Ask The Public Adjuster About Insurance Claims: September 2016

Surprises You Can Do Without

by Mark Goldwich

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

Image courtesy of flickr.com

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

Image courtesy of commons.wikimedia.org

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.

Fill out the form below for your free copy.

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.