Update on Worley overtime class action case Altier vs Worley and BP- BP granted dismissal May 2011

May 11, 2011

Doing some research today, I was able to locate a May 9, 2011 court decision granting BP’s motion to be dismissed from this class action lawsuit filed by independent adjusters working BP claims through Worley adjusting firm.  Here is the link.

It is interesting to see several more independent adjuster names on the court document now as plaintiff’s…several of which I recognize from online interactions from several sites.

In another online document from a February 25, 2011 Status Conference held  involving all BP cases, they do list both Alteir vs Worley and Alteir vs Worley and BP as item number 17 on the Agenda. Here’s the link to that pdf document found online.

The website listing the status of the 368 litigation cases against Deep Water Horizen does show these two cases still open here (search alpha order for Alteir vs Worley.

While doing some online research I also came across another case in AL that includes BP and Worley as well as ESIS who BP originally assigned cases to filed with the State of AL as one of two plaintiffshere which also lists it as a RICO case as shown in this document. I will make some contacts to see if I can get more documents if they available to the public. There is a short explanation about the type of case it is in the top right corner of the pdf document. The 2nd plaintiff listed on this AL case is CMCO, LLC and here is the trademark info I found on them but no clue if this is actually the plaintiff listed on this case.

Amazingly (not) is a website which is basically an advertisement from the firm filing the class action speaking to adjusters who may have worked for Worley found here. The website for the law firm is listed on the bottom of that link along with contact information.

As far as what independent adjusters are saying,  here is a lin to a CADO forum topic where a few were discussing this case when it first hit the news.

For links to our prior posts with the original Complaint documents which explains the details of the case if you missed it, here is the link.

As we locate more documents and information we will update the information here on the blog.


” Adjusters ” handling BP Claims file a Class Action lawsuit on two issues- Overtime pay and failure to receive 65% of daily fee per contract

February 9, 2011

Roy Cupps over at CADO posted this link in the forums there regarding a Class Action lawsuit filed by MS Attorney JP Hughes  (I could not locate a website for him but I’m working on it through network connections )on behalf of the adjusters handling the BP claims regarding two issues:

1) Overtime pay- working more than 40 hours per week and not receiving over time pay (they were on daily rate)

2) Alleged failure of adjusting firm to pay adjusters their 65% of the daily rate they were paid by the BP Fund

For complete details, here is the link:

http://www.courthousenews.com/2011/02/09/34026.htm

This is definitely a case to watch as it is standard for independent adjusters to receive a daily rate of pay for each day worked on a catastrophe or daily assignment where they agree to work for a stipulated daily rate for a given split of the daily rate. The rate these adjusters were paid is on the high end of the daily rate independents normally receive. I have no idea why this alleged adjuster would feel entitled to time and a half for hours worked over 40 hours unless the contract indicated the daily rate was for a given 40 hours which is unheard of in the claims industry for independents working on assignment.

I am very curious if this person was actually one of the actually non claim folks working on BP claims. I have actually been told by several were working in field offices that BP Csar Ken Feinburg changed adjuster job titles to “evaluators” when he took over. If that is true, do you think that the prior findings of the Fair Labor Standards commission would differ on findings on this class action?

If you missed our prior several blogs on overtime issues and adjusters, here are links to prior blogs on the topics and prior decisions on some of these cases:

https://dimechimes.wordpress.com/?s=Overtime

https://dimechimes.wordpress.com/2010/02/27/supplemental-info-on-geico-auto-adjuster-overtime-issues/

https://dimechimes.wordpress.com/2010/02/02/fenton-et-al-v-farmers-insurance-exchange-no-07-4864-dc-mn-2009-mn-staff-claims-adjuster-overtime-decision/

https://dimechimes.wordpress.com/2010/01/06/geico-wins-case-on-overtime-issues-for-auto-adjusters-view-washington-post-article/

https://dimechimes.wordpress.com/2009/02/27/adjuster-overtime-issues-supplemental-info-from-none-other-than-attorney-gloria-allreds-current-news-letter/

https://dimechimes.wordpress.com/2007/09/24/insurance-adjuster-overtime-pay-issues-and-complaints-in-the-news/

Regarding the second issue of alleged failure of  Worley Adjusting firm to pay the agreed 65% split of the daily rate, I find that very hard to believe as they have such an excellent reputation for paying adjusters fairly in the claim industry which is remarkable considering the number of adjusters who have gone unpaid by unprofessional firms since Katrina. I assume we’ll be able to view the contract when documents are filed during discovery on the case to show first of all the daily fee Worley was receiving per “adjuster” as well as the independent contract terms they were using on this assignment. I’ll keep an eye out for those to make the records in the coming months.

There were many experienced adjusters who would gladly have deployed for the given rate of pay. In addition, adjusters working out of town at BP assignments were given daily per diem while working which is unheard of for independent adjusters working for insurance carriers so those who were lucky enough to be deployed were most thankful for the assignment.

I think this case will be closely watched by all insurance carriers who use independent adjusters on daily rates. I know I will be closely following it. You can as well by subscribing to this blog to watch for updates as we post them.

If you also want to follow this discussion going on over at CADO where Roy Cupps posted this information, here is the link to that topic forum discussion there:

http://www.catadjuster.org/Forums/tabid/60/aft/11695/Default.aspx#22348


Supplemental Info on Geico Auto Adjuster Overtime Issues

February 27, 2010

It is just amazing the great information found while experimenting with Twitter this month for use in the claims industry.

One of the great finds today is a detailed article explaining the overtime issues in the case that Geico recently won by Weil Gotshal  law firm.  Their newsletter with a pdf  link to their article can be found on page 4 using this link.

We recently blogged with a link to the Washington Post articleon Geico’s win on these auto adjuster overtime issues  in this prior blog.


Fenton, et al., v. Farmers Insurance Exchange, No. 07-4864, DC MN, 2009, MN Staff Claims Adjuster Overtime Decision

February 2, 2010

Here’s some information on an over time case involving a Farmer’s case, Fenton, et al., v. Farmers Insurance Exchange, No. 07-4864, DC MN, 2009 .

It sounds like an SIU (Special Investigation Unit arson fraud adjuster) Investigator won a decision in MN on adjuster overtime pay. According to this article, it was based on the fact their supervisor made the final decision if a case was fraud or not. It seems the states are across the board based on alot of other decisions I’ve posted on this blog. This is surprising since a claim supervisor making the decision on a claim file would be applicable on all claim files that exceed an adjuster’s authority, files to be denied,  and normally any coverage issue files as well.

For information on Fenton, et al., v. Farmers Insurance Exchange, No. 07-4864, DC MN, 2009, here is a link I found on today’s email update from a great site for HR that I subscribe to at http://www.thehrspecialist.com  

Here’s the link:

http://www.thehrspecialist.com/article.aspx?articleid=30351&cigx=d.n,stid.7491,sid.374530

This link will take you to all other blogs I’ve posted that included other claims adjuster overtime cases. This does apply to staff adjusters not independent adjusters. I’m curious if the independent adjuster classifications will be questioned as well with the 2010 concentration on employee versus independent classification we’ve been reading about.

https://dimechimes.wordpress.com/?s=overtime

Doing some additional web search for a link to the court documents on the Fenton vs Farmers case, I came across this link to an entirely different court finding in Farmers favor in 07. It sure is interesting comparing this to the Fenton case:

http://www.hreonline.com/HRE/story.jsp?storyId=9595529


Geico wins case on overtime issues for auto adjusters view Washington Post article

January 6, 2010

Geico has won a case on overtime issues for staff auto adjusters according to the following article posting on the Washington post here.

We have written several other blogs here on staff adjuster overtime issues if you want to view them here.


Just a ClaimSmentor Moment #6- Update 3/09 on EA Renfroe/ Rigsby Whistleblower case-Possible Settlement

March 20, 2009

 

No time for blogging today but you won’t want to miss this blog over at Slabbed on settlement updates and court documents on the EARenfroe and Rigsby Whistleblower case. Slabbed thanks for updating this as many claims industry members are very interested in this topic. I’m hoping for EA Renfroe’s sake that this does settle. They sure did NOT deserve what the Rigby whistleblowers have put them through since Katrina. We have some old blogs here (just enter Rigsby in the search field to locate them. One of the Rigsby’s actually said in their deposition that EA Renfroe had done nothing wrong. More on that later:

http://slabbed.wordpress.com/2009/03/17/anita-lee-reports-from-team-rigsby/

 

This is an important case for adjusters to study from the stand point of Code of Conduct forms you are required to sign by carrier’s and what happens when you violate those code of conduct forms.

By all accounts I have ever heard from independent adjusters, EA Renfroe is an excellent adjusting firm to work for. I also managed their independents during my management career and found the same to be true. What a shame these whistleblowers put them through this when by their own admission their complaint was with the carrier.


Just A ClaimSmentor Moment #4- LexisNexis List of Top Law Blogs on Insurance and Claims Issues

March 12, 2009

I don’t have time for blogging today but did come across this list over at LexisNexis on top blogs for insurance. There are so many good ones I had not heard of on this list so hopefully this will link us to some great new sources of information. Clck here to view the list.

We also have our list of favorites where we find so much good information already shown in the Claim Blogs of Interest section located in the right column of this  website blog. I’ll add to my list of favorites for claims news as I get through the LexisNexis list.

Here is a video hosted by the Insurance Journal suggesting insurance companies should be blogging in this blog entry.

https://dimechimes.wordpress.com/2008/01/09/should-your-adjusting-firm-or-carrier-be-blogging/

Here is a link to other great Insurance information resources found at Lexis Nexis:

http://w3.nexis.com/sources/scripts/eslClient.pl?GSDINDUSTRY=Insurance


Guest Blog by Dr Michael Birzon, UCF Insurance Department “Tall Tails from Texas” Warning about FL Adjusters false belief TX Licenses waives FL License Exam for Residents

March 10, 2009

I had no idea when I posted the blog on the adjuster license problems in our last blog here:

https://dimechimes.wordpress.com/2009/03/06/organization-chart-for-the-claims-handling-blame-game-a-humorous-grap-of-where-all-participants-stand-in-this-game-on-claims/

Then Dr Birzon, our regular mentor on Fl licensing issues for ClaimSmentor told me he had also written an article on his warning we told you about in the last blog.  The link above has a link to his bio and insurance website at UCF for FL licensing online.

I knew the problem was very bad, just from what I was receiving on licensing information on adjuster resumes we regularly receive, but his story in the below Ezine article about 60 Allstate Adjusters is even beyond my worst nightmare on how bad the issue was! You can read his entire article on”” Tall Tails from Texas below:

—–Inline Attachment Follows—–

Google Birzon Ezine and you should pull up other articles of interest…thanks!

Dr. Michael Birzon
Florida Insurance University/UCF
(407) 927-1235
(407) 386-6454 FAX

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I am hoping that adjusting firms and adjusters will pass the link to this blog or copy and paste his article link and pass it on to adjusting firms you work with to post the warning on their website. To forward this link- just click on the blog title and it will give you just this blog article you can forward.

We thank everyone for passing this important warning on folks wanting to get licensed to handle claims. Adjusting firms should insist on seeing the license information online for the state where you assigning adjusters as we are seeing


Organization Chart for the Claims Handling Blame Game- A Humorous Graph -A Serious Look at Claim Bad Faith Issues

March 6, 2009

Insurance Company – Adjusting Firms- Claim Staff -Reinspectors -Independents  – Public Adjusters
Claim Litigation  Attorneys
 
→   →   (Everyone to R)       ←     ↓        ↑  →                           ←   ↓   →                                 ← (all 3)  →                                                 ← (all 4)
************************************************************************************************************************
What a mess  that makes no sense and it isn’t humorous at all. This is a huge insurance consumer issue. Just check out the Bad Faith organization or NAIC (National Association of Insurance Commissioners) for all kinds of information and surveys on claims handling. The link I put to NAIC is their 2009 Report on the Top Complaints by insurance consumers. You can sort by carrier, by type of complaint, by state I think, and much more!
 
When are we also going to get Insurance Departments on board to help improve this by doing the following things I’ve discussed in this blog before:
 
1) Require Insurance companies to report to all state insurance departments consumer links where they provide complaint information for carriers to provide information on adjusting firms that have been dismissed by a carrier for trends of bad faith claim handling issues. Presently, I know of no place when independent adjusters can validly find this information until it is too late. Dismiised firms are not required to be reported (if they are I am not aware of it) so they just move on to solicit new carriers so even more insurance consumers continue to be harmed by firms with bad consumer servicing problems.
 
2) I believe insurance companies require liability and errors and omissions information from adjusting firms before they use them. Are there any reporting requirements by state insurance regulators on claims ratios on E and O policies for adjusting firms or independent or public adjusters so 1) policyholders don’t hire a PA who has a large complaint ratio 2) so adjusting firms have a source to know (other than just checking regulator sites to be sure an adjusters license is still active), and so adjusters can have a valid source to see the complaint ratio of an adjusting firm so they can make a good decision about which adjusting firm they wish to deploy with so they don’t get hooked up with a firm that might be unprofessional?
 
3) Insurance Regulators should require that adjusting firms be required to disclose the name of the owner and the name of any key executives they may have on the payroll and post them on their website.  Often if an adjusting firm develops a bad reputation with adjusters or carriers, they just either a) move to another state so carriers and adjusters cannot find bad information about them at insurance department licensing sites that allow you to research licenses or b) the adjusting firm owners or key executives just change the name of the adjusting firm so adjusters don’t know who they are.
 
4) Another thing that concerns me when trying to find good adjusting firms for newly licensed adjuster recommendations , when asked by ClaimSmentor members , is that so many of the adjusting firms do not list one thing on their ABOUT pages about who the key owners are. I tell them just to go to http://www.whois.net/ but this only tells you when a website domain was open and the contact name and information for the person who opened the site. Sometimes the only results you get there are to the website company they opened the site with but it is one source of information you might try.
 
