Dec 132014
 

 

Insurers have no discriminations. The only good claim is an underpaid claim. In reality, those underpaid claims are yours, your families, your neighbors and employers, and yes, even your churches. We have helped several large one with staggeringly underpaid claims. Read below to see how they actually handle all claims. They just were not at all prepared for what they came up against.

 

Big Loss – Little Loss

Big Damage – Little Damage, there is no difference. It’s yours, and you deserve to be treated fairly.

 

 

InsuranceBusters.net Blaze Denial Crusher

 

I have removed names, but the below rebuttal was after a local church asked us to help. The carrier originally paid less than $37,000.00

After our involvement, the claim rose to over $91,000.00. They still actually owe over 1.4 million dollars. Why WOULD they pay it.

If you would like to just how good they are treating churches, read on.

December 12, 2014

 

Please be advised, I am attaching my final rebuttal to the beginning of the final complaint filed and acknowledged by the Texas Department of Insurance. I do this to keep from repeating myself. The documents included with this response will conclude our portion of this claim.

Begin Final InsuranceBusters.net Rebuttal/Conclusion:

We began this journey on the morning of October 27, 2014. Since that day, we predicted your actions and your outcome from the onset. All the way to the very end, where you produced the type of reports written to protect your profit, and that of your employer. This whole scenario should have been one of camaraderie, and mutual search to locate the coverages available to the insured, who is both of our clients. We are both bound by contract and licensure that govern both of our conducts, and sets out a specific set of responsibilities. In the break down below, I will annihilate the so-called reports that delayed this claim long past any sense of being within compliance. However, I want to reiterate a few points from our previous correspondence, which is attached, but very burdensome. The majority of the items you finally issued payment on were discussed in the very beginning of our first inspection, yet you “decided” to withhold funds until you received the report, which not really even address these areas. There are many things that have done during the process of this claim that have been warned against, not because we are all-powerful, but because we can read and comprehend what a policy and administrative time limit is. What we know for absolutely sure, before we ever delve into the fictitious reports, are this:

