Ask The Public Adjuster About Insurance Claims: 2016

This Time It’s Personal

By Mark Goldwich

As a licensed adjuster for 30 years, I am more familiar with insurance claims than most people will ever be. I have personally handled thousands of insurance claim
s of all kinds in many states around the country, and I have managed or overseen the handling of hundreds of thousands of claims by others. I have stood with people whose homes or businesses were ruined, and those who suffered no damage at all, but just wanted to be sure. I have spoken to many, many others by phone. I’ve heard their stories of loss, and of the trials of the claim process, as well as the repair and recovery processes. And I have witnessed both the despair when claims go poorly, and the joyous relief when claims go well. It is safe to say I’ve seen and heard just about everything when it comes to claims.

But it’s different when the claim is MINE, right? Well, yes and no. You see, my own home was damaged recently when on Friday, October 7, 2016, Hurricane Matthew skirted the eastern seaboard of the United States. It was not an extreme amount of damage, but more than enough to file a claim. My roof was badly damaged, as was my fence, and a few other smaller items. No big deal, I thought, at least the roof wasn’t leaking, and no large trees had fallen on the house. So, as far as storm damage, we were luckier than many. But just to be sure, I followed the advice I have given to others – I got out a pad of paper, noting all of the damages, and began logging all claim related activities. I also took photos and videos of the damages. Then on Monday morning, I called my claim in, once I was certain my covered damages would exceed my hurricane deductible.

After that, we waited to hear something from our insurance company. About a week later, my agent called, and said he was just checking to see how the claim was going. I’m not sure, I replied, because aside from his call, we had not heard anything from the insurance company at all. Not a big deal, I told him, there are plenty of people with much more severe damage, I’m sure they’ll get to me soon enough. A week later, my in-laws’ claim for similar damage was being finalized by the very same insurance company, even though we had submitted their claim for them several days after calling in our own claim. I was beginning to think this insurance company was giving me extra slow treatment, but the next day an adjuster called my wife to schedule his inspection of our damages.

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In the meantime, we began gathering estimates from different contractors just as anyone would, while waiting for the adjuster to get back to us with his estimate of the damages. When the estimate came back about a week later, I guess I should not have been too surprised that it came without a check, because I’m accustomed to this particular insurance company depreciating heavily, and making small up-front payments until the work is done, and then the recoverable depreciation is claimed and paid.

Still, I couldn’t help but compare my estimate (with no payment) to that of my in-laws. My estimate was nearly twice that of my in-laws, yet they received an up-front payment (albeit a small one), and I received no up-front payment at all. Again, same insurance company, same geographic area. It just seemed there was some disparity in our treatment. Could it be because my father-in-law retired from that insurance company after decades of service, whereas I resigned from that insurance company to represent policyholders with claims against that insurance company? Or was it all just coincidental? Either way, I was starting to feel slighted. I talked to an attorney – not because of what I perceived as delays in handling my claim, or even the disparity in the handling of my claim versus the claim of my in-laws, but because I was anticipating what might come next, and I wanted to be ready.

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From repeated experiences with this insurance company, I knew that when an insured asks for more money than the adjuster estimates, this company goes on the offensive and demands what is called an “Appraisal”. This is a process in many homeowners policies which was initially intended to reduce the number of claims being litigated. The Appraisal process basically states that if either party (the insured or the insurance company) feels there is a dispute as to the amount of the loss being claimed, either party may demand an Appraisal to resolve the perceived dispute. In doing so, each party would have to hire (and pay for) an appraiser, and the two appraisers would select an umpire, whose job would be to help resolve the dispute if the two appraisers were unable to agree on their own. The cost of the umpire is split between the parties. In other words, if you don’t agree with their estimate (and we find very few of their estimates to be agreeable), you have to pay – generally over $1,000 – in order to get the insurance company to pay the full claim. Nice, huh?

So when we were done collecting estimates from the various contractors, I starting looking for a Proof of Loss form in order to submit the estimates. Because I am an adjuster, and because I used to work for this particular insurance company, I knew the policy contained a “Condition” which required I submit a Proof of Loss (POL) within 60 days of the date of loss. I was surprised when I could not find this form online. Then I checked the insurance company website. Not there. Then I remembered this insurance company allows clients to create an online profile and track claim progress online. I did this, and I must say, it was pretty slick. I could check the status, upload documents, correspond with the claims department and my agent, even look at all my policies. Cool!

But, no POL, not even in the sections marked “Resources” or “Documents”.

So I called the claim representative designated right there on my claim status page. She answered the very first time I called. Sweet. I gave her my information, and she asked how she could help me. Not needing to discuss the claim, I simply asked for a Proof of Loss form. She said she did not complete one. I told her I know that, but I needed to complete one now that I have all my estimates together.

