ED Magedson – Founder
California Department of Insurance300 Capitol Mall, Suite 1700 Sacramento, California United States of America
RIP OFF REPORT
On June 14, 2010, a consolidated report was sent to the personal attention of Insurance Commissioner Steve Poizner. This report was based on documents that had been previously sent by the homeowner and myself to the California Department of Insurance (CDI) that outlined complaints against an insurer, Lincoln General Insurance Company (LGIC), its third party administrator, American Claims Management (ACM) and others. The contents of this report highlighted information in the files that included numerous and repeated violations of insurance regulations and codes later stated herein. This report also brought to the Commissioners attention the possibility of a fraudulent Release Agreement, negligent misrepresentation, postal fraud, conflict of interest and other items of interest. Other documented information was also brought to the Commissions attention regarding ACM Claims Examiners, Walsh Adjusting and the insureds agent, Orr & Associates.
The intent of the report was to inform Commissioner Poizner of the failure by the CDI and the Associate Compliance Officer (ACO) handling the complaints,to fully investigate, process, and take the approprate action against LGIC, ACM and possibly others regarding third party claims as mentioned therein. This report showed that the Associate Compliance Officer handling the files failed to resolve the issues in the complaints that favored the insurance company, third party administrators and others over the complainants.
The following brief summary of this writing only touches upon information that had been previously sent to the California Department of Insurance and to the personal attention of Insurance Commissioner Steve Poizner. Everything stated herein is based on several inch thick file of hard copy correspondence, communications , dated events, reports, estimates, photos etc. that can be made available.
WHO ARE THE BAD GUYS ? Brief Summary
# 1 - CALIFORNIA DEPARTMENT OF INSURANCE ( CDI )
This department describes itself as an agency that does not have the authority to resolve issues such as a Release Agreement that is likely fraudulent and negligent misrepresentation. This Release Agreement was prepared for the homeowner by the Lincoln General Insurance Company team ( LGIC ) that included myself as a claimant and settling party on the side of LGIC against the homeowner without my knowledge or consent. This department also declares that it is essentially an administrative agency that failed to administer both the homeowners and my complaints against the Lincoln General Insurance team and their third party administrator, American Claims Management (ACM) and others as later mentioned.
On page 21 of the 33 page report to the Commissioner, it referenced 34 insurance regulations and codes that were violated 294 times. This information was compiled from a 53 page addendum to the original complaints prepared by both the homeowner and myself that had been submitted to the Associate Compliance Officer (ACO) of the California Department of Insurance. This complaint addendum was compiled and based on documents and information that had been previously sent to the Department of Insurance to the date of the addendum. The above mentioned page 21 from the report to the Commissioner has been copied and later included and made part of this writing.
After receiving the above stated violations that was sent to the personal attention of the Insurance Commissioner, this agency advised me as a complainant that regulatory findings as to violations of insurance regulations, are confidential and not public information.
This department should stand up for the public and inform a complainant as to what action was or was not taken regarding complaints rather than operate under a cloak of secrecy to protect the insurance industry.
This is a consumer agency supposedly representing the public interest, suggest the claimant should enforce items such as possible fraud, conflict of interest and other violations at the claimants expense. The Department of Insurance acting as an administrative agency, and having no authority as this agency states, should have acted and administer these complaints over to the State Attorney General that has the authority to investigate and enforce any such violations.
Lincoln General Insurance and its third party administrator, American Claims Management continued violating insurance regulations and codes knowing that any recourse by the CDI would be minimal, if any. This suggest that complaints by the public against an insurance company and its third party administrators could be dismissed without any action by the CDI. The complainants would never know the results of the complaints or this agencys regulatory findings, if any.
Additionally, this agency allowed the findings of a comp report regarding actual repair cost and scope of work, that challenged estimates from American Claims Management and Lincoln General as unfair claims practice to be classified as client privilege by the Lincoln General Insurance team favoring the insurance company. The comp report clearly indicated that the estimates provided by LGIC and ACM were in conflict with each other regarding unit cost and scope of work. This comp report was submitted to the homeowner, CDI, LGIC and ACM.
The method that the CDI handled these complaints makes complaints against the insurance industry by the public pointless and no reason for the CDI to even exist. It also suggests that this is an agency that protects and favors the insurance industry over the public interest.
