Anytime you need mental gymnastics to make things work, there is a problem. Could be you have a slant, you don’t have all the facts, or you don’t quite understand… Or you do understand and hope no one else does. If we simply listen, they will tell us. Below are just a few, all recent save the Warren Buffet article. Then we must remember, the number one stated goal is to keep as much of our money as possible, for as a long as possible, to invest and earn as much as possible, by any means possible. Then they paint the entire picture that everyone else is to blame… They have slashed coverages, skyrocketed premiums and deductibles… all while funding the largest lobbies in the world to do even more under the all too common “Consumer Protection Cloak”. The entire reason that the “Prompt Payment of Insurance Claims” exists, is to prevent this. At one point, our legislative body knew and understood all of the below. To sum it up… It is way more profitable not to pay a claim and force the insured to litigate. Then, run to the legislative body and blame the contractors, the advocates, and the attorneys who represent them for bringing on this massive litigation cost… They are earning on every level. Will this ever change? Maybe. If we, the Policyholders, all stand up. Last bombshell: COVID Extension went into effect on March 23, 2020. Even though our state only closed briefly, and we stood out alongside Florida on lockdowns, and pretty much the whole scenario after 3 months… All life was back to normal except for one thing… That mandate did not expire until September 21, 2021, and only on claims not filed before that date… That is a year and a half of an… “Earnings event” in a state that did not recognize really any other COVID issues. If the insurance companies are profiting, means their shareholders are profiting. Are the the shareholders sitting on the legislative bodies and creating these mandates? Cal Spoon Article on how carriers attorney’s use the clock, against the law, to earn more for their clients… as a practice. “In February of 2022, it was reported that more than 10% of all insurance claims related to the infamous Texas freeze were still unresolved. This led to widespread accusations that insurance companies were intentionally delaying claims. But why would insurance companies even want to do this? Why is delaying this process as much as possible advantageous for insurance providers? If you’re dealing with an insurance claim, should you delay for as long as possible? If you’re searching for effective insurance defense strategies, your best bet is to book a consultation with a team of qualified insurance defense attorneys. These legal professionals can assess your unique situation and determine the best path forward. The truth is that there are many potential strategies for defending an insurance claim, and delaying for as long as possible might not be the most effective choice for you. When you speak with a qualified insurance defense attorney, you can receive legal advice that is tailored towards your specific situation. The Advantages of Delaying a Claim Companies that delay claims may experience a number of benefits. First of all, delaying a claim puts pressure on policyholders. These individuals may be dealing with mounting bills for property damage, legal fees, and medical expenses. Most people cannot afford to continue fighting insurance companies for a prolonged period of time. This means that most plaintiffs will be forced to settle for a favorable amount instead of continuing to negotiate with insurance companies for an extended period. In other words, delaying claims forces policyholders to accept lower settlement offers. Delaying claims can lower costs in other ways. For example, when an insurance company faces a deluge of property damage claims, they can delay some of them in order to avoid mass payouts all at once. This limits the financial stress on these organizations, and it allows them to invest funds from paid premiums in order to earn interest revenue and offset some of the costs. This is likely one of the main reasons for continuing delays related to the Texas freeze. Avoid Bad Faith Lawsuits With all that said, you need to be very careful about how you delay claims. If you delay continuously in an unreasonable manner, you could face a bad faith lawsuit. This is why it’s so important to work with a qualified attorney and delay claims in a legal, proper manner rather than opening yourself up to further economic losses. Enlist the Help of a Qualified Attorney Today For help from our skilled Brownsville insurance defense attorneys, reach out to Colvin, Saenz, Rodriguez & Kennamer, L.L.P. Over the years, we have helped numerous organizations defend against insurance claims in effective ways. While it’s true that delaying your claim for as long as possible may provide positive results, you need to approach this situation carefully in order to avoid legal consequences. In addition, there are other strategies that you might wish to consider. Book a consultation today, and we can discuss all of your legal options in greater depth.” “CHUBB CEO EVAN GREENBERG “ASSURED INVESTORS THAT THE PANDEMIC WOULD BE AN EARNINGS EVENT FOR THE COMPANY, BUT WOULD NOT THREATEN ITS BALANCE SHEET.” https://www.reinsurancene.ws/covid-19-will-be-the-biggest-event-in-insurance-history-chubb-ceo/ “Chip Merlin of the Merlin Law Group” https://www.propertyinsurancecoveragelaw.com/2022/06/articles/bad-faith/insurance-company-defense-counsel-admits-that-claim-delay-by-insurers-is-a-strategy/ Twelve years ago, I noted that insurers are subject to market conduct examinations where delay is the central focus in, How Profitable and Common is Not Finding Damage and Claim Delay by Insurers?: Departments of Insurance throughout the United States regularly conduct examinations of insurance company claim files. These are known as Market Conduct Examinations. The Claims Spot recently noted in 5 Claims Issues Cited for Non-compliance on Market Conduct Exams & 3 Tools to Avoid Them, recurrent wrongful claims practices by insurance companies since 2006 that are not being corrected by the insurance industry. Those highlighted wrongful practices were listed and then explained to be correctable with ‘basic’ action:
- Failure to acknowledge, pay or deny claims within specified time frames 2. Failure to pay claims properly (sales, tax, loss of use) 3. Improper documentation of claim files 4. Failure to communicate a delay in the settlement of claims in writing 5. Use of unlicensed claims adjusters or appraisers
