Ask The Public Adjuster About Insurance Claims: Claims adjuster

Showing posts with label Claims adjuster. Show all posts

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.

Fill out the form below to get your FREE copy.

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.

Image courtesy of commons.wikimedia.org

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

Image courtesy of pixabay.com

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.

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.

Image courtesy of commons.wikimedia.org

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).

Get your FREE copy by filling out the form below.

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.

Collateral Damage - Can your insurance policy become a casualty of war?

by Mark Goldwich

Image courtesy of en.wikipedia.org

While just about everyone in America is talking (if not listening) about the racial problems facing the nation, and all the theoretical reasons for the discord, as well as the perceived solutions, I was also thinking about the real life property damage consequences from the Dallas attack and other demonstrations that sometimes begin peacefully, but don’t always end peacefully, as well as events such as the Orlando and San Bernardino attacks.

After giving the obvious due consideration for the loss of life, and everything that goes along with that loss of life, and the acts that led to the loss of life, I couldn’t help but think about the property damage involved in these types of events. Often, the property that is damaged does not belong to either the victims, or the perpetrators. Instead, the owners of the property that is collaterally damaged or destroyed are additional innocent victims of the various types of mayhem that seem to be more and more common. In fact, in Dallas, the explosive that ended the event, was introduced and detonated by the police, not the assailant. Should this make a difference? I thought, “If I’m wondering about this, maybe other people are as well.”

So what about it? Is property damaged like this covered? First, we’d need to break down the causes of the property damage, because determining coverage always begins with the cause of the damage. And as you might imagine, the cause might depend on who you are asking. Was the event a riot, a civil commotion, civil unrest, looting, arson, terrorism…?

Image courtesy of YouTube

Because we are talking about insurance, these terms are usually defined in either the policy, or in case

law (a legal ruling or judicial interpretation based on a past case, usually with similar facts). Still, what one person interprets as “riot”, another may consider “terrorism”. Without even getting into this very deeply, you can probably see that what should be clear cut, with just a little wordsmithing can be made to be as confusing as which bathroom should be used by someone born with male parts. Some will say, “that’s easy”, while others will promptly chime in, “not so fast.”

To illustrate how quickly and easily key terms can be interchanged, Brendan McKenna in a 2006 article found at Insure.com noted, “At 9:30 a.m. on Sept. 11, 2001, shortly after learning about the crash of a second airplane into the World Trade Center in New York City, President George W. Bush called the events an "apparent act of terrorism." Standard property/casualty insurance contract forms provided to the industry by the Insurance Services Office contain clauses excluding "war, including undeclared or civil war" and "warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign, or other authority using military personnel or other agents." Just over a day later, Bush said that "the deliberate and deadly attacks which were carried out yesterday against our country were more than acts of terror.

They were acts of war." While the President’s words have unequivocally stated the position of the United States, they may have muddied the waters concerning the insurance issues around the attacks on the World Trade Center and the Pentagon. Many property/casualty insurance policies are written to exclude coverage for acts of war, but not for acts of terrorism. If the act-of-war exclusion clause of the insurance contracts is invoked, insurance companies can refuse to pay the benefits on the policies, including payments on businesses, homes, and cars that were damaged or destroyed.” That would have been ruinous to countless Americans who suffered tens of billions of dollars in direct and consequential damages.

Most standard Homeowner’s or Business insurance policies exclude damage caused by war, and most do cover damage caused by riot or civil commotion, but so far, I have not seen or heard of many policies having specific coverages for, or exclusions against, terrorism (especially on the Homeowner’s policies – some Business policies already exclude terrorism, but allow terrorism coverage to be purchased). So far, at least, this trend benefits policyholders, as most of the events we are referring to here would not be considered “war”, even though we generally talk about “war on terrorism”, or note that radical jihadis have declared “war” on America. As far as I know, no insurance company would consider any of the cases above to be “war”.

According to an article by Gwen Moran in HouseLogic.com, “Several states, including Florida, Massachusetts, New York, Ohio, Pennsylvania, and Texas, forbid terrorism exclusions, according to a report on terrorism’s impact on homeowners insurance from the Missouri Bar Association.”

