Insurance Claim Payment

Hello I am looking for feedback about insurance claims. I have a large claim with Nagico. I have sent several E-Mails to the company and the adjuster they hired. Lately I am not getting any return E-Mails about the claim. I would like to get feedback from other clients of Nagico how their claim is being processed.
Thanks

Heard the same thing from friends on St Maarten with Nagico claim. They can only blame the non reply on the size of the disaster for so long. If you had ignored you insurance payment you bet they would call you back for payment. Now they owe you money and to bad. They try to squeeze people knowing they need the money to settle for less. I hear many getting only a third of the claim if that. How many years of no big losses did they have of now big losses to pay out. They said in the media they have the money to pay everyone...so lets see it. What a joke!

No, correction, they wouldn't call you back for payment, they'd just cancel your policy!!! <img src="http://www.traveltalkonline.com/forums/images/graemlins/cloud.gif" alt="" /> Insurance is a freaking scam. With our huge hurricane deductible (here in Florida!!) and what they claimed wasn't hurricane damage, and what they depreciated, we got paid about 1/3 of what we need to fix our house. Now, it wasn't anywhere near total destruction, like many claims in the Caribbean, but it's just sad what they do to people.

Insurance is a for profit business. I am a public insurance adjuster. It amazes me still that consumers think they will get fair treatment from the obligor on the other side of their insurance contract. My clients in the US and the Caribbean are getting very fair settlements though payments are slow.

Is there a "not" missing in the third sentence?

Insurance is legalized theft. You are more or less required to have it, pay into it for years, and then when claim time comes you are treated like the thief. For profit indeed- insurance companies, backed by insane government regulations, steal from the wallets of hardworking people on the pretense of protecting them. Similar to what organized crime did to small businesses in the day. Fair settlement my [email]a@#.[/email]

+1000

No, sir!

Ok, then I'm not sure I understand your point. That consumers will only get fair treatment with the help of an insurance adjuster?

I am a public insurance adjuster. I work only for policyholders to document the damage and negotiate the claim. We are on the other side from the insurers. PM if you want more details.

Not sure if you are all talking about land property but for those with boat loss I'll through in my 2-cents. There was a long void with little info but then rapidly the adjuster reviewed the claim and the company settled last week.
They settled the contract exactly and with no questions. Yes, looking at replacement cost I had myself insured a little light but that was my over site and not by much. So at least for some in the boating side and with total loss there has been slow but fair response. Caribbean Insurers was the company.

Further, I have adjusted over one billion in claims for my clients in the past 20 years. If any members have insurance claim questions PM me. I will try to help.

A total loss boat should be straight forward if you have agreed value coverage. Total loss the insurer owes the policy limit.

Many of the complaints I hear from insureds in the Islands relate to underinsrance. Insurance is expensive and folks buy less than they need hoping the worst doesn’t happen. When the worst happens as it did this year policyholders get hit with coinsurance penalties or otherwise less than full indemnity. Buying insurance is a big financial transaction. Get gadvice from an experienced broker.

What is your experience with Nagico?

In my case, only the foundation is left. The only thing of value is the washer and the dryer. So basically a total loss. I submitted my notice of claim, then an adjuster was assigned my claim. I submitted a claim to the adjuster, then he wanted more information, then more information. I submitted the last set of information to the adjuster 3 weeks ago, Since then, no communication. Who should I be communicating with the adjuster or the insurance company? Thanks

Wmasters: Your first sentence should have read legalized “extortion”. I have always stated it that way even though we’ve been treated fairly

What's legalized about it

I agreed with wmasters when he called insurance legalize theft but I call it legalized extortion. If you want to borrow my money, you have to have insurance whether I pay out on it or not is up to me. In other words, give me money, it’s mine and if you have a claim maybe I’ll give some back.

The insurance company handling the payouts on the Moorings boats seems to be doing a reasonable job. Payouts have been a little slow but to date they have paid out over half the totaled boats and checks are arriving daily.

I think the "totaled" boats should have been paid out by now. (Determine totaled within 4-6 weeks and payment processing another 6 weeks maximum).

Yet to be determined is the fairness of pay outs for repairs. So far I have been pleased with my interaction with our fleet insurer. Just beginning the repairs.

I have spoken to one owner of a charter based in Soper's Hole who reports getting very little response from charter company and insurer will not speak to them. Unfortunate.

I have heard of the Issue on the Sopers hole boat. If they still use the same insurer it's a South African company. That makes communication difficult. It's in the charter companies best interest to resolve it quickly.

It can take a while to get a boat claimed as a constructive total loss. We were on the hard for hurricane storage. All of the boats had to be stood up and that took a long time. The insurer's (Yachtinsure/Lloyds of London) surveyor did a preliminary survey. He finished the survey after she was stood up on November 26 - 18 items of damage, with line #19 "CTL" - Constructive Total Loss. November 29 we had our Proof of Loss paper work completed. Now we are waiting on the wire transfer.

