| Author |
Message |
Lance J. Hoffman
| | Posted on Wednesday, March 22, 2000 - 5:24 pm: | |
I think that the adjuster has been put in an impossible position. He/she has left the storm and would have difficulty meeting with the re-inspector. He/she is faced with a re-inspector who is attempting to encourage the adjuster to settle the loss for less than value of the claim. He/she is also faced with a vendor supervisor who may not be addressing the above listed problems.
I have been faced several times with similar but much less severe circumstances and have been able to discuss the situation with the carrier and resolve the issue. I usually indicate that my estimate reflects the damages and explain my reasoning as to how the estimate addresses the Insured's damages. On several occasions the carrier representative has had very good alternatives and a situation of mutual learning has occurred. This does not appear to be the case here.
If communication and explanation with both the vendor supervisor and the re-inspector did not resolve the problem, I would not be interested in working for either again for ethical and legal reasons.
Most of the supervisors I have worked with in the past would not have asked me to re-write an estimate based on this type of information from the carrier. They would immediately address the problem with the carrier knowing that other adjusters will have similar problems. |
Greg A.
| | Posted on Sunday, March 12, 2000 - 2:13 am: | |
We all should remember the purpose of our tasks are to INDEMNIFY the insured. I have found it helpful in the past if you dissagree with a reinspector, sit down with him/her and explain your case. Sometimes, people get caught up in there roles and forget the human element involved.
It never hurts to discuss something, that may not be totally clear to all parties.
With that said, some reinspectors, you just can't talk to or with..Their egos and heads are so big, they have to leave them in the parking lot when in the offices. |
David Bennett
| | Posted on Monday, March 06, 2000 - 2:35 pm: | |
This is not an uncommon situation. Generally the carrier outlines from the start their practices and procedures. Most carriers provide pricing guides as to the amount they will pay for certain damages. Often times, the carrier address's area's (such as this) of damage with no loss of structural integrity. They may want you to settle on appearance allowances or on the acv only. These issues are the ones which each Cat adjuster should have clarified up front.
The bottom line on the damage question is "Yes the items were damaged", there can be no arguement on this aspect. The carriers position is are they damaged enough to warrant replacement? Well the courts have said damage is damage, the measure of the loss is either the repair or replacment of that item.
As to the carrier's request, it seems to me to be a relatively simple solution. First I would call and review the findings with the reinspector if you can. You have to be careful here and use the inquiring attitude not the I'm right and the damages are the damages attitude. Then you rewrite the estimate in accordance with the carriers request. In you cover report to the carrier, reattach your first estimate and simply state, the attached estimate has been rewritten in accordance with your instructions and per our phone conversation of (whatever date). You then contact the insured, advise you are forwarding a revised estimate based on the carriers reinspection. Review the estimate with the insured and then close your file.
As we all know and have experienced a carriers position on certain allowances or damage assessments may change during the course of the storm. This is true with pricing as well.
We have to be flexible and bottom line, is the carrier calls the shots. We do our job, advise the carrier of the additional damages we have observed and provide then a R/C and ACV of those items for their consideration and review.
Lets not get carried away with Bad Faith and our own EGO'S. If there is a Bad Faith or Unfair Claims Practices allegation, by writing and estimate on all the damages as we see them, and an estimate on those additional items we observe damaged, for which the carrier does not want an allowance and documenting the same via our report to the carrier. Then the ball is in the carrier's court and the battle is between the carrier and the insured, not us.
The question on morally right, does not factor when you are dealing with a written contract and the instructions from the company who is paying your service fee.
As long as you report all the damages you see, provide RC and ACV values,submit the same to the carrier for their consideration with an estimate prepared the way they request. Whether or not payment is made is not within our scope of service. That ultimately lies with the adjuster employed by the carrier, who reviews our work product and makes a decision based on the companies guidelines he is employed by. |
lmushred
| | Posted on Sunday, March 05, 2000 - 6:12 pm: | |
I had somewhat the same thing occur to me a few months ago. I was working for a large vendor, and while working for them,I had approximately 6-7 files returned to me by the vendor.
