QBE AMERICAS THE IA GUIDELINES - Eagle … AMERICAS THE IA GUIDELINES INDEPENDENT ADJUSTER SERVICE LEVEL, ESTIMATING, AND FIELD INSPECTION REQUIREMENTS for PROPERTY CLAIMS The purpose

QBE AMERICASTHE IA GUIDELINESINDEPENDENT ADJUSTER SERVICE LEVEL,

ESTIMATING, AND FIELD INSPECTION

REQUIREMENTS for PROPERTY CLAIMS

The purpose of this document is to establish guidelines to direct the actions of theIndependent Adjusting firms and their Adjusting Staff with regard to the handling of QBE

Americas, and all of it’s affiliates field claim assignments, as related to the following: ServiceLevel Expectations, Customer Interactions, Communication, File Activity, Authority,

Professionalism, Technical estimating Mechanics, Estimating Platform Usage, DamageDocumentation, Repair Scope Determination, Price Calculations, and Policy Driven

Considerations.

[January 2017 * Kevin Kelker

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SERVICE LEVEL REQUIREMENTS/ASSIGNMENT ACKNOWLEDGEMENT: ............ 3

SETTING EXPECTATIONS WITH THE CUSTOMER: ................................................... 3

FIRST CONTACT: ....................................................................................................... 3/4

GENERAL COMMUNICATION: ..................................................................................... 4

ESCALATION PROCESS: ............................................................................................. 4

APPOINTMENT AND INSPECTION: .......................................................................... 4/5

INVESTIGATION: ........................................................................................................... 5

INSURANCE TO VALUE:............................................................................................... 6

REPORTING TO QBE: ................................................................................................... 6

RECORDED STATEMENTS: ......................................................................................... 6

OFFICIAL REPORTS: .................................................................................................... 6

AUTHORITY: ............................................................................................................... 6/7

MISCELLANEOUS: ........................................................................................................ 7

APPROPRIATE ATTIRE: ............................................................................................ 7/8

ESTIMATING REQUIREMENTS .................................................................................... 8

ESTIMATES: ............................................................................................................... 8/9

MEASUREMENTS:....................................................................................................... 10

OPENINGS: .................................................................................................................. 10

PHOTOGRAPHS: ......................................................................................................... 10

DIAGRAMS: ................................................................................................................. 11

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ROOFING: ................................................................................................................ 1113

EAGLEVIEW: ................................................................................................................13

FLOORING AND ITEL:............................................................................................... 135

CABINETS:................................................................................................................... 15

DRYWALL .................................................................................................................... 15

PAINTING AND DECORATING ................................................................................. 166

SHOWER PAN LOSSES .............................................................................................. 16

FENCING ...................................................................................................................... 16

DEBRIS REMOVAL...................................................................................................... 17

DEPRECIATION ........................................................................................................... 17

OVERHEAD AND PROFIT ........................................................................................... 18

FIELD INSPECTION REQUIREMENTS ....................................................................... 18

LADDER ASSISTS AND SECURITY REQUESTS: ..................................................... 18

CONTENTS .................................................................................................................. 18

DEPRECIATION GUIDELINES………….……………………………….…………………….… 19

NOTE: Exceptions or additions to these Guidelines may be communicatedand required by QBE Americas or any of it’s affiliates, based on specificpolicy, process, or system driven directives during integration projects.These directives may be temporary in duration and include third party

business partners.

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SERVICE LEVEL REQUIREMENTS

ASSIGNMENT ACKNOWLEDGEMENT:

Assignments are considered to be on a limited task basis unless clearlyconveyed as a full adjustment.

Acknowledge receipt of assignment by email to QBE within 24 hours ofreceipt.

Acknowledgment to include QBE’s claim number, the name of the I/Afirm’s assigned adjuster and their telephone number and email address.

SETTING EXPECTATIONS WITH THE CUSTOMER:

The most important aspect of achieving customer satisfaction is toestablish expectations at every step of the claim experience; from firstcontact to claim settlement, the customer should be aware of each phaseof the claim process.

Once expectations are set, it is critical to deliver on those expectations. Reiterate each phase of the claim process to the customer:

o Contact customer.o Set appointment.o Conduct loss inspection.o Scope damages.o Diagram structure.o Photo document loss and damages.o Collect documents and loss information from the customer.o Prepare damage estimate.o The IA should discuss the general scope of damages and repair

methods with the customer to confirm understanding and processexpectations

o Report packages containing photos, estimate, scope report,diagrams, rough draft estimate, audit report, variance report, lossrecap and other required attachments will be submitted to QBE forreview. These will be based on divisional needs and requirements.

o QBE will contact the customer to explain coverage analysis and orsettlement details.

FIRST CONTACT:

First contact to be made with the customer within 24 hours of receiving theassignment. This must be a voice to voice contact.

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If contact cannot be made within the 24-hour time frame, an explanation isrequired in the initial report, and a contact letter must be sent to thecustomer within 48 hours of assignment. If no contact within seven days,the IA should contact the QBE adjuster to close the claim.

Upon voice contact with the customer, introduce yourself by first and lastname, indicate that you are calling on behalf of the customer’s insurancecompany (state company name), and explain the reason for calling.

Confirm the customer’s address and/or loss location address, phonenumber, and confirm the customer’s QBE claim number; confirm pertinentinformation about the inspection (two story, roof tarped, or any otheraccess concerns).

Recount the facts of the loss and empathize with the customer’s loss andsituation.

Provide the customer a contact phone number and email address as wellas an alternate contact number within the I/A firm.

GENERAL COMMUNICATION:

All telephone calls, faxes, letters, emails, etc. are to be responded towithin 24 hours.

If QBE’s policyholder contacts you directly and they have questions orissues other than the scope of the damage estimate or inspection, directthe policyholder to the QBE Claims Employee. Advise the policyholder orborrower, that you will follow up with QBE and QBE will respond to themwithin 24 hours.

