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

Mar 132015
 

What the Hail is Going on in Texas – Part 4 – Insurers have introduced 84(R) HB 3646 Absolution for Insurance Employees who break the Law… Public Adjuster’s Blog

I am getting the info out there. Rest assured, we will address the entire thing, but here is the actual proposed bill.

Link to 84(R) HB 3646

Other links on the previously proposed changes. I have addressed the issue in Part 1, however, now that we have a more specific agenda, we will delve deeper into a breakdown of the proposed changes. Not all of them are bad, but the majority, yes. Bad for consumers.

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

 

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......

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……

84R12055 AJA-D
By: Smithee H.B. No. 3646
A BILL TO BE ENTITLED
AN ACT
relating to insurance claims and certain prohibited acts and
practices in or in relation to the business of insurance; amending
provisions that are or may be subject to a criminal penalty.
       BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
       SECTION 1.  Section 541.002(2), Insurance Code, is amended
to read as follows:
             (2)  “Person” means an individual, corporation,
association, partnership, reciprocal or interinsurance exchange,
Lloyd’s plan, fraternal benefit society, or other legal entity
engaged in the business of insurance, including an agent, broker,
[adjuster,] or life and health insurance counselor. The term does
not include an individual employed by an insurer as an adjuster or a
third-party individual or entity engaged by an insurer to provide
adjusting, estimating, consulting, engineering, or other services
related to the insurer’s adjustment of a claim.
       SECTION 2.  Section 541.060, Insurance Code, is amended by
amending Subsection (a) and adding Subsection (c) to read as
follows:
       (a)  It is an unfair method of competition or an unfair or
deceptive act or practice in the business of insurance for a person
to engage in the following unfair settlement practices with respect
to a claim by an insured or beneficiary:
             (1)  misrepresenting to a claimant a material fact or
policy provision relating to coverage at issue;
             (2)  failing to attempt in good faith to effectuate a
prompt, fair, and equitable settlement of:
                   (A)  a claim with respect to which the insurer’s
liability has become reasonably clear; or
                   (B)  a claim under one portion of a policy with
respect to which the insurer’s liability has become reasonably
clear to influence the claimant to settle another claim under
another portion of the coverage unless payment under one portion of
the coverage constitutes evidence of liability under another
portion;
             (3)  failing to promptly provide to a policyholder a
reasonable explanation of the basis in the policy, in relation to
the facts or applicable law, for the insurer’s denial of a claim or
offer of a compromise settlement of a claim;
             (4)  failing within a reasonable time to:
                   (A)  affirm or deny coverage of a claim to a
policyholder; or
                   (B)  submit a reservation of rights to a
policyholder;
             (5)  refusing, failing, or unreasonably delaying a
settlement offer under applicable first-party coverage on the basis
that other coverage may be available or that third parties are
responsible for the damages suffered, except as may be specifically
provided in the policy;
             (6)  undertaking to enforce a full and final release of
a claim from a policyholder when only a partial payment has been
made, unless the payment is a compromise settlement of a doubtful or
disputed claim;
             (7)  refusing to pay a claim without conducting a
reasonable investigation with respect to the claim;
             (8)  with respect to a Texas personal automobile
insurance policy, delaying or refusing settlement of a claim solely
because there is other insurance of a different kind available to
satisfy all or part of the loss forming the basis of that claim; or
             (9)  requiring a claimant as a condition of settling a
claim to produce the claimant’s federal income tax returns for
examination or investigation by the person unless:
                   (A)  a court orders the claimant to produce those
tax returns;
                   (B)  the claim involves a fire loss; or
                   (C)  the claim involves lost profits or income.
       (c)  An insurer is solely responsible for any violation of
Subsection (a) by:
             (1)  an individual employed by the insurer as an
adjuster; or
             (2)  a third-party individual or entity engaged by the
insurer to provide adjusting, estimating, consulting, engineering,
or other services related to the insurer’s adjustment of a claim.
       SECTION 3.  Section 541.061, Insurance Code, is amended to
read as follows:
       Sec. 541.061.  MISREPRESENTATION OF INSURANCE POLICY. (a)
It is an unfair method of competition or an unfair or deceptive act
