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!
 

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?

 

You Will Know When You Need a Public Adjuster

Being a state licensed public adjuster provides me with an opportunity to read lots of articles and advertisements written by other public adjusters for public consumption.  With only a very few exceptions, I have found what I have read to be informative and valuable and  I am grateful to all who have taken the time to share their knowledge and expertise.

Many of these articles are written by financial and insurance experts and are directed toward insured home owners, intended to assist them in identifying when they need to call upon a public adjuster for assistance with their insurance claim.  Since many insured home and business owners are learning that such a person as a public adjuster even exists at the time they are reading the article it is natural for them to inquire more about what a public adjuster does in the first place.

Simply stated, a public adjuster is a licensed professional who will represent you to your insurance company in settling a first-party insurance claim for damage to your home or business.  Your choices in settling your insurance claim are (1) to do everything yourself, (2) hire an attorney to handle your insurance claim, or (3) hire a licensed public adjuster to handle your insurance claim.

The potential for a large insurance settlement can attract the attention of lawyers and public adjusters who may come directly to you when they learn of your financial loss.  Personal injury lawyers may call or leave phone messages when learning of an accident or injury and, likewise, some public adjusters may approach the home or business owner in person or by phone at the time of the fire, storm or other peril causing damage to the home or business.

Do you always need to hire a public adjuster to assist you?  No.  Not always.

Sometimes, the claim for damage may meet or exceed the total coverage of the policy.  The structure that is destroyed may have been insured for $100,000 and, being totally destroyed, the insurer has agreed to pay the maximum covered amount of $100,000. Hiring and paying an attorney or public adjuster to assist in this matter would be more of an expense than a benefit.

But insurance companies make money from collecting premiums … not by paying claims … and the process of recovering all of the money that an insured home or business owner is entitled to is not designed to be easy or prompt.  “Lowball” offers, delays and denials, and challenges that need to be defended are often introduced into the mix at the worst possible time for the damaged home or business owner.  Having an advocate to assist you through the process and who works for younot the insurance company … can be of great benefit.

When you find that you are faced with a difficult and cumbersome process or feel overwhelmed by the task of proving your loss to a skeptical insurance adjuster … you don’t have to face it alone.

When you find, as many do, that the insurance policy that you have faithfully maintained has failed to live up to your needs or expectations at the time you actually need it the most … you don’t have to face it alone.

When you find that you are being provided unacceptable “lowball” offers to cover your loss but are not confident in your own abilities to adequately negotiate a higher settlement … help is available.

I am not one of the public adjusters who will be contacting you at the time of the theft, vandalism, fire, storm or other peril. Instead, I wait until I am contacted by insured home and business owners who know, on their own, that they can use my help with their claim.

I am not paid anything until my client is paid and there is no cost to anyone who wishes to consult with me about their claim to see if I can help them.  Before you consider hiring me, you may contact others who have been assisted by me with their insurance claims and ask them about their experiences.

You will know when you need a public adjuster to assist you with your Missouri home or business insurance claim, and when you decide that you do, please call me at 314-803-2167 or email me at jbushart@publicadjustermissouri.com .

Lowballing an Insurance Claim

Lowballing is a negotiating tactic used by some insurance claims adjusters by which the adjuster knowingly offers far less than the merits of the claim warrants.  Lowballing is effective.  It forces many insured home owners to accept settlements that may be lower than their claims deserve.

The insurance claims adjuster’s purpose is to perform the insurance company’s promises under the insurance policy.  He has an ethical obligation to pay covered claims.  Lowballing is unethical and wrong.  An insurance adjuster who engages in lowballing is ultimately refusing to settle covered claims.

Many insured home owners are unaware that they have the option to re-open closed claims which they feel were underpaid or wrongfully denied.  Public adjusters can be helpful toward that end.  Consult with a public adjuster when you feel that your claim was underpaid or wrongfully denied.

In Missouri, I provide free consultations to insured home owners who feel that they may be entitled to more than what they were paid for their claim.  Call me at 314-803-2167.

 

Should Your Contractor Negotiate Your Insurance Claim for You?

(Words in this article that are underlined are links that will open up other pages that are relevant to this article. While this post contains links and references to legislative actions concerning this topic, it is not intended to be nor should it be considered as “legal advice”. Policyholders and contractors wanting to know how this information may or may not apply directly to them should consult with a licensed attorney.)

