Surprises You Can Do Without

by Mark Goldwich

Image courtesy of commons.wikimedia.org

Being a fan of Weather.com, I was noticing that even though it is not making national news – whatwith the first presidential debate and Charlotte riots and all – there continues to be bad weather wreaking havoc in parts of the country you might not normally think about. Deadly flooding in Iowa, Minnesota and Wisconsin, and tornados in Indiana and Utah, seem to happen with little warning,  leaving death and destruction in their path which will be remembered for years to come.

This is happening almost a month after Florida saw damage from the first hurricane to hit the state in eleven years. Hurricane Hermine did not come out of nowhere, but as hurricanes go, it developed rather quickly, going from a depression to a category 1 hurricane within 24 hours of making landfall. Typically, these depressions are tracked for weeks, with courses predicted and severity estimated in plenty of time to allow for preparation or evacuation. That didn’t happen this time, but fortunately, Hermine wasn’t a very powerful storm, and it moved through the state and was on its way relatively quickly, so damage was not nearly severe as it could have been.

As is typical of many lower level hurricanes, most of the damage resulted from flooding, not from the powerful winds hurricanes are known for. And much of the wind damage occurred when trees, planted too close to structures, and allowed to grow untrimmed, were toppled onto homes, cars, and other property. Sometimes, people are in those homes, making for a dangerous and frightening experience. The same holds true for people trapped in homes by fast-rising waters or flash floods, given no time to escape. Regardless of the nature of the damage, once the wind has stopped blowing or water recedes, there is another frightening experience awaiting those trying to put their lives back together. We hear about it every time an event like this happens.

Image courtesy of commons.wikimedia.org

Just last week I heard from someone who had a very large oak tree land on their home after Hurricane Hermine coasted through the state capitol of Tallahassee. It wasn’t even their tree – it was their neighbor’s – but it was big enough to crush a number of roof trusses on their home which allowed water to run into their attic. It also smashed a skylight, and a kitchen vent, allowing more water into their home. They placed buckets about to catch the water streaming into the house, and spent most of the night emptyin
g the buckets as they filled up with water. Before too long, insulation in the attic got so heavy from all the water, that the ceiling collapsed onto the floor. Luckily, no one was hurt, but their home was a mess.

They promptly called their insurance company first thing in the morning to report the loss. Their carrier put them at ease, telling them a “preferred vendor” would be out to take the tree off the house and begin to clean up the mess. And sure enough, an hour later they received a call from a restoration company. This particular restoration company is nationally recognized in the insurance industry, but many people have not heard of them because they do not advertise as much as other companies. It seems they don’t need to, since insurance companies so regularly refer them to policyholders who need emergency restoration work.

This may sound innocent enough, but we have found that having this special relationship between the insurance company and the emergency restoration company can be very good for all parties, except for the policyholder – the one that is in dire need. The restoration company gets work handed to them on a very regular basis, saving potentially millions in advertising nationally every year.  By getting to the job site first, this company has gotten extremely proficient at selling themselves to the policyholder to complete all the needed restoration work, especially since they already seem to have the approval and blessings of the insurance company. This nets them even more money than the emergency work they were initially called out for.

And what does the insurance company get? They get a nationally branded contractor that will respond to their requests for assistance at a moment’s notice, and local managers with whom they develop long-term relationships. They also get preferential treatment, even compared to the homeowner for whom the work is being done. After all, it is the insurance company that pays the restoration company, not the homeowner. It is only natural then, that the relationship between the insurance company and the restoration company can result in blurring the loyalty lines. Remember, they want that flow of claims to keep streaming into their pipeline, so if they have to jump through a few extra hoops, or make less money on a job here or there to keep their “partner” happy, that’s what they are going to do, even if it comes at the expense of the policyholder.

Image courtesy of commons.wikimedia.org

So in this case, the insurance company’s preferred restoration company was on the site within a few hours of the homeowner’s call. As discussed with the insurance company, the tree was cut up, the mess dealt with, and a tarp was placed on the roof to prevent more water from entering until the reconstruction could begin. Then they began to work their magic, explaining to the homeowner that they were the insurance companies preferred contractor, and that they would write up a complete estimate for all of the damages and reconstruction estimates. They said they would help take care of everything, including helping the family relocate while the work was being done, not to mention meeting with the insurance adjuster to agree on the estimate. Within days, the insurance adjuster and the preferred vendor met, just as planned, and the adjuster told the contractor, “send me your estimate”. It all seemed to be going according to plan.

