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Last Post 05/16/2010 12:40 AM by  Ray Hall
Principle of Indemnity and Insurance Fraud
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insprojohn
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04/01/2010 11:00 PM

    I would love to get some replies to the following thoughts:

     

    I posted the below as well as a very good piece on Roofer and SIU Insurance Fraud in the Community Forums

     

    Why not a partnership?  If I had to choose between reporting a scumbag insured for insurance fraud, helping the insurer get restitution, and possibly get paid a percentage; if not most of the RCV money for the roof job the insured refuses to me for I would gladly do that; instead of just putting a mechanic's lien on a home and hoping to get paid. 
    On my way to the court house to file my mechanic's lien I will stop by the district attorney's office to file fraud charges.  I believe this would help insurer's stay in business, prevent premiums from rising, and help honest contractors get paid faster. 
    Here is an idea that I am considering putting on my contracts:
    WarningInsurance fraud is a felony and I report all homeowners that commit insurance fraud to the insurance company and help them prosecute.  Instead of me simply placing a mechanic's  lien on your property;  I will contact your insurer and inform them that you were able to get your repairs done for the ACV money and that the RCV money amounts to profitting from your loss. Which is excluded by your insurance carrier.  You must refund your RCV money to your insurer or face insurance fraud prosecution.
    I think this is a great idea!  I would gladly help put some piece of garbage that ripped me off and the insurance company off in jail.  I would love to hear replies on this idea!
     
    I posted this for Roy Cupps because he believed that this was a contractor issue. As a licensed agent with 20 years experience as an insurance salesman and underwriter I very much know this is an insurance issue. 
     
    Roy,
    This is an issue of indemnification and insurance fraud.  My background: I first passed the 200 hour FL agent licensing exam in 1990.  Not a 40 hour adjuster licensing class.  Currently I am a licensed Property-Casualty Agent and Adjuster in FL and have a non-resident GA  adjuster license.
    When I pass AIC 36: Liability Loss Adjusting then I will have my AIC designation.  What is my point?  Well I got into roofing sales because I did not know a lot about construction or exterior damage to a dwelling.  I have found that my insurance background is a blessing. Due to my insurance knowledge many property owners have asked me about insurance carriers, coverage, etc...  At the moment I am not a licensed agent in GA but I have seriously considered obtaining my GA agent license as I am doing well selling roofs and if I could earn some extra $$$ selling HO3/HO5/DP2/DP3 and maybe even some extra things like inland marine, auto, umbrella policy, etc... and maybe even go after some commercial property coverages.
    My point is that since I seriously been considering getting a GA agent license I called a few agencies and all of them have told me that they are very unhappy about out of work contractors, who are trying to survive, banging on the doors of homeowners telling them that they have roof damage due to hail or windstorm.
    Well my post that you consider to be more appropriate in a roofing forum is totally appropriate in this forum. 
     
    Q. What is the concept of indemnification for loss?
    A. Property owner is supposed to be made whole and NOT to profit from a loss.  So if the insurance company pays a crooked homeowner $4500 in ACV money with a recoverable depreciation amount of $4000 and maybe even a supplemnt amount of $1000 due to some work being overlooked or adjuster material measurements being wrong, then this insurer will pay the insured an additional amount of $5,000 when proof of job completion is recieved.
    Now if the homeowner keeps the additional funds for Completion of the Work and does NOT pay the contractor then the homeowner actually profitted from their loss in the same manner as an arsonist who burns down his home would profit from his loss. This is insurance fraud!  If the insurance company was able to get the work done for the ACV amount, which in the case of the crooked insured occurs, then the insured must pay back the insurer the additional monies or be GUILTY of Insurance Fraud.
     
    Because an insured is NOT supposed to profit from a loss.  Anyway...  if the insurance companies keep paying out on these hail claims then rates will have to increase and coverage will be restricted.
    I have spoken to agents and csr's who have told me that homes with roofs of 10 years or older cannot qualify for RCV coverage and some companies will not even write new business on a home with a roof that is 8 years or older.  So these criminal insured's are screwing insurer's, fellow insured's roofers, agents and possibly adjusters if the insurance company quits writing property insurance in a particular state due to loss frequency and severity.
    I greatly look forward to replies to this post.
     
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    admin
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    04/01/2010 11:21 PM

    John, please do not make any additional duplicate post.