Be professional and empathetic in your communication andcorrespondence.

Discussions concerning coverage issues are to be directed to and handledby QBE.

If a policy or coverage question should arise from the customer, politelyrefer these to QBE for resolution; provide the QBE contact information tothe customer.

Do NOT discuss coverage issues or policy provision questions with thecustomer, Public Adjuster, contractor, etc. unless directed and approvedby QBE.

ESCALATION PROCESS:

In the event a loss or customer issue requires the matter to be escalated,contact QBE immediately, and QBE will advise how to manage thesituation or take over the matter.

APPOINTMENT AND INSPECTION:

Make every attempt to make appointments voice to voice.

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Attempt to schedule the inspection for a specific time on a specific day;avoid generalized time frames, i.e. “between 8 am and noon tomorrow”.

Work within the customer’s schedule; avoid arriving at a loss locationwithout an appointment.

Do not set appointments or complete inspections with a minor or only aminor present.

Inspection to occur within 72 hours of the first contact with the customer. Ifan inspection is not completed within this time frame, an explanation isrequired in the initial report.

If running late or a reschedule is needed, an advisory call to the customeris required.

Reschedule with an apology and work with the customer’s schedule;update QBE of the rescheduled date and reason

Leave the customer with your business card, contact information, andQBE contact information.

Winter inspections present several issues, including snow, lowtemperatures, and access. If the roof cannot be inspected due to a heavyamount of snow or ice you will need to generate additional information. Ifthe insured reports interior damage, then you will want to schedule anappointment to inspect the interior damage. You will notify the QBEadjuster and you may submit the estimate to the QBE adjuster for partialsettlement. Advise the insured you will follow up with them when itappears the local weather conditions have improved and remind theinsured they can call your office to schedule the exterior re-visit too. Ifpermission is granted by the insured, you may complete the exterior onlyinspection at your discretion and as early as possible.

INVESTIGATION:

Investigation to be completed within 7 calendar days of assignment forresidential losses and within 9 calendar days for commercial losses.

Follow-up investigation activity accomplished at a minimum of 14 calendardays until the claim is resolved or as otherwise explained in reports. Firststatus at 10 days and the follow up second status report at 21 days, fromthe time the assignment was accepted.

Notification to QBE within 24 hours if the investigation uncovers potentialcoverage issues (NOTE – the I/A is NOT to make any coveragedeterminations) Notification to QBE within 24 hours if the investigationdetermines loss exposure exceeding $10,000.

Notification to QBE within 24 hours if the investigation determines adverserisk factors or suspected fraud.

It is QBE’s policy that there will be no referrals, recommendations, orimplied use of any contractor to customers.

Reserve recommendations should be sent to QBE within 72 hrs or uponinspection finalization.

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INSURANCE TO VALUE:

Insurance to value calculations are to be completed on total structurallosses or per assignment instructions.

If an insurance to value calculation is not indicated on the assignment, theoverall insurance to value of all involved risks is to be commented on inthe initial report (examples: ‘risks appear insured to value’ or ‘risk may notbe insured to value given materials used in construction and recentaddition to the building).

Notification to QBE within 24 hours of an investigation determiningpotential insurance to value issues (NOTE – QBE will then determine anyco-insurance issues).

REPORTING TO QBE:

Use approved estimating platform reports. Reports are to be submitted electronically. The degree of detail in the reports is to be in proportion to the nature and

circumstances of the loss. An initial report is due within 10 calendar days of assignment.

Supplemental reports are due within 10 calendar days of the initial reportor sooner if requested.

Only affected captions need to be addressed in supplemental reports foradditional damages or hidden damages.

Closing reports are due within 5 calendar days of closing the assignment,submitting the estimate, and are to include the final billing invoice.

RECORDED STATEMENTS:

Statements are to be taken per assignment instructions only. Statements are to be in digital .wav file format and forwarded to QBE

when directed to do so. Do not transcribe recorded statements unless requested by QBE.

OFFICIAL REPORTS:

Official reports (police report, fire reports, etc.) are to be obtained ifoutlined in the assignment instructions otherwise Police and Fire reportswill be obtained by QBE.

AUTHORITY:

You DO have authority to reach an agreed scope of damages with thecustomer, Public Adjuster, or their contractor of choice, however, finalapproval for all such scope agreements must be approved by QBE. Suchagreements must be noted in the report submitted to QBE.

You have NO authority to reach an agreed repair price without QBE’sapproval and direction.

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You have NO authority to authorize repairs or expenses without QBE’sapproval.

You have NO authority to authorize emergency services or mitigationwithout QBE’s approval.

You have NO authority to authorize a contractor to assist in determiningan agreed scope of damage and repair costs without QBE’s approval.

You have NO authority to authorize the use of any expert without QBE’sapproval.

You have NO settlement or denial authority without QBE’s approval. You have NO authority to obtain a release without QBE’s approval. You have NO authority to accept service of a summons and complaint on

behalf of an insured and/or any affiliate of QBE. All coverage decisions will be made by QBE.

MISCELLANEOUS:

Utilize the most current and approved QBE Daily or Catastrophe FeeSchedule for all losses. The presence of a “CAT Code” on the assignmentwill determine if the Catastrophe Fee Schedule is to be used.

No additional charges for local phone calls. No additional charges for administrative, clerical, office, and/or file set up

fees. No charge for the first seventy-five (75) miles (See Fee Schedule). Mileage exceeding the first seventy-five (75) miles will be paid at the

approved QBE Fee Schedule Rate (See Fee Schedule). You agree to provide a centralized and consistent process for claim

assignments and allow for claim specific instructions in addition to theservice level requirements outlined in this document.

QBE has the right to audit all claims, related files, and records, includingbut not limited to estimates and invoices; adjuster timesheets must beavailable for inspection on time and expense billed assignments.

