Hurricane Warning

By Mark Goldwich

From his vantage point high above the earth in the International Space Station, Astronaut Ed Lu captured this broad view of Hurricane Isabel. The image, ISS007-E-14750, was taken with a 50 mm lens on a digital camera. (Photo credit: Wikipedia)

Since we are about two-thirds of the way through Hurricane Season, and it has been very quiet, I thought this might be a good time to remind people we are not out of the woods yet. When it comes to hurricanes, there is so much to know and so much to prepare, so I am going to try to consolidate things the best I can. While there are plenty of blogs that will show you how to prepare you and your family for a hurricane, what is harder to find is advice on what to do once the storm has passed.Many insurance adjustment errors, especially on catastrophe claims (like hurricanes), stem from the adjuster overlooking or misquoting damages. Usually, this happens for one of three reasons: adjusters don’t spend enough time to identify all the damages; they are unfamiliar with the damaged item; or their estimating software incorporates a bad price.

Other mistakes happen when adjusters either misinterpret the policy or misinterpret the facts on the ground. Either circumstance can result in the denial of a claim that should actually be covered -- or in a payment that is lower than it should be. As to whether the “misinterpretations” are accidental or intentional is for another day.

If you do decide to handle a claim yourself, or reopen one that you think deserves a second look, please consider yourself bound by the following ten “commandments” -- all of which a qualified public adjuster should certainly observe.

Commandment #1: Do not try to pull one over on your insurance company!

Be thorough, but be honest. Few things turn insurance adjusters on like the prospect of catching policyholders who are engaged in fraud. Most companies have entire departments devoted to rooting out fraud, and you can be sure that the insurance company’s fraud representatives will be among the best-trained people in the company. (Too bad the adjuster who comes out to inspect your home probably isn’t trained this well.). The fraud representatives have seen and heard it all, and they eat would-be cheats alive. Remember that insurance fraud is a crime. Don't even try it. And don’t ask me to try it for you, because I won’t!

English: Buras, LA, February 4, 2006 - Spray painted communications on the side of damaged homes identify insurance companies, the address of the home and items that are outside buy not considered debris. The writing provides color in a mostly monochromatic landscape. Robert Kaufmann/FEMA (Photo credit: Wikipedia)

And now: A side note. It seems a little unfair, doesn’t it? The insurance company can make one “mistake” after another that costs you money, and you can be subjected to any number of mysterious coincidences that fall to the insurance company’s benefit – coincidences that, taken together, can result in your claim being underpaid by thousands, tens of thousands, or even hundreds of thousands of dollars. And nothing bad ever seems to happen to the insurance companies (outside of record profits, I mean). But if an unscrupulous policyholder can be shown to be bumping his claim up by a few hundred bucks, that’s not a coincidence. In that situation, you may rest assured that the insurance company will seek criminal charges if at all possible, even for what might seem by comparison to be fairly trivial amounts of money. What’s more, it is very likely that the company will secure a conviction -- through the state, of course. A cynical person might wonder how even the playing field really is. I’ll only point out that the insurance companies have the lobbyists, who, in turn, have the ear of lawmakers and other powerful folks.

Commandment #2: Take notes.

Buy a notebook. Buy a pen. Put them to use. Take your time and go around the property, noting everything you see to be damaged. Everything. Besides the obvious stuff like missing roofs and two-foot flood lines, you are looking for scratches, scuffs, scrapes, cracks, bangs, dents, tears, stains, discolorations, swelling, unevenness – I mean everything. Look high and low, inside and out. Write it all down.

You should also keep a detailed log of all conversations that take place with your insurance company, adjusters, contractors, and other players in this drama. Keep track of everything: Your own time cleaning up, time you spend making emergency and temporary repairs, and every penny you spend that has anything at all to do with the claim. I can’t stress enough the importance of being thorough and detailed.

Commandment #3: Get pictures.

Photograph it all. Video it all. When I say “all,” I mean everything. You may need these images somewhere down the line. Warning: Your adjuster may want a copy of these records. Be sure to keep copies for yourself in case the adjuster happens to lose the images you provide.

