This Time It’s Personal

By Mark Goldwich

Image courtesy of GoldstarAdjusters.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Your Vacation Checklist

by Mark Goldwich

Image courtesy of pixabay.com

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

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

Image courtesy of pexels.com

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

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

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

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

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

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

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

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

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

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.

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.

There Goes the Neighborhood

by Mark Goldwich

I can’t remember the last time I heard about an extreme weather event in West Virgina, but I sure did today. And if you were on any major news network, you probably saw it too. Video footage of an entire home, floating down a swollen river while ON FIRE! It was absolutely remarkable to watch - the power of the water, and the contrast of water and fire. It was just spectacular, but in the worst possible way.

Image courtesy of en.wikipedia.org

Now imagine you are the owner of that home. When you can finally return to your former neighborhood, which could be in just a few days, or it might not be for several weeks, it will be almost impossible to recognize. Street signs could be gone, major landmarks might be missing, and if you can find where your home used to be, we already know the home will not be there. Just a clean slab, next to several other clean slabs. It must be absolutely devastating to the mental state of the family.

For younger children, it might have been the only home they have ever known. For older kids, it might represent their childhood and friends. For the parents, it was where they started their family, and built their lives. And for older folks, it may literally be their entire world. But for all of them, it is time to start over, ready or not, but definitely not by choice.

So where do you start when that is not just something happening on the news, but it is your reality? My suggestion would be to start by reaching out to loved ones. Get help, if at all possible, because you are going to need it. And then, in no particular order, take pictures or video. Grab a pad of paper and start taking notes. List your activities and your expenses. Call your insurance agent and report the claim. Go online and learn what you can about what just happened to you, and what you can expect to go through in the coming months and years (note – I did not bother to include “days” or “weeks”, because that is simply not how you are going to be measuring this journey – sorry, trust me). Figure out what assistance is available to you (Red Cross, FEMA, etc.).

Image courtesy of flickr.com

And I would always recommend professional insurance claim assistance, but especially in this case, where you have damage caused by flood AND fire. Maybe you have insurance that protects against both flood and fire – it would be great if you did, but you could still use help to determine which policy you would  want to use to cover which of the items damaged. Just knowing that could make a significant difference as to what damages you attributed to which policy. This alone could more than pay for the fee charged by the insurance adjuster.

But what if you only had insurance that would protect you against one of the two events (flood and fire)? Then you really are going to need help, because imagine this scenario: you have fire insurance, but your insurance company tells you ALL the damage to your property is caused by flood – even though there is plenty of news footage showing your home floating down the river, fully engulfed in flames. While I don’t think there would be an argument for the slab, or maybe even the flooring, or even the baseboards, I would certainly argue a lot of other items were damaged by fire alone. They could still argue if not for the flooding, there would have been no fire. They could also argue that even if the home never caught fire at all, the home and everything in it, would have eventually been destroyed by the flood. As you might guess, I would take on that fight every day of the week.

Conversely, if you only had a flood policy, but no insurance to cover your home for fire, they could argue the majority of the damage to your home, and the belongings inside, were damaged by fire and not flood. If so, I would simply argue the opposite. Is it wrong that I changed my position just like that? I would say no. My job is to fight for the insurance coverage you paid for, not to accept the exclusions they raise. You paid good money for that insurance coverage, and you certainly did not intend any of your premium to be spent on policy exclusions – those just seem to come free with the policy. So yes, quite plainly and openly, I will fight to find any applicable coverage I can, based on the facts of the loss. In other words, if two homes were floating down the river on fire, and one of them only had flood insurance while the other only had fire insurance, I would argue both should be covered, for opposite reasons. And if that sounds like I “want my cake and eat it too”, I’d counter that cliché with “what’s good for the goose is good for the gander!” Anyone who has ever had to wrestle with an insurance company over a claim knows exactly from where I speak.

Once coverage is secured, it is time to start proving your loss. This is going to be difficult as well, since there would be little left to identify, making it difficult to assign a value to it. But it has all been done before. It’s a step by step process, and it does take time, but with the right assistance, you can get back on your feet again. And one day (too long for most people to imagine), you are relocated to a new neighborhood, or your old neighborhood starts to slowly return. Here comes the neighborhood!

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.

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.

Image courtesy of commons.wikimedia.org

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.

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.

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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.

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.  

Has your Homeowner's Policy Sprung a Leak?

by Mark Goldwich

At our weekly team meeting this morning, we talked about claims we are currently handling, and how various insurance companies are using everything at their disposal to minimize claim payments, or avoid paying altogether – and what we can do about it. It’s one of the main reasons we meet each week. This week, it just so happened that a few of the claims involved water damage, and we talked about a few of the technicalities involved in these types of losses. 

