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: Wed Nov 10, 2010 04:14 am Post Subject:
[ I am sorry, guys, I have to post this again in order to earn, because I was not logged in earlier -- it seems that I was logged in then I got logged out -- don't know why; but best to always log in everytime I come here, and to insure (pun not intended) that I am still logged in before I click submit. ]
First, I want to ask the experts on claims is it reasonable for the insurance company to see the big picture, like this:
First, we are dealing with homes, not warehouses.
They insure your home for 3 million pesos maximum exposure from their part (one US$ = roughly today 43 Philippine pesos) on the house and .5 million on the contents; there are two homes insured by the company on the same amounts and with the same premiums paid by you.
They are the ones who come to how much they will expose themselves, you do not bargain on how much they should expose themselves.
They then accordingly fix how much you pay in premiums.
You therefore pay the premiums they charge you.
Now your two homes are devastated by typhoon and flooding up to the second floor to 2 feet high in one and to 4 feet high in the other, so that everything reached by the dirty water and the mud is rendered useless for the purposes they were made for.
So, you go to them and tell them:
Since you as insurer expose yourself to pay me as much as 3 millions each for all kinds of losses on the house in both homes and as much as .5 million for the contents, suppose to make it quick and simple and equitable for both you the insurer and specially for me the claimant, you just pay me 1/2 of 3 millions on each house and all of .5 million for the contents of each house, therefore the total is 4 million pesos, as against the total exposure of the company at 7 millions.
And we can dispense with the drama or play-acting of you consigning to socalled independent adjusters to come to the amount you are bound to pay me.
That 1/2 of three millions ( = 1.5 millions ) on each house and .5 million on the contents of each have already factored in all kinds of depreciations and also the deduction that I should as the claimant absorb.
Is there a law that prohibits the insurance company to proceed in that quick, simple, and equitable manner, dispensing with the play-acting from the part of the insurer employing his socalled independent adjusters?
Have courts in the US ruled in favor of claimants on the basis of what I describe above to be reasonable?
Remember a home is not a warehouse.
Gertes aka Yrger
Posted: Wed Nov 10, 2010 04:37 am Post Subject:
They are the ones who come to how much they will expose themselves, you do not bargain on how much they should expose themselves.
You keep saying this but it's incorrect (almost 100% so). The insurance company can make a recommendation as to the extent of your coverage but ultimately _you_ choose the amount. Granted, your content coverage minimum might be based on the value of the home but you are still 100% free to at least increase this coverage. You are free to insured $10,000 of items for $100,000. Keep this in mind because I have a feeling we are going to go down the same path we've been down _many_ times in the past.so that everything reached by the dirty water and the mud is rendered useless for the purposes they were made for.
Well, your point is moot but I'll still wander down this rabbit hole. How does dirt/mud render pot, pans, plates useless? How does it render tools such as hammers and screw drivers useless? But again... even though you are incorrect, your thought is 100% pointless!Since you as insurer expose yourself to pay me as much as 3 millions each for all kinds of losses on the house in both homes and as much as .5 million for the contents, suppose to make it quick and simple and equitable for both you the insurer and specially for me the claimant, you just pay me 1/2 of 3 millions on each house and all of .5 million for the contents of each house, therefore the total is 4 million pesos, as against the total exposure of the company at 7 millions.
Same rabbit hole... different day. I'm not sure how long you are going to beat this dead horse. The limit of the policy is just that... a LIMIT! At this point if you have any questions I'd _HIGHLY_ recommend you read your policy! You can also fee free to review your local laws on what duties you have to collect under the terms of a contract. This is not rocket science my friend! It's simply... _you_ (that's _YOU_) have a duty to _show what your loss is_. It's just THAT simple. No where in your policy does it state you can take the level of water in the home in order to determine what your loss is. Let me be clear on this... that is about the dumbest thing I've ever heard! You can think it all you want... you can post it over and over... it won't make it come true.Is there a law that prohibits the insurance company to proceed in that quick, simple, and equitable manner, dispensing with the play-acting from the part of the insurer employing his socalled independent adjusters?
No... but there is a law that prohibits you from making a claim like this. So I guess that is that.Remember a home is not a warehouse.
100% irrelevant.Have courts in the US ruled in favor of claimants on the basis of what I describe above to be reasonable?
