by zoobee » Sat Nov 08, 2008 03:54 pm
A couple of things going on here. We felt the adjustor didn't give us some money we were entitled to so State Farm sent him back over here. He started our meeting by accusing us of fraud. It was an outdoor garden antique column we laid down outside to protect and he said he didn't believe we layed it down because there was no debris under it. Duh, there was no debris under it because we laid it down and an enormous tree fell on it and sunk it into the ground then the water was high over it and pulled all the debris out of that area when it receded. We absolutely laid the thing down. Of course I went off on him and my husband almost had a heart attack because I was so mad he thought I was going to have a heart attack........LOL. Well after that he started telling us stories about how people are trying to get too much from the insurance and that if we ask for more money they can start taking away what they already gave us. I have been so upset over this you can't imagine. He refuses to pay for carpet that is now full of black mold because we didn't take it out of the room before the mold grew. NO ONE was going into that room. There was an 80 foot tree hanging over it for 20 days, falling a little more each day. He said he went in that room and there was no problem. I finally took the carpet out by myself and since I am allergic have been sick for two weeks. He said we should shut up because he didn't have to give us a roof but he did and we should just be happy with what we had. He also said he paid for our column and our iron fence even though he didn't believe us. He did pay for the column but only paid a third of what it would cost for the fence. There is still a tree stuck in that fence but he doesn't believe it happened in the hurricane. He said the wood fence behind it didn't get broken. How can he say that. I had an eighty foot tree on the house and just a few feet away from it a tiny tree with red flowers still had the flowers on it after the hurricane. Anything can happen in any weird way with these damages. What do you do when someone accuses you of something you didn't do and then threatens to investigate more and take away what they already gave you. It's impossible to defend yourself with these people. They can say whatever they want about you and then what do you do. Idon't have the energy to fight this and he has now terrified us. Now here is the big problem, we got a bid for the tree removal and then hired someone else to do it because our original bid person was too busy. He based our settlement on the original bid. Now he is asking for an invoice from the guy that actually did it. I can't find my invoice or the guy. He was out of La. and was travelling around after the hurricane doing tree work. We paid him cash. We have a receipt but no phone number. I am terrified that he will accuse us again of fraud and take away the three thousand dollars it cost us to get this tree removed. All I have is this receipt. This is driving me crazy because the adjustor came over here and accused us of all this stuff and now I am terrified to ask for more money or to give him this receipt and he accuses us of fraud again. I have the receipt but they won't be able to find the guy to verify it. He only took cash because he was traveling around doing disaster relief. The adjustor asked for the invoice on the way out because he thinks he is catching us for fraud on this tree thing because he thinks we had it done for less that he paid but its not true , it cost us the same. I also have photos of the crane on the tree and the guys up on the roof. What should I do? If I report him to the insurance commission it will only get worse for us if he gets mad at us again. In the middle of all this my son was hit by a tree during the hurricane and was 6 weeks in the hospital with 4 broken vertebrae and is lucky to be alive and walking and my dad is dying in the hospital and every call is a scare as to whether this is the real day he dies. This is way too much stress. This is why I am on pins and needles and went off on the adjustor to begin with. I welcome any suggestions because my brain just can't function right now. Thanks in advance.
Posted: Sat Nov 08, 2008 08:09 pm Post Subject:
zoobee...I gotta tell you this is possibly the most unprofessional and unethical thing I have ever heard regarding an adjuster.
He said we should shut up because he didn't have to give us a roof but he did and we should just be happy with what we had.
:oYou're kidding, right? He actually told you to "shut up?" That's when he would have hit the floor clutching his jaw. :x
Well after that he started telling us stories about how people are trying to get too much from the insurance and that if we ask for more money they can start taking away what they already gave us.
Strike two. In my career, I have only seen an insurance carrier seek to recover damages paid to an insured if there was provable fraud on the part of the insured. Insurers generally don't pay for losses that aren't covered. If fraud is discovered after payment has been made, the insurer cannot simply "tell you that they're going to take back what they already gave you." They would have to go through a civil process like anyone else would. They'll send demand letters which are usually ignored, then they'll threaten to file suit, and eventually, they will file suit. It isn't common that someone is jailed for insurance fraud.
He refuses to pay for carpet that is now full of black mold because we didn't take it out of the room before the mold grew. NO ONE was going into that room. There was an 80 foot tree hanging over it for 20 days
:!:The carpet replacement should be covered, since the proximate couse (originating cause) was covered. Your homeowner's policy also has several additional coverages that should help. There are coverages that deal with removal of damaged property and other areas that deal specifically with your type of loss. The tree removal and replacement is covered as well as an additional coverage. Replacement of the tree itself is normally limited to about $500 or $1000. "Bushes, shrubs and trees" (your language may vary) is commonly a section within the policy. As far as your getting sick from removing the carpet yourself since the #!!@#! adjuster wouldn't take care of it is simply ammunition in your pocket.
