Not so AMAZING video of an adjuster

Guys,

Check this video out.

its almost as if the guy says “fair and reasonable” in another language… lol can you rephrase the question?? how bout, honor the contract and dont be a DH. or the less friendly approach… is this the way your company treats its medical claims as well?

The “fair and reasonable” is a poorly phrased question. What is “Fair and Reasonable”? Does this mean according to the homeowner? Their Roofer? The insurance policy?

If the attorney had stated “Do you think it is fair and reasonable for the insurance carrier to compensate a homeowner for coveraged damages?” then you have a concise question.

[quote=“jtdew”]The “fair and reasonable” is a poorly phrased question. What is “Fair and Reasonable”? Does this mean according to the homeowner? Their Roofer? The insurance policy?

If the attorney had stated “Do you think it is fair and reasonable for the insurance carrier to compensate a homeowner for coveraged damages?” then you have a concise question.[/quote]

I believe the questioner prefaced everything by "according to the guidelines set by the Texas Department of Insurance. So apparently, Fair and Reasonable is discussed/defined by the Texas Department of Resources which an Adjuster operating in TX should be intimately familiar with.

[quote=“jtdew”]The “fair and reasonable” is a poorly phrased question. What is “Fair and Reasonable”? Does this mean according to the homeowner? Their Roofer? The insurance policy?

If the attorney had stated “Do you think it is fair and reasonable for the insurance carrier to compensate a homeowner for coveraged damages?” then you have a concise question.[/quote]

Listen to it again. The question was concise:

“You must be fair and reasonable to the homeowners when you are adjusting their claims.”

[quote]fair

  1. free from bias, dishonesty, or injustice: a fair decision; a fair judge.
  2. legitimately sought, pursued, done, given, etc.; proper under the rules: a fair fight.[/quote]

[quote]rea·son·a·ble

  1. agreeable to reason or sound judgment; logical: a reasonable choice for chairman.

  2. not exceeding the limit prescribed by reason; not excessive: reasonable terms.

  3. endowed with reason.

  4. capable of rational behavior, decision, etc.[/quote]

[quote]rea·son

  1. a basis or cause, as for some belief, action, fact, event, etc.: the reason for declaring war.
  2. a statement presented in justification or explanation of a belief or action.
  3. the mental powers concerned with forming conclusions, judgments, or inferences.
  4. sound judgment; good sense. [/quote]

The first question regarding fair and reasonable was not in the same vicinity as concise. That is what brought the hesitancy and the request to rephrase or clarify the queston.

You should quit trying to defend the indefensible, it is costing you credibility. That beady eyed POS looked about as trustworthy as a rabid dog. If he hadn’t been concentrating so hard trying to remember his “coached” lines and simply told the truth, he wouldn’t have come across as he did. If you think that guy looked natural, relaxed and truthful, you need to find a career where you never interact with people. Seriously.

[quote=“Authentic_Dad”]
You should quit trying to defend the indefensible, it is costing you credibility. That beady eyed POS looked about as trustworthy as a rabid dog. If he hadn’t been concentrating so hard trying to remember his “coached” lines and simply told the truth, he wouldn’t have come across as he did. If you think that guy looked natural, relaxed and truthful, you need to find a career where you never interact with people. Seriously.[/quote]

What’s indefensible? That the guy under oath is nervous, guarded and not a very good witness. Show me some who goes through an examination under oath relaxed and natural and I will show your someone who has been sued a lot.

Without knowing anything about the situation, to call someone a “beady eyed POS” and conclude that he’s not being truthful is as biased as they get. I’d hate to have you on a jury of “unbiased” persons for anything based on your conclusions from above. Some of the most truthful people can be horrible witnesses.

What do you suppose brought about the hesitancy about the “open and honest” question? It was concise. Just so there’s no misunderstanding, here is a transcript of the entire exchange:

[quote]Q: You’d agree that there are minimum ethical standards that adjusters have to meet when they are adjusting claims here in the State of Texas?

A: Yes, there’s standards we got to meet.

The answer was given immediately.

Q: You’re expected to be familiar with your responsibilities to the homeowners?

A: Yes.

Again, the answer was given immediately.

Q: You’re expected to be familiar with your responsibilities under the Texas Insurance Code?

A: Yes.

Notice it took a little longer to answer this time.

Q: You’re required to be open and honest when you’re dealing with the homeowners?

A: Repeat that?

Q: You’re expected to be open and honest when you’re dealing with the homeowner?

A: When I’m dealing with the homeowner, uh, open and honest, yes.

It took quite a bit longer to get the answer this time.

Q: You must be fair and reasonable?

