Category Archives: Home Owner Insurance Issues

State Farm v. Their Missouri Policyholders

August 2, 2024 By in Home Owner Insurance Issues, Property Insurance Leave a comment

“No one is listening to me!”

State Farm policyholders in Missouri who feel ‘gaslighted have increasingly contacted me’ for assistance after filing an insurance claim. This mistreatment distresses them and undermines their trust in the insurance system. I receive complaints from policyholders from all insurance companies operating in Missouri, but those from State Farm have risen sharply.

Bordering Missouri in nearby Oklahoma, the state’s Attorney General is investigating an alleged scheme to defraud policyholders.

“In 2020, State Farm arbitrarily set a goal of reducing payments on wind and hail claims by 50%, Whitten Burrage petitions said. Wildly successful, the wind-hail initiative earned State Farm hundreds of millions in Oklahoma and billions beyond, the firm’s attorneys said in court. From 2020 to 2023, dozens of policyholders filed suit when claims were denied. Whitten Burrage represented 125 cases that settled for sometimes shocking amounts, well beyond the value of the homes at issue. Even as it controlled 30% of the homeowners market in Oklahoma — making it a potential oligopoly — State Farm paid secret settlements on every one of the 125 cases that kept the nature of the alleged scheme secret. Just one of the cases settled for $3 million.” Read the full article here and ask yourself why an insurance company would not do in Missouri what it has (up to now) successfully achieved in a neighboring state.

Missourians complain that State Farm has ignored their telephone calls and emails and left their claims open, underpaid, or unpaid for months. When true, these actions violate the rules and regulations set by the Missouri Department of Insurance.

State Farm didn’t always treat its Missouri customers with such disrespect. Perhaps this is a temporary problem that is being resolved, but unpaid and underpaid policyholders need cooperation and help today.

Claims adjusters at all insurance companies must return to their duty of finding coverage and paying covered claims. Until they do, policyholders must assert their rights and know when and how to stand up and be heard by their insurance company. This will give them the confidence to navigate this situation.

What To Do

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Personal Property Inventories for Insurance Claims

January 29, 2024 By in General Home Issues, Home Owner Insurance Issues Leave a comment
Fire destruction to residential building.

Destruction due to fire.

The Crucial Role of Personal Property Inventories: Safeguarding Belongings and Streamlining Insurance Claims in the Aftermath of Fire

Introduction

In the unfortunate event of a fire, the emotional and physical toll on individuals can be overwhelming.

Amidst the chaos, the importance of having a comprehensive inventory of personal property becomes evident. A detailed record of possessions not only aids in assessing losses but also serves as a crucial tool when filing insurance claims.

This essay explores the significance of maintaining a thorough personal property inventory in the aftermath of a fire, shedding light on its value in facilitating the claims process, ensuring accurate compensation, and aiding in the recovery journey.

The Trauma of Fire Loss

A fire, whether large or small, can result in devastating losses. Beyond the destruction of the physical structure, cherished belongings, memories, and the sense of security are often casualties. In the aftermath of such a traumatic event, individuals are faced with the daunting task of rebuilding their lives. One key element in this process is the ability to navigate the insurance claims process efficiently and effectively.

The Value of a Personal Property Inventory

  1. Documentation of Possessions:
    • A personal property inventory serves as a comprehensive documentation of belongings. From furniture and electronics to clothing and sentimental items, the inventory captures the full spectrum of possessions within a home.
  2. Facilitates Claims Process:
    • When disaster strikes, time is of the essence. Having a pre-existing inventory expedites the claims process. It provides insurance adjusters with a detailed list of items, allowing for a quicker and more accurate assessment of the losses incurred.
  3. Accuracy in Valuation:
    • An inventory aids in accurately valuing the lost or damaged items. This is crucial for determining the appropriate compensation from the insurance company. With a detailed record, the assessment is more likely to align with the actual value of possessions.
  4. Prevents Overlooking Items:
    • In the chaos that follows a fire, it’s easy to overlook certain items when trying to recall the contents of a home. A systematic inventory minimizes the risk of omitting possessions from the claim, ensuring a more thorough and complete assessment.
  5. Streamlines Claims Negotiations:
    • Insurance claims often involve negotiations between policyholders and insurance companies. A well-documented inventory provides a solid foundation for these discussions, reducing the likelihood of disputes and ensuring a fair settlement.

