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Last Post 04/26/2009 11:57 PM by  HuskerCat
how to adj for risk?
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72tree
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04/14/2009 10:23 PM
    I have a couple of questions. How can a adjuster put a priice on risk? Ive been trying to find out how when we have a claim that is a price that is a covered cost. How can a adjuster tell me that he is going to pay this muhc when u cant tell someone how much to charge? An emergencey service is kinda just get it done and then after the fact they dont like the price! If the homeowner agrees to the priice. then does the insurenace compnay have to pay it? As long as its in the policy limits. When the homeowner tell the insurance compnay that they were the best and they need to be paid now! they have to pay right? i would like to get any input ii can have on this matter. thanks
    HuskerCat
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    04/15/2009 2:10 AM
    As I was reading your post, I choked on my coffee spilling it on the carpet & spitting up at the same time.  KingBee Cleaners can be here in an hour to remove the stains and clean the entire room of carpet for $500.  Or I can throw down a dry towel to sop up the majority of the spill, and have XYZ Carpet Cleaners come in later at the usual & customary rate of $39.99 per room with a minimum of 2 rooms.   There's something to be said about having the advantage or taking advantage. 
    tleitch
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    04/15/2009 2:15 AM
    Depends on what your are pricing. Personal property there should be a receipt or some kind database you can check if, there even in line with there estimate. If, your talking about cleanup or  tree cleanup see what's involved first to evaluate the price they come up with.
    Emergency service should be investigated when you go out to see the risk. If, you have something that is high there MUST BE an explanation of why and where you come up with the price. Another thing if you have a limit does not mean you get the total amount. Insurance polices are not a  maintenance policy's.
     
    This is just a very small explanation but i don't know what your asking?
    dnjsdad
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    04/15/2009 8:59 AM

    Would you like more responses to your question?  If so you need to slow down a bit take the time to make sure that people understand what it is you are asking, and use spell check.  People on here will be more than helpful, but only if they know what information you are looking for.   Be specific, your obviously asking the question about something that has happened explain the situation clearly and more than likely you will get the answer to your question, however it may not be the answer that you were hoping for.

    Medulus
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    04/15/2009 12:04 PM
    Well said, dnjsdad.

    From the tone of the question, I surmise the question is coming from an insured who has had this particular situation occur. In light of that, I could answer in very general terms, but would be loathe to second guess the adjuster or carrier in a particular situation without a lot more information.

    In general, however, the answer is "No, the insurance company does not usually have to pay whatever the invoice says." There is something called "price gouging", which is actually a crime in some states. Michigan comes to mind as a state that diligently pursues price gougers. Just ask the gas station owners who raised the price of gasoline in Kalamazoo to $4.00 a gallon on 09/11/2001 while I was buying gasoline for less than half that price from a gas station where I could see the smoke rising from the Pentagon.

    As to your specific situation, 72 tree, I have no comment because I have no idea what the facts are.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
    72tree
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    04/15/2009 10:12 PM
    well what im asking is. when the homeowner agrees to a price for the work. How can the insurance company not pay the full amount? Next question how do adjusters put a price on the risk of dangerous tree removal jobs. Or lets say i have 15 guys on a job and i get 125 a man hr. how can a adjuster tell me that im not going to pay the the full price of the claim if i have the men doing the job? Or if i say that it had to be done this way and they dont think its worth it.
    L
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    04/16/2009 1:47 AM
    i don't care how big the tree was it should not take 15 people to remove it. When insurance is involved the adjuster needs to look at the damage so you don't get taken advantage of, understand that we know what it takes to get the job done back the way it ways, NO UPGRADES. You can agree with what any contractor  wants to do but the contractor is out to make money where adjuster our not, we just want to help protect you an see the job is done properly.  It sounds like you are in a fight with the adjuster or want an upgrade. I repeat be careful, be careful. 
     
     
    I'm not hearing the whole story here. Was the work done before the adjuster was out? Did you have pictures before the Tree was removed? Could the adjuster verfiy the damage.
    sbeau4014
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    04/16/2009 6:31 AM
    Reasonable and customary for the work performed are two key words. The fact that you may have charged a homeowner $10,000 to remove a 30' X 6" diameter tree from their roof doesn't mean the insurance carrier owes the insured the $10,000. All too often the "emergency" workers that come in immediately after an event take advantage of the situation and price gouge the homeowners for work they do (roof cover up, water extraction companies, tree removal companies, etc).
    Medulus
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    04/16/2009 9:31 AM
    Now I think I am starting to get what you are asking, 72trees. I also understand where you are at in the equation. The title of this topic makes more sense now, as well, now that I know what language you are speaking.  You are probably unaware that the word "risk" in the language of insurance refers to the item that is being insured and it's value (or, in other words, the risk that the insurance company is taking).  So when you initially said, "How can an adjuster put a price on risk?" that meant (in insurance -ese) "Is an adjuster capable of valuing the replacement cost of a structure or other property being insured?" 
    I will make no assessment of your character or business practices because it is not my place to do so and I am not privy to the specifics as I would be if I were the adjuster involved.