I could go on and on with the professional, contractual and ethical errors this idiot has made, and one comment that you made piqued my curiousity:
If I report him to the insurance commission it will only get worse for us if he gets mad at us again.
How did you get that idea? Did the idiot tell you that would be the case? If so, that's strike three. Most states would consider that to fall under their unfair claims settlement practices act. Personally, I would consider that "threats by intimidation or force" which is explicitly illegal. I would think that your insurance commission could be one of your best friends right about now. I would also call the carrier directly and ask to speak with the claims boss. Not a supervisor, you want to speak with the big boss. Regional level or higher, and relate this story to him or her. :!: :!:
If it's taken care of on that level, good! Most carriers don't want these things to get out of hand. When I read your post, it was pretty obvious that the idiot doesn't like you because you went off on him. That's somewhat understandable. It doesn't give him the right to go off the deep end, nor does it give him the right to interpret the insurance contract as he sees fit. As I tell my clients and my students- "the contract is the contract, and nothing anyone says has any bearing on anything unless it's specifially stated in the contract." Now, there's way more to it than that, but that essentially it.
Finally, if you get no satisfaction from the bossman, I would seriously consider checking out your legal options. I am not recommending a lawsuit at this point by any means. Mostly cuz I think lawyers, for the most part, are a necessary evil. They're like insurance- you don't like it much until you need it, then it's your best friend.
I think this situation sucks, and I think that you're being taken advantage of unfairly and illegally. There are many others in this forum that should chime in. I'm especially interested in what InsInvestigator and Lori think.
Good luck, and stay in touch!
InsTeacher 8)
Posted: Sat Nov 08, 2008 10:01 pm Post Subject: Me Again
No the adjustor did not tell us anything about the insurance comission. It's just that if he will come and accuse us of all these things we didn't do then he is capable of anything and I don't want him coming after me. He is obviously an evil little man. I think when a woman went off on him it really pissed this guy off. I found the invoice for the tree guy so I guess I will sleep better tonight. It has his phone number on it so they will be able to verify. I am still ticked about my carpet though. I am trying to get the nerve to call State Farm, a manager or team leader at a higher level but my husband just wants to leave it alone. He says let's get the roof done and spend all the money they gave us for all the right purposes and then when that is done we will ask for more money. Thanks for all your replys and keep them coming I can use the advice. Oh, he didn't actually say shut up, he used his little stories to tell us we better not ask for more money. He was saying things like, one customer wouldn't leave State Farm alone so they investigated him and found that he had already filed a claim for damages he was claiming again and they took all the money back. Stupid stories like that that have absolutely nothing to do with us. To tell the truth I was so mad I just got the jest of his little stories and they were screaming "shut up" or I'll make your life miserable. He did say the part about taking the roof back if we ask for more money though. He said you know I didn't have to give you that roof. Well the roof is pretty damaged and gee why would he just give us a roof out of the kindness of his heart and then come and be so mean to us and threaten to take it back. zoobee
Posted: Sun Nov 09, 2008 04:25 am Post Subject:
zoobee, I understand that you aren't thrilled about going after this guy because of what he's done. While I can see things from your point of view, consider this point of view:
The idiot represents the largest insurance company in the U.S. in terms of automobile and homeowner insurance policies issued. Remember the State Farm mantra- "Like A Good Neighbor, State Farm is There." Yeah, like the Hatfields and McCoys. Some great neighbor, huh?
One of the reasons the insurance industry gets the occassional black eye is because of people like this. He does NOT represent the vast majority of people in the business, nor will anyone who has a modicum of professionalism agree with what he's done, regardless of what he perceives as provocation. Ooooh...you yelled at him. :shock: I have seen adjusters with the God complex, thankfully they're rare. They usually end up getting their company sued, or if the company is on top of things, they get fired. :D
My point is this- he cannot be allowed to get away with this. If he's doing this to you, what's he doing to other claimants? From your posts, it looks like he's interpreting coverage in somewhat of a scattered manner as well. Remember- coverage is coverage and the contract is the contract. I understand that you are hesitant to follow-up and call his bluff, but you seem to be entitled to more $$$ from your claim, you paid for the policy's coverage and State Farm's protection, and as a State Farm policyholder, you are entitled to a special little benefit.