Commandment #4: Show the adjuster all the damage.

New Orleans after Hurricane Katrina: Flood damaged West End neighborhood: On Bellaire Drive near 17th Street Canal breech, a 1966 Chevrolet Chevelle is marked not to be towed away. Note: Thousands of flood damaged autos, declared total losses by insurance companies, are being hauled away as trash. Presumably the owner of this one optimistcally intends to fix up the old car, which was completely submerged in dirty water for weeks. Photo by Infrogmation. (Photo credit: Wikipedia)

This sounds easy enough, but in order to do it, you must know exactly what to show them. Again, you’re better off working with a professional who has done this a couple of hundred times. If you choose not to do that … well, be sure to give the adjuster a copy of your own exhaustive list of damage to the property, and keep a copy for yourself. Lead the adjuster around the property and be sure he or she notes each and every item on your list.  If that means the visit takes two hours -- or ten hours -- so be it. Be more thorough than the insurance company’s adjuster wants to be. I tend to find that if an adjuster is inspecting a property for 30 minutes, I will probably be there for two hours. If the adjuster is there for two hours, I will probably be there for four to six hours. Am I just slow? I like to think not. I am thorough, though, and I am careful. I don’t want to miss any damage. The carrier adjuster just wants to move on to the next claim. I want to make sure you get everything you’re entitled to. Two different agendas!

Ask directly about the adjuster’s experience level. You wouldn’t want to be operated on by someone with little experience, and the same goes for the insurance adjustment of your largest financial asset, your home or business. Note that an ethical, experienced adjuster making any kind of effort should be able to point out a thing or two to you that wasn’t on your list.

Commandment #5: Remind the adjuster that not all homes are built with the same materials.

Insurance adjusters use computerized estimating programs that are designed to generate rough estimates (educated “guesses”) about the average amounts of damage in average homes. These software programs tend to be fairly accurate in evaluating average homes and average losses – and tend to be less accurate on very small losses, very large losses, very low quality homes, or very high quality homes. The more familiar you are with your home and the quality of its construction, the better off you will be.

Commandment #6: Review the adjuster’s completed estimate in detail, until you understand each and every line.

This is where you will find mistakes – unfortunately, though, these documents can be extremely tough to read. Room sizes may be off, damages you pointed out may have been omitted, or prices cited may be too low, either because the quality of the item being replaced is not correct, or because the prices being charged are higher than they were when the software for the estimating program was written. (This is a very common problem after a catastrophe).

Commandment #7: Have a licensed general contractor review the insurance company estimate and provide an independent estimate.

Formerly flooded residential neighborhood of St. Bernard: Auto has inscription asking where insurance company is. (Photo credit: Wikipedia)

If this is impossible, at least see if they will indicate specific concerns they may have about the ins urance estimate. This can be tough to do after a catastrophe, as contractors can be hard to come by. You may choose to get individual estimates from the roofer, carpenter, electrician, plumber, painter, A/C man, flooring specialist, or other professional. I would not suggest that you get estimates from the “cheapest guys in town.” If you get more than one estimate for a particular repair, count on the insurance company paying on the lowest figure associated with whatever you provide them.

Commandment #8: If the insurance company refuses to pay for an item, demand that they explain (in writing) why.

The company should not only do this, but also show you exactly where in the policy it says that what you are claiming damages for is not covered. This point is very important. Never simply accept that something is not covered because the insurance company says it’s not covered. The company has an obligation to make you understand why it is not covered. It is the company’s job to prove to you that something is not covered.

Commandment #9: Be persistent. Don't give up.

