RE: Doing Immoral or Wrong Actions at Carrier's Request
|
Logged in as: Guest
|
NOTICE: We are no longer using this forum for discussions. Please follow the links to the new forums.
Catastrophe Central-The Adjuster's Forum : Community Center- Forums
New Site Registration : New Site Login
Login  | |
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 8:39:57 AM
|
|
|
CCarr
Posts: 288
Joined: 4/19/2004
Home base: Toronto, Ontario
Status: offline
|
I'm a yard short of Ray on years of claims experience, but I spent a lot of years as an employee with American owned carriers. Never in any capacity in my claims career - regardless of what side of the desk my chair was on - was I asked or suggested to "sqeeze / cheap ride" an insured or any third party on a casualty claim.
However, Malvi's post of 08/22/06 in the afternoon, caught my eye; it was the opening principal sentence: "We do, some lender forced claims, most are unoccupied homes but some are occupied".
These kinds of claims can be very interesting, as the two principal keys to forced lender claims (I hope we are talking about the same thing - "mortgage impairment policy) are the precise date(s) of loss and identifying a clear cause(s) of loss.
As Malvi says, most former owners have cleared out, sometimes taking a hammer to the place in frustration etc with themselves a/o their now impatient lender. And, at the other end, lenders get the necessary piece of paper from the court at the end of the process, the dwelling with that document being sent to the carrier for the lender, now makes that dwelling insured under the lender master policy; at the time and date of the court document.
Maybe it is a month or more before the contracted property manager with a sign on the lawn, that a neighbour finally calls to tell them to cut the grass and that water is running out under the front door. Sometimes on assignment, you will walk in on squatters, or people who say they are still renting from the 'owners' that were foreclosed on.
Anyway, they can be quite an interesting mix of situations, where doing a neighbour canvas to 4 or 5 homes, you can normally start to get some dates firmed up that can be confirmed later. The key is to sort out whether the found or declared damage is pre or post the "acquistion" date of the lender.
I've never seen a 'forced' claim written with an HO3, just mostly basic fire & EC, and a few endorsements that are important to watch for.
I would look for clarification of statements made to you, about the specific changes necessary to your work product, within the relevant policy language.
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 8:59:15 AM
|
|
|
racko
Posts: 241
Joined: 2/17/2006
Status: offline
|
In response to Clayton's remarks about lender placed policies...more can be read in the recent thread "It's Repo Time". Understanding that this serves more as a CAT site than a daily claims area, there are a plenty of us out here and there is much more that could be shared outside of what has been posted there so far...anyone? Just one more opportunity for the newbies to learn something along the way while they are waiting, waiting, waiting.....
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 9:05:14 AM
|
|
|
Darryl
Posts: 132
Joined: 4/19/2004
Status: offline
|
I agree with CC except my appreciation of third party calims is different. There is no contractual liabiility and therefore all dealings are negotiations and taking an approach of proposing a low settlement is a stategy and not in itself a bad thing.
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 9:38:25 AM
|
|
|
trader
Posts: 1203
Joined: 4/19/2004
Home base: Houston, TX
Status: offline
|
Stowers Doctrine and Mary Carter Agreements come to mind in complex liability settlement discussions. As this is a catastrophe property adjusters site, not casualty claims I regret bringing it up.
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 9:58:31 AM
|
|
|
racko
Posts: 241
Joined: 2/17/2006
Status: offline
|
quote:
ORIGINAL: trader
Stowers Doctrine and Mary Carter Agreements come to mind in complex liability settlement discussions. As this is a catastrophe property adjusters site, not casualty claims I regret bringing it up.
Trader--
I never know if you are giving me a tongue-in-cheek bad time, or it's just a "senior" moment. LOL???
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 10:43:33 AM
|
|
|
olderthendirt
Posts: 570
Joined: 4/19/2004
Home base: homeless
Status: offline
|
Who is Mary Carter and why is she doing this to me. Haven't thought about her since I was an examiner handling liability losses.
_____________________________
Still sliding down the razor blade of life
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 3:51:03 PM
|
|
|
katadj
Posts: 692
Joined: 4/19/2004
Home base: New Hope, PA
Status: offline
|
I'm not convinced that we adjusters performed any immoral or wrong actions at a carriers request. That will be for others to decide.
