Denied?
|
|
Turn The Tables!
|
START HERE
Read This Article! 
Insurance Claim Delays Deliver Massive Profits To Industry By Shorting Customers
By Mollie Reilly and Max J. Rosenthal What are you owed?Insurance Policy is there to Indemnify you.
An indemnity clause, also known as an indemnification clause, is a contractual provision that outlines the responsibilities and obligations related to compensating for losses or damages. Let’s break it down: Definition: An indemnity clause is a security or protection against a loss, damage, or other financial burden, such as costs and expenses. It establishes an agreement where one party promises to be responsible for specific losses or damages that may occur under certain circumstances described in the contract. Purpose: The primary purpose of an indemnity clause is to protect a party from third-party claims. It shifts the risk associated with certain events or situations from the indemnified party (the one receiving protection) to the indemnifying party (the one providing compensation). Your Policy There is an expectation of restoring your property to pre-loss condition. But what if you purchased a replacement cost policy? Does that mean the insurance company can replace your damaged 10 year old architectural asphalt shingle that had a 30 year expected life span with a used 10 year old roof? NO If the shingles useful life cannot be restored by way of repair, your policy expects that roof to be replaced with a BRAND NEW ROOF. Not only is the roof to be replaced but there is an expectation that the roof will have the a useful life of 30 years if the roof being replaced is a 30 year roof system. If your roof is a 40 year roof and it's 10 years old and it warrants replacement, then it is replaced with a brand new 40 year roof system. In order to ensure a useful life of 30 years or 40 years, the manufacturer says it has to be installed following their instructions, recommendations, and requirements. If your roof does not warrant replacement and it warrants repair, it is the manufacturer's instructions. recommendations and requirements that are followed for the repair to allow the roof system's useful life to be restored. The expectation of most policies is to restore the useful life of the materials damaged and affected. If the useful life cannot be restored by repair or if the repair is in excess of the cost of the replacement,. then replacement is warranted. |
You are NOT represented.What is a Fiduciary?
Fiduciary relationships are often of the financial variety, but the word fiduciary does not, in and of itself, suggest pecuniary ("money-related") matters. Rather, fiduciary applies to any situation in which one person justifiably places confidence and trust in someone else, and seeks that person's help or advice in some matter. The attorney-client relationship is a fiduciary one, for example, because the client trusts the attorney to act in the best interest of the client at all times. Fiduciary can also be used as a noun referring to the person who acts in a fiduciary capacity, and fiduciarily or fiducially can be called upon if you are in need of an adverb. The words are all faithful to their origin: Latin fīdere, which means "to trust." The insurance company has a fiduciary responsibility to its shareholders. The insurance agent/broker has a fiduciary responsibility to the Insurance company they are an AGENT of. Who represents the homeowner? Who represents the property owner? Who represents the landlord? Who represents the tenant? Who represents the building owner Who represents the insured? Who represents the policyholder? Does the Insurance Company that Sold you the insurance policy represent you? Are they your fiduciary? NOPE Does the Agent/Broker that Sold you your policy represent you? Are they your fiduciary? NOPE When you submit a claim, you are NOT REPRESENTED. Many states that attempt to protect their citizens license adjusters. Unfortunately, Colorado does not license insurance adjusters that work with or for insurance companies. This means that no one is determining if the person that shows up to inspect your property loss is competent or trained, or ethical, or anything. They do not have to understand insurance. Ther do not have to understand your coverages or the expectations of the policy your purchased. Who is checking their background? Not Colorado. Maybe the insurer but maybe not. Not only are you not represented, but you may have to deal with incompetence as well. Insurance Adjusters work for the Insurance Company, NOT YOU. It is common for the insurer to send an inspector to your home that has not read your policy. If they don't read your policy, they are not knowledgeable about your policy and the coverages your purchased. If they do not know what coverages you have purchased, if they do not understand the insurance policy, how can they write an estimate based on your policy expectations? They Can't! Some in the industry want the insured to believe that any repair will do. That is factually incorrect. You can make material damages worse by performing an improper repair. Tips that may help you settle your claim fairly without hiring a public adjuster.Tip 1) Get your policy
