How insurance adjusters work

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Q: What is a Public Adjuster?

A: A Public Adjuster (sometimes called "private adjuster") is an experienced insurance professional who works only for you, the policyholder - not the insurance company. Unlike the insurance company's adjuster, since we work only for you, our efforts serve your interests exclusively.

We may just be the best kept secret of the insurance industry. Ask your family and friends, and see how few know what a Public Adjuster is. It will be very few. In fact, about 95% of the public are unaware that Public Adjusters exist, or that they have an option when it comes to settling their insurance claim - most think they must accept whatever the insurance company says. Next, check out our results. and ask yourself, "if Gold Star can recover this much money on just a few claims, how much trouble would the insurance industry be in if Gold Star handled the 1.2 million hurricane claims filed in Florida in 2004, or all the claims of Katrina, Rita and Wilma in 2005"? You do the math, the insurance companies already have! Is it any wonder insurance companies don't want you to know about us?

Q: I've suffered a loss, what do I do?

  • Call Gold Star toll free at 1-800-523-2589. Put our knowledge, experience and skills to work for you.
  • Call your insurance company promptly and notify them of your claim.
  • If possible, stop any further damage from occurring to your property.
  • Get the wet out!
  • Take photographs or video of the damage to document and prove your loss.
  • Create a detailed inventory of all the contents damaged or destroyed.
  • Save all receipts and document all intangible expenses as a result of the loss (your clean-up efforts, temporary repairs and board-up, for example).
  • Prior to Gold Star representing you, take detailed notes of all your conversations with your adjuster(s).
  • Document! Document! Document!

Q: Why Gold Star?

A: We are Florida insurance adjustment experts, and we will work only for you. We prepare, submit and negotiate the claim on your behalf, and only with your best interests in mind. We are able to explain the process, and inform you of your options every step of the way.

Having decades of experience with the largest insurance companies in the country, we know what it takes to present a claim, and achieve the maximum settlement for your loss. Insurance policies are confusing, and company adjusters are only human. They have varying degrees of experience, knowledge and ability, they are under great pressure from insurance companies and other policyholders, and have huge time constraints. The bottom line - they make mistakes - mistakes which could cost you a lot of money.

You need Gold Star on your side! We only work for you, and we have the training, experience and know-how to recover the maximum for your claim - and educate you in the process.

Q: Doesn't my insurance company have to provide me with an experienced and licensed adjuster?

A: You would think so, but don't count on it! Especially today, with so many storms and adjusters in high demand, your adjuster may have never handled an insurance claim before in his or her life! Believe it or not, insurance company adjusters get to skip all the education and licensing requirements. They can be shoe salesmen* one day, and insurance company adjusters the next - literally. Insurance adjusters are in such high demand these days, any warm body will do. Ask your adjuster about their experience, training, and licensing. *nothing against shoe salesmen, I just don't want one adjusting my claim!

Q: Don't insurance companies have rules they must abide by?

A: Sometimes it's difficult to tell, but they sure do. You will find plenty at the Department of Financial Services web site, Here's a section of the law we really like:

Title XXXVII Chapter 626 INSURANCE FIELD REPRESENTATIVES AND INSURANCE OPERATIONS View Entire Chapter 626.9541 Unfair methods of competition and unfair or deceptive acts or practices defined.-- (1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE ACTS.--The following are defined as unfair methods of competition and unfair or deceptive acts or practices:

(i) Unfair claim settlement practices.

1. Attempting to settle claims on the basis of an application, when serving as a binder or intended to become a part of the policy, or any other material document which was altered without notice to, or knowledge or consent of, the insured;

2. A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy; or

3. Committing or performing with such frequency as to indicate a general business practice any of the following:

a. Failing to adopt and implement standards for the proper investigation of claims;

b. Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue;

c. Failing to acknowledge and act promptly upon communications with respect to claims;

d. Denying claims without conducting reasonable investigations based upon available information;

e. Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed;

f. Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement;

g. Failing to promptly notify the insured of any additional information necessary for the processing of a claim; or

h. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary.

(j) Failure to maintain complaint-handling procedures. --

Failure of any person to maintain a complete record of all the complaints received since the date of the

last examination. For purposes of this paragraph, "complaint" means any written communication primarily expressing a grievance.

Q: I don't think the adjuster or insurance company is treating me fair - what can I do?