Creating a Personal Property Inventory

  1. Systematic Room-by-Room Approach:
    • Begin the inventory process by taking a systematic room-by-room approach. List each item, including its description, quantity, brand, model, and any relevant serial numbers. Digital tools, such as spreadsheets or dedicated inventory apps, can aid in organization.
  2. Photographic and Video Documentation:
    • Supplement written descriptions with photographic or video documentation. Capture the condition of items, their placement within the home, and any distinguishing features. This visual record enhances the accuracy and credibility of the inventory.
  3. Receipts and Appraisals:
    • Whenever possible, attach receipts, invoices, or appraisals to the inventory. These documents serve as tangible evidence of the value of possessions, further strengthening the insurance claim.
  4. Off-Site Storage:
    • Store a copy of the inventory in a secure, off-site location. In the event of a fire or other disasters affecting the home, having a backup ensures that the inventory remains accessible for claims purposes.

The Role of Technology in Inventory Management

Advancements in technology have revolutionized the way individuals manage their personal property inventories. Mobile apps, cloud-based storage, and digital platforms provide convenient and efficient solutions for documenting and safeguarding belongings.

  1. Inventory Management Apps:
    • Specialized inventory management apps offer user-friendly interfaces for creating, updating, and storing personal property inventories. These apps often allow users to attach photos, receipts, and additional details to each item.
  2. Digital Cloud Storage:
    • Cloud-based storage solutions ensure that the inventory is accessible from anywhere with an internet connection. This is particularly valuable in situations where physical records may be compromised or inaccessible.
  3. Backup Systems:
    • Implementing backup systems for digital inventories adds an extra layer of protection. Regularly backing up the inventory data guards against potential data loss, preserving the integrity of the documentation.

Conclusion

In conclusion, the value of maintaining a comprehensive personal property inventory in the aftermath of a fire cannot be overstated. This proactive measure not only aids in streamlining the insurance claims process but also contributes significantly to the overall recovery journey. The trauma of a fire is compounded when individuals are faced with the loss of cherished belongings, making it imperative to have a systematic and well-documented inventory.

Through a room-by-room approach, photographic documentation, and the use of technology, individuals can create robust inventories that serve as invaluable tools in the event of a disaster. Accuracy in valuation, prevention of overlooked items, and streamlined claims negotiations are just a few of the benefits that a well-maintained inventory brings to the table.

As technology continues to advance, individuals are presented with increasingly efficient and accessible tools for managing their inventories. Embracing these digital solutions, coupled with proactive and systematic inventory creation, ensures that individuals are better equipped to face the challenges posed by fire losses. Ultimately, a personal property inventory is not just a list of possessions; it is a lifeline in the aftermath of a catastrophe, providing a pathway towards recovery and rebuilding.

For more information, contact me.

 

OpenAI. (2024). ChatGPT (3.5) [Large language model]. https://chat.openai.com

Engineer Reports, Insurance Claims, and Policyholder Rights

January 29, 2024 By in General Home Issues, Home Owner Insurance Issues, Property Insurance Leave a comment

 

Insurance claims, particularly those involving property damage, rely on a thorough and unbiased assessment of the facts to ensure fair compensation for policyholders.

Engineers play a pivotal role in this process, providing expert reports to determine the extent of damage and the necessary repairs. However, concerns have arisen regarding the improper use of engineer reports by insurance companies to deny or undervalue claims.

This essay delves into the ethical issues surrounding the misuse of engineer reports, the potential consequences for policyholders, and the importance of safeguarding the rights of those seeking legitimate claims.

The Role of Engineers in Insurance Claims

Engineers are crucial participants in the insurance claims process, especially when assessing property damage. Their expertise helps determine the cause and extent of damage, the necessary repairs, and the associated costs. Insurance companies often rely on engineer reports to make informed decisions about claim settlements.

