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Hurricane Laura | Hurricane Sally Public Insurance Adjuster > Blog > 2018 > May

Month: May 2018

Representative upset over TWIA’s slow payouts, unlicensed consultants

Posted by gmweb on May 24, 2018

Rep. Todd Hunter says TWIA needs ‘new makeup’

By Mario Diaz – Reporter

Posted: 10:05 PM, May 04, 2018Updated: 10:28 PM, May 04, 2018

PORT ARANSAS, Texas – “Hurricane season is coming and I’m not back together.”

That’s the reality for people living in Port Aransas and Rockport nearly eight months after Hurricane Harvey.

Watch Video

The storm’s wrath is still being discussed and remains quite visible. The blue tarps coloring the landscape symbolize families not yet back to normal. Some are hoping for divine intervention, but the reality for many is they still cannot get answers from the Texas Windstorm Insurance Association, or TWIA.

Meredith Castor, from Port Aransas, summed up her struggles to Channel 2 Investigates by asking, “Where are they?”

TWIA is a primary insurance provider along the Texas coast, with more than 227,000 policies and nearly $5 billion in funds. Hurricane victims who paid on their TWIA policy for years said they are now being shortchanged.

“I have been given $65,000 now, but I am at a halfway point,” said Cherith Fenton during a recent interview.

Tired of being lowballed by TWIA, Fenton decided to advertise her frustration with a large sign on her property.

“Harvey knocked us down, but TWIA keeps us down,” Fenton said.

In the weeks after Harvey, Channel 2 Investigates began examining a growing chorus of complaints about issues families were having with TWIA’s adjusters.

“We’ve been through several desk adjusters. Then we find out someone quit or got fired, and we have to go through it all over again,” Castor said.

A TWIA workshop in Rockport put the struggles of many on full display.

Danile Drake said his daily routine for months consists of “just fighting TWIA, just like everybody else.”

His meeting with a TWIA representative was revealing. Frustrated because there is a tree sitting on his garage and the lack of payment, Drake, at one point, asked the TWIA representative, “Would you be upset if you were me?” The representative said, “I would.”

Drake, now on his sixth adjuster, is hoping for accountability.

“I would like to see TWIA audited,” Drake told Channel 2 Investigates.

According to Jennifer Armstrong, TWIA’s vice president of communications and legislative affairs, “We want to pay every cent that we owe.”

When Channel 2 Investigates informed Armstrong that a lot of people say the company has only paid them 40 percent, Armstrong replied, “And we are here to help. We are here to resolve those problems.”

TWIA uses field experts, including consultants, to determine how much to pay on each claim, but Channel 2 Investigates discovered that TWIA is also relying on unlicensed consultants to help determine payouts.

“We have building consultants who are not engineers, not licensed by the board. They have contracting experience, construction experience and they are determining how much the repairs are,” State Rep. Todd Hunter said.

Hunter, a former TWIA lobbyist, was stunned.

“That needs to be checked into,” Hunter said.

Hunter admits he did not know, but added, “The public needs to know. Everybody needs to know.”

He also said he is going to take a look at TWIA. Hunter believes the company deserves scrutiny.

When asked by Channel 2 Investigates if TWIA has enough money to pay people, Hunter said, “That is one of the questions I want to ask.”

The state representative also expressed his desire for change at TWIA, saying he wants to focus on policy and personnel. In his opinion, the TWIA board needs transformation.

“It seems to me we need to take a look at a new makeup,” Hunter said.

Hunter said he is in the process of creating a Coastal Windstorm Task Force that will focus on windstorm issues, insurance and TWIA.

Copyright 2018 by KPRC Click2Houston – All rights reserved.

Are TWIA Appraisals Ever Fair or Impartial?

Posted by gmweb on May 17, 2018
By Emily Marlowe on May 17, 2018POSTED IN INSURANCE
TWIA (short for Texas Windstorm Insurance Association), frequently referred to as the Texas windstorm insurance carrier of last resort, just can’t seem to get this insurance claims handling thing right. A conclusion quite alarming considering that insurance claims handling is one of the primary functions of its business. At this point many are left wondering if TWIA will ever get it right.