She said no, I didn’t need to complete one, I could just send in the estimates. When I said I would

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rather submit the POL as required by the policy, she proceeded to argue with me about whether or not the policy in fact required me to send a POL, unless she requested one from me. Even when we both pulled up the policy on our respective computers, she continued to argue the policy language, because she was reading from a section above the section in question. Even after pointing this out to her, she would not agree. Finally, I simply insisted she send me the form, even if she didn’t think I needed it. She said she would, and we hung up. Hours later she called me back and left a message saying she would NOT send me the form, stating, “That is not something we routinely send out to customers.” Again, having worked there for 17 years, I know that form is sent to customers on a very regular basis.

So, was I being intentionally lied to? If so, why? Or, was this adjuster so poorly trained that in addition to being unable to read and interpret the policy, she did not understand what this form was, or that is was required as a condition of payment? Either way, now it became personal for me. I promptly filed off complaints with the company, my agent, and the Department of Insurance in my State. All I wanted was a form – one that was required by my policy, and the company not only made it impossible for me to find this form online, but was actively refusing to provide it to me upon request. I couldn’t help but think, how many millions of people are they doing this to every year? And how often do they deny claims for failing to submit a form they don’t tell people about, don’t provide access to, and even tell people it is not required?

I may never know the answers to those questions, but just today I received a call from some supervisor in Atlanta. They received my complaint. He apologized, agreed the policy says exactly what I already know it to say, and he said they would send me a blank form. We’ll see. It just goes to show, no matter how experienced you are, things are different when they happen to you. Luckily, as upset as I may be that it happened to me, I am much more upset that this (and worse) is currently happening to untold numbers of other people far less equipped than myself at dealing with insurance company bureaucracy. Good luck to us all!

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.

Surprises You Can Do Without

by Mark Goldwich

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Being a fan of Weather.com, I was noticing that even though it is not making national news – whatwith the first presidential debate and Charlotte riots and all – there continues to be bad weather wreaking havoc in parts of the country you might not normally think about. Deadly flooding in Iowa, Minnesota and Wisconsin, and tornados in Indiana and Utah, seem to happen with little warning, leaving death and destruction in their path which will be remembered for years to come.

This is happening almost a month after Florida saw damage from the first hurricane to hit the state in eleven years. Hurricane Hermine did not come out of nowhere, but as hurricanes go, it developed rather quickly, going from a depression to a category 1 hurricane within 24 hours of making landfall. Typically, these depressions are tracked for weeks, with courses predicted and severity estimated in plenty of time to allow for preparation or evacuation. That didn’t happen this time, but fortunately, Hermine wasn’t a very powerful storm, and it moved through the state and was on its way relatively quickly, so damage was not nearly severe as it could have been.

As is typical of many lower level hurricanes, most of the damage resulted from flooding, not from the powerful winds hurricanes are known for. And much of the wind damage occurred when trees, planted too close to structures, and allowed to grow untrimmed, were toppled onto homes, cars, and other property. Sometimes, people are in those homes, making for a dangerous and frightening experience. The same holds true for people trapped in homes by fast-rising waters or flash floods, given no time to escape. Regardless of the nature of the damage, once the wind has stopped blowing or water recedes, there is another frightening experience awaiting those trying to put their lives back together. We hear about it every time an event like this happens.

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Just last week I heard from someone who had a very large oak tree land on their home after Hurricane Hermine coasted through the state capitol of Tallahassee. It wasn’t even their tree – it was their neighbor’s – but it was big enough to crush a number of roof trusses on their home which allowed water to run into their attic. It also smashed a skylight, and a kitchen vent, allowing more water into their home. They placed buckets about to catch the water streaming into the house, and spent most of the night emptyin
g the buckets as they filled up with water. Before too long, insulation in the attic got so heavy from all the water, that the ceiling collapsed onto the floor. Luckily, no one was hurt, but their home was a mess.

They promptly called their insurance company first thing in the morning to report the loss. Their carrier put them at ease, telling them a “preferred vendor” would be out to take the tree off the house and begin to clean up the mess. And sure enough, an hour later they received a call from a restoration company. This particular restoration company is nationally recognized in the insurance industry, but many people have not heard of them because they do not advertise as much as other companies. It seems they don’t need to, since insurance companies so regularly refer them to policyholders who need emergency restoration work.

This may sound innocent enough, but we have found that having this special relationship between the insurance company and the emergency restoration company can be very good for all parties, except for the policyholder – the one that is in dire need. The restoration company gets work handed to them on a very regular basis, saving potentially millions in advertising nationally every year. By getting to the job site first, this company has gotten extremely proficient at selling themselves to the policyholder to complete all the needed restoration work, especially since they already seem to have the approval and blessings of the insurance company. This nets them even more money than the emergency work they were initially called out for.

And what does the insurance company get? They get a nationally branded contractor that will respond to their requests for assistance at a moment’s notice, and local managers with whom they develop long-term relationships. They also get preferential treatment, even compared to the homeowner for whom the work is being done. After all, it is the insurance company that pays the restoration company, not the homeowner. It is only natural then, that the relationship between the insurance company and the restoration company can result in blurring the loyalty lines. Remember, they want that flow of claims to keep streaming into their pipeline, so if they have to jump through a few extra hoops, or make less money on a job here or there to keep their “partner” happy, that’s what they are going to do, even if it comes at the expense of the policyholder.

