Winning by Losing

by Mark Goldwich

Image courtesy of flickr.com

People who are pessimists may say, “I can’t win for losing,” This translates to, "If it weren’t for all the bad things happening to me, I would be fine." There are plenty of people in Texas and other areas of the country who can probably relate very well to this phrase, even if they are not normally pessimistic. 

Imagine you just bought a new home, or just moved into a better rental, or finally opened up your business, when historic flooding beyond anyone’s expectations suddenly washes everything away.Or maybe an early morning tornado flattens your home, leaving you homeless, with nothing but the clothes on your back, and the gratitude to have survived. Such calamity could lead almost anyone to wonder if the powers that be have it in for them, and that they can’t win for losing.

Then again, there are some people that might utter this phrase whenever less tragic events take place, be it a relationship break-up, a minor fender-bender, the passing of a pet, or the stubbing of a toe.

Whether you can only relate to the more extreme cases of this saying, or any of them at all, as you might have guessed, especially if you are familiar with my writing, I can take this otherwise pedestrian phrase and spin it to show how differently insurance companies view the world. Better still, I can even back it up with examples.

For insurance companies, whose profits are measured in hundreds of millions, or even billions of dollars, they see the world in a very different light indeed. Insurance companies don’t accept the notion of a phrase like “can’t win for losing”. No, for them, even when they lose, they win. In fact, I would argue part of their “winning strategy” is to knowingly (if not purposely) lose – and lose BIG – at least sometimes.

I realize it seems inconsistent to suggest that large insurance companies, with ivy-league business school minds at the helm, who are very much about winning at all costs, are at all OK with losing, ever. Hang in there for just a bit, and I'll explain how it works.

Image courtesy of Pixabay.com

Several years ago I handled a claim that has since stuck in my mind because of the way it turned out. It was really not unlike many other claims I have handled, but in this particular case, the insurance company took an unusually hard stand against paying the claim in full. In the end, we could not get the carrier to make a reasonable offer, and the insured had to retain an attorney. It took over a year for the attorney to reach a settlement before the case was to go to trial, but the insurance company agreed to pay over 8 times as much as we were willing to accept prior to the attorney’s involvement. Even after the insured’s attorney was paid, and my fee was paid, the insured was left with about 3 times as much as she was willing to accept before an attorney was retained. That “8 times” number has stuck with me ever since. By the way, that “8 times” number does not include the insurance companies defense costs, because we are not privy to that information, but an educated guess would mean the insurance company really paid 10 to 12 times as much as they could have settled for. That’s 1000%, to 1200% more. Good thing they are loaded!

The insurance company was willing to pay up to 12 times as much as we were previously willing to accept. “Why would they do that?”, I wondered for the longest time. As with many things, over the years I figured it out. If the insurance companies are good at one thing, it is the actuarial science. An actuary, according to Wikipedia.org, is “a business professional who deals with the measurement and management of risk and uncertainty. The name of the corresponding profession is actuarial science. These risks can affect both sides of the balance sheet, and require asset management, liability management, and valuation skills. Actuaries provide assessments of financial security systems, with a focus on their complexity, their mathematics, and their mechanisms.” Actuaries use mathematics, statistics and financial theory to study uncertain future events, especially those of concern to insurance. In laymen’s terms, they are “bean counters”, and very good at it.

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While I don’t believe they would ever come right out and say it, I am convinced the insurance companies have determined there are only so many people that would argue about a claim settlement. Of this small number of people, there is an even smaller subset that would hire an attorney to pursue their appropriate claim payment. And of this small group, there is an even still smaller subset that will pursue their litigated claim all the way into the courtroom. Consider this, in the nearly 12 years that I have been a public adjuster, handling thousands of claims, only a small fraction have required attorney representation, and less than 5 have ever made it into a courtroom. 

The insurance companies might say these claims settled because the insured’s did not want to take their changes in court, but given the settlement numbers, I would argue the exact opposite is true. In fact, I cannot think of a single claim where the insurance company did not settle for a significantly higher amount than what they had previously offered. The “8 times” number was a bit of an anomaly, but I would venture to guess 3 or 4 times would be more common.

