Federal Judge in Mississippi ‘Storm Surge’ Case Upholds Home Insurance Flood Exclusion

April 13, 2006

  • May 16, 2006 at 7:28 am
    Tony says:
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    Mark,
    Thanks for answering this for me. I didn\’t get my notification that a reply was made.

    Roger, any honest, hard working adjuster can see through you like a pane of glass. You KNOW Mark is right. Just because you don\’t get all your money up front, does NOT mean it will not be paid. MOST companies merely require a signed contract between the insured and a licensed GC to pay any depreciation or replacement cost benefits. You KNOW this, (IF you have been in business longer than 2 months) but you deliberately leave it out of your statement to attempt to incite support for your position.

    When are you going to realize that your best option is to leave it alone. IF you find someone out there who is not doing their job properly (NOT just not the way you want it done, but improperly according to industry standards &/or company practice which if you are as experienced as you propound, you will know what each company does and doesn\’t do)

    Any adjuster that is worth his salt that reads the tripe you are putting on this site can blow your claims out of the water. You know it, Mark knows it and I know it. Be honest and up front and maybe people will listen to what you have to say. Act as you have here and no wonder you have problems w/ adjusters.

    To all others, Mark is right. IF there is a problem w/ your estimate vs. an insurance companies est, contact your adjuster or his/her mgr asap. There is a reason they are called estimates. Like I tell all my customers, \”I am pretty good at my job, but there was only one perfect person and I ain\’t him. I do make mistakes, but will listen if the insured or their contractor can/will point them out\”.

  • May 16, 2006 at 7:59 am
    Tony says:
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    Roger,
    We are back to your shell game. I LOVE how you use underwriting and insurance terminology to try to prove you knowledge.

    What it breaks down to is you want 10% profit on your overhead. Wouldn\’t that make your profit in excess of the industry standard 10% of the cost of repairs?

    Next, you want RC up front. Bubba, READ the policy. If it says RC up front, then that is what should be paid. Most (I haven\’t read all of them) state claims will be paid at ACV until repairs have been completed or \”the expense has been incurred\”. If you and I work on a claim and agree on $10K for RC and I pay it as:

    $10,000 RC
    -$ 1,000 Dep
    -$ 1,000 Deductible
    $ 8,000 ACV

    Now if you and I have done this and agreed on it then it takes you six months to do the work and your costs go up to $11K that is your problem. You have a signed contract to do the work for X dollars. If YOU don\’t get it done in a reasonable time for the agreed on amount, why should the insurance companies compensate you for you running your company poorly. In short, your problem, not ours.

    Having said all this, MOST companies will speak to you to determine why the costs have increased and if reasonable, will reimburse you for these costs.

    You also want O&P on limited trades (one or two). O&P is due to licensed GC\’s when the expense is reasonable and necessary to effect repairs. If you have roofers on staff and you do the roof (and that is all or maybe minor paint etc) you haven\’t EARNED (difficult concept) the O&P. You KNOW there is built in profit in the base costs of an est. The O&P is for the scheduling issues, inspecting the site to insure work is progressing properly etc.

    IF you have the men to do the work, and they do it, you haven\’t acted as a GC. You acted as a ROOFER! Thus, not entitled to O&P.

    Last, let\’s try your creative math again.

    First your example of the way it \”should\” be done:

    $10,103.19 Sub-Total
    $ 114.67 Material Tax
    _________________________
    $10,217.86 Sub-sub total
    $ 1,021.79 10% Overhead
    _________________________
    $11,239.65 Total
    $ 1,123.97 10% Profit
    _________________________
    $12,363.62 Basic Business Math Grand Total

    Using the same numbers and depreciation (which isn\’t owed until the work is done per the policy).

    The amount due is:
    $10,217.86
    +$ 1,021.79 Overhead
    +$ 1,021.79 Profit
    $12,261.44 Subtotal One
    -$ 1,000.00 Depreciation
    -$ 100.00 Depreciated Overhead
    -$ 100.00 Depreciated Profit
    $11,061.44 Subtotal Two
    -$ 1,000.00 Deductible
    $10,061.44 Total due Insured NOW

    $ 1,200.00 Depreciated amount due Insured upon receipt of signed contract (depending on company) or work completion.