  1. Insurance Company Name Redacted initially spent minimal time on a claim that an insured had filed a claim for a covered loss.
  2. This fact is driven home by another simple fact, $37,000.00 vs the still grossly underpaid amount of $91,500.00 that you have now issued. Roughly 170% more than you initially offered. This is irrefutable fact. How in the world did you miss this much? Adjuster Name Redacted stated he has an office building close to the administrative building, and that he had a claim…. For the record, I think the attorneys should have a look, and see if there is anything intentionally left off this one, even after a blueprint was given, that is on his? I think this is valid.
  3. The initial valuation had taxes added. To a nonprofit tax exempt church, as they all are. This is Insurance 101, yet it still was done. (The new valuation now has tax on materials??? Tax Exempt = No Taxes.)
  4. Fortunately or unfortunately, there is no one even dealing with this claim that read and understand a deductible. This is just one more thing, that in all honesty, is the one thing Insurance Company Name Redacted should be giving that they do not actually owe, should be absorbing the cost. Every representative of Insurance Company Name Redacted, even after finally issuing the initial check, missed, again, one of the most basic facets of claim, the deductible.Insurance Company Name Redacted has represented to the insured, in writing that their deductible was much lower than it is. You can imagine their surprise when you took an additional deductible. I will say these terms and let the attorneys sort it out. If an insurer or a representative of an insurer would represent that something were true, or covered, then from that point forward, on that claim, it is.
  5. Initially, payment was with well past guidelines. Emails are attached where Mr. Joy physically lied about the whole ordeal, in writing.
  6. Insured felt as if receiving the check was contingent upon accepting the clearly low offer. This is verified by the actual check never actually leaving until well after InsuranceBusters.net’s involvement.
  7. Once the error of his ways had been brought to light, he was suddenly removed and replaced by you, Adjuster Name Redacted. Both of whom had no knowledge whatsoever that timelines even existed. Both of whom argued, at great length via email, that they did nothing wrong and did not have anything to worry about.
  8. Issuing of the penalty payment, and acknowledgement to insured validates that you are in fact under timelines, that neither of you were aware of said time lines, therefore you could never have possibly had a system in place to promptly effect a claim. No one is counting, but this is already several issues. Not one, not random, but one right after the other. All at a minimum approximately 170% benefit to the INSURER. (On a side note, this is a perfect example of the farce that is insurance. The low-ball initial payment is par for course. We are criticized for charging 10% of a claim, that is LESS than you tip your waiter, and in Texas at least, our profession is capped at a maximum 10%. Whereas in this case, which is a typical claim, the insurance company and you, Adjuster Name Redacted have attempted to rob these insureds, this CHURCH, of 170% at the MINIMUM. 10% does not sound so bad now, does it? And obviously, as you can see by the preparation of this claim, we earn every dime and are worth every single cent.)
  9. You have knowingly and willingly violated the policy and the statutes governing the handling of claims. Obviously, we are not Attorneys, and do not even attempt to pretend we are, however, when a statute says you have 15 business days, that is exactly what I understand it to mean. (EX: Traffic Citation issued. Clearly states that you have X numbers of days. Does this mean you can handle the citation on your time? No, and you cannot do that with our insureds here in Texas either.)
  10. By your own statements, in written form, you and your “legal team” have been the deciders in many areas that neither of us have the authority to do.
  • Change that policy or statute in any way. You decided to initially underpay by a minimum, from your own numbers, 170%. Then you withheld funds in an attempt to obtain that lower settlement.
  • You then got caught lying outright, in writing numerous times.
  • You then denied any wrongdoing, only to issue a check specifically for that which you had denied, just as vehemently as everything else.
  • You stated, again in writing, that you and the “legal team” paid what you THOUGHT you owed.
  • You all did that in the beginning, and again, by your own admission, were off 170%.
  • You then intentionally delayed the investigation and conclusion of this claim.
  • Then, when you finally did get finished taking and labeling a few photographs, (As I will show below, your reports are little more than that. Any of them.) You issued payment for the items that had clearly been demanded before and had nothing to do with the actual farce of reports that were submitted. Had I not been so adamant in my demeanor and logging this claim as we do every claim, we would not be talking about a bunch of heresy. We are not. We are talking about facts that are before us, in black and white, which cannot be refuted in any way.

 

We know for certain the numbers are closer to 1.5 million dollars. Because we have actually done our job. Performed the due diligence owed to our client. We became familiar with the policy and the statutes, and followed the rules to best of our ability. What that did was show how inept the industry really is. Again. But, hey, just by your numbers alone, the insured initially lost 170% of the value of their claim, because as I have outlined, no one knows or cares, and as long as it is not costing money, and actually making money, it appears to be working fine. No.

 

Who is going to complain about realizing a very real profit of a minimum, 170%?

 

Below is a breakdown of each “report”.

 

In Order Received:

 

Redacted Roof Membrane Inspector Info.

 

 

