The answer, like anything else, would depend upon who you asked……
If you ask an insurance company, their attorneys or their lobbyist they will give you their view of a horrible scourge that only wants to take a chunk of your claim! They will vilify, and outright lie, because the truth, as ugly as it is, is really very simple. Insurance is a business, and if they paid claims correctly, at all, there would be absolutely no need for my profession to even exist.
Debunking insurance company lies – This is done very simply. When a contingency contract that is approved by the state is used, the insured would not owe the Public Adjuster ANYTHING if the Public Adjuster did not recover ADDITIONAL funds. (This simple statement thrashes anything an insurer might say.) The Public Adjuster can only benefit if the INSURED, which is YOU, benefit.
When you file a claim, your insurance company tells you they are sending their guy to tell you how much or little they owe you…..
Please listen carefully to what they said.
“WE are sending OUR GUY to tell YOU how LITTLE we ACTUALLY OWE YOU!”
Now. Ask your friends, neighbors, Pastors, Judges, City Attorneys and Senators that we have helped…..
Mike Martin 5 star rating – “I would never have gotten the money to make repairs to my home without their help! A hailstorm badly damaged our home and I received a very low offer from my insurance company. A friend recommended Cal and the fight was over for me. They handled everything and we received what we were rightfully entitled to under our policy.”
The key word Mr. Martin used was entitled. We can never make an insurer pay more than what they owe. We would not want to. However, as Mr. Martin found out, what he was owed and what they offered were over 100% in difference. Whose favor do you think the discrepancy served? Your insurance company, of course. They attempted to make over a 100% profit off of Mr. Martin.
They have done the same thing to you, if you have ever filed an insurance claim….. Insurance is a business, and you are a customer. Their sworn goal is to MAKE MONEY. What better way to make money than to send your OWN guy to estimate the VALUE. This is only ONE of their tools. One of millions designed to make sure they keep making money.
A Public Adjuster is an insurance claims adjuster who advocates for the policyholder in appraising and negotiating a claimant’s insurance claim. Aside from attorneys and the broker of record, public adjusters licensed by state departments of insurance are the only type of claims adjuster that can legally represent the rights of an insured during an insurance claim process. A public adjuster will be most beneficial when it is clear that the insurer will pay the claim and the only issue is the proper identification and valuation of the loss. Most public adjusters charge a percentage of the settlement (with the percentage being lower for larger losses (over $250,000)), with the average charge being between 15% to 20%, although some states cap the fee. Primarily they appraise the damage, prepare an estimate and other claim documentation, read the policy of insurance to determine coverages, and negotiate with the insurance company’s claims handler.
There are three classes of insurance claims adjusters: staff adjusters (employed by an insurance company or self-insured entity), independent adjusters (independent contractors hired by the insurance company) and public adjusters (employed by the policyholder). “Company” or “independent” adjusters can only legally represent the rights of an insurance company.
Outside the United States Adjusters are commonly called (or translated into English as) “insurance loss assessors” (or simply “loss assessors”) and staff adjusters or independent adjusters are called or translated as “insurance loss adjusters” (or simply “loss adjusters”). However, there is a clear distinction between a loss adjuster, who works on behalf of an insurance company, and a loss assessor who works on behalf of a policy holder.
To many others, we are the super heroes. The unsung heroes who toil day and night to make sure insurers, who have every tool at their disposal, included unlimited wealth, are held accountable. May seem like a small thing…. it is not. It is often times the ONLY difference in financial desolation and complete indemnification.
We have 86 year old widows who will make you cry from the beginning of their story, all the way up until the happy ending. We have been the reason that happy ending arrived. The reason retirement wasn’t touched, the reason college funds are intact, and whole economies are sustained. With the Superpowers the license of Public Adjuster bestows upon us, we are able to breathe life back into ANY life altering catastrophic situation. Whether it was man made or an act of “Nature”.
How could we possibly make this claim?
Abilene Texas – 2011 Hail Storm
First United – Insurance paid originally approximately $25,000.00. InsuranceBusters.net settled in full approximately $385,000.00
Old Carpet Store on N. 1st. Insurance Company paid approximately $17,000.00. InsuranceBusters.net and attorneys settled claim for approximately $580,000.00.
In just two claims, the insurance carriers managed to save themselves a whopping $920,000.00! Until the insured found their voice, their Superpower, their Public Adjuster.
How do we affect an entire economy? The example above is very real. Those are actual approximate numbers to real claims that have been settled, right here in Abilene.
$920,000.00 came back from insurance companies bank accounts into those of the insureds who were actually owed. They used that money. In your stores, your restaurants, your car lots, your taxes. EVERYWHERE!!!!!
We did that……… We have BEEN DOING THAT for over five years now. It is what a Public Adjuster is supposed to do. And yes, often times, I feel as if we fit right into the Super Hero Category…… Don’t you?
If you have suffered a loss, of any type where insurance is involved, we can help.
Claim must still be within Statute of Limitations. (Texas 2 years, most other states 1 year)
By license, we can only handle Property and Casualty Insurance claims. (Sorry, no license exists, to my knowledge, that would allow us to help on a medical insurance side, we all know it is not only necessary, but mandatory.)
We can file the claim for you, or re-open an existing claim to get the money they “forgot” to pay you.
Licensed in numerous other states as well. If we are not licensed there, we have a network of Public Adjusters that we work with throughout the world, and I am sure we can point you in the right direction.
No Recovery, Absolutely No Fee! (Simple, Self Explanatory)
All insurance claim reviews are FREE.
