If an insured's contractor does not agree with the Proof of Loss furnished by the independent adjsuter, can the insured's contractor change the Proof of Loss and submit with his estimate?
Texas Subscriber
In reviewing the commercial property building and personal property coverage form, there is nothing that says the sworn proof of loss has to come from an independent adjuster, an insured, or an insured's contractor. It is however, within the insurer's right to utilize an independent adjuster to evaluate the loss. It is also within the insured's right to dispute the amount of the loss. It is unethical for an insured's contractor to change a sworn proof of loss – the insurer is only bound by the first sworn proof of loss submitted, not any secondary proof of loss that might be submitted.
What this amounts to is that the insured is disputing the amount of the loss, which if they pursue this would need to be done in accordance with the policy terms of going through an appraisal:
2. Appraisal
If we and you disagree on the value of the property or the amount of loss, either may make written demand for an appraisal of the loss. In this event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will:
- Pay its chosen appraiser; and
- Bear the other expenses of the appraisal and umpire equally.
If there is an appraisal, we will still retain our right to deny the claim.