  1. Objective Evaluation:
    • Engineers are expected to provide an objective and unbiased assessment of the damage. Their reports are crucial in establishing the facts of the case, ensuring that the insurance company has accurate information to process the claim.
  2. Determining Cause and Extent of Damage:
    • Engineers use their technical knowledge to investigate the cause and extent of property damage. This includes evaluating structural issues, assessing the impact of natural disasters, or determining whether the damage is consistent with the policy coverage.
  3. Providing Recommendations:
    • Based on their evaluations, engineers provide recommendations for necessary repairs and associated costs. This information is vital for insurance companies to determine the appropriate settlement amount.

Ethical Concerns in the Misuse of Engineer Reports

While engineers are expected to adhere to a strict code of ethics, concerns have been raised about instances where their reports are allegedly misused by insurance companies. Several ethical issues merit consideration:

  1. Conflict of Interest:
    • There may be instances where the insurance company’s interests conflict with those of the policyholder. If an engineer is influenced by the insurer to downplay the extent of damage or recommend minimal repairs, it raises ethical questions about their impartiality.
  2. Pressure on Engineers:
    • Engineers may face pressure from insurance companies to produce reports that align with the company’s financial interests. This could lead to a compromise in the accuracy and objectivity of the assessment.
  3. Selective Use of Findings:
    • Insurance companies may selectively use portions of an engineer’s report that support their position while neglecting other findings that could strengthen the policyholder’s claim. This cherry-picking of information raises ethical concerns.
  4. Undervaluing Claims:
    • If an engineer’s report is used to undervalue a claim, it can result in policyholders not receiving the full compensation to which they are entitled. This undermines the purpose of insurance, which is to provide financial protection in times of need.

Consequences for Policyholders

The misuse of engineer reports in insurance claims can have profound consequences for policyholders, extending beyond financial implications:

  1. Financial Strain:
    • Policyholders may face financial strain if their legitimate claims are undervalued or denied based on questionable engineer reports. This can lead to difficulties in covering repair costs and may hinder the ability to restore the property to its pre-damaged condition.
  2. Delays in Recovery:
    • Improperly denying or delaying valid claims can significantly impede the policyholder’s ability to recover. Timely access to insurance proceeds is crucial for initiating repairs promptly and preventing further damage.
  3. Loss of Trust:
    • Policyholders rely on the integrity of the insurance claims process. When engineer reports are misused, it erodes the trust that policyholders place in their insurance providers. Loss of trust can have lasting implications for the insurer’s reputation.
  4. Legal Battles:
    • Policyholders may be forced to engage in legal battles to contest the denial or undervaluation of their claims. Legal proceedings are time-consuming, costly, and add additional stress to an already challenging situation.

Safeguarding Policyholder Rights

To address the improper use of engineer reports in insurance claims, it is essential to prioritize the protection of policyholder rights and ensure the integrity of the claims process:

  1. Transparent Communication:
    • Insurance companies should maintain transparent communication with policyholders throughout the claims process. Providing clear explanations of engineer reports and addressing any concerns fosters trust and reduces the likelihood of disputes.
  2. Independent Third-Party Reviews:
    • Policyholders should have the right to request independent third-party reviews of engineer reports if they have concerns about bias or inaccuracies. This can help ensure a fair and impartial evaluation of the damage.
  3. Regulatory Oversight:
    • Regulatory bodies overseeing the insurance industry play a crucial role in holding insurers accountable for ethical conduct. Increased scrutiny and stringent enforcement of ethical standards can deter the improper use of engineer reports.
  4. Policyholder Education:
    • Educating policyholders about their rights, the claims process, and the role of engineers in assessments empowers them to make informed decisions. Knowledgeable policyholders are better equipped to challenge unfair denials or undervaluations.
  5. Legal Protections:
    • Legislation should be in place to protect policyholders from unfair practices. Legal avenues should be accessible to policyholders who need to contest claim denials or undervaluations based on improper use of engineer reports.

Conclusion

The misuse of engineer reports in insurance claims poses significant ethical concerns and has tangible consequences for policyholders. Addressing these issues requires a collaborative effort from industry stakeholders, regulatory bodies, and policymakers.

By prioritizing transparent communication, independent reviews, regulatory oversight, policyholder education, and legal protections, it is possible to mitigate the improper use of engineer reports and ensure that the insurance claims process remains fair, just, and aligned with the fundamental principles of risk mitigation and financial protection.