Yes. What you suggest is not legal anywhere in this world. Period. It's laughable, at best!Posted: Wed Nov 10, 2010 03:29 pm Post Subject:
I hope we're getting close to putting this thread in the grave.
So, you go to them and tell them:
Since you as insurer expose yourself to pay me as much as 3 millions each for all kinds of losses on the house in both homes and as much as .5 million for the contents, suppose to make it quick and simple and equitable for both you the insurer and specially for me the claimant, you just pay me 1/2 of 3 millions on each house and all of .5 million for the contents of each house, therefore the total is 4 million pesos, as against the total exposure of the company at 7 millions.
I'm not sure if there are any Burger King restaurants in the Philippines, but I think there are. The slogan Burger King has used for decades is "Get it your way."
That's fine for them, but it does not work in insurance . . . YOU CANNOT HAVE IT YOUR WAY!!
They give you a contract which they write. You tell them (as tcope has said) how much coverage you want (the agent might recommend an amount, you can agree, disagree and ask for less, or disagree and ask for more coverage). Those are your three options. Nothing else. [OK, Option 4, get mad and find another insurance company/agent, or, Option 5, don't carry any insurance at all, which most of us would agree is a foolish thing to do.]
You CANNOT tell them how to pay the claim. They make the rules. If you disagree with what they are offering, you can (1) argue with them politely and hope to convince them your claim is worth more, or (2) you can argue your point in court and let a judge or jury decide who's right or not.
Number (1) costs you a bit of your time and can yield positive results in most cases. Number (2) costs you a lot of money, time, aggravation, and if you lose, even more money when the insurance company demands, and is awarded, reimbursement for its legal expenses to defend itself against your claim.
Because you refuse to cooperate (be polite), you are headed down the path to option (2) -- and you may not like the eventual outcome. If you change your attitude, become more cooperative and polite, you may influence the insurance company to see things differently -- but not necessarily your way.
Because this is not Burger King.
Posted: Thu Nov 11, 2010 05:42 am Post Subject:
I have said these facts already in my messages here, but I will recount them again.
The insurance agent serving me never asked me how much coverage I wanted; everytime he came to me to renew my home and car insurances, he already presented to me the policies for me to accept and pay him.
I told him yearly that I want the best protection, and I never bargained with him about premiums.
Now it turned out that he should have told me about actual cash value insurance and replacement cost insurance for home policies, which he never did; and for comprehensive car insurance there is an additional factor which he should have informed me about, namely, the clause to cover acts of God, so that I could be protected against flooding from typhoon, which also he never did inform me about.
And I always told him to give me the best protection, never bargaining with him about premiums.
He never inspected my homes, but he was with me inside the house, the first one with which he started with me as his client, and the second one to which my wife and I moved to, because the first one is in a more flood prone level, though the flooding there was not very bad because we had built it on one meter elevation from the street level.
So he was the one or his insurance company to determine how much his insurance company should insure my two homes for, in regard to the house and also in regard to the contents.
All I did was to sign up and pay the premiums, never bargaining about premiums and about amount of exposure assumed by the insurance company.
Things were all right for several years because we never experienced any serious flooding from that time on, except for the first home but the water did not get inside the house, it only flooded the garden.
Last year with typhoon Ondoy (Sept. 26, 2009) the flooding was exceptionally bad, water got inside homes in areas in my village where it never even covered the drive way.
In my first home the water got up to four feet in the second floor, and in my second home where my wife and I actually resided, the water got to two feet high in the second floor.
Luckily on that day in the morning I had to bring my wife (it was a Saturday) to the hospital for her kidney dialysis, she had that three times a week, Tuesday, Thursday, and Saturday.
While we were in the dialysis ward of the hospital neighbors called us to inform us that water was getting into our home even the second one, but we did not worry because we assured ourselves that at most the water would just get inside the house maybe only one or two feet on the ground floor of the second house; as for the first house, we felt there was nothing to do about it, besides we had insurance of 3 million pesos on the house and .5 million for the contents, same also for the second house the one we were actually occupying at the time of the Ondoy typhoon plus massive flooding.
My wife was 72 years old and I, 73 years old, I am healthy and active but she had heart troubles, kidney troubles, and other troubles like breast tumors which required her to undergo mastectomy, etc.