State Farm is a mutual insurance company. A mutual insurer is one in which the policyholders are literally the owners of the company. This means that YOU own a tiny little fractional piece of your insurance company :!: You're a "stake (not stock) holder." You have rights!
Don't give up on this. Don't let it sit. Of course, you can do whatever you like. It's your home, and you and your husband have every right to just let the matter drop. I feel (remember, my opinion) that you've been badly mistreated and royally screwed based on the info in your posts. If what you say is indeed the case, and you're the ones that have wronged here...how can you let it sit?
Just curious. None of my business really, so feel free to tell me to stick it. I won't take it personally! :) I just want to see you taken care of like you should be.
InsTeacher 8)
Posted: Sun Nov 09, 2008 11:26 am Post Subject:
'LET ME AT 'EM, LET ME AT 'EM"... :evil: :x :x :x I honestly don't know if you can be madder than I am Z....seriously! Moron's like this are egotistical, little napoleon complex men that think they are hot crap because they have a billion dollar check book....He did not 'give you a roof' nor can he 'take it back'....he's probably over worked, he's certainly riding a storm team, he's tired, however he's making a bundle of money doing it...and has no excuse whatsoever to treat you poorly...
This type of person is an insult to my profession, and he must be stopped..
I am BEGGING YOU to contact BOTH your states dept of insurance and file a complaint against this jerk..and also try to start at the VP of claims and work your way down if necessary...this is NOT acceptable behavior...and believe me State Farm doesn't need any bad publicity in storm areas.
I think you're a compassionate, strong woman, (so am I)...think about how this douche is treating the widowed 80 yr old woman down the street! If he will act that way to you in front of your man..(poor chump would've left my house bloody) .what is he doing to a poor little old woman alone?
Oh and yes, he does owe you for the carpet, and I'm sure plenty more....set down write everything up, and start the calls...remember this isn't just for you...
Posted: Sun Nov 09, 2008 12:05 pm Post Subject:
Oh my...Zoobie I really feel for you. I hope you do report this person. If he treated you an the elderly lady this way then he has more than likely treated others this way to. Make that call and if you hear anyone else with complaints advise them to do so also. He doeasn't deserve his job.
Posted: Sun Nov 09, 2008 06:54 pm Post Subject:
Hi zoobie- for some reason I can't get away from your post. It's like a moth to one of those bug-zappers.
Lori has it right on target. I loved this:
'LET ME AT 'EM, LET ME AT 'EM"... :evil: :x :x :x
I was ready to jump through my computer when I read this post. This is one of those things that cannot be left unanswered, and this idiot must be put to task. The OP is entitled to her damages, and State Farm is placing themselves in a precarious legal situation by allowing this kind of behavior within its' ranks. If you want to get specific:
1. The adjuster is legally considered an agent of the company. Agents of a company are under what's called the "law of agency" in most states. This is a series of laws that spell out the right, duties and requirements of agents, insurers and third-parties (like insureds). One of the main principles of this law is the concept of knowledge. To put it simply- the agent represents the insurer (called the "principal" here), and owes all duty to that principle. In addition, knowledge of the agent is considered to be knowledge of the principal. This means that whatever the adjuster knows, it's assumed by law that the insurer has the same knowledge. The agent and the principal are considered "one in the same." The agent is the company and the company is the agent. Now, this law applies more commonly between the insurance agent, the insured and the company, but has been applied in more than one occasion to adjuster-insured-principal.
Additionally, (LORI- you can comment on this point), every state has it's own version of an unfair claims settlement practices act. This info is from Oregon's laws, but each state is similar. I'll just quote what I feel is pertinent, so you don't go insane trying to read law... :?
746.230 Unfair claim settlement practices. 1) No insurer or other person shall commit or perform any of the following unfair claim settlement practices: (a) Misrepresenting facts or policy provisions in settling claims; :evil:
:!: :!: :!:(b) Failing to acknowledge and act promptly upon communications relating to claims;
(d) Refusing to pay claims without conducting a reasonable investigation based on all available information; :evil:
(e) Failing to affirm or deny coverage of claims within a reasonable time after completed proof of loss statements have been submitted; :evil: (f) Not attempting, in good faith, to promptly and equitably settle claims in which liability has become reasonably clear;
(g) Compelling claimants to initiate litigation to recover amounts due by offering substantially less than amounts ultimately recovered in actions brought by such claimants; :twisted:
(L) Failing to promptly settle claims under one coverage of a policy where liability has become reasonably clear in order to influence settlements under other coverages of the policy; or
(m) Failing to promptly provide the proper explanation of the basis relied on in the insurance policy in relation to the facts or applicable law for the denial of a claim.
