Help me plan my next move here (dealing with insurance company)

I know we have some people here in the insurance industry. First let me apologize for any animosity that might surface in my post, I'm seething with rage right now and sick of insurance companies bending us over.  I'm hoping to tap into the hive mind here, especially those in the industry, for help before I make my next move (whatever that is).  

Background: We had a little weather kerfuffle called Hurricane Ian pass over our heads about 9 months ago. We fared better than most. Our insurance company sent out an adjuster and cut us a check. I can only assume that check was to buy us dinner for our trouble because it sure as heck wasn't going to repair the damage. We hired a public adjuster (more on that later). For those that aren't aware (I wasn't until after Ian), a public adjuster is an adjuster you hire that isn't in the insurance company's back pocket. The PA is fighting for you, while the other adjuster is fighting for the insurance company. 
The PA said this will take a while, it's part of the game. They no doubt have 10's of millions of dollars to pay out, every month that they don't pay out is another month to earn interest on the investments they make with our money.  We hunkered down, got the house wrapped in a tarp, and started playing the waiting game.  

Current Situation: The PA hasn't been great. Communication sucks. That might be because they are overloaded with work, it might also be (partly) because the insurance company has gone totally radio silent. They know they hold all the cards and aren't even playing by the rules (laws) of the game. For instance, after submitting a notarized Proof of Loss document they have 20 business days to respond, by law. Well, that was 6 or 7 weeks ago. They just requested another nearly identical form. This allows for another 20 business days, and I'm sure they'll wait 6-7 weeks and request another form, and on and on.  
My house is not weather tight, my yard is not secure, my shed is not sitting level, or in the same location it was before Ian came through, my back door has a hole in it with tar tape to keep the lizards out, we can't do any repairs on the inside because of potential water intrusion. Tarps aren't all that trustworthy or that's what they'd use instead of shingles lol.  I have a claim for almost $135,000.

What I Want To Do: Besides things that would land me in jail, I don't have many options, the insurance crooks hold all the cards, and they know it. Our PA is either ineffective because they suck, or ineffective because the insurance companies are just plain crooks. Or a combination of both. So I have thought about calling our mortgage company and bringing them up to speed and letting them know that the house they hold the mortgage for is not weather tight and is more than likely being more damaged with every rain. We're now in the next hurricane season, so the chances of that tarp holding on are slim to none.  

What I Don't Want To Do: I don't want to hire another PA because:
1 - I don't know what it'll take to get out of our current contract, and legal fees will not be small.
2 - I'm not confident a new PA will be able to make things happen quicker because I don't know how much of the problem is the PA and how much is the insurance company
3 - I just want this done.

So, if I were to call the mortgage company I know it probably won't fix anything, but is there any way for this to bite me in the butt if I call them and explain that 'their' house is not being taken care of.  

What really burns me is that I'm forced by law to pay these crooks, but they don't have to uphold their end of the bargain when the time comes. I'm sure after they finally do cut us a real check they'll jack our rates sky high to make up for it. 

In NC we have a state insurance commission. Decades ago I had a problem with an insurance claim & they got it taken care of promptly and to my satisfaction.  If your state has such a comission, you might want to contact it.

https://www.floir.com/

DFS Division of Consumer Services

Consumer Helpline
Phone: 1-877-693-5236
Out of State: 850-413-3089
Consumer.Services@myfloridacfo.com

OBTW, I've always heard not to accept their first check...  Just saying.    

Lawyer up

You might also want to talk to a lawyer. And document all the damage caused by not being able to do the work in a timely manner. If you really want to be prepared for a fight, document, document, document.

Rule 1. Never deposit the first check unless it will cover 100% of the damages.

Rule 2. Contact the Fla Insurance Comission and file a complaint/open a case.

I would not contact the mortgage company. In some cases they can demand payment in full for failure to maintain the property. Read the fine print. 

Who is the insurance Co? Call a lawyer that doesn't like them and have him write a letter. Then if necessary, file suit against them for damages, punitive damages,and lawyer fees. The squeaky wheel gets the grease.

First, a PA does not fight for you, they fight for themselves.  I'm really sorry you got sucked into a contract with one.  Anything you can do to get out, do it.  If you think insurance companies are bad, PAs are much worse.  We always joked that they are wanna be lawyers who failed out of school.

