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Newt
USA
657 Posts |
 Posted - 09/02/2002 : 11:33:47
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I think independance is great, and as long as there is responsibility it can be maintained. Hear me out I'll get to the point. This has some questions about the reaction to a so called independant adjusters, conduct, and attitude. I don,t have the answers to this, I have a one sided story and above all I kept my mouth shut during this conversation. I would never get involved in a debate with anyone about the conduct of someone in the same field for which I am licenced. The simple reason for this, you start getting quoted. Thats not just insurance, its any field.
My Barber bought a new motor home and took a vacation, had a wreck on the return trip caused by a blowout.
He contacted his agent, and they sent out an independant adjuster, not immediately. The adjuster left, and the insured waited a week
and called to see what the disposition was going to be. The adjuster was on vacation and wouldn't be back for another week. The insured called back in a week and got the estimate. It was half what he paid for the unit. And the client said that wasn't enough. The adjuster
informed him that was all they would pay and advised him to get a lawyer. Whoa, after I get someone really irritated I can,t see me inviting an Alan Jackson in, I think he would probably flay me alive.
It took 39 days for adjuster to come back with an offer to settle the claim in the first place. There was a complete lack of rapport
or communications, thats my opinion. Needless to say the barber is fuming and is going to start proceedings with extreme prejudice.
With what little info I have here, what will the jury say.
This is an example of going on vacation with loose ends hanging,they always seem to come un-ravelled.
Next on the agenda, would personal items that were take out of the home be covered under his HO policy, the adjuster just told him contents were not covered period and on the phone the HO was not discussed, should it have been? That is one question that would apply to many situations and , I would like to know the right way. Protocol in adjusting is one thing I know nothing about except don't use the fraud word and I will direct all personal oponions to my supervisor. Any comments ???? Here is the basic questions
(1) Would you go on vacation with a file incomplete?
(2) Would you join a debate over an insurance problem a friend has with an adjuster, that is, express an opinion?
(3) If the insured has a loss and some of that loss is on another policy with the same carrier, would you bring it to the attention
of the insured and/or insurer, if not ,which?
(4) What about if part of the claim is not with the same carrier, would you advise him/her to file the claim with the other carrier?
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william s cook
53 Posts |
Posted - 09/02/2002 : 13:12:12
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Newt,
Stay in your arena and stay friends with the barber. Most adjusters don’t like brother adjusters interfering with their claim. I am sure that the barber’s adjuster will not be an exception. A barber is ill-equipped to recover all of his entitlements without professional assistance. Often an attorney is not the best source of professional assistance. Suggest that he interview a public adjuster for possible assistance and let him make a more informed decision as to his best options and the anticipated cost of professional assistance.
William S Cook
Public Adjuster
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Newt
USA
657 Posts |
Posted - 09/02/2002 : 15:26:00
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| That is pretty much my slant on things and the thought did occur to me about the Public Adjuster. Rather than give the appearance of taking sides, or giving advice I chose to remain silent until I understand more of insurance protocol. There is a time when those that know not and know they not should hold their piece. The coverage did interest me, also the action or the lack of commications on the adjusters part. It didn't seem the normal way to handle the situation, from what I understand. No matter how good the friend, one side of a story does not make a case, not being a lawyer. |
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CCarr
Canada
1200 Posts |
Posted - 09/02/2002 : 16:00:11
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Newt, Bill Cook's words are wise and applicable for the situation you mention.
