| Author |
 Topic  |
|
fivedaily
USA
258 Posts |
 Posted - 10/21/2003 : 18:00:39
|
I am having trouble getting a contractor agree to a scope. During our phone conversations he jumps from one trade/section of the house to another. Very frustrating.
So, today I sent him a copy of my est without the prices. He got the fax and promptly called me back going nuts.
He wanted to know why I wouldn't send him my scope. I said I had. The scope is what needs to be done. The price is what it will cost to do what needs to be done.
He sensed he was ready to refuse to work with me and kept saying to just pay the claim with what I had and he would work on a supplement for the things he disagreed with. And that it was not a common practice to blind bid a job like this.
I told him he can't play the "wait until this adjuster leaves and get a new one game." I am working cleanup on this storm... I'm the last to go.
Tell me, have any of you used my method to get an agreed scope? Am I wrong? Is this not a standard practice?
Jennifer |
|
|
Ghostbuster
476 Posts |
Posted - 10/21/2003 : 18:35:29
|
| Nope, you did it right. |
 |
|
|
KileAnderson
USA
875 Posts |
Posted - 10/21/2003 : 18:44:41
|
I don't see a problem with it, but I also don't see a problem with sending him a completely priced scope. If he doesn't want to do it for that price he can either justify why he needs more money or you can tell the insured to get another contractor. There are plenty of them out there.
I think the real reason that so many contractors hate working insurance claims is because the playing field is level. When they are working with a homeowner they hold all the cards. Most homeowners don't know what things should cost and don't know what is required to effect a repair or a remodel. When faced with a knowledgeable consumer (the insurance adjuster) their pricing and practices can't withstand the light of day. Just an observation. |
Edited by - KileAnderson on 10/21/2003 18:49:05 |
|
|
|
CatDaddy
USA
310 Posts |
Posted - 10/21/2003 : 19:13:24
|
I agree with you all. Maintain control by explaining YOUR process. He cannot begin work until the both of you have agreed on an initial scope and price. If he wants to act horsy, tell him the process again and if he cannot work within those guidelines, you will ask the insureds to get someone else who will.
Kile stated the why. I agree.
CD
|
|
|
|
khromas
USA
103 Posts |
Posted - 10/21/2003 : 20:33:15
|
Jennifer,
I have used the 'scope' approach with insureds before when they have a handful of bids that at far out in left field. I went back to him with my scope and we walked it together and I let him have some input as to what I was putting into it. I kept asking for his thoughts on what I might be missing. It served the double purpose of letting him feel like a part of process and it makes it harder to argue that the settlement wasn't enough. They have a little more confidence in negotiating with the contractor after that because they have a clearer picture of the 'needed' repairs as covered under the policy and what a contractor might be trying to push through for the extra profit. I also tell the insured to not show the contractor the estimate because the first thing he will do is look to see what the total amount was and say 'I want ALL of it...plus some!' The insured has the right to tell the contractor what he wants his proposal based upon. |
Kevin Hromas |
|
|
|
fivedaily
USA
258 Posts |
Posted - 10/21/2003 : 21:12:23
|
Thanks for the feedback. I was pretty certain I was in not out of the loop on this process. I am not ready to talk about the price because there is so much difference on the scope. We have to wade through that before the pricing is even relevant.
This board can be really helpful... even if it is just for a little boost like this.
Jennifer |
|
|
|
william s cook
53 Posts |
Posted - 10/21/2003 : 22:24:55
|
Jennifer
Why are you negotiating with the contractor that is working for the interest of the insured?
The policy provides for resolution of disagreements as to amounts of damage or loss. Ask the company to pay the insured the undisputed portions of the loss and advise the insured of the appraisal option. Provide the insured a proof of loss and advise him to complete it and send it to the company. It is not within the independent adjuster's responsibility or authority to dictate the claim settlement amount to the insured. It is the insured's responsibility to present his claim to insurers. The company (not the independent adjuster) can accept it or reject it in accordance with policy language.
William S. Cook
Public Adjuster
|
Edited by - william s cook on 10/21/2003 22:26:15 |
|
|
|
jlombardo
USA
212 Posts |
Posted - 10/22/2003 : 06:29:29
|
Bill,
I think Jennifer is a staff CAT adjuster for ALLSTATE.....but your point is well noted for the IA...However, most IA 's are instructed to get an "AP" with the insured's Contractor....I do daily down in the Tampa Bay area and 99% of the assignments direct us to get an AP..........As IA's we can not take it upon ourselves to do as you suggest without prior approval and direction from the Company......I think Jnifer has a little more lee way though... |
|
|
|
CatDaddy
USA
310 Posts |
Posted - 10/22/2003 : 07:26:55
|
I do not think Jennifer's situation is at the appraisal point yet. You will be slinging proofs all over the place if you go to appraisal every time you have a disagreement with a contractor. But, if the senario comes to a standoff, and the insured is in the boat with that contractor, you do want to follow PA Cook's instructions.
