RE: "Isabel", is a Hot Potato headed behind?
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RE: "Isabel", is a Hot Potato headed behind? - 6/9/2004 8:48:24 AM
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Leam Kincaid
Posts: 52
Joined: 6/1/2004
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sbeau4014,
I have the highest respect for honorable insurers-vendors-adjusters.
I dislike hypocritical and scheming insurers-vendors-adjusters.
< Message edited by Leam Kincaid -- 6/9/2004 8:50:40 AM >
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RE: "Isabel", is a Hot Potato headed behind? - 6/11/2004 9:33:55 PM
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sjk
Posts: 20
Joined: 4/27/2004
Home base: Oxford, MD
Status: offline
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To: Kile Anderson
From: Steve Kanstoroom
Re: Response to 5/8 and 6/5 posts; Nexus to non-flood claims problems; Specific examples of low payouts, Adjusters explain drive-by adjusting, 2nd lawsuit filed
Responding to your 5/8 post, Section V Loss Settlement sets forth three methods of settling the loss – Replacement Cost, Special Loss Settlement and ACV. In the case of a primary residence, with very few exceptions, each case I have been involved with was initially calculated as ACV only to be later changed to RCV. I believe if the policyholder qualifies for RCV, then that is what they are entitled to. To date, each case that I have seen handled in any way by senior FEMA or NFIP officials bears that out – the policyholder, after further review, was paid RCV.
Regarding your 6/5 post “we are only dealing with 24,000 flood claims, not 458,000 total claims” and your request for specific examples, I have some information.
Since my 4/27 post, many industry insiders, mostly adjusters, have contacted me in an effort to shed light on adjusting practices they feel are unfair. They have provided tremendously helpful information, including emails, documents and other information in an effort to help the victims, and in many cases, in an attempt to change their position, i.e. many feel at the bottom of the ladder in regards to the industry. These documents demonstrate a nexus between the low payouts in flood claims and similar issues with non-flood claims. As they explain, it works like this:
Many adjusting firms handle multiple perils, not just flood. In order for the adjusting firm to win the favor of a particular carrier or TPA, they agree to follow certain guidelines such that claims will be paid according to the carrier’s directives. For example, it is problematic if a flood claim pays 2.00 per square foot for sheetrock when the carrier wishes to pay a lesser amount for a non-flood loss, such as the synthetic price guidelines established shortly after Isabel stuck.
I have received many calls and requests for information regarding the non-flood claims. These claims are under increasing scrutiny as well. Based upon information provided to me by industry insiders that handled large numbers of claims, as well as information from the claimants, there is increasing attention to these claims.
Regarding your desire to learn of specific examples of low payouts on a line item basis:
24.30 per yard for premium grade carpet, pad and installation – no allowance for removal
R&R 6’ x 4’ direct glued mirror, polished brass double handle faucet, 6’ corian vanity top and back splash, $138.20
R&R 4’x16’ ceramic tile island counter-top $329.70
R&R high-end double oven from premium grade corner cabinetry - $32.82
I can give you scores of other such examples. In addition, I could provide many examples of erroneous denials of coverage, errant limitations, publications or interpretations, such as:
The policy only allows 8% for profit and overhead.
This is no coverage for mold cleanup.
The policy limit is $27 per square yard for floor covering.
The policy does not pay for moisture damage.
The policy only pays for 7 days of drying equipment.
There is no coverage for items not contacted by water.
Victim told that no coverage existed for six-figure loss by adjuster, later reversed by senior FEMA official.
Depreciation on the structure is calculated at 1% per year.
Perhaps one of the most insidious – “Under Federal Law the National Flood Insurance Program requires you to file these forms”, referring to an adjuster provided proof of loss for pennies on the dollar - even though the insured had previously filed their own proof of loss for the actual amount in accordance with the policy. The toll this single tactic took on victims, often the elderly already reeling from the tragedy of losing their home, is indescribable.
Suffice it to say, many people were systematically denied coverage – all of the above examples were included in printed letters, some were form letters.
Regarding your doubts that such events occurred in large numbers, I will share more specifics with you if that would help advance the situation. Just call or email.
