Should Insurance Companies Adjust Their Own Claims?

Should Insurance Companies Adjust Their Own Claims?

The State of Hawaii’s legislature is presently reviewing a bill that would dramatically change the way insurance claims are handled.

The proposed law dares to ask the questions “Can the insurance company be trusted to be fair when determining how much they should pay?”

Some people say “No”.

Read more by clicking on the link, below:

http://www.propertyinsurancecoveragelaw.com/2016/04/articles/state-legislation/hawaii-considering-new-law-relating-to-claims-handling/#.VwuHDVRhl1s.linkedin

2015 – Our Most Interesting Claims

As more people in Missouri have become aware of the success and benefits they can derive from hiring their own claims adjuster to present their loss to their insurance company, this past year was our busiest yet.  Of our many claim settlements in 2015, here are a few that stand out from the ordinary:

  1.  After an expensive slate and copper roof was damaged by hail, the insurance company denied the policy holder’s claim for his loss.  They cited a provision in the policy that excluded the damage.  The policy holder was referred to me by his roofing contractor.  My investigation of the facts showed that the date that the exclusion was added to the policy was AFTER the date of the hail storm – and should not have been applied.  My client, who had originally been told by his insurance carrier that his damage was not covered under his policy, received a payment exceeding $80,000.00 to affect the repairs to his roof.
  2. A fire destroyed a private residence and the policy holder and family were forced to sleep and eat in a camping trailer parked in the driveway while searching for a contractor willing to perform the repair work for the lesser amount that the insurance carrier had estimated the costs to be, which was considerably lower than any contractor was willing to bid.  They hired me to assist them and, after my negotiations with the insurance carrier, they received an additional $60,000.00 for the repair of their home and the full value of their policy (over $200,000.00) for their lost contents.
  3. The policy holder was told that, in spite of the fact that water was entering his home through the storm damage to his roof, the adjuster could not identify any storm damage and that no money would be allowed for roof repair.  The policy holder hired me to assist him and, after further negotiations, the insurance company paid to replace his entire roof.
  4. A frozen water pipe broke in the ceiling of a private home which resulted in a collapse of a major part of the ceiling and water damage to walls, carpeting, and personal contents.  The policy holder decided to hire me immediately after filing his claim and his insurance adjuster called him on the telephone and attempted to talk him out of using a public adjuster — and offered him $16,227.12 to settle his claim.  The policy holder refused to accept the settlement offer, allowed me to act as his public adjuster, and we settled the claim for over $62,000.00

Since starting this business in 2012, I have recovered millions of dollars for Missouri personal and commercial insurance policy holders. 2015 was another great year.

 

Public Adjusters Negotiate on Behalf of Policy Holders … Not Their Contractor

All of my business comes to me by way of my internet advertising and referrals.  I do not “chase fires and storms” or otherwise solicit policy holders who have suffered a loss to hire me.  A potential client (or the person referring them) must contact me, first.

Referrals come to me regularly from former clients, attorneys, and building contractors who recommend me to policy holders that they know, and that might benefit from my involvement with their insurance claim.

Some Missouri building contractors will attempt to negotiate with an insurance company on behalf of the owner of the property that they are repairing or rebuilding and will often find that the insurance company refuses to cooperate with them.  Instead of contracting to do work for less than what they need to make, or before using inferior products and labor and cut corners to afford to work for the insurance company’s lowball estimate, they advise the home owner to hire a public adjuster for assistance.

I have received many referrals from building contractors and have assisted the policy holders that they referred to me with successfully reopening their claim and getting a fair settlement that covers the full cost of the project (as well as my fee) so that the contractor can receive his full pay to do quality work.  This is a win for the policy holder, a win for the contractor, and a win for an insurance company who operates in good faith.

Likewise, policy holders that I help will often ask me for advice or referrals when they have been paid and are ready to begin the work of restoring their home or business.  I will recommend many of the fine and reputable building contractors that I have come to know and admire, knowing that they will be satisfied with the results.

Sometimes I will get calls from contractors who are simply wanting me to aid them to increase their own level of profit, at the expense of the insurance company and the policy holder, by adding unnecessary work to the scope to increase the cost to the job and expect me to negotiate on THEIR behalf and convince the insurance company to pay it.  I don’t do that.

A recent case in point was a Missouri policy holder who was reluctant to hire a public adjuster but was pressured to contact me by his building contractor.  The contractor initially attempted to “represent” the policy holder in negotiating his contract with me and discussing the claim with me, but I refused, and communicated directly with the policy holder.  This is the only way I do business.

As I investigated the claim, I found that the insurance company had inspected the hail damaged roof and siding with the contractor’s estimator and had actually agreed to pay what the estimator had originally estimated the costs to be.  Then, for reasons not clearly explained, the owner of the construction company revised his estimator’s original estimate and added a large amount of money for something outside the normal scope of work, and the insurance company refused to pay for this additional cost.

