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As a recent victim of denied coverage for a viable water damage claim with AAA (Interinsurance Exchange of the Auto Club), and after hearing many similar stories about State Farm, Farmers, Alliance, etc., I'd like to encourage average consumers to fight for their rights.

Too many carriers are getting away with rubber stamp denial of benefits, shoddy claims practices, and shotgun claims administration, and people are not standing up against these carriers. As a result, the carriers have an over-developed "God complex" when making liability decisions against their insured's.

Have you read your policy lately? You really should, and then attempt to chart it to label out the contravening language, and find out just how many different ways your insurance carrier can elect "NOT" to cover legitimate claims for coverage.

Another word of advise, seek the advise of counsel before you pick-up the phone to even ask about filing a claim. You'll thank me later for this one. If you have doubt about what I'm saying, then go to the California Department of Insurance website and read-up a little bit about what's going on with the CLUE database that carriers utilize to evaluate risk on their insured's.

You wonder what my motivations are? I'm just an average working consumer, just like you, that got the short end of the stick with a carrier. I wish for nothing more than for this kind of behavior to be acknowledged and kept in check by the people that pay the bills (US!) I'm not an extremist, or gold-digger, or even an attorney. I just have a keen B.S. meter that is currently well into the red, and its time for insurance company games to stop!

If you have any opinions or suggestions, please voice them.

There is no "rubber stamping," in the insurance industry. You pay for what you get. Today's insurance is an evolution of two things: 1) Lawsuit abuse & 2) Fraud. The reason we have this "dynamic duo," is because of idiots like you-who feel they "have to get their fair share out of BIG INSURANCE." They team up with tort lawyers, win thousands (or millions) of dollars in lawsuit lotteries-and the rest of us (policyholders), have to foot the bill-either in increased premium or more exclusion in our policies. It is because birdbrains (like yourself), that insurance companies have had to cut out coverage-just to make it affordable for the rest of us. They could have kept in the coverage (that you are whining about)-but few people would be able to afford it.
You sir (and all the other policy holders), ARE THE INSURANCE COMPANY (or are you too stupid to realize that). It is because of people like yourself-insurance policies have so many exclusions in them. YOU are the problem! Butch up!!! Learn to be self-accountable! Quit making it bad for the rest of us!

Agent007 is correct that "today's insurance is an evolution of two things: 1) Lawsuit abuse & 2) Fraud". I also agree that many exclusions serve to keep premiums somewhat affordable. However, it isn't fair to call RKunz2 an idiot for questioning the denial of an alleged viable claim. Whether or not it is truly viable and whether or not the carrier should have denied or approved it, it seems belligerent to resort to abuse of RKunz2's character.

Agent007b also states that "You sir (and all the other policy holders), ARE THE INSURANCE COMPANY (or are you too stupid to realize that)." A typical insurance company, excluding mutual and captives, is ultimately owned by stockholders, not policyholders. While its true that today's insurance has been complicated by lawsuit abuse and fraud, carriers are often pressured to maintain or improve financial standing which opens up the possibly of entering into bad faith decisions about claims and insureds.

My statements simply reflect my opinion and my experience with insurance. I invite any suggestions or corrections, if necessary.

Wombadillo

Dear Agent007:

Well, I appreciate your opinion. I'm truly impressed that you had sufficient balls to speak up and state your opinion so poignantly; however, you're "perception" of this case and me is flawed.

You truly believe there's no "rubber stamping" in the insurance industry, do you? When is the last time you sat across the perverbial round table from a high level executive director for one of the nation's largest P&C carriers? Do you read multiple insurance industry publications daily and keep up with what's happening in this market? Is your company approved by A.M. Best Company as bonafide insurance experts? No? I didn't think so.

You fail to realize that I'm not a litigious person by nature, I hate lawsuits and most attornies; however, they are a necessary evil at times because I don't personally hold a law degree. You also failed to present that because we have placed this claim, we're going to pay for it ourselves in higher premiums for the next 3 years (minimum) because we've had a reported loss against our record. Now, add to that a lawsuit against the carrier, we're almost uninsurable. You honestly don't think that we haven't considered those consequences?

