Are You a Licensed PA?
So asked the Eberl adjuster after I confronted him regarding his false claim that the siding was matchable.
I had first processed the storm damage claim on the large ranch property shown above under my own contractor license in 2008. After negotiating with Farmers insurance to get them to fully pay the claim, although it took three inspections and three field adjusters to do so, Farmer’s finally did pay the claim as I had written it. Years later, the property was again damaged by a severe wind and hail storm that had caused millions of dollars in damage to an estimated thirty-three thousand commercial and residential properties in the same general area. Suspecting that the property had again been damaged, I contacted the owners to offer an inspection of the property.
The year was 2017. In 2010, I had changed my focus from general contracting to contractor training and exposing and fighting back against UPPA, which many in the industry know I refer to as one of the biggest financial scams ever perpetrated against the American insurance buying public. Because I had allowed my GC license to expire in 2013, I knew that if I was going to help the insured’s with their claim, I would have to run the repair contract through the company of a GC friend of mine who I had started in the business with many years earlier as roofing, siding, and everything else sub-contractors.
When I did inspect the property, it was immediately obvious that the storm had caused plenty of damage to the siding, roofing, gutters, trim, and just about anything else that was exposed to the elements. Although, at the time, I was deep into a lawsuit against the owner of one of the most well known forensic engineering firms in the country who had made defamatory claims about me and my contractor training program that he should not have made, I was confident I could handle the claim and make sure that, after achieving fair and full real, true, and accurate free market pricing on the repair work, I could process the claim and all of the repairs to completion. By the way, I did win the lawsuit against the engineering company owner but, since an NDA was part of the settlement, I cannot divulge any of the details. I guarantee you would be familiar with the company however, if I mentioned their name.
The first TPA adjuster I met at the claim site was a decent young guy from Missouri who was relatively new to the industry. When I mentioned to him that I thought the repair cost would come close to $100k, he admitted that his authority was limited to $40k. With that, he told me that he would turn the claim over to a more experienced adjuster who did have the authority to approve at higher limits. About a week later, I met with the new adjuster from Eberl – whose specialty was, according to his resume, window inspections and replacements. Right from the start, I knew he was going to fight me all the way. After going over the damage with him, he turned in a loss report that amounted to $44k. The roof that I had previously installed was an HD Arch and the existing vinyl siding was, as I later proved to him, no longer available. He approved replacement of the roof with standard arch and only approved payment for siding on one side of the actual house. He disallowed payment for much of the damage to the insured’s three outbuildings and a large horse barn.
After reviewing the initial loss report, I requested from the insurance company desk adjuster that a re-inspection be ordered ASAP. The desk adjuster who had previously lied to both me and the insured’s in telling us she was a desk adjuster with the actual insurance company turned out to also actually be employed by Eberl. She had also lied to the insured’s in telling them that a siding match was available and that the roofing was not HD but rather standard and would, therefore, not be approving any additional payment. Prior to the re-inspection, in order to prove that the existing siding was indeed no longer available, I personally removed a small section of the existing siding between a window and a corner post. I then installed a few panels of the new siding between the window and the corner post to prove that it would in fact, not line up with the old. The insured’s later told me that they were quite amused at the adjuster’s confusion as he attempted to figure out why the existing siding and the new siding I had installed did not line up – as if I had performed some kind of magic trick.
When the Eberl adjuster did arrive for the re-inspection, he had no choice but to agree that the new siding would not match the existing but he still refused to approve HD roofing rather than standard. He also refused to pay for full siding replacement and other damage that was caused by the storm. When I confronted him as to why he was not including the obvious additional damage that I had pointed out to him, he turned to me and angrily said, “Are you a licensed PA?” Ah yes, the implied UPPA threat. With that, I replied to the Eberl adjuster that with all the repeated lies that he and the desk adjuster had told to both me and the insured’s, neither of them were in any position to be threatening me with an UPPA charge.
