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Last Post 04/13/2008 11:04 AM by  Ray Hall
Suit Against Allstate & Statefarm & M & S/B and Xactware Inc
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HuskerCat
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01/10/2008 9:04 PM
Posted By Ray Hall on 01/10/2008 5:35 PM

I guess Insurance companies will have to fall back on competant adjusters not to expose their mutual policyholders to health hazards and really take charge in these type of losses insted of abdicating their work to the white , green and lemon color van drivers. We will save billions if we do what we are paid for on regular losses.

Hey, that sounds like anti-FICUS language!!  Sorry, everybody, for mentioning that word. 

 

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Ray Hall
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01/11/2008 12:34 AM

Yep it does sound conflicting...... I am in my regular loss mode now instead of my catastrophe mode, but still advocating change by parasitic debridement

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BobH
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01/11/2008 2:53 AM
parasitic debridement
Thank you for expanding my vocabulary...

Quick definitions (debridement)
noun: surgical removal of foreign material and dead tissue from a wound in order to prevent infection and promote healing

Let's see, I will have to practice using that in some sentences when I see the green or yellow vans at my site inspection tomorrow...
Bob H
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katadj
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01/13/2008 9:35 PM

  Well pilgrim, sometimes it's nice to hear that your ideas and thoughts are shared by others, even if you dont know them. (P.S. Caps Added for emphasis)


For Immediate Release: Contact: J. Robert Hunter, 703-528-0062
Thursday, January 10, 2008 Travis Plunkett, 202-387-6121
INSURERS MAINTAIN RECORD PROFITS IN 2007
BY OVERPRICING POLICIES AND UNDERPAYING CLAIMS
--Anti-Consumer Practices Also Lead to Bloated Surplus and Reserve Levels--
State and national consumer organizations joined the Consumer Federation of America
(CFA) today to release a new study concluding that the property/casualty insurance industry
continued in 2007 to systematically overcharge consumers and reduce the value of home and
automobile insurance policies, leading to profits, reserves, and surplus that are at or near record
levels. The study estimates that insurer overcharges over the last four years amount to an average
of $870 per household.


The report provides extensive data demonstrating that property/casualty insurance
companies are paying out lower claims in relationship to the premiums they charge consumers than
at any time in decades. The pure loss ratio, the actual amount of each premium dollar insurers pay
back to policyholders in benefits, was only 54.6 cents in 2007. Over the past 20 years, the amount
paid back as benefits has dramatically declined from over 70 cents per premium dollar, indicating a
huge loss in the value of insurance to consumers.


“Consumers ultimately pay the price for the unjustified profits, padded reserves, and
excessive capitalization that exist right now in the insurance industry,” said J. Robert Hunter, the
Director of Insurance for the Consumer Federation of America (CFA) and author of the study.
Hunter is an actuary, former state insurance commissioner, and former federal insurance
administrator.


“The insurance industry reaped record profits in 2004 and 2005, despite significant
hurricane activity,” said Hunter. “Profits in 2006 rose to unprecedented heights and 2007 may set a
fourth consecutive profit record,” he said. “Unfortunately, a major reason why insurers have
reported record-high profits and low losses in recent years is that they have been methodically
overcharging consumers, cutting back on coverage, underpaying claims, and getting taxpayers to
pick up some of the tab for risks the insurers should cover,” said Hunter.
In the last several years, insurers sharply increased premiums for homeowners and
commercial insurance and reduced or eliminated coverage for tens of thousands of Americans in
coastal areas. Insurers have succeeded in convincing Congress to continue taxpayer subsidies for
terrorism losses and are seeking additional subsidies for catastrophe insurance.
Using a number of common measures of financial health, the study finds that balance sheets
for property/casualty insurers are in better condition overall than at any time in history.

Record High Profits/ Low Losses
The study estimates that after-tax returns for 2007 are about $65 billion, just under the
record level set in 2006. If insurers release even a small part of their swollen reserves as profits,
final profits for 2007 will exceed those of 2006. Profits for the record years of 2004, 2005, 2006,
and 2007 are estimated to be $253.1 billion. The loss and loss adjustment expense (LAE) ratio for
2007 is estimated to be 66.7 percent, the second lowest in the 28 years studied. Five of the seven
lowest loss and LAE ratios in the last 28 years have occurred since 2003.
  
