catastrophe claims guide 2007

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22 00 00 77 CC A A TT A A SS TTRR OO PP HHEE CC LL A A IIMMSS GG UUIIDDEE

1-866-411-CPICwww.citizensfla.com


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i t i z e n s a t a s t r o p h e l a i m s G u i d e

TABLE OF CONTENTS

MISSIONTo efficiently provide property insurance protection in Florida to those unable to

obtain coverage in the private market, as directed by the Legislature. Qualitycustomer service is our prior ity.

VISIONWe are: Respons ive stewards of the public trust Setting the standard for superior cus tomer service and operational efficiencies Recognized as an important insurance safety net for Floridians Respected as a valuable partner in p rotecting Floridas economic health.

CORPORATE STRATEGIES Continuous Operational Improvement

Smart Financial Management and Controls to meet our PolicyholderObligations 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) foruse by its staff, its Claims Adjusting Firms, and other organizations that may be involved in the servicing of Citizensclaims. All procedures apply specifically to catastrophe claim handling though in many cases the same or similarprocedures may be followed by the non-catastrophe (daily) claims department. The principles and guidelinesdescribed in this guide may differ for individual claims depending on its unique facts and circumstances. The basicphilosophy in insurance claims is that each claim is unique and is handled on its own merits. This guide is intended toserve as a reference to standardize and explain the processes the procedures in normal claims handling, however it isnot 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


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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



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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 CasuaJoint Underwriting Association (FRPCJUA) and the Florida Windstorm Underwriting Association. resulted in the creation ofCitizens Property Insurance Corporation (Citizens/CPIC). Citizens operatesunder the direction of a seven-member board of Governors, appointed by Floridas Chief Financial Offfor three-year terms, representing geographically diverse regions of the state. The State Chief FinanciOfficer also appoints a Technical Advisory Board to provide information and advice to the BoardGovernors. The Florida Department of Financial Services (DFS) regulates Citizens and determines whareas of Florida are eligible for wind-only coverage.

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

The management and staff of Citizens place a priority on handling all claims with expediency, fairneprofessionalism, and consistency. To that end, this Catastrophe Claims Guide has been prepared as aguide for adjusters to better understand the requirements for adjustment and processing of Citizens claimIt is by no means exhaustive, and we recognize that it will not address all issues that might arise during tadjustment of claims or during a storm season. We recognize that each claim is unique. Reference mube made to the individual policy forms and endorsements for specific coverage information. In additadjusters 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 Florwill prevail. Furthermore, Citizens management reserves the right to implement changes to this guideany time. Those changes will be disseminated periodically as they occur.


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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 whichspecifically addresses the matter of unfair claim settlement practices. Please be conscious of the followi

section from that statute:

(I) UNFAIR CLAIM SETTLEMENT PRACTICES. --

1. ATTEMPTING TO SETTLE CLAIMS ON THE BASIS OF AN APPLICATION, WHEN SERVING ASA BINDER OR INTENDED TO BECOME A PART OF THE POLICY, OR ANY OTHER MATERIALDOCUMENT WHICH WAS ALTERED WITHOUT NOTICE TO, OR KNOWLEDGE OR CONSENT OF,THE INSURED;

2. A MATERIAL MISREPRESENTATION MADE TO AN INSURED OR ANY OTHER PERSONHAVING AN INTEREST IN THE PROCEEDS PAYABLE UNDER SUCH CONTRACT OR POLICY, FORTHE PURPOSE AND WITH THE INTENT OF EFFECTING SETTLEMENT OF SUCH CLAIMS, LOSS,OR DAMAGE UNDER SUCH CONTRACT OR POLICY ON LESS FAVORABLE TERMS THAN THOSEPROVIDED IN, AND CONTEMPLATED BY, SUCH CONTRACT OR POLICY; OR

3. COMMITTING OR PERFORMING WITH SUCH FREQUENCY AS TO INDICATE A GENERALBUSINESS PRACTICE ANY OF THE FOLLOWING:

A. FAILING TO ADOPT AND IMPLEMENT STANDARDS FOR THE PROPER INVESTIGATION OFCLAIMS;

B. MISREPRESENTING PERTINENT FACTS OR INSURANCE POLICY PROVISIONS RELATING TOCOVERAGES AT ISSUE;

C. FAILING TO ACKNOWLEDGE AND ACT PROMPTLY UPON COMMUNICATIONS WITH RESPECTTO CLAIMS;

D. DENYING CLAIMS WITHOUT CONDUCTING REASONABLE INVESTIGATIONS BASED UPONAVAILABLE INFORMATION;

E. FAILING TO AFFIRM OR DENY FULL OR PARTIAL COVERAGE OF CLAIMS, AND, AS TOPARTIAL COVERAGE, THE DOLLAR AMOUNT OR EXTENT OF COVERAGE, OR FAILING TOPROVIDE A WRITTEN STATEMENT THAT THE CLAIM IS BEING INVESTIGATED, UPON THEWRITTEN REQUEST OF THE INSURED WITHIN 30 DAYS AFTER PROOF-OF-LOSS STATEMENTSHAVE BEEN COMPLETED;

F. FAILING TO PROMPTLY PROVIDE A REASONABLE EXPLANATION IN WRITING TO THEINSURED OF THE BASIS IN THE INSURANCE POLICY, IN RELATION TO THE FACTS ORAPPLICABLE LAW, FOR DENIAL OF A CLAIM OR FOR THE OFFER OF A COMPROMISESETTLEMENT;

G. FAILING TO PROMPTLY NOTIFY THE INSURED OF ANY ADDITIONAL INFORMATIONNECESSARY FOR THE PROCESSING OF A CLAIM; OR

H. FAILING TO CLEARLY EXPLAIN THE NATURE OF THE REQUESTED INFORMATION AND THEREASONS WHY SUCH INFORMATION IS NECESSARY.

FLORIDA STATUTE 624.155 (Civil Remedy)


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(1) ANY PERSON MAY BRING A CIVIL ACTION AGAINST AN INSURER WHEN SUCH PERSON ISDAMAGED:

(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 ANDHONESTLY TOWARD ITS INSURED AND WITH DUE REGARD FOR HER OR HIS INTERESTS;

2. MAKING CLAIMS PAYMENTS TO INSUREDS OR BENEFICIARIES NOT ACCOMPANIED BY ASTATEMENT SETTING FORTH THE COVERAGE UNDER WHICH PAYMENTS ARE BEING MADE;OR

3. EXCEPT AS TO LIABILITY COVERAGES, FAILING TO PROMPTLY SETTLE CLAIMS, WHEN THEOBLIGATION TO SETTLE A CLAIM HAS BECOME REASONABLY CLEAR, UNDER ONE PORTIONOF THE INSURANCE POLICY COVERAGE IN ORDER TO INFLUENCE SETTLEMENTS UNDEROTHER PORTIONS OF THE INSURANCE POLICY COVERAGE.

