Incredible Insurance Claim Stories

Proeprty Claim Law
New house destroyed by fire

Insurance claims stories seems to make news headlines nearly everyday, which is no surprise, as 1 in 15 homeowners make a claim each year, according the Huffington Post. Given the many potential disasters that come with homeownership there is a high chance all of us will be reaching out to our insurance provider at one point or another to make use of the insurance we pay for.

While there are certainly stories of simple claims processes, the anecdotes below show there may not be such thing as a standard insurance claims. Some of these stories highlight fraud; others show instances where homeowners were required to pay out of pocket for disasters and faulty appliances. As you’ll see, most of these stories took quite a negotiation to get claims paid and others were unable to collect payment from their provider.

  • After a fire, a homeowner threw out a charred designer purse. Noticing the purse, the claims adjuster opened it up to find $400,000 of precious jewels and jewelry inside – saving the homeowner another catastrophic loss.
  • A homeowner was hiding cash in her bookshelf and claimed it was stolen. Fortunately, she was covered and able to recover most of the money, but if a house fire had destroyed the money, she would be out of luck as this instance was not on her policy.
  • A house was completely burnt down, but the homeowner’s claim was denied because she owned a dog on her insurance company’s prohibited dog breeds list, even though the dog had nothing to do with the fire.
  • A homeowner was denied, by their insurance company, after filing a claim for damage from their broken refrigerator. The claim was originally denied because the home was ‘customarily unoccupied,” although the insurance company is now reevaluating this decision.
  • In an attempt to cash in on his property and automobile a homeowner lit them both on fire. He did not receive money, but did receive five years in federal prison for insurance fraud.
  • An electric cooker, used by children, caused a kitchen fire, which was reported to the insurance company.
  • An insurance company denied a claim for damage, from excess steam, caused by a malfunctioning washing machine. After taking legal action and pointing out to the judge, steam is a form of water, the homeowner won the case.
  • A homeowner’s wine collection was damaged due to sewer backup, which exposed the wine to heat. The homeowner was able to win the claim, but not before a challenging battle.
  • While a family was away on vacation, their home had a kitchen fire causing nearly $16,000 in damage. Upon arriving home, they were shocked to discover they were not covered, by their policy, for insurance fire.
  • In another odd instance, a goose swallowed a homeowner’s diamond ring and the insurance company refused to cover it.
  • Another homeowner had a toilet flood causing damage to his home, Even though this was immediately reported to the insurance company, they avoided his calls, did not pay out the claim and even became hostile causing an already stressful situation to become even worse.

To ensure you are covered and receiving the appropriate compensation from your homeowner’s claim please call the Mineo Salcedo Law Firm at 954-463-8100.

Insurance Rates Still Rising In Spite of A Decade of Zero Hurricanes! Why?

The hurricane season has ended and in Florida, this means a decade of zero hurricanes in spite of the fact that the country has had a few devastating hurricanes since 2000. Florida though has had around 63 subtropical or tropical cyclones from 2000 up to 2013 causing over $64 billion in damages, 69 deaths, and 82 injuries. The strongest hurricane to hit Florida happened in 2004, Hurricane Charley. That hurricane alone cost $5.4 billion in property damages, $285 million in agricultural loss and damages, 24 deaths, and almost 800 injuries. In some areas, about 95% of the buildings were damaged. But that’s all part of Florida’s past and seeing that no hurricane has hit the state at all, it begs the question: Why does Florida have one of the highest rates in home insurance in the country?

Insurance experts have the answer. According to them, insurance providers are pointing the blame on construction materials. They say the cost of repairing or rebuilding has increased dramatically over the years, not even including the cost of labor. There is a domino effect that ends with the consumer paying higher rates.

