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Insurance Claim Basics

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Information about Insurance Claim Basics
Education

Published on February 2, 2009

Author: m1gold

Source: slideshare.net

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Insurance Expert, Author and Speaker Mark Goldwich explains the basics of property insurance claims.
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Insurance Basics by Mark Goldwich

Who is Mark Goldwich? What can Mark do to help us? Insurance Basics Did you know? “ 10 Commandments of Claims” Web resources Questions

Who is Mark Goldwich?

What can Mark do to help us?

Insurance Basics

Did you know?

“ 10 Commandments of Claims”

Web resources

Questions

Who is Mark Goldwich? Florida native – born in Miami, now in Jacksonville BSBA degree in Insurance, licensed since 1987 17 years with major insurance company Started Gold Star Adjusters, LLC. in 2004 Licensed Realtor ® , licensed private investigator, member of Jacksonville Chamber of Commerce, board member of Mandarin Council, member of WIND Network, member of NEFAR and NAR, Mandarin Council’s 2009 Small Business Leader of the Year

Who is Mark Goldwich?

Florida native – born in Miami, now in Jacksonville

BSBA degree in Insurance, licensed since 1987

17 years with major insurance company

Started Gold Star Adjusters, LLC. in 2004

Licensed Realtor ® , licensed private investigator, member of Jacksonville Chamber of Commerce, board member of Mandarin Council, member of WIND Network, member of NEFAR and NAR, Mandarin Council’s 2009 Small Business Leader of the Year

What is a Public Adjuster? Three types of adjusters – Staff, Independent, Public Staff – employed directly by insurance company Independent – works for a company outsourced by the insurance company (independent with respect to which carrier they work for, but they don’t work for policyholder) Public – hired by policyholder (you), exclusively represents only the policyholder, never the carrier – a public adjuster legally represents the policyholder, and prepares, submits, and negotiates the claim directly with the carrier on behalf of the policyholder in order to get the maximum settlement.

What is a Public Adjuster?

Three types of adjusters – Staff, Independent, Public

Staff – employed directly by insurance company

Independent – works for a company outsourced by the insurance company (independent with respect to which carrier they work for, but they don’t work for policyholder)

Public – hired by policyholder (you), exclusively represents only the policyholder, never the carrier

– a public adjuster legally represents the policyholder, and prepares, submits, and negotiates the claim directly with the carrier on behalf of the policyholder in order to get the maximum settlement.

How Can Mark Help? “ To educate insurance consumers, and use insurance expertise to effectively represent clients in maximizing their settlements, while minimizing their burden and frustration” Or, expressed as a mathematical equation…. Education + Money – (Burden x Frustration) Mission:

“ To educate insurance consumers, and use insurance expertise to effectively represent clients in maximizing their settlements, while minimizing their burden and frustration”

Or, expressed as a mathematical equation….

Education + Money – (Burden x Frustration)

Education + Money – (Burden x Frustration) = Happy Client ( Paid $219,000 more ! )

Happy Client

( Paid $219,000 more ! )

Other clients have received… Before $60,407 After $260,800 Change $200,392 Before $41,330 After $181,000 Change $139,669 Before $82,487 After $193,469 Change $110,882 Free Boat – if you can lift it!

This ‘before and after’ says it all… Before Gold Star After Gold Star $49,948 $170,000

Insurance Basics Did You Know? Insurance policy is a legal contract They write it, you agree to it when you buy it Not a guarantee you get paid what is owed You can negotiate your settlement Policies are subject to interpretation The catch: who knows more, you or them?

Did You Know?

Insurance policy is a legal contract

They write it, you agree to it when you buy it

Not a guarantee you get paid what is owed

You can negotiate your settlement

Policies are subject to interpretation

The catch: who knows more, you or them?

Basic Claim Problems Agents (or lack) – outsourcing, web-based Complex policies – even if you try to read Government trying to require simplified language Adjusters (human factor) – outsourcing, varying levels of experience, skill, motivation Fraud – so much that ins. co. employees get jaded, think ‘everyone’ out to fudge a little/lot Delays, Denials, Deflections (see my book)

Basic Claim Problems

Agents (or lack) – outsourcing, web-based

Complex policies – even if you try to read

Government trying to require simplified language

Adjusters (human factor) – outsourcing, varying levels of experience, skill, motivation

Fraud – so much that ins. co. employees get jaded, think ‘everyone’ out to fudge a little/lot

Delays, Denials, Deflections (see my book)

Did You Know? You can re-negotiate a claim after closed or denied (in Florida, up to 5 years later) Just because the insurance company sends an official letter stating the amount of loss, or denying the loss, complete with policy language – doesn’t make it so

You can re-negotiate a claim after closed or denied (in Florida, up to 5 years later)

Just because the insurance company sends an official letter stating the amount of loss, or denying the loss, complete with policy language – doesn’t make it so

Did You Know? You should not think of yourself as the customer or client (you’ll be disappointed) Consider yourself a legal adversary The adjuster does not work for you You don’t “pay their salary” You are not their neighbor, you are not in good hands, they are not on your side

You should not think of yourself as the customer or client (you’ll be disappointed)

Consider yourself a legal adversary

The adjuster does not work for you

You don’t “pay their salary”

You are not their neighbor, you are not in good hands, they are not on your side

Did You Know? In 2005 (the year of Katrina), insurance industry profits were $44 B! Was it because Katrina came late in 2005, and carriers didn’t pay claims until 2006?

In 2005 (the year of Katrina), insurance industry profits were $44 B!

Was it because Katrina came late in 2005, and carriers didn’t pay claims until 2006?

In 2006, profits actually rose to $65 B ! but…. Profits in 2007 dropped to less than $62 B how will the insurance companies survive?