NOTWITHSTANDING THE PROVISIONS OF THE ABOVE TO THE CONTRARY, A PERSONPURSUING A REMEDY UNDER THIS SECTION NEED NOT PROVE THAT SUCH ACT WASCOMMITTED OR PERFORMED WITH SUCH FREQUENCY AS TO INDICATE A GENERALBUSINESS PRACTICE.

(2) ANY PARTY MAY BRING A CIVIL ACTION AGAINST AN UNAUTHORIZED INSURER IF SUCHPARTY 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, THEDEPARTMENT AND THE AUTHORIZED INSURER MUST HAVE BEEN GIVEN 60 DAYS' WRITTENNOTICE OF THE VIOLATION. IF THE DEPARTMENT RETURNS A NOTICE FOR LACK OFSPECIFICITY, THE 60-DAY TIME PERIOD SHALL NOT BEGIN UNTIL A PROPER NOTICE ISFILED.

(B) THE NOTICE SHALL BE ON A FORM PROVIDED BY THE DEPARTMENT AND SHALL STATEWITH SPECIFICITY THE FOLLOWING INFORMATION, AND SUCH OTHER INFORMATION AS THEDEPARTMENT MAY REQUIRE:
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0626/Sec9541.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0626/Sec9551.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0626/Sec9705.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0626/Sec9706.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0626/Sec9707.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0627/Sec7283.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0624/Sec401.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0624/Sec401.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0627/Sec7283.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0626/Sec9707.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0626/Sec9706.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0626/Sec9705.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0626/Sec9551.HTMhttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=624.155&URL=Ch0626/Sec9541.HTM


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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, IFANY. IF THE PERSON BRINGING THE CIVIL ACTION IS A THIRD PARTY CLAIMANT, SHE OR HESHALL NOT BE REQUIRED TO REFERENCE THE SPECIFIC POLICY LANGUAGE IF THEAUTHORIZED INSURER HAS NOT PROVIDED A COPY OF THE POLICY TO THE THIRD PARTYCLAIMANT PURSUANT TO WRITTEN REQUEST.

5. A STATEMENT THAT THE NOTICE IS GIVEN IN ORDER TO PERFECT THE RIGHT TO PURSUETHE CIVIL REMEDY AUTHORIZED BY THIS SECTION.

(C) WITHIN 20 DAYS OF RECEIPT OF THE NOTICE, THE DEPARTMENT MAY RETURN ANYNOTICE THAT DOES NOT PROVIDE THE SPECIFIC INFORMATION REQUIRED BY THISSECTION, AND THE DEPARTMENT SHALL INDICATE THE SPECIFIC DEFICIENCIES CONTAINEDIN THE NOTICE. A DETERMINATION BY THE DEPARTMENT TO RETURN A NOTICE FOR LACK OFSPECIFICITY SHALL BE EXEMPT FROM THE REQUIREMENTS OF CHAPTER 120.

(D) NO ACTION SHALL LIE IF, WITHIN 60 DAYS AFTER FILING NOTICE, THE DAMAGES AREPAID OR THE CIRCUMSTANCES GIVING RISE TO THE VIOLATION ARE CORRECTED.

(E) THE AUTHORIZED INSURER THAT IS THE RECIPIENT OF A NOTICE FILED PURSUANT TOTHIS SECTION SHALL REPORT TO THE DEPARTMENT ON THE DISPOSITION OF THE ALLEGEDVIOLATION.

(F) THE APPLICABLE STATUTE OF LIMITATIONS FOR AN ACTION UNDER THIS SECTIONSHALL BE TOLLED FOR A PERIOD OF 65 DAYS BY THE MAILING OF THE NOTICE REQUIRED BYTHIS SUBSECTION OR THE MAILING OF A SUBSEQUENT NOTICE REQUIRED BY THISSUBSECTION.

(4) UPON ADVERSE ADJUDICATION AT TRIAL OR UPON APPEAL, THE AUTHORIZED INSURERSHALL BE LIABLE FOR DAMAGES, TOGETHER WITH COURT COSTS AND REASONABLEATTORNEY'S FEES INCURRED BY THE PLAINTIFF.

(5) NO PUNITIVE DAMAGES SHALL BE AWARDED UNDER THIS SECTION UNLESS THE ACTSGIVING RISE TO THE VIOLATION OCCUR WITH SUCH FREQUENCY AS TO INDICATE AGENERAL 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 LIFEINSURANCE CONTRACT.

ANY PERSON WHO PURSUES A CLAIM UNDER THIS SUBSECTION SHALL POST IN ADVANCETHE COSTS OF DISCOVERY. SUCH COSTS SHALL BE AWARDED TO THE AUTHORIZEDINSURER IF NO PUNITIVE DAMAGES ARE AWARDED TO THE PLAINTIFF.


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(6) THIS SECTION SHALL NOT BE CONSTRUED TO AUTHORIZE A CLASS ACTION SUITAGAINST AN AUTHORIZED INSURER OR A CIVIL ACTION AGAINST THE COMMISSION, THEOFFICE, OR THE DEPARTMENT OR ANY OF THEIR EMPLOYEES, OR TO CREATE A CAUSE OFACTION WHEN AN AUTHORIZED HEALTH INSURER REFUSES TO PAY A CLAIM FORREIMBURSEMENT ON THE GROUND THAT THE CHARGE FOR A SERVICE WAS UNREASONABLYHIGH OR THAT THE SERVICE PROVIDED WAS NOT MEDICALLY NECESSARY.

(7) IN THE ABSENCE OF EXPRESSED LANGUAGE TO THE CONTRARY, THIS SECTION SHALLNOT BE CONSTRUED TO AUTHORIZE A CIVIL ACTION OR CREATE A CAUSE OF ACTIONAGAINST AN AUTHORIZED INSURER OR ITS EMPLOYEES WHO, IN GOOD FAITH, RELEASEINFORMATION ABOUT AN INSURED OR AN INSURANCE POLICY TO A LAW ENFORCEMENT

AGENCY IN FURTHERANCE OF AN INVESTIGATION OF A CRIMINAL OR FRAUDULENT ACTRELATING TO A MOTOR VEHICLE THEFT OR A MOTOR VEHICLE INSURANCE CLAIM.

