Citizens And TWIA Bad Faith Exposed
Something is rotten in Florida and Texas regarding the manner Citizens Property Insurance Corporation and Texas Windstorm Insurance Association (TWIA) are treating their customers. Rotten because both are breaking obligations they owe to policyholders. Somebody needs to be held accountable because claims management is condoning, if not initiating, the wrongful behavior.
Citizens was investigated in 2007 regarding its claims handling. The Citizens claims management explained how they went from an inept claims organization to one which maintained standards at least as good as any in Florida. While that was debatable, I agreed that Citizens responded better to the 2007 storms than it did in 2004.
Five months ago, there was a major change in the Citizens claims organization. Within the last month, we have received complaints regarding hardball, deceitful, and bad faith claims handling by Citizens with the full support of the new Citizens claims management. While Citizens publicizes that its intent is to provide "fast, fair, honest and accurate claims service," recent examples provided to me indicate that mission statement is false.
Insurance adjusters have to investigate coverage and evaluate damages. They are ethically bound to do this promptly, honestly, and in good faith. This is required of every adjuster as part of their license with the state of Florida. Today, Citizens adjusters are being told by its managers not to provide Citizens' estimate of damage to the policyholder or policyholders representatives. At the Florida Association of Public Insurance Adjusters Winter Conference last week, many public adjusters told me that Citizens refuses to provide its estimate of damage, claiming that it is "work product."
How a policyholder knows whether Citizens' payment is accurate without an estimate of how Citizens evaluates the damage is beyond me. It would be like getting an IRS refund and the IRS refusing to tell you how it figured the number. Or, imagine a scenario where a butcher takes the steak you select, tells you to give $20, weighs the steak, and then gives you back $2.02 in change, but refuses to tell you how much the steak cost per pound and its weight. Some may consider this a possible theft, yet this is what Citizens is doing to Floridians every day.
What is worse is that TWIA has been doing the same to its policyholders with a slight twist. It paid most slab claimants approximately 10% of the face value of the policy. It generally provided no estimate for this, but has indicated it was investigating. We have received dozens of calls from potential clients asking how long TWIA can take to investigate and not provide an estimate. Texas public adjusters are calling in furious because TWIA adjusters make up excuses for not providing any of its estimates.
The worst example is a Citizens policyholder now represented by Nancy Dominguez of Florida Adjusting Services Team, Inc. The policyholder was sent a check and complete release without an estimate. Citizens sent these, obviously hoping the client would take the check and sign the release. Nancy learned of this and demanded an appraisal to resolve the amount of the loss because the check amount was far lower than the amount she estimated. In the appraisal proceeding, the Citizens estimate was finally turned over, and it was for an amount higher than the payment check it sent to the policyholder. The appraisal resulted in an award almost double Citizens' "hidden" estimate and about three times the amount of the fraudulent check.
Insurance adjusters should be prosecuted for this conduct. It is an attempt at insurance fraud.
Maybe our law firm should not complain. Our phones are ringing off the hook. Yet, while insurer bad faith is good for business, it is terrible when it is obvious these practices harm those who are already in desperate need of fair and honest treatment.
Hello again from Texas - this article about hits the nail on the head with TWIA - just this week our firm was offered an additional supplemental payment on a "Standing HOG" from slab claims, apparently their also in charge of the Standing Houses on Ground as we call them or "Constructive Total Losses" as they are known in the legal terminology. Long story short - the offer from the file handler, file closer (not unlike the hustle one would get from a used car salesman or their manager trying to get a salesman to close the deal) was not prompted by a proposed estimate of damage as drafted by the last supplemental adjuster of record that we have not seen - despite the now eight formal requests for these signed estimates that are inclusive of a Texas Department of Insurance License Number. Shorter story longer - we have never heard back from the last supplemental adjuster of record nor the two other adjusters of record whom we of course diligently send our estimtes of damage and back up documentation to with copies and originals via U.S. Mail and Certified Mail to TWIA of course. To date the file handler/used car salesman has offered us a whopping 32k against our valid and documented 127k+ estimtes and documents as undisputed and yet another $6,400.00 in free money with our FULL POLICY HOLDERS RELESE - OH YEAH!!! Needless to say this has gotten very serious at this stage - it took their name brand engineering firm over three and a half months to deliver their engineering report and yet another one and a half months for the now "lost in cyber space or other" last supplemental adjuster to forward it to us and yet another month and a half for the file handler / used car saleman to try and negoitiate this with me without any estimates or a required by law Proof of Loss Document provided - and all this time has elapsed with the good insured having been placed on DEMAND by TWIA not to demolish the home by I guess their NOT legal representative the Insurance Adjuster - the insureds have received notification by the City of pending CRIMINAL or CIVIL action due to violations of their previous notices on unsafe and hazardous dwellings - and they have had to endure financial duress in the amount of $2,251.00 per month in rental property fees and storage fees for a place to live and to take to safety and store the items on the second floor which TWIA does not want to pay despite the fact that the second floor is damaged extensively due to roof leaks and water intrusion and that we couldn't restore power due to the two ton tree that took out the power head and part of that side of the home and to top it all off - the original aduster of record who by the way and I have this formally, "is NOT their Legal Representative" wrote an entire French door window wall(18 lineal feet) on the first floor up as TORNADO DAMAGE,(the French doors and windows were found under the two ton tree in the back yard), sounds pretty much like tornado 101 to me!
