Catastrophe Claims Guide 2007

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1-866-411-CPIC
www.citizensfla.com

Citizens Catastrophe Claims Guide

TABLE OF CONTENTS

MISSION

To efficiently provide property insurance protection in Florida to those unable to
obtain coverage in the private market, as directed by the Legislature. Quality
customer service is our priority.

VISION
We are:
Responsive stewards of the public trust
Setting the standard for superior customer service and operational efficiencies
Recognized as an important insurance safety net for Floridians
Respected as a valuable partner in protecting Floridas economic health.

CORPORATE STRATEGIES

Continuous Operational Improvement
Smart Financial Management and Controls to meet our Policyholder
Obligations
Customer Focus, Outreach and Education
Effective Workforce
The Right Coverage for the Right Price
Creative Solutions for Floridas Insurance Market

This guide was prepared by the Catastrophe Claims Department of Citizens Property Insurance Corporation (CPIC) for
use by its staff, its Claims Adjusting Firms, and other organizations that may be involved in the servicing of Citizens
claims. All procedures apply specifically to catastrophe claim handling though in many cases the same or similar
procedures may be followed by the non-catastrophe (daily) claims department. The principles and guidelines
described in this guide may differ for individual claims depending on its unique facts and circumstances. The basic
philosophy in insurance claims is that each claim is unique and is handled on its own merits. This guide is intended to
serve as a reference to standardize and explain the processes the procedures in normal claims handling, however it is
not possible to account for every possible claims scenario and for this again serves as a guide only.
Citizens Property Insurance Corporation (Citizens) 2007
April 9, 2007 Citizens Catastrophe Claims Guide 2
TABLE OF CONTENTS
I N T R O D U C T I O N ................................................................................................................ 5
S T A N D A R D S ........................................................................................................................ 6
UNFAIR CLAIM SETTLEMENT PRACTICES............................................................................................... 6
SERVICE STANDARDS........................................................................................................................... 10
CODE OF ETHICS .................................................................................................................................. 11
CLAIMS HANDLING PROCEDURES ........................................................................................................ 14
QUALIFICATIONS AND RESPONSIBILITIES OF ROLES........................................................................... 16
LICENSING.......................................................................................................................................... 19
INDEMNIFICATION AND HOLD HARMLESS .................................................................................. 21
ADJUST YOUR OWN (AYO) COMPANIES................................................................................................ 22
ASSIGNMENT ........................................................................................................................................ 24
AUTHORITY........................................................................................................................................... 24
LOSS REPORTING AND INQUIRY........................................................................................................... 24
J O B W O R K F L O W S ........................................................................................................ 25
C L A I M S H A N D L I N G P R O C E D U R E S .............................................................. 39
COVERAGE ........................................................................................................................................... 39
CUSTOMER SERVICE............................................................................................................................ 39
INVESTIGATIONS................................................................................................................................... 41
PROPERTY CLAIMS............................................................................................................................... 42
ESTIMATES (Building)............................................................................................................................. 43
ESTIMATES (Contents) ........................................................................................................................... 44
DEPRECIATION ..................................................................................................................................... 45
SALES TAX............................................................................................................................................ 45
TEMPORARY REPAIRS.......................................................................................................................... 45
SAFETY ................................................................................................................................................. 46
PHOTOGRAPHS..................................................................................................................................... 46
OVERHEAD AND PROFIT ALLOWANCE.................................................................................................. 48
DEDUCTIBLES....................................................................................................................................... 48
VALUE DETERMINATION ....................................................................................................................... 48
RESERVES............................................................................................................................................ 49
EXPERT SERVICES ............................................................................................................................... 49
COMMERCIAL COINSURANCE/DWELLING REPLACEMENT COST.......................................................... 57
PROOF OF LOSS ................................................................................................................................... 58
POLICYHOLDER REPRESENTATION...................................................................................................... 58
SALVAGE / SUBROGATION.................................................................................................................... 59
SUBROGATION GUIDELINES ................................................................................................................. 61
ADVANCE PAYMENTS ........................................................................................................................... 62
MORTGAGEES / LOSS PAYEES ON PAYMENTS..................................................................................... 62
PAYMENT TO CONTRACTORS............................................................................................................... 63
ADDITIONAL LIVING EXPENSE (ALE) ..................................................................................................... 63
ALE INSTRUCTION SHEET..................................................................................................................... 65
LOSS ASSESSMENT.............................................................................................................................. 66
ORDINANCE OR LAW............................................................................................................................. 66
REPORTING REQUIREMENTS ............................................................................................................... 67
COMPLEX CLAIM REPORTING REQUIREMENTS.................................................................................... 67
W A T E R D A M A G E C L A I M H A N D L I N G P R O C E D U R E S .................... 68
STEP 1 ASSIGNMENT.......................................................................................................................... 68
STEP 2 INITIAL CONTACT AND EARLY SITE INSPECTION................................................................... 68
STEP 3 DUTY TO INFORM................................................................................................................... 68
STEP 4 SITE INSPECTION................................................................................................................... 69
STEP 5 - COVERAGE ANALYSIS............................................................................................................. 69
STEP 6 ENLISTING THE SERVICES OF A CERTIFIED INDUSTRIAL HYGIENIST.................................... 69
C O V E R A G E R E V I E W P R O C E D U R E S ............................................................ 70
COVERAGE REVIEW PROCESS ROLES & RESPONSIBILITIES............................................................... 70
REFERRAL GUIDELINES FOR CLAIMS REPRESENTATIVES, SPECIALISTS, AND ADJUSTERS............... 72
REFERRAL GUIDELINES FOR EXAMINER TO CLAIMS MANAGEMENT.................................................... 72
GENERAL INFORMATION....................................................................................................................... 72
INFORMATION TO AID THE ANALYSIS................................................................................................... 72
DOCUMENTS......................................................................................................................................... 73
RESERVATION OF RIGHTS LETTERS .................................................................................................... 73
COVERAGE DECISIONS RESERVATION OF RIGHTS.............................................................................. 74
DECLINATION OF COVERAGE ............................................................................................................... 75
POLICY NOT IN EFFECT OR REFORMATION OF POLICIES .................................................................... 76
C O N D O M I N I U M & C O M M E R C I A L C L A I M S .............................................. 77
OVERVIEW............................................................................................................................................ 77
CLAIM GUIDELINES FOR POLICY EFFECTIVE DATES AFTER JANUARY 1, 2004..................................... 77
Interpreting Condo Documents on Claims with Policy Effective Dates of January 1, 2004 and After ................. 81
CLAIM GUIDELINES FOR POLICY EFFECTIVE DATES PRIOR TO 1/1/04.................................................. 82
FLORIDA CONDOMINIUM STATUTE EXCERPT....................................................................................... 83
M O B I L E H O M E C L A I M S .......................................................................................... 84
MOBILE HOME TOTAL LOSS CLAIMS..................................................................................................... 84
APPLICABLE FLORIDA STATUTES......................................................................................................... 84
DETERMINATION OF ACV...................................................................................................................... 85
MOBILE HOME SALVAGE....................................................................................................................... 86
FLORIDA STATUTES.............................................................................................................................. 88
M E D I A T I O N , A P P R A I S A L A N D C I V I L R E M E D Y .............................. 102
CIVIL REMEDY NOTICES...................................................................................................................... 102
MEDIATION UNIT ................................................................................................................................. 103
APPRAISAL UNIT ................................................................................................................................. 104
S P E C I A L I N V E S T I G A T I O N U N I T ( S I U ) ................................................ 108
INDICATORS OF CATASTROPHE RELATED FRAUD............................................................................. 108
INDICATORS OF PROPERTY REPAIR FRAUD ASSOCIATED WITH CONTRACTORS/PROVIDERS ......... 109
INDICATORS ASSOCIATED WITH THE CLAIMS PROCESS ................................................................... 109
SIU REFERRAL FORM.......................................................................................................................... 111
Q U A L I T Y A S S U R A N C E R E - I N S P E C T I O N P R O G R A M ................. 112
E M E R G E N C Y O P E R A T I O N C E N T E R S ( E O C ) ...................................... 113
CITIZENS FORMS ...................................................................................................................... 115
LETTERS .................................................................................................................................... 127

I N T R O D U C T I O N

In 2002, the Florida Legislature passed a law that combined the Florida Residential Property and Casualty
Joint Underwriting Association (FRPCJUA) and the Florida Windstorm Underwriting Association. This
resulted in the creation of Citizens Property Insurance Corporation (Citizens/CPIC). Citizens operates
under the direction of a seven-member board of Governors, appointed by Floridas Chief Financial Officer
for three-year terms, representing geographically diverse regions of the state. The State Chief Financial
Officer also appoints a Technical Advisory Board to provide information and advice to the Board of
Governors. The Florida Department of Financial Services (DFS) regulates Citizens and determines which
areas of Florida are eligible for wind-only coverage.

Citizens policies provide Florida citizens with coverage when it is not available in the voluntary insurance
market, and pay insureds claims when covered losses occur. Insureds are advised to report losses
directly to Citizens 24 hour call centers; they may also contact their agents who will, in turn, file the report
via ePAS, Fax or through Citizens 24-hour Call Center. Citizens also receives a limited number of first
notices of loss (FNOL) from their Adjust Your Own (AYO) partners. In most instances, Citizens will assign
claims to adjusters who to contact the insured and inspect the loss as soon as possible. To expedite the
claims handling process some claims are routed for internal handling (Fast Track) which does not involve
an inspection in the initial phase. The AYO partners also receive a portion of the claim assignments which
generally means that an adjuster is not initially assigned by Citizens. These claims are handled by the
AYO companies who are responsible for all aspects of the adjustment of the loss with a determined
authority level.

The management and staff of Citizens place a priority on handling all claims with expediency, fairness,
professionalism, and consistency. To that end, this Catastrophe Claims Guide has been prepared as a
guide for adjusters to better understand the requirements for adjustment and processing of Citizens claims.
It is by no means exhaustive, and we recognize that it will not address all issues that might arise during the
adjustment of claims or during a storm season. We recognize that each claim is unique. Reference must
be made to the individual policy forms and endorsements for specific coverage information. In addition,
adjusters are strongly encouraged to consult with supervisory staff, as needed.

In all matters, the terms and conditions of the applicable Citizens policy and the laws of the State of Florida
will prevail. Furthermore, Citizens management reserves the right to implement changes to this guide at
any time. Those changes will be disseminated periodically as they occur.

S T A N D A R D S

UNFAIR CLAIM SETTLEMENT PRACTICES

Florida Statute 626.954(1)(i) contains the section of the Unfair Insurance Trade Practices Act which
specifically addresses the matter of unfair claim settlement practices. Please be conscious of the following
section from that statute:

(I) UNFAIR CLAIM SETTLEMENT PRACTICES.--
1. ATTEMPTING TO SETTLE CLAIMS ON THE BASIS OF AN APPLICATION, WHEN SERVING AS
A BINDER OR INTENDED TO BECOME A PART OF THE POLICY, OR ANY OTHER MATERIAL
DOCUMENT WHICH WAS ALTERED WITHOUT NOTICE TO, OR KNOWLEDGE OR CONSENT OF,
THE INSURED;
2. A MATERIAL MISREPRESENTATION MADE TO AN INSURED OR ANY OTHER PERSON
HAVING AN INTEREST IN THE PROCEEDS PAYABLE UNDER SUCH CONTRACT OR POLICY, FOR
THE PURPOSE AND WITH THE INTENT OF EFFECTING SETTLEMENT OF SUCH CLAIMS, LOSS,
OR DAMAGE UNDER SUCH CONTRACT OR POLICY ON LESS FAVORABLE TERMS THAN THOSE
PROVIDED IN, AND CONTEMPLATED BY, SUCH CONTRACT OR POLICY; OR
3. COMMITTING OR PERFORMING WITH SUCH FREQUENCY AS TO INDICATE A GENERAL
BUSINESS PRACTICE ANY OF THE FOLLOWING:
A. FAILING TO ADOPT AND IMPLEMENT STANDARDS FOR THE PROPER INVESTIGATION OF
CLAIMS;
B. MISREPRESENTING PERTINENT FACTS OR INSURANCE POLICY PROVISIONS RELATING TO
COVERAGES AT ISSUE;
C. FAILING TO ACKNOWLEDGE AND ACT PROMPTLY UPON COMMUNICATIONS WITH RESPECT
TO CLAIMS;
D. DENYING CLAIMS WITHOUT CONDUCTING REASONABLE INVESTIGATIONS BASED UPON
AVAILABLE INFORMATION;
E. FAILING TO AFFIRM OR DENY FULL OR PARTIAL COVERAGE OF CLAIMS, AND, AS TO
PARTIAL COVERAGE, THE DOLLAR AMOUNT OR EXTENT OF COVERAGE, OR FAILING TO
PROVIDE A WRITTEN STATEMENT THAT THE CLAIM IS BEING INVESTIGATED, UPON THE
WRITTEN REQUEST OF THE INSURED WITHIN 30 DAYS AFTER PROOF-OF-LOSS STATEMENTS
HAVE BEEN COMPLETED;
F. FAILING TO PROMPTLY PROVIDE A REASONABLE EXPLANATION IN WRITING TO THE
INSURED OF THE BASIS IN THE INSURANCE POLICY, IN RELATION TO THE FACTS OR
APPLICABLE LAW, FOR DENIAL OF A CLAIM OR FOR THE OFFER OF A COMPROMISE
SETTLEMENT;
G. FAILING TO PROMPTLY NOTIFY THE INSURED OF ANY ADDITIONAL INFORMATION
NECESSARY FOR THE PROCESSING OF A CLAIM; OR
H. FAILING TO CLEARLY EXPLAIN THE NATURE OF THE REQUESTED INFORMATION AND THE
REASONS WHY SUCH INFORMATION IS NECESSARY.

FLORIDA STATUTE 624.155 (Civil Remedy)

(1) ANY PERSON MAY BRING A CIVIL ACTION AGAINST AN INSURER WHEN SUCH PERSON IS
DAMAGED:
(A) BY A VIOLATION OF ANY OF THE FOLLOWING PROVISIONS BY THE INSURER:
1. SECTION 626.9541(1)(I), (O), OR (X);
2. SECTION 626.9551;
3. SECTION 626.9705;
4. SECTION 626.9706;
5. SECTION 626.9707; OR
6. SECTION 627.7283.
(B) BY THE COMMISSION OF ANY OF THE FOLLOWING ACTS BY THE INSURER:
1. NOT ATTEMPTING IN GOOD FAITH TO SETTLE CLAIMS WHEN, UNDER ALL THE
CIRCUMSTANCES, IT COULD AND SHOULD HAVE DONE SO, HAD IT ACTED FAIRLY AND
HONESTLY TOWARD ITS INSURED AND WITH DUE REGARD FOR HER OR HIS INTERESTS;
2. MAKING CLAIMS PAYMENTS TO INSUREDS OR BENEFICIARIES NOT ACCOMPANIED BY A
STATEMENT SETTING FORTH THE COVERAGE UNDER WHICH PAYMENTS ARE BEING MADE;
OR
3. EXCEPT AS TO LIABILITY COVERAGES, FAILING TO PROMPTLY SETTLE CLAIMS, WHEN THE
OBLIGATION TO SETTLE A CLAIM HAS BECOME REASONABLY CLEAR, UNDER ONE PORTION
OF THE INSURANCE POLICY COVERAGE IN ORDER TO INFLUENCE SETTLEMENTS UNDER
OTHER PORTIONS OF THE INSURANCE POLICY COVERAGE.

NOTWITHSTANDING THE PROVISIONS OF THE ABOVE TO THE CONTRARY, A PERSON
PURSUING A REMEDY UNDER THIS SECTION NEED NOT PROVE THAT SUCH ACT WAS
COMMITTED OR PERFORMED WITH SUCH FREQUENCY AS TO INDICATE A GENERAL
BUSINESS PRACTICE.
(2) ANY PARTY MAY BRING A CIVIL ACTION AGAINST AN UNAUTHORIZED INSURER IF SUCH
PARTY IS DAMAGED BY A VIOLATION OF S. 624.401 BY THE UNAUTHORIZED INSURER.
(3)(A) AS A CONDITION PRECEDENT TO BRINGING AN ACTION UNDER THIS SECTION, THE
DEPARTMENT AND THE AUTHORIZED INSURER MUST HAVE BEEN GIVEN 60 DAYS' WRITTEN
NOTICE OF THE VIOLATION. IF THE DEPARTMENT RETURNS A NOTICE FOR LACK OF
SPECIFICITY, THE 60-DAY TIME PERIOD SHALL NOT BEGIN UNTIL A PROPER NOTICE IS
FILED.
(B) THE NOTICE SHALL BE ON A FORM PROVIDED BY THE DEPARTMENT AND SHALL STATE
WITH SPECIFICITY THE FOLLOWING INFORMATION, AND SUCH OTHER INFORMATION AS THE
DEPARTMENT MAY REQUIRE:
1. THE STATUTORY PROVISION, INCLUDING THE SPECIFIC LANGUAGE OF THE STATUTE,
WHICH THE AUTHORIZED INSURER ALLEGEDLY VIOLATED.
2. THE FACTS AND CIRCUMSTANCES GIVING RISE TO THE VIOLATION.
3. THE NAME OF ANY INDIVIDUAL INVOLVED IN THE VIOLATION.
4. REFERENCE TO SPECIFIC POLICY LANGUAGE THAT IS RELEVANT TO THE VIOLATION, IF
ANY. IF THE PERSON BRINGING THE CIVIL ACTION IS A THIRD PARTY CLAIMANT, SHE OR HE
SHALL NOT BE REQUIRED TO REFERENCE THE SPECIFIC POLICY LANGUAGE IF THE
AUTHORIZED INSURER HAS NOT PROVIDED A COPY OF THE POLICY TO THE THIRD PARTY
CLAIMANT PURSUANT TO WRITTEN REQUEST.
5. A STATEMENT THAT THE NOTICE IS GIVEN IN ORDER TO PERFECT THE RIGHT TO PURSUE
THE CIVIL REMEDY AUTHORIZED BY THIS SECTION.
(C) WITHIN 20 DAYS OF RECEIPT OF THE NOTICE, THE DEPARTMENT MAY RETURN ANY
NOTICE THAT DOES NOT PROVIDE THE SPECIFIC INFORMATION REQUIRED BY THIS
SECTION, AND THE DEPARTMENT SHALL INDICATE THE SPECIFIC DEFICIENCIES CONTAINED
IN THE NOTICE. A DETERMINATION BY THE DEPARTMENT TO RETURN A NOTICE FOR LACK OF
SPECIFICITY SHALL BE EXEMPT FROM THE REQUIREMENTS OF CHAPTER 120.
(D) NO ACTION SHALL LIE IF, WITHIN 60 DAYS AFTER FILING NOTICE, THE DAMAGES ARE
PAID OR THE CIRCUMSTANCES GIVING RISE TO THE VIOLATION ARE CORRECTED.
(E) THE AUTHORIZED INSURER THAT IS THE RECIPIENT OF A NOTICE FILED PURSUANT TO
THIS SECTION SHALL REPORT TO THE DEPARTMENT ON THE DISPOSITION OF THE ALLEGED
VIOLATION.
(F) THE APPLICABLE STATUTE OF LIMITATIONS FOR AN ACTION UNDER THIS SECTION
SHALL BE TOLLED FOR A PERIOD OF 65 DAYS BY THE MAILING OF THE NOTICE REQUIRED BY
THIS SUBSECTION OR THE MAILING OF A SUBSEQUENT NOTICE REQUIRED BY THIS
SUBSECTION.
(4) UPON ADVERSE ADJUDICATION AT TRIAL OR UPON APPEAL, THE AUTHORIZED INSURER
SHALL BE LIABLE FOR DAMAGES, TOGETHER WITH COURT COSTS AND REASONABLE
ATTORNEY'S FEES INCURRED BY THE PLAINTIFF.
(5) NO PUNITIVE DAMAGES SHALL BE AWARDED UNDER THIS SECTION UNLESS THE ACTS
GIVING RISE TO THE VIOLATION OCCUR WITH SUCH FREQUENCY AS TO INDICATE A
GENERAL BUSINESS PRACTICE AND THESE ACTS ARE:
(A) WILLFUL, WANTON, AND MALICIOUS;
(B) IN RECKLESS DISREGARD FOR THE RIGHTS OF ANY INSURED; OR
(C) IN RECKLESS DISREGARD FOR THE RIGHTS OF A BENEFICIARY UNDER A LIFE
INSURANCE CONTRACT.

ANY PERSON WHO PURSUES A CLAIM UNDER THIS SUBSECTION SHALL POST IN ADVANCE
THE COSTS OF DISCOVERY. SUCH COSTS SHALL BE AWARDED TO THE AUTHORIZED
INSURER IF NO PUNITIVE DAMAGES ARE AWARDED TO THE PLAINTIFF.
(6) THIS SECTION SHALL NOT BE CONSTRUED TO AUTHORIZE A CLASS ACTION SUIT
AGAINST AN AUTHORIZED INSURER OR A CIVIL ACTION AGAINST THE COMMISSION, THE
OFFICE, OR THE DEPARTMENT OR ANY OF THEIR EMPLOYEES, OR TO CREATE A CAUSE OF
ACTION WHEN AN AUTHORIZED HEALTH INSURER REFUSES TO PAY A CLAIM FOR
REIMBURSEMENT ON THE GROUND THAT THE CHARGE FOR A SERVICE WAS UNREASONABLY
HIGH OR THAT THE SERVICE PROVIDED WAS NOT MEDICALLY NECESSARY.
(7) IN THE ABSENCE OF EXPRESSED LANGUAGE TO THE CONTRARY, THIS SECTION SHALL
NOT BE CONSTRUED TO AUTHORIZE A CIVIL ACTION OR CREATE A CAUSE OF ACTION
AGAINST AN AUTHORIZED INSURER OR ITS EMPLOYEES WHO, IN GOOD FAITH, RELEASE
INFORMATION ABOUT AN INSURED OR AN INSURANCE POLICY TO A LAW ENFORCEMENT
AGENCY IN FURTHERANCE OF AN INVESTIGATION OF A CRIMINAL OR FRAUDULENT ACT
RELATING TO A MOTOR VEHICLE THEFT OR A MOTOR VEHICLE INSURANCE CLAIM.
(8) THE CIVIL REMEDY SPECIFIED IN THIS SECTION DOES NOT PREEMPT ANY OTHER
REMEDY OR CAUSE OF ACTION PROVIDED FOR PURSUANT TO ANY OTHER STATUTE OR
PURSUANT TO THE COMMON LAW OF THIS STATE. ANY PERSON MAY OBTAIN A JUDGMENT
UNDER EITHER THE COMMON-LAW REMEDY OF BAD FAITH OR THIS STATUTORY REMEDY,
BUT SHALL NOT BE ENTITLED TO A JUDGMENT UNDER BOTH REMEDIES. THIS SECTION
SHALL NOT BE CONSTRUED TO CREATE A COMMON-LAW CAUSE OF ACTION. THE DAMAGES
RECOVERABLE PURSUANT TO THIS SECTION SHALL INCLUDE THOSE DAMAGES WHICH ARE A
REASONABLY FORESEEABLE RESULT OF A SPECIFIED VIOLATION OF THIS SECTION BY THE
AUTHORIZED INSURER AND MAY INCLUDE AN AWARD OR JUDGMENT IN AN AMOUNT THAT
EXCEEDS THE POLICY LIMITS.
(9) A SURETY ISSUING A PAYMENT OR PERFORMANCE BOND ON THE CONSTRUCTION OR
MAINTENANCE OF A BUILDING OR ROADWAY PROJECT IS NOT AN INSURER FOR PURPOSES
OF SUBSECTION (1).

SERVICE STANDARDS
The requirements of the Unfair Claims Settlement Practices place emphasis on the following items. It is
required that adjusters will follow these practices when handling Citizens claims.

Immediate Contact Rule
The immediate contact rule may be the most important principle of successful insurance claims handling. It
is also the embodiment of aggressive good faith. Immediate contact is essential to conduct a first-rate
investigation. The State of Florida places expectations upon insurance companies and adjusters that are
subject to change each year. These expectations such as those found within SB1486 place minimal
expectation on all insurers and adjusters. These requirements are not Citizens requirements which in all
cases expect contact prior to the absolute minimal dates established by the state. For instance, depending
upon the storm and adjuster resources, the state may require contact within 14 days of notice. Whereas,
Citizens expects the adjuster to attempt contact within 24 hours of assignment, additional attempts within
48 hours, and may request contact letters be sent within 10 days to avoid any breach of the state
requirements in place at the time.

Timely Communication
Keep the insured informed of the progress of their claim at each stage of the adjusting process. The law
requires adjusters to make timely and continual communication. To avoid a failure to acknowledge and act
reasonably promptly upon communications, you must communicate promptly whenever you receive
communications regarding a claim under consideration. Failing to affirm or deny coverage of claims within
a reasonable time relates directly to failure of communication. To avoid failing to provide a prompt and
reasonable explanationfor denial or forsettlement requires prompt and accurately recorded
communication.

Diligence

The requirements of the Unfair Claims Settlement Practices and the legal rules regarding good faith
conduct places great emphasis upon diligence. Websters Collegiate Dictionary refers to diligence as
preserving application; assiduity (steadily attentive); speed; haste; the attention and care legally expected
or required of a person. To be diligent requires a steady, earnest, and energetic application and effort.

Honesty
The standard of morality adopted and enforced by our courts places prime importance on the concept of
honesty in the handling of insurance claims. Any suggestion that dishonesty on the adjusters part was
involved in the handling of the claim could result in negative consequences for the adjuster and Citizens.

Fairness
An insurance policy is a contract. It is governed by the same rules of fairness which are an intrinsic part of
the legal principles that govern commercial transactions. Fairness is expected and constant reference is
made to the concept of fairness in the court cases relating bad faith conduct of insurers and their claims
handling personnel. Each claim should be handled based on its own merits.

Reasonableness

An examination of the Unfair Claims Settlement Practices shows the importance of reasonable conduct.
Failure to act reasonably, failing to adopt and implement reasonable standards, failing to conduct a
reasonable investigation and failing to affirm or deny coverage of claims within a reasonable time is
language contained in the NAIC Model Act. Continuingnot attempting in good faith to effectuate prompt,
fair and equitable settlements of claims in which liability has become reasonably clear, failing to promptly
settle claims where liability has become reasonably clear under one portion of the insurance policy
coverage, in order to influence settlements under other portions of the insurance policy coverage, and
failing to provide promptly a reasonable explanation or additional references to the word reasonable are
contained in the Model Act.

Reasonableness is mandatory if one is to practice aggressive good faith. The failure to act in a
reasonable manner is not aggressive good faith.