But the next day, the contractor came out again with an engineer to confirm the damages and begin the permitting process. And while they were there, the contractor first asked the homeowner to sign what is called a “work authorization”. This allows the contractor to access the property and work on the repairs – basically, hiring the contractor even though no estimate was done. While many people might not be familiar with this form, this particular homeowner was (since he himself is a contractor), and he knew this was not necessary in order for the contractor to provide the insurance company with an estimate. It was clear the contractor was not happy, and the request became more firm, with the contractor saying the form was needed for the contractor to send the estimate. The homeowner refused, and the contractor left in a huff. That was a few weeks ago, and as far as he can tell, no estimate from the preferred contractor was ever sent to the insurance company.

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A week later the insurance company then sent their own adjuster’s estimate, but it was woefully lacking. This comes as no surprise to me, and in my opinion, it is simply a strategy to coerce the homeowner into hiring the preferred contractor, in hopes of getting the process back on track.  By this, I mean the track desired by the insurance company and their contractor. Now it is our turn get this claim back on track for the policyholder, and that is exactly what I intend to do.

In the wake of such catastrophes, it is easy to see how people would be vulnerable in a time of calamity. They are desperate to have the damage repaired so they can get on with their lives. The thought of an insurance company working in concert with a contractor to take advantage of a policyholder that has paid a lot of hard-earned dollars for the promise of being treated fairly, is hard to believe. Still, based on my decades of experience, I’m afraid it might be the rule rather than the exception, and this example certainly seems to support my suspicions. After weathering the storm you need to be strong, and especially vigilant before signing anything. For those who know, help is just a phone call or keystroke away. And since being forewarned is forearmed, now you know.

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

Record Losses For All

by Mark Goldwich

Image by commons.wikimedia.org

The Weather Channel’s website, weather.com, recently published an article, “Eight Billion-Dollar Weather Disasters Have Hit the U.S. So Far in 2016”. The article noted this was only for the first 6 months of 2016, and that just one of the storms alone accounted for over 3.5 billion dollars of that damage. Also of note were the facts that 5 of the 8 weather disasters occurred in Texas, including 2 flooding events, and the damage totals did not even include late June flooding events in West Virginia. All told, at over 12 billion dollars, this could end up being the costliest January to June weather disaster period in recent history (it is already ranked #2, behind 2011’s tornado superoutbreak in April).

Now let’s try to break down who has to pay for all these damaging weather events, and how this could translate into insurance terms. First, remember that not all such losses are covered by insurance. Some properties are uninsurable, some properties are insurable but the owner chooses not to insure, can’t afford to insure, or decides to self-insure, and still others are insured, but not all the damages are covered by insurance. For example, if a 50-foot tall, 100 year old oak tree comes down in a storm, and does not land on covered property, there is no coverage for cutting up the tree and hauling it off of the property – and the bill for that could be thousands of dollars. Now, consider how many trees come down in all of these storms without landing on anything. As another example, flood insurance only covers certain types of buildings, and only up to certain limits (it is not like other types of property insurance where you purchase the amount of insurance you need).

So, out of the 12 billion dollars in damages, let’s say only 7 billion dollars are covered by insurance – that is still a great deal of money. Fortunately, the insurance companies have that money sitting in reserves, collecting more interest than you or I can get. And, let’s not forget that just because the damages are covered by insurance, and the policies are in place, and the premiums are paid, that doesn’t mean the insurance companies are going to willfully pay that money to their insureds, who have now crossed the line from (pre-loss) “customers”, to (post-loss) “legal and financial adversaries”.

Small change image courtesy of flickr.com

Care to guess how much I would predict insurance companies would offer premium paying customers with covered losses, if the covered damages were actually 7 billion dollars? Don’t read ahead. Just think about it for a minute before scrolling down. Don’t peek! If they owe 7 billion, how much would they pay without question? Should be 7 billion, right? OK, maybe they try to hold back a little – after all, some people probably try to inflate their claims, and mistakes happen, but they would probably pay at least 5 billion, don’t you think?