It seems that many adjusters unfortunately did not have your skills or experience. With few exceptions, I have not learned of adjusters setting out to do wrong, but rather felt trapped in a situation of not wanting the proof of loss to be “kicked back to them”. They of course needed the proof of loss to be signed so that they could be paid. Many had been on the road for weeks with mounting expenses. It seems that lesser qualified adjusters have a difficult time justifying expenditures greater than guidelines. Also, adjusters with limited construction knowledge often feel forced to rely upon software to take the place of their lack of experience. This is sometimes coupled with a bias that comes into play perhaps from adjusting so many repetitive losses. Also, you are not alone with your concerns about an E&O claim. Many others shared the identical concern with me, yet these same feelings propel them to overcome concerns of being blackballed in an effort to improve the situation. Many are anxious to tell their stories in the proper forum.
At this time countless victims are at their wits end. Nine months of living in a camper with their entire family, or in a one-room apartment has taken its toll. In many cases these are elderly people or families with small children and those least equipped to understand the process or manage extensive repairs. While I understand providing a proof of loss is a courtesy, these are real people with problems just like everyone else. Only tragically, now they are homeless. Just imagine how they feel when everyone that touched their claim profited. Yet they are left in a hellish situation, in some cases more than $100,000 short, with no end in sight. These are not people with a recurring loss that get new carpet every year. These are people that paid their premiums for a safety net only to find out there was none. Industry tactics used to dissuade suspected cheats have been inappropriately and callously used upon honest people with devastating results. Heart attacks, strokes, separations, depression and thoughts of suicide have plagued people that in many cases were in their golden years with no mortgage. Now they find themselves with no homeowners insurance because their homeowner’s carrier takes the position that there home has no value, while their flood carrier claims, contrary to contractors, engineers and architects, their home suffered only minimal damage.
In regards to policyholders cheating the carriers, without a doubt we have all heard such stories. In addition, several victims reported to me that they received several thousand dollars more than they expected on claims under $10,000. Adjusters have explained the reasoning behind this to me as drive-by adjustments. They say some adjusters inflate a small claim to increase a meager fee. Of course this is wrong on all levels, however, that does not warrant the abominable treatment received by many victims and the sentiment that so easily rolls off the tongues of many examiners and industry officials, “you can sue us in Federal Court”. Well, they did and last week I understand they did again and it looks like much more is on the way. I suppose it falls under the category of, “be careful what you wish for because you just may get it”.
I have spent more than 1,600 hours on Isabel flood insurance related issues in an effort to help the victims. I have met with senior FEMA and NFIP officials on numerous occasions. I understand over the years many in the industry have formed strong feelings towards some NFIP officials in control of the program. Nevertheless, at this time I believe from my first hand experiences that these same officials and senior FEMA officials are making every effort to handle the situation, as they would want it handled if they were the victims. Anything you can do to help them would be greatly appreciated by the victims. If you or anyone you know have anything you believe would be helpful, I would suggest you call FEMA Deputy Director Trey Reid at 202 646-3595 or US Senator Paul Sarbanes’ office and ask to speak with Bruce Gilmore at 202 224-4524 or Sharon Farone. In addition, you can speak confidentially with Andy Green at the Baltimore Sun at 410 494-2935. Andy has a tremendous amount of information, including enormously helpful information on the record from a courageous examiner. During Isabel the examiner was responsible for a very large number of adjusters. The press embargo on that story will be lifted when it appears it will be most helpful to the victims.
Please feel free to contact me if you have any questions or if I can help you in any way.
Steve Kanstoroom
sjk@varidynecorp.com
Cell 301 503-6078
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RE: "Isabel", is a Hot Potato headed behind? - 6/11/2004 9:43:15 PM
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KileAnderson
Posts: 199
Joined: 4/19/2004
Home base: Baton Rouge, LA
Status: offline
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Steve, all losses are settled on ACV basis as the initial settlement and if the insured qualifies they can make claim for the RC benefits once the repairs are made.
This is common practice in the insurance industry. Is it the case that the insured's were not told they were entitled to RC? Were they insured to 80% of RC? Was it their primary residence?
Please understand, I'm not saying any of what you have said is wrong, it is just that the flood policy is very complicated and not every policy holder is entitled to RC.
Oh, and by the way, how can flood coverage cover things that were not touched by water? If it wasn't touched by water then it wasn't damaged by flooding. The policy only covers damge caused directly by flooding.
There is no coverage for mold clean up. That's what FEMA has told us over and over, is this not the case?