5) Adjusting firms should be required to post links on all of their websites such as Department of Insurance Consumer Complaint contact information AND information for independent  adjusters as to where they can report violations of adjusting firm contracts with independents and adjuster non- payment of fee bill complaints. If you don’t think there is a need, just check out this site that opened post Katrina and when overloaded by complaints of non payment to adjusters, their system crashed many many times : www.professionalfeecollection.com (site was opened post Katrina and we have no idea what happened to this agency and it’s alliance of attorneys working proactively to collect unpaid independent adjusting firm fees. We know they were overwhelmed by the claim files faxed in to them and the thousands of adjusters attempting to utilize their services. It was run by a Terry Bagsby out of TX. The interesting thing was that these adjusters were all complaining about the same continuous group of adjusting firms based on discussions I had with him in 05/06.
 
6) Adjusting firms should be required by State Insurance Regulators to not only have a contract for independent insurance adjusters but they should be required to have two signed originals so one can be given to the independent adjusting firm and one can be given to the adjuster. I cannot even begin to tell you how many new adjusters have been frankly taken advantage of either not being given a copy of the contract or no contract at all.
 
We wrote in our blog done a few years back called “Splish Splash don’t go taking a bath” on this topic.(See link at bottom of this blog) I always teach new adjusters in our Fundamentals class not to deploy without seeing the contract and making sure they agree to the terms, not to sign blank forms, to watch out for Non-Compete terms, to make sure they know what the fee split is with the adjusting firm (how much they keep of the fee schedule and how much you get based on a percentage fee split) or what your daily rate is if you are getting paid a daily rate how much it is and what your fee split.
 
There is much more information in the blog I wrote linked to above. The very best advice that I would give you is to see your personal attorney about E & O insurance coverage information in the contract to be sure YOU are protected and to be sure that you are not signing something you shouldn’t be signing.
 
7) Insurance regulators need to regulate a) the length of time a carrier has to pay independent adjusting firms and TPA’s who process their claims, the time an adjusting firm has to pay the independents, holdback percentage provisions in contracts and hefty fines for those adjusting firms not paying them within a regulated time).
 
8   ) Insurance Regulators must begin setting regulations for insurance carriers as to what claim handling fines a carrier can pass on and require of  independent adjusting firms and adjusters.
 
They have gotten totally out of control on the RFP requirements I have seen such as Citizens of FL 2007 RFP 08-0016 or 07-0003 with fines as much as 1,000 per vioation. Is what developed after these fines starting being imposed in RFP’s is that independent contracts started transferring these fines on to adjusters in contracts without even specifying what these fines were.
 
9 ) Insurance regulators have got to put a stop to the erroneous information being advertised about the TEXAS adjuster’s license for independent adjusters. Just take a look at the many classifieds telling those interested in a claims career that the TX license with give them licensing in any where from 25-32 states.
 
This is inaccurate as the adjuster still has to fill out applications, finger prints and pay licensing fees for those non resident licenses. Dr Birzon at the University of Central Florida’s Insurance licensing online program has been forced to post a warning such as this on their website link (see News flash column on left of that link) because so many residents of FL had taken TX licensing classes thinking that they were waived from taking the FL Resident adjusters license.
 
I regularly receive resumes from adjusters who are permanent residents of FL that is all that I see in the licensing information of their resume is their TX license info. Dr Birzon has been so helpful answering questions on ClaimSmentor on licensing issues and even helped out a few of our adjusters who were in non compliance on CE’s and had to retake Fl license requirements again so we referred them to his online FL licensing program which the state regulators approved as a means of getting your FL license and bypassing the FL adjusters exam. These adjusters who were working out of a state on a catastrophe assignment could meet the FL Department of Insurance requirement they sit for the exam again by taking Dr Birzon’s online class at night and still service claims assigned to them out of state.
 
10 ) Insurance regulators need to require that any training firm producing adjuster 
training classes be approved by the state department of insurance to meet minimum claims experience requirements ,which I would insist included experience in claims management, as well as professional insurance education requirements that are recognized in the insurance industy such as AIC (Associates in Claims) and/or CPCU course through AICPCU. I have completed IIA, AIC, and 9 sections of CPCU with only one left to go (the much dreaded Accounting session). I cannot tell you strongly enough how much I recommend these courses  for independents as well.
 
11 ) While the insurance regulators do not control which independent firms a carrier uses, they should at minimum require that adjusting firms and TPA’s require some kind of screening. The one I prefer the most is the membership requirements at the National Association of Insurance Adjusters which is an association of independent adjusting firms who have had to go through substantial financial screening and other membership criteria you can view here.
 
12 ) There are good procedures established by the insurance regulators, emergency management, and state governors for adjusters coming in from out of state. They are called emergency adjuster regulations.
 
In a new trend the large adjusting firms are now requiring of independent adjusters, they are requiring that adjusters obtain non-resident licenses in all coastal states and those like Oklahoma  and Minnesota that have regular windstorms. There are valid reasons because carriers and independent firms cannot activate non resident adjusters who do not hold a non resident license in the state of a storm until the governor announces that by his order at the time of an emergency that independent adjusters are allowed in the state to work claims on an emergency license. 
 
If an adjuster secures a non-resident license in all the states a carrier MIGHT deploy them, they can stay longer because emergency licenses are temporary in nature and only allow adjusters to work a storm designated a catastrophe by the governor. Carriers also do not use their national catastrophe teams if there isn’t enough volume in a given state although I’ve read about alot of improvements on this. This is usually do to the fact that they have to bill the region where they deploy the adjusters for their services. Can we do something about this? It appears to me to be the only way carriers and adjusters can deploy adjusters and get around the governors emergency disaster authority. It has created a huge financial burden on independents and on CE reporting requirements when they should be concentrating on servicing insurance consumers. It is also creating a “dumbing down” of independent adjusters that can be used as we often see less experienced independent adjusters deployed because the experienced adjusters tend to leary of jumping through the huge volume of hoops and know that when the big one hits they will be deployed when carriers through out all pre-storm requirements.
 
I regularly refer new independent adjusters to these firms meeting the NAIIA criteria as hopefully a safety net for them when finding reputable firms. See their membership directory here. While I cannot guarantee it will, I would think that it would atleast provide a place to start when considering who is your “A” list of adjusting firms you will work for. How about for carrier independent staffing needs when their core adjusting firms “run out “of  core adjusters (their A team of who they will first deploy based on experience and certifications and licensing”.
 
I do know some excellent firms that might not yet meet all of the NAIIA membership criteria who are trying to do the right thing. Several that come to mind as I have gotten to know their owners through years of membership at ClaimSmentor or through the staffing side of my operation are CSP claims (owners are retired carrier management), Legacy Claims (the one owned by the Ellis’s), and Action Catastrophe Claims. I do not post those here lightly as I have spent almost four years now getting to know them and I listen intently to what experienced adjusters working for them have shared with me, I’ve watched their adjuster training programs, and I’ve heard great reports on their CMS Claim Management systems and payment records with adjusters who complied with file requirements.
 
I know of very very few independent adjusting firms run by owners or managers who have these course certfications. One of my clients who feels as strongly about this is Dennis Martin, CPCU  who runs the FL Division and catastrophe division  of William Kramer and Associates. He is a joy to work with since he understands the issues facing our claim industry , the Florida insurance crisis , and knows what happens when an adjusting firm doesn’t properly manage claims and claims adjusters and CONTROL compliance with file requirements. This is especially important with their primary concentration on commercial claims such as very large Condominum Claim Associations.
 
We co -authored an article for Claims Magazine as the featured story titled “ A Box of Chocolates” in 2008 about condo claims handling. We both can’t thank Eric Gilkey, Editor of Claims Magazine for his skills and patience working with us as neither of us had significant experience in writing an article)!
 
                                                                                                    Some Things to Ponder
This is also another thing that inquiring minds want to know!  If a file is approved first by an independent adjusting firm manager and sent on to the carrier management for approval and they approve the file and pay the claim based on their review how can they possibly go back and fine an adjusting firm a year later when their auditors catch the mistake. I know of a few firms this has happened to. Where are the insurance regulations on this?
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Why do carriers always tell our members and my staffing firm that they don’t want to consider very good experienced catastrophe adjusters for staff positions when they meet all other qualifications such as a four year degree, insurance continuing education requirements,etc? I was astonished over the past four years to receive staffing requests from 3 major carriers that said the following ” we need adjusters but we can’t get approval in our budgets to use a staffing firm. Will you send them out free to your rosters? ” You’ve got to be joking! Take the resources I have developed over 4 years of staffing and building contacts and mass emailing for them free? I did post their notices in our Career Forum where we do post jobs such as these that we come across but I sure wasn’t servicing them free. Also, while I can understand that they think cat adjusters will jump as soon as a major storm hits, don’t tell us that your staff adjusters do not do so as well. What is your turn over rate? The only thing that keeps staff adjusters on your employment lists is the fact you often offer benefits such as health but adjusting firms are
getting just as savvy in some cases and they often get employment applications from your staff adjusters just like my firm does.
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Last but not list in the things to ponder list is the failure of carriers to put a stop to “hand me down” claims. Almost every issue of non-payment to new independent adjusters has come through a 2nd or more tier adjusting firm subcontracting claims out to another adjusting firm when they run out of adjusters. Often , I doubt the carriers even know about it. When the unpaid adjusters contact the carrier, they are often told “sorry….we don’t have a contract with that adjusting firm”…well dang….I guess the first tier firm made a sidetrack agreement with the 2nd tier firm leaving the independent adjusters to hang out to dry. I’m referring to adjusters who have a contract with firm 2 or on down the line but they have no contract with the adjusting firm who had the contract with the carrier. During the 04/05 season when the FL Dept of Insurance set deadlines with HUGE fines, I saw many a carriers hurt when the primary adjusting firms couldn’t account for claim file status. I never even knew this went on until I transferred to the independent claims industry. I had one firm call me and say “and we have the 1st tier contract with the carrier” on this one. Maybe I am wrong and this is a regular practice, but I can tell you the majority of calls my staffing firm received on non-payment issues when they were looking for a new assignment because they weren’t getting paid was from 2nd or more  hand me down claim adjusting firms. I simply think the practice should be forbidden.
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There are four ways I can think of to add these regulations which are long overdue. Not being an insurance regulator, but someone with a huge interest in protecting independent adjusting firms and independent adjusters to preserve our important service to the claims industry:
 
1) Click on the link here to all insurance departments and print out a copy of this blog (just click on the blog title and it will open up just this blog versus reviewing a string of our blogs) and send a copy to either your state insurance department or to any insurance departments where you have worked assignments and/or are licensed. If you fear for your career in claims, just print it out and mail it in and don’t sign your name. If they get flooded with enough copies of this blog, maybe they will listen.
 
2) Print and send a copy to the NAIC who is responsible for cancelling the recommendations for National Licensing. Again, don’t sign it if you don’t want to. Volumes of copies of this might help. The link to the blog on this act is included at the bottom of this blog entry.
 
3) Insurance regulators who are responsible for claim handling regulations can add requirements such as these to their Good Faith claim handling regulations and licensing requirements for independent adjusters and adjusting firm licensing requirements.
 
4) How about Insurance Regulators developing a Code of Conduct form for independent adjusting firms (similar to what carriers require independent adjusting firms and adjusters are required to sign). Look at the NAIC Code of Conduct they require their member adjusting firms comply with
 
There are so many possibilities that can be done to improve the industry, reduce insurance consumer complaints, to reduce the number of consumers who have to resort to use of public adjusters thus reducing their insurance indemnification dollars, and to reduce the ever growing field of claim litigation. It is worse now than I have ever seen in over 30 years in the insurance industry.
 
Which claim career field is really responsible for the problems in our industry? Here’s a complex self assessment test. Is all it takes is four questions:
 
1) Who issues an insurance policy with insurance consumers with obligations required of both insurers and insureds? (Key to answer you will find the answer in column 1)
2) Who has to take instructions from who? (Key to answer- see column 2, 3, 4  as they answer to #1)
 
3) Who contributes to the training issues for the claim industry? See columns 5,4,3,2, and 1
 
4) Are public adjusters and consumer advocate attorneys the only driving force behind the increase in claim litigation? Yes in some instances they are but could they be successful in winning claim litigation cases by the hundreds if they weren’t finding examples of bad faith across the board- see 1, 2, 3, and 4 in the graph).  I don’t think  they are the only contributors of these huge costs which are being passed on to insurance consumers when carriers have to consider defense litigation costs when rates are determined by insurance companies.
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So why are we all mixed up and playing the blame game? This is such a goofy game not befitting of an industry that has such an important place in the lives of  every person in America that has been going on as long as I’ve had a career in claims. Here’s how the game works:
 
Step 1 ) Insurance Companies (common to all major insurers) use independent adjusters when a major storm such as Hurricane Katrina and Ike
 
Step 2) Insurance Companies provide training before the storm only to independent adjusters with atleast 2 years experience and to their staff claim departments UNTIL the big one hits
 
Step 3) Carrier Auditing Departments, Claim Examiners and Managers.  and Reinspectors start rejecting files because they don’t provide training or enough information to adjusters. It is provided during a carrier certification class which is usually a one day training session put on by CARRIERS through ADJUSTING FIRMS THEY SELECT or at a one day catastrophe induction center where they do present a good outline of file handling guidelines if you are experienced enough to just make exception to general claim handling instructions you already know
 
Step 4) Newly licensed adjusters are activated to handle claims when carriers lower their 2 and 3 year experience requirements when they THINK they have run out of adjusters based on information from the pre-selected adjusting firms who may service there claims. ***Let me point out here it is like a “where is Waldo” game for independent adjusters entering the industry to find out who is servicing the claims because the majority of CARRIERS provide no information on their website about which firms are handling their claims (God forbid someone might consider them “employees versus independents). See our prior blogs on the cycle
 
Step 5) Don’t overlook the fact that the file requirements and claims guidelines are changed by CARRIERS almost daily when on storm. Even if an adjuster’s file meets file requirements one day, by the time it make’s it through the claims management cycle (Independent or staff adjuster →Claim Examiner or Claim Manager→Insurance Company who approves claim settlement payment and settles claim with insured (often with in office claim trainees who have never handled a field inspection or an inoffice claim operation TEAM so the insured can get bounced around and never talk to the adjuster who actually inspected their claim?
 