Source: A.M. Best Aggregates and Averages (2007 data estimated by CFA based on reported
industry results for first nine months and Insurance Information Institute estimates)


Claim Payouts Continue to Drop
Consumers have experienced a startling drop in the amount of premium paid in benefits by
the insurers, from 72 percent in the late 1980s to only 60 percent today when plotted on a straightline
trend over the period.
  
This drop in the efficiency of the insurance product for consumers is startling and calls for
action by the regulators to control industry excesses.


Insurance is a Low-Risk Investment
Representatives of the insurance industry often claim that high premiums and profits are
necessary to compensate for the excessive risks they must bear. In fact, insurance is a low-risk
investment. Using standard measures of stock market performance that assess financial safety and
stock price stability, the property/casualty insurance industry represents a below-average risk
compared to all stocks in the market, safer than investing in a diversified mutual fund.
In 2007, the study estimates that stock insurers will earn a return on equity (ROE) of more
than 19 percent, well in excess of what is required by investors. The lower industry-wide ROE that
insurers report underestimates the industry’s actual ROE.


Surplus is Unprecedented: Insurers are Overcapitalized

The study estimates that retained earnings, or surplus, for the entire industry was $687
billion at the end of 2007. An adequate surplus guarantees a safe insurance industry, but this amount
is excessive by any legitimate measure. To assess the financial solidity of an insurance company,
regulators examine the ratio of net premium written to surplus, which, at the lowest level ever, 0.66
to 1 (66 cents of premium written for every dollar of surplus), is less than half of the extremely safe
1.5 to 1 ratio that is recommended by many observers and far less than the famous “Kenny” rule of
2 to 1 as an efficient surplus level. The largest loss ever suffered by the insurance industry,
Hurricane Katrina, represented an after-tax loss of $26.7 billion, or 4 percent of current surplus
when adjusted to 2007 dollars. The $12.2 billion in after-tax losses experienced by insurers after
the September 11th terrorist attacks amounts to 2 percent of surplus. Many insurers are engaged in
massive stock buy-back programs and the purchase of other corporations with this excess capital.
Insurance chief executive officers now have the highest average cash compensation of any industry
in America. Even the Insurance Information Institute (III) admits that the industry is
overcapitalized: “…there is excess capital in the industry today – estimated by some analysts to be
as much as $100 billion…” The excess capital approaches $175 to $200 billion if reserve
redundancies (see below) are eliminated.


Loss and Loss Adjustment Expense Reserves are Padded with Hidden Profits

When industry profits are high, as they have been in record amounts since 2003, insurers
tend to pad their reserves. This practice contributes to financial solidity. However, insurers also
pad their reserves because it removes income from their profit statements, thus lowering their tax
burden because reserves are not taxed and income is. This practice also allows insurers to point to
inflated “losses,” which rise due to reserve redundancies, as justification for not lowering rates.
The Insurance Services Office (ISO) estimates that loss and loss adjustment expense
reserves at year-end 2006 were 9 percent redundant, a figure that represents over $50 billion in
excessive reserves. Adjusting for the time value of money, ISO saw an additional $13 billion in
padded reserves at year-end 2006. CFA estimates that the redundancy in reserves increased in 2007
and could be up to more than $80 billion by year-end 2007.
Insurers Have Lowered Risk and Maximized Profits through Legitimate and Illegitimate Means
In recent years, insurers have reduced their financial risk by making wise use of reinsurance
and other risk-spreading techniques, such as securitization. However, the study cites several tactics
that insurers have also used to shift costs and risk onto consumers and taxpayers. Some of the
questionable methods that insurers have used to shift risk include:
· Sharp limits on coverage and availability. Insurers have imposed large hurricane
deductibles, capped home replacement and rebuilding costs, added new exclusions such as
mold, and placed unjustifiable restrictions on claims. For example, “anti-concurrentcausation”
clauses, now in wide use, attempt to strip all coverage for hurricane damage if a
non-covered event like a flood occurs, even if the flood hits hours after a home is destroyed
by wind. Some insurers have canceled policies, refused to renew policies, or refused to
write new coverage in coastal areas and entire states from Texas to Maine.
· Harsh homeowner’s rate increases. Insurers have imposed sharp rate increases on many
homeowners throughout the nation. A major reason for these recent increases is that insurers
are relying on short-term predictions of potential weather disasters, reneging on promises to
use more scientific long-term computer predictions.