In doing so, the insurance industry can maintain the trust of policyholders and uphold the integrity of its essential role in safeguarding individuals and businesses from unforeseen risks.

 

 

OpenAI. (2024). ChatGPT (3.5) [Large language model]. https://chat.openai.com

Can My Contractor Hire a Public Adjuster to Represent Me?

December 29, 2023 By in General Home Issues, Home Owner Insurance Issues, Home Repairs, Property Insurance Leave a comment

“Can a contractor hire a public adjuster to represent an insurance claim to the insurance company?”

This question has been posed to me in various forms by building contractors and policyholders alike.  At least in Missouri, the answer is a clear and concise “no”: a public adjuster cannot be hired by a contractor to represent a policyholder with an insurance claim.

Why not? 

First, the contractor is not a party to the contract (aka “the insurance policy”) between the policyholder and the insurance company and has no rights under that agreement, particularly the right to represent or hire someone else to represent the insured policyholder who is a party to that agreement.

Second, Missouri law forbids building contractors from representing Missouri policyholders with their insurance claims, and a public adjuster hired by the contractor (should such a thing be allowed) would be responsible for working in the contractor’s best interests, not the insured policyholder.  

Third, a public adjuster hired by a contractor would be paid by the contractor rather than the insured policyholder.  Since the insurance company would not cover the public adjuster’s fees as a part of the claim and the payment of the claim would be made to the policyholder, which (the contractor or the policyholder) would pay the public adjuster the contractor hired?  A conflict of interest arises regarding which party the public adjuster would serve.

Missouri Revised Statutes intentionally separate the roles of contractors and public adjusters to preclude a conflict of interest regarding who is being served and represented in an insurance claim. 

Policyholders should hire their own public adjusters when they believe it necessary to use a public adjuster for an insurance claim, and they should ensure that the public adjuster represents their interests in the claim and no one else’s. 

All good contractors familiar with successfully adjusted insurance claims will know public adjusters they can refer to their customers and are an excellent source of information.  Ask your contractor for a referral and then carefully research and personally speak to a public adjuster candidate.  When you have chosen, hire a public adjuster to represent you, and only you, with your insurance claim.

Mistakes To Avoid When Filing an Insurance Claim

March 17, 2023 By in General Home Issues, Home Owner Insurance Issues, Property Insurance Tags: , , , , , Leave a comment

 

James H. Bushart, Public Adjuster LLC

 

Insurance claims for property damage can be a complicated process and avoiding mistakes can be a challenge. It requires proper documentation and timely submission of relevant paperwork. Any mistake in filing the claim could result in delayed or denied coverage, leaving the policyholder to bear the entire cost of the damage. Therefore, it is essential to understand the do’s and don’ts of filing an insurance claim for property damage and to know when to get help. In this essay, we will discuss the mistakes that policyholders should avoid when filing an insurance claim for property damage.

Failing to Document the Damage:

The first and most common mistake that policyholders make is failing to document the damage properly. It is essential to take pictures and videos of the damaged property as soon as possible after the incident occurs. This documentation will serve as evidence for the insurance company to determine the extent of the damage and the amount of coverage required. Without proper documentation, it can be challenging to prove the damage, and the insurance company may deny the claim. 

Photographs or video of the hailstones that struck the property, for example, are valuable evidence since some weather reports might report the nearest hailstorm to have been miles away on the date of loss.  Photographs of interior water damage taken before clean-up measures began help preserve evidence of fresh damage.  Proving your claim is YOUR responsibility.  Leave it up to the insurance company to prove it for you and you are likely to be disappointed in the result of their half-hearted efforts.

 

Waiting Too Long to File the Claim:

Another common mistake that policyholders make is waiting too long to file the claim. It is crucial to report the damage to the insurance company as soon as possible after the incident occurs. Most insurance policies have a specific timeframe within which the policyholder must report the damage. Failing to report the damage within this timeframe could result in a denied claim. Additionally, waiting too long to file the claim could result in delays in the claims process, which could cause further damage to the property.

