How does the insurance company justify adding O&P to everything except the roof? To understand this question, you must first know what O&P means. In the insurance industry, Overhead (10%) and Profit (10%), commonly referred to as O&P, is owed when it becomes necessary to have multiple subcontractors perform work to repair damages to your property cause by a covered peril in the policy.
Your policy provides coverage for the cost to repair or replace the property damaged by a covered loss. Although not generally stated, this includes the cost of O&P. So, while your coverage includes this additional expense, many insurance companies use the benchmark that it is only owed if more than three trades are involved in the repair process. However, there is no binding authority on the 3-trade rule and the truth is that almost every property loss involves multiple trades. When you have a hail claim, it isn’t just the roof that is damaged.
Once you have a clear understanding of what O&P is, then it is easy to see where the question comes into play. How does the insurance company justify adding O&P to everything in their estimate except for the roof itself? The roof is the single most expensive item on the estimate most likely. By excluding O&P on this one item, it just saved the insurance company a bundle of money at the expense of the insured. Now multiply this by the number of claims just in your area and you get the picture.
Another excuse the insurance companies use is that they will pay the O&P if you can prove that the charge was actually incurred. However, there is absolutely nothing in the policy that states that O&P is only paid when incurred. In fact, it discredits the insurance adjuster’s estimate when they attempt to allow for O&P on everything except for the roof. It gives the appearance of an obvious money-saving technique when included on everything except the big-ticket item. The purpose of O&P is so that the policyholder can hire one general contractor to coordinate all repairs. That includes the roof.
It takes a licensed professional to sort through these types of issues and make sure that the policyholder isn’t being given less than they deserve.
Lots of news coming from Texas this week as the battle in Austin continues over the Hail Storm Bill (Blue Tarp Bill) (SB 10). Big insurance companies are the only beneficiary of passage of this bill.
“The easiest and most effective way to make more money is to increase premiums, to pay less on any claim, and to kill all the lawyers.” by Dale F. Kelly, Corpus Christi (Texas Trial Lawyers Association)
“Businesses can’t afford this brand of ‘tort reform’.” By David Loeb, Corpus Christi (Texas Trial Lawyers Association)
Consumers and business property owners need to be aware of what is going on and let your voices be heard before it is too late.
The adults are getting in on all the fun when it comes to personal drones. It was only a matter of time before the insurance industry found them useful too when assessing property damage insurance claims. From surveying the damages caused by storms, to inspecting roofs, to taking an inventory on insured crops, the drone has found its place in the business.
Allstate Insurance Company is using drones in Texas to conduct home inspections in the hail swaths. This is an effort to quickly handle more claims. Their plan is to compare the photographs taken by the drones to those already taken by field adjusters on the ground. Their intent is to free up more time for the adjusters to take care of other aspects of the claim all the while staying safer by not climbing ladders and onto roofs. Farmers Insurance says “we’ll get a faster inspection.” They say “it could take an adjuster a few hours to inspect this roof where a drone could do it in 20 minutes.”
Is this truly what is best for the policyholder, a faster inspection? And will this savings in time for the insurance company result in lower premiums for the policyholders? I think we all know the answer to that question. Nothing can replace the human eye when it comes to a thorough inspection of storm caused damage, especially hail damage. A lot of times, it is difficult to depict the damage from photographs taken by an adjuster who is actually on the roof. I can’t imagine that photographs taken using a drone would make this anything but more difficult.
A spokesperson from the Insurance Council of Texas believes that “the ladder might soon be a thing of the past.” Just another reason the policyholder is going to require the services of a licensed public adjuster to get a thorough inspection and estimate of the damages. If your insurance adjuster isn’t going to get on the roof, your public adjuster definitely is.
I’m always telling people to choose their battles. Whether it comes to your kids or other family and friends (or even work), there’s no need to be the devil’s advocate all the time. When it comes to a property damage insurance claim, it can certainly turn into a battlefield and it’s no fun. However, this is a battle worth taking on and it’s important to know what to do to minimize your stress and maximize your claim settlement which means getting what you are owed under the terms of the policy.
In this situation, it is always best to have a licensed professional on your side, especially when you are battling with an insurance company. You have the right to bring in a licensed public adjuster to represent your side of the claim. Here are a few of the tell-tale signs that make it important to secure the services of a claim professional:
• Documenting the damages. Most property owners don’t have the experience to recognize property damage or what to look for besides the obvious. An insurance company has an entire team of claim professionals protecting their interest – shouldn’t you? A licensed public adjuster is your team. A public adjuster is trained in policy coverage and most have worked at one time or another for an insurance company and therefore know the business from the inside out. A claim can quickly turn complicated and it will become crucial to have a knowledgeable claim professional on your side.