or practice in the business of insurance for a person to
misrepresent an insurance policy by:
             (1)  making an untrue statement of material fact;
             (2)  failing to state a material fact necessary to make
other statements made not misleading, considering the
circumstances under which the statements were made;
             (3)  making a statement in a manner that would mislead a
reasonably prudent person to a false conclusion of a material fact;
             (4)  making a material misstatement of law; or
             (5)  failing to disclose a matter required by law to be
disclosed, including failing to make a disclosure in accordance
with another provision of this code.
       (b)  An insurer is solely responsible for any violation of
Subsection (a) by:
             (1)  an individual employed by the insurer as an
adjuster; or
             (2)  a third-party individual or entity engaged by the
insurer to provide adjusting, estimating, consulting, engineering,
or other services related to the insurer’s adjustment of a claim.
       SECTION 4.  Section 541.151, Insurance Code, is amended to
read as follows:
       Sec. 541.151.  PRIVATE ACTION FOR ACTUAL DAMAGES AUTHORIZED.
(a) A person who sustains actual damages may bring an action against
another person for those damages caused by the other person
engaging in an act or practice:
             (1)  defined by Subchapter B to be an unfair method of
competition or an unfair or deceptive act or practice in the
business of insurance; or
             (2)  specifically enumerated in Section 17.46(b),
Business & Commerce Code, as an unlawful deceptive trade practice
if the person bringing the action shows that the person relied on
the act or practice to the person’s detriment.
       (b)  For purposes of this subchapter, “actual damages” means
an injury independent of the harm resulting from the insurer’s
denial of policy benefits. The policy benefits wrongfully
withheld, as well as any attorney’s fees or costs incurred to
recover those policy benefits, do not constitute “actual damages”
for purposes of this section.
       (c)  An insurer is solely responsible for any violation of
Subsection (a) by:
             (1)  an individual employed by the insurer as an
adjuster; or
             (2)  a third-party individual or entity engaged by the
insurer to provide adjusting, estimating, consulting, engineering,
or other services related to the insurer’s adjustment of a claim.
       SECTION 5.  The heading to Section 541.152, Insurance Code,
is amended to read as follows:
       Sec. 541.152.  ACTUAL DAMAGES, ATTORNEY’S FEES, AND OTHER
RELIEF.
       SECTION 6.  Section 541.154, Insurance Code, is amended to
read as follows:
       Sec. 541.154.  PRIOR NOTICE OF ACTION. (a) An insured [A
person] seeking damages in an action against an insurer [another
person under this subchapter] must provide written notice to the
insurer [other person] not later than the 61st day before the date
the action is filed.
       (b)  If the amount sought by the insured in the action
involves a claim for damage items previously submitted to the
insurer, the [The] notice must contain [advise the other person
of]:
             (1)  a sworn statement signed by the insured stating
the specific damage items and the amount alleged to be owed by the
insurer [the specific complaint]; [and]
             (2)  the amount of the [actual damages and expenses,
including] attorney’s fees the insured reasonably incurred in
asserting the claim against the insurer; and
             (3)  a stated amount that includes the amounts
described by Subdivisions (1) and (2) that the insured will accept
in full and final satisfaction of the claim [other person].
       (b-1)  If the amount sought by the insured in the action
involves a claim for damage items not previously submitted to the
insurer, the notice must contain:
             (1)  a sworn statement signed by the insured stating
the specific damage items, the amount alleged to be owed by the
insured, and the reason the damage items were not previously
submitted to the insurer;
             (2)  copies of reports, estimates, photographs, and
other items reasonably supporting the insured’s additional damage
items;
             (3)  a statement that the insured will cooperate in
allowing the insurer to inspect the insured property for purposes
of investigating the additional damage items;
             (4)  the amount of the attorney’s fees the insured
reasonably incurred in asserting the claim against the insurer; and
             (5)  a stated amount that includes the amounts
described by Subdivisions (1) and (4) that the insured will accept
in full and final satisfaction of the claim.
       (b-2)  Notice required by this section must be sent to the
insurer by certified mail, return receipt requested.
       (c)  Notice under this section [The notice] is not required
if giving notice is impracticable because the action:
             (1)  must be filed to prevent the statute of
limitations from expiring; or
             (2)  is asserted as a counterclaim.
       SECTION 7.  Section 541.155, Insurance Code, is amended to
read as follows:
