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About: Dave

Name  :  David E. Young
 
E-mail  :  dave@brown-ohaver.com
 
Website  :  http://adjusteradvocate.com/
 
Profile  :  Thanks to WordPress Themes, changing the look and feel of your WordPress site is fairly straightforward. For instance, when a viewer clicks on a link to a post author, by default he or she is taken to a page listing the posts from that particular author in chronological order, from newest posts at the top to oldest at the bottom. There are many display choices, including whether to display the complete post or post excerpts, and what additional information to display (title, category, publish date, last modified time, etc.). Each theme makes different choices, and you might want to change them.
 

Posts by Dave:

Adjusting Not Just for Anyone

One of Brown – O’Haver’s employees just told me that she was leaving. She was doing a great job and we have come to rely on her more and more in her role as a content specialist public adjuster. We appreciate her very much.

Recently, however, she came into my office to let me know she was leaving the adjusting field. When I asked her why, she let me know that, while she was content with her hours, her pay and her acceptance as an employee at our firm, she could no longer put up with (1) dishonest insurance companies trying to save money, (2) lying contractors and (3) greedy insureds.

Now not all contractors are liars and we only have a few greedy insureds as clients but that was her perception. She couldn’t put up with the business any longer.

Why would I put such devastating information in a blog? Obviously it is in Brown – O’Haver’s best interest to paint a rosy picture to obtain more clients because, frankly, we have found that we can’t just live on prayer. However, we also realize that sometimes industries do not level with people who are looking for work.

All industries have their issues. My son in law once told me that if you have a $50,000 job you will put up with $50,000 worth of crap. If you are making $100,000 you will be putting up with $100,000 worth of crap. So lets get real here. Yes, there are problems in the insurance adjusting industry but look at what nurses have to put up with. Give any sales organization bent on quotas and goals, a look and you will see that sales may not be a field for you even though some people are rockin and rollin in this job. And, what kind of guts does it take to become a law enforcement officer no matter what the pay?

Judge Judy left the bench where she was a public servant to change her career path. Martha Stewart left her job as a model to go to work on Wall Street and then left that to move on. Dr. Phil laments the time when he was a failing family therapist. Careers are not just for anyone.

Years ago I visited with a job search company where, for a fee, they will find you employment. We were high up in an office building in a major Capital city when he asked me what I wanted to do. I said, “… just about anything”. His response was to tell me to look out towards the high rise building under construction that you could see from his window..

“Do you see those people working down there on the ground?”, he asked. I nodded that I did. “Now”, he said, “do you see that guy up there”? There in plain view was a man who was hanging on , putting rivets in the large metal girders that were being lowered by a giant crane, “That guy up there is making almost ten times what the people on the ground are making”, he said. “And do you know why? He is doing some thing that others can’t (or won’t) do.

In the meantime, I am convinced that public insurance adjusters do “rebuild lives”. And even though things are not always peaches and cream, I find a great deal of satisfaction in my job.

Coverage Outside the Policy Due to Insured’s ‘Reasonable Expectations’

As an adjuster, I don’t talk to judges but I do “measure and document” the valuation of insurance claims and present those claims to insurers. I was recently asked by an ttorney to present a claim that demanded coverage be applied outside of the policy.

We see demands all the time to “reform” the policy and sometimes we see insurers rolling over as well and paying those claims as well; although, this is not something that is common.

Sometimes insurers pay “reasonable expectation” claims that literally amaze me. After the Chediski Rodeo fire, I talked with many individuals who were under-insured and two asked me if I could get their policies “reformed.” Of these two, both were insured by State Farm. I declined, referring them to attorneys who might help them if their agent had “failed to place the proper coverage”, which would be an extra-contractual claim. Both insureds declined and pursued their claims on their own. One was paid. The other was not. It amused me that the one that was paid was a destroyed second home of a famous football player. The one that was not paid was the claim of a “commoner”.

Why some insurers so easily pay celebrity claims is beyond me but these insurers must want to take care of the famous or politically connected. You may recall that State Farm paid money to Paula Jones that laid her claim against Bill Clinton to rest. State Farm paid that claim under Bill Clinton’s Umbrella Policy despite State Farm’s own practice of denying claims where “a law may have been broken.”

Let’s face it, reasonable expectations can differ from individual-to-individual depending on that person’s sense of entitlement. However, some non-politically or famous insureds do have a causal base to pursue such “reasonable expectations” claims based upon many factors which include (1) the agents’ responsibility to place proper coverage (See Southwest Autobody v. Binson), (2) notices to the insured in policy renewal billings, (3) advertising brochures and other reasons which may create reasonable expectations.

