I was talking to a guy in his early 20s in an office recently, a good guy a little ahead of his peers in that he owns his own home already. He was telling me about a water related storm damage problem and the problems he is having with his insurance company. Depspite being a smart guy, he basically has "given up" citing "all the paperwork they are asking for," and the frustration caused from his insurance company adjuster saying "have it fixed and keep all the receipts." The cliam sounded like it wasn't huge but certainly in the thousands. While the particulars of his cliam or case are not the point here, his being worn down by his insurance company and neither completing the claim nor getting any payment are were the important point that reminded me to write this datasheet that I have been thinking about.
In my opinion, whether he rolls over and gives in to the insurance company and does not pursue further, vs fights for his financial interest is reflective of a primary issue as a man, but requires specific knowledge of insurance as well.
Insurance companies are collecting premiums and operate on doing everything possible NOT to pay. If you deal with your insurance company knowing this you will have better results. If you are naive and think they are there to help you you will get screwed or worse.
The disclaimer here is that I do not work in the industry, my datasheet is based on my own research, two past massive commercial claims that I was somehow involved in, and recent insured incidents where I gained some additional tips through experience. The purpose of this is to start and I hope others who may work in the industry or had/ have issues will participate.
The Policy
The Policy is the contract between you and the insurance company. I would venture to guess that most people have never read thier policy. Now is a good time to suggest that you get a copy of and read your policy. It isn't enough to get a declarations page, packet of a few summary pages or insurance cards or proof of insurance. The policy may be 50-150 pages, may have been mailed to you or not, or may be downloadable as a pdf. Get a copy and save it. After you read this I hope you will want to see yours, even if you only have an auto policy.
Named Insured
Why am I starting with the obvious? Because it isn't obvious to most that each and every detail can and will be used by an insurance company to NOT pay a claim. Example, you have renters insurance and you have a roommate who moves in after you took out the insurance who owns the big 4k tv. The big 4k tv is stolen and you call to make a claim and get denied because the receipt is on the roommates name and you didnt call last month to add her to the list of named insured. She is fucked and you buy the next 4k because you feel like an idiot.
Policy Period
Again, the obvious, and another reason to deny a claim...
Deductabes
On your poicy you will have deductables. These are amounts that you are responsible for before the insurance starts to pay for a covered event. One policy can have different deductables for different coverages.
Personal Property
Your insured stuff.
Personal Liability
Things you are protected from others pursuing a cliam against you.
Limit of Liability
The maximum amount they will pay period. Again, different amounts can appear for different coverages in one policy.
Premium
How much the insurance costs.
Endorsements
These are key definitions that further define what and how something is covered, will require research in your policy. A crazy amount of detail can be found here - spouses, hurricanes, identity theft, etc.
Definitions
Insurance is filled with so many conflicts each policy contains a dictionary inside. Read this.
I am skipping many concepts...
Actual Cash Value vs Replacement Value - Goodwill or thrift value vs how much to buy new. Always get a Replacement value policy otherwise you are going to get nothing for your stuff.
Dollar limits on some property
The most expensive thing you own is a $3000 gamer laptop. Your place gets robbed. You didnt read your policy it has a specific limit on computers of $400. You are fucked again. You needed a special item or high value item policy in addition.
Property Not Covered
No one reads this. You work from home, your files, printer, computer, tshirt making machine, and book printing press get destroyed in a flood. Check for your loss is zero dollars and zero cents, you mentioned you work from home and they said sorry business equipment is not covered. Your roommates food stamps and stack of cash are also no covered. Your Uncles gold bars which he kept there washed away and even though you lied and said they were yours they deny your cliam. You had also rented a Lieca camera from this cool new app and it is underwater and they wont pay for that either, because it is rented. What the fuck have you been paying rental insurance all these years for? Now it doesn't matter what Tokyo Joes Platinum policy says, he is covered for everything with no deductable. What matters is what YOUR policy says.
Causes of Loss.
You are not "insured." It's not a security blanket. You are insured for VERY SPECIFIC and limited causes of loss listed under causes of loss. Fire, Flood, Theft, Aircraft, Earthquake... Read your list.
Causes of Loss not covered.
