Tale of the Tape

by Mark Goldwich

The phrase, “Tale of the Tape” is an old boxing saying, and refers to the physical characteristics of each fighter (age, height, weight, reach). The idea is, these numbers may predict which fighter has an advantage (assuming the numbers are not the same) over the other. This also assumes the person reading the tape measure is impartial.
Sometimes the tale you are being told depends on who is holding the tape measure. I was reminded of that this morning when a newly acquired professional acquaintance of mine said he recently went through an experience with his insurance company regarding his roof, and he was curious to hear what I thought about it.

He started, as many people in my hometown of Jacksonville, Florida do, by telling me
Image courtesy of commons.wikimedia.org
a ”roofing company” was canvassing his neighbor with fliers, doorhangers, mailings and door-to-door salesman. I asked if I could guess the name of the *”roofing company”, and out of the 50+ roofers in town, I named just two. Sure enough, it was one of those two I had just named without any additional information.

I say “roofing company” because, in my opinion, these are really more like roof marketing firms than roofing companies. They employ large sales forces, use high pressure tactics, focus on generating signed contracts to have the roof work done, and then subcontract out the vast majority (if not all of) the roof work to roofing crews who actually put on the roofs. Their main focus is to get the home’s owner to sign a contract to replace the roof, usually with the hope that their insurance company will pay for the replacement. Some even call themselves “insurance specialists”.

Oddly enough, though, some of these firms never even get on the roof to see if there is any damage an insurance company might pay for. And if they do get on the roof, they may still recommend submitting a claim to the insurance company, regardless of whether or not it is likely that the claim will be paid. Again, the focus seems to be on getting the deal signed, and a claim submitted. It’s as if they just hope the insurance company will pay the claim, and if they don’t, there’s always another neighbor whose insurance company might.

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In any event, for this new acquaintance of mine, the claim was submitted, and the insurance company denied the claim. “Wear and tear” he and I both said together, almost as if I already knew what the insurance company would say. “How did you know?” he asked. The answer is simple - that is the most common reason for a roof denial. That is the insurance company’s “Tale of the Tape.”

He then asked if the denial was appropriate. I explained that I did not know, but there was an easy way to find out. We would look at the roof, and give our own opinion as to how that claim should have been handled. In other words, we would give him our own “Tale of the Tape.” The insurance company was either right, or they were wrong, but the bottom line is, it should not be left up to the insurance company to decide, and I think you can guess why.

As I always do, I told him we wouldn’t charge him anything to inspect the property, nor would we charge to provide our opinion as to whether or not the claim should be paid as valid. If we did not think there was covered damage that should be paid for by insurance, we would tell him, because unlike the roof marketing firms, we don’t employ salesmen to throw lots of spaghetti at walls all over town just to see what sticks. We invest serious time into our efforts, and we can’t afford to waste that time (or risk our licenses) on claims that aren’t covered and won’t be paid. And unlike the insurance companies, our profits do not suffer when claims are paid – in fact, that’s how we earn our living.

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So I like to say we are squarely in between the roof marketing firms and the insurance companies. We may want the roof to be damaged by a covered event that leads to a claim payment, but there is a disincentive to us to pursue a claim that is without merit. In that sense, I believe the public adjuster’s tape is the most accurate of the three.
And as a case-in-point, I related to him a recent claim I handled for a neighbor of mine. One day I saw a roofing sign in their yard. The sign belonged to one of the two ”roofing companies” I mentioned earlier, so I asked the neighbor about it. They said the roof salesman convinced them to submit a claim, confident he could get the insurance company to pay for a new roof. After explaining why I thought it would have been better to call me first, I told them to keep me posted on the claim, and that if the roof is paid in full, they would not need to hire me.

Several weeks later I drove by and saw the roofing sign was no longer in the yard, but the roof had not been replaced either. I approached the neighbor again, who confirmed my suspicion that the insurance company refused to pay to replace the roof. “Wear and tear.” So the neighbor got me involved, and while the storm damage to the roof was relatively minor, there were factors which I felt obligated the insurance company to pay. And long story short, pay they did, to the tune of $13,000 – enough to replace the roof in its entirety.

There’s another saying that goes, “There’s two sides to every story.” I would argue that often in the case of insurance claims, there are usually at least three sides to every story, each telling their own “Tale of the Tape.” In this “tale” I showed how the public adjuster’s “tape” is more accurate because of the combination of incentives and disincentives at work in the insurance claim process.

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

Chipping Away

by Mark Goldwich

Recently I had the opportunity to help a contractor on a claim involving the contractor’s own home. I met this contractor just a year or two before, but he had never referred any of his customers to me. In one of my encounters with him, we were at a business coaching event, and I seized that opportunity to again explain what we do at Gold Star. I detailed how we might be able to help him and his customers, especially those with roofing issues, as both of our companies were heavily involved in this type of work.

