Claims management?

Hey guys! Newb to the site and wanted to pose a question. Our company is a start up in central Florida and we’re looking to ask opinions from roofing contractors since you guys will be our customers. Our company is a professional claims management company for contractors. Our process includes evaluating claims to ensure everything is being paid as it should be and adding items that the insurance company has disregarded this includes actual items from the project and additional line items such as contractor o/p etc etc. Then we handle all of the middle work of dealing with the insurance company to ensure they pay every dollar that they should. We also manage the claim from start to finish meaning you don’t have to deal with arguing with the insurance companies anymore we will do the proper research into building codes and department of insurance statutes to make sure they pay. This also mean salesmen don’t have to spend hours each week managing claims they can be selling more jobs with that time. By doing this we are adding additional profit to every job and cutting down wait time for final insurance payments all while increasing productivity. In theory you have a full time claims manager without having to come up with the salary for one. We do all of this on a percentage basis per claim. So far we’re seeing an average of $1500 added per claim and cutting payment time in half… So it’s going very well and we simple want your thoughts is it a good idea, would you work with someone like us, what would you be willing to pay (percentage, flat fee, monthly payment etc etc) we want to be the best and our entire concept is to be a help to you guys. If we aren’t helping you then it doesn’t make sense. We know this won’t be for every contractor some have the resources to hire their own people but many don’t so they have someone that has no idea what they are doing to manage claims and they waste time and don’t recover the amounts they could or they make salesmen do it which loses them sales because the salesmen can’t do two things at once. Give me your thoughts!

Just wanted to make sure you guys know this isn’t spam or anything were seriously looking to get feedback from roofing professionals…

It sounds to me like you are advertising public adjusting services. Are you licensed to do that?

We will not be doing the adjusting we will not be on site. All of our efforts will be comparing the insurance scope to the sales men’s reports, xactimate, local governing codes, and expediting the claims process by being in constant contact with the insurance company.

Construction market Contractors do not need insurance claim management services - Since they do not manage loss claims. They manage insured property repairs that their clients have a loss claim on. And all that that requires is meeting with an insurance adjuster that has a mature understanding of the reconstruction business market…And is not influenced by illegal market practices.

And that’s not public adjusting?

Here’s some feedback…what’s your company name? I’d like to turn you in for the unauthorized practice of public adjusting. You couldn’t be in further violation.

I will watch for a similar blog post about you in the months ahead…

propertyinsurancecoveragelaw … adjusting/

From your video it looks like you are a nice kid, but your business model is just flat out clearly in violation of the law. Stop now before you end up in hot water.

To answer your questions yes we have licensed adjusters on staff. So there will be no article and your threats are not appreciated. You do not know me nor do you have an insight into our business plan outside of the brief description I gave I asked for opinions I didn’t ask for judgement argumentative attitude… If you felt we were in danger of doing something wrongfully you could have approached it from an educational helpful stand point but you didn’t and that’s ok we are well within the legal confines of the law and we are more than well versed in the governing laws. Thanks again for you input

You made me feel bad. So I went back and read your posts again and took a look at your youtube videos (by the way, your new one has a typo in the titles).

But then I didn’t feel so bad. Did you do any due diligence before putting together this business? If you have “licensed adjusters on staff”, are they licensed public adjusters? If so, they obviously would know that there are regulations on what PAs can charge. They would also know that they have to have contracts with building owners and not roofing contractors. I can’t imagine any licensed public adjuster signing up for this business model.

Or perhaps your “licensed adjusters on staff” are not licensed PAs but general P&C licensed adjusters. If that’s the case, they should know that they cannot negotiate claims on behalf of building owners without a PA license. Or, they should know that roofing contractors cannot, using your own words, “comparing the insurance scope to the sales men’s reports, xactimate, local governing codes, and expediting the claims process by being in constant contact with the insurance company.” That, my friend, is public adjusting. Same as the description of your services in your youtube video, which clearly crosses the public adjusting line.

Sorry to burst your bubble. But you’ve stepped right in it and at a time when “it” is really stinky.