Failing to Provide Accurate Information:

When filing an insurance claim for property damage, it is essential to provide accurate and detailed information about the incident. This includes the date and time of the incident, the cause of the damage, and the extent of the damage. Providing inaccurate or incomplete information could result in delays or denials of the claim. Additionally, it could result in the policyholder being accused of insurance fraud, which could result in legal consequences.

Not Reviewing the Insurance Policy:

Before filing an insurance claim for property damage, it is essential to review the insurance policy to understand the coverage and exclusions. Many policyholders make the mistake of assuming that their insurance policy covers all types of damage, only to realize later that the damage is excluded from the policy. Therefore, it is essential to review the policy and understand the coverage and exclusions before filing the claim.  Your insurance policy is a contract worth hundreds of thousands (sometimes millions) of dollars.  READ IT.

Attempting to Repair the Damage Before Filing the Claim:

Some policyholders make the mistake of attempting to repair the damage before filing the claim. It is essential to notify the insurance company before making any repairs to the property. The insurance company will likely send a claims adjuster to assess the damage and determine the amount of coverage required. Failing to notify the insurance company before making repairs could result in a denied claim, as the insurance company will not have the opportunity to assess the damage.

Failing to Mitigate Further Damage:

When property damage occurs, it is essential to take steps to mitigate further damage. This includes taking steps to prevent water damage or securing the property from further damage. Failing to take steps to mitigate further damage could result in a denied claim, as the insurance company may view the policyholder as negligent in protecting the property.

Not Understanding the Claims Process:

Filing an insurance claim for property damage can be a complicated process. It is essential to understand the claims process and follow the guidelines provided by the insurance company. Failure to understand the claims process could result in delays or denials of the claim.  If you need help with this, contact a licensed public adjuster or attorney for advice or assistance.

Not Following Up on the Claim:

After filing an insurance claim for property damage, it is essential to follow up with the insurance company regularly. This includes following up on the status of the claim and providing any additional documentation required. 

Not Seeking Assistance from Unbiased Sources:

When you find your insurance provider putting more effort into denying your claim than paying it or you feel that you are getting unfair resistance or treatment, consult a licensed public adjuster or an attorney to assist you.

Do You Become the Enemy When You File an Insurance Claim?

June 19, 2021 By in Home Owner Insurance Issues Tags: , , , 1 Comment

Enemy for filing a claim

   “I have paid my premiums on time for twenty years and have never filed a claim.  Now, it is difficult for me to tell who has caused me more damage — the storm or my insurance carrier.”

     The above exclamation, or words like it, is something that I hear daily from Missourians who have had the misfortune of needing to file an insurance claim for damage to their homes and businesses.  Do you really become “the enemy” of your insurance carrier when you file a claim?  Do they really consider you more as an adversary than a customer?  

     I received an email today from an attorney representing an insurance carrier from out of state and who sells insurance policies in Missouri who provided a clear and convincing answer to those questions.

     My client, a commercial business, had incurred extensive and obvious hail damage to multiple buildings and filed an insurance claim.  Their insurance company hired an independent adjustment firm to inspect the damage who reported their observations to the carrier.  The carrier, after receiving their report and photographs, decided to hire an engineer who regularly assists insurance carriers in denying coverage for hail damage to properties in Missouri.

     With the hail damage being as obvious as it was, there was no legitimate reason to have an engineer look at the same dents, gouges, and tears that their independent adjuster had just seen and photographed.  I suspected that the independent adjuster had recommended that the claim be paid against the carrier’s wishes, and I requested a copy of his report.  Insurance companies will share their reports when their report supports a claim denial.  For some reason, the carrier did not want to share this one and I was suspicious of their intention.

     When I submitted a formal written request for a copy of the report from their independent adjuster that I believed supported my client’s claim for damages, I received a letter from the carrier’s attorney in response that confirmed my suspicions.  In part, it read as follows:

     “Under Missouri law, the relationship between an insured and the insurer with regard to first-party claims becomes adversarial when a claim is made on the policy.  Therefore, the insurer is entitled to assert work product privileges to prevent access to materials found in the claim or investigative file.”

     Because my client had filed a claim, he became an “adversary” to his insurance carrier and was not entitled to see documents in his file that might support his claim.  In return for his annual premiums exceeding $80,000.00 per year, this is what his money bought for him.  An adversarial relationship.