Still, why in the world would an insurance company pay even 3 or 4 times as much as they could settle a case for, and why would they ever pay 12 times as much? Simple, it costs more to pay everyone top dollar to begin with. If they make it easy, everyone will do it. So, they are willing to pay a whole lot more than needed on a select few claims (lose big), than to pay even a tiny bit more on every claim (lose bigger).

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It’s all a matter of how much, and how often they must lose, in order to maximize the winnings overall. If you are good with math, you quickly see how this makes perfect sense, and how the insurance industry has figured out how to win by losing. Just don’t give up on your claim, and you can win as well!

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.

What Are They Up to Now?

by Mark Goldwich

With a title like, “What are they up to now?”, you might think I’m writing about my kids, the presidential candidates, politicians in general, or some other high-profile group. What I’m talking about in today's blog are Insurance Companies. You see, earlier this week I attended a two-day conference presented by the Florida Association of Public Insurance Adjusters. The conference is billed as an educational and networking event designed to improve our skill sets, become better at what we do, and network with other industry professionals.

Image courtesy of Pixabay.com

One of the main takeaways from the conference was learning about significant trends in insurance industry tactics and strategies. These strategies are usually marketed as “consumer protections”, which also just happen to help insurance companies stuff billions more into their collective coffers. A happy coincidence, I’m sure (that’s sarcasm, for those of you who are unfamiliar with my writing style). Those of us whose job it is to protect the insured from their own insurance companies, see these tactics and strategies for what they really are, profit boosters.

Rather than bore everyone with all of the topics discussed, I’m going to focus on one key strategy, “Repair Cost Control”, which I will separate into two popular methods, “Managed Repair” and “Our Option”.

The idea behind “Repair Cost Control” is fairly straightforward – if the insurance companies can exert greater control over the repair process, repair costs will decrease, and profits will increase. They will naturally argue that reduced costs and increased profits translate into lower premiums, but just ask yourself when was the last time your insurance premiums were significantly reduced, despite the fact that your coverages were significantly reduced? Answer: You’re kidding me, right?

To gain even greater control over repair costs, as if having professional adjusters, estimating programs created with insurance industry input, and a host of repair professionals and attorneys at their disposal was not enough, the insurance companies have come up with “Managed Repair” (sometimes referred to as “Managed Care” to make it sound more benevolent), and “Our Option” (which could more accurately be renamed as, “Butt out, this claim is none of your business!”).

Under the “Managed Repair” process, the insurance company “guides” insurance victims to hire contractors who are “preferred vendors” that have special relationships with the insurance company,

Image courtesy of commons.wikimedia.org

rather than contractors of the property owner’s choosing. You can imagine how lucrative it could be for a contractor to enjoy such favored status. A large insurance company could provide so much work that the contractor could all but eliminate their marketing budget, which previously could have been tens of thousands of dollars each and every month. Gone! That doesn’t sound so bad, especially for the contractor and the insurance company. But think about it – the contractor gets the claim job “gifted” to them from the insurance company, and gets direction from the insurance company's adjuster.  This includes coverages, limits, and exclusions, which are all outside the scope of the contractor’s job, both realistically and legally, and the contractor gets included on claim payments, rather than getting paid by the insured property owner. Is it any wonder these contractors tend to forget they are working for the property owner, and tend to feel they are really working for the insurance company?

And what happens when the work done by a “Managed Repair” contractor is good enough for the insurance company, but not satisfactory to the property owner? “No problem,” the insurance company says, “you signed a contract with the contractor, so it is your responsibility to deal with them.” Nice!

And what of this “Our Option” mentioned as an alternative to “Managed Repair”. In my opinion, it’s even worse. Most property insurance policies have an “Our Option” clause that basically says, “we may elect to repair or replace the damaged property with a contractor of our choice.” Most insurance companies interpret that to mean that they can buy contractors, or enter agreements with contractors, so that if the insurance company agrees a loss is covered, they pay the contractor directly for the repairs, and the insured has no voice in the repair of their own property (usually, their home).