And sorry to be an a__hole, but every day I deal with guys like you trying to inject themselves into the insurance industry for the sole purpose of bleeding into their pockets a piece of a homeowner’s claim.

I’ll be watching your web site, as I suspect will the Florida Department of Financial Services.

There. Now you have my “educational helpful stand point” as well.

IP, I’m not going to waste my time watching this guy’s videos as we definitely don’t need their assistance with the insurance jobs we work on. I’m just wondering if what these guys are attempting to do is sell their services to “insurance challenged” Contractors who are essentially clueless when it comes to preparing a proper insurance estimate and/or supplement? If that is the case, I fail to see how they are in violation of anything. In essence, they could simply be the Contractors subcontractor for preparing estimates and supplemental estimates. Or if you prefer, a consultant. As long as they aren’t directly contacting the insurance company and are only working with the Contractor, I don’t see how that is a violation.

And once again, as I’ve stated to you many, many times, if all the stinking crooked Adjusters out there would simply write fair and reasonable estimates, these types of services would be entirely unnecessary. I’m not saying two wrongs make a right but perhaps part of your “Perspective” should be to understand and comment on the underhanded tactics and bad faith claim practices your peers are performing each and every day.

[quote=“Authentic_Dad”]IP, I’m not going to waste my time watching this guy’s videos as we definitely don’t need their assistance with the insurance jobs we work on. I’m just wondering if what these guys are attempting to do is sell their services to “insurance challenged” Contractors who are essentially clueless when it comes to preparing a proper insurance estimate and/or supplement? If that is the case, I fail to see how they are in violation of anything. In essence, they could simply be the Contractors subcontractor for preparing estimates and supplemental estimates. Or if you prefer, a consultant. As long as they aren’t directly contacting the insurance company and are only working with the Contractor, I don’t see how that is a violation.

And once again, as I’ve stated to you many, many times, if all the stinking crooked Adjusters out there would simply write fair and reasonable estimates, these types of services would be entirely unnecessary. I’m not saying two wrongs make a right but perhaps part of your “Perspective” should be to understand and comment on the underhanded tactics and bad faith claim practices your peers are performing each and every day.[/quote]

Dad, if they are only working behind the scenes with the contractor, then that’s the contractor’s business. He can hire whoever he wants to help him. But I did take the time to read Pro’s posts, view his videos, and check out his tweets. No doubt his business model is to handle all the communications with the insurer. And that aint allowed.

Pro? Where are you? You’ve gone silent. Did you decide to finally read the law? Realize your business model is illegal I assume?

Also, Dad, sd to your concern about insurers’ estimates, I cannot defend the entire industry. No doubt you get some lowballs. But I will tell you, in all sincerity, that my experience with most of the commercial industry is that when there is damage the insurers step up and write an estimate that they think reflects the reasonable cost of repair. I recognize that phrase is wide open to interpretation. So thats why, as you all know, I get real bids to establish cost of repair. Really makes my life easier.

IP, I guess it would depend on the content of those communications. Assuming the Homeowner is aware of the Contractor utilizing this third parties services, what is illegal about this company preparing an estimate, submitting it to the insurance company and discussing the line items? While I don’t agree with 99% of the stuff CC puts out, I do agree there is a significant difference between negotiating and discussing the validity and applicability of line items on an estimate. Since it is clear many Adjusters are either crooked or incompetent, based upon the estimates I see them write and the statements they make when attempting to deny certain justifiable line items, how else is the Homeowner going to be sure they are getting all the line items they need on their scope of loss to properly restore their property?

Have you stopped to consider, just for one freaking second, that your companies and peers are the ones essentially breeding these types of claims services companies and the growth of Public Adjusters? If the Insurance Companies/Adjusters would simply write their own estimates, in good faith, and respect Professional, Competent Contractors and fairly consider their professional recommendations, in good faith, there wouldn’t be a need for these companies and Public Adjusters would be utilized in the manner I believe they were originally intended for. IMHO, the Insurance Company’s greed and corruption have let a genie out of the bottle they’re going to wish they could stuff back in somewhere down the road. Of course, the Executives of these Insurance Companies realize that will be several years down the road, when they see the impact of that, which will be after they’ve received several years of large performance bonuses and stock options. The same stupid, greedy and short sided thinking that bankrupted General Motors and Ford and has essentially eroded the Manufacturing strength of our Country. But who gives a chit when an Executive can dictate orders that screws hundreds of thousands of their policy holders when they can spend a few million on lobbyists to control the Federal and State Lawmakers and put a few extra million in their own bank accounts.

