Adjusters as cowboys. Was: Re: VW roof...etc

[Roger M. Woodbury]

Actually there are several different types of adjusters.  Some companies
have their own adjusting staffs that do ALL their adjusting work.  Then
there are insurors who deal ONLY with independent adjusting companies or
adjusters who work independently.

Basically, insurance companies don't give a rat's ass about individual
claims for property damage.  The basic decision made for a claim is made
once the claim is reported. The claims department takes "claim A" and
matches it against "Coverage Part B" from the policy manual.  A decision is
made quickly about whether or not the claim is covered.  "Hmmmm, the roof on
this VW was ripped by vandals.  The act of vandalism is a covered peril
under this policyholders policy."  Period.

The claim details are filled in to a form, and an adjuster is assigned to
close the claim.  The adjuster receives the information about the named
insured, the vehicle damaged, the type of damage and the coverage and
deductible amounts.  The adjuster than calls or otherwise contacts the
insured, and often the claim is closed right then, with the adjuster either
issuing a check on his draft authority from the company, or a report is
filed, and the insurance company claims department issues the check.  The
vast majority of claims are handled this way.

Sometimes a claims adjuster is assigned to appriase the loss, and the
insurance company claims department "adjusts" the loss based on a whole lot
of other special factors.  A convertible roof damage would most probably not
be handled this way, unless the claims department had some reason to suspect
that the loss was not purely correct as reported.

Now, an adjuster might have been just given a shellacking by his superior
because of complaints from someone about his performance adjusting losses
over the past three months or so. "You IDIOT!  Acme Insurance, Bently
Insurance, and Cheapskate Insurance have ALL sent me nasty memos about your
appraisals taking too long (or costing too much, or resulting in State
Insurance Department inquiries, or inquiries from the local newspaper, or
the Women's Christian Temperance Union....you get the picture)"

So the adjuster goes out and with great vigor decides to squeeze every last
dime out of every last loss to show his boss what a terrific adjuster he
really is.  My wife's Mazda RX7 was backed into in a parking lot by some
elderly woman who was insured by Allstate or State Farm....one of those.
They had their own "drive-in" claims office and she took the car there.
They declined the claim on the spot, saying, in effect, that my wife had
been at fault for driving down into the parking lot.

Well, my wife was a licensed insurance agent, a Chartered Property and
Casualty Underwriter, and possessed of an enormous temper when pushed.
Although she was basically shy and retiring normally, the attitude of the
claims adjuster made her so angry, that she prepared a dossier and took
State Farm or Allstate (whichever) to court.  Since the accident happened in
a private parking lot, there was no police report, but she took photographs
of where and how it happened.  They hired a lawyer, and she went pro
se....her CPCU degree had prepared her well for arguing insurance matters in
court, and she knew much more about contributory and comparative negligence
than the lawyer who she met in court.

The judge took one look and listened to the hot shot lawyer posture, finally
cutting him off at the knees.  The judge pronounced the claims denial to be
illegal under the law, and ordered the insurance company to pay the claim
immediately, plus court costs, and the lawyer to get the he-- out of his
courtroom.  Case closed.

I have also seen claims adjusters (working for all sorts of companies...and
I do not mean to single out any one insuror over another), literally bend
themselves intoa  pretzel to try to make the specifics of a loss meet the
terms of a policy.

It is just like all things in life.  There are no guarantees, and no gold
plated "rules".  My own insurance company is USAA, arguably the best
insurance company on the planet for those who qualify.  But I had a loss
involving my motorcycle that I had a run around with because of the attitude
of the adjuster.  Basically, the adjuster was lazy and indolent, and the
thought of actually driving form his home in southern Maine, way up here in
the hustings, was too much for him.  The repair to the motorcycle involved
replacement of the rear suspension as a unit, and the adjuster tried to get
the motorcycle shop to bend it back into shape.  Repair of the piece was
SPECIFICALLY against the procedure in the BMW manufacturer's repair manual,
but it would have been about $900 cheaper, and was the difference between
repairing the bike, and declaring it a total loss.  I wanted it declared a
total loss, as I was not going to ride any more, and for sure, I wasn't
going to ride something casually repaired.  The adjuster was working on the
wrong premise, as I appealed the entire case to the eastern regional claims
manager of the insurance company in the home office.  They ended up seeing
it my way, and I got paid out of the claim.  I did NOT get all that I wanted
though, as I wanted the adjuster's license on a platter.

Sometimes adjusters see themselves as some sort of private eye...a kind of
policy Magnum, if you will.  Those people are stupid and dangerous, and
fortunately, in the minority.  But when they pop up and meddle in some
unsuspecting policyholder's life, they make it very difficult for  the vast
majority of people in the insurance industry to sleep at night.

Claims in general result in quite a lot of emotional angst for the
policyholder.  The person suffering the loss is feeling violated, and the
claims adjuster and behind him, the insurance company is most often the ONLY
course for relief from the negative feelings that go along with an insurable
loss that  is in no way within the control of the insured.

But for the insurance company claims department, and the adjuster, it is
just another claim. Either it is covered or not.  If it is covered under the
policy, then the terms of that coverage are quite specific, and the
adjustment process most often, completely mechanical.

Roger