Black Lives Matter burns down your business. Ooops. They were just labeled terrorist and terrorism and insurgency are NOT COVERED. Sorry. War, Nuclear, Neglect by you, any loss you try to cause... Read your policy.
Flood and Water
This can be very tricky, you can be covered for a flood but not wind driven rain, or you might be covered for a collapse caused by water but not for broken pipes that cause damage. Again read read read.
Additional Coverages
AKA Money left on the table because most people never ask for it. Moving expenses (limited or unlimited - read yours) Replacing your food, Replacing your locks, Resturants you had to get, rental value etc. Read up. Legal defense, fees, removal of debris. On and on. Money most people could have claimed but did not.
Liability
For example when someone says they got hurt tripping over the rake you left in your lawn, and sues you, you should have liability coverage. Refer to the limits above. This also pays for your legal defense!
Liability exclusions
Another minefield of ways not to pay. Common areas of a house association covered by an association policy, workmans comp issues, nuclear again, a work disease... Your policy will vary.
Checklist
Your state may require your insurance to have an even more detailed checklist of what is and is not covered. I am reading my policy now to do this datasheet and i guess i did this right, every box is yes and none are no. Even freezing is checked yes, but it never freezes in Miami...
The Loss
Something happened that you suffered a loss, covered or not.
The Claim
You will report to the insurance by phone or onine claim form, what happened. Have your policy number available do not make them find it they might make a "mistake." Be as brief and specific as possible. "Someone broke into my apartment and stole the 4K tv. We called the police and have a police report number." or "We had thunderstorms this morning and a tree branch fell on my roof." There may be things you cannot answer, and you need to know that ALL questions are trick questions. "It sounds like a minor incident I will mark it as safe to dwell." You might reply "Miss it does not look safe to me, I am not an engineer. I am taking my family to a hotel, how do we activate ALE (Additional living expense) coverage?" Or on a recent car claim of a friend of mine who had the same company and coverage for 10 years, "I see you just added this coverage we are going to have to investigate and call you back before making the claim." The reply, "No either get your supervisor now or verify yourself, the coverage has been the same since 2006, you will complete my claim now or I will report you to the state insurance office." Take tons of photos, and photos of any activity going forward regarding your claim including repair people in the act of repair. Take photos of every dust, scratch, water, etc. Keep the damaged items and make a list of them and thier replacement value or what you paid. Start looking for receipts for all the items, or other proof of their value. For property such as house or auto damage you will have to get an estimate. Do not let the insurance company adjuster be the only one to write an estimate, get your own.
The Adjuster
After your claim your insurance company may send out an adjuster OR may send an inspector. It is important to ask them who they are and to have someone else on your side present at all such meetings. Think I am kidding? I had one of my own insurance company send an inspector who lost all of the photos that he took and the adjuster told me that he came and there was nothing to take a picture of. Luckily I had a public adjuster and another insurance company loss analyst at the scene at the same meeting and they both told my adjuster he was lying, and send their photos. The adjuster's job is to write up or in many cases deny the claim. You may be shocked or stunned that your friendly insurance company to whom you have been paying for many years flat out denied your claim in your face. And they lied too. You had your entire game book collection stolen which cost $700, you have a $50 deductable, you have all the receipts, and your policy covers theft. That goddamn adjuster came back to you and said that he cannot be sure you didnt loan the books out and they just kept them too long and so your cliam is denied. Fucking rat bastard liars. The theif also broke your tv screen on the way out and the same adjuster says you have to mail your tv to an address in iowa and pay a $275 evaluation fee which they will reimburse if there is anything wrong with the tv, and they will make a determination then.
The Public Adjuster
(Some states apply) This is your God your hero. He knows every trick in the book that will be used by the slimeball insurance companies. He has fought yours and everyone elses. You have had problems before so you dont even try to make a claim without this guy present. The inspector shows up and doesnt look behind the wall for the source of the water damage and this guy takes your house apart in pursuit of the truth. He is accurate, through, and likes to yell. Your sorry amatuer ass would only have gotten $4000 for this claim and he shows you it is a $78,000 claim, and you pay a mere 20% for this service. You will never ever ever do a claim without him again.