Based on this logic, other states with few to no hurricanes should also have high insurance rates while states that have been hit by hurricanes in the past 10 years should have higher insurance rates than Florida because of more damages. According to Sean Shaw, a slightly controversial consumer advocate, insurance companies are just using this as an excuse to charge high rates. He adds that the higher rates consumers are paying is all part of corporate earnings especially for top executives. Shaw, who is a lawyer and son of a retired Supreme Court Justice, Leander Shaw ran for representative of the House District 61 but lost to Edwin Narain by a mere 774 votes.

Shaw remains determined to fight for the rights of consumers and whatever reasons insurance companies throw at those who dare complain can all be rebutted be it sink holes (Florida experiences the most number of sinkholes in the country) or insurance fraud.

Let’s look at sinkholes.

According to experts, sinkholes are not increasing but attention to it is growing because of the Internet and the shock value of seeing images of sink holes. In fact, insurance companies in Florida begun questioning claims on sinkhole damages so much so that in 2011, the state’s insurance law was overhauled. The new law actually devalues a property because it shuts the door on certain claims from the “sinkhole alley” of Florida which is Pasco and Hernando counties. This law makes it harder for property owners to qualify for damage claim so property owners are stuck with having to shoulder the cost should any part of their property be damaged by a sinkhole. Other lawyers say it is almost impossible to qualify under sinkhole damage because insurance companies are allowed to pick the engineers who will decide on claims. In addition, sinkhole is a separate insurance from the basic homeowner’s property insurance.

Let’s look at insurance fraud.

The Florida Division of Insurance Fraud gets over 10,000 alleged cases of insurance fraud with about 1,000 cases presented for prosecution. However, even if Florida ranks 3rd in the country for cases presented for prosecution and second in number of arrests for insurance fraud, the Florida’s Division of Insurance Fraud is highest in recovery of losses from insurance fraud. In 2009, restitution amounted to over $34 million.

Shaw insists, “At a certain point you have to tell the insurance agency we don’t care what the excuse is.” He insists that electing someone who will be pro-consumer is the best way to stop the rates from increasing.

Right now consumers have options to getting lowered insurance rates aside from electing pro-consumer leaders:

  1. Ask current state representatives and leaders to get tough on insurance
  2. Shop for insurance well in advance so you don’t get stuck with having to make fast decisions just to get it “over and done with”
  3. Invest in additional security and hurricane items like roof straps to get additional discounts

If you have an insurance claim or want to have our attorneys review your policy of insurance, please call The Mineo Salcedo Law Firm for a free consultation.  (954) 463-8100.

Citizens Seeks to Limit Coverage for Water Related Claims

226ASP6179944780Citizens Property Insurance Corporation’s Board of Governors on Wednesday approved a slate of policy changes to bolster oversight of water loss claims while continuing to protect policyholders who need immediate emergency repair to water loss claims, according to a statement from the state-backed insurer. The move was in response to what the company calls “skyrocketing” water loss claims, particularly in South Florida.

By unanimous vote, Citizens board agreed to modify policy language in response to a surge of questionable water loss claims by limiting initial payouts for emergency services and clarifying ambiguous policy language relating to coverages typically affected by water loss claims. The recommended changes will be forwarded to the Florida Office of Insurance Regulation for approval.

The recommended changes are the first steps, board members were told, to better control costs without jeopardizing customer service following a spike in the frequency, severity and litigation of water claims particularly in South Florida, which last year accounted for 72 percent of all water loss claims. Recent data shows that the claim activity is spreading to other regions of the state, according to Citizens.

The board action comes as lawmakers continue discussions to create a framework governing the use of post-loss assignment of benefits to ensure that customers remain in control of their own claims. Citizens’ contract changes would complement these legislative initiatives, the insurer said.

“The bottom line is these policy changes and clarifications are necessary first steps to keep premiums as low as possible while protecting our policyholders who have legitimate claims,” said Barry Gilway, Citizens president, CEO and executive director. “However, they in no way fix the assignment of benefits cost-driver that must be addressed by statute.”

