Public Adjuster Boot Consistency Custom

Benefits of Consistency


As a consumer, I often try to locate places that offer me the benefit of consistency. That, as most things are, is at least a two-sided coin. Consistency could be established either way, positive or negative.


Every time I have my oil changed at Oil Changes R US, I have to remind them to check ALL the fluids AND refill the windshield wiper reservoir….. As a result, I only use them when all other options have been exhausted.

I have been going to my local butcher for 10 years. We know each other by name and I know exactly what to expect every time I step up to his counter. Excellent service and honest answers to any questions or suggestions…. He does not give me a discount, nor any other special privileges to speak of… however, that was never the reason I came to his establishment to begin with, I had come to purchase meat. Over the years, I have referred 20-30 people who are now also loyal, frequent customers of his…

Not one single person attends the butcher shop for price, or convenience. They attend and spend their hard-earned money on consistency of the service given… They all knew exactly what to expect in return.

Does an insured individual, ANY INSURED INDIVIDUAL, deserve anything less?

Does your client deserve less? #ProtectTheInsured….

When you perform any portion of a claim, on behalf of an insured, you have essentially taken the role of a protector. Any harm done to them, due to that handling, or mishandling, will fall squarely upon your shoulders. Obviously, we are human, and we will miss things, and make mistakes… that is a given. However, that margin of error can be greatly reduced… by consistency in the performance of the claim. In fact, I have copied a small excerpt of the Texas Insurance Code, which can be found here in full context.

Sec. 542.003.  UNFAIR CLAIM SETTLEMENT PRACTICES PROHIBITED.  (a)  An insurer engaging in business in this state may not engage in an unfair claim settlement practice.

(b)  Any of the following acts by an insurer constitutes unfair claim settlement practices:

(1)  knowingly misrepresenting to a claimant pertinent facts or policy provisions relating to coverage at issue;

(2)  failing to acknowledge with reasonable promptness pertinent communications relating to a claim arising under the insurer’s policy;

(3)  failing to adopt and implement reasonable standards for the prompt investigation of claims arising under the insurer’s policies;

(4)  not attempting in good faith to effect a prompt, fair, and equitable settlement of a claim submitted in which liability has become reasonably clear;

(5)  compelling a policyholder to institute a suit to recover an amount due under a policy by offering substantially less than the amount ultimately recovered in a suit brought by the policyholder;

(6)  failing to maintain the information required by Section 542.005;  or

(7)  committing another act the commissioner determines by rule constitutes an unfair claim settlement practice.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.

End Excerpt.

Let me put an example in an insurance claims perspective now.

An insured has multiple properties in multiple towns. All located in the same state, with the same date of loss, the same type of loss, and similar damage. (This is example is highly unlikely, simply from logistics of any normal storm, yet a very effective way of explain what goes on.)

This insured hires a Licensed Public Adjusting firm with three offices that cover the state. The claims are split equally among the three offices. While the offices are semi-connected, have regular meetings, and are generally well aware of what the others are doing. In spite of all these similarities, and general shared abundance of knowledge, each of the offices are working independently, and each Licensed Public Adjuster is working independently within that firm, performing the entirety of that claim within their own confines, regardless of the scope or complexity.

Before long, various payments will begin to arrive. There will be so many common themes from insurance carriers that they will begin to expose their weaknesses. Patterns. Consistency. No matter how wrong I have found any given insurance carrier to be, I could never accuse them of not being consistent.

You see, one of the main ingredients to the secret of their astounding success, is without fail, their consistency.

  • Loopholes are consistently sought to circumvent coverage.
  • Adjusters are consistently trained to perform micro management of claims, which ensures any loopholes found are consistently exploited.
  • Software is consistently manipulated to cut every .02% of a penny from every penny touched.
  • Claim call centers are consistently trained on how to “answer” each individual type of claim call, and which items are NOT COVERED. (Mold. Unless otherwise scheduled specifically, as a covered cause of loss, is typically excluded in the policy. However, that same policy, of its own accord, normally adds that coverage back in IF the mold was CAUSED by a loss resulting from a COVERED PERIL. Water pipe bursts, insured is out-of-town for the weekend, water leaks and mold begins to form, and continues to do so until insured returns, and discovers the leak. Mold would NEVER HAVE BEEN PRESENT, had the original COVERED CAUSE of LOSS not occurred. This, by precise policy language, is covered. THE CALL CENTERS HISTORICALLY, CLAIM AFTER CLAIM, ADVISE AN INSURED THAT THEIR covered LOSS IS NOT COVERED. They then send a very small excerpt of the policy, which does, in fact state that mold is EXCLUDED. This is clever, because it is driven home with BOLD HEADINGS AND LARGE PRINT. The carrier has completely denied the covered loss due to a mold exclusion. It took them fifteen minutes on the phone, a claim file generated, all of the proper PREDETERMINED boxes available to click, supplying the ONLY options GIVEN on the screen before them. The carrier failed on every level of the contract, and the promise they signed when they took the insureds money and accepted a license to do business in that state. They failed to teach the claim operator to look further into the policy, and exactly as the rules and contract demand, FIND COVERAGE WHERE COVERAGE IS AVAILABLE. They failed to point out the very small, somewhat obscure portion of the policy that very specifically affords mold coverage to the insured, provided that mold was caused by a covered loss. Water, burst pipe. That failure, on an entire staff, of an entire claim center, was by design. One hour, one letter, one stamp, one claim on the insureds history, and the insurance made $50,000.00! How? The loss was covered. Without fail. They simply said no.) Long rant, but some of these must be, in order to put things into perspective, as well as apply them to situations most have seen or heard at least a few times, if not a few dozen.
  • The example above can be applied to so many different, separate individual items, that at some point in the chain reaction of realization in your head, it should scare the living hell out of you. Overhead and Profit on roofs… No OSHA regulations for height, complexity of a claim, three trades, and no base service charges… the list can and does, go on and on. Out of everything that these items have in common, there are several constants… or “consistencies”, if you will. Each time, the insurer implemented the process. Each time the carrier denied a covered claim, they benefit by realizing THE VERY REAL PROFIT that was not paid to that one time customer who is now a liability with a claim….