I have been asked … “Should my Missouri contractor, who is doing the work on my home, negotiate my property claim with my insurance company on my behalf?”

 The answer is a simple “No”. 

First,  your insurance company has no duty to your contractor as it pertains to your claim for damages.  While the insurance company cannot refuse to negotiate in good faith with you or with your licensed public adjuster hired to represent you — they have no duty at all to negotiate with anyone else.  Instead, they are free to ignore your contractor or to present him with whatever “take it or leave it” proposal they care to make.  Your contractor’s arrangement is with you and NOT your insurance company.  

It is important to you to know that just because the insurance company said “no” to your roofer or other contractor — it does not mean that they can or will say the same to you, or to someone who is licensed to represent you.

You may negotiate your own claim with the insurance company or you may hire an attorney or a licensed public adjuster to negotiate with the insurance company on your behalf.  No one other than yourself, your lawyer or your licensed public adjuster can represent you to your insurance company regarding your insurance claim (click “here” for Missouri reference).  

Additionally, in Missouri 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.  Any violation of this section by a residential contractor shall be considered an unfair practice pursuant to the Missouri merchandising practices act. (Click “here” for Missouri rules regarding this prohibition).

The discussions that take place between a contractor and your insurance company is a process where the insurance company is addressing their financial interests and the contractor is addressing his financial interests.  The property owner’s interests are not a part of the negotiation since the contractor working on your home cannot represent anyone but himself.

Sometimes, contractors who repair or remodel homes will become licensed public adjusters.  In Missouri and many other states, if your contractor is a licensed public adjuster, he is prohibited from contracting to provide repair or remodeling services regarding the damages associated with a claim he is negotiating.  If your contractor is not a licensed public adjuster, he is prohibited from negotiating your claim on your behalf with the insurance company without a license to do so.   

On certain rare occasions, some contractors will misrepresent themselves as being public adjusters and offer to negotiate their work with the insurance company when they, in fact, are not licensed.  This is not compliant with most state rules, can adversely affect the home owner’s rights under their insurance policy and can sometimes result in the contractor’s arrest.  Always ask anyone representing themselves as a public adjuster to show you the license that was issued to them by the state.  They should be able to present it, immediately, upon your request.

Any “negotiating” that a contractor may be doing is only in regard to the specific matter of his work on your home which, frankly, is something that he should probably be negotiating with YOU … not your insurance company.  Negotiations and compromises concerning the choices of materials and methods of completing the work, which can affect the cost of a project, should be decisions made by the home owner and NOT his insurance company.

Again, it is also important to understand that, just because the insurance company said “no” to your particular contractor, it does not necessarily mean that “no” is the final answer.

Sometimes the insurance company’s adjuster, who represents the best interests of the insurance company (and NOT those of the property owner), will “estimate” the costs of repair and may recommend contractors willing to comply with their “estimates”.  Such contractors may erroneously consider themselves working for the insurance company under those circumstances, and answerable to them instead of to the property owner – and sometimes without regard for the home owner’s expectations or satisfaction. 

In my opinion, a property owner should be selecting a contractor based upon ability, experience and reputation to restore the property to its original condition.  The contractor should be accountable only to the property owner for decisions affecting the project – and the insurance company should be paying the amounts necessary for restoring that property, as provided for under the insurance contract (aka “policy”).

When their client has difficulty with the insurance company concerning restoration issues, contractors  should consider referring a licensed public adjuster to assist the property owner with the claim.  

This article contains opinions of the author and is not, nor should it be construed, as legal advice.  For professional legal advice concerning the use of a contractor to represent an insured home owner with an insurance claim, the reader is advised to consult with a licensed legal professional.

Copyright 2013 James H. Bushart

www.publicadjustermissouri.com

Sinkholes Abundant in Missouri

 nixa sink hole

A recent article written by Jose Rey (SinkholeReport.com), identifies Missouri as No. 7 in the United States as having the most sinkholes.

According to the article, the states with the most sinkholes are Florida, Texas, Alabama, Missouri, Kentucky, Tennessee and Pennsylvania.

 

www.publicadjustermissouri.com

Missouri Home Owner’s Policy – Changes to Your Deductible

Many insured Missouri home owners are caught off-guard, at the time they file a claim and can afford it the least, when they discover that their “deductible” has increased to several thousands of dollars.  (The policy’s “deductible” is a dollar amount that is automatically subtracted by the insurance company from any amount that is owed, per occurrence, to the insured as a result of damage or loss to the home.)