A: Rephrase that?

Q: You must be fair and reasonable to the homeowners when you’re adjusting their claims?

A: Yes.

Q: What is it about that question that’s giving you so much trouble?

A: I don’t know.[/quote]

While I know nothing about this adjuster or this case I can gather the following information from just this short exchange. We have a lawsuit filed by homeowners against their P&C insurance company. Judging by the questions this adjuster made some errors in his adjusting. The lawyer is establishing the adjusters knowledge of his duties to homeowners. If this adjuster is knowledgeable in his duties then the lawyer can establish willful breach of contract and unfair claims settlement practices.

In case you have never seen this type of thing before (I’m not referring to watching episodes of Perry Mason or Matlock) here’s how this might play out. You have a jury of 12 individuals. Most likely many of them are homeowners themselves. They have been taken away from their lives to go and sit in a courtroom because some insurance company is not paying another homeowner what they have agreed to pay them. Being homeowners these jurors are also policyholders. They are going to be reminded of this during opening and closing arguments (assuming the case is not disposed of by summary judgment). Now you have jurors that but for the grace of God they are not sitting in the plaintiff’s seat.

These jurors are also going to be educated on how the claims process works. Some of them may have been through this before and some may not. At any rate they are going to be educated on what happens when a claim is filed. Attorneys have a lot of latitude during opening and closing arguments.

The jurors have now sat here and watched this guy’s testimony. They have seen his facial expressions and the tone of his voice. They have seen how he quickly answered the questions regarding his knowledge of minimum ethical standards, his familiarity with his responsibilities to homeowners and his familiarity with his responsibilities under the Texas Insurance Code. If they didn’t notice how quickly he answered those three questions the lawyer will likely point it out to them.

The jurors will also be reminded of the hesitation this adjuster had when he was questioned about the moral obligations of his job. When asked the “open and honest” question he showed great hesitation and even asked for the question to be repeated. He acted like he didn’t even understand what “fair and reasonable” meant. After the question was rephrased for him he took an extraordinary amount of time to agree that he must be “fair and reasonable” to homeowners.

Fortunately for this adjuster this is just a deposition. Depositions are normally for fact gathering and not testimony. The jury will never see this unless he contradicts something he said in his deposition when he testifies at trial. So his lawyers will have a chance to clean up his testimony.

I personally believe that most adjusters are open, honest, fair and reasonable when they are adjusting claims. There are some that try to be but they have been given parameters of operation by superiors, you know, the ones that send out the pawns to do the dirty work. I have had adjusters tell me they know I am right but they can’t do it because of “orders.” The only way to get to the ones who give those “orders” is to sue them or file complaints with the the State insurance departments.

Most homeowners don’t have the time nor the money to hire lawyers to sue insurance companies so it is not worth their trouble. Of course insurance companies know this so they can keep shorting homeowners because there is likely not going to be any consequences. After all, why would you pay the full amount of a claim when you can get away with only paying part of it and the homeowner is none the wiser?

I will offer some defense to this guy. We are only seeing 1:16 of this deposition and depositions usually last for hours. He may have had some saving graces in other parts of the deposition. Without being able to see the whole thing it is hard to really tell. However, this 1:16 is not a very good 1:16 for this insurance company.

[quote=“jtdew”]

Conversely, it might be somebody who has integrity and is simply going to tell the truth. What is there to be nervous about if you haven’t knowingly compromised your integrity and you tell the truth? You don’t have to be an expert in the field of Kinesics to determine this fellow has some issues aside from being “nervous”. jtdew, if I hadn’t personally listened to so many Adjusters tell blatant, bald faced lies, I’d give this guy some benefit of the doubt. And what’s the best excuse? “We’re doing what we’re ordered to do.” So it is okay to do what you know is wrong when you’re job is on the line? It is okay to compromise your integrity and ethics when the company tells you to do so? So where do you draw the line when you cheat that elderly lady, with no money and living on a fixed income, out of her justified claim? What do you tell her? “I’m doing what I’m told to do, I have no alternative.” How do you rationalize that?

[quote=“Authentic_Dad”]

[quote=“jtdew”]

What’s indefensible? That the guy under oath is nervous, guarded and not a very good witness. Show me some who goes through an examination under oath relaxed and natural and I will show your someone who has been sued a lot.