The Lawyer and the Lawsuit
Your apartment got hit by lightning and your LTR's $50,000 wardrobe is up in flames, nothing else got damaged. She is on the policy and the limit is $500,000 in personal contents. You are a baller so you have baller coverage. You have replacement value and you know your policy in and out. Your public adjuster makes a nice spreadsheet of all the Prada and has the receipts. Then, you are hit with another bolt. Your insurance adjuster is stunned. They are denying the claim, you get a copy of the denial letter and to your shock the letter says we do not cover defective drywall, please contact the drywall manufacturer. Fucking fucks. Lightning hit your place and drywall exploded. It was still caused by lightning not by the drywall. So you start talking to lawyers. You hear the wildest shit from the lawyers you interview. "No jury is going to have sympathy on all that Gucci." "I'll take this case but just so you know I am only making one phone call." " Two lawyers at my firm are fucking![[Image: 69.gif]](https://rooshvforum.network/images/smilies/new/69.gif)
two people at the firm that usually defends your insuror I dont think this will be a problem." You go with the fucking. Suits are filed and phone calls are made and letters are sent. The couple of weeks turns into 7 months. Then you get a call. "You know we are up to about $15,000 a side on your case." So the lawyers are up to $30,000 in fees for your $10,000 claim. This is a good sign, they are about to pop. The secret handshake and firm to firm code words means its time to offer you something to go away. The files are fat and you need to settle so that they can get their fees. You get the call. "You know its not much but they want this to go away and are willing to offer $1250. I know I just have to tell you. Would you be willing to come off the 10K to make this go away." You tell them verbatim. Tell them to fuck off I want to go to trial. The words they cannot hear. You get told that a trial will cost $150,000 a side and even though this firm said they will go all the way for you he really doesnt think your case warrants the expense of a trial. He will get back to you. A couple calls back and forth, you get tired and think $7500 is fucking great and the insurance company will have to pay all his fees also. Its finally done. And about a year after the lightning, a check comes in the mail.
You are one of the few who had the patience and knew the right steps. You were partially compensated for your loss. Life goes on now.
Insurance companies are legal RICO. Exact quote from an insurance lawyer.
Some strategies
Be persistent, be through, precise and be a motherfucker calling them every day. Get professional help if the size of the claim warrants it.
A check, even for a dollar, establishes that the loss is a covered loss by the insurance company. Get a partial check as soon as possible no matter what the amout.
Have a strategy and an approach. For example I now underinsure everything If I have $50,000 contents coverage in my house but have $75 K of stuff, and the whole house burns down I can make a list of everything and they will not have a way to nickel and dime me out of the policy limit. Meanwhile I pay a lower premium. (An example of an approach that might not be yours.)
A third party claim (you against someone elses insurance) will be even harder to accomplish.
You dont have to get along with your insurance company again but the lawyer to lawyer respect and working together is a fact in the industry. Do not expect a lawyer to really stick his neck out for you.
If your lawyer is truly frazzled, the offer may be at its best and his fee is about to get cut.
Play the game with your lawyer, manipulate and tell him only lawyers win, you are disapointed, etc, but when everyone settles hug and send candy to his office and tell him how great of a job he did.
The job of an insurance company is to not pay.
When making a claim call to "inform" as many other related insrance companies as possible. If you are getting calls from risk managemnent companies you are doing something right. Tell everyone someone has to pay I dont care who you guys can fight amongst yourselves.
All that matters is that they dont pay now, at all, for any reason, it does not matter to them that they will pay more later what you dont get is 1/1000 make it to the finish line, the rest give up.
If you are doing new economy and sharing app type activities, the insurance industry 100% has not caught up. You leave yourself dangerously exposed. Whatever mickey mouse tactics your own insurance uses, these shit tier insurance used by apps for sharing or riding will be the biggest nightmare of your life count on it. And the use of such apps absolutely will cancel your normal insurance while you are sharing. You are fucked fucked fucked keep this in mind.
Self insure for small things like cell phones. Same hassles apply plus high deductables and refurb phones as replacement. Save your money.
The insrance company takes your premiums, turns the money over and invest it and grows it. You pay, they grow, you lose they dont pay, they grow more. They care about making money today. There is no rainy day fund.
