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Insurance Claim Basics


Insurance Expert, Author and Speaker Mark Goldwich explains the basics of property insurance claims.

Insurance Expert, Author and Speaker Mark Goldwich explains the basics of property insurance claims.

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  • 1. Insurance Basics by Mark Goldwich
  • 2.
    • Who is Mark Goldwich?
    • What can Mark do to help us?
    • Insurance Basics
      • Did you know?
      • “ 10 Commandments of Claims”
      • Web resources
    • Questions
  • 3.
    • Who is Mark Goldwich?
    • Florida native – born in Miami, now in Jacksonville
    • BSBA degree in Insurance, licensed since 1987
    • 17 years with major insurance company
    • Started Gold Star Adjusters, LLC. in 2004
    • Licensed Realtor ® , licensed private investigator, member of Jacksonville Chamber of Commerce, board member of Mandarin Council, member of WIND Network, member of NEFAR and NAR, Mandarin Council’s 2009 Small Business Leader of the Year
  • 4.
    • What is a Public Adjuster?
    • Three types of adjusters – Staff, Independent, Public
    • Staff – employed directly by insurance company
    • Independent – works for a company outsourced by the insurance company (independent with respect to which carrier they work for, but they don’t work for policyholder)
    • Public – hired by policyholder (you), exclusively represents only the policyholder, never the carrier
    • – a public adjuster legally represents the policyholder, and prepares, submits, and negotiates the claim directly with the carrier on behalf of the policyholder in order to get the maximum settlement.
  • 5. How Can Mark Help?
    • “ To educate insurance consumers, and use insurance expertise to effectively represent clients in maximizing their settlements, while minimizing their burden and frustration”
    • Or, expressed as a mathematical equation….
    • Education + Money – (Burden x Frustration)
  • 6. Education + Money – (Burden x Frustration) =
    • Happy Client
    • ( Paid $219,000 more ! )
  • 7. Other clients have received… Before $60,407 After $260,800 Change $200,392 Before $41,330 After $181,000 Change $139,669 Before $82,487 After $193,469 Change $110,882 Free Boat – if you can lift it!
  • 8. This ‘before and after’ says it all… Before Gold Star After Gold Star $49,948 $170,000
  • 9. Insurance Basics
    • Did You Know?
    • Insurance policy is a legal contract
      • They write it, you agree to it when you buy it
      • Not a guarantee you get paid what is owed
    • You can negotiate your settlement
      • Policies are subject to interpretation
      • The catch: who knows more, you or them?
  • 10.
    • Basic Claim Problems
      • Agents (or lack) – outsourcing, web-based
      • Complex policies – even if you try to read
        • Government trying to require simplified language
      • Adjusters (human factor) – outsourcing, varying levels of experience, skill, motivation
      • Fraud – so much that ins. co. employees get jaded, think ‘everyone’ out to fudge a little/lot
      • Delays, Denials, Deflections (see my book)
  • 11. Did You Know?
    • You can re-negotiate a claim after closed or denied (in Florida, up to 5 years later)
    • Just because the insurance company sends an official letter stating the amount of loss, or denying the loss, complete with policy language – doesn’t make it so
  • 12. Did You Know?
    • You should not think of yourself as the customer or client (you’ll be disappointed)
      • Consider yourself a legal adversary
    • The adjuster does not work for you
      • You don’t “pay their salary”
    • You are not their neighbor, you are not in good hands, they are not on your side
  • 13. Did You Know?
    • In 2005 (the year of Katrina), insurance industry profits were $44 B!
      • Was it because Katrina came late in 2005, and carriers didn’t pay claims until 2006?
  • 14.
    • In 2006, profits actually rose to $65 B !
    • but….
    • Profits in 2007 dropped to less than $62 B
    • how will the insurance companies survive?
  • 15.
    • But what about all those images?
  • 16.
    • Out of the estimated…
    • $30 Billion - $50 Billion in FLOOD losses
    • Some uninsured
    • Some self-insured
    • Some unclaimed (dead owners or abandoned properties)
    • Some public or governmental properties
    • Vacant or undeveloped land
    • How much did the insurance industry pay?
  • 17. ZERO!
    • Insurance companies don’t pay for flood damage
    • Flood insurance is a Federal policy
    • Insurance companies get paid to sell and handle flood claims for the government
  • 18. Finally - Did You Know?
    • As an apartment owner or renter, you can collect insurance money on damages to your property, even if you don’t have insurance, or don’t want to submit a claim on your own insurance
      • By pursuing the insurance of another owner or renter (or the building owner/mgt. co.)
  • 19. “10 Commandments of Claims”
    • 10.Know your insurance policy - meet with your agent and have them explain it to you; make sure you have the proper coverages, endorsements, limits, and deductibles
    • Consider buying a flood policy if you don’t already have one
    • (Just because you aren’t in a flood zone, doesn’t mean you won’t get flooded. Flood zone maps are revised by the government. If you trust their accuracy now, you may be one of thousands filing for government assistance later. Think about it, we are surrounded by water. I don’t care what the flood map says, I have flood insurance.)
    • 8. Take photos or video of valuable possessions, and store important documents where they can’t be damaged
    • 7. Don’t try to pull one over on your insurance company – be thorough, but honest - it’s just not worth risking a felony conviction
    • 6. Take notes of everything that’s damaged and keep a detailed log of all conversations with your insurance company, your contractor, and everyone else
  • 20. …claim commandments
    • 5. Show the adjuster all the damage and be as thorough as possible - if the adjuster doesn’t want to spend to time to review it all, have them come back when they will
    • 4. Review the adjuster’s estimate in detail, until you understand it completely
    • 3. Request a licensed contractor review the insurance company estimate and provide an independent quote
    • 2. If the insurance company refuses to pay for anything, demand they explain why – in writing
    • 1. Be persistent and don’t give up - appeal up the chain of command
    • And, my ‘bonus commandment’ –
    • Seek professional assistance when needed (GC, acct, atty, PA)
  • 21. Useful Web Sites
    • KingOfClaims.com – Mark’s site
    • insure.com – for ins. quotes and info
    • AMBest.com – source for ratings, news, and financial data on ins. co.s
    • naic.com – insurance info for consumers
    • iii.org – goal is to improve public understanding of insurance
    • fldfs.com – FL Ins. Dept. - request assistance, file complaint, verify adjuster/company info
    • **All of these and many more links on Mark’s site
  • 22. Want To Learn More?
    • I took my….
    • 20 years of claim adjusting experience
    • For a major insurance company, traveling the country handling thousands of insurance claims
    • And as a consumer advocate, getting millions more for my clients
    • … .and I wrote my own book. Its easy to read and understand, shows what the insurance companies do, how they do it, why they do it, and what you can do about it - to get everything you deserve!
    • Available at great price – just $10
  • 23. Thank you for watching! Wishing You More ! Mark Why Pay $12.95 Amazon Price (plus shipping)? Get It From My Website For Only $10 (and I pay the shipping) www.KingOfClaims.com Copyright © 2009 Mark Goldwich DFS Lic. # A099530