We had no problem with the insurer, adjuster or surveyor. They agreed to pay the full value of our insurance, yard bills, rigging bills and related expenses. We were insured for purchase price plus improvements. We are in the USVI, so the regulatory environment may be a bit different.

Our biggest problem was getting Independent Boat Yard to move briskly to allow a crane in the yard to stand boats up. The delay contributed to additional damage from our boat lying on her side. It was a long frustrating process of mostly waiting. I was very luck to have my co-owners, Capt. Jay and Debbie, on island during the process.

Good luck to everyone working through their claims.

Cheers, RickG

It's been a long process just due to the number of boats involved. Add in the fact that Paraquita Bay could not be accessed due to silting by equipment capable of untangling the mess and things are slow. Overall however on the boat insurance side things seem to be moving along. It's takes one to two days for a adjuster to process a boat. On the Moorings side there are 5 adjusters working to process 400 boats. I am sure the same issues of scale apply across the charter industry. At this point I am cautiously optimistic that the boat insurance side is turning out well.
G

My wife and I had a very good insurance claims experience. We lost our Lagoon 42, Ocean Song, to Irma. She had arrived in Tortola on 8/24 and we were scheduled to go to Tortola on 9/30 to see, and sail her for the first time. As everyone recalls, Irma hit Tortola on 9/6. Ocean Song was located in Road Reef Marina as part of the TMM charter fleet. She was declared a CTL within one month. We had a 100% pay out of the agreed upon value about three weeks before Thanksgiving - no deductible. On 12/6 we re-ordered another Lagoon 42 with virtually the exact same options. The "new", new Ocean Song has an ex-factory date of June 2018 and will be TMM's featured boat at the Annapolis Boat Show in October 2018.

Things moved quickly for us for several reasons: 1) Ocean Song was accessible. 2) TMM's owner, Barney Crook, had made arrangements for surveys and salvaging BEFORE Irma hit. 3) TMM worked diligently to keep the survey and salvage process moving. 4) TMM facilitated all communications with the insurance company. 5) TMM did a very good job of keeping us updated throughout the process. 6) Also, TMM helped us "trade up" on build slots. Built slots on the Lagoon 42 are now about two years out for factory exit.

We feel very fortunate how well things have worked out, so there are some positive stories to be told.

Great. Enjoy your new yacht

Sounds like they never got a chance to enjoy the 'old' one! <img src="http://www.traveltalkonline.com/forums/images/graemlins/cry.gif" alt="" />

Please keep us posted on your home insurance claims tpcook. I find all of these insurance issues very informative

We have several friends with boats in Virgin Gorda Yacht Harbour who have Pantaenius as their insurance company (total of 8 boats that we know of). Pantaenius has decided not to pay any of the 8 boats for any boat damage. Zero. The 8 boats that we know of are seeking advice for filing a class-action lawsuit against Pantaenius.

I was surprised by this since Pantaenius was one of the larger insurance companies insuring boats in the Caribbean. Not nice at all!

What is their reason for not paying?
G

Pantaenius said none of the boats had an adequate hurricane plan, since they were all damaged or destroyed by the hurricane. Yet each boat's hurricane plan, filed with Pantaenius before the hurricane season, was accepted by Pantaenius.

I believe we need a Thread listing companies who handled claims appropriately with IRMA. Some of the good ones may no longer be writing in Caribbean, but definitely do not want to pay the bad ones for poor coverage/ service.

I did get a response from the adjuster telling me that they are looking at my claim.

I am hearing from several folks that some companies appear to be playing games with determining a "total loss". I wonder if there is a legal definition. One particular house above CGB was reduced to a slab and cistern. The insurance company claimed it a partial loss and hit him with a co-insurance penalty. If that is true it would be very hard for any house in the BVI to ever be determined a total loss.

Frustrating indeed. We have submitted our claim and have heard from the adjustor once to get contact number.....since then................crickets............

I really hate this co-insurance clause. I believe the insurance company should decline coverage and not write the policy. It is VERY unfair to a policy owner (who does not have the information to understand how the value of a home should be determined) to write a policy they know is under-insured. They will NEVER declare a home a total loss as they know the cistern and other parts of the home will survive almost anything.. In my case I questioned the insurer how the under-insurance clause worked and was told by E-Mail that usually if the "value" of the home was within 80% of the sum insured , the under-insurance clause would not apply. I have that in writing and the adjuster is still questioning if this is in effect.

Assuming an 80% co-insurance clause there should not be a penalty unless the slab and cistern were more than 20% of the pre-storm value of the home. I doubt that would be the case. Many insurance adjusters don't understand co-insurance and apply it incorrectly.

