Public Adjusting Takes a Vacation

by Mark Goldwich

Image courtesy of flickr.com

Like many other Americans, this week the family and I are on our last vacation of the summer.  Vacation is a bit different for me as a business owner versus my decades as an employee for a large national insurance company. Back when I worked as an employee of the insurance company, I could just go. My job and the office would be there when I returned, but I didn’t have to worry about work while I was away on vacation. Now when I go on vacation, I have to be sure to take my phone and laptop (and chargers) with me, both of which allow me to communicate in various ways with coworkers, insureds, and others. With the systems we use, I can work virtually from anywhere, as long as I can connect to a network, or get Wi-Fi, without missing a beat.

In fact, just yesterday, as I was completing the last driving leg of our trip to Williamsburg, Virginia, I got a call from an adjuster I was expecting to hear from the day before, and in just less than 10 minutes at highway speeds, we were able to settle the claim. My insured, Ms. “P”, will be very happy. Ms. “P” suffered a water leak in April when the shower valve in her daughter’s bathroom sprang a leak in the wall cavity between the bathroom and the laundry room. They immediately shut off the water and called a plumber, who located and repaired the source of the leak. She then called a contractor who extracted the water and dried the structure. In the meantime, Ms. “P” got a closet-full of shoes out of her daughter’s room, and began drying and cleaning them. A few days later, the insurance adjuster showed up, and Ms. “P” said she could tell it was not going to go well from the start. The adjuster began by saying he needed photos of odd things, like the mailbox, and the exterior of the home (none of which had any damage or were related to the claim in any way). The adjuster suggested the water was leaking for “quite some time” and questioned the insured’s truthfulness regarding certain aspects of the claim.

Image courtesy of flickr.com

Sure enough, about a week later, the insured was officially told her claim would be denied because the insurance company felt the water leak was an ongoing maintenance issue that occurred for weeks or months, and not just hours or days as the insured had claimed. Fortunately for Ms. “P”, her water restoration contractor told her about me, and one month after the leak was discovered, she hired me to help recover on the claim. As soon as I saw the damages, exactly as the insurance company adjuster saw them, I knew with certainty the loss should have been covered. I took my photos, made some notes, and had an estimate prepared. The estimate was sent in to the insurance company with a request to meet with an adjuster (either the same one, or a new one). They sent a new one, about a month later. When we met back at the house, the adjuster acknowledged he was not familiar with the claim, or why it was not covered, but assured us he would consider it with “fresh eyes”. I remained sure the claim would be paid. Ms. “P” was encouraged, but not yet convinced. Until today, when I communicated (via email from 3 states away), the general terms of the agreement the adjuster and I came to in the car yesterday. He confirmed they agreed to fully cover the claim, and even agreed to the vast majority of my estimate, plus something to compensate the insured for saving and cleaning her daughter’s shoes.

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While on vacation, the TVs where we are staying are programmed to have the weather channel appear when the TVs are turned on. For most guests, I imagine this is so the visiting tourists can check the weather and plan their days. Of course, for me, I get to see where the storms are, and remain in “work-mode”. Today, for example, I see Tropical Storm Earl is heading for Mexico’s Yucatan Peninsula, and that Maryland is recovering from recent heavy flooding. So, while my family is at a local theme park, I am taking the day off from vacationing to catch up on some emails and write this blog. Tomorrow, though, it is back to family vacation fun, I promise – but I may need to take a work call or two, and check email and text every few hours. And I wouldn’t have it any other way. I love that I can help people any day of the week, no matter where I am!

 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. 

Miracle March Means Madness For Many

by Mark Goldwich

Forecasters predicted El Nino storms could drench the Western US in general, and California in particular, calling for a “Miracle March” that could ease the current drought conditions there. And halfway through March, it looks like they might be – predictably – partially correct.

"This is going to put a dent into some of the drought, but it's not going to take it away by any stretch," San Diego-based meteorologist Mark Moede told NBC News earlier this month. But according to Erik Ortiz of www.nbcnews.com, “the return of the storms this month in parts of California has drawn parallels to 1991, when a "miracle March" that brought record rains staved off a water shortage. It was also credited with saving the ski season.”