I do very little Commercial Work and when we do, it is quite small. Therefore, I can’t comment one way or the other on how that side of the business works with respect to the way insurance companies work with their Customers or Contractors. Given the magnitude of the claims and the dollars involved, I have no reason to think there is much difference. Frankly, since I’m not involved in it, at this point, I don’t care.

No I have not in your words gone silent, I will reply in my time. Unfortunately I do not have the time to wait around for you to reply and then jump at the opportunity to argue with you. I am fully aware of the laws governing the arena we are stepping in. I have done my fair share of research and had direct communication with the right parties to determine the actual interpretation of the laws not someone’s personal interpretation. We are well within our rights. Roofing contractors everyday make contact with insurance companies which is well within their right being they are responsible for completing the scope of work outlined by the insurance company. They do not need to be an adjuster of any kind to reach out to the insurance company and being we will be acting on behalf of the contractor seeing as they do not have the staff to accommodate such claims management we will do it for them. We are simply taking what the insurance company has supplied (the scope) comparing it to industry standard estimating software to determine everything lines up to what in fact is found by the contractor and current pricing. We also provide any assistance the insurance company needs for example I don’t know how many claims get held up by needing a signature that someone missed and we all know the insurance company is not going to reach out and ask for the signature they will wait until the contractor calls to ask where the final check is to then say “oh we haven’t sent it because we need this or that signed” I want to thank AD for his input, we formed this for the exact reasons he stated I’ve been in this industry 10 years and have had numerous adjusters short change my clients and delay payments over nonsense and many contractors especially smaller or mid sized companies do not have the staff or resources to accommodate this constant insurance claims management. IP, tell me this what makes what we are offering any different than a roofing companies sales person making contact with the insurance company? Most salesmen are contract personnel 1099 or a contractors accounting department reaching out to the insurance company to handle claims none of them are requires to be adjusters?

[quote=“InsurerPerspective”]

[quote=“Authentic_Dad”]IP, I’m not going to waste my time watching this guy’s videos as we definitely don’t need their assistance with the insurance jobs we work on. I’m just wondering if what these guys are attempting to do is sell their services to “insurance challenged” Contractors who are essentially clueless when it comes to preparing a proper insurance estimate and/or supplement? If that is the case, I fail to see how they are in violation of anything. In essence, they could simply be the Contractors subcontractor for preparing estimates and supplemental estimates. Or if you prefer, a consultant. As long as they aren’t directly contacting the insurance company and are only working with the Contractor, I don’t see how that is a violation.

And once again, as I’ve stated to you many, many times, if all the stinking crooked Adjusters out there would simply write fair and reasonable estimates, these types of services would be entirely unnecessary. I’m not saying two wrongs make a right but perhaps part of your “Perspective” should be to understand and comment on the underhanded tactics and bad faith claim practices your peers are performing each and every day.[/quote]

Dad, if they are only working behind the scenes with the contractor, then that’s the contractor’s business. He can hire whoever he wants to help him. But I did take the time to read Pro’s posts, view his videos, and check out his tweets. No doubt his business model is to handle all the communications with the insurer. And that aint allowed.

Pro? Where are you? You’ve gone silent. Did you decide to finally read the law? Realize your business model is illegal I assume?

Also, Dad, sd to your concern about insurers’ estimates, I cannot defend the entire industry. No doubt you get some lowballs. But I will tell you, in all sincerity, that my experience with most of the commercial industry is that when there is damage the insurers step up and write an estimate that they think reflects the reasonable cost of repair. I recognize that phrase is wide open to interpretation. So thats why, as you all know, I get real bids to establish cost of repair. Really makes my life easier.[/quote]

Commercial vs residential…

Likely, adjusters on commercial jobs where teams of lawyers are probably at the ready to deal with underpayments, false denials, etc. are less likely to play the kind of games they play with residential property owners who put their faith in the promises of their P&C insurance companies based on what they see from their tv commercials and hope for the best.