The vendor said that the Insurance Company wanted me to change the estimate as the damage wasn't bad enough to replace the damaged items. Like previously said, you are either PG or not you aren't just a little bit.
I felt that if it was damaged, it should be part of the estimate. I took the files back in to the vendors along with all my other files that hadn't been inspected and turned them back in. I told the vendor I liked working for them and I wanted to work for them again but what I was being ask of me was wrong and I had to sleep with myself at night and that their request put me in a legal position that I didn't care to be in.
I ask them why they let themselves be put in that type of position and I was told by the manager that the Carrier gave them a lot of business each year. He also indicated that he knew that someday someone would take the stand that I did. He wasn't angry or upset. After leaving, I made one phone call to another carrier and went to work for that carrier and made more money than I would have ever made working and doing something I knew was wrong. I also sleep well at night and I don't have to worry about being named in a lawsuit. Just as a footnote. I have worked for this vendor again since then so there is no backlash. I just felt, and still do, that I want to do my job right and honestly. I don't want to settle for less even if it orig. meant me loosing money. As we all know, money isn't everything |
Eqkid
| | Posted on Friday, March 03, 2000 - 11:36 pm: | |
What can happen to an independent who low balls a claim or knowingly shorts the insured?????? from the Claifornia Department of Insurance files..
SAN FRANCISCO -- In a rare case of an adjuster facing regulatory sanctions, the Department of Insurance is seeking to revoke the license of a claims adjuster who allegedly stalled auto insurance settlements for Ohio Indemnity Insurance.
Thomas Cindric, owner of Alamo Claims Service of Alamo, Calif., slowed settlements by delaying auto inspections, requiring unnecessary paperwork and miscalculating vehicle appraisals in order to encourage claimants to settle their claims for substantially lower amounts than they were entitled to, according to the 29-page accusation issued by the Department's Compliance Bureau.
Last May, the Department fined Ohio Indemnity $325,000 and banned it from selling auto insurance in California for three years for multiple violations of the Unfair Claims Settlement Practices Act. The company, which sold automobile collision and comprehensive coverage, engaged in claims-handling tactics that caused it to postpone and avoid payment of claims.
Cindric, under contract with Ohio Indemnity, was paid $110 per claim as an independent adjuster. Like Ohio Indemnity, he is accused of low balling settlements and stalling the claims handling process.
Department investigators found that Cindric often required completion of inappropriate and unnecessary forms or refused to settle claims until police reports were filed, even if a police report was not required or necessary in order to settle the claim. Motor vehicle reports were sometimes required for no apparent reason other than to delay payment.
Cindric is also accused of delaying the assignment of appraisers to estimate the damage on the insured automobile, driving up storage costs for damaged vehicles -- charges he later refused to authorize payment for despite terms of the insurance policy requiring him to do so. The investigation also revealed that Cindric often used the wrong formula for calculating insurance settlements and used the lowest possible vehicle valuation figure.
"Our investigation revealed that this was all calculated to lower his cost of processing claims and to increase Ohio Indemnity's profits," said Insurance Commissioner Chuck Quackenbush. "It's our job to restore the confidence of consumers in the insurance policies they buy and one way to do that is to weed the bad apples out of our state."
The Department's investigation was based on more than 250 complaints received against Ohio Indemnity over a two-year period. The number of complaints represents what is believed to be only a fraction of the number of claims unfairly handled by Cindric for the company between 1992 and 1995.
During the Department's investigation, Cindric also refused to supply subpoenaed files, claiming he no longer possessed them when he actually still had them in his offices. Regulations required him to maintain claim files for several years after their closure. It was also discovered that Cindric had sent the files to Ohio Indemnity's attorneys 10 days after he claims he no longer had them. When finally turned over to investigators for review, several of the files were missing.
