8 Basic Insurance Policy and Claims Guidelines For Happy Customers

8 Basic Insurance Policy and Claims Guidelines For Happy Customers

The insurance claims world is a dangerous place for amateurs.

“Beginning in the 1990s…insurance companies reconsidered [their] understanding of the claims process. The insight was simple. An insurance company’s greatest expense is what it pays out in claims. If it pays out less in claims, it keeps more in profits. Therefore, the claims department became a profit center rather than the place that kept the company’s promise(s).” – Jay Feinman Delay Deny Defend 2010
I read this book about four years ago, when I was first thinking I could take the insurance industry and flip it on it’s head.  Ah, the arrogance of ignorance.  A few years on, and I’m a little closer to making a dent in the claims universe.  No revolution has happend yet, mind you, but I can see some changes coming.
I picked up a journal from 2013 tonight.  I like to re-read my thoughts from time to time, to help keep perspective.  I saw some notes I made in February regarding this book and thought it was time to put together a post for them.  What follows is my top eight takeaways from reading Jay Feinman’s wonderful book on insurance claims.
I’ll elaborate on each after I list them.
“You are an amateur in a field of professionals.” Jay Feinman Delay Deny Defend 2010

1) Evaluate your relationship with your carrier.

2) Pick a good company.

3) Buy the right policy.

4) Understand your coverage.

5) Understand the Claims Process.

6) Fully Document your claim.

7) Meet your adjuster.

8) Decide on your need for professional guidance.

  1. Evaluate your relationship with your carrier.

We’ve all been taught that we were in “good hands” or that our insurance company was like a “good neighbor”.  The commercials and jingles are burned into our heads with millions of dollars of advertising.  The reality is that our insurance companies are not our friends or neighbors.
Jay calls the situation a “special kind of business relationship.”  Insurance companies should not be viewed as friends.  Nor should they be viewed as enemies.  You’ve entered into a contract with a large corporation.  The takeaway advice is to look out for yourself first, while being cooperative.  No need to be abrasive or combative.
Afterall, you want this large corportation to write you some potentially large checks, right?
  1. Pick a Good Company.

I’m not going to share my opinion here regarding the good, bad & uglies out there.  You don’t have to wander around the Claims Delegates blog for long to get my thoughts on who the bad actors are.  There are a couple web sites that will help you figure things out though:
The Consumer Federation of America is a wonderful place to start.  This little piece sets the tone nicely, right on the front page.
” Consumers spend hundreds of billions of dollars a year on car, home, and life insurance products whose complexity and individual pricing permit insurer inefficiency and abuse. A large majority of the state insurance departments that regulate these insurers have neither the resources nor the will to do so adequately.”
I think they might have seen folks get taken advantage of once or twice, no?  I read in my notes that I found a quote saying, “avoid Allstate at all costs.”  I wasn’t able to locate that specific quote just now, but I did find quite a scathing report from ’07.  I don’t think things have gotten better over at Allstate over the last nine years.  I’ll just leave this link here.
Of course you can use the Google as well as I can, but here’s another “Hall of Shame” list I found.
What you should do is find a good, independent agent who has access to more than one carrier.  They have the best opportunity to shop your premium and get the best coverage.  Which leads us to…
  1. Buy The Right Policy.

The most important thing to consider when buying ANY insurance is coverage.  And when you’re talking about what IS covered in your policy, you also want to check out what things ARE NOT covered in your policy: the EXCLUSIONS.  I’ve seen policies which weren’t worth the paper they were written on because of the exclusions which were hidden inside.  I spoke with a client last week with a Builder’s Risk policy that excluded damage by fire if the fire was caused by “combustible materials.”  Really.  A job site with combustible materials? What are the odds?
They suffered a total structural loss and their claim was denied. Because they didn’t understand their policy. (oh, I’m a little ahead of myself)
  1. Understand Your Coverage.

Along with the previous section, I’ll add this advice: READ YOUR POLICY!  Just do it. That is all.
  1. Understand the Claims Process.