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So not very long after that, the contractor called and asked me to come out and take a look at a roof. It was not a customer's roof, but the roof of his own home. He mentioned he had looked at it already, and while there was some damage, he wasn’t sure there was enough to warrant putting in an insurance claim. He also noted that a few roofers had been by (not knowing what business the contractor was in), and suggested he submit a claim for the roof, (This is a very common practice here – and probably everywhere – but one I definitely do not agree with, and I’ll explain why below).

He again asked how it would work with me coming to inspect his home, if there was a cost, and would he need to turn in an insurance claim first. I assured him there would be no cost for me to take a look at his roof (and his interior water leak from the roof as well) , nor to consult with him about his options regarding any potential insurance claim.  I also reiterated that, in fact, it was better that he did not yet turn in an insurance claim. The reason I believe it is better if a claim is not already submitted, is because it gives me the opportunity to determine whether or not a claim should be submitted.

If a claim is submitted for which there is no coverage, it could present a problem for the insured when the property is inspected. The company adjuster could note a breed of dog, preexisting damage, needed repairs, a trampoline, or other element that the insurance company might elect to non-renew coverage.

And even if the claim is covered, it may not be worth submitting a claim, as the damages may not exceed the policy’s deductible. It is simply my opinion that it is better to have an expert determine whether or not a claim should be submitted for a particular loss, especially when this consultation is done at no cost.

Image courtesy of commons.wikimedia.org
So back to the contractor’s potential claim…his roof had suffered some relatively minor damage, and there was a leak on the ceiling of his dining room, which was next to the foyer. The damage on the roof was not extensive, but there was damage on more than one side of the roof,  The shingles were about 15 years old, they were not very pliable, many could not be repaired without creating additional damage to other shingles that were not damaged to begin with, and even if they could, the repairs would be fairly unsightly. On the interior, the water leak created a stain only about 1 foot in diameter, but it was near a wall which would necessitate a drywall repair,  The wall would then need to be painted, and the ceiling texture would need to be replaced.

It was not a desired scenario because the amount of damage was relatively minor, but the expense to properly repair the roof and interior would be much more significant had just a few facts and home features been different. Typically, insurance companies and their adjusters tend to dwell on this disparity between the amount of actual damage, and the expense of proper repairs. When they see damages that would only total $500 if the circumstances were different (for example, a roof that could be repaired and a leak in the middle of a small room), but are now totaling over $20,000, many of them have a hard time agreeing that the valid claim is $20,000, and not $500. I discussed the pros and cons of this particular claim with the contractor, and let him know I would be willing to pursue the claim if he wanted to go that route. However, I also let him know I felt we could be in for a battle.

But when the company adjuster came out to meet me at the property, I did not assume an attack position, or come at him with guns blazing. Instead, I guided him through the facts, calmly explaining why I felt the entire roof would have to be replaced based on the conditions present.  I even acknowledged that the damage was relatively minor in relation to the amount of repairs I was proposing. I talked to him about things we had in common – places where we worked, and people we might both know. I talked to him as a co-worker would, bouncing ideas and suggestions off him, but always coming to the conclusion that ultimately, the entire roof would have to be replaced, the ceiling would have to be retextured, and the walls repainted. He did not dispute anything I was saying, but would not commit to it all either. In the end, he said, he needed to submit his findings to his supervisor, and they would make the final determination together.

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When I told the contractor how much my estimate was for, he seemed quite surprised, and said he would be happy if he could get half that much. I told him not to worry, and before long, the insurance company was offering less than what I proposed (naturally), but already much more than half of my estimate. We eventually agreed on a number that was below my initial figure, but not by much. Needless to say, the contractor was very happy with the result, and has since referred several customers to my company. Those claims have also gone well.

The moral of my story today is to keep chipping away. I chipped away at the contractor who was reluctant to refer my service to his customers, until such time as he was presented with an opportunity to try me out for himself. Once satisfied beyond his own expectations, he felt confident in referring my company to others. Similarly, I chipped away at the opposing adjuster, taking a friendly approach to what could have easily been an adversarial situation, finding common ground and using facts and reason to lead him to a conclusion he would likely not find plausible on his own. When chipping away, you can use a chisel, a sledgehammer, or dynamite (or all three). All may be effective. Different people use different methods to chip away, but I find the chisel works best with my personality. What works best for 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.   

Not Ready for Prime Time (viewer discretion advised)

by Marc Goldwich

I was reviewing the headlines this morning which were chock full of mayhem.  Everything from the aftermath of catastrophic flooding which resulted in numerous drowning deaths in the South Carolina, to more school shootings, along with a smattering of auto-related fatalities vied for my attention. This combined with Halloween being just around the corner was enough to cause my mind to entertain the dark side of life. So I began thinking about the job of cleaning up after a catastrophe.