Your policy is not a summary that most agent give insureds you and it's not the declarations pages aka deck-page. If you want a fair settlement, you must obtain your entire policy. What do we mean the entire policy? Your entire policy consists of 3 parts. (1) The declarations pages which is basically a summary of the coverages you purchased. The deck page does NOT explain what is excluded. (2) The Insuring Agreement / Document. For example, the most common homeowner policies are the HO3 and the HO5 and less common is the HO8. These insuring documents are open peril, in other words everything is covered unless the policy specifically excludes it. The insuring document will lay out what is excluded, your duties after the loss, how the policy pays, what your remedies are if there is a dispute, etc.. (3) The Endorsements. Endorsements are addendums. Some take coverage away, some add coverage, some change or modify the coverage in some way. They are critical to understanding your policy. Did you know: COLORADO HOMEOWNERS INSURANCE REFORM ACT OF 2013 (HB 13-1225) requires insurance companies to:
After 72 hours if the insured has not received a certified copy or a copy then the insurance company is in violation of the COLORADO HOMEOWNERS INSURANCE REFORM ACT OF 2013 (HB 13-1225). Keep emailing them your request and explain that the certified copy is required Tip 2) READ YOUR POLICY!!!!! (1) Start with reading, "Duties After the Loss" or look for the Conditions section of the policy where is spells out the insured's responsibilities. Some policies require the insured to submit a Proof of Loss (POL) within 60 days of the loss. Some policies state if the insured does fulfill their duties the insurer can deny the claim. We believe this is unfair to the insured though the fact is the insured purchased the policy. Rarely have I ever seen an insured be given their entire policy to read prior to them purchasing the policy. If the insured is going to be held to that standard then the insurer should in our opinion provide the insured a copy of the policy and give the insured at least 3 Day to rescind their coverage at NO COST TO THE INSURED. What makes this particular clause worse is that the state of Colorado does not require the insurance company to provide the insured a POL form or even notify the insured or warn the insured that they need to be submitted a POL or warn the insured that the date is near, and time is running out. It sure looks dirty handed, and it sure looks like the state of Colorado is allowing this unfair behavior. Tip 3) Know Your Rights! The first place we advise and insured to go to understand their rights is to the United Policyholder website's Colorado resources pages and specifically to: Insurance Consumer Rights in Colorado (2021) - United Policyholders The page is concise and easy to understand. It's full of information that you can include in emails when the situation calls for it. For example if the insured sends the adjuster and email asking for information or asking a question or asking for their policy and they adjuster or the insurance company does not respond with an answer to the question or an acknowledgement that they have received your request and or they are not following through then you might remind them of your request and if by the third or fourth time your request or question is still being ignored then you might explain the following: Sample... To Mr. / Ms. adjuster, this is the (third/fourth) time I/we, the insured, have made this request or asked this question. I/we expect to be treated fairly by XYZ insurance and we expect answers to our questions and acknowledgement of our requests and status updates regarding our requests, etc.. I/We have consulted the United Policyholder website for Colorado insured's rights and I/we want to remind you that a law is a law. Colorado Revised Statute § 10-3-1104 (1) (h) outlines conduct by insurers that is illegal: (II) Failing to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies; XYZ insurance expects the insured to act in good faith and fulfill our contractual obligations and I/we expect XYZ to do the same. This is the fourth time we have asked this question/made this request and I/we have not received the answer/information requested. By refusing to answer and or provide the information XYZ is delaying the claim process and making it difficult for us to resolve our claim. This has become an unnecessary hardship, and we are made to continue to spend time asking/requesting over and over again. The lack of prompt communications resulting is an unnecessary hardship and delay is unacceptable. Without further delay please provide the requested information/answer to our question. Tip 4) Submit a POL as soon as you can. It doesn't matter if the policy mandates that the insured submit a POL or not. The sooner the insured provides a POL the better the insured's claim position. In essence the insurer can delay as long as they want if you don't submit a POL. The POL starts the clock. If the POL includes all the information stated in the policy that it should and if it is accompanied by a detailed estimate and if that estimate is accompanied by the proof that it is accurate then the insurance company has 60 days to pay your claim. The POL starts the clock ticking for them. Once the insured submits the POL they have 60 days to act/pay. However, if the insured provides an incomplete POL then the insurance company has the reasonable right to request further proof which is what delays most claims from our experience. Remember, Obtain your policy and read your policy. The policy most often detail for the insured what must be in the POL. POL should be accompanied with supporting documents that prove its accurate. Insured's relay on contractors and that is a mistake. The insurance company will respond better to you than the contractor. Does