This is where things get tricky.  Mr. Feinman said you’re an “amateur in a field of professionals.”  Once you have a claim you’ve entered a “system designed to make the company money.” (refer to the paragraph that started this post).
The claims center has become a profit center for insurance carriers.  They take in over $1 Trillion in premiums every year, and they want to keep as much of it as possible.  They have a lot of paid professionals on their side.  You need to have someone on yours.
Choose your champion.  Is it your contractor? Fine, as long as they aren’t the contractor your adjuster brought with them.  Just tell them that you need their help.  And ask questions.  Don’t think that you have to come off as an expert.  I’ve seen plenty of highly educated doctors and lawyers screw up their own claims because they thought they were the smartest folks in the room.  They can afford to pay for arrogance and pride, most of us cannot.
I could right a book on this section, and probably should.  Just not right now.
Be polite, be prompt and above all BE PERSISTENT.
  1. Fully Document Your Claim

This is another section that could use it’s own book, but let’s get the basics down.
Once you have a loss, you need to get incredibly organized and start keeping EVERYTHING.  Pictures are king, and don’t throw away anything.  Don’t let your contractor throw anything out either.  Keep it until you’ve been paid for it.
Don’t overshare.  There is a section in the book which talks about how too much information can be harmful to your claim outcome.  Be polite and answer questions truthfully when asked. Just don’t volunteer your life story.
Your job is to Prove your Loss.  The adjuster is not going to give you the benefit of the doubt.  It is up to you to prove, within any reasonable means, your loss.
I’m adding to my list of to-dos, a list of all the things you’ll need to include in your own claim file.  DO NOT assume that documents, emails or pictures that you send to your adjuster will be available for later viewing.  Heck, don’t assume they’ll even exist.  One of the oldest tricks I see is the “I’m afraid I don’t see that in your file ma’am” trick.  Billions of dollars of premiums yet they still have a basement full of filing cabinets where everything is cataloged. Please.
You’re apt to have to send the same form to different departments multiple times before things are settled out.  You may as well keep everything yourself in an organized fashion.
  1. Meet your Adjuster

This section is a little vaugue for me right now.  It’s been a couple years since I read the book and I’ve since given it to someone.  So I’m ad-libbing some here.
If you don’t get a good feeling from your adjuster, make the call right away.  Find their manager, and their manager’s manager, and get a new adjuster assigned.  You’re going to be dealing with this person for a long time.  If you don’t get a good vibe or believe they are going to handle your loss adequately, move on and don’t look back.
These days the person that comes to inspect your loss likely won’t even be a company adjuster.  If an IA (independent adjuster) comes to inspect, find out who the Desk adjuster is and open direct dialogue with him/her.  The IA is just a contractor to the insurance company who’s job is to write as small of an estimate of damages as possible.
Ask for advance payment.  The idea is to get them used to writing checks.  It doesn’t have to be a huge settlement check either.  Tell the adjuster about the clothing you had to replace or the groceries you had to buy.  Get them to write you a $1,500 or $5,000 check right away.  You shouldn’t have to come out of pocket for anything claim related.
  1. Decide on Your Need for Professional Guidance.

I realize this last one is exactly why you’re reading this blog post right now.  You got stuck/confused/frustrated with the progression of your claim and went to the Google for answers.  I’m glad you found us, and I hope this is helping.

Professional help is not free.  Good help is not cheap.  Getting what you pay for certainly applies here.

No, you probably won’t have coverage in your policy to pay an expert to represent you.  That’s why a lot of PAs (Public Adjusters) work on a commission or contingency basis.  I don’t, but I’m not normal.

If you’re insurance company is being completely unreasonable, it may be time to hire an attorney and let them fight it out.  A PA will do the same, except they can only take things so far before having to hire an attorney anyway.  The going rate for public adjusting is 15% of the claim settlement.

That just about covers it for now.  It looks like I’ve obligated myself to more writing.  I’ll get right on it.  In the meantime, you can read the rest of the blog here.

Need Some Advice Quick?

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Adjusters Are NOT Responsible

Adjusters Are NOT Responsible

Adjusters are not responsible for the final work product.

They never have been.

Here is an excerpt from a recent Clarity.fm call I had with a client.  The adjuster with Mercury insurance underbid his repairs by at least $10,000.  Mercury insurance also made him move back into his home despite having no kitchen, and with all his contents and cabinets filling his living room.

Not cool buddy. Not cool at all.

(Client): Any advice on what to expect on a claim like mine would be much appreciated. Thanks again.

 

Tough to say without pictures. 30-40k maybe

Jul 19 2016 7:45 PM

 

(Client): The adjuster normally bids that low? Cognitive dissonance.

Jul 20 2016 8:22 AM

No adjuster is the history of adjusting has ever been responsible for the work that needs to be actually done.

If they don’t have to build it or warranty it three years from now, what frame of reference do they have to actual costs?