QBE has the right to re-inspect all claims handled by you. You agree to provide QBE with reports when requested. You agree to protect confidential information. Where a QBE guideline may conflict with a state fair claim handling

requirement or mandate, the state guideline will supplant such guideline. Claims records to be retained for a minimum of three years after case

closure or last report filed, whichever is later; records must be maintainedlonger if mandated by applicable laws.

APPROPRIATE ATTIRE:

Dress professionally. Be clean and neat; do not wear dirty or tattered clothing.

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Do not wear shorts or “T” shirts of any kind as outerwear. Do not wear clothing with inappropriate slogans, graphics, or

advertisements. Do not wear sandals, slippers, ‘Crocs,' or open toed shoes. ‘Dockers’ type slacks are preferred, but clean jeans are acceptable. Collared shirts are preferred; these can be button up or golf type shirts.

ESTIMATING REQUIREMENTS

ESTIMATES:

Estimates are to be completed using The QBE approved estimatingplatform (Symbility) establishing RCV, depreciation, and ACV calculationsas directed in this document.

Estimates are to be component based. No “lump Sum” or single bottomline estimates are allowed.

Large or total loss estimates can include sub-bids for Plumbing, Electrical,and HVAC trades only.

Large or total loss estimates should be component based and ‘stick built’unless otherwise directed by QBE.

Estimates are to be written using the most current Symbility pricedatabase for the loss location area. No custom or created databases areto be used.

If the estimate is a supplement to the original loss damage estimate,please use the original price list for new or added components.

Estimates are to reflect a proper scope of damage and include all neededoperations.

If a new or updated database is loaded during the creation of an estimate,all previously entered components must be recalculated to the newdatabase pricing. This does not apply to Supplemental estimates.

Include overhead and profit when the complexity of loss requires the needfor a general contractor to oversee repairs (not always three distincttrades).

Estimates are to be submitted to QBE for review and approval; do NOTrelease estimates or any other documents to policyholders or any thirdparty without QBE’s prior approval. See Setting Expectations above.

Do NOT estimate damages not covered under any policy without QBE’sprior approval. This would include damages with causes such as termites,wear, and tear, etc. QBE does not allow the IA to make or determinecoverage or policy conditions.

Item comments should be used whenever less than 100% of the item isbeing estimated.

Item comments should be used to describe the estimate componentswhen unusual damages or estimate circumstances are involved; it helps

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the customer understand the estimate and avoids confusion for QBEduring potential re-inspections.

Price overrides from the estimating platform database should include anitem comment explaining the change and provide supporting informationon how the overridden price was derived; the text line should immediatelyfollow the overridden price in the body of the estimate (NOTE: notationssuch as “cannot find price in database” or “changing price to reflect ormeet contractor price” are not acceptable).

Avoid manually grouping several component operations or line itemsunder one component. Utilize the Symbility price database as it isintended to include listed operations and materials. Example: Do NOTselect the line item for 3-tab shingles and then indicate it includes allflashing, vents, etc., if it does not.

‘Write-in’ components should include a text line explaining the reason forthe write in and provide the basis for pricing with supporting information;the text line should immediately follow the write-in component in the bodyof the estimate.

A deduction for openings should be shown for each affected interior roomand taken for applicable component operations (examples: painting,cleaning, etc.); measure all openings to the inside edge of interior trim ifpresent. This also applies to exterior elevations.

Repairs to adjoining areas should be considered in the absence of anatural break. A natural break could be a doorway or flooring transitionstrip, differences in surface material of floors, walls, or ceilings.

Cabinets (wall and base), tub surrounds, showers, and mounted mirrorsare considered openings with respect to painting, cleaning, wallpaperoperations. This would not apply to framing, drywall, etc. operations.

Estimates and diagrams should show multiple doors, windows, andmissing wall measurements.

Roof estimates should show the number and type of layers (example: twolayers, composition over wood shake) in a line item note.

If estimating material or components are missing from the structure andthe quality of the item is not known, select a material grade that is equalto, or would be normal for the quality of the structure itself.

All estimates must include the applicable state and/or local sales tax.Sales tax should not be included in each line item entry but should be asingle total amount to properly reflect the material and/ or labor directed bystate law.

Each estimate must show the actual tax percentage being applied to theloss.

Each estimate must include the peril and/ or cause of loss. Each estimate must include the date of loss and inspection date. Each estimate must include the QBE issued claim number.

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MEASUREMENTS:

Measurements should be to the nearest inch. Interior room measurements should be made wall to wall (not trim to trim). Floor measurements should have cabinets, bathtubs, etc. deducted where

appropriate for the type of flooring; hard flooring such as tile or wood orvinyl tile should reflect appropriate deductions (NOTE: vinyl sheet or rollgoods should not have deductions due to the way the material ispurchased).

Exterior repairs should be broken out by elevation with measurements;examples: front, right, rear, left (NOTE: estimates should reflect totaloverall measurements and dimensions for each elevation and includedeductions for any applicable openings.

Offsets must be included in the estimate and illustrated on the diagram.Rooms should not be “squared off”.

Rooms should be identified by a name also reflected and consistent withthe estimate.

OPENINGS AND NATURAL BREAKS:

See “Estimates” Section

PHOTOGRAPHS:

Photographs are to be sufficient to properly and clearly documentdamages; show all affected areas including the cause/origin (example:photos of pipe leak or fire origin).

Photograph the risk address (unless a Rural Route, etc.) and each exteriorelevation whether damaged or not.

For hail damage claims, photographs should show the overall roof area,test squares showing damage or lack thereof, and close-ups of hail hits.

Roof photographs should include the drip edges, multiple layers, andgeneral condition of the roof surface as well as the pitch gauge (indicatingthe roof pitch)..

Photograph quality should be such that QBE can easily identify damages;wide views and close-ups are useful to verify damages.

Photographs should include damages potentially excluded from coverage(example: rotten wood).