Well, I don’t. My experience tells me they would try to pay a mere 1.75 billion dollars of the 7 billion dollars owed. Good thing we’re a litigious society, with tons of lawyers at our disposal, and we won’t let anyone take advantage of us like that, huh? Don’t count on it. Accounting for the small percentage of policyholders that would fight their claims – either on their own, or with the help of a professional public adjuster or attorney – I would doubt the figure would rise above 2 billion dollars. That makes for a nice additional profit of about 5 billion dollars on covered losses owed, but not paid.

Why do I think the insurance companies would offer so little? That would be based on my own experience, supported by a governmental agency, the Florida Office of Program Policy Analysis and Government Accountability that published a report in January 2010, which showed insurance payments were up to 747% higher when policyholders were represented by public adjusters for claims related to hurricanes (catastrophes). This report supports my own experience when dealing with insurance claims, and especially when dealing with catastrophe claims.

Exhibit 6

Public Adjuster Representation Typically Resulted in Larger Payments to Policyholders

Source: OPPAGA analysis. Data refers to the median (50th percentile or typical) payment.

Consider these two examples of actual claims I handled recently:

In one case, an insured was paid just over $2,600 for damage to his roof from a storm. The insurance company acknowledged that about 50% of the insured’s roof needed to be replaced due to a covered wind event, but decided not to pay to replace the entire roof as was required by building code (and the insured had the proper endorsement to address this). I thought it would be a simple matter of letting the insurance company know of their mistake. Instead of quickly paying the correct amount, an adjuster blustered about the amount I had estimated, misrepresenting a number of facts about the size of the roof and the cost of the repairs. It took a few months to get someone else involved that agreed the prior adjuster did not respond properly, and an additional $7,750 was paid, on top of the $2,600 initially paid.

In another case, a woman had a pipe leak inside a wall between her bathroom and laundry room, damaging some drywall, a vanity, floor tiles, and some of her daughter’s shoes. The insurance company adjuster was very difficult with her, suggesting the leak must have been occurring for an extended period of time, and questioning the insured about some items that were completely unrelated to the claim. She said she could tell there was going to be a problem within just a few minutes of him entering her home. Sure enough, she soon received a letter denying the claim altogether. She then hired me, and I recently met with another adjuster, who agreed to pay for the damages, totaling over $6,000.

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Keep in mind these are small losses, not resulting from major weather catastrophes, yet the amounts the insurance companies were attempting to avoid paying were relatively significant for such small claims. If you consider the hundreds of thousands of claims that would have been filed for the weather related catastrophes in the first 6 months of 2016, and have confidence as I do in the amounts that could be recovered with professional representation, you can begin to see why I believe the insurance companies could be avoiding as much as 5 billion dollars or more in covered claim payments.

Yes, the insurance industry might be making record payments on record numbers of weather disasters, but their insureds are also suffering record losses as well. The difference is, the insureds paid their full premiums with their hard-earned money, and don’t have the 5 billion dollars I believe is being shorted, and the insurance companies do have the money. The insureds who refuse to settle for less than everything they are owed are fully compensated – I hope that includes 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.

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.

Seems Absurd, But It Must Work

by Mark Goldwich

Today I wanted to highlight a pair of recent claims that provide great insight into the strategies employed by property insurance companies (I could do a lot more than two, but for the sake of brevity I’ll just use the two). As we go through these together, you will note a few things both have in common, even though they are being handled by different adjusters at different insurance companies. And one thing is for sure, you don’t want to be treated like any of these people.

Image from en.wikipedia.org

In the first claim, a family experienced a failed supply line to an upstairs commode. This is fairly common, as all toilets have supply lines that remain under pressure, just waiting for the next flush, and these supply lines tend to be made of fairly inexpensive material with very simple connections. These lines can easily go unnoticed for decades (until they fail). When they do fail, the water does not usually drip out. Rather it pours out at a rate that can be measured in gallons per hour. And I’m not sure how these plastic lines know, but they seem to prefer to rupture in the middle of the night, or when people are away on vacation. Devious little suckers, right?

In this case, the line failed during the night, and spewed water for hours until the next morning, when both the upstairs and downstairs were inundated with water. And wouldn’t you know it; the upstairs bathroom where the line broke was right above the kitchen, where all the cabinets became soaked as well.