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So in this case, the insurance company’s preferred restoration company was on the site within a few hours of the homeowner’s call. As discussed with the insurance company, the tree was cut up, the mess dealt with, and a tarp was placed on the roof to prevent more water from entering until the reconstruction could begin. Then they began to work their magic, explaining to the homeowner that they were the insurance companies preferred contractor, and that they would write up a complete estimate for all of the damages and reconstruction estimates. They said they would help take care of everything, including helping the family relocate while the work was being done, not to mention meeting with the insurance adjuster to agree on the estimate. Within days, the insurance adjuster and the preferred vendor met, just as planned, and the adjuster told the contractor, “send me your estimate”. It all seemed to be going according to plan.

But the next day, the contractor came out again with an engineer to confirm the damages and begin the permitting process. And while they were there, the contractor first asked the homeowner to sign what is called a “work authorization”. This allows the contractor to access the property and work on the repairs – basically, hiring the contractor even though no estimate was done. While many people might not be familiar with this form, this particular homeowner was (since he himself is a contractor), and he knew this was not necessary in order for the contractor to provide the insurance company with an estimate. It was clear the contractor was not happy, and the request became more firm, with the contractor saying the form was needed for the contractor to send the estimate. The homeowner refused, and the contractor left in a huff. That was a few weeks ago, and as far as he can tell, no estimate from the preferred contractor was ever sent to the insurance company.

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A week later the insurance company then sent their own adjuster’s estimate, but it was woefully lacking. This comes as no surprise to me, and in my opinion, it is simply a strategy to coerce the homeowner into hiring the preferred contractor, in hopes of getting the process back on track. By this, I mean the track desired by the insurance company and their contractor. Now it is our turn get this claim back on track for the policyholder, and that is exactly what I intend to do.

In the wake of such catastrophes, it is easy to see how people would be vulnerable in a time of calamity. They are desperate to have the damage repaired so they can get on with their lives. The thought of an insurance company working in concert with a contractor to take advantage of a policyholder that has paid a lot of hard-earned dollars for the promise of being treated fairly, is hard to believe. Still, based on my decades of experience, I’m afraid it might be the rule rather than the exception, and this example certainly seems to support my suspicions. After weathering the storm you need to be strong, and especially vigilant before signing anything. For those who know, help is just a phone call or keystroke away. And since being forewarned is forearmed, now you know.

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.

The Delay is in the Details

by Mark Goldwich

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To begin to understand how and why insurance claims can sometimes drag on way too long, it is important to start by understanding the key players. Insurance companies employ representatives who answer policyholder phone calls (but lack the experience or authority to do anything about it), various claim representatives/adjusters (field, office, staff, independent, examiners) of differing experience levels, as well as experts (contractors, consultants, engineers, attorneys) to help determine how a particular claim is to be handled.

The call representatives are in an office full of cubicles, all of them are connected to a computer by a headset, which reports to supervisors the number of calls taken, the average call time, the average wait time, the number of breaks taken, and other factors that determine compensation or even continued employment. The supervisors can also "listen in" on random or selected calls to grade the call rep. You know, for "quality control purposes". I'll agree with the "control" part of that.

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The field adjusters go to the property and take photos, diagrams, measurements, and collect other information about the claim to report back to a claim examiner or manager with their estimate of the damages. Sometimes they set their own schedule, and sometimes they have their appointments scheduled for them by other representatives in the office. Either way, they are usually kept very busy.

As you might imagine, insurance companies do not like paying for idle time. They get to the property, where the owner wants to describe everything, go into detail about how the loss occurred, what they did, the origins of the property damaged - and the adjusters just want the basic facts so they can get to their next appointment. Many of these field adjusters, being independent adjusters, are paid based on the amount of the claim, or the number of claims handled, not on the time they spend listening to the policyholder.

The examiner is typically the one that decides (often with the help of a manager) how much is going to be paid, if anything. Many times, the examiner has less field experience than the field adjuster that was actually at the property. Regardless, it is the examiner that usually makes the final call on coverage and payment. And keep in mind, unlike many of the field adjusters, the office examiners generally do not get paid based on the number or size of the claims, but on a salary, no matter how many claims, or what size claims, they review. In many cases, the examiner believes a more expert opinion is needed before they will "sign off" on the claim, so they assign this task to whomever they believe can help (contractor, consultant, engineer, attorney, etc.).

So, a representative sets an appointment, a field adjuster gets the claim filed and then passes the estimate to the often overworked and all too often inexperienced examinerAfter this, the examiner may hand the file off to yet someone else. Remember, these examiners are usually reviewing the files of multiple field adjusters who are all trying to crank out files for payment as fast as possible. This can result in a new stack of files being delivered to the examiner daily. All of these tasks take time, and the insurance company has plenty of time, and plenty of claims. You, on the other hand, have only one claim, and only one life to live (more about that later).

