Fraudulent “Engineer” Reports and Your Homeowner’s Insurance Claim – One Public Adjuster’s Opinion

“Plausible deniability” is a strategy used by some insurance companies to escape their contractual duties to their policyholders that leaves little or no evidence of wrongdoing or abuse.  It allows them to hide behind the wrongful acts of someone else that determines, on their behalf, that your claim should not be paid.

How might this be done?

Let’s say that wind or hail has damaged your roof and you have consulted with a trusted roofing contractor before filing your insurance claim who has confirmed the damage.  Your roofing contractor might have decades of practical experience and training working for a century-old roofing company, spending thousands of hours per year inspecting and repairing damaged roofs exactly like yours.  He may have worked with identical materials as those on your roof hundreds of times with countless numbers of expert repairs or replacements provided to hundreds of satisfied homeowners who had hail or wind damage identical to yours … but your insurance company decides to bring in their “expert” to look at your roof, instead.

Your insurance company’s “expert” might be a licensed engineer who has never installed or supervised the installation or repair of a single roof.  His specialty before becoming employed by the “engineering company” he now works for may have been geotechnical, water resources, electronics, or any other of the numerous variety of engineering specialties that have nothing at all to do with building materials.  His brief training program provided by his company may be the only credential he has earned to be an “expert” in the area that he has been called upon to inspect for your claim — and is likely to have seen fewer storm damaged roofs in a year than your contractor has seen in a month.

In this example, the “expert” provides an “engineering report” that contradicts the finding of your experienced roofing contractor and your insurance company concludes … based upon the opinion of their hired gun … that the hail damage reported to you by your experienced contractor is not really hail damage and your claim is denied.

Many of these “engineering” companies that employ licensed engineers to provide reports to insurance companies do not provide any other service. Writing these reports for insurance companies is their major (or only) source of income.  Sometimes, as reported by the television news program “60 Minutes” (click here), the company’s managers may even change the language in the engineer’s original report to benefit an insurance company at the expense of the homeowner.  The financial incentive (usually $1,500 to $2,500 per report) for future repeated business is what will often drive some of them to find creative ways to determine that your hail damage is not really hail damage, that structural damage is not really structural damage, and so on.

As most public adjusters know from the numerous “engineering reports” that we read and discuss with insurance companies, many are simple boilerplates with only the beginning and ending pages unique to the applicable home and lack merit or fact that would actually support a denial of an insurance claim. Unfortunately, most policyholders do not have the advantage of reading enough of these “engineering reports” to recognize the errors, omissions, and duplications contained within them and, accordingly, will mistakenly believe that the report cannot be refuted.

A report that I received from one of these companies today specified how the insurance company’s expert closely examined the “clay tiles” that were chipped and found the damage to be attributed to something other than hail. He then provided a lengthy and generic boilerplate description of how “clay tiles” are made and the scientific studies of the effects of hail that strikes them.  What the expert that wrote the report failed to observe was the fact that the roof was covered with eighty year old concrete tiles, and not clay tiles.  The homeowner’s experienced contractor knew the difference but the insurance company’s expert obviously didn’t. (If you are not familiar with the difference between the properties of clay and concrete tile, more information is available by clicking here. Now, you know more than a certain insurance company’s expert.)

One “engineer” report for a client that was used to deny an insurance claim for a church with a wind damaged roof incorrectly described a tongue-in-groove roof covering as plywood sheathing, identified the wrong date (and the wrong windstorm) when he incorrectly reported low wind speeds, and failed to identify and record the fact that the steeple had been lifted and moved by the wind. This report was written by an engineer from a company commonly used by insurance companies in several states to support their claim denials.  Whether his errors and omissions were caused by his negligence or bias is not important since his licensing board prohibits both.

While some state departments of insurance may not find such activities to be within their jurisdiction, there are sometimes other departments within state government that are able to act to preserve the integrity of the engineering profession and, in turn, protect the public from licensed engineers who are acting in an incompetent or biased manner.

