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Last Post 02/19/2010 11:07 PM by  rest0red
Possible contractor fraud-How to handle ethically?
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Author Messages
claims_ray
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12/19/2009 2:34 PM
Right or wrong is a very sticky line with your lively hood and possible litigation on the line.
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Ray Hall
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12/19/2009 5:04 PM

claims ray I have read your post several times and I still do not understand what you mean.

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Ol' Ghost
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12/19/2009 7:39 PM
It's quite simple what he's saying. Please allow me to offer a translation.

To traverse the maze guided by ones moral compass is a narrow path twixt the hazard of litigation opposite ones professional vocation on the other.

That's much better. Now all is crystal clear.

Ol' Ghost
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Olegred
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Posts:363


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12/19/2009 9:09 PM
Shoot, I really hope this one does not get back to me ... I remember one file I referred to SIU for possible OTH damage. I spent HOURS explaining how I thought it was mechanical, because granules are crushed and damage follows accessible areas of the roof... Brutus Ruficus, God of Adjusters, make this one go away.
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RandyC
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Posts:197


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12/20/2009 5:05 AM

Another issue might be a non-waiver agreement. I carry blanks approved by the carrier. The moment I suspect something "inconsistent" or questionable, I try to get a non-waiver agreement signed. I inform the insured of whatever question might exist-- without too much detail-- and explain the agreement allows us to continue our inspection. (Read from the approved form)

Do it early in the inspection matter of factly; it's just a formality additional to the other hand outs.

If they don't want to sign, I'd politely exit until the company could send a reservation of rights letter.


Randy Cox



 

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jpendergrass
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Posts:7


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12/20/2009 12:08 PM

Basically an easy file, just ask yourself what is the difference between adjuster and an insurance investigator, we all have to investigate the claim, determine the cause of loss then follow that direction, Mr Hall is on the money, as is the others in a different lite.  The carrier will always make the final decision, investigate the loss, COMPLETE a full report without any personal viewpoints or accusations, as that ole TV show always said, JUST THE FACTS,

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Olegred
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Posts:363


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12/21/2009 7:44 PM
Carrier paid the claim without even blinking, i've learnt today.
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Ray Hall
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Senior Member
Posts:2443


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12/22/2009 1:14 AM

Over 350 homeowners carriers in the USA. I think you will have to reserve your conclusion/ opinion until you have talked to all of them.

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Bobabooey
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12/22/2009 9:51 AM
Good job olegred. Unfortunatley, in this business sometimes you need to know when to look after número UNO.
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Olegred
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Posts:363


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12/22/2009 8:58 PM
Shoot, they are swamped with hail claims, I think their internal resources are loaded to the maximum. Paid, closed. End of story.
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Olegred
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Posts:363


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12/22/2009 9:31 PM

 I spoke with a roofer today, friend of mine, who told me that he saw several independent ADJUSTERS rip off tabs, use their fingers to "highlight" hail damage, and some other stuff which I find pretty shocking.

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Jud G.
Advanced Member
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Posts:509


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01/04/2010 1:49 PM

Aside from some subtle nuances and semantic inconsistencies, it appears that everyone here is on the same page with regard to an honest effort and good intentions.  Most opinions are in agreement that the facts must be collected on the risk and suspicions verbally relayed to the carrier.  We really can't speculate what the carrier wants or will want until we have spoken with the examiner assigned to the file.

If anyone were to conduct this investigation Ray's way without discussing their findings with the carrier would end up with an enormous fee bill that would get disputed due to unauthorized activity.  If paid, then it would be done with reservations balking at the eagerness of an overzealous attempt to tilt at windmills.  Likely, this would be one of the last assignments seen.  IMHO, this thread highlights the importance of good communication.
 
Many property assignments these days have limited information on the examiner available to the adjuster, so it is important to provide the reasons for offering additional services in your report. Don’t just do them.
 
I’d be happy to inspect other roofs in the area for dcmclaims with T&E billing available, but as a seasoned IA, most of my clients wouldn’t pay for it. Furthermore, this is an extra service that is usually not included in a standard property appraisal fee.  Jlombardo is correct in that unless you have photo/video evidence (or a confession for that matter), the claim likely end up getting paid. I will add that to require the insured to sit through a scrutinizing EUO is a great way to scare the guilty ones away.  And echoing a previous comment, even if victorious, the mortgagee will still need to be compensated.
 
I’ll offer this tip; communicating with the carrier must be ‘solution based’- not ‘problem based’.  Meaning that your suggestions must include options or solutions- they should never force the client to have to invent a solution to your inability to deliver.
 
Typically, most adjuster’s don’t have a two (2) story ladder in their back pocket and the following two (2) ways to handle this situation are also typical.
 
  • First, a wrong way: “I couldn’t get on the roof because it was too high/steep. Here are the photos secured from the ground. Thank you for this assignment.”
  • The right way involves communication to your mgr. or the carrier’s examiner with a suggestion as to how you propose to solve or accomplish a proper investigation. Some vendors/carriers already have a built-in protocol dealing with this issue so no questions are necessary.  Worst case, you go out and buy a two (2) story ladder thanking the carrier for keeping you consistently busy.  Best case, the carrier gladly allows the necessary TE to return and inspect the roof with a roofer.

 

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rest0red
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Posts:4


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02/19/2010 11:07 PM
and you all are frustrated by contractors? I am a former full service restoration company estimator about to make the move to the dark side and seriously getting a little chuckle out of this dilemna. I bet most of you know which carriers in-house people would care and which ones wouldn't. Obviously, that shouldn't affect doing what is right but wouldn't it be a little like making your own determination about a subrogation possibility or ruling it out without referring it?
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