Image courtesy of en.wikipedia.org

In the first week of March, heavy rainstorms struck California and flooded some low-lying areas, but much more rain would be needed throughout the state to counter years of dry weather. In the second week of March, another round of rains helped replenish water reservoirs, and above-average snowfall has extended California’s expected ski season beyond any of the last several years, but it is still too soon to tell if this will be enough.

And while rain and snow is certainly good for California as a whole with regards to drought relief and snow-related industries, each storm brings disaster to many individuals. During any significant rainstorm event, low-lying areas tend to flood rather quickly. It may be that only 100 homes and businesses are affected, and this may not even make local news, let alone the national news (especially in the midst of a wild presidential election cycle), but for those 100 families, their entire world has turned to mud.

Keep in mind, also, that during most severe rainstorms, there are high winds, hail, and even tornados that come with the many inches of rainfall. Throw in a few mudslides on California hillsides, and you have the makings of a disastrous “Miracle March” for many unsuspecting property owners. The storms so far have not been devastating, but streets have been washed out by floods, highways closed by mudslides – one such slide toppled a dump truck in the process – and homes have also been flooded or damaged by mudslides. The uncomfortable paradox is that much more rain is needed to make an appreciable impact on the drought conditions, but such rains would also bring misery to ever-increasing numbers of people.

Image courtesy of en.wikipedia.org

Having dealt with so many individuals and families suffering through property insurance claims from rainstorms and flooding, I know how difficult it is to recover. Homes are damaged or destroyed, personal belongings are ruined, people are separated and displaced from their homes, and dealing with all the insurance hoops, exclusions, loopholes, and delays can bring a whole new meaning to the phrase “March Madness”.

As always, it’s important to know they can recover, and they will recover. The question is, at what cost? How much aggravation will they have to endure? How much money will they recover – or how much debt will they have to take on? Typically, the answers to those questions depend on what they know, and how well prepared are they are to take on this challenge. I always say, the better prepared you are before disaster strikes, the better you will emerge from the disaster. This goes from having a disaster plan (before it happens), to having a recovery plan (after it happens).

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One thing is for sure, the insurance companies all have plans. And systems. And strategies. And resources. For you to compete, you need to have these plans in place as well, even if it just means knowing who has the plans, systems, strategies and resources to help 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.

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.

Image courtesy of commons.wikimedia.org

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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The Pope, An Immigrant, and Donald Trump walk into a bar…

by Mark Goldwich

Just kidding – the point is, no matter what your job is, it is important to be current when
broadcasting to the “masses”. (pun intended)

Image courtesy of pinterest.com

Each of us has a wealth of information, based on personal and professional experiences, formal and informal education, books read, seminars attended, and so on. So while we can speak about any number of subjects, I am often reminded that the best topics to talk about are those that are most current, or in today’s lingo, what is “trending”.

For me, being in the insurance industry, I could look to local items, like:

Just this week there was a news story and article on www.FloridaWaterDaily.com titled, “Jacksonville Budget Amendment Transfers Money from Drainage Project to Firefighters”. In the article, it talked about people with localized flooding issues caused by recent heavy rainstorms, who are upset because “A last-minute amendment passed on Monday that took money away from storm drainage to help restore the salaries of Jacksonville firefighters. The amendment passed on Monday takes about $300,000 from the drainage fund and puts it towards restoring the salaries of Jacksonville firefighters.” These residents are not against firefighters, but they pay taxes that include storm water fees, and they are tired of having to wear rubber boots every day just to walk outside their home.

Image courtesy of commons.wikimedia.org

Earlier this month I saw a story on www.news4jax.com about a fire that broke out in the kitchen of a local McDonalds restaurant at 3 a.m. Similar fires damage homes and businesses daily, and each one details the need not only for insurance, but prevention, maintenance, and fire suppression.

You can also find countless stories about local insurance agencies, insurance companies, jobs in the insurance field, or stories about insurance benefits for local city government employees and officials.

