Overhead and Profit Claim Settlement Issues Under Attack in 3 ongoing cases?

April 10, 2008

Today I received a google alert on yet a 3rd overhead and profit suit file. This case, Chivers v. State Farm. Case No: 2004-294-3 in TX ,dates back to 2004 but in an April 9, 2008 news article, apparently the case is still pending and three insurance carriers -State Farm, Foremost, and Farmers are seeking to have the Judge removed from this case.

Without more details, it’s hard to know what all of the current activity is about other than I was able to locate a few recent news stories on the case that provide a summary of the allegations against the carriers (without seeing the Complaint and other documents, I don’t know how many carriers or others are named in the suit). Unbelievably, according to one of the news articles, the judge was requiring Foremost produce copies of 600,000 files which they indicate would cost them approximately 45 MILLION dollars to produce.

Here is a link to the most current news article on the case about State Farm filing a motion to recuse the judge saying that Foremost and Farmers join in the motion:


This link above says in part:

“The original lawsuit, filed Sept. 8, 2004, alleges claims of civil conspiracy, unjust enrichment, fraud, and constructive fraud by accusing the insurance companies of not disclosing or paying to the insured’s the general contractors’ overhead and profit, whenever the repair of an insured’s loss required the services of at least three trades. ”

The article mentions that Farmers and  Foremost have joined  State Farm in the motion.

This article below says the case was heading to the Arksansas Supreme Court over the judges instruction they had to copy all 600,000 files.


If you follow our blog, you will recall two other recent blogs we’ve done on some other recent activity regarding overhead and profit lawsuits. You can click here  for the Sher case in LA where the judge allowed 25% overhead and profit and a 20% contingency fee for unspecified and unforeseen/unknown damage and here to find the blog on the OK class action case on overhead and profit.

In summary- it looks like we have three (and possibly more as there could be others I just haven’t seen anything about in the news recently) cases with three different issues on the overhead and profit:

1) Chivers v. State Farm. Case No: 2004-294-3– issue overhead and profit when three trades involved- Arkansas case 

2) Sher case v. Layfayette Insurance– LA case- issue was flood definition and levee breaks but on page 25 of judge’s decision he allowed 25% overhead and profit PLUS a 20% contractors contingency fee as the plaintiff’s expert witness testimony was unopposed. Make sure to read the link above for a discussion on that as the expert used info from a Lousiana State Office Volume on state facilities. By the way- since I wrote the blog on Sher yesterday, I’ve run across and insurance article stating that the American Insurance Association president has praised the new decision on the case based on the flood provisions being upheld. AIA represents 350 insurance carriers. I wonder if he even realized the info on the overhead and profit on page 25 of the judges decision doesn’t follow insurance claim settlement normal procedures?

3)  Burgess et al. v. Farmers Insurance Company, Inc. et al.-Class action case in OK on standard 20% overhead and profit and here is a brief summary from some of the links in the blog we did on that:

This is the website for the Burgess et al. v. Farmers Insurance Company, Inc. et al. class action lawsuit.  Homeowners have sued Farmers saying that they improperly withheld payments for general contractor’s overhead and profit (“O&P”) from amounts paid on claims under homeowner’s insurance policies to citizens of Oklahoma.   The Court has not decided if the Defendants did anything wrong. You need to decide whether to stay in the Class or exclude yourself, and you need to decide this by May 16, 2008.

It will be interesting to watch these 3 cases and see if we can find out how they are resolved. Hopefully, someone with access to PACER will provide pdf’s on these cases so we can read more detail and understand where exactly these cases stand at this point and how they end up getting resolved.

I’d recommend sharing this information with your claim managers in case they are not aware this overhead and profit issues are under attack. They may want to seek clarification from carriers on their current expectations on your estimates before you begin submitting closed files only to find out your estimates require revision to comply with any possibly new carrier expections on overhead and profit entries on your estimates.

National Association of Catastrophe Adjusters Membership Drive to 3/15/08

March 6, 2008

The National Association of Catastrophe adjusters has changed their membership drive deadline to a new deadline of March 15, 2008 for new and experienced adjusters as well as adjusting firms wishing to join (prior deadline was this past November).

I’ve written about this organization before after becoming quite impressed with them while attending the 2006 yearly convention. I was quite pleased to find such a professional organization holding a meeting that was equal in value to annual carrier claim conventions with their professionalism, opportunities to obtain CE credits for adjusters and I note this coming year (Jan 09) they will offer the National Flood NFIP certification classes as well as the California Earthquake certification.

Here is a link to their membership information! Won’t you consider joining this very worthwhile group? By getting your application in prior to the March 15, 2008 deadline, you will have the opportunity once approved for membership to be in their 2008 directory.

Again we appreciate the 2007 President, Woody Britton, for letting us know about the extension of this year’s registration deadline. We also wish a very successful year to incoming 2008 President, Angelo Cassanese.

Next 40 Hour Fundamental of Claims online LIVE Class begins 1-7-08 at ClaimSmentor

December 28, 2007

We have now set the schedule for the next online 40 hour Fundamentals of Claims Class to begin January 7, 2008 and completed on January 31, 2008. The classes are LIVE ONLINE at  our mentor site at ClaimSmentor and run on Monday and Thursday evenings from 6-9pm CST in our online classroom.

This class is much different than what you will find at vendor seminars where estimatics and scoping are the agenda and high point of all classes. That is a very important aspect of adjusting but there is so much more to claim handling than merely the estimatics. Our course concentrates on other things not often found out in the field. We have had over 100 course completers in 2007. The course consists of 24 hours of online LIVE classroom time where you can ask all of your questions regarding pre-class reading and homework assignments and network with other new adjusters. We often have experienced adjusters and prior class members come in and share experiences they’ve had with the topics being covered. There is 16 hours of pre-class reading and pre-class homework assigned for a total of 40 hours of much needed information covered. In addition, the course cost includes many self study guides to use in the field covering Additional Living Expense handling, Contents Claim handling, Condo Loss handling, and much more!

The course itself includes 2 nights of Additional Living Expense training to include working sample problems with actual ALE worksheets, Complaint resolution handling to include Insurance Dept complaints, dealing with Public Adjusters and Attorneys, Time demand correspondence handling, an evening of estimate reconciliation tips so you have tips to enhance your negotiations with insureds and contractors rather than going item by item so you know the most common problems you’ll run into with estimate comparisons, ethics, carrier standards, file requirements both for paper files and electronic claim submission, expected file order, carrier expectations for adjuster ethics, and much news you need to be aware on claim issues facing our industry in the aftermath of Katrina. One of the highlights of class the adjusters seem to enjoy the most is our mock zoning practice sessions where they enter the world of real life cat assignments where they are assigned over 50 files at a time day 1 and have to set up their inspection agenda for the next 30 days in the proper priority order according to carrier management expectations.

We’ll feel you’ll walk away from the class with a much better understanding of the job detailed requirements as licensing and estimatic classes cannot begin to cover the other much needed information.

Mariposa Claims owner David Swank provides the following endorsement for the class and our online site for mentoring adjusters on his recent blog this week:


We’ve had many adjusters who worked Katrina claims take our class and express the wish they’d learned this material prior to the nightmare they experienced working their first catastrophe claims assignments.

Whether you take this class or any others, training is a very hot topic for adjusters. Reading depositions of many adjusting firm owners or staff claim adjusters and managers in the aftermath of Katrina, training is one of the most often covered discussions in depositions as bad faith allegations are made against many in our industry. I cannot stress the importance enough of obtaining necessary claim education outside of just taking estimatic classes. You need your license, your estimatic training, and much more to be a successful member of the claims adjusting community.

To register for the class, you need to register as a member of ClaimSmentor. Once we register you, you’ll receive an email with a login id and password to participate on our site where you can access the Training Sessions- Roots and Wings forums where you can view all available self study course material that is included with the class as well as all class details and cost associated. The course is a mere $80.00 to our members (2 dollars per credit hour….a very reasonable price for the mass amount of material covered but we keep all classes reasonably priced so all members can afford our live online classes). The beauty also of the program is you can work around your present job schedule and family obligations without the need to incur travel expenses.

