State Farm Rejected Mold Claim

State Farm Rejected Mold Claim

Claim Doctor Q&A: State Far Denies Mold Claim

Often I get questions about denied claims. Too often it is too late for me to provide any meaningful assistance.  The moral of this Q&A is: Don’t delay in getting professional help.  The longer you wait, the worse your chances of a fair settlement.

 

Q: Jim R.

I’m a mold remediation contractor who is trying to help a homeowner.

They had some storm damage to the house and did not realize the damage until months later. The incident date was May 22nd 2014 and they applied for coverage 11 months later after realizing the situation.

Neighbors had roofs replaced with other repairs but these clients are struggling with State Farm to get the repairs completed.

In addition, they have a condition 2 mold situation that is concealed by carpeting and sheetrock. An air test was completed with structures still in place an did not come up elevated. The problem is that the species count of penicillium/aspergillus is 3 times higher in the affected area vs. an unaffected area.

If mold removal was to take place, without following S520 protocol, the spore count would skyrocket and mold spores would spread throughout.

This is a sensitive situation as one of the homeowners was involved in a very serious auto accident and is mostly bedridden in the affected area. Medications have reduced immunity and an increase in mold sensitivity is a major concern.

So far, State Farm has rejected any mold claim and I’m not completely sure about costs covered, if any, for the roof.

A: Andy McCabe

Hi Jim,

Thanks for reaching out.

Coverage issues are always tough, and State Farm is notorious for denying coverage for mold.

I would recommend putting together a package of anticipated costs, including the roof repairs, and have the homeowner submit it as part of a Proof Of Loss.

This is getting fairly old and it is likely less than $100k, so getting a PA to take the case isn’t very likely. That doesn’t mean you shouldn’t reach out to a local Public Adjuster to ask some questions.

I can help with developing repair scopes, but beyond that I’m afraid I don’t have any magic bullets.

Good luck,

Andy

Scoping for Xactimate

Scoping for Xactimate

Every loss scope has three main components: plenty of photos, a legible sketch and a detailed room-by-room scope.  Today we’re going to talk about room scoping.

First, some history.

I’ve been “writing” insurance scopes for nearly 20 years.  For the first few years, “writing” meant running from job taking pictures and creating sketches, then sitting down at the end of the day attempting to spew an estimate out of whatever I managed to cram into my head.  It’s safe to say it took me a couple years to learn what it takes to create a complete repair estimate.

You can only get a complete repair estimate, whether you’re using Xactimate or another estimating program, from a complete scope.  The most common disagreements in property claims are not about pricing, since we’re all pretty much using the same standard database.  Most disagreements are about the loss scope; what should have been included – and what should NOT.

Garbage In, Garbage Out

The phrase “garbage in, garbage out” is apropos in this context.  If you don’t have good information at the beginning of the estimate process, including a thorough scope, you’re NOT going to have a proper estimate in the end.

I write Xactimate estimates for contractors across the country.  My observation is that scoping is a skill that isn’t being taught well in the Restoration industry.  My experience tells me that folks are either naturally inclined to create good scopes, or they have to hire someone who is.

Every contractor, especially non-restoration contractors, has his/her own unique thought process when it comes to scoping and estimate creation.  Some take copious notes using a yellow notepad, others draw elaborate diagrams with little tiny notations and measurements.  Each has found a way to get the information they need in order to generate that all-important estimate at the end of the day.

The problem is that what works for one person, may not work for another.  When it is just one person that is charged with the photos, sketching, scoping AND estimating, there is little need for a system.  The person IS the system

Today’s project manager/estimators are some of the smartest people in the industry.  Their skill sets have been honed over the years in order to allow them to work magic on claim after claim.  Their notes and tick sheets have been equally honed to meet their own individual needs – and are little use to anyone else.

I once scoped a job with an independent adjuster who had previously been a general contractor.  To save time and effort, I ran the tape measure while he wrote the sketch.  We talked about the anticipated repairs as we walked the property and he scribbled like mad on his notepad.

At the end, I took photos of his sketch and headed back to my office to write my estimate.  To my surprise, I couldn’t read his sketch.  It was created in such a way that I had no idea what I was looking at.  So I called him for some explanation.

“My wife is the only one who seems to be able to read my sketches,” he explained after a good chuckle.  You see, he and his wife were an estimating team.  They had worked together for so long that they understood each other’s shortcuts and nomenclature.  They had their own system that worked for them.

It worked for them, but not for anyone else.

People Cannot Scale

This example illustrates the problem with relying on people as your systems.  Whether it’s estimating or building a car the truth is the same: in order to scale you must use systems.  Otherwise we’re all open to the proverbial “hit by a bus” scenario when our key employee or partner is no longer available and the whole operation grinds to a halt.