Here is a trick. Ask three lawyers, three body shop, and three public adjusters this question. "I am new to the area and I wanted to know which insurance companies in your opinion are the best at helping and paying their customers claims." You will get AVOID this one and this one. And only XYZ and XZZ are any good. Same answers - find out.
Good luck from OTR.
In my opinion, whether he rolls over and gives in to the insurance company and does not pursue further, vs fights for his financial interest is reflective of a primary issue as a man, but requires specific knowledge of insurance as well.
Insurance companies are collecting premiums and operate on doing everything possible NOT to pay. If you deal with your insurance company knowing this you will have better results. If you are naive and think they are there to help you you will get screwed or worse.
The disclaimer here is that I do not work in the industry, my datasheet is based on my own research, two past massive commercial claims that I was somehow involved in, and recent insured incidents where I gained some additional tips through experience. The purpose of this is to start and I hope others who may work in the industry or had/ have issues will participate.
The Policy
The Policy is the contract between you and the insurance company. I would venture to guess that most people have never read thier policy. Now is a good time to suggest that you get a copy of and read your policy. It isn't enough to get a declarations page, packet of a few summary pages or insurance cards or proof of insurance. The policy may be 50-150 pages, may have been mailed to you or not, or may be downloadable as a pdf. Get a copy and save it. After you read this I hope you will want to see yours, even if you only have an auto policy.
Named Insured
Why am I starting with the obvious? Because it isn't obvious to most that each and every detail can and will be used by an insurance company to NOT pay a claim. Example, you have renters insurance and you have a roommate who moves in after you took out the insurance who owns the big 4k tv. The big 4k tv is stolen and you call to make a claim and get denied because the receipt is on the roommates name and you didnt call last month to add her to the list of named insured. She is fucked and you buy the next 4k because you feel like an idiot.
Policy Period
Again, the obvious, and another reason to deny a claim...
Deductabes
On your poicy you will have deductables. These are amounts that you are responsible for before the insurance starts to pay for a covered event. One policy can have different deductables for different coverages.
Personal Property
Your insured stuff.
Personal Liability
Things you are protected from others pursuing a cliam against you.
Limit of Liability
The maximum amount they will pay period. Again, different amounts can appear for different coverages in one policy.
Premium
How much the insurance costs.
Endorsements
These are key definitions that further define what and how something is covered, will require research in your policy. A crazy amount of detail can be found here - spouses, hurricanes, identity theft, etc.
Definitions
Insurance is filled with so many conflicts each policy contains a dictionary inside. Read this.
I am skipping many concepts...
Actual Cash Value vs Replacement Value - Goodwill or thrift value vs how much to buy new. Always get a Replacement value policy otherwise you are going to get nothing for your stuff.
Dollar limits on some property
The most expensive thing you own is a $3000 gamer laptop. Your place gets robbed. You didnt read your policy it has a specific limit on computers of $400. You are fucked again. You needed a special item or high value item policy in addition.
Property Not Covered
No one reads this. You work from home, your files, printer, computer, tshirt making machine, and book printing press get destroyed in a flood. Check for your loss is zero dollars and zero cents, you mentioned you work from home and they said sorry business equipment is not covered. Your roommates food stamps and stack of cash are also no covered. Your Uncles gold bars which he kept there washed away and even though you lied and said they were yours they deny your cliam. You had also rented a Lieca camera from this cool new app and it is underwater and they wont pay for that either, because it is rented. What the fuck have you been paying rental insurance all these years for? Now it doesn't matter what Tokyo Joes Platinum policy says, he is covered for everything with no deductable. What matters is what YOUR policy says.
Causes of Loss.
You are not "insured." It's not a security blanket. You are insured for VERY SPECIFIC and limited causes of loss listed under causes of loss. Fire, Flood, Theft, Aircraft, Earthquake... Read your list.
Causes of Loss not covered.
Black Lives Matter burns down your business. Ooops. They were just labeled terrorist and terrorism and insurgency are NOT COVERED. Sorry. War, Nuclear, Neglect by you, any loss you try to cause... Read your policy.
Flood and Water
This can be very tricky, you can be covered for a flood but not wind driven rain, or you might be covered for a collapse caused by water but not for broken pipes that cause damage. Again read read read.