However, maybe its time to use some of these examples you give - for your own self study. Look at your own Homeowners policy - what does it have to say about "personal property temporarily removed"? Learn where the right and the wrong of the issues is originating from. |
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Newt
USA
657 Posts |
Posted - 09/02/2002 : 18:01:23
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I read it, and I,ll review it again, I understand that mine is anywhere in the world. He has a different carrier. Do most HO policies say about the same thing except for the exclusions and supplements. My good friend, agent and former customer, is not aware I am getting into this gig,
he is going to get a surprise visit because I need to pick his brain. Why not, he picks mine everytime he sees me. Just made a State Farm Ho policy file with all the indorsements, easy to read. So I have Farmers, State Farm HO and FWUA policy info. Clayton, I got more info than I thought I had. In the situations I mentioned I do have my answers, I was just trying to incite some interest in basics and get some other points of view. It worked so far. |
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RJ
32 Posts |
Posted - 09/02/2002 : 18:37:13
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Newt,
My response to question # 1:
Going on vacation with a file incomplete could cause you a lot of trouble if provisions are not made with all parities concerned (insured, vendor & carrier). In a staff situation this happens all of the time, however, other adjusters fill in while you are away. As an independent adjuster this option is not available and should you go on vacation with a file incomplete you better make provisions for the insured in case the insured has any questions. One that comes to mind is to take a copy of your incomplete files and a cell phone with you so work on your files will not be interrupted by your vacation.
My response to question # 2:
Entering into a debate over an insurance problem a friend has with an adjuster is asking for problems. Should your friend ask for your advice the best response you could give him or her is that he or she should pursue his or her claim with someone (agent, carrier, attorney or public adjuster) that can legally provide him or her with claim and/or legal advice. This may not be the answer your friend is looking for, however, it will keep you friends and out of trouble.
My response to questions # 3 & 4:
First of all bear in mind that the insured’s presented their claim and the adjuster must address it. For items that are included in the recommended settlement there should not be any problems.
Next the adjuster should discuss with the insured the policy provisions for those items for which are not being recommended for coverage making sure that the insured knows that the carrier will make any and all final decesions regarding his claim.
Insured's personal property may have coverage on another policy (regardless if the other policy is with your carrier or not) the adjuster should advise the insured that he could file a claim under the other policy and allow the other policy carrier to determine if coverage exists for the items the insured is making claim for that the RV adjuster is not recommending coverage for.
Remember insured’s rely on what an adjuster tell them because they, for the most part, believe the adjuster is telling them everything about their claim. In this way it can never be said that the adjuster is acting in any unfair way to either the insured’s or carrier’s benefit keeping the adjuster out of an unfair claims situation. Remember while the RV adjuster may not handle insured’s contents loss a claim for contents was presented and as an adjuster he or she should know that coverage may exist for insured’s contents on insured’s homeowners policy and this can be demonstrated in a court of law. By not informing the insured that personal property is covered under most home owner policies and the insured relying on the RV's adjuster expertise does not pursue his personal property loss with his homeowners carrier, discovers down the road that he was mislead by the RV adjuster, the RV adjuster's E & O may come into play and the adjuster could find him or herself paying for the insured’s contents loss because of his or her's lack of disclosure. After all if any one should know policy coverages it should be an adjuster and that is the way the courts are going to look at it regardless if it was a mistake or intentional act on the part of the RV adjuster. |
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Cecelia
USA
25 Posts |
Posted - 09/02/2002 : 19:22:51
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It is possible that the RV adjuster has been trained in auto only and has no idea what is covered under an HO policy. Therefore, the RV adjuster should ONLY inform the RV insured that the contents are not covered under the RV policy and that the RV insured should check with his insurance agent to see if there is other coverage available. Which could be what the RV adjuster SAID, but not what the RV insured HEARD.
Communication, communication, communication.
And communication is NOT going on vacation and not talking to the insureds on the open files. As previously posted, staff adjusters have other adjusters available to pull their files and staff adjusters also have supervisory personnel immediately available also. We I/A's usually have the original (and only copy) of the file in our possession. Going on vacation and not communcating with the insured is very, very bad. And we wonder why the insurance companies complain about our fees and our services? They'll forget all the good I/A's who handled things well and will only remember the guy who went on vacation and didn't call his insured (or the company) before he left.