Photographs are to include a brief description of the damages depicted Photographs are to be in digital format and attached to reports. The number of photos must be reasonable to document the loss

conditions properly but avoid needless duplication. Photograph any unacceptable risk at the loss location such as

maintenance concerns, safety issues; bad dogs, chemical or hazardousmaterial storage.

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DIAGRAMS:

Diagrams should be completed using Symbility diagram Diagrams are required on all claims. Diagrams should detail rooms and dimensions for all affected areas and/or

adjoining rooms (example: open runs of flooring). Rooms should be identified by their name (example: master bedroom,

kitchen, etc.); closets should be listed as separate rooms or subrooms perSymbility and NOT offsets.

Offsets should be illustrated on the diagram; rooms should not be squaredoff.

Diagram should indicate damages and note origin of loss. Interior room diagrams should include the number and position of doors

and windows. Diagram should show polar direction (N, S, E, W) and the front of the risk Rooms not damaged are required to be included in the diagram as well

but do not require measurements or openings. Roof diagrams and measurements are required on all claims where there

is possible roof damage or is the cause of loss. Roof diagrams are to include the dimensions, roof pitch, number of

stories, and the age and number of layers of the existing roofing; showmeasurements for all ridge, hips, eaves, and rake dimensions.

Roof diagrams should indicate which slopes are recommended to berepaired or replaced.

Roof diagrams should show the location of vents, jacks, and length andplacement of ridge vents.

Roof diagrams on hail claims are to include the location of multiple testsquares and the number of hits per test square.

For wind and hail claims, indicate the direction of the storm on thediagram.

Aerial Photo generated roof diagrams are allowed if needed to determine.measurements, slope, etc on a multi story, high pitch, or complex roof.The cost should be paid directly by the IA.

APPLIANCE & HVAC:

Appliance and machinery losses should include good overviewphotographs as well as close up photos of identification plates. Allappliances or HVAC equipment being addressed in the estimate shouldinclude Make, Model and Serial numbers, age and other pertinentinformation. If lightning report is needed, the IA will report to the QBEadjuster that a report may be needed and the QBE adjuster will handleaccordingly.

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ROOFING:

Repair should always be the first option considered in the estimatedscope.

Roof tear off is a fixed amount. Do not add an additional waste factor fortear off roof claims are to be physically inspected with no exceptions. Theinvestigation should occur from the surface of the roof (if additional help isneeded to gain access to roofs on multiple stories or steep pitched [>7/12],‘ladder assists’ are acceptable – see ‘Ladder Assists and SecurityRequests’ below.

If roof replacement is recommended, an explanation as to why repairs arenot possible should be included.

When estimating damages on roofs where the existing material is 20 yr.,3tab, comp shingles, 25 yr., 3tab, comp shingles are an acceptable LKQreplacement product in the following conditions; 1. The IA Adjuster mustdetermine the 20yr shingles are not available in the loss area. 2. The IAAdjuster must indicate efforts to obtain 20 yr. shingles in the narrativereport. 3. If the IA Adjuster cannot determine if there are 20 shinglesavailable or if there are questions, estimate what is currently on the roofand the QBE Claims Employee will make any needed changes.

All decisions to repair or to total a roof must be based on the conditions ofthe roof and normal reparability issues. Do not make the decision basedon the Material-Example; the roof is a 20 yr., 3-tab comp shingle roof andcan be repaired, but there are no 20-yr. shingles available in the area. Theroof can be repaired using 25 yr., 3 tab, comp shingles.

Select the appropriate waste factor for the type of roof being replaced orrepaired. If we have a 3-tab roof replacement we will allow for replacementof ridge, and waste factor should be capped at 10% waste.

Steep and two story charges are based on actual area. Do not add anadditional waste factor for these items.

Roof slopes should be estimated as separate entities unless the roof istotaled

On roof claims involving hail damage, a slope in each direction should betested; the test square (10’ x 10’) should be marked with chalk to bevisible in photographs and hail impacts circled versus marked through withan ‘X’

Replacement and/or repair recommendations are to be supported by theestimate, measurements, diagrams, photographs, and report; QBE willreview and determine the degree of damage that qualifies for total roofreplacement

Granule loss in and of itself is typically not considered damage; somegranule loss is inherent to composition type shingles.

If spaced sheathing is observed, photographs from the attic should betaken for documentation.

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In the absence of other covered damage, lifted/non-sealed tabs alone arenot necessarily indications of wind or other damage.

Additional items to consider are: ridge cap, metal valley, plumbingsleeves, chimney step flashing, skylights, vents, felt, drip edge, pipe jacks,removal and reset of A/C unit, or antenna/satellite attached to the roof,access charge, and debris removal, as appropriate. Need photos toconfirm damage and replacement.

10% waste factor on gable roof replacements. 15% waste factor on hip roof replacements and may be appropriate on

more intricately designed roofs with multiple roof lines, valley, or dormers. 10% waste factor when replacing one slope. 5% waste factor should be used for a flat roof & most metal roofs. Add linear feet when replacing the ridge shingle.

ROOFING and EAGLEVIEW: During the inspection, the field adjuster will be required to follow the Roof

Assessment Checklist and ensure each item is addressed. This checklistis for everything on the property to ensure a complete inspection of theexterior is completed.

Once the roof has been assessed and photographs have been taken, theI/A will need to determine if an EagleView report should be ordered.Additionally, the I/A may be asked by the QBE handling adjuster to orderthe report.

Information that needs to be considered when ordering a report include,but are not limited to the following; how complex is the roof? How manyfacets does the roof have? How many square feet is the dwelling? Aremore than two levels involved? Is this a high pitch roof?

Gable roofs are generally excluded from reports unless there are morethan three dormers.

You are not required to physically measure the roof when the EagleViewreport has provided this information. The I/A’s report must include thetype(s) of roofing, the age of roof, slope pitch, and the number of layers ofroofing.