Think about that. The insurance company can literally own the construction company, or employ the contractors, and if the insurance company agrees to pay the claim, they pay themselves, instead of paying you. Talk about keeping it in the family! If someone can explain how that is not a clear conflict of interest, well, you’d be the first person to explain that. But, so far as we can tell, no state agency has even thought to ask that question, let alone demand an answer to it.

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So, what’s a property owner to do in light of these trending strategies that remove you from the process while growing insurance company profits? First, you need to know that these strategies exist, and how they work. Done! Next, you need to decide whether you want to believe the insurance company is doing this in your best interests and go along with the plan, or if you want to maintain control over who repairs your property, how they repair it, and with what workers and materials. If the latter, you need to know your rights, and be willing to fight for your rights (otherwise, you will probably lose those rights).

I hope I was able to bring to light, in an easily understandable way, a couple strategies trending with insurance companies that we as insurance consumer advocates recognize are detrimental to property owners, and primarily serve to benefit insurance companies. Feel free to research the topics on your own, and learn how to protect yourself.

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 right

by Mark Goldwich

My blogs typically expose the tendency of insurance companies to either reduce claim payments, or avoid claim payments altogether. And today will be no different. But today I want to focus on what happens when claims are handled well by an insurance company. It does happen, even if far too seldom (in my opinion … based on decades of experience).

Image courtesy of commons.wikipedia.org

Recently, I was referred to an insured by a contractor who felt the insured’s roof was damaged by wind, and who also felt some of the screens on the pool enclosure were damaged as well. But before suggesting the insured submit a claim, the contractor recommended I take a look at the roof and screens, and confirm the contractor’s opinion.

I believe the first thing to go right for this insured was to have a contractor who was truly looking out for the insured’s best interest, rather than simply the contractor’s own best interest. The contractor knew if the insurance company did not agree to pay the claim, it would still count on the insured’s claim history, and could even result in the insured losing his insurance with this company, and he would be forced to find insurance elsewhere – and in Florida, that is not always easy.

Once I determined this particular claim should be valid, the insured signed an agreement with me to handle his claim, and the claim was submitted. We provided his insurance company with our contract, a letter of representation, and within just a few days we also submitted our estimate.

Less than a week later, we were meeting with a representative of the insurance company at the insured’s home. This was another thing that went right. Typically, we are lucky to hear from an insurance company within a week of submitting a claim, let alone meeting with them. Often, we don’t hear anything back from insurance companies, especially if the claim was previously submitted and closed with little or no payment prior to our involvement. And when we follow-up with the insurance companies, we often get the impression that if we never called them, they would never have called us, even though we send written correspondence requesting they contact us to schedule an inspection.

Image courtesy of commons.wikimedia.org

When we met with the adjuster, she noted that she was not told the insured was represented by a public adjuster, so she was not aware of my contract, letter of representation, or estimate. She then apologized for speaking to the insured prior to my arrival, explaining again that she was not aware of my involvement at the time. This was probably the only thing that did not go “right”, but for me, it was not a big deal. I can understand the insurance company did not get her the information quick enough, especially since it had only been a few days since submitting the claim. I showed her the original contract that I had in my file with me, allowed her to take a photo of it, and I gave her a copy of my estimate.

With that, we proceeded with the inspection. She quickly agreed the roof was sufficiently damaged to warrant a full replacement. Whether or not she would have made that same determination if I was not involved, we will never know for sure. But my experience tells me, probably not. When we discussed the screens, she stated that she did not agree with me on my scope of the extent of the damage to the screens, and she told me why. She also asked me to clarify my position, which I did.

She then did something few adjusters do on a regular basis in this area. She got in her car, and instead of leaving in a huff, she told me she would write her estimate on the spot, taking my estimate into consideration, and see if we could settle the claim right there and then. This is something I did hundreds of times as an adjuster for State Farm, but that was a long, long time ago, and except in storm situations (which this was not), we rarely see this happen today. In fact, most adjusters we meet are independent adjusters, who are third party administrators for the insurance companies (not employees), and they often tell us they are simply acting as the eyes and ears of a “claim examiner” or “claim processor” who will be settling the claim, and that they don’t have the authority to settle the claim or even say what they think is covered (even most of the employed staff adjusters we meet do not settle claims on the spot, and don’t always have the authority to detail what the carrier will and won’t pay for). So this was not only another something that went right, it was quite a refreshing change of pace.