She passed away in bed beside me on July 28, 2010, but I brought her by ambulance to the hospital and they did CPR on her until the medical staff got so tired and refused to continue -- because I told them not to stop at all.
So the doctor in charge declared my wife dead.
Now back to the insurance claim task.
A young man from the adjusters of the insurance company came to the village and walked on dried foot paths toward one home the second one, but he could not get near without soiling his shoes and clothing, because of the mud on the ground and everywhere you touched; I told him to come some days later, which he did and was able to take photos of both homes.
He gave me some papers to fill up, one to notify the insurance company that my two homes had been devastated by the typhoon and flooding, and the other to sign a waiver by which both the insurance company and I agreed that whatever further obligations and rights that would come about, both parties do not waive them.
Later, the adjusters came in with a list of requirements that I had to fill up, presenting documents, most troublesome is the list of our possessions and also receipts of purchase, invoices, etc., etc., etc.
I told them that this must be really some kind of delaying tactics, and from that point onward I was insistent that there was no need for all the play-acting about adjustment, the big picture was obvious, just give 1/2 of the insurance company's exposure on the houses (3 millions each) and full payment of .5 million on the contents of each, that amount to 4 million pesos, that should be simple, quick, and very equitable, being most reasonable.
They told me that it is the requirement to submit a list of items damaged etc. etc. etc. for proper computation.
I told them I did not have the energy and the time to do that task, besides whatever list I would give them it would be unfair to myself, because we had been acquiring things for our homes all the 35 years of our marriage, home-making, and raising two kids.
So they told me they would do it for me, and they looked over the two homes and made listing, and asked me questions.
But I said to myself how could they do me any justice, it would be impossible for them to look about and come to all the things we possessed which were now all hurled on each other like drunkards falling down on each other unconscious, in all kinds of crazy postures ad positions.
Anyway I kept quiet, saying to myself just to wait and see how they were going to come up with a payment that would be for me equitable, considering that the insurance company insured my two homes for 3 millions each on the house and .5 million each on the contents.
Now what?
One day after some weeks, the adjusters presented to me the amount the insurance company should be paying me, how much? here:
one US$ = roughly 43 Philippine pesos
I honestly think that the amount is absolutely inequitable for being unreasonable.
In this country there are no public adjusters, why? Ask the Insurance Commission why.
Ah yes, there are two public adjusters, two international marine insurance adjusters for marine insurance claims.
The Insurance Commission of the Philippines, sad to say, never seems to have any idea that it should be making available to the insuring public the existence of licensed public adjusters, as distinct from independent socalled adjusters who are assisting insurance companies.
As a matter of fact I talked with the top person in the Insurance Commission about this concern, and she told me that no one ever applied to act as public adjuster.
Why? Obvious, there is no money there.
They have been reduced to homelessness, and are now trying to make do with whatever savings they still command, for food and a temporary roof over their heads, and the only clothings they have are the ones they wore as they escaped from the calamity.
I told her the top gun in the Insurance Commission to require independent adjusters to by turns serve also home policyholders, that is perfectly within her duties as the top official in charge of making sure, that people buying insurance will get the right kind of people to help them when claim time comes.
She does not seem to me to have felt that my suggestion has any relevancy to her office as the top insurance authority in the country.
Sad.
What now?
My agent told me to trust in the goodness and fairness of the insurance company and its adjusters, that was before he saw the amount arrived at by the adjusters, 610,333.80 pesos.
So he came with me to both homes to have a personal look at things, and he said that I really should get more, much more than just 610,333.80 pesos.
In secret he introduced me to another adjuster belonging to a company one of several serving the insurance company where he himself is assistant vice president for underwriting -- that is his main job, but he also sells policies of other companies, aside from that fulltime desk job in his own insurance company (however he did not insure my homes and cars with his own insurance company, I don't know why -- I should ask him next time I see him).
This adjuster, also an independent adjuster of course, went with me and the agent to inspect both homes, and asked me questions and studied the report of the adjusters who produced the amount of 610,333.80 pesos.
He took some a week's time and produced his own computation to the amount totally of:
And he told me don't accept anything less.
So I sent a copy each of the report of this good Samaritan adjuster to the insurance company and to their adjusters.
After two months, my agent called up the insurance company and asked them for their reaction, they said they did not receive any papers from me.
Then they changed their story, they looked for my papers and they just now only found them.