  1. We have been supplied a report from the company listed above. There is no signature nor stamp, nor mention of who actually did the report, and what their qualifications were, if any. The insured has made an approximately 1.5 million dollar demand, back with proof. The insurer, via this office, was made well aware that whatever testing was necessary, to move forward.
  2. The “scientific” methodology utilized to test a black, nominal .030-.040 EPDM “RUBBER”, roofing sample was a light bar….. to test for the observance of light through the membrane….. For a visual, I will use a tire. When a nail punctures a tire, then is removed, the hole pushes back into itself and becomes necessary for a technician to submerge it, to locate the air being forces from pressurization of the tire. Without the added air, the hole would NOT be visible in any scenario where light was used, unless it was for technicians to see what they were doing. Unless layers of the membrane were actually SHAVED from the parent layer, many, many times, you would NEVER see light through the membrane. This is the actual benefit to the product, if puncture, the water still has a difficult time penetrating. That does not mean the holes are not there. The test and method both fail. It would be a good idea to take this particular sample into the court room, puncture 20 times with a pick or knife, then put it on a light bar, in front of a whole jury.
  3. I want to make note for the attorneys, and the timeline. The report is a pre-finished plug the measurement and photos in, the entire process involved in what was done, actually only took a few hours. This can be verified by simply demanding some of their previous reports. Also, they noted that they did not receive until the November 26th, well after we inspected. Another stall.
  4. The report speaks, in writing, of taking photographs at 10X the zoom. Yet the picture provided in the report do not appear to be taken with an even primitive type of modern zoom apparatus. Where are these magnified pictures that were used to deny this covered claim? Why weren’t they provided with this report, and why, instead were we given these grainy artifacts? Even if the methodology of either test were sound, which they are not, why would you hold something so valuable to your denial out? I can think of a few 1.5 million reasons.
  5. One of the most glaring things missing from this report, or any other, save ours, is the insulation. Not one word was mentioned about the devastated 2” insulation. The insulation that had absolute visible gashes in the top from the hail stones? We took four samples, out of four samples, every one of them were visibly mangled. The most damning piece of evidence on the size of hail, and whether or not the roof was affected. The rubber roofing system absorbed the bulk of the brunt, and that insulation, on the underside of the membrane shows precisely what type of beating that roof took. Why are there no mentions, at all, nor any photos? Out of all those photos, not one of the most single most damning piece of evidence. I know, because I was there. I have photographs, and you can bet someone will be back out there pulling some samples before this is over with. You cannot hide the whole existing roof, or just omit it. Oh wait, you already did.
  6. There is nothing but a report with a fancy Header. Not signed, not verified, and certainly not professional. The facts are clear. This report has been written to do one thing, and one thing only. Say there is no damage to clearly damaged property.
  7. Dismissed

 

 

Engineer Firm Redacted

 

 