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In the end, she prepared an estimate that while less than mine (they almost always are), the contractor agreed was quite adequate, so the insured accepted it, and we were all able to shake on the agreement. The check arrived about a week later - this was the final thing to go right! It’s great when things go right, but especially when it comes to insurance claims, you can’t expect things to go right, or hope things will go right, you have to intentionally plan for things to go right.

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.

Miracle March Means Madness For Many

by Mark Goldwich

Forecasters predicted El Nino storms could drench the Western US in general, and California in particular, calling for a “Miracle March” that could ease the current drought conditions there. And halfway through March, it looks like they might be – predictably – partially correct.

"This is going to put a dent into some of the drought, but it's not going to take it away by any stretch," San Diego-based meteorologist Mark Moede told NBC News earlier this month. But according to Erik Ortiz of www.nbcnews.com, “the return of the storms this month in parts of California has drawn parallels to 1991, when a "miracle March" that brought record rains staved off a water shortage. It was also credited with saving the ski season.”

Image courtesy of en.wikipedia.org

In the first week of March, heavy rainstorms struck California and flooded some low-lying areas, but much more rain would be needed throughout the state to counter years of dry weather. In the second week of March, another round of rains helped replenish water reservoirs, and above-average snowfall has extended California’s expected ski season beyond any of the last several years, but it is still too soon to tell if this will be enough.

And while rain and snow is certainly good for California as a whole with regards to drought relief and snow-related industries, each storm brings disaster to many individuals. During any significant rainstorm event, low-lying areas tend to flood rather quickly. It may be that only 100 homes and businesses are affected, and this may not even make local news, let alone the national news (especially in the midst of a wild presidential election cycle), but for those 100 families, their entire world has turned to mud.

Keep in mind, also, that during most severe rainstorms, there are high winds, hail, and even tornados that come with the many inches of rainfall. Throw in a few mudslides on California hillsides, and you have the makings of a disastrous “Miracle March” for many unsuspecting property owners. The storms so far have not been devastating, but streets have been washed out by floods, highways closed by mudslides – one such slide toppled a dump truck in the process – and homes have also been flooded or damaged by mudslides. The uncomfortable paradox is that much more rain is needed to make an appreciable impact on the drought conditions, but such rains would also bring misery to ever-increasing numbers of people.

Image courtesy of en.wikipedia.org

Having dealt with so many individuals and families suffering through property insurance claims from rainstorms and flooding, I know how difficult it is to recover. Homes are damaged or destroyed, personal belongings are ruined, people are separated and displaced from their homes, and dealing with all the insurance hoops, exclusions, loopholes, and delays can bring a whole new meaning to the phrase “March Madness”.

As always, it’s important to know they can recover, and they will recover. The question is, at what cost? How much aggravation will they have to endure? How much money will they recover – or how much debt will they have to take on? Typically, the answers to those questions depend on what they know, and how well prepared are they are to take on this challenge. I always say, the better prepared you are before disaster strikes, the better you will emerge from the disaster. This goes from having a disaster plan (before it happens), to having a recovery plan (after it happens).

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One thing is for sure, the insurance companies all have plans. And systems. And strategies. And resources. For you to compete, you need to have these plans in place as well, even if it just means knowing who has the plans, systems, strategies and resources to help 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.

Sliding Down the Slippery Slope

by Mark Goldwich

Snow Moon image courtesy of pixabay.com

Last week brought us the “Full Snow Moon”, also known as the “Full Hunger Moon”. Maybe I simply wasn’t paying close attention in the past, but this was the first time I heard each moon came with its own name, based on the month, dating back to Native Americans. With February being known as having heavy snow falls which makes hunting more difficult, it is easy to see how “Snow” and “Hunger” was connected to the name for the February moon.

Anyway, today’s forecast once again featured a weekend warning for strong winter storms, sure to bring huge amounts of the cold, wet, white stuff. Sure, it looks beautiful as it is falling, but man does it ever wreak some havoc when it lands!