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And that is where they sometimes get you. They know, after decades of practice, and millions of claims, that if they can delay policyholders long enough, a great many will just give up. There’s an old saying, “Don’t go away mad, just go away.” I am 100% convinced that insurance companies thrive on this approach to claims processing. They don’t want you to be mad enough to file a complaint or hire an attorney, but they want you to give up without getting paid in full, if at all. It can be something of a balancing act, but one they have gotten very good at with lots of practice, trial and error, not to mention input from consulting companies.

And if you still refuse to give up (probably because you have hired a public adjuster, attorney, or both) – and only a small percentage of people do this – the insurance companies are sometimes able to drag the claim out so long, the policyholder actually dies before the claim can be paid. No kidding. I have seen multiple policyholders pass away before getting their claims paid. But I want to emphasize, our policyholder’s claims do get paid. When I think about all the other people who died before their claims are paid each year, I picture a motivational sign on the wall in the insurance office that reads, “Dead people rarely hire attorneys.” A bit cynical, perhaps, but if you have seen what I have seen, you would understand completely.

Keep in mind, professionals like myself are always available to answer any questions you have at any stage of the claim process. We're happy to speak to other groups you belong to, at no charge. I constantly find people are quite surprised when I tell them there is no charge to come to their property, review their claim, go over documentation, and consult with them on the available options. This can also include an offer to visit their office to educate their staff on insurance issues. “Sounds too good to be true” they say. That’s OK, it makes them that much happier when we follow through on what we say, and deliver results.

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.

The Calm After the Storm

by Mark Goldwich

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Everyone talks about the calm before the storm when what they really should be forcused on is the calm AFTER the storm. In the wake of Hurricane Hermine last week, I wanted to talk about some storm insurance basics. First, a little about myself, just so you know I’m qualified to speak on the subject. I’m a Florida native, and have seen my share of tropical storms and hurricanes over the past 50 (or so) years. I have a Bachelor of Science degree in Insurance from the University of Florida, and my diploma is hanging on the wall behind me. I’ve been a licensed insurance adjuster in Florida since 1987. I spent 17 years with one of the country’s largest insurance companies, and personally handled or managed the handling of hundreds of thousands of claims, in many states across the country. In 2004, I decided to leave my job at the insurance company, start Gold Star Adjusters, and adjust claims for policyholders, not insurance companies. A few years later, after seeing too many terrible things happening to so many insurance claim victims, I wrote and self-published my first book, “UNCOVERED: What Really Happens After The Storm, Flood, Earthquake or Fire”.

So with that out of the way, here are some little-known facts about property insurance:

First, how do you think about your relationship to your insurance company? How many of you think of yourselves as a “customer”? Do you want to know what you really are? – You are a financial and legal adversary. That’s right. Now, if you have an insurance agent, especially an independent insurance agent, you may feel like a customer to them, and to be honest, they probably feel the same way about you. But to the claims department of the insurance company, as soon as you file that insurance claim, you are asking the insurance company to share their profits with you. To get an idea of how well that goes over with them, think about asking Microsoft to share profits with you the next time you buy a computer. Good luck.

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Did you know that although insurance is generally marketed as a “product”, your insurance policy is actually a legal contract? The insurance company writes the contract, and when you buy the insurance, you are accepting the contract. Did you also know that while you can’t negotiate how the contract is written, you can negotiate the settlement of a claim? The catch is, even if you knew you could negotiate the settlement, who do you suppose knows more about insurance? - the insurance company, or you, the policyholder?

Not only can you negotiate an insurance claim, but did you know you can re-negotiate a claim after it has been paid (or denied), or that you can re-open a claim years after it has been closed, or even after it has been denied? You can. In Florida, you have 5 years to pursue your claim...except after a windstorm or hurricane like Hermine. You see, while you weren’t looking, your insurance company, their lobbyists, and your state representatives quietly changed that a few years back. Now you only have 3 years to pursue your hurricane claim. Two years, gone, just like that. But again, even if you know this, how well are you going to do against the insurance company’s experts?

Did you know that just because your insurance company sends an official letter, complete with policy language or other legalese, stating your claim has been closed or denied, that doesn’t make it so? We get many of these denied claims paid every year.

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OK, now that you’ve learned a little more about the insurance industry than you probably wanted to know, let’s talk a little about how you can make the best of it, should you ever need to file an insurance claim (a lot of this comes from a section in my book, UNCOVERED, detailing my “10 commandments of claims”):

Know your insurance policy. Meet with your agent and have them explain it to you, and make sure you have the proper coverages, endorsements, limits, and deductibles, based on your individual needs.

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Flood is not covered by homeowner’s insurance, so consider buying a flood policy.

Just because you’re not in a designated flood zone, doesn’t mean you won’t get flooded. Flood zone maps are created and updated by the federal government. If you trust their accuracy now, you may be one of 1000s filing for government assistance later. Think about it, we (especially in Florida) are surrounded by water. I don’t care what the flood map says, if you live in Florida, you stand a real chance of flooding.