When many home owners first insured their homes, their policies originally had a $500.00 deductible that eventually changed to $1,000.  Now, with recent renewals, insurance companies have begun to assign a deductible amount that represents a percentage of the total value of the policy.  By this, if a home is insured for $300,000, a 1% deductible allows for each claim to carry a deductible amount of $3,000.  This means that a claim against the policy for a $7,000 to repair will result in a payment of $4,000.

A recent Missouri client was surprised and upset to learn that his deductible had increased from its original $1000 to over $5,000 when he filed what was his very first claim after decades of coverage.  While we were able to successfully negotiate an agreement with his insurer to waive this deductible amount for his claim, this was an exception to the rule that is not always available – as was the case of another client who discovered too late that she had a significant $2,300 amount to be deducted from her settlement of $6,400.

These increases in the deductible amounts are reported to the home owner at policy renewal on the “Declarations” page that is sent at the time of each renewal.  Unfortunately, many home owners will simply file this important page with their policies without reading and noting the change.

Take the time, today, to read your most recent declarations page to see if your deductible has changed.  It is possible to negotiate a lower deductible with your insurance company, in some cases, with a slight increase in your premium … but this must be done and in effect PRIOR to the date of any loss or damage.

Copyright 2013 James H. Bushart

What is a Missouri Public Adjuster?

Mississippi River Scenic Byway in Missouri

Mississippi River Scenic Byway in Missouri (Photo credit: Doug Wallick)

By James H. Bushartwww.publicadjustermissouri.comAside from attorneys, public adjusters licensed by the Missouri Department of Insurance are the only type of claims adjuster that can legally represent the rights of an insured during a first party insurance claim process in the State of Missouri.

Upon notification of a claim for property loss or damage, the insurance company will send an adjuster employed by them or an “independent adjuster” contracted by them to investigate the claim.  These adjusters work for the insurance company and only represent the financial interests of the insurance company.  The Missouri Public Adjuster, on the other hand, levels the playing field by representing only the interests of the insured policy holder who has suffered the loss or damage to a business or home located in Missouri.

The Missouri Public Adjuster’s main responsibilities are to:

  • Evaluate existing insurance policies in order to determine what coverage may be applicable to a claim
  • Research, detail, and substantiate damage to buildings and contents and any additional expenses
  • Evaluate business interruption losses and extra expense claims for businesses
  • Determine values for settling covered damages
  • Prepare, document and support the claim on behalf of the insured
  • Negotiate a settlement with the insurance company on behalf of an insured
  • Re-open a claim and negotiate for more money if a discrepancy is found after the claim has been settled

For more information about the Missouri Public Adjuster or to request a free, no obligation consultation regarding a particular claim, contact me by writing jbushart@publicadjustermissouri.com or call me at 314-803-2167.

Copyright 2013 James H. Bushart

New Scam Law Protects Missouri Seniors

     The following is a recently enacted Missouri law that protects seniors from certain scams regarding contractors.

     Up until 8/28/12, a building or remodeling contractor could intentionally deceive a homeowner and steal money intended for materials and/or labor for unnecessary work and similar scams and, if successfully located, be sued.  Typically, the contractor (after losing a lawsuit) would file bankruptcy to avoid paying the judgment, change the name of his company and move on to other potential victims.

     With a new law that recently makes the financial exploitation of a senior a felony, a contractor who performs such acts can be arrested if his victim is 60 years old or older.  After his arrest, his ability to make restitution and repay the money to his victim could get him a lighter sentence.

     Missourians who encounter such scammers should contact their local law enforcement officials, immediately.

Missouri Revised Statutes
Chapter 570
Stealing and Related Offenses
Section 570.145

August 28, 2012

Financial exploitation of the elderly and disabled, penalty–definitions–certain defense prohibited, additional violation, restitution.
570.145. 1. A person commits the crime of financial exploitation of an elderly or disabled person if such person knowingly by deception, intimidation, undue influence, or force obtains control over the elderly or disabled person’s property with the intent to permanently deprive the elderly or disabled person of the use, benefit or possession of his or her property thereby benefitting such person or detrimentally affecting the elderly or disabled person. Financial exploitation of an elderly or disabled person is a class A misdemeanor if the value of the property is less than fifty dollars, a class D felony if the value of the property is fifty dollars but less than five hundred dollars, a class C felony if the value of the property is five hundred dollars but less than one thousand dollars, a class B felony if the value of the property is one thousand dollars but less than fifty thousand dollars, and a class A felony if the value of the property is fifty thousand dollars or more.