As mentioned above, Insurance Commissioner Poizner, was informed in a report detailing the claims and complaints and outlining the failed manner that the CDI Associate Compliance Officer directed the complaints. The Commissioners solution to the problem was to turn the report back over to the Associate Compliance Officer which was the reason for the report to the Commissioner.
Had the CDI enforced the complaints in a timely manner, it would have prevented ACM, Williams and Gwin from continuing unfair claims claims practice that would have prevented the losses to the homeowner and myself. How many more victims have been affected by the actions of ACM, Gwin, Williama and their adjusters ?
Theirs more ..........................
The CDI and Associate Compliance Officer (ACO) knowingly allowed the following.
# 2 - LINCOLN GENERAL INSURANCE COMPANY ( LGIC )
An insurance company and its team that composed a written Release Agreement that violates its own insureds liability policy language (written later herein) by included me as a third party claimant and settling party to join Lincoln General to settle the homeowners third party claim.
This Release Agreement was written without my knowledge or consent that also includes untrue statements and Articles that was brought to the attention of the CDI Commissioner as mentioned in the report. I was first aware of this Release Agreement when I received a copy from the homeowner.
In My opinion, this Release Agreement is intentional concealment, negligent misrepresentation, and fraudulent.
See details of this Release Agreement later in this writing.
Additionally, a conflict of interest potentially existed by claims examiner Gwin CPCU, RPA for investigating claims for both LGIC and ACM on the homeowner and my claims. LGIC was / is also the bonding company for ACM during the claims investigations It appears that these investigations were not impartial..........
See details of this Conflict of Interest later in this writing
The CDI Insurance Commissioner and the Associate Compliance was informed and aware of the above.
# 3 - AMERICAN COMMERCIAL MANAGEMENT d.b.a.
AMERICAN CLAIMS MANAGEMENT ( ACM )
Third Party Administrator for Lincoln General Insurance handling both claims for the homeowner and myself against the LGIC insured contractor.
It was found during the claims investigation, ACM operated from phantom addresses, including a vacant building and other addresses belonging to Arrowhead Insurance Agency.
This third party administrator for LGIC, allowed their claims examiners Williams and Gwin to repeatedly violate insurance regulation, codes and delay claims for gain at the expense and hardship of the claimants. ACM also failed to provide required notices and assistance to claimants when the claims were initiated.
Williams for ACM, repeatedly requested the same documents from a claimant that ACM already had in their possession or that ACM should have provided for their investigation. These ACM request included Certificates of Insurance, and statement of the incident that ACM previously received from the claimants when the claims were first initiated. These documents were also sent to the issuing insurance agent and the CDI.
ACM also requested photos of the damage, repair estimate, the insureds contract that ACM should have acquired during the investigation. ACM also requested insurance endorsements that were never issued by the underwriter, LGIC or the agent that issued the certificates.
These ongoing request by Williams intentionally delayed the claims investigation for ACM. Williams continued requesting these items on the same ACM stationary with the same typed in incorrect contact phone number. This indicates that ACM repeatedly sent a copy of the same letter with only a date change. Additionally, Williams never inspected the work site damage for ACM.
When complaints were filed by the claimants with the CDI against ACM, Williams was then replaced by Mr. Dave Gwin - CPCU, RPA.
Gwin took over the claims from Williams for ACM by sending me predated mail with the intent to deceive the CDI for ACMs gain and coverup at my expense. The contents of this predated ACM mail was not true and misleading that could be considered mail fraud by Gwin and ACM. Copies of the predated male and postmarked envelopes were sent to the CDI
See: Mail Fraud later in this writing.
Immediately after I received the predated mail from ACM / Gwin, I submitted my billing statement for my time and expense based on my standard Day Rate and overhead that is detailed later in this writing. Gwin for ACM cited irrelevant case law regarding my claim, in an attempt to discourage and intimidate me as a claimant. Throughout the ACM / Gwin correspondence, this claims examiners gave different titles to the LGIC insured contractor and myself to meet their needs as I challenged ACM and Gwin.
Gwin acted as claims examiner to investigate the homeowner and my claims for both ACM and LGIC. It was also found that ACM used LGIC as their bonding company. It appears that a conflict of interest may exist by allowing Gwin to act as an impartial claims examiner for both LGIC and ACM during the claims investigation and having LGIC furnish the bonds to insure ACM.