We hope to see many of you there! We had over 20 new registrants to our site yesterday to include some very impressive adjusters with many insurance designations.

We’re also pleased to announce that Symbility Claims estimatic software had a management member of their firm join ClaimSmentor so we now have an important member or owner of all 5 major estimate software programs as members of ClaimSmentor. We reached 761 members yesterday with our new registrants! This includes now over 50 adjusting firm owners as well as many experienced adjusters. We appreciate all of the help from these experienced folks as we continue our online claim mentoring project to assist new adjusters. We will be entering into our THIRD YEAR of operation mid January and are looking forward to the new year and many new enhancements to our program are planned.

Note, we are very supportive of all adjusting firm and industry seminars and conferences and post ALL in our Seminars Forum and on our ClaimSmentor Calendar for our participants as well as preparing a yearly Claim Conference and Seminars comparison record so you can compare cost, CE credits offered, and other information such as number of adjusting firms you will have the potential to meet at the exhibit shows providing you more opportunities for exposure to new firms and new potential assignments. We also cover it from the aspect of claim managers and adjusting firm owners from the carrier aspect so you can compare the opportunities to network with important members of the insurance carriers for potential new work.

Our two favorite picks for conferences in January 2008 are:

NACA Convention- Myrtle Beach, SC January 14-17, 2008  – I had the opportunity to attend the 2007 convention in Dallas last year and it was as professional as any carrier yearly claim convention I ever attended and provides lots of opportunities for networking and CE credits as well as your NFIP yearly certification included. http://www.nacatadj.org/Convention08/Conv08TopPage.aspx

Evans Claims- Huntsville, TX – reason- one of the few offering TX Windpool Certification which is harder to come by as well as official NFIP certification and California EQ as well as many other valuable classes. While I haven’t attended their conference before, many of our ClaimSmentor members attended the 2007 session and recommended it. It is most reasonably priced and discounts for early registration prior to 12/31 bring it down even further to $169.00.


Participants on ClaimSmentor often provide feedback on the conferences so other members can consider attending them the next time around. If you know of other conferences or your firm is sponsoring one you wish listed, just email me  for posting on our site.

Best Wishes to all for a safe and enjoyable New Year’s holiday. We will be traveling and back online on January 3, 2008.

NFIP (National Flood) 2008 Adjuster Certification Classes are now posted!

December 12, 2007

***Update 2/5/09- They have changed the link to the 2009 NFIP workshop class list for adjuster- read about it here:


Here is the direct link to the classes being held January-May 2008 at a cost of $10.00. All of the information is available on their site. Here is a copy:


2008 NFIP Claims Presentation Schedule

Place: Lanham, MD
Date: Wednesday, January 16, 2008
Time: 8:30 am
Location: GreenTec IV
7700 Hubble Drive
301-794-2220 (for directions only)
Registration Deadline: Wednesday, January 2, 2008

Place: Lanham, MD
Date: Thursday, January 17, 2008
Time: 8:30 am
Location: GreenTec IV
7700 Hubble Drive
301-794-2220 (for directions only)
Registration Deadline: Thursday, January 3, 2008

Place: Ontario, CA
Date: Tuesday, January 29, 2008
Time: 8:30 am
Location: Ontario Convention Center
2000 Convention Center Way
909-937-3000 (for directions only)
Registration Deadline: Tuesday, January 15, 2008

Place: Concord, CA
Date: Thursday, January 31, 2008
Time: 8:30 am
Location: Centre Concord
5298 Clayton Road
925-671-3466 (for directions only)
Registration Deadline: Thursday, January 17, 2008

Place: Lynnwood, WA
Date: Monday, February 4, 2008
Time: 8:30 am
Location: Lynnwood Convention Center
3711 196th Street SW
425-778-7155 (for directions only)
Registration Deadline: Monday, January 21, 2008

Place: Jacksonville, FL
Date: Thursday, February 7, 2008
Time: 8:30 am
Location: Marriott Jacksonville
4670 Salisbury Road
904-296-2222 (for directions only)
Registration Deadline: Thursday, January 24, 2008

Place: Tampa, FL
Date: Monday, February 11, 2008
Time: 8:30 am
Location: USAA
17200 Commerce Park Blvd.
813-632-4000 (for directions only)
Registration Deadline: Monday, January 28, 2008

Place: Tampa, FL
Date: Tuesday, February 12, 2008
Time: 8:30 am
Location: USAA
17200 Commerce Park Blvd.
813-632-4000 (for directions only)
Registration Deadline: Tuesday, January 29, 2008

Place: Sunrise, FL
Date: Thursday, February 14, 2008
Time: 8:30 am
Location: Holiday Inn & Suites
3003 North University Drive
954-748-7000 (for directions only)
Registration Deadline: Thursday, January 31, 2008

Place: South Barrington, IL
Date: Tuesday, February 26, 2008
Time: 8:30 am
Location: Allstate Insurance Company
51 West Higgins Road
847-551-2058(for directions only)
Registration Deadline: Tuesday, February 12, 2008

Place: Carolina, PR
Date: Friday, February 29, 2008
Time: 8:30 am
Location: Embassy Suites
8000 Tartak Street
787-791-7776 (for directions only)
Registration Deadline: Friday, February 15, 2008

Place: Metairie, LA
Date: Monday, March 3, 20087
Time: 8:30 am
Location: Jefferson Parish Library
4747 West Napoleon Ave.
504-849-8817 (for directions only)
Registration Deadline: Monday, February 18, 2008

Place: Metairie, LA
Date: Tuesday, March 4, 2008
Time: 8:30 am
Location: Jefferson Parish Library
4747 West Napoleon Ave.
504-849-8817 (for directions only)
Registration Deadline: Tuesday, February 19, 2008

Place: Metairie, LA
Date: Wednesday, March 5, 2008
Time: 8:30 am
Location: Jefferson Parish Library
4747 West Napoleon Ave.
504-849-8817 (for directions only)
Registration Deadline: Wednesday, February 20, 2008

Place: St. Peters, MO
Date: Friday, March 7, 2008
Time: 8:30 am
Location: Holiday Inn Select St. Peters/St. Charles
4341 Veterans Memorial Pkwy.
636-928-1500 (for directions only)
Registration Deadline: Friday, February 22, 2008

Place: South Haven, MS
Date: Tuesday, March 11, 2008
Time: 8:30 am
Location: DeSoto Civic Center
4560 Venture Drive
888-280-9120 (for directions only)
Registration Deadline: Tuesday, February 26, 2008

Place: Pittsburgh, PA
Date: Thursday, March 13, 2008
Time: 8:30 am
Location: Radisson Hotel Pittsburgh Green Tree
101 Radisson Drive
412-922-8400 (for directions only)
Registration Deadline: Thursday, February 28, 2008

Place: San Antonio, TX
Date: Tuesday, March 18, 2008
Time: 8:30 am
Location: Henry B. Gonzalez Convention Center
200 E. Market St.
877-504-8895 (for directions only)
Registration Deadline: Tuesday, March 4, 2008

Place: Humble, TX
Date: Wednesday, March 19, 2008
Time: 8:30 am
Location: Humble Civic Center
8233 Will Clayton Pkwy
281-446-4140 (for directions only)
Registration Deadline: Wednesday, March 5, 2008

Place: Ft. Worth, TX
Date: Thursday, March 20, 2008
Time: 8:30 am
Location: Tarrant County College
5301 Campus Drive
817-515-4167 (for directions only)
Registration Deadline: Thursday, March 6, 2008

Place: Randolph, MA
Date: Wednesday, March 26, 2008
Time: 8:30 am
Location: Holiday Inn Boston Randolph
1374 North Main Street
781-961-1000 (for directions only)
Registration Deadline: Wednesday, March 12, 2008

Place: Lake Success, NY
Date: Thursday, April 3, 2008
Time: 8:30 am
Location: Allstate Insurance Company
1111 Marcus Street
516-574-5900 (for directions only)
Registration Deadline: Thursday, March20, 2008

