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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 a useful life of 30 years. In order to have a useful life of 30 years, the manufacturer says it has to be installed following their instructions. The expectation of most policies is to restore the useful life of the materials damaged and affected. |
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 the agent gives 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. Tip 2) READ YOUR POLICY!!!!! (1) Start with reading, "Duties After the Loss". 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. What makes this worse is that Colorado does not require the insurance company to provide the insured a POL form or even 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. Tip 3) Submit a POL as soon as you can. It doesn't matter if the policy mandates it or not. The sooner your provide a POL the better your claim position. In essence the insurer can delay all they want if you don't submit a POL. However, once you submit your POL they have 60 days to act/pay. The POL starts the clock ticking for them. (a) The policy often will tell 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. Tip 4) Keep communications in writing. If you speak to the insurer on the phone, they can write whatever they want into their claim log. 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. If 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. Tip 5) 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 month, 12 months 18 months 20 month after the loss and told that the insured and the contractor have done all they can. What they have done is make their case worse. Dragging the settlement out for an extended period does not help the insured. 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. |
What is a Public Adjuster? |
How do Public Adjusters get paid? |
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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.
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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.
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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
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If your being treated unfairly, maybe it's time to turn the tables.
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