       Sec. 541.155.  ABATEMENT; DISMISSAL. (a) A person against
whom an action under this subchapter is pending who does not receive
[the] notice as required by Section 541.154(b) [541.154] may file a
plea in abatement not later than the 30th day after the date the
person files an original answer in the court in which the action is
pending.
       (b)  The court shall abate the action if, after a hearing,
the court finds that the person is entitled to an abatement because
the claimant did not provide [the] notice as required by Section
541.154(b) [541.154].
       (c)  An action is automatically abated without a court order
beginning on the 11th day after the date a plea in abatement is
filed if the plea:
             (1)  is verified and alleges that the person against
whom the action is pending did not receive [the] notice as required
by Section 541.154(b) [541.154]; and
             (2)  is not controverted by an affidavit filed by the
claimant before the 11th day after the date the plea in abatement is
filed.
       (d)  An abatement under this section continues until the 60th
day after the date notice is provided in compliance with Section
541.154(b) [541.154].
       (d-1)  A person against whom an action under this subchapter
is pending who does not receive notice as required by Section
541.154(b-1) may file a motion to dismiss not later than the 30th
day after the date the person files an original answer in the court
in which the action is pending.
       (d-2)  The court shall grant the motion under Subsection
(d-1) if, after a hearing, the court finds that the person is
entitled to dismissal because the claimant did not provide notice
as required by Section 541.154(b-1).
       (e)  Subsections (d-1) and (d-2) do [This section does] not
apply if Section 541.154(c) applies. If Section 541.154(c)
applies, the action may not be dismissed but shall be abated in
accordance with Subsections (b), (c), and (d).
       SECTION 8.  Section 542.053, Insurance Code, is amended by
adding Subsection (e) to read as follows:
       (e)  This subchapter is not intended to create any right of
action against an individual employed by an insurer as an adjuster
or a third-party individual or entity engaged by an insurer to
provide adjusting, estimating, consulting, engineering, or other
services related to the insurer’s adjustment of a claim. An insurer
listed in Section 542.052 is solely responsible under this
subchapter for an action of an individual employed by the insurer as
an adjuster or a third-party individual or entity engaged by the
insurer to provide adjusting, estimating, consulting, engineering,
or other services related to the insurer’s adjustment of a claim.
       SECTION 9.  Subchapter B, Chapter 542, Insurance Code, is
amended by adding Section 542.0595 to read as follows:
       Sec. 542.0595.  PRIOR NOTICE OF ACTION; ABATEMENT OR
DISMISSAL. (a) An insured may not bring suit under Section 542.060
in connection with a claim for property damage or loss unless the
insured has provided written notice to the insurer with respect to
the claim in accordance with Section 541.154.
       (b)  A suit under Section 542.060 is subject to abatement or
dismissal to the same extent and in the same manner provided by
Section 541.155 for an action under Subchapter D, Chapter 541.
       SECTION 10.  Section 542.060, Insurance Code, is amended to
read as follows:
       Sec. 542.060.  LIABILITY FOR VIOLATION OF SUBCHAPTER. (a)
If an insurer that is liable for a claim under an insurance policy
knowingly fails to act [is not] in compliance with this subchapter,
the insurer is liable to pay the holder of the policy or the
beneficiary making the claim under the policy, in addition to the
amount of the claim, interest on the unpaid amount of the claim at
the rate of 18 percent a year as damages, together with reasonable
attorney’s fees.
       (a-1)  For purposes of Subsection (a), an insurer knowingly
fails to act in compliance with this subchapter only if the insurer
is actually aware of the insurer’s failure to pay a claim for which
the insurer is liable. There is no liability under this section for
a claim with respect to which there is a bona fide dispute as to
whether the insurer is liable.
       (b)  If a suit is filed, interest and [the] attorney’s fees
payable under this section shall be taxed as part of the costs in
the case.
       (c)  The liability for interest and attorney’s fees provided
by this section are the exclusive remedy for a violation of this
subchapter. This section is not intended to affect a right or
remedy provided by Chapter 541 or any other law outside this
subchapter.
       SECTION 11.  Subchapter B, Chapter 542, Insurance Code, is
amended by adding Section 542.0601 to read as follows:
       Sec. 542.0601.  LIABILITY WITH RESPECT TO CERTAIN CLAIMS.
An insurer is not liable under Section 542.060 with respect to:
             (1)  a claim received by the insurer if it is determined
through arbitration, litigation, or another dispute resolution
process that the claim:
                   (A)  is not covered under the insurance policy;
