by Public Adjuster » Sun Dec 20, 2009 08:26 pm
Client Calls me with a broken plumbing pipe.
Drain line pipe underneath the kitchen Cabinets has broken where it makes a 90 degree turn and turns out. Seeping water caused damage to the kitchen cabinets, tile, pantry, baseboards drywall.
This unsuspecting insured does whats natural. He calls his insurance company and sure enough they send and INDEPENDENT ADJUSTER.
The adjuster arrives, takes his photos, takes his measurements and ASSURES the home owner he will get enough money to replace the cabinets and all associated damaged materials. Well, I've seen this before.
2 months later, after not being able to use the kitchen sink h/o gets a denial letter and it states:
"your loss has fallen outside your coverage" "Your loss is due to wear and tear marring deterioration". And then it quoted the specific language excluding such losses in the policy.
The insurance company never Sent out their own plumbers to put a camera through and take a look at the pipes or their "condition". The INDEPENDENT ADJUSTER was not a plumbing expert. The insured however did have a video of the inside of the pipes showing a crack.
Well, we filed suit. And sure enough, we won. Plus court costs and attorneys fees. WHY WOULD THE INSURANCE COMPANY PUT THE H/O THROUGH THIS ORDEAL JUST TO PAY AT THE END OF 7 MONTHS??? BECAUSE THE INSURANCE COMPANIES AND THEIR ADJUSTER ARE NOT THERE TO HELP YOU THATS WHY.
Insurance Companies are "for profit" organizations. This means they are trying to increase earnings/profits and minimize payments[/ Ultimately this falls on the consumer. This claim cost them 40k. I wonder how many others they deny and h/o have no idea what their options are.
If you have had something similar to this happen to you reach me here and I might be able to help. I reside in the state of Florida.
Drain line pipe underneath the kitchen Cabinets has broken where it makes a 90 degree turn and turns out. Seeping water caused damage to the kitchen cabinets, tile, pantry, baseboards drywall.
This unsuspecting insured does whats natural. He calls his insurance company and sure enough they send and INDEPENDENT ADJUSTER.
The adjuster arrives, takes his photos, takes his measurements and ASSURES the home owner he will get enough money to replace the cabinets and all associated damaged materials. Well, I've seen this before.
2 months later, after not being able to use the kitchen sink h/o gets a denial letter and it states:
"your loss has fallen outside your coverage" "Your loss is due to wear and tear marring deterioration". And then it quoted the specific language excluding such losses in the policy.
The insurance company never Sent out their own plumbers to put a camera through and take a look at the pipes or their "condition". The INDEPENDENT ADJUSTER was not a plumbing expert. The insured however did have a video of the inside of the pipes showing a crack.
Well, we filed suit. And sure enough, we won. Plus court costs and attorneys fees. WHY WOULD THE INSURANCE COMPANY PUT THE H/O THROUGH THIS ORDEAL JUST TO PAY AT THE END OF 7 MONTHS??? BECAUSE THE INSURANCE COMPANIES AND THEIR ADJUSTER ARE NOT THERE TO HELP YOU THATS WHY.
Insurance Companies are "for profit" organizations. This means they are trying to increase earnings/profits and minimize payments[/ Ultimately this falls on the consumer. This claim cost them 40k. I wonder how many others they deny and h/o have no idea what their options are.
If you have had something similar to this happen to you reach me here and I might be able to help. I reside in the state of Florida.
Posted: Sun Dec 20, 2009 11:12 pm Post Subject:
PublicAdjuster,
While i agree with you that some insurers are rogues out to fleece the unwary, your perspective seems somewhat biased.
Insurance is like any other business, it has it's cheap and nasty's and it's quality suppliers. not all insurers are created equal, and yes while some try and make you jump through hoops until you give up, others are far more reasonable.
I don't see you posting possitive comments here, just "all insurers are evil" type bile. Please don't over generalise, be angry at those who treat their customers badly - sure, but don't rubbish the industry as a whole.
As with all other industries, insurers that treat their customers unfarily will ultimately pay the price as their customers leave them for better providers. This is natural and how the market should operate.
