Your Vacation Checklist

by Mark Goldwich

Image courtesy of pixabay.com

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

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

Image courtesy of pexels.com

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

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

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

Image courtesy of pixabay.com

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

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

Fill our the form below for a FREE copy.

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

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

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

Public Adjusting Takes a Vacation

by Mark Goldwich

Image courtesy of flickr.com

Like many other Americans, this week the family and I are on our last vacation of the summer.  Vacation is a bit different for me as a business owner versus my decades as an employee for a large national insurance company. Back when I worked as an employee of the insurance company, I could just go. My job and the office would be there when I returned, but I didn’t have to worry about work while I was away on vacation. Now when I go on vacation, I have to be sure to take my phone and laptop (and chargers) with me, both of which allow me to communicate in various ways with coworkers, insureds, and others. With the systems we use, I can work virtually from anywhere, as long as I can connect to a network, or get Wi-Fi, without missing a beat.

In fact, just yesterday, as I was completing the last driving leg of our trip to Williamsburg, Virginia, I got a call from an adjuster I was expecting to hear from the day before, and in just less than 10 minutes at highway speeds, we were able to settle the claim. My insured, Ms. “P”, will be very happy. Ms. “P” suffered a water leak in April when the shower valve in her daughter’s bathroom sprang a leak in the wall cavity between the bathroom and the laundry room. They immediately shut off the water and called a plumber, who located and repaired the source of the leak. She then called a contractor who extracted the water and dried the structure. In the meantime, Ms. “P” got a closet-full of shoes out of her daughter’s room, and began drying and cleaning them. A few days later, the insurance adjuster showed up, and Ms. “P” said she could tell it was not going to go well from the start. The adjuster began by saying he needed photos of odd things, like the mailbox, and the exterior of the home (none of which had any damage or were related to the claim in any way). The adjuster suggested the water was leaking for “quite some time” and questioned the insured’s truthfulness regarding certain aspects of the claim.

Image courtesy of flickr.com

Sure enough, about a week later, the insured was officially told her claim would be denied because the insurance company felt the water leak was an ongoing maintenance issue that occurred for weeks or months, and not just hours or days as the insured had claimed. Fortunately for Ms. “P”, her water restoration contractor told her about me, and one month after the leak was discovered, she hired me to help recover on the claim. As soon as I saw the damages, exactly as the insurance company adjuster saw them, I knew with certainty the loss should have been covered. I took my photos, made some notes, and had an estimate prepared. The estimate was sent in to the insurance company with a request to meet with an adjuster (either the same one, or a new one). They sent a new one, about a month later. When we met back at the house, the adjuster acknowledged he was not familiar with the claim, or why it was not covered, but assured us he would consider it with “fresh eyes”. I remained sure the claim would be paid. Ms. “P” was encouraged, but not yet convinced. Until today, when I communicated (via email from 3 states away), the general terms of the agreement the adjuster and I came to in the car yesterday. He confirmed they agreed to fully cover the claim, and even agreed to the vast majority of my estimate, plus something to compensate the insured for saving and cleaning her daughter’s shoes.

Fill out the form below to receive a FREE copy.

While on vacation, the TVs where we are staying are programmed to have the weather channel appear when the TVs are turned on. For most guests, I imagine this is so the visiting tourists can check the weather and plan their days. Of course, for me, I get to see where the storms are, and remain in “work-mode”. Today, for example, I see Tropical Storm Earl is heading for Mexico’s Yucatan Peninsula, and that Maryland is recovering from recent heavy flooding. So, while my family is at a local theme park, I am taking the day off from vacationing to catch up on some emails and write this blog. Tomorrow, though, it is back to family vacation fun, I promise – but I may need to take a work call or two, and check email and text every few hours. And I wouldn’t have it any other way. I love that I can help people any day of the week, no matter where I am!

 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.

Fill out the form below to receive your FREE copy.

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.

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

by Mark Goldwich

Image courtesy of en.wikipedia.org

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

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

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

Image courtesy of YouTube

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

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

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

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

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

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

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

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

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

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

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

by Mark Goldwich

Image courtesy of en.wikipedia.org

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

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

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

Image courtesy of YouTube

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

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

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

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

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

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

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

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

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

There Goes the Neighborhood

by Mark Goldwich

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

Image courtesy of en.wikipedia.org

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

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

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

Image courtesy of flickr.com

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

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

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

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

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

Winning by Losing

by Mark Goldwich

Image courtesy of flickr.com

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

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

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

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

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

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

Image courtesy of Pixabay.com

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

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

Image courtesy of commons.wikimedia.org

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

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

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

Fill out the form below for your FREE copy.

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.