When EagleView is not available, measurements must be taken or verifiedmanually and sketched in Symbility.

FLOORING and ITEL:

Repair should always be the first option considered in the estimatedscope.

If flooring replacement is recommended, an explanation as to why repairsare not possible should be included.

Typically, we only owe for one finished surface; this applies to all flooringsurfaces (examples: wood, vinyl, tile, carpet, etc.).

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We owe to replace hardwood with hardwood; the top surface (sand andfinish) is considered the finished surface - if you have carpet over ahardwood floor, do not figure to sand and finish the hardwood floor and thenreplace the carpet.

Field Adjusters must distinguish hardwood floors from laminate floors dueto high variances in price, quality, and repair options depending on typeand quality of the flooring. Generally, repairs to damaged hardwood floorscan be isolated to the damaged planks. These planks can be removedand replaced, and the floor sanded, stained, and refinished to match. It isimportant to identify the cause of loss to wood floors since wood flooringcan be damaged by non-covered causes such as warping from humidity,surface water, improper installation, etc.

The Field Adjuster should evaluate the level of damage to the hard woodfloors as hardwood floors can be sanded and refinished without replacingthe actual wood. This is dependent on the extent of damage and thenumber of time(s) the wood floor has previously been sanded andrefinished. When estimating to sand, stain, and finish hard wood flooringsome items that need to be taken into consideration are:

Refinishing the floor up to a natural break. The machinery used to sand, stain, and refinish wood floors may mar

baseboards causing them to be damaged, appropriate repairs orreplacement should be allowed.

For engineered hardwood flooring, the type and manufacturer ofengineered flooring often determines the reparability. Some manufacturersgive a warranty of 1 to 3 sandings for the lifetime of the engineered wood.

When replacing wood & tile floors, it should be replaced to a natural break(doorway, flooring material transition, etc.). It is generally difficult to stop atdoorways unless there is a clear transition. If strip flooring runs under adoor, proper estimating may require an estimate to extend into anotherroom.

Replace vinyl & carpet flooring to a ‘break’; either a different floor covering,transition strip, or floor levels. Unlike the possibility for wood & tile floor,carpet does stop at a threshold and would not extend to an undamagedroom.

Area deductions for items such as base cabinets should only be taken whencalculating ‘laid to fit’ flooring products such as vinyl tile, hard tile, woodflooring, etc.; flooring products such as roll (carpet) or sheet (vinyl) goodsare ‘cut to fit’ installation and should not reflect deductions.

Carpet and sheet vinyl measurements should be calculated by the squarefoot.

Do not clean carpet that is going to be replaced. Identify all needed flooring construction components. If there is a sub-floor,

the only replacement requirement is typically just the finished floor,however, if the sub-floor is damaged, we would owe to repair or replace asneeded

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Utilize the appropriate quantity and waste calculation method for thematerial being replaced.

ITEL Flooring Process for all QBE loss assignments. Please take andsubmit flooring samples to ITEL on all losses involving flooring damage ifthe replace quantity is equal to or greater than 150 sf, or if premium gradeflooring is being estimated. The Field Adjuster will attempt to secure ITELsample as policy language does authorize to receive a sample to determineclaim settlement. This includes carpet and wood flooring. Tile and vinylflooring reports will be left to the Field Adjuster’s discretion or at the requestof the handling adjuster.

The Field Adjuster should attempt to update the estimate with the Itelresults. If Field Adjuster is unable to update the estimate with Itel resultswithin a reasonable timeframe, they will enter all the available informationin the estimate and list as an ITEL line item. Leave the cost to supply as anopen item on estimate. The Field Adjuster will update the narrative andexplain that an Itel report was submitted and the estimate will be updatedas soon as the report is received by the Field Adjuster.

When taking flooring samples for ITEL, remove them from a closet, againsta wall or another out of the way location. Do not create a hazardous situationfor occupants. If needed, arrange to secure a sample when the mitigationwork is going on, or meet with the insured’s contractor in order to secure asample.

CABINETS:

Consider cabinet repair when possible depending on the scope of damage If cabinet replacement is recommended, an explanation as to why repairs

are not possible should be included. If there is a matching issue regardingthe replacement of the stain/veneer of the cabinets, consider using areface of cabinets.

Typically, we owe for equivalent quality of material; i.e. like kind andquality

Non-site built cabinet units can be removed and replaced on an individualbasis

Site built cabinet runs may require more extensive repair or replacementoptions depending on trim, shelving, and tie-ins

DRYWALL:

Estimate the actual square footage that needs to be repaired or replacedand include the minimum charge adjustment if applicable.

Be sure to estimate using the proper component for the repair (there aremultiple components to choose from)

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Popcorn or blown acoustic textured ceiling repairs should reflect a scopefor remove and replace on the entire ceiling versus spot repairs within theceiling area, unless the existing ceiling has been previously spot repaired

PAINTING AND DECORATING:

If only one wall in a room is damaged, go ahead and paint all walls in thesame room. This would not include the ceiling, if there was no damage tothe ceiling. You may consider using masking/tape for ceiling, if needed.

When a wall or ceiling has been water stain damaged, the standard repairis to spot seal the stain and paint the wall or ceiling with one coat

Consideration should be given when ceilings, walls, and trim are differentcolors or types of paint; for example, repairing ceiling damage does notnecessarily require painting the walls when they sustain no damageand/or are a different color than the ceiling

New drywall typically requires a prime coat prior to the finish coat, or atotal of two coats

Documentation is required if estimating three paint coats as it is rare thatdamages would require to seal/prime and then paint two finish coats

Trim should not need to be painted unless it sustains damaged.

SHOWER PAN LOSSES:

If replacement is recommended, an explanation as to why repairs are notpossible should be included.

Consideration should be given to reparability (i.e. thin set versus mud set,etc.) before replacement is determined.