The accusation seeks to revoke Cindric's license and bar him from working as an adjuster in California for five years It also seeks to revoke the licenses of any insurance adjustment firms under his management.
Remember you and your I/A Company can pay dearly for failure to comply with Fair Claim Practices..
Do it right and don't compromise... you can't afford it
Rick Holt
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Acatman2
| | Posted on Friday, March 03, 2000 - 12:25 am: | |
Here my take.
It is always nice to try on the shoes of the person whith whom you are dealing to get feel for their reasoning.
First, just imagine the insured who is getting your call. If you were that person who just paid their insurance premium to protect your property for damages from hail and someone tells you that you have damage, but it is not necessary to pay you for that damage, what would you think? Imagine if this person was your spouse, our some other loved one. Do you think that would be the right thing to do.
Sure we are adjusters who are spending money that is not ours. Remember this:
YOUR JOB IS TO ESTABLISH THE COMPANY'S LIABILITY. TO DO IT PROPERLY AND IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THE POLICY CONTRACT.
This does not include any written or verbal speculations by some has been who does not understand the consequences of his or her requests.
Run right to your manager and "spill the beans" and since you know you made the right call. Stand on it. If the company or someone else decides to alter the claim settlement subsequent to your handling, then so be it.
We can talk for days about this but every day I hear about adjusters not understanding the scope of their job.
I remember attending a CE class that was being held by a defense attorney for several large insurance companies. He advised: Remember the things you write in your file should only be the facts or reflect the facts. Most important, how would what your just wrote sound in front a jury when you read it aloud in court.
I think the adjuster can continue his relationship with the vendor and carrier as long as he does the right thing. |
Tom Weems
| | Posted on Thursday, March 02, 2000 - 9:31 am: | |
We sometimes get lost in this business and forget that we are dealing with someone elses money. The carrier has the final say, as we are independent adjusters, not employees. I have been second guessed many, many times by people who think they can tell more about the loss by looking at the pictures than I can by being there. That is part of the business. Keep a copy of the instructions you get on changes that they want made to the file, make them, and pull another file off the stack.
It's not our money. Cover your hiney, swallow your pride and move on. They will call you back when the insured raises hell and won't settle.
Question is, what are you going to say at the arbitration hearing? |
mikeanddonna
| | Posted on Thursday, March 02, 2000 - 8:43 am: | |
could not help but be interested in the on going conversation.
Let's face it in this business you learn from the begin to CYA(cover your •••)this basically means have all requests in writing (if possible)or at very least documented in file.
I would have a moral problem with the situation,but then we all have to live and eat.
The question,I would ask is,is this just the reinspector's point of view or his supervisor?
You can always give an allowance for those areas that are not severly(dings/dents)damage and do not take away from overall appearance or structural integity of the building.
But if in fact the company goes along with the reinspector not paying for damages...then it's time to cut the cord and get on with your life.
Oh well just some ramblings of a casualty adjuster who has been in the business since Moses parted the Red Sea. |
Vince Tabor
| | Posted on Thursday, March 02, 2000 - 8:14 am: | |
Well said,.. Mr Leonard Parker...you are saying:
"Eschew obfuscation" ...which is the logical, common sense approach to the problem. Thank you. |
Leonard Parker
| | Posted on Thursday, March 02, 2000 - 6:11 am: | |
Let's get down to the smallest denominator--one claim. The carrier sends you the rejection and tells you not to pay for the _____ (you fill in the blank).
You:
(1) Fuss and stew and throw the cat (or whatever else is handy).
(2) Delete the item in question.
(3) Call the insured and discuss the situation, advising that the company reinspector has rejected that portion of the claim, and suggesting that should he wish to pursue the matter further he should contact his agent for assistance.
(4) Follow it with a letter stating the same things and enclosing the revised estimate.
(5) Return the revised material, including your original estimate and a copy of the letter, to the vendor.
