Ask The Public Adjuster About Insurance Claims

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.

How the Grinches Steal Christmas

by Mark Goldwich

The sad reality is that thousands of grinches steal thousands of Christmases, every single year. They always have, and they always will. It is very unfortunate when it happens to others, and devastating when it happens to you. I’m going to try to point out the ways I have personally seen this happen in my career as an insurance adjuster, and some ways you can either reduce the risk of this happening to you, or at least ways to minimize your losses should it happen despite your best efforts.

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When can grinches strike? Anytime from when you are shopping for gifts, to after they are given. Thieves know the malls are full of people with extra cash and valuable gifts walking around, often distracted by sights, sounds, and smells (invariably,cinnamon). You can be targeted by pick-pockets if you are not careful, or people who are quick to snatch up a package being set down for a second, or those who will grab things right out of your arms. There are also those who scour parking lots looking for easy targets loaded with bags and boxes. A common ploy is to watch someone load up their car trunk full of gifts and return to the mall for more shopping. There’s more than one way to get into the trunk or car, and off they go with your goodies – receipts and all!

From the mall, you can be followed home (or to your next destination) for another chance to abscond with the gifts before you get them in the home, or they can simply make note of the address and return another time. And since most homes have new purchases under the trees this time of year, it is not difficult to look in windows and see which homes make the best targets. Or, thieves can even wait until after Christmas, and drive around looking at all the empty boxes being left at the curb, too large for trash cans.

I have handled all kinds of these holiday theft claims over the years, and it is always sad when someone loses all their presents (or their family’s presents). And as an adjuster, I also know they are probably not getting the claim paid before the New Year, and not until long after their Christmas has been ruined.

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So what’s the best ways to stop these grinches from stealing your Christmas? Common sense, mostly. First, know that the threat is out there. That alone will make you more aware of your surroundings when you are walking around the mall, or in stores. Consider purchasing gifts with credit cards, especially those that offer theft insurance protection. You will not only document your purchase this way, but you may get reimbursed easier than going to your insurance company, and without as large a deductible.

If you need to drop off gifts at the car and go back for more, I recommend getting in the car after placing the gifts in the trunk, and then driving around to the other side of the mall, so it looks like you are just arriving to shop. When you are leaving the mall for home, beware of cars following you, and drive past your home and go around the block, then double back to see if anyone is following.

Once home, be aware of anyone watching you bring presents inside, and don’t leave the car unattended or out of sight for any length of time. Close your trunk and lock your doors every time you have to take a load of gifts into the house. In the home, be sure to lock all doors and windows, and use an alarm if you have one. Take pictures of the gifts before they are wrapped, and make copies of your receipts, just in case. After Christmas, don’t put empty gift boxes at the curb – take and dispose of them somewhere else, or cut them up so they can fit inside your garbage cans. All of these things can reduce the size of the target, and since not everyone will do this, people other than you will likely present an easier target for crooks looking for the surest victims.

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And if despite all your care, a grinch makes off with your Jing Tinglers, Flu Floopers, your Tar Tinkers and Who Hoovers, just know if you can document what you purchased, and that it was stolen, your insurance claim will go that much easier. Call the police right away, and give them a complete list of everything stolen (if they don’t get everything listed right away, be sure to provide them with a supplemental list that includes absolutely everything).

Adjusters hear stories every year of people using Christmas bonuses (cash, of course) to buy expensive items that are well above their means, with no proof of purchase whatsoever. Because of this, they expect people will throw in a few extra items from their “wish list”, even if they did really suffer a holiday theft, and they may be extra suspicious when it comes to paying these types of claims. Oftentimes these cynical and callous adjusters seem as cold-hearted as the grinch that actually stole the gifts. The better you can document your claim (receipts, invoices, credit card statements, photos, police report, etc.), the faster your claim should be settled, with as little hassle as possible.

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Like it or not, the grinches are out there, and we may not be able to stop them all by singing a heartwarming (and3-times heart-growing) rendition of The Who Song (Fahoo Fores, Dahoo Dores), but we can take a number of steps to reduce our chances of falling victim, and if it happens anyway, learn ways to make the recovery process go smoother. Welcome Christmas, one and all.

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

Don't Let Your HVAC System Spell HAVOC

by Mark Goldwich

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Tucked away in hallway closets or in corners of garages, air conditioner air handlers quietly go about their business of keeping the temperature of your living space at a comfortable level. Year after year they go about their duty, all while out of sight and out of mind. Wrapped in an unassuming metal box filled with wires, tubes, and fans they use gases that convert warm air to cool air. In the process they create a surplus of condensate (water), that must be carried away by a drain pipe (if all goes according to plan).

You might not expect this to be the case, but air conditioner leaks – especially from the inside air handlers on central air units – are a very common source of water leaks that result in millions of dollars in property damage every year.

