Sep 092015
 

insurance-fraud

This should make a few heads spin.

“If the entity pointing the finger at an entire state claims everyone is committing fraud, would that statement then hold true when speaking of that same entity? Does that ability allow immunity?”

Yes, if you are Texas Mutual Insurance.

 

I spent the better part of an hour reading through these articles… They are lengthy, but well worth the read.

The Texas Tribune:

The Brief

Part I follows the case:

Part II profiles the prosecutor in charge:

Part III delves into the history of the formation: 

In 1991, the Texas Legislature created Texas Mutual Insurance Company (then called the Texas Workers’ Compensation Insurance Fund) to ensure the availability and affordability of workers’ compensation coverage. In 1992, the Fund began underwriting workers’ compensation insurance, and in 1994, it became the state’s insurer of last resort for businesses that were unable to find coverage elsewhere.

On June 15, 2001, Governor Rick Perry signed House Bill 3458 into law, changing the company’s name to Texas Mutual Insurance Company and authorizing the company to operate as a domestic mutual insurance company (with continued political oversight by the state). The bill maintained statutory mandates that the company remain a competitive force in the marketplace, guarantee the availability of workers’ compensation insurance in Texas, and act as insurer of last resort.

In other words… They are now, as of 2001, a private company. Today, they own 40% of the market in Texas, which houses the 10th largest insurance market… in the world. Their nearest competitor holds a paltry 7% of the market.

The folks who are supposed to pay you have hired their very own actual “state employed prosecutor”… who has jurisdiction over the entire state’s Worker’s Compensation division.

 

 

As previously stated, many times… even in depositions, we have found that on average, in Property and Casualty insurance, 100% of claims are underpaid by 100%…. These are figures that can be easily proven, in a matter of minutes. Cashed checks do not lie. Fact is, a large number of those claims are underpaid by over a 1000%.

In 2015, Property and Casualty insured’s in Texas dodged a bullet with SB 1628,

However, other insured’s… say those governed by these folks here, with their own arm of the government, who can throw ANYONE in jail, did not do so well in the Workmen’s Compensation area, in fact, the Texas Supreme Court ruled that they actually have immunity , and can only be governed by the Texas Department of Insurance. This means that no matter how egregious the acts of Texas Mutual, or any other insurers in their market, the insured can never receive compensation… ever.

Texas Mutual Insurance,  the largest Worker’s Compensation insurer in Texas, has never been prosecuted in its entire history…

 

Cal, you don’t even do Worker’s Compensation…”

That is correct. However, with SB 1628 laid to rest, for now, the next legislative session is coming, and insurers are already sending their minions in with Hail, Fire, and Brimstone for not Passing their Coveted Insurance Carrier Protection Act.

Here is Zelle-Hoffman getting an early start… Remember, they were big supporters of this horrible proposed legislation that would have literally stripped Texas insureds of their rights to recover if/when an insurer commits Unfair Claims Settlement Practices, and harms an insured, as they are proven to do on a mass scale.

 

I will leave you with one thought…

Out of every single piece of information you can obtain, in today’s data rich environments, you will hear Insurance Companies and their attorneys cry and cry about all these hail claims, add any claim…

“All of the sudden, there is an explosion of Hail claims in Texas… we must stop this!”

 

What you DO NOT HEAR THEM SAY…

“Owe a claim, pay a claim.”

You’re Homeowners, or Business Owner’s policy, or most of your policies, specifically cover Hail, as a covered loss. Normally with a very steep deductible, and now, within the last few years, “Payment of roofs on an ACV basis as a standard policy provision.”

I emphasize this for the same reason I took the time to write this article.

They are very crafty, these insurers with unlimited supplies of our money. They have plans for the next 20 years, and multiple contingencies in the unlikely event something like SB 1628 gets stopped by the informed citizens.

They have been crying about paying claims since the McKinsey Consultation.  They have successfully raised premiums to a number that normally fluctuates between the top 3 in the Nation for premium charges… I think more at number one than both two and three combined.

 

So… that last thought.

The people who had valid, legitimate hail claims, and actually filed them, are being prosecuted for using the very product designed and specifically paid for to cover THAT SPECIFIC LOSS!

“Are insurance companies saying they want me to pay premiums, but they do not want me to a file a legitimate claim, on my largest investment, that is probably damaged at 25% of the entire property value?”

That is exactly what I am telling you.

And if you do not pay close attention, they will have the same protections on your home and business, where you CANNOT recover or pay attorney’s fees. SB 1628 was a preview.

 

Quick breakout of how not filing a hail claim only helps an insurance company, and not an insured.

ACV (Actual Cash Value) payouts ONLY on roof claims involving Hail. Otherwise known as Non Recoverable Depreciation.

Roof is paid based on its life span. 30 year roof, 10 years old, the roof will only be paid for at approximately 66% of the value, regardless of how much it cost to replace.

If you wait to file a valid, legitimate Hail claim, you reduce the amount of money an insurer owes you, for them… They do not even say thanks, do they?

That is 3% a year that you lose on your roof. Yes, you LOSE it. If you have to replace a 30 year roof, due to covered Hail Damage, in ten years. You have lost the other 20 years of the value of the roof, while also being reduced to an ACV Payment.

Would you have needed to replace the roof otherwise? No. Typical insurance catch 22.

All things to think about.

As an aside, the prosecutor has taken a special disliking to Rick Perry and Ted Cruz.

I offer both an open invitation.

They say there is no “Impropriety”, no benefits from their relationship. Unless someone actually KNEW what they were looking at, and for, nothing would be found.

I know what to look for. I fight these animals every day.

You both have the clout, open the books and let’s have a look.

I doubt either of you will, maybe afraid of what else I will find, but the offer is there. I am one of the Best in my field.

insurance-fraud

I can see exactly what they are doing, and the methods in place to ensure them…down to the very software that makes certain that no insured is safe.

Why can’t they use that same software to contact their insureds, and let them know they have Hail Damage, and might want to let someone come take a look…

Does your agent live in your town?

Normally, yes.

On purpose.

Did they know you had baseball size Hail?

Yes, they did too…

Did they call you?

No, they were too busy with their eyes on things like SB 1628.

Ask your agent if their pay is affected by whether you file a claim or not? Does the dollar value have anything to do with it? Do you make bonuses for less claims…?

They sell this HOG to you via transferring the savings…

How many of your premiums have declined over the years?

Last one… I often hear clients state the reason they do not want to file legitimate claims, is to keep premiums low, and keep their personal rates from rising.

My response, time after time.

“Ma’am, how many claims have you filed?” NONE! Big, beaming, proud smile.

“How many times have your insurance rates rose…?”

Frown… “Almost every year”.

 

Cal Spoon

September 9, 2015

Aug 182015
 

Lest we forget the need for a strong military, with equally strong leadership. Let this be a reminder that we cannot and will not accept anything less…

Here is a video I produced several years ago that I post every year at this time. GRAPHIC FOOTAGE AND LANGUAGE. On…

Posted by Robert Surgenor on Wednesday, September 10, 2014

Aug 162015
 

In case you need it. The only reason, other than protection for lenders.

Sending the person who owes you the money to first tell you if they actually do owe… then, exactly how much or how little that amount is. Then take into consideration the largest mitigating factor in that equation.

Every dollar they pay you…is a dollar from their own profit.

We purchase insurance for one reason. To file a legitimate valid claim if the need arises. It is the only reason we spend our hard-earned money on it, unless otherwise required by lenders… or law. (Which makes the mitigating factor above all the more disturbing.)

We have found, on average, 100% of all Property and Casualty claims are underpaid by 100%….. Let that sink in. Oftentimes, that number is in the 1000 percentile. Numbers and cashed checks do not lie.

The more you know…

#ProtectTheInsured

Cal Spoon

 

Apr 282015
 

20150328_130008

State Farm – Engineers Behaving Badly….. Remember Hurricane Katrina…Hurricane Sandy… those are just the ones they have been caught, on large-scale, having their ENGINEERS change reports to drastically reduce payouts, illegally.

Foreword:

This is the “engineer’s” report they sent to my Mother’s on Thursday.

http://insurancebusters.net/…/20…/04/15.164-Spoon-report.pdf

And of course my response, below. I have included pictures and the entire report, so you get an exact feeling of what they attempted to do. To My Mother.

Edward,

I am appalled. You came to my mother’s home, stood outside her backyard, and lied to her face. I was there, meaning you lied to me as well. Justin expressed, with great emphasis, in front of Gian A. Carlo, that he would provide you with no material, and allow you to do your own thing and come to your own conclusions. This was a lie. The photos you possess, labeled taken by others, were taken by Justin. He chose to send you the best photographs he could to support denying the rest of the claim.

I am advising you, at this point in time, in writing, DO NOT DELETE ANY MATERIAL, ANY CORRESPONDENCE, NOTES, PHOTOGRAPHS, TEXTS, VOICEMAILS or DIRECTIVES FROM STATE FARM THAT PERTAIN TO THIS CLAIM.

If you look at the few photographs I have provided, and your own photo labeled 54. You will notice the lazy Suzan in the upper right hand corner. You will also notice that there is an approximately 1” gap, that is clearly visible in the photo. Now look at my photo, same cabinet, same gap, only this shows the entire cabinet, where lazy Suzan will not even open, and that the cabinets and floor have clearly dropped.

20150319_092329

You claim there is no water damage to the framing around the remodeled area, and that her house has a history of structural problems. You are provably lying on both fronts. We performed the remodel over 10 years ago. When we did that, we replaced the framing around cabinet floor in order to make the access hole in which you entered…notice the boxed framing with supports. At that time, the house was approximately 30 years old, on a pier and beam foundation, in west Texas. Normal settling had occurred. We blocked and leveled, as evidenced by your crappy photos, at that time. As you pointed out, there is very little cracking of the drywall, had there been prior settling, to the degree you show in your own diagrams, the remainder would have done so as well. Your graph is a clear indicator that exact area where the leak occurred has dropped significantly in comparison to the remainder of the house. Yet you state that was not the case. Your own evidence does not substantiate that claim, quite the contrary. When coupled with actual true photos, like mine, the evidence is overwhelming. Yet you lied, and you put your seal on it.

20150328_140922

 

The framing you claim is not damaged, please look at your own photos 19, 20, 24 and finally, 37. Again, you have lied. The plywood, as witnessed in your photograph is the cover to that manhole I spoke of earlier. If you pay attention, you will that those are 2 separate pieces of ¾ “ plywood, cut with exactly the same notches. The 1 ½ “ is necessary to bring the floor back to hardwood elevation, which was done. Notice both pieces of plywood are water damaged, with mold growth on both sides. For the people who will decide this fate at a later date. I will point out a few things and move on. That plywood was attached to that framing, see the 2” line where joist and plywood met. Stacked 2 deep, totaling 1 ½ “ layer, in which the water penetrated from the underside, not the top. Anyone would realize that in order for that water, that damage, and the resulting mold to appear on the top of the floor, destroy the cabinets, and walls, it would have first had to go through that entire layer of flooring. Again, you have provably lied. And attached your seal to it.

20150328_144419

Picture 38… you claim there is no damage to the underside. This photograph, as poorly taken as it was, clearly shows mold on the entire underside of what you have labeled as the living room. Take a look at some of the pictures I have provided. You will notice that same growth on the cabinets, the underside of the counter top… this is directly below the floor you claim, in writing, was not damaged. You photographed a portion of that damage and still deny it exits. You have lied yet again. And attached your seal to it.

Again, in picture 38, you claim this to be an existing leak. Look closely. This is the damaged area from the original water leak. The water that is now visibly dripping in numerous places, has only made a few areas wet. You do not find that curious….. Could it be, as you suggested on site, that you could have ruptured something while you were under there, in less than 18” of crawl space, crawling around. When you were there, why did you not take a photograph of the ground, where the newly developed leak had just started to make little dimples in the soft earth under the house? You had another opportunity to do so while we were standing, from the kitchen floor, looking down through the man-hole at the new leak, and I explained to you that you would attempt this, and that you should photograph as well. That leak, as you can see, is new. The damage caused by you. Look at your own photos of underneath the house, and tell me exactly where you were, and what you were laying on in order to get those photos? You were laying on that whole mess of plumbing that you can clearly see in any of the photos.