I'm the first in line to tell anyone that price shouldn't be the only factor in your insurance decision making, but ultimately people are free to make their own choice.
Posted: Mon Dec 21, 2009 01:05 am Post Subject:
Sorry... I'm not buying any of that. What cause the crack in the pipe? Was it wear and tear? If so, the pipe is not covered. Any adjuster knows that. Every adjuster also knows that the resulting damage would be covered unless there was some other exclusion that applied (such as vacancy). I find it very hard to believe that any adjuster would exclude resulting water damage because of the "wear and tear" exclusion.
What did you do that the attorney representing the home owner did not do?
Sorry... I call BS on the whole thing.
Posted: Mon Dec 21, 2009 03:11 am Post Subject:
I'm not buying this;
ASSURES the home owner he will get enough money to replace the cabinets and all associated damaged materials.
Especially from an independent, 9 times out of 10, the first listed instruction to the adjuster assigned to a case is do not make any promises to the insured/claimant. Secondly, adjusters do not nor have the authority to make any decisions as far as a settlement amount or what may or may not be included.
I find it very hard to believe that any adjuster would exclude resulting water damage because of the "wear and tear" exclusion.
Agreed
Posted: Mon Dec 21, 2009 04:31 am Post Subject:
Insurance Companies are "for profit" organizations.
And public adjusters work so the insured can get all they are owed. Well excpet for the pesky % that goes to the PA for their profit...which mind you, you fail to mention in any of your posts.
Profits = Evil (What do you live in the White House?)
As far as your story, independent adjusters like the one you mention don't mention coverage or payment unless they make the decision. 2 months and then they get a denial. What happened between those 2 months. Did the policy holder show them the proof of the crack? It is up to the insured to prove their loss - not the other way around. Something doesn't add up.
Posted: Mon Dec 21, 2009 09:37 am Post Subject:
TCOPE- After reading your mind numbing responses to my posts it is clear that you must be below average intelligence. Regardless, Ill entertain your senseless blabbering.
What Caused the break in the pipe? Ill leave that to the Insurance Company to figure out. What I know is that it was a sudden and accidental break, had resulting damage to the kitchen cabinets, tile, baseboard and drywall. In Florida, the Citizens HO-3 policy clearly states that only accidental and sudden breaks are covered. You dont buy it? Well im not selling it. You should get off the internet before you hurt yourself. You are so interested in what I do. Why don't you tell me what you do, for who and where?
You find it hard to believe that an Insurance company would deny a claim? Or that they would deny paying damage to the cabinets? You tell me how it follows logically, that the insurance company would deny the broken pipe as a covered peril and the source of the damage, but then pay for resulting damage itself...I have the denial letter in my file. And I am willing to hand deliver it to you if you wish. You call the whole thing BS ??
Trench- That Independent Adjusters do not have the authority to decide coverage and/or payment?? That's what I told TCOPE...your accomplice in mediocrity but he begs to differ. Why don't you and him get together and get your story straight?
Dasfuk- No, I dont live in the White House...do you know where the White House is located? Florida Statute gives Insurance Companies 90 days to accept liability of a claim or deny it.....so yes...the adjuster sat on the file for 2 months and then the insured received a denial letter. As I mentioned in the post, the h/o had the plumbers video showing the crack in the pipe. The independent adjuster was not interested in viewing or taking the video with him. Additionally, in Florida, insurance companies send out their own plumbers to verify losses. They did not do this in this case either.
You want to argue with me about what the adjuster told the homeowner?? You want to tell me what he mentioned or didn't. Seriously??? Well unless you were there I doubt you have any real frame of reference which makes you pretty much ridiculous.
And you're right. Public Adjusters charge a fee for their service. Do you work for free? If you do please let me know. I am already in the process of hiring TCOPE and I am sure I can find a position for you as well. But you do need to be able to read and write so let me know how far you are in the Dr. Seuss series.
Posted: Mon Dec 21, 2009 01:36 pm Post Subject:
Trench- That Independent Adjusters do not have the authority to decide coverage and/or payment?? That's what I told TCOPE...your accomplice in mediocrity but he begs to differ. Why don't you and him get together and get your story straight?