Many insurers are now using new computer-directed programs like “Colossus” and “Claims Outcome Advisor” that allow
insurers to determine the amount of overall claims savings they want to achieve before
claims are assessed for legitimacy.


· Taxpayer subsidies. Insurers and real estate interests were the major proponents of the
Terrorism Risk Insurance Act, which Congress recently continued under industry pressure.
The study estimates that insurance companies have received a subsidy of about $4 billion to
date because insurance companies do not have to pay premiums for the reinsurance provided
by the federal government. Some insurers have urged Congress to create a similar program
to cover natural disasters. Insurers have also received significant taxpayer support at the
state level, through the creation of state directed “insurers-of-last-resort.” The existence of
these companies allows insurers to “cherry pick,” by insuring lower risk households
themselves and sending higher risk households to the state company. Only Florida has taken
steps to end this practice.
“Insurers have been so successful in shifting their risk onto consumers and taxpayers that
they have produced record profits during a period of increased storm destruction,” said Hunter.


“This risk shift is reflected by the fact that insurers are paying less and less of the premium dollars
they receive in benefits to consumers.”


Recommendations for State Policymakers
1. Require insurers to offer an all-risk homeowners insurance policy. This would once again
ensure that homes are protected from catastrophic events. It would also help consumers understand
exactly what their policy covers, and encourage insurers to do more to prevent losses before they
occur.
2. Better oversee the use of socio-economic factors used to set rates, like credit scoring.
Insurers have been able to maintain excessive pricing through the use of such information as
consumers’ credit scores, prior insurance limits, occupation, and educational attainment. This
information is opaque to consumers and has not been examined by most regulators to ensure that it
results in the setting of fair rates. State regulators should require that pricing practices: promote risk
reduction; are logically related to risk (so consumers know what steps to take to reduce rates);
protect low income and minority consumers; and are open and transparent to the public.
3. Increase scrutiny of computer-based claims settlement procedures. The use of computer
procedures has shielded insurers from scrutiny of questionable claims practices, while state
insurance regulators have largely looked the other way. In 2008, regulators should pierce the
mystery of how claims are settled and stop practices that deny the full payment of legitimate claims.

4. Make state-backed reinsurance available. States should join together to offer reinsurance to
private insurers using the recent Florida legislation as a model. If all catastrophe-prone states joined
together to underwrite reinsurance at actuarially sound rates (or even at a mark-up of 50 percent
over actuarially sound rates), they would likely end or significantly diminish the periodic crises that
follow big hurricanes or earthquakes.
5. Consider offering state-backed property and automobile insurance. Policymakers in coastal
regions should consider whether the increasing rates, decreasing coverage, and turmoil created by
large numbers of periodic non-renewals have reached the point where private insurers should not be
offering certain coverage at all. In 2007, Florida allowed its primary insurer, Citizens Insurance
Company, to offer comprehensive homeowners insurance policies at competitive rates. This forced
private insurers to lower some rates and allowed Citizen’s to spread risk more broadly. States
should consider taking this approach further by offering automobile insurance, which would assure
that, over time, the state would make a small profit or at least break even on its insurance offerings.
6. Better regulate the use of catastrophe modeling. States should follow Florida’s example in
blocking catastrophe-modeling firms from using short-term projections as the basis for establishing
insurance rates and require them to return to the practice of using long-term projections. Coastal
states should consider uniting to develop a coastal weather modeling system of their own to test the
accuracy of private projections and to evaluate the fairness of insurer rate requests.
7. End unjustified geographic discrimination. If any insurer fails to market a line of insurance
that it is selling in other parts of a state (or in other states), regulators should consider convening
hearings to determine if the insurer’s license should be revoked for geographic discrimination.
8. Review homeowners insurance policy forms for hidden provisions. Insurance regulators
should carefully review the policy forms and exclusions they have allowed to become part of
homeowner’s policies, and require insurers to offer clear disclosure about exclusions and lower
rates to reflect decreased risk that results from these exclusions.