Sounds pretty straightforward - and it should be. But for some reason in this case, the insurance adjuster who initially inspected the loss only estimated about $18,000 in damages, and the insured wanted a second opinion after we were recommended to her by a co-worker of hers. It turns out her co-worker friend was right, and our estimate was more than double that of the insurance company.

Weeks turned into months as the carrier dragged its feet at every turn. First they wanted the adjuster to go back out to try to correct the estimate; then they wanted a national contractor to complete what they call a “peer review” estimate. The idea is the national contractor will write a fair estimate for what they would do the work for. In reality, the contractor knows they are usually not getting the job, and even if they do get the job, they know they can always submit a “supplemental” invoice to their pals at the insurance company so they can make a good profit. In this case, the national contractor rep told me before coming out that they will never do a job when a public adjuster is involved. Company policy. So, what do you think that does to the value of their estimate? If you guessed, “they write a low estimate”, then your intuition matches my experience. The rep was there for less than 20 minutes, mainly taking photos, and rarely measuring the room sizes, since we were giving him our estimate as a reference.

Image courtesy of flickr.com

Low and behold, the national firm generated an estimate that was much higher than the insurance company adjuster’s estimate, but it was still $12,000 less than our estimate. It is now 4 months since this loss took place, the insurance company has paid less than half of the contractor’s estimate, which is still $12,000 less than our estimate, and the insured is seriously considering accepting their offer, as they are tired of the claim dragging on. And trust me, if we were not helping her, she would have already accepted much less, just to get on with her life. Absurd, but it works.

In the next case, someone I have known for years recently asked me to look at his insurance settlement, admitting he had no idea whether it was fair or not. He had suffered wind damage to his roof, and the insurance company quickly paid to repair the damage, which totaled about half of his entire roof. So far he (and the insurance company) was lucky, as no water had leaked inside despite a number of severe rainstorms.

Immediately upon inspection of the roof and the paperwork he had received from his insurance company, I could see they were not just off on the amount being offered, they had failed to bring to his attention key facts which clearly warranted their paying for his whole roof to be replaced. They must have made a mistake, I thought, and this should be easy for them to fix. I told the insured I would let the insurance company know of their mistake, and if they simply corrected it and paid him in full, I would  charge him nothing.

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So I wrote the insurance company a half page letter, clearly explaining what their error was, why it was an error, and I even provided them with an estimate for the proper amount. After days of no response, I called the carrier, and was told the adjuster no longer worked for the insurance company. OK, I said, but didn’t you get my paperwork? Isn’t someone else going to handle this now? The rep politely said the claim was closed. I understand, I answered, but when you received my paperwork asking for the claim to be reevaluated, why wasn’t it reopened and given to someone else to handle. I could tell that if I never called them, they certainly were never going to call me. She then stammered a bit and suggested they just received my paperwork the day before(this had in fact been faxed and emailed to them about 10 days prior). Then she said she would get the claim to a manager to review it. When I asked how long it would take for someone to contact me, she admitted she had no idea. You could hear the embarrassment in her voice.

A few days later, I received an email from the new claim handler. It was very brief, and simply said he wanted to offer an initial compromise settlement of about $4,000 more than what was previously

Image courtesy of pixabay.com

paid. A compromise?, I thought, this was very straightforward. They completely ignored their own policy and state statutes calling for a full roof replacement, which meant they owed about $10,000 more. What was there to compromise? So I responded in considerable detail, showing my math for exactly how I reached the amount I claimed was due, and asking him to point out any error in my math or in my reasoning. He responded by suggesting I was inflating my measurements, and overestimating the costs. He did so by misrepresenting actual numbers presented by myself, the original adjuster, and our local property tax appraiser’s website. His misrepresentations were clear and obvious. If he thought he was being tricky, he was quite mistaken. So I factually pointed out each and every misrepresentation that he made, and again offered him the opportunity to do the right thing.

You would think at this point, seeing that I was not falling for any of his tricks, let alone all of them, that he would just give up and pay the claim in full. No, he simply dusted himself off, and in another very brief email, offered another $1,000 to settle the claim. He was still about $5,000 short. I am certain here too, that if I were not involved, this insured would in all likelihood have accepted the additional money.  This would have forced the homeowner to take out a loan to get the roof replaced. Another absurd attempt to get an insured to settle for less than what was owed. I can’t help but believe that it must work on the vast majority of insureds, or they wouldn't resort to these tactics so often.