the insurance company provide a POL form? We have not experienced any insurance company providing a POL form or explaining to an insured its necessary or the benefits to the insured or warning them if a deadline is approaching. Is this reasonable behavior? The state of Colorado seems to think so. Unfortunately, no one tells the insured that the agent is not working for the insured and is instead a fiduciary for the insurance company. That is why they are called an agent, because they are an agent representing the company. It's buyer beware. When an insured submits a claim, the insured should be able to count on fair treatment, thus the Colorado Good Faith Claims Laws. Unfortunately, it's not that easy. The insurance company adjuster is not working for you and their goal is to pay as little as possible. On it's face there is nothing wrong with that. However, it can become a very one sided process with a multibillion-dollar company holding all the cards and hiding some from you. The Insured is not Represented... Not the adjuster, not the contractor... see below. Tip 5) Keep communications in writing. If you speak to the insurer on the phone, they can write whatever they want into their claim log. This may or may not be purposely done. It may be that they remember differently than you. You will not be affective at disputing what they have written because you have no proof. We suggest if they call let it go to voicemail and then respond with email. If they leave a general message, the send an email that requests that they explain why they called and what they want. Many adjusters will resist this and keep calling. It's as simple as saving the voicemails and responding via email. This is business and you might want to believe the adjuster is your friend. That is almost never the case. In fact, what can often happen is that they are friendly as long as they can do what they want and then if challenged or if you push for something you think is fair, you might find the experience is very different. By keeping everything in writing you keep everybody honest. If you do answer phone because you simply can't help yourself, then write down what was said and email the summary to the adjuster or representative your spoke to. Make sure to end the email with a simple note. If I don't hear back than I/we will assume you agree with our summary of our conversation. If they write back and tell you they disagree then tell them you disagree and to keep everything going forward in writing. This may or may not hold up in court but at least if they say nothing it does demonstrate to most reasonable people that they agreed or at least did not disagree. Tip 6) Get to a yes or a No as quickly as possible. Your best chance to resolve your claim amicably is to get the insurance company to make expedited decisions. We are often contacted 9 months, 12 months, 18 months, and more, after the loss and we are told that the insured and the contractor have done all they can and can we take it and get a fair settlement. What they have done is make their case worse. We know that from the insured's point of view they see themselves as trying to work with the insurance company and even if the adjuster keeps asking for documents that they already provided or even when the insured has provided very detailed and reasonable support for the costs, an adjuster can simply decide to keep asking for more. We often see the insured and the contractor continuing to go along this path, each time allowing more and more time to pass. So why is that? Why might an adjuster or an insurance company drag out the process. Simple, 1) some are hoping the insured and or the contractor give up and accept the insurance company's offer. 2) all know that if enough time passes, they will automatically owe you less. It is to their advantage to delay, and they will do what they can to make it look reasonable. Sometimes it might be reasonable, though often it is not but the insured and contractor do not understand the process and play into the scheme. . If you allow them to, they will delay indefinitely. Dragging the settlement out for an extended period does not help the insured and does not help the contractor. Try never to be the reason for a delay, respond as quickly as possible. Getting to a NO quickly is better to getting from one amount to a slightly better amount over a long period. If you provide a POL and you provide manufacturer's instructions, and information showing why your estimate is fair and the insurance company has everything then need to make a decision, they will be at a disadvantage if they do not. (a) If you get to a NO then you have options. A NO is often better than a maybe or dragging it out. A no gives you options. A no or ignoring your POL will not be good for the insurer if you have provided a detailed estimate, proof that it is fair, and all necessary information that would allow the insurer to make the right decision and do the right thing. (b) You can submit a formal complaint to DORA Depending on what you are complaining about and how you write the complaint, a complaint can be affective. If you complain to DORA about your claim, they will respond better to you then the contractor. (c) You can engage a property loss appraiser. Often an appraisal will result in a higher settlement and if you engage someone that is not just competent but well qualified the appraisal award can end up achieving your goal of a settlement that is enough to properly and lawfully restore your loss. (d) You can engage an