On the topic of terrorism insurance, according to the Insurance Information Institute (www.iii.org), most personal policies cover terrorism, and most commercial/business policies do not, and even if a business did have a terrorism policy or endorsement, some losses associated with terrorism could still not be covered (fire, nuclear, biological, chemical, radiological, and cyber-terrorism), so it is increasingly important to sit down with your insurance agent to consider these threats, especially if you own a business. While talking with an agent, it may be worthwhile to see how your various insurance policies (home, condo, rental, auto, business, life, health) would react to the scenarios mentioned above.

In conclusion, there are still many questions left unanswered with regard to the insurance coverage of these types of events, and changes continue to be made as additional events occur and more data is gathered by underwriters. That said, you can be pretty sure insurance executives everywhere are meeting at conferences and other industry events to consider how to address the seemingly growing costs associated with paying claims from these types of events. Whether they will adjust policy definitions, limit exposure to these types of losses, or exclude more of these events altogether, remains to be seen, but I have a hunch they will eventually determine a strategy for maximizing profits. They always do.

ps: As I write this I am reminded that terror is an international scourge. This morning's news is filled with the tragic terror attack in Nice, France that claimed at least 50 lives, 2 of whom are American.

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.

Collateral Damage - Can your insurance policy become a casualty of war?

by Mark Goldwich

Image courtesy of en.wikipedia.org

Image courtesy of YouTube

Because we are talking about insurance, these terms are usually defined in either the policy, or in case

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 Things Go Wrong and Then Right

by Mark Goldwich

Last week I wrote about an insurance claim that actually went right from start to finish (a fairly rare occurrence in my experience). This past week I was reminded of the awful reality of how rare that is, and how terrible it can be when things go wrong (at least until they go right).

Image courtesy of flickr.com

Imagine you are the grandmother of 5 children, and you are their sole caretaker and guardian. That sounds pretty tough enough, doesn’t it? Now imagine that the home the 6 of you live in is completely destroyed in a fire…2 days before Thanksgiving! Are you crying, yet? If not, just wait.

Now imagine you contact your insurance company of many years, and they assure you (on the phone) that everything will be alright, and they will send an adjuster out right away. An adjuster does come, but instead of paying you for the loss, or even advancing you some money for a place to live, or for clothes to wear (other than those on your backs), or for your next meal, you are told they will be sending an expert to investigate and determine the cause of the fire, and that you will have to make yourself available for a recorded statement.

During that recorded interview, you are asked about your finances, your medical history, your relationships, if you have a criminal history, whether you are taking prescription medications, where you were and what you were doing when the fire broke out, whether you or anyone you know had anything to do with the fire starting, and just enough other questions to make you feel like a suspect in the arson of your own home (when it wasn’t even caused by arson to begin with).

Image courtesy of en.wikipedia,org

Weeks pass as adjusters and investigators inspect the home and consider whether or not to pay any part of your claim. All the while you are forced to live with a relative who has 3 children of their own (that’s now a household of 8 kids for those of you with rusty math skills!). Weeks turn into months, and you don’t hear anything from your insurance company well into January (certainly you have a tear at this point, right?).

It is easy to understand how anyone could begin to lose hope at this point, but fortunately one of the fire restoration companies that came around looking to bid on the job told you about a public insurance adjuster that might be able to help get the claim processed. You contact them, agree to hire them, and finally things start to go right. Within days you get a $5,000 advance so you can move into your own place while your home is being repaired. The mere sight of the check causes you to completely break down. And not long after that, your public adjuster calls to say another $235,000 is on the way.

This is what countless numbers of people go through every year in dealing with their insurance companies. And it is what gives me great pride and satisfaction in my chosen career. I was at a networking event with the adjuster that handled this claim recently, and we told the story of this claim. When we were done, the woman sitting next to me (vice president of a local credit union) was staring at me, with a mixed look of shock and disgust, and said, “I don’t get it, why wouldn’t they just pay her?” to which I replied, “Why would they want to do that?” “Isn’t that the whole reason for insurance?” she asked. “Yes” I said, “but if they paid her, their profits would be less, wouldn’t they?”