    Total Insured MAY receive from Ins. Co.
    $10,061.44 ACV
    $ 1,200.00 RC (or Depreciation) Benefits
    $11,261.44 Total due upon completion etc.

    The ONLY difference now (without the creative math) is the $1000 deductible you didn\’t include in your numbers and the $102.18 difference between the OWED profit and the profit on the overhead.

    Again, obfuscation is your modus operandi. It\’s amazing what someone who is used to dealing w/ people like you can find when they clear away your song and dance.

    To quote a great, \”Go away little boy, you bother me\”.

  • May 16, 2006 at 9:35 am
    Mark H says:
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    Roger,

    You are getting away from the additional numbers I provided. We can debate the various ways contractors apply O&P for days. You obviously prefer cumlative O&P, and as an independent contractor, you may charge however you wish.

    However, 20% of $10,217.86 is the same, whether you pay part of it with the ACV payment and the rest with the RC payment, or pay it all on the front end.

    My point is that a Replacement Cost policy does not owe the O&P on the Replacement Cost untill those costs are incurred by the insured.

    As for the TDI… Their bulletins are for Texas. I do not deal with them and probably never will. It is obvious though, that you have many issues with the TDI (and TWIA), but I get lost in your extended diatribe. Try to keep it simple for us common folk.

    Let me ask you this, Roger.

    Are you concerned about whether the claim rep wrote an accurate estimate, or that you charge more than the claim rep will pay?

    How much higher than the claim rep\’s estimate is your estimate?

    Have you and the claim rep tried to reconsile the two estimates to be sure your comparing apples to apples?

  • May 16, 2006 at 1:14 am
    Mark H says:
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    Roger, you \”forgot\” to include the remaining details of the estimate summary…

    I\’ll add them for you. (assuming this is a Replacement Cost Policy)

    Summary For Hurricane

    $10,103.19 Line Item Total
    $114.67 6.000% Materials Sales Tax __________
    $10,217.86 Replacement Cost Value
    $ 2,607.44 Less Depreciation
    __________
    $ 7,610.42 Actual Cash Value
    $ 761.04 Overhead @ 10%
    $ 761.04 Profit @ 10%
    __________
    $ 9,132.50 Actual Cash Value Incl. O&P
    $ 2,272.00 Less Deductible
    __________
    $ 6,860.50 Net Actual Cash Value Payment

    ADDITIONAL AMOUNTS AVAILABLE
    RECOVERABLE DEPRECIATION
    $ 2,607.44
    $ 260.74 10% OVERHEAD
    $ 260.74 10% PROFIT
    __________
    $ 3,128.92

    If the policy does not have Replacement Cost coverage, then the insurance does not owe O&P on the depreciation.

    You and I also know that the 10% profit is not the only profit in the estimate, as there are overhead and profit built into the unit prices.

    If you want us in the insurance industry to believe you are totally above board, then state the whole true, not just what meets your needs. It is obvious to me that you are only concerned with misleading those who do not know as much as you think you do.

    TO ALL INSUREDS:
    If your contractor\’s estimate is higher than your insurance adjuster\’s, call your adjuster to discuss it. If the adjuster refuses to even review the contractor\’s estimate, then call the adjuster\’s manager. File a complaint if you need to.

    Remember, when the work is done, it is the contractor who walks away with the money.

  • May 17, 2006 at 1:40 am
    Roger Poe says:
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    Tuesday, May 16,2006

    Tony,

    Interesting commentary. Attacking me though does not address real and unfair claim handling conduct.

    Too, you seem to think my commentary is about myself some how.

    Actually, it\’s clearly about insurers and adjusters that try to take advantage of indemnification value, and reconstruction assessing and reconstruction cost estimating naive, claimants.