The "Katrina" fiasco led to more carrier and IA kickbacks than any law would allow. This has a source and can be easily explained.
1) The lack of qualified adjusters, led to the submission of inept, incomplete and poorly documented files.
2) This same lack of adjusters applied to the examiners hired to review these files. Many were AUTO/ BI/WC or just agents , many with absolutely no examining experience.
3) The carriers issued instructions that were to be followed, by these in-house examiners as well as the IA examiners,albeit they knew not why.
4) The IA firms had the same issues and hired unqualified, untrained, inexperienced examiners, who would "Do their job" by kicking back files, to justify their employment.
A vast and wicked circle had formed and the adjuster that did the work as they were were trained to do, is the one that suffered the most.
Looking back at hundreds of files dome and the inordinate amount of kickbacks served to confirm the reasoning. Not only from one but from many , many adjusters with a combined total of over 1000 years of experience.
The advice offered above is the absolute only way to CYA, take the name and email and whatever other instrument used by an examiner, and copy same. (You could, and some did , offer an explanation, which allowed the file to pass muster, however that was rare)
Make the changes in the report and estimate and be sure to include the NAME, position and dates of the requested changes, and document why the original submission was made as submitted. You are now placing the burden of any E&O claim, lawsuit or other legal actions on that individual.
Some of the requested changes that were made included items that are so necessary, basic and part of a project that it became laughable, but reinforced the initial statements above, for instance:
1) No sanitary facilities will be allowed.
2) No building permits are required.
3) No debris removal to disposal containers.
4) No dumpsters.
5) Change pricing to X.
6) Why no picture of missing building?
7) No OH&P
8) Use residential pricing on commercial work?
The list would take a day or more to complete, and there is little we can do about it. Do we agree with this high handed treatment of the insured, of course not. BUT, if we do not comply with the demands made we have worked for naught.
Now when that moment of truth comes, and we have had it, and return all of the files to the IA Vendor, we risk being placed on a lower tier. So be it. Either we live up to our personal moral code of ethics, or jump through the hoops like trained monkeys......................................Your personal call, I'm sure what I DID WAS THE RIGHT THING
_____________________________
"Excellence often first appears as error. It is only in retrospect that wisdom emerges from ignorance and success from failure." Abraham Lincoln
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 6:07:00 PM
|
|
|
REWARDADJUSTING
Posts: 91
Joined: 12/1/2004
Status: offline
|
Some of the requested changes that were made included items that are so necessary, basic and part of a project that it became laughable, but reinforced the initial statements above, for instance:
1) No sanitary facilities will be allowed.
2) No building permits are required.
3) No debris removal to disposal containers.
4) No dumpsters.
5) Change pricing to X.
6) Why no picture of missing building?
7) No OH&P
8) Use residential pricing on commercial work?
And you wonder why there are Public Adjusters. The insurers are their own worst enemy, they create the insured's hatred toward them, they create the need for insureds to be represented.
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 8:52:47 PM
|
|
|
malvi
Posts: 57
Joined: 5/25/2006
Status: offline
|
OK Guys and Gals:
Here is a little more background on my situation. My homeowner/insured/borrower (depends who I talk to as to what he is called) is an emigrant (speak little English) when his premium was built into his mortgage he thought it was a good thing (Little did he know) anyway he went away, pipes burst, came back to a royal mess, did not know what to do was very distraught (he is not all there and I don't mean that in an ugly way) finally a friend suggested he call his insurance company and that is how I got there. Anyway, the additional "delay" was a total of 8 days (not that it made a difference). I wrote up my summary report as a chronology of events in no way did I try to represent that the additional 8 days contributed or caused more damage. The 30 days the man was gone was the critical period and he was away visiting relatives. The last time I checked it is not against any policy condition to visit family out of town. Now this company examiner is telling me to write my estimate as if the loss happened the day I saw it. What has gotten even scarier is that I spoke with my vendor and was told clearly that I do not need to see the policy and we do what the client tells us to do. By the way, this man is going to have to replace T&G oak floor out of pocket. He is also going to have to pay for the mold clean up.
_____________________________
malvi
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 9:22:23 PM
|
|
|
katadj
Posts: 692
Joined: 4/19/2004
Home base: New Hope, PA
Status: offline
|
Your Vendor and the Carrier are setting themselves up for a classic case of "BAD FAITH" for which , in most states will inure to treble damages.