Now, I am not an expert on WHY central air conditioners leak, or even HOW they work, but in my experience, both as a homeowner and also as a property damage insurance claim adjuster for nearly 30 years, these A/C leaks are typically the result of two main problems: 1) algae forming in a condensation line; and 2) ice forming on air handler coils. To really understand the whys and hows better, you need to talk to an HVAC professional.

When algae forms inside a relatively narrow condensation line, leading from the air handler to the exterior of the property, it eventually blocks the line, causing the condensed water that is trying to escape, to back up (technically, this is a “fill up”, not a back up). This creates an overflow inside the limited space inside the pan. From there, the water having nowhere else to go, winds up on the floor, and depending on the location of the air handler, and how long you go without noticing, you can have anything from a small puddle, to gallons and gallons of water everywhere.

Have you ever gone outside and watched water stream from a condensation line for a few minutes? If you have, you know the stream can be fairly heavy, and surprisingly steady. Now imagine how much water would drain from that line over the course of an entire day (or several, if you are away from home). It could be a lot of water. Finally, imagine the damage all of that water can cause inside your home!

Think about the damage that could create on flooring, baseboards, drywall, paint or wallpaper, vanities and kitchen cabinets, furniture, and anything else placed on the floor (from books to clothing to electronics, and more). If you are lucky, the cleanup can begin before mildew and mold start to grow, but the costs can still be in the tens of thousands of dollars.

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The same can be true for ice forming on the coils, usually because the air filter is not changed as often as it should be, and the coil fins get clogged and fail. Once the frozen ice thaws (and it always will), the melting water usually ends up on the floor, causing the kinds of damage noted above, but usually in smaller amounts.

Fortunately, there are ways to greatly reduce the risk for having one of these air conditioner “meltdowns”. Proper maintenance is key. Replace the air filters regularly, and check the coil fins for dust and dirt. You can also have a shut-off switch installed so water won’t continue to back up if the condensate line is blocked, and regularly use a solution to keep algae from building up in the drain line to begin with.(Check out a blogpost by an HVAC professional at

http://bestacparts.blogspot.com/2015/04/spring-cleaning-your-ptac-unit.html)

If the A/C unit is in a rental property, don’t assume the tenant is maintaining it properly. Either you, a property management company, or a professional HVAC firm should be inspecting the unit regularly to ensure it is being well maintained.

But let’s say you do have an A/C leak, which is almost always a covered loss (unless your insurance company has added an endorsement to exclude water loss claims, as more and more seem to be doing) – what can you expect as a result of submitting this type of insurance claim?

As is too often the case, the answer is…that depends. It depends on the type of policy you have, the extent of the damage, and the insurance adjuster assigned. It also depends on whether or not you are skilled and experienced in handling claims like this, or if you have professional claim representation to assist you in getting all the policy and claim benefits you are entitled to.

I have personally seen cases like this denied because, as you can imagine, A/Cs may leak some water from time to time, and sometimes it appears as if the A/C was leaking for a prolonged period of time (which is often excluded), rather than leaking small amounts at various times over the years, and then suddenly leaking a large amount of water all at once (which is usually covered).

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The claim adjuster for the insurance company make look under or behind the A/C, see what appears to be long-term damage to flooring or baseboards, maybe even some rot or mold from years ago, and quickly conclude the loss is denied based on it being a “continuous or repeated leakage or seepage of water which results in wet or dry rot or mold”. This happens all the time, and not just with A/C leaks, but all types of water leaks in various places in the home or property.

And while the insurance company will send out an official denial letter on company letterhead, with all kinds of technical language captured directly from your insurance policy, that does not mean you have to accept what they say. We get these types of claims paid in many cases – most of them, actually! Oddly enough, what can look like a slam-dunk denial to an insurance company, very often ends up being a paid claim when an experienced public adjuster is involved.

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

Tis the Season for Home Fires

by Mark Goldwich

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

All is Right With the World of Claims

by Mark Goldwich

Recently I wrote posts about two claims I was handling. They were similar in that both cases

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involved strict denials, meaning that the insurance companies were saying the claims were not covered at all, in any way, for any amount, and they had very specific reasons, using verbiage selected from the insurance policies, detailing why the claims weren’t covered. They were also similar in that from my very first consultation with the insured, I could understand exactly why the insurance company would reach the conclusion they did, yet I did not agree with the insurance company in either case. Additionally, they were different in that the two claims were the result of completely different causes of loss, and the two claims were denied for completely different reasons.

In one case, the insureds suffered damage from a pipe breaking inside a home they recently purchased, but before they actually moved into the home. The insurance company could not see a way to otherwise deny the claim, until the insured mentioned they had not moved into the home, and it had been over a month between the date the home was insured, and the date the claim was reported. You see, there was some obscure (to most people, but not to the insurance company) language in the policy that said there would be no coverage for water damage if the home was vacant or unoccupied for over 30 days (heads up for anyone that has any home, rental property, business, or other property).