CODE OF ETHICS
4-220.201 ETHICAL REQUIREMENTS
(1) PURPOSE. THIS RULE SETS FORTH THE VARIOUS ETHICAL CONSIDERATIONS AND
CONSTRAINTS FOR VARIOUS CLASSES OF INSURANCE ADJUSTERS.
(2) DEFINITIONS. THE FOLLOWING DEFINITIONS SHALL APPLY FOR PURPOSES OF THIS
RULE.
(A) ADJUSTER, WHEN USED WITHOUT FURTHER SPECIFICATION, REFERS TO AND
INCLUDES ALL TYPES AND CLASSES OF INSURANCE ADJUSTERS, (COMPANY, INDEPENDENT,
AND PUBLIC), SUBJECT TO CHAPTER 626, FLORIDA STATUTES, AND REGARDLESS WHETHER
RESIDENT OR NONRESIDENT, AND WHETHER PERMANENT, TEMPORARY, OR EMERGENCY
LICENSEES.
(B) CLIENT REFERS TO AND INCLUDES BOTH CLIENTS AND POTENTIAL CLIENTS; AND
MEANS ANY PERSON WHO CONSULTS WITH OR HIRES AN ADJUSTER TO PROVIDE
ADJUSTING SERVICES.
(C) DEPARTMENT REFERS TO THE FLORIDA DEPARTMENT OF FINANCIAL SERVICES.
(D) PERSON INCLUDES NATURAL PERSONS AND LEGAL ENTITIES.
(3) VIOLATION. VIOLATION OF ANY PROVISION OF THIS RULE SHALL CONSTITUTE GROUNDS
FOR ADMINISTRATIVE ACTION AGAINST THE LICENSEE, UPON GROUNDS, THAT INCLUDE
BUT ARE NOT LIMITED TO, THAT THE VIOLATION DEMONSTRATES A LACK OF FITNESS TO
ENGAGE IN THE BUSINESS OF INSURANCE. ADDITIONALLY, A BREACH OF ANY PROVISION
OF THIS RULE CONSTITUTES AN UNFAIR CLAIMS SETTLEMENT PRACTICE.
(4) CODE OF ETHICS. THE WORK OF ADJUSTING INSURANCE CLAIMS ENGAGES THE PUBLIC
TRUST. AN ADJUSTER MUST PUT THE DUTY FOR FAIR AND HONEST TREATMENT OF THE
CLAIMANT ABOVE THE ADJUSTERS OWN INTERESTS, IN EVERY INSTANCE. THE FOLLOWING
ARE STANDARDS OF CONDUCT THAT DEFINE ETHICAL BEHAVIOR.
(A) AN ADJUSTER SHALL DISCLOSE ALL FINANCIAL INTEREST IN ANY DIRECT OR INDIRECT
ASPECT OF AN ADJUSTING TRANSACTION. FOR EXAMPLE: AN ADJUSTER SHALL NOT
DIRECTLY OR INDIRECTLY REFER OR STEER ANY CLAIMANT NEEDING REPAIRS OR OTHER
SERVICES IN CONNECTION WITH A LOSS TO ANY PERSON WITH WHOM THE ADJUSTER HAS
AN UNDISCLOSED FINANCIAL INTEREST, OR WHICH PERSON WILL OR IS REASONABLY
ANTICIPATED TO PROVIDE THE ADJUSTER ANY DIRECT OR INDIRECT COMPENSATION FOR
THE REFERRAL OR FOR ANY RESULTING BUSINESS.
B) AN ADJUSTER SHALL TREAT ALL CLAIMANTS EQUALLY. AN ADJUSTER SHALL NOT PROVIDE
FAVORED TREATMENT TO ANY CLAIMANT. AN ADJUSTER SHALL ADJUST ALL CLAIMS
STRICTLY IN ACCORDANCE WITH THE INSURANCE CONTRACT.
(C) AN ADJUSTER SHALL NEVER APPROACH INVESTIGATIONS, ADJUSTMENTS, AND
SETTLEMENTS IN A MANNER PREJUDICIAL TO THE INSURED.
(D) AN ADJUSTER SHALL MAKE TRUTHFUL AND UNBIASED REPORTS OF THE FACTS AFTER
MAKING A COMPLETE INVESTIGATION.
(E) AN ADJUSTER SHALL HANDLE EVERY ADJUSTMENT AND SETTLEMENT WITH HONESTY
AND INTEGRITY AND ALLOW A FAIR ADJUSTMENT OR SETTLEMENT TO ALL PARTIES
WITHOUT ANY REMUNERATION TO HIMSELF EXCEPT THAT TO WHICH HE IS LEGALLY
ENTITLED.
(F) AN ADJUSTER, UPON UNDERTAKING THE HANDLING OF A CLAIM, SHALL ACT WITH
DISPATCH AND DUE DILIGENCE IN ACHIEVING A PROPER DISPOSITION THEREOF.
(G) AN ADJUSTER SHALL PROMPTLY REPORT TO THE DEPARTMENT ANY CONDUCT BY ANY
LICENSED INSURANCE REPRESENTATIVE OF THIS STATE, WHICH CONDUCT VIOLATES ANY
INSURANCE LAW OR DEPARTMENT RULE OR ORDER.
(H) AN ADJUSTER SHALL EXERCISE EXTRAORDINARY CARE WHEN DEALING WITH ELDERLY
CLIENTS, TO ASSURE THAT THEY ARE NOT DISADVANTAGED IN THEIR CLAIMS
TRANSACTIONS BY FAILING MEMORY OR IMPAIRED COGNITIVE PROCESSES.
(I) AN ADJUSTER SHALL NOT NEGOTIATE OR EFFECT SETTLEMENT DIRECTLY OR INDIRECTLY
WITH ANY THIRD-PARTY CLAIMANT REPRESENTED BY AN ATTORNEY, IF SAID ADJUSTER HAS
KNOWLEDGE OF SUCH REPRESENTATION, EXCEPT WITH THE CONSENT OF THE ATTORNEY.
FOR PURPOSES OF THIS SUBSECTION, THE TERM THIRD-PARTY CLAIMANT DOES NOT
INCLUDE THE INSURED OR THE INSUREDS RESIDENT RELATIVES.
(J) AN ADJUSTER IS PERMITTED TO INTERVIEW ANY WITNESS, OR PROSPECTIVE WITNESS,
WITHOUT THE CONSENT OF OPPOSING COUNSEL OR PARTY. IN DOING SO, HOWEVER, THE
ADJUSTER SHALL SCRUPULOUSLY AVOID ANY SUGGESTION CALCULATED TO INDUCE A
WITNESS TO SUPPRESS OR DEVIATE FROM THE TRUTH, OR IN ANY DEGREE AFFECT THEIR
APPEARANCE OR TESTIMONY AT THE TRIAL OR ON THE WITNESS STAND. IF ANY WITNESS
MAKING OR GIVING A SIGNED OR RECORDED STATEMENT SO REQUESTS, THE WITNESS
SHALL BE GIVEN A COPY THEREOF.
(K) AN ADJUSTER SHALL NOT ADVISE A CLAIMANT TO REFRAIN FROM SEEKING LEGAL
ADVICE, NOR ADVISE AGAINST THE RETENTION OF COUNSEL TO PROTECT THE CLAIMANTS
INTEREST.
(L) AN ADJUSTER SHALL NOT ATTEMPT TO NEGOTIATE WITH OR OBTAIN ANY STATEMENT
FROM A CLAIMANT OR WITNESS AT A TIME THAT THE CLAIMANT OR WITNESS IS, OR WOULD
REASONABLY BE EXPECTED TO BE, IN SHOCK OR SERIOUS MENTAL OR EMOTIONAL
DISTRESS AS A RESULT OF PHYSICAL, MENTAL, OR EMOTIONAL TRAUMA ASSOCIATED WITH
A LOSS
FURTHER, THE ADJUSTER SHALL NOT CONCLUDE A SETTLEMENT WHEN SUCH SETTLEMENT
WOULD BE DISADVANTAGEOUS OR TO THE DETRIMENT OF A CLAIMANT WHO IS IN THE
TRAUMATIC OR DISTRESSED STATE DESCRIBED ABOVE.
(M) AN ADJUSTER SHALL NOT KNOWINGLY FAIL TO ADVISE A CLAIMANT OF THEIR CLAIM
RIGHTS IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THE CONTRACT AND OF
THE APPLICABLE LAWS OF THIS STATE. AN ADJUSTER SHALL EXERCISE CARE NOT TO
ENGAGE IN THE UNLICENSED PRACTICE OF LAW AS PRESCRIBED BY THE FLORIDA BAR.
(N) A COMPANY OR INDEPENDENT ADJUSTER SHALL NOT DRAFT, UNLESS APPROVED IN
WRITING IN ADVANCE BY THE INSURER AND SUCH WRITTEN COMMUNICATION CAN BE
DEMONSTRATED TO THE DEPARTMENT, SPECIAL RELEASES CALLED FOR BY THE UNUSUAL
CIRCUMSTANCES OF ANY SETTLEMENT OR OTHERWISE DRAFT ANY FORM OF RELEASE.
EXCEPT AS PROVIDED ABOVE, A COMPANY OR INDEPENDENT ADJUSTER IS ONLY PERMITTED
TO FILL IN THE BLANKS IN A RELEASE FORM APPROVED BY THE INSURER THEY REPRESENT.
(5) PUBLIC ADJUSTERS, OTHER ETHICAL CONSTRAINTS. IN ADDITION TO CONSIDERATIONS
SET OUT ABOVE FOR ADJUSTERS, THE FOLLOWING ETHICAL CONSIDERATIONS ARE
SPECIFIC TO PUBLIC ADJUSTERS.
(A) A PUBLIC ADJUSTER SHALL ADVISE THE INSURED AND CLAIMANT IN ADVANCE OF THEIR
RIGHT TO CHOICE OF COUNSEL TO REPRESENT THE INSURED OR CLAIMANT, AND THAT
SUCH CHOICE IS TO BE MADE SOLELY BY THE INSURED OR CLAIMANT.
(B) THE PUBLIC ADJUSTER SHALL NOTIFY THE INSURED OR CLAIMANT IN ADVANCE OF THE
NAME AND LOCATION OF ANY PROPOSED CONTRACTOR, ARCHITECT, ENGINEER, OR SIMILAR
PROFESSIONAL, BEFORE ANY BID OR PROPOSAL BY ANY OF THESE PERSONS MAY BE USED
BY THE PUBLIC ADJUSTER IN ESTIMATING THE LOSS OR NEGOTIATING SETTLEMENT, AND
THE INSURED OR CLAIMANT MAY EXERCISE VETO POWER OF ANY OF THESE PERSONS IN
WHICH CASE THAT PERSON SHALL NOT BE USED IN ESTIMATING COSTS.
(C) THE PUBLIC ADJUSTER SHALL ENSURE THAT IF A CONTRACTOR, ARCHITECT, ENGINEER,
OR OTHER LICENSED PROFESSIONAL IS USED IN FORMULATING ESTIMATES OR OTHERWISE
PARTICIPATES IN THE ADJUSTMENT OF THE CLAIM, THE PROFESSIONAL MUST BE LICENSED
BY THE FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION.
(D) A PUBLIC ADJUSTER SHALL NOT PREVENT, OR ATTEMPT TO DISSUADE OR PREVENT, A
CLAIMANT FROM SPEAKING PRIVATELY WITH THE INSURER, COMPANY OR INDEPENDENT
ADJUSTER, ATTORNEY, OR ANY OTHER PERSON, REGARDING THE SETTLEMENT OF THE
CLAIM.
(E) A PUBLIC ADJUSTER SHALL NOT ACQUIRE ANY INTEREST IN SALVAGED PROPERTY,
EXCEPT WITH THE WRITTEN CONSENT AND PERMISSION OF THE INSURED.
(F) A PUBLIC ADJUSTER SHALL NOT ACCEPT REFERRALS OF BUSINESS FROM ANY PERSON
WITH WHOM THE PUBLIC ADJUSTER MAY CONDUCT BUSINESS WHERE THERE IS ANY FORM
OR MANNER OF AGREEMENT TO COMPENSATE THE PERSON, WHETHER DIRECTLY OR
INDIRECTLY, FOR REFERRING BUSINESS TO THE PUBLIC ADJUSTER. EXCEPT AS BETWEEN
LICENSED PUBLIC ADJUSTERS, OR LICENSED PUBLIC ADJUSTERS AND MEMBERS OF THE
FLORIDA BAR, NO PUBLIC ADJUSTER MAY COMPENSATE ANY PERSON, WHETHER DIRECTLY
OR INDIRECTLY, FOR THE PRINCIPAL PURPOSE OF REFERRING BUSINESS TO THE PUBLIC
ADJUSTER.
CLAIMS HANDLING PROCEDURES

GUIDELINES FOR GOOD FAITH CLAIMS HANDLING

Have you thoroughly investigated all facts surrounding the issues presented to you by the
insured, the claimant, public adjuster, the agent or the attorney?
Have you informed the insured or the claimant of their rights and obligations under the
insurance policy?
Did you pay the claim in a timely fashion? Unreasonable delay is a prime area of bad faith
litigation. If your payment differs from what the insured claimed / expected, you must accompany the
payment with a clarification of any difference.
Never make a deceptive representation to anyone. If you feel uncomfortable about anything you
are representing, be honest and advise that individual that you will confer with your supervisor. Relay
the response as soon as possible.
You can not request that the insurance policy be canceled in order to deter other policyholders
with similar claims from presenting insurance claims against the insurance company. Leave
cancellation decisions to the underwriters. However, you may complete an Underwriting Referral, as
warranted.
You may not manipulate any records, reports or other papers to support a denial of coverage.
This is dishonesty and fraud.
Do not use a claimants financial situation to devalue the partys bargaining power. Do not take
advantage of someone who needs money badly by offering them less than they are entitled to recover.
You may not make oppressive demands on the insured or the claimant. For example, in a
burglary claim, do not require the insured to document everything the insured has ever owned. It is
common practice in the insurance industry to recognize that not everyone keeps receipts for every item
possessed or purchased. You must be reasonable in your demands regarding receipts and
documentation. Just remember, the jury foreman may not keep many receipts either, and he or she
will be judging the reasonableness of your demands on an insured or claimant.
You may not tell the insured or the claimant not to talk to an attorney, or not to retain legal
counsel.
You must answer letters of inquiry and return phone calls by insureds, claimants and attorneys.
This is not only a basic, common professional courtesy, but you are also required by statute to
answer these letters of inquiry and return telephone calls in a timely manner. As a practical
matter, when you return a phone call, you must provide complete documentation as to whom you
spoke, the month, day, year, time of day the call was returned, and what the essence of the
conversation was. This documentation is absolutely essential, since it may be subpoenaed in a court
action.
Documentation can serve as excellent evidence to show that you have handled a case with timely
and continual communication. The absence of such information can strongly prejudice your case.
When someone reviews your file, the file must be like an open book showing the history and
development of the claim. This history must continue until the claim has been paid or denied.
Always remember that your claim file is subject to subpoena and may be examined by a court
and jury. Your file must be exemplary and complete. If you have a detailed, complete log of all
of the communications you had with the insured or third party claimant, you convey the
impression of professionalism and fairness in a court of law.
You must affirm or deny coverage issues in a timely fashion and with specificity.
Once coverage for liability becomes reasonably clear, you are then required to communicate
your decision, with supporting evidence in the event of a denial, or pay the claim promptly.
If the insured or claimant has two or more separate elements of the overall claim, you may not
hold out on the payment of one portion of the overall claim to coerce settlement of the other
claim. You must pay each and every element of the claim as it becomes reasonably clear that
payment is due and owing, without withholding payment on one portion pending settlement on another
portion.
You may not compel the insured or claimant to institute litigation in order to recover any or all
of their benefits under the insurance policy if coverage is reasonably clear.
If you are requested by the insured to tell what payments have been made to a third party under
a policy of insurance, you must comply with this request and document all payments made
under the policy.
If you secure a settlement from the insured covering essentially the same information as on a
Proof of Loss form, then a formal Proof of Loss form may be redundant. Requiring a redundant
Proof of Loss could be interpreted as harassment, which could lead to an allegation of bad faith
claims practices.
Give a written explanation as to any denial of a claim or compromise of a claim based on the
coverage language in the policy.
Never mislead anyone as to the applicable Statute of Limitations for a claim. If you are not sure
about the Statute of Limitations as it applies to the insurance policy or any oral contract made, or
regarding the time limit on making a personal injury claim, you must consult with your supervisor. Get
the answer in writing.

QUALIFICATIONS AND RESPONSIBILITIES OF ROLES

The following are the recommended requirements for the various independent adjuster roles working for
Citizens Catastrophe Operations. Additionally listed are the responsibilities of the positions as described in
the 2007 IA Contract (Exhibit A Independent Adjuster Statement of Work).

Individual Adjusters and Supervisors:

Team Leader must be a senior level adjuster possessing the necessary skills and traits for
managing Personal/Commercial Lines moderate to extreme damage and/or supervisory personnel
possessing necessary managerial skills for managing a catastrophe claims administration unit.
Minimum catastrophe experience of 8 years. Team Leaders will maintain the following
responsibilities:

Reports to CITIZENS Property Team Lead Supervisor;
Supervise, manage team of suppliers and adjusters with a range in span of control
targeted at 1:10 to 1:20 as single point of contact;
Manage adjuster production;
Manage adjusters compliance to claims guide;
Monitor adjusters quality and customer service i.e. maintain standards for returning
voicemails and emails;
File audits technical & fee aspects;
Facilitate file turnover;
Attend CITIZENS meetings;
Communicate changes to adjusters;
Manage the adjusters appointment scheduling;
Manage adjuster complaints & inquiries including follow-up;

Field Adjuster must possess the necessary skills and traits for managing Personal/Commercial
Lines moderate damage. Minimum catastrophe experience of 5 years. Field adjusters must be
capable of handling the responsibilities detailed below:

Acknowledgement of Claim;
First Contact;
Inspection;
Estimates;
Settlement;
Various Reports;
Diary/I-Logs (CTS);
Invoicing;
Photos;

Diagram;
Supporting documents;
Proof of Loss (if required);
Denial Letter (if required);
Reservation of Rights (if required);
SIU Referral (if required);
Underwriting Referral (if required);
Reserve Changes.

Desktop Adjuster must possess the necessary skills and traits for managing
Personal/Commercial Lines minor to moderate damage. Minimum catastrophe experience of 1
year. Desktop Adjusters must be capable of handling the responsibilities detailed below:

Exemplary interoffice communications and telecommunications skills;
Must be proficient in estimating software;
Adherence to Claims Guide;
Handle residential losses, contents losses and ALE losses;
Handle supplements for their files and others;
Complete outbound call projects;
Available for scheduled hours, including possible shift work schedule;
Reports to team lead who reports to Citizens Fast Track Supervisor;
Generally, will work in Citizens office.

File Examiner - must be a senior level adjuster possessing the necessary skills and traits for
managing Personal/Commercial Lines moderate to extreme damage and/or supervisory personnel
possessing necessary managerial skills for managing a catastrophe claims administration unit.
Minimum catastrophe experience of 8 years. File Reviewers will maintain the following
responsibilities:

Resolve technical claims issues;
Identify file requirements issues;
Identify price guide issues;
Responsible for consistent coverage interpretations, team production, quality and
customer service;
Reports to Catastrophe Team Leader;
Will work in Citizens office.
Litigation/Mediation Specialist - must be a senior level adjuster possessing the necessary skills
and traits for managing Personal/Commercial Lines moderate to extreme damage and/or
supervisory personnel possessing necessary managerial skills for managing a catastrophe claims
administration unit. Minimum catastrophe experience of 8 years. Litigation/Mediation Specialists
will maintain the following responsibilities:

Coordinate and direct files that are in litigation, mediation, appraisal or civil remedy
phases;
Prepare files for review by claims committee, attorneys, arbitrators, or other interested
parties;
Utilize Team Leaders and Field Adjusters to secure file information and necessary task
work;
Communicate with several external 3
rd
parties who may require file information;
Settle claims, when appropriate;
Responsible for preparation and review of interrogatories;
Review depositions;
Schedule examinations under oath;
Must be highly skilled in coverage and claims law interpretation;
Request coverage opinions;
Assure compliance to necessary timelines;
Maintain litigation register;
Reports to Citizens Team Lead;
Will work in Citizens office.

Complaint Resolution Specialist - must possess the necessary skills and traits for managing
Personal/Commercial Lines minor to moderate damage. Minimum catastrophe experience of 1
year. Complaint Resolution Specialists must be capable of handling the responsibilities detailed
below:

Responsible for the effective resolution of inquiring complaints, agent inquiries or other
activity;
Liaison between inquiring party and CITIZENS;
Exemplary interoffice communications and telecommunications skills;
Communicate with Team Leaders as the primary source of information from adjusters;
Handle DFS complaints;
Communicate with DFS Specialists;
Code Complaints;
Resolve Complaints;
Must possess coverage knowledge and adjusting skills;
Be available for scheduled hours, including but not limited to, shift type work.

LICENSING

Adjusters / examiners and supervisors must obtain and be able to provide satisfactory proof of
proper licensing pursuant to the regulations of the Florida Department of Financial Services.
These regulations change from time to time and may be amended during a catastrophe. Under no
circumstance will licensing be waived. Adjusters, supervisors and their firms are responsible for
taking care of this very important requirement. The best source of licensing information is:

Florida Department of Financial Services
Division of Agents and Agency Services
200 East Gaines Street
Tallahassee, Florida 32399-0319
http://www.fldfs.com

Prior to being deployed, Independent Adjusting Firms are required to submit a roster of the
adjusters they have available for deployment within twenty-four hours. The roster must include
verification of current Florida licensing compliance for every adjuster offered for deployment by the
firm.

CAPABILITIES

Adjusters must be physically able to:
Lift up to 45 lbs.
Sit and stand for long periods of time
Be able to climb roofs
Must have dependable transportation
Must have a valid drivers license
Must be able to work in adverse conditions
Citizens employees must submit to random drug and background checks. Independent
Firms are required to complete background checks and drug screening per the terms
of the current IA contract.

PROFESSIONAL STANDARDS

Adjusters must adhere to the professional standards and ethics of the profession as defined in the
Fair Claims Act and this manual.

VENDOR INFORMATION

Vendor Agreements

Prior to adjusting any losses in the 2007 storm season, Independent Adjusting Firms are required
to execute a contract with Citizens according to the terms of the 2007 RFI from the current IA
Contract.

CATASTROPHE CLAIMS

INDEPENDENT ADJUSTER SERVICES AGREEMENT

Catastrophe Claims Services. SUPPLIER will perform the property
claims adjusting services (Services) as specified in the Statement
of Work in Exhibit A. SUPPLIER shall perform no Services until the
Agreement is duly executed by CITIZENS and by SUPPLIER.

Vendor Insurance Requirements

Required Insurance Coverage

IA FIRMS (SUPPLIER) WILL MAINTAIN AT ITS SOLE EXPENSE THE FOLLOWING
INSURANCE, PURCHASED FROM AN INSURER LICENSED TO TRANSACT BUSINESS IN THE
STATE OF FLORIDA:

(A) WORKERS COMPENSATION POLICY WHICH PROVIDES COVERAGE TO SUPPLIERS
EMPLOYEES, REGARDLESS OF THE STATE OF HIRE, IN AT LEAST THE MINIMUM
STATUTORY LIMITS REQUIRED BY THE STATE OF FLORIDA, AND EMPLOYERS LIABILITY
WITH LIMITS OF $1,000,000; (B) COMMERCIAL GENERAL LIABILITY WITH MINIMUM
LIMITS OF $1,000,000 PER OCCURRENCE (TO INCLUDE CONTRACTUAL LIABILITY ON A
BLANKET BASIS FOR LIABILITY ASSUMED HEREUNDER) AND $1,000,000 IN THE
AGGREGATE;
(C) AUTOMOBILE LIABILITY WITH COMBINED SINGLE LIMITS OF NOT LESS THAN
$1,000,000 PER ACCIDENT;
(D) EXCESS LIABILITY INSURANCE WITH MINIMUM LIMITS OF $4,000,000 IN THE
AGGREGATE; AND
(E) PROFESSIONAL LIABILITY (ERRORS & OMISSIONS) WITH MINIMUM LIMITS OF
$1,000,000 PER OCCURRENCE AND $5,000,000 IN THE AGGREGATE. A CERTIFICATE OF
INSURANCE SATISFACTORY TO CITIZENS AND EVIDENCING THE ABOVE COVERAGE MUST
BE PRESENTED TO CITIZENS PRIOR TO COMMENCEMENT OF THE SERVICES. SUPPLIER
FURTHER AGREES THAT IT WILL MAINTAIN INSURANCE TO COVER ANY INDEMNITY
OBLIGATION THAT IT HAS ASSUMED UNDER THIS AGREEMENT. ALL POLICIES OF
INSURANCE REFERENCED HEREIN WILL BE PRIMARY AND WILL INCLUDE CITIZENS AS AN
ADDITIONAL INSURED WITH the exception of Workers Compensation.
Required Insurance Coverage, contd
SUPPLIER SHALL PROVIDE COPIES OF ITS POLICIES UPON REQUEST BY CITIZENS. ALL
POLICIES WILL INCLUDE PROVISIONS THAT THE INSURERS WAIVE THE RIGHTS OF
RECOVERY OR SUBROGATION AGAINST CITIZENS. CITIZENS SHALL BE EXEMPT FROM,
AND IN NO WAY LIABLE FOR, ANY SUM OF MONEY WHICH MAY REPRESENT A
DEDUCTIBLE IN ANY OF THE AFOREMENTIONED INSURANCE POLICIES. THE PAYMENT OF
SUCH DEDUCTIBLE SHALL BE THE SOLE RESPONSIBILITY OF THE SUPPLIER.

INDEMNIFICATION AND HOLD HARMLESS

Contained within all executed 2007 IA and QA contracts were the following provisions:

9.1 CITIZENS INDEMNITY. SUPPLIER SHALL AND DOES HEREBY AGREE TO INDEMNIFY,
DEFEND AND HOLD CITIZENS AND ITS BOARD OF GOVERNORS, OFFICERS,
ATTORNEYS, EMPLOYEES, AGENTS OR OTHER REPRESENTATIVES, WHOLLY HARMLESS
FROM ANY AND ALL CLAIMS, DAMAGES, CAUSES OF ACTION, LOSSES, COSTS AND
EXPENSES WHATSOEVER, (INCLUDING, WITHOUT LIMITATION, FINES DAMAGES,
LIABILITIES, LIENS, LOSSES, COSTS AND EXPENSES, INCLUDING ATTORNEY FEES AND
LITIGATION EXPENSES, WHETHER INCURRED IN ANTICIPATION OF TRIAL, AT TRIAL,
OR ON APPEAL) INCURRED BY, OR CLAIMED AGAINST CITIZENS, OR ITS BOARD OF
GOVERNORS (THE INDEMNIFIED CLAIMS), OFFICERS, ATTORNEYS, EMPLOYEES,
AGENTS OR OTHER REPRESENTATIVES, ARISING OUT OF, RESULTING FROM OR
RELATED TO SUPPLIERS PROVISION OF SERVICES PURSUANT TO THIS AGREEMENT,
OR BY REASON OF ANY NEGLIGENT, OR WILLFUL ACT OR OMISSION BY SUPPLIER.
9.2 DEFENSE OF INDEMNIFIED ACTION. IF CITIZENS OR ANY MEMBER OF ITS BOARD OF
GOVERNORS, OFFICERS, ATTORNEYS, EMPLOYEES, AGENTS OR OTHER
REPRESENTATIVES, IS NAMED AS A DEFENDANT IN ANY LEGAL ACTION OR
PROCEEDING (AN INDEMNIFIED CLAIM) IN WHICH A CLAIM
9.3 IS INDEMNIFIED HEREUNDER, SUPPLIER WILL ASSUME, AT ITS OWN EXPENSE, THE
DEFENSE OF SUCH ACTION ON BEHALF OF CITIZENS, ITS BOARD OF GOVERNORS,
OFFICERS, ATTORNEYS, EMPLOYEES, AGENTS AND OTHER REPRESENTATIVES.
CITIZENS SHALL HAVE THE SOLE AND EXCLUSIVE AUTHORITY TO RETAIN COUNSEL
AND DIRECT THE LITIGATION WITH ALL COSTS OF SUCH DEFENSE TO BE
RESPONSIBILITY OF THE SUPPLIER

ADJUST YOUR OWN (AYO) COMPANIES

What is the AYO program?
Adjust Your Own (AYO) is a program for Citizens Member Companies where a match exists between that
companys policies, and the Citizens policy. Citizens contracts with the Member Company to process and
handle to conclusion the windstorm claims for their policyholders. Thus, the homeowner and/or flood
insurance carrier handles the insureds Citizens claim.

When a catastrophe strikes, the AYO Program expands the resources of Citizens to meet its policyholders
claim needs. The AYO Program transfers a certain degree of claims-handling responsibilities of Citizens
claims to the participating Member Companies. This allows for more efficient use of Citizens resources on
the claims it retains.

The fundamental differences for adjusters in the handling of AYO claims are relative to assignments and
reporting issues. When a wind-only claim is reported to Citizens and falls within parameters causing it to
be identified as an AYO claim, Citizens may assign the claim to the appropriate AYO Company rather than
directly to an Adjuster. At that point, the claim is the responsibility of the AYO Company and all issues
relative to that claim must be directed to and handled by the AYO Company. The AYO Company may use
staff adjusters or independent adjusters. By the terms of the 2007 AYO agreements the adjusters for an
AYO may by staff or independent adjusters; however, the management of the claims must be done by staff
personnel. If independent adjusters are used, the AYO Company makes those assignments and contracts
with the firms. The independent adjuster will report to the AYO Company rather than to Citizens, although
Citizens standards and procedures as described in this Guide are still to be recognized and followed.

AYO Duties and Responsibilities
The following are the duties and responsibilities of the AYO companies as per the 2007 AYO agreement:
The (AYO) Company agrees to process, handle and adjust all Citizens claims assigned pursuant to this
agreement (the 2007 AYO contract) on properties that are covered both by a Citizens policy and a policy
issued by the Company; provided, however, that Citizens claims on properties covered by Condominium or
Townhouse Unit-Owner or Association Policies, including, without limitation, loss assessment claims (the
Condo Claims), shall be excluded from this Agreement and shall not be assigned to the Company.
Citizens shall at all times retain ownership of all Citizens claims, and all Citizens claim files, including
retaining the right to re-assign such claim for any reason without prior notice. If a claim is re-assigned,
Citizens shall notify the Company immediately and the Company shall immediately furnish all
documentation and materials relating to that claim to Citizens.

AYO Duties and Responsibilities, contd

I. Process and adjust all assigned Citizens Claims and perform its obligations in compliance with
the Citizens Catastrophe Claims Guide, in conformance with generally accepted standards in the
claims adjustment business and provide the same level of service provided by the Member
Company in the voluntary market and not in violation of any statute governing unfair claim-
handling practices, exercising at all times ordinary care and diligence in the performance of such
duties;
II. For every assigned Citizens claim the Member Company shall utilize Citizens proprietary Claims
Tracking System (CTS) to timely input all claims information and material including all
documentation, photographs, log notes and any other material relevant to the claim. The
Member Company shall utilize CTS in accordance with any Citizens directives or training
material.
III. Transmit to Citizens, promptly after a loss occurrence, copies of all loss notices not reported to
Citizens directly (which shall contain such information as Citizens shall require) and, when the
Citizens Claim has been fully adjusted, furnish a closing report and back-up documentation;
Ensure that all claims adjusted on behalf of Citizens are managed and subject to be reviewed by
Member Company employed licensed claims professionals;
IV. Assign all assigned Citizens claims to qualified independent adjusting firms or qualified adjusting
staff in accordance with the Member Companys established standards;
V. Forward any appraisal, mediation, civil remedy or legal notice to Citizens within 3 business days
of receipt. The Member Company shall indemnify Citizens for any damages, or costs incurred as
a result of the Member Companys failure to timely forward such notice;
VI. Notify Citizens within five days of assignment of any claims that might have been assigned to the
Member Company in error. The Member Company shall indemnify Citizens for any
damages, claim, lawsuit or costs rising from the delay that occurred as a result of the
Member Companys failure to notify Citizens in a timely fashion;
VII. Return any claim to Citizens upon request. All records related to a claim recalled by Citizens
must be immediately forwarded to Citizens;
VIII. Return any claim, and any relevant records, to Citizens upon receipt of a notice of intent to
mediate, appraise or arbitrate; or upon receipt of any legal, civil remedy notice or lawsuit.
Furthermore, if either the Member Company or Citizens feels that a claim could be the subject of
fraud; such claim will be immediately returned to Citizens.
IX. Train all employees, adjusters, independent adjusters and any other person or entity who adjusts
claims (for the AYO and handling Citizens claims). This training should at a minimum ensure
that all personnel are trained on Citizens policy coverage, fully and effectively utilize CTS and
are able to adjust all claims pursuant to Citizens Catastrophe Claims Guidelines.
X. Timely provide Citizens with any NFIP claim files or Member Company claim files that include
claims information that is relevant to the adjustment of the Citizens claim. Citizens hereby agree
to use this information solely for the purpose of handling the Citizens claim.