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    admin
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    04/01/2010 11:24 PM

    I will repeat my reply for this post as well. 

    I disagree,
     
    Some comments in both of your statements seem to be related to a roofing job you completed as roofer in which the homeowner did not pay you for the job.   Based on some of the statements in your post you appeared to be looking for advice or feedback on how to get Allstate to prosecute the homeowner, on forming a partnership between the roofers and insurers and a statement that you were planning to add to your roofing contract.  
     
    My suggestion to seek feedback in roofing forums was based on these types of comments. 
     
    If I felt that your post were totally inappropriate for these forums I would have locked the thread or deleted them.  

     

     

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    Ray Hall
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    04/02/2010 12:56 PM
    insprojohn. I am flabbergasted, its OK for you to make a big profit on a roof job but its stealing if the insured takes the money instead of you. Just, send your final paid cost to the insurance carrier and they can stop payment on the depreciation check. I think you also think livestock is excluded on auto comp. claims. (agents license!!) my my .
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    insprojohn
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    04/02/2010 1:47 PM

     Ray Hall,

    Domestic Animals is EXCLUDED in the HO3 policy. Why don't you read the policy before you make an untrue comment. Now with regards to Auto Comprehensive now called (OTC) coverage-which 12 years ago I was an EXPERT in since I sold that policy form all the time, I do not remember if it will cover damage such as vandalism caused by a DOMESTIC ANIMAL.  Wow - that word domestic animal again!  Anyway the HO3 policy that I forgot more about than most adjusters know about, at least the ISO version, CLEARLY states that DOMESTIC ANIMALS ARE EXCLUDED FROM COVERAGE.  I can even dig up my sample ISO HO3 policy and read it for you.  I am now reading my sample State Farm policy FP7955 and I did observe that DOMESTIC ANIMALS = FARM ANIMALS are EXCLUDED from Coverage. Under Section 1 Losses NOT insured page 9; paragraph M. Domestic Animals NOT insured.    I am now selling roofs and I know from when I did sell auto insurance OTC/Comprehensive coverage included collision with animals.   If you want to discuss CP or HO policies I am ready for that.  Unless I go back to selling insurance again I really do NOT care about liability policies.  In FL agents must pass a 200 hour licensing class.  After my 8 year absence from insurance I was required to re-take this class.  I took it online and completed it in 6 days.  I scored an 86% on my state exam. I own 4 CPCU books, AIC 33, 35, 36.  I completed the Program In General Insurance from IIA and scored 90-100% for INS 21,22,23 and AIC 33.  I only passed AIC 35 which means I got 70-80%.  Probably only got 72% on that exam LOL.  Anyway...  AIC 36 Liability Loss Adjusting is what I need to pass to get the AIC designation.  All completers of INS program only must pass 3 exams to get AIC.  Everyone else must pass 4 exams.  I am focusing on things that pay me at this moment.  So when I have time I will study AIC 36/Liability Insurance.  After I have $$$$.   Selling roofs and maybe adjusting claims - whatever pays me better is what I am into.

    But my goal is to help insurers and me NOT get screwed.  If a person is able to get their repairs done for the ACV amount because they ripped off their roofer then that is the only money they deserve.  You keep forgetting that as a FL agent my background was to PROTECT insurance companies due to the need to PRESERVE markets.  Without a market to write a risk an insurance agent has no chance to earn a commission.

    There are scumbag agents and adjusters out there.  Though both agents and adjusters have relationships with underwriters and carriers.  I believe an agent would have a greater understanding of the underwriting process due to the fact that the agent handles underwriting issues on a daily basis.  The adjuster would only handle an underwriting issue if the carrier made that request of the adjuster and it would likely be just to report back on what was observed at the property.  As an agent I know about underwriting inspections. 

    Anyway....  I was an underwriter and agent and now I have an adjuster's license too.  

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    brighton
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    04/02/2010 5:19 PM
    Insprojohn, or whatever your real name is. If you have not gotten paid the remainder for the job done, you have numerous recourses. 1) It has been mentioned that you call the carrier to see if payment can be reissued. That is if you had the insured sign an agreement to have your company named on payments.2) Call the lien holder of the house. See if they can issue payment to your company 3)Send a letter notifying the homeowner that if you are not paid in X days, a lien will be filed by the company and suit may also be institued. If no response 4) File a lien on the house. 5)File suit. 6) File a police report for theft of services. If your contract was for the amount you say you have not been paid, then no fraud is involved (I swear that an agent/adjuster/roof salesman screamed fraud on another site too). The work has been done. In many states that is called theft of services maybe not in GA.