    Two things are true. 1. Not all adjusters understand the neccessary work and/or risk involved in certain jobs and so may be prone to improperly evaluate the job and the cost of that job. In that case there is sometimes someone up the line who can more fully appreciate the situation. Sometimes, however, the people up the line who tend to have accounting rather than construction or adjusting backgrounds are part of the problem. And.....

    2. Some tree companies will take advantage of a catastrophe situation to jack up the price of tree removal by a high multiple of reasonable and customary charges for the same work. I've seen it many times. For example, 250 pine trees felled in the back yard/forest, removal invoice $250,000. It can be a feeding frenzy.

    The insured's agreement to pay a certain amount does not obligate the insurance company because they are not a party to that particular contract. All it means is that the insured may be obligated to pay the difference.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
    Ray Hall
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    04/16/2009 11:25 AM
    See the limitations in the policy for tree debris removal the limit is $1,000 for pne tree or many trees. All policys have limitations on "add on coverage".
    Ray Hall
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    04/16/2009 11:43 AM
    I had a water leak claim from plumbing in Atlanta, Ga. on July 4th in 1994 while working branch assist. The plumber told the homeowner the leak was in or under the slab and it would cost $3100 to find the leak and repair on a holiday. The homeowner agreed, but stated he would have to pay 50% by check today and 50% on Monday when the bank opened as he would be overdrawn, This was about a 9 hour job start to finish. I had copies of both checks.
     
    I wanted to turn into the AG of the state of GA, the carrier went along with me. Conclusion: The contract was binding as both parties agreed to it, as stated by the plunber. I learned a little Georgia law.
     
    Side note.. the leak was inside a closet wall cavity were the soft copper 90 degree elbo was brazed. (after the floor was busted up).  something new ever day in this biz.
    moco
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    04/22/2009 11:56 PM
    Also depends on the policy type, and applicable coverage . Certain policies, like forced coverage or for a better term if you don't know what i mean, would be lender placed. These types have no covereage for trees etc. but will sometimes depending on the carrier and examiner pay a reasonable rate to remove the tree from the rooftop to the ground,and after it is of the structure any pulping, cleanup, hauling etc is at the homeowner's expense. However, even if the carrier will pay for removal from the roof, they are going to have a limit they will pay. You want likley be laughing on the way to the bank.
    RandyC
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    04/23/2009 8:33 AM
    You have an agreement with the homeowner at a certain price. You seem to be asking how can an adjuster pay less than your agreement. You are right; the adjuster can not tell you how much you can charge. You can not tell the insurance company how much they can pay. The carrier's liability follows the policy wording...not the wording of the agreement between you and the insured. That policy most likely uses the word "reasonable".

    Imagine an envelope called "reasonable". Below a certain amount would be unreasonably low, above another amount would be unreasonably high. The adjuster's job is to settle the claim within that envelope. If you have an agreement with the insured for an unreasonable amount, the adjuster and the insurance company will only pay the "reasonable" part. Whatever portion of the amount you've agreed upon is outside the relm of reasonable is between you and the insured.

    If you have a different idea of what reasonable is, you can make your case to the adjuster, the carrier, the homeowner, and finally the judge. The dictionary, the adjuster, carrier, homeowner, and the judge all may have different ideas of what "reasonable" means, but that envelope is probably smaller than you think.

    Randy Cox

    It it doesn't fit...adjust it!





    Ray Hall
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    04/23/2009 1:26 PM
    The following wording is in the NFIP flood policys: "any and all coverage problems and claim allowance restriction must be communicated directly from the NFIP. Claims adjusters are not authorized to approve or deny claims; their job is to report to the NFIP on the elements of flood cause and damage.
     
    I think all Homeowers carriers feel the same way about catastrophe adjusters.
    HuskerCat
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    04/23/2009 11:52 PM
    My 89 year old neighbor lady had a 25 ft tall Locust tree begin to lean & fall against her covered deck after some recent high winds.  I cut it down and into small pieces, removed the stump & hauled  everything off to our campground to use as firewood.  Later, I mowed her lawn & repaired one of the underground sprinkler lines & heads that got displaced when the tree had leaned.
    Marie served me some iced tea & a few of her famous oatmeal and raisin cookies & snickerdoodles, then offered to pay me something.  I told her the tea & cookies were reasonable enough...figure I've eaten several dozen over the past few years and will hit her up for some more later.   So to answer...what is reasonable to one or another?... can you afford to pass up long-term cookies? 
    okclarryd
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    04/25/2009 6:17 PM
    There's paybacks and then there's paybacks.

    I'm jealous.
    Larry D Hardin
    72tree
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    04/26/2009 3:00 PM
    price gouging isnt applied to service work unless u are threee tiime u avg rate. the company that i have used is the best and there normal rate is very high!!! so when i had this problem i called them and they took care of it. but there prices are justifed and they can prove they have charged this befor. let say a adjuster says thats way to high, but the contract shows them that they have charged that to there company 20 other times and have been payed. why do they try to tell them there not paying.
    HuskerCat
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    04/26/2009 11:57 PM
    Other than my cookies, there are a lot of non-specific gray vague hypothetical's being thrown out.  Two wrongs don't make a right...do ten or twenty?
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