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Last Post 01/26/2009 1:00 AM by  HuskerCat
What would you do in this situation?
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dnjsdad
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01/22/2009 2:16 AM
     
    Here is my question, I hope that I get many responses.
     
    A claim is reassigned to you, insured is requesting a supplement.  You make appt. with insured and meet with them while at there home you notice that the home is 1400 sq. ft with 5 year old flooring that is in good condition.  You leave after inspecting the sheetrock damage in the living room that was missed by the original adjuster.  Your now at your office typing up the supplement and realize that the original report contained over 3000 sq ft. of flooring being replaced and 35 squares of roofing.  You know that this is inacurate information and the amount that the insured was paid was way over what they were owed.  How do you handle this and why? 
     
    Thanks,
    Dnjsdad
     
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    HuskerCat
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    01/22/2009 3:58 AM
    First of all, you already have me confused when you say the flooring was in good condition and then go on to the other mentions of drywall & roof.   What was the cause of loss, and the scope you came up with?  Was this a fire loss, or wind/tornado/water?  Your questions beget more questions.
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    dnjsdad
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    01/22/2009 9:16 AM
    Sorry, this is a hypothetical situation not one that I am currently involved with.  This is a TWIA loss.  I mentioned the floorings condition because it was obviously not replaced.    The damage was caused by a windstorm damaged roof that leaked.
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    BobH
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    01/22/2009 11:53 AM
    Posted By Jason Wells on 22 Jan 2009 
    Sorry, this is a hypothetical situation not one that I am currently involved with. 
    Most carriers will not ask for money back on an overpayment (depends who is sitting at the manager desk, but generally true). 
    If you discover "new" damages that were not included in the prior scope of repair for that Date of Loss, and there is a LARGE prior overpayment, it is customary to FIX the estimate to accurately reflect the loss as it should be.  If the statement of loss (showing prior payments) indicates a payment is to be made, you pay the adjusted amount. 

    If they are STILL overpaid, you send a letter explaining that they have been overpaid (with supporting doc's) and that any further damages that may be discovered would need to exceed this overpaid amount in order to be considered.
     
    When you are doing clean-up work, people generally "don't sweat the small stuff" if small errors occurred in the Insureds favor, you just let it remain.  But glaring issues like the "hypothetical" situation you present are different.  You don't add money on top of added money.  That's not the insuring agreement.

    Bob H
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    Medulus
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    01/22/2009 3:38 PM
    Yeah, like Bob said!
     
    Mike, you are beginning to sound like a claim examiner -- asking all the peripheral (run for the dictionary) questions before you will answer the one question he wants to have answered.  I think the spirit of Racko has once again possessed you.
     
    Part of your job on clean up is to catch the errors and report them.  The carrier needs to decide how to proceed after that.  In this case it seems a complete rewrite of the estimate including all damages (with correct measurments) and let the chips fall where they may as to whether the insured is paid a supplement or not.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    catwoman
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    01/22/2009 6:09 PM
    Very common during clean up. Ditto what Steve said. It is the carriers money, not ours. They decided what to do. WE are there to provide them with CORRECT documentation and a recommendation. We have had some tell us to let it stand and some have told us to disallow payment due to a previous overpayment.
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    RandyC
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    01/22/2009 9:18 PM
    Good question; helpful answers!

    It's not always the original adjuster that makes the errors, though. I had a hail claim last spring that needed a roof replacement. The priors showed a replacement 2 years before for 12 squares more than I figured. My roof diagram was pretty much the same as the prior except for the total paid for. It took a while to figure it out with my limited information but eventually I realized the original adjuster allowed for a couple of slopes only. Reinspection gave the insured a total replacement but added the 12 squares of original slopes to the total for supplement. If they made the same kind of mistakes with the checks, they could have paid him three times for the original slopes.
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    dnjsdad
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    01/23/2009 9:01 AM
     
     
    Thanks to all who have answered. 
     
    So what classifies and error as small with no need to mention vs. a large error?  Are we talking hundreds of dollars or are we talking thousands?
     
