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Discussion Starter · #1 ·
I am working on a home that had hail damage and is insured by Alstate. As usual, I wrote my estimate on Exactimate, faxed the est., and followed up to discuss discrepancies. Three points of contention.

1. The desk adjuster tells me chimney flashing is included in square price.
I ask: Why do you pay for chimney flashing on homes that don't a chimney? She says she will lose her job...blah blah.

2. There was other damage to gutter, shed (total), and windows. I added for O&P. O&P is included on their estimate @ 29%. Exactimate and MS/B have different ways of calculating this. I'm not sure how to argue my point.

3. MS/B seems to have different price classes of the same shingle, (i.e. 3-tab, fiberglass 20yr. ; 3-tab composition 20 yr., etc.) This the case for the contractor edition on the one a friend of mine has of MS/B. Am I missing something or is a 3-tab not a 3-tab?

At the end of the day I just want my margins where they should be. This was not a big enough deal for me to press the issue because we got it worked out close enough to let well enough alone.

I don't run into many Alstate claims but they always seem to be a pain in the asc. I am just wondering how OP have handled Alstate claims. Maybe it was just my adjuster or do you climb the ladder to find the decision maker who can look beyond the estimating program?
 

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I've only done a limited amount of insurance repair jobs and never used Exactimate. I price the jobs for what I can do them for (base cost) plus O & P. Never had a problem doing it this way. I would not let someone tell me what is the appropriate base cost, overhead margin, and profit margin for my company to do the job.
 

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Discussion Starter · #3 ·
It's not a matter of letting someone else dictate how much I can make, it is about getting to that amount. Sometimes it seems you must go over the river and through the woods...there's still pie at the end.
 

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I hauled an overweight young lady from All State (maybe 25 yo) up on a two story to look at the some damaged shingles, she swore up and down that the damage was from foot traffic.

Then she caved a little, went around and counted the number of shingles she could see that had damage and wrote a check per shingle.

What a ding bat. What a shetty company.
 

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I hauled an overweight young lady from All State (maybe 25 yo) up on a two story to look at the some damaged shingles, she swore up and down that the damage was from foot traffic.

Then she caved a little, went around and counted the number of shingles she could see that had damage and wrote a check per shingle.

What a ding bat. What a shetty company.
When that happens, ask them how you get the same shingle color. I did ythis once and they whote a check for the whole roof.

Something else an adjuster told me years ago, was to always write the estimate as usual, then add, 10+10 for overhead and profit! It always worked for me.:thumbsup:
 

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Allstate Claim

Okay, Let's see if a fellow Texan can help you, although I haven't been home in 5 years. I have a restoration and adjuster background and only work insurance claims.

Allstate has used Xactimate, MS&B and now use a program called "Fire n Ice"...made for them.

I will answer your questions below and reply if it helps or I can help you further.

Alstate Claim-O&P/'thats in our SQ price'

I am working on a home that had hail damage and is insured by Alstate. As usual, I wrote my estimate on Exactimate, faxed the est., and followed up to discuss discrepancies. Three points of contention.

1. The desk adjuster tells me chimney flashing is included in square price.
I ask: Why do you pay for chimney flashing on homes that don't a chimney? She says she will lose her job...blah blah.


All staff adjusters today are overworked and, for the most part, have limited field experience. It seems the carriers are giving more work and training/paying less...a very stressful job.

I went into Xactimate and found 3 chimney flashing line items. In addition, there are multiple other types of flashing line items.

Obviously, her answer is wrong. This is how some staff adjusters are trained. They will give you an answer that almost sound believable if you say it fast enough. If they had told the insured that story, it might have sold.

My favorite answer for carriers on an answer I don't like is: "PROVE IT". Ask her to give you the line item cost breakdown....won't happen.

So, stick to your guns.

Although I haven't done hail damage work in a few years, it used to be that if there were more than 10 hits in a 10 x 10 square, one side of the roof would be replaced; assuming there are other hits on that side.


2. There was other damage to gutter, shed (total), and windows. I added for O&P. O&P is included on their estimate @ 29%. Exactimate and MS/B have different ways of calculating this. I'm not sure how to argue my point.

I will try and find my notes that explain this. I have seen O&P as high as 42%. Again, this is part of their internal program under "Fire n Ice", I believe.

1) Ask them to explain their methodology or as you said in a post, look at the end result. Their breakdown is different for internal costing classifications.

Again, make sure the numbers work for you.

3. MS/B seems to have different price classes of the same shingle, (i.e. 3-tab, fiberglass 20yr. ; 3-tab composition 20 yr., etc.) This the case for the contractor edition on the one a friend of mine has of MS/B. Am I missing something or is a 3-tab not a 3-tab?

I believe that in MSB, you have to read the description of the line item to see the terminology or material classification.


At the end of the day I just want my margins where they should be. This was not a big enough deal for me to press the issue because we got it worked out close enough to let well enough alone.

Sounds good, unless you plan on working with this carrier a lot.


I don't run into many Alstate claims but they always seem to be a pain in the asc. I am just wondering how OP have handled Alstate claims. Maybe it was just my adjuster or do you climb the ladder to find the decision maker who can look beyond the estimating program?

No, its Allstate. A lot of carriers are now using 3rd party vendors to oversee their estimates or creating new internal programs to be mysterious.

