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s of all kinds in many states around the country, and I have managed or overseen the handling of hundreds of thousands of claims by others. I have stood with people whose homes or businesses were ruined, and those who suffered no damage at all, but just wanted to be sure. I have spoken to many, many others by phone. I’ve heard their stories of loss, and of the trials of the claim process, as well as the repair and recovery processes. And I have witnessed both the despair when claims go poorly, and the joyous relief when claims go well. It is safe to say I’ve seen and heard just about everything when it comes to claims.
But it’s different when the claim is MINE, right? Well, yes
and no. You see, my own home was damaged recently when on Friday, October 7,
2016, Hurricane Matthew skirted the eastern seaboard of the United States. It
was not an extreme amount of damage, but more than enough to file a claim. My
roof was badly damaged, as was my fence, and a few other smaller items. No big
deal, I thought, at least the roof wasn’t leaking, and no large trees had fallen on
the house. So, as far as storm damage, we were luckier than many. But just to be sure, I followed the
advice I have given to others – I got out a pad of paper, noting all of the damages,
and began logging all claim related activities. I also took photos and videos
of the damages. Then on Monday morning, I called my claim in, once I was certain my
covered damages would exceed my hurricane deductible.
After that, we waited to hear something from our insurance
company. About a week later, my agent called, and said he was just checking to
see how the claim was going. I’m not sure, I replied, because aside from his
call, we had not heard anything from the insurance company at all.
Not a big deal, I told him, there are plenty of people with much more severe
damage, I’m sure they’ll get to me soon enough. A week later, my in-laws’ claim
for similar damage was being finalized by the very same insurance company,
even though we had submitted their claim for them several days after calling in
our own claim. I was beginning to think this insurance company was giving me
extra slow treatment, but the next day an adjuster called my wife to schedule
his inspection of our damages.
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In the meantime, we began gathering estimates from different
contractors just as anyone would, while waiting for the adjuster to get back to
us with his estimate of the damages. When the estimate came back about a week
later, I guess I should not have been too surprised that it came without a
check, because I’m accustomed to this particular insurance company depreciating
heavily, and making small up-front payments until the work is done, and then
the recoverable depreciation is claimed and paid.
Still, I couldn’t help but
compare my estimate (with no payment) to that of my in-laws. My estimate was
nearly twice that of my in-laws, yet they received an up-front payment (albeit
a small one), and I received no up-front payment at all. Again, same insurance
company, same geographic area. It just seemed there was some disparity in our
treatment. Could it be because my father-in-law retired from that insurance
company after decades of service, whereas I resigned from that insurance
company to represent policyholders with claims against that insurance company?
Or was it all just coincidental? Either way, I was starting to feel slighted. I talked to an
attorney – not because of what I perceived as delays in handling my claim, or
even the disparity in the handling of my claim versus the claim of my in-laws,
but because I was anticipating what might come next, and I wanted to be ready.
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So when we were done collecting estimates from the various
contractors, I starting looking for a Proof of Loss form in order to submit the
estimates. Because I am an adjuster, and because I used to work for this
particular insurance company, I knew the policy contained a “Condition” which
required I submit a Proof of Loss (POL) within 60 days of the date of loss. I
was surprised when I could not find this form online. Then I checked the
insurance company website. Not there. Then I remembered this insurance company
allows clients to create an online profile and track claim progress online. I
did this, and I must say, it was pretty slick. I could check the status, upload
documents, correspond with the claims department and my agent, even look at all
my policies. Cool!
But, no POL, not even in the sections marked “Resources” or
“Documents”.
So I called the claim representative designated right there
on my claim status page. She answered the very first time I called. Sweet. I
gave her my information, and she asked how she could help me. Not needing to
discuss the claim, I simply asked for a Proof of Loss form. She said she did
not complete one. I told her I know that, but I needed to complete one now that
I have all my estimates together.
She said no, I didn’t need to complete one, I
could just send in the estimates. When I said I would
rather submit the POL as
required by the policy, she proceeded to argue with me about whether or not the
policy in fact required me to send a POL, unless she requested one from me.
Even when we both pulled up the policy on our respective computers, she
continued to argue the policy language, because she was reading from a section
above the section in question. Even after pointing this out to her, she would
not agree. Finally, I simply insisted she send me the form, even if she didn’t
think I needed it. She said she would, and we hung up. Hours later she called
me back and left a message saying she would NOT send me the form, stating, “That
is not something we routinely send out to customers.” Again, having worked
there for 17 years, I know that form is sent to customers on a very regular
basis.
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So, was I being intentionally lied to? If so, why? Or, was
this adjuster so poorly trained that in addition to being unable to read and
interpret the policy, she did not
understand what this form was, or that is was required as a condition of
payment? Either way, now it became personal for me. I promptly filed off
complaints with the company, my agent, and the Department of Insurance in my
State. All I wanted was a form – one that was required by my policy, and the
company not only made it impossible for me to find this form online, but was
actively refusing to provide it to me upon request. I couldn’t help but think,
how many millions of people are they doing this to every year? And how often do
they deny claims for failing to submit a form they don’t tell people about,
don’t provide access to, and even tell people it is not required?
I may never know the answers to those questions, but just
today I received a call from some supervisor in Atlanta. They received my
complaint. He apologized, agreed the policy says exactly what I already know it
to say, and he said they would send me a blank form. We’ll see. It just goes to show, no matter how experienced you are,
things are different when they happen to you. Luckily, as upset as I may be that
it happened to me, I am much more upset that this (and worse) is currently happening
to untold numbers of other people far less equipped than myself at dealing with
insurance company bureaucracy. Good luck to us all!
Mark Goldwich is president of Gold Star Adjusters, a group of public insurance adjusters dedicated to helping citizens get the maximum settlement for any insurance claim.