    Thanks Again,
    Jason
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    Medulus
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    01/23/2009 9:50 AM
    That would be up to the carrier to decide, Jason. The goal is always to come as close to paying exactly what we owe as possible. Our policy, and it may be the law but I have always simply done it anyway, is that if we inadvertantly underpay by even a penny, we cut a check for the amount of underpayment (even if it is a check for a penny) and send it to the insured. I have also tried to collect back on overpayments, but because it is the insured and the error was ours we politely requested reimbursement rather than demand it.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    dnjsdad
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    01/23/2009 10:20 AM
    Thank you.
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    Ray Hall
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    01/23/2009 5:50 PM
    "let the sleeping dog.... is used many times by the reinspector when the first dealer called the first paper trail a better hand; that is when the insured is a savy player.
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    Medulus
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    01/23/2009 6:46 PM
    I might catch your drift, Ray, but then again.....
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    dnjsdad
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    01/23/2009 7:13 PM

    Ray, once we are aware that there is a problem, are we not obligated to fix it? 

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    BobH
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    01/24/2009 12:47 AM
    Posted By Jason Wells on 23 Jan 2009 07:13 PM

    ...once we are aware that there is a problem, are we not obligated to fix it? 

    We already agreed we would fix a huge error that was made in the Insured's favor.  I was doing clean-up on one about 6 weeks ago where the claim had been "touched by many hands".  I noticed that there were 2 complete Air Conditioning systems in the estimate.  I looked over the history of estimates on this claim, and at first there was just one AC.  It didn't make sense.  I called the Insured, and confirmed they had just one AC.  Turned out there was a supplement to match a contractor quote for the AC system, but someone forgot to delete the original AC entry from the estimate.  The Insured was calling about something else, and I learned that the previous supplemental check had not been cashed yet.  Managment agreed we should "stop pay" the incorrect draft, fix the estimate to allow for the damaged (1) AC system, and re-issue the correct supplement check amount.

    Let's look at a real world "small error" situation.  You are called out to the site a 2nd time because the Insd is very vocal about some overlooked interior damages.  Maybe they were overlooked, or maybe those spots showed up on the other ceilings in other rooms because he didn't mitigate damages, but he is pointing out all these ceilings that needed to be on the estimate.
     
    You are going over the old estimate line-by-line, and notice that the dining area that opens to the kitchen should have had a large missing wall taken out of the paint, but the original estimator just entered the 14 x 16 x 8 "cube" as the dimensions, and painted all the walls and ceiling of that cube.
     
    A 14 x 8 wall is 112 Sf that should have been taken out, but at the end of the day it is going to make a bit less than $100 difference on the estimate.
     
    You are there because the Insured is "asking for more" and you are about to "take away".
     
    You have to choose your battles, and every claim is unique.  I don't think you can decide that all things are always going to proceed per A, B, C, then D.
     
    Sometimes you have to think on your feet, do what is right, but not at the expense of ruining the ability of establishing an amicable agreement in a pre-litigation environment.  The Insured should feel you are doing the right thing, not ripping him off or adding to his already existing baggage of "how long he has waited" etc.
     
    If someone before you made a small error in the Insured's favor, you have to really want to fight that battle before you start walking that road.  I'm not saying never to fix small errors, but you have to weigh the consequences.  And to me, it depends who I am negotiating with.  If I am dealing directly with the policy holder, I am more inclined to let the small sleeping dogs remain. 
     
    Or is it a contractor who is asking for 10 more squares etc, etc, then if that estimate changes from it's original version it will likely end up being right where it needs to be, per the exact measure of the roof with correct waste factor, with no fluff left on the table.  If we allowed too many turbine vents, etc, they are going off the estimate before one more square goes back on.

    Bob H
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    HuskerCat
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    01/26/2009 1:00 AM
    This hypothetical situation breeds of a realistic situation, within where an inexperienced field adjuster replaced the wrong building components within the estimating program.  Now a supplement is requested for the overlooked items, which were not really overlooked...merely mis-labeled.  At the same time, there should be photographic evidence to support either, or, or both.
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