by gertes » Wed Oct 20, 2010 11:16 am
What are the step by step tasks a loss adjuster undertakes to come to an amount of money that the insurance company hiring his service must pay to the claimant?
Isn't it inevitable that two or more adjusters working on the same loss claim will come to different amounts of money that the insurance company has to pay the policyholder?
Yrger
Isn't it inevitable that two or more adjusters working on the same loss claim will come to different amounts of money that the insurance company has to pay the policyholder?
Yrger
Posted: Wed Oct 20, 2010 04:48 pm Post Subject:
That is a vague question as there are many different types of coverage and claims.
You mention "policy holder" so I'm thinking you might mean a 1st party property damage claim.
If it's property damage then it's either the cost of repairs or the cost to replace. There can certainly be some differences there but usually not that much and the end result is the same for the party that suffered the loss... their item is repaired or replaced. Can amounts differ from one adjuster to another? Certainly... but not usually by much. If it's an automobile, I might write the damage at $5000 and another adjuster might write it at $5200. A body shop might give an estimate for $5100. Same with cost to repair something like water damage to a home. But most companies use software to assist them in determining the cost to repair these items.
I'm guessing that your question might relate to an injury settlement and especially to pain and suffering. These amounts _always_ vary. But also, no two injury claims are the same. Circumstances, the injury itself, the location, the age of the person, etc are always different. All of these things are considered so each injury claim is unique. How an adjuster arrives at the amount of an offer is based on their experience with _similar_ injuries and circumstances. At the end of the day, the settlement amount is an agreed upon amount between the insurance company and injured party.
Posted: Thu Oct 21, 2010 08:35 am Post Subject: My two homes were devastated by flooding.
I am from the Philippines.
My two homes were destroyed by a very fierce typhoon and the accompanying flood in 2009, that was the Typhoon Ondoy of Sept. 26, 2009.
It is now in my place Oct. 21, 2010.
They are located in the worst hit area of the Philippines, Provident Village of Marikina City, Metro Manila.
The policy covers the two homes against typhoon, flooding, explosion, earthquake, riot, and of course fire.
Each home was insured to three million pesos on the house and .5 million pesos on the contents, so maximum liability of the insurer is seven millions.
I did not choose how much they should be insured, the agent selling me the policy and renewing it for me every year did everthing for me, with the instruction from me to give me the best proctection and security.
The independent adjuster employed by the insurer came to the figure of 610,333.80 pesos together for both homes as regards again together each house and the contents of each.
That means the insurer will pay me only 610,333.80 for the whole loss package.
Another independent adjuster but not employed by my insurer studied the damages to my two homes, and came up with the figure of 2,437,500.54 pesos for the whole loss package compensation.
I gave that as my counter proposal to the insurer and his adjuster, with the computations of the second adjuster (not in the employment of the insurer).
They offered me now one million pesos for the whole package.
I still refuse to accept the to me slightly increased payment.
Family members and friends and people I know to be conversant with loss claims tell me that for two homes each of which was insured for three millions on the house and .5 million on the contents, I should be getting at least 1.5 millions for each home on the house, and .5 million for each home on the contents.
The insurer and his adjuster tell me that is their last and fixed offer, one million for the whole package of loss.
That is why I am trying to learn loss adjustment, so that eventually the insurer and I will have to agree on an arbitrator, and I have to be able to convince the arbitrator, that I do have very sound grounds to demand 2,437,500.54 pesos instead of only one million pesos.
Is there a hint of bad faith insurance on the part of my insurer and his adjuster?
Yrger
Posted: Fri Oct 22, 2010 04:03 am Post Subject:
They offered me now one million pesos for the whole package.
Did you ask for an estimation from your carrier? May be they'd be willing to show you through their computation or the method that they're following.
As you've said, the homes were covered for 3 million each alongside .5 million for the contents. You've also mentioned that both the homes got destroyed by the typhoon. Was this typhoon the only cause of destruction? How was the maintenance for all these years? I have this feeling that the carrier is paying the coverage limit for the contents but not for the damages caused to your homes.
