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P:  3/11/2010 12:26:11 PM
Desert Adjuster

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Last Post: 3/11/2010
Member Since: 3/11/2010

Will the standard homeowners and commercial polices pay for the expense of of the insured using a public adjuster?  i know in most cases the PA recovers their fee as a percentage of the claim.  However will the policy cover the expense as an added expense incurred by the insured to handle the claim for them?

 


Desert Adjuster

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 There are 19 replies to this message.  There are 19 replies on this page.

P: 3/11/2010 4:34:45 PM
wworkman

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Last Post: 5/20/2010
Member Since: 2/25/2009

NO.

The PA's fees would not be covered "damage." It is the insured's responsibility to pay the PA since the insured is the party who hired the PA.
 
If the appraisal process was invokved, each party is responisble to pay their own appraiser, which I view as the hiring of a PA by the insured. The carrier did not hire the PA, so there is no legal transaction to be paid

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P: 4/2/2010 4:02:34 PM
Islindini

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Last Post: 4/3/2010
Member Since: 2/6/2007

No, the policy will not pay for the PA fees.  The insured pays for this - that is why the PA always wants to push settlement as high as he can as he gets a % of the settlement.

Revisions : 0   |    Posted:  4/2/2010 4:02:34 PM    |    IP:  Recorded    |    Report this post
P: 4/3/2010 6:38:55 PM
mbernier40508

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Last Post: 5/24/2010
Member Since: 10/18/2007

A public adjuster "pushes" for the maximum settlement. Isn't the maximum settlement what is farir to an insured?

Revisions : 0   |    Posted:  4/3/2010 6:38:55 PM    |    IP:  Recorded    |    Report this post
P: 4/3/2010 9:35:49 PM
Kevin Hromas

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Total Posts: 79
Last Post: 12/15/2010
Member Since: 10/18/2007

Benier,

No PA I have run across in my 14+ years in the business "pushes" for the maximum settlement ... they fabricate damages and over-write estimates. In a just world they would be prosecuted for conspiracy to commit insurance fraud.
 
Write an ACCURATE estimate and I can deal with you ... otherwise crawl back under the rock or hole you climbed out of.
 
Don't universally use 25yr - 3 tab roofing on EVERY estimate, don't put a temp toilet out for 6 months on a 1 day roof job, don't charge cumulative OHP or add it to a simple roof job, don't use Base Service Charges on a major damage repair, don't write an estimate for $90,000 on a house worth $30,000 ... should I go on or do you catch my drift?
 
Sign your name to your posts so everyone can be sure to know what to expect if they run across you on a claim down the road.
 
Have a good one!
 
Kevin Hromas - JD, RPA, PLCS
Executive General Adjuster
Houston, TX

Kevin Hromas - JD,EGA,RPA,PLCS,WIND Umpire
Houston, TX

www.KevinHromas.com

Revisions : 0   |    Posted:  4/3/2010 9:35:49 PM    |    IP:  Recorded    |    Report this post
P: 4/4/2010 10:23:02 AM
mbernier40508

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Last Post: 5/24/2010
Member Since: 10/18/2007

14 years in the business is a pittance. You have a dislike for PAs, as did I, and as do many others who are on the insurance company side. This is a natural tendency which I can excuse because the profession is judged by some bad apples in the bin.

Interestingly, Citizens Insurance in Florida did a study of public adjusters which they hoped would show them in a bad light. Quite to the contrary, it showed complaints against PAs were less than company adjusters. It also showed PAs obtained settlements that were 1700% higher on average. When you think rationally on these facts, you have to ask yourself just who are the "crooks". NO company would ever pay more than they believe they owe. They would take it to appraisal or court first. That being the case, how can the PAs be guilty of any wrondoing? None of them were arrested or charged. The real question is "What about those who were un-represented and got 1700% LESS on their claims than those who were represented?" Why aren't the company adjusters and managers in jail for under paying those claims?
 
You contend PAs ask for things that aren't owed. If that's the case, do you allow it? Undoubtedly you do not, so what's the problem? Is the problem they ask for too much, or that they cause you a hassle? I can ask you for a million dollars, but that doesn't mean you'll pay it. Is that fraudulent? Or, is it fraudulent for companies to hire inexperienced people knowing that these people will leave things out of their Xactimate estimate. Or, is it fraudulent when supervisors always question what seems to be high estimates from their adjusters while never questioning the low estimates?
 