The only folks who can honestly give a cost estimate are those that are actually willing to do the work – all of it – for the price they quote.

The problems arise when you have “program” contractors, who are willing to compromise the quality of their work, and their integrity, by fitting a project into an unrealistically low “adjuster” estimate.

“We’ll do it for that,” actually means, “We’ll cut enough corners on YOUR project in order to make the adjuster look good.”

*Andy McCabe*

(END Clarity.fm conversation)

I’ll take this one step further.

There are adjusters who tell me, “I used to be a contractor, I know what it takes to [insert construction task].”

I’ve got a question for those adjusters: if you were such a good contractor, who was able to match brocade ceilings flawlessly and marry new base to old without visual differences, why aren’t you still doing it?

I’ve got your answer: you SUCKED as a contractor and couldn’t make a living at it.  

That’s it. Simple reality.

If you were good at hanging and refinishing cabinets, you would still be doing it.  If you were able to perform projects profitably and make owners happy with your final product, then you would be making a better living doing THAT than you are right now.

You chose adjusting as your profession because it was a decent paying job with above average benefits.  And when it comes to figuring out depreciation and interpreting policy provisions you ARE the expert.  When it comes to ordering materials, coordinating subcontractors, performing quality control and ultimately putting people’s lives back together after a major loss, you suck.

So stop pretending otherwise.

 

Need Some Advice Quick?

NEVER Ask Your Adjuster For Permission on Your Claim

NEVER Ask Your Adjuster For Permission on Your Claim

Adjusters aren’t in a position to determine scope.

Too many times, I’ve seen insureds give away their negotiating leverage by asking their insurance adjuster for permission.

Adjusters aren’t in a position to determine scope.  They aren’t in a position to determine cost.

Their job is to determine coverage.

 So why do so many folks turn into Oliver and start asking for another bowl of pourage?  Because that’s what they’ve been led to believe is the right thing to do.

I don’t buy it.

“Mr. McCabe makes very good points. The policyholder is not in a position where he should be “asking” for money from his insurance company. He should be in a position where he can prove that he has a loss and show what it will cost him to restore himself to his pre-loss condition. His questions for his adjuster, if he has any, should be pertaining to his coverage. Adjusters can give “estimates”, but I have never seen an insurance policy that limits the carrier to pay what is “estimated” to be the actual loss.

~Jim Bushart James H. Bushart, Missouri Public Adjuster

Are You Ready to Get a REAL Estimate?

Stake Your Claim

How To Get Xactimate Estimates Written by Claims Delegates

How To Get Xactimate Estimates Written by Claims Delegates

“How does it work?”

I recently received an email from a new client asking how Claims Delegates “worked”.  She asked several really great questions, and I thought I’d answer them for ya’ll.

In reality I’m being lazy, because these are actually very common questions that I receive all the time, so I’m putting them down “on paper” so I can start sharing a link instead of retyping the answers every time.  Is that OK with you?

Here we go:

What is your charge and how do you charge?

EX; by job type, job amount, amount of time it takes to write the estimate?

We charge by the hour. We have a fee range from $110 to $165 an hour for everyone from old, established clients (lower fee) to brand new folks (coaching included in services).

After the minimum service fee ($299), our estimate generation fee will not exceed 2% of the value of the estimate.

We can turn most water mitigation jobs in 24hrs.  Roof Only replacements take 24-48hrs.  Repair estimate return times depend on the complexity/size of the loss.

Is there a fee to register with your company?

There is a minimum service fee of $500 for first time clients.  This is applied as a CREDIT toward our hourly service charges.

Is there a minimum number of claims?

Or can you take claim by claim?

Absolutely not. No minimum order quantity. (There’s no MAXIMUM either… wink, wink)

It is our hope that you will enjoy the experience of someone else cranking out your Xactimate estimates so much, that you'll soon forget that you ever did it yourself.

Are You Ready to Get a REAL Estimate?

Stake Your Claim

Do you submit to the insurance company for me?

XM8 Can DoWe can send emails directly to adjusters if you prefer. 

We also have the ability to send assignments via Xactanalysis  (XactNet address: CLAIMS.PORTLAND.OR).

You can see how this works in this article.

That means that we can write estimates and submit them on your behalf to TPAs like Lionsbridge and Nexxus.

Phone and email conversations with carriers and adjusters will be billed at the negotiated hourly rate.

How is your communication with your clients?

We communicate every step of the way.  Our projects begin with a phone conversation.  It is important to us that we understand your needs and expectations right up front.