“Without these changes, Citizens would be forced either to take more draconian measures to curb costs or continue to raise rates,” Gilway continued.

Citizens said water loss claims now account for more than half of every premium dollar collected in Miami-Dade County. The issue, though concentrated in South Florida, appears to be spreading throughout the state.

One result of ambiguous language has been an increase in litigated water claims, Citizens said in its statement. In 2014, 38.4 percent of water loss claims in South Florida (Palm Beach, Broward and Miami-Dade) were litigated, more than double the frequency of litigated claims originating in the region in 2010, according to data from the insurer.

On Dec. 8, the board approved changes to:

Limit initial payouts for emergency services and temporary repairs prior to a report of loss to Citizens. Additional coverage for emergency services will be available following Citizens approval.
Exclude coverage of permanent repairs completed prior to a Citizens inspection of the damage.
Require that claims be reported within 72 hours of when policyholder knew or should have known that a loss had occurred.
Set a limit for additional coverage to restore uniformity of appearance by matching repairs with adjacent undamaged areas.
Clarify language relating to the replacement of plumbing systems following collapse, blockage or deterioration.
In 2014, Citizens said 39.2 percent of policyholders filing water loss claims in Palm Beach, Broward and Miami-Dade counties hired attorneys or public adjusters before filing an initial claim with Citizens. Elsewhere in the state, 4.2 percent of policyholders were retaining attorneys or public adjusters before reporting claims to Citizens. More than 98 percent of all litigated water claims initiate in the three county South Florida region.

Costs of litigated claims are nearly three times higher than non-litigated claims. In 2014, the average litigated claims costs $27,631 compared to $9,028 for non-litigated claims. Citizens said it must pay those costs by premiums collected by all policyholders within the territory where the loss occurs.

“With these changes, Citizens is attempting a surgical approach to protect policyholders and contain costs,” Gilway said.

If approved by OIR, the policy language changes would take effect in mid-2016 for new policies and existing Citizens policyholders when they come up for renewal.

Source: Citizens

Source: Insurance Journal: http://www.insurancejournal.com/news/southeast/2015/12/09/391379.htm

The Dangers of Using a Turkey Fryer

TurkeyFrierFireMiami-Dade Fire Rescue joined Broward Sherriff’s Fire Rescue to host a demonstration on how to safely deep fry a turkey this Thanksgiving holiday.

The event was held on Monday November 23, at the Broward Fire AcaPropane.

The use of turkey fryers for Thanksgiving turkey were a focus at the event. Turkey fryers are often an accessible and inexpensive option for Thanksgiving, but according to the National Fire Protection Association, they are very unsafe.

Some of the dangers of using a turkey fryer include having the turkey fryer tip over, spilling hot cooking oil over a large area; having an overfilled cooking pot that can cause cooking oil to spill when the turkey is put in; and putting in a partially frozen turkey in the pot, causing cooking oil to splatter. Also, without thermostat controls, deep fryers can overheat oil to the point of starting a fire.

According to U.S. Fire Administration, even a small amount of cooking oil spilling on a hot burner can lead to a large fire.

Since the use of turkey-fryers often times can lead to very painful burns, other injuries, and damage of property; it is important to consider alternatives.

The National Fire Protection Association discourages the use of oil-containing turkey fryers except by properly trained professionals, who are using professional-level equipment.

Alternatively, oil-less outdoor units are also available and are a safer choice to oil-containing fryers.

NFPA advises that people who want to have a deep-fried turkey, buy it cooked from a grocer, food retailer, or restaurant that prepares them using professional equipment.

The Thanksgiving holiday is the top day for cooking fires to happen. According to a recent report published by U.S. Fire Administration, an estimated 2,000 Thanksgiving Day fires occur annually in the U.S. in residential buildings, and the leading cause of these fires is cooking.

If you are looking forward to a deep fried turkey this Thanksgiving, it is important to consider your options with safety in mind.