< Message edited by KileAnderson -- 6/11/2004 9:49:29 PM >
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RE: "Isabel", is a Hot Potato headed behind? - 6/11/2004 9:52:29 PM
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mtmone
Posts: 81
Joined: 4/19/2004
Home base: Hatteras, NC
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according to mr. Jim Shortley it is not true that flood insurance does not cover mold. he also said direct physical loss does not equal direct physical contact.
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RE: "Isabel", is a Hot Potato headed behind? - 6/11/2004 10:26:04 PM
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mtmone
Posts: 81
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Home base: Hatteras, NC
Status: offline
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Hey, when it was clarified at the Flood insurance summit in March, it appered to be news to even adjusting company owners. But it was said... did you read the May 7th claims guidance by nfip?
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RE: "Isabel", is a Hot Potato headed behind? - 6/11/2004 10:29:14 PM
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KileAnderson
Posts: 199
Joined: 4/19/2004
Home base: Baton Rouge, LA
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I attended the claim presentation in New Orleans in mid March. I haven't read anything by NFIP since then.
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RE: "Isabel", is a Hot Potato headed behind? - 6/11/2004 10:36:23 PM
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mtmone
Posts: 81
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Home base: Hatteras, NC
Status: offline
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Go to this link: It was posted there. I'm suprised they didn't send that to you since you are a nfip certified claims adjuster.
http://bsa.nfipstat.com/wyobull/w-04020.pdf
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RE: "Isabel", is a Hot Potato headed behind? - 6/11/2004 10:38:45 PM
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mtmone
Posts: 81
Joined: 4/19/2004
Home base: Hatteras, NC
Status: offline
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well, we made efforts at mitigation....opening and closing windows to ventilate and spraying bleach with a bug sprayer but homeowners could not access their properties.
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RE: "Isabel", is a Hot Potato headed behind? - 6/11/2004 11:40:41 PM
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sjk
Posts: 20
Joined: 4/27/2004
Home base: Oxford, MD
Status: offline
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Kile –
Regarding RCV – the policyholders that I referred to were in each case living in their only home, i.e. primary residence, insured to 80% or, more in many cases. They were not told about, nor received any information regarding recoverable depreciation. The issue/problem of agents selling more than 80% of RC was raised at the March NFIP summit.
Coverage for items not physically touched by water – Coverage exists in a number of ways:
Wicking – policyholders were routinely told that the policy only pays for damage from the water line down. Of course in the case of sheetrock most were told the policy would pay for the first 4’, however, this does not remedy the problems associated with wicking and associated mold growth. Nor does it solve the problem of broken corner beads, moldings, etc. cut 4’ above the floor.
Moisture damage –
This includes damage caused by high levels of humidity that are often found in a flood loss. For example, additional damage may be caused by condensation that will likely form directly above the flooded area causing additional damage. According to wood scientists at Weyerhaeuser, high moisture content can cause wood framing to expand such that it can cause distress to sheetrock. The framing expands at a greater rate than the sheetrock can, according to United States Gypsum (USG).
Condensation inside of electronics – although the water may have been well below a piece of electronic equipment, the change in ambient conditions often results in elevated relative humidity, then condensation followed by corrosion.
In my experience with FEMA and NFIP, when properly documented, all of these have been covered perils, however, most adjusters and adjusting firms that I have become familiar with, based upon the policy and NFIP published materials, wrongly denied coverage for these perils to the detriment of the insured.
Mold Cleanup – Section III A. Coverage A – Building Property paragraph 8 b. Cleanup
I have spent considerable time on this and believe much of the confusion stems primarily from Section V. Exclusions paragraph D. 4. This paragraph makes clear that the policy does not insure for mold and mildew damage when the loss results primarily from several conditions – none of which meet the definition of a Flood as that term is defined in the policy. The policy makes the distinction between mold contamination and damage. The policy does pay for clean up of mold contamination, and also pays for mold damage, but only in the event the insured did not fail to mitigate. On the other hand, in the event the insured was prevented from returning to the property, for example such as when water does not recede for weeks, I have been told, but haven’t first hand knowledge, that NFIP has taken the position that a failure to mitigate did not occur.