ASSIGNMENT

Claim assignments can only be made by authorized Citizens designees.
The only exception to this is claims routed for AYO handling. In those cases, the AYO
company is responsible for all aspects of the claim handling, including adjuster assignment.
Neither agents nor policyholders nor any other entity, including claims personnel who have not
been so designated have any authority to assign or reassign claims to specific adjusters.
It is imperative that no firm (or adjuster) assume that it will automatically receive a claim
because it has a related HO or the Flood claim.
Attempts are made to match claims together so Insureds have as few adjusters as possible.
This may be due to multiple policies, multiple locations, commercial companion claims and
prior storm losses. However, this is not always possible and it can not be assumed that one
will receive any claim until the claim is actually assigned.
If an adjuster or firm chooses to ignore this provision and proceeds to inspect a claim that has
been assigned to another adjuster, the adjuster may not receive any compensation for any
time spent on the inspection or for any other time invested in the claim.
The only valid Citizens assignment will be identified via CTS. The assigned Adjuster will be
specifically named.
Any claims handled outside of these guidelines will not be eligible for adjuster fees incurred.

AUTHORITY
The field adjuster does not have authority to approve or disapprove claims. The File Examiner
does not have authorization to commit to any coverage above his/her authority limit.

On those claims where covered damages do not reach the deductible, the insured must be
advised and provided a copy of the adjusters estimate depicting covered damages and
application of deductible.
On those claims where the adjuster must apply a coverage condition (i.e. depreciation), and/or
exclusions (i.e., awnings, outdoor equipment) the insured must be advised of these coverage
limitations. The adjusters estimate, a copy of which is to be provided to the insured, must
reflect repairs to covered damages only.
The adjuster must advise the insured that he/she is submitting a report to the Citizens File
Examiner for final consideration.
Because a field adjuster does not have any authority, he/she is not to give a copy of the
estimate to the Insured prior to it being approved by an examiner.
In the interest of customer service, the field adjuster may review the scope of repairs prior to
submitting the claim for payment; however, it must be made clear that the claim has not been
approved and items may have been scoped that may eventually be removed from the final
settlement if it is found they are not covered under the insurance contract.

LOSS REPORTING AND INQUIRY

Citizens has established a 24-hour call center for claim reporting (866-411-2742).

J OB WORK FL OWS


FIRST NOTICE OF LOSS (FNOL)
WORKFLOW


DISPATCH
WORKFLOW


FAST TRACK/SUPPLEMENT
WORKFLOW

FILE REVIEW
WORKFLOW

COMMERCIAL/PMSC
WORKFLOW


COMMERCIAL SUPPLEMENTS
WORKFLOW

ADJ UST YOUR OWN A.Y.O.
WORKFLOW

MULTI-CAUSATION
WORKFLOW


LOSS ASSESSMENT
WORKFLOW

INCOMING MAIL
WORKFLOW

MEDIATION
WORKFLOW

APPRAISAL
WORKFLOW

MOBILE HOME EXAMINATION
WORKFLOW


C L A I M S H A N D L I N G P R O C E D U R E S

This section outlines the basic standards and procedures for the adjustment of Citizens claims. As such,
this section is applicable to adjusters, AYOs and Citizens claims staff. The adjusters primary responsibility
is that of customer service, performance and documentation based upon these guidelines. The Citizens
Claims staff and AYO management responsibility includes, but is not limited to, verifying the proper
implementation of these standards and procedures. In addition, House Bill 7077 states, in part:

SECTION 17. SUBSECTION (5) OF SECTION 627.70131, FLORIDA
STATUTES, AS AMENDED BY CHAPTER 2007-1, LAWS OF FLORIDA, IS
AMENDED TO READ:

627.70131 INSURER'S DUTY TO ACKNOWLEDGE COMMUNICATIONS
REGARDING CLAIMS; INVESTIGATION.--

(5) WITHIN 90 DAYS AFTER AN INSURER RECEIVES NOTICE OF
LOSS OF A RESIDENTIAL PROPERTY INSURANCE CLAIM FROM A
POLICYHOLDER, THE INSURER SHALL PAY OR DENY SUCH CLAIM UNLESS
THE FAILURE TO PAY SUCH CLAIM IS CAUSED BY FACTORS BEYOND THE
CONTROL OF THE INSURER WHICH REASONABLY PREVENT SUCH PAYMENT.
THE EXCLUSIVE REMEDY FOR A VIOLATION OF THIS SUBSECTION IS A
REGULATORY ACTION UNDER THIS CODE.

Citizens strictly adheres to this statutory language, which states that all claims will be closed within
90 days after the claim was reported. Citizens continuously monitors all claims to ensure that this
requirement is met. It is imperative that the claim handler recognize this time limitation on each and
every claim.

COVERAGE

This section is designed for easy reference by claim professionals involved in coverage analysis and
decisions. Its purpose is to clarify the steps which must be taken to review coverage in a particular claim.

Coverage must be evaluated in every file in light of the particular facts or allegations of the claim.

CUSTOMER SERVICE

Policyholders - First Contact:
The adjuster must contact the policyholder or his/her representative as soon as reasonable and
prudent based upon the event. It is Citizens goal is to contact the policyholder within 24 hours of
receipt of an assignment. Due to the nature of catastrophe claims handling, specific expectations
will be discussed during orientations; however, it is still expected that attempts at contact should
begin within 24 hours of assignment. There must be a minimum of two (2) attempts to contact the
policyholder at the numbers provided. If unsuccessful, the assigned agent may be able to assist
the adjuster with updated contact information. Each contact or contact attempt must be noted in
the claims file.
Because CTS records attempts at contacts and these attempts, both successful and unsuccessful,
are one of the items that adjusters and firms are rated on. It is imperative that adjusters and Team
Leads verify that all contact activity be documented in CTS.

CTS records successful contacts only when the proper activity is selected. The reports that are run
based upon these criteria in CTS are reported to DFS to show compliance with contact
requirements. This is one reason why proper documentation of the contact is absolutely
imperative. User must choose the activity of contact not a just a description of contact or the claim,
the adjuster and the firm may be reported to the DFS as not being in compliance.
After 10 days of failed contact, a contact letter should be mailed on file, "cc"-ing the agent. A copy
of the letter (and all correspondence) must be scanned in the claims file. The letter must inform the
policyholder of all available adjuster contact information (office, cell, fax, after-hours voicemail). An
example contact letter is included in this document.
If the Insured is not contacted within fifteen (15) days of the contact letter, a second contact letter
may be sent.
It should be noted that claims should not be closed without contact until all resources are used in
attempting to reach the Insured. It is possible that a phone number may not be accurate, but an
Agent or neighbor may have a current number. A review of prior losses will often turn up valid
contact information. Generally the claim was turned in for some reason; to assume an error should
be the very last option.
Most residential losses are now subject to annual hurricane deductibles. Some Insureds may feel
that they overestimated their damage and do not wish to pursue a loss. In those cases, it should
be explained that it is to their benefit to allow an inspection to document the damages even if the
loss may be under the deductible.
Ongoing Policyholder Communication

The Claims staff must promptly communicate with the policyholder in order to be in compliance
with the Unfair Claims Settlement Practices Act and to remain in good standing with Citizens.
The insured must be provided with the adjusters office and voice mail numbers as common
practice.
Phone messages or other inquiries from the policyholder or their representative must be returned
within twenty four (24) hours.
Voicemail must be cleared out at least once per day and if possible multiple times per day. After
listening to messages adjusters should delete the message to avoid overload of the voicemail
system.
Any discussion with a policyholder should conclude with a clear statement of the responsibilities of
the policyholder and the adjuster, with specific timelines for each item.

Documentation
First Contact:

The electronic file must document the dates and times of all contacts and attempts to contact
claimants, policyholders or their representatives. This information must be reported via CTS.
This activity and all activity must be documented at the time of the activity. This means an
Adjuster or Examiner may not save up I-Logs and enter them at a later date. While a Field
Adjuster may wait until he/she returns to enter logs in the evening, all logs must be entered on the
same day as the activity. Anyone in a claim office is expected to enter a log at the time of the
activity.

Other File Activity:

All claim activity will be reported via CTS. Please refer to the reporting requirements section of
your orientation manual for required actions tracked by CTS.
Any person that touches a claim file, whether an adjuster, call center representative, examiner,
DFS representative, specialist, resolutions, or anyone else MUST record their actions in the claim
file via CTS.
INVESTIGATIONS

This section of the guide is not intended to give detailed instructions on how to conduct every investigation.
However, there are several key areas that are common to all investigations which include, but are not
necessarily limited to, the following:

Facts surrounding the loss
Insurable interest
Specific coverage provided
Insureds involvement, if any
Cause and origin
Subrogation rights
Salvage potential
The investigation will naturally vary based on the type of loss. If the adjuster has questions regarding the
scope of an investigation, he/she must review the claim with his/her supervisor for direction. All losses
must address cause and origin of loss and establish the insurable interest of the property.

The claim file must include proper documentation to support the conclusions of the
investigation.


PROPERTY CLAIMS
The following list is intended to help determine which items are normally considered part of the building and
which are normally considered contents.

BUI LDI NG I TEMS

CONTENT I TEMS

Central Air Conditioners Window Air Conditioner Units
Carpets (permanently installed)
Rugs and Carpets (not permanently
installed)
Built-in Dishwashers Portable Dishwashers
Built-in Microwave Units
Portable Microwave Units, Cookout
Grills, and similar items
Built-In Ranges and Stoves Food Freezers (unless built-in)
Cabinets
Outdoor equipment/furniture stored
inside the dwelling or other fully
enclosed building at the residence
premises.
Furnaces and Radiators Refrigerators (unless built-in).
Wall Mirror (permanently installed) Clothes Washers and Dryers
Fire Sprinkler System
Pumps and related machinery
Venetian Blinds
Garbage Disposal Units
Hot Water Heaters (including solar)
Plumbing Fixtures
Permanently Installed Bookcases, etc.
Elevator Equipment
Lighting Fixtures

ESTIMATES (Building)
The adjuster will prepare computer-generated estimates on all covered losses. Xactimate has been
selected as the estimatics platform for 2007. If an exception is needed to allow adjustment based upon
use of a previously used platform, approval from Citizens management must be received. It is not Citizens
practice to accept contactor or PA estimates as the means to determine settlement value as the adjuster
has a responsibility to determine the cost of repairs. If the adjuster writes an estimate and finds the
estimate submitted by the contractor or PA is in line for the same scope of repairs, settlement may be made
based upon the submitted estimate. However, the comparison estimate must be included in the file to
document the basis for the settlement and acceptance.

The building estimate must reflect the type of building, type of construction, dimensions, total square
footage, replacement cost, and actual cash value of the item (when applicable). If a policy is written on a
replacement cost basis, with replacement cost being paid up front, Actual Cash Value need not be
calculated. Roof inspections are required on all roof claims. Diagrams are required on all inspected roofs
(including estimated pitch), and measurements are required if the roof shows any damage. From the
ground inspections are prohibited if you cannot safely inspect the roof, you must get appropriate
assistance from roofing professional. Adjusters are required to be present when the roof is inspected. In
those exceptions when approval is given for a ladder charge to assist the adjuster in getting on the roof the
adjuster is expected to complete the entire inspection. If the roof is too steep and high and authorization is
given to have company complete the roof measurement and inspection the roof estimate and all other
aspects of the claim are still to be completed by the Claim Representative. Approval for roof assistance
charges must be documented in CTS before being incurred.

Because wind is unlike hail and often can be viewed without the use of a rope and harness, consideration
may first be given to alternative methods of viewing the possible damage before asking for someone else to
climb the roof. However, at all times, safety comes first and no claim representative should ever attempt to
climb anything that he/she does not feel safe in doing.

The estimate must be itemized and reflect local price guidelines. Any deviation from the approved price list
(the most recent, local, Xactimate pricelist) requires a detailed explanation and prior approval from Citizens.
If an item is not found in the price guide, a local price may be used if documented. For items that either
appear to be priced incorrectly, have localized price anomalies or have grade differences, the Adjuster is
encouraged to use time and material estimating for the item and document how the price was created.
Such methods may be needed for unusual or commercial items and while working in areas with difficult
access.

The format must be in a room-by-room, line-by-line, unit-cost estimate with no lump-sum depreciation
shown. Depreciation must be item-by-item and line-by-line, when depreciation applies to the loss.
Room/interior diagrams are expected when there is damage to multiple rooms. Diagrams are expected
when they can add to the understanding of the file or the scope of the repairs.

Additions to the estimate for labor, base service charges, debris removal and other items may be
considered when appropriate. It is mandatory that every claim handler factor out base service charges
from the Parameters section in Xactimate. When any prices or items are deviated from the standard item
in the pricing program, it is expected that the Claim Representative will include a pricing or line note in the
estimate to explain the reason for the change. Such notes help to explain changes not only to file
examiners but also to Insureds and contractors.


ESTIMATES (Contents)

The Contents estimate (inventory) must be itemized, reflecting a description of items along with the age,
verified Replacement Cost Value, and Actual Cash Value of the items. Age, make, model and serial
numbers must be provided on all major appliances. Lump-sum depreciation is not accepted. Depreciation
must be on an item-by-item basis. The insured may prepare the contents list, but the adjuster must ensure
the Citizens inventory form (see Forms section) is utilized. Further, the adjuster must verify prices and
discuss depreciation with the insured. It is not Citizens practice to accept the insureds / PAs prices as the
only means to determine settlement value. All salvageable items must be noted, and any buy-back clearly
documented.

Depreciation must be documented when applied. If the policy does not allow for the application of
depreciation, the Claim Representative need not verify and review the Actual Cash Value of items. Serial
numbers are needed on major appliances but not on small electronics. If there is a question about
previously paid items the serial numbers can be verified both against Citizens claims and NFIP claims. The
adjuster must verify not only the item, the damage but the actual cost of the replacement of the items even
before the replacement takes place. Such documentation should become part of the claim file.
Documentation of replacement costs should be added to the claim file when appropriate.

NOTE: The selection of a general contractor or any other contractor is the responsibility of the
insured. The adjuster must not select or employ a contractor or expert on behalf of the insured, nor may
an adjuster recommend or coerce any insured to utilize the services of a particular contractor.

CITIZENS DOES NOT MAINTAIN A RECOMMENED LIST OF REPAIR
FIRMS. THERE ARE NO CITIZENS CONTRACTORS, NOR ANY
CITIZENS AUTHORIZED CONTRACTORS.

DEPRECIATION

Depreciation on any item must be based on the age and condition of the item. The adjusters experienced
judgment must be employed when determining depreciation.

Documentation must include, at minimum, the age of the item of the item being depreciated. If the adjuster
determines that no depreciation will be applied to an item to which depreciation would normally be applied,
a written explanation must be provided, either in the narrative or in the estimate itself. Likewise, if the
adjuster determines that depreciation should be applied to an item to which depreciation normally would not
apply, an explanation must be provided.

No depreciation should be applied to repair items or partial replacements such as spot repairs on a roof
and minimum charges for painting.

The estimate must differentiate between recoverable and non-recoverable depreciation (reference the
appropriate policy form to determine items that are subject to non-recoverable depreciation).

Normal depreciation will not exceed 80%.

Any depreciation deductions must be explained to the insured. At orientation depreciation will be
discussed to review which policies or items may be subject to depreciation. Generally, most
residential policies are no longer subject to recoverable depreciation. This does not affect those
items that were subject to non-recoverable depreciation.

The file may be closed pending receipt of documentation which would support a supplemental
payment for the withheld depreciation.

SALES TAX

The adjuster must include sales tax in the adjustment of all losses. Sales tax should be shown on the
estimate (for materials only not labor) and if area taxes are higher than the standard state tax, the correct
amount should be indicated based upon the property location. Sales tax should be included on all content
items.

TEMPORARY REPAIRS

The adjuster will determine what, if any, temporary repairs have been made or are necessary to protect the
property from further damage. The reasonable costs of temporary repairs that mitigate damage are a
proper item of the claim. The adjuster must secure all invoices documenting temporary repairs and attach
them with the narrative portion of the report.

Generally temporary repairs would not be subject to overhead and profit regardless of the number of trades
involved in the eventual repairs. The actual cost of repairs is known and payment should be based upon
the reasonable invoice and should not be adjusted upwards.

SAFETY

Citizens encourages adjusters to practice utmost safety when inspecting claims. When a roof is too high,
too steep or otherwise unsafe to inspect physically, the adjuster must consult with his/her Supervisor
regarding alternative arrangements for safe access and for approval of any additional expense.

PHOTOGRAPHS

Sufficient photographic documentation with narrative related to the damage must be submitted for every
inspected claim file. Color photographs are required. Digital photographs are required and must be of
sufficient clarity and quality to clearly identify the damage or lack thereof to the item. Photographs
should never include images of the insured or family members.

All photographs submitted must:
Be labeled with the date taken and the risk.
Be labeled with the location on or within the risk.
Be labeled with a description of the item being photographed.
No more than two (2) photographs may be printed/mounted on a single page.
Each interior photograph must be mounted and labeled according to:
* The date taken.
* The room represented with the corresponding damage noted (east bedroom, directly
below east gable damage).
* The floor on which the room is located if the risk is a multilevel structure.

Each claim file must include one photograph showing the front and one at least one side of the risk
(unless the risk is a condominium unit). One photograph of waterfront property must be taken
depicting the proximity of the risk to the water.
Roof photographs taken from the roof are required on all claims where there is wind damage or
alleged wind damage to the structure.
The interior photographs must include an overall photograph of the damaged room so as to show
the rooms layout and contents. This photograph must be of sufficient clarity and quality for
demonstrating what is as well as what is not damaged. Additional photographs must include close-
up views of specific damage.

A sample photo sheet follows. This exact sheet need not be used as most adjusters now use programs
that allow for download of digital photos and quick labeling. The photos need only have the appropriate
labels and be easy to access, view and clearly demonstrate all that they need to show.

CLAIM PHOTOGRAPH Claim No. ________________
RECORD Insured __________________

PHOTO #________ TAKEN __________
DATE

Description ________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________

PHOTO #________ TAKEN __________
DATE

ATTACH HERE

Description ________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________

COMMENTS:
________________________________________
____________________________________________________

ATTACH HERE
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
SUBMITTED BY: _______________________________________________________________
NAME___________________________________________________DATE________________________________

OVERHEAD AND PROFIT ALLOWANCE

A maximum amount of twenty percent (20%) overhead and profit [ten percent (10%) overhead and ten
percent (10%) profit] for the building estimate is available to the policyholder for the use of a general
contractor employed to oversee the repair of the policyholders insured property.
Overhead and Profit should not be added to any content items or items that have been separately
completed and will not be completed by the general contractor.
Overhead and Profit is part of the cost of repairs when estimated and included. When it is determined
that Overhead and Profit should be paid, it is to be paid when the claim is initially paid.
Payment for Overhead and Profit should not be withheld pending verification of incurred costs.
Emergency, temporary repairs and the policyholders own labor must not be included in the Overhead
and Profit figures.
Overhead and Profit must be separately noted on the estimate.
In most cases a General Contractor will be required on all Commercial Claims and Overhead and Profit
may be considered regardless of the number of trades involved.

DEDUCTIBLES

The applicable deductible must be taken from the gross covered loss amount, not the limit of liability.
However, in cases where the gross covered loss amount exceeds a limit of liability, the amount in
excess of the limit of liability would be subtracted from the deductible. This results in the deductible
being absorbed, or partially absorbed.
The application of the hurricane deductible can be a complex computation. Most residential policies
are now subject to an annual hurricane deductible. In cases where the annual hurricane deductible
has been satisfied, there is still a deductible. Depending upon the policy the remaining deductible may
be the All Other Peril deductible or the Other Windstorm deductible. In all cases the deductible will
never be less than $500. In some cases, the other peril deductible is the same as the hurricane
deductible meaning that the annual hurricane deductible has no net effect on the policyholder. Due to
the complexity of these issues, they are addressed in detail during orientation and a document has
been prepared (Hurricane Deductible Application) specifically to address the various issues involved.
The Hurricane Deductible will apply:

Beginning at the time a hurricane watch or hurricane warning is issued for any part of Florida by
the National Hurricane Center of the National Weather Service;
Continuing for the time period during which the hurricane conditions exist anywhere in Florida; and
Ending seventy two (72) hours following the termination of the last hurricane watch or hurricane
warning issued for any part of Florida by the National Hurricane Center of the National Weather
Service.
A hurricane deductible will apply when wind damage occurs during these timeframes even if no
hurricane strength winds are ever recorded in the area of county of the risk.

VALUE DETERMINATION

Most Citizens policies are subject to co-insurance provisions. At this time, it is anticipated that Insure to
Values may be requested for the purpose of application of co-insurance penalties. If co-insurance
penalties are to be applied, this information will be disseminated and the best methods of determining I.T.V.
will be discussed.

RESERVES

The reserves must be maintained at a proper level over the life of the file. Reserves are initially set based
upon the severity of the reported damage. The level of the reserves can be found in CTS and is also
printed on the Workorder. Reserves should be updated when it becomes apparent that the existing
reserves are inadequate. If the initial reserves are relatively close, no change may be needed. However, it
is expected that all losses should have reserves updated prior to completion.
In CTS, reserves may be updated from the Claim Detail screen located at the bottom of the screen labeled
Work on Claim. Its as easy as scrolling to the bottom of the screen and selecting the Reserve Change
link. If the reserve change being requested is a reduction in reserves or increased within your authority
limit, it will automatically update in the e-Wind system. Also, if the request is for an increase in reserves
beyond the authority of the requestor, then it will be recorded in CTS and routed to a reserve approver.
Finally, Coverage E and F DO NOT apply to Catastrophe Claims.
Reserves for all coverages (A,B,C,D) are combined. The data displayed to support your decision includes
the policy limits and the current reserve amount. You can only enter a total for the newly requested reserve
amount. On the Claims Details screen a message indicating The reserve has been updated will be
displayed below the link to Request the Reserve Change.
New View Reserve Notifications
The implementation of the update reserves function includes use of the new Notification section that has
been added to all CTS users desktops.
When you have entered a request for an increase in reserves that is above your authority level, you will be
informed if your request fails or is denied via the notifications feature available on your desktop screen. If
your request has been approved, the system is updated and no notification is given.
New Retract a Reserve Request
There may be occasions on which you wish to retract a reserve request change that you have already
entered in CTS. This can be accomplished by accessing the Reserve Update page. Once you have
retraced the request, a success message will be displayed on the Claim Details screen to indicate that
your retraction has been processed.

EXPERT SERVICES

The services of an expert may be required from time to time in order to determine the cause and origin of a
loss. If the adjuster determines that an expert is necessary, approval must be obtained from the Team
Leader, who in turn, will obtain approval as directed. Once approved, every effort must be made for the
adjuster to make arrangements to inspect the property with the hired expert.

The Expert Assignment Form (found in the Forms section of this Guide) must be used each time the Claims
Adjuster uses an expert. This form is designed to detail the exact nature of the request for services. Expert
Services must be considered when the cause of loss is undetermined at the time of inspection, when there
is potential for subrogation, suspected fraud, flood, or water damage claims with ensuing mold. A list of
approved experts is provided for your use in handling Citizens claims. Experts not appearing on the
approved list may NOT be retained on Citizens Claims. Recommendations must be submitted to
Citizens by the Claims Staff for consideration of additional firms as needed.

It is imperative that the use of these experts and their findings be documented in the electronic file.


EXPERT SERVICES LIST

APPRAISERS

Burton Claim Service, Inc.
Don Burton
2941 Cypress Creek Rd., Suite 101
FT. Lauderdale, FL. 33309
Broward: 954-972-4820
Dade: 305-947-1203 OR 1-800-330-2524
Fax: 954-972-4879
E-mail: Don.burton@burtonclaimservice.com

Gregory Roth
10930 Handel Place
Boca Raton, FL 33498
Home : 561-558-9340
Fax: 561- 558-9147
Cell: 561-703-2342
E-mail: groth2@bellsouth.net

Cabbage Key Consulting
P.O. Box 46407
St. Pete Beach, FL 33741
Ph: 727-867-0888
Fax: 727-8657988
E-mail: cabkey@tampabay.rr.com

HISI, INC.
Multi-Line Insurance Adjusting,
Appraisals and Inspection
5317 Fruitville Road, Suite 171
Sarasota, FL 34232
Ph: 941-685-5359
Fax: 941-255-1696
E-mail: dave@hisinet.com

David Maries
Premier Adjusters Co.
4025 Tampa Rd., Ste 1202
P. O. Box 1672
Oldsmar, FL 34677
Ph: 813-818-8418
Fax: 813-818-9355
E-mail: reports@pasadjust.com

Onsite Claims Service, Inc.
Peter Kapas, G.A.
6 Balfour Rd., East
Palm Beach Gardens, FL 33418
Ph: 561-627-6626
e-Fax: 561-431-7752
Fax: 561-627-3709
Email: Pete@onsiteclaims.com
Web address: www.onsiteclaims.com

Doug McColl
1556 Regency Drive
Mobile, AL 36693
Ph: 251-666-6490
Fax: 251-602-1873
Cell: 251 554 4560
E-mail: bigmccoll@comcast.net

DRY CLEANING RESTORATION

Acme Cleaners
Jim Parham
Orlando & Casselberry, Florida
Ph: 407-841-2301 ext. 2
Fax: 407-841-6022
E-mail: acme2@magicnet.net

Sir Galloway Cleaners
Mark Mills
13007 SW 87 Avenue
Miami, FL 33176
Ph: 305-252-2000 ext. 7
Fax: 305-255-5961
E-mail: sirgaloway@aol.com
Website: www.sirgalloway.com

Barton & Miller Cleaners
Rick & Sherry Miller
Plant 2600 N. Dixie Hwy
Wilton Manors, FL 33334
Ph: 954-566-4314
Fax: 954-566-4316
24hrs. 954-931-4254

Southside Cleaners and Restoration
Thomas S. Corey III
3742 Southside Blvd.
Jacksonville, FL 32216
Ph: 904-502-3376
Fax: 904-223-6918
E-mail: sscr2@bellsouth.net

Fashion Fresh
Jeff Rhea
1926 Trade Center Way
Naples, FL 34109
Ph: 239-596-3100
Fax: 239-596-8346
E-mail: jeff@myfashionfresh.com
Web Address: www.myfashionfresh.com

*Contact: Alliance of Professional Restoration Drycleaners (APRD) 1-800-540-APRD
Web Address: www.aprd.com or call for more participants in addition to above:

FORENSIC ACCOUNTING

Bruce D. Smith CPA, CFE
P.O. Box 77-1684
Coral Springs, FL 33077
Ph: 954-755-7981
Fax: 954-346-2727
E-mail: bdscpacfe@bellsouth.net

Sanderford & Associates, P.A.
8315 Gunn Hwy
Tampa, FL 33626
Ph: 813-920-1795 OR 1-877-471-2912
Fax: 813-920-1796
Web Address: www.sanderfordcpa.com
Morgan, Johnson, Carpenter & Co.
Mike Morgan.
P.O. Box 917489
Longwood, FL 32791
Ph: 407-862-6007
Fax: 352-253-0533
E-mail: mmorgan@mjc.biz


STRUCTURAL ENGINEERS

EFI
931 South Semoran Blvd.
Suite 208
Winter Park, FL 32792
Ph: 407-679-6200 or 1-800-776-0288
Web Address: www.efiinfo.com

Rimkus Consulting Corp.
Houston Headquarters 1-800-580-3228
Tampa 1-800-498-3060
Orlando 1-800-625-3060
Ft. Lauderdale 1-800-861-7644
Web Address: www.rimkus.com

GLE & Associates, Inc.
Connie Bakach
3109 W. Martin Luther King Jr. Blvd.
Tampa, FL 33607
Ph: 813-241-8350
Fax: 813-241-8737
E-mail: cbakach@gleassociates.com
Web Address: www.gleassociates.com

SDII Global Corporation
4509 George Road
Tampa, FL 33634
Ph: 813-496-9634
Fax: 813-496-9664
Web Address: www.sdii-global.com

Haag Engineering
5706 Benjamin Center Dr.
Suite 100
Tampa, FL 33634-5262
Ph: 813-901-0411 or 1-800-218-8886
Fax: 813-901-0311
E-mail:haagtam@haagengineering.com

The Pepper Engineering
P.O. Box 266348
Weston, FL 33326
Ph: 305-655-1115
E-mail: pepper@pegroup.com

HAS Engineers & Scientists
Dan Gonzales
425 Cheney Highway
Titusville, FL 32780
Ph: 321-269-9891
Fax: 321-269-9872
E-mail: dgonzalez@hsa-env.com

FORENSIC ENGINEER

Professional Forensic Services
Webb Wright
206 South Park Avenue Suite A
Winter Park, FL 32789
Ph: 800-858-0749
E-mail: pfspfs@earthlink.net
pfsroy@earthlink.net

CERTIFIED INDUSTRIAL HYGIENISTS

ACM Environmental
3505 Frontage Road
Suite 165
Tampa, FL 33607
Ph: 813-282-1232
Fax: 813-288-1543
E-mail: davidl@acmenv.com

Skyetec
9570 Regency Square Blvd.
Suite 410
Ph: 904-247-4321
E-mail: mwalraven@skyetec.com

HSA
David Gonzalez
425 Cheney Hwy
Titusville, FL 32780
Ph: 321-269-9891
Fax: 321-269-9872
E-mail: dgonzalez@hsa-env.com

TEMPORARY HOUSING

Marriott ExecuStay Insurance Housing
Solutions
1980 Riverside Park Way
Suite 200
Lawrenceville, GA 30043
Ph: 800-990-9292
Fax: 770-995-8634

Oakwood (CAT only)
4863 Shawline St.
Suite B
San Diego, CA 92111
Ph: 888 463-9269
Fax: 858-496-2002
E-mail: http://oakwood.com