This may be the most difficult commandment of all for you to follow, but it is absolutely essential. I am convinced that, as a group, U.S. policyholders walk away from millions of dollars in valid claims each year simply because they are sick and tired of dealing with the claims process. Hang in there. If it is appropriate to do so, write complaint letters to the company (making sure to cover the local, regional, and home office levels), as well as your state’s regulatory agency, Attorney General, or Governor; your municipality’s Mayor, Councilman, or Selectman; or anyone else in authority who may listen. Take advantage of any measures your policy or State has for reconciling these matters. (These are sometimes called Alternative Dispute Resolution methods.) When writing, be brief and to the point (I’ve seen people scribble page after page of ramblings that are impossible to make sense of. Even if they are right, these letters will never be taken seriously.) Keep after them. Be relentless. Try to stay calm.

Commandment #10: Seek professional assistance when needed. 

English: BOWN BROOK, NJ, 9/18/99 -- Darrell Potter Jr. returns home following the flooding in Bown Brook, NJ. Mr.Potter has flood insurance, home contents insurance and vehicle insurance. Photo by Andrea Booher/FEMA News Photo (Photo credit: Wikipedia)

Depending on the loss, this could mean a contractor, an engineer, a mold specialist, an accountant, an attorney – or, of course, you might decide that you need a good public adjuster after all (one who will not charge you anything up front, but will, instead, charge a commission on what they are able to collect for you above and beyond what the insurance company is offering. It may feel strange, having to consult with someone to make sure that your insurance company pays you what you’re actually owed. But if they did what they were supposed to, public adjusters like me would be out of work.

Think of us as your insurance against problems with the insurance company.  No, it’s not “right” that you should need insurance like that, because you have probably been paying a large amount of money to the insurance company every year, and you’ve probably been doing that for many years. But this is the way it is. At least now you know about it, and you also know what you can do about it.

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.

Deflectors to Maximum

By Mark Goldwich

Rules of Engagement (Star Trek novel) (Photo credit: Wikipedia)

If you are a Star Trek fan then you will remember that any time the Starship Enterprise was being menaced by hostile aliens Captain Kirk would always tell Scotty to set “Deflectors to maximum.”  The ship’s deflectors would then be activated in order to give the Enterprise a way to defend itself against attack.  While both the ship and crew portrayed in the sci-fi series are works of fiction, believe it or not, there is at least one industry that has learned to use deflection as a means of avoiding payment to its customers.

In my book, UNCOVERED, I list three strategies that insurance companies routinely use to reduce or avoid claim payments. The three “Ds” as I call them are Delay, Deny, and Deflect. Deflection is what happens when the insurance company finds reasons to avoid paying money that you actually have coming to you on your claim. Although deflection is listed last on my list of three “Ds”, it can be encountered at any time during the claim.

What, exactly, does the “deflection game” involve? It involves the insurance company finding ways to avoid giving a direct, truthful answer to what would seem to be a fairly basic question: “Who has the moral and legal responsibility to make sure that my legitimate claim is paid in full, promptly and to my complete satisfaction?”

Isn’t that obvious? Doesn’t the insurance company itself have the obligation to pay the claim? The answer that seems obvious to the policyholder, sometimes becomes not all that obvious to an insurance company.  Especially once they involve a multitude of adjusters, engineers, restoration companies, attorneys, insurers, re-insurers, and third-party administrators that are all paid to do their bidding. There are so many cases of insurance companies dodging this issue that I can’t really do justice to the topic in a blog of this size. I can say, though, that it seems the legal system has finally begun to catch up with a few of the worst offenders.

Case in point: In Ohio, a jury held that a life insurance and disability management services company was guilty of breach of insurance contract; the jury awarded the plaintiffs $429,400 in compensatory damages for nonpayment of claims. But that wasn’t all. The jury also found the insurance company guilty of bad faith insurance practices, and mandated an award of $1,130,000 to the plaintiffs. They coupled this with a whopping punitive damages award of $3 million.

Documents from the case give some sense of the elaborate lengths to which some companies will go to avoid paying people the money they are owed. This particular insurance company used a third party administrator, and an affiliate re-insurer (which was also a 40% owner of the third party administrator) to combine their efforts in an illegal scheme to avoid paying completely legitimate claims.