Grout failure is an example of a normal maintenance issue which istypically excluded in most policies under the wear and tear provisions. TheIA Adjuster should discuss with the QBE Claims Employee to determine ifcoverage exists.

If grout failure is evident, a shower pan test may be necessary todetermine causation and applicable coverage; any third-party testingrequired to determine causation is to be pre-approved by QBE.

If grout failure is evident as the cause of loss, provide photos to the QBEClaims Employee and obtain direction in handling the loss inspection.Direction for coverage should be provided by QBE.

Prior to the final scope, repair, access, and cosmetic impacts and optionssuch as ‘reroute,' ‘tunneling,' ‘foundation penetration,' ‘location,' etc.,should be fully discussed with QBE and based on policy coverage.

FENCING:

If fencing replacement is recommended, an explanation as to why repairsare not possible should be included. Repairs should not be depreciated.

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Depreciation only applies if one entire fence run (corner post to cornerpost) has been damaged and needs replacement; replacing anything lessthan an entire fence run would be considered a repair and not subject todepreciation. This is a general rule as some exceptions may exist andneed to be considered and noted

If a fence is co-owned, payment should reflect 50% of the estimated costfor repair or replacement; documentation of co-ownership should beobtained - but if verification of co-ownership cannot be obtained, estimatethe loss at 100%.

Estimates for verified co-owned fence losses should show the full scope ofthe damage, and then reflect 50% of the unit cost. This should be noted asa line item note in the body of the estimate.

Fence inspections should include measurements of damaged areas orruns; do not count fence sections.

DEBRIS REMOVAL:

Debris removal is an allowance for general clean-up and removal of debrisout of the house or structure and to the truck or dumpster. Scope what isbeing hauled off and figure the appropriate number of hours; this shouldbe listed as one entry for the entire estimate in a ‘General’ category at thebottom of the estimate. Only estimate for one-line item for DMO charge.Do not estimate for separate DMO charges; interior and exterior.

If a dumpster is involved, consider the proper size and the number oftimes it must be emptied. If a ‘Truck Load’ component is being consideredto haul debris, DO NOT use a fraction of a load.

DEPRECIATION: Appropriate depreciation should be addressed on all claims. Line by line depreciation should be shown with the proper application of

depreciation based on the age, usage, and condition of the item,regardless of the policy type.

Refer to the Depreciation Schedule within Symbility for direction onmaterial life span expectations.

Labor only operations, such as cleaning, are not subject to depreciation Refer to specific state DOI law that would exempt any material from

depreciation. Make a note of any laws that would apply. Do not depreciate using a single percentage factor estimate wide (i.e. 50%

of the entire estimate). Do not exceed 75% depreciation on any single line item or component Address all depreciated components as “recoverable” in the estimate. The

QBE Claims Employee will change appropriate items to “non-recoverable”as the policy conditions allow.

Depreciate Law and Ordinance issues 100% until the cost is incurred. Thesame applies to Building Permits, etc. The depreciation for these itemscan be less if instructed by the QBE Claims Employee.

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OVERHEAD AND PROFIT:

The application of Overhead and Profit (O&P) should be calculated asOverhead (10%) AND Profit (10%) instead of Overhead AND THEN Profit(21%).

Overhead and Profit should be included when the complexity of the loss orconditions of the loss require the need for a General Contractor; do notdetermine O&P based solely on the number of trades involved in therepairs.

Overhead and Profit calculations should not include tax. Tax should not be applied to the O&P calculation amount unless required

by the state where the loss occurred.

FIELD INSPECTION REQUIREMENTS

LADDER ASSISTS AND SECURITY REQUESTS:

Roof must be multiple stories and/or a slope pitch greater than 7/12;provide documentation to support the need.

Pre-approval from QBE is NOT required; provide documentation tosupport the need.

Cost for ladder assist is paid directly to the contractor, etc. by the I/A; costis to be included in the I/A bill to QBE as a pass-through cost with nomarkup and not a separate bill (no contractors, etc. will be paid directly byQBE).

Security assists for protection are to be handled in the same manner asladder assists.

CONTENTS:

Do not include the replacement and/or cleaning of damaged contents suchas furniture, clothing, electronics, toys, etc. in the structure estimate

Consider remove and reset components or contents manipulation tofacilitate structure repairs.

Inform the insured they will need to provide a list to the QBE ClaimsEmployee of the damaged contents property. The insured will need to useInventory sheets provided by QBE.

Obtain overview photos of all rooms and all higher value contents that aredamaged.

Photograph the underside of furniture cushions and the inside of thedrawers to document the brand of furniture.

The primary task of the IA Adjuster on Contents claim assignments is toinvestigate the loss conditions, photos the loss conditions, and contact theinsured.

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The IA Adjuster is not to create contents lists, or price contents lists. QBEClaims Employees will use an approved contents vendor for this activity.

SHEDS & OTHER STRUCTURES:

Determine if the structure qualifies as an Other Structure (Coverage A) orPersonal Property (Coverage B):

The Structure qualifies as an Other Structure (Coverage A) when: It is a permanent part of the realty, has a foundation, or has tie downs or is

in some other way affixed to the realty. If it was removed, it would defacethe property.

The structure qualifies as Personal Property (Coverage B) when: It is manufactured to be easily moved such as pre-fabricated plastic

storage units, or the shed is placed on skids for easy transport.

DEPRECIATION GUIDELINES

The QBE Depreciation Guidelines should be used as a guide when applying depreciationto estimates and personal property inventory forms.

1. Depreciation should be applied by percent on each line item where applicable.

2. A maximum of 75% depreciation will be taken on structural components.

3. Structural components less than one-year-old will not be depreciated unless thereare notes in the claim file to explain any deviation. Verbal discussions regardingthe age of the items with the insured or borrower should be documented in theIndependent Adjuster (IA) notes or adjuster log notes and Short Form narrative.