In November 2003 I discussed mold cleanup with Jim Shortley. He explained that NFIP would pay for mold cleanup in the form of Clorox, soap and water, provided of course there was not a failure on the part of the insured to mitigate. He also emailed me the same position. I found, however, that current mold cleanup protocols go further than that, not necessarily cost more but can, and met with Jim Shortley and Mac Plaxico in late March to discuss the same and share the information I had obtained from the EPA and several industrial hygienists. On May 7, Jim Shortley posted a memo on NFIP’s Bureau Net that addressed some of the items we covered in the meeting. The issue regarding mold clean up is included, although not to the level of our discussion. Regardless, since May 7, NFIP has paid claims for mold cleanup using current technologies required by OSHA and current techniques that include materials other than Clorox, soap and water, such as US Borax’ Timbor. You can see Jim’s memo at http://bsa.nfipstat.com/wyobull/w-04020.pdf .
I agree that the language is complex, and the regulations are vast. I perhaps said in a prior post that I believe adjusters should not be burdened with having to make interpretations or understanding hundreds of pages of regulations, but rather focus on doing what they do best. This issue was also raised at the March summit and it seemed clear to me that FEMA and NFIP officials are dedicated to making changes that will benefit the insured, the program and all those associated with the program in any way.
Kyle, I appreciate you responding to my post. If you have any questions and I do not respond timely, please do not hesitate to email or phone. I really have my hands full and do my best to look at CADO when I can.
Steve Kanstoroom
sjk@varidynecorp.com
Cell 301 503-6078
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RE: "Isabel", is a Hot Potato headed behind? - 6/12/2004 12:00:49 AM
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Gale
Posts: 736
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Home base: Murray, KY
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Mtmone, too bad the letter was not dated 7 May 2003 so those working Isabel flood claims would have had this info. Clearly had these changes had been in effect when Isabel struck and followed there would be no reason to have the lawsuits that are being filed today. I set through the 1-day NFIP class in Jan of 2004 and clearly these issues were not discussed during that class. I could not be certified even though I went through the class like the rest because I could not prove three years of adjusting experience.
Did NFIP wave this three-year experience requirement for Isabel adjusters or are there just double standards in place by the federal government?
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RE: "Isabel", is a Hot Potato headed behind? - 6/12/2004 12:13:46 AM
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katadj
Posts: 684
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Home base: New Hope, PA
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The rule is four (4) years, Gale.
And yes, there is a double standard, as the WYO companies did NOT have to have NFIP certified adjusters.
This may also be about to change, if recent information holds true.
This goes back many years and the constant changes in policy procedures are very difficult to apply and adhere to when we are not aware of them.
_____________________________
"Excellence often first appears as error. It is only in retrospect that wisdom emerges from ignorance and success from failure." Abraham Lincoln
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RE: "Isabel", is a Hot Potato headed behind? - 6/12/2004 1:11:21 AM
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Gale
Posts: 736
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Home base: Murray, KY
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Steve it is clear you have put much effort into trying to understand what has happened, why it as happened as well as helping flood victims. You have raised a lot of issues here that are each a subject within themselves. Something tells me some of these issues did not just appear for the first time with the Isabel event. In fact some of these issues are not even NFIP specific but are just normal day-to-day adjusting issues. If my thoughts are correct on this we are talking perhaps millions of property claims adjusted over the past several years that are now suspect in nature. While in my experience carriers seem to overpay claims routinely but again a few bad apples can spoil the whole barrel.
As I talk to different parties with direct or indirect interest in bad faith actions of carriers one overriding issue keeps popping up. The legal/accounting types in control of most carriers have decided in fact to remove the educated/experience adjusters from the claims handling process based on their expressed actions.
On this site over the years you have been able to read different reasons on the why some think the carriers have taken this action and some are criminal in nature. From the bottom to the top self-interest (making money) can get in the way of doing the job (taking care of the interest of the insured or taking care of the interest of the carrier depending on which adjuster you are talking with at the time). Until who’s interest the adjuster is to protect is dictated by law the other golden rule can come into pay, “He who has the gold makes the rules.” What we know is no man can serve two masters with different agendas without feeling a lot of stress.
In the world of real estate I am told in some states it is illegal for an agent to represent both the buyer and the seller in a deal without their written permission. Just as in real estate I am sure this is overkill in many cases but laws are passed due to the exceptions in life. Next I may take up the issue of adjusting software that you touched on briefly.
