All is Right With the World of Claims

by Mark Goldwich

Recently I wrote posts about two claims I was handling. They were similar in that both cases
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involved strict denials, meaning that the insurance companies were saying the claims were not covered at all, in any way, for any amount, and they had very specific reasons, using verbiage selected from the insurance policies, detailing why the claims weren’t covered. They were also similar in that from my very first consultation with the insured, I could understand exactly why the insurance company would reach the conclusion they did, yet I did not agree with the insurance company in either case. Additionally, they were different in that the two claims were the result of completely different causes of loss, and the two claims were denied for completely different reasons.

In one case, the insureds suffered damage from a pipe breaking inside a home they recently purchased, but before they actually moved into the home. The insurance company could not see a way to otherwise deny the claim, until the insured mentioned they had not moved into the home, and it had been over a month between the date the home was insured, and the date the claim was reported. You see, there was some obscure (to most people, but not to the insurance company) language in the policy that said there would be no coverage for water damage if the home was vacant or unoccupied for over 30 days (heads up for anyone that has any home, rental property, business, or other property).

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To most people, hearing the bit about there being a month between buying the home and reporting the claim would have been meaningless. After all, what is a month in the scheme of home ownership? And besides, it’s not really that uncommon to purchase a home, but not move in right away because you haven’t sold your prior home yet, and sometimes the new home is not “move-in ready”. That’s how most people think, anyway. But to most insurance adjusters, the mere mention of that month is like waving a red cape in front of a bull. It triggers some pleasure receptor in their brain, instantly bringing them back to a day in claim training when an instructor said something about a policy exclusion for losses to properties vacant or unoccupied for at least 30 days. They are suddenly curious, but only inasmuch as the answers continue to trigger those pleasure receptors.

So once the adjuster’s “investigation” confirmed the sale date of the new property, the fact that they did not move into the new property right away, and the approximate date of loss being beyond 30 days from the sale date, they had all they needed to keep those receptors firing in their brain, and their sense of curiosity quickly fades away. Their work is done. They can close that file with a form denial letter, and move to the next claim in a tall stack of claims.

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Until, that is, until they get my letter, explaining that they overlooked a key piece of information in
their “investigation.” What they missed was the fact that the insureds did not just purchase the home and not move in, the husband stayed in the home after the purchase for a few weeks to work on it and prepare to move in, while the wife returned to the prior home to prepare it to move out. With just those few weeks taken into account, the time the home was unoccupied was reduced to about 3 weeks. Initially, the carrier simply replied that they were standing by their decision to deny the claim.

After another letter explaining their error, they re-opened their investigation, and requested proof of when the loss actually occurred. Fortunately, this loss was discovered by the local utility company at the new home when they went out to read the meter, so we knew the leak occurred on or before the date the meter was read. Once we got that information in writing from the utility company to the carrier, they agreed to pay the claim, which totaled over $35,000.

In the other case, extremely heavy rains caused water to enter the insureds’ home as they slept, by filling up a unique atrium room within the home. The water could not escape the holes built into the exterior wall of the atrium fast enough, and the water rose until it was able to pass under the French doors leading from the family room to the atrium.

In this case, multiple triggers starting firing on those receptors. Words and phrases like, “flood”, “surface water”, “subsurface water”, “rising water”, “design defect” and “no opening created” overwhelmed their pleasure receptors and once again, true curiosity failed to take root. This one was easy, they no doubt thought, it’s simply not covered. The form letter went out, and the claim was closed.

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Again, that is, until the insurance company got my letter explaining they had misinterpreted their own insurance policy, whether as an innocent mistake, or something more nefarious. As the coverage question in this case was more complicated, it took more letters, and phone calls, and a demand the matter be mediated via a State mediation program, and frank discussions about attorneys getting involved and how other similar cases were ultimately ruled on by various courts – but we eventually settled this case as well. While the dollar amount on this claim was less than the other, I was happier about this resolution because the coverage issue was more contested. It took more research, and more negotiation efforts, but I felt strongly that we were right, and they were wrong. Now, the settlement agreement will say the insurance company does not admit they were wrong… but I know.

