Insurance Claim Situations And Public Insurance Adjusters

ClaimsMate Podcasts

Welcome to the Ask the Experts show, with local experts in the field of health, legal, financial, and home improvement. Now, here’s your host, Gary Knight.

Gary: And a good welcome to you today on Ask the Experts. I got a question here about PAs. It’s public adjusters. We’re going to be talking to Stephanie Corona again. She was our host not too long ago. How you doing today?

Stephanie: I am doing wonderful. How are you doing today?

Gary: I am fine. You look a little more alive today.

Stephanie: Haha, yes.

Gary: I know you’ve got to have a lot of compassion in what you do anyway, and a lot of hours too to go along with it.

Stephanie: We are still working 12, 14 hour days. Hurricane Harvey has been one of the biggest storms that has come across in a long, long time.

Gary: And I hope that’s going to go another 100 years.

Stephanie: You and me both.

Gary: All right. We’re going to recap, if that’s okay. You mentioned let’s recap of what we did in the last show, and maybe add some more stuff that we never got to. Speaking of recapping, how about the public adjuster, what is a public adjuster, and what can and can’t they do, and when and why you should call them?

Stephanie: Okay. A public adjuster is somebody that is licensed by the state of Texas to represent the homeowner or the business owner in helping them with their claims process. Most of the time, lately, it’s gotten a little bit more difficult than it used to be years ago, and the insurance companies seem to be a lot more picky about what they’re going to pay for and what they’re not going to pay for, and how you prove that the damage was actually caused by whatever has happened, such as Hurricane Harvey.

You go to a public adjuster whenever you have not been successful in negotiating with your insurance company, and usually you go to them before you go to an attorney. A public adjuster will help you either, one, negotiate a settlement, to the point where everybody’s happy and you’re fully paid, or they will assist you in surrounding you with a team of experts that will help prove your case. If we’re not able to get them to settle at that point, then is whenever we bring attorney’s in and they would become a matter of law at that point, such as breach of contract, bad faith, and a number of other things.

Gary: Okay. We’re talking to Stephanie Corona. You are a PA, public adjuster, correct?

Stephanie: I am, I am. I’ve worked for the insurance companies for awhile, and then decided to start representing the homeowner or the business owner.

Gary: So, you were talking about insurance companies not wanting to do this, not wanting to pay for this. You can talk to them in their language.

Stephanie: You can. Most public adjusters have been independent adjusters for the insurance companies before. That’s kind of how we usually get started. So, we have a lot of insider knowledge, and as long as you talk to the other adjusters that work for the insurance companies, whether they be an independent adjuster or a staff adjuster or a straight-up catastrophe adjuster that just follows catastrophes around the nation, if you talk to them in their language and you make their job easy for them by providing the documents that they need, a lot of times the settlement goes a lot easier.

Gary: There is a public adjuster for any unique problem that you may have. Is that a good statement?

Stephanie: There is.

Gary: To a point.

Stephanie: It’s just that a lot of adjusters don’t work things such as auto accidents. The software is different. It’s just as expensive as it would be for a property claim, and the cost for it becomes to the point where most people don’t do it.

Gary: I can imagine.

Stephanie: Most of your public adjusters are going to work on commercial properties, residential properties, and then you’ve got a lot of marine adjusters and crop adjusters as well.

Gary: Wow. A bunch. This is ClaimsMate. Is that correct?

Stephanie: We are ClaimsMate, yes.

Gary: Okay, and public adjuster. And here’s a number: 281-231-9242. 281-231-9242. Is that a 24/7 number?

Stephanie: It is a 24/7 number. Usually we’ll return your phone call in the morning if you call really late at night, unless it’s an emergency. If your house is on fire and you’re calling around and desperately searching for help, we will get out there right away. But usually if it’s not a fire and you’re not flooded up to your knees, we’re going to call you back in the morning.

Gary: How long do they have when an event happens like a hurricane or a tornado to get a hold of someone?

Stephanie: Usually you want to report any claim immediately, but you want to make sure that you talk to somebody and make sure that you’re reporting a claim that’s actually covered by your policy. It’s good to get some advice from a public adjuster even if you don’t hire one before opening your claim. Your policy is typically about 60 pages front and back, and it’s made and written by lawyers, and it’s really hard to understand unless it’s something that you do on a day to day basis.

Gary: Now, Stephanie, when is it time to hire an attorney?

Stephanie: Attorneys usually should come into play whenever you have done everything as you can as a public adjuster to handle matters of policy. We can discuss any type of policy problem that comes up. When it becomes a matter of law such as ambiguous language, such as breach of contract, such as bad faith, that is when you want to hire an attorney so that they can come in and they can actually get punitive damages for you as well.