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RE: "Isabel", is a Hot Potato headed behind? - 6/12/2004 8:28:22 AM
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sjk
Posts: 20
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Home base: Oxford, MD
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Gale,
I too believe it didn’t happen overnight and believe we are talking about much more than Isabel. I also believe that the removal of experienced professionals from decision making positions was not an accident but rather a carefully considered step by those who removed them. I believe the risks and rewards were considered very carefully. For years I was responsible for managing multi-billion dollar portfolios – risk management is at the core of these decisions – always contrast against the legal and marketing considerations. There came a day when someone accused me of wanting to be “right rather than rich”. Needless to say my path changed that day and I have never regretted it. I had plenty – I was blessed with more than most people on the planet, and values that money cannot buy nor take away.
If you or anyone else believes they have any information regarding criminal aspects of claims related issues, in addition to the contacts and numbers I previously posted, you or they could contact the following people:
Barbara Sale - Assistant United States Attorney, Chief Criminal Davison, 410 209-4929
Jennifer Fogul-Bublick – Counsel to the US Senate Committee on Banking, Housing and Urban Affairs 202 224-2336
jennifer_fogel-bublick@banking.senate.gov
Both Barbara and Jennifer are very familiar with the issues I have briefly written about.
Alternatively, if someone would feel more comfortable speaking with me, anonymously or otherwise, that’s fine too. Many already have.
Regarding your comments about financial incentives, I can tell you that the greatest progress I have made thus far in understanding why these problems have occurred have come by following the money trail. It looks like an octopus.
Lastly, regarding the software, I am very interested. In my world it had to stand the scrutiny of real-time FTC audits and in later years the SEC. I never once met an auditor – they always were able to perform there jobs at the user level. Our systems were very easy to audit and always passed with flying colors for making “like” decisions.
Steve Kanstoroom
sjk@varidynecorp.com
Cell 301 503-6078
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RE: "Isabel", is a Hot Potato headed behind? - 6/12/2004 11:25:18 AM
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Gale
Posts: 736
Joined: 4/19/2004
Home base: Murray, KY
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Steve and others, the sun is shining and I have about 5 acres knee to waist high and a 30” Snapper mower to tackle it with so I will have some time to thing about the contracting and adjusting software in use today in settling claims and some pros and cons.
I have one quick question Steve. If the 50 state insurance commissioners had been on the job how could some of the charges being leveled at the insurance industry ever happened in the first place? Homeowners (tax payers) must pay millions each year to support 50 commissioners and their staffs across the country but who has gained from this expense?
If you are looking at money trails why not look at the financial conditions of the commissioners and their top staffs’ net worth before and after office. Also look at where they went to work after leaving their positions as “public servants”. These men and women are not dimwits so are they just goofing off at the homeowners expense or are perhaps some are involved in criminal acts that blinds them to the needs of the homeowners they were paid to protect.
No major carrier would be involved with some of the things they are be charged with unless they knew they controlled the commissioners or at least knew they were at sleep on the job. Steve, remember before you leap this may even go higher than the commissioners themselves.
I am willing to bet someone could find one or more public servants that were self-serving if they looked in the right places. Why not start with the only group charged with and paid to protect the homeowner. I also bet the honest commissioners can point you to any dishonest commissions, past or present if there are any. You are not the last person that had rather be right than rich if you can’t be both at the same time.
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RE: "Isabel", is a Hot Potato headed behind? - 6/12/2004 12:22:09 PM
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katadj
Posts: 684
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Just how far reaching can one expect this fiasco to travel?
Only a few months ago, it started with some insured's questioning their proffered settlements on flood claims for "Isabel".
Now we are in the throws of class action lawsuits, software manufactures involvement, DOI questions, Vendor and carrier involvement, FEMA and FIMA and other governmental agencies responsibilities.
Is there ANY light at the end of this tunnel?
Can we expect changes that are beneficial to the parties involved?
It appears that WE, the adjusting community, upon which all of the aforementioned parties rely to be their "eyes and ears”, are going to suffer even more.
The fee schedules Vs: the work required are totally out of hand. When one must make 3-5 visits to a loss, complete mountains of paperwork, wait months to be paid, it could be that many opt out of doing any flood work in the future.
Time to reflect on many things.................................................................................
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_____________________________
"Excellence often first appears as error. It is only in retrospect that wisdom emerges from ignorance and success from failure." Abraham Lincoln
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