Ask The Public Adjuster About Insurance Claims: public adjusters

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The Calm After the Storm

by Mark Goldwich

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

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

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

Image courtesy of flickr.com

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

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

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

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

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

Fill out the form below for your free copy.

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

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

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

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

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

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

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

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

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

The Calm After the Storm

by Mark Goldwich

Image courtesy of commons.wikimedia.org

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

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

Image courtesy of flickr.com

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

Get a free copy of my book.

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

Fill out the form below for your free copy.

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

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

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

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.

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.

Time to Break Out the Shovel

by Mark Goldwich

Image courtesy of pixabay.com

I’ve been seeing a lot of shoveling lately. Waves of major winter storm systems bring millions of tons

of snow, blanketing streets, cities, and even entire states. With news reports and headlines calling for “Snowmageddon” and “Snowpocalypse”, followed by images of snowplows, snowblowers, and plenty of snow shovels, the piles of snow seem to be never-ending.

“So how does insurance fit in with all the snow?” you might be asking. Actually, there are two ways.

Image courtesy of flickr.com

First, all that snow (and ice) causes extraordinary amounts of property damage in the form of auto accidents, trees and power lines downed by the weight of ice and snow, frozen pipes that rupture and cause extensive water damage, ice dams create roof leaks, the weight of ice and snow can actually collapse roofs, and so much melting snow causes flooding – I actually saw a 5 foot high ice flow move down a New Jersey street.

And secondly, the heaping mounds of snow is analogous to the mountains of red tape, hoops, delays and other slush insurance companies use to drown insurance victims in their time of need.

Water (that stuff snow eventually turns into) is one of the most powerful and destructive forces on earth (think Grand Canyon, Niagara Falls, and glaciers). I know it seems fairly harmless when portrayed as fluffy little flakes floating down from the heavens, but in accumulations large enough, and depending on variations in temperature, snow melts into water, freezes to ice, and melts into water again.

image courtesy of en.wikipedia.org

In the air, the thawing and freezing cycle can produce damaging hail. On roofs, this thawing and freezing can produce ice dams, allowing water to penetrate roof systems. Sometimes this damages the roof itself as well as the interior of the structure, and sometimes only damaging the interior, while leaving no trace whatsoever on the roof. This makes for an interesting “who-done-it” for insurance adjusters – after all, without proof, why should they believe the damage was caused by an ice dam, and not simply a matter of “wear and tear”? In pipes, the cycle is usually reversed – first freezing, and then thawing, which can inundate an entire home (just don’t call it “a flood” as that is not covered unless it meets the definition of “flood”, and you actually have a flood insurance policy). And outside on the ground, this thawing and freezing and thawing again cycle can lead to actual flooding, sometimes including large chunks of ice and accumulated debris rushing along in a torrent, destroying pretty much anything in it’s path.

By now you get the idea. Water can be very destructive, even when it starts out gently. And after you plow, dig, blow, and shovel your way out from the snow, you should also be prepared to shovel your way out from the ensuing insurance claim.

As I alluded to earlier, snow, ice, and water can be tricky substances. Think of all the riddles involving water in its various properties:

- Power enough to smash ships and crush roofs. Yet it still must fear the sun. (Ice)

- This old one runs forever, but never moves at all. No lungs nor throat, but still a mighty roaring call. (waterfall)

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Because water can take on 3 physical properties (solid, liquid, and gas) in relatively short order, it can appear to be here one day, and gone the next. So unless you have photos of it, it’s very existence can be difficult to prove (especially if the one you are trying to prove it to is not inclined to believe you to begin with).

As you might imagine, some insurance adjusters might use the elusiveness of water to minimize your claim of damages. Hailstones beating down on your roof like 10 million marbles (or golf balls) are almost always gone long before an adjuster ever sets foot on your roof. Depending on the size of the hail, the damage can be anything from excessive loss of roofing granules (tiny bits of “rock”) which protect the water-shedding shingle matting, to bruising of the shingle matting, to actual holes in the shingles. Naturally, the less obvious the damage, the more an adjuster may resist paying.

Image courtesy of commons.wikimedia.org

In the case of frozen pipe claims, many policies have exclusionary clauses requiring property owners to maintain sufficient heat at all times, or to drain the entire plumbing system. For some adjusters, the simple fact that you suffered a frozen pipe is evidence enough that you failed to perform your duties.

And as indicated above, in the case of ice dams, adjusters can claim there is no evidence to prove there ever was an ice dam (since it melted away). They could also claim the roof workmanship or maintenance was faulty. Think about it, exclusions weren’t put into insurance policies to be ignored. They are there to be used. And some like using them more than others. Even if they agree to pay for the inside water damage, they may not agree to pay for damage done to the roofing system when ice built up and crept ever-higher under shingles, causing creases, removing granules, or loosening nails.