After one week's time my agent called them up again, and got the news that they would be willing to pay me one million pesos for all the losses, instead of 610,333.80 pesos as arrived at by their adjusters.
I told them no.
The good Samaritan adjuster told me and the agent serving me to ask the insurance company how it came to that one million figure, now?
In the meantime I decided to go inside the lions' den, by inviting the two adjusters of the insurance company for a meeting for them to explain to me how they could come to the pittance figure of 610,333.80 pesos, when the two homes were insured at 3 millions each on the house and .5 million each on the contents, and the water got to the second floor of both homes.
They explained to me but I am still not convinced at all; so I told them that I will get an adjuster like themselves, independent, and bring him to deal with them next time I contact them for another meeting.
You know what? I did not mention the work of the good Samaritan adjuster, and amazingly, they themselves don't seem to even know that I sent them a copy of the work of this good Samaritan adjuster.
Yes, I have the receipts of transmission from the commercial carrier LBC, I used to send my papers to the insurance company as to their adjusters also.
You know, I am really at a loss what is going on in the whole business of loss adjustment in this country called the Philippines.
Now what?
The good Samaritan adjuster and my agent told me to just wait for the other side to come up with a new computation, whereby they could now arrive at the figure of one million pesos payable to me, then we will study their work and see what kinds of liberties they are taking this time.
That is where matters stand as of now.
Today is Thursday here in the Philippines, Nov. 11, 2010; I met with the two adjusters from the insurance company the day before yesterday, Tuesday, Nov. 9, 2010.
In parting company they told me that I am the only one still with a claim not yet settled, and they also told me that they would really want to come to a bigger amount payable by the insurance company: because (amazingly) the insurance company pays them in direct proportion to the amount they arrive at for the insurance company to pay the policyholder, meaning, the more the insurance company has to pay as per amount reached by their adjusters, the more the company also will pay the adjusters accordingly, so it does not benefit them to reduce as much as they could to the barest minimum payable by the insurance company, which then will only earn for themselves almost nothing from the insurance company.
Can you believe that?
Gertes aka Yrger
Posted: Thu Nov 11, 2010 06:06 am Post Subject:
In parting company they told me that I am the only one still with a claim not yet settled . . . Can you believe that?
That, sir, is entirely believable! And, in retrospect, it's about the only thing you've said that is.
Posted: Thu Nov 11, 2010 06:11 am Post Subject:
Now it turned out that he should have told me about actual cash value insurance and replacement cost insurance for home policies, which he never did
Did you ever ask to have the policy explained? Actually he did explain everything to you... he gave you a copy of the policy for your review. When you buy something in the store do you expect them to sit down with you and explain how it works? No, they give you a manual. But this really has nothing to do with your situation... you are only trying to cloud the simple facts.You think an insurance company should pay you based on the level of water in your home rather then paying you for what was actually damaged. I'm sorry to say, this is IDIOTIC... pure and simple. No clouding this fact with all the other crap you wrote. It's just THAT simple. Ask friend, ask neighbors, ask people you bump into on the street how they think and insurance determines the amount of someone's loss. Let me know if anyone tells you that it should be based on the level of water in the home. :roll:
Posted: Fri Nov 12, 2010 09:44 pm Post Subject:
Here is something that I have found now out to be not of the utmost good faith, from the part of the insurance company and its sales agent.
The agent used to insure only one home because at that time we had only one home.
Then in 2002 we got another home in the same village and moved there. leaving vacant the old home.
The reason for acquiring a new home was because even though we had ourselves, my wife and I, built our old home on top of one meter elevation from the street level, during the typhoon season the water still when flooding was bad got inside our garden and mess it up, and at times it got up to the top of the drive way.
Now we have moved to a higher location in the same village that had never been flooded, that saved us from the worry and trouble of cleaning up the mess in the garden from flooding during the rainy typhoon season.
So the agent started selling us two policies, one on lesser premium than the other: the old home commanding less premium for being older and not as expensive looking as the new one, which however we bought it already built up by the previous owner, who wanted to emigrate to Canada.
The sales agent asked me if he could rent the old home, but I told him no, because my daughter would be completing her doctor's training, and I would want to reserve it for her as her clinic and office for her medical practice.
That got me thinking however when my daughter told me that she would not want to open an office-clinic inside the village, because the scarce patient market inside would leave her doing nothing the whole day, except every so rarely an emergency occurred to someone who could not be driven fast to the nearest hospital, which is just five minutes away by car.