Photos…you have only provided a few photos that you took that day. I would take an educated guess and say that you actually took from between 500 to 1000. Where are the rest of them? You supplied 50 of the most broad, generic photographs you could. You still could not manage to eliminate all the damage from them, as evidenced by my partial review above. I can tell, you have already sent State Farm an invoice for your services… that invoice will probably contain a per picture charge….

I would suggest that you not attempt to remain on the path you are currently on, and delete, modify, or change anything that has to do with this claim. There will be some people who want to talk to you very soon, and they will want to see them. You showed 5 photographs of that floor in your report. I personally witnessed you get down on all fours, and take correct pictures, at ground level. Then you stepped in several places directly at source of loss, bouncing a bit, and stated, oh yea, this is definitely affected. You then photographed the spaces where the new varnish had physical separated, along with filler, from the swelling of the floor.

Photograph 12, the bathroom door…that is scratching the floor, which you admit, yet say “sanding” look at your graph, and look back at this photo carefully. The door is in a perpendicular position to original state, making it optimal to see with the human eye, that instead of the bottom of the door being parallel to the floor, as it should be in this position, the door actually drops from approximately a 1” inch gap to zero… in less than 2’. This is your picture. The other ones, the ones you did not provide, but will before it’s over with, also shows the reveal of this particular door, which you specifically pointed out, yet included only one picture of, that you thought was harmless, or you would not have included it. Turns out, that is a very good photo. Keep up the good work. wink emoticon

20150328_123457

This is bad, real bad.

You referred to me as the “contractor”. I am not. I am the insured. It just so happens that I also possess a Public Adjuster’s license, as well as having held two contractors licenses prior to Texas allowing the rule to expire. I was a Premier Service Provider for State Farm for a good long while. Until I fired them. They have a little different version, just ask to pull the contract, verify the one year agreement, the end date for that, then the end date of our last assignment.

One major thing Justin did NOT inform you of, is that I am very good at what I do. I see people like you every day. Sustaining business off of knowingly helping your employer, the insurance company, deny valid, easily discernible claims. At minimum, suggest that the damage is just “minor”….. This time, you have been caught. You have used your license and title to deceptively harm another.

InsuranceBusters.net Legalities

Don’t you worry, everyone involved will get a copy of this… a ton of people who you never imagined… or you would not have attempted this. But, you know, as I have proven, while acting in the role of a Public Adjuster, this is normal for insurance companies, their engineers, and their adjusters….Just ask Victims of Katrina, Sandy…and any other loss insurers touch.

See you soon.

P.S. I am better with computers than I am with paper… As this reaches you, and you read this, know that you have been warned that all things pertaining to our file are to be kept, and nothing is to be deleted. I am not an attorney or a court. I am telling you, as the insured, that I feel you have defrauded us, and used your license and title to harm us. Anything used in that pursuit, that was deleted, or omitted, can be found. Easily.

Here are some other links pertaining this particular claim, as well as some regarding the proposed SB 1628:

Part 1 State Farm – State Farm Strikes Again!

Part 2 State Farm – Criminals Amongst Us.

SPOON_SANDRA_2015_Final Draft with_without Removal Depreciation

SPOON_SANDRA_2015_RE_Final Draft with_without Removal Depreciation

Spoon, Sandra Prompt Pay Complaint Faxed 4-7-2015

Sandra Spoon UCSP Complaint 4-13-2015

Spoon, Sandra TX Dept of Ins Complaint Ack 4-15-15

That is it for the moment…

More on SB 1628 and what has happened so far in regards to our efforts to expose the truth about it.

What the Hail….is Really Going on in Texas – Part 1

What the Hail….is Really Going on in Texas – Part 2

What the Hail….is Really Going on in Texas – Part 3

What the Hail….is Really Going on in Texas – Part 4

 

Cal Spoon

 

Apr 262015
 


InsuranceBusters.net State Farm Criminal Lead Photo

State Farm – Criminals amongst us…

I have been fighting the good fight for quite some time now. First as a contractor, then as a Licensed Public Adjuster who does only that, fight the good fight, against your insurance company….. Why, you ask?

With the aforementioned said, my knowledge of the industry is extensive, to say the least. When my mother sustained a burst pipe in her home, I actually, for the first time, became that insured. I have been called an animal numerous times for my pursuit in what I believe in. Truth be told, the other side, which is a term we use to refer to the insurance carriers and anyone who works for them with strict intent of paying you less in order to save their company more, probably has many, much, much worse terms for me. To say I am protective of my family and those I represent, is an understatement. After all, my wife, Melanie Spoon and I dedicated our entire life to the pursuit of simply making them do what they are supposed to, indemnify you in the event of a covered loss. We founded a company and a concept that destroys every lie they have ever sold us… InsuranceBusters.net. and you are here now, in that world that is what we have uncovered as the truth as we know it today.

This particular post will be long. In the briefest, most effective manner I can possibly muster, I will explain what is going on, what has been going on, and what your insurance companies, our very own Department of Insurance, and our state legislators are up to. I will provide verifiable proof with each accusation. I would recommend you to get the best attorney along with unlimited resources from Hoyer Law Firm to ensure your win in any form of case. They are one among the most trusted law firms in the state due to their expert lawyers and their willingness to accept diverse forms of cases.

What do I hope to achieve?

  1. No shame, #1 priority right now is my mother, and her problems are easily fixed. That should happen shortly after publication of this article. State Farm has issued two checks, totaling $53,250.38 As of Friday, April 24, 2015, those checks were uncashable.
    Letter from VP of Chase, stating checks had been presented three times, yet were no good.

    Letter from VP of Chase, stating checks had been presented three times, yet were no good.

    Check 1 Issued 04-10-15. Check was already late when issued, as evidenced by the internal tam report below. Still not able to cash 13 days later...

    Check 1 Issued 04-10-15. Check was already late when issued, as evidenced by the internal tam report below. Still not able to cash 13 days later…

    Check 2, Supplement to the original, yet most of these demands were made in the initial demand, meaning they should have been paid for then. Payment of this check validates the initial demand. Check is also no good.

    Check 2, Supplement to the original, yet most of these demands were made in the initial demand, meaning they should have been paid for then. Payment of this check validates the initial demand. Check is also no good.

  2. When attempting to cash these checks, we also confirmed, from not only the VP of Chase, as shown above, but from Team Manager of State Farm, Gian A. Carlo. Both stated that State Farm had strict rules with chase that they were not to cash any checks written over $10,000.00 written on a State Farm account. Unless you understood what he was actually saying, you would have done like 99.99% of the public. Accepted that as fact at went on attempting different methods to convert the checks to usable funds. To be clear, both told me to DEPOSIT THE CHECKS IN MY ACCOUNT, WHICH THEY KNOW AUTOMATICALLY PLACEs A 10-14 DAY HOLD, IN THIS, THE YEAR 2015, where you  can deposit a check with your phone…
  3. Take both pieces of information. A) A program exists on Chase computers that requires a check to be “Approved” by a method known as positive pay file. Even though State Farm has issued a check, two of them actually, and the initial was dated by computer 13 days prior to his letter stating it was still not there. That is three verified attempts to cash this check. B) The same VP above stated that this was only the first hurdle. He said that when the check actually appears, if it is over $10,000.00, the computer will automatically flag, with a do not cash order to the teller. Attached to this flag, he states, is strict instructions from State Farm NOT TO CONTACT STATE FARM UNDER ANY CIRCUMSTANCES. He stated that these were the “rules”.
  4. The avenue and method that led me here, in my opinion as humble citizen and lowly Public Adjuster, definitely not an attorney, were the criminal actions of State Farm, and every other insurer I have ever dealt with, in every aspect.
    Texas Unfair Claims Settlement Practices

    Texas Unfair Claims Settlement Practices.. These are not suggestions… They are the LAW!

     

  5. The procedures and knowledge insurers currently employee suggest that they have ample ability to perform within the limits currently in place, yet choose not to.
    State Farm's Internal Software that alerts them when they have not met deadline. 1 of 2

    State Farm’s Internal Software that alerts them when they have not met deadline. 1 of 2

    State Farm's Internal Software that alerts them when they have not met deadline. 2 of 2

    State Farm’s Internal Software that alerts them when they have not met deadline. 2 of 2

     

  6. Bring some accountability from the Texas Department of Insurance. There are strict rules on what should happen if an insurer were to continually violate statutes. Are these being followed?Texas Insurance Code 542.006. PERIODIC REPORTING REQUIREMENT.
  7. An answer to SB 1628 in the form of pulling back the veil on what it does and why. #6 above asks a question. That question is being asked because this new legislation, above all else, removes any and all penalties as mentioned above. The audits that are required, coupled with actually having insurers lose their license to do business in this state. GOOD! If the Department were to catch a Public Adjuster or anyone else acting in the manner that the carriers, who must have an individual license, backed by licensed individuals, they will run them out-of-town and straight to jail.
    When They are Supposed to Pay.

    When They are Supposed to Pay.

    What is "Supposed" to happen.

    What is “Supposed” to happen if they do not.

    Reporting and Audits.. things that all these insurers, especially State Farm, Should be doing.

    Reporting and Audits.. things that all these insurers, especially State Farm, Should be doing.

  8. How do I know they are not….. Spoon, Sandra Prompt Pay Complaint Faxed 4-7-2015 and Sandra Spoon UCSP Complaint 4-13-2015 and their response, which is typical…Spoon, Sandra TX Dept of Ins Complaint Ack 4-15-15 saying they are going to ask what the insurer wants them to do. By law, that I have posted above, State Farm has admitted to violating the prompt pay statute, and should be punished, logged, and be counting against whatever magic number it is that kicks in the audits, and penalty phase. Texas Insurance Code 542.006. PERIODIC REPORTING REQUIREMENT.
  9. Resolve the myth of insurers actually being responsible for insureds. We are always threatened that insurers may not “choose” to stay in Texas. Couple one of the largest states in the union, both size and population, paying some of the highest premiums in the nation…and tell me again they are going to pull out. Their investment cash flow from Texas insureds is massive. From the Incoming Commissioner’s own quote about the Texas Insurance Market: “One thing that surprised me is the sheer size of the Texas insurance market, which is larger than a great many countries. In fact, in the last couple of years, we’ve grown from being the 12th largest insurance market in the world to the 10th. The job of being commissioner is bigger than the state of Texas because what we do here literally does have an effect on the rest of the insurance world. It’s both exciting and humbling and I’m honored to be a part of it”. Found here.
  10. Prove that the ultimate goal of your insurance company is to sell you insurance, in order to gain investment capital. Once realized, the conclusion is simple. SB 1628 would allow them to sell you that insurance, invest your premiums, and never pay your claim. If by some miracle, you do find a PA or Attorney to take it, and the insurer does get caught, there will be no penalties. SB 1628 – Read for yourself what they would like to do.
  11. You did not buy insurance in order for the company to invest everywhere but your legitimate claim, should you file one. State Farm’s Spokesman admits, willingly, that 2/3’s of their profit comes from stocks and investments, yet will not divulge which ones. His quote, “The jump in profits and net worth was due to a positive year for State Farm’s stock investments, said spokesman Dick Luedke. About 60 percent, or $6.4 billion, of the gain in net worth can be attributed to stock investments. The remaining 30 percent of the $10.5 billion of net worth gains includes the property-casualty gains in underwriting and investment income realized from bonds.“Net worth is everything we have and that’s a lot. It did go up and it was a significant increase. About two-thirds of it was an increase in the value of our stock portfolio,” Luedke said. “It was a very good year for those who invested in stocks and bonds.”Luedke declined to give details on the businesses State Farm is invested in, but said the portfolio is diversified and comprised of companies, primarily in the U.S., that are “well managed and financed, generate cash and generally pay dividends.” from the article found here. Anyone who has gambled on anything of value, in any shape, form, or fashion should understand one basic principle. Bet small, win small. Bet large, win large. With 2/3’s being the minimal, as stated, how large of a bet do they have to make? If they made that bet, where in the hell did they get the money to float it? You got it….now you’re thinking. They got it from not paying claims, and manipulating the payments they do make in order to meet the current trend or need….. Now, skip ahead to 2014. This article is not as exciting in the fact that they attempt to downplay a net growth of close to 5 billion and profits of at least 3.4 billion in Property and casualty alone. Article found here.

Ok, now to spell it out for those who cannot see what is going on.