Step 6) Who pulls the authority from most independents which takes away great customer service of explaining their itemized estimate to the insured in person while they are out there …see column one. This also applies to carriers who have pulled field adjusters from handling contents claims and additional living expenses so the insured once again has to deal with multiple adjusters (field and in office) rather than having the personal claim service they desire from one adjuster?
 
Step 7) Carriers then blame everyone in column 2, 3, 4, and 5 for causing poor claim survey results and swears to never use much needed independents so experienced independents leave the claim industry as they have no way to support their families.
 
Step 8. ) A major catastrophe such as Ike and Katrina hit and independent adjusting firms are asked to deploy again to assist storm insurance consumers who have no idea what changes have taken place at the carrier’s regarding claim handling standards as the Carriers in Column 1 do not communicate with individual adjusters or hold yearly claim conferences updating them on the hot topics they have been dealing with while independents were at home trying to support their families. Why don’t they have newsletters for independents (refer to comment above on employee/independent issues). No instead they insist they will stop using independents again.
 
Step 9 ) Return to Step 1 and the cycle we regularly experience starts once again.
For two examples of the blame game see the final report of the Citizens  FL Task Force on Claim handling where they submitted their findings to the Citizens Board of Directors blaming both independents and public adjusters for reopen claim issues. I don’t recall seeing where any responsibility was accepted by this now largest insurer in FL except possibly understaffing with field adjusters but they are moving in the right direction training staff and Independents deployed pre-storm and with face to face meeting requirements that they are visiting unannounced to be sure the adjusters are being taught their claim handling expectations and not just glossed over.
 
See also this news article I posted recently where General Manager, Jim Oliver, of the Texas Windpool partially puts the blame on inexperienced adjusters. This is very exasperating to me when I am going on my fourth year of searching for all carrier claim certification classes for members of ClaimSmentor. I can rarely find them except by the few adjusting firms posting in classifieds which are cost prohibitive to most firms when they haven’t gotten many carrier assignments such as in 2006 and 2007. Carriers have staffed up with employed staff adjusters due to their erroneous decisions in the steps above instead of looking SQUARELY in the eyes of their claim training operations, their current trend to leave the responsibility of deployment of independent adjustering firms instead of the carrier maintaining control (again employee vs independent issues).
 
Should anyone question my dedication to keeping independent adjusters informed for the right reasons…it took me 8 hours of volunteer time to produce this one blog entry to provide resources and information for you.  I had no clue as all of our resources were internally generated as claim staff employees.
 
It has been a very long four years studying the independent insurance adjuster industry and learning that while  I had managed them for years that I knew nothing about what went on before they deployed with us. It has been a major eye opener which I openly share with those in our field who need to get caught up to speed immediately in their decisions on entering the independent field and once they confirm that decision learning the professional way to perform their duties. **Update 3/7/09: You can follow this blog through RSS feeds as long as you are not placing it on a site that has banner ad sales or revenue generated through google ads (exception CADO who also spends untold hours volunteering his time for his site). I am getting referrals to this site from Blog Colony which I still have to research which are new this week and have another site copying my links on right column on their website. I am taking proactive action through ICAN  and this wordpress administration who controls websites so be forewarned if you want to remove them if you are using a link to this site to generate revenue for yours. All independent adjusting firms or claim groups are free to put up a blog roll on this such as the one CADO (www.catadjuster.org) has on their blog page in bottom left corner. WordPress does NOT allow banners or search engine ads at this location so I will be proactive with them to shut your feed to this blog if you are using it for such purposes which we can see on our administation dashboard.
**************
I welcome any volunteers who want to edit my blog entries to correct mistakes made. I was always taught by my mentor , my dad, not to present a problem without a solution….smile. If you have the solution for my lack of social networking editorial skills I welcome your help in this additional e-mentoring project.
 
For other great resource links, articles, and claims news I highly recommend Roy Cupps CADO  site at www.Catadjuster.org which has operated atleast 10 years. His article section, news section, employer rating section, adjuster resume data base, and so much more . The archived forums provide a wealth of information about the independent opinions. We formed ClaimSmentor with Roy Cupps blessing initially in those forums but took quite a bit of harassment from a few bad apples who felt we were taking away their job opportunites so we moved the site to a private site at www.ClaimSmentor.com. I have nothing but the very highest regard for Roy Cupps and the resource links he keeps updating on his site.
 
Here are links to all prior blogs we have written in our archives since we began this service in July 2007 that discuss these issues on emergency licensing, carrier’s deploying adjusters, claim training, insurance regulations, and all other topics we’ve discussed in today’s current blog for a more thorough understanding of the changes needed :
 
https://dimechimes.wordpress.com/2009/03/06/just-one-claimsmentor-moment-2-twia-adjusters-blog-on-ike-claim-handling-issues/
 
https://dimechimes.wordpress.com/2009/02/27/adjuster-overtime-issues-supplemental-info-from-none-other-than-attorney-gloria-allreds-current-news-letter/
 
https://dimechimes.wordpress.com/2009/02/26/compare-twia-manager-jim-olivers-comments-about-a-major-galveston-storm-608-to-209-statement-on-ike-claims-part-i-of-ii/
 
https://dimechimes.wordpress.com/2009/02/23/branch-consultants-whistleblower-case-reinstated-appeal-court-decision-february-2009also-links-to-info-on-the-rigsby-whistleblower-cases/
 
https://dimechimes.wordpress.com/2009/02/19/citizens-of-fl-board-approves-selection-of-30-selected-adjusting-firms-see-list-here-with-websites/
 
https://dimechimes.wordpress.com/2009/02/19/citizens-of-fl-board-approves-selection-of-30-selected-adjusting-firms-see-list-here-with-websites/
 
https://dimechimes.wordpress.com/2009/02/14/twia-texas-windpool-offers-two-adjuster-certification-workshops-in-march-and-april-2009/
 
https://dimechimes.wordpress.com/2009/02/13/independent-adjusters-participant-in-our-poll-on-carrier-certification-exams/
 
https://dimechimes.wordpress.com/2009/02/13/have-license-ready-to-go-not-so-quick-take-this-self-assessment-test/
 
https://dimechimes.wordpress.com/2009/02/05/have-you-registered-for-your-2009-nfip-adjuster-certification-class/
 
https://dimechimes.wordpress.com/2009/02/05/2509-updates-on-the-state-farm-announcement-in-fl/
 
https://dimechimes.wordpress.com/2009/02/03/we-are-back-next-50-hour-online-fundamentals-of-claims-class-begins-march-2-2009/
 
https://dimechimes.wordpress.com/2008/10/08/2008-claims-magazine-claims-salary-survey-is-up-in-the-october-2008-issue/
 
https://dimechimes.wordpress.com/2008/09/20/new-source-for-temporary-housing-in-houston-tx-area-for-adjusters-and-insured-additional-living-expense-temporary-housing-part-ii/
 
https://dimechimes.wordpress.com/2008/09/17/independent-agents-rank-claim-service-as-top-measurement-of-carrier-performance-part-ii-of-claim-and-agency-relationships-can-make-or-break-an-adjuster/
 
https://dimechimes.wordpress.com/2008/09/03/preliminary-damage-statistics-from-hurricane-gustav-updates-on-temporary-housing-in-gustav-damage-territories/
 
https://dimechimes.wordpress.com/2008/08/26/hurricane-gustav-expected-to-be-major-emergency-tx-and-la-license-links-claim-statistics-for-ts-fay-eduardo-dolly/
 
https://dimechimes.wordpress.com/2008/08/21/fl-emergency-adjuster-regulations-for-tropical-storm-fay/
 
https://dimechimes.wordpress.com/2008/08/26/hurricane-gustav-expected-to-be-major-emergency-tx-and-la-license-links-claim-statistics-for-ts-fay-eduardo-dolly/
 
https://dimechimes.wordpress.com/2008/08/07/ms-ag-hood-and-state-farm-reach-agreement-on-katrina-disputes-wednesday-86/
 
https://dimechimes.wordpress.com/2008/08/05/citizens-of-fl-cancels-rfp-for-independent-adjusters-yet-another-time-in-2008-rebid-now-times-4/
 
https://dimechimes.wordpress.com/2008/07/23/hurricane-dolly-makes-landfall-in-texas-checking-availability-for-rosters/
 
https://dimechimes.wordpress.com/2008/06/26/nationwide-insurance-proposes-one-policy-covering-wind-and-flood-coverage/
 
https://dimechimes.wordpress.com/2008/06/02/auto-adjuster-claim-training-updates/
 
https://dimechimes.wordpress.com/2008/05/29/what-role-are-rising-gas-prices-going-to-play-in-your-deployment-decisions-for-hurricane-season-2008-carriers-and-adjusting-firms-should-meet-the-need/
 
https://dimechimes.wordpress.com/2008/05/23/colorado-hail-tornado-of-may-22-2008-updated-damage-reports/
 
https://dimechimes.wordpress.com/2008/05/19/concerned-regarding-adjuster-fee-schedules-for-citizens-of-fl/
 
https://dimechimes.wordpress.com/2008/05/14/citizens-of-fl-changes-independent-training-requirements-for-2008/
 
https://dimechimes.wordpress.com/2008/05/01/insurance-carrier-claim-certifications-where-do-you-test-for-them-much-improvement-needed-in-the-process-of-certifying-independent-adjusters/
 
https://dimechimes.wordpress.com/2008/04/30/va-tornado-damage-the-carrier-claim-numbers-are-coming-in/
 
https://dimechimes.wordpress.com/2008/04/28/top-blogs-of-interest-to-new-adjusters-july-2007-april-2008/
 
https://dimechimes.wordpress.com/2008/04/18/supplemental-request-41808-for-tx-licensednationwide-certified-adjusters/
 
https://dimechimes.wordpress.com/2008/04/11/immediate-need-for-experienced-adjusters-tx-license-for-storm-claims/
 
https://dimechimes.wordpress.com/2008/04/10/overhead-and-profit-claim-settlement-issues-under-attack-in-3-ongoing-cases/
 
https://dimechimes.wordpress.com/2008/04/09/state-farm-seeks-dismissal-on-rigsby-false-claim-actklg-update-levee-break-sher-decision-including-overhead-and-profit-issues/
 
https://dimechimes.wordpress.com/2008/04/08/fifth-circuit-appeal-opinion-overturns-punitive-damages-in-broussard-vs-state-farm/
 
https://dimechimes.wordpress.com/2008/04/07/allstate-releases-mckinsey-documents/
 
https://dimechimes.wordpress.com/2008/04/02/adjusters-read-about-class-action-lawsuit-in-ok-on-overhead-and-profit-issues/
 
https://dimechimes.wordpress.com/2008/03/29/cori-rigsby-january-2008-deposition-hoped-to-remain-anonymous-lets-compare/
 
https://dimechimes.wordpress.com/2008/03/28/branch-consultants-whistleblower-case-appeal-filed-on-the-dismissed-case/
 
https://dimechimes.wordpress.com/2008/03/06/rigsby-whistleblower-rico-case-motion-to-dismiss-3-of-insurance-carriers-to-focus-on-state-farm/
 
https://dimechimes.wordpress.com/2008/03/06/national-association-of-catastrophe-adjusters-membership-drive-to-31508/
 
https://dimechimes.wordpress.com/2008/02/23/state-farm-vs-hood-part-iii-an-interesting-news-alert-today/
 
https://dimechimes.wordpress.com/2008/02/21/60-earthquake-rocks-nv-ut-parts-of-ca-22108-adjuster-information/
 
https://dimechimes.wordpress.com/2008/02/08/errors-and-omissions-coverage-guest-bloggers-dale-moore-client-relations-director-for-cplic/
 
https://dimechimes.wordpress.com/2008/02/06/storms-in-tn-ky-ak-al-in-mo-ms-of-2508-adjuster-information-on-emergency-licensing-and-damage/
 
https://dimechimes.wordpress.com/2008/02/05/luckwhere-preparation-meets-opportunity-published-208-in-claims-education-magazine/
 
https://dimechimes.wordpress.com/2008/01/11/update-on-the-rigsby-ea-renfroe-whistleblower-case-will-the-klg-get-dismissed-on-cases/
 
https://dimechimes.wordpress.com/2008/01/10/do-you-really-know-what-your-errors-and-omissions-coverage-covers/
 
https://dimechimes.wordpress.com/2008/01/09/should-your-adjusting-firm-or-carrier-be-blogging/
 
https://dimechimes.wordpress.com/2007/12/18/renfroes-deposition-in-the-rigsby-whistleblower-case-interesting-look-into-their-thoughts-on-the-case/
 
https://dimechimes.wordpress.com/2007/12/13/ok-declares-state-of-emergency-allowing-emergency-adjuster-licenses-link-for-application/
 
https://dimechimes.wordpress.com/2007/11/20/major-changes-in-the-way-carriers-recruit-and-train-adjustersis-there-really-a-lack-of-available-adjusters/
 
https://dimechimes.wordpress.com/2007/11/14/tomorrow-is-postmark-deadline-to-get-applications-in-to-join-naca-national-assn-of-catastrophe-adjusters/
 
https://dimechimes.wordpress.com/2007/10/25/what-can-adjusters-learn-from-the-2003-cedar-fire-regarding-litigation-and-complaints-on-claims-from-ca-wildfires-blog-4-ca-wildfires/
 
https://dimechimes.wordpress.com/2007/09/29/claim-career-coachingconsultant-services-for-new-adjusters/
 
https://dimechimes.wordpress.com/2007/09/27/independent-adjuster-vs-employee/
 
https://dimechimes.wordpress.com/2007/09/24/insurance-adjuster-overtime-pay-issues-and-complaints-in-the-news/
 
https://dimechimes.wordpress.com/2007/09/21/valued-policy-law-in-florida-thrown-out-update-on-mierwza-safety-concerns-part-2fl-insurance-crisis-update-go-jeb/
 
