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

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