Image courtesy of Pixabay.com

Obviously, I was toying with her a bit, but she soon realized what I have been saying for years – the smiling faces you see on TV and the catchy jingles you hear on the radio for insurance companies are not what you will likely be faced with when you actually file a claim. You will go from loyal customer to financial adversary. Every penny they pay out in claims is money taken from their bottom line. And they don’t like that.

This story illustrates that things can go very wrong in the course of an insurance claim. But as we have seen, things can also go right, either straight from the beginning or after they started going wrong. Unfortunately, most people will never be told they have the option of hiring a professional adjuster to assist them on their claim. For them, the ending to the story could be just as heart-wrenching as the beginning.

Get your FREE copy by filling out the form below.

And this is why I network, promote, talk to people, and use social media blogs. I want everyone to know they don’t have to settle for less than everything they are entitled to. I want them to know they have options, and they don’t have to simply accept poor treatment from an insurance company. They don’t have to hire me. They don’t have to hire anyone. I just want them to know they have the right. I really just want them to know, because people who know make better decisions that lead to happier endings.

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.

Chipping Away

by Mark Goldwich

Recently I had the opportunity to help a contractor on a claim involving the contractor’s own home. I met this contractor just a year or two before, but he had never referred any of his customers to me. In one of my encounters with him, we were at a business coaching event, and I seized that opportunity to again explain what we do at Gold Star. I detailed how we might be able to help him and his customers, especially those with roofing issues, as both of our companies were heavily involved in this type of work.

Image courtesy of en.wikipedia.org

So not very long after that, the contractor called and asked me to come out and take a look at a roof. It was not a customer's roof, but the roof of his own home. He mentioned he had looked at it already, and while there was some damage, he wasn’t sure there was enough to warrant putting in an insurance claim. He also noted that a few roofers had been by (not knowing what business the contractor was in), and suggested he submit a claim for the roof, (This is a very common practice here – and probably everywhere – but one I definitely do not agree with, and I’ll explain why below).

He again asked how it would work with me coming to inspect his home, if there was a cost, and would he need to turn in an insurance claim first. I assured him there would be no cost for me to take a look at his roof (and his interior water leak from the roof as well) , nor to consult with him about his options regarding any potential insurance claim. I also reiterated that, in fact, it was better that he did not yet turn in an insurance claim. The reason I believe it is better if a claim is not already submitted, is because it gives me the opportunity to determine whether or not a claim should be submitted.

If a claim is submitted for which there is no coverage, it could present a problem for the insured when the property is inspected. The company adjuster could note a breed of dog, preexisting damage, needed repairs, a trampoline, or other element that the insurance company might elect to non-renew coverage.

And even if the claim is covered, it may not be worth submitting a claim, as the damages may not exceed the policy’s deductible. It is simply my opinion that it is better to have an expert determine whether or not a claim should be submitted for a particular loss, especially when this consultation is done at no cost.

Image courtesy of commons.wikimedia.org

So back to the contractor’s potential claim…his roof had suffered some relatively minor damage, and there was a leak on the ceiling of his dining room, which was next to the foyer. The damage on the roof was not extensive, but there was damage on more than one side of the roof, The shingles were about 15 years old, they were not very pliable, many could not be repaired without creating additional damage to other shingles that were not damaged to begin with, and even if they could, the repairs would be fairly unsightly. On the interior, the water leak created a stain only about 1 foot in diameter, but it was near a wall which would necessitate a drywall repair, The wall would then need to be painted, and the ceiling texture would need to be replaced.

It was not a desired scenario because the amount of damage was relatively minor, but the expense to properly repair the roof and interior would be much more significant had just a few facts and home features been different. Typically, insurance companies and their adjusters tend to dwell on this disparity between the amount of actual damage, and the expense of proper repairs. When they see damages that would only total $500 if the circumstances were different (for example, a roof that could be repaired and a leak in the middle of a small room), but are now totaling over $20,000, many of them have a hard time agreeing that the valid claim is $20,000, and not $500. I discussed the pros and cons of this particular claim with the contractor, and let him know I would be willing to pursue the claim if he wanted to go that route. However, I also let him know I felt we could be in for a battle.

