Property Insurance Coverage Law Blog : Florida Insurance Lawyer & Attorney : Merlin Law Group Law Firm : Tampa, Houston, Coral Gables, Gulfport

An internal TWIA Claims Memo helps show this. In part, it says:

"Shingles that show no signs of damage other than they are not sealed and can be raised with your hand are not considered windstorm damaged. Some call these "lifted" shingles. Some call them "blown up" shingles. Some call them "unadhered". Regardless of the terminology, these are not considered windstorm damaged. The shingles are mostly laying flat and are continuing to do as they were intended…….to repel water." 

 The rationale sounds familiar to me because it has been raised before. TWIA wrongly finds that part of a structure that has been physically changed, altered, or what most adjusters are trained and consider "damaged," is not damaged because the item functions as it did before the event. I bet TWIA executives have hired outcome-oriented engineers to help provide an alleged basis for this fabricated argument and adjustment standard not found in the policy.

I will go into a more in-depth discussion of this Tuesday afternoon. However, the memo is instructional because it helps show the mindset of the claims executives reviewing the field adjustment. The "slabbers" were right to March on Austin because the delay and denial of claims are coming from there.

I strongly urge any policyholder to see an attorney before agreeing to the administrative remedy because you give up very valuable rights by doing so. There are many fine and experienced attorneys that are available for a free initial consultation. If denials are based on the type of logic shown above, you will have attorneys wanting to represent you.

One of the leaders, Brenda Cannon Henley, recently spoke with me at length regarding her perceptions and anger over the situation TWIA has caused businesses and residents. She is an investigative journalist by training and has experience with the media. My prediction is that her considerable organizational talents and the determination of those from Bolivar are going to land much of this story in the media. Brenda also has a fabulous Blog, where she shares her perceptions of being a coastal Texan. She recently wrote about her experiences with Hurricane Ike and her community's frustration with TWIA:

"I can also still see great piles of debris, parts of fallen in houses, abandoned vehicles, lawn mowers, boats (did I mention boats?), pieces of trailers to move those boats, blown sand piles, heavy equipment, tools of various degrees and flying American and Texan flags. Bolivar, for all of the hard work by so many, still resembles a war zone where much combat took place. It is discouraging at times and heartening at other times. Clean up is dirty work and our beloved Peninsula will remain in this stage for a long time to come. The cleared areas, for whatever reason that they have been worked, are encouraging and new growth is appearing here and there.

Many of our people cannot come home because many of them have no home left to come to. Most are in a battle for their life against the huge Texas Windstorm Insurance Association and we've found that this sad group is not playing by the rules. More than 100 (at this point) of our friends, neighbors and family members are protesting their action (or lack of) in Austin in front of TWIA's offices on Friday, March 13, the exact anniversary of the day our lives changed so drastically. Many have come home — sort of, anyway — to RVs, fifth wheels, and partially repaired properties. We laughingly call ourselves "slabbers" the name TWIA dubbed us early on after the storm. Many others we know simply cannot face coming here to the Peninsula where they believe their dreams of a lifetime died violently six months ago. One of our neighbors has never been back and her husband says she cannot come back. She has developed a raging fear of the water, a fear of diseases she surmises are here, and a fear of losing her life, as at least four of our immediate neighbors did.

For me, personally, once I see the Gulf, with her lazy waves rolling in, or even on a windy day, when the waves beat their way to the shoreline, hear the cry of the gulls, watch the ships come and go, and see little children playing in the sand, I remember vividly why I nailed my mast to the staff here in this place and why I will fight to the bitter end to have my life continue where I choose to live. Bolivar Peninsula is for me the very closest place I've found to the heart of God and what I most imagine Heaven to be like. Until I change locations, love me, but don't worry about me. I am a survivor. I have good friends and a husband who are also survivors. We will be back strong, vibrant, happy, peaceful and content, and, hey, you can come see us on vacation or any time you get an off day from your work. We'd love to have you — as long as you behave yourselves, don't dirty up our beaches, treat the land and water respectively, and join us in our effort to get fair treatment at the hand of our insurance companies. We need your support and involvement as this battle continues."

As I read this, I felt a sense of déjà vu. It was like the Mississippi Gulf Coast following Hurricane Katrina. SLABBED welcomes Texas Windstorm Association and Ike victims to “the scheme” predicted this last year.

Brenda Cannon Henley reminds me of my former Diamondhead, Mississippi client, Judy Dutruch and her organization, "The Slingshot Gang." Slabbed reported on Judy's case in Insurance News You Can Use.