                   (B)  was properly rejected;
                   (C)  is invalid; or
                   (D)  otherwise should not be paid by the insurer;
or
             (2)  a claim with respect to which an appraisal
process:
                   (A)  is invoked under the terms of the policy:
                         (i)  by the insurer or insured before the
commencement of litigation;
                         (ii)  by the defendant within 60 days after
receiving notice of the commencement of litigation; or
                         (iii)  by the plaintiff after the
commencement of litigation; and
                   (B)  results in a valid, signed award the amount
of which is paid by the insurer not later than the 15th day after the
date the insurer receives the award, consistent with the coverage,
conditions, and limits provided by the policy, minus any prior
payments and any applicable deductible amount.
       SECTION 12.  Subtitle A, Title 10, Insurance Code, is
amended by adding Chapter 1808 to read as follows:
CHAPTER 1808. CLAIMS FOR PROPERTY DAMAGE
       Sec. 1808.001.  DEFINITION. In this chapter, “claim for
property damage” means a request for payment under an insurance
policy for damage to or loss of real property or tangible personal
property alleged to be covered by the policy.
       Sec. 1808.002.  APPLICABILITY OF CHAPTER. This chapter
applies to any claim under or related to an insurance policy that
provides insurance coverage against damage to or loss of real
property or tangible personal property, including a policy issued
by an insurance company, reciprocal or interinsurance exchange,
mutual insurance company, capital stock insurance company, county
mutual insurance company, Lloyd’s plan, or other legal entity
authorized to write property insurance in this state.
       Sec. 1808.003.  CLAIM FILING PERIOD. (a) A claimant must
give an insurer prompt written notice of a claim for property damage
after property covered under the policy is damaged or lost, but in
no event later than the second anniversary of the date on which the
damage to or loss of property that is the basis of the claim occurs.
       (b)  Failure to provide notice of a claim for property damage
by the second anniversary of the date on which the damage to or loss
of property that is the basis of the claim occurs is an absolute bar
to recovery on the claim.
       (c)  Nothing in this section precludes an insurer from
raising any defense available under the terms of its policy
relating to prompt notice or that is otherwise available under the
law.
       SECTION 13.  Section 4102.051(a), Insurance Code, is amended
to read as follows:
       (a)  A person may not act as a public insurance adjuster in
this state or hold himself or herself out to be a public insurance
adjuster in this state unless the person holds a license or
certificate issued by the commissioner under Section 4102.053 or
[,] 4102.054[, or 4102.069].
       SECTION 14.  Section 4102.066(a), Insurance Code, is amended
to read as follows:
       (a)  The commissioner shall collect in advance the following
nonrefundable fees:
             (1)  for a public insurance adjuster license, an
application fee in an amount to be determined by rule by the
commissioner;
             (2)  for a nonresident public insurance adjuster
license, an application fee in an amount to be determined by rule by
the commissioner; and
             (3)  for each public insurance adjuster examination, a
fee in an amount to be determined by rule by the commissioner [; and
             [(4)     for a public insurance adjuster trainee
certificate under Section 4102.069, a registration fee in an amount
to be determined by rule by the commissioner].
       SECTION 15.  Section 4102.103, Insurance Code, is amended by
adding Subsection (d) to read as follows:
       (d)  A license holder may not enter into a contract with an
insured and collect a commission as provided by Section 4102.104
without the intent to actually perform the services of a licensed
public insurance adjuster for the insured.
       SECTION 16.  Section 4102.104(d), Insurance Code, is amended
to read as follows:
       (d)  A public insurance adjuster may not accept any payment
that violates the provisions of this section [Subsection (c)].
       SECTION 17.  Section 4102.158, Insurance Code, is amended by
amending Subsection (a) and adding Subsections (d), (e), and (f) to
read as follows:
       (a)  A license holder may not:
             (1)  participate directly or indirectly in the
reconstruction, repair, or restoration of damaged property that is
the subject of a claim adjusted by the license holder; or
             (2)  engage in any other activities that may reasonably
be construed as presenting a conflict of interest, including
soliciting or accepting any remuneration from, [or] having a
financial interest in, or having any immediate family member own or
operate, any salvage firm, repair firm, construction firm, or other
firm that obtains business in connection with any claim the license
holder has a contract or agreement to adjust.
       (d)  A license holder may not enter into a contract with an