It’s official: This is the biggest El Niño on record, and a killer La Niña is coming

ElNinoOn Wednesday morning, NOAA released its data for the Pacific Ocean temperatures for the week of November 9. We hit a record — the current El Niño is the strongest in recorded history.

Before 2015, the largest recorded weekly reading of El Niño occurred during the week of November 26 in 1997. We passed that milestone last week. In 1997, the El Niño index set a record of 2.8:

Screen Shot 2015 11 18 at 11.50.42 AMBruce Krasting

As of last week the Pacific Ocean in region 3.4 (where El Niño is measured) hit a record of 3.0:

Screen Shot 2015 11 18 at 11.56.07 AMBruce Krasting

So another weather record has been set. What does it mean? In the very short term it means that there will be some hellacious weather in the US Pacific West/Texas in the next 90 days. It also means there will be a drought in Australia and Indonesia. Other parts of the globe will feel the consequences of the mega Niño.

Another consequence of this year’s El Niño, however, is virtually a sure thing to happen within the next half year. A very rapid change in El Niño water temperatures will follow — in nine months we will have gone 180 degrees in the opposite direction and we will be dealing with a very strong La Niña.

The following plots the changes from El Niño (red) to La Niña (blue). Note the rapid change that occurred from November 1997 to the fall of 1998. A very big La Niña followed the record El Niño:

The numbers:

Screen Shot 2015 11 18 at 11.56.54 AMBruce Krasting

A chart of the 1998 event:

Screen Shot 2015 11 18 at 11.57.30 AMBruce Krasting

This chart from Wednesday’s NOAA report is a synopsis of the computer forecasts for the collapsing El Niño and soon-to-be La Niña:

Screen Shot 2015 11 18 at 11.58.11 AMBruce Krasting

What will the coming La Niña bring us? If history is the gauge, then we should be preparing for a record hurricane season in the summer and fall of 2016 and a return to the crushing droughts in the Pacific West. This is what NOAA reports for the hurricane season of 1998:

Screen Shot 2015 11 18 at 11.58.55 AMBruce Krasting

In March of this year, the Australian Meteorology department issued its first warning that a big El Niño was in our future. I wrote about it, and in the blog I made some predictions of what it meant. Many of those things have now proved correct. So I’ll go out on a limb with some deep thoughts on the coming La Niña:

— If you live anywhere along the US coast from Virginia all the way to Texas (especially Florida), make some preparations.

— If you’re thinking of putting your house up on stilts to avoid flood damage, do it now. By March, the “Coming La Niña story will be in the media — too late to hire the construction crews to raise the house.

— To the extent possible, increase flood and wind insurance protection.

— Short the stocks of those insurance companies that have large risk exposure to the US east coast.

— If you’re thinking of buying that dream house on the ocean in the Sunbelt, wait a year — there will be some bargains. If you’re a seller, call the broker soon …

The La Niña will result in a resumption of drought conditions in the West. So consider:

— Enjoy the West Coast skiing this year — the next two years will suck.

— Don’t buy a vegetable farm (or heaven forbid a grape grower) in California just yet.

— Pot growers in California (huge biz) will get squeezed, as these growers use a ton of water.

I wonder about Phoenix and Las Vegas (more than San Francisco or Los Angeles). These cities are highly dependent on the Colorado River/Lake Mead. In a year the headline will be “Drought Returns — Lake Mead Level Resumes Drop.” What might be the implications of that? I can’t think of anything to be “long” of in that scenario — including casinos …

 

Source: http://www.businessinsider.com/biggest-el-nio-killer-la-nia-coming-2015-11

House damaged in Hurricane Andrew finally gets repaired

property-damageSOUTHWEST MIAMI-DADE, Fla. (WSVN) — A house damaged in Hurricane Andrew is finally being repaired over 20 yeas later.