Gary: I noticed, and I looked this up just to make sure I was saying this right, the different types of insurance and the state pool, you have the TWIA …

Stephanie: That would be Texas Windstorm Association. That is typically what is used along the coast for coastal properties, inland one, inland two, and inland three. Your requirements, if you have TWIA policy, are a lot more stringent than if you would have a normal insurance company. They’re a state pool. They have wind certifications that need to be done, and it’s because their risk is a lot higher because they’re closer to the coastline. So, whenever you do have a TWIA policy, you need to make sure that your contractors are up to date on the requirements that are set forth by Texas Windstorm Association, such as getting an engineer out during the putting back of your roof. If you’ve already got your roof all the way back on and you haven’t gotten that windstorm certification, you then lose your eligibility to have a windstorm policy.

Gary: That’s good information. How about TFP? I see another letter here.

Stephanie: TFP is Texas Fair Plan. They go hand in hand with TWIA as far as being a state pool. It is really for high risk properties, or people that could not normally get insurance from other insurance companies. They typically require that whenever you turn in an application to them, that you at least be turned down from three other insurance companies that are able to provide insurance in the state of Texas. If you have a high risk property such as something that has burned down multiple times or has had multiple flood claims or has had multiple break-ins, then a lot of times your regular insurance companies will not cover you. The state pool has to cover you.

Gary: Okay, okay. How about do you have insurance for collateral protection?

Stephanie: There is something that I’m starting to see a lot more often, and it’s called a force place policy. That policy is enforced by your mortgage company and it is because you have failed to maintain insurance on your own to protect their investment. So, they have a lien against your property and they have a vested interest in that property. The problem with letting them give you a force place policy is that policy only covers that structure. It doesn’t cover any of your contents. It typically doesn’t cover any other structures on the property such as swimming pools, detached garages, fences, and it typically is on an actual cash value basis, meaning if you’ve got a roof up there that has a 30 year shingle on it and it is 15 years old, and the insurance company depreciates it by 50% and takes out your deductible, you’re typically not going to be left with enough money to do your roof, because you do not get that depreciation back whenever you’re on a force place policy, unless you’ve got the Cadillac of force place policies, and I have seen a few of those.

Gary: I can imagine. These are lenders protection rights.

Stephanie: It is, and whenever that check gets cut, it does not go to the homeowner. If the homeowner is behind on their mortgage payment, that mortgage company has the right to use all of those funds to catch them up on their mortgage payment, rather than repair their home, which typically they don’t do because they’re trying to protect that investment. A lot of people now are starting to go with force place policies, and they’re not understanding that their property is not protected, the bank’s property is protected.

Gary: Correct me if I’m wrong. You’re probably paying more money for this particular policy in some cases, correct?

Stephanie: Believe it or not, unless you’re in a coastal or inland one area, typically your force place policy is going to run you the same as your state pool. So, if you would go with a state pool, Texas Fair Plan, then you would get your contents coverage, you would have coverage for your other structures, so it would be better to go with those.

Gary: Oh, okay. We’re recapping here with Stephanie Corona, ClaimsMate public adjuster, 281-231-9242 is the number that you can reach ClaimsMate. That’s 281-231-9242. Do you have a website that you want to give or not?

Stephanie: We do. It’s ClaimsMate, and that’s C-L-A-I-M-S-M-A-T-E, dot com.

Gary: Okay. We mentioned earlier, at least in the last show, is there a timeline for a public adjuster to help you?

Stephanie: Usually we like to be called in in the beginning. Like I said, if for nothing else, just to give you advice to start off with. But, we do have up to two years to go back and open a claim that even if you’ve closed it and settled it and you haven’t talked to them in six months, if you’ve got repair invoices that show you paid $50,000 and insurance only paid $30,000 and they’ve refused to pay the rest, we can still look at that documentation and try to get that covered for you.

Gary: Well, that’s good to hear. Recap duties, after loss to protect your claims status and ability to recover those funds.

Stephanie: It is very important that if you do not understand anything else in your policy, that you read the area that says your duties after a loss. One of them is to protect your property from further damage. We just had a tree fall on a house last week. They called us on Thursday. We were out there Friday morning. We had the tree company removing the tree from the structure, and we had a roofing company out there tarping that property because it was going to rain on Saturday. It was an 80% chance of rain. Had they left that tree on that property and that rain had gotten inside that home and they had not done anything to protect it, nothing inside of that home would’ve been covered from the rain damage on Saturday.

Gary: You’ve seen that.