(8) THE CIVIL REMEDY SPECIFIED IN THIS SECTION DOES NOT PREEMPT ANY OTHERREMEDY OR CAUSE OF ACTION PROVIDED FOR PURSUANT TO ANY OTHER STATUTE ORPURSUANT TO THE COMMON LAW OF THIS STATE. ANY PERSON MAY OBTAIN A JUDGMENTUNDER EITHER THE COMMON-LAW REMEDY OF BAD FAITH OR THIS STATUTORY REMEDY,BUT SHALL NOT BE ENTITLED TO A JUDGMENT UNDER BOTH REMEDIES. THIS SECTIONSHALL NOT BE CONSTRUED TO CREATE A COMMON-LAW CAUSE OF ACTION. THE DAMAGESRECOVERABLE PURSUANT TO THIS SECTION SHALL INCLUDE THOSE DAMAGES WHICH ARE AREASONABLY FORESEEABLE RESULT OF A SPECIFIED VIOLATION OF THIS SECTION BY THEAUTHORIZED INSURER AND MAY INCLUDE AN AWARD OR JUDGMENT IN AN AMOUNT THATEXCEEDS THE POLICY LIMITS.

(9) A SURETY ISSUING A PAYMENT OR PERFORMANCE BOND ON THE CONSTRUCTION ORMAINTENANCE OF A BUILDING OR ROADWAY PROJECT IS NOT AN INSURER FOR PURPOSESOF SUBSECTION (1).


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SERVICE STANDARDSThe requirements of the Unfair Claims Settlement Practices place emphasis on the following items. Irequired 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 handlingis also the embodiment of aggressive good faith. Immediate contact is essential to conduct a first-rinvestigation. The State of Florida places expectations upon insurance companies and adjusters that arsubject to change each year. These expectations such as those found within SB1486 place minimaexpectation on all insurers and adjusters. These requirements are not Citizens requirements which in cases expect contact prior to the absolute minimal dates established by the state. For instance, dependinupon the storm and adjuster resources, the state may require contact within 14 days of notice. WhereaCitizens expects the adjuster to attempt contact within 24 hours of assignment, additional attempts wit48 hours, and may request contact letters be sent within 10 days to avoid any breach of the staterequirements 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 larequires adjusters to make timely and continual communication. To avoid a failure to acknowledge andreasonably promptly upon communications, you must communicate promptly whenever you rececommunications regarding a claim under consideration. Failing to affirm or deny coverage of claims wa reasonable time relates directly to failure of communication. To avoid failing to provide a promptreasonable explanationfor denial or forsettlement requires prompt and accurately recordcommunication.

Diligence

The requirements of the Unfair Claims Settlement Practices and the legal rules regarding good faiconduct places great emphasis upon diligence.Websters Collegiate Dictionaryrefers to diligence aspreserving application; assiduity (steadily attentive); speed; haste; the attention and care legally expector 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 honesty in the handling of insurance claims. Any suggestion that dishonesty on the adjusters part winvolved 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 partthe legal principles that govern commercial transactions. Fairness is expected and constant reference made to the concept of fairness in the court cases relating bad faith conduct of insurers and their claimhandling personnel. Each claim should be handled based on its own merits.


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Reasonableness

An examination of the Unfair Claims Settlement Practices shows the importance of reasonable conduFailure to act reasonably, failing to adopt and implement reasonable standards, failing to conductreasonable investigation and failing to affirm or deny coverage of claims within a reasonable timelanguage contained in the NAIC Model Act. Continuingnot attempting in good faith to effectuate prfair and equitable settlements of claims in which liability has become reasonably clear, failing to promsettle claims where liability has become reasonably clear under one portion of the insurance polic

coverage, in order to influence settlements under other portions of the insurance policy coverage, anfailing to provide promptly a reasonable explanation or additional references to the word reasonable contained in the Model Act.

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

CODE OF ETHICS

4-220.201 ETHICAL REQUIREMENTS

(1) PURPOSE. THIS RULE SETS FORTH THE VARIOUS ETHICAL CONSIDERATIONS ANDCONSTRAINTS FOR VARIOUS CLASSES OF INSURANCE ADJUSTERS.

(2) DEFINITIONS. THE FOLLOWING DEFINITIONS SHALL APPLY FOR PURPOSES OF THISRULE.

(A) ADJUSTER, WHEN USED WITHOUT FURTHER SPECIFICATION, REFERS TO ANDINCLUDES ALL TYPES AND CLASSES OF INSURANCE ADJUSTERS, (COMPANY, INDEPENDENT,AND PUBLIC), SUBJECT TO CHAPTER 626, FLORIDA STATUTES, AND REGARDLESS WHETHERRESIDENT OR NONRESIDENT, AND WHETHER PERMANENT, TEMPORARY, OR EMERGENCYLICENSEES.

(B) CLIENT REFERS TO AND INCLUDES BOTH CLIENTS AND POTENTIAL CLIENTS; AND

MEANS ANY PERSON WHO CONSULTS WITH OR HIRES AN ADJUSTER TO PROVIDEADJUSTING 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 GROUNDSFOR ADMINISTRATIVE ACTION AGAINST THE LICENSEE, UPON GROUNDS, THAT INCLUDEBUT ARE NOT LIMITED TO, THAT THE VIOLATION DEMONSTRATES A LACK OF FITNESS TOENGAGE IN THE BUSINESS OF INSURANCE. ADDITIONALLY, A BREACH OF ANY PROVISIONOF THIS RULE CONSTITUTES AN UNFAIR CLAIMS SETTLEMENT PRACTICE.

(4) CODE OF ETHICS. THE WORK OF ADJUSTING INSURANCE CLAIMS ENGAGES THE PUBLICTRUST. AN ADJUSTER MUST PUT THE DUTY FOR FAIR AND HONEST TREATMENT OF THECLAIMANT ABOVE THE ADJUSTERS OWN INTERESTS, IN EVERY INSTANCE. THE FOLLOWINGARE STANDARDS OF CONDUCT THAT DEFINE ETHICAL BEHAVIOR.