In the first estimate provided by Gwin for ACM regarding the losses to the homeowners claim, Gwin provided only a general repair cost without a scope of actual work or unit cost breakdown. The dollar amount that Gwin provided would not cover the actual cost of repair and included an additional undocumented amount of $14,982.39. This undocumented amount was greater than the amount ACM / Gwin allowed for the cost of repair. Why? The homeowner declined the offer.
Copies of all correspondence from ACM, LGIC, Williams, Gwin and response from the homeowner and myself were sent to the CDI Associate Compliance Officer.
The CDI Insurance Commissioner and the Associate Compliance was informed of the above.
How many more victims will fall prey resulting from the unfair claims practice, unethical conduct, and deceit committed with such frequency as administered by American Claims Management, Williams and Gwin or the insurance industry in general while the CDI does nothing.
Theirs more .................
GWIN, CPCU, RPA -2nd CLAIMS EXAMINER FOR ACM & LGIC REPLACED WILLIAMS
ACM / Gwin disregarded my claim against the LGIC insured contractor for my time and expenses I incurred resulting from property damage to my project by their insured. My claim was based on my day log and standard day rate and overhead less profit that was not included. The time spent was for field meetings with the ACM adjuster, All County Environmental Inc., insureds bonding company- Roel Consulting Group-Art Renga- HCC Surety, insureds attorney- Stephen Pelletier, Contractors State License Board- investigator Arron Halloway -Industry Experts John King - Dan Francisco, subcontractors bidding on repairs and suppliers for material cost Other time and expense was also spent for preparing written reports, photo documentation, estimates, field inspections and office work. These meetings were included in the submitted claim to ACM / Gwin.
Additional later meetings with the LGIC attorney, Walsh Adjusting and the LGIC representative were added. Some of the meetings with the above named were multiple.
Other time and expense spent were for various reports, photo documentation, estimates, correspondence and other field work as required to establish cost for property damage and repairs resulting from the insured.
See code 11553 and details later in this writing.
Gwin now for LGIC, assigns Terry ODonovan of Walsh Adjusting, that submits an estimate for cost of repairs that includes shopping at E-Bay. In my comp report, it shows that the Walch estimate was in conflict and did not agree with the first estimate provided by Gwin for ACM. Both estimates were incomplete and failed to provide true cost of repairs or accurate scope of work. These findings were later classified as client privilege information by the LGIC attorney. Additionally, the ACM Gwin and Walch reports also did not agree with the findings from the State Contractors Board Industry Experts or the adjuster from the insureds bonding company.
Note: Following in this writing is a brief history of Dave Gwin, CPCU, RPA.
LGIC / ACM Gwin is replaced by the LGIC attorney
The CDI Insurance Commissioner and the Associate Compliance was informed of the above.
Theirs more .......................
ORR & ASSOCIATES INSURANCE AGENCY
Insurance Agent for the insured contractor
ACM / Gwins correspondence implies that Orr & Associates failed to maintain records regarding the issuing of Certificates of Insurance to the homeowner and myself. This potential negligent act by Orr and Associates as mention by Gwin was used by ACM Williams as an excuse to delay the processing of the claim.
See later in this writing.
The CDI Insurance Commissioner and the Associate Compliance was informed of the above
The Chartered Property Casualty Underwriters Society ( CPCU ) was informed of the unethical conduct and the alleged insurance code violations by their member Gwin, CPCU,RPA. The society showed no interest to investigate the allegations against their member.
See later in this writing.
WHO ARE THE BAD GUYS ? .......... I think all of the above are!
Theirs More .......
As mentioned previously in this writing, the following is a copy of page 21 taken from the 33 page report that was sent to Commissioner Poizner on June 14, 2010. It touches upon the numerous and repeated violations of insurance regulations and codes that had been compiled and totaled from a joint addendum to the original complaints previously sent to the CDI / ACO by both the homeowner and myself.
These violations only reflect the violations from the time the claims were first initiated to the date of the addendum that was sent to the CDI. Additional violations continued after the addendum was sent to the CDI that are not mention in the following.
ALLEGED CODE VIOLATIONS (00 X= The number of times each code was violated)
Steve Poizner: Insurance Commissioner
California Department of Insurance
Page 21 of 33
June 14, 2010
The following is only touching upon the consistency and repeated code violations committed with such frequency as to indicate the general business practice by Lincoln General Insurance, American Commercial Management, Anthony Williams and Dave Gwin CPCU,RPA.. The CDI associate compliance officer did nothing to investigate, enforce or resolve these issues. Hopefully , the Commissioner will.