Jack Dennison mentioned this scenario during our interview on The Claim Clinic He said he sees a lot of companies stuck at $1.5-$2million in revenue because they rely on a sole operator to do it all: scope, document, negotiate settlements and estimate.  These companies will never grow to their potential, Jack says, until they implement systems to reduce the workload and eliminate one-person bottlenecks.

All companies, not just restoration contractors, who want to grow will eventually wind up at the conclusion that systems are the growth engines they need.  Once there are systems in place, you and your folks can work the system instead of working yourselves to the bone.

Systems allow you to hire the right person and then train them on the process.  The reality at most companies these days is that they’ve hired for the right skillset, not the right person.  There are a lot of companies whose success depends on the capacity of one or two project managers and estimators who have a skill set that no one else at the company has.  This is a recipe for disaster.

Systems Allow You to Scale

Using a simple, powerful system for scoping will allow you to start plugging in folks who don’t necessarily know everything about estimating, and then relying on the system to gather the right information.  Over time, these new people will become adept at working the system and eventually train new hires in the same way.

This also allows for specialization without depending on one person to possess a wide variety of skills.  The claims process turns into an assembly line of interchangeable parts, any of which a new person can step into and quickly get up to speed with the basics.

Xactimate Scope Basics

The first thing to understand is that a person doesn’t need to know anything about Xactimate in order to create a complete scope.  You don’t need to know any of the THOUSANDS of codes that make up the Xactimate database.  You only need to know how to tell a story.

Good Scoping is Good Story Telling

Any decent Xactimate estimator knows that when you say, “Replace the drywall on the North wall,” that the estimate will read something like this:

  • DRYMASKLF – PF
  • DRY1/2 – W/4
  • DRYTEX – W/4
  • PNTMASKSF – F
  • PNTSP – W/4 … etc.

Notice that with just a little information, someone who knows what he is doing can create an Xactimate estimate that will fit the bill.  Unfortunately, often a good story doesn’t get told.  A statement like “fix drywall holes” wouldn’t quite be enough to go on.

So if you can tell a good story, you can probably write a scope with enough description that a professional estimator can take it, along with your pictures and measurements, and create a complete Xactimate estimate without ever stepping foot on site.

Now let’s take it a step further and show you how to systemize your scope taking to reduce your training time and provide a more consistent end product.  First, download the Scope Notes form that Claims Delegates uses for their clients: https://gum.co/xm8scope

Good Stories Start With a Good Framework

As you’ll notice, there is not a lot of information on the Scope sheet itself.  This was intentional.

My theory is that the more you give someone, the less they think.  And thinking is exactly what we want our project managers to be doing.  They are our eyes and ears in the field.  Each has to be able to think about not only what they can see, but also about the various assemblies and structures that they can’t  see.

This is why the worst scope sheets are the ones that attempt to list every possible item that may be needed in a room.  I’ve seen “tick sheets” that were multiple pages in length, and with teenie-tiny print just to fit it all in.  What’s the point?

The thinking behind these comprehensive lists is that if everything is on there, the folks filling out these things won’t forget anything.  The opposite is what happens in reality; things get left out because who can find what they’re looking for in that mess?  When you take away the ability to think, you also take away initiative and imagination.  Don’t do it.

As a matter of fact, if you have pages and pages of “tick” style scope sheets in your desk or in your truck, stop reading this right now and go throw them in the garbage.  Go ahead, I’ll wait….

Now, let’s talk about what our scope takers ACTUALLY need: structure.  It is important that when we do things, anything really, we do them the same way every time.  Even creative activities have a process and a flow.  And the more familiar we are with the process, the more we can achieve “flow.”

We want our folks to be able to get up to speed quickly and maintain a high level of efficiency for as long as possible.  We also want to plan for unforeseen circumstances that may interrupt our flow.  If we are all using the same system, in the same way, it becomes easier for other people to step into our workflow and pick up where we left off.

It is important that our systems, at every level, are easy to teach and learn, while providing the highest level of quality information throughout our organizations.   These structures, or frameworks, become the backbones of our companies’ competitive advantages.

Keep It Simple

Now take a look at the Scope Notes sheet, as well as the example sheets provided.  As you read through, you’ll quickly get the picture of what is needed.

The top section is used to keep all the paperwork organized, and to provide the Xactimate writer a way to contact the person who performed the site take-off in case there are questions.  The time is used for training and monitoring purposes: if you wrote the Living Room scope starting at 11am, and wrote the Kitchen scope at 11:30, you know that it took a half-hour to write up the Living Room.

This kind of information is incredibly useful for managers and estimators alike.  We are able to quickly identify opportunities for growth and training.

The top section also enables a scope to be written by more than one person.  Because we’ve never been called to a big emergency water damage while we were knee-deep in a whole-house scope job before. Right?