So in the spirit of all the heavy snow, I wanted to point out a few ways those cute and fluffy flakes can be dangerous to all kinds of property, and how insurance companies might try to slide out from covering the damage.

Image courtesy of en.wikipedia.org

While it looks a bit like whipped marshmallow topping, snow is actually quite heavy. Accumulated snow and ice (we usually only see the snow on top, but there is usually ice underneath) can topple trees, or at least break large branches. These trees and branches may harmlessly fall to the ground, or they can smash anything they land on…roofs, fences, pools, walkways, power lines, cars, outdoor furniture and swing sets…whatever gets in the way. Trees being heavy and dense, they can really pack a wallop. I once handled a claim where a large tree basically split a 2-story apartment building in half, causing over $400,000 in damages. 

Even without involving trees, heavy snow can collapse roofs. And what do you suppose happens to the tons of snow once it gets inside the warm building whose roof just caved in? If you guessed, “melts into hundreds of gallons of freezing water and soas every last nook and cranny of a home,” you’re right!

The snow and ice can also bring down power lines that are sparked from falling trees. When damaged by trees or just the weight of ice and snow, once the power lines come down, the damage totals rise. Food spoils, electrical components get spikes and surges (before or after the outage), and temperatures inside homes drop drastically. This often makes for frozen pipes, and in many cases, as the water inside the pipes freeze, the water expands, causing the pipes to rupture. Since these ruptures take place inside of walls, they can’t be seen – until, that is, the frozen pipes thaw out and water pours from the ruptured section of pipe.

Image courtesy of YouTube.com

Snow falling on roadways create other hazards, such as reduced visibility, black ice, snow drifts, and generally slippery conditions that are prime for auto accidents. Cars then slide into other cars, or other property, making for colossal collisions costing copious quantities of cash.

As you can see, when it comes down to it, snow (in one form or another) has the ability to damage pretty much anything it comes into contact with. Naturally, the heavier the snow even, the greater the potential for damage. But that is why you buy insurance, right? Of course, it is.

But if you’ve been following my blogs at all, even an insurance novice can probably begin to formulate some of the slippery excuses some insurance companies might try to give in order to slide out from paying these claims:

“Wear and tear”

“Negligent maintenance”

“Faulty construction, defective materials, or poor design”

“Failure to maintain heat”

“Failure to drain plumbing pipes”

“Continuous and repeated seepage of water”

“Excluded power surge”

“Abandonment”

“Failure to mitigate damages”

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Heck, some might even claim you misrepresented some obscure and completely unrelated answer on your insurance application form when you initially purchased the policy many years ago. If so, they could declare the entire policy to be void, regardless of whether or not this particular loss is covered. I call this phenomenon, “Denial by rescission”, and yes, it really happens.

Even if they can’t find a way to deny the claim completely, there are always plenty of icy obstacles they can use to delay, deflect, reduce and defend their actions and your payments. All of these can frustrate weary policyholders to the breaking point, where walking away from a fair settlement seems better than continuing to engage in the mental torture an insurance claim can inflict.

Well, that got cold and gloomy in a hurry! So let’s come back around and end on a nice note, with the names of all the full moons for the entire year (according to www.farmersalmanac.com):

– January - Full Wolf Moon

– February - Full Snow Moon

– March - Full Worm Moon

– April - Full Pink Moon

– May - Full Flower Moon

– June - Full Strawberry Moon

– July - The Full Buck Moon

– August - Full Sturgeon Moon

– September - Full Corn Moon or Full Harvest Moon

– October - Full Hunter’s Moon or Full Harvest Moon

– November - Full Beaver Moon

 – December - The Full Cold Moon; or the Full Long Nights Moon

And if you ever find yourself sliding down the slippery slope of insurance company denial, remember to call your friendly pubic claims adjuster.  He knows how to cut Frosty down to size.