(6) Make up with the cat.
This is not lack of personal, or professional, integrity. The raw truth is that you don't have the power(authority) to decide what the carrier will, or will not, pay for. Your original estimate reflected the loss as you saw it. Your file is documented. You have done your job, and you have done it properly. |
Cecelia
| | Posted on Thursday, March 02, 2000 - 12:54 am: | |
Jim states that this adjuster is very experienced and has been adjusting for a number of years. And has worked for the same vendor for a number of years. We might possibly assume that, from the recent posts here, if this adjuster is making $100 to $200k this adjuster is well-established, well-known and recognized as an "expert".
If there is damage, there is damage. I am sure the file reflects through photos and documentation the amount of damage and the location of the damage (to the gutters, the shed, the mailbox, etc). The carrier admitted there was damage and said it wasn't visible from the street (vents) and hardly visible (mailbox). I am hoping this is in writing. If not, I am in agreement that it should be. I am also in agreement that a reinspection with the reinspector is in order. The reinspector's staff supervisor should be present. This may NOT be the carrier's stance.
If the end result is the same (the carrier demands the adjuster handle the file the way the carrier wishes without regard to coverage) then the adjuster has a decision. And that decision could cost dearly in income. But it might NOT blackball the adjuster. There are companies who prefer to pay their claims properly. Keeping a completely documented file of this problem to present to potential employers would go a long way in explaining what happened here.
And Adjuster Name Withheld, do you have any idea how marketable you are in this industry? I wouldn't blame you for staying where you are and doing things the way you've been told. We all have to do what we have to do to survive. But you have other options. MANY other options. |
Tom Joyce
| | Posted on Thursday, March 02, 2000 - 12:37 am: | |
The degree of damage is to an extent a judgement call, how minor is the damages on the vents.
Would they have been replaced, does it really affect the claim. No damage to the gutters, some carriers replace them as part of the work process, some don't, personally I don't include them if not damaged. We are adjusters and make our recommendations to the company while protecting the insureds interest. Parties dont agree, we take steps to bring them together and get the claim concluded. Looks like the reinspector got a burr in his/hers pants that day and felt there was some overwriting being done. Unfortunatly, we have to deal with reinspectors and some of them feel that they have a job to protect or use it as a vehicle for advancement (not many fortunalty). Request a second look at the items you feel strongly about. Its the real world out there, but it's up you as to how you want to live in it. |
stromcrow
| | Posted on Thursday, March 02, 2000 - 12:13 am: | |
Attempt to resolve with Vendor and company. If unable to resolve I would have few options. They would be welcome to my file and my fee and they could find someone more flexible to adjust the loss. i would never work for the company again and would have difficulties to resolve with the vendor. If they tried to force me to complete the file on terms that were clearly illegal I would object in writing and copy the State commisioner of Insurance. At this point I would most certainly be (mutually agreed) in need of a new vendor. |
Been There
| | Posted on Wednesday, March 01, 2000 - 11:54 pm: | |
Capitulation, for self serving purposes is still wrong! Going along with this "get along - go along" mindset will only compromise the one single most important asset you have today.. your honor and ethics.
A famous whore named Polly Adler was once asked how she felt about loosing her virginity. She replied; "Once the cake is cut, another slice is never missed!" I respectfully submit, going along with this (illegal act) will most definitely place you in the same category as Polly.
Thanks, my self respect means more to me than $100 - 200K a year.
Been There |
newbie
| | Posted on Wednesday, March 01, 2000 - 11:27 pm: | |
Jim,
that is why he or she should re-inspect with the carrier, vendor and insured...the majority of time the carrier will fold and the loss will probably be adjusted as written and often times additional damages will be agreed to....maybe i should have posted my response with that option first... so much for mental ramblings....:^) sorry |
Jim Flynt
| | Posted on Wednesday, March 01, 2000 - 11:21 pm: | |
There are some excellent responses posted here so far, including an excellent one from a Newbie. I have even asked Roy to weigh in on this one as well.