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To most people, hearing the bit about there being a month between buying the home and reporting the claim would have been meaningless. After all, what is a month in the scheme of home ownership? And besides, it’s not really that uncommon to purchase a home, but not move in right away because you haven’t sold your prior home yet, and sometimes the new home is not “move-in ready”. That’s how most people think, anyway. But to most insurance adjusters, the mere mention of that month is like waving a red cape in front of a bull. It triggers some pleasure receptor in their brain, instantly bringing them back to a day in claim training when an instructor said something about a policy exclusion for losses to properties vacant or unoccupied for at least 30 days. They are suddenly curious, but only inasmuch as the answers continue to trigger those pleasure receptors.

So once the adjuster’s “investigation” confirmed the sale date of the new property, the fact that they did not move into the new property right away, and the approximate date of loss being beyond 30 days from the sale date, they had all they needed to keep those receptors firing in their brain, and their sense of curiosity quickly fades away. Their work is done. They can close that file with a form denial letter, and move to the next claim in a tall stack of claims.

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Until, that is, until they get my letter, explaining that they overlooked a key piece of information in

their “investigation.” What they missed was the fact that the insureds did not just purchase the home and not move in, the husband stayed in the home after the purchase for a few weeks to work on it and prepare to move in, while the wife returned to the prior home to prepare it to move out. With just those few weeks taken into account, the time the home was unoccupied was reduced to about 3 weeks. Initially, the carrier simply replied that they were standing by their decision to deny the claim.

After another letter explaining their error, they re-opened their investigation, and requested proof of when the loss actually occurred. Fortunately, this loss was discovered by the local utility company at the new home when they went out to read the meter, so we knew the leak occurred on or before the date the meter was read. Once we got that information in writing from the utility company to the carrier, they agreed to pay the claim, which totaled over $35,000.

In the other case, extremely heavy rains caused water to enter the insureds’ home as they slept, by filling up a unique atrium room within the home. The water could not escape the holes built into the exterior wall of the atrium fast enough, and the water rose until it was able to pass under the French doors leading from the family room to the atrium.

In this case, multiple triggers starting firing on those receptors. Words and phrases like, “flood”, “surface water”, “subsurface water”, “rising water”, “design defect” and “no opening created” overwhelmed their pleasure receptors and once again, true curiosity failed to take root. This one was easy, they no doubt thought, it’s simply not covered. The form letter went out, and the claim was closed.

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Again, that is, until the insurance company got my letter explaining they had misinterpreted their own insurance policy, whether as an innocent mistake, or something more nefarious. As the coverage question in this case was more complicated, it took more letters, and phone calls, and a demand the matter be mediated via a State mediation program, and frank discussions about attorneys getting involved and how other similar cases were ultimately ruled on by various courts – but we eventually settled this case as well. While the dollar amount on this claim was less than the other, I was happier about this resolution because the coverage issue was more contested. It took more research, and more negotiation efforts, but I felt strongly that we were right, and they were wrong. Now, the settlement agreement will say the insurance company does not admit they were wrong… but I know.

Being passionate about what I do for a living makes it worthwhile, even when things don’t always go my way. Fortunately, that doesn’t happen often. But when the stars align and multiple cases go our way, as they usually do, it feels even better! For now, all is right with the world (of claims).

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.

Security Threat Level Orange

By Mark Goldwich

If there is one thing in the news lately, it is security. Security threats, security risks, security leaks, heightened security, cyber security, security vetting procedures…you get the point.

While I’m not going to get into a discussion of international security or terrorism here, I thought this might be a good time to offer some basic tips and suggestions on personal and business security, whether at the home, at the office, or online.

Here are some helpful tips for personal and residential security from the US Department of State (www.state.gov):

Residential security is a critical component of any personal security program. The following guidelines should be used in reviewing your residential security.

All entrances, including service doors and gates, should have quality locks--preferably deadbolt. Check your:

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· Front Door

· Rear Door

· Garage Door(s)

· Service Door(s)

· Patio Door

· Sliding Glass Door

· Gate

· Swimming Pool Gate

· Guest House Door(s).

· Don't leave keys "hidden" outside the home. Leave an extra key with a trusted neighbor or colleague.

· Keep doors locked even when you or family members are at home.

· Have window locks installed on all windows. Use them.

· Lock louvered windows--especially on the ground floor.

· Have locks installed on your fuse boxes and external power sources.

· If you have window grilles and bars, review fire safety. Don't block bedroom windows with permanent grilles if the windows may be used for emergency egress.

· If you have burglar or intrusion alarms, check and use them.