I thought that I could earn some income by renting the house, but people interested would not accept my condition and special concession, namely, they must themselves spend for putting the house to better condition, like adding a new coat of paint, and I would credit their expenses to their rentals plus 50% in addition: so that if the rental was 8,000 pesos per month and they spent 32,000 pesos, I would credit them with 6 months rent-free use of the place as their home; I told them that it was a good offer since the house would be their home.
No one took up the offer.
You know why? Because the local people who rent for a living in a house have the unspoken attitude of reneging on the rentals, once they have used up the one month advance and two months deposit rental payment -- something like that, I am not sure exactly, or making it very difficult and troublesome for you to collect the monthly rental.
So the house, the old home, was and is still vacant for all these seven years up to the Ondoy typhoon and flooding.
In the meantime after I think for two years when the two homes would be insured by the agent on a separate policy each, he came up with one policy for both homes, and the premiums were paid not separately but together, so that in 2009 (for the period Sept. 1, 2009 to Sept 1, 2010 (by the way, typhoon Ondoy occurred on Sept. 26, 2009), the combined total premiums came to 26,712.00 pesos, and the insured amount for each house on the structure was 3 million each, and for the contents was .5 million each.
Now that I have been reading about home insurance, I realized that he or more correctly the insurance company was charging the same in effect the same premium for the old home as for the new home, although the new home is a more expensive one than the old home.
Here, both homes are described similarly or with the same description:
Occupied as: residential
Occupation code: 4.1.1A
I don't really know how they put the two homes in their accounting records, because they are not the same in terms of being expensive with the new one more than the old one.
Is that not a sign of defaulting on the principle of utmost good faith?
It is obvious that the agent and the insurance company sold one policy to cover equally two homes, from a motive to make more money from more premiums, by making the old less expensive home pay as much as the new more expensive home.
Gertes aka Yrgyr
Posted: Tue Nov 16, 2010 12:31 am Post Subject:
Now, all people interested and specially people in the insurance business as operators of insurance companies, and sales agents, and loss adjusters, in regard to home insurance, please examine the summary adjusted payable money from the insurance company servicing my two homes, devastated by the fierce typhoon and flooding of Ondoy on Sept. 26, 2009.
I will just present below the summary computations of one house, the more expensive one, first of the company's adjuster, then of the good Samaritan adjuster.
Summary of computation for payable by the insurance company from the company's appointed adjuster (CAA).
2. Sound value (FTAO) 3,000,000.00
3. Deductile (2% of 3,000,000.00) 60,000.00
4. Total reconstruction/repair cost 905,657.00
5. Less: depreciation (60%) 543,394.20
6. Net of depreciation: 362,262.80
7. Less deductile: 60,000.00
8. Insurance company pays (Please See Attached) 302,262.80.
(See attached.)
Summary of computation for payable by the insurance company from the good Samaritan adjuster (GSA).
2. Cash value/sound value
a. Replacement cost 3,100,000.00
b. Less depreciation (30%) 930,000.00 = 2,170,000.00
3. Deductable amount
Flood loss (2% x 2,170,000.00) = 43,400.00
4. Loss and damage
a. Repair cost 1,748,000.00
b. Less depreciation (30% x 1,748,000.00) = 1,223,600.00
5. Policy liability
a. Loss and damage 1,223,600.00
b. Less deductable 43,400.00 = 1,180,200.00 (payable by insurance company)
(See attached.)
Everybody, please pay attention to No. 3 of the CAA's computation and No. 3 of the GSA's computation.
What do you say about their respective mode of arriving at the deductile or deductable to be shouldered by the policy holder?
By the way what is the meaning of (FTAO) from No. 3 of CAA?
Gertes aka Ergyr
Posted: Wed Nov 17, 2010 10:35 pm Post Subject:
Please proceed to this board (see link below) for the continuation of my messages on loss adjustment re home insurance claims:
http://www.ampminsure.org/home/pay-deductible.html.
Go to the very last message in that thread, coming from me as of today.
Thanks to all who have been following this thread.
Gertes aka Ergyr
Posted: Thu Nov 18, 2010 05:36 am Post Subject:
No, thank you. This is all a bunch of hooey.
Add your comment