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Episode 45: Episode 45 – Insurance Claim Estimates Change & Are Supposed to!
- 2023/06/02
- 再生時間： 33 分
- ポッドキャスト
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あらすじ・解説
Media coverage has intensified over an allegation by three independent insurance adjusters that Florida property insurance companies are cheating their policyholders out of rightful claim payouts. The three accuse the industry of altering their field adjuster reports and reducing claim payouts – all without their knowledge or approval. Former Florida Deputy Insurance Commissioner Lisa Miller sat down with two independent field adjusters and an attorney who represents insurance companies to learn their perspective and just how damage claims – and their payouts – are ultimately decided and by whom. Show Notes The three adjusters and their allegations first appeared in public last December to testify during the Florida Legislature’s special session which resulted in a series of new consumer insurance reforms. The reforms included the end of one-way attorney fees for property insurance lawsuits, the end of Assignment of Benefit contracts, and a further tightening of claim practices, among other things. These were all abusive practices by bad actors against insurance companies and policyholders that were blamed for driving up the cost of insurance and creating market turmoil. (For full Show Notes, visit https://lisamillerassociates.com/13875-2/) Shawn Kelliher of Cape Coral is a 16-year veteran in the insurance adjusting business. His first 13 years were working for Farmers Insurance Company as a desk adjuster and then as a catastrophe field adjuster, including large loss and complex claims across the country. He said “it’s absolutely not the case” that insurance companies are out to get everybody and explained that there are many legitimate reasons why field damage estimate reports change. Field adjusters often don’t know what damage is covered by the insurance policy. “Some policies have actual cash value only coverage, some policies have specific exclusions for certain items and a lot of times we don't know that,” Kelliher said. “So we see and document the damage and that goes in our report and that’s sent up (to the independent adjusting firm or insurance company), only to be later found out that, unfortunately, in those circumstances where they (the policyholders) don't have coverage, those items have to be removed or taken out of the estimate. And it's not a malicious situation,” the Naples, Florida native said. Kelliher said he’s seen it many times over the past three years that he’s been an independent adjuster in Florida. He said he works for a variety of adjusting firms and across a vast array of insurance carriers, doing both residential and commercial work. Vanessa McGonigal, an independent field adjuster from Cooper City agrees. Often times, she said she is not aware of any changes that may take place in the final adjusting report on a claim. “If we're preparing an estimate for all of the damages we see and we submit that and coverage is not afforded for something written on our estimate, where is it that we should give permission to have that removed? If it's not covered, it's not covered,” McGonigal said. She began her career in 2009 as an estimator for a general contractor and then five years ago, became an independent field adjuster. She said she has worked for a couple of independent insurance adjusting firms, doing both residential and commercial claims, including from Hurricane Ian.Both McGonigal and Kelliher said that if there is a change to the estimate, sometimes they make it, sometimes their adjustment firm does it, or the desk adjuster at the insurance company, depending on the change and the situation. “They'll call me and say, ‘Hey, you know, I read your report, I saw your photos, this is what I was thinking. Can you kind of explain your thought process here or justify what it is that you put in your estimate?’ and we’ll have a conversation about it,” said Kelliher, who has worked “several hundred” Hurricane Ian claims. “And ultimately, again, ultimately, it's the carrier's determination of coverage. As independent adjusters, we have zero claims authority to extend coverage. The adjustments that are being made, are to bring the estimate accurate, or in line with the policy or coverages as endorsed.”McGonigal outlined the steps she takes as a field adjuster from the time she is assigned the claim to delivering her report on damage. She said her typical day could include handling up to 15 Hurricane Ian claims. That doesn’t leave a lot of time – nor should it – for follow-up, unless there’s a question or a dispute about damages, the Hollywood native said. Robert Schulte is an attorney with the Louisiana-based Monson Law Firm, working in its Florida office. He has represented Florida insurance companies in homeowners and commercial insurance matters since 2012 and is skeptical of the three adjusters’ allegations against the industry. “In the weeks before ...