A: You can call Gold Star and level the playing field, or you can call the Florida Department of Financial Services at 1-800-342-2762 (in Florida), or contact your state's Insurance Commissioner or Department of Insurance (outside Florida). Call a state representative, city commissioner, mayor, governor, anyone who may be able to help. Don't give up!

Q: I need your help! What do you charge?

A: That depends on the complexity and projected value of the claim, but typically, public adjusters charge a percentage of the claim proceeds, and can range anywhere from 10% on new claims, to 50% on supplemental claims. A supplemental claim is one that has been previously paid, closed or denied by the insurance company. After a hurricane (or other declared disaster) in Florida though, the state caps the new claim fee at 10%. Otherwise, the new claim fee cap is 20%. Just as all claims are different, compensation rates can be structured differently as well. Gold Star typically charges 10% on disaster claims, 20% on new claims, and 25-30% on supplemental claims.

Q: How about up-front fees or costs?

A: Nothing! Never! If a PA tells you they need money up front, run! And if you have already collected from your insurance company, make sure you don't sign away a percentage of that.

Q: What do you mean?

A: If you sign a contract with someone else that calls for a straight "20% of all proceeds", that may include proceeds already collected (unless specified). If that PA does nothing for you, you may still owe 20% of what you collected on your own, and be out of pocket for the 20% just by signing with that PA. This is illegal, and Gold Star never works that way. All of our contracts require us to collect for you before we get paid a dime. If you already collected from your insurance company, we only get a percentage of the additional amounts collected, until a preset percentage of the total claim is reached.

Q: I'm not sure I get it, can you give an example?

A: Sure. Suppose you already collected $100,000 from your insurance company. If you sign with another PA for a straight 20%, and all they get for you is another $1,000, you would owe them $20,200 ($100,000 + $1,000 = $101,000 x 20% = $20,200). Never with Gold Star. The most we would charge is 50% of the additional amount, so in this case, if all we could collect is another $1,000, all we would get is $500, and you would get $500. Which is better, paying $20,200 and being $19,200 in the hole, or paying $500 and being $500 ahead? Now, getting such a small additional recovery is unlikely, but at Gold Star, we cover your behind for you. Still fuzzy on the math? Give us a call. We'll go over it until its crystal clear. The bottom line is, no up-front payment, and no fee unless we collect more!

Q: Can I see what my insurance company will pay first, or do I have to hire Gold Star from the start of the claim?

A: You do not need to hire Gold Star from the start, but keep in mind, as someone untrained in handling insurance claims, you will be dealing with insurance "professionals" that will not hesitate to use any slip of the tongue against you. And once an adjuster or company has decided what they want to pay you, they tend to dig in their heals, and defend their initial settlement, no matter how bad and low it might be. It gets harder to recover everything you can, even if you are legitimately entitled.

Q: I'd still like to try to handle my claim myself, what advice can you give?

A: Of course it is impossible to tell you everything you need to know. Every claim is different, and therefore the handling of every claim is different. But here are some basics:

- Document, document, document (see 1st question above). This goes for the damaged items, and the claim handling itself. - Be thorough, but be honest. Few things turn insurance adjusters on like the prospect of catching people at fraud. They have entire departments devoted to fraud, and their fraud representatives are usually some of their best trained (too bad their claim adjusters are not all as well trained). They have seen and heard it all, and can eat would-be cheats alive! Insurance fraud is a crime. Don't even try it.

- Be persistent. Don't give up. Policyholders walk away from millions each year just because they are sick and tired of dealing with their claims. If needed, write complaint letters to the company (local, regional, home office), as well as your Department of Insurance (or anyone else that will listen). Keep after them. Be relentless. If you have a valid claim, your vigilance will pay off.

- Seek professional assistance when needed. Depending on the loss, this could mean an engineer, contractor, mold specialist, accountant, attorney, or of course, a good public adjuster.

- Read my book, " UNCOVERED ". This is by far the best guide to property claims. So many questions are answered there, and you can always contact me personally for additional information or questions specific to your situation.

Q: I tried to handle it myself and I botched it, or I am just tired of beating my head against the insurance company walls -- is it too late?

A: No, it may not be too late. Even if the insurance company made a payment, even if you already cashed it, even if the claim is years old. Give Gold Star a call. We recently recovered on a claim that was 7 years old! Consultations are always free, and if we can not collect more for you, we get NOTHING! Remember, we only get paid if we get you MORE, no matter how long we work your case! But insurance policies do have time limits (usually just for YOU, not THEM), so don't wait! Call Gold Star today, even if its just for a free consultation.


Category: Insurance

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