Now let's get real. For a few moments, let's look at the human side of this from the ADJUSTER'S standpoint. Not from a Bad Faith standpoint. Not from a legal standpoint. Those are important and we should not ignore them. We all know what the legal thing to do is, we all know what the moral thing to do is,,,,,,
BUT,,,,,
Let's look at the HUMAN side and the very real consequences for the adjuster.
If the adjuster "blows the whistle" do you think this vendor is going to hire him again? What if I told you that this adjuster has worked for this vendor for many years and has always had an income with this vendor in the $100,000 to $200,000 per year range?
The adjuster has never had this type of problem with this vendor before nor with this carrier.
Beyond that, if the adjuster refuses to "go along," isn't the adjuster signing his death warrant with this and other vendors?
The great Texan and former U.S. President, Lyndon Johnson once said: "in order to get along you have to go along." At WHAT POINT do you refuse to go along, realizing that you will not go anywhere as a result of adhering to your values and principles?
THAT is the question,,,,,,WHERE do we draw that line between doing what is RIGHT and signing our death warrant.
I hate to be crass, but gentlemen and gentle ladies, this IS the REAL world. |
Russ Lott
| | Posted on Wednesday, March 01, 2000 - 11:20 pm: | |
Ok I am gonna jump into this one. Not knowing the adjuster or seeing the damages, the issues being questioned are all issues of damage to metal. What were the company's instructions to the independent? If there is enough hail damage to total a roof and very little collateral damage was the issue discussed in the adjuster's report? If there is covered physical damage to the covered property we should recommend the actual cash value. I don't have a problem with presenting the claim to the company "as per your instructions", as long as the instructions are consistent for every adjuster, and in writing.
If I had previously gotten an agreed value settlement with the Insured and was asked to resubmit my adjustments due to a change in company policy I would surely want copies of the changes in writing. Personality conflicts are just another term for discrimination, whether is be age, color, sex, or country of origin. |
newbie
| | Posted on Wednesday, March 01, 2000 - 10:31 pm: | |
I would stand by my original adjustment, the carrier certainly has the right to accept or reject an adjustment be it from a captive employee or vendor.
Since the carrier has chosen to reject your adjustments, and according to your letter, the carrier admitted the damages to various items, I would respond to the vendor, carrier and insured in writing. Be sure to document your position with photographs if available. Send a copy of the rebuttals to the vendor, carrier, and insured ( if applicable ) and additionally notify your E&0 carrier of the potential liability situation you have been placed in by the company and vendor.
If in fact there is no exclusion for the damages to the items you discussed, and the company had not specifically instructed you to approach damages to the items you presented using alternate adjustments such as: Loss of value, Appearance Allowance...Exclusion..Etc..dents in some objects may be unsightly but not reduce it's intended useful lifespan ( Fences, Metal Vents ),therefore and adjustment for the above can be negotiated, if it is acceptable to the insured and the carrier.
If not, then your decision to replace the items was reasonable and customary. The arbitary rejection of damages from a covered peril is commonly referred to as BAD FAITH. Document your position, support your decisions with evidence, and stand your ground!
PROTECT YOUR FEES FOR SERVICES RENDERED!!!THEY WILL BE REDUCED AS WELL IF YOU DO NOT RESPOND.
Sometimes the best defense is a strong offense.
As for the carrier having it any way they want it, they are and have been able to dictate to insured and adjusters because they are seldom challenged with a credible and documented response to their opinion. If you are able you may seek the opinion of a more experienced party who is able to review your adjustments as they were presented, and have that person provide you with their opinion as well. There are times when personalities, inexperience, workload or any number of other factors can cloud our judgement.
I have often sought the advice friends and peers as sounding boards when approaching difficult situations involved in adjusting losses. This forum is certainly an excellent sounding board, but without all of the facts, it may be difficult for anyone to provide any absolution to your dilemma.