You could then easily expand your search for recent events on a statewide level, and for example, find a story about famed coach Lou Holtz, whose Orlando area home was heavily damaged by fire, along with personal items like photographs with presidents and popes, the torch he carried in the 1996 Olympic games in Atlanta, and so much more.

There has also been plenty of severe weather all across the state recently, damaging homes, businesses and cars. A www.weather.com article earlier this year posted the following events which all occurred on the same day in Florida:

-          Storms brought down trees and knocked out a few traffic signals in St. Petersburg, Florida.

-          Throughout Tallahassee, Florida, reports popped up of trees blocking roadways and damaging homes after a storm struck around 10:30 a.m.

-          A National Weather Service employee spotted a funnel cloud in Miami early this afternoon.      Another funnel cloud was reported by a trained spotter in Boynton Beach, Florida, at 4:20 p.m.

Widening the search to regional or national levels, and again for international news on industry or related topics would only yield more current events to investigate, discuss, and opine upon.

Once I find a current topic I want to discuss, I always try to find a way to add my own personality to the subject, whether by comparing it to an actual situation that has occurred in my business, or by giving my own position on the topic. I also want to give the reader something else to think about, in addition to what is being reported on. After all, every story would be different depending on the background or point of view of the reporter.

Most news stories aren’t going to go into all facets of the event. Take a simple story about a home fire, for instance. I could talk about the importance of getting the right insurance policy, or documenting your valuables so you can prove your claim later, or presenting your claim to the insurance company, or even fighting to maximize your claim, and much more. Someone else could talk about restoration methods, new construction materials, fire suppression equipment, smart-home wiring, using LEED-certified products in the reconstruction – the potential list of alternative topics using just this one scenario is absolutely endless.

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In this article I talked about writing articles that are current. Even though I am relatively new to writing my own articles, I have learned enough to use timely material, based on relevant topics, and inject my personality, to create a product people can not only learn from, but enjoy (hopefully). After all, I’m not a writer; I’m just an insurance adjuster, who owns a small business, and writes 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.   

Hurricane Season is Here

by Mark Goldwich

With so many other topics consuming the 24-hour news cycle lately, and so much time since a hurricane hit their usual targets, a pair of storms whipping up winds today are an important reminder we are in the midst of the height of hurricane season, and we must not be lulled into a false sense of security.

Courtesy en.wikipedia.org

Danny became the first named storm of the Atlantic Ocean Hurricane Season on Tuesday, and quickly became the first hurricane of the Atlantic season on Thursday, according to the National Hurricane Center. By Friday, just 1 day later, it strengthened from a Category 1 hurricane to a Category 3 hurricane, with winds reaching 115 MPH. And as I write this on Saturday morning, Danny has already begun to weaken. It is still a Category 2 hurricane, but is expected to be further downgraded to a tropical storm by tomorrow, and is not expected to have any impact on the United States.

This is not only a good reminder of the need to be prepared for such events, especially for those of us living in hurricane-prone regions, but of how quickly things can change. When Danny was first mentioned earlier in the week, it was simply a tropical storm to be watched, and weeks away from any possibility of affecting the U.S. Even when it reached Category 2 strength, some said it was expected to weaken, and not reach the Category 3 level. And keep in mind, a Category 3 hurricane is considered a “major” hurricane, and capable of catastrophic damage.

And while Danny has already begun to weaken, and meteorologists can opine about high pressure fronts and wind shear and all sorts of other reasons storms act the way they do,  in the end the storm is a living, breathing, and relatively unpredictable phenomenon. As a result, even professionals never know for sure what the storm will do.

Image courtesy of en.wikipedia.org

Eric Holthaus, a meteorologist writing for Slate.com on Thursday wrote, “Danny is currently struggling to strengthen and has a tough road ahead of it: Dry air blown in from the Sahara and a pocket of cyclone-killing wind shear over the Caribbean will probably offset the potential boost from increasingly warm water. It’s not possible to confidently predict Danny will even be a storm at all beyond five days from now. On the other hand, it’s perhaps equally as likely that Danny will be a formidable hurricane in 10 days. There are model runs to support both possibilities.”