    Regards your slamming of Mr. Hall and accusing him of not reading the policy before making a comment. I highly reccomend that you do the same with his posting prior to your tirade. Mr. Hall stated that " I think you also think livestock is excluded on auto comp. claims. (agents license!!) my my" . Mr. Hall said LIVESTOCK and you went off on DOMESTIC animals. Livestock are not considered domestic animals in legal definitions I have read.

    You also state in your original post " At the moment I am not a licensed agent in GA but I have seriously considered obtaining my GA agent license as I am doing well selling roofs and if I could earn some extra $$$ selling HO3/HO5/DP2/DP3 and maybe even some extra things like inland marine, auto, umbrella policy, etc... and maybe even go after some commercial property coverages." Perhaps you should surrender your adjsuter licenses from FL and GA and go back to selling insurance or stay with roof sales. You write in about a situation then you profess to be the expert. If you are the expert, then why are you writing to this site.

    If I did not know better, this is almost identical to postings on another site about a year ago. An agent turned adjuster turned roofer was complaining about almost the same identical thing and accusing the insured of fraud. Only the client got paid and did not use the agent/adjuster/roof salesman to put on their roof. The rantings got them locked out of that site for good. His first name was also John.
    Rocke Baker
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    insprojohn
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    04/04/2010 12:36 AM
    brighton - You really make yourself look bad when you claim to know a lot and end up appearing ignorant. What is the difference between a domesticated horse and a wild horse? Well in the old west when a wild horse aka LIVESTOCK EINSTEIN was captured the horse had to be DOMESTICATED. Therefore your entire RANT proved your IGNORANCE. I will NOT apologize for your STUPIDITY.
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    ceckraft
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    04/06/2010 3:30 PM
    The typical exclusion (in a homeowners policy) applies to birds, vermin, rodents, insects, and either domestic animals or animals you own or keep (the key is domesticated animals). An auto policy with comprehensive usually covers this. But we must always examine the specific policy before striding out on the weakened bridge.

    A squirrel is, indeed, a rodent and I've never heard of a homeowners policy covering damage caused by a squirrel. (I just added that one for fun)

    I don't think any of the above commentators are stupid. We all have a little ignorance lurking though. But our worst enemy is our temper. If we must resort to insults, it must be much more subtle. No direct volleys allowed. Hint, hint!
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    Olegred
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    04/29/2010 9:57 AM
    sad, but true, I've seen many roofers burnt by homeowners..... That is in part why I got out of roofing business myself.... As a salesman you spend all this time and energy negotiating the deal with an adjuster but when the homeowner gets the check for, say, 10k, it changes everything... all of a sudden they want an estimate, start shopping around and etc. There are ways to keep them in the bag from the beginning like contigency agreement and etc. but in the end if they decide to bail there's little you can do.... In reality it's more prudent to drop the guy than fight the battle and go find another customer.... that is when the job hasn't started ... if you already started the job and have a signed contract (which you should, are you kidding?) then you have all the leverage you need to get paid (lien anybody?)... but john whatever your name is ... you sound like a loser anyways....
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    carribbeandreams2004
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    05/04/2010 12:11 AM

     Well I do not think John is loser. It sounds like he was ripped off and appears to know a lot about insurance.  I think Olegred is a loser for calling a guy who probably does not even know how to fill out a lien form (John) a loser.  I bet John is gonna go learn how to fill out a mechanics lien now.

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    ceckraft
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    05/05/2010 10:43 AM
    Yep, we are all losers. Reminds me of an old Beatles song, He's a real no where man.......... C'mon guys, quit calling each other "Loser". I probably just lost something in the translation.

    But it won't be the last time the "Insured" screwed the adjuster and the contractor at the same time. It makes you mad, but as stated in previous comments, we learn and get smarter.
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    Leland
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    05/16/2010 12:17 AM
    If a homeowner gets paid for a roof and doesn't pay their roofer for the completed work, it is not insurance fraud.

    It's called owing money to the roofer.
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    Ray Hall
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    05/16/2010 12:40 AM
    I have received phone calls from roofers who state I represent Mrs. insured I ask them to bring their TX. public adjusters license, or they just a roofer with clean finger nails, sometime.
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