YOU HAVE NOTHING TO LOSE AND EVERYTHING TO GAIN!
Start the New Year out Right, with some of your money finding it’s way back to your pocket, where it belongs.
I am Cal Spoon, Public Adjuster, and I wear it proudly.
Sometimes, He sends people to help. There is absolutely no doubt in my mind, that every bad thing I have ever done has led me to EVERY good thing I am capable of today. I believe I am doing exactly what He specifically designed me for, and He is not done with me yet.
Insureds need protection from insurance companies. Period. We have factually, provably altered the course of people’s existence. For the good. Come sit with me anytime, and we will pick up the phone and call any number of clients you wish, who will more than likely talk your ear off. From everyday grandmothers to senators and judges, restaurants to churches and everything in between, one thing remains. We have always done one thing. Had one Purpose. #ProtectTheInsured
Have I always been good, kind, or on the right side? Absolutely not. I was a raging idiot who attempted to destroy myself, and everything I loved. Until I became a father. Something snapped, rightly so, and my whole existence changed. I have fought since that very day to right any wrongs that I could, and make a living amends for the ones I cannot. I am self-taught. All of those years taught me defeat at its most base level. Something anyone who has ever enjoyed any victory, has had to have suffer as well. In order to do what we do, it takes everything we have ever learned. The times I spent in trouble, and on the wrong side, now stand as a beacon. I understand what they are doing and where they are going, and the result of their actions, always known, always understood. Insurance companies knowingly under pay their insureds. By how much, how often, and which companies has been lamented by many, yet never factually backed. Until now. Every Claim, Every Time.
Time and again, I hear, “you were in trouble with the law, numerous times?” To which I have to smile. I have been down this road many times. Many attorneys, insurers, enemies, competitors, con artists, crooks, and yes, everything in between. At some point in every single relationship, this suddenly becomes an issue. I use the word suddenly, because my history is worn as any tiger wears theirs stripes, as scars, battle wounds and markings, proving that I have fought the very worst this world has to offer. I am still standing. Between a mother who never gave up, a core family, and for the last ten 10 years, the love of my life, and an unwavering Faith in God, not only are we standing, we are fighting. Using EVERY SINGLE lesson from EVERY single scar.
When my answer comes, it is not what they expected.
“Yes. All those things are true. Many, many more that are not written down. Both good and bad. What I would like you to look at, is the result, every time. Historically, provably with the very records that follow me anywhere I go, and are given in extreme detail to any state I apply for a license from, I accepted my guilt, my consequence, and my duty to my community without fail. I served every single punishment the court gave me, and many they did not, the ones that were self-made, yet again in this journey called life. Crazy thing. I was seventeen years old. I will be 42 in a couple of days. My life did not even BEGIN until I was 23………. When I realized the error in my ways, I immediately set about a path of change that ultimately led to whom you see today. The reason we are even having this conversation, and you are trying to use my past to discredit me, is the very reason we are here. I am a fast learner, and by twenty-three years of age, I had learned the value of the rules, and that following them, to the letter, suited me much better than anything I had tried thus far. Once this became the norm, the next natural occurrence was to wonder why everyone else was NOT following the rules, which, in turn, brings us full circle back to why we are having this conversation about my past.”
At this point, normally, whoever is on the other end has figured out what is actually going on, or they are blind, and no matter what, it will be a brutal finish.
We are having this conversation, in short, because I spent a lifetime building a construction company, knowledge base, both on physical and administrative, only to end up fighting with the very companies I respected, over items that were clearly damaged, clearly owed, yet defiantly and adamantly denied.
Between the years of 2007-2009 many things happened. Wall Street, Housing, Oil. Every person I know was affected. Some way more than others. We were paying an extremely high General Liability premium as a large construction company. When everything went bust, people became desperate and attempted any number of things to keep from paying the debt they owed. Overnight, oil had dropped from $144 to around $37. This was on top of the housing and Wall Street fiasco. We had approximately 30 Projects going. About a million dollars’ worth of materials on the ground. Most of our clients were oil related, (almost every industry in West Texas is) and they went from well off to owing everyone, including the contractor who was in the middle. Some of them attempting to discredit us in order to not pay us. Only a few, but we all know, the squeaky wheel makes the most noise. There were three instances where we filed contacted our insurance agent, asked about coverage, and were told no, they did not cover that. We, like everyone else, absorbed those losses, and moved on.
At this point in time, everyone we knew, attorneys, accountants, other contractors kept chiming one thing. FILE BANKRUPTCY!
Now, I don’t know about you, but I do NOT like that word. In essence, Wall Street filed bankruptcy, housing filed bankruptcy, banks filed bankruptcy, and ultimately, our country is merely filing a prolonged type of bankruptcy, both monetarily and morally.
The thing about bankruptcy, in only hurts the people who put faith in YOU in the first place. All the crooks, the criminals, the ones who stole and did horrible things, have ALREADY succeeded! The only ones left to hurt, are those who do not deserve it.
I refused to file. Instead, we worked our butts off, sacrificed everything we had built, and finished all but two projects. One by mutual agreement, which I will be eternally grateful for, the other by lawsuit.
We finished. All of them. We have eventually paid almost every single debt, with only a few remaining.