But when the company adjuster came out to meet me at the property, I did not assume an attack position, or come at him with guns blazing. Instead, I guided him through the facts, calmly explaining why I felt the entire roof would have to be replaced based on the conditions present. I even acknowledged that the damage was relatively minor in relation to the amount of repairs I was proposing. I talked to him about things we had in common – places where we worked, and people we might both know. I talked to him as a co-worker would, bouncing ideas and suggestions off him, but always coming to the conclusion that ultimately, the entire roof would have to be replaced, the ceiling would have to be retextured, and the walls repainted. He did not dispute anything I was saying, but would not commit to it all either. In the end, he said, he needed to submit his findings to his supervisor, and they would make the final determination together.

Fill out the form below to receive your Free copy.

When I told the contractor how much my estimate was for, he seemed quite surprised, and said he would be happy if he could get half that much. I told him not to worry, and before long, the insurance company was offering less than what I proposed (naturally), but already much more than half of my estimate. We eventually agreed on a number that was below my initial figure, but not by much. Needless to say, the contractor was very happy with the result, and has since referred several customers to my company. Those claims have also gone well.

The moral of my story today is to keep chipping away. I chipped away at the contractor who was reluctant to refer my service to his customers, until such time as he was presented with an opportunity to try me out for himself. Once satisfied beyond his own expectations, he felt confident in referring my company to others. Similarly, I chipped away at the opposing adjuster, taking a friendly approach to what could have easily been an adversarial situation, finding common ground and using facts and reason to lead him to a conclusion he would likely not find plausible on his own. When chipping away, you can use a chisel, a sledgehammer, or dynamite (or all three). All may be effective. Different people use different methods to chip away, but I find the chisel works best with my personality. What works best for 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.

The Pope, An Immigrant, and Donald Trump walk into a bar…

by Mark Goldwich

Just kidding – the point is, no matter what your job is, it is important to be current when
broadcasting to the “masses”. (pun intended)

Image courtesy of pinterest.com

Each of us has a wealth of information, based on personal and professional experiences, formal and informal education, books read, seminars attended, and so on. So while we can speak about any number of subjects, I am often reminded that the best topics to talk about are those that are most current, or in today’s lingo, what is “trending”.

For me, being in the insurance industry, I could look to local items, like:

Just this week there was a news story and article on www.FloridaWaterDaily.com titled, “Jacksonville Budget Amendment Transfers Money from Drainage Project to Firefighters”. In the article, it talked about people with localized flooding issues caused by recent heavy rainstorms, who are upset because “A last-minute amendment passed on Monday that took money away from storm drainage to help restore the salaries of Jacksonville firefighters. The amendment passed on Monday takes about $300,000 from the drainage fund and puts it towards restoring the salaries of Jacksonville firefighters.” These residents are not against firefighters, but they pay taxes that include storm water fees, and they are tired of having to wear rubber boots every day just to walk outside their home.

Image courtesy of commons.wikimedia.org

Earlier this month I saw a story on www.news4jax.com about a fire that broke out in the kitchen of a local McDonalds restaurant at 3 a.m. Similar fires damage homes and businesses daily, and each one details the need not only for insurance, but prevention, maintenance, and fire suppression.

You can also find countless stories about local insurance agencies, insurance companies, jobs in the insurance field, or stories about insurance benefits for local city government employees and officials.

You could then easily expand your search for recent events on a statewide level, and for example, find a story about famed coach Lou Holtz, whose Orlando area home was heavily damaged by fire, along with personal items like photographs with presidents and popes, the torch he carried in the 1996 Olympic games in Atlanta, and so much more.

There has also been plenty of severe weather all across the state recently, damaging homes, businesses and cars. A www.weather.com article earlier this year posted the following events which all occurred on the same day in Florida:

- Storms brought down trees and knocked out a few traffic signals in St. Petersburg, Florida.

