The other day I met with an adjuster out at a loss. I had heard of this adjusters reputation through the grapevine and the grapevine did not have much good to say about him. Anyway this adjuster shows up with the usual insurance adjuster repertoire of tools: tape measure and camera. This guy was so good that it only took one “o” to spell it and you started with a capital G.
My point in telling this story is not to rant and rail at every adjuster with whom hubris is a personality trait, but rather to point out as I’ve done before that some times losses are not open and obvious. Yet adjusters routinely show up without the tools necessary to do their job beyond what is obvious. The village idiot can see damage that is open and obvious; it takes a professional to see damage that is not.
Here’s the rub: the policyholder depends upon the insurance company to send out a professional adjuster. Those sent out however by and large are not professionals. I know it, you know and the insurance company knows it.
I say the insurance company knows it because they don’t trust these people with authority to agree on scope or price. They don’t trust them! Now here’s my question: if the insurance company doesn’t trust the adjuster they send out to adjuster your loss, why should you?
Tuesday, July 22, 2008
Wednesday, July 16, 2008
Causation Disputes
Lately it seems that insurance companies have been taking issue with losses by asserting a difference of opinion as to causation. For example, take an insured who reports wind damage to their home. The insurance company hires an “expert” to examine the home. This “expert” (I put “expert” in quotation marks because I find that many of them have a predetermined opinion as to causation) comes out and following a casual inspection of the property opines that the home suffers from a variety of ills relating to deferred maintenance or some such argument that is similar in nature.
The insurance company in turn takes exception to the claim citing the wear and tear, deterioration, inherent vice and latent defect exclusions or the improper maintenance language under the concurrent causation section of the policy. The insured is left blinking like the proverbial deer in the headlights.
Understand this is little more than a tactic. Most houses suffer from maintenance related damages. Whether it’s a broken roof tile from someone walking on the roof or a pipe under the sink that leaked for a few days before anyone noticed it, every house has some blemish, some flaw. The question here is whether the maintenance is responsible for the loss or some casualty is responsible such as the wind in our example.
Insurance policies are unilateral contracts between the policyholder and the insurance company. The policyholder is given the option of accepting the policy as written or going somewhere else. Because it is a unilateral contract any ambiguity is automatically decided in favor of the policyholder. Unfortunately, many insurance companies are using “experts” to try and remove ambiguity from the claim adjustment process.
Now in our example, even though the house may suffer from wear and tear or deterioration or latent defects etc… when those conditions serve to weaken the structure and make it more susceptible to wind, the proximate cause of the loss becomes wind not wear and tear and the loss should be covered. In reaching this conclusion I ask myself a simple question: did the loss occur absent the casualty. If the answer yes, then wear and tear may be responsible. If the answer is no, then the casualty (in our example wind) is responsible and the merits of the claim should be considered in the context of the cause of loss.
A repositioning of the loss as wear and tear is improper and you should take a stand against the company when they attempt to do this.
The insurance company in turn takes exception to the claim citing the wear and tear, deterioration, inherent vice and latent defect exclusions or the improper maintenance language under the concurrent causation section of the policy. The insured is left blinking like the proverbial deer in the headlights.
Understand this is little more than a tactic. Most houses suffer from maintenance related damages. Whether it’s a broken roof tile from someone walking on the roof or a pipe under the sink that leaked for a few days before anyone noticed it, every house has some blemish, some flaw. The question here is whether the maintenance is responsible for the loss or some casualty is responsible such as the wind in our example.
Insurance policies are unilateral contracts between the policyholder and the insurance company. The policyholder is given the option of accepting the policy as written or going somewhere else. Because it is a unilateral contract any ambiguity is automatically decided in favor of the policyholder. Unfortunately, many insurance companies are using “experts” to try and remove ambiguity from the claim adjustment process.
Now in our example, even though the house may suffer from wear and tear or deterioration or latent defects etc… when those conditions serve to weaken the structure and make it more susceptible to wind, the proximate cause of the loss becomes wind not wear and tear and the loss should be covered. In reaching this conclusion I ask myself a simple question: did the loss occur absent the casualty. If the answer yes, then wear and tear may be responsible. If the answer is no, then the casualty (in our example wind) is responsible and the merits of the claim should be considered in the context of the cause of loss.
A repositioning of the loss as wear and tear is improper and you should take a stand against the company when they attempt to do this.