Please don't preach about high premiums. We pay legitimate premiums in exchange for coverage. If the carrier refuses to extend that coverage under reasonable circumstances, then why exactly are we paying premiums in the first place?

And those laws that are in-place to protect "them" and us? Do you realize I've been told by 2 attornies, and the California DOI that carriers really don't have to abide by those laws? What does that tell you? I'd be curious to hear your opinion on that one.

The other fault in your arguement is ignorance. Don't take that the wrong way because I did not disclose details of the claim, but trust me when I tell you, this case is nowhere near large enough for me to make "millions" in a bad faith lawsuit. I don't have attornies beating down my door to take this thing because there ISN'T any money in it. Like I said, that's not the reason for pursuing anyway. I ONLY want to be covered for the loss to my property, under a policy that entitles me to said compensation. This isn't a get rich scheme, and no I'm not remodeling my entire house from it, I just want the damages covered, and that's not too much to ask. What if I didn't have the resources to fix the damage to begin with? Would my house lay in shambles forever? Would I expose my children to potential health risks? I had to move a family of 4 to a dive hotel for 13 days because we had no water, you ever done that?

By the way, you're absolutely correct. "WE" are the insurance company (at least we should be), the problem is too many people, probably like you, that just sit back, pay money and then keep their mouth shut when legitimate claims come up. The insurance carriers in this country are definitely in control, make no mistake about that, and they're terribly arrogant about that control. It's purely a numbers game.

Think about this; for the sake of discussion, we'll say that a carrier receives 300 legitimate water damage claims a month, and by practice they deny all 300. One decides to fight the denial, so the carrier bucks up and covers the loss. How much money did they just save? Interesting arguement isn't it? Not far from the truth either.

Dear Wombadillo:

You're right, there is too much fraud and abuse out there. What most people don't realize is its present on both sides of the court.

I heard a case about a local that had a water damage claim, worse damage, etc., but the claim was worth less than $50,000 ACV. Well, the insured jumped on the bandwagon, filed for bad faith, and currently is up to $750,000, more than what he owes (or owed) on the house to begin with. I'm appalled by this story because it is people like that, which create problems for the rest of us. Maybe, he and people like him are the reason I got denied, which really irritates me.

There's also a lot of carrier abuse against their insureds. Anyone that won't acknowledge that point is not living in the real world. I deal with carriers all day long in my profession, so I see what happens. I can't name them specifically, but I once offered professional opinions on matters for the largest comp carrier in CA to help them avoid potentially damaging claims against their company.

The insurance fraud (committed by insureds) needs to stop; no doubt about it, but the outright, blatant mistreatment of the insureds by these carriers must stop too. Recently, we went to dinner with a large top 100 broker. They're a premier and very reputable company. They told us that they don't want their insureds calling the carrier to place claims because you can take the same claim, present it 2 ways, one way gets accepted, the other way gets denied. That was a wake-up call for me. Where are we going with this nonsense as a society? Am I going to need an attorney to negotiate with my HMO to make an appointment the next time I get a cold? This is utterly ridiculous!

Thank you for your opinion, I do appreciate the feedback.

Dear everybody (you too, Wombadillo),

I really don't think RKunz2 is an idiot. Insurance is an emotional product (non-tangible). I knew using emotionally charged words would get the ball rolling on this subject. I guess it worked (Hehehehe )!

Agent007

P.S. I sell the mess (Insurance that is; P&C, Life, Health, whatever). I will admit thou"¦I'm convinced claims adjusters & underwriters have ice water running through their veins.

Anyone else care to comment about the "poor" insurance carriers, and their plight? Any opinions about their "angel like" ethics and good business practices?

Take a look at this, and ask yourself the question.....what business in the world can raise its price by 300% and still have customers knocking down the doors for more? I certainly can't do it in my business, can you?

By the way Agent007, I figured out long ago that you were "in the business." Doesn't take a rocket scientist to get that one. That's good though, I want to hear from people in the inner circle. Let's see how influenced a group you are.