Holthaus went on to say, “Though it’s borderline meteorological sacrilege to even discuss the possibility of a tropical cyclone landfall so far in advance, a Danny landfall in the mainland United States has the tenuous support of two of the leading weather forecast models, the Euro and the Global Forecast System, the flagship model of the U.S. National Oceanic and Atmospheric Administration. The Euro, widely regarded as the world’s most accurate weather model, has been relatively consistent over the last several model runs that a weak version of Danny could approach Florida in about 10 days. The GFS has been much more variable, showing a potentially stronger landfall anywhere on the East Coast—as well as the possibility of a much safer curve out to sea. But you should take this information with an Everest-sized grain of salt.”

Predictions are made, analyzed, evaluated, revised, and then reanalyzed in hindsight after events actually occurred. If the person making the prediction turns out to be correct, they are congratulated for “knowing” what would happen. If they are wrong, they simply explain what happened to cause the prediction (not “them”) to miss the mark.

Meanwhile, a depression in the Pacific Ocean strengthened into what is now called Tropical Storm Kilo on Friday, churning about 500 miles southeast of Hilo, Hawaii. Forecasters believe Kilo could grow in strength into a hurricane by Monday, the Central Pacific Hurricane Center said. One forecast track indicates it could move under Hawaii before changing course back toward Hawaii, and may threaten the state as a hurricane by Wednesday.

Image courtesy flickr.com

In the end, all we can do each time a depression, or storm, or hurricane is taking shape, is to pay attention and prepare for the worst based on information gathered from multiple sources. Of course, it is always better to be prepared (even if nothing happens) than to be unprepared, because when the rare instance of a major storm does happen, being unprepared can lead to disastrous consequences. 

There are so many resources to take advantage of today, and I do not want to bore anyone with disaster plans and safety kits (I’ve probably done this enough already), but I do want to remind you to take some time to at least contemplate what you would do if you had 24 hours to prepare for a large-scale natural disaster. Get on the computer, and find a disaster plan you like, complete with emergency supply kit, and at least print it out and review it with your family. This 30-60 minute exercise would not only create some “family time”, but would hopefully become a habit, and over time increase in everyone the confidence that comes from such repeated planning. The last thing you want to wind up doing is standing in a big box store as a hurricane bears down trying to grab the last couple of pieces of plywood, or the last few cans of food on the supermarket shelves.

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This type of exercise is good for much more than hurricane planning, I believe it helps shape the way people react and act in all kinds of stressful situations, allowing them to remain calm, prioritize needs, and take measured actions in coordination with others (or alone).

So thank Danny and Kilo, for the wake-up call to remind us that Hillary’s email scandal and pre-season football is not the most important news of the day. Remember that while the hurricane season has been quiet so far, it's far from over. Stay vigilant, my friends.

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.   

Watch Your Step

by Mark Goldwich

Just as every rose has its thorn, every job has its hazards. In the world of insurance adjusting, depending on the type of adjusting being done, these hazards can range greatly (probably much like many other jobs). For anyone curious about the potential hazards of my industry, or for those who might be interested in a career in adjusting, the following will give you an idea of the risks we face.

First I’ll start with those adjusters who work primarily in an office setting (and yes, many insurance adjusters, especially as technology improves, never leave an office to settle your insurance claim). Besides the obvious hazards of getting into car accidents going to and from the office, or tripping on your own shoelaces, most in-office hazards come from repeated activities – staring at a computer screen all day, sitting in a chair all day, and typing for hours on end.

Image courtesy of flickr.com

Many corporate offices have access to ergonomics specialists within their Human Resources departments, or offer training videos on workplace safety. In addition to taking advantage of these resources, certainly it is wise to always be aware of things like tripping hazards (loose carpet, uneven surfaces, electrical cords, changes in floor elevations that are minor or difficult to see, or items placed on the floor near a corner). Then there are slipping hazards (water or other fluids dripping or leaking on a hard surface), sharp edges on furniture or accessories.  Las but least we come to the falling hazards (usually from a heavy or unstable object placed too close to the edge of a shelf or other piece of furniture). I'll bet you didn't know the work place could be such a hazard zone.