Place: Branchville, NJ
Date: Monday, April 7, 2008
Time: 8:30 am
Location: Selective Insurance
40 Wantage Avenue
3877-348-0552 (for directions only)
Registration Deadline: Monday, March 24, 2008

Place: Charleston, WV
Date: Wednesday, April 10, 2008
Time: 8:30 am
Location: Charleston Civic Center
200 Civic Center Drive
304-345-1500 (for directions only)
Registration Deadline: Wednesday, March 27, 2008

Place: Norfolk, VA
Date: Monday, April 14, 2008
Time: 8:30 a.m.
Location: USAA
5800 Northampton Blvd.
800-531-8222 (for directions only)
Registration Deadline: Monday, March 31, 2008

Place: Greenville, NC
Date: Thursday, April 17, 2008
Time: 8:30 a.m.
Location: Greenville Convention Center
303 SW Greenville Blvd.
252-321-7971 (for directions only)
Registration Deadline: Thursday, April 3, 2008

Place: Greenville, NC
Date: Friday, April 18, 2008
Time: 8:30 a.m.
Location: Greenville Convention Center
303 SW Greenville Blvd.
252-321-7971 (for directions only)
Registration Deadline: Friday, April 4, 2008

Place: Cayce, SC
Date: Thursday, May 1, 2008
Time: 8:30 am
Location: South Carolina Farm Bureau
754 Knox Abbot Dr.
803-936-4290 (for directions only)
Registration Deadline: Thursday, April 17, 2008

Place: Cayce, SC
Date: Friday, May 2, 2008
Time: 8:30 a.m.
Location: South Carolina Farm Bureau
754 Knox Abbot Dr.
803-936-4290 (for directions only)
Registration Deadline: Friday, April 18, 2008

Place: Mobile, AL
Date: Thursday, May 8, 2008
Time: 8:30 a.m.
Location: Cottage Hill Baptist Church
4255 Cottage Hill Rd.
251-660-2422 (for directions only)
Registration Deadline: Thursday, April 24, 2008

Last Modified: Monday, 03-Dec-2007 14:33:15 EST



2008 NFIP Claims Presentations
How to Register for a Claims Presentation

In 2008, the NFIP Bureau and Statistical Agent will offer 24 Claims Presentations in cities throughout the country. They will be conducted between January 16 and May 8, so that an adequate number of flood-certified adjusters will be available before “hurricane season’ begins on June 1.

Advance registration is required. You must register by mail; you must pay the $10.00 fee with a check or money order made payable to: National Flood Insurance Program. Do not send cash. Your registration and payment must be received by the registration deadline date for the session that you choose. Your registration will not be accepted after that date.

No space will be reserved until payment has been received. Refunds and changes of session cannot be granted. Registrations are nontransferable.

Please do not call the NFIP Bureau and Statistical Agent about the status of your registration. We will mail an acknowledgement of receipt to the address that you provide on the Registration Form (PDF 13 KB, TXT 1 KB).


Here’s the registration form:


Please submit an updated resume when you have completed your 2008 NFIP Certification as we maintain seperate rosters of NFIP certified adjusters for special requests for flood certified adjusters. Please submit your cert# and information on the certs applicable for personal and or commercial lines.

We’ve had many interesting forum discussions the past few years about the National Flood program requirement that requires four years of experience to receive the certification. My personal opinion is that since the class is so reasonably priced at $10.00 it is worth registering for the class if you are an adjuster with less than four years just so you have a clearer understanding of what the flood policy provides as far as coverages. We have also had many newer adjusters with agency backgrounds and construction backgrounds who were approved by NFIP for their certification with less than four years of experience. Others are of the opinion that newer adjusters should not register as they are taking spots for more   experienced adjusters. I don’t think that is the case at all as NFIP offers certification classes at other locations such as the special classes Pilot held last year as well as the National Association of Catastrophe Adjusters convention holding classes at the 2007 convention.

These classes do fill up quickly so I wouldn’t wait for the after the holidays to get your registration form sent in along with your payment if your interested in obtaining your 2008 flood certification.

Lose the Hammer- 8 Characteristics of an Awesome Adjuster-book review by NU Sam Friedman

October 22, 2007

I enjoy following National Underwriter’s Editor Sam Friedman’s blogs on many insurance issues.

Here is a particularly good blog written recently “Lose the Hammer” where he critiques the book written by an instructor, Carl Van of the International Insurance Institute titled 8 Characteristics of an Awesome Adjuster.

Here is a link to the site map for CE courses they have by state. First, this link here is to the Mediation and Arbitration 14 hour CE class they offer ( next select YOUR state on the map here to see what they have for adjusters)in Florida for example. Here is a link to many other excellent “soft skill” courses offered for adjuster’s on their site and it appears these are offered in the field at the carrier sites also (click on their Training Schedule link). Many other classes are also available so just check out their entire claim training section.

We hope you enjoy the book. If you’ve missed our other blogs which contained recommended reading, you’ll find some of our past posts below:

You can’t win a fight with your Client- click here

Dinosaur Brains-if your dealing with ugly situations on claims- click here 

Neandrathals at Work- getting along with a few crazy co-workers and boss- click here

Who moved my  Cheese- click here   (In our version- who moved my claims cheese?)

While your researching reading material to stay current on claim trends, here is also a link to the Claims Education magazine put out by the Insurance Institute on their summer 2007 latest issue here. Here is also a link to National Underwriter’s Claims Magazine here.

We try to do one book review a week if we run across anything we think would be good to share and try to do so on Sundays if you want to check back.

Thank you again to our many readers for staying in touch with our blog. We are proud to announce we reached our 10,000th blog guest Friday night 10/20/07. WordPress has an awesome stat program and you as a reader can also follow our blog stats if your interested by looking at the blog count on the right hand column of the blog or “About us” tab in right hand column as well on the Blog Stats box.

Auto Adjuster Claim Training- What options do I have?

October 11, 2007

One of the interesting aspects of owning a website or blog is reading the user statistics on what search terms bring users to your website. One of the most frequently used search phrases we often get on both this blog and my staffing firm website  is “Auto Claim Training” so today we are going to concentrate on that topic.

Adjusters in our ClaimSmentor forums often ask if they should train as auto adjusters in addition to the training they are doing on property claims. If you are looking at it from the aspect of working as an independent and expanding the value you have to bring to the table to adjusting firms and carriers, the answer is a definite YES! I do recommend first you complete your training first on property claims if that is where your primary interest lies as it is of utmost importance you first do a great job in your primary area of expertise such as residential claims. I’ll blog in the next week on my favorite picks on property claim training options for new adjusters with some online options, self study training options, and field classes and schools but for today, let’s concentrate on the auto side of things!

First, why learn auto claim handling? Let’s look at some statistics on recent storms in 2007 to give you an idea on the number of auto claims reported versus property claims so you have a true perspective on the opportunities to work auto claim losses. Click HERE to see a Claims Journal article from August 2007 regarding a major hailstorm in Colorado which says in part:

“The Rocky Mountain Insurance Information Association says insurance companies expect claims from nearly 5,200 homeowners and 11,000 car owners.”

These are not isolated numbers as it is very common to see these kind of loss statistics on auto versus property claims during a storm. Matter of fact, here are some interesting numbers from the Insurance Information Institute in this article stating that $68.00 of every $100.00 in auto insurance premiums is used to pay claims. This article also attributes 25% of the comprehensive claims on the auto policy are for theft losses. Claims for property damage account for $16 for collision, another $16 for property damage liability, and $7 for the comprehensive claims for a total of about $40.00 of these claim dollars going to property claims when you add in the other expense dollars shown in this report. Unbelievably the attorneys fees are 11% of the $68.00 claim dollars split evenly between plaintiff and defense counsel according to this report linked above.