  • State Farm has software currently installed that tells them, in no uncertain terms, that they have timelines, and what they are, and when they owe. These timelines are contingent upon someone else entering the data correctly, but once entered, tell the truth on what was entered. They know they are not paying claims on time, yet choose to ignore the penalties. On $26,000.00 it was less than $55.00. That is cheap. Unless it is reported, and the Department of Insurance has to do something.
  • State Farm has made illegal deals with Chase, who then created programming inside their software to coincide with this positive pay file, requiring the number to appear on the screen. This could be called a security measure, until you add the fact that even the check that was computer generated, 13 days PRIOR to this attempt at cashing the check, and was still not present. If it was security, once State Farm Computers issued the draft, the order would go simultaneously to the Positive Pay File. It does not, as proven above.
  • State Farm has made additional illegal deals with Chase, who then again implemented the results of those deals into their software that would automatically”red flag” any checks over $10,000.00. This, in and of itself, is illegal. They may be able to attempt a lie, and suggest another security measure…you know… consumer protection. But the instructions attached to the file, to NOT CONTACT STATE FARM UNDER ANY CIRCUMSTANCES, destroys that claim. When I write a check, and issue it to anyone, I have promised I have the money in the account, in the bank that the draft was written on, and the recipient can walk in, with proper identification, and cash that check, regardless of the amount. The answers I received from all of them were the same, and the one they had told anyone has asked any of these questions or ran into this issue… Deposit in your bank, and wait the 10-14 day period. First off, that is not your money, it is the recipients. You can no longer control it or manipulate it in any manner. IT NO LONGER BELONGS TO YOU! And last, but not least.
  • Texas Department of Insurance, this one is particularly for you. When State Farm installs proprietary software on an outside vendors computer system, designed to automatically not cash checks over $10,000.00, they require the insured to have a bank account in order to be indemnified. In all my years, all my experience, every single claim we have ever done, every policy, rule, or code, I have never seen anything that would require an insured to first obtain a bank account prior to being indemnified. State Farm has done this systematically, and made sure no one was spared by using software to “catch” every single one. I have filed complaints, I will bring this matter to your attention again, tomorrow, April 26, 2015.
  • SB 1628  is a farce. From all the evidence above, and trust me, there is more, much more, Insurers not only have the capability to install software to tell them when they have broken the laws, they have enhanced that software to coincide with Chase @ a minimum, to hold insureds funds as long as humanly possible, in order to reap huge profits of money invested in other ventures. This bill would remove those pesky fees and certainly stop the avalanche of Department ordered audits and checks balances. This cannot pass. If it does, every single elected official who voted for it, is either completely ignorant to the world around them, or lining their pockets with insurers bribes to stay ignorant.

This is but a portion of what is going on. This is part 2 in the saga of my Mother’s water claim. One month and 11 days, she still has not received a dime, even though she has two checks worth over $53,000.00. They still owe her another 50.

Part 1: State Farm Strikes Again! – My own Mom, and every reason you should scream NO! to Texas Senate Bill 1628

Side Note: The check is a criminal offense, however, the second I remand the fraudulent documents to the police department, and sign the affidavit, they have all control. Meaning I have sworn I will only accept payment from the Police Department, after they have done their deal, collected, went through the ritual, and decide to issue her payment… for $53.000.00. I cannot do that. She is a nervous wreck now, even with my help, she is scared. Especially when their checks would not cash. The letter provided by Chase clearly states they cannot process the payments, because they do not exist. To validate, see Justin Nelson’s email verifying amounts, and that initial check was good as well, and there were no problems on State Farm’s end. This email, as proven by the date sent and received, was 2 days prior to the letter written by Chase Vice President stating, emphatically, that checks were not on State Farm’s positive pay file. After all this, after us calling, three trips to the bank….those checks are still no good.

Email from State Farm verifying Checks were good. Notice amounts in correlation to check s above.

Email from State Farm verifying Checks were good. Notice amounts in correlation to check s above.

Here, for the record, is most of the pertinent info of this claim, which has led me, from the insurers side, to uncover some of the most damning evidence against insurers, and their dirty tactics I have personally witnessed.

SPOON_SANDRA_2015_Final Draft with_without Removal Depreciation

SPOON_SANDRA_2015_RE_Final Draft with_without Removal Depreciation

Spoon, Sandra Prompt Pay Complaint Faxed 4-7-2015

Sandra Spoon UCSP Complaint 4-13-2015

Spoon, Sandra TX Dept of Ins Complaint Ack 4-15-15

That is it for the moment…

More on SB 1628 and what has happened so far in regards to our efforts to expose the truth about it.

What the Hail….is Really Going on in Texas – Part 1

What the Hail….is Really Going on in Texas – Part 2

What the Hail….is Really Going on in Texas – Part 3

What the Hail….is Really Going on in Texas – Part 4

Cal Spoon

Apr 132015
 

Sandra Spoon State Farm Horror Stories (1)

 

State Farm insures my mother’s home. First, she suffered a heart attack. Upon returning home from the hospital, she discovered mold growth under her kitchen sink. She got down on her hands and knees, and cleaned up the mold. It came right back, and we called a plumber to come inspect. He did, and found a busted hot water line that was spraying a constant stream of HOT WATER directly to the underside of the main wall of her pier and beam home. Sandra Spoon State Farm Horror Stories (7)This happened and was located on the 16th of March, when she contacted State Farm and filed a claim. Sandra Spoon State Farm Horror Stories (5)Two days later, they had still not contacted her back, so I got involved. I am a licensed Public Adjuster in many states. Texas is my home, and where I prefer to spend the majority of my time. I perform claims adjustments on the behalf of insureds, just like my mother. Sandra Spoon State Farm Horror Stories (6)In her case, I am handling as her son, not a Public Adjuster. I mentioned the date above, because today’s date is almost an entire month since the claim was filed. My mother, after having a major heart attack, suffering a huge water loss, which destroyed the home she has lived in for 40+ years, having to pack all of her belongings, 40 years’ worth, into boxes and every available storage place, then having to be readmitted to the hospital, in order to install two additional stints, then, being forced to recuperate in a travel trailer. This has all transpired in the last month. In that month, State farm has been made well aware of the claim, the extent of damages, and the amount necessary to return her to pre-loss condition. 20150318_091946State Farm even came out, a week after the loss, and agreed they owed at minimum, 27k. She has still not received a single dime, even though we have spent in excess of $10,000.00 in getting to a point where the full damages could be verified, contents could be removed and stored, and temporary living accommodations. Sandra Spoon State Farm Horror Stories (10)I helped file a complaint last Monday, April 6th, 2015 with the Texas Department of Insurance. State Farm, like all carriers licensed in Texas, is under the insurance codes rule book. There are very specific timelines governing how and when a claim must be paid. State Farm violated these rules when dealing with my mother’s claim. Sandra Spoon State Farm Horror Stories (2)Since that time, a week has passed. Friday, I was contacted by their adjuster, who claimed that it was the claims handlers fault, and that the actual supervisor was out of the office all weekend…oh yeah, and Monday too… When State Farm received this complaint, which was Monday, because we sent a copy to them as well, they could never again possibly claim that they did not know….we sent them the actual statute. They still, even knowing full well they were breaking the law, did not contact us until Friday, only to blame another, who has refused to return calls for over three weeks, and was conveniently nowhere around. I sent their adjuster a text this morning, asking for an update. He figured out already that is was not a good idea to send me anything in writing, because that can get him in trouble, and asked me to contact him to discuss the details of her claim. I called…he gave me the exact same story from Friday, with one exception. He asked me, point-blank, after being full aware that over $10,000.00 has already been spent, and that they have not sent the first dime, HOW FAR ALONG IN THE REBUILD PROCESS SHE WAS? Understand, they have paid nothing, and are trying to get her in the middle of the process, only to withhold funds. Putting her and me in a bind, as they do all insureds…. As you can see from the photos, this is not a minor thing, nor is it a pick on State Farm thing. Quite the opposite… I believe they are picking on my mother because, well, she is the mother of the owner of InsuranceBusters.net… need I say more?

InsuranceBusters.net JPEG Logo

 

Anyway… How does this affect you? Good question, and easily answered. Senate Bill 1628, pushed by Larry Taylor, one of our elected Senators, seeks to remove penalties when State Farm and other insurers in Texas do not honor the simple contract they signed with the insured. My mother is one of those insureds, as am I. My mother’s claim is a text-book example of exactly what insurer’s do, even with the current laws, that prohibit them from doing so, they do it anyway. Without me, how in the world is my mom ever going to fight these monsters, which flip their nose and their wallets while directly, with full knowledge, break the law?

She can’t.

If they are successful in changing these laws…what is she, or you, or I going to do in the event we are put in her position?

Requested changes found here.

Be helpless, just like they want us. That way they can offer substantially less than what they owe, while not having a single thing to stop them. Even David had a small weapon against Goliath. I am posting this for many reasons…the main one… I am furious. They have put my mother in the worse position known…that of the unknown. A very scary place when your home, your largest investment, is tore apart from floor to ceiling, and your insurer is playing games.

 

Share this article if you agree. Insurers do not follow the current rules to help consumers/insureds out. Removing the laws preventing insurance companies from doing that very thing, will never, ever make them pays claims fairly, nor on time. This is no way to #ProtectTheInsured…

 

Cal Spoon

04-13-2015

 

******UPDATE****** on SB 1628 from Texas Watch!

Mar 252015
 

Moore Oklahoma Tornados, Again. For the second time in as many years.

Moore, Oklahoma has been hit with another Tornado.

 

InsuranceBusters.net Tornado and Hail in Oklahoma 1

 

InsuranceBusters.net Tornado and Hail in Oklahoma 4

 

InsuranceBusters.net Tornado and Hail in Oklahoma 3

 

 

Two years after the Historic EF5 Tornado that devastated Moore, Oklahoma, another unwanted visitor appeared with the all the too familiar Tornado Sirens.

 

We have been in Oklahoma for almost our entire career in Public Adjusting. That’s six years. In those six years, we have helped many of your friends and neighbors. We are still here to help.

Other links and videos on separate weather occurrences that have gone on today, March 25, 2015.

InsuranceBusters.net Tornado and Hail in Oklahoma 5

 

InsuranceBusters.net Tornado and Hail in Oklahoma 6

 

InsuranceBusters.net Tornado and Hail in Oklahoma 7

 

InsuranceBusters.net Tornado and Hail in Oklahoma 8

 

 

InsuranceBusters.net Free Claim Review

 

If you have filed an insurance claim in the last two years, I invite you to take advantage of a FREE Insurance claim review. Often, people do not want to believe that their insurance company would actually UNDERPAY their claim by a 100% or more, on purpose.

Unfortunately, Insurance is a business, and the only way to make a huge profit is to systematically underpay EVERY claim.

Think of it this way…..

InsuranceBusters.net Legalities

 

Need references, we have them too! All over, but you can contact these local Churches, right here in Abilene and ask about our incredible services, that are FREE unless and UNTIL we RECOVER! It does not matter if you live in a small one room home, a mansion, or your business, we can and will help. There only 734 Licensed Public Adjusters in the ENTIRE STATE of TEXAS. We hold several of them, you can verify our license in Texas, #1603054 here, a direct link to the Texas Department of Insurance Licensing Division, and another here, to my personal license Cal Spoon, Licensed Public Insurance Adjuster. And here, in Oklahoma

First United Methodist of Abilene Website

First United Methodist Facebook

Fountaingate Fellowship of Abilene Website

Fountaingate Fellowship Facebook

 

I hope you hire us, but if you do not, there are other choices, I have listed a few of them below, I do not personally endorse these companies, however, I feel that you should have options, something very few have given to you, the insured. Please use due diligence before hiring anyone, but please, hire someone and do not let these insurance companies continue to profit from not paying claims correctly. We cannot fix EVERY CLAIM, however, if you find us, and have us represent yours, you can count on your insurance company paying what they owe…no more…..no less.