The scheme involved a whole host of complex accounting maneuvers, as well as false information that was submitted to an insurance commission. Now, I realize that, at this point, you may be having some difficulty getting your head around all this. That’s because a) such cases are pretty complicated and b) you’re probably still thinking of insurance companies as responsible businesses with an obligation to take care of their customers. All too often, it seems they’re simply not very responsible and are not thinking about the interests of their customers. 

What in the World?

There are other cases like the Ohio case.  Many have a disturbing, and all-too-common, theme – the insurance company says that paying is actually someone else’s responsibility. But the “someone else” either never follows through or only partially follows through on its obligation to pay. Or they say that the other party’s report or advice “prevents” them from paying you (as if they can’t override the opinion of an outside party). I’ve personally seen this happen many, many times. 

In general, the usual deflection is as follows. After a supposedly licensed and professional insurance company adjuster inspects the property, he or she just can’t seem to figure out whether or not to pay the claim. So, they hire an engineer to help determine what the “cause of loss” was, in order to determine whether or not it is covered. Sounds reasonable, right? Keep in mind, we have done hundreds of these where the cause of loss was as simple as “wind” or “hail”. And the real kicker is, the engineer always tends to be the same one the insurance company uses over and over and over again.  Surprised?  Well you shouldn’t be, since this individual’s very livelihood may depend on maintaining a good relationship with the insurance company. You can probably see why we are not surprised when again and again, the engineer’s report suggests that it was not really wind that caused the shingles to fly off the roof or get beat up during a storm, but that it was just an “old roof” that was “improperly installed”, and had “manufacturing defects”. The adjuster might then say something like, “I’m sorry, but the engineer says it’s not covered, so there’s nothing I can do about it.” THAT’S deflection, and fortunately for our clients, there IS something that can be done about it!

Do all of these cases wind up in court? No. In my opinion, very few of the cases that could go to court ever get there and most policyholders in these situations do not get the impartial hearing they deserve.

Why not? Because many policyholders simply don’t have the time or perseverance to wander through a bureaucratic maze that has no clear resolution. (As we all know, going to court can be a long, expensive process.) After all the delays and denials, many people are simply sick of the process of trying to get the insurance company to pay up. They either take whatever crumbs they’ve already been tossed, settle prior to trial, or give up altogether.

It’s not really that surprising that most of these situations don’t land in a courtroom. By the time most people start thinking about lawsuits, they’ve already been battling the insurance company for a year or more. Then they are told the lawsuit will probably take another two to three years! Be honest. What would you do? Sometimes, when people find themselves caught in the “deflection game,” they’ll give just about anything to be done with the process.

Isn’t the legal system supposed to correct problems like this? In theory, yes. And there are some encouraging signs. A 2007 DecisionQuest poll of practicing attorneys found 75% of respondents would now expect jurors to agree with the sentiment that insurance companies “would do anything to avoid paying even legitimate claims.” That’s refreshing evidence of reality-based thinking within the halls of justice. But most of these cases, as we have seen, never reach a jury. For your own protection and economic well-being, it may be wisest to stop thinking of insurance companies in terms of your friendly neighborhood insurance agent, and start thinking of insurance companies as resembling the people who ran their firms into the ground by setting up a nearly-incomprehensible maze of wholly-owned, partially-owned, and “affiliated” companies … companies whose relationship with one another seems to require an advanced degree.

I realize that sounds like a harsh assessment. But the irresponsible use of deflection warrants it, in my view. Let me give you a brief example that may help you understand why I feel as I do about this.

Think of a big insurance company. Let’s call it Baseball, Mom, and Apple Pie Insurance – BMAPI for short. BMAPI’s motto is, “Faithful and friendly, during good times and bad.” It has an expensive ad campaign that features gorgeous sunsets, adorable puppy dogs, and happy policyholders who dearly love and respect their local BMAPI agent.

Now, if BMAPI handles, say, 1.5 million claims in a year, and then deflects an average of just $300 on each claim, that adds up to nearly five hundred million dollars more for BMAPI to keep for itself and invest as it sees fit.

Yes. Nearly half a billion dollars.

Follow me on this next part, because it’s extremely important.