Sunday, July 6, 2008
Pre-Storm Preparation
While TS Bertha (7/6/08) has prompted me to expound upon storm preparation, this advice is good for any storm, hurricane, flood, winter storm, earthquake etc… Following a major catastrophe, reports of losses are made in staggering numbers prompting insurance companies to begin hiring contract adjusters to handle the increased claim volume. Most of this staffing increase takes the form of contracts with independent adjusting firms who begin the mad and sometimes frantic search for bodies. I use the term bodies intentionally in that every company has their “A” list adjusters and their “D” adjusters as well as all categories in between. As you can imagine, “A” list adjusters are the best and the independent adjusting firms try and keep them busy all year long so as not to loose them to the competition. “D” list adjusters are called upon only as a last resort, but on major events they are going to be called in to adjust claims. As the policyholder, you have no idea whether the adjuster assigned to your claim is top notch or an also ran. You won’t get this information even if you ask for it. Let’s face it, who would be willing to admit they were marginal. Don’t waste your time asking it’s not material.
What is material is your ability to demonstrate your loss: be able to prove the extent of damage and document that damage.
Before and after pictures are great for this type of proof. The difficulty arises with the before component of this equation. Most people never think about loss before it happens and are caught unawares and unprepared for loss after the fact. This lack of planning is compounded because the policyholder calls the insurance company to report the loss and for all intents and purposes abandons the determination of their loss to the insurance company adjuster: who may be an “A” adjuster but more likely is something else.
This company adjuster arrives on scene with their camera and tape measure to determine the loss. You show the adjuster the damage and the adjuster only includes a fraction of what is shown in their report to the insurance company. In the interim, you begin the clean up and repair process. Then the much anticipated check arrives in the mail and bingo you’re not satisfied. What happened?
In a nutshell, lack of preparation and naivety combine with incomplete reporting to create the perfect post loss financial storm.
Now consider this scenario. Pre-loss photographs are taken and post loss photographs are taken utilizing the identical views. Additionally, post loss photographs are taken of close ups of the property damaged by the storm. Before shots are contrasted with after shots and the differences labeled. The whole package is then given to the adjuster with a letter requesting these photographs be forwarded to the insurance company. You have a much better chance at getting a reasonable recovery than simple hoping for one. Obviously the better the photograph the greater the ability to distinguish and document the differences between the pre and post storm conditions.
This action will not substitute for having the right tools to prove loss, but will greatly aid you in obtaining a recovery as compared to abandoning your claim to the insurance company adjuster.
What is material is your ability to demonstrate your loss: be able to prove the extent of damage and document that damage.
Before and after pictures are great for this type of proof. The difficulty arises with the before component of this equation. Most people never think about loss before it happens and are caught unawares and unprepared for loss after the fact. This lack of planning is compounded because the policyholder calls the insurance company to report the loss and for all intents and purposes abandons the determination of their loss to the insurance company adjuster: who may be an “A” adjuster but more likely is something else.
This company adjuster arrives on scene with their camera and tape measure to determine the loss. You show the adjuster the damage and the adjuster only includes a fraction of what is shown in their report to the insurance company. In the interim, you begin the clean up and repair process. Then the much anticipated check arrives in the mail and bingo you’re not satisfied. What happened?
In a nutshell, lack of preparation and naivety combine with incomplete reporting to create the perfect post loss financial storm.
Now consider this scenario. Pre-loss photographs are taken and post loss photographs are taken utilizing the identical views. Additionally, post loss photographs are taken of close ups of the property damaged by the storm. Before shots are contrasted with after shots and the differences labeled. The whole package is then given to the adjuster with a letter requesting these photographs be forwarded to the insurance company. You have a much better chance at getting a reasonable recovery than simple hoping for one. Obviously the better the photograph the greater the ability to distinguish and document the differences between the pre and post storm conditions.
This action will not substitute for having the right tools to prove loss, but will greatly aid you in obtaining a recovery as compared to abandoning your claim to the insurance company adjuster.
Monday, June 30, 2008
A Different View
In April, I attend the Infrared Training Institute’s building diagnostics training in Orlando, Florida. This was in preparation for the purchase of an infrared camera to assist me in damage assessment. These cameras are a significant investment in both training time and camera expense. The model I ultimately decided upon was the FLIR B-360. This model has good resolution and the ability to take both visible light pictures as well as infrared pictures. Since that training I’ve been using the camera at every opportunity. What a difference the camera makes!
I have a client whose roof was damaged in Hurricane Wilma. There is water penetration through the moisture barrier. Evidence of water is no open and obvious throughout the structure. However, the ability or inability of the adjuster to see the water does not have any bearing upon the damage the water is causing. In the evaluation process, I have been using high resolution cameras, moisture meters and hygrometers. The affect has been a series of photographs documenting the extent of moisture, which compelling as they are, pall in comparison to the infrared photographs. Take a look at the following two pictures. The first is what the adjuster would see with a point and shoot camera. The second is the infrared image of the same area. The guy in the picture is Mitchell Gottlieb who works with me.