insured for the primary purpose of referring the insured to an
attorney and without the intent to actually perform for the insured
the services of a licensed public insurance adjuster .
       (e)  A license holder may not act on behalf of an attorney in
having an insured sign an attorney representation agreement.
       (f)  A license holder must become familiar with and at all
times act in conformance with the criminal barratry statute set
forth in Section 38.12, Penal Code.
       SECTION 18.  Section 4102.160, Insurance Code, is amended to
read as follows:
       Sec. 4102.160.  CERTAIN PAYMENTS PROHIBITED. A license
holder may not:
             (1)  advance money to any potential client or insured;
or
             (2)  pay, allow, or give, or offer to pay, allow, or
give, directly or indirectly, to a contractor, attorney, or any
other person who is not a licensed public insurance adjuster a fee,
commission, or other valuable consideration for the referral of an
insured to the public insurance adjuster for purposes of [based on]
the insured entering into a contract with that public insurance
adjuster or for any other purpose [; or
             [(3)     otherwise offer to pay a fee, commission, or
other valuable consideration exceeding $100 to a person not
licensed as a public insurance adjuster for referring an insured to
the license holder].
       SECTION 19.  Subchapter D, Chapter 4102, Insurance Code, is
amended by adding Section 4102.164 to read as follows:
       Sec. 4102.164.  ACCEPTANCE OF REFERRAL PAYMENTS PROHIBITED.  
(a)  A licensed public insurance adjuster may not accept a fee,
commission, or other valuable consideration of any nature,
regardless of form or amount, in exchange for the referral by a
licensed public insurance adjuster of an insured to any third-party
individual or firm, including but not limited to an attorney,
appraiser, umpire, construction company, contractor, or salvage
company.
       (b)  The commissioner shall adopt rules necessary to
implement and enforce this section.
       SECTION 20.  The heading to Section 27.02, Business &
Commerce Code, is amended to read as follows:
       Sec. 27.02.  CERTAIN OFFERS MADE AND INFORMATION PROVIDED IN
CONNECTION WITH INSURANCE CLAIMS [FOR EXCESSIVE CHARGES].
       SECTION 21.  Sections 27.02(a) and (b), Business & Commerce
Code, are amended to read as follows:
       (a)  A person who sells goods or services, including a
contractor, appraiser, estimator, or insurance restoration
contractor, commits an offense if, in connection with a claim for
property loss or damage under a property or casualty insurance
policy:
             (1)  the person advertises or promises to [provide the
good or service and to] pay, waive, absorb, rebate, subsidize,
credit, or otherwise cover for any reason [:
                   [(A)]  all or part of any applicable insurance
deductible or other uninsured amount owed by an insured under the
terms of the policy; [or
                   [(B)     a rebate in an amount equal to all or part of
any applicable insurance deductible;]
             (2)  [the good or service is paid for by the consumer
from proceeds of a property or casualty insurance policy; and
             [(3)]  the person knowingly provides or causes to be
provided to an insurer any estimate or other statement as to the
cost of repair for the good or service to be provided that has been
increased, inflated, or otherwise manipulated [charges an amount
for the good or service that exceeds the usual and customary charge
by the person for the good or service] by an amount equal to or
greater than all or part of the applicable insurance deductible or
other uninsured amount owed by an insured under the policy; or
             (3)  the person knowingly provides or causes to be
provided to an insurer any false or misleading material information
within any estimate, bid, proposal, or other statement as to the
scope of damage or cost of repair for the good or service to be
provided [paid by the person to an insurer on behalf of an insured
or remitted to an insured by the person as a rebate].
       (b)  A person who is insured under a property or casualty
insurance policy commits an offense if the person:
             (1)  knowingly submits a claim under the policy based
on conduct [charges that are] in violation of Subsection (a) [of
this section]; or
             (2)  knowingly allows a claim in violation of
Subsection (a) [of this section] to be submitted, unless the person
promptly notifies the insurer of the conduct in violation of
Subsection (a) [excessive charges].
       SECTION 22.  Section 38.12(d), Penal Code, is amended to
read as follows:
       (d)  A person commits an offense if the person:
             (1)  is an attorney, chiropractor, physician, surgeon,
public insurance adjuster , as defined by Section 4102.001,
Insurance Code, or private investigator licensed to practice in
this state or any person licensed, certified, or registered by a
health care regulatory agency of this state; and
             (2)  with the intent to obtain professional employment
for the person or for another, provides or knowingly permits to be
provided to an individual who has not sought the person’s
employment, legal representation, advice, or care a written
communication or a solicitation, including a solicitation in person
or by telephone, that:
                   (A)  concerns an action for personal injury or
wrongful death or otherwise relates to an accident or disaster
involving the person to whom the communication or solicitation is
provided or a relative of that person and that was provided before
the 31st day after the date on which the accident or disaster
occurred;
                   (B)  concerns a specific matter and relates to
legal representation and the person knows or reasonably should know
that the person to whom the communication or solicitation is
directed is represented by a lawyer in the matter;
                   (C)  concerns a lawsuit of any kind, including an
action for divorce, in which the person to whom the communication or
solicitation is provided is a defendant or a relative of that
person, unless the lawsuit in which the person is named as a
defendant has been on file for more than 31 days before the date on
which the communication or solicitation was provided;
                   (D)  is provided or permitted to be provided by a
person who knows or reasonably should know that the injured person
or relative of the injured person has indicated a desire not to be
contacted by or receive communications or solicitations concerning
employment;
                   (E)  involves coercion, duress, fraud,
overreaching, harassment, intimidation, or undue influence; [or]
                   (F)  contains a false, fraudulent, misleading,
deceptive, or unfair statement or claim; or
                   (G)  concerns the proposed adjustment of a
property damage insurance claim and is made by a person other than
the licensed public insurance adjuster who would be directly
providing the proposed public insurance adjusting services to the
recipient of the communication.
       SECTION 23.  Section 4102.069, Insurance Code, is repealed.
       SECTION 24.  Chapter 541, Insurance Code, as amended by this
Act, applies only to conduct that occurs on or after the effective
date of this Act. Conduct that occurs before the effective date of
this Act is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
       SECTION 25.  Subchapter B, Chapter 542, Insurance Code, as
amended by this Act, applies only to a claim for which notice of
claim is provided to an insurer on or after the effective date of
this Act. A claim for which notice of claim is provided to an
insurer before the effective date of this Act is governed by the law
as it existed immediately before the effective date of this Act, and
that law is continued in effect for that purpose.
       SECTION 26.  Chapter 1808, Insurance Code, as added by this
Act, applies only to a claim under an insurance policy delivered,
issued for delivery, or renewed on or after January 1, 2016. A
claim under a policy delivered, issued for delivery, or renewed
before January 1, 2016, is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
       SECTION 27.  The repeal by this Act of Section 4102.069,
Insurance Code, does not affect the authority of a person to act
under a temporary certificate issued by the Texas Department of
Insurance under that section before the effective date of this Act.
       SECTION 28.  Sections 4102.103(d) and 4102.158(d),
Insurance Code, as added by this Act, apply only to a contract
entered into on or after the effective date of this Act.
       SECTION 29.  (a) Except as provided by this section, Section
4102.104, Insurance Code, as amended by this Act, applies only to
payment for a service performed on or after the effective date of
this Act.
       (b)  Payment for a service performed before the effective
date of this Act or performed after the effective date of this Act
under a contract entered into before the effective date of this Act
is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
       SECTION 30.  Section 4102.160, Insurance Code, as amended by
this Act, and Section 4102.164, Insurance Code, as added by this
Act, apply only to a referral made on or after the effective date of
this Act. A referral made before the effective date of this Act is
governed by the law as it existed immediately before the effective
date of this Act, and that law is continued in effect for that
purpose.
       SECTION 31.  The changes in law made by this Act apply only
to an offense committed on or after the effective date of this Act.
An offense committed before the effective date of this Act is
governed by the law in effect when the offense was committed, and
the former law is continued in effect for that purpose. For
purposes of this section, an offense was committed before the
effective date of this Act if any element of the offense occurred
before that date.
       SECTION 32.  This Act takes effect September 1, 2015.

 

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

http://insurancebusters.net/what-the-hail-is-going-on-in-texas-part-4-insurers-have-introduced-84r-hb-3646-absolution-for-insurance-employees-who-break-the-law/