My job, according to the building contractor who pressured the policy holder to hire me, was to get the home owner this extra sum for this unnecessary work so that he could pay it to the contractor.  I refused to do this and advised the policy holder that the insurance company had offered a fair settlement that matched the original estimate provided by his contractor, and that I was withdrawing from his claim.

An insurance claim is a matter that is between the policy holder and his insurance company, and the only acceptable resolution to an insurance claim is complete restoration of the insured property to the condition that it was immediately before the event that caused the loss.  The contractor is hired by the policy holder to perform the work to meet that level of restoration and the insurance company has a duty to pay the costs associated with that level of restoration.  Nothing more … nothing less.

I appreciate the many referrals that I receive from building contractors who are looking to help policy holders achieve fair settlements so that they can be paid in full for their valuable services; however, when the policy holder and I agree to work together on his claim, I represent the policy holder and his interests, only.

Home destroyed by fire.

Home destroyed by fire.

What A Public Adjuster Does for You (Video)

A public adjuster is one of three classifications of insurance adjuster categories.

(1) There is the insurance company claim adjuster who is directly and exclusively employed by the insurance company to protect the insurance company’s financial interests in the handling of an insurance claim.

(2) There is the independent claims adjuster who is contracted to work for various insurance companies to protect the insurance company’s financial interests in the handling of an insurance claim.

(3) There is the public adjuster who is licensed by the state to work exclusively for the policy holder and represents the policy holder’s interests in the negotiations with the insurance company for a settlement to the claim.

For Sale – The Privacy of Home Buyers in the USA and Canada

Most home shoppers who see a “For Sale” sign in the front yard of a home they are considering to purchase are not aware that more than just the house is being sold.  In some cases, their own privacy and personal information is on the market the moment that they begin the buying process — whether they end up buying the home or not.

Buyers considering the purchase of a new home will often hire a home inspector to examine the home for them and report its condition.  If you are considering the purchase of a new home and are looking to hire a home inspector, consider the inspector’s commitment to your privacy in addition to his other qualifications.

There are home inspectors who will offer lower fees to their clients as an incentive to hire them — and then sell private information about the home buyer (or the home) to third parties willing to pay them for this information, to make up for the lower fee.  Usually, the home buyer is unaware that the home inspector is gaining from the sale of his private information.  Nor is the home buyer aware as to whom or how many third parties their private information is being provided to.

If your home inspector is offering a variety of “free” add-on services in addition to his report of the condition of your home, chances are good that you’re private information (and information about your home) is being provided to an unnamed third-party.

Contractors who sell and install home alarm systems, for example, consider home inspectors to be a valuable resource for new customer leads and will reward them with cash and other incentives to provide them with the names, phone numbers and addresses of new home buyers.   Sometimes the home inspector will sell their clients’ private information directly to a contractor but may also sell the information to “lead brokers” who, in turn, sell the information to a variety of contractors and service providers.

Rarely are home buyers informed by their home inspector that he is profiting from the sale of their private information or to whom the information is being sold.  At least one lead broker forbids home inspectors who provide him with private data about their clients from revealing anything concerning the inspector’s contract with the lead broker to the home owner, which includes his “compensation” arrangements.

Many clients of home inspectors, some who are on state sponsored “Do Not Call” lists, are unaware how the telemarketers calling them came to get their name while some are even more surprised to find door-to-door solicitors knowing to ask for them by name shortly after moving in to their new home.

Not all home inspectors engage in this practice and consumers should ask an inspector they consider hiring as to whether or not he or she engages in the sale of private information about his or her clients.  Added services that require personal information or client registration such as “free” short term warranties or “free” product recall research are important red flags that should be explored.

If you choose to hire a home inspector who will be providing your information to any third-party for any reason, it is wise to have the inspector provide you with the third party’s name, address, telephone number and other identifying factors to ensure that you can contact them should you find yourself receiving harassing or unwanted solicitations as a possible result — and to trace any other parties to whom that party may have provided your information to, when necessary.

In this age of private information gathering by government agencies and computer hackers, consumers should be proactive in protecting their private information from being bought, sold and re-sold among various parties that are unknown to them.  The purchase of a new home is no exception.

Copyright James H. Bushart 2013

Consider Risk Management Strategies When Buying a Home

 

Real estate markets in many parts of the country are heating up, with prices rising at a good clip. In many areas, it is a true seller’s market. So buyers should take heed of the various risks inherent in buying a home and should use sound risk management strategies before taking the plunge on an asset of such size. Here are some risk management and insurance tips to consider for your clients who are shopping for a home.

