Delays, denials and lowball payments for disaster insurance claims
You pay your home insurance premiums for years, and when disaster strikes, you expect your insurance company to cover your loss, but a growing number of victims of natural disasters are running into delays and denials in getting their insurance claims paid.
National investigative correspondent Angie Moreschi found it’s part of a nationwide trend and is leaving homeowners desperate and frustrated.
UPDATE 4/29/23: The Jackson’s attorney Donna Stockham tells Spotlight on America, two days after this story was published, she was contacted by Heritage Property & Casualty Insurance to resolve the dispute over their insurance payment. Stockham says the two sides have now come to a settlement for the Jackson’s, and the family is finally working on collecting bids to repair their property. “It’s liberating for the family when you can start making decisions and not just be in a holding pattern,” Stockham said.
HURRICANE IAN VICTIMS BATTLE TO GET CLAIMS PAID
More than six months after Hurricane Ian, 80-year-old Carol Jackson and her daughter Kalindi are still living in a Federal Emergency Management Agency trailer in their backyard.
“It’s devastating and depressing. I can’t believe it,” Jackson said.
Hurricane Ian hit Florida with ferocious 150 mph winds on Sept. 28, 2022. The Jacksons' neighborhood, just south of Venice, was ground zero for wind damage.
“The big damage is right here, where the ceiling collapsed,” Kalindi Jackson said, showing Spotlight on America the family’s kitchen, where a blue tarp still covers a gaping hole in their roof. Pictures taken after the storm show pink insulation that came crashing down, when the hurricane’s Category 5 winds ripped open the roof and blew out windows, leaving their home unlivable.
From the outside, you can see the roof is cracked in half at the peak; windows are broken and boarded up; and the car port is structurally unsound, marked off by yellow caution tape with its roof propped up by tree trunks found near the home after the storm.
Very little has been done to fix the damage, since a mitigation company, the Jacksons say they paid for out of pocket, came out to their home 12 days after Ian hit.
“I thought it was awful and I thought it was bad, but at that point, I thought we have insurance, it’ll be fixed,” Kalindi said.
Kalindi put in a claim with Heritage Property Insurance, their company for the last eight years, but says they heard nothing for weeks. Finally, she says, after calling repeatedly, she reached the insurance adjuster assigned to their case.
“He told me they had not yet determined we were even hit by a hurricane,” Kalindi said, recalling her stunned disbelief at his comment. “So that’s when I knew I needed some help.”
She called attorney Donna Stockham, who has handled homeowner insurance cases for nearly two decades.
“It was astonishing to me,” Stockham said. “It’s kind of unimaginable, when you look at the amount of damage to this house, that anything but hurricane force winds could cause this.”
After the Jacksons’ attorney got involved, Heritage agreed to cover the claim, sending a check in December of 2022, but it was for just a fraction of the damage repair estimate. Stockham says she made multiple attempts to follow up with the Heritage to try and resolve the dispute over the amount but heard “crickets.”
Spotlight on America repeatedly tried to contact Heritage for nearly two weeks, leaving multiple messages with no response, even going to their Tampa headquarters.
Finally, a public relations company contacted Spotlight on America on behalf of the company and provided a statement from their lawyer, saying:
“Our goal is always to pay every eligible claim and we continue to participate in Insurance Villages in Southwest Florida, one as recently as this week, to help our policyholders who need assistance following Hurricane Ian. Due to the privacy concerns of our policyholders, we cannot comment on the specifics of a claim," said John Londot of Greenberg Traurig on behalf of Heritage.
PATTERN OF DELAYS AND DENIALS
Stockham says since the record damage caused by Ian, her office has seen delays, denials, and lowball payments become a pattern with multiple companies. She blames recent pro-insurance laws passed in Florida, making it harder for homeowners to sue insurance companies.
“The carriers seem especially emboldened, and the way that they're treating their insureds has been very harsh,” she said.
Data on the Florida Office of Insurance Regulation website shows that more than half of Hurricane Ian claims submitted as of March 9, 2023 remain unresolved. FLOIR shows there have been a total of 494,078 residential property claims submitted.
Of those, 255,235 claims, nearly 52%, have been closed without payment, are still open without payment, or are still open with payment, indicating they are not yet resolved.
The remaining 238,843 claims have been closed with payment, but Stockham says that is not an indication a homeowner believes it was a fair payment, just that they did not challenge the payment.
“What we’re seeing with a lot of files is (insurance companies) are keeping them under thresholds of about $25,000. They’re not denying it. They’re paying it but underpaying it. We just don’t see that as a coincidence,” Stockham said.
WHISTLEBLOWERS CITE QUESTIONABLE TACTICS
Spotlight on America talked with two insurance industry whistleblowers, who say they’ve seen questionable tactics firsthand.
“Legitimate claims are not getting paid,” independent adjuster Ben Mandell said.
His colleague Mark Vinson, also an independent adjuster, added, “They’re cheating the homeowners.”
Independent adjusters work for insurance companies, often contracting with them after major storms to help provide estimates for the large number of claims after a disaster.
After Hurricane Ian, both Mandell and Vinson were contracted to work for two insurance companies they declined to name publicly. They say those insurance carriers drastically reduced several of their damage estimates without their knowledge, before sending them to homeowners.
