Is this a recent change in policy?

So I have had 2 insurers recently who are trying to short change my clients post agreeing on both a supplement and settling on final payout. I just want to know is this normal; or is this a recent change in policy for the insurers this year.
I will list each case separately:
I have a file that the settlement was agreed on, as was the supplement and then I find out from the general contractor that they can not comb out the AC. I contacted the adjuster on file, and he said it was fine and just get him something in writing. A week and half goes by, and I finally have the information from the general contractor and I send it up. I contact the insurer and the adjuster of record has been removed because he was apparently and independent temp adjuster, and the new guy is trying to decline payment on parts of both the supplement and the original not to mention saying that if he doesn’t get to send an inspector out he may not cover the AC.

The other insurer agreed more than a month ago to pay for a supplement, and settled on the claim. They agreed to release overhead and profit as well as recoverable depreciation. I get a call a month later from my client telling me she received a letter and needed to request depreciation and needed proof the work was finished. Again a new adjuster of record is in place and the insurer received a letter of completion and found out my client was a smart shopper and got a good deal, and now they are trying to fight on the release of depreciation.

Also I have a second file with the first insurer. The only requests in the supplement were steep removal and overhead and profit. Everything is good and the insurer is saying they will take care of that. Then I get a new adjuster of record, and he wants to reinspect before he will pay O&P. A week later I get another new adjuster of record and he is telling me he won’t pay o&p or the supplement claiming that since the general contractor was able to do the work for under the original xactimate estimate he does not deserve o&p , and he also shouldn’t receive the extra funds from the steep removal. I asked him what happened to the reinspect and he tells me “the work is already done so it doesn’t matter.” I speak with his manager and he tells me that he won’t pay for the same reason as the insured got a good deal and the GC doesn’t deserve the money. This adjuster set has repeatedly ignored my letter of representation as well.

Are you an attorney or public adjuster?

[quote=“dstew66”]

Are you an attorney or public adjuster?[/quote]

I am a licensed public adjuster, independent adjuster, and agent. My company helps small and medium size roofers and general contractors with their supplements, and we public adjust for insured clients as well. Sometimes we do get clients through a roofer or a general contractor in situations where it would be more beneficial to all parties if we assist that way.

I understand some people on this board don’t like PAs . In fact I regularly see statements about how all PAs are hit men, and they just add ridiculousness to claims to pad their pocket. I am not one of those PAs. I charge the same whether I am doing a supplement or if I am working as a PA; 10% of the supplement amount not the claim as a whole. I believe that slow and steady is the path to success. My business model is based on bulk; so I can afford to actually make sure that everything on the claim is legitimate.

From what I can tell, the written policies/contracts between the HO and P&C Insurance company haven’t changed substantially in quite some time. My own certainly hasn’t. That has not stopped the P&C Insurance companies from changing their internal policies on how to scope and payout claims. That has changed substantially in the past 5 years and I have hundreds of examples to prove that.

According to Insured Perspective, none of that is true. Everything is the fault of the Roofing Contractors and PA’s. The Roofers and PA’s apparently snuck into the corporate offices of the P&C Insurance Companies one weekend and rewrote the claims handling process procedures. It wasn’t McKinsey Consulting nor was it SF’s ACE program that had anything to do with it. It was McKinsey General Contractors and ACE Roofing who were the culprits.

NLMUS:

Case #1: It is written in the insurance policy that the insurer has every right to inspect the damages pretty much at any time. You indicate that you had an agreement. Is there anything to document this agreement? Email, fax … etc.

If you do, then, the insurer may have estopped themselves and should honor the damages.

Case #2: You indicate that your client was a “Smart Shopper”. Correct me if I am wrong, but, it reads as though you or your client are attempting to collect over and beyond what was spent for repairs.

Keep in mind the principle of indemnity, which is the basis for insurance, means that the insured is made whole once he or she has been compensated for a covered loss less their deductible. The deductible is the amount of money which that policyholder agreed to self insure with their insurer.

This is the type of scenario that leads to somebody falsifying documents and can lead to trouble.

CASE #3: Sounds like a variation of case 2. If the contractor did the work for less than the estimate involved, then, the insurer should release recoverable depreciation up to that amount less the policyholder deductible.

Am I missing something here?

[quote=“jtdew”]NLMUS:

Case #1: It is written in the insurance policy that the insurer has every right to inspect the damages pretty much at any time. You indicate that you had an agreement. Is there anything to document this agreement? Email, fax … etc.

If you do, then, the insurer may have estopped themselves and should honor the damages.

Case #2: You indicate that your client was a “Smart Shopper”. Correct me if I am wrong, but, it reads as though you or your client are attempting to collect over and beyond what was spent for repairs.

Keep in mind the principle of indemnity, which is the basis for insurance, means that the insured is made whole once he or she has been compensated for a covered loss less their deductible. The deductible is the amount of money which that policyholder agreed to self insure with their insurer.

This is the type of scenario that leads to somebody falsifying documents and can lead to trouble.
Lets avoid that.

CASE #3: Sounds like a variation of case 2. If the contractor did the work for less than the estimate involved, then, the insurer should release recoverable depreciation up to that amount less the policyholder deductible.

Am I missing something here?[/quote]

I made the number one mistake when posting on the internet and posted tired.
In each case the GC contract is for the claim amount plus any supplements. The GC was the smart shopper not the client; my fault I was very tired. So the insured isn’t making any additional money on this claim.
That’s what I am questioning as the insurer has nothing to do with the GC. The GC contract is between insured and GC not the insurer and GC. So what is the issue?