If the insurance company is being slow, I 100% promise you it's not intentional.  Contrary to popular opinion, insurance companies don't want to drag out a claim...that costs money.  If the adjuster is non responsive, get a manager or director on the phone.  Write to the DOI, that will definitely get their attention.

If you don't believe anything else I say, after 27 years in this business, dump that public adjuster as soon as you can like a hot potato.  Bad news.

In reply to SKJSS (formerly Klayfish) :

This sounds like a reply of someone who's worked for an insurance company for 27 years. 

lnlogauge said:

In reply to SKJSS (formerly Klayfish) :

This sounds like a reply of someone who's worked for an insurance company for 27 years. 

I'll chime in with two comments.

Someone with experience in the industry can be the best person to give feedback.

This is GRM ,not Facebook. We start with an assumption of good intent from our regulars. If that's not the case, it will be obvious soon enough.

I responded to your last post with an offer to reach out which still stands.  For reference I am still going back and forth with my Ian claim which isn't quite as large as your suggested amount but not way off so I can commiserate.

I doubt that the mortgage company angle will do anything.

Filing a department of financial services complaint demands a response however since you are represented by a public adjuster you may not be privy to what all is happening on the insurance companies side.  Their response may very well be that they are evaluating all that is being claimed which may or may not be covered.  Often times fencing, sheds, screens, patios etc are not covered during hurricanes depending on your company and policy. 

Things happen, claims fall through the cracks, adjusters can be ignorant, wrong, or miserable people.  From my own personal experience I have never seen a file sit because they just want to delay it.  Overworked, overlooked or just a lazy adjuster sure but I've never seen any type of systematic or incentivizing for delaying claims.  

There are good PAs and there are those that just throw everything at the wall to see what sticks which delays everything since the insurance company needs to explain the reason for denying each disputed item.  Then there are those that are basically referral funnels for attorneys.  Usually they bring out mitigation and tarping companies which charge exhorbinate amounts for the work they do which again also delays everything.  Question, have you seen their demand/estimate and all the invoices for work completed?  I've seen many tarping invoices which are similar cost to roof replacement.  

Also as much as I appreciate toymans posts in general, the cashing the check thing is a myth at least in property insurance. That is simply the undisputed amount of damages unless you signed a release first which is quite rare in my experience and usually on an odd claim where coverage is very questionable. Typically they come into play with attorneys or PAs where there is a disagreement to the damages or coverages but a payment is made to avoid litigation.  There really aren't punitive damages unless the insurance company acted in bad faith claim which is difficult to prove and somewhat rare.  It sounds like they made undisputed payment based on their assessment somewhat quickly. 

A lawyer typically charges take 30-40 percent of the settlement.  An example I saw from an Ian claim. There was an prior claim from Irma (2017) in which 30k was paid to the PA / Attorney and 10k went to the insured.  He claims to have made minor repairs to the roof which was likely all that was needed at the time but a release was signed for replacement of the roof.   Filed an Ian claim as now the roof was destroyed but it was the same roof as the Ian claim.... probably isn't going to turn out too well for him.

Floating Doc (Forum Supporter) said:

lnlogauge said:

In reply to SKJSS (formerly Klayfish) :

This sounds like a reply of someone who's worked for an insurance company for 27 years. 

I'll chime in with two comments.

Someone with experience in the industry can be the best person to give feedback.

This is GRM ,not Facebook. We start with an assumption of good intent from our regulars. If that's not the case, it will be obvious soon enough.

Thanks Doc.  Indeed, 27 years has not only given me very thorough knowledge, I literally wrote the book for two insurance companies.  Are claims perfect?  Hell no.  Do claims go sideways?  berkeley yeah.  However, I can promise you it's NOT from intent to avoid paying or trying to delay.  In fact, metrics are studied over and over on how to pay faster.

And yes, not cashing the check is pure myth.

lnlogauge said:

In reply to SKJSS (formerly Klayfish) :

This sounds like a reply of someone who's worked for an insurance company for 27 years. 

Yep, we call that real-world experience. What useful experience do you bring to the discussion, aside from throwing the insult grenade?

I don't work in property claims but have talked to enough of my co-workers in that department to know that PA's are mostly just there for their cut of what you get. They always slow down claims, not get them completed sooner.