One of TWIA’s preposterous findings in nearly every case is that "slabbers" have exactly the same amount of damage to the estimated replacement cost of the structure--11.2%. Ms. Henley told me she has seen 53 adjusters’ estimates to total loss structures and each of them show only 11.2% damage. All our clients have only 11.2% estimated damage as well. Last week, I posted a sad joke about this, The Parable of Hurricane Ike Insurance Claims.

An adjuster comment was posted to Views From Hurricane Ike TWIA Insurance Adjusters which helps voices additional causes for the anger and need to protest TWIA’s disgraceful claims handling:

"You cannot imagine the hurdles TWIA put property adjusters through on "Ike" claims. I really felt sorry for the Texans that had to suffer three times for one storm. (the actual hurricane), (the TWIA claims process), (contractors repairs)

I hope that Texas can get its act together when it comes to state windpool. When an adjuster calls the carrier regarding a claim, you would think the carrier would understand that it must be an important call for the adjuster to stop what he is doing and contact them. Phones turned off at 3PM, no return phone calls, no communication on payments to insured, and the best excuse is "We have 50 file reveiwers and it will take some time to get to each file." This is a clear misunderstanding of logistics for a storm that created more than 75,000 claims. They should have tried for 500 file reviewers and provide the service the policy holder paid for."

Honest and fair claims handling requires adjusters to fully and honestly explain how an estimate is calculated. None of these TWIA customers have been given this information. I do not expect the full, honest reason will be revealed until TWIA management is put under oath to explain the adjustments. Until then, maybe the protest will spur some action from the Texas Department of Insurance. Hopefully, those good regulators will start investigating the absurd claims behavior, and encouraging TWIA to follow the rules required of all insurers.

The parable is a story of two men, Larry and Moe, who were on the peninsula when Ike hit. Larry was struck by a flying 2X4 launched by the wind, then, when the surge came, he grasped a floating timber and made it to safety. He was treated for his injuries, estimated at 11% of his being.

Moe was not so lucky. He was killed instantly by a flying TV set. The storm surge subsequently swept his body away.

The medical examiner compared Moe's corpse to Larry. After taking several months to consider the situation, the examiner declared that Moe was only 11% killed by wind, because that's what happened to Larry. He opined that 89% of Moe's death must have been due to flooding.

The TWIA policyholders from Bolivar Peninsula are furious with their claims treatment. It is my understanding that many may protest in Austin on March 13. More power to them.

Many claims departments now try to make up a "reasonable" basis for denying claims by using engineering experts that provide outcome oriented opinions. The worst I saw was last week when an engineering opinion said a loss was caused by a "concurrent cause" of loss that just happened to be excluded under the policy.  Honest engineers do not use the unique "concurrent cause" terminology used in insurance policies unless the insurance company adjusters have convinced them to do so. 

The bottom line is that policyholders should not trust insurance companies to do an honest evaluation of a claim with honest evaluations by engineering firms that pander to the insurance industry.  Often, a reasonable investigation is not done because the investigation is not honest and leans towards findings in favor of denial or minimizing claims.  The insurance industry simply blackballs engineers that give honest opinions or words reports that result in higher payments to policyholders.  All of us in the insurance claims industry know of this current state of being.

My new client was born and raised in Houston. He started his own company ten years ago after working in construction for 25 years.  His roof was damaged and water entered the attic causing damage to the insulation and then more damage as the water dripped down into the rest of the structure.  However, the insurance adjuster found that the windows leaked and allowed for the water damage.  That cause of loss would be excluded under my clients commercial policy. 

After a fist fight almost ensued between my client and the adjuster, the adjuster agreed to hire an engineering firm.  Texas Wind hired a well known insurance engineering vendor and sure enough, that engineer somehow opined that lower floor windows had water leaked and water defied gravity, finding its way into the attic.  Is such a finding a "reasonable" basis?  Doubtful. As my Led Zeppelin readers would say, "The Story Remains the Same."  Many insurers take a hard line. With a wink and a nod, they accept unethical and fraudulent opinions.  I guess I should not complain because this failure to provide the "peace of mind" of full and prompt payment leads to very lucrative and enjoyable work for my law firm.  But it should never come to this manner of resolution. 

Following Hurricane Ike, I would strongly encourage all policyholders to never accept an insurance company's version of loss.  Sadly, many insurers do not respect their customers or empathize with the loss that has affected their lives and are looking for ways to lower payments in a legitimate or illusory legitimate manner.