Recommendations for Federal Policymakers
1. Repeal the McCarran-Ferguson Act’s antitrust exemption for insurance. The excessive
pricing and unjustified claims practices documented in this report are abetted by collusive and
anticompetitive behavior allowed under this law. Congress should impose the same antitrust law
relative to insurance with which virtually every other business in America must comply.
2. Authorize interstate cooperation on catastrophe insurance. Congress should authorize states
to use interstate compacts to create multi-state risk “pools” to cover wind and other catastrophic
losses. Such legislation should allow states to permit the accumulation of tax-free reserves if the
funds collected are kept for the purpose of paying claims after wind disasters strike.
3. Repair the troubled National Flood Insurance Program (NFIP) before vesting it with any
additional authority. Congress should not pass any legislation to subsidize wind insurance or to
add wind coverage to the National Flood Insurance Program. The NFIP is in disarray. Out-of-date
flood maps used by the NFIP have underestimated flood risk and resulted in unjustifiably low
insurance rates. This has created hidden subsidies for unwise construction in the nation’s floodprone
areas, helping to create a $20 billion shortfall in NFIP funding. The use of private insurers to
run the program has resulted in between one-third and two-thirds of flood premiums flowing to
insurers, not to the payments of claims. There is also evidence that insurers have shifted the cost of
wind claims they should have paid to taxpayers—who support the NFIP.


4. Eliminate any federal policies that might undermine the development of the securitization
of insurance risk. The federal government should undertake a study of federal laws and rules to
ensure that the responsible securitization of insurance risk is encouraged, not discouraged, by
federal tax policy. Fostering increased securitization of catastrophe risk is a far more favorable
option for consumers and taxpayers than insurer efforts to receive more taxpayer subsidies.


Advice for Consumers
1. If possible, do not do business with a company that has a history of anti-consumer
behavior. When purchasing or renewing a homeowner’s policy, consumers can contact their state
insurance departments to get information on companies in their areas that have sharply raised rates
and cut back in coverage in recent years.
2. Carefully review policies at purchase or renewal to determine whether high out-of-pocket
costs will be imposed. Consumers should look for separate deductibles for wind damage, anticoncurrent-
causation clauses, mold exclusions, limits on replacement costs, and other restrictions on
coverage.
3. Consumers who live away from coastal areas should actively shop for better coverage and
rates. Because insurance companies are overcapitalized, they are looking for new business in lower
risk areas. Rate decreases and better coverage are possible.
4. Demand thorough oversight of insurer actions by state regulators. If consumers have a
problem with rates or coverage, they should file an immediate complaint in writing with their state
insurance agency and follow up for a response. Consumers should also contact insurance regulators
to find out what they are doing to require that rates are fair and reasonable and that insurers are not
unjustifiably withdrawing coverage.
The report was written by the Consumer Federation of America and released with national
and state consumer organizations, including Americans for Insurance Reform, Center for Economic
Justice, Center for Insurance Research, Center for Justice and Democracy, Consumers Union,
Empire Justice, Florida Consumer Action Network, Foundation for Taxpayer and Consumer Rights,
Neighborhood Economic Development Advocacy Project, New Jersey Citizen Action, Texas
Watch, and United Policyholders. A copy of the report can be found at:
www.consumerfed.org/pdfs/2008Insurance_White_Paper.pdf.

Consumer Federation of America (CFA) is a non-profit association of 300 consumer groups, with a
combined membership of more than 50 million people. CFA was founded in 1968 to advance the
consumer’s interest through advocacy and education.

 

"Anyone who has never made a mistake has never tried anything new... Albert Einstein"
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sbeau4014
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01/14/2008 12:22 AM

Just seeing the name of the author of that "release" tells me a lot about the quality and integrity of the article. Enough said on that. Let each form their own opinion

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Gale Hawkins
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01/15/2008 12:40 PM

Thanks Dave for post this. It was the McCarran-Ferguson Act’s antitrust exemption for insurance http://www.iii.org/media/research/mcf/ that I was trying to think of when writing my post this morning on http://www.catadjuster.org/Forums/t....aspx#6600 relating to the XML Open Standard and what roll ISO may play in controlling the carriers how they could use that control for the good of the industry..