Claims Magazine ran a very good article in the October 2007 issue regarding a survey with auto repair facilities polling them on their complaints with insurance carriers on auto claims. Here is a link to this article. This article lists “Lack of field staff training” first on the list and then lists the 3 worst carrier offenders according to the shops survey results. Having worked for an excellent carrier, I was surprised to see some of these negative results for carriers such as Progressive listed as the worst offender at training (in the eyes of the repair shops surveyed). Take the time to read the rest of this survey on other topics as the carriers involved might just surprise you! I’d also previously posted a bad faith article on the Merlin Law Group website and carrier training is one of the issues listed in this article as a reason for bad faith claims against carriers. In today’s environment, I’m amazed to see this as even an issue since all carriers should have training as a top priority. As a staff claim employee, we often cross trained between the auto claims department and the property claims division especially in the catastrophe claim divisions when there may not have been enough work to keep auto catastrophe adjusters busy year round. In 1985, all fire adjusters went to auto school and property adjusters to auto school! That effort to switch us around lasted about 1 year when property adjusters wanted to paint cars by the square foot like a wall! (Just kidding but the project ended and we returned to our former positions when they felt it was best to let auto folks do what they knew best and fire adjusters do their residential estimating they did best,etc).

Here is an example of an auto staff adjuster opportunity with Farmers Insurance. You will see that while they prefer a 4 year degree, they will accept those with a 2 year Associates degree and substitute auto body management experience or lead estimator experience for the degree requirements. Just as with staff homeowner positions, each carrier will differ on their requirements. Here is also an article you will find interesting about Nationwide Insurance indicating they were reducing homeowners policies and concentrating on auto…another reason in the “Who moved my Claims Cheese” blog series comments as a reason to consider auto claim training to find an additional source of claim assignments when the property side remains slow. I constantly keep my eye on all job opportunities on the staff side as well as the independent side to post in our Career Forum on ClaimSmentor and recently have seen alot of postings for Auto property and liability adjusters as well as for claim managers. Just two companies that come to mind are Safeco and Farmers with recent postings. I can also tell you from an independent staffing position, I am thrilled to receive resumes from multi line adjusters who can work residential property AND liability AND auto claims as they are most useful for adjusting firms who can utilize them for all operations as needed. It’s definitely something to consider!

Here is a list of some of the auto claim training options we are aware of you may wish to consider if you are an independent requiring training. Today, we’ll limit that training information to property claim training on the auto side. We’ll have further blog information on liability training on the residential and auto side down the road. Just as with property claims, you need your adjuster’s license first and foremost. After that follows policy training and auto estimatic training as well as auto file requirement training. Auto has many sections of the auto policy to learn. I remember years ago attending a 3 week auto claim training school and finding the policy very frustrating to deal with for a homeowner adjuster. We are used to a coverage section and an exclusion section while the auto policy had many subsections each with their own insuring agreement and exclusions. Testing without an open policy was a true nightmare trying to remember which section applied to which test question,etc. The point I am making here is to make sure you don’t make the mistake that some new property adjusters make thinking that estimatics is all you need to know!

Wardlaw Claims- I list this first as one of their instructors, Tim Whiteman, is a member of ClaimSmentor and has been very supportive of our online mentoring program as well as the fact several of our participating adjusters have taken their Auto classes and highly recommended them. I particularly like the fact that they handle property AND liability claim training at their school in Waco,TX and the cost of the programs looks very reasonable. I note there are auto training classes that Tim is teaching listed for October and November on the auto training classes.Here is a link:

Wardlaw Claims
Auto training classes: http://www.wardlawtraining.com/wctc_classroom.cfm?Value1=3
( Maximum cost is $550 for Auto Claim school)
Auto Self Study classes: http://www.wardlawtraining.com/wctc_selfstudy.cfm (Unbelievably priced at less than 24.00 each)

Pacesetter Claims: http://www.pacesetterclaims.com/PCSTech1.aspx

You need to call them for their latest training schedule. I’d ask for Jim Shrewsbury-VP of Claims in the Auto Division who is also a member of ClaimSmentor.

Crawford and Company
Tractor and Trailer Appraisal School- for adjusters with 3 years of auto experience http://www.crawfordandcompany.com/content.aspx?CID=736&SID=2

Vale National School Neil Robertson in the Fresno, CA branch is a ClaimSmentor member if you want a contact there
( Auto Estimatics only) Cost $1,095. There are 3 locations to choose from.

CNC Resources– Mobile, AL Ask for Becky Leckband, Hr Director for class schedule- she is a member of ClaimSmentor

Southern Farm Bureau Tech– Tractor Trailer School
Auto Claim Training- 3 week program http://www.farmbureautech.com/physical%20damage%20estimating.html
2007 Course Schedule http://www.farmbureautech.com/2007_course_schedule.htm

Worley Adjusting Company

While I don’t see a current Auto Basic Claims Class on the current schedule, they did hold one in March 07 so you might want to contact them for more information on the next class


Here’s a link to a prior Accident Reconstruction CE course you may want to contact them for the next class since it is 7 hours of TX CE’s:


While looking into a career in Auto claims, you might also want to check out this Independent Auto Appraisers group at www.iada.org. They held an interesting automotive repair conference in FL in 07 and I see they have the next scheduled for 2008 in Las Vegas. They have some great links on their site for NADA book values and other useful links for Auto Adjusters and Auto Claims Representatives.

There does seem to be advancement opportunity in the Auto Claims field atleast from the staff adjuster standpoint. Here is a link to a recent job with Travelers Insurance for Training managers to train new auto adjusters as just one of many examples.

Fee payments to auto adjusters differs from independent fee schedules we previously blogged about. From the staffing requests we have received, they seem to pay by the vehicle inspected and payment depends on whether you inspect the damage in a carrier drive in or catastrophe operation or if you inspect it at a body shop or other storage facility for non driveable cars. The ranges we are getting are $75.00 per drive in inspection average with the carrier setting the drive in appointments about 30 minutes apart. One such position scheduled 20 appointments per day through the drive in. Remember you will be splitting that fee with the adjusting firm somewhere along the lines of a 60/40 split. The field appointments have averaged about $150.00 per inspection with similar splits. I’ll be interviewing a few Auto Independent Claim managers and blogging about their input on income for auto independent adjusters. I read many forum posts saying there isn’t enough auto work to keep them busy but during 2007 we’ve had as many auto requests for staffing as we have for property so I’m not sure that is true overall in the industry. It is also important to note that normally carrier auto management decisions are made by a seperate group of claim executives on the Auto side so just because the property side may not be using independents does not necessarily mean the auto side will not be. We’ve been working along side an adjusting firm on a consultant standpoint on marketing in recent weeks and it seems our leads are generating more offers for auto independent assignments than property as well. I do believe this in part is due to the fact there are much less adjusting firms willing to take the auto claims versus property as the fee billings are significantly less. We do have several auto associates who also differ with that opinion as they have been fortunate to get multitudes of claims from car dealership carriers for hail damage to vehicles on the lot and to commercial fleets of vehicles. It certainly remains worth exploring these opportunities.

I’ll post a supplement to this blog tomorrow adding additional information. Forgive any format problems as I’m on a Mac today and it’s been difficult going back and forth between websites not being used to the features on this system. I’m counting the days until our computers are set up here!

Valued Policy Law case in Florida overturned- Update on Mierwza /Safety Concerns-Part 2/Fl Insurance Crisis update-Go Jeb!

September 21, 2007

I’ve got quite a bit of blogging to catch up on after extending my business trip this week to 5 days versus the 3 we expected to be out for as there were many developments in the claims industry during my trip.

For starters- we were discussing adjuster safety in one of our last blogs here and the fact that insurance carriers do not define a weapon in their Code of Conduct forms although they forbid adjusters to carry them. Well, I’m sure glad they did not define it as FAA regulations do! Flying up for our business meeting, the mascara and lipstick were confiscated and coming back the cigarette lighter was! So- I guess things could be worse if we had to live by those restrictions! (Smile) If your an adjuster reading this, you might want to catch up on numerous reply postings over on the topic we posted on CADO (here)about the next opportunity to view “Muffled Cries” on Forensic files which is 9/22/07 at 6:30 PM EST. This is the show about Tampa adjuster, Katie Froeschle ‘s murder while handling a rental dwelling claim. There have been a significant number of replies from adjusters on the Cado forum topic by experienced adjusters who have also faced some pretty tough situations while working claims indicating this was not an isolated situation with Katie but a situation many of us have faced (yes, I have many of my own war stories from my years in the field). The thing that surprises me the most is that many of these incidents happened to male adjusters contrary to my thought that had a male adjuster gone out on the claim Katie did that a murder may not have happened.