In 2006, profits actually rose to $65 B !

but….

Profits in 2007 dropped to less than $62 B

how will the insurance companies survive?

But what about all those images?

But what about all those images?

Out of the estimated… $30 Billion - $50 Billion in FLOOD losses Some uninsured Some self-insured Some unclaimed (dead owners or abandoned properties) Some public or governmental properties Vacant or undeveloped land How much did the insurance industry pay?

Out of the estimated…

$30 Billion - $50 Billion in FLOOD losses

Some uninsured

Some self-insured

Some unclaimed (dead owners or abandoned properties)

Some public or governmental properties

Vacant or undeveloped land

How much did the insurance industry pay?

ZERO! Insurance companies don’t pay for flood damage Flood insurance is a Federal policy Insurance companies get paid to sell and handle flood claims for the government

Insurance companies don’t pay for flood damage

Flood insurance is a Federal policy

Insurance companies get paid to sell and handle flood claims for the government

Finally - Did You Know? As an apartment owner or renter, you can collect insurance money on damages to your property, even if you don’t have insurance, or don’t want to submit a claim on your own insurance By pursuing the insurance of another owner or renter (or the building owner/mgt. co.)

As an apartment owner or renter, you can collect insurance money on damages to your property, even if you don’t have insurance, or don’t want to submit a claim on your own insurance

By pursuing the insurance of another owner or renter (or the building owner/mgt. co.)

“10 Commandments of Claims” 10.Know your insurance policy - meet with your agent and have them explain it to you; make sure you have the proper coverages, endorsements, limits, and deductibles Consider buying a flood policy if you don’t already have one (Just because you aren’t in a flood zone, doesn’t mean you won’t get flooded. Flood zone maps are revised by the government. If you trust their accuracy now, you may be one of thousands filing for government assistance later. Think about it, we are surrounded by water. I don’t care what the flood map says, I have flood insurance.) 8. Take photos or video of valuable possessions, and store important documents where they can’t be damaged 7. Don’t try to pull one over on your insurance company – be thorough, but honest - it’s just not worth risking a felony conviction 6. Take notes of everything that’s damaged and keep a detailed log of all conversations with your insurance company, your contractor, and everyone else

10.Know your insurance policy - meet with your agent and have them explain it to you; make sure you have the proper coverages, endorsements, limits, and deductibles

Consider buying a flood policy if you don’t already have one

(Just because you aren’t in a flood zone, doesn’t mean you won’t get flooded. Flood zone maps are revised by the government. If you trust their accuracy now, you may be one of thousands filing for government assistance later. Think about it, we are surrounded by water. I don’t care what the flood map says, I have flood insurance.)

8. Take photos or video of valuable possessions, and store important documents where they can’t be damaged

7. Don’t try to pull one over on your insurance company – be thorough, but honest - it’s just not worth risking a felony conviction

6. Take notes of everything that’s damaged and keep a detailed log of all conversations with your insurance company, your contractor, and everyone else

…claim commandments 5. Show the adjuster all the damage and be as thorough as possible - if the adjuster doesn’t want to spend to time to review it all, have them come back when they will 4. Review the adjuster’s estimate in detail, until you understand it completely 3. Request a licensed contractor review the insurance company estimate and provide an independent quote 2. If the insurance company refuses to pay for anything, demand they explain why – in writing 1. Be persistent and don’t give up - appeal up the chain of command And, my ‘bonus commandment’ – Seek professional assistance when needed (GC, acct, atty, PA)

5. Show the adjuster all the damage and be as thorough as possible - if the adjuster doesn’t want to spend to time to review it all, have them come back when they will

4. Review the adjuster’s estimate in detail, until you understand it completely

3. Request a licensed contractor review the insurance company estimate and provide an independent quote

2. If the insurance company refuses to pay for anything, demand they explain why – in writing

1. Be persistent and don’t give up - appeal up the chain of command

And, my ‘bonus commandment’ –

Seek professional assistance when needed (GC, acct, atty, PA)

Useful Web Sites KingOfClaims.com – Mark’s site insure.com – for ins. quotes and info AMBest.com – source for ratings, news, and financial data on ins. co.s naic.com – insurance info for consumers iii.org – goal is to improve public understanding of insurance fldfs.com – FL Ins. Dept. - request assistance, file complaint, verify adjuster/company info **All of these and many more links on Mark’s site

KingOfClaims.com – Mark’s site

insure.com – for ins. quotes and info

AMBest.com – source for ratings, news, and financial data on ins. co.s

naic.com – insurance info for consumers

iii.org – goal is to improve public understanding of insurance

fldfs.com – FL Ins. Dept. - request assistance, file complaint, verify adjuster/company info

**All of these and many more links on Mark’s site

Want To Learn More? I took my…. 20 years of claim adjusting experience For a major insurance company, traveling the country handling thousands of insurance claims And as a consumer advocate, getting millions more for my clients … .and I wrote my own book. Its easy to read and understand, shows what the insurance companies do, how they do it, why they do it, and what you can do about it - to get everything you deserve! Available at great price – just $10

I took my….

20 years of claim adjusting experience

For a major insurance company, traveling the country handling thousands of insurance claims

And as a consumer advocate, getting millions more for my clients

… .and I wrote my own book. Its easy to read and understand, shows what the insurance companies do, how they do it, why they do it, and what you can do about it - to get everything you deserve!

Available at great price – just $10

Thank you for watching! Wishing You More ! Mark Why Pay $12.95 Amazon Price (plus shipping)? Get It From My Website For Only $10 (and I pay the shipping) www.KingOfClaims.com Copyright © 2009 Mark Goldwich DFS Lic. # A099530

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