Licensed professional engineers are accountable to the state departments that issue their licenses.  Accordingly, policyholders that believe they are victims of an improper relationship between their insurance company and an “engineering company” have recourse through the state department that licenses the engineer that wrote the incorrect and/or biased report.

Formal complaints from homeowners that have merit will be investigated by the licensing board, and the competency and integrity of the licensed engineer that wrote the report will be evaluated by the board that issued his or her license. Engineers who write reports that contain incorrect, partial, or biased information will have to justify their actions (if they can) to their respective licensing boards that monitor and enforce competency and impartiality. Their actions, if found to be due to incompetence or partiality, could result in sanctions up to and including fines and forfeiture of their licenses and these findings can be used by homeowners to address their denial or underpayment through the proper channels available to them … through their policies or judicial means.

Enough enforcement actions taken against licensed engineers that participate in the practice of routinely providing insurance companies with “plausible deniability” for their refusal to pay legitimate claims could effectively reduce this threat to policyholders seeking to be indemnified for their losses.

[Note:  Policyholders should also take care to ensure that the “engineer report” was actually written by a licensed engineer.  In some cases, these damage inspections are conducted by “consultants” and “home inspectors” who are not licensed engineers.  The reports that they compose are subsequently sent to engineers to sign and affix their seal before forwarding them to an insurance company for their use. When you find the inevitable errors or omissions in these reports and report them to the insurance company, be certain that the insurance company is not addressing these errors with advice from the consultant instead of the engineer.]

2016 – Our Most Interesting Claims

(From our many claims of 2016, the following are the more interesting.)

Hail Damage to a Commercial Building — An insurance agent sold himself a policy for a commercial structure that he personally owned and that was subsequently damaged in a violent storm of high wind and softball sized hail. He filed a claim and the insurance company’s adjuster inspected his loss, applied his deductible, and wrote him a check for only $127.

The understandably shocked insurance agent attempted to negotiate a fair settlement for his loss on his own but could not get cooperation from the adjuster or his claims department. Eventually, the carrier’s claims department stopped responding to the calls from the agent and from his contractor.  After several weeks of frustration and lack of progress, he contacted me and hired me to assist him with his claim.

After three weeks of negotiating with the insurance company and revisiting the property with a different adjuster, the insurance company agreed to settle for a little over $111,000.00.

You read that right.  After originally valuing the loss at only $127.00 over the deductible, the insurance company agreed to the existence of extensive hail damage and paid more than $111,000.00 to restore the damaged property.

If being lowballed on an insurance claim can happen to an insurance agent, it can certainly happen to you.

[The agent now sells insurance for a different insurance company.]

 

Water Damage — After finishing their morning routine and leaving their home for work, the policyholder and his family were unaware that a water supply line in their bathroom had broken. When they returned home at the end of the day, there was more than two inches of water covering several thousand square feet of floor space and wicking up the walls. The insurance company’s adjuster did not convince the policyholder that he was making a fair assessment of the damage and I was invited to assist with the claim.

The initial calculation to address the damage to the structure that was provided by the insurance company’s first adjuster was $24,763.83.  After a few weeks of negotiations, we agreed to settle for the full cost of repairing the damage to the structure … which came to $69,764.94.

 

Hail Damage to a Personal Dwelling — The concrete and asbestos roof tiles were destroyed by a hail storm and water entered the interior walls of the home. The insurance company offered $28,000.00 to replace the roof and repair the interior … but the homeowner could not find a contractor willing to do the work for that price.

One of her contractors referred the homeowner to me to communicate with the insurance company on their behalf. In a shorter period of time than it took the policyholder to negotiate a $28,000.00 offer, I negotiated a settlement for $98,000.00 and she immediately hired a contractor to restore her home to its original condition prior to the storm.

 

Hail Damage to a Commercial Building — When the claim was first filed by my client, the insurance company said that there was no hail damage to the slate roof. After an inspection by someone the carrier identified as an “engineer” (who wasn’t), the insurance company agreed to pay only $61,000.00 for a partial repair to the damaged roof.