First off a big hearty thank you to everyone that has offered help and comments, including inlogague to be specific just because he's getting slapped around.  He's probably been slapped around by an insurance company (who hasn't) and is jaded.

A little update: My wife and I talked at length with the PA last night. There was some communication with the insurance company, but they didn't communicate that to us. Basically there wasn't a lot to report at that time, just more feet dragging from the insurance company. They ask for a form (that starts a 20-day clock ticking) then say they never requested that, or shouldn't have, and request another one, starting another 20-day clock. Yeah, you can't tell me the insurance companies want these paid quickly. It's only been 9 months with our house taking on water.

A question to SKJSS: you say dump the PA. Why? Can you tell me how I'd be ahead of the game? I seriously want to know. I've never heard a serious complaint about a PA, but hear them about insurance companies all the time.
You say the PA isn't working for my benefit, but the insurance company is? The PA get 10% of the total claim, so they are working for both of us.
I'll admit that if a PA wasn't involved we would be done with this claim. Months ago, in fact. See, the insurance company cut us a check for about $7K. They said our fence isn't covered ($21K in materials alone), our lenai isn't covered, the water damage in the house isn't covered, the well isn't covered, pipes on the side of the house that are in the next county aren't covered, etc. They covered $0 on the roof. I'll defend the insurance company on the roof coverage because at that point the roof leaks weren't apparent, it wasn't until the water continued to work through the insulation, and it rained more, that we started seeing it. We could have claimed that after we used the check for a tank of gas and dinner at a nice mexican restaurant.  
The PA says that our fence IS covered because it's attached to the house (the insurance company doesn't argue that, they just ignored that), the water damage on the walls IS covered because while the policy doesn't cover wind-driven rain (THAT'S WHAT A HURRICANE IS YOU CROOKS) it does cover water intrusion if the opening is caused by the wind (WHAT?!?!), the well isn't covered, but the lenai is covered. 
In short, if we trusted the insurance company we would have collected $7K and possibly been paid for part of the roof replacement at a later date. All of the other stuff they lied about or were ignorant of, you chose which it is.  
I'm mandated by law to buy a service. I just want the service I'm paying for in a reasonable amount of time. 

Here's why people vilify insurance companies.
My neighbor didn't go through a PA. His roof was severly damaged and his interior ceilings caved in. The insurance company paid for the roof and the interior work. The amount they paid for the roof was shy by about $7,000. When he said something they said 'well, a roof shouldn't cost that much'. Well, it shouldn't but it does. They were about $10K short on the interior repairs and haven't coughed up any more money for that either. So he's out $17K because his insurance company didn't think the roof should cost that much. Well, homeowners insurance shouldn't cost what it does, but here we are.  
I had a claim for a flooded basement years ago in MI. The adjuster came, assessed the damage and cut us a small check. Then he said 'as you replace furnishings and belongings give us the receipt and we'll reimburse you'. That works great for them because they know we aren't going to go out and buy 100% of the things that were damaged, it took years to find and accumulate that stuff. Just give me the #@^ check, just like I give you a check every month.

I really wish I could take my monthly insurance premium and put it in escrow and tell the insurance company they will get 100% of their money after my claim is settled. Of course I can't do that. They know they have us by the short hairs.

Again, I'm sorry if animosity is bleeding through. I've reworded or deleted parts of this post. It's just incredibly aggravating to sit here powerless while a company can simply not deliver the service I'm paying for. It could be worse. The storm hit on a Tuesday night/Wednesday morning. A friend of mine got an e-mail on Friday that his insurance company filed for bankruptcy. He get's $0. He's not alone. So I do count myself fortunate, just really tired of the games.

In reply to SKJSS (formerly Klayfish) :

It is interesting that most attorneys don't agree with you because of frequent underhanded practices by insurance companies. I will grant that attorneys are not necessarily objective in these matters but neither are insurance companies. While I don't doubt that there are some honest people that work there, insurance companies didn't become some of the biggest financial companies in the world by rushing to give away money. 

9 months to complete a property claim is not forgetful or overloaded employees. It is an unacceptable business practice by a company that appears to not want to uphold its end of a deal. Florida has had insurance problems for decades for all kinds of reasons and with insurance companies running losses of over a billion dollars last year alone they are looking for every chance to deny or reduce payouts to stop the bleeding. DrBoost got a check and cashed it, I would guess that the insurance company is dragging their feet hoping that he will just go away. 