https://dimechimes.wordpress.com/2007/09/14/field-adjuster-safety-concerns-be-careful-remembering-katie-froeschle-of-tampa-fl/
 
https://dimechimes.wordpress.com/2007/09/13/humberto-makes-landfall-as-category-1-hurricane-damage-links-and-stats-and-adjuster-licenses/
 
https://dimechimes.wordpress.com/2007/09/12/commitment-part-2-standby-calls-what-should-i-do-how-are-cat-codes-determined/
 
https://dimechimes.wordpress.com/2007/09/12/tropical-depressions-8-and-9-humberto-and-ingrid-standby-discussion-commitment-discussion-continued/
 
https://dimechimes.wordpress.com/2007/09/10/the-big-c-commitment-problems-with-independent-adjuster-relationships-advice-by-guest-blogger-rocke-baker/
 
https://dimechimes.wordpress.com/2007/09/08/ts-gabrielle-east-coast-windpool-and-emergency-licensing-information/
 
https://dimechimes.wordpress.com/2007/08/30/adjustin-to-adjusting-guest-blogger-linda-goodson-first-storm-duty-was-katrina/
 
https://dimechimes.wordpress.com/2007/08/23/whistleblower-cases-and-your-e-and-o-coverage-part-2/
 
https://dimechimes.wordpress.com/2007/08/12/splish-splash-dont-go-takin-a-bath-understanding-independent-firm-contracts/
 
https://dimechimes.wordpress.com/2007/07/31/naic-model-independent-adjusters-licensing-act-cancelledand-changes-in-nm-nc-and-tx-licensing/
 
https://dimechimes.wordpress.com/2007/07/30/who-moved-my-claims-cheesedealing-with-change-in-the-insurance-adjusting-community/
 
https://dimechimes.wordpress.com/2007/07/27/claim-career-information-the-pros-and-cons-of-going-staff-adjuster-versus-independent-adjuster/
 
https://dimechimes.wordpress.com/2007/07/26/catastrophe-adjuster-resumes-the-requirements-to-get-noticed-do-differ/
 
https://dimechimes.wordpress.com/2007/07/26/most-commonly-asked-question-is-how-much-income-can-i-make-as-an-adjuster/
 
 

Adjuster Overtime Issues Supplemental Info from none other than Attorney Gloria Allred’s current news letter!

February 27, 2009

Speaking of reading interesting information found on the internet! I found this information on Gloria Allred’s law firm website. If you are a Greta Vansustern  fan on Fox News (9 pm CST week nights) you will definitely recognize her. This is a post she has on her current newsletter about overtime and wage and hour issues you will find interesting:

http://www.amglaw.com/CM/News/eNewsletter.asp

Here is a link to our prior blogs on Adjuster overtime issues. One of these days we’ll get a great employment attorney to answer adjuster questions on overtime issues. (Gloria…..hint we are a big fan of Foxnews but this is a  volunteer free non income producing volunteer effort blog trying to educate trainee independent adjusters with no ads so we need pro bono-smile! ):

https://dimechimes.wordpress.com/2007/09/24/insurance-adjuster-overtime-pay-issues-and-complaints-in-the-news/

**Update 2/27 4 pm CST:

Had I read Gloria Allred’s Bio before making this entry I might have been less likely to have teased her on an open blog. She has a most impressive background. Here is a link:

http://www.gloriaallred.com/CM/Custom/TOCAbout.asp


Compare TWIA Manager Jim Oliver’s comments about a major Galveston storm 6/08 to 2/09 Statement on Ike Claims- Part I of II

February 26, 2009

It is amazing what you can run across on the internet when you just spend some time looking around.  Anyone that follows posts made here knows we certainly do that…if only we could afford a great editor to turn this information into fine editorial posts!

Atleast we plug along the best we can here given very very limited time these days due to my daughter’s medical recovery from tumors discovered in 2008 and subsequent major surgery a few weeks ago to correct damage caused when the tumors shattered nerves and bones as they developed and the radiation damage caused in the aftermath of tumor removal operations. So bear with me  here and take the information and article  links we post here and gather as much information as you can from the articles. Our goal here is very clear to those in the independent claims industry who have a most difficult time when they are not on assignment with carriers gathering hot topic information to educate them on the problems facing our industry. Reporter NOT…Editor NOT..Journalist NOT but interested in helping independent claims adjusters understand our industry…now that is a BIG YES! I sure miss the days with a carrier having a great administrative assistant to take my reports and by magic turn them into professional appearing work product! (Thank you Gail, thank you Cindy and many others!). So set aside your grammar, spelling, and run on sentence checkers and read the professional articles linked within this post.

While researching information today after reading an article from the Galveston news the other day updating the statistics on TWIA (Texas Windpool ) claims from Ike quoting manager Oliver found here, I ran across another article quoting the General Manager at TWIA, Mr Jim Oliver, over at Gene Taylor’s old website/blog here .

I hope you read both- it is almost scary how very dead on he was about the “what if a Category 3 hit Galveston” written in June 08. I have to say that manager had the intuition and knowledge to evaluate the what if’s correctly and what effect it would have on the state of  Texas and the policyholders. He was almost dead on as well about the dollar amount of damage. This is a don’t miss comparison. Do his comments sound familiar about major carriers pulling off the coastal coverage?

A few comments on the first link in the February 09 article found on MS Congressman Gene Taylor’s old blog.

Here we go again about “inexperienced adjusters” quoting from comments by Jim Oliver. I’m sorry but someone has to stand up for those inexperienced adjusters  and independent adjusting firms (whose hands are tied as to who can and cannot attend the carrier training based on experience) who they had working some  of the TX Windpool claims. I am not blaming TWIA .It is a constant problem in the Insurance Company/ Independent Adjusting firm/ Independent Adjuster relationships.

Let me explain why. I feel qualified to do so after founding and supporting our site  at ClaimSmentor where we have over 1,000 partipants with about 50% of them being new independent adjusters. I can tell within 30 days of membership those who are serious about their training and those that thought  it was a “get rich quick scheme” or career because they either 1) walk away and forget the thoughts of a claims career  when they find out how much is really involved BEFORE deploying or 2) they are extremely serious in their pursuit of professional claims development and I see them on the site forums at night and on weekends (you would NEVER find staff doing so if they aren’t on salary or on the clock).

They spend literally thousands  of dollars and time without the benefit of an employers expense account for per diem while attending carrier certification classes, taking required estimate software training classes, adjusting firm conferences, being forced in some cases to pay for training   just to get on rosters in hopes of being deployed on a storm (I’ll post some unbelievable samples for you tomorrow).

Now here is the real kicker that goes on every day in this industry which drives all of us crazy as there is no such thing as a carrier mentoring new independent adjusters. All national carriers and the windpools set a minimum number of years experience  required BEFORE an independent adjuster can sit  in at an independent adjusting firm designated by the  carrier’ to administer  required training for them. The carriers may send one to a few representatives to the adjusting firm selected to present the material but that isn’t always the case either.

It is usually a minimum of two or three years experience required yet the carriers do NOT allow them to take carrier certification exams without the experience….until something major hits and then they often waive the certification requirement if they are licensed. Heck- look at TX emergency adjuster license information  on the TX Ins Dept website and they even allow emergency adjusters to work under an experienced adjuster (unless they changed something recently).

 Also, check around on the majority of carrier websites and you will not even find mention on their claim links  information or links to independent adjusting firms who they can take classes with so independent adjusters  even know who presents them. It is all based on who they  (independent adjusters )  know and what advertisements or forum posts they find as to where they can find an exam to take.

In additon, thousands travel across the country just to find one. I do not know of any carrier yet adminstering them online. Rumor has it one major carrier will be presenting their training on laptops given to the adjusting firm but the independent will still have to travel across the country to watch the laptop presentation and to take the test. We understand the need for a proctor to administer the exam but come on….how about Prometrics or one of the exam centers with national services where adjusters take license exams? How about the fact that an independent has no clue who may call to deploy them from an adjusting firm standpoint so they have to take as many carrier exams as they can complete before each storm season so they can go? What about the fact the carrier’s often think that there are no experienced adjusters available when the reality is there are many many independents who are turned away because they just haven’t taken their exam yet prior to the storm the carrier will not make any common sense exceptions yet they have 20 years in the  claim industry? Believe me this does go on…I hear it from adjusters, adjusting firms, and my claim staffing firm has experienced this many many times.

I am not supporting inexperienced adjusters with a license only…just the inexperienced adjusters who have taken classes (not 3 day schools or worse yet a one day class!)  and by that I mean classes approved by state insurance departments who approve  trainers  for CE courses sometimes requiring  at minumum 5 years or more experience in the m industry person and continuing insurance education in insurace such as the AIC or CPCU designation?  It is one thing to have field adjusted claims and an entirely different thing to manage claims and understand all of the reasons there are file requirements due to Bad Faith claims and the current litigation environment.

Today there are many experienced adjuster resumes from adjusters with 10 plus years experience with a vast amount of litigation experience that can run circles around some carrier “claim examiners”, reinspectors, and entry level claim managers. I hear these war stories too from the field. Why is ok for all the blame about what went wrong on a storm squarely on the shoulders of independent adjusting firms and independent adjusters who are required to follow carrier established guidelines. As the saying goes “if they tell you to staple the photos upside down…don’t argue or we will lose our contract to service their claims”.

Now exactly how are they  (independent trainees ) supposed to gather that experience?

Experienced independent’s do not have time to train them as it slows down their productivity and they do not make one dollar until closed files get approved and they receive payment usually weeks and months later. Believe me, the carrier quotas for contact and inspections in  this industry are sometimes impossible for staff or independent adjuster to meet. The carriers are driven by Department of Insurance deadlines for contact, inspected, and closing numbers and atleast in the past they had to report those numbers at minimum to the department of insurance on a weekly basis. The second concern I hear regularly is that they would be concerned about liability issues if a trainee they aren’t responsible for as an independent fell off of a roof or if the adjuster happened to be involved in an accident while handling inspections on their daily agenda? These are valid concerns. That is why we started ClaimSmentor- to see what we could accomplish online to avoid those concerns and I can tell you – it works and they will be much better trainees when they can accompany a field adjuster later during a storm.

I agree with the decision of carriers to best service the policyholders however….when something major such as Ike or Katrina causes massive damage those requirements are thrown out the window and anyone with a license can successfully deploy without any real life training or often given a one day training seminar when they arrive on site.

How about the carriers that cross train  staff claim central adjusters who have NO field experience versus a good percent of independent adjuster trainees that often have fantastic construction general manager experience, insurance agency experience, or other skills much more easy to work with than trying to train someone on construction.

I can vouch for the fact it is easier to teach a contractor who knows construction and estimate programs to complete claim forms and learn policy than it is to teach an in office phone adjuster who has no construction experience to learn that side of adjusting. I know- I started in office and moved to the field after two years in office so I understand the difficulty dealing with construction training while handling an insured in crisis.

Ask anyone who has deployed with merely a license if an adjuster’s license prepared them whatsoever for a carrier’s file requirements, estimate format or estimate scoping guidelines and they will tell you definitely NOT!

What about the carrier staff adjusters who may not even have a non resident license in that state? Check any insurance department website and see what they have to say about waiving non resident licenses for staff adjusters. Is it because the carrier has deep pockets and independent adjusting firms and adjusters do not in the event something goes wrong or do the insurance departments merely assume the carrier’s have trained all in office folks before deploying them on a major disaster?

 How about the carriers that are forced to use auto adjusters to adjust property claims because their executive office forbids use of independents in these poor economic times and worse yet underwriters who definitely have a great grasp on coverage but no clue how to handle a claim or to understand construction  repair concepts?

This is a nationwide problem with most carrier’s which I have never understood.  If we accept premium dollars do we not owe it to policyholders to have the properly trained claims adjusters?

Hail damage experienced adjusters do not necessarily understand total losses for major hurricane damage or major fire loss damage estimates.

There is alot of improvement needed all around in the catastrophe claims industry on the carrier side , the independent side, the insurance department regulations, and the National Assn of Insurance Commissioner’s who cancelled the proposed National Independent Adjusters Model Licensing Act which those who are independents do not understand to this day. I’ve blogged about that in the past and will post a link to that blog in Part II.

Watch later this week for part two….for tonight- enjoy reading the two articles. You will definitely be quite shocked at Jim Oliver’s correct assessment of what would happen in Galveston.

I’ll also leave you with a link for Slabbed’s  interpretation of this article and TWIA from a consumer perspective written today after I shared a link to the Galveston article with them based on an entirelydifferent  blog discussion we had the day before . You’ll find their blog article here.

You may disagree with Slabbed posts but if you follow them regularly you will atleast come to the understanding they are diligent in their efforts to help slabbed  homeowner’s(those who lost entire home but the slab during a storm) in the fight about homeowner policy exclusions that create the non coverage issues . I feel the same way about Attorney Chip Merlin’s blog entries. If you don’t know Chip…and I have never personally met him..he is a force to be dealt with. He has offices in FL, MS, and now Houston as well.You can also find photos of him giving a seminar at the National Public Adjuster Association conference at www.NAPIA.com.  

 In fact, I link to his  blog often as well for training purposes. Yes, I do understand he represents the insured not the insurer but that does not change the fact we can learn from his articles and blogs when you don’t find any insurance attorney’s writing such great blogs (except Rossmiller who hasn’t blogged for almost 6 months). If an independent or staff adjuster read them such as his posts on Bad Faith…he is “shouting from the roof tops “that would prevent adjusters from being sued if they just followed fair claim handling guidelines. You just have to “toughen up” to read both and have a thick skin so you don’t take the negative comments about the insurance industry as a whole personally. By the way…if you are a Fox news  fan or Headline News  fan it might be, he is regularly interviewed on the horrific missing childrens cases in central FL (Caylee and Haleigh) . You shouldn’t let the negative comments keep you from reading some important information and articles on his website and blog. Both Slabbed and Merlin’s blogs post links to court documents on active insurance claim litigation we all rarely ever get an opportuntiy to view since staff nor independents are privy to file documents on a claim not assigned to them.