**********************************************************

Prop. 103 Blocks 10% Homeowners Insurance Rate Hike By State's 4th Largest Insurer; Saves Consumers $26 Million

Northern Cal. AAA Agrees to Keep Homeowner Premiums Unchanged After Consumer Group Challenge

A proposed 10% homeowners insurance rate hike by CSAA (Northern California's branch of AAA) has been stopped after the California Department of Insurance and the Foundation for Taxpayer and Consumer Rights (FTCR) objected to the proposal. The rate increase would have raised CSAA premiums by $26.3 million and affected the companies' 330,000 policyholders. CSAA has agreed to maintain current rates for 2004, rather than face a regulatory hearing requested by FTCR in order to justify the 10% increase, in accordance with the state's insurance laws established by Proposition 103.

"CSAA wanted rate hikes that it did not need," said FTCR's senior consumer advocate Douglas Heller. "The company will have enough money to pay claims and earn a fair profit, without forcing homeowners to pay higher premiums. Thanks to California's Proposition 103, we are able to intervene and stop skyrocketing premiums."

Proposition 103, which was enacted by voters in 1988, requires the insurance commissioner to scrutinize insurance rate changes before allowing insurers to alter rates, a system known as "prior approval." Prop 103 also allows consumer groups such as FTCR to intervene and challenge rate hikes.

After reviewing the proposed rate hike plan, FTCR determined that CSAA, which has been allowed to increase rates by 26% in the past two years, had gone too far and would not be able to justify the proposal when placed under the microscope of Prop 103's regulatory review. On August 18, 2003, FTCR requested a hearing on the rate hike, but today the group withdrew that request in response to CSAA's agreement not to raise rates.

FTCR recently challenged a 19.7% rate hike on homeowners insured by Safeco, which the company subsequently withdrew and then re-filed. FTCR expects to continue its challenge to that increase and will challenge other companies' that propose excessive rate hikes.

"The insurance commissioner must continue to block unfair rate hikes and insurance companies must recognize that they cannot expect to propose increase after increase without a rebellion from consumers," said Heller.

Dear RKunz2,

Like most so-called consumer "advocates," your reasoning is based upon "knee-jerk," reactions-not on sound economic principles (I have to keep in mind; I am dealing with someone from California-land of the fruits & nuts). All your "propositions," and other forced priced measures-do nothing more than make you feel good (and get politicians reelected). They do very little to help an economic or insurance situation.
Let me break it down real simple for you: Let us say it took you $2 to make something or provide a service. Simple reasoning would assume that to make a profit you would have to charge more than $2, right? Then, special interest consumer groups (the kind you and your ex-governor Davis loved), force "propositions" into place that said you could only charge $1? How long do you think you would stay in business, or reduce the quality (read cheaply made, or in the case of insurance-reduce coverage) of your product/service -hmmmmmmmmmm? Say, weren't you the one belly-aching about "reduced coverages," in your first letter to the Journal? Big Dummy, don't you know everyone of those rate reduction you so gleefully allured to in your last statement to the Journal-means reduced coverage/or an insurance company pulling out of a market (thereby reducing competition). A classic example of a 100% regulated (and your way of thinking) Insurance Market (read complete government control), is New Jersey. It got so bad in New Jersey, State Farm pulled out-and dumped a million policies on the Market (most still cannot find coverage). Just another example of your stinking thinking. Why don't you go to this website, and found out what a great idea that has been:

<a href='http://www.cse.org/informed/issues_temp ... sue_id=820' target='_blank'>http://www.cse.org/informed/issues_temp ... _id=820</a>

Another good example is when one year, the Insurance company I represent-went to the Texas Department of Insurance to get a 10% Rate Reduction in auto insurance (because they had low claims the year before-and wanted to pass the savings on to the customer and get more market share). The TDI told them; this would be too unfair to the other Insurance companies. My company was told they could only reduce their rates 5%-because regulation dictated-rates could only be raised or lowered by 5%. Big Government at work-protecting the little man. Moral of this story; if you want prices to go down (as well as taxes)-reduce the government. This creates competition (a word, I'm sure your not too familiar with). Competition reduces prices. I'll bet, I'm giving you more of an economic education-then all the years you went to your outward-based education schools.
Isn't the run away budget problems, y'all are having in California because of; too much government, too much regulation, too many special interests? Just as it didn't take a rocket scientist, to figure out I was in insurance-it doesn't take a rocket scientist to figure out you're a Democrat (your whining, and lack of self-accountability gave that one away-and you decsr). Don't mean to be so blunt with you, but I'm hoping people who read this, will see the fallacy of your argument; that regulation is NOT the way to go. I'm sure those who are on the borderline will see my sound reason-and look at this problem with their head-and not from a purely "feel good" reaction.

