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I had a 2004 hurricane claim with a PA that doesn't climb roofs. Just as well because he is a reknowned alcoholic. He used to work for the same IA as me years before I worked for that IA. He was off by 8 SQ on a single family home roof. When he got my estimate, he just went to the bottomline and got upset about the total cost difference. He insisted that he measured the roof properly. I went by a few days later and remeasured - my measurements were correct. He insisted on going to appraisal. I thought about calling his boss and giving him a heads up that somebody was going to look pretty stupid at appraisal.....but then I fiugured - Nah, let him learn the hard way.

Runnerup - Same PA who wanted me to replace a huge screen enclosure and S-tile roof because they had both been "tweaked" by the hurricane. Not a lick of evidence that the enclosure was bent or leaning - just some screens blown out. Everything was square, level, plumb and solid as a rock. Not a single tile cracked or missing or a single ceiling stain. I thinke he demanded appraisal on that one too.

Back in 1998, working hail up north, for an well known IA vendor, who has alot of QC people who Double check roofs, and report and rate adjusters, I had a particular claim which the dwelling was on a corner lot. The front of the Dwelling faced one road, and the front of the garage faced the other. HOWEVER, THE DWELLING AND THE GARAGE WAS CONNECTED VIA AN AIR CONDITIONED BREEZWAY. This meant that the dwelling and garage was all one building. Basically all North, South, East & West, or in this Case Front, Right, Back & Left.

So I drew the Roof Diagram, Measured it all up, and figured the roof squares, Also the siding was an aluminum siding so I scoped it Front, Right, Back & left. After a few more Appointments I went Back to my RV, and Drew the Claim Up, And Did what I was supposed to do, did the RGF factors Etc. And Closed the Claim, PDF Stacked it and sent it in to review. Of course it went through and on this particular Storm the file reviewer was also the Storm manager. And he approved it and sent it up. Insured Agreed, and Claim would have been closed HOWEVER

The Carrier QC, just happened to grab that Claim, and went and Re Inspected it, and I received a call from My Storm manager and said hey Man We have a problem. And he proceeded on Jumin on me. He said the Dwelling had a Garage, and I had Missed the Garage. So The QC Went and made a Big Stink to the Insured's, and all of the sudden it was a big deal.

Well The QC, asked me to meet him at the risk, so I did the next morning. When He told me, that the way that the CARRIER wants it Done was The Garage to be Detached, SO, I went back and seperated the Garage out and resubmitted it, Against my better judgement, and It went through My Storm manager, and Both the QC and Storm manager made Bad Reports on me as a result.

SO I kind of blew it off, and a few weeks later there was a massive downpour, and this Particular Claim, The Insured's Dwellng was leaking into the interior, SO Since the QC made a big deal out of it, They had a staff Adjuster who was also The LEAD QC for the Carrier come out, as they expected problems with the insureds. Next thing I know, Im Getting a call from the head QC of the carrier telling me that My estimate seperated the House and Garage, and that was wrong. I was asked to meet him at the SAME House. So i Did, I brought a copy of the my last estimate, and the Estimate I was told to write by his QC, and My Storm manager.

Needless to say, the QC who had me change the estimate, and seperate the garage, AND the Storm manager were let go as a result. And the Head QC is a Good Friend of mine to this Day!

MORAL OF THE STORY, STAY WITH YOUR GUT FEELINGS!

Your QC story reminds me of  file audits conducted by a former employer.  Naturally, the audits are conducted by those with limited claims experience.  They are generally bean counting robots with a checklist, and job justification on the forefronts of their mind.  Anyway, 10 to 15 random closed files are pulled from each adjuster for each line of biz (prop, auto, liab,etc).

I received the audit sheet back, and failed 4 out of the 10 or 15 property loss files because there was no diagram in those 4 files.  Damn near blew a gasket when I pulled up those files and found that they were theft losses of personal property from vehicles!  Wanted to put some diagrams in a dark place right then and there for that auditor, but the snake had already left the office...headed for the next state.  Sent him an email with nary a reply, and told my branch manager about it with little more than a blank look returned.   This was several years ago, and I've heard nothing much has changed there.  I can laugh about it now, but not at the time.

Had the erstwhile Montana flood TPA examiner kick back a file on an elevated building loss on Hatteras Island.:The rebuild of a brick chimney from the foundation being undermined is not allowed as an elevated building cannot have a brick fireplace.

This is case is fiction; but could be true.

In January 06 four of the largest Homeowners insurors in Dallas Metro  decided to try to come up with a money saving idea on the cost of the hail loss roof claims in the area.

All decided to pull the records for the past 10 years and get the claim history. The results was 95% of the dwellings in the area had the old roof measurements intact.

On May 31, 2006 a monstor hail storm with baseball size straight down hail hit.

The satellite photos of the 29th of May and June 1st confirmed the damage.Each carrier hired 20 top notch IA's each to review the data and write the check reuest. 95% of the losses were paid and closed in three weeks.

Does this sound like the future ? Are we a commodity?

Uhh, gee...last time I looked at the calendar, that sounds like the past, Ray!

But, seriously what carrier would do that? There always has been and always will be wear & tear, plus the neighboritis.   There has to be hands-on, eyes-on, inspections (by honest to goodness adjusters).   Your scenario would only multiply the roof buying that happens on too many storms.