Stephanie: I’ve seen it happen a lot. So, the very first thing you must always do is try to protect your property from further damage. The second thing you must always think about doing is in that policy language it states that you must sign a proof of loss within 90 days. They are starting to enforce that more and more. Used to be if they didn’t give it to you and you didn’t sign one and it came up six months later and you wanted to fight them for a little bit more money, that was not a big deal, but we are seeing now where if you did not file a proof of loss whether they gave you one or not, and you want to attempt to go after more money or reopen the claim at month six, they’re denying that ability because that proof of loss was not turned in within a timely fashion.

Gary: This incident that happened, when was it, last week did you say?

Stephanie: It was last week, yes.

Gary: Nobody got hurt.

Stephanie: Nobody got hurt.

Gary: Well, that’s good to hear. It does happen, though.

Stephanie: It does happen, and this is a very good case because this was a force place policy, and we had a very large home on eight acres, and the policy was only for the mortgage amount of $389,000. It had 10% coverage of $38,900 on a different house on the property. That is the house that the tree fell on. So, if it would’ve crushed that whole house, the most we would’ve been able to get that claim would’ve been $38,900. If the house would’ve burned to the ground, that would’ve been the most we would’ve been able to get them.

Gary: Wow, so there is a little closeness there, which way you’re going with it, right?

Stephanie: Exactly. So, it may seem like you’re getting a better deal with a lower price from the force place policy, until something like this happens.

Gary: How about what and how? How you’re spending your claim funds, and what are the consequences of not making those repairs from the money?

Stephanie: That’s another thing that we get called out on a lot.

Gary: It happens.

Stephanie: It happens. Let’s say the hail storm that came through Hitchcock four years ago, a lot of people got paid for a full roof replacement. Unfortunately, a lot of those people out there are elderly, they have higher deductibles, they’re on social security, so after you took out their deductible and after you gave them the opportunity to repair their roof, they probably did not do that. They probably kept that money to live off of, because their roof was not leaking. Then we had the hurricane come through, and half their roof got blown off, and guess what? They’re not covered anymore.

Gary: Really?

Stephanie: No, and nor was any of the damage inside their home covered.

Gary: Oh.

Stephanie: So, all of their belongings that got damaged, all of their cabinets that were destroyed, the half of the roof that is missing is no longer covered because they did not use the funds the first time to replace their roof.

Gary: We’re talking to Stephanie Corona at 281-231-9242. That is the number to call. If something’s happening, even during the show or maybe the last couple of weeks, you should get a hold of that number immediately, I would think.

Stephanie: Please give us a call. Like I said, we have no problem giving you information and education to start off with, and then we can help you if the insurance company doesn’t treat you fairly.

Gary: ClaimsMate public adjusters. That number again is 281-231-9242, and Stephanie, what are we going to talk about … What do you want to talk about when we come back?

Stephanie: We can take some phone calls or we can continue going down the road we’re going.

Gary: Okay. Fun, fun, fun. It’s Ask the Experts. Don’t go away. This is AM 700, KSEV, the Voice of Texas.

Gary: Hey, we’re listening to the music right now bringing us back to Ask the Experts. It’s ClaimsMate today, public adjuster Stephanie Corona is with us today, and that number is definitely 281-231-9242. We have a number that you can call us if you want to talk to us live, talk to Stephanie live. We’re 281-558-5738. That’s not my home number, is it? No. Sometimes you never know. 281-558-5738 is KSEV number, and you can give us a call anytime. I have a quick question here. Somebody called in and didn’t want to go on the air. They wanted to talk about the claim they have. Why can’t they use their own contractor to handle the claim?

Stephanie: That’s a very good question, and for a long time, contractors were able to go in and successfully negotiate a lot of good settlements for their clients. Recently, the state attorney general has decided that contractors cannot put themselves out there as an insurance specialist, and that the insurance company does not have to talk to a contractor ever on your behalf. So, if the contractor has decided they’d like to charge you $300 a square for your roof, but insurance has only paid you $225 a square for your roof, that contractor cannot get anywhere with the insurance company usually anymore. They can try to submit a supplement, but that insurance company is under no legal obligation to talk to them or negotiate with them.

The contractors that are still advertising that they are insurance specialists or that they can negotiate a settlement are actually breaking the law in the state of Texas now.

Gary: You brought up a good question about, well, I was thinking of hospitals, how the insurance company fights the … They have no problem. Maybe they do, but it looks like they settle for maybe 20% less than what the bill was.

Stephanie: That’s what was happening. It became more of a negotiation between the contractor and the insurance company for the lowest price, which meant that the quality of work that the contractor could do had to be lessened. So, they feel that if a public adjuster steps in and we just talk about the repair methods, nationally approved pricing, and the nationally approved software, then we’re paying the most that we actually can get for that roof, and then you can hire the best contractor out there and they don’t have to cut corners. So, your roof will not be leaking in a year from now.