Check the loss ratios of insurers for the last several years. They have plummeted. Many reasons for this...but its not underwriting because EVERY insurance company's loss ratios have gone way down, no matter which comparison or years you use. While adjusters are jumping up and down at profit sharing meetings because their particular company had yet another banner year, policy holders are suffering with heavy handed adjusters who think they hold the keys to the company vault and to not let anyone in. I only deal in facts, Mr. Thomas. These are the facts. You seem to feel that insurance companies are the most honest entity on the planet. The loss ratios disprove that. The study in Florida disproves that. My own files disprove that when I am able to obrtain settlements, on average, of 30% more than the original payments when I come in after the fact. So, they paid me because the claim I submitted was fraudulent? If so, why didn't they arrest me? The ones who should be arrested are those who paid the 30% less to begin with.
 
If you are sertiously injured, you wouldn't think of representing yourself. Yet, you suggest a homeowner can go it alone against someone with superior knowledge? It's like a tee baller going against a major league pitcher. You could throw that kid anything, and he'd have to take it. BUT.....you couldn't throw a PA any old thing and expect him to swallow it. We level the playing filed, Mr. Thomas. I routinely patiently tell a company adjuster what needs to be done and happen. Things adjusters don't know or don't think of. I obtain settlements that are the maximum. This is what is fair, and this is what the people worked a job for to be able to pay their premiums, so that people like you would have a job.
 
Insurance companies won't go out of business if they paid the maximum on every claim. They would raise the premiums commensurate with those payments, and ALL policyholders would get a fair settlement, instead of only those represented by an experienced PA.

Revisions : 0   |    Posted:  4/4/2010 10:23:02 AM    |    IP:  Recorded    |    Report this post
P: 4/4/2010 2:36:31 PM
Kevin Hromas

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Last Post: 12/15/2010
Member Since: 10/18/2007

Benier, (Still scared to sign your name?)

Don't give yourself too much credit for obtaining higher settlements for your clients. There is an "irritation factor" figured into the carrier process in dealing with an insured who has retained a PA and it has nothing to do with how "good" a job you do. It is a pure factor of a cost analysis approach to getting a claim closed and off of the books.
 
And yes, carriers know full well that they can attempt to recover over-payments on claims by raising the premiums. Give yourself a pat on the back for making Florida the xxxx-hole that it is for affordable insurance and why companies are leaving in droves (when the Govenor is not begging them to stay.) Citizens Insurance is the carrier of last resort in Florida ... and since they are the largest carrier in the state now, that should tell you something.
 
PA's and Trial Lawyers know how to job (xxxx) the system. On a claim in which suit has been filed, the carrier will obtain a "projected litigation cost" and use that amount in mediation negotiations. Trial lawyers know this and file frivolous lawsuits with no intention of ever having to face a jury of reasonable people. But then they crow about obtaining "fair" settlements for their clients ... right before they skim 30-40% off the top. It is a pure business decision by the carrier alone.
 
But keep right on telling yourself how you are a champion for insured's rights ... and let us all know what color the sky is in that world you are living in.
 
Kevin Hromas - JD, RPA, PLCS
Executive General Adjuster
Houston, TX

Kevin Hromas - JD,EGA,RPA,PLCS,WIND Umpire
Houston, TX

www.KevinHromas.com

Revisions : 0   |    Posted:  4/4/2010 2:36:31 PM    |    IP:  Recorded    |    Report this post
P: 4/4/2010 4:18:56 PM
mbernier40508

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Last Post: 5/24/2010
Member Since: 10/18/2007

Kevin, my friend, you are like a liberal who ignores facts as if facts don't mean anything. You can check the study I referred to yourself. I bet the carriers were very irritated to pay public adjusters 1700% (not a typo) more on average than the people who were un-represented. They sure throw away a lit of money to get rid of irritations, don't they?

 
As for the examples on the claims I handled, these are claims that were settled by the insurers. I only take claims where I know people were under paid by more than 20%. I give those people free advice on how to get that 20% themselves. I read an interesting thread a few weeks back where someone just like you said public adjusters just take the insured's money and don't do any good. Among the replies were from an insurance defense attorney of 42 years who said HE would hire a public adjsuter, and from an independent adjuster, who said he would hire one because he worked for a wide array of insurance companies and knew how dirty some can play.
 
Just what is your worry wiuth public adjusters? That you yourself will have to pay an extra 30%? (as if you ever would to get rid of file). Are you concerned that they know just as much, if not more, than you do and make you job harder? This is really the truth, Kevin. You're very busy, and don't like a PA puts your feet to the fire, and makes you abide by the rules of fair play. you'd much rather have an uneducated and unsophisticated policyholder to pull the wool over his eyes. That person won't question and challenge your every move, will he? That's the way you like it. Your own little fiefdom where you can save your company money while telling that little grandma she'll just have to find a contractor to do the work for your price, and you know she can because plenty of them hang out in front of Home Depot.