Mandell and Vinson say they submitted 18 estimates to the companies, and 15 were reduced by 50 to 90%.
They provided Spotlight on America an example. It showed their original estimate of damage to a Florida home after Ian was for $40,468.54. But the final damage estimate sent to the homeowner was for just $2,658.10 — a 93% reduction.
Both Mandell and Vinson told Spotlight on America that misrepresents what they found.
Moreschi: "So, what did they change?"
Vinson: "They took the roof off."
Mandell: "They took the roof off."
Vinson: "We’ve shown picture evidence to them, that there’s the damage. Here’s the estimate and by the time it makes it to the policy holder, it’s gone."
Mandell says the company never talked to them about the reduction, and he only learned about it when a homeowner called him up to complain that the insurance company denied their claim.
“We’re certifying that’s what we saw. We’re certifying this is the damage. It’s got our name on it. If it’s not right, we don’t want our name on it,” Mandell said.
They acknowledge insurance companies legally have the right to make adjustments to their estimates but say it should be done transparently, so customers understand what happened.
While Mandell and Vinson did not name Heritage Insurance as one of the companies they worked for, Spotlight asked the Heritage spokesperson about the practice of reducing estimates without a field adjuster’s knowledge.
The company responded with a statement saying they are working on changing the software they use to better reflect who makes changes to an estimate.
“The company is working to see if they can update the software to reflect the name of the desk adjuster, whose role it is to edit field reports before a claim determination is made final and any notice is sent to homeowners,” said Londot on behalf of Heritage.
The full statement continues:
“The software used in the estimating process is called XactAnalysis, which is widely used throughout the insurance industry. This software tracks the work of the desk adjusters and the field inspectors - who are usually short- term contract employees, especially after a major hurricane or other disaster when we need a surge of people in the field. The software records the name of the field inspector and then the name of the desk review agent who reads, edits, and processes the claim. When those reports are exported from the system, the desk reviewer’s name is not currently tagged to their changes, even though their changes are tracked internally under their name. Therefore, the company is working to see if they can update the software to reflect the name of the desk adjuster, whose role it is to edit field reports before a claim determination is made final and any notice is sent to homeowners.”
NATIONWIDE TREND
The American Policyholder Association is a consumer watchdog group that investigates complaints of unfair claim payments and often refers cases to state attorneys general.
“We're actually seeing evidence of adjusters’ reports being changed to dramatically reduce policy payouts. We're also seeing damage being valued just below the deductible amount, so that there is actually no payment whatsoever due,” said APA executive director Doug Quinn.
Quinn says they’ve found allegations of claim-tampering extend far beyond Florida.
“We've seen it all over the country at this particular point. We have criminal cases related to this in Florida and Louisiana. We've also had reports in Texas, California, Colorado. So, quite a few cases that we're actually vetting right now,” he said.
On the other side, Insurance Information Institute communications director Mark Friedlander insists fraudulent tactics are not common but should be investigated.
“That's very concerning because it gives the insurance industry a black eye. Most insurers have handled Hurricane Ian claims with the highest level of ethics and integrity. If somebody has crossed that line, they need to be held accountable,” Friedlander told Spotlight on America.
He says companies are also victims and blames inflated claims and frivolous lawsuits for driving several carriers out of business.
“Florida has averaged more than 100,000 lawsuits per year for property claims for three consecutive years. That accounts for 80% of the U.S. total,” he said.
The Florida Office of Insurance Regulation told Spotlight on America it has initiated more than 50 investigations into the handling of Hurricane Ian claims, including allegations of altered estimates and delayed payments.
The office declined Spotlight’s request for an interview, but FLOIR Communications Director Samantha Bequer provided a statement saying in part:
“When conducting an examination or investigation, OIR’s market regulation units take a comprehensive review of all business practices to identify issues such as form compliance, claims handling, insurer communication, proper claims investigation, interest paid on overdue claims, adequate monitoring of third-party administrators and managing general agents, and claims settlements. For instance, desk adjusters changing field adjusters estimates is not in itself a violation of Florida law. However, a pattern or practice of insurers underpaying claims is a violation of Florida law.”
Bequer said they would not release further information because the investigations are ongoing, but said FLOIR recently issued an informational memorandum to insurance carriers in the state to “inform them of regulatory actions taken by OIR to investigate claims handling processes, and notify them of catastrophe reporting deadlines.”
The Florida state legislature is also considering a new bill to require more accountability for insurance companies, which is expected to be voted on in the coming weeks.
JACKSONS STILL IN LIMBO
As for the Jacksons, with another hurricane season almost here, their home is still unlivable.
“We’re talking about a house that has been severely structurally compromised. There’s questions as to whether or not it’s going to need to be taken down, because there’s so much damage to the house,” attorney Stockham said.
Stockham says the amount the Jacksons received from the insurance company is not enough to make the needed repairs. She says the family had hoped to come to a settlement, but due to a lack of response from the company, has been left with no alternative but to sue for more money.
“It’s incredibly frustrating and disappointing. I mean, you expect better than this. We’re their customers,” Kalindi said. “My mom, you know, she doesn’t deserve this. She deserves a safe home to live in.”
