The Independent Insurance Claim Adjuster Resource

In a brief review, we noticed that nearly all states have passed legislation that refer to “Unfair Claims Practices”.  Essentially, most states have set forth some bare bone guidelines that force insurers to fairly investigate and pay claims for damages that they are legally obligated to the liability for, or would be legally obligated.  The acts are much more in depth than what meets the eye though.  For example, Colorado’s statute on Unfair Claim Practices sets out several limitations that include, but are not limited to “Failing to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies” see C.R.S. 10-3-1104(h)(3).

In nearly all cases, the legislature was clear in it’s intent to protect both first party insureds and third party claimants with these acts.  We’ll be expanding on this theory in another post but make the point that case law in nearly all states limit a third party claimant’s right to sue an insurer for bad faith as they are not a party to the contract or policy. This often leaves the Department of Insurance or Regulatory Agency responsible for the policing of insurers when they treat third party claimants unfairly.  A regulatory agency can fine insurers limited amounts, but this doesn’t necessarily prevent unfair claim practices to third party claimants.  If a claimant is forced to bring suit upon a tort-feasor he bears an expense for counsel and risk at trial.  None of the funds that are collected from regulatory agency action against insurers can be collected by a 3rd party claimant and most courts limit bringing administrative judicial records or findings into Civil litigation.  At best, a third party claimant is left to attempt recovery for the forced suit from the insurer through mis-guided attempts of negligence per se against the insurer, or the state.  Everyone knows that suing the state could take a decade. Read more…

By the Independent-Adjuster.com Staff – For immediate release – November 29th, 7:08pm MST.

Independent-Adjuster.com has recently learned through an anonymous source that a local Denver area independent claim professional is considering amending the Colorado Department of Regulatory Agency – Division of Insurance to an on-going legal battle stemming from a negligence based tort claim against a Denver property owner.  The claim professional feels strongly that the department failed to consider his DORA Complaint against the property owner’s insurer with any reasonable application of the law.

Colorado case law does not provide third party claimants with any remedy for claims against liability insurers representing property owners, thereby leaving the duty of policing up to the limited powers of the regulatory agency.

We have learned that the Plaintiff, who remains anonymous at this time, has filed his Complaint as a Plaintiff in Propria Persona or as a Pro Se litigant, meaning that he represents himself in the matter.  His legal education and background was not available at the time of this release.  We will provide updates on this story as they become available.

The appraisal clause is designed to be a simple and low cost form of mediation in the event of a disagreement on the value of damages; generally limited to property claims.  Much like mediation, there are few written rules governing the appraisal clause.  In the appraisal process each individual party (the insurer and the insured) select a competent appraiser and then the appraisers come together and select and umpire who, in the event the appraisers cannot reach an agreement, hears each appraiser’s findings and then makes a ruling on the matter.  When the appraisers cannot decide on an umpire they can petition a local court or judge to assign one at random

In most states an appraiser can be anyone including an engineer, an independent adjuster, a public adjuster, an attorney, or your best friend.  The appraiser should be independent and impartial from the claim process that preceded invocation of the appraisal clause.   It’s important that the appraiser understands the rules and processes through which Appraisal is completed, and have some background on how insurance polices work.  If an appraiser doesn’t properly understand the boundaries of appraisal Read more…

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Why Public Adjusters are enemies of Independent Agents – October 2nd, 2010

by Phillip A. Crimaldi

As if the insurance claim profession isn’t plagued with enough problems, I came across an obscure article titled “Why Public Adjusters are not enemies of Independent Agents“, published in March of 2010 by Ronald Reitz, CPPA, on the Insurance Journal’s website.  After much consideration, the article was undoubtedly written as a stunt to drive web traffic for the Insurance Journal and Mr. Reitz’s own business, if not in an attempt to help any unsuspecting insurance agents be removed from their rights to sell insurance for a conflict of interest.  Unfortunately, the article was also a slap in the face to independent insurance agents and public adjusters nationwide.

Although this reply addresses the basic outlying conditions of how Mr. Reitz provides stretch-of-the-imagination conditions and suggestions to independent agents, the underlying fact is that he goes to great length to expose the agents’ errors and omissions coverage by suggesting the agent gets more involved in the claim process.  The fact is that many insurers prefer their agents stay out of the claim process because they have employed claim representatives with a focus on excellent customer service.


Under the heading “Here’s why working with a public adjuster can be good for an independent insurance agency and for its customers:”, Mr. Reitz goes on to give six numbered paragraphs and a few guidelines which are so far the opposite of helpful, that they actually demean that intelligence of the insurance community.  At best, Mr. Reitz’ theory on befriending independent agents is an insult that warrants an apology to independent agents, public adjusters and their employees.  We arrived on this conclusion through the following analysis of the article, by the paragraph:

1.  Mr. Reitz explained that after a disaster, insureds have hundreds if not  thousands of questions and that as an independent agent, they’ll be coming to their independent agents and agencies for answers.  Worse, as an independent agent you’ll be having to answer the phone every few minutes to resolve your client’s fears! He continues on that as an agent you’ll have to read the policy and get back to them, and that you might find yourself at odds with the insurer “if you add your own opinion or interpretation of the policy language“.  

We disagree in full, Mr. Reitz. The article first tries to instill fear in the young and unsuspecting agent by employing a Captain Obvious approach.  Any agent knows that when disaster strikes, his phone is going to be ringing off the hook and that the duty to support his clients will be called into play.  The mere concept that you’ll have to “resolve their fears” is the biggest lie I’ve ever read on the web.  Although insured may have some fears initially on the claim process, it is highly doubtful any agent would have any ability to even resolve anything at any point in the claim process.  Agents are removed from the claim process for good reason and to revisit the history of how and why claim representatives were introduced to the claim process would be over-extending ourselves into the obvious need for at least some impartiality.

Read more…