The rest of the Scope Notes follows a simple pattern:

  • Room Name and Dimensions
  • Equipment/Sub Trades
  • Framing / Structure
  • Floor scope
  • Walls scope
  • Ceiling scope

Filling out each section is as simple as asking the question, “What Sub Trades do I anticipate using in this room to return it to pre-loss condition?”

Or, “What wall repairs will be needed to return this room to pre-loss condition?”

Easy right?  We move our minds in the same pattern in each room: outside-in and bottom-up.  This happens to be the exact way I teach my students/contractors.

Writing scopes in this way also allows the Xactimate writer to show the same flow pattern inside their estimate.  I even advocate using the labels – Subs, Floor, Wall, Ceiling – inside each room of the Xactimate estimate.  It telegraphs to the adjuster and homeowner that we’ve thought of everything; because if we follow the flow, we HAVE thought of everything.

The Best Way to Eat An Elephant

The most common questions I get from folks who are new to this system are regarding specific items. Like, “what about cabinets?”

I answer that by asking another question, “Where do you put cabinets?”  Floor? Wall?  It doesn’t matter really. Just as long as you put them in the same place every time.

Insulation?  Is it wall, floor or ceiling BAT?

Baseboards?  Well fancy pants, do you attach baseboards to the floor or the wall?

It really doesn’t matter which you prefer.  The important thing is that you are going through the mental exercise of thinking about each assembly as individual pieces of the whole.  By breaking up the room into parts, you are less likely to get caught up trying to think of everything at once.

What’s the best way to eat an elephant? One bite at a time, Grasshopper.

What would you like to learn next?

I’m writing these articles based upon requests for information from my Claims Delegates clients.  Is there something you’d like to read about next?

Send a tweet to @TheClaimDoctor or head over to the Facebook page and leave me a note.

GOT XACTIMATE?

Your Xactimate estimate in 24hrs!

Ten Thousand Percent Return

Ten Thousand Percent Return

When was the last time you received a 10,000% return on an investment?  Sounds unreal doesn’t it?

Did you know that is exactly what you get when you let Claims Delegates write your Xactimate estimates?  Go ahead and do the math: a ONE PERCENT fee means that for every dollar you spend, you get $100 of revenue in return.  That’s some serious ROI!

Xactimate Is Revenue

An important concept I touched on in the first part of Mitigation Moneyball is that Xactimate estimates equal Revenue.  Think about it; have you ever had a bill that was less than your Xactimate estimate?  I hope not. (yes, I understand that there are sometimes discounts given, but that’s a different topic).

That means that your company’s revenue is directly tied to the size of the Xactimate estimates you produce.

With that in mind, you can do two things to improve your revenue numbers:

  1. Increase the size of your Xactimate estimates and
  2. Reduce the costs of developing those estimates.

The good news is that Claims Delegates can help with both!

We’ve been writing estimates in Xactimate for over fifteen years.

We know the inside secrets of squeezing every penny out of the database.  We also understand the ins-&-outs of insurance programs and what adjusters are generally willing to pay for – as well as what things will raise red flags.

Would you like to be assured of high margins on every estimate?  Better make sure you hire an estimator that understands the system as a whole. HIRE CLAIMS DELEGATES

Lock in your costs before you start

The second thing you can do to improve margins is to LOCK IN YOUR COSTSJack Dennison preaches about buying out jobs and making sure your subs work hard for you.  How many subs do you know that work for ONE PERCENT?

When you hire Claims Delegates, you’re locking in your estimating costs at ONE PERCENT of revenue.  It’s tough to say “no”, right?  We’re able to write estimates at a high rate of efficiency because that’s all we do – write Xactimate estimates.

Our writers aren’t out “marketing” to adjusters, managing the on-site operations of job sites, or hanging out by the water cooler talking about their weekends.  Our writers are focused on YOUR estimate.  What you get is a thorough Xactimate estimate that costs you a fraction of hiring a full-time employee.

What are you waiting for?

 

Increase your revenues and lock in your costs. Call Claims Delegates today!

888.745.7568

Who Controls Your Xactimate Estimates?

Who Controls Your Xactimate Estimates?

Does the IRS do your taxes?

No? Of course not.

Then why do we feel compelled to let the insurance company settle our claims?

I’ve talked about this a lot before, so I’ll try not to repeat myself here.  I just wanted to put something out that was on my mind.

Xactimate is a Settlement Tool

Just like the federal form 1080EZ, an Xactimate estimate is a tool to quantify a loss.  That’s it.  And it’s a tool that is available to everyone, if you know what you’re doing.

That’s why I created Claims Delegates; to help EVERYONE who wants to take control of their claim.  Writing your own “estimate” using Xactimate puts you squarely in the driver’s seat.  And isn’t that where you want to be anyway?

Let’s get started, shall we?

GOT XACTIMATE?

