Coastal Claims Services

Main Office (386) 314-0074 – Additional Locations in North Carolina, South Carolina, Georgia, Missouri

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 Boiler & Mechanical Failure Claims

These types of claims are often referred to as equipment machinery breakdown claims. If you are interested to know what does your equipment breakdown coverage covers and the examples of the coverage for homeowners, commercial businesses and industrial properties, the format and how the coverage is explained in your policy, our licensed public adjusters are capable of explaining the details and definitions for you. There may be exclusions in your specific coverage that may or may not work against you, such as interruption loss or relocation cost etc.

Equipment breakdown claims are also known as:

  • Boiler and Machinery Claims and/or
  • Systems Breakdown Claims
  • Machinery Insurance Damage Claims

Does your Residence, Business, Commercial Entity, or Industrial Operation use:

  • Electricity?
  • Heaters, coolers or refrigerators?
  • Communication Networks, Telephone systems & Information Systems?
  • A factory or manufacturer or goods processing?
  • Equipment to sell, transport, deliver and keep track of sales?

Answering yes to these questions qualifies for Equipment and machinery breakdown Insurance claim

EQUIPMENT BREAKDOWN COVERAGE

The Equipment Breakdown policy covers loss and damage to insured equipment and resulting loss of revenue (Business Income) while the equipment is being repaired or replaced.  Normal wear and tear is not a part of the coverage.

The policy can be endorsed to include Contingent Business Income.  This covers you in the event a critical component of your business e.g., a vendor or supplier can’t meet their obligations you the insured due to a mechanical breakdown of their own.

What Do Boiler/Mechanical & Machinery Claims Cover?

  • Electronic Equipment – Fax Machines, Copiers, electrical motors
  • Machinery/Mechanical Equipment – Transformers, motors, voltage regulators/meters, generators, gear shifts
  • Boilers & Pressure Vessels- engines, pumps, compressors etc
  • Heating & Cooling (i.e. Air conditioning and refrigeration)
  • Information and Telecommunication Systems e.g., telephones and computers
  • Production systems
  • Renewable & Alternative energy – e.g wind turbines
  • Hull Damage – Aircraft Machinery & Marine Machinery

Business Interruption / Business Loss

Businesses are typically insured by a commercial insurance policy.  In addition to providing insurance covering damage to property, such policies can cover loss of business income.  However, this type of coverage is typically only triggered when there is a direct physical loss to the property that causes the loss of business income. It is important to have loss of business income coverage because it may be the difference between a business staying in business or going out of business.

Generally, commercial property insurance policies will define what is meant by the loss of business income.  They will also contain limitations on how long the insurer may be obligated to pay such indemnity and how much may be paid under such coverage.

Loss of business income claims can be complex and often require the assistance of a forensic accountant to determine the amount of lost income.  Insurers may attempt to minimize your claim by using their own forensic accountants and argue for a shorter period of time to pay the loss of business income benefits.  These are some of the reasons why it is important to consider hiring a public adjuster to assist you with your loss of business income claim.

There are often additional damages associated with the cause of business loss.  Damages to the structure the business is located in, loss of use or rents, temporary relocation and mobilization costs, etc.  By hiring a public adjuster, we will bring the expertise to coordinate all of these costs being estimated and accounted and working to get you the maximum benefit for ALL of the various issues associated with your business loss.

 

Condominium Association or Homeowner’s Association Insurance Claims

Condominium and Homeowner’s Associations that have suffered a loss on the property can have a very complex and layered problem to deal with.  The interests of the association verse the interests of the individual unit owners can be at odds.  The association’s voluntary board members are often put in difficult positions having to make decisions that affect their communities and neighbors that are far beyond their level of expertise.  The property management company may be asked to make recommendations or handle a loss that is beyond their scope of work or experience.  There are budget and reserve concerns to be considered.

We understand the complexities and nuances of handling these claims.  For condominium associations, is the master policy a “bare walls” policy or an “all in” policy?  Is it a single limit policy or is each structure individually scheduled and insured? Who handles gaining access or attending all of the multiple inspections necessary for all of the units when multiple units have been affected by a loss?  Who serves as the point of contact for the association members or residents?  Who can separate out the damages owed by the unit owner verse the association?  At Phoenix Claims Consulting, the answer is “We Do.”

Homeowners association claims have some similarities to condominium association claims but they have other significant differences.  Usually, the master policy only covers the common areas or community structures like gatehouses, laundry and pool facilities, etc.  Often there is a collective agreement on maintaining the association member-owned structures, but usually, each individual owner is responsible for the entirety of their own portion of the building.  This creates many issues in the claims process when there is a single continuous roof system, exterior siding material or foundation for multiple units, shared firewalls, but each owner owns their share of those things separately.  How do you repair only 25% of a roof system and not repair the rest of the roof in a case where 4 owners share a building, but only 1 has filed a claim for damages?  Who handles the subrogation or negotiation of these issues?  Who coordinates multiple claims with multiple carriers when each unit owner has their own policy and insurance company to facilitate a restoration like this?  At Coastal Claims, the answer is “We Do.”