In 1971 the Texas Legislature developed the Texas Windstorm Insurance Association to provide insurance coverage for Texas families, businesses, schools, and properties in ‘high risk’ areas along the fourteen coastal counties. Over the past decades TWIA has attempted on several occasions to receive immunity from both the courts and Texas Legislature to shield it from being responsible for damages (and causes of action) directly related to its own bad acts.

In the aftermath of Hurricanes Ike and Dolly in 2008, TWIA reached new lows. TWIA sent ill-equipped, untrained, unsupervised adjusters to assess Texans damages, and ultimately deny the same. As years went on more and more Texans began to sue TWIA, its adjusting companies, and adjusters, and more evidence of TWIA’s bad acts came to light.

Texans discovered alarming incidences of unlawful claims handling at the hands of TWIA and its adjusters. There, TWIA and its go-to primary adjusting companies – including ABJ, Brush County Claims, Crawford & Company Inc., GAB Robins, Eberl Claim Service, Pacesetter Claims Service, Schafer Wood & Associates, and Wardlaw – purposefully and systematically denied, delayed, and underpaid hurricane claims for families, businesses, and schools throughout Texas. TWIA and its primary adjusting firms were exposed for blatant racism, sexism, and overall improper claims handling procedures.

In 2011, rather than punish TWIA and its adjusters for their undeniable bad acts, the Texas lawmakers (elected officials) wrote new laws that protect TWIA (even when it commits bad acts) by granting immunity in part, and punished the policyholders (Texas homeowners & business owners) by writing laws that restrict legal remedies for policyholders mistreated by TWIA.1

TWIA claimed to be ‘reformed’, but TWIA’s claims handling practices for Hurricane Harvey continue to show that a zebra can’t change its stripes, and you can’t teach an old dog new tricks. Most would think that TWIA would cut ties with those adjusting firms under fire for extensive bad claims handling with TWIA after Hurricanes Ike and Dolly. Not the case.

In fact, in 2017 alone TWIA paid these adjusting firms millions while at the same time making an average claim payment of $6,587.14 for Harvey victims’ TWIA damage claims.2

For example, in 2017 alone TWIA paid Crawford & Company $1,574,965.27; TWIA paid Schafer Wood & Associates $4,396,287.22; TWIA paid Pacesetter Claims Services, Inc. $5,899,015.62; TWIA paid Eberl Claims Services $7,568,334.73; and most alarming, in 2017 alone TWIA paid Wardlaw Claims Service $11,409,092.34.3

As concerning is that the Texas Department of Insurance (“TDI”) has approved various TWIA Appraisal Umpires currently employed with these firms or other firms previously paid copious amounts of money by TWIA for work on various claims.

The Texas Department of Insurance developed criteria and requirements for appraisal umpires to resolve property damage claims on TWIA policies.4 However, it appears as though TDI is either not enforcing its rules as strictly as anticipated, or some applicants have slipped through the cracks and been approved as appraisal umpires.

TDI states that an applicant has a “disqualifying conflict of interest” if they (among various factors):

  • Are a current TWIA contractor or contractor’s employee;
  • Are an employee of the adjusting company or public insurance adjusting company that adjusted the loss;
  • Have any other direct or indirect interest, financial or otherwise, of any nature that substantially conflicts with the umpire’s duties.5

TDI also notes there is a potential conflict of interest if the applicant is a former TWIA employees or contractor or contractor’s employee.