Conversely, it might be somebody who has integrity and is simply going to tell the truth. What is there to be nervous about if you haven’t knowingly compromised your integrity and you tell the truth? You don’t have to be an expert in the field of Kinesics to determine this fellow has some issues aside from being “nervous”. jtdew, if I hadn’t personally listened to so many Adjusters tell blatant, bald faced lies, I’d give this guy some benefit of the doubt. And what’s the best excuse? “We’re doing what we’re ordered to do.” So it is okay to do what you know is wrong when you’re job is on the line? It is okay to compromise your integrity and ethics when the company tells you to do so? So where do you draw the line when you cheat that elderly lady, with no money and living on a fixed income, out of her justified claim? What do you tell her? “I’m doing what I’m told to do, I have no alternative.” How do you rationalize that?[/quote]

WOW

Ҥ 541.060. UNFAIR SETTLEMENT PRACTICES. (a) It is an
unfair method of competition or an unfair or deceptive act or
practice in the business of insurance to engage in the following
unfair settlement practices with respect to a claim by an insured or
beneficiary:
(1) misrepresenting to a claimant a material fact or
policy provision relating to coverage at issue;
(2) failing to attempt in good faith to effectuate a
prompt, fair, and equitable settlement of:
(A) a claim with respect to which the insurer’s
liability has become reasonably clear;”

Each and every one of you see some form of this on a daily basis. Material facts are just that material facts. Does the house have drip edge? Does the house have starter shingles installed? Does the house have valley metal? Does the policy have and ordinance of law endorcement?

Lets take those 4 questions and apply them to a SF claim.

  1. Does the house have drip edge? yes, but we dont pay for that…
  2. Does the house have starter shingles installed? Yes but, we dont pay for that or its included in the waste.
  3. Does the house have valley metal? Yes but, we dont pay for that…or its included in the line item pricing…
  4. Does the policy have an ordinance of law endorcement? Yes but, I am not paying for drip edge starter or valley metal. Take it and do the job or we will send someone else out who will…

Guys the list goes on and on. These emboldened adjusters are stealing from us with their lies and misrepresentations. I havn’t even said anything about the prompt fair and equitable settlement yet.

It has been ruled that the adjuster has a fiducary duty to the insurance company not the policy holder. Throw those lying bastards under the bus every chance you get. Then put it in reverse!!!

This isn’t a matter of not understanding the question. “Fair and reasonable” is easily understood by even a 12 year old. The guy knew he was toast and his hesitation appeared to be an attempt at a Bill Clinton “depends on what the meaning of the word is is” argument, at least in his mind - he just couldn’t put it into words.

As representatives of P&C ins co’s, all adjusters act on behalf of ins co’s who have a fiduciary duty to their policy holders which ultimately means that the adjusters are acting in a fiduciary capacity and therefore owe a fiduciary duty to insured’s themselves, in all cases.

There is a reason adjusters purchase E&O policies, now more than ever, that usually carry a $15,000 min deductible. Staff adjusters may be defended at the co’s expense. IA’s will have to turn in claims with their E&O insurance. One big claim might be enough for an adjuster to lose their E&O coverage, even if they are sued for damage that occured as a result of them “just following orders” of XYZ Big P&C ins co.

Question to XYZ Big ins co: Under the terms of your replacement policy, if a property is destroyed, your company will pay all costs to completely rebuild, correct? Normal and usual costs include contractor overhead and profit, correct? The new building would obviously have to be built according to current codes, correct? Obviously, the answers are affirmative unless the ins co attempts a futile argument that O&P and current code are not considered.
That would then force the ins co to open their books to prove that O&P and code upgrade costs are not included and it’s not likely they’ll be open to that which leaves them no alternative but to admit that the logical assumption that those costs are already figured into the insured’s premium is accurate.

That’s why it makes no sense that ins is attempting to deny payment for O&P on 100% of each less than full replacement claim (on all trades), drip edge, starters, ridges, flashings, etc. They know that most contractors don’t think through these issues. P&C ins tells their adjusters to “follow orders” and not pay and when they run into a contractor who knows what they are doing, they simply refuse to pay, spout the usual nonsense or just clam up. Then it’s time to go after the claim department heads. Whose got time for that? Good question. It takes time but if nothing is done, nothing will change. One of the reasons I’m aggressively pointing out these problems to State legislators and Governors who all want to get re-elected.

As more and more contractors educate themselves on these issues, they become much better informed than condesending, lieing, cheating adjusters and can then beat back adjusters specious arguments for not paying. The days where an adjuster could get away with this nonsense are just about over. But, it’s going to take aggressive contractors who have studied the issues and know how to effectively argue their points and defeat adjuster nonsense.

How can one have any integrity when what they have chosen to do for a living involves cheating thousand’s of people out of money that is rightly owed to them. Adjusters and claim dept heads and managers made their choice and they have to live with the consequences. I’ve got no sympathay for any of them!