Tag: Insurance

State Farm Faces Criminal Investigation Over Hurricane Claims

By MARK GREENBLATT (@greenblattmark)
Sept. 7, 2012

State Farm Insurance, the nation’s largest home insurer, faces a new criminal investigation in Texas related to how it handled potentially tens of thousands of hurricane claims there, ABC News has learned exclusively.

Gregg Cox, who leads the public integrity unit of the Travis County District Attorney’s office in Austin, confirmed to ABC News his investigators recently launched the probe after reviewing newly released communications from top State Farm managers in Texas. Some of the same communications have led to lawsuits by customers who say they were defrauded by State Farm Lloyds, the Texas subsidiary of the larger insurance company.

The documents in question relate to an alleged cover-up by State Farm management related to its denial of consumer insurance claims for a common type of roof damage that occurs during high wind events and hurricanes.

Jim Warner, a longtime homeowner in Missouri City, Texas, had been a customer of State Farm Insurance for more than 20 years before finding himself in the center of the now brewing criminal investigation. He says he had never filed an insurance claim until Hurricane Ike in 2008 and had always paid his monthly bills to State Farm on time.

However, Warner filed suit against State Farm after he says the company did not follow through on its slogan that promises, “Like a good neighbor, State Farm is there.” Warner always believed his policy would cover all types of damage to his roof, but when he went to file a claim he says he was shocked to learn that was not the case.

However, when the “catastrophe section manager” for State Farm saw that statement written out, he directed it be removed from what state regulators would be told, instructing, “This letter needs to be revised to delete the reference to unseal tab.”

The reference was subsequently removed, and that same catastrophe manager then forwarded the newly revised letter to other unnamed colleagues at State Farm “for your review” before it was sent off to the state.

Attorney Mostyn says State Farm fought hard to keep from having to disclose those and other documents, but lost the fight. He says other documents show the insurer attempting to delete other references to the company’s policy of not paying lifted-shingles claims.

Warner’s lawsuit alleges that nearly 100,000 people may have had their claims for similar problems wrongly denied, estimating that many additional consumers who did not hire independent investigators to inspect their roofs may be unaware they are actually damaged today and susceptible to problems in future windstorms.

Longtime Texas state Sen. Rodney Ellis reviewed many of the documents and communications.

“The documents are troubling, and very scary,” Ellis said. “They tell a story that indicates there is a serious problem. I think law enforcement ought to step in and people ought to be held accountable.”

Ellis says he had received many complaints from his own constituents about similar problems and had previously asked the Texas insurance commissioner to launch a widespread investigation of State Farm. While he says that has not happened to date he welcomes the Travis County criminal probe.

Ellis has successfully called other insurance companies to task on the very same issue of not paying for lifted shingles damage. He previously called for a civil investigation by the Texas Department of Insurance against the Texas Windstorm Insurance Agency and its sister company the Texas Fair Plan Association, alleging a similar organized pattern of non-payment of lifted-shingle claims.

The resulting investigation ultimately led to enforcement action by the Texas Department of Insurance against both companies. The state regulator required each of those companies to go back and reevaluate claims and pay for, among other things, shingles lifted and unsealed by hurricane force winds on roofs.

ABC News has confirmed grand jury subpoenas have been served to State Farm.

“We have requested a large amount of information from them, and they are complying with our requests,” said Gregg Cox of the Travis County D.A.’s office.

State Farm declined an interview request for this story. However, the insurer said in a statement that, “State Farm Lloyds is cooperating fully with the Travis County investigation and has successfully settled the majority of civil litigation involving Hurricane Ike claims. To date, we have paid policyholders more than $1.5 billion dollars, much of which went to repair or replace roofs. We have been actively working to resolve questions related to roofing shingle claims. We will continue these efforts to maintain the trust of Texas homeowners, of which more than one in six has placed their confidence in State Farm Lloyd’s to protect their homes.”

State Farm Lloyds says it will soon file papers with the court disputing the claims made in the Warner’s recently amended lawsuit.

The criminal investigation by the Travis County District Attorney’s office is focused on State Farm’s actions in Texas. ABC News will be looking into stories and complaints from consumers who live in other states. If you have something you would like to share you can email Mark Greenblatt.

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Warner’s lawsuit alleges that State Farm documents establish a clear internal policy of intentionally denying consumer claims for roof damage similar to what Warner experienced. Warner’s attorney, Steve Mostyn, claims the systematic denial of those types of claims may have quietly saved State Farm close to $1 billion.

Mostyn says State Farm documents obtained in the lawsuit reveal an attempt by managers to hide the company’s policy of non-payment from state insurance regulators.

“They absolutely went through an effort to cover it up,” Mostyn said. “These emails are coming from the top. They’re setting policy. And that policy by their own admission … shows conclusively they have not paid thousands of people.”

In Warner’s case, his problems began after he says the high winds of Hurricane Ike caused the shingles on his roof to become “lifted.” Those winds, Warner alleges in his suit, broke the seal under Warner’s shingles that normally create a water-tight barrier. Warner says an independent adjuster he hired agreed the damage was extensive and recommended Warner’s roof be replaced.

Warner alleges, however, State Farm repeatedly refused to admit the unsealed tabs were damage that should be paid under the policy. So Warner filed a consumer complaint with the Texas Department of Insurance, hoping the regulator could help. However, Warner’s lawsuit says it was during that very investigation of his complaint to insurance regulators that State Farm began to cover up its practices of refusing to pay for this kind of damage.