Image from commons.wikimedia.org
In case you're not aware, there is an entire industry set up for handling these kinds of events. Typically called “Biohazard Clean-up” or “Crime Scene Clean-up”, these companies are e an offshoot of emergency restoration companies. Whether the hazard you need gone consists of  toxic waste, deadly mold, body fluids or most any other kind of nasty stuff that crop up after an emergency, there are trained professionals who are only too happy to roll up their sleeves and dive right in. 

The hit Discovery TV show “Dirty Jobs” is a favorite of mine, but I doubt you will ever see Mike Rowe tackling this type of job. While certainly “dirty” enough, my guess is it would simply be too disrespectful to find any humor in this line of work, and for his show, humor plays a major role.

There are other shows which depict and deal with death, usually CSI or homicide, but I have never seen one address the clean-up aspect that invariably needs to take place after the police finish their investigation. Since you can now watch shows on just about any occupation imaginable, I would not be surprised to find a show following biohazard clean-up teams around.

So what would that entail? First let’s think about the types of situations these companies and their crews might deal with. Things like:
-          Sewage backups
From commons.wikimedia.org
-          Crime scene residue
-          Suicide
-          Homicide cleanup
-          Blood cleanup
-          Accidental death cleanup
-          MRSA and H1N1 decontamination
-          Hoarding scenes
-          Animal waste/remains
-          Chemical spills
-          Tear gas cleanup
-          Meth lab cleanup
-       Radiological hazards
None of these events should be taken lightly, or undertaken by anyone except certified biohazard professionals. Not that most people would want to deal with any of these problems
These companies need to be well versed in applicable state and federal regulations, they need to be licensed and certified (where required), they need to use appropriate transportation and/or disposal protocols, and they may need to be registered with the states’ Department of Health. These companies can also expect to be regulated by governing and advisory bodies such as OSHA (Occupational Safety and Health Administration), NIOSH (National Institute for Occupational Safety and Health), DOT (Department of Transportation), and EPA (Environmental Protection Agency).

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The dirty work of these professionals usually begins when the coroner’s office, or other governmental entity officially releases the scene to the property owner or other responsible party. Depending on the type and severity of the “event”, the clean-up teams are required to wear protective clothing, may seal off rooms to prevent or minimize the spread of airborne or physical elements of the bio-hazard scene, and follow specified methods and practices to decontaminate such scenes.

The scenes must be meticulously cleaned of all harmful material, which typically includes the removal of any porous materials (whether personal belongings like clothing and sheets, or building materials such as carpeting, wood subfloor, or drywall) – which must all be properly disposed of, and then sanitized. You can only imagine the mess that will be left, even after the mess that was the biohazard is removed.

And many people are so distraught after dealing with such a loss, that they overlook the fact that insurance may cover the expense of the clean-up efforts. Just remember this rule of thumb, if property is damaged as a result, it is probably covered by insurance (either yours, or someone else’s).
ServPro.com provided the following bio-hazard and sewage emergency tips:

After any biohazard or sewage contamination in your home or business, your primary focus should be safety:

-          Is it safe to stay in the house?
-          Exposure to biological and chemical contaminants can pose serious health consequences.
-          Flood water can contain sewage, pesticides, and other contaminants.
-          Only do activities that are safe for you to perform.
Image courtesy of aftermath.com

What to Do After a Contamination
-          Stay out of affected areas.
-          Call emergency service personnel if the situation is life-threatening.
-          Treat all bodily fluids as if they are contaminated.
-          Turn off the HVAC system if there is sewage damage.

What Not to Do After a Contamination
-          Don’t leave wet fabrics in place. Hang furs and leather goods.
-          Don’t leave books, magazines, or other colored items on wet carpet or floors.
-          Don’t use your household vacuum to remove water.
-          Don’t use television or other household appliances.
-          Don’t turn on ceiling fixtures if ceiling is wet, and keep out of rooms where ceilings are sagging.

Let’s all hope we never need these tips, but as we can plainly see from watching the news, the fact is, biohazard clean-up is a grim reality for many families. As with anything else, the more you know in advance of an emergency, the better equipped you will be in handling that situation.

In this article I discussed the subject of biohazard clean-up, and the professionals that are trained to perform what just might be the dirtiest job of all. I mentioned some of the types of events this might involve, and included tips for dealing with such an event.

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.   