675.5(b)(3) violated 01X
2695.1(a)(1) violated 07X
675.5(c) violated 03X
2695.1(a)(2) violated 02X
675.5(h)(3) violated 01X
2695.1(b) violated 01X
2695.1(g) violated 01X
679.70(c) violated 03X
2695.2(n) violated 01X
790.02 violated 41X
2695.3 violated 01X
2695.3(a) violated 04X
790.03 violated 02X
2695.3(b)(2) violated 01X
790.03(b) violated 07X
790.03(e) violated 07X
2695.5(b) violated 01X
790.03(h) violated 03X
2695.5(e)(2) violated 03X
790.03(h)(1) violated 07X
790.03(h)(2) violated 16X
2695.7(b) violated 03X
790.03(h)(3) violated 46X
2695.7(b)(2) violated 02X
790.03(h)(4) violated 28X
2695.7(c)(1) violated 01X
790.03(h)(5) violated 40X
2695.7(d) violated 46X
790.03(h)(7) violated 02X
2695.7(g)(7)(iii) violated 01X
790.03(h)(12) violated 05X
2695.7(f) violated 04X
790.03(h)(13) violated 03X
11553. no response ____________________________________________________________________________________________
I have been a Design / Build Contractor since the mid 1960s, and at no time have I ever experienced claims handled in such a manner by an insurance company, its third party administrators, claims examiners and adjusters as this.
Since the time the claims and complaints were first initiated by the homeowner and myself, this claims / complaint process has turned into a clandestine type operation. It appears that the CDI and the ACO have protected and favored the LGIC / ACM team including both its Claims Examiners, adjusters and insurance agent above the claimants and the public.
THE QUESTION IS WHY ? ................................
ADDED DETAILS to the above
TIME AND EXPENSE CLAIM
After ACM Gwin declined my claim for time and expense resulting from property damage caused by their insured, I responded and submitted the following Insurance Code 11553. to ACM Gwin. There was no response from ACM or Gwin.
Additionally, the following are pages 19 and 20 taken from the June 14, 2010 report to Insurance Commissioner Poizner referencing insurance code Article 11553. This code had also been previously submitted to the CDI Associate Compliance Officer in earlier correspondence. It has also been submitted to Dave Gwin of American Claims Management.
PART 3. LIABILITY, WORKERS COMPENSATION, AND COMMON CARRIER LIABILITY INSURANCE
CHAPTER 1. GENERAL REGULATIONS
INSURANCE CODE SECTION 11580 - 11589.5
Article 1. Reserve of Insurance .................. 11550 - 11558
11553. As used in this article, the terms loss payments and loss expense payments, mean all payments to claimants or on account of claims. Such payments include but are not restricted to those for:
(a) Medical and surgical attendance.
(b) Legal expenses.
(c) Salaries and expenses of investigators, adjusters and field men.
(e) Stationary, telegraph and telephone charges.
(g) Salaries and expenses of office employees.
(h) Home office expenses, and all other payments made on account of claims, whether or not such payments are allowed to specific losses.
The following breakdown are answers to the above article that relate to Loss payments, Loss expense payments, and all payments due to claimants on / or account of claims as per code 11553
1 -Was I a claimant? ............................................................................................. Yes
2 - Did I have loss payments? ............................................................................... Yes
3 - Did I have loss expense payments? .................................................................. Yes
4 -Would all these payments to claimant be on account of a claim ? ..................... Yes
(b) Not known at this time.
(c) Yes- conducted investigations and field work (see submitted day log and rate sheet to ACM)
(g) Work log and standard rate sheet was submitted to ACM, Dave Gwin CPCU,RPA
(h) Yes - Home office expenses, Day log and Standard Rate Sheet was submitted to ACM, Gwin for time and expenses spent. (profit was not charged) No response from ACM - Gwin.
As a result of property damage by the insured, time and expense I incurred was directly attributed to meetings in the field / job site / office with the following:
01- ACMs adjuster
02- Insureds attorney
03- Insureds bonding company adjuster
04- LGIC attorney
05- LGIC adjuster
06- LGIC representative
09- Contractors State License Board Investigator
10- Industry Experts
11- Other field meetings for on and off site with subcontractors, suppliers for estimated repair cost.