Your Xactimate estimate in 24hrs!

How NOT to Take Pictures for Xactimate Scopes

How NOT to Take Pictures for Xactimate Scopes

Excuse Me, Your Meter is Showing

Alright ladies and gentlemen, it’s time for some brutal honesty.  You take crappy pictures.

There, I said it.  And I won’t apologize.  The pictures you are taking are driving us nuts.

We’re your estimators and your adjusters.  We know what you’re trying to do.  You want to make sure that you document everything.  I understand, and it’s not actually your fault.  You’ve been conditioned to take unnecessary pictures.

Over the years you’ve taken the blame for NOT taking pictures of things that cost your company money.  Heck, Farmers won’t even pay for dump runs unless you supply us a picture of the full trash bags.  I get it.

It doesn’t make a lot of sense to us either.

But enough is enough.  The time has come to reel in the crazy resto-razzi photo shoots and bring some sensibility to the camera madness.  The first thing I want to bury wherever they put Hoffa is the pictures of your moisture meter.

When has anyone ever asked you to provide a picture of your moisture reading?  Really.  I’ll pause to let you think about it… Never. The answer is never.  I’ve not once, in my nearly twenty years of restoration, had an adjuster or TPA ask for a picture of a moisture meter.  They don’t care how pretty your Tramex is, and neither do I.

If the material is wet, tear it out. Don’t waste time with pictures.  If you want to dry the material, take your reading and mark it on your RDC along with your room sketch.  That’s it.  Leave your camera out of it.

I’m not sure where this habit came from, but I can tell you where I see it most.  I see it most from folks that are new to restoration or mitigation.  In their sincere desire to be the best and work the hardest, they end up taking pictures of things that don’t have much bearing in the end.  If that is you, take this as your opportunity to stop wasting effort on things that don’t matter.

Taking pictures of your moisture meter telegraphs to the adjuster that you might not be the most experienced cat in the sandbox.  So stop it.  Have I made my point?

Ok then, you may be asking, what should I be taking pictures of?  I’m glad you asked.  Before I answer, let me back up a scosh.

Everything you do, no matter whether you’re a mitigation technician or a general manager, should be defined in a standard of operations.  You should have a system for everything, including scoping losses and taking pictures.

Every loss scope has three main components: the photos (which we’ll cover now), the sketch and the scope (which I’ll cover in later articles).  If done properly, and with enough attention to detail, a good estimator can create an Xactimate estimate using only two of the three main components.  The reason we have all three is to create some redundancy in our overall scoping system.

I’ve even written full repair estimates using only the mitigation scope and pictures taken after demo.  It’s not ideal, but it can be done.

I’ve developed a system called the 24HR TECH, which provides a framework for water damage technicians to learn and then perform their jobs at the highest levels of efficiency and profit.  There are five separate sections that call for taking pictures of specific items.  I’ll walk you through the Room Notes section now.

First, before you enter a room, you should have the Room Notes sheet in your hand.  Some folks are trained to label each room with a piece of painter’s tape.  That works well.  When I’m working a high-rise loss, I like to take a picture of the unit placard.  Either way, take a picture of the room name.

The reason is simple: it marks your camera “roll”.  Even though we don’t use film anymore (yes kids, we used to have cameras that didn’t have phones attached), when your pictures are downloaded into the job folder, the room name pictures serves as a neat marker for which room the pictures were taken in.  Everything after a room placard or label is part of that room, until we see the next room placard or label.

This also eliminates the need to label each picture in the field.  (Please tell me you don’t do that still.)

Second, you take several room overview shots.  The panorama function on most cameras – I mean – phones, does a nice job here.  Pick a corner and take your pictures from left to right.  Be sure to stick to less than 180-degrees if you use a panorama, otherwise things get weird.  Then walk to the opposite corner and take another set from left to right.

Third, take pictures of the floor then ceiling.  Take as many pictures as necessary to capture the unique properties of the room.  Did you catch all the fixtures?  Is there base shoe molding?  Could I count the number of outlets to double check my scope notes?

Fourth and finally, take pictures of items of interest and pre-existing conditions.  If you want to take note of a swollen window casing?  First step back and take a picture of the window as it sits in the room, then take a close up picture of the damage.  Always keep in mind to frame your shots for the person who will view them; that person will likely NOT be you.  You have to telegraph context with your pictures.

That sounds like a lot of pictures, right? Yes, it is.  A three room water loss should have at least 50 photos.  And that’s completely OK.  Be thankful that you don’t have to carry around files full of polaroid pictures./

And guess how many pictures there should be of your moisture meter… Zero, that’s how many.    11/28/16: after many rounds of social media debating, I must redact my last statement.  Take pictures of your meter when drying the structure.  Just make sure you take an “overall” picture, then a close up.  That will help adjusters and PMs get an idea of what they’re looking at.