    You know, the kind of insurers and adjusters that pretend they can\’t grasp the fact that when a builder builds a house, they put a roofing system on using their financially planned for roofing contractor sub.

    The roofing system has BOTH the builders\’ AND the roofing contractors\’ business cost built into it. Agreed?

    (By the way, the same primary-general-builder / sub-trade contractors business cost value principles apply to all trade work components of a given structure, that make up it\’s whole).

    If someone were to then insure the ACTUAL construction value of their roof only, what all TRUE replacement cost value would need to be covered / indemnified?

    If you said, A builder valued roofing system, and all that that means, you would be correct…no?

    Some construction business naive adjusters cannot grasp basic dollar investment math behind \”Cost Plus 10% estimation schedules.

    Simply stated, hard and soft business costs (overhead) require real investment dollars to accomplish a given goal, that of making a pre-tax 10% return on the whole [overhead cost dollars] investment risk.

    Yes Tony, anticipating a 10% profit on ALL parts of the \”Cost\” investment puzzle is fair and reasonable.

    Do not get into the construction business, or claim to estimate reconstruction losses correctly, if you do not realize that business overhead is a constant project-to-project dollar investment.

    Now you have no reason to not understand that business overhead dollars is part of the whole investment risk of the investing contractor, and a true 10% profit potential can be anticipated, on insurance related projects, or none insurance related projects, only when ALL \”Costs\” have a 10% margin applied to them.

    Oh, and another thing Tony, I did include depreciation in the State Farm figures.

    The point of the figures was to show how synthetic replacement cost math, that pretends that Contractor business overhead and profit is NOT part of Replacement Cost Values, upfront, would leave a claimant with a synthetic ACV sum.

    You may want to review my past commentary from that perspective.

    Too, I rarely have a problem with adjusters that can properly assess damaged property, understand sound reconstruction procedures and recognize rational reconstruction cost estimation methodology.

    Any insurers / adjusters that intentionally try to do the opposite, and harm my clients, family, neighbors, or me, well…they get reported to the proper authorities.

    rogerpoegc@yahoo.com

    P.S. For the past fourteen years, and especially the last four years, I and other contractors, and consumers, have met all kinds of unscrupulous and dishonorable insurers and adjusters.

    Those insurers and adjusters that like to confuse the general public, and pretend they don\’t, no longer have the luxury of getting away with either illicit scheme.

    You may want to pay close attention to the Enron case actors, and as you do, keep in mind that complacency can be a serious matter that draws other\’s attention…

  • May 17, 2006 at 7:43 am
    Roger Poe says:
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    5-17-2006

    Tony,

    What kind of construction business was it?

    What kind of estimating data did you use in the business to formulate construction costs?

    rogerpoegc@yahoo.com

  • May 18, 2006 at 2:25 am
    Tony says:
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    Roger,
    It was a small company that mainly handled small new construction or minor to moderate reconstruction. Usually our contracts were between $1000 to (the largest was) approx $30,000. We used a time/material cost basis. We would figure out the materials and the approx amount of time and give a price based off that. If we estimate a job would take 40 hours and it took 50 we didn\’t whine and complain, it was our mistake, we ate the difference. In the same vein if it took 30 hours, we weren\’t offering refunds either. Now having said that, if we ran up against something unexpected (rot for instance) we would notify the owner and discuss what needed to be done.

    Like I said, a small company, but we were happy with it. You would be amazed how many people need help on the little things.

  • May 17, 2006 at 3:50 am
    Tony says:
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    Roger,
    I think you are missing the point on RC vs. ACV. The insurance companies don\’t owe you a penny. They owe the insured (depending on policy) ACV or RC up front. It makes absolutely no difference if you use the term \”synthetic replacement cost\”, \”synthetic ACV\” etc. The issue is what is owed up front. That is really quite simple, and depends solely and wholly on what the policy states will be paid (ACV vs. RC).