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katadj
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02/24/2008 1:10 PM


 

 
Industry News

February 21, 2008 - LAKE FOREST, CA -- Bluebook International Inc., a leading provider of accurate, "on demand" residential replacement cost, risk analysis and other essential property value information reports for more 91% of the nation's single family residences, announced today that Bob Dowdell has joined the Company as Advisory Council Chairman.
Dowdell is the former Chief Executive Officer of Marshall & Swift/Boeckh, a leading supplier of local building cost information, residential and commercial property valuation technology and services for the property and casualty insurance sector in the U.S. and Canada. During his tenure there he transformed the organization from paper-based publishing companies to “knowledge companies” that provide a wide variety of services to the property insurance, appraisal, and assessment industries.
Mark Josipovich, Bluebook CEO, said, “We are very pleased to have Bob join us in this capacity. He brings a level of experience and vision to our team that will be especially valuable in our goal to deliver ever more accurate, sophisticated risk management applications and to meet demand for our products and services with our distribution partners and insurance clients.”
The Charter of the Bluebook Advisory Council is both to provide the company with strategic guidance as it addresses today’s rapidly increasing demand for its current products and services and to assist in defining the next generation of risk management applications of Bluebook data to meet the demands of the Insurance and Mortgage Lending industries.
Dowdell stated, “I am really pleased to join Bluebook and am very excited about the opportunities for the application of their unique data and software applications to produce ever more accurate, risk specific solutions and services for both the insurance and mortgage lending sectors. Bluebook’s property data solutions provide a foundation for a whole new range of risk identification analyses for property insurers. The unique information sets that Bluebook has will enable carriers to better determine appropriate coverage amounts directly, without the laborious efforts that were required in the past.”
About Bluebook
Bluebook International, Inc. provides accurate, "on demand" residential replacement cost, risk analysis and other essential property value information reports for nearly 91% of the nation's single family residences. Bluebook's proven web based underwriting and integrated data solutions help validate proper premiums, mitigate risks, reduce cycle time and enhance productivity for the property and casualty insurance industry, residential real estate and related services markets. Bluebook's information and services are utilized by leading insurance, mortgage banking and recognized providers of the residential real estate services industry.  Web address:  http://www.bluebook.net
 

 Makes one wonder about the offer/acceptance in light of this tread?  no?

 

 

"Anyone who has never made a mistake has never tried anything new... Albert Einstein"
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Ray Hall
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02/24/2008 3:30 PM

Meeting the RC provisions in the RC clause in Homeowners claims is almost not a problem in my opinion. I can not remember having to compute the formula in 30 years on a Homeowners policy. The big 5 insurance carriers usally state if we insure it it's the correct amount. (and usually more).

I am surprised by the number of regular claims carriers who demand this workup. IT only takes 30 min. or about 10% of the total time to work a regular claim on the average. But if 10% of the workers time is used on the I2RC , a full year working these losses comes out to about 150 hours per year doing work that does not effect the gross loss.  Now I do not propose the fee bills be cut 10% and this task dropped, but just treat your field eye balls as well as your inside adjusters and your contractors .

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katadj
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03/12/2008 3:29 PM

Here is the testimony on the link that Gale has mentioned.

 

The Hearing was held on3-7-07 and nothing more, to my knowledge has been presented.

http://frwebgate.access.gpo.gov/cgi...35166.wais

 

 

 

 

"Anyone who has never made a mistake has never tried anything new... Albert Einstein"
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Tom Toll
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03/13/2008 10:30 AM

That was a lengthy and very good read. Obviously not many at that hearing understands policy. The separation of flood and wind sometimes is difficult, and engineers are retained to attempt, (notice the word attempt), to determine what damage was wind and what damage was flood. I am sure there were mistakes made, but if there were, these people deserve proper treatment. Only time will tell. I can attest that there was some lowballing by some carriers. When a company says to not change data base prices, even though prices increase during these events, that could be interpreted as lowballing. That did occur and that should be looked into.

Success is not final, failure is not fatal: it is the courage to continue that counts.
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Ray Hall
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04/10/2008 7:22 PM

I have always had a problem with a certain estimating program and the contractors and carriers who insist on this program. Well my problem with no income unless I gave into the pressure won out back in November 2007.

I do not believe any person will argue such as a contractor, lawyer or homeowner with sworn affidavits that will be introduced as part of this argument . The argument would be before any panel. This side could be by one of about 25 other adjusters that I know. This side could convice the panel a good fair profit margin was  in the original estimate , if the scope was correct and agreed too.

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Gale Hawkins
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04/12/2008 1:38 PM

Ray I notice some tend to treat all software as a form of intelligence instead of just a tool as it is designed to be. How carriers closed claims before estimating software was invented with nothing but just adjusters, pencil and paper is a mystery to me.

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Ray Hall
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04/13/2008 11:04 AM

This topic needs a vice president of a large insurance to answer; but do not hold your breath. A very good plaintiff attorney could also chime up. I will write my op ed after about 10 more qualified adjusters write one.

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