Tag Archives: Claims

2016 – Our Most Interesting Claims

December 12, 2016 By in Property Insurance Tags: , , , Leave a comment 







I have handled many different kinds of insurance claims for policyholders. These are some examples of the situations I encountered and the outcomes I achieved. I did not violate any privacy or confidentiality agreements when writing these descriptions. My goal is to inform policyholders of what they can expect from insurance claims and that an alternative exists other than walking away from a denied or underpaid claim. These examples are not meant to imply that similar results are guaranteed. 


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 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 were 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 hailstorm 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.



					

	




				
					



	

		

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

			


	

		March 7, 2015   By   in General Home Issues, Home Repairs, Property Insurance Tags: , , , , 				1 Comment
					


	

		

						
Public adjusters work for the policyholder. No one else.


I am a licensed public adjuster and all 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, insurance agents, 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 (when not prohibited by law) 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 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 policyholder hires the contractor 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, only.


Home destroyed by fire.
Home destroyed by fire.

					

	




				
					



	

		

					
A Broken Water Pipe and the Insurance Claim

			


	

		February 15, 2014   By   in Home Owner Insurance Issues, Home Repairs, mold, Property Insurance Tags: , , 				Leave a comment
					


	

		

						
The recent cold blasts and “polar vortexes” that have made their way south into Missouri this winter have not been kind to some homeowners … 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.
They have a 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 to the home’s structure and 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 house 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 the search for a public adjuster to represent him, he found this blog on the internet and called me for assistance.


In about four weeks, we negotiated a settlement with his insurance company for over $38,000.00, with which he can fully restore his home to its original condition and replace his personal property precisely as promised by his insurance policy.


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