Report: #1008447

Complaint Review: Foremost Insurance

  • Submitted: Mon, February 04, 2013
  • Updated: Mon, February 11, 2013
  • Reported By: roxanne — timbo Arkansas United States of America
  • Foremost Insurance

    oklahoma city, Oklahoma
    United States of America

Foremost Insurance They sent me a letter saying i filed a wind report for a damaged roof when i filed a snow and ice report oklahoma city, Oklahoma

*Consumer Suggestion: Is it Wind or is it Water?

*Consumer Comment: Get a public insurance adjuster

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I recently purchased a home.  About a month after moving in, we got a hard rain and there were two small leaks on the porch.  We fixed it ourselves.  It had rained again, no leaks.  In December, we were under a flash flood.  It rained, froze, snowed 13 inches and stayed for almost 2 weeks on the roof, then melted and another flash flood.  Our house is leaking everywhere.  When the person came out for the insurance company, he kept saying "wind damage" and i kept saying, "No, there wasn't any wind problems".  I kept having to tell this man repeatedly about the severe rain, freezing, snow and severe rain again.  He sent me a report and said they denied my "wind" claim.  I did not file a wind claim.  Is it that the snow is covered and they don't want to file it as such?  Has this happened to anyone else?
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#1 Consumer Suggestion

Is it Wind or is it Water?

AUTHOR: ClaimAdvocate - (United States of America)

The issue of water Vs Flood is still an ongoing issue from 2005 in Katrina. You bet, they cant determine water from flood, so in your case is it wind or water or both? The last post is exactly right, you need an advocate on your side who know what to say and more importantly what not to say. You could coverage under both or concurrent causation issues.

I find most insured's doing collateral damage by trying to determine what peril caused the loss and what coverage applies under the policy to their demise. I have spent 40 yrs inside the national carriers and now retired have been an advocate helping policyholders seeing both sides of the fraud. 

Not all company adjusters are ill trained, just most of them. Many simply wont do the right thing even though they know to ask the right questions may afford coverage. I reverse coverage on denied claims almost always now and to my surprise, almost every claim has coverage afforded if properly investigated and the coverage is properly interpreted using underwriting , loss control and rating techniques.

Few  Claim Adjusters have any training in the underwriting intent and interpretation in the contract. Of course management do not want them to know to much. They rely on at least a 20 % denial margin to make profits to pay for their claims overhead. When they do confirm coverage, adjusters today are taught to pay 40% -60% of the loss value and if you fight hard you may get them up to 75% of the costs and walk away. They practice delay-delay -delay to wear you out. It works on 90% of their claims.  

Lest we forget, this may be your first encounter with a claim, but this is a daily job 24/7 for the claims adjusters and they get training tips "How to save Money thru Claims" daily from expert contractors, CPA, lawyers and engineers on their side. They all preach "stop the leakage" . Its a new concept that has been out for the past 10 yrs to settle for less than the true value of the loss. They have over 200 nuances to low ball your costs and delay the process for months and years.

You first have to trigger coverage. Ice dam is a covered peril. Water that leaks inside is also covered for the resulting damages on an all risk policy (h*o-3). If the wind did not tear off or LIFT the shingles, they wont pay for the outside shingles, but they do owe for the resulting inside water damages to attic stains, insulation and mildew control.  If the shingles lifted they owe the entire claim. 

Yes you need an Advocate that has handled these type of claims. Be sure he has insurance company experience as a staff adjuster and is not just an ex-contractor, they rarely understand the coverage issues involved. There is more to your claim than writing an estimate, its a coverage issue first and if coverage is triggered then its a repair cost issue. Your agent and an attorney are completely useless to you in these cases. Never pay over 10% for a Public Adjuster. Most states are now passing state laws to set the fees at 10%.

You do have coverage in several ways, but dont speak out of turn and do irreversible damage to your claim. What you say will be used against you. Take an ACV cash out settlement and go hire your own sub contractor for a lot less by paying yourself as your own General Contractor putting the money into your pocket, not theirs. Don't let them use their Preferred Contractor Program against you, they will low ball the work and costs every time. Your agent and company are only your best friend when you pay premiums, not after filing a claim.   

The Advocate  
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#2 Consumer Comment

Get a public insurance adjuster

AUTHOR: MovingForward - (USA)

I'm in Florida. We have issues regularly with insurance adjusters that work for the insurance companies filing reports that do not reflect the actual damage to the property. Remember, the insurance company is looking to protect their interest, which means sending someone out that can manipulate the report so the insurance company is not responsible for a payment on your claim. You need someone that can look after your interest and that would be a public adjuster. Interview several public adjusters to get a good one.
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