Many of TDI’s Approved Umpires for TWIA Appraisal should likely be disqualified. Unfortunately, TDI has approved (as TWIA appraisal umpires) many current or former TWIA employees and/or contractors and/or contractor’s employees. For example, TDI has approved appraisal umpires affiliated with Crawford & Company (who as stated above TWIA paid over $1 MM in 2017 as a contractor); and those affiliated with Engle Martin a/k/a Eberl Claims Services (who TWIA paid over $7.5 MM last year), Nelson Forensics (who TWIA paid over $1 MM in 2017).6

This further begs the question: Is the appraisal process ever fair? Does anyone win in appraisal? Both sides have to incur unnecessary expenses – to pay for both appraiser and umpire – and in these TWIA matters it is largely uncertain when appraisal is appropriate. The law in Texas states if TWIA accepts coverage for a claim in full or part, and the policyholder only disputes the amount of the loss then the policyholder may demand appraisal.7

The problem here is TWIA’s actions frequently don’t match up with its written words. For example, a homeowner in Victoria may file a claim for Harvey wind damage to her home (the roof was blown off the home and Harvey rains poured in through the opening for days). That policyholder may have a contractor’s or public adjuster’s estimate showing $75,000.00 to repair Harvey damages. TWIA sends an untrained ‘consultant’ to inspect the property, and then issues a letter that says “TWIA accepts your Hurricane Harvey Claim in Full. As a result of our investigation we have determined that wind damaged the roof of your home and we will pay $2,000 to replace the roof. The water damages to the interior are excluded as wear and tear…”An example of something similar is shown below:

This has become common for TWIA claims, and it is unclear what exactly TWIA is accepting – TWIA didn’t pay the amount necessary to replace the roof, as stated in the contractor or public adjuster estimate, and TWIA said that the interior damages were excluded. So, did TWIA accept the claim in full? Or did they actually deny it in full? Or did they deny it in part and accept it in part, and if so, what exactly is accepted?

And more important, what is the next step – does the policyholder need to invoke appraisal? Can they file a lawsuit? Is TWIA responsible for its misrepresentations? Why did our Texas Government pass laws that protect TWIA’s bad acts?

These important questions must be answered by TWIA and by our Texas Government officials.

Texans, don’t sit by and let TWIA and its adjusters (or any insurance company or adjuster for that matter) treat you unfairly. Texas policyholders are owed a duty of good faith and fair dealing. TWIA and its adjusters must be held accountable – the Texas Department of Insurance allows consumers/policyholders to file a complaint if they’ve been treated unfairly by an insurance company, adjuster, or agent. Do not hesitate to go to https://www.tdi.texas.gov/consumer/complfrm.html to file a complaint today – help bring awareness to the Texas Department of Insurance and our Texas Government about these issues.

As always, an experienced insurance attorney may help offer guidance or representation on these complex legal questions.
_______________________
1 See House Bill No. 3 “HB 3”
2 See https://www.twia.org/news-and-announcements/twia-ultimate-losses-harvey/; see alsohttps://www.twia.org/wp-content/uploads/2018/01/HB3-List-Final-2017-V2.pdf.
3 https://www.twia.org/wp-content/uploads/2018/01/HB3-List-Final-2017-V2.pdf.
4 See https://www.tdi.texas.gov/forms/pcgeneral/pc406umpireapp.pdf.
5 https://www.tdi.texas.gov/forms/pcgeneral/pc406umpireapp.pdf.
6 See https://www.tdi.texas.gov/commercial/documents/umpires.pdf.
7 Tex. Ins. Code §2210.574.

For state insurance officials, the ‘p’ term is a dirty word

Posted by gmweb on May 15, 2018

Shhh. There’s a term state insurance officials apparently dare not use right now.

That term is “public insurance adjuster.”

Public insurance adjusters are often seen by insurance companies as adversaries because — unlike regular claims adjusters who work for insurance companies inspecting damages and working up repair cost estimates — public adjusters work directly for policyholders and often challenge estimates by insurance companies’ adjusters.

In a tip sheet presented as a list of “myths” and “facts” about hurricane insurance released last week, Jimmy Patronis, Florida’s chief financial officer, avoided using the term even as he urged policyholders confronted with a claim denial or inadequate claim payment to “always get a second opinion to verify the cause of loss and/or the cost to repair or replace the damage.”