  1. Notice on this report, at the end, there is a signature and license number with the required information. This is necessary information from any report, any time. The validity of this report, however, stops right there and picks up were the other left over.
  2. This report, like the other one, is a carbon copy of every report the firm has supplied to insurance carriers since their unholy union. Meaning, it is also a fill in a few blanks, and spit out whole report, situation, designed to deny covered losses, and actually attempting to help the adjuster with optimum or not so much photos, and indicators of many things that have absolutely nothing to do with whether or not that roof or property sustained hail damage.
  3. We will start with the 2” insulation board. There is one photo, showing the 2” insulation, but that is it. Even in that photo, on page 25, photograph 28, you can see that the sample cut out was right in the center of a large indention. A hail indention. The photograph also shows precisely what is in between the hail and everything else. Not one mention, not one photo of the top side. I personally watched him take numerous photographs. This is something you all three are involved in, knowingly. You have kept the most damning evidence to yourself.
  4. In this generic report, the engineer does one thing well. He describes what each roof is, and the known pitfalls and manufactures defects.
  5. He stopped there, and went rogue. He listed every defect he could come up with, which were all manufactures defects, and have nothing to do with the insured. If Insurance Company Name Redacted so chooses, they can subrogate the manufacture. In all the engineers reasoning of the known problems, he failed to outline several of the most important factors about the defects. One, and probably the most important, is that not one single defect he mentioned or observed made toe roof MORE susceptible, which, by his own admission, it does exactly that. His Words, straight from his report… (See how that Copy and Paste works?) (“EPDM membranes contain oils added by the manufacturer to facilitate mixing of other materials such as polymer and carbon black that also provide flexibility to the finished membrane. As the EPDM membrane ages, the oils within the membrane degrade and volatilize as the result of exposure to heat and ultraviolet (UV) rays.  The loss of oils within the membrane causes a resultant loss of mass and volume.  As the EPDM loses volume, it begins to shrink.  The shrinkage or contraction is most evident at walls, where the resulting tension produced in the EPDM causes an inadequately secured flashing membrane to pull away from parapet walls until the roof and flashing membrane are stretched taut, a condition sometimes referred to as “tenting.”  As the tension increases over time, the roof membrane attachment at the base of the parapet walls can tear loose, thus further damaging the roof system. When the roofing industry became aware of the EPDM shrinkage problem, it made changes to the EPDM roof membrane and recommended details for membrane attachment at parapet walls.  Originally, ASTM D4637, Standard Specification for EPDM Sheet Used in Single-Ply Roofing, required a maximum dimensional change after heat aging of 2 percent.  This was changed to a maximum of 1 percent.  Changes in EPDM formulas and improved attachment requirements have significantly diminished EPDM roof system shrinkage failures.”) What he is saying, yet said the opposite in order to deny the claim, is that this particular roof was EVEN MORE SUSCEPTIBLE to damage, through no fault of the insured.
  6. Lowery goes on to say the following, (“Hail damage to modified EPDM membrane roofs can be defined as an identifiable mark of distress caused by hail that has measurably reduced the integrity or functionality of the overall roof covering, where the roof covering was sound prior to the hail impact. The damage is commonly found in the form of a fracture or tear through the entire thickness of the membrane.  The impact may also take the form of a circular or elliptical mark with a pattern of “spider web” cracking.  It can also be in the form of semi-circular tears in the membrane.   Controlled laboratory testing has found that hail smaller than 2 ½ inches in diameter lacks sufficient mass to cause a significant loss in functionality or integrity to ballasted roof covering.  Hail smaller than 2 inches in diameter does not damage unballasted EPDM membranes.2  Field investigations have confirmed these tests.3”) Notice that he talks about a controlled environment, and the necessity of 2 1/2” hail to damage the roof. Again, he fails to mention that this roof was already MORE SUSCEPTIBLE than most, and again, he has admitted to extreme hail in both direction that the storm was traveling and the building stood in the middle of. This is common knowledge for anyone in this town. My point is that while he tried to minimalize the hail, he did not say one thing about this particular roof, the one we are inspecting and the one all have agreed was hit by hail.
  7. Next, Mr. Lowery goes on to state, (“At the main church building, dents were found in roof vents, metal coping, metal louvers, and the metal window trim, and clean spots were found on the north and west sides of a light pole (Photographs 5 through 10). Except for two dents in a north-facing wall on top of the roof, no dents were found in the EIFS (Photographs 11 and 12).  At the office building, dents were found in a roof vent, window sill flashings, north- and west-facing metal fascia trim, and HVAC condenser fins (Photographs 13 through 16). Many factors should be considered when estimating the size of hail that impacted a property, including the gauge (thickness) of the metal, the angle of impact, the speed of impact, and the hardness of the hailstone.  However, laboratory tests allow us to predict the size of hail based on on-site collateral indicators.  In general, dents in light-gauge metals, such as the furnace vent caps, can be up to three times larger than the actual hailstone, whereas dents in heavier gauge metals may be as small as half the size of the impacting hailstone. Based on this study of the collateral indicators, hail no larger than ¾ inches in diameter fell at these two sites.  The hailstones appear to have originated from the northwest.  While larger hail may have impacted this property, no evidence was found in any of the collateral surfaces.”) He says all kinds of stuff to say nothing, ending with LARGER HAIL MAY OR MAY NOT HAVE HIT THIS PROPERTY, BUT I AM GOING TO STATE NO LARGER THAN ¾” in my report. I love visuals, so I will give another one. Take a basketball, go to the top of the highest building you can get onto. Dunk it ink, and send it over the side. (Use proper safety precautions of course.) When it lands, tell me if the ink spot is as large as the basketball? Or maybe, just maybe, you will have a very predominant approximately 3” round mark with a bunch of splatter from run off on impact. However, the main impact, will not be anywhere near the size of the basketball, thereby throwing this whole farce of a theory out. The ball, or hail stone, everyone that hit, would have to squash itself flat in order to make the same indentation as the size of the stone. There is much more difficult, scientific explanation than that, unlike you folks, I want to make this as simple as possible, while giving an accurate visual of what they are attempting to claim. All of these reports were meant to confuse and distract the average person, who is not versed in either construction knowledge or policy knowledge. Unfortunately for you, you ran into some with both.
  8. Strangely missing from the report, are any photos of the window trim and anodized bronze frames at the very entrance of the church. OK, let me answer for you. Like the insulation, it blows the whole ¾” hail stone bit right out of the window. I mention these, because they hold in large tempered safety glass. These are reinforced structural frames designed for strength. There are dents a golf ball will roll in on that ENTIRE from assembly. These are not easily damaged as has been attempted to allude to. These dents are the outside corner of the actual frame, actually crushing the metal downward, creating a crease on the front side from the pressure on impact. There is not a ¾” stone or metal that could make that metal bend in that manner. All over.
  9. I could go on, but I have to leave something for the attorneys.

