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MRichardson1952
USA
24 Posts |
 Posted - 12/17/2003 : 23:26:14
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JimF,
Thank you, your comments seem to be fair and reasonable. Another question, if a re-inspection results in a modification of the original adjustment, weather up or down, and the original adjuster has been paid their hold back, who pays for the re-inspection? And, if the original adjuster has been paid in full for the file in question, but maybe still has some outstanding fees due on unrelated files, does the company have the right to deduct from those fees expenses relating to a seperate file ?
As you know, some files re-open long after the adjuster has been fully compensated. |
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CCarr
Canada
1200 Posts |
Posted - 12/17/2003 : 23:26:40
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C Bond, it has been an "adjuster" function to explain coverage to an insured, since JC was a corporal; with the ultimate goal to have them understand your explanation. You suggest it is the worst time, but in reality it is the appropriate and correct time; in effect what you are doing is explaining the contract that they are a party to, and that you as a representative of the other party are exercising the contract clauses. Of course, the carrier can do as they wish with your findings and ultimately exercise the contract however they see fit.
As to your most recent experience, being told not to discuss coverage, but to agree on scope only - this is not adjusting claims, you were not acting as an adjuster when you performed that singular function. At best, the carrier or vendor (whoever imposed those instructions) had you acting solely as an estimator.
My ire and disgust with this, is not directed to you - directly or indirectly - but I find that function / role as an insult to an adjuster, and a degradation of our industry. |
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MRichardson1952
USA
24 Posts |
Posted - 12/17/2003 : 23:30:30
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CCarr,
I agree fully, yet in the past few years, it has been the battle cry of the company's that we agree on scope and figures, but make no committment from the field. As they do pay our fees, there seems to be an onus to comply with the one signing the check. |
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JimF
USA
1014 Posts |
Posted - 12/17/2003 : 23:48:18
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I agree with Clayton's comments and share his disgust with such a disgusting practice of not letting an adjuster 'adjust'. I agree as well that there is no more appropriate time to discuss policy coverage than at time of loss.
Mark, to answer your earlier question, I would personally not think it appropriate to take a holdback from other files after a reopen file has been paid, but that view is not I am sure, shared by all vendors.
Files which reopen for whatever reason, are sometimes handled by carrier staff not immune to work, while others will willing kick back to the vendor any file which needs only a modicum of work to reclose. Similarly, vendor staff may well handle the 'easy ones' without penalizing the initial adjuster, while others seem to steal every last nickel of every adjuster's holdbacks. All I can suggest, is to ask around among the seasoned adjusters to separate the goods ones from the bad ones. It goes without saying we can never know too much before we go.
I hope this answers your question.
And Clayton, Merry Christmas up there in the cold North woods! |
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C Bond
32 Posts |
Posted - 12/18/2003 : 00:36:18
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CCarr,
Thank You for your comments and no offence taken. I agree with your position on the reponsiblities and ulimately the definition of adjuster. I do believe the most appropriate time to explain the product being sold ( the policy) is at the time of purchase. Agents sure don't sit and tell the insured, " well if this or that happens there's no coverage. Do you still want to buy?" But we do at a time when emotions can be high. This is what I ment by "the worst time".
When I work local claims coverage is applied and discussed with the insured. Agreements on scope and estimate are reached and the claim is closed accordingly. The guildlines of not discussing coverage in a cat situation has frustrated both I and the insured as I am unable to tell them that a particular loss will not be covered at the time of the inspection. It doesn't feel right when you have to say, " I'll figure it up and your company will contact you" knowing the whole time the claim is a denial. The Insured's know somethings wrong when I give this responce to the age ol' question by the insured, "Well, what do you think." This type of interaction just reinforces the insureds mistrust for the industry as a whole.
The fact still remains, as Mark pointed out, that the company paying my fee makes the rules. I read in another post somewhere that it IS beneficial to "Ride for the Brand." I like a good western.
Another thought, perhaps the carriers have found that the "Mum's the word policy" has provided two advantages for them during cat situations. 1) Bad adjusters are not so blatantly exposed to the insured and 2) Phonelines to the office aren't snarled with irate insured that call as soon as we leave to complain about their coverage. Because they don't know anything yet.
