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.

Insurance Adjuster and Engineer Make a $69,000 Mistake at Policy Holder’s Expense

An expensive slate roof with copper flashing was severely damaged by hail.  The insurance company’s adjuster and his contracted engineering company agreed that it was damaged by hail … but still refused to pay for the repair.

The insurance company’s adjuster referred to a paragraph written on the third page of a letter that had been sent to the policy holder six months before which totally excluded hail damage to soft metals that did not result in leaks.  He told the policy holder that the vast majority of the $69,000 (plus) damage to his roof would have to be paid at his own expense.

The policy holder’s roofing contractor referred him to me for assistance with his claim.

My close examination of the policy, the letter and the engineer’s report (in addition to localized weather reports) revealed that the exclusion the adjuster used to deny coverage did not take effect until four weeks after the hail storm. Accordingly, his denial of the claim was improper and he owed the insured for the damages.

When I brought this to their attention,  the insurance company reluctantly acknowledged their duty to pay.  The policy holder will be made whole and the contractor will be able to serve another home owner in need of his services.

“No” is not always the final answer.  Have a licensed public adjuster review your claim before walking away from your money.

Filing a Claim Turns This Homeowner Into His Insurance Company’s Adversary

After we have wrapped up negotiations with their insurance company I will often ask my clients to provide me with a few words describing their experience.  Today I was gifted with more than just a testimonial and recommendation … but an education.  I thought I would pass it on.
After a few hours of being away from the house running errands we arrived home to find water POURING out of the ceiling of the main floor of our house, only to find out that a water pipe had burst on the 3rd floor of the house which resulted in flooding all 3 levels of our house! Since I had never filed an insurance claim before, I was under the impression that the insurance company was on my side, therefore would take care of the damage on the property I had been paying them to insure…after all, this was MY insurance company, right? I soon found out just how wrong I was!!  
 
The insurance company’s adjuster came out about a week after the pipe burst, and inspected the damage to the house, then we anxiously awaited his figures so we could begin the work and get our family moved back into our home.  We were shocked at that point to find out that the insurance company only wanted to pay us $11,000 to fix all 3 stories of our flooded home!!  I immediately called my agent for help, and despite his good intentions, I quickly discovered that no matter how well you know your agent, and how good you think they are, they have absolutely no pull with the large insurance company.  It was at this point that I knew the insurance company had no interest in helping me, and realized I would have to help myself, so I began searching the internet for options to help with insurance claims.
 
When I began doing research online for help with my insurance claim, I discovered the profession of a “Public Adjuster”, which I had never heard of before. I found a few different companies online, and began calling around, as I wanted to ensure I found someone that was reliable. I was not impressed with the large companies that covered the entire US, as they just treated you like another number…I did not feel that they would provide the personal level of service that I was looking for to address this major event that I had going on. I then called Mr. Bushart, who personally answered the phone, listened to all of the problems I had, then explained how he could possibly help me. By the time I got off of the first call with him I was very relieved…I finally had found help!! 
 
I have to admit though, at first I was leery of committing to pay the fee a public adjustor charged, so I thought about it for about a week before I committed to hiring Mr. Bushart, but in the end, I would have been more than happy to pay him twice as much as he charged. Not only due to the eventual insurance payout of nearly quadruple their initial estimate, but more importantly because of the personal level of service he provided. He actually made two 9 hour roundtrips to my house…first to view the damage, which I expected, but then he came back the second time when the insurance company sent their adjuster back out to address the discrepancies between their adjuster’s estimate, and Mr. Bushart’s estimate. I was very glad that he did make it back the second time…it was worth every penny I paid to be able sit there and watch Mr. Bushart use his vast knowledge to shoot down the insurance company’s arrogant adjuster!   
 
I hope to never have to go through another insurance claim again, but if I do, I will call Mr. Bushart in on Day #1!
Andrew Kestner, Dexter, MO
I am very grateful to Andrew for helping me to better understand what it is like to be in his shoes during such a tumultuous time in his life and how he came to hire me.
He added:
Sorry it took so long to get this to you, but here is my story, feel free to take any or all of it to put on your website…I had trouble condensing it into a couple of sentences.  Also, don’t ever hesitate to give any of your potential clients my phone number if they have any questions about how great your service is!
 

A Broken Water Pipe and the Insurance Claim

The recent cold blasts and “polar vortexes” that have made their way south into Missouri this winter have not been kind to some home owners … particularly  a recent client who had the misfortune of having a bathroom water pipe burst on the second floor of his home.

Broken water pipe on the level above.

Broken water pipe on the level above.

For an undetermined number of hours, water cascaded from the second floor bathroom, then through the ceiling of the first floor master bedroom, and then soon created a path into the finished basement and game room.  The damage was significant … not only to the structure of the home but also to the furnishings, clothing, pool table and electronic equipment that found itself underwater for hours before being discovered.

He called his insurance company who, in turn, hired a local “independent adjuster” who came to the home to assess the damage and determined that the insurance company would agree to pay approximately $11,000.00 to cover the loss of personal property and restore the home to its original condition.   Having recently spent much more than this to install the destroyed wooden floors and finish his basement the previous summer — my client was offended by his insurance company’s apparent disregard for his condition and  was understandably upset.

In search for a public adjuster to represent him, he found this blog on the internet and called me for assistance.

In a little more than four weeks, we were able to negotiate a settlement with his insurance company for over $38,000.00 with which he will be able to fully restore his home back to its original condition and replace his personal property exactly as promised by his insurance policy.

Most states now license public adjusters to assist home owners and business owners with their property claims.  Help is available.  All you need to do is ask.

New York Joins Missouri in Forbidding Contractors from Representing Home Owners with Insurance Claims

There is a new law in New York to protect home owners.

“There’s a firewall that will help homeowners after their house is consumed by flames.

“A new state law mandates a legal separation between public insurance adjusters and the contractors they recommend to victims of house fires.

“The measure, intended to protect fire victims from two-timing insurance scammers, was borne of a series of complaints filed against a City Island business that was operating as both public adjuster and contractor.”

Read more: http://www.nydailynews.com/new-york/bronx/new-firewall-protects-homeowners-insurance-scams-article-1.1564929#ixzz2pJ34d8e3

Missouri House Bill 1086 — New Restrictions Concerning Contractors and Insurance Claims

A proposed revision to Missouri law will further restrict Missouri contractors from being involved in residential and commercial insurance claims.

“A [residential] contractor shall not represent or negotiate, or offer or advertise to represent or negotiate, on behalf of an owner or possessor of [residential] real estate on any insurance claim in connection with the repair or replacement of roof systems, or the performance of any other exterior repair, replacement, construction, or reconstruction work.”

http://www.house.mo.gov/billtracking/bills141/biltxt/intro/HB1086I.htm

Read more:  Should your contractor represent your interests regarding your insurance 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.

 

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