Get up from your desk on a regular basis and take a brief walk around, doing simple eye, wrist, back or neck exercises based on professional advice and your personal needs. Not only can you avoid some of the repetitive motion conditions, you may take this time to take note of other potential hazards in the office, and recharge your batteries.

Many insurance adjusters who work in an office, also work in the field, whether at private residences, commercial properties, or car repair shops. These adjusters not only spend more time in their cars trying to avoid getting hit by other drivers, but typically find themselves in unfamiliar surroundings, without the benefit of management and/or HR sanitizing every surface year-round. 

Once you venture outside, the number of hazards increase exponentially, and there are far too many to name here. I’ll just give an idea of a few I have encountered over the years.

Image courtesy of en.wikimedia.org

As field adjusters, and especially as catastrophe adjusters, a major component of the job is climbing onto roofs. Most people can appreciate the obvious hazard of falling off the roof, but that is only half the battle. The method for getting on and off the roof – the ladder – is the other half. You have to be careful to set up the ladder properly, facing the right direction (yes, most ladders have instructions printed right on them with illustrations to show how to set up the ladder safely), and on the right surfaces. I once set up my ladder in the trunk of my car because I just needed 2 more feet to get up on a roof. The smart thing would have been to leave and return with a ladder that would reach this particular roof, but when in a hurry, and having a appointments to keep, people tend to improvise. It looked like it would work fine, and in fact it looked like I was in the clear until I made it to the eaves. At that point, there was enough of a shift in the weight being placed on the ladder that the felt-like material in the trunk suddenly gave way, quickly taking the legs of the ladder out from under me. All I could do was react, placing one hand on the roof, and another on the gutter, expecting the ladder to drop away completely and leave me hanging until I could drop myself down as safely as possible. Fortunately, the ladder didn’t drop completely away, and I was able to climb down without any injury to myself – and I only had to pay the homeowner for a minor gutter repair.

One of my adjusters was not as lucky when the ladder he set up on the side of a home slipped out from under him. He was just getting back on the ladder to climb down from the roof when this happened, and his first instinct was to push himself away from the ladder so he could land a safe distance away on his feet. Except for the possibility of twisting an ankle upon landing, I think he would have been fine, but he didn’t see there was a clothesline behind him, and as he came down, the clothesline hit the back of his legs, causing his body to rotate backwards, and he landed hard on his upper back and head, nearly losing consciousness.

Over the years I’ve heard many stories of people who were so focused on reading their tape measures, or were too engrossed in trying to identify damage on a roof, that they simply stepped off the edge of the roof, sometimes resulting in serious injury or death.

Image courtesy of pixabay.com

Then there was the time I was on a wood shake roof in Oklahoma when I came upon a section of the roof that was home to a swarm of wasps, and they did not appreciate my trespassing in their space. This might have been just the right time to be scared stiff, because it gave me time to think about my next (slow) steps, and not get the wasps any more excited than they already were. Disaster averted!

In addition to the above, there are a host of dangers on roofs alone – high voltage electrical lines, slippery spots of mold or mildew, and rotten wood that can give way beneath you and land you in the attic, to name a few. And don’t forget the sun, lightning, and other weather conditions – I once got hailed on while inspecting a hail claim!

Then you have other critters you come across while doing property inspections, from bats to bees, to spiders and snakes, to overly protective and aggressive dogs. I even once found myself surrounded by a tribe (or trip) of goats on a farm in Texas. At first it was cool as a few gathered around to see what I was doing there. But before long they were all around me, nibbling and crowding and a few butting. Good thing I had my trusty ladder with me to help fend enough of them off so I could make my escape.