- Throughout Tallahassee, Florida, reports popped up of trees blocking roadways and damaging homes after a storm struck around 10:30 a.m.

- A National Weather Service employee spotted a funnel cloud in Miami early this afternoon. Another funnel cloud was reported by a trained spotter in Boynton Beach, Florida, at 4:20 p.m.

Widening the search to regional or national levels, and again for international news on industry or related topics would only yield more current events to investigate, discuss, and opine upon.

Once I find a current topic I want to discuss, I always try to find a way to add my own personality to the subject, whether by comparing it to an actual situation that has occurred in my business, or by giving my own position on the topic. I also want to give the reader something else to think about, in addition to what is being reported on. After all, every story would be different depending on the background or point of view of the reporter.

Most news stories aren’t going to go into all facets of the event. Take a simple story about a home fire, for instance. I could talk about the importance of getting the right insurance policy, or documenting your valuables so you can prove your claim later, or presenting your claim to the insurance company, or even fighting to maximize your claim, and much more. Someone else could talk about restoration methods, new construction materials, fire suppression equipment, smart-home wiring, using LEED-certified products in the reconstruction – the potential list of alternative topics using just this one scenario is absolutely endless.

Fill out the form below to receive a Free Copy.

In this article I talked about writing articles that are current. Even though I am relatively new to writing my own articles, I have learned enough to use timely material, based on relevant topics, and inject my personality, to create a product people can not only learn from, but enjoy (hopefully). After all, I’m not a writer; I’m just an insurance adjuster, who owns a small business, and writes about it.

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 Shortest Distance

by Mark Goldwich

Image courtesy of en.wikipedia.org

There’s an old saying that is also a scientific fact – “The shortest distance between two points is a

straight line.” I was thinking about this because I wanted to present another real case scenario, where the insurance company quickly denied a valid claim based on an incomplete or otherwise flawed investigation. And I was then struck with the obvious question of “why do they do this time and again?”

First I’ll present the scenario, and then I’ll make a case for why it happens.

In this case, a couple was moving from Jacksonville to Gainesville. They found a home in Gainesville, and got it under contract before selling the home in Jacksonville. And besides, the home in Gainesville still needed some work, so the husband was going to go back and forth, doing the needed work, until the Gainesville home was ready, and the wife would remain in Jacksonville until that time, or until the Jacksonville home was sold.

So they took out insurance on the Gainesville home, and then something happened to delay the closing, and the insurance policy was canceled. The policy was then reinstated prior to the second scheduled closing, which went off without a hitch. After the closing, the husband spent a week in the Gainesville home they just closed on, doing repairs and getting it ready. At the end of the week, he drove the 2 hours back to Jacksonville, and about 2 weeks later they got a notice in the mail from the utility company in Gainesville, saying there was a spike in the water usage, indicating a water leak somewhere.

Mold image courtesy of en.wikipedia.org

Luckily (that doesn’t seem like an appropriate word here, but it fits), they knew a neighbor in Gainesville that they quickly called to check things out. The neighbor could not see any problems, there was no water leaking out the doors, so he shut off all water going to the house just to be sure. When the husband returned to the Gainesville home a few days after that, and went inside, there was water everywhere, and mold was already starting to grow.

So they called their insurance company, and told them about the loss. The insurance company sent someone out to the property a few days later, and took a recorded statement of the homeowners. And within just a few more days after that, they received a letter from the insurance company…drum roll…denying the claim in its entirety. The letter explained in detail that the policy had an exclusionary clause which prohibited payment in the event of a water leak, but only if the home was vacant or unoccupied for 30 days, unless the property owner shut off the water and drained all plumbing lines of water (this is typical in the North where plumbing lines left unattended in the winter tend to freeze and rupture). In this case, the water was not turned off, as no sudden freezes were expected in the middle of summer in Florida.

