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FEMA Announces a Review Process for Sandy Claims

FEMA Announces a Review Process for Sandy Claims

The Federal Emergency Management Agency’s (FEMA) National Flood Insurance Program (NFIP) recently announced that they would provide policyholders that were impacted by Hurricane Sandy the opportunity to have their flood insurance claim files reviewed.  This review was the result of allegations of fraud and improper conduct by flood insurance companies, insurance adjusters, and engineers working for the insurance companies.  Based on FEMA’s statements, it wants to ensure that it treats NFIP policyholders who suffered a loss from Hurricane Sandy fairly and is committed to reviewing claim files to ensure that policyholders receive every dollar they are entitled to under their policy.

FEMA is notifying approximately 142,000 NFIP policyholders who submitted a Hurricane Sandy flood claim that they could request that their claim files be reviewed. Letters will be sent to claimants who incurred a loss from Hurricane Sandy from Oct. 27, 2012, through Nov. 6, 2012.  Policyholders who received the maximum amount under their policy (policy limits) or were in litigation will not qualify for this review.

Once a claim is filed an adjuster will contact the policyholder to guide them through the review process.  Policyholders are required to submit any additional information they would like considered as part of their review.  The adjuster will make a recommendation after a review of the claim file and any new information provided. If the policyholder does not agree with the recommendation, the policyholder will have the opportunity to request in writing an additional review of the file by a neutral reviewer.

After the policyholder makes the request, the neutral reviewer will examine the file and will contact the policyholder to discuss any concerns. The policyholder may request an oral presentation involving the policyholder, the adjuster and the neutral reviewer. An oral presentation is not necessary; but will be an option.  The neutral reviewer will examine information in the file and documentation, and will ask questions of the adjuster and the policyholder when an oral presentation is requested.

This neutral reviewer will make a recommendation to FEMA and FEMA will give substantial weight to the recommendation.  If the results of the review support additional payment, FEMA will direct the insurance carrier to issue payment.  FEMA will notify the policyholder by letter.  Policyholders who receive additional funds will need to provide a signed Proof of Loss. A Proof of Loss is a policyholder’s statement of the amount of money being requested, signed to and sworn to by the policyholder with documentation to support the amount requested.

About the Author: Christopher W. Gerold is an attorney in Chiesa, Shahinian & Giantomasi’s (“CSG”) Disaster Recovery Claims Group. For the past three years, Chris has been representing homeowners, condominium associations and businesses with their Sandy related insurance claims with a special focus on flood insurance. For more information on flood insurance and ways CSG can help you with your flood insurance claim, please contact Chris at (973) 530-2061.