 Truth be told, adjusters inheriting files from a few bad apples  (experienced and inexperienced it just depends on the adjuster’s ethics and training) make the same comments about some files involving poor file claim handling by a percentage of adjusters. The only difference is staff and independents cannot post publicly for fear of losing their jobs. It still doesn’t mean we can stick our heads in the sand and not study the issues and all work a little bit harder to do the right thing no matter what pressure we are under and we all know how bad that pressure is on storms such as Ike and Katrina.

I’ve been there and have so much empathy for not only the claims industry but for policyholders suffering these losses with no coverage. I’ll post more on the 2009 Multi Peril Act as well later this week.

Speaking of Attorney’s, what happened to one of the rare great blogs with the insurance company perspective many of us followed over at David Rossmiller’s blog? Those of us who follow these forums and blogs miss the point and counterpoint between the insured’s perspective and the carrier’s perspective! If you know if Rossmiller is ok, let us know! I think his last blog was in September of 2008 which is remarkable considering his opinions posted on Scruggs and Scruggs recent appearance in MS court with no comment from Rossmiller.

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Update 1:24 am CST- Ok- I just had to add one more great article titled “Talent Cultivation” from a February 09 issue of Claims Magazine found here:

http://www.claimsmag.com/cms/Claims/Monthly%20Issues/Issues/2009/02/Features/FEATURE%20cover%20story?origin=channels-Education-Training

**Link will move to archived links there when the March issue comes out.

When will carriers learn if they are going to depend on independents for major catastrophes as they downsize their staff that they need to make carrier certifications more accessible online and that independent adjusters need to be trained when they don’t have an inbox overflowing with new assignments waiting for them after a storm class on scene. They can have an “A” list of experienced certified independents that are activated on regular hail storms and a “B” list of less experienced independent adjusters also trained and ready to go when the major storms like Ike and Katrina! Now that would be talent cultivation and a claims mentor of the finest nature! We have hundreds of very trained adjusters  as well as experienced adjusters. At ClaimSmentor  you can deploy with NO fee as we invite your HR departments to post job opportunities for both experienced and for trainee adjusters  and independent claim managers and claim examiners regularly!

Join us and come in and download their resumes!  You decide if many of them are better than a newly licensed only trainee!

**Update 2/27/09…Just one more link: Here is a Self Assessment Test with 125 questions a newly licensed adjuster can review and see how many of these topics covered in our Fundamentals Class at ClaimSmentor  and this is far from a complete list of basicessential things they need to know before deploying.

You can’t teach this im a 1 day or a 3 day class. They may learn very very basic essentials but many that take my class online after taking many very good field classes advise that much of this material was not covered. Mind you these are new adjusters who have taken and passed adjusters license exams, estimate software classes, and in many cases have passed atleast 1 carrier certification exam. They usually have the 3 basics at minium (license, software, and 1 carrier certification ) and tests that cover basic estimating but not the majority of these other important topics. Is it any wonder we have files often mishandled due to a lack of training?

https://dimechimes.wordpress.com/2009/02/13/have-license-ready-to-go-not-so-quick-take-this-self-assessment-test/

Carriers should not complain about needing inexperienced independent adjusters not trained on claim file requirements if they are not willing to let them take their training. They pick up the expense as independents. Follow the example of NFIP who allows them to attend their workshops but will not certify them without 4 years experience….but sometimes make exceptions during major disasters IF they took the current year’s workshop.

My many heartfelt thanks go out to the now hundreds of experienced adjusters who participate on ClaimSmentor to help answer trainee questions without any hassle in our forums and even join us sometimes stopping by in our live online classes for trainee adjusters as well as thanks to the claim managers who also do the same. Our site would not be possible without their partipation and willingness to support our e-mentor project.

**Update 2/28/09 10:45 AM: I had not been following the claim statistics that often recently and today ran across an Insurance Journal article form August 08 about the TWIA losses already depleting funds when two other minor hurricanes came in before Ike. Read this link for the information:

http://www.insurancejournal.com/news/southcentral/2008/08/26/93100.htm


FL Emergency Adjuster Regulations for Tropical Storm Fay

August 21, 2008

 

Independent adjusters working Tropical Storm Fay claims will need a FL Emergency Adjuster license per the following directive by the FL Department of Insurance if you do not have a resident or non resident FL license:

http://www.myfloridacfo.com/agents/Emer-Rules/Emer_Adj_Instruct.htm


Renfroe’s deposition in the Rigsby Whistleblower case-Interesting look into their thoughts on the case

December 18, 2007

You never know what your going to run across on different claim issues we like to follow in the claims industry. Today was one of those days that a follow up on the Renfroe / Rigsby whistleblower case lead me in a direction not expected on a Scruggs firm link to a deposition given by Jana Renfroe of the EA Renfroe firm which was given to the Rigsby attorney in March of 2007. It was hours worth of interesting reading not just from a human interest story in this major case with the players involved but from a management perspective which I felt could be a very useful training tool  as many issues came up in the form of questions that managers and owners of adjusting firms need to have a good handle on regarding employment, performance records they maintain on personnel, training records, all communications, and in maintaining all  deployment records with carriers.

I post about this deposition as it provides very useful and interesting insights into things claim managers need to be prepared to provide deposition testimony about should the need ever arise as has often happened in the aftermath of Katrina. The questions asked in the deposition of the EA Renfroe owners are things all managers should be prepared to answer should they be deposed on similar cases. The purpose of this particular deposition was made clear in the statements by the Renfroe’s attorney to Mr Hawley, the attorney representing the the Rigsbys. The deposition was taken in March of 2007 regarding the breach of contract allegations on the Renfroe / Rigsby contract. When Attorney Hawley (Rigsbys attorney) tried to bring in the issues of the wind vs water claim calls, objections were raised. I was surprised the attorney even tried to broach those topics with Mrs Renfroe as she testified in her deposition she was not an adjuster but had traveled with husband Gene in their early years prior to having children. I was most impressed with the fact that she had obtained her MBA and I  thought she made a credible witness on her own behalf  in the deposition as I read it.( I have to admit it would have been very interesting watch in person after doing kinesic interview technique training in my early years as an adjuster). I was a bit surprised at her lack of knowledge regarding more particulars on contacts at the carrier level and IDL certification specifics as the owner of the firm but her role was more financial and personnel related. I very much liked comments she made in her deposition regarding their desire to be “partners” with their independents and their wish that the Rigsbys had notified them of their concerns with what the Rigsbys felt were “irregularities” so they could have had the opportunity to investigate their allegations as they would with other concerns raised with carrier staff or independent personnel they deploy.

I have  wondered what the Renfroe’s position was on the Rigsby whistleblower case as I’m sure many of you have (they are owners of EA Renfroe who the Rigsbys worked for).

Today’s google alert sent an interesting link to this information on the
Scrugg’s site and I happened to click onto the link they had to Jana Renfroe’s
deposition taken in March 2007. It took hours to read to comprehend everything
but was a good learning tool as to things an adjusting firm or manager should
think about regarding contracts, regarding having a 1-800 hotline established
for your adjusters to report suspected fraud or wrong doing, and to consider how
your firm is going to look when being deposed on training requirements your firm
has, documents you maintain to keep up with those training achievements,
deployment selections, and how you track performance evaluations for your
independents. Of much interest is the comment on the last page of the deposition
by Jana Renfroe on page 94 when asked what she thought of the allegations made
by the Rigsby’s and her indication that “she didn’t know what to believe”.  
I’ll outline other allegations. Note on about page 80 where she testifies in her
deposition that thus far the attorney fees on the case have been about half a
million dollars….unreal! Also interesting her testimony that there is not a
joint litigation effort between Renfroe and State Farm on these issues. I’d been
wondering about that. 

*********

Here’s the Scruggs webpage:

http://www.scruggskatrinagroup.com/state-farm-on-the-defensive/index.php

Note- that the link above also has links to the AOL subpeona’s for the
Rigsbys personal email accounts ( I bet they hate having those email addresses
published!) 
 

Here’s the link to the subpeona on the Rigsbys AOL email:(watch what you say
even on your personal email!)

XXXXXX-link discard 3/09- Scruggs site down since he went to prison and no longer works.

****************  

Link to Jana Renfroe’s deposition: (from above link)-link removed 3/09 as Scruggs site down

*****************
If you missed it, here was the original complaint against the Rigsbys by EA
Renfroe: (I’ll see if slabbed has this-the Scruggs site is down)

***********************
Here is some of the more interesting information summarized from the 94 pages of the
deposition (see numbers on bottom right of each page- each page has a number
(1-94) for whole page and each page of the transcript is like 4 pages reading
1-372 but I refer to the number 1-94 for the whole page in most cases.

It is very interesting reading this entire deposition to get a history on EA
Renfroe’s beginnings in the mid 90’s. Gene had been a long term adjuster/manager
with Crawford prior to opening their own firm in 94 or 95 in Atlanta. Many of
the early members and managers came from Crawford. Most impressive is that while
Jana has no adjusting background herself, she did travel with Gene prior to
having a child and later completed her degree as well as her MBA before they
opened EA Renfroe. The deposition is a who’s who of managers and “liasons” at
Renfroe and State Farm that they dealt with. These are some of the pages I
personally found most interesting, possibly given my State Farm background in
claims for 28 years to include catastrophe management:

 The first page of the deposition which was being taken by defendent Moran and Rigsby’s attorney, Mr
Hawley shows that Cori and Kerri as well as Gene Renfroe were present during Mrs
Renfroe’s deposition(thus the comment about kinesic interview observations). Note that the Renfroes’ attorney objected to any line of questioning during the deposition that could have been part of discovery on the
wind vs water issues and wanted the questions limited to questions about breach
of the employment contract so you’ll read many objections by the Renfroe’s
attorney during the course of the deposition.

Page 29 (pages 113-116)- How they hire- Ms Renfroe said they prefer offering employment to
retired military as a second career and other recruiting is done through word of
mouth via referrals from other adjusters. (Glad to see confirmed my assessment
that some of the major carrier independent players don’t solicit new employees
through advertisements but rely on their reputation thus many good adjusters are
left out of the mix leaving carriers with impression that there are no adjusters
available when a particular adjusting firm they use runs out of core players). On various other pages throughout the deposition they discuss their number of independents and state they originally had 100-150 and have grown to
about 1200. The testimony says they deactivate about 150 adjusters per year and
that over the course of time they have serviced State Farm claims since the mid
90’s they have had about 100 requests to deactivate an adjuster over performance
issues. Also somewhere in the report it indicates they sent about 300 adjusters
to Katrina and about 20 managers. I was surprised as I expected the numbers to
be much greater on the Katrina assignments.

Page 34 begins a history of their State Farm work and initial contacts with Dan
Kerrigan ( he used to handle all independent assignments). It is interesting
reading this section and seeing there isn’t more formal “courting” of this
client and that they deal with section managers and team managers on various
assignments with very little interaction as far as yearly meetings,etc…

Page 37- very interesting comments on Sales calls by Don Goodin of Renfroe for
non cat work in Atlanta, Chicago, and Arkansas where they can pick up non cat
assignments as being some of their only sales calls on the carrier.

Page 37- mentions some of the conventions they meet with carrier such as PLRB
and possibly windstorm conference,etc

Page 48- Comment that they sent about 300 adjusters to Katrina

Page 49- see their deployment criteria- primarily qualifications then seniority
then availability is the order they used

Page 52- Begins info on Rigsbys position as liasons on the State Farm Katrina
work. Also discusses beginning here the names of the State Farm section managers
and team managers involved.

Page 53- comment that they sent 20 or so liason managers were sent by Renfroe to
Katrina work for State Farm. Discusses who from Renfroe reported to Lecki King
(she is the one Scruggs group posted the photo of pleading the 5th during her depo on engineer firm questions)

Page 54- Starts discussing the employment contract Rigsbys signed with EA
Renfroe

Page 59- I found this strange- the Rigsbys attorney asking Jana Renfroe
adjustment questions on wind vs water when it is established somewhere in the
deposition that she had not been an adjuster yet he was trying to pin her down
on wind vs water coverage issues. She is not licensed adjuster and should not
have been making those coverage decisions anyway but the attorney didn’t seem to
be getting the point.

Page 62-63- See discussions on Code of Conduct report and what procedures they
had set up in their firm for adjusters such as Rigsby’s to report fraud or other
problems to the firm

Page 64- VIP- see reasons they are NOW setting up a 1-800 hotline they indicate
will be monitored by a 3rd party for adjusters to report wrongdoing to avoid any
further “excuses” by adjusters for not feeling comfortable to report wrong doing
by the carrier personnel or other independents

Page 65- Hawley wants to know how the Renfroe’s would have investigated the
allegations had the Rigsby’s ever reported it to them prior to reporting to
outsiders (note that in various places in the deposition they ask how they
handled investigations of performance issues of their independents or of a
carriers wrongdoing)

Page 71- A discussion of EA Renfroe’s connection with Haag Engineering (see
interesting comment on page 72 also alleging State Farm says they will use Haag
Engineering again)

Page 73- starts discussion of the “data dump” weekend and what knowledge Renfroe
had about it. Important note about what they didn’t know- all Rigsby would tell
Renfroe’s Don Goodin is that they couldn’t talk to them and that it wasn’t about
Renfroe but it was about what State Farm had done to them. This page also goes
on with the testimony about how Renfroe found out about the Rigsby’s from State
Farm but again were not told what they’d done but that they were being suspended
WITH PAY (my comment- unreal SF would pay them on daily management rate while
they were suspended but later in the testimony that say that one of the Rigsby’s
went out on stress leave and one said she terminated assignment so neither ended
up on the paid suspension apparently from this testimony in the depo of Jana
Renfroe)

Page 76- Says Cori called Mrs Renfroe in August to talk although they didn’t
complete the discussion as Mrs Renfroe ended the conversation at that time

Page 77- Says they didn’t know what was going on since Cori didn’t tell them and
State Farm Section mgr Dave Randall refused to tell them. They say it was when
their employees were first getting criminal investigation request for records
that they first started to have any idea what was going on yet they didn’t
pursue any additional facts from State Farm since Section Mgr Dave Randall told them he
couldnt tell them anything else other than that the Rigsby’s were to be
suspended.