When my wife read the definition of Public Adjuster, over the phone, the hair on the back of my neck started tingling, as it is now, in the most peculiar way. We had been doing this very thing for our ENTIRE career. We had even become a Premier Service Provider for State Farm, for approximately 2-3 years. We were constantly in a battle of having to complete an insured loss for what they paid. It was impossible, and resulted in us terminating the agreement. (State Farm Likes to claim differently, as they do about your coverage, I outright challenge them, produce the paperwork, they cannot, because it does not exist.) My last conversation was on speaker phone, with the regional manager of the PSP program and his supervisor. I told them both, if I could find someone to pay me to do the work, make sure it was done correctly, and on time, and take any blame for ANYTHING and EVERYTHING an insurer claimed they DID NOT owe for, yet had to be done, I would hire everyone they could find. I then hung up the phone, only to receive an immediate call back, stating, now Cal, you are in contract, and you can’t just stop. To which I replied, “Take a good look at those contracts. We signed a one year contract, over two years ago. We never extended the contract and have just kept moving. I have no contract with you, you have no hold on us, lose this number……”
I know this is a bit drawn out, however, these small details are imperative. Here’s how.
We began to shut down our building company. We had shut off all advertising, rerouted all phone lines, completed all projects and were moving in full force towards InsuranceBusters.net. We had received all the study materials and were preparing to take the entrance exam. (Last known statistic, less than 22% of the people who take this test pass on the first attempt.)
As I began to read the study material, a fire that had been slowly burning inside of me, began to grow. The more I read, the more I understood, the stronger the flame. Within 2 hours of beginning the material, I had furiously taken notes on a yellow legal pad. (I am famous for these, they are everywhere and contain ideas such as InsuranceBusters.net, WrapVertising.net and so on.)
These were not happy notes…. Each one indicated an instance where my insurance was OBLIGATED to have helped. The entire reason we had purchased it. I became even angrier when I realized that the few times we had actually had the AUDACITY to contact them, they outright lied to me and my wife. The lie itself was bad enough, however, financially, we were bearing all the costs the insurance company was supposed to have. Yet they saved all that money, by simply saying no. At one point in time, and several since then, we were destitute. Every single penny went to someone else, to pay for what my insurance originally owed. We are not talking a couple of thousand, we are talking hundreds of thousands, with damages in the millions.
Was my anger valid? Did they actually owe? How would you prove it now?
I already did. From that yellow piece of paper, and my limited knowledge at that point, I contacted my insurance company on the only one we still were within time limits, and wore them out. They sent us a check for $20,000.00, immediately, with a final settlement. Still new, still green, and completely ecstatic that I was correct, they were let off that easy! In actuality, this one issue cost over 1 million in actual, no telling how much in heart and soul and time. We have paid the majority of that, and still brought InsuranceBusters.net to where it is today.
What would have happened if the insurance company would have just paid what they owed on the claims they owed?
I do not know. What I do know is that, I, my wife and daughters, and many others suffered tremendously over someone simply saying, “We do not cover that.” When I say suffer, I mean in every sense of the word. Financially, physically, emotionally, mentally and yes, our egos.
You want to know why I am fierce. We, as a family, as a business, have suffered terribly, on numerous occasions, unnecessarily, simply because of the word no……
As I calmly look whoever the accuser is, directly in the eye, “When I was young, and hell-bent on self-destruction, and I actually did things knowingly that hurt people, I felt remorse, I admitted my guilt and accepted my punishment without fail. Since those early years, around 23, there has been very little in the way of intentional harm and a whole documented slew of intentional rights. I have done it all proudly, and with the ability to look anyone in the eyes. Now that we have made sure to air all my dirty laundry, let’s take a look at yours…….”
This is just one company, and these are just a few instances, but they are considered number one, so a pretty good gauge. This is Evil. It goes against the very fabric of WHY you/I purchased the insurance in the first place. It leaves you, the insured at a financial loss that will take years before the full extent is known. All because you were never intended to be indemnified in the first place.
I have, at some point in life, been everything someone has accused someone else of being. The difference? In a nutshell, I was an adolescent, lashing out at anyone and anything, especially myself, or anything that looked like it may first love me, then leave me to my own. I did a bunch of stupid, childish, illegal things. I paid for, and still do, each and every one of them, 20+ years later, longer than I was alive prior to being so stupid. I live with it every time I apply for a new license, a new office lease, temporary housing, everywhere, in every situation. I have to. Bearing this burden makes me acutely aware of my surroundings, and those around me who are not only not carrying their own burdens, but are attempting to hide their own behind the simple fact that mine are out there, open, addressed.
What does all this mean? It means, quite simply, that the past has absolutely NO negative effect on the future. Quite the contrary. The past has dictated that the future becomes one of order. One of rules. Rules which we must all follow. There is nothing left hiding in Mr. Spoon’s closet. Nothing left for me to fear. All those problems were stepping-stones, some of them really close, some I nearly had to drown before reaching the next. Each bringing a lesson of what to do next.
Today…Throughout the United States, and London of course, we are known. To insurers, we are their archenemy, and they will attempt to discredit not only us, but our profession. To that, I say one thing, “We are capped at 10% of the settlement by law. This is LESS than YOU tip your waiter. An insurance company is not capped! They are allowed to charge staggering amounts in premiums while GIVING their OWN valuations to INSURED LOSSES! (Actual Example: Church A receives $25,000.00 loss payment. Insurer initially fights tooth and nail, denying owing any more, at all. Ninety days, no attorneys, we settled the claim for $385,000.00. What was the difference between the original $25,000.00 and the final $385,000.00? We were. We were the difference, and we kept the church from asking the already overtaxed parishioners from having to commit additional funds, funds they did not have.) This one claim, had we not been involved, would have netted the insurance carrier a benefit of $355,000.00! Where is their cap? There is not one! Please, do not get the silly notion that this is an anomaly, it is not. It is every claim, every time. Again, if you care to challenge, come on down. I have five years’ worth of proof after proof after proof.