The reasonable expectations doctrine applied in Arizona includes the theory that when insurance terms cannot be understood by the reasonably intelligent consumer, the court will interpret those terms in a manner that allows the benefit of those terms to inure to the consumer even when there is no coverage. (Hanks v. American Family Mutual, Gordinier v. Aetna Casualty).

I believe that the doctrine of reasonable expectations will gain momentum. For years, we have been involved in claims that involve “matching” issues only to see insurers hang onto their wallets and not pay such claims. However, things are changing and these claims are getting paid, even though I know that realistically, insurers cannot take the hit for all economic losses that an insured might encounter. As a consequence of this, insurers are responding with pointed language in their policies that no matching losses will be considered. We’ll see where this issue goes from here. But … in the meantime, insureds will continue to make such claims if it makes sense knowing that insurers won’t roll over easy, unless they are making payments to Bill Clinton or football stars.

The Use Of Hearings In Resolving Insurance Disputes

 

It is common knowledge that dispute valuations in insurance claims leads to “appraisal.” Appraisal is a somewhat of a buzz word for arbitration where arbitrators (appraisers) determine values. Simply put then, an appraiser is an arbitrator and appraisal is an arbitration. This isn’t totally a fair equation of words. After all, a brown trout is different from a rainbow trout. Arbitration is not an appraisal, but an appraisal can be an arbitration, especially when the courts have decided such a thing.

The appraisal provision in insurance policies was placed in these policies many years ago to prevent or foreclose upon litigation and provide both insureds and insurers a method in which to value a claim outside of a courtroom. A typical insurance policy will have an “appraisal” process which must be undertaken before an action can be brought on a policy.

The parties in the policy, the insured and the insurer, each appoint an appraiser who select a third appraiser as the umpire. The appraisal panel then works like a three judge appellate court where the parties will present their valuation positions before the panel and two of the three appraisers can sign an award that is binding upon all parties.

This week while serving as an appraiser, the insured wanted us to consider input from sources which the insured was vital to his case and subsequently requested a hearing. While the other appraiser was lukewarm over the idea due to his involvement in so many appraisals where there had not been a hearing, I agreed. However, the umpire we had selected would have nothing to do with a hearing. As a matter of fact, he insisted that no hearing could be held. Instead, he said the parties had to allow the appraisers to determine values without input from either. The umpire was wrong. I raised a complaint to that position and the umpire resigned.

In some respects, his resignation was a gift to the parties because by denying a hearing, any award could be challenged, but is a hearing really required?

Arizona revised statutes contemplate that a hearing take place where requested. Nothing in the insurance agreement says that the appraisal will be decided without a hearing. There is nothing in the policy contradicting the right to a hearing. However, we must first look at our Arizona case law. According to Hanson v. Commercial Union Ins. Co., 723 P.2d 101 (Ariz. Ct. App. 1986), arbitrations provisions in our Arizona Statutes apply where not contradicted by the language of the insurance agreement. Specifically, in view of the similarity between arbitration and appraisal enforcement proceedings (Jefferson Ins. Co. v. Superior Court (1970) 3 Cal.3d 398, 401, 90 Cal. Rptr. 608, 475 P.2d 880), the court applied the standard of arbitration set forth in A.R.S. 12-1505 and A.R.S 12-1512 to the appraisal proceeding and created the general standard of review applicable to arbitration. If appraisals are controlled by the arbitration statutes, hearings, if requested, are necessary.

A.R.S. §12-1505 provides various reasons for which an award might be opposed. A.R.S 12-1512, A, 4 stands tall where it clearly sets forth that an appraisal award can be challenged when, “the arbitrators refused to postpone the hearing upon sufficient cause being shown therefore or refused to hear evidence material to the controversy or otherwise so conducted the hearing, contrary to the provisions of section 12-1505…”

The court may order an appraisal rehearing before the arbitrators who made the award or their successors appointed in accordance with section 12-1503. The time within which the agreement requires the award to be made is applicable to the rehearing and commences from the date of the order.

Appraisal is a wonderful method to resolve valuation disputes. It is unfortunate that so many people, including the umpire we had selected as our third appraiser, lack knowledge of this simple procedure. The appraisal must commence in an appropriate manner, which includes offering a hearing to the parties. Following proper procedures will prevent the appraisal award from being challenged.