You can find us on Facebook here–>> InsuranceBusters.net Main Facebook Page and our Abilene, Texas specific page, Or Oklahoma Specific Page here:

Thanks in advance, Cal Spoon

InsuranceBusters.net

 

Just one more way InsuranceBusters.net is helping to always #ProtectTheInsured:

 

 

 

Mar 162015
 

InsuranceBusters.net Tennessee HB453

What the Hail is really going on in Texas – Part 2 “Tennessee Drops Truth Bomb with Proposed Legislation”

 

In a crushing blow to insurers and their minions, lawmakers in Tennessee have introduced laws that specifically and directly eradicate the very laws attached in the proposed draft bill, as seen here. Draft Texas Insurance Legislation

 

Tennessee is proposing Senate Bill 398 Sponsored by Senator Frank S. Nicely and HB453 Sponsored by House Representative Bill Dunn

The bill can be found on their site here: http://www.capitol.tn.gov/Bills/109/Bill/HB0453.pdf

 

I am also adding a copy here for convenience. Please read it, it is short, but sweet. An it sends a very clear message to elected officials in Texas…removing penalties and adding roadblocks for insurers to file legitimate claims DOES NOT WORK!

SENATE BILL 389

By Niceley

HOUSE BILL 453

By Dunn

AN ACT to amend Tennessee Code Annotated, Title 56, relative to insurance.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:

SECTION 11. Tennessee Code Annotated, Section 56-8-104, is amended by adding the following new subdivision: ( ) Unfair Insurance Provisions. (A) Including in an insurance policy a provision that would, ninety (90) days from the date a claim was filed with an insurer, prohibit any party from taking appropriate court action to obtain relief in regards to an unsettled claim, including but not limited to, including a provision that would require alternative dispute resolution prior to filing a court action; or (B) Including in an insurance policy a provision that would require the insured to complete repairs prior to the settlement of a claim.

SECTION 2. Tennessee Code Annotated, Section 56-8-105(1), is amended by deleting the subdivision and substituting the following: (1) Knowingly misrepresenting relevant facts or policy provisions relating to coverages at issue, or including provisions in a policy that favor the insurer against the insured;

SECTION 3. Tennessee Code Annotated, Section 56-8-105(2), is amended by deleting the subdivision and substituting the following: (2) Failing to acknowledge, within fifteen (15) days from the date the communication was received, pertinent communications with respect to claims arising under its policies;HB0453 001442 -2-

SECTION 4. Tennessee Code Annotated, Section 56-8-113, is amended by deleting the section and substituting the following: (a) Except as otherwise provided in subsection (b), title 50 and this title shall provide the sole and exclusive statutory remedies and sanctions applicable to an insurer, person, or entity licensed, permitted, or authorized to do business under this title for alleged breach of, or for alleged unfair or deceptive acts or practices in connection with, a contract of insurance as defined in § 56-7-101(a). Nothing in this section shall eliminate or otherwise affect any: (1) Remedy, cause of action, right to relief, or sanction available under common law; (2) Right to declaratory, injunctive, or equitable relief, whether provided under title 29 or the Tennessee Rules of Civil Procedure; or (3) Statutory remedy, cause of action, right to relief, or sanction referenced in title 50 or this title. (b) (1) Any insured alleging an unfair trade practice pursuant to § 56-8- 105(1) or (2) by an insurer, person, or entity licensed, permitted, or authorized to do business under this title may bring a civil cause of action against the insurer, person, or entity for damages. (2) If the court finds that the unfair trade practice was a willful or knowing violation of § 56-8-105(1) or (2), the court may award three (3) times the actual damages sustained and may provide other relief as it considers necessary and proper. (3) Upon a finding by the court that § 56-8-105(1) or (2) has been violated, the court may award to the insured bringing the action reasonable attorney’s fees and costs.- 3 – 001442

SECTION 5. This act shall take effect upon becoming a law, the public welfare requiring it.

They actually have that last statement in the bill….. very telling Texas. So, Texas… What the Hail is Really going on?

 

InsuranceBusters.net Legalities

 

A colleague of mine, who operates in Tennessee brought this to my attention. I am oh so glad he did….Now, I am bringing it to yours.

 

InsuranceBusters.net What the Hail is Really Going on in Texas

 

From a previous article: What the Hail is Really Going on in Texas – Part 1

Legislation in Tennessee attempting to eradicate the very laws similar to those proposed in Texas by Senator Larry Taylor and pushed by Steven J. Badger. They have had a very good taste of this Insurer Friendly type legislation and are actively, with bills on the floor, trying to REMOVE IT!

http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=HB0453

 

Another Public Adjusters perspective who lives in a state where they currently have this type of proposed legislation in place. They have the bill listed above introduced and well on its way to passing, TO CHANGE THESE LAWS TO THE ONES TEXAS CURRENTLY HAS IN PLACE.

In other words, they are taking their freedoms back while Texans are being stripped of theirs……No.

http://www.cornerstonepac.net/trending-1.html

 

Some good links, with a broad perspective.

Cal Spoon 02/19/15

#ProtectTheInsured

If you would like to add information to this, feel free to comment below, or contact me through the link at my name.

 

Here are some good articles and sites where information was obtained.

http://www.calactx.com/2015/02/06/attorneys-insurers-facing-off-over-hail-litigation-in-texas/

http://www.zelle.com/news-events-342.html

http://www.wardlawclaims.com/adjusters/2015-adjuster-conference/

https://insurancecouncil.org/

http://www.claimsjournal.com/news/southcentral/2014/12/01/258372.htm This article is very suspicious, simply because we have no facts, yet I believe they found and culminated a good story to appeal to Hispanic Americans and not filing ANY claims.

See some of the damage for yourself: http://www.srh.noaa.gov/bro/?n=2012event_midvalleyhailprelim

http://www.valleycentral.com/news/story.aspx?list=195030&id=878662#.VOCjwPnF-T8

https://www.nicb.org/newsroom/news-releases/hail-damage-claims-in-the-us

http://www.propertycasualty360.com/2013/04/17/top-10-states-for-wind-and-hail-losses

http://www.bizjournals.com/austin/blog/abj-at-the-capitol/2015/01/altering-insurancetexas-lawmakers-take-aim-at.html?page=all

Biased reports, only giving partial facts….. http://www.tala.com/wp-content/uploads/2014/08/HAILSTORM-REPORT.pdf

http://www.nytimes.com/2015/02/17/nyregion/hurricane-sandy-victims-say-damage-reports-were-altered.html?smid=fb-share&_r=0

http://www.propertycasualty360.com/2015/02/04/war-on-hail-declared-in-texas-as-insurers-fight-ex

http://thelawdictionary.org/article/what-percentage-of-lawsuits-settle-before-trial-what-are-some-statistics-on-personal-injury-settlements/

http://www.law360.com/articles/606208/2014-hail-related-insurance-litigation-year-in-review

http://www.bloomberg.com/apps/news?pid=nw&pname=mm_0907_story1.html

https://www.tpciga.org/faqs.html

http://www.insurancecouncil.org/docs/public/link/SettlingUpAfterIke-galveston-9-13-13.pdf

http://www.newsday.com/business/ag-raids-li-engineering-firm-in-probe-of-sandy-claims-denials-1.9950513

http://newyork.cbslocal.com/2015/02/17/superstorm-sandy-victims-insurance-companies-conspired-not-to-pay-us/

http://www.nbcnewyork.com/news/local/HiRise-Supervisors-Bogus-Home-Inspection-Reports-Sandy-Search-Warrant-292458671.html

Mar 162015
 

InsuranceBusters.net What the Hail is Really Going on in Texas

What the Hail is Really Going on in Texas?….Accountability! An In Depth Look at Proposed Legislation

 

“The Insurance Company Protection Act of 2015”

Amendments to Sections 541 & 542 of the Texas Insurance Code

 

Clarification and full disclosure: My name is Cal Spoon. I am a licensed Public Adjuster # 1594236 and I ownInsuranceBusters.net, License #1603054 in the Great state of Texas along with a slew of others. Texas is my birthplace, and my home. It is where my family resides and two of our offices are located. You could say I have a vested interest. I am a consumer as well as an insured. I have family who are also affected by every bad decision in here.

Things I am not. Politically involved or motivated, an attorney….well that about sums it up  as far as insurance goes, and that is what this is about.

A “Consumer Protection” change to the existing “Consumer Protection” act already in place. Unfortunately, when something works as it is supposed to, and protects the actual consumer, someone comes along with changes such as these that actually GUT ANY protections the insured had before. This is a travesty, and could not be construed as anything else from anyone who was properly informed on ANY of the issues they are attempting to change. Prepare to be informed.

 

To: Texas Legislature

Senators and Representatives of the State of Texas

Insureds….. Everywhere.

 

Please find enclosed a full and detailed description of the travesty that these proposed changes would have on the current landscape of insured home and business owners. Please realize, this is the only publication that I am aware of that is NOT provided by the very people who stand to profit from these very revisions.

Without haste, let’s look at who is actually introducing these heinous revisions.

Senator Larry Taylor – This will not be the first time Mr. Taylor has put his foot in his mouth, and as is true with every politician, in order to benefit himself.

  1. Taylor owns the Taylor Insurance Agency. When he sells insurance, and his sales lead to claims filed, his commission, bonuses and general income takes a hit. No lawsuits means he will reap the benefit of those non-suit losses. How? Because covered claims do not get paid with the current legislation, and penalties in place. See his page here: http://www.trumantaylorinsurance.com/
  2. Lobbyist, who spend hundreds of millions of dollars a year for what…to buy votes and steer legislature to their benefit. This is wrong on so many levels, however it is the norm, and usually results in the everyday citizen losing the voice they voted into office to swift city slicker who talks fast. Mr. Taylor receives campaign donations and no telling what else we are unaware of. Regardless of how he is compensated, his vote is being bought. The cost? Protections for insureds throughout Texas, and eventually, like any evil that prevails in one place, it will rear its ugly head in another.
  3. Taylor had this to say in a recent article. “They’re incentivized to drag these claims out,” said Taylor, who owns the Truman Taylor Insurance Agency in Friendswood, a Houston suburb. “I don’t know of any savings account that offers eighteen percent. There’s too much of an incentive for abuse.” Taylor said he plans to frame the legislation as a “consumer-bill-of-rights type bill” because the costs of litigation could cause insurers to increase their premiums. Texas homeowners already pay an average of $1,661 per year for insurance, 60 percent more than the national average, according to the National Association of Insurance Commissioners.
  4. Taylor, the 18% fee is not one anyone with any common sense would categorize as a savings account. It is a penalty to an insurer when they shirk the duty your constituents and their insured. It is a PENALTY, NOT A SAVINGS ACCOUNT!
  5. TWIA – While Mr. Taylor boasts his wins against TWIA, let’s take a closer look at what his junk changes actually did for constituents…you know…insureds. Here is what attorney Eric Dick had to say. “In 2013 the Texas legislature changed the law for Texas Windstorm Insurance Association (TWIA). Specifically, it removed the liability for TWIA from Texas Insurance Code, Chapter 541 and 542, and Texas Business and Commerce Code, Chapter 17.  It’s important to note that Texas Insurance Code 541 (and Texas Business and Commerce Code, Chapter 17) provide a safeguard for unfair or deceptive insurance practices.  Texas Insurance Code 542 provides a strict liability penalty when an insurance company doesn’t promptly pay a claim. The legislature then added Texas Insurance Code 2210.574 and 2210.575 which reduces penalties for insurance companies and requires appraisal in the event TWIA underpaid the claim.  If appraisal isn’t promptly requested then the insurer has no remedy.”

 

House Insurance Committee: The following members of this committee should resign, and their replacements be well versed in insurance, without being able to actually profit, directly or indirectly from any legislation they have passed. (This should be a no brainer, but read on.)

 

Rep. Guerra, Bobby District 41 – whose clients list as attorney can be found here. As you can see, they represent some of the largest insurers in the Nation. There is no way this bill will not directly benefit every one of his clients, because he represents the insurer…NOT THE INSURED! http://www.guerraleeds.com/clients/

 

Rep. Meyer, Morgan District 108 – whose clients also include some of the largest insurers in the world. Again, and without question as to where their true loyalties lie.  http://www.bracewellgiuliani.com/practice-detail/insurance-litigation

 

Rep. Vo, Hubert District 149 – I am not certain where Mr. Vo fits in, but here is what Wikipedia has to say about him. “The Houston Chronicle has reported numerous stories about apartment complexes owned by Vo. The complexes have been cited by the City of Houston for various building code violations. [1] “His rival, Greg Meyers, made this comment, which just literally cuts this whole scenario to the bone. “”Hubert Vo is obviously abusing his public office to benefit his personal business,” he said. “This is a serious breach of leadership, ethics and integrity, and it needs to be fully investigated by outside parties to determine if any undue influence was sought by Representative Vo.” Found here: http://www.chron.com/news/houston-texas/article/Lawmaker-Vo-used-state-letterhead-in-complaint-to-1534846.php

My question for Mr. Vo, very simple: If you cannot fix the apartments you own, and the city has to cite you, to which you retaliate with an official letter of Official Letterhead, claiming you were being picked on, when in actuality, you were taking money from YOUR OWN TENANTS, which resulted in profits for you. What is the difference between your situation, and that of the insured citizens of Texas? None. You will take as much as you can, only acting on the horrible conditions when there was absolutely no other choice. Article here:http://www.chron.com/news/houston-texas/article/Lawmaker-Vo-takes-blame-for-substandard-apartments-1769007.php  Just out of curiosity, did Mr. Vo file insurance claims on any of those properties?