ABC News reviewed documents obtained in the lawsuit including an initial draft of State Farm’s response to insurance regulators about Warner’s complaint. In that draft letter, State Farm clearly disclosed how the company did not pay for insurance claims related to broken seals on roofs, saying, “Regarding the detached seals, there is no coverage as this condition is not considered… physical loss.”

McAllen Hail Claims

Was your home or business harmed by the hail that pummeled McAllen on March 19, 2012? If your area was hit by the intense rain, wind, and hail the size of golf balls or baseballs, then you are now likely dealing with insurance claims in the aftermath of the storm damage. It can be a frustrating process, but if done right you can get the money you need.

There are some symptoms of hail damage that you can spot yourself. First, look for loose granules on asphalt roof shingles. Also check for granules in your rain gutters and downspouts, because the loose granules will eventually wash away. Finally, look for hail dents in exposed surfaces like vents, siding, decks, and also automobiles.

Don’t be fooled though! It is not enough for you to perform all inspections yourself. It is not uncommon for hail damage to be unseen, so it is necessary to have it inspected by a professional. Roofs are especially at risk of hail damage and often sustain more harm than it appears. Not only can the roof shingles be damaged, but the structure itself may be damaged by a hail storm. This is one reason to make sure a professional assesses your damage because a quick up-front insurance claim payment may cover only apparent roof damage. But they will leave behind damage to the structure that you may not notice until problems arise later, and then you’ll be stuck dealing with insurance claims all over again. Make sure everything is handled right in the first place!

What You Should Do Now

• Take pictures and video of the structure, contents and debris prior to moving or disposing of anything. Take pictures of any dented siding or broken windows. Also photograph any roof shingle granules that may have washed into rain gutters or downspouts.
• Tarp any openings in your roof and walls if possible to prevent further damage.
• Take pictures of any hail on your property to document the amount of hail that occurred.
• Do not dispose of any damaged property contents even though you think they may be a complete loss.
• Note all hail damage that was not present before the storm.
• Hire a contractor to clean up debris. If you do it yourself, you may not be compensated by your insurer or may only be given minimum wage.
• Keep written receipts for all expenses, especially if you pay cash.
• Only give copies of photos and documents to the insurance adjuster, not the originals.
• Make sure a contractor’s contract has a clear estimate of charges. If a contract says “the work will be done for an amount the insurer agrees to,” find another contractor. In many cases this type of contract is illegal.

When Your Adjustor Arrives

• Have the adjuster sign for anything you give him/her. This is your receipt that you have provided the documents requested.
• Do not understate what you feel your loss may be.
• Point out all hail damages and have a witness with you when the adjuster inspects the property.
• Seek professional assistance before signing a proof of loss for the adjuster, to make sure that the document is correct in every aspect.
• Be cooperative, but stand your ground on damages that you are expecting to be covered.
• Be wary of the following statement: “If there is anything else I did not cover, you can just supplement the claim later.” Supplementing is much more difficult than getting your claim paid properly up front.
As much as you hope the claims process will go smoothly, many McAllen property owners may still have problems with insurance claim delays, disputes, and denials. Texas insurance law requires insurance companies to show reasonable cause for denying or delaying payment, if the policy clearly covers hail damage. Your adjustor should come out promptly to assess your hail damage, and you can prevent disputes later on by following the guidelines listed above. It can be especially frustrating to see your neighbors getting new roofs while your own hail damage claim has been denied, so don’t give up! Continue pursuing your insurance claim if you feel that your policy is not being handled appropriately.

Membership in Professional Organizations Helps a Small Public Adjusting Firm Achieve a Big Result

In the true spirit of Labor Day, I hope all of you take time to reflect on your work and still find time to relax. For today’s blog, I encourage you to take a look at the article, Small Public Adjusting Firm—Big Results. It is an inspiring story of one public adjuster who became a public adjuster after having built “his world around serving insurers.”

Clay Morrison is a public insurance adjuster who, in a former life, owned a restoration company. His largest customer was State Farm. Clay is now the president of Morrison & Morrison, Inc. His public adjusting office is based out of League City, Texas and similar, to many public adjusters, the business includes family—the “other” Morrison is Clay’s wife, Ruth, a Texas attorney and corporate counsel for the firm.

Morrison decided to become a public insurance adjuster when he was “urged” by one large insurance company to go against his ethical standards and change the way business was done. Morrison’s article, published in the NAPIA Summer Bulletin, details the closed door meeting he was invited into with an upper level claims manager who made a request for Morrison to help State Farm.

The request:

“We refer a lot of restoration business to you, and we need your help in rectifying the consumer’s entitlement mentality.”

Morrison declined State Farm’s request, but his very successful restoration business was quickly out of business.

Now, Morrison is a public insurance adjuster, member of the NAPIA board, Secretary of the Texas Association of Public Insurance Adjusters (TAPIA), FAPIA member, and a Windstorm Network certified umpire.

Morrison explains that even as a small operator of his own public adjusting firm, he found it very important and beneficial to be a member of professional educational programs. Morrison acknowledges the expense of being active in multiple associations, but explains his two reasons for going the extra mile and spending the extra dollar.

Number 1: “If you want to be successful in a field, you must associate yourself with people who are most successful in that field.”

Number 2: “If you endeavor to do something, you should strive to be the best.”

Two valuable points for all of us to consider as we enjoy this holiday weekend and our work.

Article by Nicole Vinson from http://www.propertyinsurancecoveragelaw.com