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

Is it Time for a Little Fall Cleaning?

by Mark Goldwich

Image courtesy of commons.wikimedia.org

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

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

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

Image courtesy of commons.wikimedia.org

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

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

image courtesy of pixabay.com

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

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

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

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

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

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

Not Ready for Prime Time (viewer discretion advised)

by Marc Goldwich

I was reviewing the headlines this morning which were chock full of mayhem.  Everything from the aftermath of catastrophic flooding which resulted in numerous drowning deaths in the South Carolina, to more school shootings, along with a smattering of auto-related fatalities vied for my attention. This combined with Halloween being just around the corner was enough to cause my mind to entertain the dark side of life. So I began thinking about the job of cleaning up after a catastrophe.

Image from commons.wikimedia.org

In case you're not aware, there is an entire industry set up for handling these kinds of events. Typically called “Biohazard Clean-up” or “Crime Scene Clean-up”, these companies are e an offshoot of emergency restoration companies. Whether the hazard you need gone consists of  toxic waste, deadly mold, body fluids or most any other kind of nasty stuff that crop up after an emergency, there are trained professionals who are only too happy to roll up their sleeves and dive right in. 

The hit Discovery TV show “Dirty Jobs” is a favorite of mine, but I doubt you will ever see Mike Rowe tackling this type of job. While certainly “dirty” enough, my guess is it would simply be too disrespectful to find any humor in this line of work, and for his show, humor plays a major role.

There are other shows which depict and deal with death, usually CSI or homicide, but I have never seen one address the clean-up aspect that invariably needs to take place after the police finish their investigation. Since you can now watch shows on just about any occupation imaginable, I would not be surprised to find a show following biohazard clean-up teams around.

So what would that entail? First let’s think about the types of situations these companies and their crews might deal with. Things like:

-          Sewage backups

From commons.wikimedia.org

-          Crime scene residue

-          Suicide

-          Homicide cleanup

-          Blood cleanup

-          Accidental death cleanup

-          MRSA and H1N1 decontamination

-          Hoarding scenes

-          Animal waste/remains

-          Chemical spills

-          Tear gas cleanup

-          Meth lab cleanup

-       Radiological hazards

    

None of these events should be taken lightly, or undertaken by anyone except certified biohazard professionals. Not that most people would want to deal with any of these problems

.

These companies need to be well versed in applicable state and federal regulations, they need to be licensed and certified (where required), they need to use appropriate transportation and/or disposal protocols, and they may need to be registered with the states’ Department of Health. These companies can also expect to be regulated by governing and advisory bodies such as OSHA (Occupational Safety and Health Administration), NIOSH (National Institute for Occupational Safety and Health), DOT (Department of Transportation), and EPA (Environmental Protection Agency).

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The dirty work of these professionals usually begins when the coroner’s office, or other governmental entity officially releases the scene to the property owner or other responsible party. Depending on the type and severity of the “event”, the clean-up teams are required to wear protective clothing, may seal off rooms to prevent or minimize the spread of airborne or physical elements of the bio-hazard scene, and follow specified methods and practices to decontaminate such scenes.

The scenes must be meticulously cleaned of all harmful material, which typically includes the removal of any porous materials (whether personal belongings like clothing and sheets, or building materials such as carpeting, wood subfloor, or drywall) – which must all be properly disposed of, and then sanitized. You can only imagine the mess that will be left, even after the mess that was the biohazard is removed.

And many people are so distraught after dealing with such a loss, that they overlook the fact that insurance may cover the expense of the clean-up efforts. Just remember this rule of thumb, if property is damaged as a result, it is probably covered by insurance (either yours, or someone else’s).

ServPro.com provided the following bio-hazard and sewage emergency tips:

After any biohazard or sewage contamination in your home or business, your primary focus should be safety:

-          Is it safe to stay in the house?

-          Exposure to biological and chemical contaminants can pose serious health consequences.

-          Flood water can contain sewage, pesticides, and other contaminants.

-          Only do activities that are safe for you to perform.

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What to Do After a Contamination

-          Stay out of affected areas.

-          Call emergency service personnel if the situation is life-threatening.

-          Treat all bodily fluids as if they are contaminated.

-          Turn off the HVAC system if there is sewage damage.

What Not to Do After a Contamination

-          Don’t leave wet fabrics in place. Hang furs and leather goods.

-          Don’t leave books, magazines, or other colored items on wet carpet or floors.

-          Don’t use your household vacuum to remove water.

-          Don’t use television or other household appliances.