To our insureds, we are a modern-day Robin Hood’s, who actually use the rules/laws to protect them! What their insurance company was supposed to do all along, and has convinced an entire world that it is a good idea to send the guy who actually owes the money out to tell you EXACTLY how LITTLE it really is, you know……
I aspire every day to be my Father’s son. To live as I talk and talk as I live. To be the type of son He would want to be proud of. The type of son who would sacrifice all that he loves for that which he believes in. I believe in who I am, and feel extremely confident about my role in life. We have helped so many…..
That’s me, Cal Spoon in a nutshell. Nowhere near perfect, but never even dreaming of ceasing to attempt and reach some level of peace, of a restored balance after chaos reigned for such a period of crucial learning years.
I have heard a phrase used numerous times in connection with my name. He is like a Tiger, every once in a great while, you may get lucky enough to catch a hold of his tail…… but then, what are you going to do, you have caught a tiger by the tail? You have to wonder who actually caught who……
All an insurance company has to do to underpay your claim, is do it. There is absolutely NOTHING standing in between them, you, and their profit…. Except us. Licensed Public Adjusters in Oklahoma. Specifically with office located in Abilene, Texas. Galveston, Texas and Norman, Oklahoma. But we help insureds all over the USA. Insureds just like you.
Never be afraid to ask questions. You can catch us on Facebook, Twitter, LinkedIn and multiple other platforms, or all the information you could want or need has been put in an easy to search and read format.
My name is Cal Spoon. My wife, Melanie Spoon and I started this company almost six years ago. We are both licensed Public Adjusters and we have built it on doing one thing, one premise. #ProtectTheInsured. When we do that one simple thing, we personally, without fail, are going to benefit. Every time, every claim. What other profession, especially in an insurance claim, has someone PROMISED BY CONTRACT, not to charge unless they actually benefitted you, the client, the important one?
Insurers have no discriminations. The only good claim is an underpaid claim. In reality, those underpaid claims are yours, your families, your neighbors and employers, and yes, even your churches. We have helped several large one with staggeringly underpaid claims. Read below to see how they actually handle all claims. They just were not at all prepared for what they came up against.
Big Loss – Little Loss
Big Damage – Little Damage, there is no difference. It’s yours, and you deserve to be treated fairly.
I have removed names, but the below rebuttal was after a local church asked us to help. The carrier originally paid less than $37,000.00
After our involvement, the claim rose to over $91,000.00. They still actually owe over 1.4 million dollars. Why WOULD they pay it.
If you would like to just how good they are treating churches, read on.
December 12, 2014
Please be advised, I am attaching my final rebuttal to the beginning of the final complaint filed and acknowledged by the Texas Department of Insurance. I do this to keep from repeating myself. The documents included with this response will conclude our portion of this claim.
We began this journey on the morning of October 27, 2014. Since that day, we predicted your actions and your outcome from the onset. All the way to the very end, where you produced the type of reports written to protect your profit, and that of your employer. This whole scenario should have been one of camaraderie, and mutual search to locate the coverages available to the insured, who is both of our clients. We are both bound by contract and licensure that govern both of our conducts, and sets out a specific set of responsibilities. In the break down below, I will annihilate the so-called reports that delayed this claim long past any sense of being within compliance. However, I want to reiterate a few points from our previous correspondence, which is attached, but very burdensome. The majority of the items you finally issued payment on were discussed in the very beginning of our first inspection, yet you “decided” to withhold funds until you received the report, which not really even address these areas. There are many things that have done during the process of this claim that have been warned against, not because we are all-powerful, but because we can read and comprehend what a policy and administrative time limit is. What we know for absolutely sure, before we ever delve into the fictitious reports, are this:
Insurance Company Name Redacted initially spent minimal time on a claim that an insured had filed a claim for a covered loss.
This fact is driven home by another simple fact, $37,000.00 vs the still grossly underpaid amount of $91,500.00 that you have now issued. Roughly 170% more than you initially offered. This is irrefutable fact. How in the world did you miss this much? Adjuster Name Redacted stated he has an office building close to the administrative building, and that he had a claim…. For the record, I think the attorneys should have a look, and see if there is anything intentionally left off this one, even after a blueprint was given, that is on his? I think this is valid.
The initial valuation had taxes added. To a nonprofit tax exempt church, as they all are. This is Insurance 101, yet it still was done. (The new valuation now has tax on materials??? Tax Exempt = No Taxes.)
Fortunately or unfortunately, there is no one even dealing with this claim that read and understand a deductible. This is just one more thing, that in all honesty, is the one thing Insurance Company Name Redacted should be giving that they do not actually owe, should be absorbing the cost. Every representative of Insurance Company Name Redacted, even after finally issuing the initial check, missed, again, one of the most basic facets of claim, the deductible.Insurance Company Name Redacted has represented to the insured, in writing that their deductible was much lower than it is. You can imagine their surprise when you took an additional deductible. I will say these terms and let the attorneys sort it out. If an insurer or a representative of an insurer would represent that something were true, or covered, then from that point forward, on that claim, it is.
Initially, payment was with well past guidelines. Emails are attached where Mr. Joy physically lied about the whole ordeal, in writing.
Insured felt as if receiving the check was contingent upon accepting the clearly low offer. This is verified by the actual check never actually leaving until well after InsuranceBusters.net’s involvement.