In the infrared image the yellows and oranges are evidence of moisture penetrating through the roof and running down the wall. I had previously documented the extent of moisture damage to the wall with a moisture meter, so I know this is water damage.
I now have a visual representation of water behind the wall. This will get the claim paid and paid richly.
I have a client whose roof was damaged in Hurricane Wilma. There is water penetration through the moisture barrier. Evidence of water is no open and obvious throughout the structure. However, the ability or inability of the adjuster to see the water does not have any bearing upon the damage the water is causing. In the evaluation process, I have been using high resolution cameras, moisture meters and hygrometers. The affect has been a series of photographs documenting the extent of moisture, which compelling as they are, pall in comparison to the infrared photographs. Take a look at the following two pictures. The first is what the adjuster would see with a point and shoot camera. The second is the infrared image of the same area. The guy in the picture is Mitchell Gottlieb who works with me.
In the infrared image the yellows and oranges are evidence of moisture penetrating through the roof and running down the wall. I had previously documented the extent of moisture damage to the wall with a moisture meter, so I know this is water damage.
I now have a visual representation of water behind the wall. This will get the claim paid and paid richly.
Thursday, April 17, 2008
My Antenna Is Up
I was speaking to a client the other day when something hit me. She was telling me that since the insurer she had in 2005 had cancelled her; the “new and improved” insurer has inspected her home with each renewal. Several other people have expressed the same observation. It seems that insurance companies are inspecting houses on a regular basis here in South Florida.
Now my curiosity is piqued. I am inherently suspicious of insurance company motives. Rarely if ever, to they operate in an altruistic manner, so the question arises, why inspect the risk yearly?
Here is one possible explanation. Many times in the claims environment insurance companies will inspect a loss and assert a position that this damage or that damage is caused by wear and tear or long term water leakage or some other gradual cause of loss. In effect the insurance adjuster examines the damage and pronounces a pre-loss condition to a post-loss inspection. A counter argument to these pronouncements can be made: that the company is engaged in post loss underwriting in order to limit claims otherwise payable. Proving this argument may involve obtaining a copy of the underwriting file, prior claims files and the hiring of expensive experts to establish the condition of the property pre-loss. It certainly adds a level of complexity not contemplated by an insured who simply wants to get their house repaired.
The question that arises is this: Are pre-loss inspections an attempt by the insurance company to limit claim payments in the next hurricane or catastrophe? Consider this: by conducting pre-loss inspections and uncovering loose or missing tiles, an insurance company may try to assert that wind damage to a roof is wear and tear or demand that an insured affirmatively state which tiles were missing or loose before the storm. A failure to correctly answer might then result in a denial based upon insurance fraud.
Only time will tell.
Now my curiosity is piqued. I am inherently suspicious of insurance company motives. Rarely if ever, to they operate in an altruistic manner, so the question arises, why inspect the risk yearly?
Here is one possible explanation. Many times in the claims environment insurance companies will inspect a loss and assert a position that this damage or that damage is caused by wear and tear or long term water leakage or some other gradual cause of loss. In effect the insurance adjuster examines the damage and pronounces a pre-loss condition to a post-loss inspection. A counter argument to these pronouncements can be made: that the company is engaged in post loss underwriting in order to limit claims otherwise payable. Proving this argument may involve obtaining a copy of the underwriting file, prior claims files and the hiring of expensive experts to establish the condition of the property pre-loss. It certainly adds a level of complexity not contemplated by an insured who simply wants to get their house repaired.
The question that arises is this: Are pre-loss inspections an attempt by the insurance company to limit claim payments in the next hurricane or catastrophe? Consider this: by conducting pre-loss inspections and uncovering loose or missing tiles, an insurance company may try to assert that wind damage to a roof is wear and tear or demand that an insured affirmatively state which tiles were missing or loose before the storm. A failure to correctly answer might then result in a denial based upon insurance fraud.
Only time will tell.
Tuesday, April 15, 2008
The Crux of Adjusting
Disputes in insurance claims fall broadly into several categories: coverage disputes, damage disputes and causation disputes. This message addresses damage disputes.
The insurance adjuster’s job is to ascertain what the insurance company’s minimum contract responsibility is under the terms and conditions of the insurance policy. In so doing they look for the open and obvious damage and damages that can be documented using a camera and a tape measure. Sometimes these open and obvious damages actually reflect the full extent of the loss, however many times they do not. The crux of adjusting then becomes how you resolve that difference.
