FEMA Announces Insurance Claims Review
On May 15, 2015, over two-and-a-half years after Hurricane Sandy, the Federal Emergency Management Agency (FEMA) announced that people who submitted a Hurricane Sandy flood insurance claim and who are not satisfied with the amount of money they received for their losses may ask for a review of that claim. FEMA has started to notify approximately 142,000 people that they may request a review under this program.
The review process will cover all claimants who has storm losses from Oct. 27, 2012 through Nov. 6, 2012. The review process will not include policyholders who filed lawsuits for damages in federal court.
The FEMA notices are being mailed out now, with the first letters going to those who had submitted engineer reports as part of their claim. If you think you should have received a letter from FEMA but didn’t, you can call the toll free number below.
Getting Help From FEMA
For those policyholders who want to start the review process immediately, FEMA set up a toll-free telephone number that people can call as well as a website with a downloadable application that can be emailed, faxed, or mailed to FEMA.
- Website: www.fema.gov/hurricane-sandy-nfip-claims
- By telephone toll-free: 866-337-4262
- For individuals who are deaf, hard of hearing or have a speech disability using 711 or VRS, please call 1-866-337-4262. For individuals using a TTY, please call 800-462-7585.
- Email by downloading an application online and submitting it to: FEMAfirstname.lastname@example.org
- Fax by downloading an application online and submitting it to 202-646-7970 Attn: Hurricane Sandy NFIP Claims Review Department
- By mail: Federal Emergency Management Agency, Attn: FIMA, Mail Stop 3020, Rm.720500 C. Street SW, Washington, DC 20472
What To Expect When You Start The Process
When you contact the National Flood Insurance Program (NFIP) Claims Processing Center, they will need the following information:
(1) Policyholder name
(2) Name of Insurance Carrier
(3) Insured Property Address
(4) Policy Number
(5) Claim Number
(6) Current Mailing Address
Policyholders will be asked a series of preliminary questions to determine whether they qualify for review. People who are eligible to proceed will be asked a second set of questions related to Hurricane Sandy. Those currently in litigation or who have received policy limits (the maximum amount they could have gotten under their flood insurance policy) will not qualify for a review.
After completing the intake, the call center will forward the data collected about the claim to the claims processing team.
What The Claims Processing Team Will Do
Each policyholder’s file will be assigned an ”adjuster” who will act as that person’s case worker. The claims that were originally submitted with an engineer’s report will be assigned an engineer who is not currently undergoing investigation. The adjuster or engineer assigned to your claim will act as your caseworker.
FEMA will request the policyholder’s file from their insurance company and forward it to the NFIP review office within two business days of receipt. The claims processing team will send a confirmation letter to the policyholder when they have received the policy holders’ insurance file.
The same adjuster will work with you throughout the review process and advise you on how to submit new information to include in the review.
You will have 14 days from the date the adjuster or engineer contacts you to submit new information. If there is no new information, the review begins right away. If you do have new information, it is very important that you keep in regular communication with your caseworker about the new information and the documentation you are actively working to get and send in. If your caseworker either can’t reach you or hasn’t heard from you for 30 days, your review will be put on “hold” and you don’t want that to happen.
Adjusters and engineers will verify / confirm that the file includes all of the necessary documentation. They will explain to the policyholder what is covered or not covered under their policy and answer any questions the policyholder may have. Once you submit a request, it should take the caseworker less than 90 days to complete the review.
What You Need to Do
Even though FEMA will be requesting and reviewing the file with all your documentation for your claim that you previously submitted, it is highly recommended that you submit copies of all relevant documentation to support the review of your claim, including but not limited to: Photographs of Damage, Contractor Invoices, Receipts, Public Adjuster Estimates, and Engineer Reports.
FEMA has also agreed that a policyholder can request that their property be re-inspected at no charge. Homeowners can also prepare a statement that details any additional expenses that you believe should be covered in the review.
You can also submit an Affidavit explaining expenses up to $7,500 even if you have no documentation. If a third party will be assisting you with the review, it is recommended that you submit a third party authorization letter to FEMA telling FEMA the name and contact information of the person who is authorized to speak about your file. This letter can be used for an attorney, family member or friend that is not named on the policy, or a contractor who has been working with you.
What FEMA Does Next
Following a review of all submitted documentation, the adjuster will make a recommendation of the amount of additional money that should be paid to the policyholder, or determine that no additional payments are necessary. If you do not agree with the recommendation, you will be able to have an additional review of the file by a neutral third party. This may be a retired judge or an attorney with insurance expertise. This neutral party will make a recommendation to FEMA, and FEMA will give substantial weight to the neutral party’s recommendation.
If the results of the review support additional payment, FEMA will direct the insurance company to issue payment to the policyholder, and will notify the policyholder by letter. Policyholders who receive additional funds will need to provide a signed Proof of Loss form. The Proof of Loss form is the policyholder’s statement of the amount of money being requested. The Proof of Loss statement is signed and sworn to. Once all parties involved have been notified of the results, the case will be closed.
The Duplication of Benefits (DOB) Issues—Pay Attention to This!
Once the review has been completed, and assuming an additional payment has been made, the next issue is a possible Duplication of Benefits problem. The Federal Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act) requires that people who receive disaster recovery funding must not get the same assistance from two different sources.
Under the Stafford Act, Federal agencies cannot provide disaster assistance for damages or losses that are covered by insurance. If a policyholder receives additional insurance money and also received Sandy-related disaster assistance from another source such as the U.S. Small Business Administration (SBA), the Department of Housing and Urban Development (HUD), or one of HUD’s state or local grantees such as New York Rising, the New York City Build it Back program, or the New Jersey – Reconstruction, Rehabilitation, Elevation, and Mitigation (RREM) Program, the policyholder may have to repay the disaster assistance from the governmental agencies if the agency that provided the original assistance determines that the new, additional insurance payments duplicate a benefit previously provided. This is why you must complete the Duplication of Benefits analysis.
Because disaster assistance provided to each person varies widely based on their insurance coverage and eligibility for federal funding, each person must complete a Duplication of Benefits analysis specific to their situation. Your case worker (adjuster or engineer) or other person who is providing assistance such as a lawyer can help with this analysis.
Can There Be A Duplication of Benefits (DOB) Problem with Personal Property Claims?
If part of the review you asked for includes claims for loss of contents or personal property, you may have to submit a Duplication of Benefits analysis for these benefits as well.
Contents recovery payments resulting from this FEMA review are not considered a Duplication of Benefits issue for the NY Rising program. However, they are considered DOB if an SBA loan was used for those same contents. (For example, if you purchased a washing machine using money from an SBA loan, and if you received insurance money for it as a result of this process, you will need to repay SBA.) Submission of a contents claim should provide as much information as possible, in order to ensure payment for those items. It is recommended that you create an excel spreadsheet with the following categories: Brand, Item Description, Location of item in home, Age, Quantity Lost, Replacement Cost. PHOTOGRAPHS! Actual photographs are preferred, but comparable photos can be used as a last resort. The use of comparable photographs will not guarantee payment on an item. Meanwhile, an Affidavit can be drafted explaining expenses up to $7,500 even if the homeowner has absolutely no documentation.
The decision by FEMA to open the Sandy Claims review process is a great step forward for thousands of homeowners. For many, it is the first step towards rebuilding or repairing their homes which were devastated more than two years ago.
-Melissa H. Luckman
Staff Attorney, Disaster Relief Clinic
Touro Law Center