This voicemail was forwarded to us from a city claims adjuster in Florida. The caller is clearly not the happiest camper in the world. But it’s always refreshing to hear a well-reasoned, coherent argument for why a claim should not have been denied.
Bill was confident his printouts would speak for themselves.
“Mr. —–, William ——– here, guess what? Just this very past minute, a f—— power outage here, okay. Now I’m tired of this f—— bulls—. Now that claim’s gonna get f—— paid, excuse my language. Or I’m gonna get this s— on TV and let people see this. ‘Cause I’m tired of this crap. You’s know exactly what the hell’s going on out here, you’s are denying it. This s— needs to get fixed, okay.
“I-I’ll tell you what, why don’t you come out here, and I’ll show you all the printouts from my color printer. Every time the power cycles off, this thing has to recycle and then start back up again. And I’ll show you all the start-up pages. How’s that sound? And all the wasted ink. I’m tired of this crap, I really am.“ Continue reading
This piece was submitted to us by an adjuster with nearly a quarter-century worth of experience with the same company. We can’t help but wonder how this adjuster’s quality was all those years before their “manager” decided to get more hands-on…
After working for USAA for 23 years they reorganized our large loss casualty examiner group into the “call center.” We would get all kinds of stray calls and first reports of claims (because they did away with the loss report unit) along with the usual work of handling the more complex injury claims.
This was sent to us by a public liability claims adjuster for a city risk management department:
Unfortunately the memo portion of a check is not strictly enforced.
Our office got a complaint call from a claimant with whom we’d settled for $2,500.00 after she tripped on a sidewalk. She called in two years after we’d settled with her to ask that we remove her “from our insurance system as soon as possible or turn the system off.” She said that her personal health insurance refused to pay for her injuries unless we remove her from our database.
I had a claim assigned to me for a break-in to an insured’s house. I got a copy of the police report the insured filed, and it looked like the house was unoccupied at the time of the break-in, and the only claim was for damage to the house itself; no contents were stolen.
It took some time, surprisingly, but I finally tracked down our insured, who our documents showed as the owner of the house, and got him to meet me at the property. It was there at the meeting that he told me that he didn’t actually own the house anymore, and that the man he sold the house to made it one of the conditions of the sale that our insured keep paying for insurance on the house. While that struck me as odd, and possibly illegal, he thought nothing of it and still expected he’d be getting a check for the damaged property.
He somewhat got it when I explained what insurable interest was, and how he didn’t actually have any in the house once he sold it, and the guy he sold it to shouldn’t have made him keep insurance on a house that he no longer owned. Okay, problem solved, I thought.
But then he asked me if, despite him not actually owning the house, or suffering a loss, if there was any possibility that I could somehow find a way of paying him for the damages.
I had to then explain the concept of insurance fraud and file auditing and tell him how I really wasn’t in much of a position to lose my adjusting license or go to jail for helping him out by “finding a way” of paying him for damage to a house he didn’t own.
I think he sort of understood. Maybe.
Municipalities will typically have an employee change their name to "Nature" so that they may carry out "Acts of Nature."
After being affected by a tropical storm, calls flooded the city’s risk management department and people expected to get paid for lost food after power went out. This is a typical conversation that occurred several times a day:
Adjuster: “Risk Management Division, how may I help you?”
Citizen: “Um, um…I was told to call you, that you could pay for my food.”
Adjuster: “Who advised you to contact the City?”
Citizen: “The news.”
Adjuster: “Did you have food spoilage because of a power outage from the storm?”
Adjuster: “Why is the City at fault for your food spoilage?”
Citizen: “Because I lost my electricity.” Continue reading