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(A) AN ADJUSTER SHALL DISCLOSE ALL FINANCIAL INTEREST IN ANY DIRECT OR INDIRECTASPECT OF AN ADJUSTING TRANSACTION. FOR EXAMPLE: AN ADJUSTER SHALL NOTDIRECTLY OR INDIRECTLY REFER OR STEER ANY CLAIMANT NEEDING REPAIRS OR OTHERSERVICES IN CONNECTION WITH A LOSS TO ANY PERSON WITH WHOM THE ADJUSTER HASAN UNDISCLOSED FINANCIAL INTEREST, OR WHICH PERSON WILL OR IS REASONABLYANTICIPATED TO PROVIDE THE ADJUSTER ANY DIRECT OR INDIRECT COMPENSATION FORTHE REFERRAL OR FOR ANY RESULTING BUSINESS.

B) AN ADJUSTER SHALL TREAT ALL CLAIMANTS EQUALLY. AN ADJUSTER SHALL NOT PROVIDEFAVORED TREATMENT TO ANY CLAIMANT. AN ADJUSTER SHALL ADJUST ALL CLAIMSSTRICTLY IN ACCORDANCE WITH THE INSURANCE CONTRACT.

(C) AN ADJUSTER SHALL NEVER APPROACH INVESTIGATIONS, ADJUSTMENTS, ANDSETTLEMENTS IN A MANNER PREJUDICIAL TO THE INSURED.

(D) AN ADJUSTER SHALL MAKE TRUTHFUL AND UNBIASED REPORTS OF THE FACTS AFTERMAKING A COMPLETE INVESTIGATION.

(E) AN ADJUSTER SHALL HANDLE EVERY ADJUSTMENT AND SETTLEMENT WITH HONESTYAND INTEGRITY AND ALLOW A FAIR ADJUSTMENT OR SETTLEMENT TO ALL PARTIESWITHOUT ANY REMUNERATION TO HIMSELF EXCEPT THAT TO WHICH HE IS LEGALLYENTITLED.

(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 ANYLICENSED INSURANCE REPRESENTATIVE OF THIS STATE, WHICH CONDUCT VIOLATES ANYINSURANCE LAW OR DEPARTMENT RULE OR ORDER.

(H) AN ADJUSTER SHALL EXERCISE EXTRAORDINARY CARE WHEN DEALING WITH ELDERLYCLIENTS, TO ASSURE THAT THEY ARE NOT DISADVANTAGED IN THEIR CLAIMSTRANSACTIONS BY FAILING MEMORY OR IMPAIRED COGNITIVE PROCESSES.

(I) AN ADJUSTER SHALL NOT NEGOTIATE OR EFFECT SETTLEMENT DIRECTLY OR INDIRECTLYWITH ANY THIRD-PARTY CLAIMANT REPRESENTED BY AN ATTORNEY, IF SAID ADJUSTER HASKNOWLEDGE OF SUCH REPRESENTATION, EXCEPT WITH THE CONSENT OF THE ATTORNEY.

FOR PURPOSES OF THIS SUBSECTION, THE TERM THIRD-PARTY CLAIMANT DOES NOTINCLUDE 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, THEADJUSTER SHALL SCRUPULOUSLY AVOID ANY SUGGESTION CALCULATED TO INDUCE AWITNESS TO SUPPRESS OR DEVIATE FROM THE TRUTH, OR IN ANY DEGREE AFFECT THEIRAPPEARANCE OR TESTIMONY AT THE TRIAL OR ON THE WITNESS STAND. IF ANY WITNESSMAKING OR GIVING A SIGNED OR RECORDED STATEMENT SO REQUESTS, THE WITNESSSHALL BE GIVEN A COPY THEREOF.

(K) AN ADJUSTER SHALL NOT ADVISE A CLAIMANT TO REFRAIN FROM SEEKING LEGALADVICE, NOR ADVISE AGAINST THE RETENTION OF COUNSEL TO PROTECT THE CLAIMANTSINTEREST.

(L) AN ADJUSTER SHALL NOT ATTEMPT TO NEGOTIATE WITH OR OBTAIN ANY STATEMENTFROM A CLAIMANT OR WITNESS AT A TIME THAT THE CLAIMANT OR WITNESS IS, OR WOULDREASONABLY BE EXPECTED TO BE, IN SHOCK OR SERIOUS MENTAL OR EMOTIONALDISTRESS AS A RESULT OF PHYSICAL, MENTAL, OR EMOTIONAL TRAUMA ASSOCIATED WITHA LOSS


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CLAIMS HANDLING PROCEDURES

GUIDELINES FOR GOOD FAITH CLAIMS HANDLING

Have you thoroughly investigated all facts surrounding the issues presented to you by thinsured, the claimant, public adjus ter, the agent or the attorney?

Have you informed the insured or the claimant of their rights and obligations under thinsurance policy?

Did you pay the claim in a timely fashion?Unreasonable delay is a prime area of bad faithlitigation. If your payment differs from what the insured claimed / expected, you must accompanypayment with a clarification of any difference.

Never make a deceptive representation to anyone.If you feel uncomfortable about anything youare representing, be honest and advise that individual that you will confer with your supervisor. Rethe response as soon as possible.

You can not request that the insurance policy be canceled in order to deter other policyholderwith similar claims from presenting insurance claims against the insurance company. Leavecancellation decisions to the underwriters. However, you may complete an Underwriting Referral,warranted.

You may not manipulate any records, reports or other papers to support a denial of coverageThis is dishonesty and fraud.

Do not use a claimants financial situation to devalue the partys bargaining power. Do not takeadvantage 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 aburglary claim, do not require the insured to document everything the insured has ever owned. Itcommon practice in the insurance industry to recognize that not everyone keeps receipts for every itepossessed or purchased. You must be reasonable in your demands regarding receipts anddocumentation. Just remember, the jury foreman may not keep many receipts either, and he or shwill 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 legcounsel.

You must answer letters of inquiry and return phone calls by insureds, claimants and attorneysThis is not only a basic, common professional courtesy, but you are also required by statute tanswer these letters of inquiry and return telephone calls in a timely manner. As a practicalmatter, when you return a phone call, you must provide complete documentation as to whom yospoke, the month, day, year, time of day the call was returned, and what the essence of theconversation was. This documentation is absolutely essential, since it may be subpoenaed in a couaction.


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Documentation can serve as excellent evidence to show that you have handled a case with timelyand continual communication. The absence of such information can strongly prejudice your casWhen someone reviews your file, the file must be like an open book showing the history andevelopment 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 couand jury. Your file must be exemplary and complete. If you have a detailed, complete log of of the communications you had with the insured or third party claimant, you convey thimpression 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 communicat

your decis ion, 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 no hold out on the payment of one portion of the overall claim to coerce settlement of the othclaim. You must pay each and every element of the claim as it becomes reasonably clear thatpayment is due and owing, without withholding payment on one portion pending settlement on anotportion.

You may not compel the insured or claimant to institute litigation in order to recover any or 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 undea policy of insurance, you must comply with this request and document all payments madunder the policy.

If you secure a settlement from the insured covering essentially the same information as on aProof of Loss form, then a formal Proof of Loss form may be redundant.Requiring a redundantProof of Loss could be interpreted as harassment, which could lead to an allegation of bad faiclaims practices.

Give a written explanation as to any denial of a claim or compromise of a claim based on thcoverage language in the policy.

Never mislead anyone as to the applicable Statute of Limitations for a claim. If you are not sureabout the Statute of Limitations as it applies to the insurance policy or any oral contract made, regarding the time limit on making a personal injury claim, you must consult with your supervisor. the answer in writing.


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QUALIFICATIONS AND RESPONSIBILITIES OF ROLES

The following are the recommended requirements for the various independent adjuster roles working Citizens Catastrophe Operations. Additionally listed are the responsibilities of the positions as describedthe 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 formanaging Personal/Commercial Lines moderate to extreme damage and/or supervisory personnelpossessing necessary managerial skills for managing a catastrophe claims administration unit.Minimum catastrophe experience of 8 years. Team Leaders will maintain the followingresponsibilities:

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 becapable of handling the responsibilities detailed below:

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

Photos;


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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 managingPersonal/Commercial Lines minor to moderate damage. Minimum catastrophe experience of 1year. 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 formanaging Personal/Commercial Lines moderate to extreme damage and/or supervisory personnelpossessing necessary managerial skills for managing a catastrophe claims administration unit.Minimum catastrophe experience of 8 years. File Reviewers will maintain the followingresponsibilities:

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.


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Litigation/Mediation Specialist - must be a senior level adjuster possessing the necessary skillsand traits for managing Personal/Commercial Lines moderate to extreme damage and/orsupervisory personnel possessing necessary managerial skills for managing a catastrophe claimsadministration unit. Minimum catastrophe experience of 8 years. Litigation/Mediation Specialwill maintain the following responsibilities:

Coordinate and direct files that are in litigation, mediation, appraisal or civil remedyphases;

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 3rd 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 managingPersonal/Commercial Lines minor to moderate damage. Minimum catastrophe experience of year. Complaint Resolution Specialists must be capable of handling the responsibilities detailebelow:

Responsible for the effective resolution of inquiring complaints, agent inquiries or otheractivity;

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.


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LICENSING

Adjusters / examiners and supervisors must obtain and be able to provide satisfactory proof oproper licensing pursuant to the regulations of the Florida Department of Financial ServiceThese regulations change from time to time and may be amended during a catastrophe. Under ncircumstance will licensing be waived. Adjusters, supervisors and their firms are responsible taking care of this very important requirement. The best source of licensing information is:

Florida Department of Financial ServicesDivision of Agents and Agency Services

200 East Gaines StreetTallahassee, Florida 32399-0319

http://www.fldfs.com

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

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. IndependentFirms are required to complete background checks and drug screening per the termsof the current IA contract.

PROFESSIONAL STANDARDS

Adjusters must adhere to the professional standards and ethics of the profession as defined in theFair Claims Act and this manual.
http://www.fldfs.com%20/http://www.fldfs.com%20/


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VENDOR INFORMATION

Vendor Agreements

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

CATASTROPHE CLAIMS

INDEPENDENT ADJUSTER SERVICES AGREEMENT

Catastrophe Claims Services. SUPPLIER will perform the propertyclaims adjusting services (Services) as specified in the Statementof Work in Exhibit A. SUPPLIER shall perform no Services until theAgreement is duly executed by CITIZENS and by SUPPLIER.

Vendor Insurance Requirements

Required Insurance Coverage

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

(A) WORKERS COMPENSATION POLICY WHICH PROVIDES COVERAGE TO SUPPLIERSEMPLOYEES, REGARDLESS OF THE STATE OF HIRE, IN AT LEAST THE MINIMUMSTATUTORY LIMITS REQUIRED BY THE STATE OF FLORIDA, AND EMPLOYERS LIABILITYWITH LIMITS OF $1,000,000; (B) COMMERCIAL GENERAL LIABILITY WITH MINIMUMLIMITS OF $1,000,000 PER OCCURRENCE (TO INCLUDE CONTRACTUAL LIABILITY ON ABLANKET BASIS FOR LIABILITY ASSUMED HEREUNDER) AND $1,000,000 IN THEAGGREGATE;(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 THEAGGREGATE; AND(E) PROFESSIONAL LIABILITY (ERRORS & OMISSIONS) WITH MINIMUM LIMITS OF$1,000,000 PER OCCURRENCE AND $5,000,000 IN THE AGGREGATE. A CERTIFICATE OFINSURANCE SATISFACTORY TO CITIZENS AND EVIDENCING THE ABOVE COVERAGE MUSTBE PRESENTED TO CITIZENS PRIOR TO COMMENCEMENT OF THE SERVICES. SUPPLIERFURTHER AGREES THAT IT WILL MAINTAIN INSURANCE TO COVER ANY INDEMNITYOBLIGATION THAT IT HAS ASSUMED UNDER THIS AGREEMENT. ALL POLICIES OFINSURANCE REFERENCED HEREIN WILL BE PRIMARY AND WILL INCLUDE CITIZENS AS ANADDITIONAL INSURED WITH the exception of Workers Compensation.


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Required Insurance Coverage, contd SUPPLIER SHALL PROVIDE COPIES OF ITS POLICIES UPON REQUEST BY CITIZENS. ALLPOLICIES WILL INCLUDE PROVISIONS THAT THE INSURERS WAIVE THE RIGHTS OFRECOVERY OR SUBROGATION AGAINST CITIZENS. CITIZENS SHALL BE EXEMPT FROM,AND IN NO WAY LIABLE FOR, ANY SUM OF MONEY WHICH MAY REPRESENT ADEDUCTIBLE IN ANY OF THE AFOREMENTIONED INSURANCE POLICIES. THE PAYMENT OFSUCH 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 HARMLESSFROM ANY AND ALL CLAIMS, DAMAGES, CAUSES OF ACTION, LOSSES, COSTS ANDEXPENSES WHATSOEVER, (INCLUDING, WITHOUT LIMITATION, FINES DAMAGES,LIABILITIES, LIENS, LOSSES, COSTS AND EXPENSES, INCLUDING ATTORNEY FEES ANDLITIGATION EXPENSES, WHETHER INCURRED IN ANTICIPATION OF TRIAL, AT TRIAL,OR ON APPEAL) INCURRED BY, OR CLAIMED AGAINST CITIZENS, OR ITS BOARD OFGOVERNORS (THE INDEMNIFIED CLAIMS), OFFICERS, ATTORNEYS, EMPLOYEES,AGENTS OR OTHER REPRESENTATIVES, ARISING OUT OF, RESULTING FROM ORRELATED 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 OFGOVERNORS, OFFICERS, ATTORNEYS, EMPLOYEES, AGENTS OR OTHERREPRESENTATIVES, IS NAMED AS A DEFENDANT IN ANY LEGAL ACTION ORPROCEEDING (AN INDEMNIFIED CLAIM) IN WHICH A CLAIM

9.3 IS INDEMNIFIED HEREUNDER, SUPPLIER WILL ASSUME, AT ITS OWN EXPENSE, THEDEFENSE 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 COUNSELAND DIRECT THE LITIGATION WITH ALL COSTS OF SUCH DEFENSE TO BERESPONSIBILITY OF THE SUPPLIER


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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 companys policies, and the Citizens policy. Citizens contracts with the Member Company to process ahandle to conclusion the windstorm claims for their policyholders. Thus, the homeowner and/or floinsurance carrier handles the insureds Citizens claim.

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

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

AYO Duties and Responsibil itiesThe 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 thagreement (the 2007 AYO contract) on properties that are covered both by a Citizens policy and a poliissued by the Company; provided, however, that Citizens claims on properties covered by CondominiumTownhouse Unit-Owner or Association Policies, including, without limitation, loss assessment claims Condo Claims), shall be excluded from this Agreement and shall not be assigned to the CompanCitizens shall at all times retain ownership of all Citizens claims, and all Citizens claim files, incluretaining the right to re-assign such claim for any reason without prior notice. If a claim is re-assignCitizens shall notify the Company immediately and the Company shall immediately furnish documentation and materials relating to that claim to Citizens.



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AYO Duties and Responsibil it ies, contd

I. Process and adjust all assigned Citizens Claims and perform its obligations in compliance withthe Citizens Catastrophe Claims Guide, in conformance with generally accepted standards in theclaims 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 suchduties;

II. For every assigned Citizens claim the Member Company shall utilize Citizens proprietary ClaimsTracking System (CTS) to timely input all claims information and material including alldocumentation, photographs, log notes and any other material relevant to the claim. TheMember Company shall utilize CTS in accordance with any Citizens directives or trainingmaterial.

III. Transmit to Citizens, promptly after a loss occurrence, copies of all loss notices not reported toCitizens directly (which shall contain such information as Citizens shall require) and, when theCitizens 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 byMember 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 asa 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 theMember Company in error.The Member Company shall indemnify Citizens for anydamages, claim, lawsuit or costs rising from the delay that occurred as a result of theMember 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 Citizensmust 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 offraud; such claim will be immediately returned to Citizens.

IX. Train all employees, adjusters, independent adjusters and any other person or entity who adjustsclaims (for the AYO and handling Citizens claims). This training should at a minimum ensurethat all personnel are trained on Citizens policy coverage, fully and effectively utilize CTS andare 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 includeclaims information that is relevant to the adjustment of the Citizens claim. Citizens hereby agreeto use this information solely for the purpose of handling the Citizens claim.



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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 andprior storm losses. However, this is not always possible and it can not be assumed that onewill 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 hasbeen assigned to another adjuster, the adjuster may not receive any compensation foranytime 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 bespecifically 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 Examinerdoes 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 beadvised and provided a copy of the adjusters estimate depicting covered damages andapplication of deductible.

On those claims where the adjuster must apply a coverage condition (i.e. depreciation), and/orexclusions (i.e., awnings, outdoor equipment) the insured must be advised of these coveragelimitations. The adjusters estimate, a copy of which is to be provided to the insured, mustreflect repairs to covered damages only.

The adjuster must advise the insured that he/she is submitting a report to the Citizens FileExaminer for final consideration.

Because a field adjuster does not have any authority, he/she is not to give a copy of theestimate 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 tosubmitting the claim for payment; however, it must be made clear that the claim has not beenapproved and items may have been scoped that may eventually be removed from the finalsettlement 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).



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JOB WORKFLOWS



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FIRST NOTICE OF LOSS (FNOL) WORKFLOW



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DISPATCHWORKFLOW



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FAST TRACK/SUPPLEMENT


WORKFLOW


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FILE REVIEWWORKFLOW



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COMMERCIAL/PMSCWORKFLOW



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COMMERCIAL SUPPLEMENTS WORKFLOW



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ADJUST YOUR OWN A.Y.O.WORKFLOW



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MULTI-CAUSATIONWORKFLOW



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LOSS ASSESSMENTWORKFLOW



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INCOMING MAILWORKFLOW


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MEDIATIONWORKFLOW


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APPRAISALWORKFLOW


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MOBILE HOME EXAMINATIONWORKFLOW


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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 sucthis section is applicable to adjusters, AYOs and Citizens claims staff. The adjusters primary responsibiis that of customer service, performance and documentation based upon these guidelines. The Citizen

Claims staff and AYO management responsibility includes, but is not limited to, verifying the proimplementation of these standards and procedures. In addition, House Bill 7077 states, in part:

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

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

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

Citizens strictly adheres to this s tatutory language, which states that all claims will be closed with90 days after the claim was reported. Citizens continuously monitors all claims to ensure that thisrequirement is met. It is imperative that the claim handler recognize this t ime limitation on each anevery claim.

COVERAGE

This section is designed for easy reference by claim professionals involved in coverage analysis andecisions. 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 hoursreceipt of an assignment. Due to the nature of catastrophe claims handling, specific expectationwill be discussed during orientations; however, it is still expected that attempts at contact shoubegin within 24 hours of assignment. There must be a minimum of two (2) attempts to contact tpolicyholder at the numbers provided. If unsuccessful, the assigned agent may be able to assisthe adjuster with updated contact information. Each contact or contact attempt must be noted ithe 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 TeamLeads verify that all contact activity be documented in CTS.


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CTS records successful contacts only when the proper activity is selected. The reports that are rubased upon these criteria in CTS are reported to DFS to show compliance with contacrequirements. This is one reason why proper documentation of the contact is absolutelyimperative. User must choose the activity of contact not a just a description of contact or the claithe 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 coof the letter (and all correspondence) must be scanned in the claims file. The letter must inform tpolicyholder of all available adjuster contact information (office, cell, fax, after-hours voicemail)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 lettmay be sent.

It should be noted that claims should not be closed without contact until all resources are used iattempting 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 vacontact information. Generally the claim was turned in for some reason; to assume an error shoube the very last option.

Most residential losses are now subject to annual hurricane deductibles. Some Insureds may feethat they overestimated their damage and do not wish to pursue a loss. In those cases, it shouldbe explained that it is to their benefit to allow an inspection to document the damages even if thloss may be under the deductible.

Ongoing Policyholder Communication

The Claims staff must promptly communicate with the policyholder in order to be in complianwith 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 commopractice.

Phone messages or other inquiries from the policyholder or their representative must be returnewithin twenty four (24) hours.

Voicemail must be cleared out at least once per day and if possible multiple times per day. Aftlistening to messages adjusters should delete the message to avoid overload of the voicemailsystem.

Any discussion with a policyholder should conclude with a clear statement of the responsibilitiesthe policyholder and the adjuster, with specific timelines for each item.

DocumentationFirst Contact:

The electronic file must document the dates and times of all contacts and attempts to contacclaimants, policyholders or their representatives. This information must be reported via CTS.

This activity andall 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 Fie Adjuster may wait until he/she returns to enter logs in the evening, all logs must be entered on thsame day as the activity. Anyone in a claim office is expected to enter a log at the time of thactivity.


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Other File Activity:

All claim activity will be reported via CTS. Please refer to the reporting requirements sectionyour 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 clai

file via CTS.INVESTIGATIONS

This section of the guide is not intended to give detailed instructions on how to conduct every investigatHowever, there are several key areas that are common to all investigations which include, but are nnecessarily 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 scope of an investigation, he/she must review the claim with his/her supervisor for direction. All losmust 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 theinvestigation.


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PROPERTY CLAIMS The following list is intended to help determine which items arenormally considered part of the building andwhich arenormally considered contents.

BUILDING ITEMS CONTENT ITEMS

Central Air Conditioners Window Air Conditioner Units

Carpets (permanently installed) Rugs and Carpets (not permanentlyinstalled)Built-in Dishwashers Portable Dishwashers

Built-in Microwave Units Portable Microwave Units, CookoutGrills, and s imilar itemsBuilt-In Ranges and Stoves Food Freezers (unless bui lt-in)

CabinetsOutdoor equipment/furniture stored

inside the dwelling or other fullyenclosed building at the residence

premises.Furnaces and Radiators Refrigerators (unless bui lt-in).

Wall Mirror (permanently installed) Clothes Washers and Dryers

Fire Sprinkler System

Pumps and r elated machinery

Venetian BlindsGarbage Disposal Units

Hot Water Heaters (including solar)

Plumbing Fixtures

Permanently Installed Bookcases, etc.

Elevator Equipment

Lighting Fixtures


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

The building estimate must reflect the type of building, type of construction, dimensions, total squfootage, replacement cost, and actual cash value of the item (when applicable). If a policy is written oreplacement cost basis, with replacement cost being paid up front, Actual Cash Value need not bcalculated. Roof inspections are required on all roof claims. Diagrams are required on all inspected ro(including estimated pitch), and measurements are required if the roof shows any damage. From thground inspections are prohibited if you cannot safely inspect the roof, you must get appropriaassistance from roofing professional. Adjusters are required to be present when the roof is inspected. those exceptions when approval is given for a ladder charge to assist the adjuster in getting on the roof tadjuster is expected to complete the entire inspection. If the roof is too steep and high and authorizationgiven to have company complete the roof measurement and inspection the roof estimate and all othaspects of the claim are still to be completed by the Claim Representative. Approval for roof assistancharges 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, consideratiomay first be given to alternative methods of viewing the possible damage before asking for someone elseclimb the roof. However, at all times, safety comes first and no claim representative should ever attempclimb 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(the most recent, local, Xactimate pricelist) requires a detailed explanation and prior approval from CitizIf an item is not found in the price guide, a local price may be used if documented. For items that eitappear to be priced incorrectly, have localized price anomalies or have grade differences, the Adjuster isencouraged to use time and material estimating for the item and document how the price was createdSuch methods may be needed for unusual or commercial items and while working in areas with difficaccess.

The format must be in a room-by-room, line-by-line, unit-cost estimate with no lump-sum depreciashown. Depreciation must be item-by-item and line-by-line, when depreciation applies to the loRoom/interior diagrams are expected when there is damage to multiple rooms. Diagrams are expectewhen 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 bconsidered when appropriate. It is mandatory that every claim handler factor out base service chargfrom the Parameters section in Xactimate. When any prices or items are deviated from the standard itein the pricing program, it is expected that the Claim Representative will include a pricing or line note inestimate to explain the reason for the change. Such notes help to explain changes not only to filexaminers but also to Insureds and contractors.


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ESTIMATES (Contents)

The Contents estimate (inventory) must be itemized, reflecting a description of items along with the averified Replacement Cost Value, and Actual Cash Value of the items. Age, make, model and serinumbers must be provided on all major appliances. Lump-sum depreciation is not accepted. Depreciati

must be on an item-by-item basis. The insured may prepare the contents list, but the adjuster must ensurthe Citizens inventory form (see Forms section) is utilized. Further, the adjuster must verify prices adiscuss depreciation with the insured. It is not Citizens practice to accept the insureds / PAs prices as tonly means to determine settlement value. All salvageable items must be noted, and any buy-back cleardocumented.

Depreciation must be documented when applied. If the policy does not allow for the applicationdepreciation, the Claim Representative need not verify and review the Actual Cash Value of items. Sernumbers are needed on major appliances but not on small electronics. If there is a question aboupreviously paid items the serial numbers can be verified both against Citizens claims and NFIP claims. Tadjuster must verify not only the item, the damage but the actual cost of the replacement of the items ev

before the replacement takes place. Such documentation should become part of the claim fileDocumentation 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 thinsured. The adjuster must not select or employ a contractor or expert on behalf of the insured, nor maan adjuster recommend or coerce any insured to utilize the services of a particular contractor.