• Terms of your coverage. Some agents don’t even fully understand the terminology used and scope of the coverage they are selling, so how on earth are you expected to. Even just the basic terminology used in a policy is confusing and causes a need for interpretation. A licensed public adjuster is trained to interpret the coverage for you and decipher the exclusions and endorsements. This can be key to determining whether there is coverage or not based on the peril causing the damages. A denial of coverage is bad news and certainly deserves a second opinion of a licensed professional who works for you the policyholder.
• Who has time to deal with the claim process? You have a job and kiddos to run around. The last thing you need to add to your to-do list is an insurance claim. A licensed public adjuster does the work for you alleviating the stress and time from your plate. This is particularly valuable when you consider having to make yourself available for every adjuster meeting, inspection, and expert visit for viewing the property. The time it takes to document the claim and then navigate through the process is reason alone to hire someone to do it for you. This becomes especially certain when dealing with a fire or flood claim and having to put together an inventory of contents affected by the event.
• Insurance company is working at a snail’s pace. A property damage claim can become a lengthy process when an insurance company drags its feet and keeps you hanging. This can be especially frustrating when your property is a wreck or at risk of additional damage because of exposure. A licensed public adjuster can be the force behind pushing the claim through at a more reasonable pace.
A beating heart is the tell-tale sign that a public adjuster is needed when it comes to property damage insurance claims – the indicator, signal or sign that conveys the status of a situation. You’re not alone and life is too short to spend it fighting battles. Contact a licensed claim professional to evaluate your claim and help protect your most valuable assets.
Often we have a potential client call after they have visited with their insurance agent or maybe even their contractor or roofer. They question us specifically on why to hire a public adjuster. Usually this means they have already been told by one of the foregoing not to hire a public adjuster. Let’s just say that, in our opinion, if someone is telling you not to hire a public adjuster, then most likely that person views them as a nuisance to their work or has maybe had a bad experience in the past with one. Either way, there is a motive for this suggestion and, like any other profession, there are good ones and bad ones.
What you need to know is that a public adjuster is required to be licensed by the department of insurance in each of the states they work. The job of the public adjuster is to conduct a thorough inspection of the damages and to put together an estimate that fully encompasses the scope and costs of all repair. They are also going to do their best to protect you from any unnecessary costs that might be suggested by the insurance adjuster. Having someone who works exclusively for you also means that you have a licensed professional to manage and negotiate the claim start to finish, relieving you of much time and stress in a process that you have little or no experience with.
A licensed public adjuster also knows there is much more to hail damage than just your roof — windows, gutters, vents, siding, etc. Specifically, a roofer is most likely going to be advising you about just the roof and absolutely is not licensed to negotiate your claim with the insurance company and in fact is barred by law from doing so. A public adjuster is trained in policy coverage and knows the tricks of the trade. They most likely have previous experience working for an insurance company and know the business from the inside out.
The insurance claim process is not a fun one for sure. Just another reason for you to reach out to a licensed public adjuster in your area or another qualified claim professional and get the answers you need to get the settlement you deserve.
The unauthorized practice of public adjusting (“UPPA”) is alive and well. From those contractors and roofers who straight up tell the policyholder they don’t need the help of a public adjuster to those husband/wife teams where one is the public adjuster and the other is a contractor (who are they kidding). There is a reason these practices are unethical and in some states against the law — it protects the policyholder from someone with an obvious conflict of interest and who is not qualified to give a thorough opinion. UPPA is a vehicle for fraud and takes advantage of the insured when they are most vulnerable. Far worse is when the perpetrator leaves the property owner in worse condition than before the damages occurred, particularly when these insureds are the elderly and/or non-English speaking.
Some public adjusters who began their careers on the insurance side know firsthand about the love insurance companies have for UPPA, and how they even encourage it. Lots of insurance adjusters are instructed by their company to make sure the policyholder’s contractor is present for the inspection. This is because they KNOW that the contractor is not allowed to participate in the negotiation. Why would that make any sense? Well, the insurance companies want the contractor to be present for the inspection and meeting with the insured so that they can then tell the property owner “sure, take that and we can get it done for that.” If the policyholder feels confident they can get the work performed for the amount the insurance company is offering, then good deal, right? No, not good deal. What about other damages that have occurred that the contractor isn’t worried about and neither is the insurance adjuster? Your public adjuster would make sure that ALL damages sustained and covered by the policy are addressed.