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Finally, you have all the hazards that are difficult to see when the destruction is especially heavy. After a severe disaster from fire, hurricane, flood, or tornado, there are many sharps pieces of debris that are literally everywhere. I have stepped on nails, been cut by glass, and poked by sharp or pointy spikes of wood or metal. Getting a tetanus shot every 10 years was not a problem for me. And most recently, I stepped into a quicksand-like mixture of sand and sewage, going from walking on solid ground to sinking to my knees in just 1 step. You hear about quicksand, or see it depicted on TV or in movies, but until you are in it, you can’t really imagine the holding power it has on you – I was stuck! And I stunk!

Overall, I have been very lucky throughout the years to escape any serious injury. Then again, except for a few times when lapses in judgement almost cost me dearly, I’d like to think I was pretty careful more often than not, considering my surroundings, taking  care to minimize the risks I was taking. Whatever your job, be careful, be observant, and listen to that little voice in your head (that grows louder as you grow older). 

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.  

Back It Up

by Mark Goldwich

Water damage claims are one of the most frequent and costly type of home insurance claim. Whether from burst pipes, roof or appliance leaks, flooding, or sewer back-ups, the damage from water can be fast and devastating. Not to mention the mold that can quickly grow if the property is not immediately and completely dried out.

Image courtesy of commons.wikimedia.org

Water damage can be even worse in the case of commercial buildings. The large multi-national carrier Zurich (www.zurichna.com) says, “Water damage is the number one source of property claims for owners of high-rise residences, hotels, office buildings, retail establishments and other commercial structures.” They noted the total damages to commercial property caused by water is in the billions of dollars each year. In a 2010 study, Zurich found 62% of all water losses were caused by wear and tear or human error, which they suggest could have been prevented by water prevention programs.

However it happens, water can be fast moving, and not immediately obvious, traveling through wall cavities and other tight spaces before being noticed. If the water source is pressurized, and no one is in the property at the time of the leak, tremendous amounts of water can be released in just a few hours, let alone a weekend, or longer. All that water usually leads to damage.

Water damages all kinds of property, and does so relatively quickly. Many building materials and personal property absorb water on contact. Water causes items to stain, swell, sag, weaken, and to rust, and cause electrical components to short out or fail. Finished surfaces may bleed onto carpets, and oriental carpets may have colors run or fade.

The good news is most water damage can be covered by insurance, but you have to know what the insurance covers so you can get the right insurance, with the right endorsements. That is a whole other discussion altogether, and one that should be done with a good insurance agent.

I did want to point out something that demonstrates the level of complexity and subtlety that can be found in insurance policies, and the importance of knowing someone that can assist you through the process, especially when it involves something as frequent, damaging, and costly as water claims.

The example I am thinking of is water “back-up”, as opposed to water “fill-up”. In most insurance policies, damages caused a water “back-up” is not covered, in fact it is specifically excluded, unless you have a specific endorsement called “Back-up of Sewer or Drain”, or something similar, that gives you back the coverage. Since it is an endorsement, it comes at an additional cost. And because insurance is expensive enough, many people tend to decline such endorsements that increase their premiums. On the other hand, most insurance policies do not exclude “fill-ups”, so they can be covered.

Image courtesy of wikipedia.org

So, what is the difference between a “back-up” and a “fill-up”? As the name implies, a water “back-up” is when water backs up through your sewer or drain pipes, and enter your home, usually at the showers, tubs, and toilets. This water usually originates from beyond your drain line, and unless you have a septic system or drain field on your property, it usually originates away from your premises (community sewer system).

In a “fill-up” situation, there is a blockage in the drain line on your property (or common property in the case of a condominium or similar property), and the water “fills” up in the drain line until it enters the home, again, usually at the showers, tubs, and toilets.

For ease of understanding, I explain it this way…if localized heavy rains cause the city sewers to fail and water is pushed through the city lines and into your lines and it comes out of your drains and toilet, that is a “back-up”, and is generally excluded by homeowners insurance. But if your son is playing with a tennis ball at the same time he is using the bathroom and happens to drop the ball in the toilet as he is flushing (anyone care to guess how I thought up that scenario?), and the ball clogs the line and causes water to come out onto your floors, that is a “fill-up”, and is generally covered under most policies (currently). Obviously, there can be many different scenarios for each type of loss (especially the “fill-up”), but I hope you get the basic picture. If you do, you’re a step ahead of nearly all homeowners, and far too many insurance adjusters.

