CertainTeed Class Action Settlement? Details in Post along with website info

February 11, 2010


The above link contains information about a class action settlement on the CertainTeed roof shingles.

Wouldn’t it be interesting to know how many roof totals adjusters have done for shingles not resealing due to the premature wear and tear mentioned in this article. I’m curious if insurance carriers have enough details-doubtful- in their wind/roof claim files to go back and recover through this settlement? Any ideas readers?

For the class action website we previously wrote about, here is a link to our prior blog on this topic:


I double checked CertainTeed’s press releases and there is no news yet posted http://www.certainteed.com/pressroom/

Website for CertainTeed Shingles Class Action Lawsuit

January 31, 2010

Adjusters will be interested in this information as I imagine you are running into this issue regularly on roof claim losses.

Here is the link to the Class Action Lawsuit and proposed settlement for the CertainTeed roof shingles and all court documents:


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.

Adjusters- Read about Class Action lawsuit in OK on Overhead and Profit issues

April 2, 2008

The majority of adjusters on our rosters handle property versus auto claims or a combination of both thus I believe many of you would be interested in knowing about the Class Action lawsuit going on in OK against Farmers Insurance styled Burgess et al. v. Farmers Insurance Company, Inc. et al.

An excerpt taken from the Class Action website for this case says 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.

This is an important case and you may wish to share a link to this blog with your claim managers at the adjusting firm level or if your an independent claim manager, you might wish to share this with your insurance carrier management as they may wish to discuss this with their corporate legal departments to review their current position on the overhead and profit issues discussed in this case.

Here is a link to the first article with links to all of the court documents to include the complaint:

Click here

A link to the lawyers representing the class members:

Click here

Here’s also an article about it from a negative anti-Farmers site with their posting on the case:

Click here

It seems we are hearing more often about suits involving these issues. Here is an example from a 2007 article  addressing the standard 20% and the belief by some that 20% was not enough for Katrina claims in a case against State Farm and one against Travelers (any lawyers viewing- any updates on these cases would be great!): Click here for that article

Contractors are also discussing these issues on some of their forums and blogs: Click here for an example

These articles and developments are just one topic example of why it is utmost important that you obtain your training on estimatics and claims handling by reputable firms that are up to date with current events with issues which could effect our claims industry. Too often I hear about new adjuster turned estimating school with no understanding of claim management issues or current issues going on that students need to know about. Always check out the experience and qualifications before you sign up for the multitude of estimating classes out there these days on the market!

Branch Consultants vs Multiple Insurers and Adjusting Firms Whistleblower case thrown out by Judge today!

October 17, 2007

Here is breaking news on the Branch Consultant case which is the case involving 4 unnamed adjusters alleging under the False Claims Act that a multitude of carriers and multiple independent adjusting firms moved wind damages to the flood program improperly charging them with wind damages by attributing the damage to flood.

Here is the news article today on this case indicating the judge threw out the case.


Here is a 2nd article that came out tonight which reveals for the first time that I have seen in any articles the name of one of the adjusters:

“Kanner said that he believes that the only hope of a real investigation of possible overbilling of the National Flood Insurance Program is for someone in Congress to invite his key adjuster, Max Johnson, to testify about his findings and demand to know why the Justice Department and the Department of Homeland Security, which is in charge of the flood program through the Federal Emergency Management Agency, isn’t doing more. ” Read the rest of the linked article for additional comments by Branch’s attorney, Mr Kanner.


* Note this link above also discloses many more reasons why Judge Beer dismissed the case because of the Rigsby/Renfroe/State Farm case. Simply interesting for those of us in the adjusting community. This link is a must read. Also from this link you’ll see a list of the carriers and adjusting firms that were named in the suit but read farther down in my blog entry for the article that says Allied adjusting firm was the 5th adjusting firm also named in the suit:

“The Branch case involved Allstate Insurance Co., State Farm, Liberty Mutual Fire Insurance Co., Fidelity National Insurance Co., Fidelity National Property and Casualty Insurance Co., American National Property and Casualty Co., American Reliable Insurance Co., Standard Fire Insurance Co., Pilot Catastrophe Services Inc., Crawford and Co., NCA Group Inc., Simsol Insurance Services Inc., and Colonial Claims Corp.

The Rigsby case was filed against State Farm, Allstate, Nationwide Insurance Co., USAA Insurance Co. , Forensic Analysis Engineering Corp., Exponent Failure Analysis, Haag Engineering Co., Jade Engineering, Rimkus Consulting Group Inc., Structure Group, Renfroe and several individuals.”

I hope Rossmiller’s blog  provides more in depth review of the activity today and links to the court documents. I’ll post more information as other news is released on this case.