An independent adjuster has all the same responsibilities and authority as a staff adjuster where I come from. What good would IAs be if they were only allowed to do parts of the job and not all. Granted they only get $10000 in draft authority, but the decision making is the same. Staffers do not go to appraisal without consulting their management. Some might tell you they can but they don't. The appraisal process is serious business and you want management in the boat.
CD |
|
|
|
KileAnderson
USA
875 Posts |
Posted - 10/22/2003 : 08:59:43
|
| CatDaddy is right. I'm an IA and I am expected to do the same scope of work as a staff adjuster, the only difference is I am expected to do more than twice as many claims as the Staff guy and my draft authority is only $10,000, but I've never had a problem getting authority for higher payments from management. I have paid claims in excess of $75,000 on the storm that I'm working now and those biggies all involved working closely with contractors. I guess it just depends what company you work for and how much faith they place in your work and abillities. |
|
|
|
CCarr
Canada
1200 Posts |
Posted - 10/22/2003 : 09:03:40
|
Through Jenn's question, Bill has raised a number of pertinent issues, regardless of whether it is staff handled or by an IA in accordance with the instructions of the carrier.
The general prevailing "system" of property claims resolution, staying within the context of weather perils, be they 'day to day' or cat type claims, is that the adjuster attends and does what is required to satisfy cause and coverage; then turns to cost via a scope and estimate. That end result is then, in varying styles, left with the insured, discussed with the insured, 'sold' to the insured, pushed / dictated to the insured. The "system" works well for over 99% of such claims, but not 100% of the time.
The ground rules for the "system" are rooted in Section I - Conditions, for homeowners claims.
I would also question why an adjuster is "negotiating" with a contractor that is working for the interest of the insured. I recognize (again it doesn't matter whether it is staff or IA) that this interaction when confronted with that scenario, normally resolves itself over 99% of the time, but it could be argued with some success that it breaks one of the ground rules; "Loss Payment - We will adjust all losses with you". Of course "you" is defined in the policy, and is not the contractor.
Yes, the "Appraisal" Condition is available at the will of either party, "we" or "you", but that is getting to be more cumbersome, unpredictable, time consuming, and expensive.
Although the insured's ("your") duties after a loss are clearly spelled out, there is no mention at that Condition that the insured must (or even could) present his structure loss estimate (only personal property), or that it is the insured's responsibility to do so. That onus only falls to the insured after the insurer's request for a proof, ".... send us .... specifications of damaged buildings and detailed repair estimates ....". This language and the absence of it where the duties of the insured are spelled out, is what allows the "system" to function to this point.
Agreed, effort is required to try and reach resolution with a contractor if the insured has engaged one to be involved at this stage. However, any effort at site with the contractor, I think should always have the insured as a 100% participant, observer and listener. By doing that, I'm satisfied that I have continued in my attempts to "adjust the loss with you".
This failure to resolve a claim based on "our" detailed estimate, is where the "system" gets bogged down and impedes the desired ratio of closed files to open. However, no where to this point has the insured been asked nor has the insured any legal authority with policy language to subject the insurer to his or any obtained detailed estimates. This is another reason why I would not want to be perceived as "negotiating" directly with a contractor working for the interest of the insured. What policy language dictates that or allows it to happen?
Failure with attempts to resolve scope or quantum in the presence of an insured with his contractor, after reasonable efforts, would lead me to the Proof of Loss stage and "send us" route for resolution.
You might say at this point that you are no further ahead towards resolving the issues at hand. However, a seldom used option, "Our Option" then becomes available to the insurer after proper compliance and submission of the Proof of Loss and proper notice by the insurer to the insured. This option allows a contractor of the insurer's choice to repair or replace the damage. This option must be studied on a case by case basis, but it is a viable alternative to resolve the file. The insurer in choosing this option finds the insurance contract reverting from a contract of indemnity to a contract of repair, and all the legal ramifications that it creates. However, insurers have dealt with that issue with their network of preferred vendor contractors who in exchange for that 'title' and some volume of work, will guarantee their repair processes.