Time and expense was also incurred in investigations for analysis of the damages, preparation of reports, estimates, photo documentation, correspondence, phone calls etc.
The method that the claims were handled by the unethical practice of ACM, Williams, Gwin, and the LGIC team including the alleged negligent acts by Orr and Associates as well as the CDI failing to act, also contributed to my losses.
The above documents can be made available.
MAIL FRAUD ?
It was also brought to the Commissioners attention, that predated correspondence by ACM / Gwin, referencing his other correspondence, had been mailed to me as a claimant for Gwins personal gain with the intent to deceive and mislead the CDI at my expense as a the claimant.
This unethical business practice by ACMs, Claims Examiner Gwin in using the US mail to send predated correspondence to a claimant with the intent to deceive could be considered an act of Postal Fraud. Copies of the predated correspondence and postmark envelopes were sent to the CDI / ACO and can be made available.
CONFLICT OF INTEREST ?
ACM correspondence from Claims Examiner Gwin, stated that he had taken over the handling of the claims from ACMs 1st Claims Examiner, Williams. Later correspondence from Gwin also indicated that he was also the Claims Examiner for LGIC during the claims investigations.
This appears to be a conflict by Gwin representing both American Claims Management and Lincoln General at the same time during the investigation of the homeowner and my claims. This unfair and bias claims investigation by ACM / Gwin strongly favored LGIC. The CDI / ACO was aware about Gwin representing both LGIC / ACM.
Additionally, American Commercial Management is / was a d.b.a. of American Claims Management that acted as the Third Party Administrator for Lincoln General Insurance regarding the claims. ACM is a subsidiary of Arrowhead Insurance Agency. Lincoln General is / was also the bonding company for ACM, Bond # FX-6611436 and # FX-661110912 during the investigations.
Here we have a supposedly impartial Third Party Administrator, ACM, that is administrating claims for LGIC that is also the bonding company for ACM by an individual investigating the claims representing both ACM and LGIC.
This makes a claimant question how impartial and fair the investigations were performed by ACM regarding the claims. The Commissioner and the CDI / ACO was aware of this situation. These documents can be made available.
FRAUDULENT RELEASE AGREEMENT AND NEGLIGENT MISREPRESENTATION?
Throughout the correspondence by ACM and the LGIC team, the homeowner and myself were referred to as third party claimants. The Release Agreement also referred to the homeowner and myself as Third Party Claimants and Settling Parties. The following are brief notes regarding this Release Agreement that I was not aware of until I later received a copy of this agreement from the homeowner.
The LGIC team never informed, advised or provided me a copy of this Release Agreement.
Without my knowledge, consent or being aware of such a Release Agreement, language in this agreement between the LGIC team and the homeowner, placed me as a claimant, collectively on the side of LGIC and the insured as a Settling Party. The homeowner was placed as a claimant on the other side as a Settling Party to settle their claim.
I was not a Settling Party as this release states and identifies me. There are also numerous other written statements in this Release Agreement that are not true and intentionally misleading.
Additionally, the language in the insured contractors LGIC policy states under:
SECTION 1V - COMMERCIAL GENERAL LIABILITY CONDITIONS
3. Legal Action Against Us
No person or organization has a right under this Coverage Part:
3- a To join us as a party or otherwise bring us into a suit asking for damages from an insured: or ...............
I was intentionally brought into this Release Agreement as a Settling Party without my knowledge or consent to join LGIC and their insured, knowing that I had a claim against their insured. The intent of this Release Agreement was to have the homeowner settle for an amount less than would be required to repair the covered damages as mentioned in the Comp Report. This Release Agreement clearly indicates another example of the intentional unethical business practice by the LGIC team that is probably negligent misrepresentation and fraudulent.
This Release Agreement also states that the insured was the General Contractor on my project which is not true. The insured was one of several contractors working on the project under my building permits that were issued to me under my name based on the approved plans and specifications, scope of work that I drew and wrote. These documents were made part of the insureds contract for this specific project. The Commissioner and the CDI was aware.
In addition to the insured contractor being called the General Contractor by the LGIC team in this Release Agreement, the LGIC/ACM Gwin team, also called the insured contractor a Construction Manager in their other correspondence. The LGIC/ACM Gwin team in their correspondence, also called me the General Contractor, Project Architect and Construction Supervisor. Titles were given out to both the insured and myself by the LGIC/ACM Gwin team to fit the current needs at the time for their convenience and advantages as different situations arose in the claims. The Commissioner and the CDI was aware.