Communication, communication, communication. |
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Newt
USA
657 Posts |
Posted - 09/03/2002 : 09:45:33
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In this situation, the items he mentioned to me were personal clothing, bicycles and other personal items. And my opinion they would be covered 1000 dollars or ten percent which ever is greater. The reason to stay mute on the subject, is knowing to whom you are hearing this from, even good friends will bend the truth and if you want to be mis-quoted pass something along. They can still be a friend and embelish the truth. I thought it was a good topic and I learned a lot from it. I thought I did the right thing by holding back from any dialog, for the simple reason , for all practical purposes I am not an adjuster yet. You could have determined
from your own experience and given sound advice. Then again you might have detected what I know about the insured and did the exact same thing.
I got something out of this and many thanks to all who joined in, this is how we learn.
About the ten percent Jim, is that correct? That is what I got out of my policy and I think his was another carrier. Another thought has ocurred to me he switched carriers because he had a
previous claim he was in litigation over. I don't have the details, I wont ask , maybe he will tell me the details and we can get another run going. I could talk to his former agent ,good friend and former customer of mine for some details.
Cecelia ,how about that course, are you doing OK? You were right about the communications, first, you got to sell your self and then get your point accross. If you don't show concern and sell yourself,no one is going to take any thing you say as gospel, that is a fact. I know Jim feels the same way, because he is an example. They would never use him as an expert witness twice if he had not sold himself the first time.
The last point I would like to make, If I knew I was going on vacation, I would have scheduled
around the claim or passed it on to someone else. If I know a situation is unstable, then the vacation is out until I get the problem "I" created settled.
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Newt
USA
657 Posts |
Posted - 09/03/2002 : 14:57:08
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Jim, As I see it the items were damageged by the vehicle impact and they are covered.
You will have to excuse me ,I have very little policy information (I am working on it)so it makes it difficult for me to keep up. I have a SF HO policy and a Farmers this is not much to go on.
I got my info from Sec 1 Losses Insured Coverage B Personal Property---Item 6 vehicle, meaning impact by a vehicle..
Another Item that grabed my attention was an amendatory indorsement (ALABAMA} suits against
insurers:Reference to "one year" is changed to "six years" |
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william s cook
53 Posts |
Posted - 09/03/2002 : 20:40:37
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Newt
One of the specified perils for coverage "C" under an ISO policy is listed as vehicles. If the insured had placed everything that they owned in the motor home and had a wreck any where in the world, even in Alabama, the insurers would owe with the only limitation of $1,000.00 for electronic items that plugged into the power point but had alternative power source to the cigarette lighter, and some minor incidentals like tapes, CDs etc. The normal non-covered contents items would remain not covered items. Part of the loss I would pursue would include the expenses of any storage of contents or getting any undamaged covered contents items back to home base from the loss site. The issue of whether or not a deductible would apply should be reviewed as well. This is all predicated on the application of the current in-force policy terms to the current loss. Tell your barber friend to present his loss to the company in its entirety and let his adjuster (not the agent) advise him of the application of the proper coverage for contents items.
William S Cook
Public Adjuster
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RJ
32 Posts |
Posted - 09/04/2002 : 00:25:59
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Newt’
While there is not a requirement to inform an insured about the possibility of coverage for a loss in another policy that the insured may have in force it is a requirement that FWUA & other carriers make of it’s adjusters to inquire about on every claim. As for the named peril that Jim is referring to in policies issued by carriers this may vary from named perils to all risk. Location that coverage is afforded will also vary from a named location to any where in the world.
That is why an adjuster must have access to policy information & policy endorsements for every claim. While most policies are written on industry standards (ISO being one) & have similar endorsements it is not uncommon for carriers to modify policy language & endorsements.
Oh, by the way, there are All Risk (all peril) policies written on personal property. I know because I have handled them. What All Risk means is that no matter how a loss occurs the loss is covered. Most of the time the coverage also extends to anywhere in the world unless specified otherwise. Therefore, if the insured in this case had an All Risk policy coverage extended to any where in the world his personal property loss would be covered with out question.