The most important breaking news applicable to settling claims comes out of Florida where the Valued Policy Law settlement guidelines for total losses established in the Mierzwa case were overturned. We wrote about valued policy laws and recent decisions in this blog here. If you read this blog, it contains an explanation of the Mierzwa case and how that applied to the FL Valued policy law so just take a minute to read that blog if your not familiar with the case.

While we were out, this case was overturned. Here is a link to the Supreme Court decision on this Florida Farm Bureau vs Cox case. Rather than reinventing the wheel, I’ll refer our readers to the Insurance Coverage blog entry of 9/21/07 here which explains the new decision. Basically, this was a win for the insurance industry as described here in this news article also which in part states:

“The unanimous opinion written by Justice Charles Wells said Florida’s 108-year-old valued policy law was intended to prevent haggling over the worth of destroyed property, not to be used to cover perils that were not insured”

According to this article, this takes the case for the insured back to court now to decide what damage was attributed to wind vs what is flood damage since this decision would no longer allow them to collect policy limits since the major damage was caused by non covered flood damage. The policy limit was 65K and Florida Farm Bureau had evaluated the building damage at less than 12K. The way the Mierwza case stood, the carrier would have had to pay the limits under Valued Policy laws even though the majority of damage was from a non covered loss (flood ..and note the insured did not have a flood policy which amazes me having handled many flood claims myself back in my days as a Santa Rosa County, FL staff adjuster dealing with repeated flood claims on Blackwater river there).

I’m glad to see these recent court decisions both in LA and FL where the courts are upholding policy provisions and the intended purposes of valued policy laws. I wonder how much has been paid by carriers in FL on the Mierzwa case ruling and what this will do to the many other pending cases on these very type of issues.

Wind and water decisions will continue to be tough for all adjusters to evaluate. The consumer groups are being very active pushing for passage of the 2007 Multiple Peril Act being pushed by MS Gene Taylor. It is unfortunate they do not begin to realize what they are pushing for and the ramifications of having wind handled by the government similiar to the Flood policies. I’m going to try to get a blog entry in next week explaining just some of the horrors in the flood policy exclusions such as the 12 square foot of deck landing coverage,etc. I think if policyholders understood the  coverage available in a flood policy better and the extreme limitations in coverage they might be much more hesitant about moving the wind to the government if the wind coverage would be as restrictive. It is definitely NOT consumer friendly nor is it adjuster friendly to understand the flood policy or the many unnecessary forms and procedures by NFIP to handle those losses. I don’t think many pushing for it even realize the flood policy has had a 250K limit on a residential building. In layman’s terms just ask yourself this question- how many homes on the beach can you buy for 250K? Give me a break! I sure hope the wind policy won’t contain such unrealistic coverage limitations. These consumers probably also do not know anything about the news releases last year when the powers that be ran out of funding on the flood claims? I’ll post some of those articles in next week’s blog. 

I am a proponent of having the coverage by private carriers to end this ridiculous necessity for an adjuster to have to determine what is wind and what is water damage providing the appropriate rates can be charged for this coverage. This would also satisfy the politicians and the insurance consumer. None of us …..adjusters or insureds …….like the current exclusions under the homeowner policies. Just think how much easier the life of an adjuster would be to go in and assess all damage and close the file. Better time service on claims and more income to independent adjusters who can close more files! Chubb insurance is one of the carriers already doing so. See their press release from last spring here about their coverage. Why can’t other carriers do the same? I imagine this is a mute question at the moment with the mass exodus of coverage as they non renew and send out policy cancellations by carriers in coastal communities. I’d imagine the need by insurers for engineer’s who help assess the cause of each type of damage would be greatly reduced, the cost to defend litigation on the wind vs water would be eliminated, less claim managers would be needed to manage the litigation and coverage issues, and reduced claims costs for such huge expenses should lead to greatly reduced policy premiums so it would be a win win for all parties. Think of the reduction in Insurance Department complaints when consumers no longer have to argue over the coverage assessments for wind vs water damages! Makes sense to me!  You can’t blame them(carriers)if they don’t want to write the combined coverage no matter how much the public (myself included as a coastal resident) protests with the recent political developments in LA and MS on litigation for non covered flood losses and actions by MS Congressman Gene Taylor and Senator Trent Lott as well as Charlie Crist  in FL who has been a one man torpedo destroying insurance relationships in FL by his anti carrier policies while at the same time throwing out all rating rules for his big push for the growth of Citizens of FL with his rate freezes on their premiums……don’t even get me started on that but watch for a blog next week on more about this issue! For now I’ll leave you with a referral to another Rossmiller Insurance Coverage blog that addressed Jeb Bush’s recent comments about the insurance crisis in FL which also happened while we were gone this week! I’m very glad to see Jeb Bush speak out as he was so respected while in office here. Oh for a return to those days!

Valued Policy Law Katrina decisions in the news this week and Fl Valued policy law updates since the 04/05 seasons

August 31, 2007

I wasn’t expecting to create a new blog entry until the holiday was over but we’ve had developing news this week on the LA Valued Policy law cases going through the court systems there. We also have several storm disturbances mentioned in the news so I want to be sure to distribute these updates before folks are going running out on any hurricane losses this season.

Here is a news article from the Associated Press put out by Advisen regarding the Landry vs Lousiana Citizens Property Insurance. This case originally went to court in December 2006 and ruled Citizens did have to pay policy limits on the case because of the valued policy law although it was another wind vs water case of attributing damage between these perils. However, Tuesday of this week, the 3rd Circuit Court of Appeals stated the following according to this news release:

“But the state 3rd Circuit Court of Appeal on Tuesday, in a 3-2 decision, set down this standard: if the Landrys can show that the “efficient or proximate cause” of the destruction was such covered perils as wind, rain or hail, Citizens would have to pay the full value of the property _ without a deduction for flood waters. To avoid that, Citizens would have to show the main destruction was caused by floods. ”

The article goes on to say that 3 weeks earlier a federal appeals court in NOLA affirmed a lower court ruling in favor of insurance companies saying the LA Valued Policy Law does not apply unless the damage is wholly attributable to a covered peril such as wind. I found the case referred to in this Claims Journal article citing the Chauvin vs State Farm Fire and Casualty case here. Here is another outstanding paper by the Tort Trial and Insurance Practice Law Journal (Winter 2007) which provides a short summary on the Chauvin case found on the Zelle firm’s site where you’ll find other excellent information on their articles page. This article is worth the time to read all 36 pages. You’ll find the Chauvin cases discussed on page 35/36 as well as other cases in FL we’ll discuss below. This Times-Picayne article also provides more details on the Chauvin’s case and comments from trial lawyer spokesman, Allan Kanner, hoping other cases will make it to the state Supreme Court for more favorable decision for policyholders. Here is also a “public opinion” blog on the ruling by an angry consumer over the issue here.

I checked the Insurance Coverage blog to see if there are any mentions of the new rulings and found this June 06 blog with links to both the FL Valued law and the LA valued law which also mentions another case I’m not familiar with. I’m curious what they’ll have to say now if they provide new information now that we have these additional new LA nd FL cases providing other new decisions.

Fl has also seen much news on the FL Valued policy law as a result of Hurricanes Ivan and Dennis. This article summarizes the well known Mierzwa vs Fl Windstorm case as well as the subsequent decisions by the courts on the FL 1st DCA 2006 cases of Vanguard Fire and Casualty Company vs Golman. That case involved allegations of breach of contract and bad faith and this article provides interesting reading to understand FL valued policy law changes. This is important as many independent adjusters have not worked cases in FL since Dennis in 05 and this is an 06 decision. (Vanguard is now in receivership by the way) The Zelle Property coverage update referred to above and again here reviews the Citizens Property Ins Corp vs Ceballo case holding that although the FL Valued policy law covers policyholders, they are not entitled to 25% of limits for Ordinance and Law coverage without proof of incurred expenses. This is found on page 35 of this document. Note that the information in this document goes on to say “that the court certified it’s opinion to the FL Supreme Court realizing that it’s opinion may be in conflict with another appellate court decision”..referring to the Mierzwa case.