 

The engineer has committed one of the worst crimes against a person I can imagine. He used his degree and title to write a report full of partial truths, omissions, and opinions that are just that, opinions. Opinions that have always benefitted them, and the insurance carriers who hire them, while helping deny a multitude of covered losses. By using smoke and mirrors, and the average insureds lack of knowledge in anything to do with an insurance claim. If I remember correctly, A Jonathan Gruber is in the proverbial hot seat right now. You know, one of the “architects” of Affordable Care, who has publicly claimed he did it via the stupidity of the American voter. Another nice visual. You are all doing the same thing, claim after claim, time after time. Not on this one.

 

 

Last but not least, the icing on the cake, the final report provided by Adjuster Name Redacted and Adjuster Name Redacted.

 

Before I get started, I want to point out something that has absolutely bothered me to pieces. As this claim has worn on, I have finally put my finger on it. Adjuster Name Redacted drives a large pickup with Texas state farm tags. Meaning they do not pay taxes for the registration, and a few other perks. Perks, like anything else, come with restrictions and limitations, much like an insurance policy. Every time I have met with Adjuster Name Redacted, he has been driving that truck. May seem like nothing, but to me, it is exactly the way the whole claim has been handled. By every single person involved. The insured is completely helpless. There is an army of employed people who rely on the payment of insurance companies to feed their families and pay their bills. Not just insureds, but all those employees. The ones who work directly like a staff adjuster, or Adjuster Name Redacted. Then you have subcontractors, like Engineer Firm Redacted. Engineer Firm Redacted is paid to perform, as evidenced by his report, his only loyalty lies within his employer. Not his license, not right and wrong, but what he is expected to do. Then I see Adjuster Name Redacted drive up in a vehicle that has been given special privileges that stipulate very clearly how they are to be used. Here is what I found on the subject:

 

Farm Registration

Farm Vehicle Registration (TRC 502.433)

(a) The registration fee for a commercial motor vehicle as a farm vehicle is 50% of the applicable fee, if the vehicle’s owner will use the vehicle for commercial purposes only to transport:

(1) The person’s own poultry, dairy, livestock, livestock products, timber in its natural state, or farm products to market or another place of sale or processing;

(2) Laborers from their place of residence to the owner’s farm or ranch; or

(3) Without charge, materials, tools, equipment, or supplies from the place of purchase or storage to the owner’s farm or ranch exclusively for the owner’s use or for use on the farm or ranch;

 

Farm registration cannot be used for other types of gainful employment other than farming and ranching.

 

I do not think adjusting claims qualifies, and by his own admission, he has an office around the corner. Now this angers me for several reasons. One is, he enjoys a privilege I do not, yet he is classified in the same category as an adjuster. The other is the simple fact that the total disregard of rules and regulations are what have brought us to this response, and the unfortunate event that must be less than pleasant. This was not my choice. Our firm has given Insurance Company Name Redacted ample time and opportunity, along with a set of the most comprehensive reports available for that building. That is combining all of yours. And it was prepared and handed to you within days, yet all of this time, all of these rules just wantonly trampled on. Just like FVR TRC 502.433.

 

The next issue would be Adjuster Name Redacted’s own building. He stated very clearly that he had a building within a few blocks, and that he had sustained damage. I would like to know, if that is true, did he accept the same thing he gave to this church? I think that is very valid question. It establishes quite clearly whether he has a few different standards of claims management or not, and whether what was done, was done on purpose, with full knowledge and intent. That’s for someone other than me to deal with.

