That next day is a weekend, and you’re sitting at your new home with your family on a Saturday when out of nowhere, the remnants arrive. There has not been much on the news about it, because there’s just rain and a little wind. This particular storm, embedded in the system coming through, has grown into a massive straight line wind storm in a matter of minutes. The next thing you know, the roof of your home blows up in the air. Part of the roof slams back down onto the house, but the majority of the roof is gone. Everyone is safe, but you watch in horror as rain seems to pour into your home in buckets. The storm is short lived, maybe just a few minutes, but everything in your home is saturated.
You ask what that means and they tell you that it means it is showing your floors, walls, and ceilings are reading as high as the meter reads. The restorers begin to extract the water from your carpet and other floors and then begin removing the carpet and pad from the house. They tell you that they can’t do a lot more right now because they have a Service Level Agreement (SLA-that’s how they Vendor got the job. They have a contract with the either the Insurance Company or the TPA). The SLA limits the amount of work they can do in what is called EMS—Emergency Services. They do set up a couple of dehumidifiers. The advise that since this job is a Category 3 job, they can’t start blowing air all around for fear of contaminating the two rooms downstairs that escaped major damage. However, they tell you they need to speak with the TPA and let them know the extent of the damage. They’ve put the dehumidifiers in to “stabilize” the house. You have no idea about structural drying; in fact, you didn’t even really know it was a thing, but you trust that insurer is looking out for your best interest. I mean, after all, you’ve paid them an annual premium with no claims for over 3 years.
The way you see your relationship is:
What you don’t know is that your agent is the one who is concerned about your best interest. And if you get the right adjuster, he or she is, as well. However, the carrier, the one that actually foots the bill is not concerned about your best interest, they’re concerned about their bottom dollar. So, they hire a TPA to deal with their claims. The TPA has absolutely no skin in the game for you, as they are just there to objectively manage the claim. The restorer is in a bad position because they now have 2 contracts in play—one with you, and one as a vendor with the TPA (or the insurer depending on with whom they have a contract.
All of this puts you, the homeowner, in a bind. You now have a contract through your policy with the insurance company. You also now have a contract with the restorer to dry, repair, and clean your home. Now, you have a TPA involved in your claim, and what you don’t know is that the TPA works only for the insurer, and not for you. And the restoration company is in a bind, because they have two contracts! They have one with the TPA who guarantees them a certain amount of work, and they have one with you, who has authorized them to perform the work. You are about to go on a journey that is going to disappoint you as you find out how it all really works, and how you, the homeowner, the policy holder, are the ones who ultimately get left out of the loop.
Oh, by the way, you’re about to learn the way the system really works, in most cases, and that includes the relationship hierarchy, particularly in your situation in this example: