Figure 1-6: ICC Claims Process Schematic
Figure 1-6. The illustration above shows a flowchart of the ICC claims process. The following steps must be taken: (1) Policyholder suffers flood loss and reports loss to the Insurer (NFIP Direct or to the Write Your Own (WYO)). (2) During first visit, claims rep. completes Damage Assessment Form (DAF) if damage appears to be 50% of replacement cost and is in an SFHA. (3) Claims Rep. sends DAF to Mitigation Division Director at FEMA Regional Office. (4) Claims rep. advises policyholder of ICC if the structure appears to be substantially damaged. (5) Policyholder applies to the community for a permit to begin repairs. (6) Local official determines if this flood involves "substantial damage" or a "repetitive loss" that would trigger local cumulative substantial damage ordinance. (7) Policyholder confers with local officials on local ordinance requirements and mitigation options. *(8) Policyholder notifies the Insurer of substantial or repetitive damage repair requirements. (9) Policyholder obtains a permit from the community to begin repairs. (10) Policyholder gets cost estimate from a contractor to begin the required work. (11) Insurer sets up ICC claim file and checks if the policy is rated post-FIRM with negative elevation difference. (12) For post-FIRM construction with negative elevation difference, claims rep. must determine: (a) whether the structure was built in compliance at the time of construction; (b) whether a variance was issued at the time of construction; (c) whether there has been an increase in BFE. Once variables are determined, use decision table in Appendix 1-7, and then go on to step 13. (13) If a community issued a variance at time of construction or before the current loss, claims rep. must obtain a copy for claim file. (14) Claims rep. determines on what basis the community determined the loss involving substantial damage. Claims rep. makes certain substantial damage caused by flood, and also makes sure no variance has been issued for current loss. (15) If claim involves repetitive loss structure, insurer must verify that repetitive loss damages involve flood claims paid by the NFIP direct or a WYO. Note: claims rep. must obtain documentation from community of building value at the time prior to flood claim. (16) Claims rep. must verify, within a reasonable range, that flood damage for the loss(es) supports the community's valuation. (17) Once the claims rep. confirms that the damage meets the requirements for ICC eligibility, the claims rep. will forward an ICC Proof of Loss to the policyholder and indicate under what conditions an advance payment may be made. (18) Policyholder may receive partial ICC payment provided that claims rep. received assigned contract for the work, a permit from the community to do the work and a return of the signed ICC Proof of Loss. (19) Claims rep. advises policyholder that if the work is not completed, any partial payment must be returned to the Insurer. (20) When mitigation work is complete, local official inspects property and issues a certificate of occupancy or a confirmation letter. (21) Policyholder furnishes claims rep. a copy of letters of confirmation or a certificate of occupancy from the community. (22) Insurer pays the final ICC claim installment with appropriate documentation.

*Please note: Steps 8-11 do not necessarily occur in this exact order or may occur simultaneously. Claims rep. must get documentation for elevation requirements different from final FEMA BFEs (e.g., unnumbered A zones or FEMA advisor BFEs freeboard requirements.)


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