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.  

How to Write Your Way To Celebrity (Maybe)

by Mark Goldwich

Back in 2005, about a year into my new career as a Public Adjuster, I was telling my wife’s boss “war stories” about claims I was handling in the Florida Panhandle following Hurricane Ivan. After hearing me recount how adjusters would miss appointments without as much as a phone call, write horribly low estimates one after the other, attempt to deny items that were clearly covered by the policy…not to mention the delays! One delay after another, month after agonizing month. It was unbelievable, yet I could recite the details for what seemed like hours on end.

My wife’s boss, a motivational speaker and author of multiple books who goes simply by “Pegine”, stopped me mid-sentence and said, “Is this true? Do the insurance companies really do these things?” Absolutely, I told her. After all, I wasn’t just repeating what I heard from someone else, I was talking about actual claims I was personally working on. These things were really happening, and on a regular basis. While it was not how I was taught as a company adjuster, I quickly saw it as the status quo, especially after a catastrophe. But she was completely beside herself, and emphatically told me, “You need to write a book – people need to know this!”

“Besides,” she explained, “writing a book is a great way to set yourself apart from your competition, and increase your credibility as an expert in your field.” I reminded her I was not a writer, I was an insurance adjuster. But she didn’t seem to care. Her mind was made up. She told me about a “ghostwriter” friend of hers, and explained how it all worked. I would tell the stories, he would make them print-worthy, and the public would be made aware – both, of what the insurance companies were up to, and who could help them level the playing field. It was a win-win-win situation.

So for the next several months, as I made the 5-hour drive from Jacksonville to Pensacola Beach, and back again every week or so, I would dictate my stories into a micro-cassette recorder (this was years before voice-to-text smart phones), and pop them in the mail to the “writer”. He would then clean it up, create an order for it all, as well as teach me things about writing and publishing I had no idea about. He helped me find a graphic designer for the cover (who also created my logo and designed my website), and an on-line self-publisher to print the books (the first edition, anyway).

Initially, the book was going to be a “pocket book”, small and thin, 80 pages tops, with just enough information to raise awareness and promote myself as an expert in the field of property insurance claims. But as the months went on, I found more and more information “needed” to be included, and more and more “stories” were naturally generated as I continued to beat insurance companies at their own game. The book grew in both size and thickness, from 5”x7” and under 80 pages, to 6”x9” and over 125 pages.

In 2006, “UNCOVERED – What REALLY Happens After The Storm, Flood, Earthquake or Fire” was born! I was very proud to be a published author, less than three years into my new business venture. I hired a publicist to let the world know about the book by sending press releases, and waited for the media to call. Don’t laugh. No, I didn’t get a lot of media attention, and the books weren’t exactly flying off the shelves of bookstores, but I did make it on a local news station’s “Hurricane Special”, as well as a morning TV show, the local paper and business journal, and some radio shows (local and national). I sold a few books here and there, but mainly gave them away as door prizes during networking events, or to clients, prospects, or strategic alliances. My point here is, don’t think you are going to make a great living selling books, and be able to retire early from the career you wrote the book to promote in the first place. Just accept the fact that you are not going to be selling a ton of books, and focus on using the books to promote your business (and/or yourself).

But the book really does help. It has now been about 8 years since I wrote my first book, and people are still impressed that I wrote a book. I’ve had a client tell me the deciding factor for her hiring me over a competitor was because I wrote the book (which I gave to her when she asked me to “interview” for the claim she needed help with). The claim turned out to be a big success. She recovered many tens of thousands more than her insurance company initially offered, and I received a sizeable commission fee – plus she did a great testimonial video for me. Thanks to that one book, that one claim paid for everything that went into writing and publishing the 2,000 initial copies of my book. Talk about a great return on investment!

No, my book did not make me a celebrity, and it did not make me rich. But it does lend credibility to me and my business, it sets me apart, and all these years later, it still offers the opportunity to promote my business. And that is not to say your book will not do so much more for you. Besides, you might be surprised at how much you can learn about yourself, your business, your industry, and your competition, by going through the book-writing process.