The issue raised by Jenn and the very small portion of claims (less than 1%) that are not normally resolved within the procedures of the accepted "system", regardless of quantum, are the claims that must adhere to policy language requirements, to avoid pitfalls later or the inability to avail other settlement directions. |
|
|
|
jlombardo
USA
212 Posts |
Posted - 10/22/2003 : 09:35:54
|
Kile,
I too am an IA and over the past year, we have seen a shift in our handling procedures... We will do all the staff adjuster does, but we do not have any authority to conclude....we only take proofs when directed. Most of the companies handle the ALE portion in house ....we do all the other adjustment functions , but any thing that drags on seems to be handled by the staff people......Sink holes especially ....we will inspect, photo, diagram, and make a recommendation that an engineer should or should not be hired and then at that point the staff folks take over and handle the engineers, grouting, ALE....once the stabilization is done, then we are asked to reinspect and write an estimate of repairs......this way the Companies avoid including the ALE and Grouting costs in the fee schedule.........This is the trend here in Florida.........Has nothing to do with "how much faith they place in your work and abilities"...it is a matter of dollars saved by the Companies on IA charges. |
|
|
|
CCarr
Canada
1200 Posts |
Posted - 10/22/2003 : 10:06:34
|
| The "limited assignment" or "task assignment" lives on Joe and endures over the years. It is a great way to get a knowledgeable presence at the loss site, gather some data, then let the staff conclude based on available data. Also a great way to minimize IA handled ratios as they appear as a demon on spreadsheets. A claims manager can direct that claims be assigned to staff adjusters with authority to redirect task assignments at their discretion, and those files will appear as staff handled on the 'white shirt's' spreadsheets. |
|
|
|
william s cook
53 Posts |
Posted - 10/22/2003 : 20:15:36
|
As always, Mr. Carr is very much on target with the issues he has so eloquently and pointedly addressed. One of the salient points that he makes in regard to an independent adjuster negotiating with a contractor for settlement of a named insured's claim is founded in privity of contracts. (Chime in here AJ) Neither the contractor nor the independent adjuster is in privity to the contract between the insurance company and the named insured. It is possible that the contractor may not be fully up to speed with the policy language and the insured’s entitlements under the contract of insurance and the state statutes. He should withdraw from negotiating with the adjuster, present his findings to the insured that can legally negotiate with a staff adjuster. Let the contractor maintain his contractual relationship with his client (named insured). However a staff adjuster is considered to be in privity to the contract with the named insured as he is the "company" (parties are defined in the HO policy). Only an attorney or a public adjuster in most areas (apparently with an exception to tornado alley) can negotiate a claim on behalf of a third party absent privity to the contract.
Independent adjusters may be granted authority by the company to pay undisputed claims up to any limit allowed. I would opine that an independent adjuster does not have the legal authority to deny an insureds claim of ten cents.
In the instant case Jennifer has indicated that she is the cleanup person on the storm and the last to go. One can assume that an equally positioned contractor can create a stalemate to the detriment of the contractual entitlements of the named insured. If insurers or their representatives are adamant that their findings are absolutely correct, that is ok by me go ahead and take over the repairs per the policy and call the insured when repairs are completed, based on the newly created contract that insurers will now take over repairs and be responsible for the repairs. This claim is probably over 45 days old at this point in time. My advices to the hapless insured is to furnish the insurers a proof of loss based on the insureds contractor of choice's findings and let insurers pay the claim based on that proof or provide a written explanation with reference to policy language as to what portions will not be paid and why. Then we have a valid dispute that can be addressed in mediation in some states or appraisal in all states.
Just my thoughts and far short of the clarity that Mr. Carr provides when he puts pen to paper.
William S Cook
Public Adjuster
|
|
|
|
CatDaddy
USA
310 Posts |
Posted - 10/22/2003 : 22:52:37
|
An independent adjuster cannot deny a claim of ten cents? An independent adjuster does not have the knowledge of the policy that a staff adjuster has? Only a PA can save the day for this poor insured? OMG! Cant believe you guys are sitting back and believing that.
I speak from one perspective. Where I come from, IAs are the company too. We work very hard not to give anyone a reason to look at one of our guys and feel like they have to ask "are you staff or independent?" We all dress the same, have alot of the same equipment, alot of the same training etc. We ask vendors for qualified people and we send them out to do a job; the same one we ask the staffers to do. In the last few years, we have changed our structure to include a higher percentage of IAs at each storm we set up, with the minimum in most cases being a 1 to 1 ratio. The last 4 I have been on, the number of IAs was greater.
I really shouldnt get my feathers ruffled when I read some of these "advertisements for services". Most are fiction but everyone is a superstar when they're typing their own bio.
Come on in boys. The water is fine!
CD |
Edited by - CatDaddy on 10/22/2003 22:54:12 |
|
|
|
jlombardo
USA
212 Posts |
Posted - 10/23/2003 : 05:30:41
|
Catdaddy,
Most of the IA's down here do not deny claims, nor advise insured of a loss being covered.....ie. we tell the insured that "we are recommending payment......" or that "this does not appear to be a covered loss, but let me check with the company "--yes , we do take non waviers based on our own initiative....In our reports, I always insert the following-or something similar..."If, after reviewing the information we have submitted,you feel that coverage is in order and this is a covered loss, than we suggest that you honor this claim....etc.." This seems the best way to stay out of trouble......if I feel that a claim is not covered, than I will ask the company to review the file and send out the appropriate denial letter,but only if they agree.....Please understand, if I get to a water loss and the loss is due to some obvious non covered peril-ie. Flooding and I am working with a H0-3 policy, I will explain that this particular loss is not covered and show the insured the area of the policy that would exclude it.......but always advise the insured that I will report to the Company and the FINAL decision is theirs....Maybe I walk on the side of caution, but until a company hands me a written letter that says "Joe, You belong to us, here is a check book, go forth and settle claims for us..." I will continue to walk on the side of caution...as I believe ALL Independents should, unless specific directions,IN WRITING, are given by the CARRIER...... |
|
|
|
Topic |
|
|
|
Blind Bids
Forum Locked