Posted: Fri Oct 22, 2010 08:11 am Post Subject:
Family members and friends and people I know to be conversant with loss claims tell me that for two homes each of which was insured for three millions on the house and .5 million on the contents, I should be getting at least 1.5 millions for each home on the house, and .5 million for each home on the contents.
Just because you have 7,000,000 ps in coverage doesn't mean you are entitled to collect that amount in the event of a loss. You have to prove your damages according to the terms of your contract of insurance. Certainly, with the disparity in the amount the insurer is offering and what your public adjuster calculated your losses at, there should be more movement on the part of your insurer.
As Spillthebeans suggests, perhaps the issue is the determination of "Actual Cash Value" -- which is defined as "Replacement cost MINUS Depreciation".
Obviously, this is taking way too long to resolve. Unfortunately, I have no idea of the regulatory system in the Philippines, and cannot offer guidance as to whom to direct a complaint. Perhaps someone with more familiarity with that part of the Pacific Ocean territory will be able to step in and assist.
Posted: Fri Oct 22, 2010 02:04 pm Post Subject: No public adjusters to serve policyholders, you just have...
No public adjusters in the Philippines to serve policyholders, you just have to trust in the honesty and goodness of the insurance company and its adjuster who is an independent adjuster, licensed to only serve insurance companies.
Since I don't know anything about making a claim, I read up on the Insurance Code of the Philippines and learned that there are two kinds of loss adjusters, the socalled independent adjusters who work for insurance companies and the socalled public adjusters who work for policyholders.
So I looked up the website of the Philippine Insurance Commission, and it has a listing of licensed independent adjusters but no listing for public adjusters.
Just the same I poured over the list of independent adjusters, plenty of them, but at the bottom of the long list there are two public adjusters which are international ones.
On calling them up by phone I learned that they don't do home insurance, they are into ship insurance, and call themselves public average adjusters -- whatever that means.
A gentleman from the Steven (public average) Adjusters was kind to talk with me, and I told him that they should be able to help me because two flooded homes are similar to two boats sunk in a storm in the seas, and miraculously floated back to the surface.
He told me it does not work that way with ships as with flood-devastated homes, because ship owners and insurance companies already agreed in the policy on how much the insurer will pay the policyholder, but that is not the case with home insurance between insurance companies and policyholders.
As I said earlier, I don't know nothing about insurance -- except to pay the premiums the insurance policy agent seller tells me to pay, and feel so safe and secured that when disaster strikes the insurance company will pay me as if it were the fairy godmother, to put me back on my feet.
So, there are no public adjusters to serve policyholders, these people just have to trust in the goodness and conscience of insurers and their socalled independent adjusters.
Why the Insurance Commission of the Philippines to all appearances never took any efforts to motivate people applying for license to act as independent adjusters to go instead into public adjusting, that is a mystery to myself.
I may be unkind, but in effect the whole Insurance Commission in the Philippines is an "independent adjuster" for insurance companies.
Anyway, on further inquiries I found out that lawyers can also do the work of public adjusters if they are members of the bar, even though they are not licensed by the Insurance Commission to work as public adjusters.
I fear approaching lawyers because they charge very much, for every sheet of paper they use, for every minute of court appearance, for every trip, for every phone call, etc., over and above their enormous professional fees.
And right away they want to demand a retainer's fee before they take up your cause, which retainer's fee must be paid every month.
So, I say to myself that perhaps I can do a DIY job with my insurance loss claim, by reading about loss adjustment in the internet.
Sad to say, it is not like looking for websites teaching people how to fix their homes or how to cook, everything free just that we get to be exposed to the ads in their webpages.
No, yes, no, no one in the Philippines is talking about insurance and insurance claims in the internet.
But I have come across plenty of talking in the internet from people in the USA.