Seeking the advice of counsel would be one of my last options, as this can be very costly, and this seems to be a difference of opinion, if you live near the assigned losses it may be advisable to offer to meet the re-inspector, along with a member of the vendors management team at the loss sites. Contact your insured and ensure they are present during your re-inspections.
Document the re-inspections and request they again place the disputed items in writing, along with their recommendations for presentation of the completed adjustment.( Photo's of all parties present at the loss wouldn't hurt).
As an independent adjuster you do not have the authority to accept or reject any claim, nor would you want it. The carrier is responsible for this.
Under most conditions you are granted a certain amount of authority, generally in a catastrophe situation there is little question as to cause and origin, and therefore most claims are assumed to have coverage and are generally settled on the opinion of the adjuster (appraiser). Errors, especially repetitive ones, may provide an opportunity for the party whom the error was levied against to seek financial remedies.
Most software vendors have included simple statements on the loss summaries and itemized estimates that explain that all decisions concerning coverage for the loss are at the discretion of the carrier ( company ) and are subject to review and acceptance. If you are hand writing your damage estimates, a simple hand stamp can be used.
Remember to contact the insured and inform them that there is a delay in their settlement and advise them of the reason, the company has rejected a portion of their loss, and the fact that you are attempting to settle their losses. They may also prove to be a useful tool, as most companies have taken the low road when it comes to their contracts of insurance, and will often accept losses based on a customer service aspect rather than legal.
Good Luck |
sbihm
| | Posted on Wednesday, March 01, 2000 - 10:18 pm: | |
If a re-inspector wrote things like this in my reinspection file i would laugh....as a staff adjuster i am expected to pay for a few granules missing from a 3 tab-, i would say that if the inspector has written an inspection on your work and has worded the inspection like this you would have legal recourse. If things are as you say. |
Txlady
| | Posted on Wednesday, March 01, 2000 - 6:42 pm: | |
Gentlemen, it seems to me there is not a real issue to discuss. Either it is the legal action or it's not. Better to not work for this vendor or carrier again rather than get sued and lose what you've got. If it's damaged, you owe for it and if it's not, you don't. The only time dents but no damage would come into play is with the endorsement for reduced premiums on a metal roof. Even then, you still owe for the dented vents, just not for the dented roofing. |
BeenThere
| | Posted on Wednesday, March 01, 2000 - 6:21 pm: | |
Jim
While I agree that the Adjuster is being forced to choose between what is morally, financially, and politically right there is a larger question that begs to be addressed here. What is LEGALLY right. I would suggest the adjuster in question obtain competent counsel regarding his contingent liability in this matter. It would appear to me that some laws, or (rules) are being savaged in this situation and I can only guess who will be the subject of ridicule and/or litigation, should this matter come before the Commissioner, or a civil/criminal judge.
I have had similar experiences in the past and have asked the "staff adjuster/re-inspector" to send me a "Memo" on each claim, outlining the alleged “deficiencies" and required course of action. This does present some protection, however a good attorney (sic) could interpret this as a form of collusion.
I am sure carriers would love to have IA's take this kind of drastic action and they could sit back and disavow any knowledge. Kind of reminds me of the Allstate/California earthquake fiasco.
Been-There |
R.D. Hood
| | Posted on Wednesday, March 01, 2000 - 5:42 pm: | |
Ok, here's my take. The loss speakes for itself.
The adjuster has the obligation to the insured the carrier and themselves to properly and completely document the loss.
If, in fact, the re-inspector admits there is damage and has instructed the adjuster to "not pay for it" that individual is highly suspect for a bad faith complaint.
The articles in question are damaged or not. Like being a "little bit pregnant" you are or your not.
The adjuster has done exactly what any respectible professional would do. Examine,determine and present the facts as they are viewed by them.
Write a complete and comprehensive scope of the loss in concert with an estimate to return same to the pre-loss condition, in as good as or better than.