Agent007

P.S. Sorry, RKunz2 didn't mean to confuse you with the facts.

<!--QuoteBegin-RKunz2+Oct 13 2003, 12:14 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (RKunz2 @ Oct 13 2003, 12:14 PM)</td></tr><tr><td id='QUOTE'><!--QuoteEBegin-->As a recent victum of denied coverage for a viable water damage claim with AAA (Interinsurance Exchange of the Auto Club), and after hearing many similar stories about State Farm, Farmers, Alliance, etc., I'd like to encourage average consumers to fight for their rights.

Too many carriers are getting away with rubber stamp denial of benefits, shoddy claims practices, and shotgun claims administration, and people are not standing up against these carriers.  As a result, the carriers have an over-developed "God complex" when making liability decisions against their insureds. 

Have you read your policy lately?  You really should, and then attempt to chart it to label out the contravening language, and find out just how many different ways your insurance carrier can elect "NOT" to cover legitimate claims for coverage. 

Another word of advise, seek the advise of counsel before you pick-up the phone to even ask about filing a claim.  You'll thank me later for this one.  If you have doubt about what I'm saying, then go to the California Department of Insurance website and read-up a little bit about what's going on with the CLUE database that carriers utilize to evaluate risk on their insureds. 

You wonder what my motivations are?  I'm just an average working consumer, just like you, that got the short end of the stick with a carrier.  I wish for nothing more than for this kind of behavior to be acknowledged and kept in check by the people that pay the bills (US!)  I'm not an extremist, or gold-digger, or even an attorney.  I just have a keen B.S. meter that is currently well into the red, and it's time for insurance company games to stop! 

If you have any opinions or suggestions, please voice them.[/quote]
Well said agent007. I think it is sad that rkunz2 who started this discussion identifies himself "as a recent victum". Your right the comments do sound like a democrat. I know, and he knows, off all the hysteria that the mold hype produced. We also Know we have to pay for all those new houses the insurance companies built and rebuilt. :blink: :blink: :blink:. The Department of Insurance's did not react fast enough to stop the radical spead of this legal insurance fraud, but now they want to force companies to lower rates, because alot of consumers are complaining. Most consumers don't realize the surpluses that must be maintained by insurance companies to handle contastropies, and the fact that most of them were depleted do to paying out mold claims. They want rates lowered, but they also want insurance companies to rebuild a city like Houston once a Catagory 5 Hurricane gives it a direct hit. The insurance companies do want to be there for consumers and help them when they have a leginimate Claim like their house burning down, or a hurricane blowing it over, but sorry rkunz2 the bridge for water coverage has been burned, and it is not going to be rebuilt. One factor that is constantly overlooked is the burden put on surplusses because of 911. Property and casualty companies in america have had a real tough time finding reinsurance for their book of business from europian companies, or the rates have really gone up, and of course that has to be passed on to consumers and the surplussed that must be maintained grows for the companies. I will finish with reminding everyone, as 007 did, that insurance companies are in business to make money, and much to the surprise of many insurance commissioners they are not goverment entities that can continue to spend more money then is coming in.

Thanks,

burdronjeff

to all:

It's nice to see different opinions and facts brought up here. I have a lot to learn about the risk and insurance industry and its great to read your thoughts. Agent007: I grew up 'on the left' and in the last year I've shifted rather quickly towards the right. This shift is partly a reaction against big government, dense regulations, and the attitudes of many liberals.