  • Consider the financial risks by not overextending yourself when buying a home. A good rule of thumb is not to buy a home that costs over 2.5 times your annual salary. Many online calculators can assist you in determining the maximum price for a home you can afford.
  • Consider the property and casualty risks. What are the key loss exposures to the home? For example, is the home in a flood zone? How far is it from the nearest fire department? Is it in an earthquake seismic zone 3 or 4?
  • What is the condition of the home? If it is apparent the home has not been properly cared for by viewing surface level deficiencies, there is a good chance that deeper problems may eventually manifest themselves. Thus, the value of a good home inspector cannot be overemphasized. If it is an older home, when were the various systems upgraded?
  • What types of losses have appeared on the Comprehensive Loss Underwriting Exchange report during the past 5 years? For example, a pattern of water losses may be a warning sign.
  • What type of loss control features does the home have? For example, is there a central station burglar and fire alarm system or a sprinkler system? If the home is in a hurricane-prone area, what windstorm protection devices are in place?

Get more personal lines insurance and risk management tips and ideas from IRMI.

Copyright 2013
International Risk Management Institute, Inc.

 

Carbon Monoxide Poisoning and Detectors

 Carbon monoxide (CO) is a colorless, odorless, poisonous gas that forms from incomplete combustion of fuels, such as natural or liquefied petroleum gas, oil, wood or coal.

Facts and Figures

  • 480 U.S. residents died between 2001 and 2003 from non-fire-related carbon-monoxide poisoning.
  • Most CO exposures occur during the winter months, especially in December (including 56 deaths, and 2,157 non-fatal exposures), and in January (including 69 deaths and 2,511 non-fatal exposures). The peak time of day for CO exposure is between 6 and 10 p.m.
  • Many experts believe that CO poisoning statistics understate the problem. Because the symptoms of CO poisoning mimic a range of common health ailments, it is likely that a large number of mild to mid-level exposures are never identified, diagnosed, or accounted for in any way in carbon monoxide statistics.
  • Out of all reported non-fire carbon-monoxide incidents, 89% or almost nine out of 10 of them take place in a home.

Physiology of Carbon Monoxide Poisoning

When CO is inhaled, it displaces the oxygen that would ordinarily bind with hemoglobin, a process the effectively suffocates the body. CO can poison slowly over a period of several hours, even in low concentrations. Sensitive organs, such as the brain, heart and lungs, suffer the most from a lack of oxygen.

High concentrations of carbon monoxide can kill in less than five minutes. At low concentrations, it will require a longer period of time to affect the body. Exceeding the EPA concentration of 9 parts per million (ppm) for more than eight hours may have adverse health affects. The limit of CO exposure for healthy workers, as prescribed by the U.S. Occupational Health and Safety Administration, is 50 ppm.
Potential Sources of Carbon Monoxide
Any fuel-burning appliances which are malfunctioning or improperly installed can be a source of CO, such as:
  • furnaces;
  • stoves and ovens;
  • water heaters;
  • dryers;
  • room and space heaters;
  • fireplaces and wood stoves;
  • charcoal grills;
  • automobiles;
  • clogged chimneys or flues;
  • space heaters;
  • power tools that run on fuel;
  • gas and charcoal grills;
  • certain types of swimming pool heaters; and
  • boat engines.

PPM

% CO in air

Health Effects in Healthy Adults

Source/Comments

0

0%

no effects; this is the normal level in a properly operating heating appliance

35

.0035%

maximum allowable workplace exposure limit for an eight-hour work shift

The National Institute for Occupational Safety and Health (NIOSH)

50

.005%

maximum allowable workplace exposure limit for an eight-hour work shift               OSHA

100

.01%

slight headache, fatigue, shortness of breath, errors in judgment

125

.0125%

workplace alarm must sound (OSHA)

200

.02%

headache, fatigue, nausea, dizziness

400

.04%

severe headache, fatigue, nausea, dizziness, confusion; can be life-threatening after three hours of exposure

evacuate area immediately

800

.08%

convulsions, loss of consciousness; death within three hours.

evacuate area immediately

12,000

1.2%

nearly instant death
CO Detector Placement

CO detectors can monitor exposure levels, but do not place them:

  • directly above or beside fuel-burning appliances, as appliances may emit a small amount of carbon monoxide upon start-up;
  • within 15 feet of heating and cooking appliances, or in or near very humid areas, such as bathrooms;
  • within 5 feet of kitchen stoves and ovens, or near areas locations where household chemicals and bleach are stored (store such chemicals away from bathrooms and kitchens, whenever possible);
  • in garages, kitchens, furnace rooms, or in any extremely dusty, dirty, humid, or greasy areas;
  • in direct sunlight, or in areas subjected to temperature extremes. These include unconditioned crawlspaces, unfinished attics, un-insulated or poorly insulated ceilings, and porches;
  • in turbulent air near ceiling fans, heat vents, air conditioners, fresh-air returns, or open windows. Blowing air may prevent carbon monoxide from reaching the CO sensors.