4. The Independent Adjuster must show applicable depreciation as outlined inthis “Guide” from dollar one.

5. No depreciation will be taken on contents items that are less than six months oldunless there are notes addressing why depreciation was warranted (i.e. excessivewear and tear or condition).

6. QBE Claims Employees will review all estimates and inventories to confirm thecorrect percentage of depreciation was applied to the loss in accordance withpolicy guidelines.

7. Any necessary revisions to estimates and inventories or deviations from theguidelines need to be addressed in the IA Short Form narrative report or in theadjuster log notes. A line-item- by-line-item discussion of each component is notrequired.

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8. QBE Claims Employees should contact the IA for an explanation regarding the ageand condition of the home, any major components related to the loss and anexplanation as to IA deviations from the guideline if these were not included in theIA’s narrative. In cases where the depreciation amount is not significant, it isacceptable for the adjuster to document the file and pay the claim.

9. The following structure trades are not subject to depreciation: asbestos, cleaning,contents manipulation, l, equipment, excavation, permits & fees, rough carpentry,labor, scaffolding, temporary repairs, wrecking & hauling, and water extractionservices.

10.Depreciation taken should be spot checked on each estimate by focusing in on thefive largest estimate items based on the items stated Replacement Cost.

2821 Emerywood Parkway, Suite 100, Richmond, Virginia 23294

p. 877.884.9446 | f. 703.832.0528 | nationalrestore.com

For Adjusters v4, 20160115

The information provided in this guide is for National Restorations, its repair firms, and customers and is specific to photo

inspection handing process, which includes insurance claims, commercial projects, and private restoration work that is

sourced and referred by National Restorations. This guide is propriety and confidential

Cabinet Photo Guide

CABINET PHOTO INSPECTION GUIDE

National Restorations 2 of 8

Introduction

What We Do

National Restorations, headquartered in Richmond, Virginia, is a national company that

specializes in restoring all types of wood. We specialize in cabinets and furniture but also work

with paneling, wainscot, molding, chair rail, etc. We work with over 250 insurances companies

(including the top 15), commercial markets, and the hospitality industry. We provide our

customers an alternative to replacing damaged wood furniture and cabinetry (or other wood)

by restoring the damaged areas to pre loss condition. For example, if upper cabinets over the

stove are damaged during a grease fire, we will restore the damaged cabinets only and finish to

match the surrounding cabinets. If a lower cabinet is water damaged, we fabricate a new

cabinet box and reinstall the existing face frame and doors and finish to match the surrounding

cabinets.

Please visit our website (www.nationalrestore.com) to see examples of our work.

The photos and information you provide give us the information needed to estimate both the

repair of damages and our opinion of replacement cost of the furniture or cabinet items in

question. Consequently, it is imperative that you follow our procedures and guidelines to ensure

we have all of the information necessary to provide accurate and comprehensive restoration

estimates in a timely manner.

We look forward to working with you and please feel free to contact us should you have any

questions or require additional information.

Submitting a Photo Evaluation Assignment:

Web Form Submission: www.NatinalRestore.com/assignments

Email: [email protected]

Phone: 877.884.9446

Be sure to specify that you want a Photo Evaluation



Photos We Need

Photos

o Photograph the entire kitchen/bathroom showing all cabinets

o Photograph the cabinet side panels and back side of islands and peninsulas

o Photograph all the plumbing inside cabinets

o If damage is to the interior of the sink cabinet, remove all items and then photograph

o Photograph the inside of the damaged cabinets

o Photograph the interior and outside of the drawer showing the joints and slides

Photograph the front, back and edge of a typical door Photograph all damaged areas

(overall and close up photos)

o Photograph the countertops and a close up of an edge

o Photograph any pre-existing damages and note them as unrelated to loss

Information

o Provide individual linear foot measurements for all upper, lower, island and full height

cabinets such as 15 ft. of uppers, 19 ft. of lowers, 2 ft. full height, 6 ft. island cabinet

o Provide a detailed damage description and origin of the loss. See examples below

o Use all upper case when typing the damage description in the appropriate photos

o Explain any reason that prevented you from preforming a proper/complete inspection



Photo Examples Photographs must be very CLEAR to ensure we can accurately estimate everything required to

properly repair the damage. (When emailing, please keep the size of email message under

25MB of it will fail to deliver)

Upon arrival, take a photo of the front of

the residence

Take overall photos showing the entire kitchen showing all upper, lower and island cabinets and

both sides of any peninsula cabinets



Photo of the cabinet sides and back side of all peninsula and islands cabinets

Open sink cabinet doors and take photo of damage and all plumbing

Photograph the inside of the damaged cabinets to show any slide outs, drawers or any other

accessories.



Open one drawer and photograph to show the interior and the slides

Open one door and photograph the back panel and edges, and the front panel as well



Take close up photos of all damaged areas such as separations in joints, burnt areas, water-

damaged areas of cabinets, bottom areas and toe kicks



Take a close up photo of the countertops

Damage Description Examples A detailed damage description is important to make sure we understand the scope or repairs

and any exclusion. Here are a few detailed, yet brief examples:

• Water damage to floor of sink cabinet from water supply line. No other visible damage

• Stove fire damaged the 3 upper cabinets above the stove area. No other cabinets

damaged

• Broken icemaker water line damaged 2 lower cabinets on each side of the fridge.