When I spoke with the property owners, they explained the facts to me, just as they did to the ^st, which was just a few days prior to when the insured called the claim in, after going to the property and seeing all the damage. And since August 1^st is more than 30 days after the property was purchased on June 13^th, they quickly concluded that the property was vacant or unoccupied for more than 30 days. Case closed.

insurance company and their representatives. So, why the denial? The main reason is the insurance company set the date of loss as August 1

Image courtesy of dreamstime.com

But why August 1^st, and if that is not the correct date of loss, what is? The insured told me they called the insurance company on or about August 4^th to report the claim. I have no doubt they were asked at that time “when did the loss occur?”, as is standard practice. Naturally, the insured did not know when the loss occurred, since they were not living in the property at that time, so they would have answered with, “I don’t know when it happened.” Everyone could agree it did not happen on August 4^th, and that it must have been prior, so I can only imagine the insurance representative input August 1^st as the date of the loss, simply for convenience. (If they did it because they knew the policy well enough to know this date would likely result in a denial, that would make them evil). This practice of approximating the date of loss is not at all uncommon, but it often makes for confusion down the road. As it did here.

The fact is, the property owners received the letter from the utility company on about July 23, meaning it was mailed a few days earlier, and the letter stated the meter was read on July 19. This proves the loss must have occurred prior to July 19. And since the homeowner left the property on June 24, and there was no problem with the water at that time, the date of loss must be between June 24 and July 19. No matter how you slice it, the property could not be empty for more than 25 days. And even in Common Core math, 25 is less than 30. Will the carrier agree with my position? We’ll find out soon enough, but for now, the insurance company and their hired adjusting firm are both playing dumb.

Now to answer the original question, “why does this happen?” Initially, I believe it happens by a combination of coincidence and convenience. They are not sure of the date, so they simply guess. Or, they are not sure of the cause of the loss, so they simply guess. Sometimes they base it on the opinion of the insured, or a witness. The problem is, the date might be wrong, or the insured or witness might not understand the difference between “flood”, “back-up”, or “fill-up” – heck, some seasoned adjusters don’t know the difference. But once they are shown the difference, you would think they would make the correction in their record, and re-adjust the claim accordingly. Alas, I don’t find that happens in most cases, and if it does, it only happens much later. Instead, the carrier insists their initial decision (or “instinct”) was correct, and they will fight any other position fiercely.

Fill out the form below to receive your Free Copy.

When I was in my early days of training as a company adjuster, I was showed a diagram that looked like a baseball field. I was told that for every single claim, regardless of type or size, you had to go around the 4 bases of the “claim diamond”. First base was Policy – there had to be a valid policy in force. Second base was Coverage – there had to be coverage for this type of claim. Third base was Exclusions – if there was an exclusion for this event, you could not proceed to Home Plate, which of course was Payment – paying the claim (paying the appropriate amount is a whole other story).

It just seems now adjusters are not taught this same diagram, where you run from point to point,

around what looks like a square, never running in the same straight line. Instead, they appear to go straight to third base, looking for that exclusion, so they can stop all that running around. Maybe it’s laziness on the part of the carrier in conducting their training, or maybe it’s laziness in the newer adjusters, or maybe they all just want to save a few million dollars each year. Whatever it is, it is working pretty well for them, and all insurance consumers need to be aware.

In this article I presented a real-life case scenario, where a valid claim was erroneously – if not intentionally – declined despite facts which refute the denial. I also offered reasons why this happened in this particular case, as well as why it happens regularly throughout the industry. And the moral of the story is…Having a professional guide you through the claim minefield will help you make it to home!

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.

Back It Up

by Mark Goldwich

Water damage claims are one of the most frequent and costly type of home insurance claim. Whether from burst pipes, roof or appliance leaks, flooding, or sewer back-ups, the damage from water can be fast and devastating. Not to mention the mold that can quickly grow if the property is not immediately and completely dried out.

Image courtesy of commons.wikimedia.org

Water damage can be even worse in the case of commercial buildings. The large multi-national carrier Zurich (www.zurichna.com) says, “Water damage is the number one source of property claims for owners of high-rise residences, hotels, office buildings, retail establishments and other commercial structures.” They noted the total damages to commercial property caused by water is in the billions of dollars each year. In a 2010 study, Zurich found 62% of all water losses were caused by wear and tear or human error, which they suggest could have been prevented by water prevention programs.