This Release Agreement also intentionally omits the fact that as the holder of the Building Permits, I was and still responsible for this project under my license for the insureds damage until the project is completely repaired and ready for a final inspection approval and a Certificate of Occupancy is issued by the Building Department. As of this time the project is incomplete.
Additionally, intentional delays by the ACM / LGIC team and both its Claims Examiners caused the allowable time limitations to exceed between inspections. As a result, additional cost, fees and expense to reissuing the permits and re-inspections under my license are not listed or mentioned in the settlement. The cost analysis prepared by LGIC / Walsh Adjusting estimate also neglects to account for these cost or mentioned in the Release Agreement. This condition created by the insured and ACM / LGIC also probably has me listed as abandoning the project by the Building Department that could jeopardize my license.
It required 5 pages in my 33 page report to the Commissioner Poizner, to challenge the untrue Articles and information in this Release Agreement that in my opinion, was intentional, fraudulent and negligent misrepresentation. This Release Agreement and the report sent to the Insurance Commissioner can be made available.
CERTIFICATES OF INSURANCE
Correspondence from Williams for ACM / LGIC implied that the investigation required the Certificates of Insurance. This is not true. The claims were made against the insureds grant liability.
These certificates were attached to the initial claims by the homeowner and myself and mailed directly to the agent. Additionally, my claim along with a copy of the Certificate of Insurance was also directly mailed and faxed to ACM. Copies of the claims and certificates were also sent to the CDI by the homeowner and myself. There is also correspondence from ACM by Gwin stating that the insured contractors insurance agent, Orr and Associates, had no record of issuing these Certificates of Insurance. ACM / Gwins correspondence was also sent to the CDI.
Copies of the initial claim and Certificate of Insurance can be made available including the date, time of transmission to the ACM fax phone number.
CHARTED PROPERTY CASUALTY UNDERWRITERS SOCIETY (CPCU)
The CEO of the Chartered Property Casualty Underwriters Society ( CPCU ) was informed of the unethical conduct and the probable insurance code violations by their member Gwin, CPCU,RPA.
The society showed no interest to investigate the allegations against their member unless adjudicated by either the courts or the Department of Insurance.
These requirements by the CPCU Society as mentioned, to investigate a complaint by a claimant against their member presents a problem. The position taken by the CDI / ACO as only being an administrative agency without authority, has placed the burden of enforcement for violations of insurance regulations and codes on the claimant and the public as required to file a complaint against a CPCU member with the society.
This stance taken by the CPCU Society, would mean that their member is protected by the CDI and no complaint would be acknowledged by the CPCU Society unless adjudicated by the courts.
It also means that individuals or companies in the business of insurance that are CPCU members are protected by the CDI and immune from disciplinary action for violations of insurance regulations or codes unless the claimant files suit against such CPCU member individuals or companies at the claimants expense.
It appears that it is a no win situation for a claimant or the public that relies on the CDI as a consumer agency for help. The claims and complaints by the homeowner and myself as documented in the files confirm the uselessness of the CDI.
Therefor, the CPCU Society would have no incentive to investigate the allegations of a complaint against their member because the CDI is only an administrative agency that has no authority to enforce violations of its own regulations as the CDI / ACO has implied.
This would not only allow the CPCU Society member to continue violating the CPCU Code of Professional Conduct, it would also allow any person or company in the business of insurance to disregard any insurance regulation without fear of recourse from the CDI for gain at the expense of the public
The unethical conduct by the CPCU member also violated the societies rules as noted in The Canon, Rules, and Guidelines of the CPCU Code of Professional Conduct: R1.1 - R3.1 - R3.2 - R3.3 - R6.2
Also brought to the attention of the CDI Commissioner and the Associate Compliance Officer was a Comp Report that was prepared and submitted to homeowner, the LGIC team, ACM and the CDI.
As stated previously, the comp report compared the two cost of repairs estimates from ACM, Gwin and from the adjuster of Walsh Adjusting Company for LGIC. Both of these estimates failed to include the required scope of work or real unit cost for the required work of repairs under the policy coverage. Additionally, the two reports did not agree with each other or reports prepared by the CSLB or the insureds bonding company.