-          Don’t turn on ceiling fixtures if ceiling is wet, and keep out of rooms where ceilings are sagging.

Let’s all hope we never need these tips, but as we can plainly see from watching the news, the fact is, biohazard clean-up is a grim reality for many families. As with anything else, the more you know in advance of an emergency, the better equipped you will be in handling that situation.

In this article I discussed the subject of biohazard clean-up, and the professionals that are trained to perform what just might be the dirtiest job of all. I mentioned some of the types of events this might involve, and included tips for dealing with such an event.

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.   

Why Buy Insurance?

by Mark Goldwich

Just this week I got asked a question I am asked several times every year. I was speaking with a woman who had recently had a water loss at her home, and she was considering whether or not she needed our assistance with her homeowners’ insurance claim. Along the way, as it tends to happen, we talked about her insurance policy, what it generally covers, and what it generally doesn’t.

While homeowners insurance policies vary from company to company, there are many similarities when it comes to coverages and exclusions. Most policies cover by one of two methods – “all risk”, which certainly sounds like it covers the insured for just that, all risks, or anything that happens. Does anyone really believe an insurance company will pay for anything that happens to your property? Of course not. What they really mean, and what you should hear (in your head) when they say “all risk”, is that the insurance company will cover you for all risks that are not later excluded in the policy.

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If the policy is not an all risk policy, it is what is called a “named peril” policy. With a named peril policy, you are given a list of perils that are covered, and also a list of exclusions. Generally, there are exceptions to the perils, and also to the exclusions. If the event that damaged your property is a named peril, you still need to review the exclusions, but if the event is not one of the named perils, it doesn’t matter what the exclusions are – it’s just not covered.

It might surprise you then to hear both policies appear to cover similar things, such as fire, windstorms, accidental pipe leaks, and theft, to name a few.  Both types of policies tend to exclude similar things, such as wear and tear, mechanical breakdown, flood, pollution, rust, mold, repeated leakage, and more.

So what ‘s the difference?. There are two main differences. First, the all risk policy covers more items, simply because it covers the limited number of events listed in a named peril policy (and for that reason, it is both more expensive, and  it is easier to market as a better insurance product). The other difference, at least as how it has been explained to me, is that with the all risk policy, the legal burden to prove a claim is not covered is on the insurance company; whereas with a named peril policy, the burden prove a loss is covered is on the insured.

After we talked about her policy and the coverage and exclusions contained, that’s when she asked the obvious question: “Why do I even have insurance anyway?”

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There are a few answers to this question (even though it’s almost always said halfheartedly). If there is a mortgage on the property, as is usually the case, the mortgage company requires the homeowner to purchase insurance to protect the mortgage company’s financial interest in the property.  In that case, the homeowner has no choice, but it may be for the best.  If there is no mortgage on the property, the homeowner does have a choice, and a decision to make. They could purchase insurance, or not.

Most people in this situation decide to purchase insurance rather than saving the money they would otherwise be spending on insurance premiums to use that money to pay for any unexpected events that the crop up. They know it would take several, if not many, years to save enough money to cover the expense of even a relatively minor loss. And they also know a major loss, at almost any time, would leave them wholly unable to rebuild or replace everything lost.  This could mean financial ruin for them.

Ultimately, people buy insurance because they can’t afford to suffer a major loss without it. They prefer to transfer the risk of paying for such a loss to a company that is financially able to pay a large loss, or even a total loss. They can afford manageable monthly payments, and they can usually afford their deductible, but just as people tend to buy homes using a mortgage instead of paying cash, they use insurance to pay for repairs to the home instead of paying for those repairs themselves.

Even those who could afford to pay cash for their home, or who could pay cash to repair or replace their home in the event of a catastrophic loss, tend to use insurance to spread and share the cost, as well as avoiding liquidation of assets or conversion of  investments in order to generate the needed cash.

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You see, when people ask the question “Why do I even have insurance anyway?” it’s more of a rhetorical question. They know why they have insurance, they are merely complaining about paying higher and higher amounts of premiums for lower and lower benefits. It should also be noted this question invariably comes when a claim is not being covered, or not being paid completely. No one ever asks this question after collecting $200,000 for a large loss just months into their first year of insurance when they have paid less than $1,000 in premiums. No, it usually comes after 10 years of paying premiums faithfully and then having a relatively small claim declined.