     Of course, we’re suing.  Soon, that report and all the other documents in the file will be in the hands of his attorney.  He will recover all the money owed to him by his insurance carrier along with (most likely) punitive damages and his attorney fees.  He is, indeed, an “adversary” to his insurance company – but not because he filed a claim.  Rather, it was the insurance carrier that decided to vexatiously withhold money that was due to him under his contract rather than to pay him what he was entitled to.  That action taken by them, and not their claim, is what made him an adversary … and a worthy one, at that.

“My Contractor Says My Roof is Shot but My Insurance Company Won’t Pay”

June 14, 2021 By in Home Owner Insurance Issues, Home Repairs, Property Insurance Leave a comment

   

Reporting damage and hoping for the best.

 

     I will get at least one phone call this week, as I do every week, from someone who is upset with their insurance company for denying their claim for a “leaky roof”.  It usually goes something like this: “My contractor told me my roof must be replaced.  There is hail damage to it, but my insurance company refuses to pay for it.  I need your help.”   Before they call me – actually, before they call their insurance company and file a claim – there are things they should know.

     The first thing an insured home or business property owner should know is their duty to prove their loss when they file an insurance claim.  Simply reporting damage to their insurance company does not fulfil their duty under the insurance contract to prove they have a covered loss.  Most policyholders are unaware that they have this burden of proof and will merely report damage to their insurance provider and then leave it to the insurance company and their adjuster to prove their claim for them. 

     As one can reasonably expect the effort to prove the policyholder’s claim is not always accomplished to the satisfaction of the insured policyholder, when expecting their insurance company to be zealous in proving that the policyholder is entitled to money.  Instead, they find that the insurance company has sent their adjuster to the damaged property primarily to fulfil their duty under the insurance agreement – the duty they have to prove that an exclusion to coverage under the policy exists and payment should be denied.

     The contractor may have told the policyholder the truth.  The roof might need replacement and there might be hail damage present.  Neither of these two facts, however, sufficiently prove that the loss is covered under the insurance policy.  

     Before filing the claim, the prudent insured property owner will first determine the following:

     1. When did the hail damage occur?  A shingled roof can last twenty to thirty years and, over its lifetime, will be struck by many hailstorms and can be insured over that same period by many different insurance companies.  Which hailstorm is being reported to be the one that caused the damage and what company insured the roof on that date?

     2. How significant is the hail damage?  Roofs will age and incur damage from normal wear and tear, a condition that is excluded under the insurance policy.  Is the hail damage to the roof significant enough by itself to warrant a replacement, or are there only a few selected shingles damaged by hail and the rest of the roof needs replacement for other natural (and non-insurable) reasons?  

     3. Is there evidence of hail damage to exterior surfaces other than the shingles?  While resilient composite shingles are designed to deflect hail strikes to minimize damage, other surfaces are not.  Damaged shingles should also be surrounded by other evidence of hail strikes to soft metals such as appurtenances, gutters, downspouts, fascia, mailboxes, HVAC units, patio furniture, wood deck surfaces, lawn furniture and other surfaces struck by the same hailstorm.  Not only can this additional damage be included as part of the claim, but it will also serve as proof of the severity and (sometimes) the date of the storm. 

     These are a few of the things that one must consider when proving their coverage for a loss to a roof due to hail damage.  There are more, and a good roofing contractor can assist a policyholder in compiling evidence to provide to the insurance carrier that the damage is covered under their insurance policy. 

     Needing a new roof and having a valid insurance claim for damage to an existing roof are not the same thing.  Policyholders who file insurance claims have the duty to prove their covered loss.  The best time to prove it is to themselves before they file the claim so that they may, in turn, prove it to their insurance company when the adjuster arrives.

To prove a covered loss in the manner required for a successful insurance claim is not always easy to do.  When in doubt, consult with a licensed public adjuster.  Don’t get mad … get paid.

Missouri Law and Your Insurance Company

May 16, 2021 By in Home Owner Insurance Issues, Property Insurance Tags: , , , , Leave a comment

Not everything that is unethical is illegal.  There are ways of stepping right up to the line without crossing it and no one can do it better than some insurance companies with their vast financial resources and lobby power at the state government level.