Being passionate about what I do for a living makes it worthwhile, even when things don’t always go my way. Fortunately, that doesn’t happen often. But when the stars align and multiple cases go our way, as they usually do, it feels even better! For now, all is right with the world (of claims).

 Mark Goldwich is president of Gold Star Adjusters, a group of public insurance adjusters dedicated to helping citizens get the maximum settlement for any insurance claim.  

Security Threat Level Orange

By Mark Goldwich

If there is one thing in the news lately, it is security. Security threats, security risks, security leaks, heightened security, cyber security, security vetting procedures…you get the point.
While I’m not going to get into a discussion of international security or terrorism here, I thought this might be a good time to offer some basic tips and suggestions on personal and business security, whether at the home, at the office, or online.

Here are some helpful tips for personal and residential security from the US Department of State (

Residential security is a critical component of any personal security program. The following guidelines should be used in reviewing your residential security. 

   All entrances, including service doors and gates, should have quality locks--preferably deadbolt. Check your:
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·         Front Door                                               
·         Rear Door
·         Garage Door(s)
·         Service Door(s)
·         Patio Door
·         Sliding Glass Door
·         Gate
·         Swimming Pool Gate
·         Guest House Door(s). 
·         Don't leave keys "hidden" outside the home. Leave an extra key with a trusted neighbor or colleague. 
·         Keep doors locked even when you or family members are at home. 
·         Have window locks installed on all windows. Use them. 
·         Lock louvered windows--especially on the ground floor. 
·         Have locks installed on your fuse boxes and external power sources. 
·         If you have window grilles and bars, review fire safety. Don't block bedroom windows with permanent grilles if the windows may be used for emergency egress. 
·         If you have burglar or intrusion alarms, check and use them. 
·         Keep at least one fire extinguisher on each floor, and be sure to keep one in the kitchen. Show family members and household help how to use them. 
·         Periodically check smoke detectors and replace batteries when necessary. 
·         Keep flashlights in several areas in the house. Check the batteries often, especially if you have children in your home. (They love to play with flashlights!) 
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A family dog can be a deterrent to criminals. But remember, even the best watch-dog can be controlled by food or poison. Do not install separate "doggy doors" or entrances. They also can admit small intruders. 
·         Choose a location that offers the most security. The less remote, the safer your home will be, particularly in a neighborhood close to police and fire protection. 
·         Know your neighbors. Develop a rapport with them and offer to keep an eye on each other's homes, especially during trips. 
·         If you observe any unusual activity, report it immediately (family, neighbors, police). 
·         Establish safe family living patterns. If you understand the importance of your contribution to the family's overall security, the entire household will be safer. 
·         While at home, you and your family should rehearse safety drills and be aware of procedures to escape danger and get help. 
·         Educate family members and domestic help in the proper way to answer the telephone at home. 
·         Vary daily routines; avoid predictable patterns. 
·         Know where all family members are at all times. 
·         Use these same guidelines while on [vacation].