Here you will find some links to a history of articles on the case and the court documents:

US Attorney won’t intervene in the case:


May Times- Piscayne article “Insurers accused of overbilling the federal Government”


June article (not part of this case but related) saying Government Accountability office (GAO) did not find problems alleged:


Just totally for the human interest of it..here’s Kanner’s picture- the attorney who represented the whistleblowers:

Here’s Kanners profile/picture:


I found the Kanner Law firm website- note on his publications page he sites a forthcoming article on Property Damage Claims and Business Interruption losses. While there are links to many cases they have handled, I don’t find one for this suit:


Dr Michael Birzon’s of the University of Central FL’s earlier blog on the case:


The earlier articles above didn’t name the 5th adjusting firm but this article does list Allied as the 5th adjusting firm and goes into much more details on the fines:

We now have the 5th name in this National Underwriter article- Allied out of Ft Lauderdale:


There is much more in this article also about 8 billion in fraud and 11,000 fines,etc…

Here’s a 2nd article that listed Allied Adjusting:


Next was the important action in July 2007 by Judge Beer’s requesting the US Justice Department become involved:


I found the article specifying how much these whistleblowers stood to gain- here is what it says so if the federal government had gotten involved, they would get reduced fees but it would still be a huge windfall to these whistleblowers due to the extent alleged to be involved:

“If whistleblowers are successful in pursuing the suit without the U.S. attorney’s intervention, they could be awarded as much as 30 percent of the proceeds if the suit is victorious. If the U.S. attorney’s office decides later to take over the investigation and the effort is successful, the whistleblowers’ take is reduced to 15 percent to 25 percent of the proceeds, Dugas said, because the government is the one doing the heavy lifting.

Under the False Claims Act, anyone who knowingly submits fake bills to the government is liable for three times the amount of damages sustained by the government, according to the Branch suit. There is also a civil penalty. ”


It’s on page 4 of this 6 page story.

Here is a link to the original complaint filed:


Here was an article coming out of Mobile, AL quoting Pilot Catastrophe Services attorney on the case:


Congressman Gene Taylor’s website comments on the allegations of carrier abuse:


Another June article out of LA on the reliance on private insurers involved in flood:


This July Claims Journal article advised Scottsdale Insurance had been dropped from the suit:


Here was a July Bloomberg.com article quoting several other carriers involved in the suit:


Forbes.com wrote a July 9, 2007 article which said in part that the request for Justice Dept involvement was withdrawn ( link is no longer working but with Forbes subscription I’m sure you can find it based on topic and having date written-below is a quote from that article):


“A federal judge on Monday withdrew an order challenging U.S. Attorney David Dugas for not intervening in a whistleblowers’ lawsuit that accuses insurance companies of overbilling the federal government for flood damage from Hurricane Katrina.”

Here’s another article..sounds like the 2 folks who commented on the article are ready to shout “guilty” against the insurance industry as they have no understanding of the NFIP directives to carriers:


Now here’s some of the best info I’ve seen on the whistleblower case and what happened  explaining it all with links to the US attorney’s brief and the original request..very interesting:


Here is the US Attorney’s brief filed Friday:


Homeland Security Report- 18 pages worth reading- their survey and findings on the files. Make sure to note that this says they have subpeoned the wind files from the WYO carriers:


Here is Branch’s response to the court on IG brief filed:


Links to various states whistleblower acts on False Claims Act- I didn’t realize they varied by states- some allow only for False claims involving health issues- anyway- here is the state by state guidelines:


And here is other information on the False Claims Act in general:


That’s the entire history of articles I had on this case. I will post the pdf document for the dismissal as soon as it’s located. This is an important case for adjusters to study and learn from.  I hate to think of the dollars wasted on E and O and other defense costs involved by the adjusters, adjusting firms, and carriers who had been named in the suit. No one in the claims industry including policyholders had anything to gain on this case as the expense all results in higher premiums for us all down the road. Make sure you read what these whistleblowers stood to gain in the links provided above. The hard part is to know the adjusters  making the allegations were anonymous and still out there working for carriers and/or adjusting firms. Cases like this cost all independents jobs…..we’ve all watched as carriers have increased their numbers of staff adjusters since this case and the Rigsby/Renfroe/State Farm case also involved independent adjusters.

The initial news article posted at the top of this blog addresses the possibilty of an appeal so this may not be over yet. After 30 years in the property claims business, I find it very tough to believe the allegations in this case but by viewing all information posted publicly on the case, I’m trying to learn both sides of the issue and hope that you will also by viewing all information available to us  like that found in the links above. I would imagine I’ll have lots of supplemental comments to this blog as new information becomes available this week.