Refusing to back down after our negotiations were stalled by the insurance company, we took the claim to appraisal and prevailed with an award of over $130,000.00 to replace the slate roof.

Painting Your Home

Doing regular maintenance on your home is important for keeping things in working order, as well as keeping up physical appearances. Applying a new paint job is a great way to kick off that long list of repairs. Old or damaged paint can leave your home looking outdated and neglected. Start off your home maintenance projects with a fresh paint job for each room in your house.

Living Room

The living room is usually the main room of a home. It is often the room we relax, entertain, and well, live. The paint type you use will depend on whether your living room is formal or informal. An elegant matte or eggshell finish would work best in a formal room. These finishes are also best for painting the ceiling. Matte and eggshell have a soft sheen and can be washed without being damaged.

If the room is an informal space, a satin or semi-gloss paint may be the best choice. These finishes are best for homes with small children as they are durable and more stain resistant than matte or eggshell paint.

Bedrooms

A wide variety of finishes can be used in the bedroom. Which one is right for you will depend on the use of the room. High traffic rooms, such as a small child’s room, should be painted with a semi-gloss, satin or eggshell finish. These are the easiest to clean and are the most durable.

An adult bedroom that is used mainly for sleeping would not require a high traffic finish. A matte or flat paint would work great in a master or guest bedroom. These types of finishes are best for older or imperfect walls for their ability to mask flaws. They’re also best for rooms that get a lot of sunlight as they won’t reflect the way satin or semi-gloss will.

Bathrooms

Bathrooms are unique in that they experience high traffic, temperature changes and lots of humidity. The paint in this room should be resistant to stains, moisture, mold, and mildew. A semi-gloss paint would be the best option for bathrooms. This finish can be scrubbed clean without damaging the surface making cleaning and disinfecting easy and safe for the integrity of the finish.

Kitchen

Kitchen walls suffer from a lot of the same abuse that bathroom walls do. Food splatters and steam from cooking can wear on your paint. Like the bathroom, a semi-gloss finish works best for the high traffic area. The walls will most likely need to be cleaned and wiped down frequently and the semi-gloss is durable enough to withstand the constant cleaning.

The color of paint you choose for each of these rooms will depend on the feel you want to convey in the room. Shades of brown, red and rust orange can be used to create a warm or rustic ambiance. Shades of white or blue can be used to make the room feel clean and bright. Black, grays, and whites work well for making the room feel modern and contemporary. A light color on the ceiling can be used to contrast dark walls. Additionally, a dark color can be used for a tall ceiling.

A fresh paint job with the proper type of finish can make a room look new and well-maintained. Your list of home repairs and maintenance might be overwhelming, but repainting your home doesn’t have to be. Use the information you’ve gained here to conquer this home improvement project. With the correct finish and color paint your home will feel like a brand new place.

This article was donated by Jon Reyes from Clearwells. Jon has been writing articles for over 10 years and is a commanding voice in the community with his articles high in demand.

 

Overhead and Profit … Another Way to Lose It.

 

Duaban Roof Inspection 087

About a third of my business comes to me in the form of referrals from contractors who have customers with property damage and insurance companies that are unwilling to pay what is necessary to restore the damaged property to its condition prior to the damaging event.

Recently, I received a call from a frustrated general contractor who explained that his customer’s insurance company was refusing to pay him overhead and profit for replacing a roof.  He told me that his original bid for interior water damage to the home did not include damage to the the roof,  and that the roof was added to his scope of work after the damage had been discovered by the insurance company’s adjuster.

When he subsequently contracted with the policyholder to replace the roof (in addition to the interior), he made the common mistake of agreeing to accept “what the insurance company agreed to pay” as his fee.

Overhead and profit was included with his contract for the interior and the insurance company agreed to pay him for it, but refused to pay overhead and profit for the roof.  He felt that this was improper and asked for my assistance with the claim.

I didn’t have very good news for him.