It should be an interesting season with the continual new decisions coming out of the courts. From what I can best assess at this time, these decisions do seem to be upholding the intent of the policy contract provisions. I do wonder how many cases were settled on these valued policy law initial decisions as many of the articles linked to above indicate carriers did settle some of these cases out of court over the initial decisions. Hopefully, one of these great legal blogs we follow will address these decisions and provide their opinion as to what this all means for the 07 storm season in LA, FL, TX, and other storm prone regions. I hope adjusters will take the time when looking at these links to observe and read some of the many great blog entries and news articles free for our reading to better understand the claim issues.

Speaking of developing information- take a look before you sign off the blog at this new Ordinance and law information coming out of FL which indicates a new statute may be in effect in October 1, 2007 requiring extensive wind mitigation measures be done to homes in excess of $300,000 in designated zones. It sounds quite expensive as a roofing trade association is quoted as saying the extra cost to replace a roof would run about $6,000. I am very curious if the insurance agents are aware of this new potential expense and are offering increased Ordinance and Law coverage in the event an insured in a designated area must replace their roof subjecting them to this new requirement to do so. This will have a major effect on insurance damage estimates if carriers have to incur this cost. The trade association says they are working with Crist to try to postpone this. I sure hope so, the last thing we need in FL is another expense right now on top of the skyrocketing insurance premiums. This article I just came across today says that the majority of carrier rate increases have come in prior to the upcoming deadline and are averaging about 28% rate increase requests and some of the major carriers have not filed their requests yet. (Could this be due to Crist taking them all in for rate increase hearings as he recently tried to do ??? )You can imagine what the passing of this rule would do to Floridians in addition to the current rate hike proposals should this pass. It is still amazing that Citizens has a rate freeze through 2009. I’m running to Tn when those rate freezes are lifted! We’ve had the same neighbors going back 10 years and have lost several neighbors who have moved out of state after witnessing Katrina damages combined with what is going on in this state with property taxes and insurance for coastal residents.

I updated the stats on the earlier blog this week on new suits on the 2 year statute of limitations cases. According to the articles coming in, thus far about 2, 964 new cases were filed this week in LA. Here’s that blog if you want to read the updates.

**Update 9/1/07- After writing this blog I did in fact locate an updated opinion on the Insurance Coverage blog on the new decision in LA on the Valued policy law (it just wasn’t showing up in an internet search when I was researching earlier today). Here it is and it’s highly recommended reading for a legal opinion as to how this attorney feels this confuses the anti concurrent cause provision and what this this means to us. You read it and form your own opinion.

Statute of Limitations- Katrina 2 year anniversary brings deadline to file LA suits

August 29, 2007

The 2 year anniversary of Katrina  is today while the LA statute of limitations came and went yesterday which was the deadline to file Katrina lawsuits in LA by insureds.

LA had extended their statute of limitations on property claims from 1 year to 2 years following the Katrina storm damage. Yesterday was the last day for insureds in LA to file suit. AL and MS have different terms with AL with a 6 year limit and MS with a 3 year according to the chart below so it may still be years that we continue to see new litigation. The chart also shows a 2 year property damage statute in TX (Rita claims). We do not yet know if there were a mass number of suits filed or not this past week in LA. We will report back on that when information becomes available.

Here is a good blog article by the Merlin group  giving a simple explanation as to what that means for insureds on their claims in LA as well as from an attorney’s perspective. They point out, as I did in the Citizens blog on the task force last week, about the 5 year statute of limitations in FL which a task force board member indicated he wanted to reduce because of the long tail on  claim file reopens. Click here for that blog. The interesting thing is that just because an insured can no longer file suit on a case, does not mean that a carrier will refuse to take a look at a claim request to reopen a file for supplemental damage, it simply means the insured no longer can file suit on the case.

Don’t mistake this for their handling of a newly reported loss at this late date. Claims with late reporting barring unusual circumstances are always handled under a Reservation of Rights while the cause of the reporting delay is investigated with a denial in order for late reporting if the investigation determines the carrier’s right to inspect a loss and investigate the claim have been prejudiced by the late reporting.  Here is a good article written about liability claims but explains reservation of rights letters and provides very good instruction for completing one. The Citizens 2007 Claims Procedure manual also has some ROR sample forms as does a link in my blog on  Scruggs  about the 242 carrier exhibits which contains many actual ROR letters sent out on coverage issues if you need to see  samples of finalized ROR letters.

You might also be interested in looking at the actual FL statute of limitations which does not just pertain to insurance claims but to other actions such as 1 year for a lien to be placed on real property for services or material performed(such as a contractor may do if an insured fails to pay the bill).

Here is a good article explaining both the Statute of Limitations and the Statute of Repose if you do not know the difference. This next article here gives general guidelines on the number of years different statutes run while this last article gives you a chart for all 50 states. An adjuster needs to make sure these are up to date stats before applying them to a particular loss. Make sure to note that there are different statutes for different kinds of losses such as an injury versus a property damage loss. Other factors such as federal or state laws will govern the proper limitation period as the articles linked to above explain. This explanation  from FL on “tolling” a statute and things to consider when dealing with minor children is also good information to know as to when the statute “clock” stops running on various issues.

Here is also information on the federal statute of limitations under the Federal Tort Claims Act that pertained to the Katrina Canal Breaches Consolidated litigation.

The Merlin blog points out some issues in MS causing delays there and here is an article coming from Alabama about FEMA grants and the Increased Cost of Compliance allowances to elevate a building in a flood zone there. It is hard to imagine that two years later they are just working on raising homes in the damaged zones. Anyone driving through MS in places like Biloxi can see the reconstruction problems abound as demolition has not even begun in many cases on the coast. The Fema trailer camps break your heart when you realize those folks have been living basically on a concrete pad with wall to wall campers not much more than the size of a small one or two man tow camper.

As these anniversaries approach bringing with them state statute of limitations, do not just assume you are to deny a claim or not respond  and timely answer a suit through your carrier’s counsel. These are major issues you need to immediately bring to the attention of your claim manager for direction and guidance on claim handling for any loss approaching or surpassing the state statute of limitations.

I’ll let you know as soon as we start seeing the numbers of new suits alleged to be filed with this week’s deadline in LA. Lest we forget while thinking of this two year anniversary, there were 2,000 deaths, 800,000 homeless, and extensive damage as this anniversary article summarizes. It puts insurance policies and statutes of limitations in perspective. In the insurance world they are very important but to the Katrina victims the coverage issues and statutes just bring a new storm of pain and trauma as they learn of these problems after the storm. I’ll end today’s blog with this insurance article summarizing the stats from both Katrina and Rita with numbers. The number of files that may be effected by the statute of limitations is a very very small percentage of the claims settled as you can see. One can certainly appreciate the comments of this news organization regarding trial lawyers “self serving fiction” spouted in unfounded comments about insurance contracts/claims when viewing the REAL numbers of claims which are unsettled.


Update 8/30- This article is being added as it gives an update on new suits filed which seems a minor number in this article. Also note this report indicates there are a few deadline changes allowing for an extra few days to file.

Update 4:30pm 8/30/07- Here is a new article indicating brisk activity at the courthouse

Update 10:20 Pm 8/31- According to this new article– 2,984 new suits were filed in the last week just in the two jurisdictions mentioned in this article- and these are unrelated to the levee cases which are also mentioned in this new article.

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.

Cool items to add to your comprehensive adjuster equipment/gear lists!

August 10, 2007

We follow some of the new adjuster cool tools and equipment/clothing options and here are a few of our favorites this quarter! Check them out!