File the complaint. I'd file one against the insurance company and your private adjuster. Neither one of them is doing their job. 

FLORIDA OFFICE OF INSURANCE REGULATION

200 East Gaines Street
Tallahassee, Florida 32399
(850) 413-3140

If you wish to speak with a consumer services insurance specialist to file a complaint or ask a question about a policy, please email: Consumer.Services@Myfloridacfo.com

My niece when through this with Hurricane Ida in Louisiana.   A huge tree (I'm talking 4.5 feet in diameter) from their neighbor's yard partially fell on their house. crushed the roof, and made the home totally unlivable.  The neighbor's took the full trunk of that tree and was completely crushed almost to the ground.  My niece's  house only got hit by 18" branches.

  They ended up hiring an attorney and a public adjuster to get the money to rebuild their house.  And, of course, the lawyer cost close to 1/3 of the settlement.   Once an agreement was made then the mortgage company stepped in and said they own the house therefore they get to decide the timing and amounts of the disbursement.    So more fighting over percent complete status.  They were in a "do" loop for months.  It took over a year before they could get back in.  They never got the total money needed to fix the  house.. My sister ended up loaning them $10,000 to get the house finished because she was tired of her daughter, plus husband, big dog, and 4 young children, living with her.   I think my niece is still fighting for the rest of the money owed so she can pay back my sister.

She also had a horrible time with contractor's price gouging.  The plumber charged like $40,000 to dig about 10 feet under the slab to replace the drain pipes for two adjacent bathrooms (The Tree falling actually caused the house to flex all they way to the slab and cracked the drain piping under the slab).  The house is less than 1000 feet from the Mississippi River, it was in flood stage, therefore they had to wait until the flood stage receded before the plumber could dig a 3 foot deep trench to get to the piping.  (This is a federal rule BTW and not unfounded - the river was my back yard growing up - its power is awesome)- So , anyway, that was a several  month delay waiting for the water levels to recede.

In reply to DrBoost :

You might tell your friend that Florida has an insurance guaranty association that is paid for by an assessment on insurance payments. He should still be able to file a claim even though the insurance company is insolvent. The association should then back the claim and pay it. It would be worth a couple of phone calls. 

Florida Insurance Guaranty Association

In reply to Toyman! :

Thanks for that info. 
 

Meh, not going down this rabbit hole again.  The PA goal is to inflate the claim and take what cut they can.  I can't comment on third hand information about a neighbor, friend, relatives claim... I would need to see the actual file.

Insurance companies loose money the longer a claim stays open.  Adjusters are partly evaluated on how quickly they close files.  Believe me, don't believe me, whatever.  Hell, I retired a few months ago so now I really don't give a crap... I'm just laying out the facts.

SKJSS (formerly Klayfish) said:

First, a PA does not fight for you, they fight for themselves.  I'm really sorry you got sucked into a contract with one.  Anything you can do to get out, do it.  If you think insurance companies are bad, PAs are much worse.  We always joked that they are wanna be lawyers who failed out of school.

Reading this really burns me up, so I thought I'd address it directly.
You say PAs don't fight for me, they fight for themselves. But when the PA wins, we win. Is the insurance company fighting for me? If the insurance company wins, how do I fare????
We didn't get sucked into a contract with one. That implies we are dolts that got taken advantage of. We sought out a PA because the insurance company gave us about 6-7% of the value of our potential claim. From experience we know how crappy the insurance industry is, and how crooked they are. 
Insurance people might make disparaging jokes about PAs, but you should hear how the general public talks about insurance companies. Failed lawyers would be a few very large steps up the ladder.
Sorry, I just took offense at the tone of your statement. I can now tell you are in the insurance industry. The level of care and compassion for those putting lives back together is obvious.

Like I said, not going down the rabbit hole.  I speak from extensive first hand experience.  My comment wasn't directed at you personally, rather at the PA.  If you are happy with them, go with it.  You asked for advice, I provided it from an insider perspective.  As with a plaintiff lawyer, they slow the claim process down dramatically and the "extra" money they get lines their pocket, not yours.  Been there, done that... didn't even get a Tshirt