Do place CO detectors:

  • within 10 feet of each bedroom door and near all sleeping areas, where it can wake sleepers. The Consumer Product Safety Commission (CPSC) and Underwriters Laboratories (UL) recommend that every home have at least one carbon monoxide detector for each floor of the home, and within hearing range of each sleeping area;
  • on every floor of your home, including the basement (source:  International Association of Fire Chiefs/IAFC);
  • near or over any attached garage. Carbon monoxide detectors are affected by excessive humidity and by close proximity to gas stoves (source:  City of New York);
  • near, but not directly above, combustion appliances, such as furnaces, water heaters, and fireplaces, and in the garage (source:  UL); and
  • on the ceiling in the same room as permanently installed fuel-burning appliances, and centrally located on every habitable level, and in every HVAC zone of the building (source:  National Fire Protection Association 720). This rule applies to commercial buildings.

In North America, some national, state and local municipalities require installation of CO detectors in new and existing homes, as well as commercial businesses, among them:  Illinois, Massachusetts, Minnesota, New Jersey, Vermont and New York City, and the Canadian province of Ontario. Installers are encouraged to check with their local municipality to determine what specific requirements have been enacted in their jurisdiction.

How can I prevent CO poisoning?

  • Purchase and install carbon monoxide detectors with labels showing that they meet the requirements of the new UL standard 2034 or Comprehensive Safety Analysis 6.19 safety standards.
  • Make sure appliances are installed and operated according to the manufacturer’s instructions and local building codes. Have the heating system professionally inspected by an InterNACHI inspector and serviced annually to ensure proper operation. The inspector should also check chimneys and flues for blockages, corrosion, partial and complete disconnections, and loose connections.
  • Never service fuel-burning appliances without the proper knowledge, skill and tools. Always refer to the owner’s manual when performing minor adjustments and when servicing fuel-burning equipment.
  • Never operate a portable generator or any other gasoline engine-powered tool either in or near an enclosed space, such as a garage, house or other building. Even with open doors and windows, these spaces can trap CO and allow it to quickly build to lethal levels.
  • Never use portable fuel-burning camping equipment inside a home, garage, vehicle or tent unless it is specifically designed for use in an enclosed space and provides instructions for safe use in an enclosed area.
  • Never burn charcoal inside a home, garage, vehicle or tent.
  • Never leave a car running in an attached garage, even with the garage door open.
  • Never use gas appliances, such as ranges, ovens or clothes dryers to heat your home.
  • Never operate un-vented fuel-burning appliances in any room where people are sleeping.
  • During home renovations, ensure that appliance vents and chimneys are not blocked by tarps or debris. Make sure appliances are in proper working order when renovations are complete.
  • Do not place generators in the garage or close to the home. People lose power in their homes and get so excited about using their gas-powered generator that they don’t pay attention to where it is placed. The owner’s manual should explain how far the generator should be from the home.
  • Clean the chimney. Open the hatch at the bottom of the chimney to remove the ashes.  Hire a chimney sweep annually.
  • Check vents. Regularly inspect your home’s external vents to ensure they are not obscured by debris, dirt or snow.
In summary, carbon monoxide is a dangerous poison that can be created by various household appliances. CO detectors must be placed strategically throughout the home or business in order to alert occupants of high levels of the gas.
by Nick Gromicko and Rob London

 

Finally — A Legitimate Reason to Get a “Home Energy Score”

While it may prove to be of little to no value to the home owner, for a small fee of $25.00 you can help put a wounded veteran to work by allowing him to provide an energy inspection on your home resulting in a “Home Energy Score”.

At least it is not being done without the home owner’s consent as a part of a real estate transaction.  Go for it.

Drought and Foundation Damage

Structural issues are resulting as foundations are shifting in this summer’s dried out soil brought on by the drought.

This article explains the problem and some possible solutions:  http://usnews.msnbc.msn.com/_news/2012/07/19/12835597-foundation-repair-business-soars-as-drought-hits-homes?lite

Some of the damage will not be evident until the rains come, so be vigilant.

Mold Damage is Not a “Physical Loss” According to Court and Insurer

http://www.law360.com/southeast/articles/328671/6th-circ-says-no-insurance-for-universal-image-s-office-mold

Universal Image Productions, Inc. v. Federal Insurance Company

The U.S. Court of Appeals, Sixth Circuit, holds that mold contamination, while certainly inconvenient and irritating, does not result in a direct physical loss to a building.

The court relied on the opinions of several other courts around the country in determining that direct physical loss or damage requires tangible damage, an actual physical change to the property, or a loss of use of the property.

In this instance, mold contamination did not meet the requirements, and so, the insuring agreement pertaining to direct physical loss or damage was not met.

The insured was not entitled to coverage under the terms of its policy.

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