LGIC reacted to my comp report by retaining their attorney to handle the matter and classified their investigation regarding my findings as Client Privilege. The CDI was aware of these discrepancies in the reports and classified by LGIC.
This means that in the state of California, any insurance company that has a claim against it, can lowball their estimate of repairs and if challenged by a claimant, call it Client Privilege. If a claimant questions, challenges or does not accept the insurers lowball offer to settle, the insurer forces the claimant to file suite and tie up the project and claim for an indefinite period of time and be backed by the CDI because they are only an administrative agency without authority as the record shows.
Example: If a home improvement claim as in this situation, the homeowner is then forced to live in hardship without a kitchen, master bath, front an rear entrances, loss of homeowners insurance etc.
This strategy by the LGIC / ACM team then forces the homeowner to settle out of frustration for amounts less than the actual cost of required repairs for the project to continue and be habitable with the sanction of the CDI.
Copies of the Gwin, ACM report, and the Walsh Adjusting report along with the comp report can be made available.
Additionally, there were also two Industry Experts reports from the California State Contractors License Board and a report from the insured contractors bonding company that also was in conflict with the LGIC / ACM Gwin reports. All of these reports can be made available along with photographs.
I would also mention, the insured contractors lost his contractors license over this project.
Communications from Gwin to the CDI Associate Compliance Officer also implies that the CDI / ACO did nothing or was remiss in the investigation of code violations. Copy of this communications can be made available.
In other correspondence to me from ACM / Gwin, he cites case law with the intent to intimidate and discourage a claimant regarding claims. This is a violation of the CPCU Society.
Theirs more ...................
LITTLE HISTORY ON ACM AND GWIN, CPCU, RPA - CA LICENSE # 2E75350
Gwin was a partner in Pacific Claims Service that was acquired by Arrowhead Claims Management, Inc. in or around January 2004. This acquisition added to American Claims Management formed in 1988 which is a wholly owned subsidiary of Arrowhead General Insurance Agency, Inc.
When Gwin acted for ACM, during the claims investigation, the CDI listed Gwins business address at:
6055 Lusk Blvd.
San Diego, CA 92021
This address at the time of ACM Gwin claim investigation, actually belonged to a company called Care Fusion. which is an international medical supply and service company.
It was also found that a company called Inspire Claims Management, # 2B35807 (expired 5/31/2004) former name Arrow Claims Management #2B35807 was also listed at this address by the CDI with the same license number.
American Commercial Management (ACM) d.b.a. American Claims Manage # 2C37446 listed a CDI business address during the claims investigation as:
2544 Campbell Place
Carlsbad, CA 92108
This address was found to be a vacant building during the claims investigation.
American Claims Management #2C37446 also listed a business address listed at:
2365 Northside Drive Suite. 450
San Diego, CA 92108
701 West B Street Suite. 22210
San Diego, CA 92101
These addresses were found belonging to Arrowhead Insurance Agency # 0699809 during the claims investigation.
The CDI has Dave Gwin CPCU,RPA CA Lic# 2E75350 business address currently listed at:
1450 Frazee Road Suite. 414
San Diego, CA 92108
Note: This is Gwins last known business address that could have changed as of this writing
The lobby register has this address belonging to:
NationsBuilders Insurance Services Inc. #OD80808 (inactive)
The CDI has this business address at:
73-726 Alessandro Ave Suite. 200
Palm Desert, CA 92260
Main office for this company is located at
NationsBuilders Insurance Services Inc.
2589 Paces Ferry Road SE
Atlanta, GA 30339
As a claimant and complainant, this phantom operation, is like the story of the fox guarding the chicken coop. The Commissioner and the CDI was informed of this history without concern.
There is also a history of dated correspondence from Gwin, Williams, ACM and the LGIC team stating untrue and misleading statements and other information that has been documented and brought to the attention of the Commissioner and the CDI. These documents can be made available.
CDI Complaints # CSB-6384134 - Design Build Contractor
# CSB-6377949 - Homeowner
LGIC Claims # 43694 - Homeowner & Design Build Contractor
This report was posted on Ripoff Report on 11/26/2010 08:04 PM and is a permanent record located here: http://www.ripoffreport.com/r/California-Department-of-Insurance/Sacramento-California-95814/California-Department-of-Insurance-Mr-Steve-Poizner-Insurance-Commissioner-Does-the-Cali-665723. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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