attorney. These are some tips. Claims are complicated and our best advice is to engage a competent, knowledgeable, public adjuster (PA) to represent you. Tip 7) Choose the right contractor. The wrong contractor is most contractors... ok that's our opinion but we find very few we would hire. What's most important and why? 1) Do not assign your claim. This is called an AOB or an Assignment of Benefits. What you will be told... If you assign the claim benefits to our construction company, roofing company, exterior company, etc., we can do everything for you. The truth is the contractor goal is profit. They did not get into business to help people and go broke. This is America and businesspeople want to make money and as much money as possible. God Bless them. The insured's goal however is not profit and if it is then there is fraud involved. The insured's goal is to have their property restored to pre-storm/pre-event condition and better if replacement is warranted and replacement cost was purchased. We have seen contractors focus on the roof and items they perceive as most profitable and then convince the insured to take over the less profitable items or ignore them. A contractor that has been assigned the claim can settle the claim in their best interest... which may not and in our experience often is not in the insured's best interest. 2) Read the contractors contract. It amazes us how many people sign contracts that assign benefits, that state that if the contractor damages your property they are not responsible the insured is, that if you cancel they still get paid that they don't have to follow manufacturer's instructions or code and they can do the work based on "Industry Standard". What the F_ _ _ _ is that? We recommend using your own addendum that takes priority over their contract, have then sign it and if they will not show them the door, thank you and goodby. What's in the addendum? 1) That the contractor will perform the work by following and adhering to the adopted building codes for the municipality where the property is and they contractor will agree to follow and adhere to the manufacturer's instructions, recommendations, and requirements. 2) The contractor is responsible for any and all damages they cause. 3) If interior water damage is involved then the contractor is IICRC certified and agrees to follow and adhere to the IICRC standards. A lot of times finding the right contractor is as easy as eliminating the wrong ones. If they know they have to sign it, and they walk away you have avoided a bad contractor. If they know they have to sign it and agree to sign it, then may have found the right contractor. The contractor must provide an estimate for the work they are doing. Don't rely on the roofing company and or the exteriors company to provide all the subcontractors. We are not saying that they cannot provide their costs for these items what we are saying is get your own too. Contact a window repair company to inspect the windows. Windows are often missed, and the repair is often undervalued. Contact an HVAC company. What is HVAC, well is a hail claim it could be a heat pump or an AC unit or an evaporative cooler (swamp cooler). It could be bathroom exhaust vent caps or furnace vents caps or water heater vents caps, the flues for those exhaust, etc.. What if the contractor will not provide an estimate and wants to use the insurance companies? Our opinion is that is the wrong contractor. Does the contractor's estimate have to be created in Xactimate which is used by most insurance companies? NO! The estimate just needs to be detailed, broken down so that it can be compared to the insurance company's estimate. Do we have other Tips? YES WE DO. Too Many to list here and likely you have already stopped reading. |
What is a Public Adjuster? |
How do Public Adjusters get paid? |
|
Only the Public Adjuster works for the insured. Public Adjusters are the ONLY adjusters in Colorado that are Licensed!
The Insurance agent by Colorado law is working for the insurance company. It may seem like they are on your side but most don't explain the coverages, don't warn you about degrees of risk, don't always understand the coverage themselves. CAI has had to correct insurance agents giving advice to their insured's. The insurance adjuster is not there to be fair. They are not there to be your friend, though they will try to convince you they are. They are there to pay you the least amount possible for your claim. Essentially you are on an Island by yourself.
|
Colorado has set a maximum rate of 10% when there is a catastrophe.
10% is generally the fee. However, on larger claims that fee is generally negotiable. Who pays the public adjuster? The insured pays the public adjuster fee. It is our opinion that Colorado has enacted laws that advantage the insurance company and disadvantage the property owner. The insurance industry gives candidates money for their campaigns. Hiring just any public adjuster may not make sense. The insurance industry does lobby state government representatives that they gave money to get elected. It doesn't take a brain surgeon to connect the dots. Can you get a fair settlement without a public adjuster? We would like to think so. If you can't that's when you might want to consider engaging a public adjuster. |
Not all Public Adjusters are Equal
Prior to becoming a Public Adjuster and then obtaining the designation Senior Professional Public Adjuster (SPPA), I worked for the insurance companies as an independent adjuster and consultant.
