Actually it makes perfect sense to me. Deny all claims, and if the customer asks questions, approve it. Look at the State Farm customers on my street. They denied three people. Two out of the three just took them at their word, accepted the denial, and let it drop. Only one (me) took it any farther. A small sample, to be sure, but it makes sense that a certain percentage of people will accept the denial and not pursue it any further. If they don’t pursue it, bonus for the insurance company. If they do pursue it, they’re out a little bit extra for the additional adjuster fees, but that’s pretty minor in relation to what they save overall.
And the Masonic lodge/George W. thing is a poor analogy, those are extraordinary claims. There is nothing extraordinary about a company doing everything in their power to take in as much money as possible and pay out as little as possible, and getting as close to the ethical and legal line as they possibly can to do so.
Perhaps no, but there is evidence, provided by the Katrina whistleblowers. Evidence that is backed up by their perfect record on my street.
Many states require liability insurance for driving a car. I assume there are similar laws for other professions, but I really don’t know. So there is at least one instance.
I don’t think s/he was bashing high profits. But the high cost of a huge ass building downtown where land goes for quite a premium is some token of evidence that the companies aren’t barely squeezing by, as the person he was responding to claimed.
I think it’s perfectly fair to blast companies that are making money hand over fist by denying services the customer was promised or at the very least making it as difficult as possible to get the service you paid for.
In addition to that, in many cases you really have no idea what will happen to your insurance rates if you even call them up. Someone else hit your parked car? Your rates might go up. Depends on if we like you. That’s a shitty service that everyone has the right to hate.
This raises my hackles a bit…but then I remember how Ford dealt with the exploding Pinto and I have to allow you to believe what you want on that score.
You’re right with your first premise and wrong with the second. Major insurance companies have been convicted of similar conspiracies yet they remain in business. A cursory look at the history of insurance industry litigation shows that these companies are frequently on the wrong side of the law–often as a result of systematic intention. That doesn’t mean it’s happening today. Indeed, this history is part of why the current regulatory bureaucracy exists. But to dismiss such conspiracies as being on the order of Masonic rituals is naive.
Again, storms can do weird things. I’m sure you all have seen tornado footage with one house being little pieces of matchsticks, and the house right next door having all of its windows intact, and hardly a scratch.
This also has to deal with building materials, the age of the roof, how the was the house is situated on the lot, etc, etc.
I do have to agree with **Inigo Montoya **when he says
"As an insurance adjuster I offer my word as my cite: There is no conspiracy, expressed or implied, to systematically deny payment of valid claims. That’s just stupid and belies a level of ignorance that disgraces The Dope. "
As a contractor on the other side of the fence, you wouldn’t necessarily expect me to agree, but I do.
Oh, and** Don’t call me Shirley**, this statement is not necessarily true either.
“The adjuster was either blind, pathetically incompetent, or a fuckin liar.”
Just because your readjustment went in your favor, DOESN’T mean your contractor is the best thing since sliced bread, DOESN’T mean the first adjuster was the anti-Christ in a plot with the military industrial complex, and DOESN’T mean that you actually had hail damage that met the criteria.
From a professional point of view, it’d be interesting seeing the evidence.
Oh, and a handshake from across the fence, Inigo Montoya.
ETA- It takes all of about 2 minutes to determine hail damage that’s good enough for a claim. Really. Anything after that is wishful fishing on the contractor’s part.
What the…had to let that one slip didn’t you! Now we’re going to have to pay all those homeowners in Iraq for all those broken windows! No more gravy train for you! Bad dog!
OK, dahfisheroo, I’ll play along. My roof had major hail damage. This was confirmed by my contractor, and by the second adjuster who came out and approved not just a new roof, but also new downspouts, vents, and a new AC comb. Not two weeks before, the first adjuster told me that she had “looked over every square inch of the roof and not found a single incidence of hail damage.”
Please explain a scenario in which the first adjuster is not either lying or completely incompetent.
so let me get this straight.
Let’s say you buy a brand new house. After you move in a heavy wind comes up, a window blows out of the house due to (pick one) piss poor design, bad engineering, a shitty installation, or a combination of the above, and this is your (the home owner’s) fault?
If this happened, wouldn’t you sue the architect, the engineering firm, the manufactures of the various pieces of the window assemblies, and the general contractor and possibly various sub contractors?
How is John Hancock any different than you would be in the same situation?
Upthread, I made the point that I had a roof last week, that was IN BETWEEN two roofs that had been replaced because of hail damage, and that this particular house had two walls of siding replaced, the A/C combed, furnace cap replaced, and gutters as well. No roof. There wasn’t enough damage on the roof. Did I try to get the roof replaced? Sure, you bet, part of my job. Was it a bad adjustment, was the adjuster screwing the homeowner over? I don’t believe so. Was the homeowner pissed? You bet. Was it an iffy roof? 80-20 was my guess, and that’s what I told him.
I also mentioned upthread that hail claims are popular because what is a hail dent on a shingle is debatable.
Again, it depends on the condition of the roof, the color, (some colors show dents much better than others,) the actual shingle material, the way the house is situated on the lot. It also depends on if this is in the middle of a swath of hail damage, if the insurance companies are going in front of the Legislature for increasing rates, or if the readjuster thought your roof was marginal damage, yet didn’t want to spend the time and money to get the engineers involved.
Your argument that the adjuster is lying or incompetent is this-
1)My neighbors got their roofs replaced.
2)My contractor said it was damaged.
Neither of those things mean your roof was damaged enough to warrant replacement.
Your 3rd argument is
It was readjusted to have a new roof.
That still doesn’t mean the first adjuster was lying or incompetent.
Perhaps the readjuster was lying or incompetent? Just because the first one *disagreed *with you, and the second one agreed with you, doesn’t make the second one more competent or truthful. Really.
Not sure why I am arguing about this, but your self righteous indignation about something you have no professional experience about is grating. You probably didn’t even know you had damage until your neighbor said "Hey, I got a new roof for free, you should try to get one, too! Or, “Hey, I am doing free inspections in your neighborhood, let me go check…Yep, you have damage.”
Citing your contractor’s opinion doesn’t mean shit He has a vested interest in you getting a new roof. Taking an average size house, with your approximate damage should run about $10,000 say. Out of that $10,000, the contractors gross profit should be around $5,000, give or take. I wouldn’t say he has an impartial opinion on the matter.
If the readjuster said, “Hey, the first adjuster is an asshole and a liar, we’re firing him for incompetence.” You might have a point. He didn’t. You don’t.
I’m glad you got a new roof. I hope everything went well for you.
This is a good example of why there would be some disagreement. Imagine an older roof with normal weathering and the damage is even harder to find. And honestly…does it look like it needs to be replaced?
Ah, now I see the problem. You can’t read for comprehension. No wonder we’re going in circles.
Actually, my argument was:
My neighbors got their roofs replaced.
Except for the neighbors that had State Farm.
My contractor said it was damaged. By hail.
The readjuster said it was damaged. By hail.
You also seem to be missing the part where the first adjuster said unequivocally that there was absolutely no hail damage. Not as single dent. She didn’t say that it was 80-20, as you did in your example. She didn’t say that there was some damage but not enough to qualify for replacement. She said there was none. And then the second adjuster said that there was some. It’s when she said that there was NO damage that she became a liar. Or, if she truly believed it, incompetent.
That’s my point. Just because they agree with you, doesn’t make them correct. It doesn’t make them incorrect, but it by no means makes them correct. Why is the only motivation allowed in this case a vast conspiracy or incompetence? Not greed, or trying to please a customer?
I can see even though the two people in this thread who do this for a living every single day have made several valid points, that doesn’t seem to matter to you, because you’re still right, and she was lying and/or incompetent.
Look at my pictures. Can you see that there is room for disagreement on damage?
Absolutely I can see why there is room for disagreement. I notice that in all of your examples there is SOME damage but there is some disagreement as to whether it rises to the level of replacement. That I totally get. But that’s not the case here. This is not a disagreement between two people, one of whom thinks that there is some damage but not enough to justify a claim, and another person who thinks there is. This is a disagreement between somebody who says there is NO damage, absolutely none, and another person who says there is some. Do you see the difference?
Also, are you honestly saying that you don’t think it’s just a little bit suspicious that out of about 20 houses on a street, 17 had enough hail damage that they were approved on the first adjustment, and 3 were denied, and all 3 of the houses that got denied were “covered” by State Farm? You don’t think that’s odd? In the slightest?
Oh, right, insurance adjusters are “tasked with upholding a written legal contract.” Excuse me while I roll my eyes. :rolleyes: If not individual adjusters then certainly insurance companies as a whole have an obvious incentive to deny or delay claims or to pay them at the the lowest rate possible: Because that is literally less money out the door. In fact, this is so obvious an inherent incentive that many states have statutes requiring insurance companies to pay triple damages for bad faith, and most states have official insurance commissioners whose entire job is to ride herd on the industry. And what the hell is wrong with “assisting someone else in getting paid – for a price”? What, lawyers are supposed to work for free? Sure, you can come up with egregious examples of attorneys over-charging, but you can also come up with egregious examples of bad faith in insurance claims handling. So don’t bother flinging the mud over on the attorneys’ side of the fence, m’kay? There’s plenty of mud to go around.
Anyway, here’s a slightly different perspective, and one that certainly will garner less sympathy: As a former trial attorney who worked in insurance defense for a while, I can tell you that in the Northwest at least, the worst company to work for is State Farm. Not only do they have a reputation for stonewalling claims, they nickel-and-dime their outside counsel, demanding approval of every litigation-related decision before it is made; placing arbitrary limits (like how long you can depose a witness for – and to hell with how important he is or what she might say, the depo can only last so long); and slow-paying their bills. I have a strong “the customer is always right” ethos so I’m pretty damn patient dealing with client questions and demands, but even I reached to point where I wanted to tell State Farm bean-counters, “If you want to do my job, fucking go to law school.” It’s extremely doubtful I’ll ever be back in private practice, much less in insurance defense, but I would NEVER work for State Farm, and I know many other attorneys who simply refuse to work for them. The book of business isn’t worth the headache – and they bring a BIG book of business, because they stonewall claims.
I think part of the problem is that when consumers purchase homeowners insurance, they are usually distracted and strapped for cash and they tend to take the cheapest policy their broker offers them that will satisfy their mortgage company. It’s not until many years of premiums later that they learn they were paying for lousy service. So the free market doesn’t incentivize insurance companies in the same way that, say, a restaurant might be forced by the market to provide good service.
As far as conspiracies go, I think that’s a bit of a straw man argument. There’s no need for the CEO of an insurance company to explicitly tell the adjusters to deny valid claims. You just review the division head’s performance and say something like this:
“I’m not telling you to deny valid claims, but your numbers indicate that last year your division was quite generous and I’m concerned that you’re giving our policy holders a little too much benefit of the doubt. Remember that they do have the right to an internal appeals process blah blah blah”
This will be passed along to the adjusters, who will get the message.