CAUSE AND ORIGIN

ACM Environmental
David Lint
3505 Frontage Road
Suite 165
Tampa, FL 33607
Ph: 813-282-1232
Fax: 813-288-1543
E-mail: davidl@acmenv.com

SEA LTD
David Root
13930 Lynmar Blvd.
Tampa, FL 33626
Ph: 800-881-7324
Fax: 813-814-1716
E-mail: www.sealimited.com

John Rumplasch
PO Box 266168
Weston, FL 33326
Ph: 954-349-1180
Fax: 954-349-1181
E-mail: investjr@aol.com

Semmens Invest.
7640 Via De Manana
Scottsdale, AZ 85258
Ph: 800-687-6799
Fax: 480-429-0145
E-mail: marketing@sieengineering.com

Richard Schwartz
P.O. Box 551376
Davie, FL 33355
Ph: 954-327-8908
Fax: 954-327-8986
E-mail: rich@rsafire.com

Vikra Consultants
Bob Lemmon
8730 Pinion Drive
Lake Worth, FL 33467
Ph: 561-433-9232
Fax: 561-433-9464
E-mail: vikrasue@aol.com

Rimkus Consulting Group
Mike Manley
101 South Hoover Boulevard
Suite 101
Tampa, FL 33609
Ph: 800-498-3060
Fax: 813-289-5440
E-mail: rimkus.com

Ward & Whitemore
P.O. Box
Prior Lake, MN 55372
Ph: 952-461-7000
Fax: 952-461-7100
E-mail: rwhitemore@www.ufc.com

LEAK DETECTION

American Leak Detection
P. O. Box 144
Port Richie, FL 34673
Ph: 727-945-0109
Fax: 727- 945- 7879
Pasco, Hernando, Levy, Citrus
Steve, Terri, Steve Jr. and Benjamin Nagel

237 Goolsy Boulevard
Deerfield Beach, FL 33442
Ph: 305-948-4303
Fax: 954-437-5622

P.O. Box 245245
Pembroke Pines, FL 33024
Ph: 954-437-4414
Fax: 305-948-4303
Larry & Harriett Hite
Miami, Dade, Monroe County

Leak Finders American
2289 Pembroke Rd. #54
Pembroke Pines, FL 33025
Ph: 954-450-5559
Fax: 305-653-5006

P MB 68
958 South Military Trail
West Palm Beach, FL 33415
Ph: 561-744-6999
Fax: 561 744-1319
Martin, Palm Beach St. Lucie Counties
Bill & Karen Peterson

CONTENTS

Intel Laboratory
6745 Philips Industrial Blvd. Suite 1
Ph: 904-363-0196
Fax: 904-363-2379
E-mail: www.itelinc.com

International Contents Expert
1769 Blount Road
Pompano Beach, FL 33069
Ph: 954-979-4740
Fax: 954-975-2454
E-mail: clemo@inconex.com

WEATHER EXPERTS

Compu-weather
2566 Route 52
Hopewell Junction, NY 12533
Ph: 800-825-4445
Fax: 800-825-4441
Patti Robertson (for Florida)

Metro Weather
71 South Central Ave.
Suite 102
Valley Stream, NY 11580
Brett Zweiback
Ph: 800-488-7866
Fax: 800-768-7998

SALVORS

Callahan Salvage & Appraisal Company
P.O. Box 190
11625 Highway 64
Eads, TN 38028
Ph: (901) 867-3300
Contact: Ron Callahan

North American Salvage, Inc.
P.O. Box 294
Montrose, AL 36559
Ph: (800) 452-1112, ext. 2096
Contact: John S. Gonas

Greer & Kirby (National)
3384 Buford Drive, Suite 9
Buford, GA 30519
Ph: (770) 945-1001
Contact: Mike Greer

R & R Salvage Corp.
1537 W. Elizabeth Avenue
Linden, NJ 07036
Ph: (800) 732-6238
Contact: Patrick Kennedy

Harris & Wilenon
2543 Powers Avenue
Ph: (904) 737-5477
Contact: Royce Wileron

Weller Salvage
2525 Chicago Drive SW
Grand Rapids, MI 49509
Ph: (616) 538-5001
Fax: (616) 530-3035
Contact: Steve Bolling

COMMERCIAL COINSURANCE/DWELLING REPLACEMENT COST

Except for dwelling policies insuring mobile homes, and policies with wind endorsement 04-75, Citizens
policies contain either a replacement cost coverage provision or a coinsurance requirement. The dwelling
policies have a replacement cost insurance-to-value requirement of eighty percent (80%). The commercial
and commercial residential policies may contain different coinsurance requirements (80%, 90%, and 100%,
for example). The adjuster will need to refer to the appropriate policy form to determine which coinsurance
figure applies.

Dwelling Losses:

The adjuster must determine the replacement cost value of the building(s) and whether or not the amount
of insurance carried meets the eighty percent (80%) requirement.

If the eighty percent (80%) requirement is not met, the adjuster must allow for the greater of the actual cash
value (ACV) of the claim or the replacement cost formula application as follows:

(

1
AMOUNT OF INSURANCE CARRIED
2
AMOUNT OF INSURANCE REQUIRED
) % X (
3
AMOUNT OF LOSS -DEDUCTIBLE)
1
Amount of Insurance Carried is the amount shown as the coverage limit.
2
Amount of Insurance Required is the amount referenced above multiplied by eighty percent (80%) of the full
replacement cost of the building.
3
Amount of Loss is RC for buildings and other structures except mobile homes.

Note: Proportion is applied after deductible is taken fromthe amount of the loss.

Commercial Losses:

A coinsurance evaluation is required. The adjuster will need to refer to the appropriate policy form to
determine the coinsurance percentage required for that item. Commercial losses for which coinsurance is
not met must be adjusted with the penalty applied as follows:
(

1
AMOUNT OF INSURANCE CARRIED
2
AMOUNT OF INSURANCE REQUIRED
) % X (
3
AMOUNT OF LOSS) -DEDUCTIBLE
1
Amount of Insurance Carried is the amount shown as the coverage limit.
2
Amount of Insurance required is the value of covered property multiplied by the coinsurance percentage.
3
Amount of Loss is RC for buildings and other structures (except mobile homes).

Note: Proportion is applied to the amount of loss before application of the deductible. The
difference in the above two formulas is that for the Dwelling Policy, the deductible comes off before
the math computation; where as for the Commercial Policy the math computation is completed and
then the deductible is taken.

PROOF OF LOSS

Prior approval must be obtained from the Claims Examiner prior to a Proof of Loss being taken.
A proof of loss initiated by claims staff is permitted ONLY when unusual circumstances
surround the claim or at Citizens management discretion.
When a proof of loss is to be initiated by claims staff, the following procedures must be strictly
adhered to:

Send a blank Citizens Proof of Loss form to the insured with a letter citing the Duties After Loss as
stated in the policy;
Do not offer assistance in the completion of the Proof of Loss.

If you receive a proof of loss from any outside source, it must be IMMEDIATELY scanned into the claim
file and the hardcopy forwarded to the Examiner via overnight delivery.

POLICYHOLDER REPRESENTATION

If an attorney represents the policyholder, and no letter of representation is on file, the adjuster
must request one and must document the electronic file upon receipt of proper documentation from
the attorney. Unless the attorney gives written instructions to the contrary, all communication must
be conducted through the attorney and all claim payments must name the attorney (or firm) as an
additional payee.

If a public adjuster represents the policyholder, the adjuster must request a copy of the
policyholders contract with the public adjuster, scan into the claim file. All written communication
must be sent to the insured, with a copy to the public adjuster. All claim payments must name the
public adjuster or firm as specified in the contract as an additional payee.

Note: In the State of Florida a public adjuster may assist an insured in the claims process,
but unlike an attorney a public adjuster may NOT restrict communication or access to the
insured.

Professionals other than attorneys and public adjusters may assist policyholders with their claims.
Florida law, however, prohibits those persons from engaging in negotiations regarding insurance
coverage or settlements.

An Insured may not remove a Public Adjuster from a payment unless proper documentation from
the Public Adjuster indicated he/she released his/her rights to the payment.

The addition of an attorney does not allow for the removal of a P.A. or any other proper payee. An
attorney may be added but cannot remove other parties.

The Citizens system must be updated within 24-hours of notice that the insured is represented.

SALVAGE / SUBROGATION

Salvage
The adjuster must address all issues pertaining to salvage before the examiner can conclude the claim.
Salvage cannot be abandoned arbitrarily. However, no adjuster will personally dispose of salvage unless
specifically instructed in writing by Citizens to do so. Salvage requests should be sent to
catsalvage@citizensfla.com.

Buy Back:
When relatively small dollar amounts are at issue, allow the insured to retain the salvage in
exchange for an appropriate credit in the adjustment of the claim. When an insured retains any
salvage, the adjuster must document that agreement in the estimate. As with all other issues of
the claim, the adjuster must also take necessary steps to ensure that the insured understands that
process.

Salvers:
When larger items or larger dollar amounts are at issue, the assistance of a salvage company may
be in order. In such cases, the cooperation between the adjuster, examiner, salvor and the
insured, can lead to a prompt conclusion to a claim that might otherwise be protracted due to an
outstanding salvage issue. Salvage companies (salvors) are in a better position to furnish prompt
and reliable information regarding grade, obsolescence, availability and value of an item. They are
also equipped to check schedules and prepare inventories when larger quantities of property are
involved.

Mobile Homes:
Refer to the section titled Mobile Home Total Loss Claims.

Proceeds:
All checks must be made payable to Citizens and mailed directly to Citizens remittance attention to
the File Examiner. Adjusters should not accept payments on behalf of Citizens. The
Subrogation/Salvage Report must be completed and returned with all recoveries.

Subrogation
The adjuster must address subrogation potential on all claims. The adjusters supervisor or subrogation
unit must be placed on notice of all potential subrogation claims in order to ensure Citizens subrogation
rights are protected. Subrogation requests should be sent to catsubrogation@citizensfla.com.

The Subrogation Checklist provided in the Forms section of this Guide is intended to assist the adjuster in
identifying subrogation potential, properly documenting the claim and preventing spoliation of evidence.

Proceeds:
All checks must be made payable to Citizens and mailed directly to Citizens remittance attention to the File
Examiner. Adjusters should not accept payments on behalf of Citizens. The Subrogation/Salvage Report
must be completed and returned with all recoveries.

Below is further information which may be helpful to the adjuster in determining subrogation potential:

On every loss or claim adjustment, the subrogation possibilities must be checked out.
For example:

1. What is the cause of loss? The actual specific cause not just the peril. Remember that damage
which appears to have been caused by an act of God may have been exacerbated by human
negligence.

2. Did the cause of loss result from the acts of some third person (a person other than the insured, his
agent or employees)?

3. Can you prove the cause of loss? By:
- Substantiating evidence
- Direct or circumstantial

4. How can you prove it? - Very Important!
- Witnesses statements
- Photographs
- Experts analysis
- Written description
- Diagrams

5. What duties were owed by the third party to the insured?
- Common law due care
- Statutory
- Contract, e.g., bailment or lease

6. Is the duty apparent or must you obtain a legal opinion?
- If uncertain discuss with your supervisor.

7. What is the loss or damage? Can you prove it?
- How: Surveys, records, estimates, expert opinion

8. Was the insured notified of the companys possible subrogation claim upon payment of loss? If
not, your chance of subrogation may be waived.

9. How is the insured notified of the companys subrogation claim?
- Subrogation Receipt
- Loan Receipt
- Assignment
- Letter
- Law

10. Have you determined that there was no subrogation waiver that would eliminate subrogation?


11. Is a potentially responsible third party financially responsible? This must be determined.
- What insurance is available?
- Limits
- Name of carrier, policy number
- What assets other than insurance?
- Financial worth

12. Has your insured asked the third party or his insurance company to pay? (Give no legal advice
you cant practice law.)

13. Is the subrogation claim subject to an arbitration agreement?

14. Has evidence been obtained to present a good file for arbitration if the subrogation claim cannot be
settled?
- Statements
- Diagrams
- Photographs
- Substantiation of paid loss amount.

SUBROGATION GUIDELINES

LIMITATION AND REPOSE PERIODS

Statutes of Repose

Product Liability: 12 years after delivery of product to first purchaser 95.031

Construction Defects: 4 years from date of owners possession, except for latent defects (there
is a discovery requirement), subject to a maximum period of 15 years after
date of owners possession or completion of contract, whichever is latest
95.11(3)(c)
Statutes of Limitation

Tort: Negligence and construction claims 4 years 95.11(3); Prof. malpractice
2 years 95.11(4)

Contract: Written 5 years 95.11(2)(b); Oral 4 years 95.11(3)(k)

Local or State Govt: Claim presented within 4 years of accrual 11.065(a)


CONSTRUCTION DEFECTS ITEMS TO CONSIDER

Obtain statement.

Age of home.

Who was contractor, do they have a copy of the contract?

Who is subcontractor?

Photos of damaged area (yes, even under the house!), hopefully showing the defect.

Get written report from plumber, roofer who fixed the damage describing what the problem was
and what they had to do to fix it.

If applicable, get a copy of the building codes.

Should nail plates have been installed where there is future possibility of nails going through the
structure (floor or walls)?

ADVANCE PAYMENTS

The Field Adjuster may request advance payments from the Examiner for a reasonable amount of the
estimated covered damages. This request is made via a Preliminary Status Report submitted via email
to catadvancerequest@citizensfla.com .
When possible, advance payments should be issued under the Contents lines of coverage so that the
check can be issued without any encumbrance such as a mortgagee. This may only be done if there is
sufficient documented and covered damage to the coverage line. The adjuster may not request an
advance against content simply to avoid a mortgagee, if there is not covered contents damage
sufficient to cover the advance request.
The Preliminary Status Report must include clear documentation regarding why the advance payment
was issued and the estimated reserve amounts. There must also be clear documentation of the loss
details. Depending upon the size of the advance sufficient documentation should accompany the
request. Generally this would involve photos of the damaged items on which the advance is requested.
For any advance payment that is requested via CTS, the Claims Adjuster/Examiner must provide clear
instructions as to where the advance check(s) should be sent.

Note: Overnight delivery of high-priority checks may be considered. In this event, a physical address and
phone number are required, as overnight services cannot deliver to a post office box.

MORTGAGEES / LOSS PAYEES ON PAYMENTS

During the first contact with the insured, the adjuster needs to verify the mortgagee. If there is a change to
the mortgagee, the adjuster must secure written documentation to support changing the claim payment. An
endorsement request may be included from the agent or the insured may provide a copy of the current
mortgage statement or payment coupon. If the mortgage has been paid off, the adjuster must include a
Satisfaction of the Mortgage with the closing report.

All payments issued must include the name of the mortgagee(s) or loss payee(s) in the order in which
they appear, in addition to all named policyholders listed on the policy.
Mortgagees must be included once the total Gross Claim Amount for building items reaches $7500.00.
Any additional payments made after a claim reaches $7500 in covered building damage must include
the mortgagee.
When the mortgagee is included, all Additional Payees including second, third and forth mortgagees
must appear on the check unless proof of loan satisfaction is confirmed.

PAYMENT TO CONTRACTORS

Contractors are not normally added to claim payments.
A contractor name must only be included as an additional payee when there is a signed Work
Authorization, Direction to Pay, or approval by policyholder.
The adjuster must include the signed Work Authorization or Direct to Pay with the final report to the
Examiner.
Be aware that the above only applies to adding a contractor as a payee. Citizens does not make direct
payments to any party that does not include the insured.
Adding a contractor does not remove the need to include a mortgagee when appropriate.

ADDITIONAL LIVING EXPENSE (ALE)

Coverage is provided for additional living expenses incurred when a covered peril renders the dwelling
uninhabitable. Citizens intends that insureds be reimbursed promptly for all reasonable expenses
afforded by this coverage.

If a dwelling is rendered uninhabitable by more than one peril, for example flood and wind,
Citizens ALE coverage will apply only for the period of time reasonably required to repair the
covered damages, i.e. the wind damage.

If the insured has ALE coverage available for the same loss on different policies, Citizens will
pay its pro rata share of the covered ALE loss.

ALE coverage ceases upon repair of the damage caused by a covered peril that rendered the dwelling not
fit to live in. Please note, however, that an insured may not delay or prolong repairs for the purpose of
extending the ALE coverage beyond a reasonable length of time. Payment will be for the shortest time
required to repair or to replace the damage or, if the insured permanently relocates, the shortest time for
his/her household to settle elsewhere and for not more than a period of three hundred sixty five (365) days
beginning on the date of loss. This amount may differ based upon the actual policy involved. Prior to
commitment to any amounts, the adjuster should refer to the actual policy involved.


The adjustment of an ALE claim must begin on the adjusters first meeting with the insured, the first step
being to establish the insureds normal monthly expenses. The adjuster must complete the LOSS-OF-USE
FORM.

When determining normal expenses, the adjuster must give careful attention to such items as:

How often the insured normally eats lunch out.
How often the family normally dines out or gets take-out food for home.
What the normal grocery expenses are.
What the normal long-distance telephone expenses are, and so forth.

Note: Submission of an organized and detailed breakdown of living expenses is the responsibility of the
adjuster. Supportive documentation (the ALE form), and receipts, is required and must be verified on all
ALE claims.

ALE INSTRUCTION SHEET

HELPFUL DETAILS FOR DOCUMENTING AN ALE CLAIM
MEALS
We will pay the difference in costs between the charges for eating out and the normal cost of eating
at home until you have cooking facilities. Save actual meal receipts, this must show the date,
number of people served, and the cost.
MOTEL/
HOUSING
Temporary quarters (motel, apartment, trailer, rental home, etc.) are covered. For a severe loss, an
apartment or rental home with cooking and laundry facilities is more practical. A motel/hotel stay
must provide a motel receipt with itemized breakdown of the charges, including room, phone, room
service, etc. Credit Card receipts and cancelled checks are not acceptable.
UTILITIES
The cost to transfer or hook up utilities is a covered expense. Only the utility expenses in excess of
what you normally pay is covered.
TRANS-
PORTATION
We will pay the IRS rate for mileage driven to and from work, school, etc. and your temporary
quarters in excess of the normal miles driven. Please record the additional miles and
the number of trips per week.
PETS
The cost to board an animal(s) until other arrangements can be made is covered. Only the cost of
feeding your pet in excess of what you normally pay is covered.

SOME ITEMS NOT COVERED BY ALE

Mortgage payments and all other normally incurred expenses.

Emergency personal property replacement. Damaged items will be considered under your Contents
coverage.

Long distance phone calls are not covered except calls to your adjuster, contractor, and calls that
normally were local but become long distance due to the move to your temporary residence. Charges
for local calls at a motel are covered.

Extended time periods due to insureds election to delay repairs/rebuilding or time required making
additions or alterations to the home.

Medical expenses.

Hotel movies and room service.

LOSS ASSESSMENT

This is a claims-made coverage. The date of loss is the date on which the assessment was levied
rather than the date on which damage actually occurred. The date the assessment was levied is the
date the Condominium Board of Directors approved the assessment. This date will be reflected in the
minutes of the Board meeting. Therefore, a separate claim file must be established.

Refer to the appropriate policy form for the applicable deductible and limit.

IN ORDER TO DETERMINE WHAT, IF ANY, PORTION OF THE LOSS ASSESSMENT CAN BE
REFUNDED UNDER THE POLICY, THE FOLLOWING INFORMATION IS REQUIRED:

A copy of the minutes of the meeting at which the loss assessment was levied.
The total number of units assessed and the amount each unit was assessed.
An itemized breakdown or estimate reflecting the damages assessed.
The name, address, phone number and policy number of the master insurance policy carrier or local
agent.

ORDINANCE OR LAW
Coverage:
Cost
HO-3 25% of Coverage A Additional Limit
DW-2 (except mobile homes) 25% of Coverage A Additional Limit
CR-2 Excluded
CP-2 Excluded

Documentation Requirements:

1. Letter of code compliance from governmental agency (municipal or county) on agency
letterhead, signed by building official and specifically quoting the code provision that applies.

2. Ordinance or Law must be incurred or a verified, signed and dated G.C. contract that
accurately reflects the code upgrade. The proper scope and the correct cost itemizations must
be written and included in the file. The verification must not just be of what the cost would be
but what the cost was. This means the cost must have been incurred before any portion of it
can be paid under this coverage.

3. The fact that a building is not code compliant is not necessarily the same as an ordinance or
law being enforced. Often the ordinance or law is enforced due to failure to comply with a
code, but a code alone may not trigger an ordinance. This must be verified.

Procedures:

1. Write estimate for the covered damages only.
2. Do not include Ordinance or Law in the estimate unless the above documentation requirements are
included in the file.
3. Separate estimates are required for actual damages and for code upgrades.
4. If the covered property was damaged by multiple perils and Ordinance or Law applies, the Claims
Representative must determine the percentage of covered damage to the whole damage. That
percentage will be applied to the costs of any improvements required by Ordinance or Law with
regard to consideration of payment.

EXAMPLE:
If a roof in Dade County suffers damage to eighty percent (80%) of its size, but the existing roof meets the
current county/city codes, then we only owe to repair the damaged portion of the roof. However, if the roof
is damaged more than twenty five percent (25%) and the existing roof does NOT meet the current codes,
then a letter of code compliance must be secured before the cost of the upgrade can be included in the
estimate.

REPORTING REQUIREMENTS
Property Claims:

A preliminary report is due and should be entered into CTS within (15) days of inspection. The report is not
needed and will be waived for any claim submitted to the Examiner within the 15 days. Generally it is
expected that most residential claims should be written up and submitted within 15 days so the preliminary
reports should not be required on any but complex, large or commercial losses. Photos and other claim
documentation should regularly maintained in CTS. Specific action reporting is also required in CTS on
timeframes established at the beginning of any catastrophe.

COMPLEX CLAIM REPORTING REQUIREMENTS

CLAI MS RESERVED I N EXCESS OF $350,000 AND /OR I NVOLVI NG:
Mold Commercial
Coverage Question Multi-Causation
The initial Status Report must reflect status of the claim and must
include any supporting documents (Water Questionnaire). The
proposed action plan for claim resolution must also include
documented timelines.
Status Report

30 Days of Assignment
The updated Status Report must be submitted every 30 days until
settlement. All captioned items must be addressed and, if incomplete,
an explanation for the delay in resolution of that section must be
provided.

WA T E R D A M A G E C L A I M H A N D L I N G
P R O C E D U R E S

STEP 1 ASSIGNMENT

Citizens expects that all claim assignments resulting in water damage, with or without ensuing mold,
must be handled by experienced adjusters who are both knowledgeable and competent in recognizing
losses, which possess an environment conducive for mold growth. These adjusters must have a thorough
working knowledge on how to proactively mitigate and/or remediate losses of such nature.

Since mold is primarily a direct result of moisture related events, adjusters must have a fine working
knowledge of the publication; Standard and Reference Guide for Professional Damage Restoration
IICRC S500, www.iicrc.org, which aids Water Damage Mitigation Contractors in alleviating water related
damages.

STEP 2 INITIAL CONTACT AND EARLY SITE INSPECTION

In this critical step, the adjuster must express empathy and be prepared to respond prudently with early
intervention, mitigation and remediation measures when necessary.

When possible, the Adjuster will strive to inspect the property as quickly as possible.

The adjusters goal in Step 2 must be to obtain first-hand knowledge of the loss events, extent of damage
and the possibility of the presence of mold.

STEP 3 DUTY TO INFORM

During the initial conversation and/or subsequent site inspection(s), adjusters must be genuinely
empathetic to the policyholders situation. Adjuster must take what ever time is necessary to clearly
explain the severity of the situation and policyholders responsibilities to repair and protect the property as
outlined in the relevant policy and/or endorsement language. It is the Adjusters responsibility to ensure
that the policyholder understands their responsibility for mitigation steps and what those steps might be,
based on the specifics of the situation.

STEP 4 SITE INSPECTION

SCOPE & ESTIMATE
The Adjuster should meet all requirements for inspections and estimates outlined in the Standards and
Procedures section of the Claims Guide and/or Orientation Manual. Additionally, for claims with water
damage the Adjuster must:

1. Obtain copy of flood adjustment.
2. Measure the height of the water line on any and all damaged walls.
3. Document damage by a photo including a tape measure indicating the water line.

Citizens requires adjusters refer to Estimate Preparation Guidelines, (found in this section) which offers
insight and guidance on the accountabilities for estimate preparation and the use of a Certified Industrial
Hygienist.

STEP 5 - COVERAGE ANALYSIS

Coverage analysis and communication with the insured should follow the same guidelines outlined in the
Standards and Procedures section of the Claims Guide and/or Orientation Manual.
Coverage denials must be exercised with caution and communicated only after the adjuster has completed
a thorough and comprehensive investigation in accordance with Citizens coverage procedures.
When coverage issues exist, the adjuster must verbally communicate the issues to the insured and then
send a Reservation of Rights or declination of coverage letter.
STEP 6 ENLISTING THE SERVICES OF A CERTIFIED INDUSTRIAL HYGIENIST

The following mold handling section is currently in progress and will be incorporated in the next release of
this claim guide.

Refer to Citizens technical bulletin for guidance on handling mold losses.


C O V E R A G E R E V I E W P R O C E D U R E S

This section is designed for easy reference by claim professionals involved in coverage analysis and
decisions. Its purpose is to clarify the steps which must be taken to review coverage in a particular claim.

Coverage must be evaluated in every file in light of the particular facts or allegations of the claim.

Upon receipt of any new claim, verification of coverage must be considered an immediate and high
priority. Our goal is to provide our insureds with prompt, full, and fair evaluations of the applicable
coverage.

During the course of any claim investigation, situations can change, or new information can come to light,
which would cause a claim to fall under the REFERRAL GUIDELINES (Refer to Page 5) requiring Citizens
review. Should this occur, a prompt referral must be made to the assigned Citizens File Reviewer.

COVERAGE REVIEW PROCESS ROLES & RESPONSIBILITIES

Claims Representative / Specialist / Adjuster
(Including anyone directly handling the claim)

The coverage review process begins with the Claim Representative / Specialist / Adjuster. Upon receipt of
a claim, the Claim Representative / Specialist / Adjuster must:

1) Verify a complete and correct copy of applicable coverage is available. Identify each endorsement by
title and number and obtain a copy of any manuscript endorsements, if needed. The policy information
must then be included in the file.

2) The Claim Representative / Specialist / Adjuster may obtain complete copies of all policy forms and
endorsements from the Citizens website following the path below:

www.citizensfla.com
Adjuster Resources
Underwriting Forms
Click on appropriate policy

Certified copies of policies may be requested from the assigned Claims Support Representative

Examiner

The Examiner is responsible for seeing that there are appropriate coverage decisions on all claims. This
responsibility includes ensuring:

That the Claim Representative / Specialist / Adjuster has obtained all of the required policy
documents.

That the Claim Representative / Specialist / Adjuster has identified all of the coverage issues
relating to the particular claim.

That the Claim Representative / Specialist / Adjuster has clearly communicated all coverage issues
to insureds and their representatives, both verbally and in writing via the Claim Explainer.

That an understandable Reservation of Rights or Declination of Coverage letter has been issued
when coverage is at issue or a decision has been made that coverage does not exist.

In keeping with this responsibility, it is expected that the Examiner will:

Be sure that all coverage decisions within authority are made as soon as possible following a
necessary and thorough coverage investigation.

Where the claim does not meet Citizens Referral Guidelines and claim issues fall outside of the
Claim Representative / Specialist / Adjusters ability to resolve, make the appropriate coverage and
/ or escalation decision.

Consult with Citizens Claims Manager or Litigation Manager as necessary.

Ensure that files with coverage issues are reserved in accordance with Citizens current
evaluation/reserving guidelines.

Approve any Reservation of Rights or Declination of Coverage letter before the letter is sent to
appropriate parties.

REFERRAL GUIDELINES FOR CLAIMS REPRESENTATIVES, SPECIALISTS, AND
ADJUSTERS

The Claim Representative / Specialist / Adjuster will make an immediate referral to his/her Claims File
Examiner for further direction or escalation in the following situations. If a claim does not meet any of these
situations, the claim is referred to the Examiner for review upon completion of adjustment.

1. An attorney coverage opinion is requested.

2. There is no policy in effect on the date of loss.

3. The policyholder is claiming that there should be coverage in effect that is not afforded by the
policy.

4. An Examination Under Oath is requested.

5. Any claim involving suspected fraud or arson regardless of claim amount.

Referrals from a specialist or adjuster to a file examiner must occur within CTS. Referrals from an
examiner to any other party must be in accordance with the following Submission Guidelines

REFERRAL GUIDELINES FOR EXAMINER TO CLAIMS MANAGEMENT

The following information must accompany each referral of a claim. You may use a format that is easiest
for you. The objective is to provide the Claims Administration Coordinator complete information and
documentation to be able to make a decision or provide assistance.

GENERAL INFORMATION

The submission must identify:
Insured(s)
Claimant(s)
Claim Number
Policy Number
Effective Dates, and
Limits

INFORMATION TO AID THE ANALYSIS

The submission must contain:
A Brief Statement of the Facts
Identification and Analysis of Coverage Issues
Recommendation(s) for the action(s) to be taken on behalf of Citizens
A Summary of Proposed Future Investigation.

DOCUMENTS

The following documents must be submitted when a claim is referred to Citizens:
Schedule of Policy Forms by Title and Number
Copy of all suits, if applicable
Drafts of proposed letters
Any other documents that will aid the Claims Administration Coordinator to make a decision or
to provide assistance

RESERVATION OF RIGHTS LETTERS

Reservation of Rights letters is the method by which Citizens attempts to preserve its rights to disclaim
coverage until the investigation develops sufficient information upon which a well-informed decision
concerning coverage can be made. Whichever method is chosen, Citizens coverage position must be
clearly stated. The agreement or letter must be drafted in accordance with the applicable laws of the
State of Florida.
Claims personnel must conform to the following rules concerning non-waivers and reservation of rights
letters:
The Examiner must issue non-waivers or reservation of rights letters. It is acknowledged,
however, that there may be instances where the issuance of an on scene non-waiver will be
necessary and can be completed by an Adjuster.