We have handled both large and small association claims resulting in millions of dollars in recoveries over the years.  We have the network of various specialized professionals at our disposal who work with associations regularly which can be crucial in preparing and presenting a condominium or homeowners association insurance claim.  We see it so often that associations will hire a specialized trade person to handle all of the various needs of the community like landscapers, pool service, maintenance, property management, accountants, etc, but they will try to take on seasoned large loss adjusters from an insurance company on claims worth $100,000’s to millions of dollars by themselves and just hope for the best.  You hire professionals to do what they do because you have a need they specialize in.  If you have an insurance claim, you have a need for a claims adjuster who is on your side protecting your interests.  Let us be Your expert on Your team.  The adjuster that is sent by the insurance company has one client, the insurance company.  They are not paid to adjust claims so that you receive every dollar you are owed.  It’s actually quite the contrary.

If you have suffered a loss at your association, please do not hesitate to contact us for your FREE CONSULTATION.  Let us advise you on your options, so you can make informed decisions about how to best restore your community.

Loss By Collapse

Collapse insurance coverage and claims are extremely difficult to settle on your own, and waiting for a collapse to happen is risky and dangerous. We highly recommend consulting with a public adjuster who has the right resources and contacts to advise you of the best course of action.

Why are building collapse claims so complex? In the past, building collapses were broadly covered by most insurance policies.  Insurance companies have changed how they define “collapse” in recent years. Additionally, the cause of the collapse may determine whether or not the loss is covered by insurance or not. If the collapse claim is denied, other portions of the insurance policy may provide coverage for the loss. These claims often require the expertise of structural engineers and other loss consultants to substantiate the cause and extent of the collapse.

Recent additions to the insurance form employed by most insurance policies now limit collapse coverage to an “abrupt collapse”. Insurance coverage and policies vary greatly so it is important to send a copy of your insurance policy to your public adjuster for review. Additional coverage and/or collapse insurance coverage of an ‘abrupt collapse’ means a “rapid falling down or collapse of the building or any section of your building with the resulting in the structure or part of the building not being able to be used for its intended purposes.” Your policy may also provide a list of factors within the collapse that it may cover, including:

  • Hidden decay
  • Hidden insect or vermin damages
  • Defective construction (if the loss occurs during construction, remodeling or renovation)
  • Weight of contents, people and/or property
  • Weight of rain collected on the roof

 

A “loss of revenue by collapse” occurs when either a full building, or a portion of the building, suddenly falls down and/or caves in. This sudden collapse can cause destruction of personal belongs and property and could put the building’s occupants in danger. This collapse can temporarily leave a person without a home to live in (such as condominium building collapse) or a business to return to (commercial building collapse).

If you are concerned about an existing problem but need input before filing a claim, have an open claim that you are in over your head with, or have received an underpaid settlement or denial, We Can Help!  Coastal Claims public adjusters are highly trained in all areas of insurance coverage, including collapse insurance, to ensure we can properly represent you during the insurance claim process. Our adjusters understand the stipulations contained in the “other coverage” section of your insurance policy. Additionally, they can interpret your policy and assess the damage and file the collapse insurance claim for you.

Vandalism & Theft

Although the majority of strategies and methodologies in adjusting theft and vandalism damage claim is similar to that of other losses, there are unique aspects of this peril that require special attention and expertise.

Typical questions posed by insurance companies after receiving notice of a theft/vandalism claim are: Did a theft/vandalism actually occur? Did the policyholder actually own or possess the items being claimed stolen, and if so, can proof be provided? What is the value of the item or items being claimed? Was there any related property damage such as broken windows, doors, locks, or equipment related to the theft or vandalism?

With respect to the theft/vandalism event, most are substantiated and supported by official police reports which document the actual event.  These reports are used by insurance companies to verify an event happened and also to assist them in future subrogation avenues it may pursue.  It is absolutely critical that a police report be filed in claims involving theft and/or vandalism. You should make sure the police report and the report of items being claimed is accurate as to the list of items stolen. Should you discover additional items later be sure to update the police report and tell the insurance company you have filed a supplemental police report.

With respect to ownership and value, insurance companies rely heavily on documentation provided by the policyholder to prove ownership and substantiate value.  This documentation could take the form of video, pictures, receipts, credit card statements, appraisals, insurance policy endorsements, etc.  Try to provide as much documentation as possible to help substantiate the claim for theft with your insurance company.

In the event no title or ownership documentation can be provided; in the case of larger losses, most insurance companies will invoke their right to an examination of the insured under oath also called EUO.  In addition to EUOs, the company may also request financial documentation from the insured to establish a basis of ownership and in some cases, tax returns and support showing a person had the income and lifestyle for the items they claimed were stolen.