 

Rep. Sheets, Kenneth District 107 – If you remember House Bill 930, and the travesty that was meat of that bill, which was designed to deter insureds from filing ANY claims at all. They “shelved” this bill until a later time. I wrote a small article on the effects of this bill, found here: http://insurancebusters.net/2013/03/22/hb-930-big-insurance-in-texas-bought-state-representatives-in-texas-short-and-longterm-fall-out-for-insureds/  This would have been another attack on insureds that is not only unjustified, but would penalize ANYONE who filed a claim. Why in the world did you buy insurance in the first place?

 

There is so much more to these folks and their ties to insurance than this, however, I have to find stopping points, and attempt to condense as much information as I can into something our fellow voters can and will read. I am going to attach a link to the actual draft can be found, and then I will move onto the merit of the actual proposed changes and their fallout for insureds.

InsuranceBusters.net Change the World

 

Draft Copy of Proposed Changes to Texas Insurance Code: http://insurancebusters.net/wp-content/uploads/2015/02/Draft-Texas-Insurance-Legislation.pdf

The Existing Texas Insurance Code Can be Found Here: http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.542.htm

 

I am only a lowly Public Adjuster. Definitely not an esteemed Senator, nor State Representative. Not even an attorney. In fact, I am just a guy, like you, the insured. I got into trouble when I was 17 years old. This single thing has haunted me since then…. 25 years. Until I became involved heavily into the insurance side of this industry, I truly believed the entire population was better than me, and that held especially true of the police force, judges, attorneys and pretty much any government office. What I have actually found out, is that when I was got into trouble, I always raised my hand and took my consequences. As it turns out, I am in a select category of people who actually believe that is the only way. The ultimate realization that all of these people who looked down upon me, were committing atrocities daily. Elected officials caught in schemes from one end of the world to the other. Every time, breaking laws, both moral and legal, that cannot even begin to be comprehended. Our elected officials have been bought out. Almost every single one of them. What other purpose do lobbyist have? In saying that, one must realize proof is needed. I have posted a copy of the draft revisions and will now address each point in turn. Yes, some of these are painful for my profession as well, and the truth is quite simple, there are rotten apples everywhere. In every profession, in every city, in every state. That is no different from Columbine or any other horrific event where an INDIVIDUAL or SMALL GROUP OF INDIVIDUALS acted independently, yet their actions have been combined and turned into a call for strict gun control. This type of legislation, in any form, only serves to punish the responsible law-abiding citizens while allowing the criminals to run free. Stricter laws are needed for Public Adjusters, I agree. However, one cannot, in one fell swoop lump them together in a thinly veiled attempt at reducing costs to insurers who would not have had the opportunity to be PENALIZED, had they not broken the rules in the first place. The original authors of this legislation where not slaves to lobbyist, and profiting from their own companies who were directly affected by the very legislation being presented. There should be an inherent law that restricts anyone who can introduce and change legislation to be in that same field, ever. This is common sense and one of the largest example of a conflict of interest that can be used.

The opening statement of the draft, attempting to change the current legislation with their big claim to fame being the ludicrous claim that by relieving the current standards in place, which insurers cannot comply with now, that we, the CONSUMERS, will be protected. I am not sure if anyone actually reads this, or maybe it is treated as the affordable care act, and we must first “pass” it to see what is actually in it…

There are a few statistics thrown in for good measure. Where are the numbers substantiating these claims, and who performed these studies? We have studies of our own, that we have conducted over the last five years. We will get into that later, with specifics, however, my point here is that numbers are being quoted that are “approximate” at best, and there is no validation, nor correlating evidence that would OR could state otherwise. Evidence that social media outlets such as Facebook, Twitter, and YOUTUBE have also contributed to the rise of claims, along with massive TV, radio, internet and sports presence insurers have. These issues have not even been addressed as contributing factors, when in fact, they are probably more responsible than all the other elements combined, yet insurers chose to actively attack the only protections insureds had.

One must also realize at this point, many people who have damaged property are afraid to file claims. They are afraid of rate hikes, denials, and negative claims history…… Again, I will ask the redundant question. Why do we purchase insurance? The notion that more insureds are filing claims, and this upsets the insurers who accepted their overly priced premiums, yet are mad that some of them actually had the audacity to file a claim, and expect that insurer to act on the contractual promise they made. Shame on them.

 

Before you read this, you must first remember that you purchased insurance for one reason, to file a legitimate claim if you had one. You expect the insurance company to come to where the loss occurred, valuate your loss, and pay you everything your policy promised it would….. Somehow, we lose all sense of reason in this respect. The simple idea that we expect the entity who owes to come out and voluntarily pay their profits, when there are absolutely no safeguards in place, is, well….ridiculous. Any money an insurance company owes you, and does not pay, turns into immediate profit. If owed you $10,000.00, yet looked you dead in the face and said I only owe you $2500.00, I would receive the benefit of $7,500.00.

This is from the following article, and explains from Allstate’s own CEO: http://www.bloomberg.com/apps/news?pid=nw&pname=mm_0907_story1.html

“Jerry Choate, Allstate’s chief executive officer from 1995 to ’98, said at a news conference in New York in 1997 that the company’s new claims-handling process had reduced payments and increased profit, according to a report in a March 1997 edition of National Underwriter magazine. Insurers can’t make significantly more money just from cutting sales costs, he told reporters. “The leverage is really on the claims side,” Choate said. “If you don’t win there, I don’t care what you do on the front end. You’re not going to win.”

The more cash insurers can keep from premiums, the more they can invest. This pool of assets–most of which the companies invest in government and corporate bonds–is known as float.

“Simply put, float is money we hold that is not ours but which we get to invest,” billionaire Warren Buffett, CEO of Berkshire Hathaway Inc., wrote in his annual letter to shareholders this year. “When an insurer earns an underwriting profit, float is better than free,” he wrote in 2006. Omaha, Nebraska-based Berkshire Hathaway generated 51 percent of its $11 billion profit in 2006 from insurance.” End Article Quote
So, we have a clear understanding, they are using our premiums that are owing to us and fellow insureds to buy into our government…

Actual Changes:

  1. Page 3 line 18 Strikes the word knowingly. Current licensing rules require licensee to be competent and knowledgeable. This actually allows them to “knowingly” misrepresent the facts.
  2. Page 4 lines 1 thru 5 adds an additional section that has at least one phrase that is wholly ambiguous, in favor of the insurance company. “Compromise Settlement.” In insurance, a carrier owes what the policy allows, there is not a compromise, and the insured did not pay for a compromised settlement. In my opinion, the whole section is added to install this phrase.
  3. Page 4 lines 9 & 10 adds another section, adding yet more ambiguity to the process by using the phrase “reasonable investigation” without actually defining “reasonable”. This allows a proven gray area that insurers manipulate to delay and mitigate their loss. The insured should always have a very CLEAR set of standards.
  4. Page 4 lines 16 thru 21 adds section (B) which frankly, is confusing to me, and I read these numerous times daily, it is my job. It appears to state that if an insurer would believe they are liable for one portion, yet it has a liability issue on another, that they, the insurer, could withhold payment…. Again, this one is somewhat confusing even to me. If you want anyone to follow rules, they must be clear and concise.
  5. Page 7 lines 22 thru 24 continued on Page 5 lines 1 & 2 adds a new section with a thinly veiled statement at the end, “except as may be specifically provided in the policy”. This language allows them to add language to their policy that could completely circumvent the ENTIRE STATUTE. This is just one of the many attempts throughout this proposed “Consumer Friendly” bill that would give insurers that very ability, to completely shirk their obligations whenever they choose.
  6. Page 7 lines 3 thru 6 adds the insurers ability to claim a “compromise settlement” amount on a claim that THEY determine is doubtful or disputed. Think of the hurricanes, Katrina, Ike, Rita, Sandy, Irene and give me one good reason to believe that any insurer could ever be trusted solely to pass judgment on the merit of a claim.
  7. Page 7 lines 21 thru 23 adds subsection (c) which again allows an insurer to determine a “good faith dispute” over coverage, alleviating any responsibility or penalties when an insurer chooses to conveniently decide there is a dispute.
  8. Page 6 lines 1 thru 3 adds subsection (d) where the insurer is limiting, through our own legislation, the insureds ability to seek all necessary relief when fight Goliath.
  9. Page 6 lines 19 thru 23 removes the ENTIRE PENALTY and remedy for an insurer who violates any, or as is most common, all of the governing rules against treating an insured fairly. Does the common citizen, or consumer pay penalties when they are late on credit cards, loans, bills…taxes? Every part of their life, they pay fees when they do not honor their obligations. And when they are deceitful, they are not exempt of from Deceptive Trade Practices, nor any other protections afforded to an insurance carrier. Why would we exempt them from the very rules the rest of us have to abide by….they have more control than any citizen ever dreamed coupled with the ability to approve or deny a claim based on profits and losses…and not merit.
  10. Page 7 lines 15 thru 17 adds language that requires an insured to go through even more hoops than before. First and foremost, the insured is a laymen. To require them to jump through multiple arduous tasks with multiple names, titles and certified transactions could only deter a portion of people from filing a claim at all, or, if they did file the claim, and did it to the best of their ability, yet missed a few of the crucial steps, the insurer could and absolutely would throw their claim out, whether valid or not. Again I recommend any of you revisit the flood vs wind issues with Katrina and multiple others where insurance companies were caught, and found guilty of shirking their claims responsibility and passing their costs of to the consumer, yet again, through NFIP.
  11. Page 7 lines 21 thru 23 and Page 8 lines 1 and 2 adds the additional language to support the above listed changes as well as limiting the insureds time to file a claim. Currently, they have two years, which is a good practice, and are also accommodated by the current statutes these mongrels are attempting to revise. Statute of limitations is correct at two years. It allows physical damage that may not surface immediately, to be overlooked. Especially when a claim was filed, yet the insurer unfairly denied coverage. A two year statute of limitations allows a period of time for many reasons, most of which are tied to this concept. If an insurer will not pay for “unseen damage”, the insured would obviously need time to consider exactly what those “unforeseen damages” may actually be, and claim them on their policy before it expires. The next policy will not pay for a loss that occurred during another policy period, which is correct.
  12. Page 8 lines 3 thru 14 adds the ***ADDITIONAL*** burden on the insured to follow a strict and foreign procedure, just to file the claim, while adding additional language that would exempt the insurer from ANY responsibility provided the already confused insured missed some of these “critical” steps, or risk being denied on a covered loss.
  13. Page 8 line 18 adds the word “business” days. There are already 15 consecutive days given. The previous legislators saw a need to define reasonable because insurers obviously benefit, and use that benefit, when it is not specified. I will also add, add in the changes addressed above, the insurer here, and through the remainder of this section, attempt to tell you they need more and more time, and no consequences, when they are very clearly attempting to add ***ADDITIONAL DUTIES TO THE INSURED AND REMOVING ANY AND ALL PENALTIES, WHILE REDUCING THEIR TIME AND ABILITY FOR RECOURSE ON THE VERY SAME ISSUES INSURERS ARE REQUESTING MORE TIME FOR, YET REDUCING ANY PENALTY IF THEY STILL choose NOT TO MAKE THE DEADLINE! They are penalizing you, the laymen, when insurers, the presumed professional, shirks every duty their license and current statutes require of them.
  14. Page 8 line 24­ adds the words “inspection reports” for what insurers can demand, while refusing to provide the same to an insured, even after a court has demanded them to do so. Here is just one blatant, provable example…there are so many more. http://www.nytimes.com/2015/02/17/nyregion/hurricane-sandy-victims-say-damage-reports-were-altered.html?smid=fb-share&_r=1
  15. Page 9 lines 2 thru 15 adds actual language that would first, and again, allow the insurer to define reasonable, then require a signature under oath, followed by a statement under oath, which historically scares people, and is added as a scare tactic to the actual LEGISLATION. Do you feel you should be submitted to formal proceedings just to file a claim?
  16. Page 9 lines 20 thru 24 and Page 10 lines 1 thru 7 add language that absolves all insurance carriers from following any kind of time line, such as the one currently in place. This same section also allows the Department of Insurance to make a choice, if and when an insurer is found to have violated the rules it says they are exempt from, the language used states that the Department of Insurance ***MAY*** assess interest, but this still does not constitute a violation of the Unfair Claim Settlement Practices. If you can read, this is a direct violation and the only reason the statute even exists to begin with. On that note, we have filed at least 100 separate complaints with the department of insurance. Responses varied from “we are not a Regulatory Agency”, which is exactly what they are, to the most common, which is they suggest the insured hire legal counsel. This promotes an atmosphere that there are no rules and no one to enforce if there were. The Department of Insurance is tasked with doing just that, and the commissioner has a massive amount of power, especially when they repeatedly violate the same simple rules, over and over, yet nothing changes. This very bill, in part, proposes that if you removed the EXISTING PENALTIES, the insurer would act even better….. Really. We have documented proof on any claims made personally by me. All complaints are at my office, and available. Prepare to spend days. It will take you that long to go through the info, only to find that every single insurer acts exactly the same, which is however they choose. Lately, two insurers in particular, GuideOne and Hanover have actually obtained attorneys PRIOR to even sending “undisputed amount” owed under current legislation. This is while the good laws we have in place are already there…how do you really expect them to act when the rules have been removed…?
  17. Page 10 lines 14 thru 16 adds the word reports, which we have addressed above, and strikes some irrelevant policy language due to previous changes. There is nothing wrong with the current statutes as far as consumers are concerned, however, having a few rules to follow for an insurer is frowned upon, and this does not make any sense, common or otherwise. When the other provisions fail, so to must this one.
  18. Page 10 lines 21 & 22 mirrors the changes above and are equally useless.
  19. Page 11 lines 4 & 5 removes existing good language to be replaced with their amended time frames and self-absolution from above.
  20. Page 11 lines 9 thru 20 additional time has already been given, yet insurers want an additional out they can use to delay payment by merely sending a note stating that “They NEED more TIME”. This single move allows the insurer an ADDITIONAL 45 days to hold funds owed to the insured, yet again, without penalty. Let me pose a very quick scenario here. Hurricane Ike occurred around the time the stock market fell, and oil took a nose dive. By their own admission, they use our premiums as “float” money, and claim it is “free” money. It is not, it is money owed to insureds. With methods like above, your insurer could be investing heavily because the bottom fell out. They picked up a ton of shares of crude at $37.00 a barrel. Say it comes time where they have to release a ton of money to insureds, they trigger plans already in place to extend the payouts in order to maximize the time available for the oil to return to a minimum standard of $70.00-$100.00….. You do not have to be an economist to understand that they are not profiting from the premiums, but from the leveraging of the money they owe you, the insured. They ae now asking you to let their “FREE FLOAT MONEY” become penalty free, if and when they do get caught.
  21. Page 12 lines 2 & 3 as well as line 7 add language to solidify the “compromise settlement” phrase they have introduced into this very legislation. This very phrase is ambiguous, and lets the insurer, yet again, make a definitive ruling on their profit, while making it impossible for an insured to recover when they are actually caught.
  22. Page 12 lines 16 thru 20 adds language that appears to open the door for more and multiple deductibles, while extending the time frame for an insurer to respond on all claims. What is an insurance company supposed to do? Provide and service insurance. That is it. Why in the world can your insurer not simply work and handle claims in the very lenient time frame already given, when it is the only job they have? (See my line item 20 for answer.)
  23. Page 12 lines 23 and 24 Page 13 lines 1 thru 24 and page 14 lines 1 thru 13 this single portion deals with the penalty part of violating any of the rules they stated insurers did not have to follow above. Please read that statement over and over until you understand it fully. This gives them multiple ways, just as listed above, to draw out and delay payment for as long as they can, then send to appraisal, to drag out at least another 60 days, when the appraisal is non-binding, and then allow an insurer 15 business days to pay to avoid paying ANY attorney’s fees, penalties, fines, or interest. This is 10 more business days than allowed originally, and still in this statute, coupled with ALL the facts created in that process, yes they still want to hold your money for an ADDITIONAL 15 BUSINESS DAYS!
  24. Page 15 lines 1 thru 13 add language that would reduce the penalty payment from 18%, which is the current, correct rate for failing to abide by the rules and withholding funds from your insured to a miniscule 3%. How many of you pay this type of interest on anything you own? Larry Taylor’s words ring in my ear, yet again…****”They’re incentivized to drag these claims out,” said Taylor, who owns the Truman Taylor Insurance Agency in Friendswood, a Houston suburb. “I don’t know of any savings account that offers eighteen percent. There’s too much of an incentive for abuse.”**** Mr. Taylor, this is NOT AN INTEREST ACCOUNT, IT IS A PENALTY! Pretty simple question here. If you have no penalty for holding that money, and every benefit from holding it, including the use of it, does this not create a conflict of interest in its own right?
  25. Page 15 lines 21 thru 23 adds an additional 15 days to ***EACH*** of the stated deadlines, amounting to an additional 45 days, to exceed all of the time extensions they have already attempted to extend.
  26. Page 16 lines 4 thru 24 and Page 17 lines 1 thru 24 and page 18 lines 1 thru 4 removes existing health consumer languages and add provisions that would be detrimental to every single insured. Not only Texas, but the other states in the union who will follow suit, and harm even more insureds…consumers…taxpayers… In essence they have gutted the entire reason for anyone to take an insureds case on a contingency basis. They also added language like knowingly. As time and history has told us, we cannot tell when our own government knows something, much less when an insurer knew it was breaking the law. The very statutes proposed dictate a much more sinister objective. One that after being in this industry for many years, the research needed to complete this article, and my own life experiences that paint a very vivid picture of exactly what insurers have planned and already accomplished in Texas. ************************** I know this is has been a long journey, I know of no other way to explain, in plain English, exactly what is going on. As you have seen none of this benefits you, the insured. Quite the opposite. It cripples you and any resources you might have against the largest corporations in the world. Now, let me put it all together for you, so that you may see the larger picture. In September of 2013, TAPIA and Defense attorneys won what they believed to be a huge win for insureds. The removal of contractors from the claim process. At the time, like most Trojan Horses, everything looked very positive. Fast forward to the 2015 legislation, and insurers are now attempting to remove any recourse or reason an attorney of Public Adjuster would help an insured. This effectively leaves you, the insured, standing in the middle of a crash up derby, all alone, with the drivers all wearing blindfolds. (You must realize, currently both attorneys and Public Adjusters are normally paid on contingency, if there is no recovery, there is no fee. Public adjusters are capped at a maximum of 10% of the claim, while attorneys are restricted to only “New” money, meaning anything the insured paid prior to issues arising are untouchable from the attorney. The insured is not left with a huge bill and no results. This particular method is THE ONLY WEAPON DAVID HAS AGAINST GOLIATH.) Both professions are regulated heavily. Make no mistake, if an insurer could catch any of these people doing what they claim, they would parade them in front of you like trophies…we are the biggest threat to them, and they are attempting to remove that threat, at your expense, while claiming your honor at the same time…. You cannot do both. This also limits the recovery from other remedies and makes them exclusive to this code, again giving insures an out to circumvent the new lax rules. You have to realize, again, these laws did not just appear, they were added by very smart people who had already suffered the damages of an insurance company who had no rules, and no recourse. Insurers are now trying to “Un Do” the laws already here.
  27. Page 18 lines 8 thru 23 and Page 19 lines 1 thru 13 adds additional language to solidify the additional steps an insured must take prior to attempting to sue their insurer. This also adds an additional work load on the attorney by requiring a ton of additional documentation before even taking a claim, then reducing their fees to almost nonexistence. More work for less pay….do you want some of that?
  28. Page 19 lines 14 thru 23 and Page 20 lines 1 thru 18 adds language to again strengthen the additional duties required of an insured to perform additional, confusing acts, that if not performed, according to this section, they can throw your claim right out of court, valid or not. Does this sound like a consumer friendly bill?
  29. Page 20 lines 19 thru 23 and Page 21 lines 1 thru 7 adds language that allows an insurer to absolve the actions of their agents and employees and claims adjusters as long as the insurer says it will. This takes the ability to hold adjusters and employees responsible for underpaying claims to meet quotas and gain bonuses. Their license, as issued, should control their actions, not their employers. You must have the license to have the job, therefore the license precludes the employment agreement, and you cannot have one without the other. This is not an opinion, it is a fact. Each must remain individual, because both understand the consequences, no other profession allows the employer to absolve wrongdoing of their employees. Laws and rules are for everyone.
  30. Page 21 lines 9 thru 16 solidifies an insurer’s ability to dismiss anything that does not conform the new strict filing regulations listed above. Do you see ANY of these solidifying the insureds rights? No, that’s because that is what the current legislation already does.
  31. Page 21 lines 17 thru 22 and Page 22 lines 1 thru 23 and Page 23 lines 1 thru 23 adds language that solidifies the insurance companies position on a settlements. It clearly allows an insurance carrier to force an insured to instigate suit, provided they could find an attorney to take their claim, to obtain a settlement offer the insured owed prior to attorney’s ever getting involved. It then limits any and all recovery, while stating that this practice does not constitute an act of unfair or deceptive trade practices. I can promise you one thing, if you attempted anything like this against an insurer or anyone else, they would convict you of both. And hang you like they try to do contractors. As State Farm did to Joe Radcliffe, and eventually lost a $14.5 million dollar verdict because of. http://insurancenewsnet.com/oarticle/2013/12/19/radcliff-wins-defamation-award-against-state-farm-a-439079.html#.VOZN_fnF9S0
  32. Page 24 line 1 thru 21 adds completely new section that appears to limit the existing four-year statute to two years. An attorney would definitely need to explain this to the rest of non-attorneys…. ;-)
  33. Page 24 lines 22 thru 24 and Page 25 lines 1 thru 16 this allows the commissioner to implement or use laws as they see fit. Most of the time, the insurance commissioner comes from somewhere within the insurance industry, usually with a very high-profile career, when they are elected, pay close to attentions to their donors and those that have the most to win and lose from their success…. Follow the money.
  34. Page 25 lines 20 thru 24 Limits ability to collect interest, removing yet again, any penalty for failure to perform.
  35. Page 26 lines 5 & 6 adds public adjuster to the lists of professionals who are not allowed to solicit to the penal code. I do not personally solicit. I have no issues as long as there are standards set in place as to when and where the solicitation can happen. There is room for improvement, as with any mechanism.
  36. Page 27 lines 18 thru 23 Outlines when the Public Adjuster can send any approved material. When an insured is in need, 31 days is a lifetime, and this should be shortened to a maximum of 14 days for any communication save whatever their final on solicitation would be.

You do not need all of these to prevail, or even a majority. A few, some of them even singularly, will suffice to allow insurers to circumvent the ENTIRE STATUTE, rendering the Department of Insurance useless, Contractors useless, Public Adjusters useless, and no recourse in the court system. Essentially, and with complete totality rendering the very consumer it was supposed to “protect”, absolutely, without fail, all alone against Goliath. David at least had a weapon. This….this travesty, exists only to harm the consumer. They just were not prepared for people to actually fight back that understood what the ramifications of these actions will cause.

 

After all of this information, all of the items stacked against you and I, the average insured…Does this really look like a consumer friendly bill, or does it look like what it actually is… Another attempt to protect big corporations at the expense of the little guy…you and I?

 

This is what once Texas Insurance Commissioner says… ” It’s despicable not to make good-faith offers to everybody,” says Robert Hunter, who was Texas insurance commissioner from 1993 to ’95 and is now insurance director at the Washington-based Consumer Federation of America. “Money managers have taken over this whole industry. Their eyes are not on people who are hurt but on the bottom line for the next quarter.”

 

 

Insurers always threaten to leave…..who are they leaving? Their customers…..they are always there in some form or another, under the name Lloyd’s.

Insureds often believe their insurance company is backing them with THEIR money. They are not. They are backing you with your own money. If at any time, it appears they may lose money, even your money they had intended to keep, they will simply disappear, and guess who foots the bill, again?