Providing second opinions — then helping manage the claim to ensure policyholders get every dollar to which they are entitled — is what independent public insurance adjusters do.

They work for a fee or percentage of the claim and, yes, they often work to the chagrin of insurers who would prefer policyholders accept their decisions as the last word. Disagreements cost more money — whether they result in expanding the scope of the repair, or fighting it out in court.

When it calls for new laws aimed at reducing costly litigation against insurers, state-owned Citizens Property Insurance Corp. often points out how much more money claims “with representation” cost the company. Its description of “with representation” refers to claims in which policyholders have hired either plaintiffs attorneys or public insurance adjusters.

Claims with representation cost Citizens, on average, three times as much as when customers don’t challenge estimates by Citizens’ adjusters.

It’s not just Patronis who apparently doesn’t want to be connected to the term.

The Sun Sentinel asked Patronis spokeswoman Anna Alexopoulos Farrar whether the “second opinion” that Patronis urged claimants to “always get” was an endorsement of hiring a public adjuster. Farrar responded with this statement:

“As with any major repair, the CFO recommends consumers get a second opinion from a licensed contractor or other licensed professional on repairs made to their home. For example, making sure you are getting the right types of repairs made, and the appropriate amount of repairs (not over repairing).”

Asked whether her response about getting a second opinion from a licensed contractor or “other licensed professional” could be interpreted as advocating hiring a public adjuster, Farrar said “yes” but again did not include the term in her second response: “Yes it could include but also licensed professionals like roofers or plumbers.”

Even Erin VanSickle, deputy chief of staff for Florida Insurance Commissioner David Altmaier — whose office is overseen by Patronis — refused to use the “p” term when asked whether Patronis’ tips sheet could be interpreted as endorsing use of public adjusters.

“If a claim is denied or if the claim payment is inadequate to effectuate covered repairs, a consumer has a number of options to pursue, including a followup call to a contractor or engineer, the consumer’s insurance agent, the [Department of Financial Services] Consumer Services helpline, or other professionals qualified to render an opinion on coverage or scope of damages,” VanSickle said.

Every occupation has its share of bad apples, and some public adjusters have been caught committing claims fraud. Insurers also don’t like when public adjusters solicit business from policyholders by advertising or canvassing neighborhoods — creating claims where none might have otherwise existed.

Earlier this decade, complaints by insurance companies led to new regulations governing public adjusters, which are compiled on the chief financial officer’s website.

A database on that same website shows there are about 1,800 public insurance adjusters licensed in the state of Florida, indicating there’s plenty of demand for the service they offer.

Paul Handerhan, who is senior vice president for public policy at the Florida Association for Insurance Reform and a licensed public adjuster, says the mainstream of the public adjuster industry takes a dim view of adjusters who canvass neighborhoods, “knocking on doors, saying, ‘I want to come in and look at your pipes and flooring,’ and incentivizing a policyholder to file a claim.”

An honest public adjuster will explain to policyholders, before filing a claim, that they will be responsible to pay a deductible and the public adjuster’s fee of up to 20 percent of the claim before they receive any claim settlement check, Handerhan said. An honest public adjuster will tell the policyholder that an insurance policy isn’t meant to be used as a home warranty contract, that all claims show up on the insurance industry’s equivalent of a credit report, and that filing three claims within 36 months could trigger a non-renewal and make it difficult to find another willing insurer, he said.

“They’ll tell [policyholders] that they need to be careful about filing claims,” Handerhan said.

State officials have sided with insurers over public adjusters before.

In 2008, the state Legislature enacted a law barring public adjusters from soliciting policyholders within 48 hours of a hurricane or other major event. In 2012, the state Supreme Court overturned the law, ruling it was unconstitutional and violated free speech.