Are you in the insurance business? My understanding of the 80% clause is that if you insure your home for 500K , your replacement value (as determined by the insurance company) can be as much as 500k/0.8= 625k and your under-insurance clause will not be in effect. So if you have a 250k loss they will pay the entire 250k and not be reduced. max amount they will pay is 500k.

Yes, I am in the insurance business. Your illustration is correct. Another way to look at is that if the remaining value of the building is less than 20% of the full replacement cost then you will not get hit with a co-insurance penalty even if you are underinsured. It is important that the replacement value of the building (not the amount of damage) be calculated with pre-storm costs. Repair costs after Irma are up 30-40%. Don't let the adjuster use those values in calculating the replacement cost value for the co-insurance formula.

I was under the impression that the "co-insurance clause" doesn't care what "survived"
I was always led to believe that the co-insurance clause "cared" whether you carried sufficient coverage based on the value of the insured property "as a whole"

So.. given tpcook's example of a $625 home carrying $500 coverage
Let's assume the cistern and slab is worth $150 of the $625... damage (and let's just assume rebuilding) costs are $625-150=$475
.... I felt... say, under 80% coinsurance... you were good and covered (minus deductibles)

Your concept of "what survived" versus the "co-insurance clause" has me confused - as it seems to be separate issues
... but, I am not in the insurance business

Assume the following:

Value of the dwelling: $1,000,000
Coinsurance: 80%
Required Insurance: $800,000
Insurance limit carried: $500,000
Damage: $800,000

Divide the limit of insurance $500,000 by the Required Insurance $800,000 = 62.50% Recovery Percentage

Multiply the amount of damage $800,000 by the Recovery Percentage 62.50% = $500,000. The insured is paid the policy limit.

If the amount of damage is changed $700,000 the insured only recovers $437,5000.

So you don't need to have a total loss to recover the policy limit you need to have an 80% loss or 20% value remaining.

I am not in the insurance business, but the sources I checked by googling "co-insurance clause" (here, here, and here) all match the above explanation.

Dan

Yes - we are all understanding it correctly - now that the numbers have been added
It was the discussion of whether the slab & cistern was worth more than 20%/less than 20% that didn't connect with me
But.. that seems to be a red herring in the picture

Keep in mind that the purpose of coinsurance is to encourage policyholders to adequately insure their property. Most losses are partial losses. Without coinsurance policyholders may intentionality under insure gambling that they will only sustain a partial loss and still recover their full loss. This defeats the basic insurance principal of spreading the risk over a pool of policyholders.
A good broker will assist their client with determining adequate limits to satisfy the coinsurance requirement. If the broker fails to adequately advise the client about coinsurance and the need to insure to full value they could be on the hook for the shortfall. I suspect a lot of brokers in the Caribbean are sweating about this right now.

Errors & Omissions - Google it. Might help the cause.

It's not a red herring its a fact as proved by the formula I presented. Perhaps you just don't get it.

Also, keep in mind that the cistern may not be covered property under a lot policies. In that case it should not even be considered on either side of the coinsurance formula.

However you dress this up...we got hosed and still dont have the " hosed" check that we were supposed to get in " 5 to 10 working days" three weeks ago.

Mal - well... you've certainly had your share of stress and challenges this past calendar
...... in both places...... as if either one wasn't enough....
So - here's hoping the winds change... and change in your favour in this New Year

And the same good wishes to all others that have been struggling through this past year
Boat(s), house, cars and business'... it has been painful to watch and be able to help so little

To a peaceful year....

Jan 3 rd. I have tried to call the BVI government about a couple of issues. No phones are being answered. I have fried to call my mortgage bank (first Bank) with several different numbers. No one is answering. Same thing with Nagico. No one is answering phones. Complete breakdown in communications. Not sure what I can do.

ditto, tpcook, ditto.

We are about the same. This recovery is going to be on island time no matter how you slice it.

So today I received an answer from the insurance company on my claim. They are trying to tell me that the villa was under insured and are deducting because of that. I asked about how the under insurance worked and was told in an E-Mail from the director of Nagico that as long as it was within 80% it would not be invoked. Now they are saying that the E-Mail that I received was an explanation only and not part of the policy. I think they induced me to buy the policy by the statements that they made and this is a fraud against me. They also said that if I wanted to have the 80% under insurance that I could have bought the policy with that in effect, however in the E-Mail back to me they did not mention any cost to purchase the 80% under insurance, so that again is a fraud as the broker failed to ask me whether I wanted the 80% or not.
I am VERY angry on the way I am being treated by this company.

Co-insurance clauses only come into effect if the loss is partial. From the pictures I saw it is hard to believe that the villa was not a total loss.