The only reasonable suggestion is for the non-English speaking insured to engage an atty.that speaks his /her language.
What a blatant display of total STUPIDITY.
Oh, Alan , where are you when you are so needed??????????????????????????????????? ajacksonjd@aolcom
_____________________________
"Excellence often first appears as error. It is only in retrospect that wisdom emerges from ignorance and success from failure." Abraham Lincoln
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 10:59:07 PM
|
|
|
trader
Posts: 1203
Joined: 4/19/2004
Home base: Houston, TX
Status: offline
|
I think the real story was not investigated. If an insured left town 22 days before the loss. There is a record. If the loss date was 8 days before he/she returned how was that date determined. Please give me the answers to these three questions and I will advise you how to move the loss forward. Your file examiner/supervisor.
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/23/2006 11:52:45 PM
|
|
|
malvi
Posts: 57
Joined: 5/25/2006
Status: offline
|
The insured left town while he was awa the loss happened when he returned to town he discovered the mess but because of his language barrier and other limitations he did not realize he could file an insurance claim. During the following eight days while he was trying to figure out what he could do as to repairs a friend asked what his carrier was doing for him. The insured said he had not reported because he did not realize it would be covered. The claims was then filed, assigned to me and you know the rest.
Thanks
Malvi
_____________________________
malvi
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/24/2006 12:15:21 AM
|
|
|
trader
Posts: 1203
Joined: 4/19/2004
Home base: Houston, TX
Status: offline
|
Were did he visit ? Was it winter or summer ? How long has he owned the property? Who was his insurance carrier before this carrier ? In the 8 days he/she was mucking around on the wet floors, what did they do to make life more comfortable for themselves ? How much was the water bill the month before and the month after? What room did the pipe burst ? What was the damage in the room most distant from the room of the burst ? What caused the pipe to burst ? What material was the pipe. ? The age of the pipe ? Anyone working on any pipes in the last 90 days. Does the house have a water pressure gage ? Please get the answers to this odd loss and lets try to move it forward. Your supervisor.
** Malvi sorry just looked up your bio. What i am I missing, you know how to handle this type claim.
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/24/2006 2:36:01 AM
|
|
|
gulfsun
Posts: 40
Joined: 9/13/2005
Home base: Fort Myers Florida
Status: offline
|
Malvi
I am a little confused as well. I have been following this thread and you have been asking for direction on how to handle this claim. I just looked at your bio and then the link to your IA website.
What Gives??
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/24/2006 7:27:31 AM
|
|
|
brighton
Posts: 39
Joined: 6/10/2005
Status: offline
|
I read the webpage for malvi as well. From all indications, it appears that their experience is more of the Casualty side of the business. Let's give him credit where credit is due, he is asking for our experiences in this type of loss.
What Trader has said to do is precisely what is needed. One other item, find out if the current carrier filed a PILR. Companies are now submitting these on water damage claims as well. There might be prior claim for the same type of loss. Maybe not.
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/24/2006 10:59:36 AM
|
|
|
racko
Posts: 241
Joined: 2/17/2006
Status: offline
|
A fire starts in the insured's kitchen garbage bin. The insured just left the house to go shopping. The fire spreads to 3 other rooms before the neigbors have alerted the fire department and it is brought under control.
Now the insurance company is offering to pay for the damage to the garbage bin, because if the insured had been home...the fire would not have spread any further.
How can they take that position? That, my friends...was Malvi's question.
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/24/2006 12:15:44 PM
|
|
|
Dimechimes
Posts: 256
Joined: 11/3/2005
Home base: Destin, FL and Franklin, TN
Status: offline
|
It appears the Assn of Trial Lawyers (ATLA) is getting involved(see petition link and the lengthy report link) alleging carriers are putting profits over just and fair settlements to policyholders. There is also a National Underwriters story on this and an opinion this report is written to counter the recent Nationwide wind/flood case ruling in favor of carriers:
http://www.peopleoverprofits.org/
Here is a link to the NU article:
http://cms.nationalunderwriter.com/cms/nupc/Breaking+News/2006/08/23-PETITION-mr
I can say in my 28 yr career with a carrier though I never received pressure to holdback payments- if anything there were frustrations at times when we seemed too lenient on settlements to "make it go away" or in the case of some SIU issues that resulted in settlements instead of backing up our SIU folks decisions. I assume that was due to corporate's ability to see the big picture and weigh in lots of factors those of us in the trenches weren't looking at.