Additional Coverages
AKA Money left on the table because most people never ask for it. Moving expenses (limited or unlimited - read yours) Replacing your food, Replacing your locks, Resturants you had to get, rental value etc. Read up. Legal defense, fees, removal of debris. On and on. Money most people could have claimed but did not.
Liability
For example when someone says they got hurt tripping over the rake you left in your lawn, and sues you, you should have liability coverage. Refer to the limits above. This also pays for your legal defense!
Liability exclusions
Another minefield of ways not to pay. Common areas of a house association covered by an association policy, workmans comp issues, nuclear again, a work disease... Your policy will vary.
Checklist
Your state may require your insurance to have an even more detailed checklist of what is and is not covered. I am reading my policy now to do this datasheet and i guess i did this right, every box is yes and none are no. Even freezing is checked yes, but it never freezes in Miami...
The Loss
Something happened that you suffered a loss, covered or not.
The Claim
You will report to the insurance by phone or onine claim form, what happened. Have your policy number available do not make them find it they might make a "mistake." Be as brief and specific as possible. "Someone broke into my apartment and stole the 4K tv. We called the police and have a police report number." or "We had thunderstorms this morning and a tree branch fell on my roof." There may be things you cannot answer, and you need to know that ALL questions are trick questions. "It sounds like a minor incident I will mark it as safe to dwell." You might reply "Miss it does not look safe to me, I am not an engineer. I am taking my family to a hotel, how do we activate ALE (Additional living expense) coverage?" Or on a recent car claim of a friend of mine who had the same company and coverage for 10 years, "I see you just added this coverage we are going to have to investigate and call you back before making the claim." The reply, "No either get your supervisor now or verify yourself, the coverage has been the same since 2006, you will complete my claim now or I will report you to the state insurance office." Take tons of photos, and photos of any activity going forward regarding your claim including repair people in the act of repair. Take photos of every dust, scratch, water, etc. Keep the damaged items and make a list of them and thier replacement value or what you paid. Start looking for receipts for all the items, or other proof of their value. For property such as house or auto damage you will have to get an estimate. Do not let the insurance company adjuster be the only one to write an estimate, get your own.
The Adjuster
After your claim your insurance company may send out an adjuster OR may send an inspector. It is important to ask them who they are and to have someone else on your side present at all such meetings. Think I am kidding? I had one of my own insurance company send an inspector who lost all of the photos that he took and the adjuster told me that he came and there was nothing to take a picture of. Luckily I had a public adjuster and another insurance company loss analyst at the scene at the same meeting and they both told my adjuster he was lying, and send their photos. The adjuster's job is to write up or in many cases deny the claim. You may be shocked or stunned that your friendly insurance company to whom you have been paying for many years flat out denied your claim in your face. And they lied too. You had your entire game book collection stolen which cost $700, you have a $50 deductable, you have all the receipts, and your policy covers theft. That goddamn adjuster came back to you and said that he cannot be sure you didnt loan the books out and they just kept them too long and so your cliam is denied. Fucking rat bastard liars. The theif also broke your tv screen on the way out and the same adjuster says you have to mail your tv to an address in iowa and pay a $275 evaluation fee which they will reimburse if there is anything wrong with the tv, and they will make a determination then.
The Public Adjuster
(Some states apply) This is your God your hero. He knows every trick in the book that will be used by the slimeball insurance companies. He has fought yours and everyone elses. You have had problems before so you dont even try to make a claim without this guy present. The inspector shows up and doesnt look behind the wall for the source of the water damage and this guy takes your house apart in pursuit of the truth. He is accurate, through, and likes to yell. Your sorry amatuer ass would only have gotten $4000 for this claim and he shows you it is a $78,000 claim, and you pay a mere 20% for this service. You will never ever ever do a claim without him again.