Once the error of his ways had been brought to light, he was suddenly removed and replaced by you, Adjuster Name Redacted. Both of whom had no knowledge whatsoever that timelines even existed. Both of whom argued, at great length via email, that they did nothing wrong and did not have anything to worry about.
Issuing of the penalty payment, and acknowledgement to insured validates that you are in fact under timelines, that neither of you were aware of said time lines, therefore you could never have possibly had a system in place to promptly effect a claim. No one is counting, but this is already several issues. Not one, not random, but one right after the other. All at a minimum approximately 170% benefit to the INSURER. (On a side note, this is a perfect example of the farce that is insurance. The low-ball initial payment is par for course. We are criticized for charging 10% of a claim, that is LESS than you tip your waiter, and in Texas at least, our profession is capped at a maximum 10%. Whereas in this case, which is a typical claim, the insurance company and you, Adjuster Name Redacted have attempted to rob these insureds, this CHURCH, of 170% at the MINIMUM. 10% does not sound so bad now, does it? And obviously, as you can see by the preparation of this claim, we earn every dime and are worth every single cent.)
You have knowingly and willingly violated the policy and the statutes governing the handling of claims. Obviously, we are not Attorneys, and do not even attempt to pretend we are, however, when a statute says you have 15 business days, that is exactly what I understand it to mean. (EX: Traffic Citation issued. Clearly states that you have X numbers of days. Does this mean you can handle the citation on your time? No, and you cannot do that with our insureds here in Texas either.)
By your own statements, in written form, you and your “legal team” have been the deciders in many areas that neither of us have the authority to do.
Change that policy or statute in any way. You decided to initially underpay by a minimum, from your own numbers, 170%. Then you withheld funds in an attempt to obtain that lower settlement.
You then got caught lying outright, in writing numerous times.
You then denied any wrongdoing, only to issue a check specifically for that which you had denied, just as vehemently as everything else.
You stated, again in writing, that you and the “legal team” paid what you THOUGHT you owed.
You all did that in the beginning, and again, by your own admission, were off 170%.
You then intentionally delayed the investigation and conclusion of this claim.
Then, when you finally did get finished taking and labeling a few photographs, (As I will show below, your reports are little more than that. Any of them.) You issued payment for the items that had clearly been demanded before and had nothing to do with the actual farce of reports that were submitted. Had I not been so adamant in my demeanor and logging this claim as we do every claim, we would not be talking about a bunch of heresy. We are not. We are talking about facts that are before us, in black and white, which cannot be refuted in any way.
We know for certain the numbers are closer to 1.5 million dollars. Because we have actually done our job. Performed the due diligence owed to our client. We became familiar with the policy and the statutes, and followed the rules to best of our ability. What that did was show how inept the industry really is. Again. But, hey, just by your numbers alone, the insured initially lost 170% of the value of their claim, because as I have outlined, no one knows or cares, and as long as it is not costing money, and actually making money, it appears to be working fine. No.
Who is going to complain about realizing a very real profit of a minimum, 170%?
Below is a breakdown of each “report”.
In Order Received:
Redacted Roof Membrane Inspector Info.
We have been supplied a report from the company listed above. There is no signature nor stamp, nor mention of who actually did the report, and what their qualifications were, if any. The insured has made an approximately 1.5 million dollar demand, back with proof. The insurer, via this office, was made well aware that whatever testing was necessary, to move forward.
The “scientific” methodology utilized to test a black, nominal .030-.040 EPDM “RUBBER”, roofing sample was a light bar….. to test for the observance of light through the membrane….. For a visual, I will use a tire. When a nail punctures a tire, then is removed, the hole pushes back into itself and becomes necessary for a technician to submerge it, to locate the air being forces from pressurization of the tire. Without the added air, the hole would NOT be visible in any scenario where light was used, unless it was for technicians to see what they were doing. Unless layers of the membrane were actually SHAVED from the parent layer, many, many times, you would NEVER see light through the membrane. This is the actual benefit to the product, if puncture, the water still has a difficult time penetrating. That does not mean the holes are not there. The test and method both fail. It would be a good idea to take this particular sample into the court room, puncture 20 times with a pick or knife, then put it on a light bar, in front of a whole jury.
I want to make note for the attorneys, and the timeline. The report is a pre-finished plug the measurement and photos in, the entire process involved in what was done, actually only took a few hours. This can be verified by simply demanding some of their previous reports. Also, they noted that they did not receive until the November 26th, well after we inspected. Another stall.
The report speaks, in writing, of taking photographs at 10X the zoom. Yet the picture provided in the report do not appear to be taken with an even primitive type of modern zoom apparatus. Where are these magnified pictures that were used to deny this covered claim? Why weren’t they provided with this report, and why, instead were we given these grainy artifacts? Even if the methodology of either test were sound, which they are not, why would you hold something so valuable to your denial out? I can think of a few 1.5 million reasons.
One of the most glaring things missing from this report, or any other, save ours, is the insulation. Not one word was mentioned about the devastated 2” insulation. The insulation that had absolute visible gashes in the top from the hail stones? We took four samples, out of four samples, every one of them were visibly mangled. The most damning piece of evidence on the size of hail, and whether or not the roof was affected. The rubber roofing system absorbed the bulk of the brunt, and that insulation, on the underside of the membrane shows precisely what type of beating that roof took. Why are there no mentions, at all, nor any photos? Out of all those photos, not one of the most single most damning piece of evidence. I know, because I was there. I have photographs, and you can bet someone will be back out there pulling some samples before this is over with. You cannot hide the whole existing roof, or just omit it. Oh wait, you already did.