Here are some more personal safety tips from a personal security and identity theft expert,
  1. Fundamentals: Body language is 55 percent of communications. That’s your walk, posture, facial expressions and eye contact. Awareness is being alert to your surroundings at all times. Intuition is when the hair on the back of your neck stands on end. Voice tone and pitch equal 35 percent of communications. The way a person communicates physically and verbally can determine whether or not a predator deems them a good target.
  2. Prevent Abductions: When returning to a parked car, scan the area around your car and be alert to suspicious activity. Be aware of vans. Abductors and rapist open up the side doors and pull in their victims.
  3. Never Use Your Keys As A Weapon: Contrary to popular belief, your keys are not a good weapon. Using your keys as a weapon can injure your hand, the keys can break, you lose your “key to safety” and you lose access to your car and home, which are safe havens. Unless it’s a LARGE key. Then it’s a good weapon.
  4. Prevent Home Invasions: You tell your children not to talk to strangers, so why do you open the door to a total stranger? Home-invaders pose as delivery people, public workers, or people in distress. Install peepholes, talk through the door. Under no circumstances do you open the door unless you get phone numbers to call their superiors. If someone is in distress tell him or her you will call the police for them.
  5. Safety On The Street: One dollar bills and change in an easily accessible pocket. Then if someone tries to rob you, you can throw the “chump change” several feet away. The robber will draw his attention to it, giving you time to escape. Do not fight over material items.
  6. What To Do If Attacked By A Date Rapist: If he won’t let you go, gouge his eyes out! Fight as hard and as determinedly as you would if he was a stranger. By assaulting you, he has crossed the line, and now he is a stranger. Remember: you are worth fighting for! If all else fails, you can always let him kiss you, then bite down on his lip till your teeth meet.
  7. Safety In Your Car: In the event of a minor accident, stop only in a well-lit area. Carjackers often provoke such “accidents” just to get a victim to stop. Do NOT stop on a deserted, dark street. Drive to a police station or a gas station. Use a cell phone and call 911.
  8. Home Safe Home: Consider a second line or a cell phone in your bedroom. That’s because burglars often remove a telephone from the receiver when they enter a home. Of course, an alarm system activated while you are sleeping will prevent a burglar from getting this far. Newer alarms have cellular options, a safeguard even if the phone lines are cut.
  9. Vacation/Business Traveler Safety: Be suspicious of a call from the hotel desk just after checking in requesting verification of your credit card number “because the imprint was unreadable.” A thief may have watched you enter the hotel room and called from the guest phone in the lobby. Never open your hotel room to anyone.
  10. Social Media Security: What you say and post could lead an attacker right to you or a family member. Just because other people post information about themselves and whereabouts, doesn't mean you should. Plus, you should never post travel plans online telling a burglar you aren't home.
Most of the above tips could easily be applied to your workplace. And although so many of these seem to be common sense, the more you review this list, especially with younger family members that may not fully appreciate the concepts, the more second nature your actions become under high pressure situations. The reason athletes, first responders, and others practice the same drills over and over again, even long after they are quite skilled, is so they don’t have to think about the skills in the heat of the moment.

And finally, cyber tips are everywhere, especially (oddly enough) online. My friends at have several blog posts that can help, and I found a very detailed Cyber Security Planning Guide at, and a “top ten” list of safe computing tips at  The lists of tips are too plentiful to detail here, but please take a few moments to check these out. These cyber tips are not common sense to most of us, which is all the more reason to try to become familiar with safe computing practices. 

Mark Goldwich is president of Gold Star Adjusters, a group of public insurance adjusters dedicated to helping citizens get the maximum settlement for any insurance claim.  

Is it Time for a Little Fall Cleaning?

by Mark Goldwich

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As the Fall season is upon us, with more and more proof descending from the trees each day, I began to wonder why no one ever says, “Time for a good Fall cleaning” like they do each Spring. According to, “Spring cleaning is the practice of thoroughly cleaning a house in the springtime. The practice of spring cleaning is especially prevalent in climates with a cold winter.”

I read on to learn “It has been suggested that the origins of spring cleaning date back to the Iranian Norouz, the Persian new year, which falls on the first day of spring. Iranians continue the practice of "khooneh tekouni" which literally means "shaking the house" just before the new year. Everything in the house is thoroughly cleaned, from the drapes to the furniture. A similar tradition is the Scottish "New Year's cleaning" on Hogmanay (December 31), a practice now also widespread in Ireland, New Zealand, and to North America.