However it happens, water can be fast moving, and not immediately obvious, traveling through wall cavities and other tight spaces before being noticed. If the water source is pressurized, and no one is in the property at the time of the leak, tremendous amounts of water can be released in just a few hours, let alone a weekend, or longer. All that water usually leads to damage.

Water damages all kinds of property, and does so relatively quickly. Many building materials and personal property absorb water on contact. Water causes items to stain, swell, sag, weaken, and to rust, and cause electrical components to short out or fail. Finished surfaces may bleed onto carpets, and oriental carpets may have colors run or fade.

The good news is most water damage can be covered by insurance, but you have to know what the insurance covers so you can get the right insurance, with the right endorsements. That is a whole other discussion altogether, and one that should be done with a good insurance agent.

I did want to point out something that demonstrates the level of complexity and subtlety that can be found in insurance policies, and the importance of knowing someone that can assist you through the process, especially when it involves something as frequent, damaging, and costly as water claims.

The example I am thinking of is water “back-up”, as opposed to water “fill-up”. In most insurance policies, damages caused a water “back-up” is not covered, in fact it is specifically excluded, unless you have a specific endorsement called “Back-up of Sewer or Drain”, or something similar, that gives you back the coverage. Since it is an endorsement, it comes at an additional cost. And because insurance is expensive enough, many people tend to decline such endorsements that increase their premiums. On the other hand, most insurance policies do not exclude “fill-ups”, so they can be covered.

Image courtesy of wikipedia.org

So, what is the difference between a “back-up” and a “fill-up”? As the name implies, a water “back-up” is when water backs up through your sewer or drain pipes, and enter your home, usually at the showers, tubs, and toilets. This water usually originates from beyond your drain line, and unless you have a septic system or drain field on your property, it usually originates away from your premises (community sewer system).

In a “fill-up” situation, there is a blockage in the drain line on your property (or common property in the case of a condominium or similar property), and the water “fills” up in the drain line until it enters the home, again, usually at the showers, tubs, and toilets.

For ease of understanding, I explain it this way…if localized heavy rains cause the city sewers to fail and water is pushed through the city lines and into your lines and it comes out of your drains and toilet, that is a “back-up”, and is generally excluded by homeowners insurance. But if your son is playing with a tennis ball at the same time he is using the bathroom and happens to drop the ball in the toilet as he is flushing (anyone care to guess how I thought up that scenario?), and the ball clogs the line and causes water to come out onto your floors, that is a “fill-up”, and is generally covered under most policies (currently). Obviously, there can be many different scenarios for each type of loss (especially the “fill-up”), but I hope you get the basic picture. If you do, you’re a step ahead of nearly all homeowners, and far too many insurance adjusters.

In the end, the damage looks exactly the same. Water (sometimes called “grey water”, “black water” or “category 3 water”) comes up from drains and toilets. But in one case, the resulting water damage is excluded, and in the other case it is covered. If that wasn't bad enough, I have personally handled several cases where the insurance company adjuster did not seem to know the difference, did not know there was a difference, or didn’t bother to determine whether it was from a “back-up” or a “fill-up”. They simply denied the claim, citing the standard “back-up” exclusion – that is, until I required they revisit the claim and correctly pay the appropriate claims as “fill-ups”.

Fill out the form below to get your Free copy.

I have no doubt this denial scenario happens many times a week, every week of every year, throughout the country. This results in millions of dollars not paid to premium-paying policyholders who purchased the coverage, but did not understand why the claims were improperly denied, did not get adequate treatment from their insurance company, and did not get assistance from an experienced consumer advocate (usually because they did not know they could).

It just goes to show how a subtle difference in terminology, based on the understanding of how a specific loss takes place, can make all the difference in whether or not a claim is paid, and the importance of knowing who to use as a resource for a particular situation.

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.