There is nothing but a report with a fancy Header. Not signed, not verified, and certainly not professional. The facts are clear. This report has been written to do one thing, and one thing only. Say there is no damage to clearly damaged property.
Engineer Firm Redacted
Notice on this report, at the end, there is a signature and license number with the required information. This is necessary information from any report, any time. The validity of this report, however, stops right there and picks up were the other left over.
This report, like the other one, is a carbon copy of every report the firm has supplied to insurance carriers since their unholy union. Meaning, it is also a fill in a few blanks, and spit out whole report, situation, designed to deny covered losses, and actually attempting to help the adjuster with optimum or not so much photos, and indicators of many things that have absolutely nothing to do with whether or not that roof or property sustained hail damage.
We will start with the 2” insulation board. There is one photo, showing the 2” insulation, but that is it. Even in that photo, on page 25, photograph 28, you can see that the sample cut out was right in the center of a large indention. A hail indention. The photograph also shows precisely what is in between the hail and everything else. Not one mention, not one photo of the top side. I personally watched him take numerous photographs. This is something you all three are involved in, knowingly. You have kept the most damning evidence to yourself.
In this generic report, the engineer does one thing well. He describes what each roof is, and the known pitfalls and manufactures defects.
He stopped there, and went rogue. He listed every defect he could come up with, which were all manufactures defects, and have nothing to do with the insured. If Insurance Company Name Redacted so chooses, they can subrogate the manufacture. In all the engineers reasoning of the known problems, he failed to outline several of the most important factors about the defects. One, and probably the most important, is that not one single defect he mentioned or observed made toe roof MORE susceptible, which, by his own admission, it does exactly that. His Words, straight from his report… (See how that Copy and Paste works?) (“EPDM membranes contain oils added by the manufacturer to facilitate mixing of other materials such as polymer and carbon black that also provide flexibility to the finished membrane. As the EPDM membrane ages, the oils within the membrane degrade and volatilize as the result of exposure to heat and ultraviolet (UV) rays. The loss of oils within the membrane causes a resultant loss of mass and volume. As the EPDM loses volume, it begins to shrink. The shrinkage or contraction is most evident at walls, where the resulting tension produced in the EPDM causes an inadequately secured flashing membrane to pull away from parapet walls until the roof and flashing membrane are stretched taut, a condition sometimes referred to as “tenting.” As the tension increases over time, the roof membrane attachment at the base of the parapet walls can tear loose, thus further damaging the roof system. When the roofing industry became aware of the EPDM shrinkage problem, it made changes to the EPDM roof membrane and recommended details for membrane attachment at parapet walls. Originally, ASTM D4637, Standard Specification for EPDM Sheet Used in Single-Ply Roofing, required a maximum dimensional change after heat aging of 2 percent. This was changed to a maximum of 1 percent. Changes in EPDM formulas and improved attachment requirements have significantly diminished EPDM roof system shrinkage failures.”) What he is saying, yet said the opposite in order to deny the claim, is that this particular roof was EVEN MORE SUSCEPTIBLE to damage, through no fault of the insured.
Lowery goes on to say the following, (“Hail damage to modified EPDM membrane roofs can be defined as an identifiable mark of distress caused by hail that has measurably reduced the integrity or functionality of the overall roof covering, where the roof covering was sound prior to the hail impact. The damage is commonly found in the form of a fracture or tear through the entire thickness of the membrane. The impact may also take the form of a circular or elliptical mark with a pattern of “spider web” cracking. It can also be in the form of semi-circular tears in the membrane. Controlled laboratory testing has found that hail smaller than 2 ½ inches in diameter lacks sufficient mass to cause a significant loss in functionality or integrity to ballasted roof covering. Hail smaller than 2 inches in diameter does not damage unballasted EPDM membranes.2 Field investigations have confirmed these tests.3”) Notice that he talks about a controlled environment, and the necessity of 2 1/2” hail to damage the roof. Again, he fails to mention that this roof was already MORE SUSCEPTIBLE than most, and again, he has admitted to extreme hail in both direction that the storm was traveling and the building stood in the middle of. This is common knowledge for anyone in this town. My point is that while he tried to minimalize the hail, he did not say one thing about this particular roof, the one we are inspecting and the one all have agreed was hit by hail.
Next, Mr. Lowery goes on to state, (“At the main church building, dents were found in roof vents, metal coping, metal louvers, and the metal window trim, and clean spots were found on the north and west sides of a light pole (Photographs 5 through 10). Except for two dents in a north-facing wall on top of the roof, no dents were found in the EIFS (Photographs 11 and 12). At the office building, dents were found in a roof vent, window sill flashings, north- and west-facing metal fascia trim, and HVAC condenser fins (Photographs 13 through 16). Many factors should be considered when estimating the size of hail that impacted a property, including the gauge (thickness) of the metal, the angle of impact, the speed of impact, and the hardness of the hailstone. However, laboratory tests allow us to predict the size of hail based on on-site collateral indicators. In general, dents in light-gauge metals, such as the furnace vent caps, can be up to three times larger than the actual hailstone, whereas dents in heavier gauge metals may be as small as half the size of the impacting hailstone. Based on this study of the collateral indicators, hail no larger than ¾ inches in diameter fell at these two sites. The hailstones appear to have originated from the northwest. While larger hail may have impacted this property, no evidence was found in any of the collateral surfaces.”) He says all kinds of stuff to say nothing, ending with LARGER HAIL MAY OR MAY NOT HAVE HIT THIS PROPERTY, BUT I AM GOING TO STATE NO LARGER THAN ¾” in my report. I love visuals, so I will give another one. Take a basketball, go to the top of the highest building you can get onto. Dunk it ink, and send it over the side. (Use proper safety precautions of course.) When it lands, tell me if the ink spot is as large as the basketball? Or maybe, just maybe, you will have a very predominant approximately 3” round mark with a bunch of splatter from run off on impact. However, the main impact, will not be anywhere near the size of the basketball, thereby throwing this whole farce of a theory out. The ball, or hail stone, everyone that hit, would have to squash itself flat in order to make the same indentation as the size of the stone. There is much more difficult, scientific explanation than that, unlike you folks, I want to make this as simple as possible, while giving an accurate visual of what they are attempting to claim. All of these reports were meant to confuse and distract the average person, who is not versed in either construction knowledge or policy knowledge. Unfortunately for you, you ran into some with both.
