Mediation gives you the opportunity to settle claim disputes with your insurance company by allowing you to meet with them in an informal setting (conference) with a certified, neutral mediator or (Sinkhole) Neutral Evaluator to assist in resolving your claim.
Mediation is non-binding, which means none of the parties are required to accept the outcome. If a settlement is reached, you have three business days to rescind the agreement if you have not cashed the check and you inform the company of your decision.
Top 5 Common Concerns
- Residential Mediation
- Automobile Mediation
- Sinkhole Neutral Evaluation
- Commercial Residential (i.e.: Homeowners Association, Condo Association)
- CCRC (“Community Care Retirement Communities”)
Residential Mediation - A dispute must be $500 or more after the deductible is applied. The dispute must be a disagreement over what caused the damage or if you do not agree with the amount the company offered to repair the damages. If the dispute does not meet the eligibility requirements, yet the parties agree to participate in mediation, written documentation is required for the Department to proceed. The insurance company pays the entire cost ($350) of the mediation.
Automobile Mediation - Claim disputes for property damage claims in any amount or for bodily injury claims up to $10,000, caused by the ownership, operation, and use or maintenance of a motor vehicle. Claims against your insurance company and claims against the other party’s insurance company are both eligible for mediation. The program is voluntary. The total cost for mediation is $200. The cost of mediation is divided equally between the insurance company ($100) and the policyholder or third-party claimant ($100).
Neutral Evaluation - A sinkhole report must be issued by your insurance company. If your insurance company confirms there is structural damage to a covered building that is consistent with a sinkhole loss or if it cannot determine the cause of the structural damage, the law requires it to engage a professional engineer or a professional geologist to conduct testing and issue a sinkhole report. Neutral Evaluation is mandatory if requested by you or your insurance company. The Neutral Evaluation is non-binding, and both parties retain their right to pursue legal action. Your insurance company is required to pay the reasonable costs associated with the Neutral Evaluation program.
Commercial Residential Mediation - This program is available for policies in which a Condominium Association, Cooperative Association or Homeowners’ Association are the policyholder. A dispute must be $500 or more after the deductible is applied. The dispute must be a disagreement over what caused the damage or if you do not agree with the amount the company offered to repair the damages. If the dispute does not meet the eligibility requirements, yet the parties agree to participate in mediation, written documentation is required for the Department to proceed. The insurance company pays the entire cost of the mediation, which shall not exceed $5,000.
Continuing Care Retirement Communities (“CCRS”) Mediation - Available for residents of Continuing Care Retirement Communities for disputes other than challenges involving increases in monthly maintenance fees. The cost of mediation ($250.00) shall normally be paid by the provider. If a resident elects more than one mediation in any 12 month period, the cost of the second and all subsequent mediations in that 12 month period shall be borne by the resident. If a resident elects more than three mediations in any time period, the cost of the fourth and all subsequent mediations shall be borne equally by the resident and the provider.
The following types of claims are not eligible for Residential and Commercial Residential mediation:
- Claims arising from a commercial lines policy
- Claims arising from a National Flood Insurance Program (NFIP) policy
- Claims that involve liability coverages
- Claims currently in litigation or appraisal
- Claims that an insurance company suspects involves fraud
- Claims that arise from a cause of loss not covered in the policy
Upon receipt of an eligible request for mediation, the Department will notify the parties they have 21 (calendar) days to otherwise resolve the dispute before a mediator is assigned. Once mediator has been assigned, the mediation conference is to occur within 21 days. When applicable, good cause continuances can be requested by the parties. You may settle the claim with the insurance company prior to mediation.
A conference may be held in person, or by telephone, by videoconference, or by other electronic means, if feasible. All parties, the mediator and/or Neutral Evaluator must have the ability to participate using reliable technology.
Be sure to bring any supporting documents, including your policy, photographs, estimates, bills, reports, letters, etc. It is important to bring specific dollar estimates or quotes for all items that are in dispute.
All policyholders listed on the claim’s effective policy must attend the conference.
If the Policyholder(s) and an Assignment of Benefit (AOB) both retain rights to the claim, all with rights must attend the conference.
If only the AOB retains right to the claim, the Policyholder(s) do not need to be in attendance (as they no longer have settlement authority).
The conference may also be attended by persons who can assist a party in presenting the claim or defense in the conference, such as contractors, adjusters, engineers, and interpreters.
A scheduled conference does not have a set number of hours for the parties to mediate. A conference can be held if both parties agree that they are making progress.
Another option is to pursue the dispute in a court of law. You may wish to seek the advice of an attorney that may be able to further explain this process.
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