Responding to a request for comment about Patronis’ tip sheet, Jimmy Farach, president of the Florida Association of Public Insurance Adjusters (FAPIA), pointed out that Patronis’ two predecessors didn’t hesitate to use the words. Farach provided videos of former CFOs Alex Sink and Jeff Atwateracknowledging the importance of public insurance adjusters.

“I understand the important place public insurance adjusters have in the whole scheme of the world of insurance. What would we do without public adjusters? Where would people go if they had no other place to turn?” said Sink, speaking at what a Florida Association of Public Insurance Adjusters spokeswoman said was a “political event” in 2010.

And Atwater, serving as keynote speaker at the association’s 2013 annual dinner, said: “The work of public adjusting is defined by the noble work of helping somebody navigate a path they have no way of knowing how to navigate themselves, and don’t believe they can.”

Plus, said Handerhan, not all policyholders use public adjusters for adversarial purposes. Some claimants who have busy work lives find it worth the fee to hire a public adjuster to handle complicated claims, he said.

“That can also benefit the insurance company,” he said, “to work with a public adjuster who understands the terms and coverages in the insurance contract and has the ability to evaluate damages.”

Here are Patronis’ “myths” and “facts” about hurricane insurance:

MYTH 1: I already have homeowner’s insurance, so everything on my property is covered and I’m financially prepared for the storm season.

FACT: All homeowner’s insurance policies contain limitations and exclusions. Also, you may need a separate policy for windstorm or flood if these coverages are not included in your homeowner’s policy. It is important to review your policy to understand your coverages and exclusions.

MYTH 2: When an insurance company denies a claim, or provides an inadequate claim payment, I must pay out-of-pocket to cover any additional expenses from damages that occurred to my property.

FACT: You should always get a second opinion to verify the cause of loss and/or the cost to repair or replace the damage.

MYTH 3: When contractors offer to waive my insurance deductible to provide repairs at a discounted rate, this is simply a kind gesture.

FACT: Waiving the deductible or providing a discounted rate directly to you is a form of insurance fraud.

MYTH 4: An Assignment of Benefits (AOB) agreement is the only way to get immediate assistance for Floridians who have damage to their property.

FACT: You do not need to sign an Assignment of Benefits to get your residence repaired, even for emergency repairs. You should make first contact with your insurance company by immediately reporting the claim.

MYTH 5: Insurance companies can take as long as they want to respond to an insurance claim filed by Floridians.

FACT: Typically, insurance companies must acknowledge your insurance claim within 14 days from the date the claim was reported and they must pay undisputed amounts of your claim within 90 days from the date of damage.

MYTH 6: If my neighbor’s property is blown into my yard and damages my own property, my neighbor’s insurance will cover the cost of damage.

FACT: The damage to your property is covered by your own homeowner’s insurance policy, unless you can prove your neighbor was negligent, then the damage would be covered under their homeowner’s policy.

MYTH 7: My insurance agent is the only person I need to contact when filing an insurance claim.

FACT: While you may call your agent, you should immediately report the claim to your insurance company. Most insurance companies have a toll-free claim number to report your claim.

rhurtibise@sun-sentinel.com, 954-356-4071, twitter: twitter.com/ronhurtibise

Federal insurance program falls short for flood victims

Posted by gmweb on May 3, 2018

A CBS News investigation reveals that a federal fund intended to protect flood victims often benefits private insurance companies instead. The National Flood Insurance Program, run by FEMA, is $25 billion in debt. In some years, up to two-thirds of the money that’s supposed to help flood victims goes to private insurance companies and the attorneys they hire to fight flood claims.

When record floods hit Louisiana in 2016, 150,000 people had damage to their homes with an estimated cost of $15 billion. Two years later, many homeowners are still struggling to rebuild  –  and fighting the same companies and lawyers that they fund with their premiums and taxpayer dollars, reports “CBS Evening News” anchor Jeff Glor.

Ricky Wall and Melissa Miles were trapped in their home for three days when flooding hit Louisiana in 2016.

“It was coming so fast, it was white-capping over the roads,” Wall recalled.