Strangely missing from the report, are any photos of the window trim and anodized bronze frames at the very entrance of the church. OK, let me answer for you. Like the insulation, it blows the whole ¾” hail stone bit right out of the window. I mention these, because they hold in large tempered safety glass. These are reinforced structural frames designed for strength. There are dents a golf ball will roll in on that ENTIRE from assembly. These are not easily damaged as has been attempted to allude to. These dents are the outside corner of the actual frame, actually crushing the metal downward, creating a crease on the front side from the pressure on impact. There is not a ¾” stone or metal that could make that metal bend in that manner. All over.
I could go on, but I have to leave something for the attorneys.
The engineer has committed one of the worst crimes against a person I can imagine. He used his degree and title to write a report full of partial truths, omissions, and opinions that are just that, opinions. Opinions that have always benefitted them, and the insurance carriers who hire them, while helping deny a multitude of covered losses. By using smoke and mirrors, and the average insureds lack of knowledge in anything to do with an insurance claim. If I remember correctly, A Jonathan Gruber is in the proverbial hot seat right now. You know, one of the “architects” of Affordable Care, who has publicly claimed he did it via the stupidity of the American voter. Another nice visual. You are all doing the same thing, claim after claim, time after time. Not on this one.
Last but not least, the icing on the cake, the final report provided by Adjuster Name Redacted and Adjuster Name Redacted.
Before I get started, I want to point out something that has absolutely bothered me to pieces. As this claim has worn on, I have finally put my finger on it. Adjuster Name Redacted drives a large pickup with Texas state farm tags. Meaning they do not pay taxes for the registration, and a few other perks. Perks, like anything else, come with restrictions and limitations, much like an insurance policy. Every time I have met with Adjuster Name Redacted, he has been driving that truck. May seem like nothing, but to me, it is exactly the way the whole claim has been handled. By every single person involved. The insured is completely helpless. There is an army of employed people who rely on the payment of insurance companies to feed their families and pay their bills. Not just insureds, but all those employees. The ones who work directly like a staff adjuster, or Adjuster Name Redacted. Then you have subcontractors, like Engineer Firm Redacted. Engineer Firm Redacted is paid to perform, as evidenced by his report, his only loyalty lies within his employer. Not his license, not right and wrong, but what he is expected to do. Then I see Adjuster Name Redacted drive up in a vehicle that has been given special privileges that stipulate very clearly how they are to be used. Here is what I found on the subject:
Farm Vehicle Registration (TRC 502.433)
(a) The registration fee for a commercial motor vehicle as a farm vehicle is 50% of the applicable fee, if the vehicle’s owner will use the vehicle for commercial purposes only to transport:
(1) The person’s own poultry, dairy, livestock, livestock products, timber in its natural state, or farm products to market or another place of sale or processing;
(2) Laborers from their place of residence to the owner’s farm or ranch; or
(3) Without charge, materials, tools, equipment, or supplies from the place of purchase or storage to the owner’s farm or ranch exclusively for the owner’s use or for use on the farm or ranch;
Farm registration cannot be used for other types of gainful employment other than farming and ranching.
I do not think adjusting claims qualifies, and by his own admission, he has an office around the corner. Now this angers me for several reasons. One is, he enjoys a privilege I do not, yet he is classified in the same category as an adjuster. The other is the simple fact that the total disregard of rules and regulations are what have brought us to this response, and the unfortunate event that must be less than pleasant. This was not my choice. Our firm has given Insurance Company Name Redacted ample time and opportunity, along with a set of the most comprehensive reports available for that building. That is combining all of yours. And it was prepared and handed to you within days, yet all of this time, all of these rules just wantonly trampled on. Just like FVR TRC 502.433.
The next issue would be Adjuster Name Redacted’s own building. He stated very clearly that he had a building within a few blocks, and that he had sustained damage. I would like to know, if that is true, did he accept the same thing he gave to this church? I think that is very valid question. It establishes quite clearly whether he has a few different standards of claims management or not, and whether what was done, was done on purpose, with full knowledge and intent. That’s for someone other than me to deal with.
On to the report:
Insurance Company Name Redacted
I have addressed the many deficiencies of the initial valuation on numerous occasions. They are well documented and verified by the minimal additional amount released versus what is actually owed, versus what was initially paid. Approximately 170%. I expect you to issue an additional check for the administrative penalty. You have previously acknowledged that these items were damaged, yet demanded the funds be held until reports were received. Well, those reports have arrived, and there is not a single thing in those reports that you did not already possess prior to your statement, and subsequent rewriting of the policy and the statute in one fell statement. Their reports did not provide one single bit of data to affect those items. Those entire building that were not even looked at. The front glass as you walk in either of the only two entrances in the front of the building. There is clear evidence of what you did and did not know, and when that knowledge was obtained.