The Lawyer and the Lawsuit
Your apartment got hit by lightning and your LTR's $50,000 wardrobe is up in flames, nothing else got damaged. She is on the policy and the limit is $500,000 in personal contents. You are a baller so you have baller coverage. You have replacement value and you know your policy in and out. Your public adjuster makes a nice spreadsheet of all the Prada and has the receipts. Then, you are hit with another bolt. Your insurance adjuster is stunned. They are denying the claim, you get a copy of the denial letter and to your shock the letter says we do not cover defective drywall, please contact the drywall manufacturer. Fucking fucks. Lightning hit your place and drywall exploded. It was still caused by lightning not by the drywall. So you start talking to lawyers. You hear the wildest shit from the lawyers you interview. "No jury is going to have sympathy on all that Gucci." "I'll take this case but just so you know I am only making one phone call." " Two lawyers at my firm are fucking
two people at the firm that usually defends your insuror I dont think this will be a problem." You go with the fucking. Suits are filed and phone calls are made and letters are sent. The couple of weeks turns into 7 months. Then you get a call. "You know we are up to about $15,000 a side on your case." So the lawyers are up to $30,000 in fees for your $10,000 claim. This is a good sign, they are about to pop. The secret handshake and firm to firm code words means its time to offer you something to go away. The files are fat and you need to settle so that they can get their fees. You get the call. "You know its not much but they want this to go away and are willing to offer $1250. I know I just have to tell you. Would you be willing to come off the 10K to make this go away." You tell them verbatim. Tell them to fuck off I want to go to trial. The words they cannot hear. You get told that a trial will cost $150,000 a side and even though this firm said they will go all the way for you he really doesnt think your case warrants the expense of a trial. He will get back to you. A couple calls back and forth, you get tired and think $7500 is fucking great and the insurance company will have to pay all his fees also. Its finally done. And about a year after the lightning, a check comes in the mail. You are one of the few who had the patience and knew the right steps. You were partially compensated for your loss. Life goes on now.
Insurance companies are legal RICO. Exact quote from an insurance lawyer.
Some strategies
Be persistent, be through, precise and be a motherfucker calling them every day. Get professional help if the size of the claim warrants it.
A check, even for a dollar, establishes that the loss is a covered loss by the insurance company. Get a partial check as soon as possible no matter what the amout.
Have a strategy and an approach. For example I now underinsure everything If I have $50,000 contents coverage in my house but have $75 K of stuff, and the whole house burns down I can make a list of everything and they will not have a way to nickel and dime me out of the policy limit. Meanwhile I pay a lower premium. (An example of an approach that might not be yours.)
A third party claim (you against someone elses insurance) will be even harder to accomplish.
You dont have to get along with your insurance company again but the lawyer to lawyer respect and working together is a fact in the industry. Do not expect a lawyer to really stick his neck out for you.
If your lawyer is truly frazzled, the offer may be at its best and his fee is about to get cut.
Play the game with your lawyer, manipulate and tell him only lawyers win, you are disapointed, etc, but when everyone settles hug and send candy to his office and tell him how great of a job he did.
The job of an insurance company is to not pay.
When making a claim call to "inform" as many other related insrance companies as possible. If you are getting calls from risk managemnent companies you are doing something right. Tell everyone someone has to pay I dont care who you guys can fight amongst yourselves.
All that matters is that they dont pay now, at all, for any reason, it does not matter to them that they will pay more later what you dont get is 1/1000 make it to the finish line, the rest give up.
If you are doing new economy and sharing app type activities, the insurance industry 100% has not caught up. You leave yourself dangerously exposed. Whatever mickey mouse tactics your own insurance uses, these shit tier insurance used by apps for sharing or riding will be the biggest nightmare of your life count on it. And the use of such apps absolutely will cancel your normal insurance while you are sharing. You are fucked fucked fucked keep this in mind.
Self insure for small things like cell phones. Same hassles apply plus high deductables and refurb phones as replacement. Save your money.
The insrance company takes your premiums, turns the money over and invest it and grows it. You pay, they grow, you lose they dont pay, they grow more. They care about making money today. There is no rainy day fund.
Here is a trick. Ask three lawyers, three body shop, and three public adjusters this question. "I am new to the area and I wanted to know which insurance companies in your opinion are the best at helping and paying their customers claims." You will get AVOID this one and this one. And only XYZ and XZZ are any good. Same answers - find out.
Good luck from OTR.
![[Image: f5b5b838eb7983c950303949b0aac306.jpg]](https://s-media-cache-ak0.pinimg.com/564x/f5/b5/b8/f5b5b838eb7983c950303949b0aac306.jpg)