· Keep at least one fire extinguisher on each floor, and be sure to keep one in the kitchen. Show family members and household help how to use them.

· Periodically check smoke detectors and replace batteries when necessary.

· Keep flashlights in several areas in the house. Check the batteries often, especially if you have children in your home. (They love to play with flashlights!)

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A family dog can be a deterrent to criminals. But remember, even the best watch-dog can be controlled by food or poison. Do not install separate "doggy doors" or entrances. They also can admit small intruders.

· Choose a location that offers the most security. The less remote, the safer your home will be, particularly in a neighborhood close to police and fire protection.

· Know your neighbors. Develop a rapport with them and offer to keep an eye on each other's homes, especially during trips.

· If you observe any unusual activity, report it immediately (family, neighbors, police).

· Establish safe family living patterns. If you understand the importance of your contribution to the family's overall security, the entire household will be safer.

· While at home, you and your family should rehearse safety drills and be aware of procedures to escape danger and get help.

· Educate family members and domestic help in the proper way to answer the telephone at home.

· Vary daily routines; avoid predictable patterns.

· Know where all family members are at all times.

· Use these same guidelines while on [vacation].

Here are some more personal safety tips from a personal security and identity theft expert, www.RobertSiciliano.com:

Fundamentals: Body language is 55 percent of communications. That’s your walk, posture, facial expressions and eye contact. Awareness is being alert to your surroundings at all times. Intuition is when the hair on the back of your neck stands on end. Voice tone and pitch equal 35 percent of communications. The way a person communicates physically and verbally can determine whether or not a predator deems them a good target.
Prevent Abductions: When returning to a parked car, scan the area around your car and be alert to suspicious activity. Be aware of vans. Abductors and rapist open up the side doors and pull in their victims.
Never Use Your Keys As A Weapon: Contrary to popular belief, your keys are not a good weapon. Using your keys as a weapon can injure your hand, the keys can break, you lose your “key to safety” and you lose access to your car and home, which are safe havens. Unless it’s a LARGE key. Then it’s a good weapon.
Prevent Home Invasions: You tell your children not to talk to strangers, so why do you open the door to a total stranger? Home-invaders pose as delivery people, public workers, or people in distress. Install peepholes, talk through the door. Under no circumstances do you open the door unless you get phone numbers to call their superiors. If someone is in distress tell him or her you will call the police for them.
Safety On The Street: One dollar bills and change in an easily accessible pocket. Then if someone tries to rob you, you can throw the “chump change” several feet away. The robber will draw his attention to it, giving you time to escape. Do not fight over material items.
What To Do If Attacked By A Date Rapist: If he won’t let you go, gouge his eyes out! Fight as hard and as determinedly as you would if he was a stranger. By assaulting you, he has crossed the line, and now he is a stranger. Remember: you are worth fighting for! If all else fails, you can always let him kiss you, then bite down on his lip till your teeth meet.
Safety In Your Car: In the event of a minor accident, stop only in a well-lit area. Carjackers often provoke such “accidents” just to get a victim to stop. Do NOT stop on a deserted, dark street. Drive to a police station or a gas station. Use a cell phone and call 911.
Home Safe Home: Consider a second line or a cell phone in your bedroom. That’s because burglars often remove a telephone from the receiver when they enter a home. Of course, an alarm system activated while you are sleeping will prevent a burglar from getting this far. Newer alarms have cellular options, a safeguard even if the phone lines are cut.
Vacation/Business Traveler Safety: Be suspicious of a call from the hotel desk just after checking in requesting verification of your credit card number “because the imprint was unreadable.” A thief may have watched you enter the hotel room and called from the guest phone in the lobby. Never open your hotel room to anyone.
Social Media Security: What you say and post could lead an attacker right to you or a family member. Just because other people post information about themselves and whereabouts, doesn't mean you should. Plus, you should never post travel plans online telling a burglar you aren't home.

Most of the above tips could easily be applied to your workplace. And although so many of these seem to be common sense, the more you review this list, especially with younger family members that may not fully appreciate the concepts, the more second nature your actions become under high pressure situations. The reason athletes, first responders, and others practice the same drills over and over again, even long after they are quite skilled, is so they don’t have to think about the skills in the heat of the moment.

And finally, cyber tips are everywhere, especially (oddly enough) online. My friends at www.WorkingtheWebtoWin.blogspot.com have several blog posts that can help, and I found a very detailed Cyber Security Planning Guide at https://transition.fcc.gov/cyber/cyberplanner.pdf, and a “top ten” list of safe computing tips at https://ist.mit.edu/security/tips. The lists of tips are too plentiful to detail here, but please take a few moments to check these out. These cyber tips are not common sense to most of us, which is all the more reason to try to become familiar with safe computing practices.

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.