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 policyholder 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 hailstorm – 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 policyholder 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 policyholder 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 policyholder 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 policyholder 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 policyholder 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 policyholders. 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 a totally different story.

Unfortunately for many policyholders, 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 on 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 policyholders 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 policyholders 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 homeowner to hire a public adjuster for assistance.

I have received many referrals from building contractors and have assisted the policyholders 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 policyholder, a win for the contractor, and a win for an insurance company who operates in good faith.

Likewise, policyholders 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 policyholder, 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 policyholder 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 policyholder in negotiating his contract with me and discussing the claim with me, but I refused and communicated directly with the policyholder.  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 policyholder to hire me, was to get the homeowner this extra sum for this unnecessary work so that he could pay it to the contractor.  I refused to do this and advised the policyholder 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 policyholder and his insurance company, and the only acceptable resolution to an insurance claim is a 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 policyholder 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 policyholders achieve fair settlements so that they can be paid in full for their valuable services; however, when the policyholder and I agree to work together on his claim, I represent the policyholder 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 policyholder six months before which totally excluded hail damage to soft metals that did not result in leaks.  He told the policyholder 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 policyholder will be made whole and the contractor will be able to serve another homeowner 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.

Mesothelioma Treatment Information for Homeowners

As a cancer survivor, I have learned to appreciate how valuable the tool of reliable information about the various forms of cancer, treatment and support can be.

The following is an excerpt from a recent email that I received:

“As you know, the primary victims of Asbestos exposure and Mesothelioma include veterans, emergency personnel, firemen, mechanics, and even homeowners. By providing a live chat option (the only mesothelioma/asbestos website that offers a live chat 24/7), Q & A sessions, survivor blog posts, and an annual $10,000 scholarship, MesotheliomaHelp.org strives to make a powerful impact on our community. The viewers of your website are one of MesotheliomaHelp.org’s main targets!

“I think the missouripublicadjuster.org viewers would really appreciate having access to these valuable resources. Would you mind posting the MesotheliomaHelp.org link?”

Here is that link:  www.mesotheliomahelp.org/treatment/

 

What A Public Adjuster Does for You (Video)

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

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

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

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

Take Heed with Your Financial Records

 

Think of a family as a mini-business. Families plan, save, buy, and invest just like most businesses. For this reason, maintaining the proper family records is just as important as keeping business records is. Saving these records for the proper amount of time is an integral part of this whole process. The following tips are good rules of thumb to follow concerning your family and financial records.

  • Essential personal and family records such as birth, marriage, and death certificates should be permanently stored, preferably in a safe deposit box. The same rule applies to passports and original Social Security cards. Backup electronic copies via scanning should also be maintained.
  • Vital property records, such as real property deeds, burial lot deeds, and motor vehicle titles, should also be permanently stored in a safe deposit box.
  • An inventory of household goods and appraisals should be stored in a safe deposit box or electronically with backups. Photographs or videos of valuable personal property should also be maintained and safeguarded.
  • Insurance policies should be kept a minimum of 7 years in a home file. A list of all current insurance policies and policy numbers should be maintained in the safe deposit box or electronically with backups in the event of a house fire.
  • Auto service records should be retained in a home file for the duration of the ownership of the vehicle. These records may be helpful when selling the vehicle later.
  • Copies of canceled checks for non-tax-deductible expenditures should be stored in a home file or electronically for 3 years. Receipts and records of deductible expenses should be stored in a fireproof home file or electronically for 6 years.
  • Copies of past tax returns should be kept a minimum of 6 years (15 years is best).

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

Copyright 2014
International Risk Management Institute, Inc.

%d bloggers like this: