by gertes » Wed Oct 20, 2010 11:16 am
What are the step by step tasks a loss adjuster undertakes to come to an amount of money that the insurance company hiring his service must pay to the claimant?
Isn't it inevitable that two or more adjusters working on the same loss claim will come to different amounts of money that the insurance company has to pay the policyholder?
Yrger
Isn't it inevitable that two or more adjusters working on the same loss claim will come to different amounts of money that the insurance company has to pay the policyholder?
Yrger
Posted: Sun Oct 24, 2010 02:10 pm Post Subject:
I am really very happy to have found this website with this forum where they pay you to write.
This is the best thing that has ever happened to me in all my years of exposure to the internet.
Okay, we are agreed that a home insurance policy paying as much as 3,000,000 pesos for the house and 500,000 pesos for its contents will in fact pay those amounts, if the conditions after the destruction of the home guarantee these amounts of payment, i.e., to the maximum limits of 3,000,000 on the house and 500,000 on the contents.
Yes, you are correct, the Insurance Commission in my country is really to my observation very toothless, as in general the government as a whole and government people in general are also, sad to say that.
If you have family members and friends or even just acquaintances who have ever lived and worked in the Philippines, ask them for their experiences in the Philippines, see if they also have the same sad conclusion I have about the government or people running my country.
Now, let me just give a brief history of my two homes in Provident Village, Marikina City, Philippines, the worst hit area during the Ondoy typhoon of September 26, 2009.
First I have had already a home insured by the same insurance company with a policy against fire, typhoon, flood, explosion, the whole package, sold to me by my ever faithful agent representing the insurance company.
As I said I don't know nothing about insurance except that the insurance company will pay me to the limit of the amount for which a home is insured by them, if destruction or loss occurs to the home without any fault from my part.
Now this village where I have my two homes is routinely visited by a very fierce typhoon and flooding every some ten years, but every year there is some flooding, for the whole village is surrounded by a river encircling it almost 3/4 of the perimeter.
The developers built a dike to keep water from the river from coming into the village, and also there are pumps to get rain water out, yes, into the river; but that does not stop the flooding just the same every year during the rainy months which begin in May and can extend all the way to end of October.
When we built our first home, my wife and I added one meter elevation for the foundation platform (that is around 3 1/2 feet from the street level), which the house proper and everything else like the car port would be resting on.
That saved us from flood water getting inside our home.
But every year during the rainy and typhoon season my wife and I had to worry about how high the water would come in and head toward our home; so we would bring in everything that was outside the house up to the one meter elevated platform of the house, because every homeowner has a lot of things that will be spoiled by flood water if you leave them on the unelevated surface areas of your walled in property.
If you ever come to the Philippines you will notice that every homeowner, having a separate house as distinct from an apartment unit, takes the trouble and cost to raise a concrete gated wall as high as seven feet to encircle the whole expanse of his titled land, because otherwise he will lose things to all kinds of opportunity thieves and burglars if not professional ones.
My wife and I got so tired with every year going through the routine of moving things inside the house or relocating them onto the elevated platform where our house and the car port are resting on.
We started saving money and eventually hoarded enough to look for another place to buy in the same village that is on a higher level not reached by the yearly flooding.
In 2002 we found a good home in a spot of the village never reached by flooding, so we bought it from the owners who were emigrating to Canada -- every Filipino wants to move to countries abroad in the West -- sad.
This is a better house though the lot is smaller, our first self-owned house occupies a lot of 409 square meters, the one we bought now occupies a lot of 336 square meters.
Now the agent selling us home insurance sold us two policies, the old one that commanded less premiums and the new one that commanded more premiums.
This went on until I think some four years ago when he told me that one policy would cover two homes, and I would pay the same premiums for both homes. I accepted the new policy, telling him that if that was what he thought best for me and my family, affording me the best security, it’s perfectly all right with me.
In September 2009 the premiums for the one policy covering two homes came to 26,712.00 pesos, and each home insured to 3,000,000 on the house and 500,000 on the contents.
No, I never bargained with him about premiums and never about amounts payable by the insurance company he represents.
Some years back I was approached by another agent offering me a policy that is cheaper but with more benefits, like assistance during a calamity and after the calamity with help as regards electrical connections, etc.
I told my 'faithful agent' about the offer of another agent, he told me that those are all promises but when it is time to deliver I would be disappointed, whereas his company is always quick and complete when time to deliver comes; so I told him all right I will continue with you because for one thing I don't have to go to your office, you serve me every year by coming to my home in the evening hours to give me the paper work and to receive my payments.
Now, that 'faithful agent' knows all the time that we have moved and are living now in the new place and our furniture were transferred to the new place, but we still left things in the old place.
At one time he asked me to let him rent my old place, I said no, telling him that my daughter was planning to use it for a doctor's clinic when she would finish her training – that is true, but there was another reason and it is because tenants in the Philippines have a bad habit of defaulting on rentals, causing you endless troubles to get them off your property for accumulated non-payments of rentals.
Okay, last year on September 26, 2009, that exceptionally fierce typhoon Ondoy struck and flooded even our new home, up to two feet on the second floor; if you have never seen the devastation of a home visited by typhoon flooding up to the second floor of a home, then you cannot imagine how everything gets destroyed by water and mud.
So, my two homes were destroyed by typhoon and flooding, and there were insured to 3,000,000 pesos each on the house and 500,000 pesos each on the contents, but the insurance company just cared to pay me first only 610,333.80 pesos, then on my objections raising it to one million.
That is why I think that insurance company and their adjuster are into the utmost bad faith.
Gertes aka Yrger
Posted: Sun Oct 24, 2010 07:17 pm Post Subject:
If you cannot obtain any genuine assistance from the Insurance Commission, then it sounds like you will need to resort to legal action in court. Not knowing how the Philippine legal system works, I can't really offer any more advice than I have. Good luck.
If nothing else, you should have some sort of written explanation of how the insurance company has arrived at its loss estimate, and if it is not declaring your properties total losses, on what basis it has made that determination.
Posted: Mon Oct 25, 2010 02:53 pm Post Subject:
Well, in fact they had given me a report with computation of why and how they arrived at the payment of 610,333.80 pesos.
My insurance sales agent is really in his calling card an AVP for underwriting of an insurance company, but also on the side on his own endeavor a one man insurance agent/broker serving his own developed circle of insurance policy buyers, he in this private role representing various other insurance companies.
He was introduced to me by my neighbor, but I didn't know him from Adam and Eve before that reference from my neighbor. This neighbor later got another agent to serve him, no longer using his previous agent the one now still serving me for my now three homes and three cars, and this neighbor also told me about this other agent, the one who offers more benefits like assistance during a calamity and after the calamity (see immediately preceding post from me).
My question at this point -- before I go into the written report of the insurance company offering me only 610,333.80 -- is how could my agent have gotten a policy for me for two homes, one of which the old home is not as good as the new home, both on 3 millions each for the house and .5 million each for the contents, both on the combined (not broken down in the policy contract into what premiums for which home) total of 26,712.00 pesos?
I am really ignorant about the mechanism involved in regard to the drafting of a home insurance policy contract, but now reading the contract I can see that there is some questionable feature in the contract sold to me by my 'faithful agent,' namely: how can one home not as good as another home both get the same amounts of coverage, and without any break-down of how much each home cost in their respective premiums, instead only a combined total amount of premiums to be paid by the policy buyer?
Coming now to the written report explaining why the insurance adjuster serving the insurance company represented by my agent arrived at the amount of 610,333.80 pesos:
At the beginning of my claim history against the insurance company, my agent to my observation was not helpful, he told me to just trust in the goodness and fairness of both the insurance company and its adjusters.
After I think about three months he became positively more inclined to help me by giving me time and effort from his part, instead of just continuing to tell me to just trust in the goodness and fairness of the insurance company and the adjusters it employs.
This change of heart seemingly occurred when he did take the trouble to inspect my two homes, and realized the enormity of the destruction.
And when he saw the report of the company's adjusters (plural because it is not only one adjuster, but a whole another company doing nothing but serving insurance companies in adjusting the claims of policyholders) offering to pay me only 610,333.80, he was also disturbed at the meager payment amount -- in his own spontaneous observation.
So he brought to me an adjuster belonging to an adjusters company which his own insurance company employs regularly, that insurance company where he is an AVP for underwriting.
I brought that adjuster to my two devastated homes along with my agent accompanying.
The adjuster asked me questions, and he came to the immediate impression that the payable loss should be much bigger than just 610,333.80 pesos.
The three of us had around three meetings, I think at the end in a fourth meeting the adjuster gave me his report to counter the report of the adjusters employed by my insurance company; and they my agent and the 'good Samaritan' adjuster instructed me to send in my own name and signature a copy each of this report to the insurance company and its adjusters company.
This report contains a detailed explanation on computation as to the why and how the loss compensable should be 2,437,500.54 pesos, instead of the unrealistic (word used by the good Samaritan adjuster) amount of just 610,333.80 pesos.
After some three months I received by way of my insurance agent the information -- I told him to follow up on my counter report -- that the insurance company and their adjusters are willing to pay me one million pesos for all the compensable losses for both houses as regards both the house and the contents of each.
I told my agent to tell them that I cannot and will not accept that amount, and to ask them to produce their written counter report justifying their new adjusted amount of just one million pesos in reaction to my claim now of 2,437,500.54 pesos.
That is where matters now stand, I am waiting for their written report containing the computation for the why and how they now reached the amount still not acceptable to me of only one million pesos, whereas the good Samaritan adjuster (kept anonymous of course) calculated the compensable loss to the amount of 2,437,500.54 pesos.
Gertes aka Yrger
Posted: Wed Oct 27, 2010 11:28 am Post Subject:
When I filed my claim I was given a list of requirements to meet in order for the insurer's adjusters to process my claim.
They asked for my land title and other proofs of ownership of the houses, etc.
I said no, I was not going to deliver any copy of land title and house ownership proofs, because the fact that I had been renewing my policies for the two homes every year faithfully to the present is enough reason why they should not be asking me for such documents.
I told them that they were engaged in delaying tactics.
So they backed off, but I also assured them that I do have land title and documentary proofs that I own the two houses, just that I was not going to play their game of supplying proofs of ownership, because the fact that the insurance company convinced me to buy their policies is enough reason for anyone to insist that they the insurance company has the certainty that I am the owner of the two homes, namely: two lots and two houses.
If the adjusters wanted proofs they should go to the insurer which employed them.
Next, the adjusters required me to make a listing of all my possession in order to compute how much loss I had incurred from the typhoon and flooding.
I told that that was an irrational requirement, how could I ever make as complete a listing of all my possession in order not to miss anything at all, when my wife and I have been married for 35 years, maintained a home for the same 35 years, and managed a family with two kids, in all the 35 years we have acquired so many things that we could not remember as to be able to list every single item.
I told them since the water reached up to two feet in the second floor in one house and four feet in the other house, then as much as 5/6 of all our possessions specially the expensive pieces of furnitures, appliances, etc., had been destroyed by the dirty flood water and mud.
So what they could and should do logically was, since the contents of each home was insured by the insurer at 500,000 pesos (43.50 pesos equal US$1.00 as of the present) -- and they the insurer company were the ones who computed how much the house and the contents of each house should be insured for (3 million pesos and .5 million pesos respectively), it was certainly most reasonable for them to just multiply the .5 millions by 5/6, which 5/6 represented the possessions very badly damaged by flood water and mud -- because the water reached up to two feet in the second floor of one house and four feet in the other house.
They insisted that a listing was required, so I told them then you be the ones to list them, as you could see them by inspecting them inside each home.
That was a mistake because they conveniently did not list everything they could see, and they refused to look at the photos my son had taken before he started to attempt futilely to clean up the mess, with the special leave he got from his employer to help his parents clean up the two homes.
And I believe that is why for the contents of the two homes the adjusters computed losses much less than they should know better.
This thing of listing every single piece of possession is to my observation a pure gimmick, to not pay for every piece of possession destroyed; how can any homemaker ever recall all the possessions in his home, as to do justice to himself for getting the equivalent compensation?
Gertes aka Yrger
Posted: Wed Oct 27, 2010 12:03 pm Post Subject:
Next, the adjusters required me to make a listing of all my possession in order to compute how much loss I had incurred from the typhoon and flooding.
I told that that was an irrational requirement, how could I ever make as complete a listing of all my possession in order not to miss anything at all, when my wife and I have been married for 35 years, maintained a home for the same 35 years, and managed a family with two kids, in all the 35 years we have acquired so many things that we could not remember as to be able to list every single item.
I am not taking any particular side as I respond to this.
This request is a standard requirement of all insurance companies, and probably stated in your contract(s). Most Insurance Regulators and many of us as agents recommend to homeowners to make both a written and visual record (photos, videotapes) of their dwelling's contents (furniture and fixtures) and their personal possessions (clothing, jewelry, fine art & collectibles, etc.).
We have no idea what the details of your coverages are, since there could be at least two different ways to calculate a compensable loss: actual cash value (replacement cost minus depreciation) and replacement cost (no deduction for depreciation). Other ways to determine reimbursements include market value and stated/agreed value.
This thing of listing every single piece of possession is to my observation a pure gimmick, to not pay for every piece of possession destroyed; how can any homemaker ever recall all the possessions in his home, as to do justice to himself for getting the equivalent compensation?
Without this detailed listing, you and the insurance company will probably never come to a resolution of your claims. You can claim 500,000 ps in property losses, but if your property was only valued at 100,000 ps, why should you be entitled to the other 400,000 that you never possessed, simply because an agent wrote you coverage exceeding your potential loss? Insurance is not designed to provide a profit, but to restore you to the condition you were in prior to the loss ("to indemnify"). Just because you have a particular set of limits does not entitle you to collect the full value of the policy if your losses do not meet those limits.
Additionally, you've had more than a year in which you could certainly have made a valliant attempt to recollect as much of your property loss as possible.
You're 500,000 ps claim may be entirely valid, but you are, in some sense, partly to blame for the situation in which you currently find yourself because of your own effort at foot-dragging. A little more cooperation could prove valuable.
Posted: Sat Oct 30, 2010 02:36 am Post Subject:
Before I go into why I think the insurance company and its adjusters are into making it impossible for me to collect as much compensation -- of course to the limit of their liability as I can -- by requiring me to make a listing of all my possessions, let me go into a related subject.
-------------------
I need information from knowledgeable people here.
I heard that when the insurance company pays for the loss of contents of my home, they are going to take away everything of contents in my home, because they now own all contents in my home?
There are contents in my home not damaged and there are contents that are damaged to the extent that that they are destroyed, meaning not worth repairing, or the repair would be more expensive than replacing them by buying even if just second-hand replacements if these be available -- which is not usually the case.
What I think is reasonable is that they could take away everything in the listing of items damaged in the typhoon-flooding, but not everything if not listed.
What do they plan to do with the damaged and even destroyed contents from my home whatever they could take away?
In my country, there is a big flourishing business of junk dealers, the insurance company can earn some money selling to junk dealers by weight of the in effect junk contents from my home.
But honestly, even though the damaged contents are in effect junk they are still of sentimental value to me, and again honestly I must admit that as I have a lot of time in my hand, I can enjoyably attempt to restore them to at least appearance condition if not functional operation, instead of myself throwing them all away as of absolutely no value whatever, neither material nor sentimental.
Then also I can sell them myself as junk to junk dealers.
Is there anything in the policy contract requiring me to surrender listed damaged contents to the insurance company
I don't seem to find any such stipulation in the home insurance policy I bought from the insurance company that covers my two typhoon-flood damaged or totally in effect destroyed homes.
What do you guys here say?
Gertes aka Yrger
Posted: Sun Oct 31, 2010 03:12 am Post Subject:
There are contents in my home not damaged and there are contents that are damaged to the extent that that they are destroyed, meaning not worth repairing, or the repair would be more expensive than replacing them
OK, so why is it so hard to make a list of the damaged/destroyed items?
What I think is reasonable is that they could take away everything in the listing of items damaged in the typhoon-flooding, but not everything if not listed.
What do they plan to do with the damaged and even destroyed contents from my home whatever they could take away?
Your "reasonable" solution is not unreasonable. When the insurance company reimburses you for damaged or destroyed items, generally they would be entitled to take possession of that property (but not anything else). Whether they do or not is up to them.
If they do take it, what they choose to do with it is of no concern to you -- it's no longer yours, you've been paid for it. If they don't want to take it, then you are free to dispose of it in any manner of your choosing. Including selling it to a junk dealer and pocketing the money.
Is there anything in the policy contract requiring me to surrender listed damaged contents to the insurance company
Probably. You'd have to read your policy to know.
I don't seem to find any such stipulation in the home insurance policy I bought from the insurance company that covers my two typhoon-flood damaged or totally in effect destroyed homes.
OK, so have it read by someone who understands insurance contracts and see if they can find it. If not, then the issue is a non-issue. If it's not in the contract, they cannot force you to do so.
[If the contract is in English, I can look at it for you. If it's in Tagalog, I won't directly be able to help -- but I do have a long-time friend at another agency whose wife is Filipino, and she could probably read it for me. If you want to send me a PM, I can provide you with various means of getting a copy of the policy to me.]
Posted: Sun Oct 31, 2010 04:33 am Post Subject:
So they backed off, but I also assured them that I do have land title and documentary proofs that I own the two houses, just that I was not going to play their game of supplying proofs of ownership, because the fact that the insurance company convinced me to buy their policies is enough reason for anyone to insist that they the insurance company has the certainty that I am the owner of the two homes, namely: two lots and two houses.
Yeah, no one has ever taken out a policy on a dwelling that they did not own in order to collect on the insurance when it's damaged. You having to place a copy of those documents on a fax machine or press a few buttons to email in order to curve insurance fraud is WAY to much to expect someone to do.I told that that was an irrational requirement, how could I ever make as complete a listing of all my possession in order not to miss anything at all, when my wife and I have been married for 35 years, maintained a home for the same 35 years, and managed a family with two kids, in all the 35 years we have acquired so many things that we could not remember as to be able to list every single item.
I don't understand why they would not just send you a blank check and have you fill in the amount owed. That is what I would do. But sometimes I use my magic 8-ball to determine how much I owe someone. Really just depends.So what they could and should do logically was, since the contents of each home was insured by the insurer at 500,000 pesos (43.50 pesos equal US$1.00 as of the present) -- and they the insurer company were the ones who computed how much the house and the contents of each house should be insured for (3 million pesos and .5 million pesos respectively), it was certainly most reasonable for them to just multiply the .5 millions by 5/6, which 5/6 represented the possessions very badly damaged by flood water and mud -- because the water reached up to two feet in the second floor of one house and four feet in the other house.
I just _had_ to quote that again. It's CLASSIC!"Hi, insurance company... 4/32'nd of my property was damaged, please send a check for 4/32nd's of my limits."
What was damaged.... a $5,000 table or a $5 doll does not come into play... it's the "5/6th" of your property that determines what is owed. :roll:
They insisted that a listing was required, so I told them then you be the ones to list them, as you could see them by inspecting them inside each home.
Wait for it...
That was a mistake...
I DID NOT SEE THAT ONE COMING! :shock:
And I believe that is why for the contents of the two homes the adjusters computed losses much less than they should know better.
I believe that they are dealing with someone that cannot help themselves and was completely unreasonable and behaving ignorantly from the start. They asked _you_ to itemize your loss and you refused. You told _them_ to come up with an amount. Then when they do, you accuse them of under-evaluating your loss. CLASSIC!how can any homemaker ever recall all the possessions in his home
Were all of these items stolen? Did they vanish? Or where they still in the home and could be accounted for as they were thrown out? As you pull out an item, you write it down or even take pictures of groups of items. Is it a pain? Heck yes! But this does not give you a reason to blame the insurance company for wanting an accounting of things that were damaged. I can obtained $50,000 in contents coverage... this does not mean that there is $50,000 worth of items damaged in the home. Some of those items could be in another location, some of those items might not have sustained any damage, some of those items might be repairable, etc.Posted: Sun Oct 31, 2010 05:24 am Post Subject:
I can obtain $50,000 in contents coverage... this does not mean that there is $50,000 worth of items damaged in the home. Some of those items could be in another location, some of those items might not have sustained any damage, some of those items might be repairable, etc.
They might even still be in a store somewhere waiting to be sold for the first time.
I didn't want to go as far as to accuse the OP of trying to commit insurance fraud, but this would make an interesting segment on a reality TV show: "Insureds Behaving Badly."
Posted: Sun Oct 31, 2010 09:34 pm Post Subject:
First off, the insurance agent selling me the policy of home insurance never took any listing of my contents before he delivered to me every year the policy on my two homes, for 3 million pesos on the house each and .5 million on the contents of the house each.
Now that both homes had been devastated by typhoon-flooding, they are insisting that I should make a listing of all my properties in each house.
Can you make a listing of all the possessions in your home when you have always been living in a home your own, from since you got married and raised two kids, and furnished that home continuously from even before your wedding day to the present, when the typhoon-flood devastated your home -- the dirty water and mud reaching as high as four feet in the second floor?
Take the World Trade Towers brought to the ground by terrorists crushing commercial airplanes into them, do the owners of these towers have to make a complete listing of all the possessions they have in them, before the insurer will come to an estimate of how much he has to compensate for their insurance covering contents possessions in those towers?
There must be an easier and still fair to both sides, the insured as the insurer, to come to an estimate of the liability of the insurer in regard to the contents of a home, than requiring a homeowner already victimized by a natural calamity and now homeless, to still search his mind for all the possessions he had ever acquired and brought to his home, and they remained in his home until the typhoon-flooding destroyed them all.
First, there is the limit of liability already fixed by the insurer company, in my case the contents of each home was insured by them up to .5 million pesos; so that is already a figure for them and me to work on even without me writing item by item a list of all my possessions, which is irrational and certainly to my mind intended to harass the homeowner as to condition him to receive even the most unfair compensation that the insurer will deign to pay him.
Here is what the insurance policy states about the possessions covered by the policy:
That includes every fork and spoon and plate and bowl in the kitchen, and every spool of thread, and every piece of handkerchief, every chair and stool, and folding table, and piece of bedding, etc., etc. etc.
Now with a house that is devastated by typhoon-flooding up to four feet in the second floor, the insurer cannot see that even the total liability of .5 million pesos (one US dollar is roughly today equivalent to 43 pesos more or less) by which he binds himself to pay the insured, he the insurer cannot see that he should already pay the .5 million pesos, because this amount is not even enough to restore all the possessions lost to the typhoon-flooding.
As a matter of fact the policy contract specifically states that the insurer will pay only up to the limit of the insured liability, and the insured must undertake on his own to reinstate or replace by any other amounts that are still necessary to restore everything else, that cannot be provided for by the limit of the insurer's liability, in my case .5 million pesos.
How come that the insurer is being irrational when the situation is clear that all the losses of possessions can command more than .5 million, so just pay .5 million, the limit of his liability, and the matter is finished as regards compensation for the losses of the contents in the house.
Even though the insurer factors in deduction and depreciation whatever, his liability sitll cannot be less than .5 million pesos.
Gertes aka Yrger
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