In one case, the insurance company sent out an engineer to inspect the claim. That in and of itself was not so unusual, but my adjuster knew an engineer was not typically sent out for this particular type of water loss. So, when my adjuster met with the engineer (as we usually meet with anyone an insurance company sends out), he asked enough questions to learn exactly why the insurance company picked him (a certified mold specialist) to inspect this claim. The engineer explained there are known types of molds that only grow after a certain number of days. Right away, this told my adjuster more than it would ever tell even the most savvy property owner. The insurance company was hoping the engineer could identify a species of mold that could only grow after an extended period of time. Why? We are convinced it is so they could try to deny the claim under a technical policy exclusion that precludes coverage (theoretically) for “repeated leakage or seepage of water from a plumbing system” – most property policies have an exclusion that reads something along those lines.

Image courtesy of commons.wikipedia.org

Some policies go on to say there is no coverage if the leak goes on for at least 14 days, some exclude good neighbors on your street, odds are at least 1 of them are insured by this huge national company with a catchy jingle and endless ads on TV) doesn’t always take full advantage of this exclusion. After all, if they did, they could deny every single plumbing leak claim that is ever presented, since all leaks and seepages, by definition, occur over “a period of time”. You have a sudden and accidental pipe burst, and water goes everywhere, causing a lot of damage to your home and belongings. That should be covered, right? Not so fast according to the wording of this particular insurance company policy. Even if you were home, and awake, and standing right where the pipe burst, how long would it take you to get to the main water shut-off valve and turn the water off? I guarantee the answer is “a period of time”. Now, I will say this particular insurance company (I won’t say who it is, but if you have at least 5 good neighbors on your street, odds are at least 1 of them are insured by this huge national company with a catchy jingle and endless ads on TV) doesn’t always take full advantage of this exclusion – after all, if they did, they could deny every single plumbing leak claim that is ever presented, since all leaks and seepages, by definition, occur over “a period of time”.

Instead, they simply pick and choose which they want to cover, and which they don’t. To be honest, I don’t know how they have been able to get away with this for so long. A good public relations team, and good lobbyists, are probably a good start. These leaks, if they result in rot or mold, and one just says the loss is not covered if the leak “occurs over a period of time”. Think about that for a minute (or any period of time). You have a sudden and accidental pipe burst, and water goes everywhere, causing a lot of damage to your home and belongings. That should be covered, right? Not so fast according to the wording of this particular insurance policy. Even if you were home, and awake, and standing right where the pipe burst, how long would it take you to get to the main water shut-off valve and turn the water off? I guarantee the answer is “a period of time”. Now, I will say this particular insurance company (I won’t say who it is, but if you have at least 5

I will say this though – regardless of the language they use, and the resources they employ to have the scenario appear to fit the exclusionary policy language, we are usually able to get these claims paid. How? Because we use technicalities too. When the carrier says the leak went on for more than 14 days, we simply address the damages that occurred during the first 13 days (and we usually find it is not much different than the damages that took place from day 14 on. If they find mold that only grows after an extended period of time, we can find other mold present that only takes 72 hours to grow. If they claim this leak resulted in rot, we may be able to establish that the rot they are referring to resulted from a completely different leak several years ago, and is therefore unrelated.

Image courtesy of en.wikimedia.org

Not all leaks come from pipes. Another common leak source we deal with frequently comes from roofs. Roofs can leak for a number of reasons, some are covered, and some are not. Generally, if the leak occurred due to storm damage, falling object, vandalism, or some other sudden and accidental cause, the roof repair is usually covered; but if the leak was due to a lack of maintenance, faulty construction or design, the roof repair is usually excluded. What about the damage done inside the home as a result of the roof leak? This again may depend on the specific policy language. Some policies cover this interior “resulting damage” regardless of whether or not the roof itself is covered, and some policies specifically say a covered event must create an opening in the roof (or wall) before they will pay for the interior water damages. When pressed on what constitutes an “opening” that the water enters through, adjusters vary. Some will pay if roof shingles are damaged in any way, and others insist the word “opening” means, “if you are standing inside the home and can look up and see the sky.” We eat those guys for lunch!

And I recently wrote about two other water claims that were vehemently denied. In one case a covered source of rainwater was improperly denied as being “flood” or “surface water”, when in fact it was neither. And in another case, an extensive water loss was strongly denied because the carrier erroneously believed the loss occurred after the property was left vacant for more than 30 days, when it was not. In both cases, a more technical investigation of facts and policies led to payments exceeding $50,000.

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As you can imagine, in a voluminous insurance policy, rife with legalese containing coverages, conditions, exclusions, exceptions, and exceptions to exclusions, there is plenty of room for technicalities, and for debate over said technicalities. This is all the more reason to have an insurance claim expert on your side, just as the insurance companies have experts on their side.

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.