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.

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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.

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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.  

Endeavor to Persevere

by Mark Goldwich

I decided to write about perseverance this week, because I have been reminded lately that perseverance plays a major role in insurance claims, and in what we do as public insurance adjusters (advocates for insurance consumers).

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For the second time in my career (one should have been enough), I heard of a woman who lost her home to a fire. As if that wasn’t bad enough, she also lost her husband in the fire. To make it even worse, she was there with him at the time of the fire. She got out just ahead of him before he collapsed, very close to the front door. The fire department was there right away, but the heat was simply too intense. They could hear the husband calling out, but they just couldn’t reach him. They even grabbed a rake from a neighbor to extend their reach, all to no avail.

That was two months ago. Her homeowners insurance company has not paid her anything. Instead, they have taken multiple statements from her, made numerous requests for information, including cellphone records so they can see if she was plotting this fire herself. She feels they have treated her like a criminal, instead of like the victim. The same is true of the life insurance company. Her husband only had $10,000 in life insurance, and nearly all of that will go to pay for funeral costs, but the life insurance company is still waiting for the medical examiner’s office to complete their report listing the official cause of death.

People in these difficult circumstances often lose hope and give up. Between the financial stress of not knowing how you will be able to pay your everyday expenses, added to the anger of being treated like a criminal by the very people you paid to give you peace of mind should something like this happen is enough to make even the strongest of us want to quit and walk away from the entire process.

As a public adjuster, part of my job is to help the insurance victims stay strong, understand their rights, and build resolve to see the process through to the finish. We do this by educating, as well as by sharing our experiences, offering hope,  and just by being there with them throughout the claim. Sometimes we literally hold their hand, or give them a hug. We are confident if they can just outlast the insurance company, they will almost always recover what they are owed. Our confidence helps to bolster their confidence, which is often shaken, or even broken, following this type of ordeal.

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Thinking about perseverance quickly reminded me of a scene from an old Clint Eastwood movie, “The Outlaw Josey Wales”. In this particular scene, Chief Dan George plays the character of Lone Watie, an aging Native American Indian who teams up with Eastwood’s Wales character. Lone Watie recalls a time before the Civil War when he and other leaders of Indian tribes went to Washington to complain about their treatment.

“I wore this frock coat to Washington before The War. We wore them because we belonged to the five civilized tribes. We dressed ourselves up like Abraham Lincoln. You know, we got to see the Secretary of the Interior. And he said, "Boy, you boys sure look civilized." He congratulated us and he gave us medals for looking so civilized. We told him about how our land had been stolen and how our people were dying. When we finished he shook our hands and said, "endeavor to persevere!" They stood us in a line: John Jumper, Chili McIntosh, Buffalo Hump, Jim Buckmark, and me – I am Lone Watie. They took our pictures. And the newspapers said, "Indians vow to endeavor to persevere." We thought about it for a long time. "Endeavor to persevere." And when we had thought about it long enough, we declared war on the Union.”

In other words, they got the message that the politician was just trying to placate them, maybe even mock them, and that their treatment was not going to change for the better. While he told them to persevere, he meant it in the way of maintaining the status quo. That is not what I mean by persevering. By persevere, I mean to be tenacious, stop at nothing, stand one’s ground, and not take “no” for an answer. Same words, but very different meaning.

When I hear all the personal stories of people losing their homes to fire, flood, or other calamity, and losing their personal effects like photographs, records of achievement, and other sentimental mementos that simply cannot be replaced,  I think about the pompous politician from the movie saying, in a condescending tone, “Endeavor to persevere.” These are real people, with real families, and real feelings. They didn’t ask for their homes to be destroyed and their lives to be turned upside down. They deserve better than that. They paid their premiums, often year after year, for decades sometimes, without ever submitting a claim. They deserve better – and that’s what we offer – a better listener, a better understanding, a better response, and a much better result.

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This is why no matter what insurance company representatives might say about me, my business, or my industry, or what they can convince state insurance officials and even legislators about us, I know in my heart we are doing what is right. We will endeavor to persevere, not by standing around “looking civilized”, but by declaring war on insurance companies and their representatives. And by using our knowledge, skills, experience, and other strategic weapons, we will win the war. 

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.