All of these findings could have been avoided with enforcement of best practices and an internal review process. With some basic actions, a company can minimize or eliminate their risk of being out of compliance. Claim delay is illegal. It should never be a strategy used against an insurer’s customers before or after litigation. Insurance defense counsel should not engage in this unethical conduct nor promote it as a strategy. “Emergency Declaration extending Prompt Payment Statutes for additional 45 days” From the Governor of Texas: TO ALL TO WHOM THESE PRESENTS SHALL COME: WHEREAS, I, Greg Abbott, Governor of Texas, issued a disaster proclamation on March 13, 2020, certifying under Section 418.014 of the Texas Government Code that the novel coronavirus (COVID-19) poses an imminent threat of disaster for all counties in the State of Texas; and WHEREAS, in each subsequent month effective through today, I have issued proclamations renewing the disaster declaration for all Texas counties; and WHEREAS, the Commissioner of the Texas Department of State Health Services, Dr. John Hellerstedt, has determined that COVID-19 represents a public health disaster within the meaning of Chapter 81 of the Texas Health and Safety Code; and WHEREAS, I have issued executive orders and suspensions of Texas laws in response to COVID-19, aimed at protecting the health and safety of Texans and ensuring an effective response to this disaster; and WHEREAS, a state of disaster continues to exist in all counties due to COVID-19; NOW, THEREFORE, in accordance with the authority vested in me by Section 418.014 of the Texas Government Code, I do hereby renew the disaster proclamation for all counties in Texas. Pursuant to Section 418.017, I authorize the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster. Pursuant to Section 418.016, any regulatory statute prescribing the procedures for conduct of state business or any order or rule of a state agency that would in any way prevent, hinder, or delay necessary action in coping with this disaster shall be suspended upon written approval of the Office of the Governor. However, to the extent that the enforcement of any state statute or administrative rule regarding contracting or procurement would impede any state agency’s emergency response that is necessary to cope with this declared disaster, I hereby suspend such statutes and rules for the duration of this declared disaster for that limited purpose. In accordance with the statutory requirements, copies of this proclamation shall be filed with the applicable authorities. IN TESTIMONY WHEREOF, I have hereunto signed my name and have officially caused the Seal of State to be affixed at my office in the City of Austin, Texas, this the 7th day of September, 2020. Governor Greg Abbott Found here. Governor Abbott’s September Disaster Proclamation. COMMISSIONER’S BULLETIN # B-0007-20 March 23, 2020 “Warren Buffet on the Float” Insurers receive premiums upfront and pay claims later. … This collect-now, pay-later model leaves us holding large sums — money we call “float” — that will eventually go to others. Meanwhile, we get to invest this float for Berkshire’s benefit. … If premiums exceed the total of expenses and eventual losses, we register an underwriting profit that adds to the investment income produced from the float. This combination allows us to enjoy the use of free money — and, better yet, get paid for holding it. Alas, the hope of this happy result attracts intense competition, so vigorous in most years as to cause the P/C industry as a whole to operate at a significant underwriting loss. This loss, in effect, is what the industry pays to hold its float. Usually this cost is fairly low, but in some catastrophe-ridden years the cost from underwriting losses more than eats up the income derived from use of float. … Our float has grown from $16 million in 1967, when we entered the business, to $62 billion at the end of 2009. Moreover, we have now operated at an underwriting profit for seven consecutive years. I believe it likely that we will continue to underwrite profitably in most — though certainly not all — future years. If we do so, our float will be cost-free, much as if someone deposited $62 billion with us that we could invest for our own benefit without the payment of interest. Let me emphasize again that cost-free float is not a result to be expected for the P/C industry as a whole: In most years, premiums have been inadequate to cover claims plus expenses. Consequently, the industry’s overall return on tangible equity has for many decades fallen far short of that achieved by the S&P 500. Outstanding economics exist at Berkshire only because we have some outstanding managers running some unusual businesses. “Chip Merlin Blog post” Lawsuit Alleges Field Adjusters Stated Under Oath That Florida Based Insurer Commanded That Reports Be Altered To Reduce Or Deny Claims—Did Insurers Do This To Dupe Florida Legislators? https://www.propertyinsurancecoveragelaw.com/2022/01/articles/insurance/lawsuit-alleges-field-adjusters-stated-under-oath-that-florida-based-insurer-commanded-that-reports-be-altered-to-reduce-or-deny-claims-did-insurers-do-this-to-dupe-florida-legislators/ Florida insurance companies have been notorious for increasing rates and filing news articles at the start of legislative sessions that support their legislative propaganda efforts. The typical scapegoats are lawyers and contractors. Somebody from the Attorney General’s office and newspaper reporters should call the lawyers for a contractor regarding a complaint1 filed and follow with an investigation about a lawsuit which states:
- Instead of ensuring that field adjusters created honest, accurate reports to confirm that UPC’s insured received an assessment that reflected their loss, Defendants specifically instructed desk adjusters to modify the estimates created by field adjusters to decrease estimates in order to ultimately decrease the amount of money UPC pays to its insureds when claims are made under the insurance policies. In many circumstances, Defendants instructed field adjusters to modify reports to give UPC a “factual basis” to deny coverage altogether. Defendants pressured adjusters to create factual bases that were fraudulent in order to deny claims.