At that point, the Eberl adjuster increased and the desk adjuster approved the revised repair estimate at just over $55k. Even though I had already proved that the replacement siding would not match the existing, the desk adjuster told the customer that if it did not, she might approve replacement of all the siding at a later date – which obviously made no sense. After reviewing and auditing the $55k loss report, I called for a second re-inspection of the property and let the desk adjuster know that her refusal to fairly and fully pay the claim and repeated lies were inviting potential legal action against her, her employer, and the P&C insurance company her employer was representing. She agreed to order my requested second re-inspection.
During the second re-inspection, the Eberl field adjuster who appeared to be concerned that he might have backed himself into a corner by not fully approving payment for all of the damage, agreed to add additional legitimate line items to his estimate. The desk adjuster returned a revised loss report that showed $72k as the final total – which was till substantially below the real, true, and accurate free market price of the repairs. When I confronted the desk adjuster about the missing items that I had included on my estimate – which was not written on either Xactimate or Symbility, she demanded that I and the insured’s accept the offer then demanded that I never contact her again. She also placed a call to a woman in Denver who represented herself as a CAT manager for the actual insurance company. When the Denver CAT manager contacted me, she also made implied UPPA threats to me and stated that any further demands that the desk adjuster pay any additional money on the claim would be rejected.
At that point, considering that litigation may become necessary, wanting to know where to send any required legal documents such as a complaint and subpoena’s, I attained the personal addresses of the field adjuster, the desk adjuster, and the CAT manager – all whose pictures are shown below.
The following Thursday after hearing from the CAT manager, with approximately $24,500 still owed by the insurance company with which to pay for all of the proven covered damage and GC O&P, I called the insurance company supervisor and made it clear to her that I possessed clear evidence that both the field and desk adjuster had repeatedly lied to both me and the insured’s in attempting to unfairly underpay the claim and that if I did not hear from her within five days that the final legitimate balance of $24,500 was forthcoming to the insured’s, I would be turning in a complaint to the State AG, the Minnesota Commerce Department, and the Coalition Against Insurance Fraud. I also informed her that I would be informing the media regarding what I believed was as an intentional attempt to defraud the insured’s. I also informed the supervisor that I would be recommending to the insured’s that they file suit against all of the involved parties including the owner of the TPA adjusting company, and the actual P&C insurance company.
The following Monday, the fifth day, I received a call from the supervisor who apologized profusely to me for any “misunderstanding” then informed me that a check for the requested final $24,500 amount due on the claim would be sent out to the insured’s that day. The insured’s received the check on Thursday of that same week – with no PA, appraisal, or litigation involved. Just as it used to be and still should be.
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UPPA – Is it really about consumer protection? Who needed protection in the above case and many thousands of others like them each and every year…the insured policyholders. Who was and is best able to provide that protection to the insured’s? The contractors who know better than anyone, exactly what is damaged and how much the repairs should really cost.
Brian S. Goodman however, who was a key driver in getting UPPA passed into law, wasn’t concerned about consumer protection when he helped write the initial NAIC UPPA model act, he was concerned about preventing restoration contractors from doing what they had been doing for decades and what was once their “lane” – negotiating their customers claims at real, true, and accurate free market pricing and protecting their customers interests, so that he could increase the income to and membership in his organization. Now, the P&C insurance industry that once supported Goodman’s actions is attempting to prevent PA’s from assisting insured’s. Funny how that all works out…
Goodman’s claim that UPPA was needed to protect insured consumers from contractors who were, according to him, ripping them off, was and remains about as valid as Dr. Fauci’s claim that masks were needed to protect millions of people from contracting Covid.
Learn more about the UPPA scam and how UPPA came to be at www.iccoa.com/uppa – “The Unmasking of UPPA – From FREE Market to FORCED Market”.
Larry Burtis – 3RSystems, LLC
Minneapolis, Minnesota USA