Insurance CompaniesFlood for NFIP | Berkley North Pacific | Brotherhood Mutual | Lloyds of London | Chubb | Berkshire Hathaway | POE | The Hartford | The Hanover | Horace Mann | Indemnity Insurance | Nationwide | Liberty Mutual Insurance | Safeco Insurance | Bankers Insurance | Louisiana Citizens | Indiana Insurance | Ohio Casualty | American Family | Shelter Insurance | Auto Owners Group | The Kemper | NCAA / AAA Insurance | American First Insurance | CNA | Cincinnati Insurance | Teachers Insurance | Republic Group | Encompass Insurance | Tower Hill Insurance | Homewise | Florida Citizens | Erie Insurance | Scottsdale Insurance | TD in Canada | and other associated
Training to be your ExpertBelow is a partial list of the courses and training Philip Weber has completed.
Senior Professional Public Adjuster Certificate – The Institutes - Risk & Insurance Knowledge Group Adjusting Business Interruption for Retail Insured’s – Craig Acheson (AHY Forensic Accounting) and Michael C. Little AIC CPCU (Hanover Insurance Group) Building Codes: Loss and Claim Exposure management – Kent G. Robinson General Adjuster (Stet Travelers) Isam Hasenin President (Hasenin Consulting Engineers) Claims Technology – Dennis Wallen (Reliable Adjusting Company Enterprises) Commercial Claims – J.P. Turner Commercial Roofing – Donan Engineering Commercial Roof Damage Assessment - Haag Engineering Condominium Losses - by Elizabeth E. Andrews Esquire & Kirt Varhagen National Product Line Manager (Safeco Insurance) Comparing Property and Boiler and Machinery Coverage and Adjustments – Richard Sprock (Bruckmann & Victory LLP) and William F. Cassidy (Douglas G. Patterson & Associates, Inc.) Earthquake: When the Big One Hits, Will Your Adjuster be Ready? - By Dan Dyce, (Earthquake Response Manger for CEA) Earthquake Coverage and Handling Earthquake Claims - Dan Dyce, (Earthquake Response Manger for CEA) Earthquake Damage Assessment and Repair - By John D. Osteraas (Principal Engineering & Practice Director/Exponent Failure Analysis for Menlo Park, CA) Estimating Electrical Damage Losses – Donald Skaff (LWG Consulting Inc.) Fraud: The Politics of Arson – Gil Minock Assistant VP (Amerisure Insurance Company) Sean O’Brien Atty/Shareholder (Bradshaw Fowler Proctor et al) David J. W. Proctor Atty/ Shareholder (Bradshaw Fowler Proctor et al) Robert Riede Atty/Shareholder (Bullivant Houser Bailey) Chris Van Vleet Special Agent/CFI (Bureau of Alcohol, Tobacco, Firearms General Claims Handling Expectations – Dennis Wallen Good Faith Claims Handling – Paul W. Burke Partner (Drew Wckl & Farnham, LLP) & Daina E. Kojelis (Zurich North America) Hurricane Losses: Using Initial Scope and Reserve Analysis to Manage Expectations and Outcomes – David Wilde Adjuster (Wilde Claims) Elise M. Farnham (Illumine Consulting) Mark Kubena Engineer (Insight Engineering, LP) Insurable Interest Problems in the Large Homeowners Claim – Billy J. Handsaker Regional Large Loss Representative III (Allied Insurance/A Nationwide Company) Robert C. Burrell Partner (Borgelt, Powell, Peterson, Frauen) Inspection & Evaluation of Residential Roofing - Haag Engineering IntegriClaim Expert Class - Nashville PLRB Conference Preventing Leakage in Building Damage Estimates – Sam White (Travelers) Property Mediation Strategies for Early Resolution - Monica O’Neill Attorney (Kent & McBride) Thomas B. Ruttler Attorney & Steve Zickefoose Regional Claims Analyst (Westfield Group) Quality Claim File Notes – Steven J. Polansky Esquire (Marshall Dennehey Warner Coleman Goggin) & Keven Willging Esquire (St Paul Travelers) Reconstruction in a Catastrophic Environment – Fred Frederick Manager of NGA Unit (AIG Domestic Claims) Dixon Grier CPA Partner(Matson, Driscoll, and Damico) James L. Wraith Atty/Partner Selvin, Wraith Halman) Residential Roof Damage Assessment - Haag Engineering Subrogation: Building the Case with Your Expert – Todd Denenberg Partner (Grotefeld & Denenberg) & Kenneth W. Robinson Regional Manager (LWG Consulting) Transportation and Warehouse Losses: Coverage, Adjustment, and Subrogation – Marilyn Raia (Bullivant Houser Bailey PC) Thorny Issues with Commercial