After two decades, Ileana Garcia is finally getting her roof repaired after Hurricane Andrew sent a pine tree falling onto it.

“All of that came down,” Garcia said while pointing to her ceiling.

Garcia used insurance money to have her roof repaired but the work was very shoddy. For the past 23 years, she has experienced consistent leaks. However, Garcia is now on the way to receiving a new roof.

Garcia is grateful for the new roof. “I don’t want to get emotional but I wouldn’t have been able to do this on my own,” she said. “I have no words to say, you know, how I feel. It’s just incredible. I’m very happy.”

And Garcia doesn’t have to do it on her own thanks to a give-back-to-the-community campaign by South Florida’s T&S Roofing Systems of Miami. The program is called No Roof Left Behind.

“This is an opportunity for employees all to get together for a common cause,” said Louis Toledo, president of T&S Roofing Systems. “It’s been very much a morale booster for our company and I’m very happy, to be able to do it.”

Garcia was nominated for the program by her neighbor and friend Patricia Winters. “Illeana has been my friend and neighbor for about 10 years. As long as I’ve known her, she has been a giver,” Winters said.

Source: http://www.wsvn.com/story/30521626/house-damaged-in-hurricane-andrew-finally-gets-repaired

Citizens Uses Scare Tactics

warning letter

The role of the State government as a property insurer is continuing to decrease.  Since 2012, Citizens Property Insurance has passed off more than 1 million property insurance policies to private carriers, and another surge is to come over the next four months, said Barry Gilway CEO and president of Citizens.

Citizens’ board of governors was informed that there will be an enormous upcoming action in November. Gilway foresees a large amount of take-out policies being offered to private carriers as early as January, getting thousands of more policies in the private market

By the end of 2016, Citizens estimates that it will hold less than 450,000 policies. A massive reduction in comparison to 2012 when Citizens held 1.5 million property insurance policies, but insufficient surplus to cover the state if a major hurricane had hit.

Citizens currently has 575,000 policies issued and more than 7.5 billion dollars in surplus.

Getting to low numbers has come with controversy and questions on the way Citizens has shifted many of its policies. Letters from private carriers companies announcing they were going to acquire the homeowner’s Citizens’ policy looked like junk mail, many times ending in trash cans, preventing homeowners from opting out to remain with Citizens. Critics have complained that Citizens has used “scare tactics” by warning homeowners of a 45 percent increase in assessments for those who chose to remain with Citizens. However, the likelihood of the assessments was low, as Citizens had $7 billion to cover potential losses.

Recently, Citizens’ approach has been more consumer friendly. Citizens now sends a warning letter to residents to inform them that a private insurer will be contacting them shortly to switch into the private market. The letters have been reworded, still warning of potential assessments but having less of a doomsday feel.

State officials have been working on shrinking Florida as an insurer ever since the State’s private market has gradually rebounded from the early 2000s hurricanes. If Citizens carries too much risk, everyone in Florida can be hit with surcharges to make sure there is enough funds to cover Citizens. In essence, bigger the State insurer is, the bigger the risk that is carried down to all taxpayers.

The State’s intent was to have Citizens be the insurer of last resort. This meant, they would only take policies that the private market would not take. However, during the mid-2000s, major private carriers stopped writing policies and Citizens’ numbers increased dramatically.

Despite the fact that the numbers are shrinking, Citizens is still raising premiums on many policyholders- particularly in Southeast Florida.

 

Florida insurer’s appeal, over assignment of benefits, rejected by court

gavel-568417_640An appeals court Monday pointedly said it is up to state lawmakers — not the court system — to tackle a controversial issue in the insurance industry known as “assignment of benefits.”

A three-judge panel of the 1st District Court of Appeal refused an insurer’s request to rehear a case decided in June.

Also, it declined to ask the Florida Supreme Court to take up a key issue in the case through a process known as “certifying” a question to the Supreme Court.