See: (The TPCIGA is a non-profit association created by the legislature to pay certain claims of Texas insurance consumers in the event that a property-casualty company becomes insolvent.  TPCIGA is not an insurance company; it does not issue policies, collect premiums or make a profit, or otherwise stand in the shoes of an insolvent insurance company.  We exist solely to pay claims when an insurer becomes insolvent.  All insurance companies that are licensed to sell property and casualty insurance in Texas are required to be members of the association and to contribute to our fund.  Our governing statute is found at Tex.Ins.Code chap. 462.)

 

Closing:

If you have read this, and can find anywhere that this an actual protection bill for the insured, please do not hesitate to comment below. Be careful and concise, let us know who you are, and who you represent, just as I have.

If you are going to cite statistics on anything, especially hail claims in McAllen, Texas, provide facts, all of them. Yes many lawsuits were filed, and in my opinion, not near enough. We hold an amount of data that is unprecedented. This is just our database. There are many other who will be linking and adding to this saga. Insurers, by design, have figured out how to cut costs prior to you ever filing a claim. Deciding to not pay for certain things before you even paid for the policy. Nothing that you see in insurance today came overnight. They have in arguably spent enough money to make an ENTIRE WORLD believe that letting the person who owes the debt decide how much that debt is, or if it even exists, is not only acceptable, but in your best interest……think about that one for a while.

 

Cal Spoon 02/19/15

#ProtectTheInsured

If you would like to add information to this, feel free to comment below, or contact me through the link at my name.

 

Here are some good articles and sites where information was obtained.

http://www.calactx.com/2015/02/06/attorneys-insurers-facing-off-over-hail-litigation-in-texas/

http://www.zelle.com/news-events-342.html

http://www.wardlawclaims.com/adjusters/2015-adjuster-conference/

https://insurancecouncil.org/

http://www.claimsjournal.com/news/southcentral/2014/12/01/258372.htm This article is very suspicious, simply because we have no facts, yet I believe they found and culminated a good story to appeal to Hispanic Americans and not filing ANY claims.

See some of the damage for yourself: http://www.srh.noaa.gov/bro/?n=2012event_midvalleyhailprelim

http://www.valleycentral.com/news/story.aspx?list=195030&id=878662#.VOCjwPnF-T8

https://www.nicb.org/newsroom/news-releases/hail-damage-claims-in-the-us

http://www.propertycasualty360.com/2013/04/17/top-10-states-for-wind-and-hail-losses

http://www.bizjournals.com/austin/blog/abj-at-the-capitol/2015/01/altering-insurancetexas-lawmakers-take-aim-at.html?page=all

Biased reports, only giving partial facts….. http://www.tala.com/wp-content/uploads/2014/08/HAILSTORM-REPORT.pdf

http://www.nytimes.com/2015/02/17/nyregion/hurricane-sandy-victims-say-damage-reports-were-altered.html?smid=fb-share&_r=0

http://www.propertycasualty360.com/2015/02/04/war-on-hail-declared-in-texas-as-insurers-fight-ex

http://thelawdictionary.org/article/what-percentage-of-lawsuits-settle-before-trial-what-are-some-statistics-on-personal-injury-settlements/

http://www.law360.com/articles/606208/2014-hail-related-insurance-litigation-year-in-review

http://www.bloomberg.com/apps/news?pid=nw&pname=mm_0907_story1.html

https://www.tpciga.org/faqs.html

http://www.insurancecouncil.org/docs/public/link/SettlingUpAfterIke-galveston-9-13-13.pdf

http://www.newsday.com/business/ag-raids-li-engineering-firm-in-probe-of-sandy-claims-denials-1.9950513

http://newyork.cbslocal.com/2015/02/17/superstorm-sandy-victims-insurance-companies-conspired-not-to-pay-us/

http://www.nbcnewyork.com/news/local/HiRise-Supervisors-Bogus-Home-Inspection-Reports-Sandy-Search-Warrant-292458671.html

 

Legislation in Tennessee attempting to eradicate the very laws similar to those proposed in Texas by Senator Larry Taylor and pushed by Steven J. Badger. They have had a very good taste of this Insurer Friendly type legislation and are actively, with bills on the floor, trying to REMOVE IT!

http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=HB0453

 

Another Public Adjusters perspective who lives in a state where they currently have this type of proposed legislation in place. They have the bill listed above introduced and well on its way to passing, TO CHANGE THESE LAWS TO THE ONES TEXAS CURRENTLY HAS IN PLACE.

In other words, they are taking their freedoms back while Texans are being stripped of theirs……No.

http://www.cornerstonepac.net/trending-1.html

Mar 162015
 

InsuranceBusters.net David Stewart Article

What the Hail is Going on in Texas?

The Arrogance of Goliath.

By David Stewart, J.D.

Public Adjuster

 

What the Hail….is Really Going on in Texas – Part 1

What the Hail….is Really Going on in Texas – Part 2

 

Arrogant – having or showing the insulting attitude of people who believe that they are better, smarter, or more important than other people.[1]

 

Has the property insurance industry suddenly stopped paying these claims? Or are more sinister forces involved, causing both the increase in number of claims being submitted and number of claims resulting in litigation. There is no question it is the latter[2]

 

Have Texas insurance companies all of a sudden stopped paying hail damage claims? Of course not. The real cause of the Texas hail claims crisis is obvious[3]

 

Or perhaps it isn’t so… obvious. To some.

 

As a public adjuster I am in the trenches helping home and business owners with their property damage claims. I am not a Texas public adjuster, but I have friends who are. What the hail is going on in Texas goes on in every state. In any debate there are always two sets of facts. In order to make an informed analysis of the situation it is prudent to have both sets of facts.

 

A few days ago as I was getting ready to leave my hotel room I received a call from a State Farm Team 92 claims adjuster (I’ll call him Bob, not his real name). He, like myself, deals with many claims for many different people. It’s our job. However, the topic of our conversation was not about us. It was about a homeowner’s hail claim.

 

One has to realize that these home and business owners are everyday people. When they have a catastrophe (and to them even having a small water leak might qualify as a catastrophe) they believe that their insurance company is going to take care of them. After all, isn’t that what insurance companies promise to do when they sell a policy?

 

Have property insurance companies stopped paying their claims? Of course not. They pay them every day of the week. It’s not a question of do they pay their claims, it’s a question of how they pay their claims. The average policyholder knows little about their policy and even less about how to restore their property after a loss. They know they need a professional to help them. Their professional is the contractor they hire to fix their property.

 

I can’t deny there are contractors and public adjusters that operate in less than ethical ways. All industries have their problem element. One has to be careful when dealing with the problem that they aren’t also affecting the rest of the element, or those who need the element.

InsuranceBusters.net Blaze on Black

TYPICAL CLAIM

 

The typical claim evolves in this matter. A policyholder suffers a loss. The first thing they do is contact their insurance carrier. This is actually one of their duties after loss as written in their policy. The carrier sends out an adjuster who inspects and adjusts the loss. The adjuster writes his “estimate,” cuts the policyholder a check and is on his way. Now the contractor becomes involved.

 

There are two types of contractors. Contractors who are just interested in cash flow and contractors who actually try to operate a stable business model. The contractor who is just interested in cash flow is more than happy to take what the insurance company offers to pay. Many will even offer to pay the deductible. Neither this type of contractor nor the policyholder know anything about the estimating platform or the policy language. The contractor does the work, the policyholder gets their property fixed and everyone is happy, at least momentarily.

 

If the policyholder happens to contact a contractor who actually operates a stable business model, things may not go as smoothly. The contractor inspects the damage, looks at the insurance adjuster’s scope and tells the policyholder there isn’t enough to properly do the work. The policyholder then contacts their adjuster and tells him the contractor said there isn’t enough to do the work. Now one of two things will happen.

 

First, the adjuster will contact the contractor and try to work out the differences with the contractor. This is the proper way to handle it and the way it should be done every time. The more common approach is for the adjuster to tell the policyholder their contractor is too high and they need to get more bids. Really? Where in the policy does it say that?

 

The policyholder, now thinking their contractor is too high, contacts other contractors for more bids. The policyholder quite likely would prefer to work with their original contractor, but are now under the false assumption that their contractor is “too high.” They get bids until they finally come up with a bid that the insurance adjuster feels is low enough to pay. Again I ask, where in the policy does it say that?

InsuranceBusters.net Oklahoma City Hail From Norman Weather Office

 

GENERIC ESTIMATES

 

Getting back to my conversation with “Bob,” I was discussing my scope and my documentation with him. I asked him if he had read it and he said he had. The main part of the argument concerned the roof scope. State Farm uses Xactimate so it is prudent when dealing with a State Farm claim to scope a loss with Xactimate. Anyone who has ever seen a State Farm roof scope knows that it is very basic. By very basic I mean they just use a few line items and then claim all the detail work is included. My conversation with Bob revolved around the use of the asphalt starter strip and the ridge cap line items.

 

I have done extensive research and analysis which included delving into the software, studying building codes and manufacturer’s installation instructions. I produced a “white paper” outlining precisely why each of these line items needed to be included in a properly composed Xactimate roof scope.

 

I will briefly explain what my analysis revealed. The argument is that starter strip and ridge cap are included in the hypothetical “waste factor” of the field shingles. Anyone who knows anything about roofing knows that the field shingles go on rather quickly. They are placed in position and nailed on and any good roofer can install field shingles at a fairly rapid pace. More material can be installed in a lesser amount of time.

 

The same is not true for the accessories, such as ridge cap and starter strip. Starter strip is done a couple of different ways. First, one can buy pre-manufactured starter strip and use it. This is how it is mainly done with architectural shingles. The other method requires using 3-tab shingles with the tabs removed. Common sense dictates that if one has to remove a portion of the shingle they are installing then it takes more time to perform that task. It is much quicker to place a shingle on the roof and pop 4 nails into it than it is to have to cut 3 tabs off that same shingle, lay it in place and then pop 4 nails into it. Yet, insurance adjusters would have you believe this is “included” in their “waste factor.”

 

In my analysis I compared the components of the field shingles with the component of the starter strip line item in Xactimate. The cost analysis in comparing an amount of starter strip to an equal amount of field shingle material revealed a cost difference of $147.67 per 234 LF of starter material installed.  This equates to .60/ LF.

 

This may not seem like much but it does add up. Let’s say on an average hip roof you have 300 LF of eave. Multiplying 300 times .60 comes to $180. Again, that may not seem like much. However, suppose a contractor does 100 of those roofs. That $180 is now $18,000.

 

This is now $18,000 that a contractor has left on the table and $18,000 of unjust enrichment to the insurer. Yes, it is unjust enrichment. The policy holder paid the premium for that benefit and the carrier improperly denied it. And that is just on 100 roofs. How many roofs are scoped in a year due to storm related claims? Thousands? Ten-thousands?  Hundred-thousand? Do the math.

 

When analyzing the ridge cap line item we find an even larger discrepancy. For every 100 LF of ridge cap bundled into the hypothetical “waste factor,” a claim is shorted over $161 per 100 LF of ridge cap on a loss. Once again, do the math. How much unjust enrichment does this add to an insurance company’s bottom line that should have gone to their policyholders?

 

If one needs further proof one simply needs to look at the labor components of these two items as compared to the labor component of the same amount of field shingles. The starter strip labor component shows a labor cost factor 3 times greater than the labor cost to install the same amount of field shingles. The same analysis for the ridge cap line item shows a labor cost factor nearly 4 times greater than the labor cost to install the same amount of field shingles. These facts are in the software program and are there for anyone who wishes to find them. When these facts are revealed we have one line item that shows a labor cost 3 times the comparable amount of field shingles and a line item that shows a labor cost nearly 4 times the comparable amount of field shingles. Yet, we are told “that’s included in our waste.” I’ll ask again. Where in the policy does it say that?

 

As previously mentioned, Bob said he had read my papers. This means Bob was aware of the facts that I have just explained. Bob told me it was company procedure to pay those items in the waste factor. I told Bob I didn’t care about company procedure. Company procedure is not part of the policy and the policyholder never agreed to “company procedure.” I also told Bob that the policy says the insurer will pay the “actual and necessary amount” spent to repair or replace the property. My papers establish that both of those items are “actual and necessary” costs of a roof replacement.