It just goes to show, whether or not we have a mortgage, and whether or not we’ve been paying premiums for a long or short time, we buy insurance just in case, for peace of mind, to hedge our bets, to leverage another financial tool at our disposal, and for any number of other reasons based on our personalities, our risk tolerance, and our desire for stability. In other words, why ask why?

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.  

What Are the Odds?

by Mark Goldwich

If one thing is for certain, it is that there are no guarantees in life. Or, as other people have said, the only sure things in life are death and taxes. I never did agree with the taxes part of that statement, since you can choose jail (or death) over paying taxes.

Anyway, now that I started thinking about death, a concept I’m not at all fond of, I wanted to look at the ways people die, and how they can avoid that, or at least put it off for a while. So I got on the National Safety Council website (www.nsc.org) and found an article titled “What are the odds of dying from…”

To me, this is good information to have for a few reasons. One, if you know the most likely ways you are going to die, you can then learn some steps to help you beat the odds. Also, if you know the least likely ways you are going to die, you can ease your mind a bit when it comes to worrying about dying in a particularly nasty, but highly unlikely way.

For example, the NSC showed Heart Disease and Cancer led the way towards death with 1 in 7 odds. So, if you do just a little research, you can take some pretty easy steps to greatly reduce your odds. Stop (or never start) smoking, exercise regularly, maintain a healthy diet and weight, and see your doctor.

Image courtesy of wikipedia.org

On the other end of the spectrum, dying from a lightning strike came in last with the odds of 1 in 164,968. Now, I was not thinking of this the other day when I was playing catch in the front yard with my son, under a tree, with lightning cracking nearby. If I did, even though the odds are not high, I would have gone into the house even sooner than I did. Still, there are many other ways to die, but I'm not going to list all the odds. What I will do is give you a few, with some thoughts on how you can reduce your risk. 

Did you know the odds of dying in a motor vehicle crash are 1 in 112? That’s worse than I thought it would be, making me glad I always wear a seatbelt.  Other than that, I could really stand to be more careful when I drive (no texting, no speeding, no aggressive lane changes). Besides improving my life span, good driving habits can save me money on insurance premiums.

Does knowing the odds of death by firearms discharge are 1 in 6,699 make you feel better? This one is tricky, because many of these deaths are caused by the person’s own gun, which means not owning a gun would better your odds. Then again, as a gun owner, I would recommend you take a firearm safety course, use a trigger lock, and take extra care whenever handling or cleaning a gun. After all, the answer to avoid dying in a car accident would be to never drive or ride in a car. This notion highlights the difference between “possible” and “realistic”.

How about choking to death from eating food? The odds of this are listed as 1 in 3,375. As someone that has used the Heimlich Maneuver twice on my own daughter before her 7^th birthday, may I suggest being careful to cut food into pieces too small to choke on, not putting too much food in your mouth at one time, and chewing food well before swallowing. And parents, please particularly watch out for hard candies with your kids. My daughter’s first choking “incident” was on a Life Saver – how ironic!

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Most people have a fear of dying in a plane crash, much more so than dying in a car crash, but when you consider the odds of dying in a car vs. a plane are 1 in 112 vs. 1 in 8,015, I’ll take that plane ride any day of the week. I recall someone asking me why I would jump out of a perfectly good airplane (back in the day when I would skydive for fun on weekends). Even then, without knowing the odds, I would always say, “there is no such thing as a perfectly good airplane” meaning, all planes seem perfectly good, right up to the time they crash. The fact is, skydivers are much more likely to die on the car ride to or from their jump site, or when the plane they are to jump from crashes (this takes out the whole group of jumpers, not just the one that might die during the jump).

Insurance is a system by which financial risk is avoided or reduced by transferring the cost of that risk to another. The event may still happen, but your financial risk is reduced or eliminated. Similarly, taking extra precautions reduces your risk of accidents, and in the case of accidents, it is not just money you are trying to save, it is your health, or even your life. 

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.