This Time It’s Personal

By Mark Goldwich

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As a licensed adjuster for 30 years, I am more familiar with insurance claims than most people will ever be. I have personally handled thousands of insurance claim
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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From repeated experiences with this insurance company, I knew that when an insured asks for more money than the adjuster estimates, this company goes on the offensive and demands what is called an “Appraisal”. This is a process in many homeowners policies which was initially intended to reduce the number of claims being litigated. The Appraisal process basically states that if either party (the insured or the insurance company) feels there is a dispute as to the amount of the loss being claimed, either party may demand an Appraisal to resolve the perceived dispute. In doing so, each party would have to hire (and pay for) an appraiser, and the two appraisers would select an umpire, whose job would be to help resolve the dispute if the two appraisers were unable to agree on their own. The cost of the umpire is split between the parties. In other words, if you don’t agree with their estimate (and we find very few of their estimates to be agreeable), you have to pay – generally over $1,000 – in order to get the insurance company to pay the full claim. Nice, huh?

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
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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.

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.        


  1. Wow, all I can say is wow. Insurance companies keep getting egg on their faces when it comes to paying claims in a timely manner. Thank God I had very little damage at my house.

  2. "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?" Incredible, outrageous, and apparently very routine for some in the insurance business.

  3. When it comes to getting your fair share from the insurance companies you need to take it personally. You also need a public adjuster in your corner.

  4. Alot of people don't realize that insurance companies are in the business to make money, not spend it on paying claims! When someone buys an insurance policy, they feel "special" in that they are "protected" if a (covered) loss occurs, but then - as outlined above - a loss occurs and the carrier does everything possible to not pay the claim! It's usually the people that are not familiar with the antics of insurance companies and the claims process that get taken advantage of the most.


  5. Handled lots of claims without that form being filled out. Not sure I remember denying the claim for not having that form. However, also remember claims where that form was sent to policy holders. The company needs to revise the conditions or make the form available. They didn't know what they were getting into. You were by far the go to knowledge person (or one of them) when I was learning the trade. You are a good resource and advocate to help clients get paid what they are owed under the contract.

  6. Thanks for sharing your story Mark! Just because we are told something by an adjuster does not mean it's actually true.

  7. It does sound like you are getting the run around from the insurance company. If you are, I really hope it is not because of your past employment with the company. I hope you are able to get this resolved soon, and you are able to get your home repairs done.

    Modesto Culbertson @ DZ Law Group