Most independent adjusters over a period of time handle claims for a variety of carriers. Since there are differences in policy language it is very important that an adjuster have a strong background in policy language, terms and conditions and good common sense in applying coverages.
Now when it comes to discussing the loss with an insured the adjuster must have a meeting of minds between him or herself and the insured in order to have a recommended settlement stay settled. To this point it only makes common sense that if you know something that may help the insured then tell the insured in such a way to point him in another direction especially if it could aid & assist the insured. Jim is right in that there is not a moral or legal obligation to help the insured, however, if an adjuster can communicate in a proper manner his knowledge he or she will not only settle claims in a fair manner he or she will have happy insured’s & carriers.
Unfortunately if an adjuster is not familiar with general policy language in various types of policies Jim is right in that he or she can do more harm that good which could have adverse effects on the insured, carrier and him or herself.
Newt’ for the most part almost all insured’s do not know or understand the policy that they have purchased. Unless the adjuster has the policy and dec page to read he or she can not know either. However, experienced adjusters know enough that can help an insured without crossing the line.
Jim you are assuming that the RV owner has an unmodified (unendorsed) ISO HO 1, 2 or 3. That information was not given in Newt’s post and you know what the word assume means.
I still maintain that since the RV adjuster was presented by the RV owner with a personal property loss the RV adjuster must review his policy coverages with the insured. At that point he has to deal with a very upset and anger insured when the RV adjuster informs him that there is not any coverage for his personal property loss in the RV (auto) policy. By advising the insured to go back to his agent and inquire about possible coverages in other policies that he may have may result in a very happy insured or maybe not depending upon other policy or policies he has purchased. No matter what the out come at least the insured was treated fairly & honestly and will know that the RV adjuster helped him as much as possible. For your edification this is called public relations.
Over the years I have had to break the sad news to many insured’s and believe me when I tell you that it makes a big difference in the manner in which you break the bad news, it makes a big difference. Be abrupt and short & you will have an angry disillusioned insured that will make your life a living hell. Be kind and helpful with full disclosure and the vast majority of time you will have a very disappointed insured that understands why there is no coverage. Some insured will still be upset and pursue their claim with the agent & or carrier, however, most of the time they will not be so apt to attack you on a personal level or your recommendations. However, there will always be a few that no matter what you do they will never be satisfied.
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Newt
USA
657 Posts |
Posted - 09/04/2002 : 08:16:20
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I think all of your comments are worth a lot to new members, I know they were to me. Although we didn't have near enough info, you folks touched a lot of bases, that is what makes study in this manner exciting. Two sayings I always lived and worked by is ,"WORK SMARTER NOT HARDER". The other doesn't apply in all cases OF insurance, just in how the business is run,"IF YOU TAKE THE BOSS A PROBLEM,HAVE THREE SOLUTIONS, TWO OF WHICH DONT" COST ANY THING". I think one of the most important things we learn here is, you have to sell yourself as being KNOWLEDGABLE& CONCERNED before you get them to buy the settlement. Wrong right or indifferent an unhappy customer is the adjusters fault. This is not just insurance, any profession would be the same.
Some people are hard to please, or impossible, one thing I'll have to remind myself of is," I AM THE PLEASER NOT THE PLEASEE".(new words)
Ok folks, the bum is comming out, if any of you folks have any info you would care to part with, let me know and I will pay the postage. I plan on ordering some books from the "adjuster 101". I have set goals for my self to become a new adjuster in one year and just finished my first quarter. My accomplishment seems like zilch yet I have Tx and Al Lic,Farmers Cert,FWUA and Xactimate, it is a good start but I feel real inadequate. I think I am getting old. |
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ALANJ
USA
159 Posts |
Posted - 09/04/2002 : 09:36:39
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| He could submit his own proof of loss and wait out the 60 days. |
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Independant ,Think again
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