Page 78- Renfroes’ first learn finally in August 06 (2 months after Rigsby’s
suspended) about the Sun Herald articles and about the 20/20 show as Rigsby’s
husband Paul Moran notified them of the articles ( Can you imagine the position
he must have been in? He is now divorced from Rigsby). Here she goes on to
explain in response to deposition question what rold Cori and Kerri played about
going to the attorney

Page 79-talks about the call from State Farm and the suspension issue again. Mrs Renfroe
comments she was “shocked and hurt” after watching the 20/20 program.

Page 80- Jana Renfroe admits it was “pretty quickly” after the 20/20 show that
SHE made the decision to sue the Rigsby’s “to defend our contracts and integrity
of our contracts”.. Interesting also is her comment that the Rigsby’s were “long
time trusted employees” (my comment-ouch – hmmmmmmmm what effect would that comment have on
future developments in the case?).

Page 81-Continues on page 81 about the Breach of the employment contract and Mrs
Renfroe’s belief the first breach occurred when the Rigsby’s didn’t come to Mr
and Mrs Renfroe to report the problem

Page 82- interesting questions and answers about the breach not involving fact
that they participated in criminal investigation- only the fact they never notified
them of the problem. Somewhere else in depo it says they wanted to be part of
the solution – not left out of the info until they went public.

Page 83- Rigsby’s attorney refers to State Farm as a “sacred cow”

Page 84- Jana refers to fact Rigsby’s had worked State Farm claim for 8 years and no prior
complaints and finding the alleged “irregularities” strange,etc

Page 85- In response to questions about what internal investigations they
conducted after they knew with other adjusters they say none because they didn’t
want to interfere with the ongoing criminal investigations

Page 86- Jana Renfroe says no one at Renfroe consulted with anyone one at State
Farm concerning filing the suit against Rigsby’s ( interesting as I would have
thought this had been discussed!)

Page 87….Ms Renefroe approximates current litigation on the Rigsby case now at
1/2 MILLION dollars…unbelievable!

Page 88- Jana Renfroe’s “absolutely not” comment about coordination or agreement
between Renfroe and State Farm attorney’s on this or any other litigation.

Page 89- She denies any knowledge other than what the Rigsby’s said in their
depos about the State Farm documents the Rigsbys refer to

Page 92- Hawley wants to know if Renfroe has lost any adjusters due to Rigsby
disclosures or due to the 20/20 show and Renfroe responds she doesn’t know ( my
own guess here is it would be hard to tell due to lack of storms since these
revelations and whistleblower case have been going on)

Page 93- remember the recent decision on the OK case involving SF and Renfroe?
Jana Renfroe indicates they had not even been following that case and were
surprised about the decision and also what the issues were on that case she
indicates were clothing issues with independents wearing SF clothes and
performance evaluation issues

Page 94- Very interesting closing answer by Jana Renfroe when asked if she
believe Cori and Kerri Rigsby and she answered “she didn’t know what to believe”

*******************
If I later find Gene Renfroe’s deposition posted or any of the depositions of
other Renfroe managers I’ll post them.

I hope others reading this learn as much as we did reading through this. Many assumptions I personally had such as State Farm and Renfroe possibly coordinating efforts, the when and where the Renfroe’s learned of the Rigsby’s actions, and the fact that the Renfroe’s didn’t know much more than the rest of the adjusting community about this whole whistleblower case until watching 20/20 sure were a surprise to read.

The outcome of these cases remains a mystery and a soap opera those in the claims community can’t help but follow since it is so very unusual for our industry to have such crazy actions going on. Hopefully, posting of depositions such as this will open many eyes that think the only thing to adjusting is a simple 3 day class. An adjuster and adjusting firm have serious problems and responsibilities to properly document claim files, thoroughly handle investigations, and properly document personnel deployments as well as very serious responsibilities to properly train those adjusters deployed to fulfill claim obligations to the policyholders who have paid dearly for the right to insurance protection during major disasters.

Update 3/22/09 – Since Scruggs went to prison, the Scruggs site was pulled down so the links that were in this post no longer work. I’ll see if Slabbed has a link to the deposition on their site.


Just when you thought the Rigsby/ EA Renfroe Whistleblower case/Scruggs issues couldn’t get worse!

December 14, 2007

Just when we thought we’d heard it all after the indictment of Scruggs over alleged bribery, today we now come across a new lawsuit alleging sexual misconduct and inappropriate use of the Rigsby documents by another partner in the Katrina Scruggs group according to this newest post by David Rossmiller of the Insurance Coverage blog found here. Make sure you read the full complaint  found here for all of the details and alleged misuse of the documents through a key firm in the Katrina Scruggs group firm, Nutt and McAlister according to this Insurance Coverage blog entry. Here is also the link Rossmiller provided in his blog with the complaint exhibits found here. (See Exhibit C which was Judge Acker’s order on the Rigsby documents).

David Rossmiller has been providing thorough updates on the Scruggs indictment and related issues so there is no need to report seperately on them here but you’ll find them fascinating and covered in great detail in his blogs beginning with the indictiment. If you don’t already know his blog address by heart, you’ll find all the “Scruggs Nation” blogs at  David Rossmiller’s Insurance Coverage Law Blog.

Other blogs of interest also providing excellent updates on the Scruggs/Katrina issues include:

www.overlawyered.com and here are a few samples of their updates found here and here.

Here’s a good summary of the players and issues involved as well by the NY Times found here.

Another good detailed source of information providing updates on the Scruggs issue is www.legalnewsonline.com and you’ll find the link to all of their Scruggs postings by clicking here.

Another is www.yallpolitics.com and here is just one of many blog updates notifying us of the selection of a judge in the Northern Florida district who will now hear the contempt case after Alabama judges recused themselves found by clicking here.

Rossmiller and others such as Legalnewsonline.com are posting information about how this ties in to AG Jim Hood and ramifications on the pending Katrina litigation against State Farm. Thus, of interest today was this posting about Jim Hood’s redesign of his website which formerly itemized their allegations against the carrier. Very interesting seeing what the redesign is all about! The article on that issue  was also posted today by the www.legalnewsonline blog found by clicking here. This made me wonder what’s become of the Katrina Scruggs group website Scruggs was running with constant updates including the “mug shot” of Lecky King, a claim management employee with State Farm over her alleged pleading the 5th during a deposition involving communications with engineer firms involved on some of the Katrina cases. I couldn’t find that photo anywhere on the site today but things have moved around quite a bit. I’m glad for her if they finally took that dern photo down. I found this copy(click here) sent out by the remaining partners of the Katrina Law group posted at the beginning of December about Scruggs withdrawal from the group while the indictment allegations are being sorted out (and it lists Nutt & McAlister as one of the 3 remaining group partners).

If you missed our 3 blogs on the Scruggs/EA Renfroe/Rigsby ongoing cases, here is a link to my earlier blogs which provide more specifics about the claim documents and allegations. You’ll find links to all previous blogs here on the subject by clicking on this link here.

We’ll all be watching to see how the indictment develops, what ramifications this will all have on the claim suit files, Hood’s action against the carriers, and for more information about the reason for Trent Lott’s resignation after his recent notice he will be retiring. I think there is still much more to be learned in the coming weeks and months ahead…..stay tuned!

I cannot imagine the claim managers having to report on these pending cases with every new twist and turn and reevaluation of their cases. This has got to be creating a tremendous burden on the claims industry. I’ve never witnessed anything like it in 30 years in the claims business. Remember when the worst press a claim department dreaded was a dissatisfied policyholder spray painting derogatory comments on their home or roof after a storm? That’s kids play after all of these soap opera events which have happened in the aftermath of Katrina. Not a good time to be in the claims business! Not only are staff managers and adjusters bearing the burden of this nightmare (slash soap opera) but the public is bearing the brunt of the litigation expenses by way of increased premiums and reduced possibility of carriers as more and more carriers reduce policies in force in coastal communities. When will this soap opera ever end so claims folks can get back to doing what they do best…..settling claims according to the terms and conditions of the policies? I’ll be waiting for updated blogs by David Rossmiller  and others that explain how these lawyers think this indictment, the retirement of Lott, the Hood cases,etc will end up resolving specific to claim files and suits pending. So far from what I’m reading in this article on the Clarion Ledger article found here, Lott doesn’t think he’ll be able to push through legislation he’d previously proposed before his departure.

We’ll post additional new decisions on the contempt case and other related issues as they develop.


Independent Adjuster vs Employee?

September 27, 2007

Storm season always brings up the topic “are you an independent adjuster or are you an employee” as independents start receiving new contracts from adjusting firms for the season.

We wrote a blog about the caution new adjusters need to use when signing independent contracts in our blog called Splish Splash don’t go takin’ a bath. Here is a link to it.

While we are still hoping for a great employment attorney to provide an opinion on some of the issues Independent adjusters commonly face, (am I dreaming someone will come forward and volunteer to interpret these things for us as a guest blogger employment attorney or volunteer employment attorney participant)? I’ll post some links to some interesting things we found while researching this topic.

While I’m not sure we entirely understand the issue as it relates to court decisions, we think we’ve come up with a consensus that the issue relates to “independent judgment”  and “control” issues vs whether or not you or your adjusting firm considers you as an independent.

The majority of independent contracts the adjusters have shared with us state the adjuster understands they are a 1099 reporting independent but there are several such as ASU which states on their website here that their adjusting firm is 100% employee owned. I had the opportunity to meet several of their members at the 2007 NACA convention and find this approach most appealing for adjusters to have benefits, educational assistance, 401K plans and many other benefits independents normally don’t have access to with the majority of firms. Do you know of other firms providing employee status vs independent? It would be great to hear about these opportunities via reply to this blog if so!

I found an interesting site called The Society for Human Resource Management (SHRM). Here is a link to their website. They say they are the largest professional organization devoted to Human Resource management.

Their website points out that there are many agencies that have statutory jurisdiction over the “independent vs employee” issue. Here’s an excerpt from their site about this:

“The many statutory jurisdictions that cover classification of independent contractors include the Family and Medical Leave Act, the Americans with Disabilities Act, the Internal Revenue Code, the Fair Labor Standards Act, the National Labor Relations Act, and individual state-by-state unemployment insurance codes” thus the comment above about not being sure we understand all of the issues because there are just too many federal and state laws involved in the classification determination.

An employment law attorney and member of their site addressed the House Labor and Education committee on July 24, 2007 stressing the need for guidance for employers to properly classify employees due to the confusion with all of the programs listed above. Here is a great article about her testimony. I think the following statement in her testimony best addresses the problem independent adjusting firms, carriers, and adjusters face as they create and sign contracts:

“Every new working relationship brings with it the challenge of asking the right questions to ensure the employment situation is being properly classified as an employee or non-employee worker,” said Walters. “In my experience, employers do on occasion unwittingly, misclassify employees as independent contractors,” she said.

Here is a link to the House Committee July 24, 2007 hearing that includes links to the webcast of the testimony at this meeting and to the presentations of several other speakers to include Paul DeCamp, Wage and Hour Administrator from the Department of Labor. Note that the question in the title of the hearing was “What Policies and Practices Best Protect Workers“. 

Chairman Andrew’s  opening statement is found here  and Chairman Woolsey’s opening statement is found on this link. These are worth the read as they outline the reasons employers may misclassify employees…basically to avoid health insurance and workers comp and other benefits such as social security payments they would have to pay or an employee would be due. From information gleaned in Woolsey’s opening statement, CA considers the problem so significant ( see yesterday’s blog too on CA and adjuster overtime issues) that they have State Assembly Bill S.B. 622 that if passed would assess penalties of up to 15K per violation or 25K  per violation if employers have engaged in a pattern of misclassification. This document here says that this bill passed the Assembly 9/10/07 and the Senate on 9/12/07. Those are pretty hefty fines and I hope that adjusting firm owners have been advised of these new provisions by their employment attorneys and have reviewed these issues as they pertain to using independents for each various operation such as carrier daily branch assist on daily claims, inside adjusters in carrier claim central operations, as well as their classifications for catastrophe independent adjusters especially for the types of contracts I’ve seen that require exclusive work with the independent firm or carrier. Would the use of independents as inside adjusters be cause for concern about classifying them as other than 1099 employees? How about daily assist or daily adjusters working under an exclusive contract? I don’t know but I bet a good employment attorney would know the proper classification. I would also want to know about how a bill such as this one passed in CA would apply to an adjusting firm going out to CA to work earthquake claims. There are many firms holding California Earthquake Certification classes in preparation for an inevitable earthquake out there but have they done equally thorough research into classification of adjusters and if those rules would apply to out of state adjusting firms coming in to work catastrophe assignments? I’m not sure how those laws apply when your working out of state as a vendor vs it being the permanent state of your adjusting firm office.

Paul DeCamp’s testimony found here is longer but if I were an adjusting firm owner, I’d certainly take the time to read this and look at the list of 7 items he calls relevant factors to determine if a worker is properly classified. The one I found interesting the most from the independent adjuster standpoint is the relevant question of “Permanency of the relationship”. Page 2 of his testimony also goes into interesting details about “the process” of reviewing these factors and payroll records and how they conduct their inspections. I had no idea that the Wage and Hour Divisions primary responsibility was dealing with complaints as the testimony says 70-78% of their work is addressing workers complaints on these issues. It is  also very important to read the comments further down on page 5 that says that temporary help is often in the most commonly misclassified category. I’d also read the comments  since this is a national program and the testimony states that they are recommending misclassifications  found by the Wage and Hour Division (WHD) for many other violations for some of the other agencies(listed at the beginning of this blog) that they find value in sharing that information nationally with other state and federal programs(page 6). Pg 7 indicates that GAO feels that employers should be notified when they make these reports to other agencies to investigate while WHD did not think it was appropriate for them to report them due to the fact they do not know the rules nor administer the programs for the other agencies looking at independent classifications. 