Just be ready to dig yourself out from under a drift of insurance legalese, skeptical adjusters, and carrier-dependent engineers. Or, you may want to consider hiring an experienced consumer advocate. Like a dependable snow shovel, we can plow the way for your return to normalcy.

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.

Tis the Season for Home Fires

by Mark Goldwich

Although we’re thankfully past hurricane season, and once again, we (especially those of us in Florida and other hurricane prone regions of the U.S.) have again fared better than predicted. We had a close call or two, but no hits to the State. Still, we can not afford to let our guard down.

Image courtesy of eletunk.com

As temperatures drop, a new disaster season begins – that of home fires. Whether from space heaters, fireplaces, holiday candles, Christmas tree lights, cooking accidents, or a variety of other sources, the end of hurricane season on November 30 each year seems to mark the beginning of home fire season.

I’ve talked about home fires before, but with incidents involving home fires on the rise, it’s worth pointing out a few important items to reinforce some key concepts.

Just as you did for hurricane season, make sure you have a plan for fire season. Have a plan for detecting fires (replacing batteries), putting out fires (fire extinguishers), escape routes, alternative meeting locations, calling assignments, disaster kits (for people and animals), temporary living, disaster cash, and of course, plans for documenting your claim to your insurance company (this begins with having insurance to begin with, and keeping your insurance up-to-date based on your changing needs.

Image courtesy of backalleytaxes.com

Did you know that it’s your responsibility to prove to the insurance company what you owned when your home burns to the ground? You may pay for $100,000 (or much more) in personal property coverage, but you may only receive payment for what you can both remember and prove that you owned.

I once had a client that lost well over $100,000 worth of belongings when her 2-story home of over 40 years burned to the ground. Tragically, her husband perished in the fire. Would you believe her “top-notch” insurance company would only pay her for about $40,000 in property because that is all she could remember in her traumatized state of mind?

This is why I highly recommend you consider photographing, filming and listing all your possessions, or at least your most valuable ones, and keep copies (with receipts, owners manuals, and appraisals) in more than one location and/or in a fire and waterproof safe.

A fire at this time of year can really ruin your holidays, and let’s face it, no matter how well you plan for the disaster, or how well you can handle the insurance claim, your holidays will be forever marred by the fire. Your home will not be rebuilt in time to host family, and you may not be able to purchase all the gifts you would like to for the family, but surviving the fire is step 1, and dealing with the aftermath is step 2. Rather than dwell on what was lost, make the best of what you have, and look forward to what can once again be possible.

Image courtesy of flickr.com

I have a family I am working with right now, that suffered a fire very early in the season. It seems an

electrical fire began without warning in the garage, and quickly spread to the rest of the home. The home, and most of the contents, were badly damaged. This family will be without their home for the holidays, but they found a similar rental home just a few blocks away, and this is covered by most insurance policies (don’t let them stick you in a cheap hotel for an extended period of time).

And while they got out of the home safely, they escaped with little more than the clothes on their backs. Fortunately in this case, the insurance company gave them an advance on their claim for personal property, so they can buy needed clothing and other essentials without having to overextend themselves on credit cards. If you ever found yourself in a similar situation, and your insurance company refused to give you such an advance, I would take that as a bad sign of things to come. You should ask for an explanation in writing, and consider complaining to a higher level of management at the insurance company, if not the Department of Insurance in your State. You should also consider getting professional assistance on your claim.

What did happen in this case, once I was hired, was the insurance company immediately called the insured, questioned them for hiring me, and told them to check their agreement with me as they may still be able to cancel that agreement (in Florida, insureds have 3 days to cancel a Public Adjuster agreement). While highly unethical, it is not uncommon for insurance company representatives to try to prevent insureds from getting profession help (care to guess why?).

The other thing they did immediately upon notice of my representation, was agree the home was a total loss, so I would not be entitled to any fee based on that payment, which was fine with me. I was confident there would be other ways for me to assist the insured.

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Remember, not all disasters come with names and media coverage – or warning – like hurricanes do. The best time to be prepared is always…now! Also keep in mind you have rights, as well as responsibilities, that come with your insurance policy. If you are ever unsure of what those rights might be, all you have to do is ask. You can start by asking the insurance company, but if questions remain, I highly recommend you ask a true advocate, not someone hired by the insurance company to protect their interests.

Fires and other disasters can really put a damper on your holiday plans, but they don’t have to ruin 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.