There is a reason that one must be licensed to handle public adjusting. These claim professionals are regulated and require proper training and certification to be licensed to negotiate a claim on behalf of the policyholder. They have no affiliation with an insurance company whatsoever and therefore work independently solely for the insured, alleviating the conflict of interest when one tries to negotiate on behalf of both sides, which quite frankly cannot happen. You must pick a side and advocate for that side. In other words, if you are wearing an Allstate shirt then you are advocating for Allstate. A public adjuster is licensed and bonded and requires adequate training and certification. They are your exclusive representative and, with their experience and knowledge, they are more likely to obtain a favorable settlement of your claim.
With so many out there preaching that you don’t need a public adjuster or that a public adjuster may not be your best choice, it leaves one to wonder why do I need a public adjuster after all? The insurance company is like any other business. They are going to attempt to get out as cheaply as they can. The public adjuster is there for you to make sure that the insurance company pays what is owed on the claim based on the coverage you have paid for.
You pay a premium for this coverage and it only makes sense that you be compensated accordingly. It makes sense to consult with or hire a public adjuster to make sure the claim is handled properly. Only a public adjuster or attorney are legally licensed to represent you in the negotiation of your claim with the insurance company.
A recent article by the Fort Worth Star-Telegram concerning SB10 proposing constraints on litigation surrounding hail claims in Texas includes some interesting numbers. According to the data contained in the article, there were nearly 400,000 hail claims filed in Texas in 2015 which resulted in 9,910 lawsuits. You do the math – that is a mere 2.4775%.
Based on these numbers, do we really need any legislative remedy?
The insurance companies want you to believe the claims that result in litigation are the cause of higher premiums and/or cancellations. Some of those companies even use the threat of pulling out of the state completely which they say would also result in an increase in premiums and narrow the pool of insurers to choose from.
Senate Bill 10 is not good for the Texas consumer and is yet another attempt at placing constraints on the consumer when it comes to being paid properly on a claim. Although more streamlined than previous attempts, SB 10 is still too broad and does nothing more than help pad the insurance industry’s pockets.
Hail Storm Senate Bill 10 pending in Texas as a result of complaints and lawsuits filed following the major hail storms across South Texas. Texas Watch group is responding and calls these storm bills “tornadoes that are bearing down on every property owner in this state.” The passage of these types of bills would result in the policyholder being limited to whatever the insurance company says is right or good.
“He who represents himself has a fool for a client.” — Abraham Lincoln
This phrase remains as applicable today as it was 200 years ago when said. Mostly attributable to Abraham Lincoln, the above quote may have had earlier origins. In the context of our famous President, who was also a lawyer, he means that a lawyer should not represent himself or herself in court. The overriding principle is the loss of objectivity, the inability to see both sides of the equation, and, worse, to be consumed with punishing a perceived wrong.
However, the above quote also has universal application. Stated alone, you are taken more seriously when qualified people speak for you. Fundamentally, it relates a perception that you have other people on your side, which is important because it often feels like a David v. Goliath situation. Also, it sends a message that you are willing to take this matter further if needed.
In litigation, a qualified attorney is a necessity. Your chances of being taken seriously without are slim to none. Interview as many as possible and retain the one who has the factual and legal capacity to understand the claim, has the resources and time to do so, and most importantly, cares about you as a client.
While the right to represent oneself is provided for in both civil and criminal proceedings, legal matters can be complex and quite the challenge for someone with no formal education or training in the law. We are all human and humans have emotions. Emotions can cloud even the best of judgment, especially when you are talking about things of financial nature. When personally invested, emotions combined with the complexities of the situation make it obvious that professional help is necessary.
Another layer to personal representation to consider is, whether you’re hiring a property damage attorney or a licensed public adjuster, the experts are an important piece of the puzzle. For litigation purposes, anything outside of “common knowledge” requires the hiring of an expert. Specialists and/or experts have one thing certain in common, years of education and training in their area of expertise that can be used objectively in the given situation.
Representing oneself is likely to end badly. Just because you have the time to handle a complicated property damage claim on your own absolutely doesn’t mean that you should. Attorneys who handle these types of cases work on a contingency fee which means you have no out of pocket expenses and they get paid when the case is settled. So, if you aren’t paying anything out of pocket, then why wouldn’t you hire an experienced attorney to handle the matter for you?
The death toll continues to climb as we emerge from a weekend filled with severe weather and tornadoes. From Mississippi to Georgia, storms pounded the area with heavy rain, high winds, and one of the worst tornado outbreaks seen. A state of emergency has been issued in Georgia and Mississippi as authorities report at least 15 deaths in Georgia alone.
Florida apparently was not spared from the devastation as tornado rips through Palm Beach damaging school district and other properties. The homes and properties there are generally built to sustain hurricane force winds, but that didn’t protect them from these severe storms.
If you find yourself in a situation like this, there is help. Find a public adjuster or other claim professional near you to handle your insurance claim. You have enough to worry about without the added burden of insurance.
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