Who'll Stop the Rain?

by Mark Goldwich

Hurricane Joaquin image courtesy of Flickr.com
The latest news has the fairly sizable hurricane Joaquin threatening the East Coast of the United still recovering from 2012’s “Superstorm” Sandy. You may recall New Jersey experienced especially devastating flooding when Sandy drenched that region.
States, even though the most current predictions are it will never make U.S. landfall.  However, a storm as big as this doesn't have to hit to produce coastal flooding by the time Joaquin exits the area. In fact, the Carolinas are already experiencing flooding completely unrelated to this hurricane, so any additional rains as a result of Joaquin will make things dramatically worse. I also noted that emergency preparations are already underway in New Jersey, which is

I will first start with this – if you don’t already have flood insurance, you should seriously consider getting it as soon as possible. It may be too late for you to be covered in the event Hurricane Joaquin does strike, but there will always be another event that causes flooding, which very few of us are immune. I have been saying for years that “we are all in a flood zone, it just may not have happened yet.” Even if the place you live is not recognized as a flood zone by FEMA or a mortgage company that doesn't mean that flooding can't occur. If you are in a “low-risk” flood zone (as determined by FEMA), your mortgage company may not require you purchase flood insurance, yet your property may still be at risk. Countless people make that mistake each and every year, with dire financial consequences. And that may never change, at least not for everyone, but if you are reading this, I hope you will act now, and not become a statistic. Another of my flood-related sayings is, “if you place too much trust in FEMA flood maps today, you may be waiting in FEMA assistance lines tomorrow!”

Here are some interesting flood facts from www.FloodSmart.gov:
  • In the past 5 years, all 50 states have experienced floods or flash floods.
  • Homeowners' insurance does not cover flood damage.
  • Just a few inches of water from a flood can cause tens of thousands of dollars in damage.
  • A car can easily be carried away by just two feet of rushing water.
  • New land development can increase flood risk, especially if the construction changes natural runoff paths.
  • Federal disaster assistance is usually a loan that must be paid back with interest. For a $50,000 loan at 4% interest, your monthly payment would be around $240 a month ($2,880 a year) for 30 years. Compare that to a $100,000 flood insurance premium, which is about $400 a year ($33 a month).
  • A Preferred Risk Policy provides both building and contents coverage for properties in moderate- to low-risk areas for one low-price.
  • You are eligible to purchase flood insurance as long as your community participates in the National Flood Insurance Program. Check the Community Status Book to see if your community is already an NFIP partner.
  • In most cases, it takes 30 days after purchase for a policy to take effect, so it's important to buy insurance before the storm approaches and the floodwaters start to rise.
  • In a high-risk area, your home is more likely to be damaged by flood than by fire.
  • Even though flood insurance isn't federally required, anyone can be financially vulnerable to floods. In fact, people outside of mapped high-risk flood areas file over 20-percent of all National Flood Insurance Program flood insurance claims and receive one-third of Federal Disaster Assistance for flooding.
  • From 2005 to 2014, total flood insurance claims averaged more than $3.5 billion per year.
  • Since 1978, The NFIP has paid nearly $50 billion for flood insurance claims and related costs.
  • There are currently more than 5.3 million flood policies in force across more than 22,000 communities in the U.S.
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These are sobering statistics, which should make all non-insured homeowners pause to consider. It would be great if more people did know more about how flood insurance works, and who it can protect. Too many individuals and families are impacted each year simply because they got bad information about flood insurance, didn’t understand the information they were given, or didn’t have the resources to obtain the correct information. My goal would be to reach at least one person, and make a difference.

Along these lines, there was another section at FloodSmart which detailed common misconceptions about flood insurance. It was there I learned that floods are the #1 natural disaster in the country, and that many people (wrongfully) believe they are somehow not eligible for flood insurance, either because of where they live, or their mortgage status. I can’t tell you how many people have told me after the fact that they didn’t think they needed flood insurance because “the mortgage company said it wasn’t necessary.” The mortgage company probably said it wasn’t “required”, or maybe that is what they meant to say, but either way, the message was lost in translation.

The fact is, according to NFIP (National Flood Insurance Program):
  • You CAN get flood insurance nationwide.
  • You CAN get flood insurance if you live in a floodplain or high-flood-risk area.
  • You CAN get flood insurance if you live outside a floodplain, or a low-to-moderate flood-risk area, and at lower cost.
  • You CAN get flood insurance if your property has been flooded before.
  • You CAN get flood insurance from insurance agents in your area.
  • You CAN buy flood insurance even if your mortgage broker doesn't require it.
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Were you already aware of all this? If so, wonderful – you are a flood maven! If not, it might be time to do a little more research. People with accurate information about flood risks and protection options can make better decisions and plan for disasters. Sometimes the key is knowing who to ask, or where to look before the storm clouds gather and you begin to wonder, "Who'll stop the rain?"

In this article I used current weather conditions to again remind people of the need to prepare for potential disasters like flooding, and the cost of failing to do so. I also provided information from a valuable resource on the subject of flooding, www.FloodSmart.gov, and presented statistics and misconceptions to help people gauge their own levels of understanding on this topic. I hope you scored 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.