You’ve heard the old adage “The Right Tool For The Right Job”. This applies to insurance adjusting as well. Sometimes the right tool might be an ice pick to show charring in wood framing and at other times a golf ball to demonstrate hollow spots in tile flooring. When choosing a tool, ask yourself two simple questions: what am I trying to demonstrate? And how is this best demonstrated?
Let me give you an example. I had a client whose sliding glass door was damaged in a hurricane. Following the hurricane the wind whistled through the door whereas prior to the storm it did not. Taking a picture of the door was ineffective. The loss was proven two ways. First, I set up audio equipment to capture the whistle as it was actually occurring. Second, I videoed the door capturing the rattle of the door as it was shaken back and forth using only my pinky finger and thumb as leverage. The insurance company agreed to replace the door. Had they not agreed to pay for the door, additional more expensive proof would have been required: proof the insurance company would have been on the hook for.
The insurance adjuster’s job is to ascertain what the insurance company’s minimum contract responsibility is under the terms and conditions of the insurance policy. In so doing they look for the open and obvious damage and damages that can be documented using a camera and a tape measure. Sometimes these open and obvious damages actually reflect the full extent of the loss, however many times they do not. The crux of adjusting then becomes how you resolve that difference.
You’ve heard the old adage “The Right Tool For The Right Job”. This applies to insurance adjusting as well. Sometimes the right tool might be an ice pick to show charring in wood framing and at other times a golf ball to demonstrate hollow spots in tile flooring. When choosing a tool, ask yourself two simple questions: what am I trying to demonstrate? And how is this best demonstrated?
Let me give you an example. I had a client whose sliding glass door was damaged in a hurricane. Following the hurricane the wind whistled through the door whereas prior to the storm it did not. Taking a picture of the door was ineffective. The loss was proven two ways. First, I set up audio equipment to capture the whistle as it was actually occurring. Second, I videoed the door capturing the rattle of the door as it was shaken back and forth using only my pinky finger and thumb as leverage. The insurance company agreed to replace the door. Had they not agreed to pay for the door, additional more expensive proof would have been required: proof the insurance company would have been on the hook for.
Thursday, April 3, 2008
Tools of The Insurrance Company Adjuster
The next time your home or business is damaged by catastrophe give this your consideration: watch what the insurance company adjuster brings with them to the scene. I’ll bet you will be able to put the tools into a couple of buckets, camera and tape measure. The camera is used to document the open and obvious damage and the tape measure is used to quantify the areas damaged. Ok, I forgot something, a flashlight. They need to be able to see what they are looking at.
My question to you is this: What happens if your damage is not open and obvious? Take a look at the photo below. This is a photo of a wall taken to a hurricane damaged house. What’s wrong with the wall?
You can’t tell. The damage is not open and obvious. A camera and tape measure is not going to help you recover money from the insurance company. You can have all the opinions you want as to whether the wall is damaged, but unless you can prove it, you’re SOL. “Sorry about that the adjuster says. I just don’t see what your talking about.” Remember they can always tell you what isn’t covered by the policy and damage which can not be proven is not covered.
Having the right tool on the other hand can mean the difference between a recovery and no recovery. Here is that very same photograph where I am taking a moisture reading. The moisture meter is pegged. It doesn’t take a genius to figure out the wall is wet. The result? The insurance company paid for the water damaged wall.
There is no substitute for having the right tool for the right job. If the insurance company adjuster doesn't have the right tools at their disposal what makes you think they are equipped to adjust your loss?
My question to you is this: What happens if your damage is not open and obvious? Take a look at the photo below. This is a photo of a wall taken to a hurricane damaged house. What’s wrong with the wall?
You can’t tell. The damage is not open and obvious. A camera and tape measure is not going to help you recover money from the insurance company. You can have all the opinions you want as to whether the wall is damaged, but unless you can prove it, you’re SOL. “Sorry about that the adjuster says. I just don’t see what your talking about.” Remember they can always tell you what isn’t covered by the policy and damage which can not be proven is not covered.
Having the right tool on the other hand can mean the difference between a recovery and no recovery. Here is that very same photograph where I am taking a moisture reading. The moisture meter is pegged. It doesn’t take a genius to figure out the wall is wet. The result? The insurance company paid for the water damaged wall.
There is no substitute for having the right tool for the right job. If the insurance company adjuster doesn't have the right tools at their disposal what makes you think they are equipped to adjust your loss?
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