The issue in the case involves homeowners signing over policy benefits to contractors. In the June decision, the appeals court backed the state Office of Insurance Regulation, which turned down requests from Security First Insurance Co. to restrict the ability of policyholders to assign policy rights without the insurer’s approval.

The practice known as “assignment of benefits” often occurs when homeowners need repairs for problems such as water damage. In such cases, contractors pursue payments from insurance companies.

The insurance industry argues that such assignment of benefits can lead to inflated costs and fraud.

Contractors argue that the practice helps homeowners quickly hire contractors for emergency repairs.

But the appeals court Monday said a “century of precedents” have found that policyholders can make assignments without insurers’ consent.

“We again conclude … that it is for the legislative branch to consider this public policy problem, not the courts, at this juncture,” said the ruling, written by Judge Scott Makar and joined by judges Stephanie Ray and Ross Bilbrey.

“Legislative review provides a more detailed inquiry into the current situation in the industry and greater flexibility in achieving meaningful reforms, if deemed necessary. On the other hand, courts are ill-equipped to pass judgment on the merits of the policy debate at hand, and less likely to be able to formulate a remedy that is mutually beneficial to insureds and insurers.”

 

Source: Orlando Sentinel, October 26, 2015

Florida Man Arrested for Stealing Nearly $100,000 in Insurance Claims from Elderly Hurricane Sandy Victims

The Florida Division of Insurance Fraud announced this month the arrest of a Naples, Florida man, Daniel T. Phelps.  Phelps allegedly stole two insurance claim payments totaling over $96,000 from an elderly New Jersey business owner who shortly after Hurricane Sandy in 2012, sustained damage to his business.

George Capuzzi had filed an insurance claim as a result Hurricane Sandy. However, he suffered from health-related issued and was in need of assistance with the filing of the hurricane insurance claim for his business. Considering Capuzzi’s need for assistance, a mutual friend referred Daniel Phelps to Capuzzi as someone who could assist him the claims filing process.

The Division of Insurance Fraud received information demonstrating that Phelps had stolen two checks from Capuzzi who was awaiting an insurance disbursement to make the necessary repairs to re-open his business in Atlantic City, New Jersey.

Phelps took advantage of the elderly business owner and re-directed the delivery of the insurance claim checks to his girlfriend’s home in Naples. Once mailed, Phelps took a trip to South Florida. After receiving the checks, Phelps fraudulently endorsed Capuzzi’s name. Phelps attempted to mask the fraudulent deposit by utilizing his step-brother’s driver’s license to deposit the checks into a joint bank account. He then transferred the funds out of the joint account into his personal bank account, where he used the money at will.

During the following three months, the Department of Insurance Fraud said Phelps spent the $96,000 on a new Jaguar car, a trip to Key West, a boat, and Lasik eye surgery. As of today, due to Phelps’s fraud George Capuzzi’s business has not re-opened.

Earlier this month, Phelps was picked up at the Broward County Health Center on charges of grand theft, scheming to defraud, and criminal use of personal ID. Phelp’s case will be prosecuted by the Office of the State Attorney.

Summer’s Windstorms

florida-summer-stormJust this past summer several powerful windstorms have hit  several areas in Florida. These storms have been strong enough to damage shingles and tear off roofs.

As advocates for policy holders, we have seen that many insurance claims arising out of storms will be underpaid, delayed, or wrongly denied. Homeowners may be intimidated by denial letters and left without direction.

Regardless of why your damages have not been paid, we can review your claim free of charge. Hire an insurance expert who can navigate you through the process and rightfully obtain a settlement for your damages.

We will let you know whether the insurance company is acting with good faith and doing the right thing. If legal representation is advised and we obtain a fair settlement, insurance company will be responsible for paying attorney’s fees and cost.

Our goal is to get you a settlement that is rightfully yours. We will not let “NO” be the final answer. Call The Mineo Salcedo Law Firm for a free consultation.  (954) 463-8100.