Take photos or video of your property and valuable possessions, and store important documents where they can’t be damaged (the cloud, family, safe deposit box, etc.). These photos and videos could prove to be invaluable when it comes time to documenting your loss.

Don’t try to pull one over on your insurance company – be thorough, but honest. Many of their best adjusters work in their “fraud” units. It would be nice if their best and brightest adjusters were the ones paying claims, instead of being the ones denying claims, but that’s another story, and a testament to the priorities of the insurance companies. Inflating a claim is just not worth risking a felony conviction.

Take notes of everything that’s damaged and keep a detailed log of all conversations with your insurance company, your contractor, and everyone else. Show the adjuster all the damage and be as thorough as possible. If the adjuster doesn’t want to spend to time to review it all, make a note in your log, and have them (or someone else) come back when they have more time. Review the adjuster’s estimate in detail, until you understand it completely. Request a licensed contractor or other professional review the insurance company estimate and provide an independent quote.

If the insurance company refuses to pay for anything at all, demand they explain why – in writing. Even if they explain why in writing, get a second opinion. I can’t tell you the number of times we have gotten claims fully paid after the insurance company initially denied the claims, in writing, including the exact policy language they relied upon to deny the claim to begin with. My motto is, “the claim is covered until I say it is not”.

Be persistent and don’t give up. Appeal up the chain of command. Too many policyholders give up too easily, and as a result, I am convinced they leave many tens (if not hundreds) of millions of dollars in the insurance companies’ bank accounts every year.

And, lastly, seek professional assistance when needed. Whether from a public adjuster, attorney, contractor, engineer, politician, consumer reporter, or anyone else you think can help.

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.

The Calm After the Storm

by Mark Goldwich

Image courtesy of commons.wikimedia.org

So with that out of the way, here are some little-known facts about property insurance:

First, how do you think about your relationship to your insurance company? How many of you think of yourselves as a “customer”? Do you want to know what you really are? – You are a financial and legal adversary. That’s right. Now, if you have an insurance agent, especially and independent insurance agent, you may feel like a customer to them, and to be honest, they probably feel the same way about you. But to the claims department of the insurance company, as soon as you file that insurance claim, you are asking the insurance company to share their profits with you. To get an idea of how well that goes over with them, think about asking Microsoft to share profits with you the next time you buy a computer. Good luck.

Image courtesy of flickr.com

Not only can you negotiate an insurance claim, but did you know you can re-negotiate a claim after it has been paid (or denied), or that you can re-open a claim years after it has been closed, or even after it has been denied? You can. In Florida, you have 5 years to pursue your claim (except after a windstorm or hurricane like Hermine). But again, even if you know this, how well are you going to do against the insurance company’s experts? You see, while you weren’t looking, your insurance company, their lobbyists, and your state representatives changed that a few years back. Now you only have 3 years to pursue your hurricane claim. Two years, gone, just like that.

Get a free copy of my book.

Know your insurance policy. Meet with your agent and have them explain it to you, and make sure you have the proper coverages, endorsements, limits, and deductibles, based on your individual needs.

Fill out the form below for your free copy.

Flood is not covered by homeowner’s insurance, so consider buying a flood policy.

And, lastly, seek professional assistance when needed. Whether from a public adjuster, attorney, contractor, engineer, politician, consumer reporter, or anyone else you think can help.

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.

When the World Comes Tumbling Down

by Mark Goldwich

Image courtesy of en.wikipedia.org

By now most everyone has seen the terrible images from central Italy, where a magnitude-6.2 earthquake struck in the middle of the night earlier this week. Small towns substantially damaged, hundreds of casualties, and many more wounded. While there have been some dramatic rescues, including a girl about 8 years old that was pulled out of rubble the day after the quake, at least 250 lives were lost. Compounding matters were the fact that the earthquake struck at night when most people were inside and sleeping, in buildings that were not specifically built to withstand this type of stress. Add to this the fact that at least one of the areas was busy with tourists, and this makes it difficult to accurately know how many people are still missing.

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It is scenes like these that should cause people to take account, not only of all that they have, but of all that could be lost, from loved ones, to property, belongings, pets, if a sudden disaster were to strike without warning. It seems so distant when it comes to us via cable news from half way arount tha world, but events like this happen all too often. Right now there are wildfires burning out of control in California, incinerating homes and leaving virtually nothing behind. There are floods devastating entire neighborhoods, and storms brewing in the Atlantic. All of these have, can, or will bring heartbreak and loss to hundreds or even thousands of people. Yet there is only so much that can be done about it (and even less to prevent it).

In Italy, it is still very early on in the aftermath of the earthquake. I am sure there will be much discussion (and finger pointing) revolving around the construction methods, design, and engineering of the buildings that were destroyed. Hopefully, they can move past that point and quickly develop consensus on how these buildings will be repaired or replaced. Improved construction materials, methods, design, permitting and inspections can greatly impact the ability of structures to withstand whatever nature has in store.

