed equal Claim Denied

Higgerty Law is experienced in dealing with Insurance companies, and are knowledgeable about how to navigate the tactics that insurance companies typically employ.

RECOMMENDED APPROACH

• Maximizes Recovery and Protects Client Interests:

ADJUSTMENT TRACK LITIGATION TRACK

Insurance Claim Process Legal Process

• Comply with Insurance Company Requests and Procedures

• Take steps to independently assess and evaluate claim

• Negotiate and communicate with Insurance Company

• Initiate legal steps to protect homeowners’ rights

RESULT: Forced resolution of claims with optimal outcome for claimants

DUAL-TRACK APPROACH

MAKING A CLAIM – THE PROCESS

STEP 1: Complete an Independent

Damage Assessment

STEP 2: Identify Potential Additional

or “Hidden” Damages

STEP 3: Complete a Formal

Appraisal/Valuation of Damages

STEP 4: Conduct a Review/Critique of

the Insurance Company’s Appraisal

STEP 5: Complete the Insurance

Company’s Proof of Loss Form

STEP 6: File the Proof of Loss

STEP 7: Dispute Resolution Process

STEP 8: Initiate Litigation

OVERVIEW

Step 1: Damage Assessment• An expert assessment of damages should be conducted in order to:

• Provide a comparison to any assessment prepared by the insurance company;

• Identifies potential losses and potential recoveries;

• Provides confirmation to the homeowner as to the potential scope of their damages for valuation.

Higgerty Law has professional contacts who are able to provide a thorough assessment at a reasonable cost.

Step 2: Identification of Additional Damages

• Identification of “hidden” or “additional” damages that may not be covered in a typical assessment:

• Out-of-pocket expenses;

• Additional Living Expenses;

• Psychological or emotional damages;

• Health or physical damages; or,

• Long-term damages.

Higgerty Law has the knowledge and experience to identify these non-typical damages.

Step 3: Appraisal/Valuation• An expert should conduct an appraisal or valuation of the losses or

damages, in order to:• Compare with and potentially rebut the insurance company’s appraisal;

• Identify potential recoveries;

• Provide a sense of the overall value of the claim.

Higgerty Law has professional contacts who are able to provide a thorough and realistic valuation of damages.

Step 4: Rebuttal of Insurance Company’s Appraisal

• Once appraisals have been completed by both the insurance company and an expert, a comparison of the results should be conducted in order to:

• Identify discrepancies;

• Identify overlooked items;

• Provide contrast for rebuttal of reports.

• A formal appraisal including any rebuttal of the insurance company’s appraisal should then be prepared.

Higgerty Law has experience in rebutting insufficient insurance company reports, and are positioned to be able to fight for the best-case appraisal.

Step 5: Proof of Loss• Once the appraisals have been completed, homeowners must

complete and submit a “Proof of Loss” form to their insurance companies.

• Forms are provided by the insurance companies, and may differ slightly from company to company.

• Proof of Loss forms MUST be provided within 60 days of the insurance company receiving notice of the claim.

Higgerty Law can assist clients in properly completing and submitting the Proof of Loss forms, and will ensure that important deadlines are met.

Step 6: Submitting Proof of Loss

• Proof of Loss MUST be submitted before dispute resolution and 60 days before commencement of action (and 60 days before the expiration of the 2 year limitation period).

Higgerty Law can assist clients in properly completing and submitting the Proof of Loss forms, and will ensure that important deadlines are met.

Step 7: Dispute Resolution• A process wherein each party (insurance companies and homeowners)

selects a representative to advocate on their behalf, and the two representatives select an umpire.

• Each party will make submissions through their representative, and any two of the three panel members will provide a decision as to the quantification of the claim.

• The decision is binding as to quantification, but not contractual liability under the policy.

Higgerty Law has experience with dispute resolution, and is able to represent clients throughout the process while presenting the best possible claim for our clients.

Step 8: Litigation

• After loss quantification from dispute resolution, if not settled, a court action should be initiated within the requisite timeframe.

• Settlement may occur at any point in the process.

Higgerty Law has a proven track record of success with litigation, and is able to navigate the legal process for our clients.

PLAN OF ACTION• Strength in Numbers: Commonality of issues provides an

opportunity to present a united front to insurance companies through group cooperation.

• Targeted Approach: Shared issues amongst homeowners allows for a targeted negotiation towards ultimate resolution of those issues with any one or more insurance companies.

• Pursuit of outstanding and unique claims through a contingency arrangement.

HOW WE CAN HELP• Experienced in complex and large-scale insurance claims;

• Identification of policy limits and issues;

• Identification of coverages and entitlements;

• Negotiations with Insurance Companies;

• Facilitation of expert/professional assessments and rebuttals;

• Preparation and submission of proof of loss forms;

• Facilitating dispute resolution;

• Preparing for and conducting litigation.

WHY HIGGERTY LAW?

• Senior counsel has combined legal experience of over 70 years;• Adept at navigating complex litigation;• Skilled in resolving large-scale claims;• Experienced at negotiations with Insurance Companies;• Knowledgeable background in dispute resolution;• Emphasis on cutting-edge technology, allowing for ease of

communication;• Access to industry contacts and resources;• Affordable billing/fee structure; and,• Proficiency in 7 different languages.

STRUCTURE OF PROPOSED REPRESENTATION

• Initial Retainer of $750.00 per household

• Contingencies:• 10% before litigation;• 15% after litigation but before discovery preparation;• 20% thereafter, up to and including trial, but not appeal.

WHAT NEXT?Speak with one of our representatives in the lobby;

e-Mail us at info@higgertylaw.ca;

And don’t forget to visit us online at www.higgertylaw.ca or on facebook https://www.facebook.com/higgertylaw/

Complete our Questionnaire and Intake Form online at http://www.higgertylaw.ca/fort-mcmurray-insurance-questionaire/;

QUESTIONS

THANK YOU FOR YOUR TIME AND

ATTENTION!