This is my newest discovery from Neat Receipts which has very small scanners to scan in documents and receipts as well as a business card scanner to keep up with all of your contacts made out in the field! They advertise they weigh in at about 1 lb. Adjusters know how hard it is to pack up all of your important gear and equipment for field appointments. What a great option for catastrophe duty or any field assignments while dealing with insureds replacement cost receipts, contractor estimates and much more! We all meet alot of wonderful contacts out on assignment but what a chore keeping up with their business cards when you travel for a living! There is a business card scanner you can also keep with you. If anyone knows of alternatives at a lower price, let us know about them and we’ll pass the word! These look like much needed time saving devices to aid you in quicker closings rather than having to wait for an insured to copy documents and mail them in to the office as well.

How about these laser glasses for those of you using disto and other laser measuring devices? We’ve read all kinds of tips in forums for adjusters to see the laser measurements outdoors but what a great option these reasonably priced laser glasses would be at $12.95! Here is a link– just scroll down to find the red and green glasses options!

Cat adjuster clothing is always a challenge and one of our senior adjusters especially recommends these Gall brand pants ( Tachtical T-111) for field adjusters. They look fantastic. He reports they use them exclusively due to the multitude of deep pockets and the option to insert knee pads which they find great for roof damage inspections. We ordered the catalog which is free and there were many other great things in the catalog that would interest adjusters! I can’t imagine any carrier or adjusting firm who wouldn’t approve of these pants in the “khaki pants” requirement! We’ll show you some links to several carrier dress code policies in another blog down the road.

Ladder safety is a constant concern to field adjusters as we learn of new cases each season when an adjuster falls off of a roof. I just love this product Safe-T Ladder by Guardian. We had an adjuster test one out when Guardian sent us one to sample under our ClaimSmentor Roving Reporter program where we evaluate products and seminars through donations made to our site. This product received glowing reviews from our evaluating adjuster. Should you have a product, book, or training class you wish  to donate for evaluation in our forums by one of our volunteer participating adjusters, just contact us at  ClaimSmentor.

Have a great weekend everyone. We may have few additional lazy weekends ahead as we get closer to the peak of hurricane season.

Will someone lose the infamous post it note already?

August 7, 2007

When will we ever hear the last of the infamous  post it “sticky ” note? You see, it’s become quite the talk in lawsuits and insurance articles since Katrina. Together, let’s find a way to bury the use of the dern practice.

First of all, a little history on the real intention of post it notes by claim managers.

There was one school of thought that said you shouldn’t use sticky notes on claim file jackets because “if it’s not in the activity log …….it didn’t happen”. The problem is that sensitive adjusters didn’t like being critiqued in a claim file where their errors were pointed out. You see files are always pulled later for various management surveys and they did not like the perception others would have that they didn’t understand their job or were error prone on file requirements. Managers that dared to use the logs to properly document their review activities faced the risk of being unpopular which could lead to negative comments on the much dreaded employee opinion surveys where adjusters rate their managers. Carriers often require management log notes be written in a dedicated color thus the term “red ink” in the file. It stands out  as if to say “wrong wrong wrong” and adjusters just don’t like it. Adjusters often felt the need to then “duke it out” in the file to justify their activities which is never pretty in an activity log.

The other side of the fence used to use them as it was more “adjuster friendly” to avoid critiquing an adjuster’s work product in the file while you gave them a first opportunity to correct the error of their ways unless you found trends with the same mistake often repeated. First of all, this practice is wrong as management reviews are an important aspect of the claim process to make sure all coverages are addressed and that files are properly documented. By using a post it note, they could easily detach from the claim jacket and a manager risks the possibility that the adjuster will throw out the note hoping for a less particular manager to review and approve the file while their boss was on vacation or while multiple managers are assisting with file reviews during a storm. Anyone in management knows the adjusters who circumvent their file authority and run over to another manager to see if they’ll approve it. We are all too busy to have to review claim files  multiple times  especially during a catastrophe operation. A manager shouldn’t have to go back through an entire file to verify the errors are then later  corrected especially with a volume of claims during cat season. They should be able to review their prior log entry and then be able to go right to the pertinent items in question to assure that the necessary corrections are made. Another reason the practice of sticky notes should be avoided is because it became all too convenient for the manager type who lacked the confidence to make a call on a tough decision in the file. Rather than be questioned later by their middle manager for a call they made during an audit, they’d give the adjuster instructions outside of the file on a post it note. Great- just great! Where does this leave the adjuster if a case went to suit over a coverage decision they handled at the request of their manager? I know I nor the adjusters I came up the ranks with appreciated a spineless claim manager type who wouldn’t support their decisions in a file.

So I continue to ask myself- what could they have been thinking with this infamous little sticky note? You mean you haven’t seen it? Here it is as shown in numerous articles……..

The importance of avoiding the use of post it notes becomes quite apparent when viewing the following news stories and litigation complaint allegations. We are not picking on this one carrier as we are sure this isn’t the only firm who has ever used a post it note while providing instructions for the reasons listed at the beginning of this blog.

The sticky note shown above comes from this article by ABC News. You’ll also see it blasted in the press in this article about MS Gene Taylor’s testimony at a house subcomittee hearing . How about the fact it’s traveling the political blog circuit such as Ana Maria’s A.M. in the Morning blog here. If it hasn’t made the nationwide circuits enough in the news, how about the fact it’s appeared in this document presented by MS Attorney General Jim Hood as part of his testimony before another house subcommittee(see page 34 of pdf document). It seems no one is exempt from having to testify about this as shown in the deposition of Ms Deputy Insurance Commissioner Harrell who was even asked about it as shown in this Scruggs Katrina group pdf document of Harrell’s deposition on page 98.

We can’t pretend to understand why such an important comment was made on a sticky note as we have no idea. The fact this sticky note is making the rounds through Katrina litigation speaks volumes about the perception by those writing about it. You read the postings and you decide what those perceptions are and I don’t think you will find them a positive reflection on our industry.

You should avoid the use of  post it notes in all cases. Electronic activity logs in the ever increasing use of electronic claim management systems hopefully will decrease the use of such practices. This wouldn’t help resolve the verbal instructions some managers may give you. Hopefully, you can use this blog entry to open dialogue in your firm to address  how serious it is that all pertinent documents and instructions be placed where they belong in activity logs. Adjusters need to make sure their managers are willing to “go out on a limb” when instructing them and they need to make sure their files hold up under file review so the use of instructional management comments aren’t necessary. If you are having trouble with a  manager unwilling to log their comments, you might approach a manager with your adjusting firm and share this blog with them  so they can then pass this information on to someone with the carrier so you aren’t the subject of such blog entries and discovery material.

Log notes are an important part of the discovery process. For example, it is not appropriate or good claim handling practice to put the common first contact entry as “called insured, made appointment for X date”. There should be much more discussed in your first conversation such as severity code issues which might involve the need for additional living expense advances, temporary emergency repairs to tarp a roof, and much more. If you are not familiar with requirements for good activity logs to protect yourself and the carrier you serve, you might be interested in Activity Log Self Study Guide, File order, and electronic document naming suggestions to improve your activity log submissions. There are generally accepted guidelines by carriers you need to be familiar with. Not only will good log notes improve the professional file appearance but will  also improve the timelines often used in court against adjusters by logging all appropriate entries in the proper format. It is very difficult to recall the specifics of your meetings and discussions years later should suit be filed on a case as with the multitude of Katrina cases now going to court two years after the fact. Just ask yourself reviewing your log if it is a complete chronology of file events and if it supports the claim file decisions as a stand alone document from initial coverage review through your final settlement recommendations without the need to refer back to another single document in your file.

We thought along the lines of many of you that you could merely assume log note entry training could get a mere mention in your training sessions. That is not the case. During our online 40 hour Fundamentals of Claims class, we have mock claim scenarios set up with sample activity logs and trainees must complete activity logs based on the circumstances in the stated scenario. I can assure you having taught this class for the past 1.5 years, it is not a simple matter of common sense. Without your training and instructions as adjusting firms and carriers, it is not unusual to see even the most experienced adjuster skimping on their activity logs. As we teach the new adjusters, you will see many improper logs when reviewing reassigned files that may have made it through the channels during peak storm activity. The Katrina suits and links above clearly show we need to all improve training in this area. 