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No matter the type of disaster, there are things that can be done to increase your chances for survival. For example, you can carefully research and choose where you live. In insurance terms, this is called risk avoidance. Terrified of tremors? Don’t live on or near a fault. Have a fear of fires? Avoid wildfire-prone areas. Scared of cyclones? Don’t reside in areas known as “tornado alley”. Frightened of floods? Pick a home on elevated grounds and far from large bodies of water. Harried by hurricanes? Move far inland, but hopefully not near a fault line, tinder-dry canyon, low-lying riverbank, or tornado area.

Let’s face it, no matter we live, we face some risk of widespread damage by a catastrophic event. The next consideration is to accept the possibility of loss, but to take steps to reduce the potential impact on your way of life. The applicable insurance term for this is risk transfer. Typically, this involves buying the appropriate insurance, and thereby transferring the financial risk from you, to the insurance company.

Impace windows courtesy of HomeRute

Along the way, you can do other things, like being sure your home is built to withstand various calamities as best as you are able. If you live in areas prone to storms, spend a few extra dollars to have wind resistant windows installed. If in a low-lying area, homes on raised pilings are a plus. And of course, homes built to withstand earthquakes would be preferred if you live in areas that periodically experience earth tremors.

And finally, you need to take steps to minimize loss of life. Besides the steps mentioned above, this would include anything from living in areas known for early warning systems, well planned escape routes, and responsible civil authorities, to developing your own plans for escape (which should certainly include heeding evacuation calls), communication, regrouping, and subsistence, as well as having a well built and well stocked basement or storm shelter. Plans for all types of disasters abound freely on the internet, so it would be senseless not to take advantage.

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Nobody can guarantee a life free of natural catastrophes, but there are plenty of things you can do to reduce the likelihood, degree of impact, and overall consequences, no matter what Mother Nature has in store for you. Please keep our friends in Italy, and in Louisiana, and Colorado, in your thoughts and prayers and be proactive before the world comes tumbling down around you.

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.

Your Vacation Checklist

by Mark Goldwich

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Summer break is nearly over, but vacations happen year round, so it is never too late (or too early) to learn a thing or two that could really come in handy should disaster strike while you are away, from the perspective of an insurance claims professional.

First, be sure you have insurance to begin with, and that it is the right insurance for you and your property, with the right coverages, endorsements, and deductible. Whether you are going on vacation or not, you should meet with your insurance agent yearly, or you should review your policy carefully if you don’t have an agent. Why? As you might imagine, insurance policies differ from company to company, and each insurance company may also have policies that differ. Some policies are actual cash value only, meaning they will deduct for depreciation in the event of a loss, while other policies are replacement cost value, meaning they will not deduct for depreciation, but fully pay whatever it costs to replace what you had that was damaged, lost, or destroyed. Even this is not consistent, in that some policies say they are replacement cost, but will only pay the full replacement value if you replace the item, and they will not pay actual cash value until or unless you actually replace the property first.

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Another consideration that needs to be made when researching insurance options is what I call “internal limits”. Most people understand their policies have overall policy limits for which their property is covered, like a limit for all items related to the structure, and another limit for all of their personal belongings. However, some don’t realize there are usually internal or sub-limits for items, usually for personal property. For example, all your personal property may be insured for $50,000, but your policy may have multiple sub-limits for items like jewelry, cash, antiques, camera equipment, business property, stamps, firearms, silverware and goldware, watercraft, trailers, expensive rugs or tapestries, and even computers. Sometimes these limits apply only if the property is damaged under certain circumstances (like theft), and sometimes these limits apply regardless of what caused the damage.

In short, it’s important to have an idea of what these limits and circumstances are, and whether or not you can buy additional insurance to cover your property. Oftentimes you can, but unless you know what the limits are, how can you know whether you need to buy more insurance or a better policy? Early in my career as an insurance company adjuster, an associate and I inspected a claim for a theft loss that highlights this well. As we interviewed the homeowner, he explained that while he was out of town, thieves broke into his home and stole a number of items, including jewelry, cash, and designer clothing from his wife’s boutique. Other items were stolen and damaged as well, but the items listed above were all subject to relatively low internal limits.

The cash limit was $200, the jewelry limit was $2,500, and the limit for clothing used in his wife’s

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business was $1,000. Normally, this wouldn’t be so dramatic, but in this case, the amounts he was claiming were extraordinarily high. You see, he was claiming the amount of cash stolen exceeded $200,000, the amount of jewelry exceeded $100,000, and the clothing exceeded $50,000 in value. We were shocked, he could probably sense in our questions that we doubted his story, but he assured us he could document and prove all the items and quantities being claimed. He even noted the money was still in the U.S. Marshall’s bags from when the money was recently returned to him. A strange claim, indeed! And to say he was upset about the shortcomings of his policy sub-limits would be an understatement – I was glad to make it back to the office alive! No doubt most people will never experience a loss of this magnitude, but it well illustrates the point of internal policy sub-limits, and the importance of being familiar with those in your policies.