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

CITIZENS AUTHORIZED CONTRACTORS.


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

Documentation must include, at minimum, the age of the item of the item being depreciated. If the adjudetermines that no depreciation will be applied to an item to which depreciation would normally be appla written explanation must be provided, either in the narrative or in the estimate itself. Likewise, if adjuster determines that depreciation should be applied to an item to which depreciation normally would apply, an explanation must be provided.

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

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

Normal depreciation will not exceed 80%.

Any depreciat ion deductions must be explained to the insured. At or ientat ion depreciat ion will discussed to review which policies or items may be subject to depreciation. Generally, mosresidential policies are no longer subject to recoverable depreciation. This does not affect thositems that were subject to non-recoverable depreciation.

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

SALES TAX

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

TEMPORARY REPAIRS

The adjuster will determine what, if any, temporary repairs have been made or are necessary to protect thproperty from further damage. The reasonable costs of temporary repairs that mitigate damage are proper item of the claim. The adjuster must secure all invoices documenting temporary repairs and atta

them with the narrative portion of the report.Generally temporary repairs would not be subject to overhead and profit regardless of the number of tradinvolved in the eventual repairs. The actual cost of repairs is known and payment should be based upthe reasonable invoice and should not be adjusted upwards.


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SAFETY

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

Sufficient photographic documentation with narrative related to the damagemust be submitted for everyinspected claim file. Color photographs are required.Digital photographs are required and must be ofsufficient clarity and quality to clearly identify the damage or lack thereof to the item.Photographsshould 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 ri(unless the risk is a condominium unit). One photograph of waterfront property must be takdepicting the proximity of the risk to the water.

Roof photographs taken from the roof are required on all claims where there is wind damage oalleged wind damage to the structure.

The interior photographs must include an overall photograph of the damaged room so as to showthe rooms layout and contents. This photograph must be of sufficient clarity and quality fdemonstrating whatis as well as what isnot 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 programsthat allow for download of digital photos and quick labeling. The photos need only have the approprlabels and be easy to access, view and clearly demonstrate all that they need to show.


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April 9, 2007 Citizens Catastrophe Claims Guide

CLAIM PHOTOGRAPH Claim No. ________________RECORD Insured __________________

PHOTO # ________ TAKEN __________DATE

Description ________________________

__________________________________

__________________________________

__________________________________

__________________________________

__________________________________

__________________________________

PHOTO # ________ TAKEN __________DATE

ATTACH HERE

Description ________________________

__________________________________

__________________________________

__________________________________

__________________________________

__________________________________

__________________________________

COMMENTS:

________________________________________

____________________________________________________

ATTACH HERE

____________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________

SUBMITTED BY: _______________________________________________________________NAME___________________________________________________DATE________________________________


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OVERHEAD AND PROFIT ALLOWANCE

A maximum amount of twenty percent (20%) overhead and profit [ten percent (10%) overhead and tpercent (10%) profit] for the building estimate is available to the policyholder for the use of a gencontractor 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 separatelycompleted 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 determinthat 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 Overhe

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 Pro

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 liabilHowever, in cases where the gross covered loss amount exceeds a limit of liability, the amount iexcess of the limit of liability would be subtracted from the deductible. This results in the deductbeing absorbed, or partially absorbed.

The application of the hurricane deductible can be a complex computation. Most residential policare now subject to an annual hurricane deductible. In cases where the annual hurricane deductiblhas been satisfied, there is still a deductible. Depending upon the policy the remaining deductible mbe the All Other Peril deductible or the Other Windstorm deductible. In all cases the deductiblenever be less than $500. In some cases, the other peril deductible is the same as the hurricanedeductible meaning that the annual hurricane deductible has no net effect on the policyholder. Due

the complexity of these issues, they are addressed in detail during orientation and a document habeen 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 the National Hurricane Center of the National Weather Service; Continuing for the time period during which the hurricane conditions exist anywhere in Florida; a Ending seventy two (72) hours following the termination of the last hurricane watch or hurricawarning issued for any part of Florida by the National Hurricane Center of the National WeathService. A hurricane deductible will apply when wind damage occurs during these timeframes even if 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 InsurValues may be requested for the purpose of application of co-insurance penalties. If co-insurancpenalties are to be applied, this information will be disseminated and the best methods of determining I.Twill be discussed.


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RESERVES

The reserves must be maintained at a proper level over the life of the file. Reserves are initially set basupon the severity of the reported damage. The level of the reserves can be found in CTS and is alsprinted on the Workorder. Reserves should be updated when it becomes apparent that the existingreserves are inadequate. If the initial reserves are relatively close, no change may be needed. However, 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 labeledWork on Claim. Its as easy as scrolling to the bottom of the screen and selecting the Reserve Changelink. If the reserve change being requested is a reduction in reserves or increased within your authoritylimit, it will automatically update in the e-Wind system. Also, if the request is for an increase in reservesbeyond the authority of the requestor, then it will be recorded in CTS and routed to a reserve approver.Finally, Coverage E and FDO NOT apply to Catastrophe Claims.

Reserves for all coverages (A,B,C,D) are combined. The data displayed to support your decision includethe policy limits and the current reserve amount. You can only enter a total for the newly requested reseramount. On the Claims Details screen a message indicating The reserve has been updated will bedisplayed 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 hasbeen 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 binformed if your request fails or is denied via the notifications feature available on your desktop screen. 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 alreadyentered in CTS. This can be accomplished by accessing the Reserve Update page. Once you haveretraced the request, a success message will be displayed on the Claim Details screen to indicate thatyour 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 oloss. If the adjuster determines that an expert is necessary, approval must be obtained from the TeamLeader, who in turn, will obtain approval as directed. Once approved, every effort must be made for 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 Clai Adjuster uses an expert. This form is designed to detail the exact nature of the request for services. ExpeServices must be considered when the cause of loss is undetermined at the time of inspection, when theris potential for subrogation, suspected fraud, flood, or water damage claims with ensuing mold. A lisapproved experts is provided for your use in handling Citizens claims.Experts not appearing on theapproved list may NOT be retained on Citizens Claims. Recommendations must be submitted toCitizens 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.


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EXPERT SERVICES LIST

APPRAISERS

Burton Claim Service, Inc.Don Burton2941 Cypress Creek Rd.

catastrophe claims guide 2007

Documents