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/24/2006 12:17:01 PM
|
|
|
gordon1
Posts: 89
Joined: 9/16/2004
Status: offline
|
Plain & Simple if it is a standard HO-3 policy: The carrier owes for it as long as the insured did not do anything to worsen the damages & the insured took neccessary steps to prevent further damage & mitigated the damages as well as abided by policy conditions. If it was a forced place policy, the policy language is likely different & may actually be a manuscript policy.I would ask the examiner where in the policy it states they don't owe.
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/24/2006 7:04:06 PM
|
|
|
malvi
Posts: 57
Joined: 5/25/2006
Status: offline
|
Hi Everyone:
More clarifications, first excuse any misspelling I had Lasix eye surgery today and still cannot see very well. Second, I am a she not a he. Yes, the bulk of my experience is on the causality side of the fence although for the first 10 years of my career I handled property and continued to do so on and off. The last two years I went on my own (with hubb) knock on wood we are doing OK. As to my little insured/borrower etc... the carrier is not questioning whether or not the loss happened, and they are not questioning the cause of the loss (sorry trader I disagree with the nature of some of your questions when it comes to determining the scope of the damage). Agree all questions are revellent if there was any question or doubt as to the cause of the loss howver everyone agrees (even the carrier) that the cause of the loss was the busts pipes and that it is a covered loss, so in my opinion from here all out is all about the exent of the damage and not the cause of loss. Everything shown on the estimate and the photos is consistent with water damage, buckeld hardwood floor, damaged plaster behind the hot water base board heaters, damaged cabinetry particualry those housing plumbing ,etc. As to what th insured did he clean up as best be could. The argument withth caiirer centers on that it if the loss had been discovered sooner their would be less damage. Inother words instead of replacing the floor it would have been possible to clean and wx (an example). My issue is that in the years that I have been in this industry as a staff adjuster (and trainer) I never told. suggested, instructed an adjuster (wether house, or independent) to re-write an estimate or re-evaluate a claim based upon a "what it would have been". I have challnaged many opinions as to a cause of loss, I have played devis's advecate (for training) arquing the other side of the issue (toget people to think beyond the obvious and dig a little) but once I agreed the loss was covered the damages are what they are (liability or property) end of story. My problem is that I know this man is getting shortchanged (in my opinion) and I believe the carrier (examiners can only enforce company policy) is taking advantage of the book of business they write (poor uneducated folks who in most cases do not have the knowledge to challange the big guy").. I have been told to write an estimate guessing on what the damage should have been. That is what I find wrong. My question is, have you guys faced a similar situtaion before? If so, what did you do, > I can't turn to my vendor bcause the attitude is do what the carrier say and shut up (don't think don't have opinion just be a nice little monkey). I hae never knowinglly set out to cheat anyone and I beleive that is what I have been told to do.
_____________________________
malvi
|
|
|
|
|
RE: Doing Immoral or Wrong Actions at Carrier's Request - 8/24/2006 7:33:10 PM
|
|
|
dcmarlin
Posts: 145
Joined: 2/10/2006
Home base: Morrison, CO
Status: offline
|
To try to differentiate between what happened the first day vs. the third vs. the ninth will be very difficult. There are just too many factors involved. Based on the amount of water that was released as well as the water pressure, (you can get this from the water dept.) and the size of the hole/split, you can estimate how long the leak was ongoing. Depending on the wording in the policy, that may or may not be a coverage issue. Obviously, the mold did not start for a few days. But, trying to determine if the wood floor needed replacement the first day or the fifth is almost impossible.
_____________________________
Is there anything beer can't do! - Hank Hill
|
|
|
|
!! You are viewing a post in the forum archive.
NOTICE: We are no longer using this forum for discussions. Please follow the links to the new forums.
Catastrophe Central-The Adjuster's Forum : Community Center- Forums
New Site Registration : New Site Login
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts
|
|
User Agreement | Privacy Statement| Contact |Copyright 1995 - 2006 CatAdjuster.org. All rights reserved.
0.094
|
Printable Version