First, I explained that public adjusters represent policyholders and not their contractors.  Accordingly, if I were hired by his customer to assist him in getting all of the money that he is entitled to recover under his policy for the damage to the home, one of the many things I have to do is prove that the policyholder has incurred certain costs.

In this case, since the policyholder had signed a contract with a general contractor to have his roof replaced for “what the insurance company agreed to pay“, the policyholder was not incurring the additional costs of overhead and profit and could not claim them.  His insurance company has no obligation to pay him more than what he is being charged to address the covered damages.

In my opinion, a better procedure for the contractor would have been to provide an amendment to his bid that included the roof replacement and all associated costs, including overhead and profit.  His client could then show the insurance company what he was being billed by his contractor of choice.  At that point, the insurance company would be able to address the total cost of roof replacement incurred by their policyholder and chose whether or not to comply with the terms of their policy.  Under those conditions, refusal by the insurance company to pay for an incurred expense (such as overhead and profit) could be addressed much differently.

Contractors who agree to charge “what the insurance company agrees to pay” must accept the fact that they have allowed the insurance company … not the market … to set their fee for them.  They will certainly not be collecting more than what they charge.

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.

 

Total Loss of Contents versus Total Content Coverage. What Will I Be Paid?

In this example, let us say that your home is insured for $500,000.00 and your personal contents are insured for $100,000.00 and a fire has totally destroyed the building and its contents, reducing 100% of everything to a smoldering pile of ashes.  What was not destroyed by flame and smoke was finished off by the water from the hoses that extinguished the blaze.

In Missouri, you can expect to be paid the full value of your policy coverage for the building which is, in this case, a total cash amount of $500,000.00.  Personal contents, on the other hand, is totally different story.

Unfortunately for many policy holders, it will not be until after a catastrophic loss that they will learn that a total loss of their contents does NOT necessarily result in being paid the full amount for which they insured their contents.

You will be required to provide a complete inventory of every item in the house, along with the age and replacement cost for each item.  Every piece of furniture, item of clothing, dish, bar of soap, box of band aids, cotton ball, grocery item, jewelry item, tool, and content items claimed must be recorded by kind and quantify.

You will likely overlook many items that do not immediately come to mind as you put your list together from memory and the dollar value of what you can remember may be considerably less than the full amount that you insured your contents for.

After your inventory has been compiled, your insurer will take several weeks to review your list and depreciate each individual item by its age, and will award an amount equal to replacement cost for your contents – – – minus the amount of its depreciation.

Assuming you are able to remember everything you own, are able to prepare an inventory from memory, and find that it will cost $100,000.00 to replace these items, you will still only be paid the cost to replace them after subtracting for depreciation.  Some items can depreciate from 25% to 50% per year, depending the formula used by the insurance company.

Even if you have a full replacement policy that pays the full replacement cost for each content item lost, the first payment to you will be the depreciated value of the claimed content items and – after you purchase a replacement and provide a receipt proving that you paid to replace the item – you will receive a second check for the balance between what you were originally awarded and the actual price you paid to replace it.

Today … before the fire, tornado, or flood … is the time for you to begin to document the contents of your home.  Use photographs or video as you open every drawer, look at every shelf in the closet, through every box in the basement, every cabinet in the kitchen and garage, and so on.  Store this written, photographed or video recorded inventory somewhere other than inside your home so that it will be accessible after your loss.

Even though your contents are insured, it will still be your burden to prove that they were present and what they were worth.  Following a catastrophic and traumatic loss that destroys everything you own, your ability to recall these details is likely to be extremely impaired.

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 Executive Pleads Fifth Over Altered Engineer Reports

How widespread is this practice?  How long has it been going on?  How many improper denials of coverage have been based upon bogus reports?

I think insured home and business owners should monitor these developments very closely.

http://www.propertyinsurancecoveragelaw.com/2015/02/articles/hurricane-sandy-1/insurance-executive-pleads-fifth-over-altered-reports-during-superstorm-sandy-hearing/#%2EVOepK55-2Vw%2Elinkedin

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.

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