Adjuster Name Redacted, at your direction, I am sure, has submitted another estimate, describing what you all have decided to pay. While it is substantially more than you started with, it does not even come close to actual sustained, covered loss.
The idea that you can go into a roofing system, and pull out a minimal amount, put it back, and guarantee that it will not leak for the duration of the life span of the roof. Impossible. Almost as ridiculous as saying the gutter is a concealed gutter, without acknowledging that it was attached to the roof drain system that like the roof, was never designed to come off or go on in piece meal fashion. The insured did not pay their premium in piece meal fashion.
How did hail damage all the metal roofs and all the outside structures, but shucks, not a SINGLE hit on the roof? Same as the Fascia and subsequent roof drain system.
The whole set of aluminum windows at the North Elevation, same as the church, is mangled, just like the church, and was not even addressed.
Very clear that again, you just did what you wanted. None of the items we have addressed have been addressed by you. Yet.
The Sheds were very close to mine. Amazing that when the damaged item does not cost so much, the scope and numbers are much closer. Not near as amazing is how selective that hail was.
Like the admin building, you have delved into a whole mess of damages, then only offered to pay for things you want. The links below go to OSHA, and some of their mandates for fall protection and general safety. The Texas Department of Insurance has also released their stand point on whether it owed or not, but I am sure you can find that on your own.
The point is, again, these are rules, not suggestions. Something you all are having a very hard time understanding. You are obligated to include these costs, yet you have chosen not to. That’s a choice and suggests if gives you the ability to change things that it does not.
Where did the 22-year-old number come from for depreciation? The Church has not owned that building for that long, not that I am aware of, and they did a massive overhaul of the whole exterior. I do not believe there was much that was not redone, including those front windows. They do not look 22 years old to me.
The patio covers that are described are not what is currently on the insured premises. These are engineered floating Safety covers. You were given a correct method of indemnification, yet you chose an item that by name alone, suggests it is not the same structure. Just happens to be ½ the cost of what is there.
In a majority of the area where cap flashing is present, there is a product called a gravel stop that is attached to the whole assembly. This is not addressed.
Damaged flashing at bottom of chase on north wall, not a peep. This is where the stucco is being replaced and I physically pointed it out.
You did not address balusters, rails, and the paint on the building. The list just goes on and on. As for me, I have come to the end of my journey in this saga. I have left a very detailed and well documented trail of what you have and have not done. Even this valuation, as sad as it is, is still 170% more than you already tried to get away with.
What would the insured have done had they not had someone to turn to who actually had their best interest mind? The same thing more than 99% of insureds who file claims do, accept whatever their insurance company tells them. Are they happy? No. They just don’t that they have a choice. Especially when they are being spoon fed the ridiculous notion that it is a good idea for you to send the guy who owes to tell you how much. As you can see, it is pretty simple to underpay by at least a minimum of 170%. Even with that payment and your “Final Offer”, you are still 150% off the correct number. Does anyone really believe you anymore? I don’t think so….but maybe.
Soon, very soon, some people I know are going to come asking you some questions about this. I hope you do better than you have here.
As I am an insurance lawyer, I pay attention to specific insurance companies and the way they pay and settle valid insurance claims.
Over the last two years I have noticed a significant difference in the way that State Farm handles the settlement of its claims with its policy holders. The end result is that State Farm is recklessly concerned with denying, defending, and delaying paying its claims instead of taking care of its customers. I find this troubling as State Farm spends billions of dollars in advertising that they pay their policy holder’s fairly when the policy holders have to make a claim when this couldn’t be further from the truth.
Specifically, I remember seeing a State Farm television commercial portrayal of a no name insurance company dangling a dollar with a fishing lure while their poor policy holder was jumping and trying to catch it. The overall innuendo was that State Farm pays its valid claims when other bad apple insurance companies don’t. Kind of funny.
In my personal experience, I find State Farm to be the worst insurance company out there in paying its claims. If they get the chance expect them to deny or underpay a valid insurance claim.
For example, I have seen instances where State Farm’s own expert says that certain items of a roof should be paid for (ie: a safety anchor.) When a State Farm insurance adjuster is questioned about why he didn’t pay for the safety anchor, he explains that he has never heard of that line item being paid for and in over 1,000 instances State Farm has never paid for it.
The sad thing is that policy holder had been with State Farm for well over twenty years.
Another example is a case where State Farm received a judgment against it for a modest sum for blatantly breaching its contract. Instead of paying this judgment, State Farm has decided to fight out of “principle.”
If you are or know someone who is insured with State Farm, I highly suggest changing insurance companies. Otherwise, if you have a valid insurance claim expect to have a fight on your hands.
Eric Dick, Attorney at Law
Call or Text me at 832-207-2007
We will advise and assist you in the preparation of building damage assessment reports, estimates, inventories, and other factual proofs of loss. We will handle all the necessary details for compiling and filing claims, as required by the terms of your insurance policy. We will also meet and confer with the insurance company representatives and handle all negotiations essential to proper, satisfactory, and equitable adjustment of your claim.
We currently service all of Texas, Oklahoma, Nebraska, and everything in between. We are Licensed Public Insurance Adjusters, #1603054.
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