**Update 10/18- I knew David Rossmiller of the Insurance Coverage blog would come through with an update on this. Here is today’s entry which ties all of this together for us and also mentions the connection with this case and the Rigsby whistleblower case:


Also, Dr Michael Birzon of the University of Central FL wrote the following blog last night found here:


I’ll continue to update this throughout the day if any significant new things are learned. We only have 1 of the 4 adjuster’s names thus far and if I find the other 3 I’ll post it immediately.

Auto Adjuster Claim Careers An interview with Carey O’Connor with CSP Claims

October 13, 2007

Special thanks to adjusting firm owner, Carey O’Connor with CSP Claims www.cspclaims.com for spending time with me Friday as I interviewed him for this blog series on careers in auto claims adjusting.

Carey’s background is similar to mine with many years on the staff claims side of the business prior to opening CSP claims with several other partners who also had claim staff management experience. I find that a very important element in the success of an independent adjusting firm since they know the “ins” and the “outs” of the business and how things work from a carrier management perspective. We are here to serve the carriers and I’m continually amazed to read some postings by some independents that don’t seem to understand that major point. I will say during my years as a staff claim manager, I worked with many wonderful outstanding independents who “got it” and did a great job for us and I’m sorry to see that many of those types of independents are gun shy about posting on some of the public forums where we could all be getting better reputations with the carriers. I’m seeking out some of these folks for blog interviews and would love to hear from many of you even if only in reply via comments to some blog entries.

Carey’s recommendations he agreed to share with our ClaimSmentor and Dimechimes Corporation readers interested in a career in auto adjusting includes the following:

1) The BEST place to get the multitude of training on the auto side( as well as the property side) is to work as a staff adjuster FIRST for a number of years to gain access to a thorough training program and a large variety of losses.

2) Carey feels the number one auto estimatic software a trainee should learn is CCC Pathways. He advises the majority of smaller and medium carriers who are using independents are either using this system currently or are moving to the system which he sees happening more frequently.

3) Carey highly recommends trainees participate in I-CAR training for learning many more aspects of collision estimating.

4)Carey advises that the top 2 catastrophe property assignments on auto claims assigned out to independent auto adjusters is for hail damage and flood damage to vehicles which can be learned in a very short period of time. Much more difficult is collision losses with many more car parts involved requiring a much more indepth training to properly estimate collision repairs to vehicles on daily claims.

5)Carey advises the majority of auto liability assignments they get from numerous carriers involves limited assignments for the property damage claims involving the repairs to a claimant’s vehicle.

6) In both cases (insured and claimant vehicles) the fee allowances by carriers runs on average about $70.00 per vehicle if inspected at a carrier’s catastrophe drive through operation or $110-$155.00 per vehicle for those handled at a body shop or storage facility or other location for non driveable cars. This rate depends on the allowance of the carrier. There is a fee split with the adjusting firm just as there is on the homeowner claims.

7) CSP Claims has access to a Paint/Dentless repair company for training auto adjusters and a new facility for property training classes and hopes to be offering the auto claim training classes in the not too distant future so you should check back with them after the first of the year if you are looking for a reputable source for your auto training classes.

(8) Carey also indicated the biggest challenge new auto adjusters face is dealing with the repair vs replacement parts issue with body shops and repair facilities similar to what property adjusters face in the home estimating side of things. To comfortably and professionally deal with these issues, Carey feels it is of utmost importance that a good auto adjuster stay up to date on current repair standards by continually taking advantage of the courses available to auto repair technicians to stay current and that you obtain your I-CAR Certifications.

(9) Similiar to a homeowner adjuster having an advantage if they have a background in construction, Carey thinks it is very valuable for auto adjusters to have previous experience as auto estimators or technicians involved at auto repair facilities so they can better be in a position to discuss estimate reconciliation issues with repair facilities. Better yet is to have prior experience as an auto staff adjuster with solid experience not only in repair procedures but claims experience and a significant understanding of the auto policies.

10) Carey felt from an assignment standpoint, the carriers are much more willing to assign auto claims out to independent adjusters due to the lower fees involved (vs homeowner fee schedules) and their firm has been successful in bringing in new carriers for assignments on the auto side while things from the homeowner side have been much slower for everyone in the independent industry. He agrees with our assessment that the majority of carriers have vastly increased the number of staff catastrophe adjusters leaving much less work on the independent side without major storms.

We thank Carey for his time sharing information with us for this blog to assist you in making your decisions regarding auto claim adjuster careers. We hope you’ll take a minute to visit their website at www.cspclaims.com

Here is also a link to information about I-CAR certifications mentioned above as well as to CCC Pathways with Paint/Dentless repair software that Carey mentioned.

We’ll address other Auto adjusting issues later this coming week as well as provide information on other auto estimatic software often requested such as Mitchell.

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.