LMB absolutely. I have only seen minor things in commercial and large loss claims and insurance providers hardly ever fight anything of course being a legitimate cause. However in residential homeowners get shorted all the time and the homeowners just take their word that’s all they should be getting when in reality it leaves them looking for a subpar contractor to slap on a discounted restoration. Home owners pay their insurance companies every month and as soon as they need them to do what they are supposed to they don’t. A lot of contractors know how to deal with these situations but many do not or simply do not have the training or man power to deal with these occurrences so they just take what they can get out of the insurance company. I spent 4 years of my time in the industry dealing with receivables from insurance companies and I saw the ridiculous run around first hand.

It’s no different. And the roofing companies that negotiate with insurance companies are violating the law as well.

I’m sorry to sound like an a__hole, but I’ve read everything you have posted. Your business model is the unauthorized practice of public adjusting. There’s no way around it. It’s just a matter of time before you piss off an adjuster, like me, and he turns you in. It’s an eventuality.

Stick your head in the sand if you want, but you are violating the law. It’s that simple.

So, I did a water repair a few weeks ago. I submitted my scope to the insurance company, and they called and negotiated with me… They didn’t want to give me O&P. They called and we went back and forth negotiating for a percentage. Maybe I should sue the insurance company since they initiated the “negotiation” with me.

[quote=“InsurerPerspective”]

It’s no different. And the roofing companies that negotiate with insurance companies are violating the law as well.

I’m sorry to sound like an a__hole, but I’ve read everything you have posted. Your business model is the unauthorized practice of public adjusting. There’s no way around it. It’s just a matter of time before you piss off an adjuster, like me, and he turns you in. It’s an eventuality.

Stick your head in the sand if you want, but you are violating the law. It’s that simple.[/quote]

Once again, I’m calling bullchit. There is a very distinct difference between presenting a well prepared estimate and discussing the merits of each line item, as relates to the damages, and “negotiating”.

You also need to remember there are still a lot more states that don’t have any law regarding this than those who do. I, and several of my more experienced people, discuss the estimates for the jobs we are working on multiple times per day with field adjusters and inside adjusters. I don’t say, however, things like “okay, you’re at $15,000, I’m at $13,000, can we split the difference?” I simply present my case, as a competent professional contractor, for the need for the line items I have on my estimate. I think the difference between us and this claims management company is, if we reach an impasse where we firmly believe the insurance company is denying line items that are absolutely essential to the repair, we simply go the Homeowner and have them call their Insurance Company. We let them do the negotiating. We’re simply Professional Consultants. We also refrain from having policy discussions, policy limits, etc…

Unless this company is located in Texas, frankly, I’d tell TDI to kiss my petunia if they got on my case.

Of course, they can also always join CC Network and move to the big time. LMAO!

I agree with that 100%. I also speak with contractors every day about their estimates. I have no problem there. But Pro plans to do much more. His own quotes…

“Our process includes evaluating claims to ensure everything is being paid as it should be and adding items that the insurance company has disregarded this includes actual items from the project and additional line items such as contractor o/p etc etc. Then we handle all of the middle work of dealing with the insurance company to ensure they pay every dollar that they should. We also manage the claim from start to finish meaning you don’t have to deal with arguing with the insurance companies anymore we will do the proper research into building codes and department of insurance statutes to make sure they pay.”

"All of our efforts will be comparing the insurance scope to the sales men’s reports, xactimate, local governing codes, and expediting the claims process by being in constant contact with the insurance company."

“We are simply taking what the insurance company has supplied (the scope) comparing it to industry standard estimating software ***to determine everything lines up ***to what in fact is found by the contractor and current pricing.”

And from his website… "Americlaims Pro! Professional Insurance Claims Management. We*** increase profit and ensure quicker insurance payments.*** "

Watch the videos as well.

He’s acting as PA. No way around it.