Because I don't need to. An adjuster can define coverage and recommend a settlement amount, but a carrier ultimately makes the final decision.
Posted: Mon Dec 21, 2009 02:57 pm Post Subject:
What Caused the break in the pipe? Ill leave that to the Insurance Company to figure out. What I know is that it was a sudden and accidental break, had resulting damage to the kitchen cabinets, tile, baseboard and drywall.
I don't think you get it.... first, something can wear out and break suddenly. Because something fails suddenly does not automatically mean it's covered. But that is not even the point of my post. The _resulting_ damage is not part of the worn out part coverage. Its separate... and is almost always covered. Every "adjuster" knows that so I doubt a carrier would have denied that portion of the claim.. You dont buy it? Well im not selling it.
You certainly are! The whole reason for _all_ your posts here are to sell your services. That is the _only_ reason why you are here. You've not added one bit of helpful information so far.You tell me how it follows logically, that the insurance company would deny the broken pipe as a covered peril and the source of the damage, but then pay for resulting damage itself
This is what scares me... it's one of th first things a property adjuster learns... that the resulting damage is covered under the policy. It's property damage 101.That's what I told TCOPE...your accomplice in mediocrity but he begs to differ.
Get your facts straight. I never even came close to mentioning anything like that. I have worked as an independent adjuster in the past and it's correct... it's an extremely rare situation where they would commit to coverage (only if they are acting as a 3rd party administrator of the company, which is not really what we are talking about here).Florida Statute gives Insurance Companies 90 days to accept liability of a claim or deny it.
You can't even get this correct (does not surprise me, though)... it's not one or the other. They can simply inform the insured what more info they need and take longer. This is true in at least a vast majority of states if not all.As I mentioned in the post, the h/o had the plumbers video showing the crack in the pipe. The independent adjuster was not interested in viewing or taking the video with him.
Why was the claim denied? Did they deny that the pipe was cracked? I doubt it. So why would they need video of this.Additionally, in Florida, insurance companies send out their own plumbers to verify losses. They did not do this in this case either.
I handled claims in Florida for 17 years with many different carriers. Never had I heard of any adjuster sending out "their own" plumber. In this case the insurance company sent out an independent adjuster... that is done all of the time. A plumber cannot do what an licensed adjuster can... inspect all the damage and know how to determine if the cause of loss is covered under the policy. They also cannot scope the entire loss. I don't know all the facts but I doubt anyone denied that the pipe was broken. So I fail to see why the plumber's information was so important.But you do need to be able to read and write so let me know how far you are in the Dr. Seuss series
You come here to sell your service and offer no real input and then you act like this. Well, at least you've not change my opinion of "public adjusters". :roll: :lol:Posted: Mon Dec 21, 2009 03:21 pm Post Subject:
You want to argue with me about what the adjuster told the homeowner?? You want to tell me what he mentioned or didn't. Seriously???
I or anyone else would argue that point, because an adjuster is possibly making a promise to a homeowner that they have no authority of keeping. How would you feel if I told you that you would recieve an x amount of dollars to cover your damage, and then the insurance company decided that they only feel they are liable for less x amount of dollars?
Well unless you were there I doubt you have any real frame of reference which makes you pretty much ridiculous.
I agree, I wasn't there, I just find that hard to believe that an adjuster would make a promise like that. I never mention a settlement amount until I speak with my client and then make the offer to the insured/claimant. I would never make a statement that I will take care of anything.
Posted: Tue Dec 22, 2009 04:21 pm Post Subject:
I've never heard of companies having to send out plumbers. It is the insured's responsibility to prove their loss. I also can't understand why they didn't cover the resulting damage.....there is more to this story.
You want to argue with me about what the adjuster told the homeowner?? You want to tell me what he mentioned or didn't. Seriously???
Was Mr. PA at the property when this statement was made? How do you know what was said. Sorry to say, but people lie after the fact...granted on both sides. Also, some people also think that just when an adjuster walks in the door that they have a covered loss. If this claim was going to be denied, they should have taken a non-waiver on the spot.
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