Initial responsibility for preparing timely, proper non-waivers and reservation of rights letters
rests with the Examiner. Reservation of Rights letters must be prepared immediately after
receipt of information that a possible coverage issue or policy violation exists.

Where possible, the Reservation of Rights letter must not be sent without first explaining the
basis for the reservation to the intended recipient.

The Reservation of Rights letter must clearly explain the reasons for the reservation as to
coverage. It must cite the applicable policy provisions and the facts upon which the decision to
reserve rights is based.

A Reservation of Rights letter is to be sent to anyone who may claim to be an insured
after we become aware that a possible coverage question as to that person or as to the
claim exists. The individual(s) receiving the Reservation of Rights must be updated
promptly if our position changes.

Do not request that an insured sign and return a copy of the Reservation of Rights letter.

All Reservation of Rights letters must be individually typed. Pre-Printed form letters are not
permitted. The Citizens templates should be used.

Reservation of Rights letters must contain a request that the insured provide any additional
pertinent information and notify Claim Representative / Specialist / Adjuster if the facts and
assumptions stated in the letter are incorrect. If the insured responds, be sure to consider the
additional information supplied by the insured.

Reservation of Rights letters must contain an invitation to the recipient to contact the Claim
Representative / Specialist / Adjuster or Examiner if the recipient has any questions.

The Reservation of Rights letter must be sent by certified mail, return receipt requested to the last
known address of the recipient. A copy of the Reservation of Rights letter must be scanned into CTS
and maintained on the claim file with the return receipt attached.

COVERAGE DECISIONS RESERVATION OF RIGHTS

When issuing a reservation of rights letter, remember that the purpose is to preserve Citizens rights during
the investigation. These are not decisions concerning coverage. At the time the initial coverage analysis is
complete, the Claim Representative / Specialist / Adjuster must have identified, at minimum:

What is the coverage issue?
Do we need legal guidance?
What facts need to be established to resolve the issue?
How will these facts be established? (through discovery, interview insured, at trial?)
Can this issue be resolved before or during trial of the underlying case?
Do we need to file a Declaratory Judgment Action? When?

When the subsequent investigation discloses sufficient information upon which a coverage determination
can be based, the insured must be informed of the coverage decision, both verbally and in writing. That
decision can be to:

Accept coverage unconditionally
Disclaim coverage
File suit to get a judicial determination on coverage

Remember, a reservation of rights may not preserve Citizens rights if a coverage
decision, or action pursuant to that decision, is delayed unreasonably after
information has been discovered to support a coverage disclaimer.

Under most circumstances, the Coverage Review and any necessary investigation must be completed
within thirty (30) days of receipt of the claim. If additional time beyond the thirty (30) days is required, the
policyholder or legal representative must be advised of the status of the investigation. The claim file must
be well documented as to the reasons for the inability to reach a coverage decision and be updated with a
date by which a decision is expected.

DECLINATION OF COVERAGE

The adjuster must be familiar with coverages, extensions of coverage, exclusions, and limitations of the
policy forms and endorsements. The adjuster must correctly apply all provisions thereof to the facts and
circumstances of each individual loss. The adjuster must also take care to explain and discuss these
issues with policyholders or their representatives over the course of the investigation of claims. For all
claims involving full or partial denials, all correspondence sent to the policyholder or his/her representative
must include the following information, detailed in the Declination Letter:

Reference to the policy section(s) upon which the denial is based. If circumstances call for only a
partial denial, the correspondence to the policyholder or their representative must state such.

If the loss contains non-covered items as well as covered items, the adjuster may reference such non-
covered items within the estimate, provided that an appropriate reference is made to the policy section
that causes the item(s) to be not covered.

If the covered loss is below the deductible, the adjuster must include the estimate along with the denial
letter.

All declinations involving questionable coverage issues must be handled in accordance with the
Coverage Review Procedures (found in this Guide).

The Adjuster must also update the electronic file with denial details.

When a decision is made that there is no coverage for a loss, a denial of coverage letter must be sent to each
individual affected by the decision after discussion of the reasons with the insured(s).
The Denial of Coverage Letter must clearly explain the reasons for the denial of coverage. It must cite the
applicable policy provisions and the facts upon which the coverage decision was based. If the letter is issued
on a liability claim that is not in suit, the insured must be requested to promptly forward any lawsuit, if
received, to the Supervising Manager.
Denial of Coverage letters must be sent as soon as possible after receipt of information that causes the
decision that there is no coverage.
The Supervising Manager must approve all Denial of Coverage letters prior to the letters being sent.
The Denial of Coverage letter must be sent by certified mail, return receipt requested to the last known
address of the recipient. A copy of the Denial of Coverage letter must be maintained on the claim file with
the return receipt attached.

When denying coverage under a personal residential policy that is in effect at the time of the loss and:

There is a disagreement as to the cause of loss
There is no suspicion of fraud
The amount in controversy is $500 or more

The following language must be added to the denial of coverage letter:

If you disagree with our decision, the Florida Department of Financial Services has
established a mediation program for the resolution of the first party property insurance
claim disputes. If your first party property insurance claim is denied or otherwise not

resolved within 21 days from the date of this letter and the amount in dispute is $500 or
more, you may request mediation by calling the Citizens Resolution department at 1-866-
411-2742 or by writing the Resolutions Unit at Citizens Property Insurance Corporation, attn:
Mediation Request 8301 Cypress Plaza Drive Suite 500 Jacksonville FL 32256. Additional
mediation information is available at the DFS website www.fldfs.com.

Upon receiving your request for mediation, the Department of Financial Services will select
a mediator and Citizens will assign a Mediation Adjuster. In addition, at any time you may
move to disqualify the mediator for good cause. Good cause consists of a conflict of
interest between a party and the mediator; the mediator is unable to handle the conference
competently; and/or reasons which would reasonably be expected to impair the conference.
Any complaints concerning the mediator shall be in writing and sent to:

Department of Financial Services Regional Office
Tallahassee Service Office
200 East Gaines St.
Suite 531
Tallahassee, FL 32399-0321

It is not necessary for you to retain an attorney to represent you at the mediation
conference. However, if you plan to be represented by an attorney at the mediation
conference, you must inform the Mediation Adjuster prior to the conference.

If you have any questions concerning this denial or your rights of mediation, please feel
free to contact the Citizens Resolutions Unit at 1-866-411-2742.

POLICY NOT IN EFFECT OR REFORMATION OF POLICIES

Occasionally, a coverage review will establish that there is no policy in effect with Citizens on the date of
loss. There may be instances when an insured believes that they requested and must have coverage that
is not afforded by the policy. Under such circumstances, the Claim Representative / Specialist / Adjuster
must immediately notify the File Examiner, take a non-waiver agreement or issue a reservation of rights,
and continue to adjust the claim under the terms of the policy as written or as if coverage existed.

All such situations must be referred to the File Examiner. Under no circumstances may Claims
Department personnel reform any policy or waive policy terms or conditions. If the investigation
establishes that the policy must be either issued or reformed, Citizens Claims Manager will take
responsibility for the appropriate action. Under no circumstances may the Claims Department make a
payment where it is determined that there is no coverage.


C O N D O M I N I U M & C O M M E R C I A L C L A I M S

OVERVIEW

UPDATE 2007: All losses that may occur in 2007 would be subject to the statute cited below. However,
the entire section referencing the handling claims both before and after the adoption of the statute is
included. Due to the fact that Citizens experienced a number of storms in 2004 and some of the damage
occurred on property that was still subject to the pre-statute guidelines, any new claims are subject to the
new (post January 1, 2004) handling guidelines.

The new 2003 Condominium Statute went into effect January 1, 2004. Florida Statute 718.111(11)
concerns the insurance coverage that is provided to condominiums and their unit owners. Prior to 2003,
amendments to this provision were much less uniform and often required insurance carriers to obtain and
review declarations of the condominium association to ascertain information contained therein to resolve
certain coverage issues that arose with the insured. As a result of this non-uniformity and to encourage
lower or stable insurance premiums, the Florida Legislature amended the current statute to Florida Statute
718.111 (11)(a)-(d).

CLAIM GUIDELINES FOR POLICY EFFECTIVE DATES AFTER JANUARY 1, 2004

For the year 2004 and later, it will be necessary for the adjuster to determine which insurance policies have
been issued or renewed in order to verify that the new statute will apply. This information will need to be
obtained from the condominium association themselves.
The new statute is effective for new or renewal condominium association and unit owner policies effective
on or after January 1, 2004.
Condominium Association Reported Loss
If the association is reporting a new loss that occurred on or after January 1, 2004 AND the
association policy was issued or renewed prior to the date of loss AND on or after January
1, 2004, the Claims Administrator will no longer need to consult declarations of
condominium, to determine the association and unit owners insurable interest, unless the
loss involves freestanding buildings where there is no more than one building in or on
such unit.1 Florida Statute 718.111 (11) (a)-(d) will assist in these losses.
Condo-Unit Owners Reported Losses
On all Condo-Unit Owner new losses, the Claims Administrator must investigate and determine the
Association Policys issuance or renewal effective date.
If the unit-owner is reporting a new loss that occurred on or after January 1, 2004 AND:
The association policy was issued or renewed prior to the date of loss AND on or after January 1, 2004; the
Claims Administrator will no longer need to consult declarations of condominium, to determine the
association and unit owners insurable interest, unless the loss involves freestanding buildings where there

is no more than one building in or on such unit. Below please find the important changes to the recently
amended Florida Statute 718.111 (11)(a)-(d).

A declaration of the condominium may require unit owners to insure freestanding
condominium units or units where no more than one (1) building exists as opposed to the
association being required to insure the same;

Every hazard insurance policy issued or renewed after January 1, 2004 shall provide
primary coverage for:

1. All portions of the condominium property located outside the units;
2. The condominium property located inside the units as such property was
initially installed or replacement of like kind and quality in accordance with the
original plans and specifications or if the original plans and specifications are
not available as they existed at the time the unit was initially conveyed.
3. All portions of the condominium for which the declaration of condominium
requires coverage by the association;

Standing alone, the above paragraphs, particularly paragraph 2, might lead the reader to conclude that wall
coverings, floor coverings and built-in cabinets and fixtures that were part of the original unit as built would
be covered under the associations policy. However, the language which follows these three paragraphs
shifts that responsibility for those and other items to the unit owners policy. The statutory language which
immediately follows these three paragraphs states:

Anything to the contrary notwithstanding, the terms condominium property, building,
improvements, insurable improvements, common elements, association property, or
any other term found in the declaration of condominium which defines the scope of
property or casualty insurance that the condominium association must obtain excludes all
floor, wall, ceiling coverings, electrical fixtures, appliances, air conditioners or heating
equipment, water heaters, water filters, built-in cabinets, countertops, window treatments,
including curtains, drapes, blinds, hardware and similar window treatment components or
replacements of the foregoing which are located within the boundaries of the unit and only
serve one unit and all air compressors that service only one unit, whether or not located
within the boundaries of that unit;

Commencing January 1, 2004, mortgagee approval is not required for associations to
amend their declarations of condominium to conform to the coverage sections amended in
this section; and
All real or personal property located within the boundaries of the unit owners unit is
excluded from hazard insurance coverage to be provided by the association as set forth in
the above referenced exclusions and shall be insured by the individual unit owner without
subrogation rights to the association. The association is specifically permitted to include
reasonable deductibles in its coverage. The unit owner is no longer required to be
considered as an additional insured under the association policy.

Florida Condominium Statute 718.111 (11) (a)-(d)
11) INSURANCE.--IN ORDER TO PROTECT THE SAFETY, HEALTH, AND
WELFARE OF THE PEOPLE OF THE STATE OF FLORIDA AND TO ENSURE CONSISTENCY
IN THE PROVISION OF INSURANCE COVERAGE TO CONDOMINIUMS AND THEIR UNIT
OWNERS, PARAGRAPHS (B) AND (C) ARE DEEMED TO APPLY TO EVERY
CONDOMINIUM IN THE STATE, REGARDLESS OF THE DATE OF ITS DECLARATION OF

CONDOMINIUM. IT IS THE INTENT OF THE LEGISLATURE TO ENCOURAGE LOWER OR
STABLE INSURANCE PREMIUMS FOR ASSOCIATIONS DESCRIBED IN THIS SECTION.
THEREFORE, THE LEGISLATURE REQUIRES A REPORT TO BE PREPARED BY THE
OFFICE OF INSURANCE REGULATION OF THE DEPARTMENT OF FINANCIAL SERVICES
FOR PUBLICATION 18 MONTHS FROM THE EFFECTIVE DATE OF THIS ACT,
EVALUATING PREMIUM INCREASES OR DECREASES FOR ASSOCIATIONS, UNIT
OWNER PREMIUM INCREASES OR DECREASES, RECOMMENDED CHANGES TO BETTER
DEFINE COMMON AREAS, OR ANY OTHER INFORMATION THE OFFICE OF INSURANCE
REGULATION DEEMS APPROPRIATE.

(A) A UNIT-OWNER CONTROLLED ASSOCIATION SHALL USE ITS BEST EFFORTS TO
OBTAIN AND MAINTAIN ADEQUATE INSURANCE TO PROTECT THE ASSOCIATION, THE
ASSOCIATION PROPERTY, THE COMMON ELEMENTS, AND THE CONDOMINIUM
PROPERTY REQUIRED TO BE INSURED BY THE ASSOCIATION PURSUANT TO
PARAGRAPH (B). IF THE ASSOCIATION IS DEVELOPER CONTROLLED, THE
ASSOCIATION SHALL EXERCISE DUE DILIGENCE TO OBTAIN AND MAINTAIN SUCH
INSURANCE. FAILURE TO OBTAIN AND MAINTAIN ADEQUATE INSURANCE DURING
ANY PERIOD OF DEVELOPER CONTROL SHALL CONSTITUTE A BREACH OF FIDUCIARY
RESPONSIBILITY BY THE DEVELOPER-APPOINTED MEMBERS OF THE BOARD OF
DIRECTORS OF THE ASSOCIATION, UNLESS SAID MEMBERS CAN SHOW THAT
DESPITE SUCH FAILURE, THEY HAVE EXERCISED DUE DILIGENCE. THE
DECLARATION OF CONDOMINIUM AS ORIGINALLY RECORDED, OR AMENDED
PURSUANT TO PROCEDURES PROVIDED THEREIN, MAY REQUIRE THAT
CONDOMINIUM PROPERTY CONSISTING OF FREESTANDING BUILDINGS WHERE
THERE IS NO MORE THAN ONE BUILDING IN OR ON SUCH UNIT NEED NOT BE
INSURED BY THE ASSOCIATION IF THE DECLARATION REQUIRES THE UNIT OWNER
TO OBTAIN ADEQUATE INSURANCE FOR THE CONDOMINIUM PROPERTY. AN
ASSOCIATION MAY ALSO OBTAIN AND MAINTAIN LIABILITY INSURANCE FOR
DIRECTORS AND OFFICERS, INSURANCE FOR THE BENEFIT OF ASSOCIATION
EMPLOYEES, AND FLOOD INSURANCE FOR COMMON ELEMENTS, ASSOCIATION
PROPERTY, AND UNITS. ADEQUATE INSURANCE, REGARDLESS OF ANY
REQUIREMENT IN THE DECLARATION OF CONDOMINIUM FOR COVERAGE BY THE
ASSOCIATION FOR "FULL INSURABLE VALUE," "REPLACEMENT COST," OR THE LIKE,
MAY INCLUDE REASONABLE DEDUCTIBLES AS DETERMINED BY THE BOARD. AN
ASSOCIATION OR GROUP OF ASSOCIATIONS MAY SELF-INSURE AGAINST CLAIMS
AGAINST THE ASSOCIATION, THE ASSOCIATION PROPERTY, AND THE CONDOMINIUM
PROPERTY REQUIRED TO BE INSURED BY AN ASSOCIATION, UPON COMPLIANCE
WITH SS. 624.460-624.488. A COPY OF EACH POLICY OF INSURANCE IN EFFECT
SHALL BE MADE AVAILABLE FOR INSPECTION BY UNIT OWNERS AT REASONABLE
TIMES.

(B) EVERY HAZARD INSURANCE POLICY ISSUED OR RENEWED ON OR AFTER
JANUARY 1, 2004, TO PROTECT THE CONDOMINIUM SHALL PROVIDE PRIMARY
COVERAGE FOR:

1. ALL PORTIONS OF THE CONDOMINIUM PROPERTY LOCATED OUTSIDE THE UNITS;

2. THE CONDOMINIUM PROPERTY LOCATED INSIDE THE UNITS AS SUCH PROPERTY
WAS INITIALLY INSTALLED, OR REPLACEMENTS THEREOF OF LIKE KIND AND
QUALITY AND IN ACCORDANCE WITH THE ORIGINAL PLANS AND SPECIFICATIONS
OR, IF THE ORIGINAL PLANS AND SPECIFICATIONS ARE NOT AVAILABLE, AS THEY
EXISTED AT THE TIME THE UNIT WAS INITIALLY CONVEYED; AND

3. ALL PORTIONS OF THE CONDOMINIUM PROPERTY FOR WHICH THE DECLARATION
OF CONDOMINIUM REQUIRES COVERAGE BY THE ASSOCIATION.
ANYTHING TO THE CONTRARY NOTWITHSTANDING, THE TERMS "CONDOMINIUM
PROPERTY," "BUILDING," "IMPROVEMENTS," "INSURABLE IMPROVEMENTS," "
COMMON ELEMENTS," "ASSOCIATION PROPERTY," OR ANY OTHER TERM FOUND IN
THE DECLARATION OF CONDOMINIUM WHICH DEFINES THE SCOPE OF PROPERTY OR
CASUALTY INSURANCE THAT A CONDOMINIUM ASSOCIATION MUST OBTAIN SHALL
EXCLUDE ALL FLOOR, WALL, AND CEILING COVERINGS, ELECTRICAL FIXTURES,
APPLIANCES, AIR
CONDITIONER OR HEATING EQUIPMENT, WATER HEATERS, WATER FILTERS, BUILT-

IN CABINETS AND COUNTERTOPS, AND WINDOW TREATMENTS, INCLUDING
CURTAINS, DRAPES, BLINDS, HARDWARE, AND SIMILAR WINDOW TREATMENT
COMPONENTS, OR REPLACEMENTS OF ANY OF THE FOREGOING WHICH ARE LOCATED
WITHIN THE BOUNDARIES OF A UNIT AND SERVE ONLY ONE UNIT AND ALL AIR
CONDITIONING COMPRESSORS THAT SERVICE ONLY AN INDIVIDUAL UNIT, WHETHER
OR NOT LOCATED WITHIN THE UNIT BOUNDARIES. THE FOREGOING IS INTENDED
TO ESTABLISH THE PROPERTY OR CASUALTY INSURING RESPONSIBILITIES OF THE
ASSOCIATION AND THOSE OF THE INDIVIDUAL UNIT OWNER AND DO NOT SERVE TO
BROADEN OR EXTEND THE PERILS OF COVERAGE AFFORDED BY ANY INSURANCE
CONTRACT PROVIDED TO THE INDIVIDUAL UNIT OWNER. BEGINNING JANUARY 1,
2004, THE ASSOCIATION SHALL HAVE THE AUTHORITY TO AMEND THE DECLARATION
OF CONDOMINIUM, WITHOUT REGARD TO ANY REQUIREMENT FOR MORTGAGEE
APPROVAL OF AMENDMENTS AFFECTING INSURANCE REQUIREMENTS, TO CONFORM
THE DECLARATION OF CONDOMINIUM TO THE COVERAGE REQUIREMENTS OF THIS
SECTION.

(C) EVERY HAZARD INSURANCE POLICY ISSUED OR RENEWED ON OR AFTER
JANUARY 1, 2004, TO AN INDIVIDUAL UNIT OWNER SHALL PROVIDE THAT THE
COVERAGE AFFORDED BY SUCH POLICY IS EXCESS OVER THE AMOUNT
RECOVERABLE UNDER ANY OTHER POLICY COVERING THE SAME PROPERTY. EACH
INSURANCE POLICY ISSUED TO AN INDIVIDUAL UNIT OWNER PROVIDING SUCH
COVERAGE SHALL BE WITHOUT RIGHTS OF SUBROGATION AGAINST THE
CONDOMINIUM ASSOCIATION THAT OPERATES THE CONDOMINIUM IN WHICH SUCH
UNIT OWNER'S UNIT IS LOCATED. ALL REAL OR PERSONAL PROPERTY LOCATED
WITHIN THE BOUNDARIES OF THE UNIT OWNER'S UNIT WHICH IS EXCLUDED FROM
THE COVERAGE TO BE PROVIDED BY THE ASSOCIATION AS SET FORTH IN
PARAGRAPH (B) SHALL BE INSURED BY THE INDIVIDUAL UNIT OWNER.

(D)THE ASSOCIATION SHALL OBTAIN AND MAINTAIN ADEQUATE INSURANCE OR
FIDELITY BONDING OF ALL PERSONS WHO CONTROL OR DISBURSE FUNDS OF THE
ASSOCIATION. THE INSURANCE POLICY OR FIDELITY BOND MUST COVER THE
MAXIMUM FUNDS THAT WILL BE IN THE CUSTODY OF THE ASSOCIATION OR ITS
MANAGEMENT AGENT AT ANY ONE TIME. AS USED IN THIS PARAGRAPH, THE TERM
"PERSONS WHO CONTROL OR DISBURSE FUNDS OF THE ASSOCIATION" INCLUDES,
BUT IS NOT LIMITED TO, THOSE INDIVIDUALS AUTHORIZED TO SIGN CHECKS AND
THE PRESIDENT, SECRETARY, AND TREASURER OF THE ASSOCIATION. THE
ASSOCIATION SHALL BEAR THE COST OF BONDING.


Interpreting Condo Documents on Claims with Policy Effective Dates of January 1, 2004 and After

Association Responsible For: Unit Owner Responsible For:

718.111(11)(b)

Every hazard insurance policy
issued or renewed on or after
January 1, 2004, to protect the
condominium, shall provide
primary coverage for:

718.111(11)(b)1.

All portions of the condominium
property located outside the
units;

718.111(11)(b)2.

The condominium property
located inside the units as such
property was initially installed, or
replacements thereof of like kind
and quality and in accordance
with the original plans and
specifications or, if the original
plans and specifications are not
available, as they existed at the
time the unit was initially
conveyed;

718.111(11)(b)

Anything to the contrary
notwithstanding, the terms
condominium property, building,
improvements, insurance
improvements, common elements,
association property, or any other
term found in the declaration of
condominium which defines the scope
of property or casualty insurance that
a condominium association must
obtain shall exclude all floor, wall, and
ceiling coverings, electrical fixtures,
appliances, air conditioner or heating
equipment, water heaters, water
filters, built-in cabinets and
countertops, and window treatments
including curtains, drapes, blinds,
hardware, and similar window
treatment components, or
replacements of any of the foregoing
which are located within the
boundaries of a unit and serve

only
one unit and all air conditioning
compressors that service only an
individual unit, whether or not located
within the unit boundaries.

718.111(11)(b)3.

All portions of the condominium
property for which the declaration
of condominium requires
coverage by the association.

Note:

The language of the statute clearly
defines what is considered
condominium property as defined in
the declaration of condominium for the
purpose of insurance; and thus, is to
be covered under the unit owners
policy.

Citizens Condominium Association and Condominium Unit-Owners policies have been amended
by endorsement so their policy coverages comply with statutory changes.

CLAIM GUIDELINES FOR POLICY EFFECTIVE DATES PRIOR TO 1/1/04

CONDO DOCS
The adjustment of condominium losses, whether for the Association master policy or for an individual unit
owner policy, presents unique challenges for the adjuster. Issues pertaining to ownership, day-to-day
maintenance, and casualty insurance requirements must be addressed and resolved according to the
applicable statute and the condominium associations Declaration of Condominium (hereafter referred to as
condo docs).

I. Adjusters should be familiar with Florida Statute 718.111 (11). The relevant portion of that statute
and guidelines based thereupon is included in this section.

II. The adjuster will need to obtain a copy of the following sections of the condo docs:

A. Association name and date page usually found on first or last page of the Declaration of
Condominium;
B. Casualty Insurance section;
C. Maintenance section; and
D. Definitions (including boundaries).
E. All Amendments pertaining to any of the above sections.

Wind Only Policy NOTE: Although condominium unit owner coverages are shown as Coverage C, certain
items normally considered building items may be covered in addition to contents and personal property
provided that the coverage is referenced as CONTENTS, ALTERATIONS, APPLIANCES, FIXTURES,
AND IMPROVEMENTS. The Limit of Liability can be used in whole or split in any proportion between the
contents loss and the alterations, appliances, fixtures, and improvements loss. The entire adjustment of
these claims must be subject to the condo docs, the condominium statute, and the policy language.

The adjuster must make arrangements to obtain a copy of the condo docs. This process should begin
when telephone contact is made with the insureds or their representative.
Adjusters should not discuss coverage with insureds until all necessary sections of condo docs have
been reviewed and the issues regarding insurance responsibility have been clarified. Only then can an
djuster begin to scope, prepare, and estimate the covered damage. a

INTERPRETING CONDO DOCS (General Guidelines)
The following guidelines are reliable unless specifically stated otherwise in the Declaration of Condominium
or the policies.

I. FLOOR, WALL & CEILING COVERINGS:
If docs are written prior to Oct. 1, 1986 and the Casualty Insurance section includes the word
BUILDING or STRUCTURE and does not specifically back out the responsibility for the floor, wall
and ceiling coverings, or have not been specifically amended, the Association insurance provides
the primary coverage for initially installed coverings or coverings of like, kind and quality; the Unit
Owners insurance provides coverage for upgrades.

If docs are written after Oct. 1, 1986, regardless if the words BUILDING or STRUCTURE are
included in the Casualty Insurance section BUT not specifically named as being covered by the
association policy, then the Unit Owners insurance provides primary coverage.

II. ELECTRICAL FIXTURES, APPLIANCES, HEATING & AIR CONDITIONING EQUIPMENT,
WATER HEATER, AND BUILT-IN CABINETS:
Primary coverage falls under Unit Owners policies provided the items are located within the unit
and the Maintenance Section holds the Unit Owners responsible to repair, maintain or replace
the items.

Exception: Exterior mounted air compressors are covered under the Unit Owners policies since
they are an integral part of the HVAC system whose other integral parts are located within the
unit.

III. STORM SHUTTERS:
Storm shutters mounted on an exterior exposure of the building (or balcony) are covered under
the Association policy.

Storm shutters mounted on an interior exposure of the building (or balcony) are covered under
the Unit Owner policies.

If shutters are specifically addressed in the Casualty section, it will take precedence over these
guidelines.

IV. LARGE DEDUCTIBLES:
When casualty insurance responsibility rests on the Association and the loss is less than the
deductible, that amount which falls under the deductible cannot be transferred to the Unit Owner
claim. The Unit Owner policies provide excess coverage only when the Association policy limits
have been exhausted. In the event that the Association assesses unit owners for the deductible,
the unit owner policy does provide coverage up to the $1,000 limit under the Loss Assessment
portion of the policy. Loss Assessment issues are discussed elsewhere in this Guide.

The above guidelines reflect legal opinions gathered from various law firms and are supported by the FAIA
and the Bureau of Condominiums.

FLORIDA CONDOMINIUM STATUTE EXCERPT

Chapter 718.111 CONDOMINIUMS F.S. 1997

(11) INSURANCE

(B) EVERY HAZARD POLICY WHICH IS ISSUED TO PROTECT A CONDOMINIUM
BUILDING SHALL PROVIDE THAT THE WORD BUILDING WHEREVER USED IN
THE POLICY INCLUDE, BUT NOT NECESSARILY BE LIMITED TO, FIXTURES,
INSTALLATIONS, OR ADDITIONS COMPRISING THAT PART OF THE BUILDING
WITHIN THE UNFINISHED INTERIOR SURFACES OF THE PERIMETER WALLS,
FLOORS, AND CEILINGS OF THE INDIVIDUAL UNITS INITIALLY INSTALLED, OR
REPLACEMENTS THEREOF OF LIKE KIND OR QUALITY, IN ACCORDANCE WITH
THE ORIGINAL PLANS AND SPECIFICATIONS, OR AS THEY EXISTED AT THE
TIME THE UNIT WAS INITIALLY CONVEYED IF THE ORIGINAL PLANS AND
SPECIFICATIONS ARE NOT AVAILABLE. HOWEVER, UNLESS PRIOR TO
OCTOBER 1, 1986, THE ASSOCIATION IS REQUIRED BY DECLARATION TO
PROVIDE COVERAGE THEREFORE, THE WORD BUILDING DOES NOT INCLUDE
UNIT FLOOR COVERINGS, WALL COVERINGS, OR CEILING COVERINGS, AND,
AS TO CONTRACTS ENTERED INTO AFTER JULY 1, 1992, DOES NOT INCLUDE
THE FOLLOWING EQUIPMENT IF IT IS LOCATED WITHIN A UNIT AND THE UNIT
OWNER IS REQUIRED TO REPAIR OR REPLACE SUCH EQUIPMENT: ELECTRICAL
FIXTURES, APPLIANCES, AIR CONDITIONER OR HEATING EQUIPMENT, WATER
HEATERS, OR BUILT-IN CABINETS. WITH RESPECT TO THE COVERAGE

PROVIDED FOR BY THIS PARAGRAPH, THE UNIT OWNERS SHALL BE
CONSIDERED ADDITIONAL INSUREDS UNDER THE POLICY.