Another point interesting to property and catastrophe adjusters would be the comments on page 4 indicating that construction companies are in the group receiving the largest findings of misclassifications. The findings in Decamps report about this are echoed by Sara Stafford with a construction firm who testified that firms such as hers are often penalized by losing contract bids as they include the cost of employee benefits in their estimating costs (overhead and such) when other construction firms improperly classify employees as independents which costs the complying firms work by abiding by the classifications. I imagine this would be the same for independent adjusting firms who would have to increase fee schedules to cover their overhead for employee benefits if they were required to provide workers comp and benefits. Here is the link to Sara’s testimony. I didn’t have time to get to the testimony of two other speakers you can find on the links above.

Other research we found in the past few months includes:

This informational article from the state of Texas on form C-8(0406) found here which contains 20 relevant topics to test your classifications.

Here are some interesting comments on independents here with several more good factors to consider.

I really liked this 20 factor check list for small businesses to determine employee vs independent contractor check list to determine under common law what factors apply found here.

This article here from another law firm discusses NY’s “right to control” factor. It’s an older article from 98 but a good article. This website is full of employment articles at www.ebglaw.com.

Here is a good weblink for IRS information on independent contractors which refers also to links for several publications  you would want to refer to found here on their website.

I found this case from Vermont that the Insurance Journal posted quite interesting from May 2007 where at home workers for a knitting company were determined to be employees versus independent contractors. Here is a link to the article.

It took several days to have time to finish up this blog entry due to weeding out alot of repetitive information and narrow it down to some of the most concise current information you might find useful. The research has been well worth the while as I’ve learned that these issues are not set in stone but very active current topics of discussion, court cases, and federal and state agency hearings and discussions right here and now in 2007. The National Law Journal  at www.NLJ.com on their 9/27/07 article update says this will be a banner year for Supreme court labor and employment cases as they have granted review of many cases in this overview of the article:

September 27, 2007

TODAY’S NEWS

FROM THE UPCOMING ISSUE  |  Supreme Court loads up on employment cases
Besides adding such high-profile issues as the constitutionality of lethal injection executions and voter ID laws to its docket, the Supreme Court ensured, through its latest grants of review, what is likely to be a “banner” year for labor and employment law.

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This appears to be the time for independent adjusting firms to update the opinions from their employment lawyers if they haven’t already done so to verifiy if their current practices meet all of the 2007 regulations with all of these current discussions going on. All Independents are waiting on weather (wow as independents call it) for assignments so while everyone is waiting you might want to take the time to double check the classifications to make sure everyone is compliant with their state and federal 2007 regulations. I am most curious about how the state laws apply when an adjusting firm from one state ventures into other states to handle losses. Are they subject to those other state laws too? This feels like going to college! The more you learn the more questions you have!


Insurance Adjuster Overtime Pay Issues and Complaints in the news

September 24, 2007

I’ve been trying to find time to write about the big ongoing question about adjuster overtime pay and a related issue on the commonly asked question ” am I an independent or am I an employee”.  The new suit brought by two AIG adjusters   in September 2007 again brings this topic to the forefront and we’ll watch this case to see if anything new develops to help us understand these issues. We would appreciate any comments by employment attorneys to help us clarify these issues. Today we will provide information on the overtime issue and tomorrow we’ll blog about the Independent adjuster vs employee questions which we are frequently asked about by adjusters when signing independent adjusting firm contracts.

Here is a link to the news article about the AIG adjusters new suit. Here is also a link to the Bloomberg article on this new suit.It’s not just carrier staff adjusters and employees filing these suits as this article shows adjusting firms are the subject of such suits also in this article saying Pilot Catastrophe  Services  also received a Complaint in 2004. I’d like to know how the adjusting firm case was resolved but could find no information on the web about the outcome of the case.

The AAICP -American Association of Independent Claims Professionals wrote an excellent article on this overtime issue in June 2004 found here. This article in part says:

“Insurance claims adjusters are still exempt from federal overtime requirements under the United States’ Department of Labor, Wage and Hour Division’s final version of the controversial changes to the white collar exemption regulations. As requested by the American Association of Independent Claims Professionals (AAICP), an association of independent claims adjusting companies, the Labor Department specifically noted in the new regulations that claims adjusters are generally exempt from overtime pay requirements regardless of what kind of company they may work for – an insurance company or an independent. The new regulations also make some adjustments to exempt salary requirements that may affect claims adjusters, including raising the minimum exempt salary and creating a new pseudo-presumption of exempt status for higher wage-earners.”

Here is more important information in this article:

“As requested by the AAICP, the new regulations specifically use insurance claims adjusters as an example of an exempt administrative employee:

Insurance claims adjusters generally meet the duties requirements for the administrative exemption, whether they work for an insurance company or other type of company , if their duties include activities such as interviewing insureds, witnesses and physicians; inspecting property damage; reviewing factual information to prepare damage estimates; evaluating and making recommendations regarding coverage of claims; determining liability and total value of a claim; negotiating settlements; and making recommendations regarding litigation.  ”

Please read the full article for other important details.

Here is another article from the AFL CIO which specifically addresses insurance adjusters and overtime issues which concurs with the article from AAICP stating in part:

“Insurance claims adjusters—Again, court cases on whether insurance claims employees receive overtime pay have gone both ways—some courts have said they are exempt and other have said they should receive overtime pay. This is a very heavily-litigated field, and corporations have not been able to win a blanket victory. The Bush Administration has handed them that victory by changing the nationwide regulation to specify that these employees are generally disqualified from receiving overtime pay. (New Section 541.203(a)) A quarter of insurance claims adjusters make less than $35,000 a year. “

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In a more recent case involving Farmers, White and Case provides this analysis of an overtime case in multiple states in this February 2007 article on Farmers prevailing in a case on the claim adjuster overtime issues. Here is the link to their article.

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One of the most excellent articles I could find (here)is  from Holland and Knight in December 2006 which addresses the duties of adjusters who alleged use of computer estimating systems and claim manual among other things took away their individual judgment thus they were entitled to overtime pay. Some important comments in this article include:

 

 

“The Farmers claims adjusters asserted that they were not exempt from the overtime pay requirements because the work that they performed was part of the “production” side of the business, not the “administrative” side. They also argued that because they had to follow claims manuals and guidelines, and use computer programs to determine loss values, they did not exercise sufficient “discretion” and “independent judgment” to fall within the exemption.The trial court found that all of the claims adjusters were doing “administrative” work; that is, that their role was on the administrative side of the business, not the “production” side. In addition, the trial court found that most of the claims adjusters used a sufficient amount of discretion and independent judgment in their work to qualify for the exemption. However, the trial court found that some claims adjusters, such as automobile adjusters and adjusters who mostly handled claims less than $3,000, had to follow so many guidelines and rules that they did not exercise an adequate amount of discretion and independent judgment to meet the exemption”. 

I found this article addressing the size of the claim particularly interesting in light of all of the claim central operations handling smaller losses.

Here is another good article by the Jackson Lewis firm from November 2006 outlining more duties of adjusters and providing more information on the Ninth Circuit ruling that claims adjusters are exempt from overtime pay while noting that CA courts reached opposite conclusions. This brings us to this September 19, 2007 article  here by National Underwriters discussing some recent CALIFORNIA cases where Allstate, State Farm, and Farmers agreed to pay millions on other cases out there. Is this because they are cases in CA subject to other laws or is it because of overtime regulation interpretations prior to the new overtime rules of the Federal Labor Standards Act?

This MSNBC article here from August 2004 explains what changed with the new overtime regulations when they went into force. I’m not an employment attorney so I am not sure of the answer to this question as to why some carriers were settling these cases but it may be due to the regulations in CA differing as an article  addessing several CA cases settled by carriers in Los Angeles Business Journal explains here. 

 Here is an interesting article from October 2006 by CFO.com indicating the 2004 update to the FLSA has increased the confusion on overtime pay and the number of suits filed. Particularly interesting on page 3 of this article is the list of FLSA auditor “red flags” indicating things they look for to see if a firm is in violation of overtime issues such as having all employees on salary versus some time card employees. Adjusting firms should read this article.

The bottom line in all of these articles seems to verify that adjusters are not entitled to overtime pay with the exception of CA (see this 2nd article here from Holland Knight on CA regs opposed to Federal regs) . I’d make sure your adjusting firm is compliant on these issues especially during catastrophe operations when many firms are working employees at the required carrier hours of 7am-7pm 6 or 7 days per week. Check with your employment attorney to verify you have your firm properly classifying your employees and adjusters. There are many new in office programs adjusting firms are participating in such as running call centers, using an increased number of adjusters in claim central operations at carrier catastrophe centers, running additional living expense and contents claim units from their adjusting firm home offices or field catastrophe centers.

Due to the increased number of suits as a result of the new 2004 FLSA decisions as indicated in these articles, it appears wise to get a legal opinion on your overtime decisions BEFORE your firm is subject to such a complaint. Review of this Department of Labor article found here says it best:

 “The status of an insurance claims adjuster, however, does not rely on the “claims adjuster” job title alone.  There must be a case-by-case assessment to determine whether the employee’s duties meet the requirements for exemption. “

In my earlier years as a staff adjuster, we were never paid overtime pay except when moved to “time card” status while attending claim schools as they advised us training status required overtime pay while normal work did not. We were never paid overtime as claim managers in line field units, claim central operations, or while serving as catastrophe claim managers working 7 days per week 12 hours per day. In more recent years when performing temporary catastrophe management duties with independent adjusting firms, they also paid us on salary with no overtime. I can assure you in both staff and independent positions that adjusters normally work far beyond a 40 hour work week to keep up with carrier performance guidelines and Department of Insurance mandated deadlines during catastrophes. This 28 year carrier career was all prior to 2002 with the independent experiences from 2003 to the  present.

 I am curious what adjusters today (after the 2004 changes) are experiencing on these salary, time card, and overtime issues and hope to hear from many of you in reply to this blog. Please list your position, your state of employment, your carrier or adjusting firm, and your method of pay both for regular 40 hours and overtime. Should you not wish to comment in the blog, you can send emails to us and I can post your input anonymously in reply to this blog. We’ll also post this in our  forums at ClaimSmentor for continuing ongoing discussions with our members.


Have you thanked your adjusters as we enter Labor day weekend?

August 30, 2007

As we enter labor day weekend the next 3 days, we hope that many catastrophe adjusters share time with their families and friends with what may be the last of long weekends for sometime should hurricane season activity actually pick up in September. Here is one of the latest pictures from our new favorite weather site, Ralph’s Tropical Weather,  showing atleast 5 new lows being investigated as we speak!

This week we’ve learned of friends deployed to Midwest flooding, CO storms, and other locations finally getting assignments after the very slow storm season for 2006 for many independent adjusters so they will be unable to share the holiday with their families. We hope the insurance consumers will come to appreciate the many sacrifices adjusters do make to choose the life of a catastrophe adjuster.

How interesting to read here  that the 12 hour/7 days a week American work schedule as we entered the Industrial revolution lead to unions to help the deplorable conditions American employees suffered in the late 1800’s ! Did someone forget to share that with insurers who still require those very hours today for storm adjusters?

Today is a great day for carriers and adjusting firms to take a moment out to thank adjusters who service their claims before labor day weekend begins. We used to recognize adjusters committing to work disasters with storm banquets to thank them for their service as they rotated in and out of assignments back to their regular offices every 30 days. That practice today has basically become extinct now that carriers have dedicated catastrophe operations initially created so an insured would not have to deal with an ever changing group of adjusters for consistent handling of their claim. That was a great concept in it’s time and still is but the beauty of the program is eroded over the past few years due to the current practice of in office claim central units requiring insureds again  to deal with “team” adjusters  who are not familiar with their file. It  also became unpopular for banquet facilities to post signs with a carrier name for such gala events and even for conferences due to a large number of consumer complaints on carriers wasting “premium dollars” on such wasteful spending. Other issues arose regarding the serving of liquor or hosting cash bars as well as sexual harassment issues for jokes in today’s ever increasing world of litigation. It still amazes me today the number of insureds that will call in to a carrier office to complain of adjusters taking a long lunch or telling jokes in a restaurant “when they should be out handling my claim”. Listen folks, adjusters are human also and field adjusters commonly work 15-18 hours 7 days a week. They return from 10-12 hours in the field to their rooms at night to enter claim estimates to meet stringent carrier quotas on inspected and closed files due each and every day while out on assignment. They need a break and they need recognition for their hard work. It’s fighting an uphill battle to even mention things like this with the negative impression of “adjusters” out there. New adjusters need to be most careful in following carrier guidelines not to wear storm clothing after hours and to always be cognizant of the public when out in groups for dinner. You can be over heard discussing private cases and this is not a very good thing in the eyes of the public. Instructions from most carriers require you wear “civilian” clothing when going out to dinner on your way back to your room to work files.

Hmmmm……..I guess we don’t learn from history very well in the claims industry. Our work hours meet time frames from the 1800’s and we have totally done a major turnaround in the current “claim central” operations circumventing the very reason we created catastrophe claim field operations to begin with. An in office adjuster who has never experienced the trenches of disaster does not share the same empathy as they have no understanding of the trauma experienced by insureds during a storm. They have never walked up to a home that looks reasonably repairable from the street only to walk to the back of the structure and see it torn in half. Nor have they marched down the street with a ladder in 100 degree heat to measure roofs when you’ve been dropped off  from a carrier bus on a street corner during an “Andrew”. I have managed in office adjusters, field adjusters, and catastrophe adjusters and there is a major difference in the understanding of urgency and the empathy of these different groups of adjusters if they have never worked in the field on a catastrophe operation- especially during the initial phases of cat operations.

I hope we will all take a few minutes to thank our adjusters in some form or fashion over labor day weekend.

We at Dimechimes Corporation thank the many dedicated adjusters servicing the property insurance industry! We look forward to working with members of our rosters as new staffing requests are received this season. Please be safe on your way to your new assignments.