Just Thoughts,

Wombadillo :ph34r:

Agent007,
I happen to be a Democrat who agrees with everything you say. Please don't make this a partisan issue. I also find it particularly annoying that many people think their insurance policy is to be used as an alternative to maintaining your home in an acceptable manner. Why should the insurance company have to pay a water damage claim because you can't remember to check the water hose to your washing machine or because your roof is 50 years old and has never been replaced? Does your insurance company pay to repair your car when the water hose on your car bursts??? No, it doesn't nor should it! Many people have begun to think that having insurance is a way to avoid personal responsibility and that's just sad. If you can't maintain your home then why should everyone who pays their premiums and maintains THEIR home have to pay for your irresponsibility? Insurance companies are not money trees. That money comes from the insureds. You, as an insured, should be irritated with the guy next door who does not maintain his home and suffers an expensive claim because ultimately you will be the one who pays for it in the form of reduced coverage or higher premiums. The company can't go out to their money tree and grab some more money. There is only so much available. If the company runs out of money, guess what? They go out of business.
Also, I didn't hear any insureds complaining when the markets were doing well and we passed that savings on to the insured. During that time, many companies would have been losing money had they relied on the premiums from insureds to pay expenses and claims. They were only able to stay afloat due to the money earned on the invested premiums. If you want lower premiums talk to your elected officials about increasing the punishment for insurance fraud and getting the lawyers out of the equation. It's ridiculous when you can get millions of dollars for spilling coffee in your lap (what you should get is the stupidity prize) or mold growing in your house (try actually cleaning your home once in a while and buying a container of bleach).

Just my opinion,
Lisa

Lisa,

You may be a Democrat-but you sound like a Republican (at least fiscally)! In your reply-I could not have said it better!!! But-I DO mean to be partisan-and I ain't gonna apologize! The Democrats have nothing I agree with (They might have a platform, somewhere in their party, I agree with-but I have not found it yet).
Lisa, everybody is biased/partisan (whether they want to admit it or not).

The Democrats stand for:

 No limits on punitive damages in law suits (because they get so much money from tort lawyers).

 Bigger Government

 Social everything (in the old days this was called communism), i.e. Health Care, cradle to grave government programs, and so on.

 Anti-business, (Democrats want complete Government regulation of Business).

 Taxing people to death (because the Democrats believe your money-is not your money, but the Government's. It is out of their goodness, you're allowed to keep any of the Government's money).

 Very Anti-Family (this is where you and I might differ, you sound like a fiscal Republican-but you might lean socially Democratic), i.e. Pro-homosexual, Pro-abortion, Pro-pornography, Pro-Divorce.

 Very Anti-Military (I'm a Navy Vet by the way).

 Pro Gun Control (a big no-no, here in Texas).

I believe, if the Democrats, where to have complete control-the Country I love (and fought for), would cease to exist! Lisa, if you don't stand for something (passionately, at that)-you'll fall for anything!

Let me bring it on home for you, if you believe everything you wrote in your letter to the Journal (i.e. restricting tort lawyers and such), then every time you vote Democrat-you vote for something the opposite of what you believe! Think about it!

Agent007

P.S. "And ye shall know the truth, and the truth shall make you free." John 8:32

Dear Forum Guests:

Actually, I'm a Republican for those that care, neither should you because this isn't politics. As for Democrats, I don't care for their policies; never have, never will.

Here's a question for everyone, where exactly are you getting your information? Could it be from the same people that sign your checks? Wow, I wonder if that is truly unbiased information? Not that mine is, but you have to understand, I have represented carriers for 15 years, made a fair living doing it too. As a business owner, I also understand the ideals behind making a profit, please don't insult my intelligence on that one; however, I also know how to service my clients.

All of you defending the insurance companies are really quite entertaining, whaaaa, whaaaaa, whaaaa....blah, blah, blah.........Oh, the poor insurance companies can't make a profit, their loss reserves have been hit hard, the combined ratios are in Red territory........PLEASE??? Oh yes, and 9/11, most certainly caused the current Hard Market we're in now, no different than many other businesses, we were all affected, so NO, I don't feel bad for the carriers. How many other industries are posting RECORD PROFITS right now??? Even with the hits to their reserves, most companies didn't even flinch about their overall financial stability (i.e.-Lloyds). State Farm and Farmers, worked for them both in the past, they're top 5 carriers in the market, and certainly in no danger of going insolvent.

Com'on people, let's get into reality here. Can anyone offer some real opinion without the bias of the company that signs their paycheck?

You all want to believe that I'm jaded and ignorant because that lends plausibility to your argument. As a business owner, you really believe I want more government regulation? I'm up to my eyeballs in regulations! The problem is too many organizations that have their hands in my back pockets! DON'T preach to me about costs of doing business.