Now, the Philippines used to be a colony of the USA which called it the Commonwealth of the Philippines, something like that, from the beginning of the 1900's to the end of the Second World War in August 1945, when the USA threw out the Japanese who invaded the Philippines, and almost the whole Southeast Asia, and could have taken over also India and even Australia, if it were not so stupid from ambition to try swallowing up the big dragon that is China.
The US then US granted independence to the Philippines.
After so much searching I came upon this website where there is a forum for people like myself to ask experts in insurance matters, and everyone here is an American except yours truly.
Yrger
Posted: Fri Oct 22, 2010 07:14 pm Post Subject:
The Insurance Commission of the Philippines is not beholden to the adjusters or insurers. On their home page, it says right at the top: "We safeguard the rights and interests of the insuring public." They exist to assist YOU with this problem.
Here is the link to their Request for Assistance (complaint) form:
http://www.insurance.gov.ph/htm/..%5C_@dmin%5Cupload%5Cservices%5CPub_Assist_form.pdf
Download the document, fill it out and state your position, as you have here, and ask for their help.
Posted: Sat Oct 23, 2010 01:05 pm Post Subject:
No public adjusters in the Philippines to serve policyholders, you just have to trust in the honesty and goodness of the insurance company and its adjuster who is an independent adjuster, licensed to only serve insurance companies.
Since I don't know anything about making a claim, I read up on the Insurance Code of the Philippines and learned that there are two kinds of loss adjusters, the socalled independent adjusters who work for insurance companies and the socalled public adjusters who work for policyholders.
So I looked up the website of the Philippine Insurance Commission, and it has a listing of licensed independent adjusters but no listing for public adjusters.
Just the same I poured over the list of independent adjusters, plenty of them, but at the bottom of the long list there are two public adjusters which are international ones.
On calling them up by phone I learned that they don't do home insurance, they are into ship insurance, and call themselves public average adjusters -- whatever that means.
A gentleman from the Steven (public average) Adjusters was kind to talk with me, and I told him that they should be able to help me because two flooded homes are similar to two boats sunk in a storm in the seas, and miraculously floated back to the surface.
He told me it does not work that way with ships as with flood-devastated homes, because ship owners and insurance companies already agreed in the policy on how much the insurer will pay the policyholder, but that is not the case with home insurance between insurance companies and policyholders.
As I said earlier, I don't know nothing about insurance -- except to pay the premiums the insurance policy agent seller tells me to pay, and feel so safe and secured that when disaster strikes the insurance company will pay me as if it were the fairy godmother, to put me back on my feet.
So, there are no public adjusters to serve policyholders, these people just have to trust in the goodness and conscience of insurers and their socalled independent adjusters.
Why the Insurance Commission of the Philippines to all appearances never took any efforts to motivate people applying for license to act as independent adjusters to go instead into public adjusting, that is a mystery to myself.
I may be unkind, but in effect the whole Insurance Commission in the Philippines is an "independent adjuster" for insurance companies.
Anyway, on further inquiries I found out that lawyers can also do the work of public adjusters if they are members of the bar, even though they are not licensed by the Insurance Commission to work as public adjusters.
I fear approaching lawyers because they charge very much, for every sheet of paper they use, for every minute of court appearance, for every trip, for every phone call, etc., over and above their enormous professional fees.
And right away they want to demand a retainer's fee before they take up your cause, which retainer's fee must be paid every month.
So, I say to myself that perhaps I can do a DIY job with my insurance loss claim, by reading about loss adjustment in the internet.
Sad to say, it is not like looking for websites teaching people how to fix their homes or how to cook, everything free just that we get to be exposed to the ads in their webpages.
No, yes, no, no one in the Philippines is talking about insurance and insurance claims in the internet.
But I have come across plenty of talking in the internet from people in the USA.
Now, the Philippines used to be a colony of the USA which called it the Commonwealth of the Philippines, something like that, from the beginning of the 1900's to the end of the Second World War in August 1945, when the USA threw out the Japanese who invaded the Philippines, and almost the whole Southeast Asia, and could have taken over also India and even Australia, if it were not so stupid from ambition to try swallowing up the big dragon that is China.