Revisions : 0   |    Posted:  4/4/2010 4:18:56 PM    |    IP:  Recorded    |    Report this post
P: 4/5/2010 1:38:56 PM
FloridaPA

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It is unfortunate to read such animosity towards PAs.  Yes, there are “good and bad” people from both sides of the coin making it worse for the insured, however, in most cases, it is always the “little” guy who keeps getting the short end of the stick.  Let’s admit it, Insurance providers, now that is a conspiracy book I would enjoy reading….although, I have come across some few good people in the industry.

I suppose this gentleman has never hired an attorney in his lifetime either as he trusts everyone. 

Perhaps if the insurance provider would write a policy that ANY person could understand in basic terms, there wouldn't be a need for attorneys or Public Adjusters.

I remember reading a policy that didn't cover for anything, exclusions in every angle that protected the insurance company - ALWAYS.  I had another case where it was a sinkhole and the insurance co claimed it was "settling". Made me sick.

Take me to that perfect and fair world some of you think exist...

Revisions : 0   |    Posted:  4/5/2010 1:38:56 PM    |    IP:  Recorded    |    Report this post
P: 4/5/2010 3:10:05 PM
mbernier40508

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Member Since: 10/18/2007

Florida PA, good comments. As for a book on the conspiracy of insurance companies, I have recently completed such a book. One of the chapters deals with your very own state of Florida where the carriers succeeded in bribing the legislature to enact a 2 day rule, allowing them to have first crack at the insured. There's a PA in Florida who is filing suit over this, as well he should. They have the same law in Rhode Island, and a PA group paid a lobbyist 10 grand to talk to the legislators. I commented in my book that they must have had a huge laugh over this PA group not having enough money to bribe them with. The insurers have millions for lobbyists alone. Not to mention the millions they have to pay the legislators. I imagine the insurers ponied up millions to the crooked legislators to get the two day rule instituted, on the guise that the insured's are confused. The ONLY thing the insurance companies are concerned with is PROFIT! They want to make more profit every year than they did the year before. I have no problem with this, but let's not lie and contend the insurers are concerned with policy holders being confused. They know very well that public adjusters always get what is just and fair, instead of what their company adjuster feels like giving him. This has been proven time and time again. Like Mr. Thomas, carriers hate PAs with a passion, and will do anything to keep them away from educating a policy holder. Mr. Thomas contends they throw money at a PA to get rid of the file. That's nonsense. PAs aren't attorneys. They won't pay a PA a DIME more than a claim is worth. They may buy out of a suit, but not out of a PA. A PA merely submits a claim for what he feels needs to be done. On the other side, the company adjuster submits a minimum claim because he knows someone will look at his file, and maybe even reinspect the loss. If he has ANYTHING in there he shouldn't, he could lose his job. I recently had occasion to learn that an independent adjuster was turned into SIU because the company thought his estimates were too high, and they thought he was steering business to a certain contractor. Turns out the adjuster is a former contractor, and knew how an estimate really should be made, as opposed to some staff and IAs who never hand a sheet of drywall. Ever hear of an IA or company adjuster investigated for under paying a claim? How is it claims cna be paid at one amount by a staff adjuster, and tens of thousands more paid when a good PA gets the file, and no one ever4 investigates the staff adjuster for under paying to begin with? As if they would ever knowingly overpay a PA. It just doesn't happen, in spite of what the high falooting 14 year GA contends. I suppose the calims that I got that extra $30,000. $40,000.00 and more, they just wanted to get rid of me. Hogwash. 

As for Florida having a high loss ratio, that's because of wind and rain and not because of PAs. If regular insurance companies won't write in that state because of regulations, that's OK with me. It only proves how stupid the legislators are to over regulate the carriers to such an extent that no one wants to do business there any more. Politicians are more crooked than the mafia, and the insurance company have tons of money to buy them off. They call them campaign donations, lavish dinners and vacations, and who knows what in big brown envelopes under the table when they vote to keep PAs away for two days, chuckling that it's for the good of the people.
 
If that is so good for the public, how is it that PAs in your same state get well over a thousand percent more on claims of the same type than those who are not represented? These legislators are protecting the people from getting more money???

View Revisions : 1   |    Posted:  4/5/2010 3:10:05 PM    |    IP:  Recorded    |    Report this post
P: 4/8/2010 9:36:46 PM
Meg

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Last Post: 5/31/2010
Member Since: 7/25/2008

Who's Mr. Thomas?