And for similar reasons, it is crucial to have at least a basic understanding of all other aspects of the policy. Without this basic knowledge, it is impossible to know whether or not you have the right policy and endorsements for your needs. Once you are confident of your policy, you can be a bit more at ease when you leave for vacation.

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But just having the right policy is not enough. You need to have a plan as well. This can include how to prepare your home to make it less attractive to thieves, to be less susceptible to electrical and plumbing losses, and general life and home protection ideas, including a contact list to use in the event of some disaster, and a step by step strategy for beginning to deal with the claim remotely. I actually found some very good ideas and tips on insurance websites for www.Nationwide.com and www.Travelers.com (hey, just because I don’t trust those guys to help you after a loss doesn’t mean I won’t recognize any of their good works).

With a comfortable knowledge of your policy, a plan in place, and your home prepared, it’s time to pack your bags and enjoy your trip!

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.

Public Adjusting Takes a Vacation

by Mark Goldwich

Image courtesy of flickr.com

Like many other Americans, this week the family and I are on our last vacation of the summer. Vacation is a bit different for me as a business owner versus my decades as an employee for a large national insurance company. Back when I worked as an employee of the insurance company, I could just go. My job and the office would be there when I returned, but I didn’t have to worry about work while I was away on vacation. Now when I go on vacation, I have to be sure to take my phone and laptop (and chargers) with me, both of which allow me to communicate in various ways with coworkers, insureds, and others. With the systems we use, I can work virtually from anywhere, as long as I can connect to a network, or get Wi-Fi, without missing a beat.

In fact, just yesterday, as I was completing the last driving leg of our trip to Williamsburg, Virginia, I got a call from an adjuster I was expecting to hear from the day before, and in just less than 10 minutes at highway speeds, we were able to settle the claim. My insured, Ms. “P”, will be very happy. Ms. “P” suffered a water leak in April when the shower valve in her daughter’s bathroom sprang a leak in the wall cavity between the bathroom and the laundry room. They immediately shut off the water and called a plumber, who located and repaired the source of the leak. She then called a contractor who extracted the water and dried the structure. In the meantime, Ms. “P” got a closet-full of shoes out of her daughter’s room, and began drying and cleaning them. A few days later, the insurance adjuster showed up, and Ms. “P” said she could tell it was not going to go well from the start. The adjuster began by saying he needed photos of odd things, like the mailbox, and the exterior of the home (none of which had any damage or were related to the claim in any way). The adjuster suggested the water was leaking for “quite some time” and questioned the insured’s truthfulness regarding certain aspects of the claim.

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Sure enough, about a week later, the insured was officially told her claim would be denied because the insurance company felt the water leak was an ongoing maintenance issue that occurred for weeks or months, and not just hours or days as the insured had claimed. Fortunately for Ms. “P”, her water restoration contractor told her about me, and one month after the leak was discovered, she hired me to help recover on the claim. As soon as I saw the damages, exactly as the insurance company adjuster saw them, I knew with certainty the loss should have been covered. I took my photos, made some notes, and had an estimate prepared. The estimate was sent in to the insurance company with a request to meet with an adjuster (either the same one, or a new one). They sent a new one, about a month later. When we met back at the house, the adjuster acknowledged he was not familiar with the claim, or why it was not covered, but assured us he would consider it with “fresh eyes”. I remained sure the claim would be paid. Ms. “P” was encouraged, but not yet convinced. Until today, when I communicated (via email from 3 states away), the general terms of the agreement the adjuster and I came to in the car yesterday. He confirmed they agreed to fully cover the claim, and even agreed to the vast majority of my estimate, plus something to compensate the insured for saving and cleaning her daughter’s shoes.

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While on vacation, the TVs where we are staying are programmed to have the weather channel appear when the TVs are turned on. For most guests, I imagine this is so the visiting tourists can check the weather and plan their days. Of course, for me, I get to see where the storms are, and remain in “work-mode”. Today, for example, I see Tropical Storm Earl is heading for Mexico’s Yucatan Peninsula, and that Maryland is recovering from recent heavy flooding. So, while my family is at a local theme park, I am taking the day off from vacationing to catch up on some emails and write this blog. Tomorrow, though, it is back to family vacation fun, I promise – but I may need to take a work call or two, and check email and text every few hours. And I wouldn’t have it any other way. I love that I can help people any day of the week, no matter where I am!

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.

Record Losses For All

by Mark Goldwich

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The Weather Channel’s website, weather.com, recently published an article, “Eight Billion-Dollar Weather Disasters Have Hit the U.S. So Far in 2016”. The article noted this was only for the first 6 months of 2016, and that just one of the storms alone accounted for over 3.5 billion dollars of that damage. Also of note were the facts that 5 of the 8 weather disasters occurred in Texas, including 2 flooding events, and the damage totals did not even include late June flooding events in West Virginia. All told, at over 12 billion dollars, this could end up being the costliest January to June weather disaster period in recent history (it is already ranked #2, behind 2011’s tornado superoutbreak in April).