After you submit a Project Intake form, you will begin to receive automated emails from the Claims Delegates XM8 System.  You will receive email updates at every stage of the process, from “Intake” to “Delivery & Upload” of your estimate.

Once an estimate is delivered, a secondary meeting can be set up in order to work through any needed revisions.  Often an email response with changes is sufficient.

We will follow up every week or so after that, to check on the status of any needed Supplements.

Need Some Advice Quick?

Do you do construction estimates as well?

ScopingXM8Absolutely we do construction estimates in Xactimate. 

Our largest estimate to date is a $3.5million apartment building that suffered major water damage.  The project required the use of as-built architectural plans as the basis for our Xactimate sketch.

Of course, most projects fall into the more manageable $15,000 to $35,000 range.  Through the use of Scope Notes sheets and sharing of pictures via Google Drive, we put together a complete Xactimate estimate according to your needs and specifications.

And it all comes with your letterhead and estimator’s name attached.  In the end, the files are all yours (including any ESX files generated).

Do YOU have a question? Hit us up on your favorite Social Media channel!

What is Depreciation and Why Should I Care?

What is Depreciation and Why Should I Care?

I thought I’d record a short video to share my take on depreciation.

I had several hours of driving to do and decided to at least get some thoughts out there.

Depreciation, in short, is the difference between ACV and RCV of your property – whether that be your house, car or furniture.

RCV is the Replacement Cost Value of something.  Phrased differently, RCV is what it would cost to replace an item today.

ACV is the Actual Cash Value, or sometimes referred to as Fair Market Value.  It’s a more subjective valuation of what an item is worth on the open market today.

Why should you care?  Because when it comes to paying out your property claim, your insurance adjuster will use the ACV value as the basis for their initial (and sometimes only) settlement offer.  I see potential errors and problems every day when it comes to property claims and depreciation.  I’ll list a couple here.

Flat Rate Depreciation

This is the most common error I see, and also the most dishonest in my opinion.  Taking a flat 25% or 35% depreciation on a claim is just lazy adjusting and is completely inaccurate.

The adjuster who uses this technique is essentially saying that everything in the estimate has decreased in value at the same rate over the same amount of time.  In the case of property claims, it’s like saying your carpets and countertops have the exact same “useful life”, have experienced the exact same wear and tear, and were installed at the exact same time.  It’s just not an accurate portrayal of reality.

The biggest issue I have with Flat Rate depreciation is the fact that it also reduces the labor costs at the same rate.  How does labor depreciate in value?  It doesn’t.  Depreciating labor then becomes another tool for insurance carriers to reduce the “severity” of claims when dealing with uninformed claimants and contractors.

50% or more Depreciation

I shake my head every time I see an adjuster take 50% or more value from an item.  And I’ve been there when homeowners get fairly upset and insulted by it.  Taking that much depreciation is just hurtful and unfair.

The problem is in the rebuild.  When that homeowner goes to hire a contractor to perform repairs, what is the first thing that contractor will need: a deposit.  A claim that has been depreciated at this level puts the homeowner in a position of having to come out of pocket to start repairs, even if the claim is fully covered.

What Can We Do?

The first thing you can do is understand your policy and the part that depreciation plays.  Most homeowner’s and auto policies have depreciation written in.  It is possible to buy an insurance policy that is “RCV”, you’ve just got to know what to ask for.

The second thing is to understand that depreciation is subjective and completely negotiable.  If you feel that depreciation has been taken unfairly or incorrectly calculated, push back.  Don’t settle for a “that’s just the way it is” answer from your adjuster.  Ask them how they calculated depreciation, and come to the table with your own valuations.

The third thing to do is to learn how to RECOVER the depreciated amount taken.  This is the area that most carriers hope you just forget about.  If you never ask for your depreciation, guess who gets to keep it.  It’s not like the insurance company is going to call you up in a couple months and say, “hey, remember that recoverable depreciation?  Are you gonna want that back?”

Recover Your Depreciation

The most common way to recover depreciation is you spend the money.  For contents, that means going out and replacing that TV or coffee table and providing a receipt for replacement cost.  This is not a straightforward or simple process, and your carrier with drag it’s feet the entire way.

For property damage repair, you can usually get an RCV check written if you show that you’ve contracted for AT LEAST the full amount of the settlement.  This means you’ve negotiated a repair contract with a contractor and their bid meets or exceeds the full claim settlement amount.

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