Good log notes are one aspect of the file that differentiate a great adjuster from the average.Managers recognize who is  capable of handling complex claim issues thus they are selected for clean up duty to handle reopen files. Any adjuster who has stayed behind for clean up can attest to the fact that it is very difficult to follow behind an adjuster on  reassigned files when they did not document authority extended, pending items, coverage issues and other important discussion details.

Please help us end the improper use of post it notes and other verbal instructions so we never have to view this topic in the perception of the public again! As NIKE says “just do it”…….if it happened log it…period.

Watch for our future  blog on the limited file review practice consisting  only of  a random sampling of closed files being reviewed that will track along with other file requirement discussions showing a smart carrier will not just decrease managers to save on expenses when the reality is it is just moving the claim expense elsewhere in the adjustment expense ratio to defense costs for bad faith claim handling suits…..or is it? We’ll explore the topic and report our findings soon.

Who moved my “claims cheese”…dealing with change in the Insurance adjusting community

July 30, 2007

One thing that is certain in the insurance claims adjusting community is CHANGE!

Years ago, as staff claim managers, we were asked to read the book Who Moved my Cheese by Dr Spencer Johnson. What a great book with parables to help us understand change and the varying ways folks deal with change through the characters of Hem, Haw, Sniff, and Scurry. This book has developed into training programs and much more and is highly recommended for adjusting firm presentations and for adjusters experiencing change.

So what is changing in our insurance adjusting community? To name just a few things that we are experiencing which is creating havoc for independent adjusters income:

Carriers are moving to large in house claim central operations handling many claims over the phone by staff adjusters. Here is just one of many new announcements.

Carriers are withdrawing coverage in nationwide coastal communities. Are you prepared to work claims for the many state windpools by taking pre-orientation training seminars that they are requiring or are you one of the adjusters saying ” they’ll call me without it anyway-they will be desperate”?

Insureds are self insuring and increasing deductibles due to the rising cost of insurance reducing the number of claims to be worked by independent and staff adjusters.

We’ve had 2 major whistleblower suits in the wake of Katrina caused by independents leading to increased use of staff adjusters by carriers. If your not familiar with them read this and this interesting news article.

Carriers are announcing limited assignments versus full assignments to independents in many cases which will result in reduced fees adjusters can earn. Examples include carriers handling the additional living expense and contents claim while allowing the independent adjuster to handle the building estimate portion of the loss only.

We’ve had an unprecedented number of trainee adjusters enter the field due to heavy claim activity after the 2004 and 2005 storm season resulting in less assignments per adjuster. Look at these articles showing the numbers of emergency adjusters in FL in 04 and the number of independent licenses issued in Tx was discussed in this TDI article:

Agent Licensing: Matt Ray, Deputy Commissioner, Licensing, stated that the licensing statutes and TDI staff performed well during the disaster. The statute is designed to facilitate carriers’ ability to bring in adjusters. If an adjuster has a license in another state, then the adjuster does not need a Texas license in order to be a temporary adjuster. If a professional adjuster’s home state does not license adjusters, the adjuster can work in Texas under the company’s supervision and the company will be held accountable for the adjuster’s actions. TDI has issued 50,000 adjuster licenses, and 15,000 are non-residents. If an adjuster is licensed in another state, then TDI grants reciprocity without a test or application. TDI issues emergency adjuster licenses to individuals who are not adjusters, for example, other staff who work for the carrier, so they can get into the field quickly. Emergency adjuster applications are given priority for processing by TDI Licensing staff. TDI does not issue badges to agents or adjusters.

http://www.tdi.state.tx.us/commish/storms/tsdc52006.html   (this link is now moved so article is posted above).


Carriers are increasing the number of staff field adjusters for line units and catastrophe operations further reducing assignments to independent adjusting firms.

Multitudes of new start up independent adjusting firms are decreasing the number of assignments to other  adjusting firms. This also results in less negotiation with carriers of adjuster fee schedules by the adjusting firm to avoid losing carrier contracts.

Large fines are being assessed to adjusting firms by carriers such as Citizens of FL causing some intimidating clauses to be added to independent adjusting firm contracts to pass these fines on to their adjusters. Look at page 5 of this RFP for just ONE of the fines to be assessed to adjusting firms. Several others can be found in the 103 page RFP the firms used when considering the requirements to work these claims. How about other fines in the news such as this  $3,500 fine in 2004 for adjusters discouraging insureds from filing a DOI complaint?

Our community has an increased influx of start up training firms for estimatic software training and Adjuster 101 classes. In many cases, new adjusters are being trained by barely more experienced adjusters turned training facility. The advice given ,we hear in several cases ,would not meet the minimim carrier expectations. Can you imagine being a new adjuster trying to decide which firm to train with?

National Assn of Insurance Commissioners is working on a Model Act for Independent Adjusters which will change the way independent adjusters are licensed when the act is adopted by State Insurance Departments. Right now they don’t have the latest draft up so here’s a link to the last one we could view.

Unprecedented numbers of independent adjusters are experiencing serious problems with receipt of fee bill payments after months of working out on catastrophe assignments. Here is a site started due to this problem during Katrina that was overwhelmed with the volume of adjusters reporting such problems. Adjusters have no clear cut answer on how they are to proceed to recover these fees reducing the number of adjusters in our community. It’s firms such as this one outlining just one example of some problems faced by adjusters working for this outfit. Here is also a link to many other articles on this firm.

There seems to be an ever increasing requirement to attend adjusting firm conferences and seminars to be placed or remain on their rosters. Stories abound of adjusters spending thousands of dollars annually at a time their income is greatly reduced after the slow storm season of 2006 with no hurricanes yet they have no choice if they choose to remain deployable with different adjusting firms.

Adjusters in great numbers are being named in suit files for bad faith when simply following carrier directives for claim handling. Here’s an example of a suit file naming many adjusters. Is this going to drive up the costs for Errors and Omissions coverage for adjusting firms and adjusters?

New carriers are entering the market requiring adjusters take more carrier certification classes. It’s important the carriers conduct these as shown here in this Merlin Law Firm list of actions that can bring rise to bad faith allegations.

It is important with our ever changing environment that you stay abreast of many important developments in our adjusting community. While your home on down time in between storms, enjoy your family and get that much needed rest but keep up with important issues by reading professional publications such as Claims Magazine  and subscribing to news reels such as the Insurance Journal  and National Underwriter’s breaking news articles . You’ll also see a list of my favorite Claims Blogs listed on the right column of my blog that you might find very interesting and help us keep up to date with claim issues.

You need to continue your education to increase your odds of being selected from among the thousands of adjusters seeking employment/deployment by participating in carrier certifications such as those put on by reputable firms such as Eberl’s and Worley and many other firms. One of the most important designations you can obtain as an adjuster is the Associates in Claims AIC designation which is recognized by both carriers and adjusting firms. It’s tough to find the time, I know! I’m still working on my last part for my CPCU designation and it’s hard work but it will be worth the effort. I remember a division manager telling me for every 5 who say they cannot do it since they are on cat, he could always seek out and find those who did which he promoted for their efforts.

Here’s a link to keep up with many states licensing changes on the left column of our website. CADO also has an excellent site for all states licensing requirements here.

You are welcome to participat at ClaimSmentor to help you keep up with many of these issues and links such as those provided in this article should you not have time to keep up with the many different issues facing us.

So who are you….Hem,Haw, Sniff, or Scurry? Read the book and you decide! I see examples of each of these characters daily in the claims adjusting community. There are those who find every reason not to follow the new trends, those that debate it in forums and tell others why they don’t need to pay attention to these new trends, those who explore the new information and consider the changes in our industy, and those that agree the changes are reducing their income and move with the new opportunities finding income generating opportunities in these new claim central operations, as staff adjusters, and with new carrier assignments through their favorite adjusting firms as they pick up new clients. We hope you will see the advantages of moving ahead to remain a member of the independent adjusting community!