• Holes drilled in toe kicks

• Water damage from apartment above damaged tops and sides of 3 upper cabinets on left

side of the window. Doors and face frame were not affected, lowers were not affected

HVAC Services Assignment Guidelines for HVACiQualify the claim for HVAC Services using the Decision Table:

HVAC ServiceType

Loss Threshold Eligible Policy Types Eligible Perils

Desk

Review

Assignment

Criteria

Completed Equipment

Repairs/Replacement exceed $2,500

Reported peril is not in question

Homeowners

ROP (Rental Owners)

SFP/SHP

Business owner

Commercial Property

Fire

Lightning

Loss of Power

Damage from Electric Current

Theft/Vandalism

Water

Other/Unknown

Fire

Wind

Hail

Explosion

Property Damage

Onsite

Inspection

Assignment

Criteria

Estimated repairs to existing

equipment exceed $2,500 and/or

reported peril is in question*

Loss estimate reflects replacement

of equipment and/or reported peril

is in question*

*For claims reported with HVAC damage only and peril of lightning, a lightning report is not required if assigned to

vendor for onsite inspection

Complete Assignment to HVACi:

• Assignment made in Symbility Claims Connect directly to HVACi by IA or QBE CP

• Assignment Methods o (888)407-5224

• Desk Review – include estimates, invoices and photos

• Onsite Inspection – include estimates, applicable contact information

Eligible Residential Systems

Boiler, Furnace, Geo Thermal, Heat Pump, Mini Split System, Packaged Unit, PTAC (Packaged Terminal),

Radiant Heat, Split System, Window Unit, Evaporative Coolers

Eligible Commercial Systems

Boiler, Chiller, Evaporative Cooler, Exhaust Fan, Furnace, Geo Thermal, Heat Pump, Make-Up Air Unit,

Mini Split System, Package Unit (RTU), PTAC, Refrigeration, Split System, Ventilator, Heat Pump

ASSIGNMENT OUTLINE & PROCESS

1. Assignment made in Symbility Claims Connect directly to HVACi by IA or QBE CP

The assignment should be made to HVACi once it is established there is a possibility of damage to

HVAC items over $2500.

2. The I/A does NOT need to create an estimate for damage prior to sending the assignment to HVACi.

It won’t be until after HVACi has returned the assignment back to the IA the estimate will be

updated with HVACi repair/replace cost. This is very similar to our current ITEL process. However, it

is imperative the IA provides high quality photos and narrative to HVACi. HVACi will review the

photos submitted by the IA and determine if a desktop review can be performed or if the photos

and information from the IA is lacking, they will need to complete a field inspection.

3. HVACi will provide the following information with the completion of their handling; analysis

and report for each claim as to why the item can be repaired or needs to be replaced, any

field inspection completed by HVACi will include photos, a report and estimate. The report

and estimate submitted by HVACI will not include O/P, but it may include tax in the amount.

4. The IA will update their estimate with a single line item based on the HVACi report. Please

make sure O/P and tax is applied correctly.

Currently the process for billing will be that HVACi will submit an invoice to QBE directly and

payment will be issued at the desk level. We are working towards having a bulk billing method

in place. But until then, payment will be made at the desktop level.

It is imperative the IA provides high quality photos and narrative to HVACi. Longer cycle times

can be prevented only by the quality of photos submitted by the I/A’s. If the photos are lacking

or there is no information submitted, HVACi will need to send out to the field for an inspection.

This will make you wonder how many claims did we issue a payment for replacement of HVAC equipment vs repair?

RESIDENTIAL CLAIMS

COMMERCIAL CLAIMS

National Restorations provides accurate and quick evaluations of claims involving damage to cabinets

and wood furniture.

They have an in-house team of expert restoration professionals who provide qualified written

Restoration Evaluation Reports (R3).

NR’s repair partners – independent restoration firms – back the written R3 report with a five-year

workmanship guarantee.

National Restoration Assignment & Work Process

Offer an easy to use process

1. The assigned vendor and I/A will complete their assigned inspection of the insured

property. During this inspection, it is discovered there is cabinet damage. The IA will

explain to the insured that it may appear the damage to the cabinets will exceed $3000

and if this is the case, then National Restoration will handle the cabinet settlement

section of their claim. This settlement will in part be based on the IA’s notes/photos.

2. The I/A completes their estimate for cabinet damage and confirms all the cabinet

damage listed in the estimate is over $3000.

3. The I/A will assign the claim to National Restoration in Claims Connect. A copy of their

estimate with cabinet damage is sent with the assignment to NR.

4. NR accepts the assignment and will handle one of two ways.

• They will either complete a phone evaluation with the insured and this will be

based off the IA’s estimate/photos/scope of the cabinets.

• If the IA did not provide sufficient photos/scope notes, then NR will need to

complete a physical inspection of the property.

Each assignment has one point of contacto Estimator (Photo Evaluation)

o Project Coordinator (On-Site Evaluation)

o Deliver expert settlement information

SETTLEMENT OF NATIONAL RESTORATIONS HANDLING

1. Once National Restoration has completed their handling, they will attach the R3 report

and photos to the claim.

2. National Restoration will open the estimate and create a revision of the original IA

estimate. This revised estimate will have all the IA’s line items related to cabinet repairs

(only) removed and replaced with a single line item bid, which is based on NR’s quote to

repair/replace. No tax or O/P will be included with this single line item submitted by

NR.

The Restoration Network is a network of local professional restoration firms who

handle both residential and commercial losses.

Greater than 5 years’ experience (most have more than 1O!)

Vetted through stringent background and financial checks and verification of required

insurances and quality of craftsmanship

REOPENED ASSIGNMENT

If you receive a request to review an item that National Restoration settled, National Restoration will

need to reopen the assignment. This will send the task notification to ASI & the request will be taken

care of by National Restoration for the cabinets only.

SCREENSHOTS OF ASSIGNMENT PROCESS

ASSIGN CLAIM IN CLAIM CENTER AND SELECT NATIONAL RESTORATION

SELECT ASSIGN VENDOR > UNDER ASSIGNMENT TYPE SELECT CAB/FURN REST

Open Estimate and select Share with > National Restoration

AGAIN, PLEASE REMEMBER TO FOLLOW THIS PROCESS!!

QBE AMERICAS THE IA GUIDELINES - Eagle … AMERICAS THE IA GUIDELINES INDEPENDENT ADJUSTER SERVICE LEVEL, ESTIMATING, AND FIELD INSPECTION REQUIREMENTS for PROPERTY CLAIMS The purpose

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