    Do I think that 10% profit is too much, nope. Sure don\’t. I do have a problem w/ contractors griping about the amount paid when the ADDITIONAL 10% is for a GC for his efforts in scheduling, planning, ensuring proper and timely completion, etc. and the people griping they don\’t get it are acting solely as roofers. The afore mentioned 10% is for the GC, not a/the subs. The prices that most companies pay are adequate for the company to make a profit based on that alone. Now is there varying rates based on a cat situation, quite possibly. I suggest looking more at quantity of jobs as opposed to making a years worth of profit on one job. In short, while I can sympathize, it isn\’t my problem, it is the guy who is earning the 10%.

    10% overhead costs is another amount paid. Whether I feel as if it is owed or not, is not my decision (which by the way, I do believe it is a fair and adequate amount), but the company I work for says pay it TO A GC, so it is owed. Simple as that.

    You quote: \”Cost Plus 10% estimation schedules. The rub is that the prices insurance companies pay is not cost, but there is a built in profit for the subs. So your quote should be: \”Actual incurred cost, plus 10%\”. That would be much more accurate.

    Your \”builder valued roofing system\” cracks me up. You are trying to compare apples to oranges and using poor terminology to do so. IF a GC hires a sub to roof a building in addition to other work (painting, drywall, electrical, flooring, etc) then the GC should be owed and paid O&P on all items including the roofing. IF a GC ACTS as a roofer and does no other work or a minimal amount (paint a ceiling, etc) O&P should NOT be owed or paid. O&P is not built in additional profit for a GC, just because he is a GC. It is for the work a GC does in supervising the reconstruction process, especially if the GC has no or minimal staff to actually do the work and has to use a myriad of subs.

    Why do I think your commentary is about you? Good point. I\’ll give you that one. I think you are echoing the sentiments and trying to justify opinions of various contractors you know including yourself. I have dealt w/ contractors who purport opinions like yours and most of the time when they realize they aren\’t going to pull the wool over someones eyes, they back off. I will give you credit for persistence. The rub lies in that your arguments are specious (look it up)at best and have no basis other than what you perceive as the insurance companies bias against you/yours/etc.

    You put out blanket statements about AllState, State Farm, Traveler\’s etc without crediting these companies for the quality employees that they have. An average of 1-2% of people will be difficult to work with in any given claims situation. This statistic has been around for years and has been verified by different companies. I wonder what percentage of people you have mislead or even just talked to, are difficult to work with. BTW, I am NOT talking about trying to cheat someone, or pay less than what is owed, etc. I simply mean common courtesy, decency and understanding that these adjusters are doing the VERY best they can and working with them instead of berating them, chastising them or trying to bully them.

    Last, you are really tiresome. Your rants and diatribes do not take into account any points of view other than your own, with no room for any type of informational sharing. You think you are owed more than you got/get and want more. That is why I think your commmentary is about yourself and not the industry as a whole. I try to give honest forthright opinions/facts (when I have them) to explain the claim process (with my company anyway) so people who come here may gain some insight into the procedure. You want to argue over nickels when there are $100 bills laying on the table? Go for it, but don\’t be surprised when an adjuster who has heard BS like yours before, stands up and does what is right, even though it may not be expedient for him, the customer or you.

    Like mama said, \”You can catch more flies w/ honey than with vinegar\”. Moral: Treat adjusters right (courteous, honest, fair and if there is a problem treat it like a mistake, which it probably was, not an attempt to defraud someone) and they will work with you. Don\’t and do not be surprised when you and your customer get an appt next month at the earliest.

  • May 17, 2006 at 4:43 am
    Roger Poe says:
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    Wednesday, May 17, 2006

    Tony,

    Have you ever owned a construction business?

    rogerpoegc@yahoo.com

  • May 17, 2006 at 5:55 am
    Tony says:
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    In a manner of speaking. My brother and I used to several years back. It was not a large business, but we were quite comfortable. Then I got married and moved out of state, so take that as you will. He did the construction aspects and I handled the business end along w/ earning customers. That is one of the reasons I am rather passionate about this issue. I know that there is good money to be made with no one going hungry for those who do the right thing and just plain work hard.



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