Gary: That’s good news. Does my insurance adjuster handle my claim?

Stephanie: Your insurance adjuster, that’s what they call them, is actually your insurance company’s adjuster. Those adjusters that are out there are either staff adjusters that work directly for your insurance company, or they’re an independent adjuster that works for a from that is hired by nothing by insurance companies. Those insurance adjusters have to answer directly to the insurance company that you hired to represent you for your policy. They do not represent you, they do not have your best interest at heart, they try to do their job as best as they can, but a lot of times there’s somebody sitting out behind a desk that has not actually seen your property. So, they don’t know exactly what’s going on out in the field. They just know that maybe the photos weren’t good enough, maybe the explanation wasn’t good enough, but for whatever reason, they don’t agree with that adjuster that’s been out in the field, and sometimes when you thought you were getting $30,000, you end up with $15,000, and that would be the reason why.

Gary: Let’s go over this … Well, let’s take Harvey. Do they still have time to get a hold of you? Isn’t time running out?

Stephanie: We are definitely still working Harvey claims. We will be working them right up until the two year marker as far as I’m concerned. A lot of the adjusters that came in, the independent adjusters that did the initial inspections, came from other states because this was a very large storm and we needed additional help outside of the Texas adjusters. So, they’re gone back home, and we’re having to get new adjusters involved, and we’re definitely still getting new inspections and new things approved for some of these homeowners.

Gary: Wow. Speaking of homeowners, does the homeowners policy cover the flood?

Stephanie: A homeowners policy does not cover flood insurance. In fact, it won’t even cover it if it just got up to your doorway and the wind blew it underneath the door. You actually have to get a national flood insurance program policy, and that is run by the department of homeland security and FEMA. So, you’re really dealing with the federal government whenever you’ve got a flood policy. So, the rules on flood change drastically from any other type of homeowners insurance.

Gary: So, you probably run into a few people that don’t have flood insurance, especially in places where it wasn’t supposed to flood. I bet you’re having a lot of problems.

Stephanie: We have a lot of clients that don’t get flood insurance, and the one thing that I can tell you is if you are not in a flood zone, please, by all means, get a flood insurance policy. They are only about $300 or $400 a year, and it takes less than two inches of water to do over $100,000 of damage in a 2,500 square foot house.

Gary: Just because it says it’s a 100 or 200 year flood zone, it could turn around and do it within a month or two.

Stephanie: I’m sure there are at least a million people in the city of Houston alone right now that can tell you that. Just because they said it would never flood there, it actually did, so..

Gary: Have you ever had a claim that has been denied, and what can that person do about it?

Stephanie: Most of the claims that come to us, they’ve either been denied or they’ve been severely underpaid. We work them in a fashion that we’re successful about 95% of the time out in the field of getting successful settlement. There are times whenever engineers get involved and the waters get real muddy, and we are not successful. At that time, we’re surrounded by tons of great attorneys that work first party claims as the bulk of their business. They’re very knowledgeable. They’re surrounded by very educated and very knowledgeable people, and most attorneys work kind of like public adjusters do. They work off a contingency basis. So, they charge a percentage of whatever they’re able to get you.

Gary: So, why can’t I deal with the insurance claim myself? Why do I need a public adjuster?

Stephanie: Well, you can, but it’s kind of like dealing with the IRS by yourself. If you’re five years behind in your taxes, do you want to pick up the phone and call and talk to an IRS agent?

Gary: No.

Stephanie: Or would you like to pick up the phone and call a forensic accountant and say, “Hey, I’m in trouble, and I might need some help”? Your insurance policy is written in a way that is very confusing. They use a lot of ambiguous wording. They say it’s covered here, but then you get to page 60 and it’s not covered, and then there’s an endorsement at the end that may or may not cover it. Unless you read that policy language every day, all day long, it is very easy to get confused.

Gary: How about the insurance company that they have? Are they looking out for their best interest in any way?

Stephanie: Most of them are. They’re trying to do the right thing. I’m not going to sit here and say that every insurance company is bad. I’m not going to sit here and say that every public adjuster is good. Unfortunately, this has become a kind of feeding frenzy industry, so everybody’s got their fingers in the pie right now, from the insurance company to the adjusters to the public adjusters to the attorneys to the contractors. So, you need to make sure you surround yourself with people that are educated and that have a good team of solid referred people around them.

Gary: With that note, Stephanie Corona is taking calls. ClaimsMate public adjuster. If you need one, it doesn’t hurt to call.

Stephanie: No. We give out lots of free advice. In fact, I spend a good portion of my week answering emails and telephone calls from all over the country, where we help people for free because they’re unable to get a public adjuster in their area.

Gary: Stephanie Corona, thank you very much.

Stephanie: Thank you so much.


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