The number I just used to get to roughly half a billion dollars of extra income for BMAPI was, you will recall, three hundred dollars of, shall we say, “savings.” Now, you might well ask: How realistic is that figure I just used? Is three hundred dollars a valid number - or a dubious number? Hear me, please, when I tell you that my typical additional recoveries – that is, the money I get the insurance company to agree to pay in valid claims over and above what it had already agreed to pay out – is NOT in the hundreds of dollars.

It’s in the THOUSANDS of dollars. That’s an average case.

star trek phaser model (Photo credit: Wikipedia)

Realizing that hundreds if not thousands of dollars are being withheld by the routine use of insurance company deflectors are not science fiction.  They are all too real.  Now if I could only find my phaser.

For more information on bad faith insurance issues, visit: www.badfaithinsurance.org.

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

The Denial Zone

By Mark Goldwich

When you experience a fire, flood or storm, you'll find yourself traveling through another dimension -- a dimension not only of sight and sound but of insurance claims adjusters. As you try to get your insurance company to cover your damages you’ll find yourself moving into a land of both shadow and substance, full of legalese and excuses. You've just crossed into... the Denial Zone.

1959 Series Logo (Photo credit: Wikipedia)

We’ve all watched an episode of the classic Rod Serling series, The Twilight Zone where an unfortunate man or woman find themselves in a land where everything seems to have been turned on its head, where illogic rules and the world with which the main character was familiar has suddenly become a terrifying place.  Well, any of you who have ever filed a property damage claim with an insurance company can commiserate with such a plot line.  Frequently, the insurance company’s own adjusters will deny a claim for some arcane reason, or often no reason at all.  What you have long thought of (and paid for) as a lifeline in time of need suddenly turned into a terrifying world where what you thought of as black and white is now suddenly a million shades of gray. 

In order to keep you from being sucked into the Denial Zone, I have created a series of questions and answers to try to help you make sense of the infuriatingly obtuse world of insurance claims.

Q: I've always heard about insurance companies denying claims, but why should I be

so concerned about  this “denial” business? My agent said I had an “all-risk” policy.

A: Buying such a policy does not, in the real world, protect you from having some or all of your claim denied.

Q: Realistically, what are the odds that the insurance company will deny some or all of my claim?

A: Depending on the type of loss, the odds could be very strong. They are certainly higher than most policyholders imagine when they buy a policy (especially an “all-risk” policy) or file a claim after a fire, flood, or other disaster.

Q: Why is there such a strong chance of having my claim denied if I have an “all risk” policy?

A: This is a huge question, one that’s very similar to the questions frustrated policyholders ask me when they get bad news from the insurance adjuster. Most policyholders are extremely surprised when they get word that all or part of a claim has been denied. I can tell you that they, too, want to know “why” such an outcome is possible. The short answer is that the insurance company probably didn’t broadcast what the policy didn’t cover when you bought it. The longer answer has to do with what they really meant when they sold you that so-called “all-risk” policy. Let’s delve into that longer answer now through more Q&As.

Q: Isn’t an “all-risk” policy meant to protect me against all risks?

A: Alas, no. In most cases, it’s actually structured to exclude certain risks, despite its name. Back when you bought your policy, the insurance agent was trying to sell you on a certain policy. Remember that?

Well, it’s tough to sell a policyby  broadcasting to the prospective buyer that Situation A is not covered, and Situation B is only covered in a certain very narrow way, and Situation C is covered only if Situation D is not in play. So the agent will generally say something like, “This is an all-risk policy that generally covers you for all risks, subject to certain limitations and exclusions.”

Q: Did you notice what just happened?

A: The most important information sped by you. It hurtled past in that innocent-sounding word “generally,” and then it sped by again in the little addition at the end of the sentence: “limitations and exclusions.” (Or whatever similar language the insurance agent might decide to use; there are a lot of ways of sidestepping the question of what “all-risk” actually means.)