We’ll see you back on the blog next Tuesday!


Enough is enough- Citizens FL Claim Reserve problem-to the tune of $300 Million

August 24, 2007

Hadn’t I just written about claim reserves last week in this Claims / Agency Relationship blog?

August 22, 2007 www.Tallahassee.com published this article regarding Citizens of Florida stating that an outside auditor has told Citizens it needs to add almost $300 million to its reserves. The article goes on to quote some folks from Citizens who indicate it’s due to files reopening from Wilma at the encouragement of public adjusters and south Florida attorneys.

The article quotes Mr Julio Robaina, who chaired the legislative task force on Citizens claim handling, as saying “he will introduce legislation to stiffen regulation of public adjusters and to reduce the amount of time consumers have to file a claim”. Chip Merlin of the Merlin Law Group had quite a comeback you’ll have to read about in the link above to this article. Does Mr Robaina really think he’d get the votes necessary to “reduce the time consumers have to file a claim”? Look at what is going on all over this great state to property taxes and mortgage foreclosures and Mr Crist’s efforts 100% pro consumer/ 100% anti carrier as recent articles explain. Does this political representative know anything about the statute of limitations and what is involved in over turning the state laws on these regulations?

Read further here on this Merlin Law group presentation to the task force on page 7 where he addressed the fact Citizens lacks sufficient home office and staff management. Now I’m not sure what the Merlin group who handles bad faith cases against insurers has to do with presenting to the task force but I am sure glad someone is pointing out the problems. Don’t you think that is giving them fair warning of the problems they should already be more than aware of? Where is Citizens going to be when it comes to defending adjusters accused of bad faith due to their claim handling instructions if that becomes an issue as it has with other insurers during Katrina?

Didn’t FL just tighten up public adjuster licensing 7/1/07 which now requires a public adjuster to take the exam versus the exemption from licensing exams by taking online courses? As to the other practices by PA’s made in this article about giving gifts to insureds, we can surely hope the Dept of Insurance is curtailing that now rather than waiting for new legislation to be passed. Here is a task force document  on page 10 already addressing PA’s and task force recommendations.

I did double check the Merlin blog to see if there was a current blog entry on this new announcement.There is not yet but this entry from late July  goes into a great deal of information on the financial problems at Citizens of FL. There is another more recent blog here addressing the Florida crisis and insurance reform problems.

New adjusters may not be familiar with loss reserve procedures and should read  this great simple explanation on claim reserves and how they are set found here. Many independent adjusters are surprised reading this to learn that this is part of their duties when evaluating a claim even long before your estimate is completed based on your initial assessment of the damages as this article does a great job of explaining. While bulk reserves may be set up by a carrier on all claims based on past historical data at the onset of a new cat, there is still a responsibility to have accurate reserves…especially when it comes to large losses. In recent years, there has been concern expressed about reserves set coming up in court cases when they differ from settlement amounts so you will need to know the carriers current reserve procedures before making recommendations to a manager in your log notes and reports.

The part I do not understand is how the Citizens Board of Govenors just got the news. Establishing and updating reserves on pending claim files is one of the most basic of carrier management duties during an open file review which should be done at regular intervals (bi weekly or monthly) on large pending cases to determine how the case is progressing and to double check that reserves are either adequate or that a revision to a reserve needs to be made either up or down based on the current damage assessment on the case. Most carriers produce management reports listing the cases that need a reserve review on a regular basis.Was this not being done (that seems pretty obvious …… what am I missing here)? Claim file reopens do not all happen at one time unless there is unusual activity such as a class action lawsuit? The only two cases I’m aware of are the two mentioned on the Hurricane law groups site here with one for roof damage building permits and the other on wind damage to glass and FL building codes. The class action link does have attachments to the suit in pdf forms. It is routine for storm losses to reopen due to  construction industry price increases after a storm. This can occur much later than when the initial estimate by the adjuster was written due to contractor workloads or lack of available local contractors in a given storm zone. No surprises there either. Adjusters remaining on the site handle those revisions as necessary on an ongoing basis. So what’s up?

You can find all minutes of the Board of Govenors meetings right on the Citizens of FL website here. I’ve been very disappointed with the promptness with which the website posts the meeting minutes from the Claim Committee notes. For instance, there was a meeting June 14th and the minutes for that meeting still showed minutes from an April Claim committee. I wrote the web master and received a response that the June minutes were still not up in August because they have to be approved by the committee and they did not know when the next claim committee meeting would be. Come on’ folks…the task force shows the claim committee met with the task force I believe it was August 1 yet the minutes from a June meeting were still not up? Those committee notes are the only direct source information adjusters can go to to verify information they are getting from different vendors since the emails they are getting vary so greatly! If you can’t get the minutes up timely to your meetings, how in the heck are they going to manage claims for 1.3 million Floridians in a timely fashion?

I am not picking on Citizens but I do think it is very important to bring out issues independents are concerned about. Citizens of FL is now the #1 insurer in our state. Our independent adjusters want and need the claim assignments. PLEASE treat us fairly, please enhance the communications, and please be alot more realistic about time service expectations during a major disaster. Your threats of imposing huge fines is not having the effect you apparently expected (what else are we to assume?)..instead, adjusters are hesitant to service your claims and you are confirming their concerns every day by the way you are handling the pre-assignment training. (Example-one vendor email says Citizens now requires adjusters must enter their Xact  email address…hello ..you make sure independents understand they are not “employees” yet to have an Xact email they need an active keycode…are you going to pay that hefty fee for a quarterly subscription to Xactware while they are sitting at home idle waiting for THE POSSIBILITY you may deploy them???).

It is appalling to me that Citizens outlines many different fines for infractions against adjusting firms in their Adjusters RFP which are going to be passed on to adjusters but there is no effort to give timely notice to independents on important information they need. Some of these fines are listed at $1,000 each. Just in the past two weeks adjusters who had completed pre-disaster training were again told to go back and take another course on ethics and apparently the adjusting firms had as little or barely more than 1 week’s notice to get this information out to their rosters, accomplish the training, and report back. What a mess this continues to be and adjusters don’t have claim 1 yet from a new hurricane nor one dollar in income from you !

I’ll be making another blog post next week on the current “pre-disaster” training issues adjusters are experiencing as well as I have great frustrations regarding some comments in the June Board of Govenors meeting where a large FL Independent agency group, FAIA, expressed concerns about Citizens training from the agency side feeling that agents are regulated by state insurance departments for licensing and for CE credits and they had some issues with the mandatory Citizens training for agents (they didn’t mind taking it but I gather it was the way it was being administered). At this same meeting, the Citizens claims committee was there and there was no one representing the 6,000 expected independent adjusters at the meeting to express what would be our major concerns about what has taken place the last month over the continual changes and adminstration of independent adjuster training to work their claims. Just one minor example is the fact Citizens has never even bothered to post the website addresses and email contact information on their Job links so these independents would even know where to apply. The only information, if you searched hard enough, is in the purchasing documents where the announcement was buried (like adjusters would even think to look in purchasing documents? ). The announcement has several incorrectly named firms and no contact information. Here is the link to this meeting board notes. You will find the FAIA (FL Assn of Insurance Agents) comments on page 32-37 and the claim committee comments to the Board on page 45.

I guess if we have one thing to be thankful for over this additional Citizens of FL reserve fiasco, it’s that it isn’t as bad as the Citizens of LA case where they have major computer glitches going on and lots of lost financial data. They apparently aren’t doing a good job of managing claims either. You can read all about the Citizens of LA fiasco here and here.  This article addresses further issues of information blocks while they are trying to  gather information needed to fix the problems over there.

This Insurance Institute article on carrier insolvency brings up the recent FL insurers, Poe Financial Group and Vanguard Insurance, insolvencies. Why is Citizens allowed to operate with inadequate rates and improper reserves? I just don’t understand. Hopefully, someone will come forward and explain to our readers why this is different.

Make sure when you read the document linked above from the Board meeting notes on their discussion on Citizens being a “governmental” agency on page 10. Well, if Citizens of FL actions on reserves, pre-disaster training, the Citizens of LA issues, and the FEMA and congressional hearings on the wind/water issues are any example of government running as an insurance carrier and their suggestion of the Multiple Peril Act of 2007 adding wind coverage to FEMA ,then why should we want any part in supporting such proposals? Please let the private carriers go back to doing what they WERE doing best in the private market.

While none of us in the adjusting community like denying claims under the wind/water controversy- it is still the contract insureds agreed to no matter how many cry “big bad insurance company”and until private carriers develop a comprehensive policy covering both, I’m 100% against the government administering additional programs. Insureds need to ask themselves…if they  signed a loan agreement to pay back x dollars and did so then the loan company came back and told them that the contract didn’t matter- they need to cough up several more thousand dollars they did not agree to- what would they do? I assume as a loan recipient, if they used the same line of thinking they use with carriers, that they would just roll over and pay the extra thousands so they don’t get bad publicity. I still do not understand why so many expect that carriers should pay what was not covered in the insurance contract. I do “get it” that some bad calls may have been made on a small percentage of individual claims which never should have happened. The current midwest floods show that the public still does not “get it” regarding the need to buy flood coverage. Just this week- 2 years post Katrina- news reports are coming out that many locations in the midwest are reporting much damage with only 5-10% of homeowners in flood zones having purchased coverage. Again, I do believe we will see the carriers and the adjusters be the “fall guys”. Things need to improve in this industry but I think the FEMA and Citizens examples show it’s not the answer to turn it over to “governmental” agencies.

If the government wants to do something for the very necessary adjusting community, how about developing an Insurance Claims Advocate group member on your task force like you do for consumers..click here for task force member links. This committee list shows two claim members- one from Citizens and one from another insurance carrier. There is not one member of the task force committee investigating claims from the independent adjuster group yet they are relying on 6,000 plus independents to service their claims. It could not be one of your 45 selected vendors if you want valid input as they would have to give you “politically correct” input to maintain their appointment. Think about it…we might be able to help straighten out some of these “claim handling issues” you are investigating. Independents work for many different carriers and they might just be able to provide outstanding information on improving claim handling procedures. It sure seems like Citizens is missing the boat if these articles are any examples of what we are going to face servicing their claims.

Please don’t get the wrong impression- we have LOTS of empathy for insureds when we must deny a claim due to coverage issues. That still doesn’t give us the right as adjusters to change the settlement terms we must abide by. We are also very concerned citizens of the state of FL with our friends and families in this state. We have inside knowledge of how claims should be handled and we fear for what the coming hurricane season brings our state.


Claims Magazine Claims Salary Survey is up..please participate!

August 24, 2007

We are honored that Claims Magazine, Managing Editor, Eric Gilkey has requested both ClaimSmentor participants and Dimechimes Corporation roster folks participate in the 17th annual survey on claim salaries. Feel free to pass this on to anyone participating in claims whether carrier personnel or independent adjusters. The more participants the better the results will be when we read the survey in the October 2007 issue. Please help make a difference in claim income for adjusters by taking this survey.

Here is the information from Eric:

Claims Magazine is currently conducting its 17th annual salary survey for claim professionals. The survey is meant to convey opinions and salary ranges for carrier and independent claim staff professionals, from adjusters to vice presidents. It’s meant to be a tool for industry professionals to use to compare their salaries to other professionals in the industry and get a snapshot into the industry’s current state. All salary figures will be kept confidential and are only used to tally results. Comments used in the write up will be ensured anonymity if used. To participate, go to www.claimsmag.com and look for the survey link under the breaking news section. 

Eric Gilkey

Managing Editor | Claims Magazine | Florida UnderwriterProgram Chair | Calif. Insurance Fraud SymposiumThe National Underwriter Company

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We had recently posted two different blog entries on adjuster income as found publicly on many websites and in the press here if you missed them. Here and Here

Thank you all in advance for participating in this survey.

 “Make things Happen” by participating!


Whistleblower cases and your E and O coverage- part 2

August 23, 2007

I have updated the 8/22/07 blog today to include information on the 2nd whistleblower RICO case, more info on the Scruggs whistleblower case, as well as to discuss adjusters need for E and O coverage. You can view that entire blog here:

https://dimechimes.wordpress.com/2007/08/22/special-prosecutors-file-criminal-contempt-charges-on-ea-renfroerigsby-whisteblower-case/

Here are two more articles to read with Scrugg’s attorney commenting and a WSJ update from yesterday on the case:

Here are the first comments I’ve seen published from an attorney representing Scruggs on this:

http://online.wsj.com/article/SB118780916398705534.html?mod=sphere_wd

Here is also the WSJ Law Blog entry from yesterday on the case:

http://blogs.wsj.com/law/2007/08/22/dickie-scruggs-charged-with-criminal-contempt/

See you tomorrow!

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Well- nothing is simple on these cases. As soon as I thought I’d finished reporting on the whistleblower cases, the next item reviewed is this August 23rd blog alleging more allegations against carriers:

http://news.bbc.co.uk/1/hi/business/4251394.stm

This was linked to in this AM in the morning blog entry:

http://aminthemorning.blogspot.com/2007/08/insurers-being-sued-over-katrina.html

Here is a June news article  on the Hood  breach of contract suit and a NU news article from May in case you aren’t familiar with that action involving the Katrina cases:

http://sev.prnewswire.com/insurance/20070615/DCF01515062007-1.html

http://www.propertyandcasualtyinsurancenews.com/cms/nupc/Breaking%20News/2007/05/02-HOOD-dh

Here is an August 2007 Clarion news article about the carrier attempting to dismiss the suit:

http://www.clarionledger.com/apps/pbcs.dll/article?AID=/20070810/NEWS/708100370/1001/news

I hope all of you  are trying to objectively understand what is going on with these cases. Take the time to go directly to the carrier websites and look at their news and press releases for their “direct from the source” news releases. You’ll find  quite interesting information in what appears to be a war of the press releases by all parties involved but I prefer to think of it as the carriers trying to educate the public about many misconceptions found in the press. I’m glad to see them posting information from their perspective when years ago they remained silent on these issues on their websites.

Off to work now..no time to specially link those articles vs just posting them as is!