The US then US granted independence to the Philippines.
After so much searching I came upon this website where there is a forum for people like myself to ask experts in insurance matters, and everyone here is an American except yours truly.
Yrger
Posted: Sat Oct 23, 2010 01:57 pm Post Subject:
[quote=MaxHerr]The Insurance Commission of the Philippines is not beholden to the adjusters or insurers. On their home page, it says right at the top: "We safeguard the rights and interests of the insuring public." They exist to assist YOU with this problem.
Here is the link to their Request for Assistance (complaint) form:
http://www.insurance.gov.ph/htm/..%5C_@dmin%5Cupload%5Cservices%5CPub_ Assist_form.pdf
Download the document, fill it out and state your position, as you have here, and ask for their help.
[/quote]
I have been to the public assistance desk of the Insurance Commission four times, and it has led to nothing.
The hearing officer does not do anything except to record what happened in the exchange between me and the insurer with their adjusters.
Besides, the hearing officer told me that their power to decide is only advisorial, meaning, they can only advise the insurer to pay, and that up to only 100,000 pesos -- which is a ridiculous amount, but that is the fact in the Philippines, for example in another but affined area, senators are paid a monthly salary of only 35,000 pesos (http://www.senate.gov.ph/senators/terms.asp#Salaries), and the president only 63,002 pesos (http://propinoy.net/2010/08/04/aquino-receives-first-paycheck/) -- and they don't mind because they make so much much much more money just being in office from other endeavors having 'nothing' to do with their government offices.
If the amount involved is more than 100,000 pesos (in my case the insurer's adjuster computed loss payable by the insurer as just only 610,333.80, then on my complaint raising it to one million pesos), and the insured is stubbornly refusing the offer of the insurer, he can and must directly go to the Court of Appeals, where you have to deal with topshot lawyers of the insurer and spend a fortune, your already diminished whole life's savings, besides a case in the Philippines can take as much as 20 years to finish.
That is why I am trying to learn about adjuster's work, so that I can convince the insurer's adjuster that I deserve more than just one million pesos.
And now I have to learn everything about how insurance companies in the Philippines fix their premiums for home insurances.
Gertes aka Yrger
Posted: Sat Oct 23, 2010 03:20 pm Post Subject:
First off, I like to ask the experts here in all subjects in home insurance policies for your information and knowledge and opinions.
When the insurance company works out a home insurance policy to sell to me to guard me against destruction from typhoon, flood, riot, fire, earthquake, explosion, etc., promising to pay me as much 3,000,000 on the house and 500,000 on its contents, does that mean that the insurance company will in fact pay out 3,000,000 and 500,000 pesos for the total of 3.5 million pesos, if the house and the contents thereof are totally destroyed?
And why would they sell me such a policy when they can limit the amounts payable to lesser than 3,000,000 pesos on the house and 500,000 on the contents?
By the way one US$ is at present equivalent to roughly 43.50 Philippine pesos
Gertes aka Yrger
Posted: Sat Oct 23, 2010 09:56 pm Post Subject:
does that mean that the insurance company will in fact pay out 3,000,000 and 500,000 pesos for the total of 3.5 million pesos, if the house and the contents thereof are totally destroyed?
And why would they sell me such a policy when they can limit the amounts payable to lesser than 3,000,000 pesos on the house and 500,000 on the contents?
The "limits" you describe are the MAXIMUM amounts the insurance company is obligating itself to pay in the event of a loss. Other language in the contract controls how they determine/define the loss payable ("Replacement Cost", "Actual Cash Value", "Market Value", "Stated Value". etc). Just because you have a loss does not always mean payment of 100% of the loss or 100% of the policy limits. If you have a 50,000 ps loss, why would you expect them to pay 3,000,000 ps?
It's unfortunate if the Insurance Commission of the Philippines is as "toothless" as you describe. The Insurance Commissioners/Superintendents here in the states have far more clout.
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