Now let’s try to break down who has to pay for all these damaging weather events, and how this could translate into insurance terms. First, remember that not all such losses are covered by insurance. Some properties are uninsurable, some properties are insurable but the owner chooses not to insure, can’t afford to insure, or decides to self-insure, and still others are insured, but not all the damages are covered by insurance. For example, if a 50-foot tall, 100 year old oak tree comes down in a storm, and does not land on covered property, there is no coverage for cutting up the tree and hauling it off of the property – and the bill for that could be thousands of dollars. Now, consider how many trees come down in all of these storms without landing on anything. As another example, flood insurance only covers certain types of buildings, and only up to certain limits (it is not like other types of property insurance where you purchase the amount of insurance you need).

So, out of the 12 billion dollars in damages, let’s say only 7 billion dollars are covered by insurance – that is still a great deal of money. Fortunately, the insurance companies have that money sitting in reserves, collecting more interest than you or I can get. And, let’s not forget that just because the damages are covered by insurance, and the policies are in place, and the premiums are paid, that doesn’t mean the insurance companies are going to willfully pay that money to their insureds, who have now crossed the line from (pre-loss) “customers”, to (post-loss) “legal and financial adversaries”.

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Care to guess how much I would predict insurance companies would offer premium paying customers with covered losses, if the covered damages were actually 7 billion dollars? Don’t read ahead. Just think about it for a minute before scrolling down. Don’t peek! If they owe 7 billion, how much would they pay without question? Should be 7 billion, right? OK, maybe they try to hold back a little – after all, some people probably try to inflate their claims, and mistakes happen, but they would probably pay at least 5 billion, don’t you think?

Well, I don’t. My experience tells me they would try to pay a mere 1.75 billion dollars of the 7 billion dollars owed. Good thing we’re a litigious society, with tons of lawyers at our disposal, and we won’t let anyone take advantage of us like that, huh? Don’t count on it. Accounting for the small percentage of policyholders that would fight their claims – either on their own, or with the help of a professional public adjuster or attorney – I would doubt the figure would rise above 2 billion dollars. That makes for a nice additional profit of about 5 billion dollars on covered losses owed, but not paid.

Why do I think the insurance companies would offer so little? That would be based on my own experience, supported by a governmental agency, the Florida Office of Program Policy Analysis and Government Accountability that published a report in January 2010, which showed insurance payments were up to 747% higher when policyholders were represented by public adjusters for claims related to hurricanes (catastrophes). This report supports my own experience when dealing with insurance claims, and especially when dealing with catastrophe claims.

Exhibit 6

Public Adjuster Representation Typically Resulted in Larger Payments to Policyholders

Source: OPPAGA analysis. Data refers to the median (50th percentile or typical) payment.

Consider these two examples of actual claims I handled recently:

In one case, an insured was paid just over $2,600 for damage to his roof from a storm. The insurance company acknowledged that about 50% of the insured’s roof needed to be replaced due to a covered wind event, but decided not to pay to replace the entire roof as was required by building code (and the insured had the proper endorsement to address this). I thought it would be a simple matter of letting the insurance company know of their mistake. Instead of quickly paying the correct amount, an adjuster blustered about the amount I had estimated, misrepresenting a number of facts about the size of the roof and the cost of the repairs. It took a few months to get someone else involved that agreed the prior adjuster did not respond properly, and an additional $7,750 was paid, on top of the $2,600 initially paid.

In another case, a woman had a pipe leak inside a wall between her bathroom and laundry room, damaging some drywall, a vanity, floor tiles, and some of her daughter’s shoes. The insurance company adjuster was very difficult with her, suggesting the leak must have been occurring for an extended period of time, and questioning the insured about some items that were completely unrelated to the claim. She said she could tell there was going to be a problem within just a few minutes of him entering her home. Sure enough, she soon received a letter denying the claim altogether. She then hired me, and I recently met with another adjuster, who agreed to pay for the damages, totaling over $6,000.

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Keep in mind these are small losses, not resulting from major weather catastrophes, yet the amounts the insurance companies were attempting to avoid paying were relatively significant for such small claims. If you consider the hundreds of thousands of claims that would have been filed for the weather related catastrophes in the first 6 months of 2016, and have confidence as I do in the amounts that could be recovered with professional representation, you can begin to see why I believe the insurance companies could be avoiding as much as 5 billion dollars or more in covered claim payments.

Yes, the insurance industry might be making record payments on record numbers of weather disasters, but their insureds are also suffering record losses as well. The difference is, the insureds paid their full premiums with their hard-earned money, and don’t have the 5 billion dollars I believe is being shorted, and the insurance companies do have the money. The insureds who refuse to settle for less than everything they are owed are fully compensated – I hope that includes you.

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.