~Meg~

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P: 4/29/2010 8:54:47 PM
dps64919

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Last Post: 4/29/2010
Member Since: 10/18/2007

As an IA, I have no problem dealing with or working with PA's.   If your confident in completing a good scope and estimate, then there should be no problem working with the PA.    
 
If the issue is mainly pricing, that's an easy obstacle to overcome and get taken care of.  The pricing in any estimating software is not 100% accurate.  All an estimating software program is is a tool.  Which a lot of staff adjuster's (both field, desk adjusters, and estimate reviewer's) forget. 
 
PA's have their place in our business.  Deal with them just like you would with a contractor.  More importantly, start off dealing with PA's like you would like to be dealt with. 
 
 
 

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P: 5/31/2010 12:54:41 PM
digitory

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Last Post: 12/20/2011
Member Since: 5/27/2010

Just as many negative comments can be made by a "public adjuster" about an "independent adjuster" as an "independent adjuster" about a "public adjuster".

Now say that 10 times fast...
 
My point is, from the side of the fence you play, you are going to dislike the person on the other side; the person that makes you work more, and the person that is not looking out for the interests of your client.
 
And as one poster stated that criminal charges should be made against public adusters...this kind of statement could also be made by someone on the other side of the fence....
 
Case in point: An IA made a settlement offer of $100,000, although the PA presented a claim, with a line by line inventory for $175,000. The IA did not investigate and research each and every line item, just slashed prices with out any supporting documentation.
The insured invoked appraisal; and the two appraisers presented their case to the umpire. The umpire ended up awarding $168,350.
 
Should the IA be arrested for trying to "steal" $68,350 from the insured? This would be a felony, wouldnt it?

Revisions : 0   |    Posted:  5/31/2010 12:54:41 PM    |    IP:  Recorded    |    Report this post
P: 5/31/2010 1:26:24 PM
William S Cook

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Last Post: 11/17/2013
Member Since: 11/1/2006

Spoken like a true IA Mr Horamas  LOL
 
No IA I have run across in my 40+ years in the business "pushes" for the full entitlements ... they overlook damages and under-write estimates. In a just world they would be prosecuted for conspiracy to commit insurance fraud.
 
Write an ACCURATE estimate and I will not have to deal with you ... otherwise slither  back under the rock or hole you climbed out of.
 
Don't universally use 15yr - 3 tab roofing on EVERY estimate, don't fail to put a temp toilet out for 1 months on a small job, don't ignore OHP or add it to a simple claim where the owner may make complete part of the repairs, don't use an insurer favored dataBase for Charges on a major damage repair, don't write an estimate for $30,000 on a house with $90,000 damages... should I go on or do you catch my drift?
 
William S Cook
Florida Public Adjuster
 

William S Cook Public Adjuster Licensed PA in several states

Revisions : 0   |    Posted:  5/31/2010 1:26:24 PM    |    IP:  Recorded    |    Report this post
P: 5/31/2010 4:08:46 PM
Kevin Hromas

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Last Post: 12/15/2010
Member Since: 10/18/2007

Way to go, Billy!

Make your last post here on Claimspages something to really be remembered for. Sounds like something on the playground that a 3-year old would say when they can't come up with any coherent argument so they just resort to butchering names and nonsense statements.
 
Michael has a choice here ... either you go ... or I do.
 
Believe me ... I have more than enough work going on to waste time with imbeciles. People around the country who want honest answers to tough questions know how to get hold of me and receive any help I can offer.
 
Kevin Hromas - JD, RPA, PLCS, WIND Umpire
EGA - Houston, TX

Kevin Hromas - JD,EGA,RPA,PLCS,WIND Umpire
Houston, TX

www.KevinHromas.com

Revisions : 0   |    Posted:  5/31/2010 4:08:46 PM    |    IP:  Recorded    |    Report this post
P: 6/8/2010 8:01:31 PM
rivaclaims

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Last Post: 6/9/2010
Member Since: 6/8/2010

Ex-Miami-Dade cop accused in insurance scheme

BY DIANA MOSKOVITZ
dmoskovitz@MiamiHerald.com

The advertisement for Global Adjusters proclaimed, ``We maximize your insurance claim recovery.''

The problem, according to prosecutors, was that the Miami company inflated client claims illegally.

At the helm of the alleged scam was former Miami-Dade police Officer Jorge Espinosa, 32, Miami-Dade State Attorney Katherine Fernández Rundle announced Thursday.

Espinosa drew scrutiny in 2004 after he shot and killed an unarmed teenaged burglar. He wasn't charged in that controversial case, but resigned and took up work as a licensed public adjuster.