 

He agreed with me, but at this point he made an interesting statement to me. He said “You know you’re fighting Goliath, don’t you?” After questioning what he said, he told me again. “You know you’re fighting Goliath, don’t you?” In essence, he just admitted to me that State Farm was a philistine.

 

In modern usage a philistine is “a person who is hostile or indifferent to culture and the arts, or who has no understanding of them.” I have said many times that estimating insurance losses is an art so I really could not disagree with his admission. State Farm is indeed hostile or indifferent to the art of estimating and have shown on many occasions, the present one included, they have no understanding of it. Even after being presented with the evidence.

 

As it was I told him that I was aware that I was fighting Goliath. I also told him my name is David and I know how that story ended.

InsuranceBusters.net Golf Ball Dents @ Fountain Gate Church in Abilene

BACK TO THE ARTICLE

 

“A new generation of public adjusters also appeared. In the past two years alone, membership in the Texas Association of Public Insurance Adjusters has more than doubled.”[4]

 

According to the Texas Department of Insurance, how many licensed public adjusters are there?

 

Public Insurance Adjuster – Number of Licenses as of 8/31/14 – 747.[5]

 

Are we supposed to believe that a mere 747 public adjusters in the state of Texas are helping create what Mr. Badger and others are calling a crisis?

 

Adjuster – Property and Casualty – Number of Licenses as of 8/31/14 – 48,770[6]

 

If one compares the number of license public adjusters to the number of licensed property and casualty adjusters, the public adjusters are outnumbered 65 to 1.

 

Going back to the article:

 

“Further, to assist these individuals in pursuing their claims, a new generation of ‘roofing experts’ emerged, many with absolutely no previous experience with roofing systems but prepared to issue reports.”[7]

 

This is an interesting statement. What exactly are the requirements to become a property and casualty adjuster?

 

I went to the United States Department of Labor website and found the following:

 

“A high school diploma or equivalent is typically required by employers who hire workers as entry-level claims adjusters, examiners, or investigators. Higher positions may require a bachelor’s degree or some insurance-related work experience. Auto damage appraisers typically have a postsecondary non-degree award or work experience in identifying and estimating the cost of automotive repair.”[8]

 

Work experience in related occupation – None.[9]

 

Have you ever heard of the pot calling the kettle black, Mr. Badger? I could imagine the great confidence homeowners would have if they knew the only qualifications necessary to handle their property damage claim is a high school diploma or equivalent. I’m sure there are property adjusters who have experience in construction related fields and do actually know what is necessary to repair damaged property. It has been my experience that they are few and far between.

 

However, your typical high school graduate will have no idea how to install field shingles, let alone the other detail work that is required to properly install a roof. All they know is what they are told. Sketch the roof in Xactimate and then insert the pre-made, insurance company macro[10]. Boom! 5 minutes and you’re done!

 

This is not scoping a claim. This is simply regurgitating company procedure in number form. It has nothing to do with the “actual and necessary” cost of repairing property. And just think, there are over 48,000 of these running around the state of Texas adjusting homeowner claims.

 

Going back to my conversation with Bob, the philistine, Bob admitted that he understood my position and even agreed with me. However, I was fighting “Goliath” and “Goliath’s” position is “that’s included in the waste.”

 

What exactly do you call it when you are shown, with documented proof, that your position is in error yet you keep on doing what you were doing regardless of the proof? What happens when more and more public adjusters and policyholders learn that the position of the philistine is in error and they have the proof to back it up? The philistine runs and cries to the legislature that the rules need to be changed so they can continue doing what they have always been doing.

 

SOME PERSONAL EXPERIENCE

 

Would insurance companies actually send adjusters out to a loss that have no knowledge of the subject matter they are sent to adjust? Well, you would like to believe if you are a policyholder with a claim you would get an adjuster who knew what the hail they were doing. Unfortunately, that is not the case.

An Actual Sign to Hire Adjusters for Insurance Companies After ONLY 4 DAYS of Training. This is the person you will see when you call in a loss....with four days of training......

One of my recent commercial hail claims involved hail damage to a modified bitumen roof on a downtown commercial building. Pretty simple really. However, upon reviewing the scope the adjuster had it adjusted as an EPDM roof. Anyone who has any actual roofing experience would know the difference between a modified bitumen roof and an EPDM roof. Anyone with any roofing experience would also know to check for additional layers under the top layer. This roof had additional layers of built up roofing under the modified bitumen roof. The adjuster sent to this loss did not include this in his scope. It is painfully obvious that the adjuster sent to this loss was in no way qualified to be adjusting this loss.

 

This adjuster scoped this loss at just over $50k. When I got done assessing the damages it was over $200k. When I first started working on this claim I honestly thought I would be able to get this one settled. The carrier on the claim has historically been pretty good about paying their claims. I sent my scope to the desk adjuster with my demand. I received a letter from the desk adjuster only objecting to a few of my line items. In other words we have a further undisputed amount. I sent a demand for the undisputed amount nearly 3 months ago. Illinois insurance regulations require undisputed amounts to be paid within 30 days. This adjuster has still not sent this undisputed amount, which is in excess of $100k. A claim that I fully expected to be able to settle is going to litigation because this carrier has decided not to pay a legitimate claim.

 

Four years ago I had never heard of a public adjuster. I was a sales rep for a roofing contractor. Before I knew about the insurance “game,” I would sell roofs. The enlightenment started when people would call with a storm claim and want an estimate for their roof. I would present them with our going rate. However, I was not able to get any of these jobs. Depending on the size of the roof, the insurance adjusters “estimates” were anywhere from several hundred to several thousand dollars below what it actually took to do the job. Did they get their roofs done? Of course. There are low-ball contractors in every market.

 

My success rate with regular retail bids was pretty good. On a retail bid I was actually selling the benefits of our company and the company had been around a long time and had a good reputation. However, I eventually realized that on “bidding” insurance claims I was not “bidding” against other contractors. I was bidding against an insurance company.

 

This all happened before I learned about Xactimate. Nearly all the storm claim bids were done with Xactimate. I finally went to a class about storm claims taught by a contractor. It was at this class that I learned about Xactimate. Once I subscribed to Xactimate and started looking at all the line items that were actually included in the software I realized why insurance scopes were so low. They were not using the software as it was designed to be used. I have already previously discussed bundling ridge cap and starter strip into a hypothetical waste factor. Depending on the size of the claim, this might leave anywhere from 300-500 dollars off the claim. When you start finding all the other items that they leave out of their scopes, that 300-500 might easily be 1-2k or several thousand dollars.

 

Without knowing the estimating software, a homeowner has no idea that their adjuster is intentionally leaving hundreds, if not thousands of dollars, out of their claim. They would never know this unless someone knowledgeable with the software, such as a public adjuster or contractor, told them this was being done.

 

WHAT THE HAIL IS GOING ON?

 

There most definitely is something the hail going on. Just what the hail is going on? Is it because “Texas insurance companies (have) all of a sudden stopped paying hail damage claims? Of course not.” Now that some more facts have been added perhaps Mr. Badger’s conclusion is not so “obvious.” What the hail is going on in Texas is not just a Texas “crisis.” The crisis exists everywhere there is an insurance claim being adjusted.

 

I have no reason to believe there is not some questionable activity on the side of some contractors and public adjusters. However, I absolutely know there is questionable activity happening on the insurance side. No, Texas insurance companies have not all of a sudden stopped paying hail damage claims. Those who deal with those claims are becoming more knowledgeable and are exposing the fraudulent activity of the insurance companies.

 

Insurance companies can no longer get away with the deception they have been using for years. We are learning the software and the tactics used by insurance companies. We know the law and we know how to properly scope a claim. We have more experience than a high school diploma. We know how to properly scope a roof because we have done it for years.

 

The insurance industry is not under attack. The insurance industry is being exposed. They are being exposed of sending incompetent adjusters out to scope losses they know nothing about. They are being exposed for their bastardization of the estimating software. Even their phony engineer reports are being exposed. There most certainly is a crisis in the insurance industry, Mr. Badger. The crisis is we are onto the scheme. When we expose the scheme, just like the philistine, they ignore the facts and just go right on doing what they are doing. Arrogance! Pure arrogance!

 

Toto is chewing on the curtain and the wizard is being exposed.

 

An article by David Stewart,

Licensed Public Adjuster.

[1] http://www.merriam-webster.com/dictionary/arrogant

[2] Badger, Steven J. “The Emerging Hail Risk: What The Hail Is Going On?” Claims Journal. Wells Media Group, Inc., May 2, 2014. Web. February 2015.

[3] Badger, Steven J. “Juror Witnesses Firsthand What the Hail is Going on in Texas.” Claims Journal Wells Media Group, Inc., December 1, 2014. Web. February 2015.

[4] Badger. “The Emerging Hail Risk, id.

[5] http://www.tdi.texas.gov/licensing/agent/revaglityppia.html

[6] http://www.tdi.texas.gov/licensing/agent/revaglitypapc.html

[7] Badger. “The Emerging Hail Risk, id.

[8] http://www.bls.gov/ooh/business-and-financial/claims-adjusters-appraisers-examiners-and-investigators.htm#tab-4

[9] Id.

[10] A macro is a pre-set group of line items that are inserted into a Xactimate estimate.

 

Some good links, with a broad perspective.

Cal Spoon 02/22/15

#ProtectTheInsured

If you would like to add information to this, feel free to comment below, or contact me through the link at my name.

 

Here are some good articles and sites where information was obtained.

http://www.calactx.com/2015/02/06/attorneys-insurers-facing-off-over-hail-litigation-in-texas/

http://www.zelle.com/news-events-342.html

http://www.wardlawclaims.com/adjusters/2015-adjuster-conference/

https://insurancecouncil.org/

http://www.claimsjournal.com/news/southcentral/2014/12/01/258372.htm This article is very suspicious, simply because we have no facts, yet I believe they found and culminated a good story to appeal to Hispanic Americans and not filing ANY claims.

See some of the damage for yourself: http://www.srh.noaa.gov/bro/?n=2012event_midvalleyhailprelim

http://www.valleycentral.com/news/story.aspx?list=195030&id=878662#.VOCjwPnF-T8

https://www.nicb.org/newsroom/news-releases/hail-damage-claims-in-the-us

http://www.propertycasualty360.com/2013/04/17/top-10-states-for-wind-and-hail-losses

http://www.bizjournals.com/austin/blog/abj-at-the-capitol/2015/01/altering-insurancetexas-lawmakers-take-aim-at.html?page=all

Biased reports, only giving partial facts….. http://www.tala.com/wp-content/uploads/2014/08/HAILSTORM-REPORT.pdf

http://www.nytimes.com/2015/02/17/nyregion/hurricane-sandy-victims-say-damage-reports-were-altered.html?smid=fb-share&_r=0

http://www.propertycasualty360.com/2015/02/04/war-on-hail-declared-in-texas-as-insurers-fight-ex

http://thelawdictionary.org/article/what-percentage-of-lawsuits-settle-before-trial-what-are-some-statistics-on-personal-injury-settlements/

http://www.law360.com/articles/606208/2014-hail-related-insurance-litigation-year-in-review

http://www.bloomberg.com/apps/news?pid=nw&pname=mm_0907_story1.html

https://www.tpciga.org/faqs.html

http://www.insurancecouncil.org/docs/public/link/SettlingUpAfterIke-galveston-9-13-13.pdf

http://www.newsday.com/business/ag-raids-li-engineering-firm-in-probe-of-sandy-claims-denials-1.9950513

http://newyork.cbslocal.com/2015/02/17/superstorm-sandy-victims-insurance-companies-conspired-not-to-pay-us/

http://www.nbcnewyork.com/news/local/HiRise-Supervisors-Bogus-Home-Inspection-Reports-Sandy-Search-Warrant-292458671.html

Legislation in Tennessee attempting to eradicate the very laws similar to those proposed in Texas by Senator Larry Taylor and pushed by Steven J. Badger. They have had a very good taste of this Insurer Friendly type legislation and are actively, with bills on the floor, trying to REMOVE IT!

http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=HB0453

Another Public Adjusters perspective who lives in a state where they currently have this type of proposed legislation in place. They have the bill listed above introduced and well on its way to passing, TO CHANGE THESE LAWS TO THE ONES TEXAS CURRENTLY HAS IN PLACE.

In other words, they are taking their freedoms back while Texans are being stripped of theirs……No.

http://www.cornerstonepac.net/trending-1.html