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CCarr
Canada
1200 Posts |
Posted - 12/18/2003 : 00:37:13
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Mark, I have not heard - directly or indirectly - the "battle cry" which you mention and that C Bond has experienced.
Personally, I would have nothing to do with it, as a participant.
However, if that is being done, and people are accepting those assignment parameters; there are several things that should be clearly understood.
(1) repeating, that singular function of estimating, is not the "adjustment" of a claim, but solely the quantification of it.
(2) an "adjuster" is not needed to estimate damages.
(3) If the industry is slanting towards taking away the "adjustment process", there is no longer a need for "adjusters". Why is that? Will anyone argue that the carrier has found a way to give the 'handler' a financial break, by taking away a principal function of the adjustment of a claim? Or, has that function been removed because the carriers are tired of the improper - whether "improper" is measured as inadequate, wrong, or the inconsistent application of that eliminated function? I'll go with the latter likelihood. In that case, things have really gone to hell, and no wonder any former tar pot can walk into what used to be a profession - adjusting. |
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JimF
USA
1014 Posts |
Posted - 12/18/2003 : 08:00:39
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Unfortunately, the battle cry that Mark and CBond mentioned is, in fact, starting to rear it's ugly head.
During Hurricane Isabel, Carolina Claims Service adjusters handled claims predominately for 4 carriers. Of these carriers, one carrier informed CCS and CCS adjusters that we were, as Mark and CBond mention, not to discuss coverage or the policy but to arrive at an agreed scope only. This written instruction was made known to CCS and CCS adjusters only after the arrival of both in Norfolk. While this carrier was not the largest provider of the total percentage of claims handled by each adjuster, they were nevertheless, an important factor in contribution to the totality of income earned on this storm.
(And please don't ask me how I dealt with the insureds of this carrier, so I don't have to confess my sins retroactively)
So yes it does happen, and probably more than I realize, and it bothers me tremendously. Were I invited to work on a storm under a situation wherein only one carrier was providing claims with the attached requirement that coverage and policy could not be discussed with an insured, clearly it would be an agonizing decision whether to accept the assignment or not.
Without wanting to step on anyone's toes, I signed on as an adjuster and simply ask to be allowed to adjust.
If they now decide they only need claims handlers or estimators, maybe it's time for this old knucklehead to head back to the ranch and let the young whippersnappers have at it.
Perhaps, given the importance of both topics, file reopens and this new trend away from discussing policy, that we split the topics by creating a new thread so as not to lose sight of either?
Ghostbuster what do you think of this new fangled idea? |
Edited by - JimF on 12/18/2003 08:08:42 |
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MRichardson1952
USA
24 Posts |
Posted - 12/18/2003 : 08:50:27
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From what I've been reading on the entire CADO site, maybe one of the reasons the company's don't want much more than an agreed appraisal is due to the volume of new people working a catastrophe for the first time. It could be a simple liability defense the company may be taking until they're satisfied that the people in the field don't bind them over for something they may truly not owe.
It's happened in the past that even if the company doesn't owe for something, but the adjuster implied that there was coverage, that following a court action brought by the insured for bad faith, the courts held that the adjuster speaks with almost equal authority as the CEO of the company, and can expose the company to liability even in the absence of policy language to the contary.
JimF is correct in that an adjuster almost never knows what each company may require until the adjuster is right there on site in some kind of meeting regarding the handling of claims for that particular storm.
At that time I doubt any adjuster would just pack up and return home because of limits placed upon him. |
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TomS
USA
32 Posts |
Posted - 12/18/2003 : 08:52:03
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I seem to agree with most all posts, however, a wrinkle in the shirt, how about this? Is the system as we have known it changed? Absence any written contract are we not still adjusting claims, submitting, getting paid minus retention and waiting until claims are paid and closed and then obtian retention?
I am hearing more and more of "vendors" "paying adjuster when carrier pays vendor". Are we not still working for vendor and "the vendor" "owes" us no matter the final outcome?