But, let's dispense with all the BS. What I'm talking about here is simple; service and delivery of product that was duly paid for. I'm honest to a fault, and I REALLY don't appreciate a cocky low-level insurance adjuster, like the one that handled my case, making snide remarks and innuendos. If I was really out to bend someone, believe me, I wouldn't be here talking about it, it'd be done.

Lisa,

Wow, well stated! Applause! You know, that might apply, if I lived in a ghetto, but not the case.

Now, you're getting into underwriting issues. Fact, the structure is 26 years old. It's been through no less than 3 complete inspections, and passed all. EVERY private market carrier has the option to "properly" underwrite ANY exposure they consider taking. Post-facto underwriting is not an acceptable practice. If my carrier didn't want the exposure of a 26-year-old structure ("aging naturally" as they put it), then they most certainly had the option to deny the policy entirely, or increase the premium accordingly. Either way, it's about straightforward and honest business, not collecting premiums for years in hopes nothing happens, and then summarily deny claims when they arise.

As for neglect, I challenge your assertion strongly. I sat down and made a list of MAJOR repair/maintenance items done within a 5 1/2 year period of ownership on this house, do you know that I came up with 27 items? Most people don't do 1/2 of what we've done do this house in 20 years! So, com'on down from your high horse because the neglect issue doesn't fly with me. See what you don't know is I'm one of those freaks about maintenance, both on my cars and my home that supports our family. If I see something that evenly remotely looks like it needs to be fixed/replaced/repaired, or whatever, I do it. That's the plain and simple truth.

Do I expect my insurance carrier to pay on a loss that's a result of a sudden and unforeseeable event, you're damn right I do! That's why we all carry insurance in the first place.

You know, most people see a few shingles missing on their "50 year old roof" and put a claim in for wind damage; therefore, getting their entire roof replaced. Me, I see the roof is old, worn, and has just seen better days, what do I do? I get the darn thing replaced at my cost! I see a 10-year-old water heater that nothing apparent is wrong with, what do I do? I replaced it at my cost. When a toilet fixture cracks top to bottom, you just replace that one fixture, right? Not me, I replaced every toilet in my house, including the plumbing that went with it because I never wanted to have that problem again. You know, $10,000 here, $400 there, those are just the little things, right? So Lisa, what have you done to maintenance your house lately, beyond vacuuming it once in a while?

Oh, oh, yes I forgot something else. This leak that occurred from a drain line, that system was maintenanced as scheduled, and was also built as part of the original structure, which means that it had to be built to code and inspected by the City before permits could be finalized.

Most people pull 2nd mortgages (home equity loans) to pay-off their Benz or BMW, boats, credit cards, etc., we actually pulled it to put back into the house. You see, where we live, you don't have the option of letting your house get, or even appear, to be rundown because we live in a nice neighborhood. Most of the time, I feel like we work as hard as we do, just to keep up with the proverbial Jones' but believe me when I say, the house stays maintained.

Dear burdronjeff:

"Most consumers don't realize the surpluses that must be maintained by insurance companies to handle catastrophes,..."

Really? I don't realize the loss reserve ratios that P&C, W/C, E&S, Auto, Life, Health, and other companies have to maintain to be prepared for castrophies? Hmmmm, interesting. Yes, I certainly don't talk like I know ANYTHING about the insurance market, do I? So Jeff, when was your last AASCIF Conference, or Workshop? When was the last time you sat down with industry experts and discussed current events? Yes, I suppose you're right, maybe I just don't get it, you think?

Insurance companies are in business to make a profit; now, that's a profound statement, but not entirely accurate. Not ALL insurance companies are "For Profit" entities, but that aside, you don't think I know that? I own a business for love of Pete!

What I would like to know is do you know what a bigger reason for insurance carrier failure is, other than insufficient loss reserves? How about executive fraud, gross negligence or mis-management. Ever heard of Reliance Group Holdings? What about Credit General? Why are these companies being investigated? Someone had their hand a little too deep in the cookie jar, I think. Not terribly different from a few others that you may or may not have heard about; Enron, WorldCom, Adelphia, Mattel.

You know Jeff, you're right! The insurance companies are here to help, they're angels of light on a dark day, and no one could find a more honest or solid set of ethics in business today. NOT!!!