Property Coverages – F.M. Bud Ferrer (Smith Smith Feeley LLP) and Kelly Taylor (CSE Insurance) Water Damage Claims – Daniel Berazzani (Liberty Consulting) and Gerald Motejunas (Smith & Brink PC) Valuation of Residential and Commercial Contents – Brian Kraynak (Liberty Mutual Insurance Company) Wind vs. Wave Damage Assessment - Haag Engineering Wood Roof Damage Assessment – Haag Engineering Building Types Responsible forLarge and Small Farms, Warehouses, Restaurants, Highrise Condos (above 30 stories), Homeowners Associations, Master Homeowner Associations that had multiple smaller HOA’s under them, Apartment buildings, Golf Courses with Multiple buildings, Office Buildings, Large Schools with multiple buildings (high schools, JR high Schools, etc), Churches (large and small many with multiple buildings), Mobile Homes, Mobile Home & RV Parks, Motorhomes and Camping Trailers, Duplexes, Fourplexes, Single Family, Large estate Single Family, Individual Condos and Townhomes.
Certifications (Some of)Senior Professional Public Adjuster (SPPA) | PCCP | NFIP: Residential, MH, & Commercial NFIP # 30002970 | AmFam Commercial | Nationwide | Florida Citizens | Scottsdale | TWIA | THIG | USAA | HomeWise | Shelter | Southern Fidelity | Hanover | Capitol Preferred | Frontline | VPIA | Certified Umpire | CA. Earthquake Accreditation | Rope and Harness
Assignments Responsible forDetermining Cause of Loss (Damage), Photo Documenting Damages, Ordering/Hiring and Consulting with Experts as Needed, Educating Property Owners including dispelling myths, Measuring Accurately by hand (roof measurements could not be off more than an inch, interior measurements could not be off), Diagraming and dimensioning using Xactimate and IntegraClaim, Symbility (and its predecessor), Problem Solver (Insurance Companies Hired Me to Resolve problems when attorneys were imminent), Supervisor & TEAM Lead, Determining and Reporting Fraud and or Potential Fraud, RE-Inspections (often called “Clean Up” staying behind after other adjusters leave, re-inspecting usually because someone disagrees with the first adjuster), File Review/Desk Adjusting (reviewing independent adjusters work before it was submitted to insurance carriers), Creating Reports including but not limited to: General Loss Reports, Narrative Reports, Valuation Reports, Proof of Loss Reports, Property Reports, Photo Reports, and a multitude of Flood Reports. Kept detailed logs of each claim noting interactions with everyone involved with the claim and everything aspect I had involvement with to resolve the claim, kept accounting information such as expenses and time for expense billing. Worked with many types of software, MS Suite, Cad Programs, and much more. Xactimate (Estimating Software) Trainer, Assisted Indiana Insurance with Software Conversion when they were purchased by Liberty Mutual.
|
Experience w/ insurance companies.Philip was not just an adjuster. Frankly adjusters are a dime a dozen. Philip was trained by the nations TOP ADJUSTERS and considered to be at the top of the craft. Insurance companies would hire Philip to resolve claim issues for claims that were headed to court and Philip was able to resolve them.
Philip was asked to train adjusters and consulted with insurance companies on estimating software, aerial imaging, and was hired by one insurance company that was purchased by a bigger insurance company to help then convert from IntegraClaims to Xactimate.
Experience Matters Philip Weber's experience resolving claims is extensive. He has worked for or on behalf of all of the insurance companies you see to the left and even some that we did not include on the list.
In 2015 Philip started Claim Animalz because he wanted to help the public get fair property settlements. Philip has consulted and provided expert services for property owners and their contractors since then. Philip's clients average Claims Settlement was 3 times greater than the insurance companies initial offer. Yes you read that right, three hundred percent more on average! |
Hire Claim AnimalzTurn the Tables
|
If your being treated unfairly, maybe it's time to turn the tables.
|