And what does the adjuster do, when faced with this situation and cannot make vendor pay or "advance" monies from his services rendered during tenure on cat site. In other words, what is an adjuster to do to obtain his monies from vendor?, file griveance,submit invoice to carrier, file liens, or wait, or all the above? Once the vendor has their mind made up as to "not" paying until paid, the old golden rule is certainly in play, "he who has the gold, rules"
Have a nice holiday guys, and look to the cold north, I hear the claims are coming in at a fast pace up there. |
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Ghostbuster
476 Posts |
Posted - 12/18/2003 : 09:46:36
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Ahem! Now that I've had my coffee and a big bowl of steaming grits, your Minister of Propaganda has in his grimy paws the fee schedule that we purloined from GAB in 1984. For property losses there are two catagories for billing. The 'No Frills Adjustment', wherein all adjusting functions were performed except for salvage handling, subrogation, outside expert retention, and questionable claims situations. The other catagory is the 'Agreed Appraisal', where our function was to get an agreed price with the Insured or their contractor on repairs without discussing the contract coverages.
This flap over not discussing coverages tain't nuthin' new. Here is something of interest, the 'Agreed Appraisal' figure for losses over $2500 is $185.00 back in 1984. How does that compare with todays figures, balanced with the degrading effects of prit near 20 years of inflation? |
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J G Cournoyer
USA
19 Posts |
Posted - 12/27/2003 : 00:14:18
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quote:
Originally posted by JimF
Mileage, photos, phone calls/fax charges and T&E for the additional time for the reinspection and a 'second' report is 'generally' the practice under the scenario you depicted.
I do disagree however, with the scenario wherein the insured does not understand coverage because the initial adjuster did not take the time to explain it to the insured, and in such instance, all or a portion of the fee billed for the file should be forfeited for a reinspection, for failure to properly complete the claims process.
" did not take the time to explain" ever told a spouse, just to have the other spouse call the office saying they didn't understand? |
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J G Cournoyer
USA
19 Posts |
Posted - 12/27/2003 : 01:00:43
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quote:
Originally posted by CCarr
C Bond, it has been an "adjuster" function to explain coverage to an insured, since JC was a corporal; with the ultimate goal to have them understand your explanation. You suggest it is the worst time, but in reality it is the appropriate and correct time; in effect what you are doing is explaining the contract that they are a party to, and that you as a representative of the other party are exercising the contract clauses. Of course, the carrier can do as they wish with your findings and ultimately exercise the contract however they see fit.
As to your most recent experience, being told not to discuss coverage, but to agree on scope only - this is not adjusting claims, you were not acting as an adjuster when you performed that singular function. At best, the carrier or vendor (whoever imposed those instructions) had you acting solely as an estimator.
My ire and disgust with this, is not directed to you - directly or indirectly - but I find that function / role as an insult to an adjuster, and a degradation of our industry.
AGREED!!! |
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TomS
USA
32 Posts |
Posted - 12/27/2003 : 04:52:43
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I love to wake up to the CADO page with NAPALM in the morning all over it.
It seems that "all" of us are saying the "same" thing only in different language.
The carriers "are" and have been trying to replace us. They want the vendors to charge a fee so low and they (carriers) get them to accept it, that it is hard to make a living on the road. The vendors are trying to stay afloat, the adjusters are doing the claims, and as always, "after you leave a site, the "clean-up" guy finds every reason in the world to get all the billing. That was o.k for the most part, when the vendors were holding 10% as you did not have much to argue about, but now, with some unethical vendors, "waiting" to pay adjusters, when carrier pays them, you leave a lot of money on the table with hopes the vendors do pay you. I cannot go to the grocery store, load my wagon and then tell the cashier how much money I am paying for their products, but the vendors and carriers think and try to do that almost every storm. Whatever happened to "I worked for Joe Blow claims and Joe Blow claims owes me for work performed", what happened to intellectual and "real" property of the cat adjuster? It seems that the carriers and "some" vendors actually look a reasons to cause pay conflicts so they can put vendor and adjuster on the road or out of business.