“Another possibility of the origin of spring cleaning can be traced to the ancient Jewish practice of thoroughly cleansing the home in anticipation of the spring-time memorial feast of Passover. In remembrance of the folktale of the Jews' hasty flight from Egypt following their captivity there, during the seven-day observance of the Passover memorial or remembrance, there are strict prohibitions against eating or drinking anything which may have been leavened or fermented with yeast. Jews are not only supposed to refrain from leavened foodstuffs, they are expressly commanded to rid their homes of even small remnants of chametz for the length of the holiday. Therefore, observant Jews conducted a thorough "spring cleaning" of the house, followed by a traditional hunt for chametz crumbs by candlelight (called bedikat chametz) on the evening before the holiday begins.

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“In North America and northern Europe, the custom found an especially practical value due to those regions' continental and wet climates. During the 19th century in America, prior to the advent of the vacuum cleaner, March was often the best time for dusting because it was getting warm enough to open windows and doors (but not warm enough for insects to be a problem), and the high winds could carry the dust out of the house. For the same reason, modern rural households often use the month of March for cleaning projects involving the use of chemical products which generate fumes. The most common usage of spring cleaning refers to the yearly act of cleaning a house from top to bottom which would take place in the first warm days of the year typically in spring, hence the name.”

Now, I will admit that “Spring cleaning” typically refers to cleaning done inside the home, so perhaps “Fall cleaning” should refer to cleaning done outside the home. After all, the weather has cooled down (some, but not much yet), and there is plenty to clean up outside the home, the most obvious of which is the leaves. While Fall leaves make for great photographs, and great fun (if you like diving into a huge pile of them), for most property owners, the falling leaves represent a lot of work…work that has either got to be done yourself, or that you have to pay others to do.

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But now that we are thinking about cleaning up around the home, let’s go beyond raking leaves in the yard. Keep in mind, not all leaves that fall end up in the yard. Many land on the roof, and collect in valleys, or low spots, or gutters. I have seen roofs that have had so many leaves fall for such a long time without being cleaned up, that the leaves had decomposed into dirt, and small trees were sprouting up!

Leaves left on roofs can create a number of problems. They tend to gather, so the pile of leaves grows bigger and bigger (without any raking). When leaves gather on a roof, they invite pests of all kinds to nest and reproduce. Water flow is restricted by the leaves, which may allow water to make its way into your home, without ever “creating” an opening. The reason most roofs are sloped is so water (as well as snow) can flow quickly off the roof, fast enough so it does not find a way into the building. 

When you reduce the speed at which the water is attempting to exit the roof, you increase the opportunity for the water to find a way in. Also, decomposing piles of leaves stay wet longer, and can damage roof shingles.  The same goes for leaves that gather too long in gutters. The leaves eventually decompose, making room for more and more leaves, which also decompose, and after a while the gutters are full of a mushy organic material that supports insect life, plant growth, and weighs heavy on the gutters, as well as the pins that attach them to the roof structure.

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In other words, if you see a bunch of leaves on your roof, or in your gutters, it is best to clear them out as soon as possible. Your home will not only look better, but it will function better, and last longer. And you shouldn’t wait for “Fall cleaning” to do this, but do it anytime you see a “gathering” of leaves, twigs, or branches. This might also be a good time to trim back tree branches and shrubs from your roof or the walls of your home. There should never be tree branches close enough to scrape against your home in a breeze, and there should be a clear space of at least a foot between your home and any shrubs.

I was recently on a roof that had a flat portion in the back, under several huge trees of differing species, and it was literally covered in a 4 inch blanket of leaves in various states of decomposition, with some twigs and dead branches thrown in for good measure. I asked the owner (who was older than I am, and I am no Spring chicken) for a broom, and spent at least 30 minutes clearing off the leaves (a shovel would have done the job a lot faster, and with a lot less effort, but that could easily damage the roof, so don’t try this at home!). I was drenched with sweat, but did a good deed, and got in an extra workout for the day! Oh, Karma, where art thou!

Mark Goldwich is president of Gold Star Adjusters, a group of public insurance adjusters dedicated to helping citizens get the maximum settlement for any insurance claim.