Apparently not shy about the killing, Espinosa worked it into his new career, warning a couple who wanted to drop his services that ``he was a former police officer and had killed a juvenile in the line of duty,'' according to an affidavit accompany his arrest warrant.

10 FELONY COUNTS

He was charged with 18 felony counts, including grand theft, filing false insurance claims and organized scheme to defraud, for allegedly pumping up claims by tens of thousands of dollars.

``The consumer -- you and I -- pay the ultimate price,'' Fernández Rundle said.

A message left for Espinosa with the Global Adjustors answering service was not returned.

Also charged were Eduardo Rodriguez, 42, Camilo Campuzano, 33, Ricardo Borja, 36, and Michael Rodriguez, 26, all of whom face various conspiracy charges and if convicted could be sentenced to five to 15 years.

The investigation focused on two homes that had suffered kitchen fires.

In one, the residents called Espinosa on the recommendation of an acquaintance to check out damage to the cabinets and microwave.

On Feb. 24, Espinosa and Michael Rodriguez came to the Southwest Miami-Dade home and told the residents that they could get more insurance money if the tile floors also looked damaged. Espinosa then smashed the floor twice with a frying pan, but it didn't work, the arrest form said.

So he grabbed a yellow hammer from the garage, which the resident said she refused to use. ``As she walked she heard two loud strikes of the hammer on the tile floor,'' the document said.

Espinosa even gave her a cover story: she had dropped a plate during the fire, causing the damage, the arrest form states. Espinosa put through paperwork valuing the claim at nearly $70,000, when it should have amounted to no more than $10,000 to $20,000, Fernández Rundle said.

In the second kitchen fire case, Espinosa reported tile damage, even though the residents told him and Borja that it was pre-existing damage, the form said.

Espinosa said that didn't matter and added it to the claim, even offering to throw in $15,000 in cash if they signed a retainer agreement with him, according to the arrest report.

FIREARMS REVEALED

But within days, the couple changed their minds and called Espinosa. He went by and told them that previous clients who had wanted to cancel business with him had been visited by his companions, who ``lifted their shirts, in an intimidating manner, to reveal firearms tucked in their waistbands,'' the report said.

He then brought up the fatal shooting.

In 2004, Espinosa killed 17-year-old Leonardo Barquin outside a home that had been broken into. Prosectors declined to file charges, citing insufficient evidence, flawed police work and a state law that allows police to fire at fleeing felons.


More to Come!

Revisions : 0   |    Posted:  6/8/2010 8:01:31 PM    |    IP:  Recorded    |    Report this post
P: 6/9/2010 9:06:33 AM
William S Cook

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Total Posts: 67
Last Post: 11/17/2013
Member Since: 11/1/2006

Please do not judge all ex Miami cops by the activites of this one bad apple.  I have known many Miami ex cops over the years and have found them all to be honest hard working individuals with excellent and extraordinay ethics.  It would not be fair to tar all Miami ex cops with the same brush that should be applied to the one in your referenced article.

William S Cook
Florida Public Adjuster

William S Cook Public Adjuster Licensed PA in several states

Revisions : 0   |    Posted:  6/9/2010 9:06:33 AM    |    IP:  Recorded    |    Report this post
P: 6/9/2010 11:31:23 AM
rivaclaims

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Last Post: 6/9/2010
Member Since: 6/8/2010

Amazing....we are not to paint a broad brush for Miami Cops...Public Adjuster but you paint a broad brush for Insurance Companies and Adjusters...

Revisions : 0   |    Posted:  6/9/2010 11:31:23 AM    |    IP:  Recorded    |    Report this post
P: 6/9/2010 3:25:09 PM
Kevin Hromas

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Total Posts: 79
Last Post: 12/15/2010
Member Since: 10/18/2007

That's funny ... when I read the article, never once did I think ... Boy, ex-cops are scumbags!

Kevin Hromas - JD, RPA, PLCS, WIND Umpire
EGA - Houston, TX

Kevin Hromas - JD,EGA,RPA,PLCS,WIND Umpire
Houston, TX

www.KevinHromas.com

Revisions : 0   |    Posted:  6/9/2010 3:25:09 PM    |    IP:  Recorded    |    Report this post
P: 6/9/2010 11:15:21 PM
dcmarlin

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Total Posts: 26
Last Post: 8/22/2011
Member Since: 10/28/2007

I may be stating the obvious but have to assume the post by the P.A. above focusing on the ex-cop factor rather than the public adjuster factor is strictly to obtain a reaction from others on this adjuster website.

I do not think one can otherwise be that "thick" ..... although, I have been wrong before.

Revisions : 0   |    Posted:  6/9/2010 11:15:21 PM    |    IP:  Recorded    |    Report this post

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