All Forum Posts by: Sara Nobles

 Jason, on behalf of our client participants, carriers pay many, many "reasonable" claims every day/month/year. That stated, adhering to the contractual obligations of the policy/coverage is paramount in garnering settlements when a claim occurs. As you indicated, though the Program utilizes a unique arrangement and participates in the actual settlement, it does not have the ability nor does it adjudicate the claims (as we've communicated many times).

Though the denial of your claim never makes anyone happy, no carrier does so without thorough investigation. Accordingly, "reasonable" may be the issue here. With your permission, I will share further details here, if only to help others avoid similar outcomes.  

@Gautam Venkatesan

We at Affinity and NREIG are more than happy to discuss policy provisions, common to Insurance Services Office, ISO, policies, which are the coverages we offer. I would defer to, BreAnn Stephenson, with Affinity Loss Prevention Services (http://www.affinitylps.com), who will be starting a new thread to address these and other ways to manage the risks of residential real estate investing. I will post the thread link when I have it from her…thanks!

Without Jason's permission and due to privacy concerns, I would not disclose that information.

Jason,

In your own letter, which you have shared here, you explicitly admit that the carrier denied the claim. So, I'm confused as to why you continue to accuse NREIG (the agency) of denying this claim. There is no simpler way to state that Affinity and NREIG do not adjudicate, settle or deny claims.

Your request for a report on this loss was rejected by Lloyd's of London, again, the carrier. They are well within their rights to do so, as the report is a proprietary work product, which they are under no legal obligation to provide to you. Likewise, Affinity Claims Management and NREIG, are not privy to this report, and thus also unable to provide it to you. This is not information suppression, as their basis for denying your claim was very clearly stated in their May 1, 2014 letter, wherein you were advised of your failure to comply with policy provisions. This denial is accurate and factual, unless, of course you believe that the utility company for the location in question is also engaging in some sort of cover up or conspiracy to prevent you from receiving a settlement?

The Arizona complaint you have mentioned has been closed with no prejudice against either the insurance carrier, or us, the agency, as confirmed per my phone conversation with the Arizona Department of Insurance this afternoon.

In response to your correspondence, a letter was issued to you on August 8, 2014 on behalf of the Underwriters at Lloyd's of London. I am happy to post this as a rebuttal to all of your points for the members of this community to assess and make their own conclusions about your statements regarding our company, which for the final time, had no role in the denial of your loss.

@Darish D.

As I had shared in a previous post in this thread, I do want to clarify that Affinity and NREIG do not do not adjudicate, settle or deny claims. Though claims are filed through Affinity Claims Management, who acts as an advocate for program participants in the claims process, losses are forwarded to the insurance carriers, who conduct a thorough investigation of the loss as it pertains to the policy language and any applicable provisions. The authority to settle or deny claims rests solely with the insurance carriers.  

All,

It is good to see that people are doing their due diligence on Bigger Pockets and comparing experiences as they navigate their way through the investing world.

I would like to disclose that I serve as the Claims Manager for Affinity Claims Management (ACM), the claims management company for the NREIG Program. I have worked as a property claims adjuster and commercial property agent for the past decade.

I may be reiterating points that have been presented earlier in this string, but wanted to do my part in providing clarification to any points that may be misunderstood related to how claims are handled when incurred by an NREIG Insurance Program participant.

There seemed to be a question on who decides if a claim is paid or denied: Any claims suffered by NREIG Program clients are submitted to ACM. We assist by collecting necessary information (the facts of the loss) to forward to carriers, helping identifying any potential coverage issues associated with the reported loss and then the filing of the claim with carrier(s). Through the claim reporting/filing process ACM acts as an advocate for program participants. ACM does not and cannot make any pay or deny decisions. That authority rests with the carrier no matter the size/value.

Once claims are submitted to the insurance carrier they are adjudicated by the carrier’s own employee adjusters or by a third party adjusting firm vetted and contracted by the carrier. As an example, McLarens Global Claims Services is a third party adjusting firm contracted by many carriers. McLarens has a strong knowledge of how our program is structured, as well as the ISO policies on which our coverages are written.

Upon completion of the loss investigation, all resolutions are fully vetted by the insurance carriers’ underwriting departments to ensure all decisions are based on the language in the policy contract and comply with state insurance regulations, relative to the location of the loss. To clarify an earlier comment, local independent adjusters are not engaged to adjust program losses.

As you can see the claims process is pretty straight forward and varies little from the standard insurance market where claims may be filed through an agent or directly with the carrier. In the end the carrier bases its payment decisions on the facts of the loss and the language and provisions of the policy.