All of this and TWIA has now offered a whopping $1,400.00 for the on site power outage as ALE and a whopping $5,000.00 in contents coverage for "some" of the reconditioning and storage of the second floor items that we have now spent in excess of $16,000.00 on in INCURRED AND VALIDATED EXPENSE.
THIS IS THE $6,400.00 THAT HAS BEEN OFFERED - ONLY - WITH THE FULL POLICY HOLDERS RELEASE. Oh - I might add - that was a one time only - this day only - offer.
We are dealing with a couple of dozen of these in this immediate are - and believe me although it was rather humerous at first - no one is laughing anymore. It is my understanding that TWIA is asking our Legislature for Governmental Sovereignty for BAD FAITH DAMAGES - After I finish my last round of letters and proofs' on these next week I will be heading to some Politicians offices - I really need to chat with the State Rep. Wayne Smith and the State Senator -Mike Jackson and have of course made recommendations to my insured's NOT TO SIGN the FULL POLICY HOLDER RELEASE and have given them their options to consider in achieving indemnity for their valid and covered claim losses.
So far as these TWIA file handlers or used car salespeople -everyone out there should be collecting those TDI License Numbers on them - remember - I have in writing from TWIA that the Insurance Adjuster is NOT their Legal Representative! Good luck with that also - to date after dozens of formal requests I still haven't gotten a single TDI License Number and guess what - I have no responses - let alone signed estimates or TDI License numbers on any of the NOT Legal Representatives that are strickly contracted IA's - My Professional Opinion of this is that there are no supplemental adjusters still on these files and that this is all "smoke and mirrors" - just like the year of 2004 in Florida with Citizens whom I worked two of the Florida four for as a General Adjuster - Same tactics, same engineering firms - the only thing missing so far is the "Goon Squad" and I'll just bet that that Eagle is out there somewhere and that I haven't spotted it yet, must be using another name.
On closing I do have some serious questions in regards to some legal language that has been used extensively and formaly in our negotiations with the TWIA file handlers and they are:
What is GAP Coverage - it is my understanding that the Wind Polciy does not include GAP Coverage for a Constructive Total Loss. Do we now have a new PERIL, to the best of my knowlege and I do keep up with my CEU's - there was no GAP Coverage or Endorsement offered by TWIA or any other Wind Insurer. Is this now an E&O problem with the Agent/Broker?
Why are the TWIA file handlers the only ones that can determine coverage on the AMBIGUOUS items in the Insurance Policy, of which there are many I have been told. Yes - they are openly using this "A" word and declaring openly that they are the only ones that can interpret and determine the AMBIGUOUS coverage, so am I to acertain from these remarks that these file handlers are - Judges? Does the State of Texas have a law in place now that the INSURANCE CARRIERS, probably un-licensed file handlers - rule on AMBIGUITY and that it rules in favor of the INSURER and to such an extent that TWIA has openly admitted that there were intentional AMBIGUITYS' drafted into the Insurance Contract for exactly that reason? I'm supose to be getting that in written form shortly as requested and will be passing that on to a lawyer as I'm just a Lowely Public Adjuster and can't even begin to understand what these fine folks are talking about but if they send it to me to show my insureds in writing then I'll probably be able to get that FULL POLICY HOLDER RELEASE signed, 1 time - 1 day only offer though - hurry / hurry the offer is ending in another one minute and sixteen seconds!!!
This file is definetly looking for Legal Representation and this P.A. may be also if she can't keep her mouth shut.