I remember prior "Hugo" cats, that vendors would "advance" lots of cash, if adjuster had so many claims in his possession. The came ole "Andrew" and I know for a fact "one" "big" (at the time) vendor gave out 5k To 10k advances if you signed up with them, whether you had a claim or had even adjusted a claim or not. Some new "adjusters" just got the advances and made a pretty good lick doing that!
Our business, yes mine included, has changed for so many reasons, and primarily, (IMHO), because the carriers 'KNOW' that there are so many adjusters, bodies, roofers, contractors, telephone operators, lets see, oh yeah, even a bounty hunter I recall,and even "your" brother-in-laws neighbor who just lost his job, can get "hooked" in this business at the first big storm.
Does anybody think that the situation is going to get better? We, adjusters, have got to do something, but the main problem is that "when" the cat hits, no one will say stick it and/or stay together,and say we ain't working for peanuts, and here is 1500 cat adjusters names that you can't get unless you pay them fairly for their knowledge and experience, etc.
I have worked "staff","vendor" and cat adjuster for many years, and the talk in the office is when a cat hits, well, here is our "new" fee schedule and if ole G.A.B. won't do it, then Crawford will, and if they don't we got Joe Blow claims service will and then here comes the paper "person" along with twenty other "people", who went to Leonards and got a license of some sort to do it.
Fact is, somebody will work those claims and come home saying they made a fortune for doing nothing, and then their buddy wants a job and guess what,he is hooked up and the "hits just keep on coming".
Wake up fellows, it ain't "us" its the vendors and carriers that are giving us the _ _ _ _ Job! We just allow it to happen.
Wow, started off just visiting and reading, and looks like I tossed my opinion in the fray, just want everyone to know , not looking for a fight, just providing another view and again I M H O !!!!!
Have a great day, and may the upcoming New Year be prosperous and healthy for one and all.
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JimF
USA
1014 Posts |
Posted - 12/27/2003 : 06:47:42
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I handled Hurricane Isabel claims in Norfolk, Virginia exclusively for Carolina Claims Services of Columbia, SC and continue handling clean-up (and new) files exclusively for this same vendor.
There are many other adjusters who post here who are still working clean-up for Hurricane Isabel and they can also share that new hurricane related damage claims still continue to be reported weekly if not daily.
If anyone questions this, please feel free to verify such by calling CCS at 803-731-4005. Dominic Ciserano, Carolina Claims Services President, is my supervisor.
I can honestly say that this CCS experience has probably been the easiest cleanup assignment I have ever worked, as CCS only brought in highly qualified, experienced and knowledgeable adjusters. Adjusters who take great professional pride in their work and work product. CCS has experienced few if any reopens due to mistakes made by the initial adjuster.
Files can and do reopen when unseen and unforeseen damages are discovered after an initial inspection, when repair costs exceed what were reasonably considered and allowed at the time by competent initial adjusters, or when the unreasonable insured continues with unreasonable demands including matching issues.
Most folks here have enough familiarity to know that I have been around and involved in property valuation and adjusting for a not inconsiderable number of years. Thirty two this past September to be exact.
Property valuation and adjusting is what I do for a living. It's not what I do for a life. |
Edited by - JimF on 12/27/2003 13:54:02 |
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Davey
USA
38 Posts |
Posted - 12/27/2003 : 07:54:24
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I guess it's time to throw my 3 cents in. Mark, you're picking on the wrong guy. While Jim Flynt may be a little hard to take sometimes, he may well have forgotten more than some of our bretheren have ever bothered to learn. Subtilness and modesty aren't in his resume, but he's right a whole lot more than not. While I don't always agree with what he has to say, I value his opinion because he's BEEN THERE.
As TomS said, it is the vendors and the companies that will be our downfall. Many times any warm body who knows the right person, agrees to use certain software, and will sit through a certification/brainwashing meeting, will get work. Well, I for one, am not interested in driving all over the country, spending thousands on additional software, and listening to the "party line". Just for the chance of competing with some 90 day wonder for a few hail claims.
Next ! |
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File Reviews, Reopens & Holdbacks ~ A Process
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