But how far is too far? 

This is how the statute reads …

Universal Citation: MO Rev Stat § 375.1007.

Improper claims practices.

375.1007. Any of the following acts by an insurer, if committed in violation of section 375.1005, constitutes an improper claims practice:

(1) Misrepresenting to claimants and insureds relevant facts or policy provisions relating to coverages at issue;

(2) Failing to acknowledge with reasonable promptness pertinent communications with respect to claims arising under its policies;

(3) Failing to adopt and implement reasonable standards for the prompt investigation and settlement of claims arising under its policies;

(4) Not attempting in good faith to effectuate prompt, fair and equitable settlement of claims submitted in which liability has become reasonably clear;

(5) Compelling insureds or beneficiaries to institute suits to recover amounts due under its policies by offering substantially less than the amounts ultimately recovered in suits brought by them;

(6) Refusing to pay claims without conducting a reasonable investigation;

(7) Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed and communicated to the insurer;

(8) Attempting to settle a claim for less than the amount to which a reasonable person would believe the insured or beneficiary was entitled by reference to written or printed advertising material accompanying or made part of an application;

(9) Attempting to settle claims on the basis of an application which was materially altered without notice to, or knowledge or consent of, the insured;

(10) Making a claims payment to an insured or beneficiary without indicating the coverage under which each payment is being made;

(11) Unreasonably delaying the investigation or payment of claims by requiring both a formal proof of loss form and subsequent verification that would result in duplication of information and verification appearing in the formal proof of loss form;

(12) Failing in the case of claims denial or offers of a compromise settlement to promptly provide a reasonable and accurate explanation of the basis for such actions;

(13) Failing to provide forms necessary to present claims within fifteen calendar days of a request with reasonable explanations regarding their use;

(14) Failing to adopt and implement reasonable standards to assure that the repairs of a repairer owned by or required to be used by the insurer are performed in a workmanlike manner;

(15) Failing to promptly settle claims where liability has become reasonably clear under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.

 

Fighting the Good Fight

May 5, 2021 By in Home Owner Insurance Issues, Property Insurance Tags: , , , , , , Leave a comment
Fighting the good fight

Photo by Pavel Danilyuk on Pexels.com

 

     I recently read a touching and inspiring tribute written by an attorney who advocates for policyholders and who had recently lost a valuable partner and fellow advocate to cancer.  Together, they would fight the good fight. There are not enough fighters like them in this arena, and in his tribute to his partner, he described her drive and enthusiasm for battling with insurance companies on behalf of their clients.

     Being one who shares in the same fight (though not at such grand of a scale), I felt a great sense of personal loss.  Even though I did not know her, personally, I know her heart and I have shared similar pain with the clients who had purchased insurance for peace of mind but found, when disaster came to their door, that this peace was only a temporary illusion.

     Though Missouri law tasks an insurance company to provide prompt and fair assistance to its policyholders in exchange for payment of premiums, minimizing risk, and filing a claim only upon sustaining damage – some insurance companies, to protect their own financial interest, inflict more stress and financial harm upon their policyholders than the destructive event that prompted their claim, and at a time when the policyholder is most vulnerable with the least financial reserve.  Instead of providing the warm professional care and assistance projected by their televised mascots, the policyholder is frequently met with fierce opposition and obstruction intended to exasperate, wear down, and break the resolve of the most committed policyholder defending his own rights under the very insurance policy he bought for “peace of mind”.

     Fighting through a barrage of tactics used by insurance companies to delay, deny, and defend against the policyholder is certainly not an enjoyable experience for either the policyholder or his advocate.  It is, however, something that must be done in order to receive a dollar-for-dollar payment for the incurred loss.  That is the reality that is not shown on friendly and warm television commercials.

     We lost a fighter.  Who will take her place?

 

 

 

 

 

Are the Engineer Reports Purchased By Insurance Companies to Deny Claims Accurate and Truthful?

April 29, 2021 By in Home Owner Insurance Issues, Home Repairs Tags: , , , , , , 4 Comments
engineer report to deny claim

Photo by Pixabay on Pexels.com

     In search of an expert to provide them with a reason to deny a claim, many insurance companies will turn to the engineering profession. 