In the end, the damage looks exactly the same. Water (sometimes called “grey water”, “black water” or “category 3 water”) comes up from drains and toilets. But in one case, the resulting water damage is excluded, and in the other case it is covered. If that wasn't bad enough, I have personally handled several cases where the insurance company adjuster did not seem to know the difference, did not know there was a difference, or didn’t bother to determine whether it was from a “back-up” or a “fill-up”. They simply denied the claim, citing the standard “back-up” exclusion – that is, until I required they revisit the claim and correctly pay the appropriate claims as “fill-ups”.

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I have no doubt this denial scenario happens many times a week, every week of every year, throughout the country. This results in millions of dollars not paid to premium-paying policyholders who purchased the coverage, but did not understand why the claims were improperly denied, did not get adequate treatment from their insurance company, and did not get assistance from an experienced consumer advocate (usually because they did not know they could).

It just goes to show how a subtle difference in terminology, based on the understanding of how a specific loss takes place, can make all the difference in whether or not a claim is paid, and the importance of knowing who to use as a resource for a particular situation.

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.  

Diving Into Deflection - Part 2

by Mark Goldwich

Last time we ended by talking about the fact that despite all the frustrating tactics used by insurance companies, including unnecessary delays, confusing denials, and mysterious deflections, most claims – even those with both high values and merit – never seem to make it into court.

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.

Are these “deflection” situations isolated cases? If you ask representatives of the insurance industry, the answer will be an immediate “Yes.” If you ask Elliot Spitzer, former New York Attorney General, and former Governor of the State of New York, he’d offer a somewhat different assessment of the situation.

What did Spitzer have to say about this? In a lawsuit, Mr. Spitzer accused major insurance companies of "fraud, bid-rigging, and antitrust violations," and charged some of the biggest players in the game with fleecing their customers. Spitzer warned that the American insurance industry “needs to take a long, hard look at itself," and suggested that "if the practices identified in our suit are as widespread as they appear to be, then the industry's fundamental business model needs major corrective action and reform."

He went on to note that "there is simply no responsible argument for a system that rigs bids, stifles competition and cheats customers." Mr. Spitzer’s investigation and lawsuit

focused first on corporate customers, but specifically included individual consumers as being among those victimized by industry practices. His press release was entitled,

"Investigation Reveals Widespread Corruption In Insurance Industry."

Image by dcemp.com

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 seemed to require an advanced degree. I realize that sounds like a harsh assessment. But the irresponsible use of deflection warrants it, in my opinion. 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 – sorry, “saves” – 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 (1.5 million times $300 = $450,000). That’s right, 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 in my average case. 

Image courtesy of the lostogle.com

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Ponder that, if you will. Not three hundred dollars per case. Thousands of dollars per case. And that’s not the exception to the rule. That’s what usually happens.  Deflection is real! Taking this fact into consideration, let's do that math in our heads … 1.5 million times $3,000 = $4.5 BILLION! That’s per year, for just one company. Not too shabby! Are you starting to see why a cynical person might start to think all the coincidences that seem to favor insurance companies might not be so coincidental after all?

But now I really must be exaggerating about the $3,000 figure, right? I would say that is conservative, and base that on thousands of claims we have helped our clients settle for $5,000, $20,000, $100,000 and more (we even helped a client recover over $396,000 on a claim the insurance company insisted for 4 months was not covered at all). And keep in mind, we are just 1 firm, in 1 city, in 1 state, in a great big country.

For more information on bad faith insurance issues, please take the time to visit this web site: www.badfaithinsurance.org -- or just do a Google search with the words “bad faith” along with the name of your own “friendly and faithful” insurance company, and see what kind of ugliness pops up. You may be surprised.

In the next blog, we’ll get some more clarity on exactly how the “deflection game” is likely to be played in your world.

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.