Also, how could one quantify the loss if the satellite image did prove new hail damage?  Depend on the roofers' measurements and stated number of layers present on the roof?  With carrier changes, and the mobile society we have (people living an average of 4 years in the same house)...how do you get those previous claim records/estimates? The prior carriers are not going to give out any specifics.  The old claim histories might show dollars paid, but was it just for roof or include gutters, siding, windows, interior water damage, etc? 

Mike: All the major carriers are using inside adjusters to settle catastropohe losses now. CLUE  reports  have the address as well as the name are shared by insurance carriers. It has the past losses and types. The same computer storage companies who has the foot print of the dwellings for the tax man MAY have the roof diagram!! The resolution on sat. photos will show hail hits.

For the last 50 years insurance claim managers have been climbing roofs and can tell the stormers when they hit town were the hail started and stopped.

People are standing in line to measure roofs and take photos of exteriors for less than $50.00 per house if you need them.

 

AND JUST WHEN I THOUGHT IT WAS OVER HERE WE GO AGAIN !

PREACH ON RAY!

But what if he is right.

A quick one from my days as an agent. A large hail storm came through and nailed several counties here in Texas, my area got several newbies assigned. One day one of my insureds came by my office waving a check for about $10k complaining that it was not near enough. I accepted the check back after contacting the BCO and agreed to meet the insured the next day to inspect the roof and contact the IA for them. I recieved the estimate from the claims supervisor and proceeded to meet the insured. The home was about 13-1400 sq ft, and the adjuster had allowed for tearoff and replacement of the existing roof, plus tear off of wood shingle under the comp, also redecking. The roof was just the original single layer comp, not overlayed, no wood shingles to tear off. I generally did not get between the insureds and adjusters, but this insured insisted, ant I am glad  did this time. Needless to say the roof was reinpected and the insured recieved a check for about $3400 intead of the $10k they thought was not enough. The IA was sent for "more training". The insured stayed with me for several more years until I sold my agency.

Before the days of GAB, Crawford, Groves & Powers, Lawson & Caraway, Engelbritzen, Fearnow and some others, catastrope losses were handled like other losses.

Seems to me the brook is running dry for the catastrophe adjusters who are thirsty and a new place to drink should be found.

http://www.foxnews.com/story/0,2933...27,00.html

 

North Korea Suspected of Collecting Millions in Reinsurance Fraud

Monday, December 04, 2006

 

NEW YORK —  The cash-strapped regime of North Korea, which has a worldwide reputation for its criminal dealings in weapons sales, drugs and near-perfect counterfeit U.S. $100 bills, may have found a new illicit source of hard foreign currency: international reinsurance fraud……

Well Gale,

 

I've got to say that story shows to whom the "I Thought I Had Heard It All" Award belongs.

http://today.reuters.com/news/artic...amp;rpc=22

 

U.S. hurricane aid fraud likely tops $1 bln: report

Wed Dec 6, 2006 3:24pm ET

 

WASHINGTON (Reuters) - Fraud involving payments supposed to help victims of Hurricanes Katrina and Rita likely exceeds earlier estimates of $1 billion and only a tiny fraction of the money has been recovered, according to a U.S. government report released on Wednesday…..

Does insurance fraud qualify for "I thought I heard it all"?

We should start a thread for the most bizarre fraud. That would be interesting.

JWG

Talking about fraud, many years ago,while working for a small IA firm, I was handling a home burglary claim.  Through my investigation, I had a gut feeling something was wrong.  Certain things just didn't seem right. 

The insured gave me a receipt for a very expensive computer that was in the name of her boyfriend.  To get coverage under the policy, she said it was a present from him.  It was from a one-man computer shop so I called the guy to get a replacement price.  The computer guy gave me a statement that he never sold the boyfriend a computer.  He also advised he had a recent burglary and a bunch of his invoices were stolen.

When I questioned the insured (and boyfriend as he lived with her) about the computer receipt, they decided to no longer claim the computer.  They also decided not to claim other items which I thought were bogus. 

When I mentioned this claim to a liability adjuster in my office, she recognized the name of the insured and boyfriend.  It just happened that she was handling a slip and fall claim where my insured was her claimant.  And, the boyfriend was the physical therapist who was submitting bills for massage therapy.

Both claims were submitted back to the carrier's SIU department.

While it would be next to impossible to be off subject in this tread I see nothing wrong is starting a thread about insurance fraud. Because we have gone from 100’s to a few threads it naturally tends to be to many subjects being grouped in the same thread. If someone would prefer to pick the location and start a tread on insurance fraud I will be glad to move my last two post. As the new forum develops more threads over time the choices will be more complete as was the case in the past when CADO made fresh starts of the forum.

http://my.earthlink.net/article/nat...1197337378

Study: La. Slowly Slipping Into Gulf

January 01, 2007 6:02 PM EST

NEW ORLEANS - A new report by scientists studying Louisiana's sinking coast says the land here is not just sinking, it's sliding ever so slowly into the Gulf of Mexico. The new findings may add a kink to plans being drawn up to build bigger and better levees to protect this historic city and Cajun bayou culture.

If the land is shifting - even slightly - engineers may need to take that into consideration as they build new levees…

 

 

http://cbs4.com/topstories/local_st...02512.html

 

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