Glenn I agree with you, but they claim it is not a total loss. (so they can use under insurance clause)
All of this is VERY disturbing to me and my son. We will be drafting a letter to the adjuster that we consider this a fraud in many ways

Have you consulted an attorney? Might be best, at this point.. And I would do it BEFORE I sent any letters..

Thnaks Carol

Are they saying that you have 100% coinsurance?

HI Thorsten - sympathies on this trying time - we are still awaiting our insurance company's offer.

I woud love to see the numbers they ome up with. I have explained some true partial losses to some people on Facebook that workedout about right. Mostly recent additions without updating the policy.

tpcook, I am sorry, this is indeed frustrating. They are invoking the same on our villa on Jost. We were lucky to be a partial loss but at the same time, this sucks!

In my case they made a math mistake and the under insurance factor is 87.6% This has become so DIFFICULT for me that my son is entering the picture to deal with all the cast of characters involved. So far no work permits from the government even though they promised a quick decision for skilled workers, the Bank is being very difficult to reach about my mortgage, the insurance company is shoddy. Dealing with companies in the BVI is VERY difficult

I'm sorry to hear about all of the difficulties with your insurance company. I'm not sure if anyone has spoken about the idea of hiring a Public Adjuster to navigate the settlement for you. We had a fire at our house two years ago, and based on the advice of the firemen, we hired a Public Adjuster to deal on our behalf with the insurance company. His fee was 7% of all settlements, however, we got back far more than expected, even factoring in his fee. What the Public Adjuster does is calculate everything that was lost, come up with a replacement cost, and tell that to the insurance company. They negotiate the final number, but they are negotiating more as equals, as opposed to the insurance company simply dictating their terms. The final settlement number, with a Public Adjuster, is always MUCH more than what we would have been simply offered by the insurance company. So rather than sit back and let the insurance company mandate a low settlement number to you, I would urge you to hire someone to advocate on your behalf. Not only will you have someone getting you a better settlement, but you'll also have someone dealing directly with the insurance company, saving you the stress and anxiety of doing this yourself. I hope this advice is helpful, and I apologize if this has been covered in a previous post. Best wishes on a fair resolution.

I just received the first proposal from the insurance company, but it is so ridiculous that we (My son and I) are responding that we are preparing or arbitration in the matter. I may need some one to act as an arbitrator in the matter. As an example, they are saying we are under insured by 87.6% and then in another paragraph they are saying the estimate that we submitted was too high even though it was at a per sqft rebuild of $237 The villa is heavily damaged and nothing can be reused except for the cistern. I estimated a 40 week rebuild and they think 30 weeks. A villa cannot be built in the BVI in 30 weeks.

Basically the insurance company is abusing their clients.

Sent you a PM

The BVI government is giving my builder the work permits he needs, So the rebuild will start Feb 10. The insurance company seems to be interested in finishing the claim but so far I have not seen a final proposal. The bank also is trying to help with the mortgage. So maybe the stars are aligning.

tpcook - stay on them even if you agree to a settlement amount. I made a settlement with my adjustor in person with the promise of a payment within a 2-3 weeks. It's been 18 days and so far only a "recommendation for payment" has been made to Lloyds. I suspect I'm still 3 weeks out from a check to my bank.

Jason ..see my post..if you re on island go to the office and pick it up!

Well, we received our Proof of Loss for De Life on November 30, 2017. The wire transfer arrived January 25, 2018. Our hold up was slow pay by one of two LLoyds's syndicates. We had to push to get to settlement this quickly. It worked out okay for us in the end.

Cheers, RickG

We’ve been very pleased with the service we’ve received from CIL. They’ve gone out of their way in difficult circumstances. No complaints at all.

The insurance company is still asking for more information on what my rental income was for the last 3 years. I have provided my uSA income tax forms, my computer spreadsheets showing the name, date and amount of all income. I also offered to send them every contract and the cashed checks from my guests. All of this shows without anyu doubt what my yearly income from the villa was. Now they have to think about it. BVI government is still working on the work permits. meanwhile I have bought flight tickets and accommodation on VG to meet the builder and the architect on site to discuss the project. Frustratingly slow. meanwhile the clock ticks

Unless you are making a claim for lost business revenue what does rental income have to do with a settlement? It has nothing to do with reproduction cost.

Not to mention disclosing private individuals' Credit Card and Bank account numbers.
That seems to be on the wrong side of privacy rules... curious if the insurance companies can "demand" that info

Mt policy covers me for lost rent. to a max of 10% of the sum insured.

The insurance company has the right to review and copy the insured's books and records. This is a grey area but typically it's limited to the documents necessary to validate the claim presented. Credit card and bank account numbers are not needed to prove the claim. What is more important is proof of the revenue received. That can be documented by the insured's bank account statements and other accounting records.