The insured relies on the adjusters knowledge of the policy, the evidence of damage, and the amount required to repair the affected items, and to recommend that the loss be paid to the named insured(s). The insured is not the expert, the adjuster is.
While this practice has occured in the past, it certainly is not commonplace. IHMO, the adjuster is correct, given that all the facts presented are truthful.
Is it ANY wonder why the Public Adjusters have made a living, with stuff like this happening?
GB, have a need for another burger flipper, this field of endeavor is starting to smell. |
Jim Flynt
| | Posted on Wednesday, March 01, 2000 - 4:44 pm: | |
In case I wasn't clear, the reinspector works/worked for the carrier as a carrier employee.
For your information, the adjuster is very experienced and would be considered a very good adjuster.
It seems to me the adjuster is being forced to choose between doing what is morally right for the insured, what is politically right for the vendor/carrier, and what is financially right as well as practical for HIS FUTURE. I was not clear on this in the last paragraph of my earlier post. |
Ghostbuster
| | Posted on Wednesday, March 01, 2000 - 4:36 pm: | |
Uhhh-oooh! This don't look so good.
#1. Does this reinspector represent the views of the carrier? If so, perhaps our boy better write off this carrier, lest the Bad Faith lawyers crawl out & grab him by the ying-yang.
#2. The vendors comment about personality conflicts could be a typical smoke screen to divert becoming invloved. That said, tho, it is true that the carrier can do as they well please. But above all, our boy must do all he can to cover his tokus from the gators all around.
#3. For the vendor to demand the estimate be altered to the carriers specifications reveals they may not be worth being associated with either, particularly when the Insured already has the first settlement estimate in hand.
It could cost our boy a lot of money, but in the long run, it may be to his advantage to walk away from this vendor and carrier and find work elsewhere. |
Jim Flynt
| | Posted on Wednesday, March 01, 2000 - 3:41 pm: | |
I received the following email from a CADO reader asking for my opinion as to how he should respond to this situation. I have asked for his permission before posting his email and with his positive response it is posted now. I am asking you to review and weigh in on how YOU would handle it. Some details have been changed to disguise the vendor, carrier and adjuster.
Here is the letter which I ask you to consider:
*****************************************************************************************
"Dear Jim:
I have a situation that I am at odds over and I wanted to see what your take was.
I recently worked a hail storm for a large vendor handling claims for one insurance carrier.
After I left the storm, I received an overnight package with a large number of the claims I adjusted sent back to me which were reinspected by the carrier reinspector.
The reinspector states such things as:
(1) Dents on the power vents are small and cannot be seen from the street, so don't pay for them.
(2) Roof is totaled but no damage is seen on the aluminum gutters, so don't pay for them.
(3) Window wraps show signs of hail impact but no damage so don't pay for them.
(4) Even though shingle roof is totally damaged, no damage is visible to metal shed (although adjuster noticed hail impact) so don't pay for metal shed.
(5) While you noticed hail damage to a brass letter box, insured did not report it to carrier as it was not on loss report. Damage is hardly visible from the top and not the sides. Do not pay for damage to item.
I have copies of all claim photos and estimates are saved on my computer.
The adjusting company (vendor) tells me to change the estimates and call the insureds and send in the new estimates to the carrier and to the insureds per the carrier reinspector.
I asked the vendor why and their position is that the carrier can have it any way they want it. The vendor also suggested that perhaps I had a personality conflict with the reinspector.
Any suggestions? What should I do?
Adjuster Name Withheld"
****************************************************************************************
We have all either experienced something similar to this or heard of it happening to other adjusters.
WHAT would YOU suggest to this adjuster?
It would be especially helpful if we could hear from some vendors as well (even if you have to post anonymously).
Assuming that the adjuster is in fact correct with regard to damage, it seems to me the adjuster is being forced into doing what is morally right for the homeowner and what is politically correct for future assignments. How do YOU see it? What would YOU do and WHY? |
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