 

 

On to the report:

Insurance Company Name Redacted

I have addressed the many deficiencies of the initial valuation on numerous occasions. They are well documented and verified by the minimal additional amount released versus what is actually owed, versus what was initially paid. Approximately 170%. I expect you to issue an additional check for the administrative penalty. You have previously acknowledged that these items were damaged, yet demanded the funds be held until reports were received. Well, those reports have arrived, and there is not a single thing in those reports that you did not already possess prior to your statement, and subsequent rewriting of the policy and the statute in one fell statement. Their reports did not provide one single bit of data to affect those items. Those entire building that were not even looked at. The front glass as you walk in either of the only two entrances in the front of the building. There is clear evidence of what you did and did not know, and when that knowledge was obtained.

 

 

Adjuster Name Redacted, at your direction, I am sure, has submitted another estimate, describing what you all have decided to pay. While it is substantially more than you started with, it does not even come close to actual sustained, covered loss.

 

Admin Building/Sheds:

  1. The idea that you can go into a roofing system, and pull out a minimal amount, put it back, and guarantee that it will not leak for the duration of the life span of the roof. Impossible. Almost as ridiculous as saying the gutter is a concealed gutter, without acknowledging that it was attached to the roof drain system that like the roof, was never designed to come off or go on in piece meal fashion. The insured did not pay their premium in piece meal fashion.
  2. Taxes, again.
  3. How did hail damage all the metal roofs and all the outside structures, but shucks, not a SINGLE hit on the roof? Same as the Fascia and subsequent roof drain system.
  4. The whole set of aluminum windows at the North Elevation, same as the church, is mangled, just like the church, and was not even addressed.
  5. Very clear that again, you just did what you wanted. None of the items we have addressed have been addressed by you. Yet.
  6. The Sheds were very close to mine. Amazing that when the damaged item does not cost so much, the scope and numbers are much closer. Not near as amazing is how selective that hail was.

 

 

Church:

Like the admin building, you have delved into a whole mess of damages, then only offered to pay for things you want. The links below go to OSHA, and some of their mandates for fall protection and general safety. The Texas Department of Insurance has also released their stand point on whether it owed or not, but I am sure you can find that on your own.

 

OSHA FALL PROTECTION AND SAFETY PROTOCOL LINKS

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9720

 

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10605

 

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10756

 

The point is, again, these are rules, not suggestions. Something you all are having a very hard time understanding. You are obligated to include these costs, yet you have chosen not to. That’s a choice and suggests if gives you the ability to change things that it does not.

 

  1. Where did the 22-year-old number come from for depreciation? The Church has not owned that building for that long, not that I am aware of, and they did a massive overhaul of the whole exterior. I do not believe there was much that was not redone, including those front windows. They do not look 22 years old to me.
  2. The patio covers that are described are not what is currently on the insured premises. These are engineered floating Safety covers. You were given a correct method of indemnification, yet you chose an item that by name alone, suggests it is not the same structure. Just happens to be ½ the cost of what is there.
  3. In a majority of the area where cap flashing is present, there is a product called a gravel stop that is attached to the whole assembly. This is not addressed.
  4. Damaged flashing at bottom of chase on north wall, not a peep. This is where the stucco is being replaced and I physically pointed it out.
  5. You did not address balusters, rails, and the paint on the building. The list just goes on and on. As for me, I have come to the end of my journey in this saga. I have left a very detailed and well documented trail of what you have and have not done. Even this valuation, as sad as it is, is still 170% more than you already tried to get away with.

 

What would the insured have done had they not had someone to turn to who actually had their best interest mind? The same thing more than 99% of insureds who file claims do, accept whatever their insurance company tells them. Are they happy? No. They just don’t that they have a choice. Especially when they are being spoon fed the ridiculous notion that it is a good idea for you to send the guy who owes to tell you how much. As you can see, it is pretty simple to underpay by at least a minimum of 170%. Even with that payment and your “Final Offer”, you are still 150% off the correct number. Does anyone really believe you anymore? I don’t think so….but maybe.

 

 

Soon, very soon, some people I know are going to come asking you some questions about this. I hope you do better than you have here.

 

End Final Rebuttal/Conclusion

Cal Spoon / InsuranceBusters.net

 

#ProtectTheInsured

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