- As this scheme has come to light, some field adjusters have stated under oath that UPC commanded them to add language to their reports which was inaccurate and outright false.
Allegations of a lawsuit are just allegations and not the truth. But, after reading the following, I feel many people should follow up with what is going on and why this type of behavior is tolerated: Rod Buvens, a field adjuster acting on behalf of UPC through PLS following Irma, testified that UPC’s desk adjuster instructed him to add language into his report “[t]hat no wind damages were observed upon inspection” at the property at issue, despite this language being categorically false based upon Mr. Buvens’ own inspection of a property. Relating to homes damaged by Irma, Mr. Buvens advised UPC’s desk adjuster, Josh DeMint, numerous times that the statement “no wind damages were observed upon inspection” was incorrect multiple times; yet, Mr. Buvens was still required to include the categorically false statement in his report at the demand and instruction of UPC. Mr. Buvens testified that UPC demands its field adjusters remove items from an estimate, which ultimately results in UPC owing less to its insureds. 34. For example, Mr. Buvens testified that he was specifically instructed to remove portions of his estimate, which would have amounted to an additional $1,376.30 that UPC would have owed pursuant to the insurance policy. Moreover, if Mr. Buvens’ report and estimate were not wrongfully modified by UPC, the insured in this specific instance would have obtained a full roof replacement, which would have cost UPC thousands of dollars more pursuant to the insurance policy. I strongly urge all policyholders with UPC claims to make reference to this alleged conduct and get this evidence. How about policyholders who did not climb on their roofs after Hurricane Irma and later reported leaking roof problems with UPC? How were they treated? Look at this secret text:
There is no greater conflict of interest than the one between a carrier and the insured they owe. A Texas Supreme Court Justice put it best. “We note at the outset that the insurance claim process is inherently adversarial. The adversarial process begins as soon as a claim is filed and ends only when the resolution of the claim is finally determined and accepted by the parties.” found here: https://cases.justia.com/…/supreme…/2019-17-0640.pdf…
Why the bad faith, prompt payment, and any other consumer protection legislation in insurance, regardless of the title under which it is shrouded, exist.
There is a special relationship, but certainly not the one they are pushing. Which is, because they are the insurer, they must have their insured’s best interest in mind.
No, the special relationship is the fact that you purchased a policy before an event, regardless of whether the event ever occurred.
That is the only special relationship that exists, and it is born from the contractual obligations of both sides, before the event, and after the event. No one gets to change that, unless the contract does.
Trust me, they have done a ton to get rid of verbiage they view detrimental to profits, and implement concepts rather than facts. For instance… Duties After a Loss has evolved over the years. Some of the Older policies say… “Requirements in the event of Loss.”
To put it into perspective, a scenario I run into often. Insured has significant loss, I notify them that loss has been valued $250,000.. to which they really do not respond, especially in a way I would expect, so… I say the same thing in a slightly different way. Your loss has been valued at a quarter of a million dollars… Shock, awe, disbelief…
You see, nothing changed, but the way I presented it…The phrase, and thereby the perception that only a few things are required of the insured… are a bold face lie, that the policy, every single one I have ever read, proves in seconds.
We were not a response to them… they were the carriers response to us, and control.
Not only of our industry, but indirectly, because of their adjustment of the claim, MRP programs, preferred vendors… all the way to the manufacturers, of every industry they insure, which is… all of them.
This single lie has done more than anything else we can uncover to get us where we are today… everyone believing this is the way it has always been, and there is no changing it.