I know this is going a bit deep, but the law is specific on these matters, and the idiot, from what I can determine, has stepped over the line on a few of these. This can get both him and the company whacked legally and on a civil basis. The law is there to protect you in these situation, so use the law and get what you deserve!
Please excuse the ranting and raving, but this kind of stuff drives me crazy. I have spent the better part of 25 years in this business in one way or another, always trying to do the right thing. I can't stand this, and I have a tendency to go off a little bit when I see people getting screwed.
InsTeacher 8)
Posted: Mon Nov 10, 2008 01:23 pm Post Subject:
Please excuse the ranting and raving, but this kind of stuff drives me crazy. I have spent the better part of 25 years in this business in one way or another, always trying to do the right thing. I can't stand this, and I have a tendency to go off a little bit when I see people getting screwed
I'm with you brother!Fire, he hasn't threated (to our knowledge) a widow, my point was if he will talk to this woman IN FRONT OF HER HUSBAND like this how will he act without a man in the room...
As teacher stated all states have fair claims practice laws on the books...there are there to protect the comsumer...I don't know if he's crossed a line there or not, and of course he is going to deny deny deny (if he admits he'll get fired)...but whether or not it's against the fair claims practice or not it absolutely is against the way state farm, or any carrier wants their adjusters to behave...
Do you have any idea how many times a week I want to tell people to shut up or go somewhere ? Tons, let me tell you, and they ALL deserve it...but I can't....and neither can he...the thing I think he'll be most in trouble for is the whole, 'roof' thing...and not taking care of this carpet...
PLEASE OP get on this and let us know how it comes out.
Posted: Tue Nov 11, 2008 05:24 pm Post Subject: update
I hope you don't get three versions of this post, I have typed it 3 times and it disappeared so if the others actually went thru, that's what's going on.
Hello again and thank you for all this wonderful support! I thought I was going nuts for a while there and its just me. I think I have figured out what is going on here.
The guy really believes he should not have given us a roof and he was in survival mode. He does not want to get another adjustor over here because he makes 15% on what he gives us and if he really didn't have to give us a roof then he will be in trouble. He just doesn't want anyone else over here questioning this roof. Five roofers have said that we need a new roof, debris under the shingles, seals broken, tiles missing, etc. Only one roofer, a couple of days ago, said, "you know they didn't really have to give you a whole new roof"! Now I am obsessing on whether or not we are taking something we were not suppose to get. I know, I'm just a little psycho right now. Ok, I'll go with the 5 to 1 theory for peace of mind.
The funny thing here is that I am a trained negotiator! I started to think about what they taught us to do in a divorce mediation to get people to settle. We were supposed to tell all these bad stories about what happen to so and so to plant the idea in their mind that if they didn't settle they might get less than what they already had! I haven't done a divorce mediation in 20 years and the reason is I was just not very good at it. My heart was just too big and all it did was make me feel bad. When I went off on the guy my husband said, "what happen to all those years of training?" I said, "I guess it went thru the roof" .......LOL.
I sent the contracts for the roofer and the contractor to State Farm yesterday and we will see if they do the right thing. They were both for more than they gave us. I included the carpet again. If they come about I will leave this alone, if not, I will fight for what is right, including going after this adjustor. They made an error in addition in their favor of $18.50 and told them about. It will be interesting to see what they say about that.
I am the type of person that will drive back to the store to pay for something if I think I didn't get charged. I guess that is why I was so upset that he accused us of all this nonsense. On the other hand if you get on my bad side in these types of matters I am a force to be reckoned with. I hope they do the right thing.
Will keep you posted,
zoobee
Posted: Wed Nov 12, 2008 09:01 am Post Subject:
Will keep you posted,
Please do, it would be an entertaining yet learning experience for many of us. No wonder why many people are mad about the adjusters and why the adjusters are so grossly misunderstood. But I'm sure that he is one such exception and not all who are in this profession are same. He can't actually take-away from you what you deserve. You have paid for the policy honestly for a long period of time and certainly deserve to be treated fairly. Please, don't let this person get a walk-over and report him to the higher authority. I can fairly understand your desire to get out of this bad business as soon as possible but that certainly wouldn't solve the problem.
~Jeremy
Posted: Wed Nov 12, 2008 12:14 pm Post Subject:
He does not want to get another adjustor over here because he makes 15% on what he gives us and if he really didn't have to give us a roof then he will be in trouble
Ok, this is making more sense now...he may represent State farm, but he's an independent adjuster and does NOT work for state farm...I've heard (and seen) alot of bad things from some of these guys...State Farm would never allow an adjuster of their's to behave this way, he'd have been sniffed out and fired long ago...Add your comment