(C) EVERY INSURANCE POLICY ISSUED TO AN INDIVIDUAL UNIT OWNER SHALL
PROVIDE THAT THE COVERAGE AFFORDED BY SUCH POLICY IS EXCESS OVER
THE AMOUNT RECOVERABLE UNDER ANY OTHER POLICY COVERING THE SAME
PROPERTY WITHOUT RIGHTS OF SUBROGATION AGAINST THE ASSOCIATION.

M O B I L E H O M E C L A I M S
MOBILE HOME TOTAL LOSS CLAIMS
Citizens insures a large number of mobile homes in various coastal regions of Florida. In many areas,
mobile homes serve primarily as seasonal homes. In other areas, mobile homes provide affordable
housing for individuals and families. Major storm events or daily fires can result in large numbers of claims
for damage to these mobile homes. A high percentage of Citizens mobile home claims may involve total or
near-total losses. As such, these claims present special issues to be addressed by the Claims
Representative handling them. This section of the Citizens Claims Guideattempts to address some of
those issues.

Due to the increased demands of claims processing under the Florida Valued Policy Law and statutes
involving mobile homes and salvage, it is highly recommended that specific examiners handle only mobile
home claims. There are issues with how different policies and policy language affect the adjustment of
mobile home claims and are paramount to accurate and efficient closure of claims. It is very difficult to
effectively adjust mobile home claims and dwelling claims utilizing the same examiner.

APPLICABLE FLORIDA STATUTES
Two Florida Statutes are of particular importance in the handling of mobile home total loss claims. They
are (1) Florida Statute 319.30(3), which pertains to Salvage Titles; and (2) the Valued Policy Law as
stated in Florida Statute 627.702. Copies of both are included herein as attachments.

Salvage Titles. Section 319.30(3)2(b), Florida Statutes, prescribes that an insurance company which pays
money as compensation for the total loss of a mobile home shall forward the certificate of title to the
Department of Revenue of the State of Florida within seventy two (72) hours after receiving such certificate
of title. The Department must issue a certificate of destruction before the Insurance Company can dispose
of the mobile home.

However, Section 319.30(3)(a)1. of the same statute states that the mobile home does not need to be
disposed if the insurance company and owner agree to repair rather than replace. Insureds often fail to
carry enough insurance to replace their homes. In such instances, reaching an agreement to repair, rather
than replace, the mobile home eliminates the need for Citizens to take the certificate of title and possibly
render the insured homeless. A Policyholders Release/Settlement Agreement/Election to Repair is
included in this section to be utilized in such a scenario.

The Valued Policy Law. Florida Statute 627.702 requires that Citizens pay the policy limit if the mobile
home is rendered a total loss. If the mobile home is rendered a total loss by a combination of perils (wind
and flood, for example), Citizens must contribute its fair share to a point where either the insured has been
paid the ACV of the home from both insurance carriers or up to the Citizens limit of insurance on that
particular mobile home. The ACV of the home governs the full amount of settlement from the applicable
insurance carriers (presumably wind and flood). Please see the examples below.

For both examples, assume that an insured has a Windstorm policy and a Flood policy with the
following limits:
CITIZENS POLICY: $40,000
FLOOD POLICY: $40,000

The insured suffers a total loss to the mobile home. Both perils are determined to have contributed equally.
The ACV of the unit is established as $50,000. In this instance, Citizens would pay its pro rata share of the
ACV (not of its limit of insurance), or $25,000. Likewise, Citizens would expect the flood carrier to do the
same, although that decision rests solely with the flood carrier.

Assume the same scenario as above except that it is determined that the peril of flood contributed seventy
five percent (75%) to the total loss of the mobile home, and the peril of wind contributed twenty five percent
(25%) to the total loss of the mobile home. Citizens in this example would pay twenty five percent (25%) of
$50,000, or $12,500 [not twenty five percent (25%) of $40,000].

In both examples above, since the insureds loss from the peril of wind did not exceed the windstorm
policys limit of insurance, the policy deductible would apply.

DETERMINATION OF ACV

Mobile homes insured under a DW2 policy are settled at Actual Cash Value. Other mobile home policy
forms may have Replacement Cost Settlement provisions added as an endorsement. Refer to the
appropriate policy form for details. Citizens must subscribe to the Broad Evidence Rule. It requires that all
relevant factors be considered when determining ACV. Square foot calculations can not be the sole source
at determining value. Other factors may include, but are not limited to, market value, area and location,
improvements, quality and condition.

The NADA Manufactured Housing Appraisal Guide offers the most detailed, comprehensive consideration
of all these factors, including a local market adjustment on the mobile home park, itself. The intent of the
guide is to give the Claims Examiner a tool to develop an accurate valuation of the mobile home. It
specifically speaks to other important variables that may impact value, including a Community Adjustment
Section. It also provides an Additional Adjustment Section, allowing the Claims Examiner to input any
additional modifiers. We believe that its values will satisfactorily address our total loss claims better than
any other system.

Illustration: Place a $20,000 mobile home in a desirable retirement community, perhaps on a waterfront
lot, and add $10,000 in additions and improvements, and it may become a $60,000 home instead of a
$30,000 one as simple mathematics would suggest. This figure does not consider the land value. Stated
differently, if the insured could have sold the mobile home the day before the loss for $60,000, that figure is
the ACV regardless of its stated value in the NADA book.

Mobile homes are on rental lots as well as on land owned by the insured. If the insured owns the land on
which the mobile home is located, one method of establishing the ACV is to determine what the whole
property would have sold for before the loss and what the land alone will sell for after the loss. The
difference should be the ACV of the mobile home. Furthermore, in areas such as retirement communities,
mobile homes change ownership frequently. Specific real estate agents in a given community specialize in
the resale of these mobile homes and are very familiar with their values. They often can be of assistance in
gathering the documentation necessary to determine ACV.


MOBILE HOME SALVAGE

The examiner is responsible for obtaining a valid Florida title in the insureds name, a Power of
Attorney, and a Debris Removal Release from the insured when the property has been deemed a total
loss, and the insured does not choose to repair. If a lien holder (or mortgagee) has the title, the examiner
still must obtain the Power of Attorney and Debris Removal Release. The examiner must draft and send a
letter of guarantee to the lien holder (and insured) stating the requirements under the salvage title law and
advise that Citizens cannot comply until the lien holder sends the title to the examiner with the lien released
with a guarantee of payment. This letter will also advise the insured and/or the lien holder that Citizens will
not be responsible for compliance with the salvage title law if the title is not released promptly.
Furthermore, the examiner cannot assist with salvage/debris removal until the clear title is received.

The examiner will request the indemnity payment for the mobile home jointly to the insured and lien holder
once the letter of guarantee from the lien holder is in hand. The examiner will promptly send the indemnity
payment to the insured.

When the examiner receives the clear title, Power of Attorney and Debris Removal Release they will apply
to the State for a conversion of the title to a Certificate of Destruction in accordance with the state statute
referenced. If the lien holder or the insured does not comply with the request to forward the title or other
documents in a reasonable time frame, a letter will be sent to the State with a copy to the insured and lien
holder notifying the state of the total loss mobile home and that Citizens cannot comply with the salvage
title statue until the clear title is received.

Duty of Adjuster:

Identify and understand correct policy and coverage
Scope and prepare an accurate estimate of all storm related damages
Diagram the mobile home and identify any and all additions including outbuildings
Photo documentation
Complete the Mobile Home Checklist
Address any contents or ALE possibilities on the claim before submitting to examiner

Duty of Claims Examiner:

Verify that claim file contains required adjuster documentation
Identify policy and review estimate for accuracy with the policy; compare documented damage with
photos provided
Verify documentation, and percentage of the loss to ACV.

When the loss exceeds 80% of the ACV, prepare and send out an options letter with appropriate forms,
(Election to Repair, Power of Attorney, Debris Removal).
Hold the file open for return of forms, and process according to option desired by insured.


OPTION 1 Total Loss:

1. Examiner receives Original Title(s) in insureds name, completed Power of Attorney and completed
Debris Removal Release.

2. On receipt of documents, draft payment letter to insured and issue policy limit payment for
coverage A Building to insured. Insured should be contacted to address that salvage will be
scheduled for removal after company receipt of Certificate of Destruction.

3. Process Title(s) document into a Certificate of Destruction through authorized title company.

4. Contact authorized salvage company, assign Certificate of Destruction to salver and request that
salver contact insured and set appointment.

5. On completion of salvage, verify removal (through before and after photos provided) and issue
payment to salvage company through expense payment request.

6. Close claim with payment to salver, and title company.

OPTION 2 Total Losses with Election to Repair

Once Election to Repair document is received, process claims payment for coverage A Building policy limit.
Close file once the payment is issued. The Election to Repair form identifies the insureds responsibilities
and no further disclosure to the State is required. At this point, underwriting must be notified of the
insureds decision to repair the mobile home.


FLORIDA STATUTES
(partial and edited)

319.30 DEFINITIONS; DISMANTLING, DESTRUCTION, CHANGE OF IDENTITY OF MOTOR VEHICLE
OR MOBILE HOME; SALVAGE.

(3) (A) AS USED IN THIS SECTION, A MOTOR VEHICLE OR MOBILE HOME IS A TOTAL LOSS:

1. WHEN AN INSURANCE COMPANY PAYS THE VEHICLE OWNER TO REPLACE THE WRECKED OR
DAMAGED VEHICLE WITH ONE OF LIKE KIND AND QUALITY OR WHEN AN INSURANCE COMPANY
PAYS THE OWNER UPON THE THEFT OF THE MOBILE HOME; A MOBILE HOME SHALL NOT BE
CONSIDERED A TOTAL LOSS IF THE INSURANCE COMPANY AND THE OWNER AGREE TO REPAIR,
RATHER THAN TO REPLACE, THE MOBILE HOME; OR

(B) THE OWNER OF ANY MOBILE HOME WHICH IS CONSIDERED TO BE SALVAGE SHALL, WITHIN
SEVENTY TWO (72) HOURS AFTER THE MOBILE HOME BECOMES SALVAGE, FORWARD THE TITLE TO
THE MOBILE HOME TO THE DEPARTMENT FOR PROCESSING. HOWEVER, AN INSURANCE COMPANY
WHICH PAYS ONLY AS COMPENSATION FOR TOTAL LOSS OF A MOBILE HOME SHALL OBTAIN THE
CERTIFICATE OF TITLE FOR THE MOBILE HOME AND, WITHIN SEVENTY TWO (72) HOURS AFTER
RECEIVING SUCH CERTIFICATE OF TITLE, SHALL FORWARD SUCH TITLE TO THE DEPARTMENT FOR
PROCESSING. THE OWNER OR INSURANCE COMPANY, AS THE CASE MAY BE, MAY NOT DISPOSE OF
A ... MOBILE HOME THAT IS A TOTAL LOSS BEFORE IT HAS OBTAINED A SALVAGE CERTIFICATE OF
TITLE FROM THE DEPARTMENT. WHEN APPLYING FOR A SALVAGE CERTIFICATE OF TITLE, THE
OWNER OR INSURANCE COMPANY MUST PROVIDE THE DEPARTMENT WITH AN ESTIMATE OF THE
COSTS OF REPAIRING THE PHYSICAL AND MECHANICAL DAMAGE SUFFERED BY THE VEHICLE FOR
WHICH A SALVAGE CERTIFICATE OF TITLE IS SOUGHT. IF THE ESTIMATED COSTS OF REPAIRING
THE PHYSICAL AND MECHANICAL DAMAGE TO THE VEHICLE IS EQUAL TO EIGHTY PERCENT (80)
PERCENT OR MORE OF THE CURRENT RETAIL COST OF THE VEHICLE, AS ESTABLISHED IN ANY
OFFICIAL ... USED MOBILE HOME GUIDE, THE DEPARTMENT SHALL DECLARE THE VEHICLE
UNREBUILDABLE AND PRINT NOTICE ON THE SALVAGE CERTIFICATE OF TITLE THAT THE VEHICLE IS
UNREBUILDABLE; AND, THEREAFTER, THE DEPARTMENT SHALL REFUSE ISSUANCE OF ANY
CERTIFICATE OF TITLE FOR THAT VEHICLE. NOTHING IN THIS SUBSECTION SHALL BE APPLICABLE
WHEN A VEHICLE IS WORTH LESS THAT $1,500 RETAIL IN UNDAMAGED CONDITION IN ANY
OFFICIAL USED ... USED MOBILE HOME GUIDE ... .

627.702 VALUED POLICY LAW.

(1) IN THE EVENT OF THE TOTAL LOSS OF ANY BUILDING, STRUCTURE, MOBILE HOME AS DEFINED
IN 320.01(2), OR MANUFACTURED BUILDING AS DEFINED IN 553.36(11), LOCATED IN THIS
STATE AND INSURED BY ANY INSURER TO A COVERED PERIL IN THE ABSENCE OF ANY CHANGE
INCREASING THE RISK WITHOUT THE INSURERS CONSENT AND IN THE ABSENCE OF FRAUDULENT
OR CRIMINAL FAULT ON THE PART OF THE INSURED OR ONE ACTING IN HER OR HIS BEHALF, THE
INSURER'S LIABILITY, IF ANY, UNDER THE POLICY FOR SUCH TOTAL LOSS SHALL BE IN THE AMOUNT
OF MONEY FOR WHICH SUCH PROPERTY WAS SO INSURED AS SPECIFIED IN THE POLICY AND FOR
WHICH A PREMIUM HAS BEEN CHARGED AND PAID.

(2) IN THE CASE OF PARTIAL LOSS BY FIRE OR LIGHTNING OF ANY SUCH PROPERTY, THE
INSURERS LIABILITY, IF ANY, UNDER THE POLICY SHALL BE FOR THE ACTUAL AMOUNT OF SUCH
LOSS BUT SHALL NOT EXCEED THE AMOUNT OF INSURANCE SPECIFIED IN THE POLICY AS TO SUCH
PROPERTY AND SUCH PERIL.

(3) THE PROVISIONS OF SUBSECTIONS (1) AND (2) DO NOT APPLY WHEN:
(A) INSURANCE POLICIES ARE ISSUED OR RENEWED BY MORE THAN ONE COMPANY INSURING
THE SAME BUILDING, STRUCTURE, MOBILE HOME, OR MANUFACTURED BUILDING, AND THE
EXISTENCE OF SUCH ADDITIONAL INSURANCE IS NOT DISCLOSED BY THE INSURED TO ALL
INSURERS ISSUING SUCH POLICIES;

(B) TWO OF MORE BUILDINGS, STRUCTURES, MOBILE HOMES, OR MANUFACTURED BUILDINGS
ARE INSURED UNDER A BLANKET FORM FOR A SINGLE AMOUNT OF INSURANCE; OR

(C) THE COMPLETED VALUE OF A BUILDING, STRUCTURE, MOBILE HOME, OR MANUFACTURED
BUILDING IS INSURED UNDER A BUILDER'S RISK POLICY.

(4) THE AMOUNT OF ANY LOSS REFERRED TO IN SUBSECTION (1) OR SUBSECTION (2) SHALL BE
SUBJECT TO ANY COINSURANCE CLAUSE CONTAINED IN THE POLICY PURSUANT TO S. 627.701.
(5) THIS SECTION DOES NOT APPLY AS TO PERSONAL PROPERTY OR ANY INTEREST THEREIN,
EXCEPT WITH RESPECT TO MOBILE HOMES AS DEFINED IN S. 320.01(2) OR MANUFACTURED
BUILDINGS AS DEFINED IN S. 553.36(11). NOR DOES THIS SECTION APPLY TO COVERAGE OF AN
APPURTENANT STRUCTURE OR OTHER STRUCTURE OR ANY COVERAGE OF CLAIM IN WHICH THE
DOLLAR AMOUNT OF COVERAGE AVAILABLE AS TO THE STRUCTURE INVOLVED IS NOT DIRECTLY
STATED IN THE POLICY AS A DOLLAR AMOUNT SPECIFICALLY APPLICABLE TO THAT PARTICULAR
STRUCTURE.
(6) WITH REGARD TO MOBILE HOMES INCLUDED IN SUBSECTION (1), ANY TOTAL LOSS SHALL BE
ADJUSTED ON THE BASIS OF THE AMOUNT OF MONEY FOR WHICH SUCH PROPERTY WAS INSURED
AS SPECIFIED IN THE POLICY, WHETHER ON AN ACTUAL CASH VALUE BASIS, REPLACEMENT COST
BASIS OR STATED AMOUNT, AND FOR WHICH A PREMIUM HAS BEEN CHARGED AND PAID ONLY IF
THE INSURED HAS ELECTED TO PURCHASE SUCH COVERAGE AT THE INCEPTION OF THE POLICY.
HOWEVER, WHEN COVERAGE IS WRITTEN FOR A MOBILE HOME ON ANY BASIS OTHER THAN STATED
VALUE, A COMPETE DISCLOSURE OF THE RELATIVE COST BETWEEN THAT POLICY AND THE STATED
VALUE POLICY SHALL BE MADE TO THE INSURED ON A FORM AND IN A FORMAT APPROVED BY THE
DEPARTMENT. SUCH FORMS SHALL DISCLOSE AND DESCRIBE THE DIFFERENCES BETWEEN THE
TYPES OF POLICIES AND SHALL BE SIGNED BY THE INSURED. COPIES SHALL BE MAINTAINED IN
THE INSURERS FILE, AND A COPY SHALL BE MADE AVAILABLE TO THE INSURED. EACH INSURER
LICENSED TO WRITE INSURANCE COVERING MOBILE HOMES SHALL MAKE SUCH STATED VALUE
COVERAGE AVAILABLE AT THE OPTION OF THE INSURED.
(7) NOTHING HEREIN SHALL BE CONSTRUED AS PROHIBITING AN INSURER FROM REPAIRING OR
REPLACING DAMAGED PROPERTY AT ITS OWN EXPENSE AND WITHOUT CONTRIBUTION ON THE PART
OF THE INSURED EXCEPT, AS PROVIDED IN SUBSECTION (6), WHEN AN INSURED HAS ELECTED TO
PURCHASE STATED VALUE COVERAGE, SUCH REPAIR OR REPLACEMENT OF DAMAGED PROPERTY
SHALL BE IN LIEU OF ANY LIABILITY CREATED BY SUBSECTION (1); AND ANY INSURER SO
REPAIRING OR REPLACING SHALL HAVE NO LIABILITY PURSUANT TO SUBSECTION (1), PROVIDED
SUCH INSURER RETURNS TO THE NAMED INSURED A PORTION OF THE PREMIUM, FOR ALL POLICY
TERMS DURING WHICH THE POLICY LIMITS WERE THE SAME AS THOSE IN EFFECT ON THE DATE ON
WHICH THE LOSS OCCURRED, EQUAL TO THAT PORTION OF THE PREMIUM PAID FOR THE LIMITS OF
INSURANCE ON THE STRUCTURE IN EXCESS OF THE COST OF REPLACEMENT.
(8) ANY PROPERTY INSURER MAY, BY AN APPROPRIATE RIDER OR ENDORSEMENT OR OTHERWISE,
PROVIDE INSURANCE INDEMNIFYING THE INSURED FOR THE DIFFERENCE BETWEEN THE INSURABLE
VALUE OF THE INSURED PROPERTY AT THE TIME ANY LOSS OR DAMAGE OCCURS, AND THE AMOUNT
ACTUALLY EXPENDED TO REPAIR, REBUILD, OR REPLACE WITHIN THIS STATE, WITH NEW
MATERIALS OF LIKE SIZE, KIND, AND QUALITY, SUCH PROPERTY AS HAS BEEN DAMAGE OR
DESTROYED.


OPTIONS LETTER
Date:

Insured Name:
Insured Address:

Loss Address:

RE: Citizens Policy Number: 1217013
Citizens Claim Number: CO188729
Date of Loss: 09/25/2004

Dear Policyholder:

This letter is to inform you that the results of our inspection of the damages to your mobile home in regards
to the above captioned matter reveal that the unit has been determined to be a Total Loss.

You are entitled to collect the benefit of the Limit of Liability under your Coverage A in the amount of
_____________ less any advance or prior payments. Prior to releasing payment, we need you to make the
decision as to which of the following settlement options that you wish to pursue:

Option #1

Election to Repair: This option allows you to retain possession of your mobile home and collect the
Coverage a limit as noted above.

In order to initiate this option, we will need you to:

1. Sign and notarize the attached Election to Repair form and return this original document to us.
2. You will be responsible for taking the title(s) to the DMV and having the title(s) Branded on your
mobile home.
3. You must understand by selecting this option, the Branding of the Title will become part of
the vehicles history.
You should be aware that to get insurance again when you elect to Repair, you have to:

1. Complete the repairs
2. Have the unit re-inspected.
3. Most counties in Florida will require the mobile home be brought up to code in the completion
of said repairs.

Option #2

Total Loss No repair: This option will require that you release the unit to Citizens Insurance Company.
You will then be paid the limit of your Coverage A mentioned above.
If wish to proceed with the total loss settlement and release the salvage to Citizens, then we will need to
secure the following items from you:

1. Power of attorney (Signed and notarized)
2. Debris Removal Release (Signed and notarized)
3. The Original Title(s)
a. One title if a single wide
b. Two titles if a double wide
c. Three titles if a triple wide

We have attached the aforementioned documents to this correspondence for your convenience. Please
return the items called for under the settlement option you wish to pursue.

Please be advised of the Florida statutes regarding total loss payments:

Section 319.30(3)(a)(1) Florida Statutes, provides that a motor vehicle or mobile home is a total loss when
an insurance company pays the motor vehicle owner to replace the wrecked or damage motor vehicle with
one of like kind and quality or when an insurance company pays the owner upon the theft of the motor
vehicle or motor home. This includes all motor vehicles and mobile homes regardless of the year or make.

Section 319.30(3)(a)(2), Florida Statutes, states, A motor vehicle or mobile home shall not be considered a
total loss if the insurance company and owner of a motor vehicle or mobile home agree to repair, rather
than to replace, the motor vehicle or mobile home. However, if the actual cost to repair the motor vehicle or
mobile home to the insurance company exceeds 100 percent of the cost of replacing the wrecked or
damaged motor vehicle or mobile home with one of like kind and quality, the owner shall forward to the
department, within 72 hours after the agreement, a request to brand the certificate of title with the words
Total Loss Vehicle. Such a brand shall become part of the vehicles title history.

Section 319.30(3)(b), Florida Statutes, requires an insurance company which pays money as compensation
for total loss of a motor vehicle or mobile home to obtain the certificate of title for the motor vehicle or
mobile home and, within 72 hours after receiving such certificate of title forward it to the Department of
Highway Safety and Motor Vehicles for processing. Application for a salvage certificate of title or certificate
of destruction must be made by the insurance company. The vehicle identification number plate must
remain on the vehicle. Vehicles worth less than $1,500 retail in undamaged condition as listed in any official
used car guide are exempt from the provisions of the law.

Should you have any questions or information contrary to these findings, please contact the undersigned.

Sincerely,

File Examiner Name
Citizens Property Insurance Co.
Large Loss/Mobile Home Unit
(866) 858-0649, Ext. ####
(866) 858-0642 Facsimile

Attachments:
1. Election to Repair form
2. Power of Attorney
3. Debris Release form
4. Self-addressed stamped envelope


15 DAY LETTER
Date: ______________________

Insured: ____________________________
Address: ____________________________
___________________________________

Property Address: ________________________________________________

RE: Citizens Policy Number:
Citizens Claim Number:
Date of Loss:

Dear Policyholder:

We have completed the adjustment process for your claim and have determined that your mobile home is a
total loss. We have one more responsibility to fulfill prior to issuing the payment to finalize the file.
Accordingly, please find enclosed within the body of this letter a copy of the Florida Statute governing
disposition of the title when a mobile home is declared a total loss.

If you have the title in your possession, please return it to us with the completed Power of Attorney

If there is a lien, please arrange for the lien holder to release the lien and forward the title to us. In that
case you must also sign the enclosed Power-of-Attorney so that we may execute the title on your
behalf.

If the lien holder is out of town, to expedite the matter, we suggest that you sign the Power-of-Attorney
and forward it to the lien holder. Please ask the lien holder to forward the title with the lien released
and Power-of-Attorney to our office.

If the insurance company and owner of a motor vehicle or mobile home agree to repair, rather than to
replace, the motor vehicle or mobile home then complete the enclosed Election-to-Repair form and
return it to us for processing. No other documentation is required.
ction 319.30(3)(a)(2), Florida Statutes, states, "A motor vehicle or mobile home shall not be considered a
"total loss" if the insurance company and owner of a motor vehicle or mobile home agree to repair, rather


Section 319.30(3)(a)(1) Florida Statutes, provides that a motor vehicle or mobile home is a "total loss"
when an insurance company pays the motor vehicle owner to replace the wrecked or damage motor
vehicle with one of like kind and quality or when an insurance company pays the owner upon the theft of
the motor vehicle or motor home. This includes all motor vehicles and mobile homes regardless of the year
or make.

Se

ds
r total loss of a motor vehicle or mobile home to obtain the certificate of title for the motor vehicle or
icate

ust place responsibility on you and/or your lien
older for compliance with this salvage title law. Also, we cannot assist in removal of your salvage mobile

________
department, within 72 hours after the agreement, a request to brand the certificate of title with the wor
"Total Loss Vehicle." Such a brand shall become part of the vehicle's title history.

ection 319.30(3)(b), Florida Statutes, requires an insurance company which pays money as compensation S
o f
Highway Safety and Motor Vehicles for processing. Application for a salvage certificate of title or certif

If we do not hear from you within fifteen (15) days, we m
h
home until we have a lien-free title.

Very truly yours,

djuster: _________________________________ A


TOTAL LOSS SETTLEMENT LETTER

Date: ______________

Insured: _______________________
Address: _______________________
______________________________

Loss Address: ______________________________________

RE: Citizens Policy Number:
Citizens Claim Number:
Date of Loss:

Dear Policyholder:

This letter is in response to the above-referenced Total Loss Mobile Home claim filed with our office.

Enclosed is our payment in the amount of $_______________. The drafts represent payment for:

Item Building APS Contents

Amount of Loss
Less Recoverable Depreciation
Less Non-Recoverable Depreciation
Less Deductible
Less Advances

ACV Amount Paid

The payment for your Coverage A loss may include the name of your mortgagee or lien holder in
accordance with policy conditions. You may wish to contact your mortgagee or lien holder to determine the
proper procedure for negotiating this payment.


Section 319.30(3)(a)(1) Florida Statutes, provides that a motor vehicle or mobile home is a "total loss"
when an insurance company pays the motor vehicle owner to replace the wrecked or damage motor
vehicle with one of like kind and quality or when an insurance company pays the owner upon the theft of
the motor vehicle or motor home. This includes all motor vehicles and mobile homes regardless of the year
or make.
Section 319.30(3)(a)(2), Florida Statutes, states, "A motor vehicle or mobile home shall not be considered a
"total loss" if the insurance company and owner of a motor vehicle or mobile home agree to repair, rather

department, within 72 hours after the agreement, a request to brand the certificate of title with the words
"Total Loss Vehicle." Such a brand shall become part of the vehicle's title history.

Section 319.30(3)(b), Florida Statutes, requires an insurance company which pays money as compensation
for total loss of a motor vehicle or mobile home to obtain the certificate of title for the motor vehicle or
Highway Safety and Motor Vehicles for processing. Application for a salvage certificate of title or certificate

Please feel free to contact this office should you have any questions.

Sincerely,

Adjuster: ________________________


ELECTION TO REPAIR

Name of Mobile Homeowner: ___________________________

Mobile Homeowners Address: ___________________________
___________________________

Citizens Policy: _____________________
Claim Number: _____________________ Occupancy: __________________ Use:
_________________

Date of Loss: __________________ Physical address of Loss: _______________________________
________________________________

The Undersigned secured party (_______________________________), as the Owner of that certain
mobile home unit above-described, which has been damaged by windstorm and for which the Insured has
made a claim for damage coverage under the policy of insurance above-described.
(_____________________________________), does hereby confirm his/her/their election to receive and
accept proceeds under the policy to be used and applied towards payment of cost repair of the unit as a full
and complete settlement under the policy and agrees to the following terms:

1. Settlement Amount: The total amount to be paid by: Citizens Insurance to the Insured under the
Policy for the subject casualty loss and damage is the Settlement Sum stated below:

Settlement Sum: $____________________________

The amount above-stated is being paid by: Citizens Insurance to the Insured and accepted by Insured for
the use and application towards cost and repair pursuant to Florida Statute section 319.30(2) (a).

2. Repair: The undersigned Insured accepts the Settlement Sum above-stated for application to towards
cost to repair damage to the unit. It should be the responsibility of the undersigned to cause any and all
repairs to be made and to pay for such costs without any additional contribution from: Citizens Insurance
under the insurance coverage of the policy.

3. Release: Upon receipt of the Settlement Sum above-stated, the undersigned Insured shall thereupon
be deemed to have fully released and discharged : Citizens Insurance under the Policy from any and all
further claims pertaining to the loss herein above described, except and excluding any claim which the
insured may have, if any, pertaining to coverage under the policy for loss or damage to unscheduled
personal property and/or additional living expense incurred prior to the executed date of this document.


Please Note: If the cost of repairs exceeds the actual cash value, the mobile home owner will be
required to process the mobile home title with the Department of Highway Safety and Motor
Vehicles pursuant to FS319.30(3)(a)2.

_________________________
Insured/Homeowner

Executed by Homeowner this _____ day of ____________, 200_.

State of Florida
County of __________. Sworn to and subscribed before me this _________ day, ________ A.D.,
200_.
____________________________
____________________________
My commission expires: ______________________
Notary Public


DEBRIS RELEASE
DATE

Insured___________________
Address: __________________
_________________________

RE: Claim Number :
Date of Loss :

Dear Policyholder:

This letter is to confirm the damage to your property and the resulting debris removal. Citizens
Property Insurance Corporation had contracted _________________, Inc. to remove and dispose of
the damaged mobile or manufactured home debris from the insured location. We anticipate this
removal process will commence in the very near future.