2. For purposes of this section, the following terms mean:

(1) “Deception”, a misrepresentation or concealment of material fact relating to the terms of a contract or agreement entered into with the elderly or disabled person or to the existing or preexisting condition of any of the property involved in such contract or agreement, or the use or employment of any misrepresentation, false pretense or false promise in order to induce, encourage or solicit the elderly or disabled person to enter into a contract or agreement. Deception includes:

(a) Creating or confirming another person’s impression which is false and which the offender does not believe to be true; or

(b) Failure to correct a false impression which the offender previously has created or confirmed; or

(c) Preventing another person from acquiring information pertinent to the disposition of the property involved; or

(d) Selling or otherwise transferring or encumbering property, failing to disclose a lien, adverse claim or other legal impediment to the enjoyment of the property, whether such impediment is or is not valid, or is or is not a matter of official record; or

(e) Promising performance which the offender does not intend to perform or knows will not be performed. Failure to perform standing alone is not sufficient evidence to prove that the offender did not intend to perform;

(2) “Disabled person”, a person with a mental, physical, or developmental disability that substantially impairs the person’s ability to provide adequately for the person’s care or protection;

(3) “Elderly person”, a person sixty years of age or older;

(4) “Intimidation”, a threat of physical or emotional harm to an elderly or disabled person, or the communication to an elderly or disabled person that he or she will be deprived of food and nutrition, shelter, prescribed medication, or medical care and treatment;

(5) “Undue influence”, use of influence by someone who exercises authority over an elderly person or disabled person in order to take unfair advantage of that persons’s vulnerable state of mind, neediness, pain, or agony. Undue influence includes, but is not limited to, the improper or fraudulent use of a power of attorney, guardianship, conservatorship, or other fiduciary authority.

3. Nothing in this section shall be construed to limit the remedies available to the victim pursuant to any state law relating to domestic violence.

4. Nothing in this section shall be construed to impose criminal liability on a person who has made a good faith effort to assist the elderly or disabled person in the management of his or her property, but through no fault of his or her own has been unable to provide such assistance.

5. Nothing in this section shall limit the ability to engage in bona fide estate planning, to transfer property and to otherwise seek to reduce estate and inheritance taxes; provided that such actions do not adversely impact the standard of living to which the elderly or disabled person has become accustomed at the time of such actions.

6. It shall not be a defense to financial exploitation of an elderly or disabled person that the accused reasonably believed that the victim was not an elderly or disabled person.

7. (1) It shall be unlawful in violation of this section for any person receiving or in the possession of funds of a Medicaid-eligible elderly or disabled person residing in a facility licensed under chapter 198 to fail to remit to the facility in which the Medicaid-eligible person resides all money owing the facility resident from any source, including, but not limited to, Social Security, railroad retirement, or payments from any other source disclosed as resident income contained in the records of the department of social services, family support division or its successor. The department of social services, family support division or its successor is authorized to release information from its records containing the resident’s income or assets to any prosecuting or circuit attorney in the state of Missouri for purposes of investigating or prosecuting any suspected violation of this section.

(2) The prosecuting or circuit attorney of any county containing a facility licensed under chapter 198, who successfully prosecutes a violation of the provisions of this subsection, may request the circuit court of the county in which the offender admits to or is found * guilty of a violation, as a condition of sentence and/or probation, to order restitution of all amounts unlawfully withheld from a facility in his or her county. Any order of restitution entered by the court or by agreement shall provide that ten percent of any restitution installment or payment paid by or on behalf of the defendant or defendants shall be paid to the prosecuting or circuit attorney of the county successfully prosecuting the violation to compensate for the cost of prosecution with the remaining amount to be paid to the facility.

(L. 2000 H.B. 1386 & 1086, A.L. 2003 S.B. 556 & 311, A.L. 2005 H.B. 353, A.L. 2012 S.B. 689)
*Word “of” appears here in original rolls of S.B. 689, 2012.

Copyright 2013 James H. Bushart

Missouri Public Adjuster

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