However agents decide to phrase this part about the exclusions during their discussions with you, they usually do not go into too much detail about what the exclusions are. In fact, in the average policy, there are pages and pages of exclusions and limitations. (A

recent trend in hurricane policies is particularly troubling: the items that are usually damaged first and most are, in many cases, not covered at all!)

As the insurance industry is no doubt aware, members of the general public simply do not understand what’s in all those dense pages of type. In fact, most people do not even attempt to read the policies in the first place. It’s hard to avoid the conclusion that the

industry counts on consumer ignorance about the policies they’re buying.

Q: How is that different from lying to me about what the policy actually covers?

A: I’m not an attorney, so I can’t answer that, but I can tell you that the agent and the insurance company would, if you accused them of lying, probably point to the fact that you failed to read or understand the vast oceans of complex text that outlined all the

exclusions in your policy. So to the industry (and, as a general rule, to a court of law) it’s not lying, because they gave you the fine print. You simply didn’t take the time to read or understand it. Good thing, too, because according to people who know much more about the law than I do, lying to you about what the policy actually covered would be fraud, which is a very serious matter.

Q: What kind of things am I, the policyholder, likely to think are covered … that actually aren’t?

A: The answer could fill another book this size. Just as a preliminary summary, though … and to help you get your head around the magnitude of the gap that usually exists

between what people assume is covered and what is in fact covered … here’s a thumbnail sketch of some of the “surprises” waiting for property owners after a disaster.

Assume there has been a hurricane in a given area. I can tell you with certainty that, at some point, there are going to be property owners who say … “I thought my policy covered things like trees and lawns for hurricanes.” Almost never, even though these are typically among the first things that are badly damaged in a windstorm. Result: Denial!

“I thought my policy covered fences damaged during a hurricane.” Ditto. More and more, fences are not covered in the event of damage by a hurricane. Note: restoring fencing to a property is usually extremely expensive. Result: Denial!

“I thought my policy covered exterior paint.” Normally, yes, but many companies no longer cover this for hurricanes, even though exterior paint is very vulnerable in windstorms.

“I thought my policy covered swimming pools and out buildings.” Again, it usually does, but it may not for a hurricane. Result: Ridiculously expensive denial!

And here’s the big one: “I thought I didn’t need flood insurance!” Sometimes people are told this by an insurance company. Sometimes they’re told this by a mortgage company. However it happens; if homeowners believe it, the result can be an extremely unpleasant and costly surprise: Denial!

Even if you endure all the delays, and even if you somehow work your way through the labyrinth of denials, the insurance industry may well have one more coincidence up its sleeve. This coincidence catches a lot of insurance consumers by surprise. It often

contributes to the exasperated, exhausted homeowner’s conclusion that it’s better to give up, settle for what they can get, and perhaps accept dimes, nickels, or even pennies on the dollars they are actually owed. This coincidence is known as deflection, and we'll talk about that in a future blog.

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.

Fires & Rainstorms & Floods, Oh My!

by Mark Goldwich

The fire, flood, hurricane or tornado that descends on a community is one kind of disaster that’s easy for the victim to recognize as such. Even an isolated event, like a pipe leak or a theft can be disastrous to a business or homeowner. The difference is those kinds of disasters are easy to recognize as such and most people realize that they must be prepared for them.

What happens to the people who then try to secure the insurance compensation they’re entitled to is, all too often, another kind of disaster. And it’s that second disaster that nobody is expecting. Literally millions of people have been victimized by the second kind of disaster after having endured the first kind. The saddest thing about it is this: most victims of the second type of disaster do not even realize that this disaster has taken place.

Think about it. If you don’t know what is covered and why it’s covered ... or how to identify and estimate all the damages you’ve sustained … or how to determine what you should actually get paid … how would you know whether the insurance company was holding back when it came to compensating you fully for valid claims?

Even if you were to figure out the insurance company was, through error, oversight, or any other reason, not paying you all it should … you would still have to convince the insurance company that you were right and they were wrong. That is not something they are particularly fond of admitting.

If you believe, as I do, that one disaster at a time is quite enough, you’ll want to consider the following words very carefully indeed: There are three things insurance companies would rather you didn’t know that are very likely to happen after the disaster.

The first thing insurance companies don’t want you to know is that no matter how well you hold up your end of the bargain, there may be extensive delays throughout the entire claim process. You will find that your calls don't go through, or you will leave a message (either via voicemail or through a message service), that never seems to get returned.

This can go on for weeks or months.

Eventually, you may be informed that some other company is “handling” the job of sending an adjuster out to look at your loss ... and you may figure out that this company, in turn, has passed the job on to yet another company. This “hand-off” phase may continue until two, three or four layers of bureaucracy are built up. Then you will learn that an appointment has to be made, an estimate has to be written, a payment has to be approved – and you will see that each step brings additional, unexpected, and incomprehensible delays.

All the while, everybody you talk to will assure you that the delay and unresponsiveness is somebody else’s fault. But no one will take action to speed up the process. Time is on the side of the insurance companies, and they know it. The idea seems to be that if they can put you off long enough, you will quit, forget about the whole business, accept whatever they offer, or (quite literally) die before they have to pay up.

The second thing insurance companies don’t want you to know is they will often deny coverage for all or part of the loss. Either intentionally or unintentionally, the insurance company will report – often wrongly – that your loss is not covered. If you’re covered for

wind damage, they may say the damage was caused by water. If you’re covered for water damage, they may say it was caused by wind.

If you’re covered for both, they may say it was caused by a combination that they can’t cover, or they may say the damage was actually caused by something else. In my experience, the rule is a reliable one. Inevitably you will be told by someone, at some point in time that your policy covers less than you thought it did.

The third thing insurance companies don’t want you to know is that they can deflect responsibility for actually paying you. Your loss may, in theory, be covered ... but you may learn (perhaps long after the fact) that you didn’t document the claim as precisely as was required, or that the adjuster was unable to tell exactly what caused the damage, or that some other problem held up processing. Typically, you may learn that someone who seems to be an employee of the insurance company actually represents an entirely different organization. When you try to figure out who’s actually responsible for delivering on obligations to you, you may not be able to track anyone down.

Again, time is on the side of the insurance company. For a shockingly large percentage of these situations, the deflection of responsibility results in people with valid claims simply walking away from the situation.

You may find out about these problems when it’s too late to do anything. You’ll listen helplessly as somebody from the insurance company explains how they wish they could pay you, but they can't because of the lapse in time (a window that nobody told you about), because of the company’s policy, because of some obscure regulation, because of a recalcitrant boss, or because of some equally creative explanation. It’s not their fault; they can’t do anything about it.

This is real. This is not something I’m making up. This changes peoples’ lives, and not for the better. It’s hard to express the level of frustration people feel when a claim is delayed, especially for such (seemingly) inexplicable lengths of time. People have other things going on in their lives. They often have medical problems. They could be moving. They have work issues. They may have family members who are in need of extra assistance. Whatever they’re facing, policyholders often reach a point where they just want to move on to the next chapter in their lives.

They get frustrated. They feel out of their element and overwhelmed by all the paperwork, all the questions, and all the details. They just do not want to deal with insurance companies anymore. They tell themselves that they really do not care how much they lose -- they just want to “wrap it all up.”

By an extraordinary coincidence, that mentality, and the delays that produce it, combines to keep the insurance companies from having to pay out a great deal of money.

People simply do not realize how much they are losing by voluntarily entering that “just wrap it up” phase of their insurance claim. All they know for certain is that they cannot stand the delay for another day. They want it over with. I can only suggest you hang in there and not give up. More importantly, the insurance companies don’t want you to know that it is your right to hire a public insurance claims adjuster that can fight for what is rightfully yours.  Last but not least, you need to know that when it comes to dealing with the aftermath of fires and rainstorms and floods, you’re not in Kansas anymore.

Mark Goldwich is president of Gold Star Adjusters, a firm that specializes in helping clients fight for what’s rightfully theirs.  For more information, go tohttp://insuranceclaimsadjuster.us/