Please be advised that you should remove all desired personal property items from the home. All
remaining contents and home debris will be scheduled to be removed and disposed of by Citizens
Property Insurance. Any personal property remaining in the home at the time of the removal will be
disposed.

By signing below, you are indicating that you are aware that the mobile home is being scheduled to be
removed and that you have removed all desired personal property items from the home. No further
notice will be given about the removal once the title has been transferred into a certificate of destruction
and the debris is scheduled for removal. Please return this form once you are ready to have the debris
scheduled to be removed.

If you have any questions or concerns about this process, please do not hesitate to call me.

Sincerely,
_________________________________________
Signature of Insured
_________________________________________
Claims Adjuster Sworn to (or affirmed) and subscribed before me this ___
day of __________, 20__, by (name of person making statement).
STATE OF _________________________COUNTY OF _______________________
__________________________________________________
(Signature of Notary Public-State of Florida) Name of Notary Typed, Printed, or Stamped
(NOTARY SEAL)
Personally Known ___ OR Produced Identification ___Type of Identification _________ ______________


TOTAL LOSS INFORMATION SHEET

Dear ____________

Title:

Please process the described loss into a Certificate of Destruction for Citizens Property Insurance
Corporation, 7077 Bonneval Rd., Ste. 500, Jacksonville, FL 32216, and forward the Certificate of
Destruction to the Examiner and address shown below.

Claim Number:

Policy Number:

Insured Name:

Vehicle Description:

VIN:

Address of the Loss:
(Include Zip Code)

Cost of Repair:

Actual Cash Value:

Date of Loss:

Title Lost. Please process per T04-10

Please return the Certificate of Destruction (ATTACH A COPY OF THIS FORM TO THE
CERTIFICATE), along with billing information, to the address shown below:

Citizens Property Insurance
ATT: Mobile Home Unit
2100 Centerville Rd.
Suite A
Tallahassee, FL 32308


INFORMATION TO LIEN HOLDER

Date: ___________

RE : Citizens Insured : _______________________

Citizens Claim Number : _______________________

Your Account Holder : _______________________

Account Number : _______________________

The above-referenced Citizens insured has presented a claim involving the mobile home for which you are
he lien holder of record. The mobile home has been declared a total loss. t

Attached is a letter of guarantee providing that, upon receipt of the insurance proceeds, you will forward the
title and release of lien directly to Citizens. Please complete this form and return it to our office. We must
ave the completed form prior to releasing payment. h

If you have any questions, please do not hesitate to contact our office at _______________.

Very truly yours,

__________________
Claims Adjuster

Department of Motor Vehicles
Neil Kirkman Building
Tallahassee, Florida 32399-0500

RE: Mobile Home Title

Citizens Claim No. : ___________________
Lien Holder : ___________________

To Whom It May Concern:

Please be advised that we paid a total loss of $ amount paid to our insureds and lien holder on date
2004.

We have sent several letters to lien holder and have made several telephone calls to try to obtain the
Certificate of Title to this unit so that we can comply with the Florida Statute concerning salvage titles. As
of this date, however, we have not received the title to this mobile home.

Please be advised that this mobile home, description under Title Number ___________ is a total
loss, but a salvage title cannot be obtained at this time as the lien holder will not release the title. We have
no choice but to close our file at this time.

Very truly yours,

_________________
Claims Adjuster

cc:

Lien Holder
Address line 1
Address line 2
City, __________State__________ZIP_____________


M E D I A T I O N , A P P R A I S A L A N D C I V I L R E M E D Y

The following section gives an overview of the Citizens Disputed Claim Unit (DCU), which handles all
matters related to the Florida Civil Remedy Statute. These include formal DFS complaints, Mediation, and
Appraisal. A more detailed explanation of the roles and responsibilities of the Mediation/Appraisal
Examiner can be found in Appendix A Mediation and Appraisal Procedures.
CIVIL REMEDY NOTICES
Civil Remedy refers to claims in which the insured and/or his/her representative has filed a formal complaint
with the Florida Department of Financial Services (DFS). This complaint is filed using the form DI4-363,
revised 11/1999. On the form, the complainant, being the insured, attorney or public adjuster, are to list the
statutes allegedly violated and the specific language of the statute; list the specific policy language that is
relevant to the violations; and describe the circumstances leading to the violations.

When the DFS accepts the request as a valid complaint, it sends a letter of notification to the insurer listing
the complainant, insured name, policy number, claim number, DFS file number, and the acceptable date.
From this acceptable date, the insurer has, by statute 624.155(2)(a), sixty (60) days to resolve the
complaint and file an answer describing the disposition of the claim to the DFS. A copy of this answer
should be sent to the complainant.

If the complaint is not settled in the sixty (60) day window, the insurer can be subject to attorney fees and if
an award of more than policy limits is awarded in legal proceedings, the insurer is required to pay the
amount over policy limits, attorney fees and interest from the date suit was filed. Although it is normally
difficult to prove, the insurer could be held in bad faith.
Specific Authority 624.308, 626.878, 626.9611 FS. Law Implemented 624.307(1), 626.611, 626.621,
626.865(2), 626.878, 626.9541(1)(i) FS. HistoryNew 6-2-93, Amended 12-18-01.
CHAPTER 4-123 CIVIL REMEDY
4-123.001 PURPOSE.
THE PURPOSE OF THIS CHAPTER IS TO ESTABLISH PROCEDURES REGARDING THE
CIVIL REMEDY PERMITTED BY SECTION 624.155, FLORIDA STATUTES.
SPECIFIC AUTHORITY 624.308(1) FS. LAW IMPLEMENTED 624.155, 624.307(1) FS.
HISTORYNEW 4-25-90, FORMERLY 4-103.001.
4-123.002 PROCEDURE.
(1) ANY PERSON MAY BRING A CIVIL ACTION AGAINST AN INSURER WHEN SUCH
PERSON IS DAMAGED BY A VIOLATION OF ANY OF THE PROVISIONS IN SECTION
624.155(1)(A), F.S. OR BY THE COMMISSION OF ANY ACTS ENUMERATED IN
SECTION 624.155(1)(B), F.S.
(2) AS A CONDITION PRECEDENT TO BRINGING SUCH ACTION, THE DEPARTMENT
AND THE INSURER SHALL BE GIVEN SIXTY (60) DAYS' WRITTEN NOTICE OF THE
VIOLATION. THE NOTICE SHALL BE SUBMITTED ON FORM DI4-363, "CIVIL REMEDY
NOTICE OF INSURER VIOLATION," REV. 11-98, WHICH IS HEREBY ADOPTED AND

INCORPORATED BY REFERENCE. THE FORM MAY BE OBTAINED FROM AND SHALL BE
SUBMITTED TO THE DEPARTMENT OF FINANCIAL SERVICES, BUREAU OF CONSUMER
ASSISTANCE, 200 EAST GAINES STREET, TALLAHASSEE, FLORIDA 32399-0300. NO
FEE IS REQUIRED.
(3) THE INSURER RECEIVING A NOTICE FILED PURSUANT TO SECTION 624.155,
FLORIDA STATUTES SHALL REPORT TO THE DEPARTMENT ON THE DISPOSITION OF
THE ALLEGED VIOLATION.
SPECIFIC AUTHORITY 624.308(1) FS. LAW IMPLEMENTED 624.155 FS. HISTORY
NEW 4-25-90, FORMERLY 4-103.002, AMENDED 8-28-00.
MEDIATION UNIT

STRUCTURE OF MEDIATION TEAM

The Mediation Teams consist of three types of Mediation Specialists, all Independent Adjusters (IA). The
three groups report directly to a Team Lead, also an I.A., who is associated with the same IA Firm. The
Team Lead reports directly to the CPIC Mediation Supervisor. The three types of specialists are:

Mediation Preparation Examiner
Mediation File Examiner
Mediation Attending Examiner

MEDIATION PREPARATION EXAMINER DUTIES:

1. Prepare and mail mediation acknowledgement letter and request for any documents the
insured and/or their representative plans to present at the mediation hearing.
2. If the adjustment of the claim was handled by an AYO Carrier and the file has not been
uploaded into the system, notify the team lead, via e-mail, requesting he/she acquire the file.
3. Check for prior and associated claim history. If there are any prior and/or associated hurricane
and/or daily claim files, ensure they are also prepared for the mediation process. If they are
not uploaded into the system, notify the team lead via e-mail and request the file be acquired.
4. Prepare the file in an electronic format.
5. Complete the Master Forms Workbook Vitals page.
6. Notify Mediation File Examiner via e-mail the electronic file is complete and transfer electronic
file to the assigned examiner.
7. The mediation preparation examiner will be trained and available to perform the duties of the
file examiner and the attending examiner when necessary.

MEDIATION UPDATES AND CANCELLATIONS

The insured and/or their representative can request mediation from the DFS or through the
insurance company. If the request is received through the insurance company, it is the
responsibility of the insurance company to provide the notice via fax to the DFS. Only the insured
and/or their representative can cancel or withdraw a mediation request. Once a claim is settled
before mediation, it is incumbent on the Mediation Specialist to encourage the insured to call the
DFS and cancel the mediation request. The company cannot request the cancellation; we can only
request confirmation of the cancellation.

The CPIC Mediation Supervisor and the Unit Assistant have access to the Collins Center
Scheduling Database. The database includes daily updates. These updates are the official
scheduling of mediation conferences. No mediation schedule or cancellation can be considered
final until it appears on this official update from the Mediation Center.
APPRAISAL UNIT

APPRAISERS AND UMPIRES

The appraisal clause is a policy condition that basically states that the insured or we as the insurer fail to
agree on the amount of loss, either one may:
a. Demand mediation. The settlement in the course of mediation is binding only if both parties
agree, in writing, on a settlement, and you have not rescinded the settlement within (3) business
days after reaching a settlement. You may not rescind the settlement after cashing or depositing
the settlement check or draft that the insured provides.
b. Demand appraisal. Demand appraisal of the loss. In this event, each party will choose a
competent appraiser with twenty (20) days after receiving written request from the other. The two
appraisers will choose a competent and independent umpire. If they can not agree upon an umpire
within fifteen days, you or we can request to petition the court to have the court make the choice be
made by a judge. If the appraisers submit a written report of an agreement to us, the amount
agreed upon will be the amount of the loss. If they fail to agree, they will submit their differences to
the umpire. A decision agreed to by any two will set the amount of the loss. The party selecting
that appraiser will pay each appraiser. Other expenses of the appraisal and the compensation of
the umpire will be equally shared by the insured and insurer.
Florida courts have consistently held that appraisal is appropriate only to determine the amount of the loss,
while questions of coverage are for the courts. Both the insured and the insurer each appoint a competent,
independent appraiser. The two appraisers then select a competent, impartial umpire.

Qualifications for each partys selected appraiser are minimal. According to the policy language, they must
be competent and independent. An appraiser does not need to be a lawyer, but can be a non-lawyer with
expertise appropriate to the issues at hand. With respect to the policy requirement that an appraiser be
independent, one court has defined this as an outside appraiser, unaffiliated with the parties and one where
the appointing party does not have an ownership interest in the firm designated to do the appraisal. The
courts have held that a direct or indirect financial interest in the outcome of the appraisal does not require
the disqualification of an appointed appraiser. Thus, an appraiser paid by a contingent fee percentage of
the award was deemed to be an independent appraiser within the meaning of an appraisal clause. The
selection of an appraiser is done by the examiner at Citizens based upon the location of the loss to be
appraised and from the approved appraiser vendor list. Each examiner is provided a list of approved
appraiser vendors from their team lead. This list is periodically revised.

Selection of an appraiser or appraisal firm is done by a committee of Citizen Employees and examiners.
The committee is comprised of the Appraisal Supervisor, team leads and two examiners within the
appraisal teams. This committee meets quarterly to review the current list of approved vendors, make any
modifications to the existing approved vendor list and to review any new submissions for becoming an
approved vendor. Evaluation of approved appraiser vendors is based upon established scoring guidelines
for both new submissions to the approved list and to remain on the current approved list. The number of
appraisers on the approved vendor list is subject to operational efficiencies for any given geographical
area.

Once an appraisal firm is on the approved list our guidelines and expectations are that they must provide a
detailed summary report of their work on each appraisal and provide us with a Xactimate estimate of the
damages in question. Color photos of both damaged and non damaged items should accompany their final
report. They are to keep the examiner apprised of the appraisal progress in a timely manner through
phone calls and email correspondence. The usual and customary fees per hour for appraisal services are
from $110-$150 per billable hour. Umpires also are to be independent and neutral. We as the insurer are
not a party to the decision as to what umpire is used in mediation. The two appraisers must agree as to the
decision of what umpire is to be used. If they cannot agree the court may be petitioned to appoint an
umpire. Both parties to the mediation split the cost of the umpire services. The customary rate for an
umpire is $200-$275 per billable hour.

Appraiser Expectations

1. Upon receipt of an appraisal assignment, respond to the respective examiner confirming receipt of
assignment within 48 hours of assignment.
2. Upon receipt of the claim file from the Citizens examiner, the designated Appraiser is to review the
file in detail and identify any special issues, paying close attention to instructions outlined by the
examiner.
3. Unless agreed in advance and included in the Memorandum of Appraisal coverage C, contents,
and coverage D, additional living expenses, are not to be addressed in the appraisal process. Nor
will Ordinance or Law issues if these coverages are included, proper photo documentation,
receipts, and evidence of ownership must be submitted. Depreciation is to be considered on all
contents. Non-recoverable depreciation shall be addressed with the insureds appraiser. Assigned
appraiser will consult with Citizens if the insureds appraiser is presenting work outside the loss
scope.
4. Contact the insureds appraiser. Deliver perspective Umpires list. Report contact and agreed
Umpire to CPIC examiner as soon as you have a confirmed umpire. If there is an impasse, CPIC
will petition the court for an appointment.
5. Advise the examiner on status of inspection appointment as soon as the appointment is confirmed.
claimsdocuments@citizensfla.com
6. The use of experts will always be discussed and authorized with the CPIC examiner before
utilizing. Once an expert is retained, the Citizens appointed appraiser will coordinate with the
expert and be present along with the insureds appraiser at the inspection by the expert.
7. Inspection. Citizens require photos of all damages including no damage, roof photos, dimensions
and diagram. Elevation photos showing relationship of swimming pools, decks, porches, pool
enclosures, and other structures.
8. Complete Xactimate estimate to include all damages. Clearly separate damages per line of
coverage on all estimate and award. An estimate must accompany ALL awards. An estimate must
accompany all awards supporting the award. If repairs have already been made the appraiser will
obtain documentation of damages (i.e. insured photos, paid receipts or contractors statements
regarding damages) the award needs to be submitted when completed. The award must contain
the claim number(s) and/or dates(s) of loss the award settles, multiple loss dates if applicable.
Awards must be submitted immediately once two signatures are obtained.
9. Provide a report with the award summarizing the appraisal process including photos and
supporting documentation to the Citizens examiner within 5 days via email or regular mail.
claimsdocuments@citizensfla.com
10. CPIC examiner will give instructions and direction on all appraisal demands that have multiple
dates of loss.
11. Contact your CPIC examiner immediately with any situation that hinders the appraisal process.


S P E C I A L H A N D L I N G U N I T S

RESOLUTION UNIT

The Resolution Area is the liaison between the Citizens Property Insurance Corporation and its insureds
and their representatives regarding complaints involving Catastrophe-related claims. It consists of three
components, each dealing with issues arising from different sources:

DFS Response Unit responsible for handling of requests for information or assistance received by the
DFS from Citizens insureds and notifications of election to mediate that the DFS receives from Citizens
insureds.
Executive Complaints Unit responsible for issues arising from Citizens senior management, the offices of
the governor, treasurer, or other officials having supervisory control over Citizens, the office of the
Insurance Consumer Advocate, or any Florida-based elected official, whether local, state or federal.
Please note that this may include non-catastrophe related issues.
Resolutions Unit responsible for issues arising from any other source, usually either passed to the unit
from the call center or assigned to the Resolution Unit by e-mail from other areas.

The types of issues that are referred to the Resolution Area tend to be similar, regardless of the origin of
the complaint, except for specialized items such as mediation and the Agents Hotline. All issues are
normally documented in CTS.

The major issues by type of issue are:

Check Issues
Underwriting Issues
Claim Reporting
File Reopening
Fraud Allegations
Claims Inquiries

Most issues that are referred to the Resolution area can be resolved at most within a day or two. Unless
there are unusual circumstances or we are awaiting additional information from the insured, no issue
should remain unresolved for more than ten working days maximum.

In most cases, a formal response to the complainant is not necessary, although it may be preferable under
certain circumstances if so decided by the Supervisor, Coordinator or Team Lead. However, in the case of
formal requests for assistance from the DFS, a formal response must be provided.

CALL CENTER

OBJECTIVE: To be the avenue for any overflow of the first notice of loss calls and to handle most service
calls from the insured, agents and other interested parties. The Call Center directs traffic to the
appropriate parties and answers questions regarding the processes involved in processing the claims.

Functions include:

Internal or overflow for the CAT First Notice of Loss (FNOL) claim reporting.

Provide information to the insured and others such as claim status, the name and phone number of the
adjuster, examiner, payment, and procedure for supplemental claims.

Contacts adjusters, examiners and or others regarding the need of the insured who has called.

Provides ongoing status and communication to the insured, agents and authorized parties, reducing
the inquiries to the adjusters and examiners.

Requests Stop Pays.

Follows up with ongoing check issues, voids, reissues and Magnetic Ink Character Recognition
problems (MICR).

Processes FEMA letters, advising of no coverage in force etc.

Provides direction to the insured on how to have the mortgagee, address or name changed on policy.

Process of incoming faxes, forwarded to appropriate department

Adjuster Estimates provided via Fax or mail to Named Insured, Public Adjuster or Agent.

Small Business Administration documents submitted to proper department.

Translation services: Spanish, French and Creole.


S P E C I A L I N V E S T I G A T I O N U N I T ( S I U )

Insurance Claims Fraud

Insurance claims fraud can be committed by policyholders, contractors or anyone working on behalf of a
policyholder - pursuant to the filing of an insurance claim. Therefore, Citizens formed a Special
Investigation Unit (SIU) for the purpose of investigating suspect insurance claims.

Each adjuster is responsible for recognizing the presence of fraud indicators, commonly referred to as red
flags, and referring the file to SIU for further investigation. Directions to refer a suspect claim to SIU can
be found on the Adjuster Portal.

While most claims are legitimate, some are fraudulent. Therefore, it is appropriate for the claims
adjuster to review all claims for possible fraud. Determining the fraud probability of any claimis
facilitated when the adjuster is familiar with various fraud indicators.

These indicators should help isolate those claims which merit closer scrutiny. No one indicator by
itself is necessarily suspicious. Even the presence of several indicators while suggestive of
possible fraud, does not mean that fraud has been committed. Indicators of possible fraud are red
flags only, not actual evidence.

INDICATORS OF CATASTROPHE RELATED FRAUD

Note: Catastrophe insurance claims fraud includes inflated and totally fabricated losses,
intentionally caused damages, claims for preexisting damage and backdated policies

Insureds with Insurance Coverage:

Insured declares extensive losses without physical evidence
Items claimed do not match claimants life-style, dcor, house occupation or income
Items claimed cannot physically fit in existing floor space.
Lack of carpet indentation from alleged large furniture or appliances
Extensive commercial losses occur at site where few or no security measures are in effect
Insured is unusually knowledgeable regarding insurance terminology and the claims settlement
process.
Insured is overly pushy for a quick settlement
Insured is willing to accept an inordinately small settlement rather than document all claims losses.
On scene investigation reveals no remains of the items claimed and normally found in a home or
business (i.e., Kitchen - major and minor appliances; Living Room television, stereo equipment
etc...)
Investigation reveals absence of family photographs, heirlooms or items of sentimental value.

INDICATORS OF PROPERTY REPAIR FRAUD ASSOCIATED WITH
CONTRACTORS/PROVIDERS

Note: Property repair fraud involves unethical, incompetent and dishonest building contractors,
who employ a variety of illegal or questionable techniques. This includes, collecting payment for
defective or unperformed services, damage inflation, insurance fraud conspiracy, bribery, or
insurance adjusters and kickbacks. Insureds may conspire with the repairer to cover their
deductible, upgrade their property or repair preexisting damage or defects.

Does not maintain a local office or have a local telephone number
Can not provide references
Want payment up front
Have inadequate equipment to perform job
Arrive at loss site without being solicited
Offer below market prices.too good to be true
Offer cash incentives to get the job done
Estimate is very general.lump sum
Are not bonded or are underinsured
Are not licensed or are newly licensed
Multiple contractors using same license

INDICATORS ASSOCIATED WITH THE CLAIMS PROCESS

Note: Fraud related to the clams process includes people impersonating insureds and fraudulently
collecting on their claims, forging and cashing claimpayment drafts and using contractor damage
repair estimates to collect for property damages never intended to be replaced or repaired.

Insured unable to provide proof of identification and/or home ownership.
Insured cannot provide receipts, cancelled checks or other proof of ownership for recently
purchased items. (i.e. warranty information, user manuals).
Insured provides numerous receipts for inexpensive items, but no receipts for big ticket purchases.
Insured provides receipt(s) with incorrect or no sales tax figures.
Insured provides receipt(s) with no store logo (blank receipt).
Loss inventory indicates unusually high number of recent purchases.
Insured cannot recall place and/or date of purchase for newer items of significant value.
Insureds indicates distress over prospect of an examination under oath.
Insured cannot provide bank/credit card records for recent purchases of significant value.
Insured provide receipts/invoices from the same supplier that is numbered in sequence.
Insured provides receipts/invoices from same supplier with sequence numbers in reverse order of
purchase date.
Insured provides two different receipts/invoices with same handwriting or typeface.
Insured provides credit card receipts with incorrect or no approval code.
Insured claims identical items under different policies or with a different insurance company.
Insured cannot produce damaged item(s) for viewing.
Insured claims unrepaired damage from a previous disaster.


EMPLOYEE INSURANCE FRAUD

CITIZENS REQIRES THAT ANY EMPLOYEE WHO SUSPECTS ANOTHER EMPLOYEE OF FRAUD TO
DUAL REPORT. WITHIN 48 HOURS OF HAVING INFORMATION THAT WOULD LEAD A
REASONABLE PERSON TO SUSPECT THAT FRAUD MAY HAVE BEEN COMMITTED BY AN
EMPLOYEE OF THE CORPORATION, AN EMPLOYEE SHALL NOTIFY:

Unit of Internal Audit and Investigation

Department of Financial Services
Division of Insurance Fraud
Toll-free: 1-800-378-0445
Local: (850) 413-3115
Website: http://www.fldfs.com/fraud/

FLORIDA STATUTE 627.351(6)(j)1:
An employee of the corporation shall notify the Division of Insurance Fraud
within 48 hours after having information that would lead a reasonable person to suspect that fraud may
have been committed by any employee of the corporation.

SIU REFERRAL FORM

PLEASE RETURN TO: catsiu@citizensfla.com

Date:

Adjuster:
Company:
Contact No.:

Insured:
Loss Address:

Claim No:
Policy No:

1. Have any payments been made on the claim? If yes, how much?

2. Amount of Unpaid Claim suspected to be in question.

3. Amount of Paid Claim suspected to be in question.

4. Was the claim filed by written loss notice or by telephone?

5. Were any forms or payments on this claim sent through the mail?

6. Was a Proof of Loss submitted? If so, was it notarized?

7. Provide a description of the nature of suspected questionable activity. (i.e.
Faked/Exaggerated Property Damage, Application Misrepresented, Suspected
Arson, false receipts, etc.)

8. Which items, documents, or areas do you think would be productive to
investigate?


Q U A L I T Y A S S U R A N C E R E - I N S P E C T I O N
P R O G R A M

Implemented in 2007, the Citizens Re-inspection program focuses on the level of service offered by the
Citizens Catastrophe Operations Department. The program, run by the Quality Assurance (QA)
Department, consists of an oversight team, which manages a team(s) of Independent Adjusters that
focuses on the quality of claim handling by Citizens field adjusters. The re-inspections will be done during
and after the Catastrophe event, with a focus on both open and closed claims. The purpose of conducting
these re-inspections is to identify estimatic-related training issues, perform customer service reviews, and
audit individual adjusters and their respective Independent Adjusting Firms. During the file review process,
re-inspectors will be assigned to certain geographic areas located within the affected area of the
catastrophe event. The re-inspectors will be given an exhaustive list of claims that are to be reviewed. The
re-inspector will then make appointments with the Insureds to view the damages/repairs. The re-inspector
will then perform a thorough review on both the quality of the adjusters estimate/coverage analysis and the
level of service provided to the Insured. These results are then forwarded to the Citizens Quality
Assurance staff, who receive and review the individual files. The QA staff will then compile this information
and identify training issues, claims requiring immediate attention (due to items scoped in error, customer
service related issues, etc.), and performance level indicators. Any training or performance-related issues
will be promptly communicated to the adjusters Firm, so that the appropriate action can be taken. Any
trends in estimatic or policy-related errors will be corrected via training seminars, conducted by the QA
Department.

When the need for a re-inspection event arises, the QA Department will solicit re-inspectors from
Independent Adjusting firms who have active contracts with Citizens. Because the nature of each re-
inspection project varies based on the specific type of catastrophe event, the qualification requirements for
the re-inspectors are tailored to the specific project. The re-inspectors used are typically very experienced,
professional, have prior Citizens catastrophe experience, and are well trained on Citizens commercial,
residential, and mobile home policies and claim handling procedures.


E M E R G E N C Y O P E R A T I O N C E N T E R S ( E O C )
An EOC is a temporary Citizens consumer assistance facility. The goal is to be set-up and operational by
Citizens Rapid Response Team within 48 hrs of a major catastrophe.

Emergency Operations Purpose:

1. Immediate response to disaster
2. Assist policyholders with first notice of loss
3. Assist policyholders with ALE when warranted
4. Answer common questions at the beginning of a catastrophe
5. Provide general assistance to our policyholders
6. Relay feedback from the field regarding types and severity of damages
7. Keep management abreast of any problems or issues unique to the storm

EOC Staff Titles and Descriptions

Supervisor: This individual is responsible for the overall operation of the EOC
Team Lead: An individual the EOC Supervisor chooses to help in the running of the EOC
IT Rep: All IT functions are the responsibility of the this individual
General Services: This individual could be a temp employee and their responsibility is the setup
and maintaining the physical operation of the EOC.
Greeter: This person is the first to meet and assist the insured
Accounting Rep: All ALE checks will be handled by this individual that accounting dept has
trained.
Customer Service Rep: This person will assist the insured with a first notice, general questions
and prepare documentation for an ALE check.
Policy Verification Rep: If an insured has major issues with their police this individual will take the
time to research the policy problems.
Rapid Response Team: At a minimum will consist of the EOC Coordinator, EOC supervisor, a
team lead, the IT rep and General Services
Adjuster: This is a licensed individual that can review the policy with the insured and make any
recommended ALE payments.

This is an EOC operational flow chart. Note titles with an asterisk are the rapid
response team members for the initial setup of the EOC.
*EOC Supervisor
*Team Lead *Team Lead *Security
*Adjusting Firm Lead
Customer Service Rep
*IT Rep Adjuster
Customer Service Rep PV Rep Adjuster
Customer Service Rep
PV Rep Adjuster
Customer Service Rep Check Writer Adjuster
Customer Service Rep Greeter/HR Rep Adjuster
Customer Service Rep *General Service Adjuster

EOC Deployment:
The Catastrophe Operations Manager will make the call when to deploy our Rapid Response
Team
Our Rapid Response Team is made up of chosen first response volunteers from departments
throughout Citizens
The Rapid Response Team is accountable for the set-up and activation of the EOC operations
EOCs will be staffed with a arrangement of Citizens staff and temporary employees
Notice of EOC deployment, its preliminary location, and if necessary, any subsequent locations of
the EOC will be the responsibility of the EOC Coordinator and Catastrophe Operations Manager.
Citizens staff will need to obtain their cash advance, cell phones and rental vehicle prior to
deployment.


CITIZENS FORMS

FIRST PARTY PROPERTY - Status Report

Claim
Number:
Cause of
Loss:

Insured:
Adjusting
Company:
Policy
Number:
Adjuster
Assigned:
Loss
Location:
Date
Assigned:
Date
of Loss:
Date Insured
Contacted:
Date
Reported:
Date Loss
Inspected:

INSURED

In this section, briefly describe insured, location of loss, household members and any other
factual information regarding the insured.

COVERAGES

In this section recap all policy pertinent information such as the policy number, effective dates,
named insured, deductibles, policy forms and endorsements, mortgagees, lien holders,
additional insured(s), etc.

COVERAGE ANALYSIS

This section encapsulates a detailed explanation of the damages as they compare to applicable
coverage.

RESERVES

COVERAGE LIMIT RESERVES COVERAGE LIMIT RESERVES
Ordinance &
Law A

Debris
Removal

Ordinance &
Law B

Debris
Removal

C

Debris
Removal

D

This section will include all reserves relative to the limits of liability, along with a brief
explanation of the reserving philosophy and future recommendations.

INVESTIGATION


Prepare a chronological account of the investigation to date. Brevity is strongly recommended,
keeping in mind the need for factual and detailed information.

DAMAGES

This section will offer a detailed recap per applicable coverage (dwelling, other structures,
personal property and/or loss of use) of the damage investigation and limits of liability.

SETTLEMENT

Based on preceding categories, prepare detailed settlement recommendation(s). Future factors
and/or supplemental exposures are to be considered as part of this category, as well as
attorneys or experts evaluation and recommendation. Recap the details of the settlement
negotiations, if applicable. If in suit, note if settlement was reached at mediation.

SUBROGATION / SALVAGE

Prepare an analysis and plan of recovery of any subrogation and salvage possibilities relative to
the comments offered in the INVESTIGATION heading.

PROPOSED HANDLING

Prepare an analysis and plan of action, along with a proactive diary for resolution and identify
potential problem areas.