     There are highly respected and valued professional licensed engineers who design and build bridges and skyscrapers, who safely and efficiently channel waterways through and around large cities, who design and test the durability of aircraft and automobiles, who meet and overcome construction and building challenges around the globe – and then there are those who market themselves to insurance carriers for the purpose of providing written reports for them to use to deny insurance claims for wind and hail damage to homes and businesses.  There is money in it.  Insurance companies will pay them upwards of $2,500.00 per report.  Most of these reports provide little more than boilerplate narratives regarding simple roofing materials and most of them contain little or no scientific or engineering data – but aside from their apparent lack of relevance, how accurate is the information that is provided?

     As a public adjuster representing business and homeowner policyholders with their insurance claims, I read many of these reports and too often find errors, misrepresentations, and ambiguities salted among information intended to present a “scientific” spin on what are usually simple, routine observations that virtually anyone can make.

     Much of what you will find in these reports, sometimes as much as two-thirds or more of the entire report, is a boilerplate filler of generic information that could be (but not always) relevant to their observations.  It looks impressive at first glance, just as it is intended to, but is it even correct?  Not always.

     An engineer in several of his recent reports used by various insurance companies to deny claims includes the following language:  “According to the National Roofing Contractors Association (NRCA), the lifespan of a roof is 20 years.”  His report was peer-reviewed and stamped by another engineer with his firm – an engineering firm widely used by insurance carriers throughout the country. This claim by the engineer caught my attention because he was writing about a certain type of roofing material that carried a 30-year warranty and, as most people familiar with roofing materials know, various roofing materials have various lifespans – some as high as over 50 years.  

     I did not believe that the National Roofing Contractor’s Association would be so uninformed as to publish what he claimed they did, so I wrote to them and inquired as to where I could find the information from them that this engineer was quoting in his report used to support a denial of a cliam.  The Vice President of Technical Services for the NRCA responded to me, as follows:  “The 20-year figure is not from the NRCA.  Lifespans vary greatly.”  Thus, the engineer was not only wrong in his peer-reviewed statement of fact regarding the lifespan of a roof, but he also misrepresented the source for his errant facts.  

     Some engineers will provide comments and conclusions about the density or speed of hailstones as being less than required to damage roofing material and provide absolutely no information as to how they were able to measure the density or speed of the hailstone that melted away months or years before their observation.  We are to simply take their word for it, like the quotations from the NRCA, perhaps.

     The engineer paid by the insurance company might use ambiguous language that appears to say something but doesn’t.  For instance, did the engineer say that large hailstones did not strike your roof, or did he simply say that he did not observe evidence of large hail strikes?  There is a difference.  Could there be evidence that he did not “see”, such as bruised indentations on weathered asphalt composite material that is soft to the touch?  Did he say this, or did he leave it to the insurance company to use in the manner of their own choosing?

     Insurance carriers, being corporations who have a fiduciary duty to protect the financial interests of their shareholders as well as a contractual duty to fulfill their promises to their policyholders, will often find this conflict of interest resulting in their wrongful actions of grossly underpaying or wrongfully denying their policyholders’ claims.   The misuse of engineer reports is one of the ways they do this.

     Often, insurance companies will knowingly allow the engineer’s errant attempts to interject policy interpretations into his report to be used to deny a policyholder’s claim.  I have personally reversed an attempt by an insurer to deny an insurance claim because the engineer reported that the damage to the roof “could not be seen from the ground” when there was nothing in the policy to exclude damage for that reason, as one of many examples.  

     An expert witness in court must present his credentials, provide his testimony under oath, and be subjected to cross-examination, but insurance companies present biased hired guns as experts in the claims process and deprive vulnerable policyholders of necessary funds to restore their homes and businesses, with impunity.

     The advice to not believe everything you read should be extended to engineer reports paid for by your insurance company to deny your insurance claim.  Have them closely reviewed by your own expert for accuracy, relevancy, and truth before accepting that your claim should be denied as a result of an engineer’s report.  Whatever you do, do NOT let the insurance company’s engineer be the final word on the validity of your claim.