Again, I apologize for the length. Those who know me personally know I have no problem talking… typing… sheesh.

Let’s pick up with our insured and his team of Licensed Public Adjusters, and wrap this post up nice and neat.

As I have pointed the patterns out above, this firm will do the same. As I stated in the beginning, that can be a dual edged sword.

Office One                              Office Two                              Office Three

Claims received:         30                                            30                                            30

Payment on:                10                                            20                                            30

Claims in limbo:          30                                           15                                            0

Initial payment:           60 days.                                 40                                            15

Average demand:       $30,000.00                              $42,000.00                              $51,000.00

Average received:       $8,000.00                                $19,000.00                              $40,000.00

Claims closed:             0                                              15                                            30

Net to Insured:            $80,000.00                              $380,000.00                            $1,200,000.00

                                    No process                             Some Process                         Boot Camp    

While very crude, with generic situations, the benefits of a team that had developed a system that would almost mirror an insurance companies… literally to the move. However, two key differences. The first and most glaring, we work directly for the insured to do what the insurance company, by licensure, law, and policy, should have had the skill set and tools required to do, who also represented not only to the insured, but every good neighbor the insured knows, that not only could they… no… no that was not near far enough, but that they would go above and beyond to do the “right thing”…. Does any of the horse crap I have just explained… in significant detail, complete with multiple examples…. That can be easily proven with our data base. Denial letters to cashed checks for hundreds of thousands of dollars… Churches, Senators, Judges… Insurance Agent and Adjusters alike… we have helped them all. We have proven these things time and again.  Enough so, that we can now teach others. We can fill the gaps the study guides on provide. We can bust those profitable myths… Here’s a good one. “If I cash these insurance proceeds, I have accepted the payment and my claim is closed.” I have had insureds carrying checks in excess of $100,000.00 around for over a year… fearing if they cashed, they were done. This is an outright myth that is perpetrated by every single carrier.           

How? Out of all those billions of dollars in commercials, every single place your eyes rest or your ears listen, have you once heard them proclaim that it was ok to go ahead and cash that check, statute of limitations will not allow them to close the claim until a contractually specified time that did not conflict with minimum statutory time limits, normally a minimum of 1 year. There are very few, if any, legitimate reasons they could close the claim prior to that time.

I have never once heard them publicly proclaim that it was ok to cash or deposit any funds without fear of harm from future unforeseen or hidden damages being excluded.

The consistency with which they have withheld that pertinent information that the majority of insureds fear.

Out of all this, I hope that you bring away one thing.

Success with any insurance claim comes from a series of events that do not just “happen”. Regardless of who is working the claim, a Licensed Public Adjuster or an Insurance Company, the outcome of that claim, on every level, depends on what you put it into it.

If you follow the example of the third company, you have realized that there is a BEGINNING and ENDING to your portion of this claim. Your job is to perform that portion to the best of your ability, close that claim, either receive full compensation or valid reason why not, and close the claim, or perform the claim to the best of your ability, receive every bit of undisputed funds on the insureds behalf, and refer a competent attorney who practices Property and Casualty as a specialty, and will take a valid insureds claim on a contingency fee basis, thereby completing your portion of the claim, while giving the attorney the SAME BENEFIT YOUR INSURANCE COMPANY HAS, SOMEONE WHO REPRESENTED THE CLIENT, AND DID THEIR JOB THOROUGHLY AND COMPLETELY, and provided a proper trail of documentation and demands that can easily be followed by a jury and explained and proven to a an insurance companies hired gun attorney in a way that leaves no doubt of what YOU had done… or hadn’t.

So… the insured, who began this whole conversation…

Was he harmed?

Could it have been prevented?

If he ever needs another Licensed Public Adjuster, who do you think he will call?

Do you think, as a consumer, and savvy real estate owner, they would not realize that there was a massive difference in what they received, when they received, and how many claims were still open and being dealt with?

I would specify team 3, every time, without fail.

Ok… that is the insured’s perspective… let’s look at it from business side.

Office 1         $080,000.00

Office 2         $380,000.00

Office 3         $1,200,000.00

Any more questions?

 Cal Spoon

August 26, 2015

Feel free to leave questions and or comments…