Covered in sewer water, they thought things couldn’t get worse. Their home was ruined, but they had a flood insurance policy, that they were required to buy, worth $176,000.

“The insurance company was a nightmare,” Wall said. “It was–”

“Almost as bad as the flood,” Miles added.

“I about had a stroke fighting with them people every day,” Wall said.

“This is ridiculous that I’m paying for something that I have to fight for,” Wall said.When insurance didn’t pay enough to fix their home, they had to come up with the cash themselves to do it. So they decided to fight the National Flood Insurance Program for lowballing them. They are still fighting for $40,000.

Run by FEMA, the National Flood Insurance Program is responsible for all flood policies in the U.S. Insurance premiums and taxpayer dollars fund the program, about $3 billion a year. But FEMA doesn’t administer all the policies. It outsources to private insurance companies called Write Your Owns – or WYOs. They and all of their agents get paid out of the same pot of money as flood victims.

Some years up to two thirds of that pot goes to WYOs and the attorneys they hire to fight against flood victims. In effect, by paying their premiums on time every year, homeowners like Wall and Miles help fund the very lawyers fighting them in court.

“How can they sleep at night doing us what they done?” Wall said.

Wall’s insurance company hired the Louisiana law firm of Gerald Nielsen to fight Wall and Miles’ claim. Nielsen’s firm has been fighting flood claims on behalf of insurance companies for over 30 years, not without controversy.

After Superstorm Sandy, Congress criticized Nielsen’s firm for how it defended WYOs whose engineers allegedly altered reports to avoid paying claims.

“He dealt with Sandy victims like they were the perpetrators, enriching himself at their expense,” New Jersey Sen. Robert Menendez said at the congressional hearing.

A New York judge called Nielsen’s firm “misconduct” in one Sandy case “remorseless” for delaying cases at taxpayer expense.

To give you an idea of the costs involved here, you can rent a 1965 Bentley Silver Cloud for just under $1,000 for the afternoon. Nielsen’s office spent five times that to ship documents to a law office from one that’s half a mile away.

CBS News obtained a budget, drafted in 2014 for a Sandy case, showing Nielsen’s firm estimated that a single case would cost $188,000 taxpayer dollars if it went to trial. The cap on any home flood policy is $250,000.

Nielsen didn’t want to talk to us about his fees and expenses when we caught up with him in the parking garage by his office.

“I’ve got to go through ethics counsel because some of which you’ve asked clearly is privileged,” Nielsen said.

A public information request revealed FEMA paid Nielsen’s firm at least $29 million for Sandy cases alone.

“Things need to change. Somebody needs to do something about it,” Wall said.

Wall hired attorney John Houghtaling; his firm represents flood victims and fought in court against Nielsen’s firm during Sandy.

“There was no effort to mitigate the costs. In many cases we were asked to have experts reinspect for a third time homes that were totally destroyed,” Houghtaling said.

FEMA said it has no authority to fire lawyers hired by private insurance companies.

“They’re jacking around policy holders. That’s unacceptable and somebody’s gotta do something about it, and by God it’s supposed to be FEMA,” Louisiana Sen. John Kennedy said. He has a bill to change that.

“Once they get that authority, I will chase them like a hound from hell until I find out that they’ve fixed this problem because I believe that there is a problem,” Kennedy said.

Homeowners like Wall wish FEMA had tightened its belt before making him pay out of his own pocket.

“That’s not fair. And they say that’s the American way? That’s not fair,” Wall said.

Nielsen said in a letter to CBS News he could not talk about his fees and expenses, but that he was acting at the direction of his clients and that all of his firm’s bills were reviewed by the clients and FEMA. FEMA responded to our report, saying it will pay “every dime” policyholders are due and that it has created an oversight team to address billing and other litigation matters.

© 2018 CBS Interactive Inc. All Rights Reserved.
Source: https://www.cbsnews.com/news/fema-national-flood-insurance-program-funds-go-to-lawyers-fighting-victim-claims/
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