In addition to ownership and measurement of loss issues, a very detailed review and evaluation of the insurance policy must be completed.  Most policies contain limits or exclusions for certain scope items related to theft/vandalism claims and in many cases, certain items must be scheduled in a policy in order for coverage or higher limits to apply. Often this can be accomplished by what is called an inland marine floater insurance policy. Third party appraisals will be required to schedule items and a limit will be set as to the maximum amount you will be paid in the event of a theft.

A problem we have seen over the years following a loss for an item on a schedule is that the insured will assume they will be paid the dollar limit on the schedule as it was based on an appraisal. This is always true, as an insurance company will often go out in the market and seek a price from companies that have buying power to reduce the estimated replacement price, particularly on jewelry.  They will then offer you the money based on lower price or offer to buy it for you. This is true despite the appraisal you had that they accepted and charged you a premium on. Also, appraisals can vary greatly in the opinion of a value. So you may want to ask the insurance carrier to give you the name of the company they use or will use if a loss occurs and go to that firm to get your appraisal for the scheduled items.

Although theft/vandalism claims are very common, they can be some of the most complicated and time-consuming matters to resolve.  Let Coastal Claims guide you through the process.

Sinkhole

Some insurance policies contain coverage for sinkhole damage as long as the damage is caused by sinkhole activity. This coverage usually costs extra and must be chosen by the policyholder. Our sinkhole adjusters will tell you that sinkhole claims are one of the most difficult claims for policyholders to handle due to the technical nature of the sinkhole investigation, the number of insurance company experts involved, the length of the investigative process and the complexity of the property insurance coverage issues involved. It is very important for a policyholder to understand both their options for sinkhole repair under their policy and the various players in the sinkhole repair process in order to obtain a fair settlement and permanent fix. If not handled properly, it can affect the value of and further imperil both you and your property. For that reason, we recommend that most policyholders consult with an expert that works for you and not the insurance company.

In the United States, most of the damage caused by sinkholes occur in Florida, Texas, Alabama, Missouri, Kentucky, Tennessee, and Pennsylvania. Most of Florida is prone to sinkhole development because it is underlain by limestone or dolomite, which is susceptible to dissolution by naturally flowing groundwater.  Ever so slowly, this forms underground channels, voids and cavities in the limestone or dolomite.  Sinkholes form with the eventual collapse of the overlying soils down into the channels, voids and cavities below.

Sometimes sinkholes are revealed suddenly as they swallow sections of major roadways or even when buildings disappear.   The more common sinkhole damage is much subtler.  Sinkholes may appear as a slight depression in a lawn, a leaning tree or fence post.  When they occur underneath or around a house or building they can cause cracking of the interior walls, ceilings, floor slabs and tiles.  Sinkholes will cause damage to building foundations, exterior walls, driveways and even pools and pool decks.

Different states have very different statutory regulation of sinkholes and sinkhole related damages.  In 2011, Florida had a massive overhaul of its sinkhole statutes eliminating the requirement of insurance companies to cover for sinkhole activity unless damages met very specific criteria.  Tennessee quickly followed suit and changed their statutory regulations in a bill modeled after Florida’s.

Sinkhole investigations require a very niche expertise.  They are often extremely technical in nature with many moving parts and issues to overcome.  If you have concerns about your property having a sinkhole loss, please contact us immediately for an assessment of your situation.  We have successfully settled hundreds of these types of claims.

Sinkhole Failed Repair

Did your sinkhole repair work? Did you follow your insurance companies forced repair protocol? Did you GROUT? If so, the odds are it did absolutely nothing to compact the soils let alone stabilize your foundation. Why? Simply because compaction grout tends NOT to do what the geotechnical engineer guessed that it would. In fact, we have interviewed “insurance company experts”, and they have stated that they cannot confirm where the grout will go! In nearly EVER single case I have witnessed a home being grouted it caused more damage, failed to stop cracks from appearing and never compacted the soil. The sad truth is your insurance policy promised to not only stabilize the land beneath BUT to also stabilize the foundation. If grout only comes to within 15 feet of your foundation how is possible to stabilize your foundation? The fact is it was never designed to stabilize your foundation which in my opinion is the single most important aspect of repairing a sinkhole home. The good news is you may be entitled to having your insurance company pay for those repairs.

If you think the repairs did not work, then call us immediately! We will conduct a FREE inspection of your property to ascertain whether it is showing signs of distress. Often times we are able to point out damages that the property owner was told “it was normal” by the insurance company or by their engineer.

At Coastal Claims, we are committed to pursuing the rights of residential and commercial property owners in sinkhole damage cases. We will work closely to sort out your issues and hold your insurance company accountable for the failed repairs, so you can get the peace of mind you deserve.

Your Rights After a Failed Sinkhole Repair:

If the repairs on your property have failed to properly stabilize the soil and foundation, we can go back to the initial claim for additional repairs in many instances. In some instances, we may need to file a new claim for sinkhole damages.