Prepared by: Date:

TOTAL INCURRED AT TIME OF THIS REPORT:

Paid Loss:

$
Outstanding
Loss:

$

Paid Expense:

$
Outstanding
Expense:

$

Total:

$

Total:

$

Does the above payment close the entire file? YES NO

Prepared by: Date:


PROPERTY SETTLEMENT

Claim
Number:
Cause of
Loss:

Insured:
Adjusting
Company:
Policy
Number:
Adjuster
Assigned:
Loss
Location:
Date
Assigned:
Date
of Loss:
Date Insured
Contacted:
Date
Reported:
Date Loss
Inspected:

COVERAGES
In this section recap all policy pertinent information such as the policy number, effective
dates, named insured, deductibles, policy forms and endorsements, mortgagees, lien
holders, additional insured(s), etc.

COVERAGE ANALYSIS
This section encapsulates a detailed explanation of the damages as they compare to
applicable coverage.

INVESTIGATION
Prepare a chronological account of the investigation to date. Brevity is strongly
recommended, keeping in mind the need for factual and detailed information.

DAMAGES
This section will offer a detailed recap per applicable coverage (dwelling, other structures,
personal property and/or loss of use) of the damage investigation and limits of liability.

SETTLEMENT
Based on preceding categories, prepare detailed settlement recommendation(s). Future
factors and/or supplemental exposures are to be considered as part of this category, as
well as attorneys or experts evaluation and recommendation. Recap the details of the
settlement negotiations, if applicable. If in suit, note if settlement was reached at
mediation.

SUBROGATION / SALVAGE
Prepare an analysis and plan of recovery of any subrogation and salvage possibilities
relative to the comments offered in the INVESTIGATION heading.

SETTLEMENT
BREAKDOWN

(See attached Claim Payment Recap Sheet)


PROPERTY CLAIM PAYMENT RECAP SHEET

Item

Gross
Claim
HOLDBACK

Depreciation O&L Cov.

Less
Advance
Payments

Less
Deductible

Net
Claim

Dwelling

Other Structures

Contents

ALE

Law & Ordinance

Debris Removal

TOTAL:

Management Approval: Date:


$

AMOUNT OF POLICY AT TIME OF LOSS POLICY NUMBER

DATE ISSUED AGENCY AT

Any person who knowingly and with intent to injure,
defraud, or deceive any insurance company files a
statement of claim or an application containing false,
incomplete or misleading information is guilty of a
felony of the third degree.

DATE EXPIRES

AGENT
To the Citizens Property Insurance Corporation of J acksonville, Florida.
At time of loss, by the above indicated policy of insurance you insured

against loss by to the property described under Schedule A, according to the
terms and conditions of the said policy of and all forms, endorsements, transfers and assignments attached thereto.
1. Time and origin: A loss occurred about the hour of oclock M.

STATE KIND

on the day of , . The cause and origin of the said loss were:

2. Occupancy: The building described, or containing the property described, was occupied at the time of loss as follows, and for no other
purpose whatever:

3. Title and Interest: At the time of the loss the interest of your insured in the property described therein was
No other person or persons had any interest therein or
encumbrance thereon, except

4. Changes: Since the said policy was issued there has been no assignment thereof, or change of interest, use, occupancy, possession,
location or exposure of the property described, except:

5. Total Insurance: The total amount of insurance upon the property described by this policy was, at the time
of the loss
$
6. The Actual Cash Value of said property at the time of the loss was... $
7. The Whole Loss and Damage was.. $
8. Less Amount of Deductible and/or participation by the insured. $
9. The Amount Claimed under the above numbered policy is.. $
The said loss did not originate by any act, design or procurement on the part of your insured, or this affiant; nothing has been done by or with the
privity or consent of your insured or this affiant, to violate the conditions of the policy, or render it void; no articles are mentioned herein or in
annexed schedules but such as were destroyed or damaged at the time of said loss; no property save has in any manner been concealed, and no
attempt to deceive the said company, as to the extent of said loss, has in any manner been made. Any other information that may be required will
be furnished and considered a part of this proof. The furnishing of this form or the preparation of proofs by a representative of the above
insurance company is not a waiver of any of its rights.
FLORIDA STATUTE 627.425 Forms for proof of loss to be furnished. An insurer shall furnish, upon written request of any person claiming to
have proof of loss under an insurance contract issued by such insurer, forms of proof of loss for completion by such person, but such insurer shall
not, by reason of the requirement so to furnish forms, have any responsibility for or with reference to the completion of such proof or the manner of
any such completion or attempted completion.
State of Insured:
County of Notary Public:
Subscribed and sworn before me this day of , Notary Seal
Sworn Statement in Proof of Loss


U Un nd de er r w wr r i i t t i i n ng g R Ri i s sk k I I n nf f o or r m ma at t i i o on n
C Cl l a ai i m m R Re ef f e er r r r a al l F Fo or r m m
Corporate Underwriting Division

Line of Business: Personal Lines Commercial Lines Wind-Only

Date: Policy Number:

N

amed Insured:

L

ocation of Loss:
Claim Issues
Claim Number: Date of Loss: Cause of Loss:

Other Claims:

Underwriting Issues (check all that apply)
General Condition of Property: Liability:
Vacant or unoccupied Pool: No fence; fence less than 4 tall
Inaccessible (Un)Licensed/registered daycare w/o GCL
Pre-existing damage (explain) Exotic, rare or dangerous animals (explain)
Condemned, uninhabitable or otherwise poor Appliances or similar items in the open (attach photo)
Over water (partially or entirely) Trampoline, skate or bicycle ramp

Defective/outdated systems (roof, heat, wiring,
etc.)
Other excessive liability exposure (explain)
Portable/open flame primary heat source
Farm, ranch, orchard or nursery operations
Miscellaneous:
Occupied by more than 2 families Change of Insured name or mailing address

Business conducted on residential premises
(explain)
Number of stories/units different from dec page
Sinkhole exposure Construction different from dec page
MH not tied down or permanently installed Mortgagee different from dec page
Building code violations (explain)
Remodeling in process Present Claim: (UW follow-up suggested)
Over/Under-insured (attach documentation) Major structural damage
Total loss

Comments:

Adjuster Name:

Phone #
Rev. 4/2004 8301 Cypress Plaza Drive, Suite 500 J acksonville, FL 32216 (904) 296-6105 Fax (904) 279-0338


Expert
Assignment
Form

Date of Loss: Claim No:

Policyholder:

Contact Name: Contact No:

Loss Location:

Assignment Date:

Expert Assigned:

Expert Contact No:

Independent Adjuster:

Adjuster Contact No:

Reason for Inspection:

Estimate of Repairs Requested: YES NO

Prior Losses Related to Inspection:

Completed Repairs Related to
Inspection:

Attachments: Claim Assignment Form

4/17/2004


Payment Request for Loss Adjusting Expense

To: Citizens Claims Department
7077 Bonneval Road, Suite 500

From:

Re: Insured:
Policy #:
Eff. Dates:
Claim #:
Invoice #:
Provider:
Service Dates: From: To: Required on all Legal
Expenses
File in Suit Yes No

Please process payment for the attached invoice for loss adjusting expenses for the above
referenced claim. We have reviewed this invoice and have verified that the services have been
performed and the billing amount is correct.

Total Amount Requested:

Total Remaining Expense Reserve on File:

Total Loss Reserve by Coverage: Reserve: Coverage:
Reserve: Coverage:
Reserve: Coverage:

Additional Comments:

Requested By: Date:
Supervisor Approval: Date:

Note: All requests must have the proper authorized signatures to be processed.
Requests submitted without approval will be returned.

Subrogation / Salvage Form
Date: Claims Administrator:

Reimbursement for (please check one):

Salvage Recovery (includes buy-back) Subrogation Recovery
Other Recovery (please explain)
__________________________________________________________
__________________________________________________________
Line of Business: Claim Number:

Date of Loss: Policy Number:

Check Amount: Check Number:
Name of Insured:

Deductible Recovery Amount (if applicable): $

Attached Invoices (please attach a detailed invoice for each expense)

T&E Billing (total amount):
$_______________________________________________

Expenses:
Vendor: ________________________________ Amount: $
_______________
Vendor: ________________________________ Amount: $
_______________
Vendor: ________________________________ Amount: $
_______________
Vendor: ________________________________ Amount: $
_______________

FOR CITIZENS USE ONLY

Date Posted (PMSC): ______________________ Date Received (ePAS): ________________________

Payment Posted in Jax Claims? Yes No

Was Deductible Recovery Paid? Yes No N/A


RELEASE AND SUBROGATION RECEIPT

Received of the ___________________________________Company of _____________ the sum of
_________________________________________DOLLARS ($_________) in full payment, release and
discharge of all claims of the undersigned against the said Company, arising from or connected with any
loss or damage by reason of
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
which loss or damage arose or occurred on or about the ____ day of _________, 20____; and in full
payment, release and discharge of all claims and demands against the said company under the certain
policy of insurance No. ________________ issued through the ______________________________
Agency of the said company.

In consideration of, and to the extent of said payment, the undersigned hereby subrogates said
Company, to all of the rights, claims, and interest which the undersigned may have against any party,
person, property, or corporation liable for the loss mentioned above, and authorizes the said Company to
sue, compromise, or settle in the undersigneds name or otherwise all such claims and to execute, sign
releases, acquaintances, and to endorse checks or drafts given in settlement of such claims in the name of
the undersigned, with the same force and effect as if the undersigned executed or endorsed them.

Warranted no settlement has been made by the undersigned with any party, person, persons,
property, or corporation against whom a claim may lie, and no release has been given to anyone
responsible for the loss, and that no such settlement will be made nor release given by the undersigned
without the written consent of the said Company and the undersigned covenants and agrees to cooperate
fully with the said Company in the prosecution of such claims, and to procure and furnish all papers and
documents, in the undersigneds possession, necessary in such proceedings and to attend court and to
testify if the Company deems such to be necessary but it is understood the undersigned is to be saved from
costs in such proceedings.

IN WITNESS WHEREOF, __________________________has affixed _______ hand and seal this
________ day of _______________, 20______.

WITNESS: ________________________ (SEAL)

_____________________________ _________________________
(Address)
_____________________________ _________________________
(City) (Zip)
STATE OF ___________________
SS:
COUNTY OF ___________________
On this _____________day of __________________, 20 _____, before me appeared
__________________________ to me personally known, and who acknowledge the execution of the
forgoing instrument as ____________ free act and deed, for the consideration set forth therein.
My Commission Expires ______________________
Notary Public


LETTERS

CITIZENS PROPERTY INSURANCE CORPORATION
PO BOX 19700
J ACKSONVILLE, FL 32245-9700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

CLAIM WITHDRAWN
Date

Insured Name
Insured Address 1
Insured Address 2
Insured City, State Zip

RE: Citizens Claim Number:
Citizens Policy Number:
Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

This letter is a follow-up to our conversation on (date), where we discussed your request
to have the claim referenced above withdrawn. Please permit this letter to confirm we
have closed this file accordingly.

If you should have any additional questions or concerns, please contact the undersigned
at the phone number shown below. Thank you for allowing us to assist you with your
claim.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:


PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

CONTACT
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

This letter is in response to the property loss notice we received in regard to the claim
referenced above.

We have attempted contacting you at the phone number(s) provided with your claim, but
have been unsuccessful reaching you thus far.

Please contact the undersigned at the phone number shown below to discuss your claim.
We look forward to assisting you with your loss.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:

PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

DENIAL
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

This letter is a follow-up to our conversation on (insert date), where we discussed the
claim referenced above.

During that conversation, we discussed your concern for the damage to (insert item)
caused by (insert cause of loss). Unfortunately, your policy does not provide coverage
for (insert item or cause of loss). Please refer to the following policy provisions, which
state in part:

(Insert applicable policy provisions)

(Insert conditionssuit against us language)

By stating the above reason for denial, Citizens Property Insurance Corporation does not
intend to waive any policy defenses in addition to those stated above, but specifically
reserves its right to assert such policy defenses at any time.

When a dispute exists regarding your claim, or when we have denied payment of your
claim, Florida Law requires we notify you of your right to participate in the Property
Insurance Mediation Program established by the Department of Financial Services.
Enclosed is an insert with detailed instructions on how you may request mediation.

If you should have any additional questions, or have any other information you would
like us to consider in regards to this claim, please contact the undersigned at the phone
number shown below. Thank you for allowing us to assist you with your claim.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:

PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

DENIAL EXAMPLEEXTERIOR PAINT
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:


During that conversation, we discussed your concern for the damage to the exterior paint
of your home caused by wind. Unfortunately, your policy does not provide coverage for
exterior paint. Please refer to the following policy provisions, which state in part:

HOMEOWNERS
HO 23 70 07 01

WINDSTORM EXTERIOR PAINT OR WATERPROOFING
EXCLUSION SEACOAST FLORIDA

A. Exclusion
Coverage for any building or structure under this policy excludes loss caused by:
1. Windstorm or hail; or
2. Windstorm during a hurricane;

to paint or waterproofing material applied to the exterior of the building or structure.

Homeowners
CIT 23 10 05

SPECIAL PROVISIONS - FLORIDA

8. Suit Against Us. No action can be brought unless the policy provisions have been complied with and
the action is started within five (5) years after the date of the loss.




Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:

PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

COMMERCIAL DENIAL
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:


During that conversation, we discussed your concern for the damage to (insert item)
state in part:


(Insert conditionslegal action against us language)



Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:


PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

INITIATIONDUTIES
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

This letter confirms receipt of your recent property loss notice. The claim number above
has been assigned to your file.

We have assigned an adjuster to handle your claim, who will contact you within the next
few days to schedule an appointment to inspect your damage. Once your property has
been inspected, the adjuster will submit a report for final review and approval.

In the meantime, please comply with the following policy provisions from the section of
your policy entitled Conditions:

(Insert applicable duties after loss language)

We are required by the terms of your policy to include your mortgage company on any
checks related to the building and other structures portion of your claim. Please verify
the mortgagee(s) shown below is/are correct:

(insert mortgage company shown on policy)
(insert mortgage company shown on policy)

If the above information is incorrect, please inform your adjuster and agent to make any
necessary changes to avoid delays in your claim payment.


Citizens Property Insurance Corporation is committed to handling your claim as quickly
and fairly as possible. Your cooperation and patience during the claims process is greatly
appreciated. If you should have any additional questions or concerns, please contact the
undersigned at the phone number shown below.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:


PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

LOSS BELOW DEDUCTIBLE & DENIAL
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

This letter confirms our discussion on (insert date), where we discussed the claim
referenced above, and the subsequent inspection and investigation by our adjuster.

The inspection revealed the cost to repair your damaged property would not exceed your
$(insert amount) deductible. Please see the attached estimate indicating the specific
damages noted.

Our investigation represents an evaluation by Citizens Property Insurance Corporation of
your loss. You may wish to obtain your own estimate for the repairs. If the estimate you
obtain is greater than your deductible, please contact us promptly.

During our conversation, we also discussed your concern for the damage to (insert item)
state in part:


(Insert conditionssuit against/legal action against us language)



(Optional paragraph #1)

If you should have any additional questions or concerns, or have any further information
you would like us to consider, please contact the undersigned at the phone number shown
below. Thank you for allowing us to assist you with your claim.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:


PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

LOSS BELOW DEDUCTIBLE
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

This letter is in response to the claim referenced above, and the subsequent inspection
and investigation by our adjuster.

The inspection revealed the cost to repair your damaged property would not exceed your
$(insert amount) deductible. Please see the attached estimate indicating the specific
damages noted.

Our investigation represents an evaluation by Citizens Property Insurance Corporation of
your loss. You may wish to obtain your own estimate for the repairs. If the estimate you
obtain is greater than your deductible, please contact us promptly.

If you should have any additional questions or concerns, or have any further information
you would like us to consider, please contact the undersigned at the phone number shown
below. Thank you for allowing us to assist you with your claim.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number


Enclosure

cc:

PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

RE-OPEN REQUEST FOR INFORMATION
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

This letter will acknowledge our receipt of your recent request that we reopen the above
referenced claim for additional consideration.

In order to consider your request, we will need the following information to further
evaluate your claim:

1.
2.
3.
4.

Please forward the information requested above to the address or fax number shown in
the letterhead, and to the attention of the undersigned. Also, reference your name and
claim number on this correspondence so we can expedite the handling of your request.

Thank you for allowing us to assist you with your claim. If you should have any
additional questions or concerns, please do not hesitate to contact the undersigned at the
phone number shown below.

Sincerely,

Claim Owner

Claim Owner Role
Phone Number

Enclosure

cc:

PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

RESERVATION OF RIGHTS COMMERCIAL
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

We are writing this letter in regard to the claim referenced above. Until we can
investigate all of the facts, circumstances and covered damages surrounding this claim, it
is necessary for us to handle your claim under a Reservation of Rights.

This Reservation of Rights letter is in response to the loss notice received on (insert date)
for claim number (insert #) at Citizens Property Insurance Corporation (CITIZENS).

With respect to the alleged (insert cause of loss) loss, the rights of CITIZENS may have
been substantially prejudiced for any or all of the following reasons:

1. Insert specific reason.

While proceeding with the investigation of this claim, CITIZENS has neither waived nor
intends to waive any rights or defenses under said policy, but specifically reserves its
right to assert such policy defenses at any time.

Please refer to the section of your commercial policy entitled Conditions, which states in
part:

3. Duties In The Event Of Loss Or Damage
a. You must see that the following are done in the event of loss or damage to Covered
Property:
(1) Notify the police if a law may have been broken.

(2) Give us prompt notice of the loss or damage. Include a description of the
property involved.
(3) As soon as possible, give us a description of how, when and where the loss or
damage occurred.
(4) Take all reasonable steps to protect the Covered Property from further damage,
and keep a record of your expenses necessary to protect the Covered Property,
for consideration in the settlement of the claim. This will not increase the
Limit of Insurance. However, we will not pay for any subsequent loss or damage
resulting from a cause of loss that is not a Covered Cause of Loss. Also, if feasible,
set the damaged property aside and in the best possible order for examination.
(5) At our request, give us complete inventories of the damaged and undamaged
property. Include quantities, costs, values and amount of loss claimed.
(6) As often as may be reasonably required, permit us to inspect the property proving
the loss or damage and examine your books and records.
Also permit us to take samples of damaged and undamaged property for inspection, testing
and analysis, and permit us to make copies from your books and records.
(7) Send us a signed, sworn proof of loss containing the information we request to
investigate the claim. You must do this within 60 days after our request. We will
supply you with the necessary forms.
(8) Cooperate with us in the investigation or settlement of the claim.
b. We may examine any insured under oath, while not in the presence of any other insured
and at such times as may be reasonably required, about any matter relating to this
insurance or the claim, including an insured's books and records. In the event of an
examination, an insured's answers must be signed.

Again, your claim is under further review and investigation. Please be aware any
recommendations made by the adjuster investigating this loss are subject to CITIZENS
review and final approval. We appreciate your continued cooperation as the investigation
continues.

Thank you for allowing us to assist you with your claim. If you have any additional
questions, please do not hesitate to contact the undersigned at the phone number shown
below.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:

PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

RESERVATION OF RIGHTS COMMERCIAL WIND
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:






Please refer to the section of your commercial wind policy entitled Conditions, which
states in part:

4. You Duties After Loss. In case of a loss to Covered Property, you must:
a. Give prompt notice to us, or your producer, who is to give immediate notice to us.
b. Take the following steps:
(1) Protect the Covered Property from further damage; and

(2) Make reasonable and necessary repairs to protect the Covered Property; and
(3) Keep an accurate record of repair expenses; and
(4) Prepare an inventory of damaged and undamaged property showing in detail the
quantity, description, actual cash value, and amount of loss. Attach all bills, receipts
and related documents that justify the figures in the inventory.
c. As often as we reasonably require:
(1) Show us the damaged property;
(2) Provide us with records and documents we request and permit us to make copies;
and
(3) Submit to examinations under oath while not in the presence of any other named
insureds and sign the same.
d. Send to us, within sixty (60) days after our request, your signed, sworn proof of loss
which sets forth, to the best of your knowledge and belief:
(1) The time and cause of loss;
(2) Your interest and that of all others in the covered property involved, and all liens on
the covered property;
(3) Other insurance which may cover the loss;
(4) Changes in title or occupancy of the covered property during the term of the policy;
(5) Specifications of damaged buildings and detailed repair estimates;
(6) The inventory of damaged and undamaged personal property described in
Condition number 4.b., Your Duties After Loss.

continues.

below.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:


PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

RESERVATION OF RIGHTS DWELLING POLICY
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:






Please refer to the section of your dwelling policy entitled Conditions, which states in
part:

4. Your Duties After Loss. In case of a loss to covered property, you must see that the following are
done:
a. give prompt notice to us or our agent;

b. (1) protect the property from further damage;
(2) make reasonable and necessary repairs to protect the property; and
(3) keep an accurate record of repair expenses;
c. prepare an inventory of damaged personal property showing the quantity, description,
actual cash value and amount of loss. Attach all bills, receipts and related documents
that justify the figures in the inventory;
d. as often as we reasonably require:
(1) show the damaged property;
(2) provide us with records and documents we request and permit us to make copies;
and
(3) submit to examination under oath, while not in the presence of any other named
insured, and sign the same;
e. send to us, within 60 days after our request, your signed, sworn proof of loss which sets
forth, to the best of your knowledge and belief:
(1) the time and cause of loss;
(2) your interest and that of all others in the property involved and all liens on the
property;
(3) other insurance which may cover the loss;
(4) changes in title or occupancy of the property during the term of the policy;
(5) specifications of damaged buildings and detailed repair estimates;
(6) the inventory of damaged personal property described in 4c;
(7) receipts for additional living expenses incurred and records that support the
fair rental value loss.

continues.

below.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:

PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

RESERVATION OF RIGHTS DWELLING WIND POLICY
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:






Please refer to the section of your dwelling wind policy entitled Conditions, which states
in part:

4. Your Duties After Loss. In case of a loss to covered property, you must:
a. Give prompt notice to us, or your producer, who is to give immediate notice to us;
b. Take the following steps:
(1) Protect the property from further damage; and

(2) Make reasonable and necessary repairs to protect the property; and
(3) Keep an accurate record of repair expenses; and
(4) Prepare an inventory of damaged and undamaged property showing in detail
the quantity, description, actual cash value, and amount of loss. Attach all
bills, receipts and related documents that justify the figures in the inventory;
c. As often as we reasonably require:
(1) Show us the damaged property;
(2) Provide us with records and documents we request and permit us to make
copies; and
(3) Submit to examinations under oath while not in the presence of any other named
insureds and sign the same;
d. Send to us, within sixty (60) days after our request, your signed, sworn proof of loss
which sets forth, to the best of your knowledge and belief:
(2) Your interest and that of all others in the covered property involved, and all liens
on the covered property;
(3) Other insurance which may cover the covered loss;
(4) Changes in title or occupancy of the covered property during the term of the policy;
(6) The inventory of damaged and undamaged personal property described in Condition
number 4.b.(4), Your Duties After Loss;
(7) Receipts for additional living expenses incurred.

continues.

below.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:

PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

RESERVATION OF RIGHTS HOMEOWNERS POLICY
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:






Please refer to the section of your homeowners policy entitled Conditions, which states
in part:

2. Your Duties After Loss. In case of a loss to covered property, you must see that the following
are done:
a. Give prompt notice to us or our agent;
b. Notify the police in case of loss by theft;

c. Notify the credit card or fund transfer card company in case of loss under Credit Card or
Fund Transfer Card coverage;
d. Protect the property from further damage. If repairs to the property are required, you
must:
(1) Make reasonable and necessary repairs to protect the property; and
(2) Keep an accurate record of repair expenses;
e. Prepare an inventory of damaged personal property showing the quantity, description,
actual cash value and amount of loss. Attach all bills, receipts and related documents
that justify the figures in the inventory;
f. As often as we reasonably require:
(1) Show the damaged property;
(2) Provide us with records and documents we request and permit us to make copies;
and
(3) Submit to examination under oath, while not in the presence of any other "insured,"
and sign the same;
g. Send to us, within 60 days after our request, your signed, sworn proof of loss which sets
forth, to the best of your knowledge and belief:
(2) The interest of the "insured" and all others in the property involved and all liens on
the property;
(3) Other insurance which may cover the loss;
(4) Changes in title or occupancy of the property during the term of the policy;
(6) The inventory of damaged personal property described in 2.e. above;
(7) Receipts for additional living expenses incurred and records that support the fair
rental value loss; and
(8) Evidence or affidavit that supports a claim under the Credit Card, Fund Transfer
Card, Forgery and Counterfeit Money coverage, stating the amount and cause of
loss.

continues.

below.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:

PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

REQUEST FOR INFORMATION10 DAY CLOSE
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

This letter is a follow-up to our letter of (insert date(s)), in which we requested the
following information needed to evaluate your claim:

1.
2.
3.
4.

As of this date, we still have not received a response to our request(s). Therefore, if this
information is not received within 10 days of this letters date, we will place your file in
an inactive status.

Please forward the information requested above as soon as possible to the address or fax
number shown in the letterhead, and to the attention of the undersigned, to avoid any
further delay in the handling of your claim. Also, reference your name and claim number
on this correspondence.

claim.

Sincerely,

Claim Owner
Claim Owner Role

Phone Number

Enclosure

cc:

PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

REQUEST FOR INFORMATION
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

This letter will confirm our conversation on (date), where we discussed the claim
referenced above. This letter will also recap what we discussed, and will provide you
with a summary of the information we need from you.

During our conversation, we discussed the following information needed to evaluate your
claim:

1.
2.
3.
4.

Please forward the information requested above to the address or fax number shown in
the letterhead, and to the attention of the undersigned. Also, reference your name and
claim number on this correspondence so we can expedite the handling of your claim.

claim.

Sincerely,

Claim Owner

Claim Owner Role
Phone Number

Enclosure

cc:

PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

SETTLEMENT & DENIAL
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

This letter confirms our conversation on (insert date), where we discussed the claim
referenced above. Enclosed is our payment in the amount of (insert settlement amount).
The payment represents payment under the following coverage(s):

Building Other Structures Contents ALE/FRV
Replacement Cost
Recoverable Depreciation
Contractor's Overhead & Profit
Non-Recoverable Depreciation
Prior Payments/Advances
Deductible
Net Payment

Attached is our (insert basis for paymentestimate, statement of loss, etc), which
outlines the basis for payment.

Your policy may provide replacement cost coverage whereby you are permitted to
recover up to the amount withheld above for recoverable depreciation. For you to claim
this additional amount, you must complete repairs and/or replacement of the depreciated
items, and submit the final repair invoices or receipts within (insert specified amount of
time from conditionsloss settlement) from the date of loss. Please refer to the Loss
Settlement provision of your policy, if applicable, for complete details.


You may also be entitled to an additional amount for contractors overhead and profit, if
an amount is shown above as being withheld for this item. You may recover this once
you present a signed agreement with a licensed general contractor.

Request for replacement cost benefits or contractors overhead and profit should be sent
to the address or fax number shown in the letterhead. Please include your name and
claim number on all correspondence related to your claim.

If your mortgage holder has been shown as a payee on your draft, please understand we
are obligated to do so under the terms of your policy. Please contact your mortgage
holder for their procedures for endorsing payments.

During our conversation, we also discussed your concern for the damage to (insert item)
state in part:


(Insert conditionssuit against/legal action against us language)




Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure
cc:


PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

SETTLEMENT
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

Enclosed is our payment in the amount of (insert settlement amount). The payment
represents payment under the following coverage(s):

Building Other Structures Contents ALE/FRV
Replacement Cost
Recoverable Depreciation
Contractor's Overhead & Profit
Non-Recoverable Depreciation
Prior Payments/Advances
Deductible
Net Payment

Attached is our (insert basis for paymentestimate, statement of loss, etc), which
outlines the basis for payment.

Your policy may provide replacement cost coverage whereby you are permitted to
recover up to the amount withheld above for recoverable depreciation. For you to claim
this additional amount, you must complete repairs and/or replacement of the depreciated
items, and submit the final repair invoices or receipts within (insert specified amount of
time from conditionsloss settlement) from the date of loss. Please refer to the Loss
Settlement provision of your policy, if applicable, for complete details.

You may also be entitled to an additional amount for contractors overhead and profit, if
an amount is shown above as being withheld for this item. You may recover this once
you present a signed agreement with a licensed general contractor.

Request for replacement cost benefits or contractors overhead and profit should be sent
to the address or fax number shown in the letterhead. Please include your name and
claim number on all correspondence related to your claim.

If your mortgage holder has been shown as a payee on your draft, please understand we
are obligated to do so under the terms of your policy. Please contact your mortgage
holder for their procedures for endorsing payments.

Thank you for allowing us to assist you with your claim. If you should have any
additional questions or concerns, please do not hesitate to contact the undersigned at the
phone number shown below.

Sincerely,

Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:


PO BOX 19700

TELEPHONE: (866) 858-0649 FAX: (866) 574-9128

SWORN PROOF OF LOSS
Date

Insured Name
Insured Address 1
Insured Address 2

Date of Loss:
Cause of Loss:
Insured Location:

Dear Policyholder:

This letter is in response to the claim referenced above, and the subsequent investigation
by our adjuster. While your claim is under investigation, we request that you complete
and have notarized the enclosed Sworn Proof of Loss form. Please refer to the following
policy provisions from your policy entitled Conditions:

(Insert applicable policy language from duties after loss)

Enclosed is a blank Sworn Proof of Loss form and blank (insert other forms enclosed for
insured to complete and document loss) to assist you in complying with the provisions
above. Please also comply with the provisions above by submitting these forms within
the timeline specified above.

While proceeding with the investigation of this claim, Citizens Property Insurance
Corporation has neither waived nor intends to waive any rights or defenses under said
policy, but specifically reserves its right to assert such policy defenses at any time.

below.

Sincerely,


Claim Owner
Claim Owner Role
Phone Number

Enclosure

cc:

Catastrophe Claims Guide 2007

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