Stay tuned for part 2 of the “Origins of the Adjusters… All of them” series. We are waiting for someone, anyone… to claim that 10K reward. While we wait, we do not wait. We already are pretty certain that the reason it has not been claimed… is that it cannot be done.
Reward: $10,000.00 dollars for anyone who can factually prove that the Insurance Adjuster came before the Public Insurance Adjuster…
Origins of the Adjusters… All of them.
Reward: $10,000.00 dollars for anyone who can factually prove (by preparing a minimum 3-page typed report with authenticated documentation and cites) that the profession of Insurance Adjuster’s (those retained by and/or employed by the insurance companies/carriers) were licensed and broadly utilized within the industry before the Public Insurance Adjuster in the United States… First person to email the info here: firstname.lastname@example.org
I do not believe they did.
Everything we can dig up, with all the modern technology available, suggests that the Profession of Public Insurance Adjusting was licensed somewhere between 1925 and 1937. (All details are sketchy, so I am very broad with dates.)
In that research, it is clear that licensing was occurring due to abuse by Public Insurance Adjusters. This is understandable, but also telling. They were already there… This was to regulate them.
See: Public adjusters have been practicing in New York since at least 1895:
Milch v. Westchester Fire Ins. Co., 13 Misc. 231, 232 (N.Y. Com. Pl. 1895). (Plaintiff was a public adjuster of claims for losses arising by the destruction by fire of buildings an contents covered by insurance policies)
Meyerson v. Hartford Fire Ins. Co., 16 Misc. 286, 287 (N.Y. App. Term. 1896). (Parties had acted as public adjusters representing the interests of insureds)
We have all believed that we were a relatively new profession, and that explained away a whole lot of things. Like how come there weren’t that many of us, or that we are the only ones, aside from an attorney, who can actually work for the insured after a covered loss, yet… we are one of the best kept secrets of a 100 plus years of… lies and propaganda.
Common policy language: “2. Your Duties After Loss. After a loss to which this insurance may apply, you shall see that the following duties are performed:”
All we really must do, is look at the most glaring fact available, you know, the one right in front of all of our collective noses and understood by anyone you ask.
Is it a conflict of interest to send the person who owes you the money out to tell you how much?
Absolutely. 100%. Without fail…
Conflict of Interest: “a situation in which a person is in a position to derive personal benefit from actions or decisions made in their official capacity.”
- After a loss that the carrier owes for, who do they send out? Their adjuster, whether it is staff, or independent, it is still their representative, and they work solely for the carrier, and are prohibited, by law, from working for the insured, unless they possess… a PIA License.
- The carrier who owes, then sends their own adjuster to “adjust the loss”.
Now… when this understood, and proven, we can begin the process of breaking down how they did it… One of the largest scams in history, getting everyone in the entire world to believe the carrier was supposed to send their representatives to tell you how little they owe you.
Stay tuned for the results, and the next part of this series? Series… yes. We are going to begin a mind map and document every single thing that we can get our hands on… and do what they have been so successful at… following the data.
In the interim, while we give folks a chance at that 10k, I presented a poll in two separate groups.
Are the majority of insurance adjusters Male or Female? While this may seem like an innocent enough question, it is not. I believe it will show us what the collective thinks, as to what is fact, and has been. Second part, it is because most of those women work inside at places like “Fire Claims Central” or whatever the claims department calls itself.
Poll 1 29 males – 3 Females
Poll 2 32 males – 3 females
Answer to that and lot of other “data” found here: Adjuster Statistics
That should lead to the next question….
What are all those adjusters inside 100,000 sf buildings full of cubicles doing?
You get three guesses, and the first two do not count.
They are protecting their employers, with little to no oversight by the Departments of Insurance allegedly designed for that very purpose.
Yes, when it comes unraveled, folks will finally understand that it did not happen by chance.
There was a very specific plan put in place, as early as the 1920’s, that netted what we see today.
Unparalleled greed with every regulating body participating, knowingly or unknowingly, in one of the largest schemes the world has ever witnessed.
Our colleagues know that we do not lash out at the problem, without having a solution.
There is a very simple solution to this entire, nefarious mess.
Problem is, the folks who made it this way, do not think it is a problem, for them anyway. Record Profits coupled with sky high deductibles and premiums… not how it was originally meant to be, and nowhere close to what the contract/policy states, and never mind common sense… Sending the business out that owes, to tell you how much…
Ask the folks that have been hit with catastrophic damages and left to deal with an insurance company, and their adjuster. Heck, I have an even better one. Supreme Court Justice of Texas put it eloquently… “We note at the outset that the insurance claim process is inherently adversarial. The adversarial process begins as soon as a claim is filed and ends only when the resolution of the claim is finally determined and accepted by the parties.” Found in Barbara Technologies vs State Farm
Yes, once the claim is filed, your adversary is sending their guy to assess…
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