From the restorer side, we are constantly fighting or having to stick to our guns to challenge the carriers.

I recently sent a report and hope to have a meeting with Florida government officials to bridge the gap on estimates between regular contractors and insurance company estimates.

I hope this helps. Let me know if you have any further ??


 

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Discussion Starter · #7 ·
You make some great points and offer great advise. The reality is I just took the easy way out and left money on the table in the process. Even though I haven't had to work with Allstate much, I will stick to my guns in the future.

I am interested in what you are doing in Florida with the law makers, I hope you keep us posted as things progress.
 

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Discussion Starter · #8 ·
write the estimate as usual, then add, 10+10 for overhead and profit! It always worked for me.:thumbsup:
With most companies I have dealt with that works fine if there are 3 trades or more. Many of them balk when that is added to a roof estimate.

I have been told there is a way around this, but have not pushed the issue as most of the claims we work have multiple damages anyway.


Insuranceclaims- What is your experience with the 3 trade argument??
 

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Insurance Carrier Payout Strategy

Wow, if you can afford to leave money on the table, maybe I should come work for you....things must be good in North Texas.

Please take no offense, but, a key word I use a lot when speaking to anybody is the word "education"....got that from my parents. Out of college in the 70's, I worked for the oil companies in Houston in accounting and tax law; wanted to see how people work with their hands and get some job cost experience, so I joined the union, when the oil boom was going good for one year, which turned into 10 years throughout the U.S. and Puerto Rico, and in 1994, I got into insurance restoration with the Northridge earthquake.....1999 Oklahoma City Tornadoes, claims and restoration throughout the country.......IICRC and ASCR certifications.........2004-2008 Florida Hurricanes and Tropical Storms.

So, for, 16 years, I have seen the restorer go from being a friend of the carrier to an adversary. With the 2004-2005 Florida hurricanes and other disasters throughout the country in the last few years, carriers want to pay less and increase their profit margins.

I am providing three sets of info, which will help you decided how to handle future claims. It is long. At the end, I will finish your 2 replies.
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There are two different sets of info below concerning the McKinsey Allstate Documents. This info is separated by dotted lines. You can also do a search on Google for "McKinsey Allstate Documents".
tp://www.injurytriallawyer.com/blo...icyholders.cfm

Insurance Coverage Disputes & Bad Faith Claims

7/25/2008
Christopher M. Davis

From Good Hands to Boxing Gloves: How Allstate Has Earned Billions by Shortchanging Policyholders & Claimants


The book From Good Hands to Boxing Gloves: The Dark Side of Insurance


(2008) by David J. Berardinelli, discusses how Allstate revolutionized the claims handling process by implementing policies to diliberately reduce benefits and claim payouts by intentionally paying out less than the true value of the claim.

Mr. Berardinelli states that our insurance system is founded on two key rules: the indemnity principle and the fiduciary principle.


Together these principles are intended to level the playing field between the insurance company and the policyholder. These principles balance the insurer’s legitimate goal of being profitable while allowing the insured policyholders to get prompt and fair payment for covered losses.


Mr. Berardinelli states that casualty insurance is a unique insurance product. It’s different from other kinds of insurance like life insurance. Life insurance pays a set benefit when you die regardless of the cause or consequences of your death. But casualty insurance is indemnity coverage. It doesn’t pay a set benefit. It pays as much as the policyholder needs, up to the policy’s limit, "to restore an insured to the same financial position after the loss that he or she was in prior to the loss."


To indemnify someone means to make them whole again. That means the insured doesn’t get paid more than the actual loss. It also means the insured shouldn’t get paid less than what it takes to make the insured whole again. The insurance company's duty is to pay the full amount the policy holder needs to be put back in the same position he or she was in before the loss. This is called the indemnity principle.


Mr. Bernadelli states that Allstate implemented a program to intentionally pay out less than the true value of claims.


Essentially, Allstate intentionally violated the indemnity principle, leaving policyholders and claimants much less than the insurance coverage they were entitled to receive.


How did Allstate accomplish this? Well Allstate often deliberately delays paying legitimate claims by asking for useless information or demanding more proof than it really needs. It would delay payment or force policyholders to jump through needless hoops, in hopes they’ll give up or take less than the full and fair amount of the benefits they’re owed under the policy. Allstate paid for studies which showed that nearly 85% of claimants would accept whatever lowball offer Allstate made, and not bother with the hassle. When you are talking about hundreds of thousands of claims, this adds up to hundreds of millions saved for Allstate.


Another tactic Allstate uses is to pressure policyholders who are in a financial bind into accepting a quick payment that’s far less than what they need to make them whole. It forces policyholders to file needless, expensive, and time consuming lawsuits as the only way to get what they need to fully restore them to where they were before the loss. Again, Allstate found that most people will not bother to go through the hassle of hiring a lawyer and filing a lawsuit. More money saved for Allstate.


Mr. Bernadelli found that Allstate repeatedly violated the important principles which are necessary to protect people who purchase insurance. Yet Allstate continues to get away with its tactics. Allstate continues to put its own financial interests ahead of their insured’s needs, and now the system is no longer fair. The playing field is no longer level and an insured either accepts less than they receive or seeks legal counsel to level the field.
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Description

It's the story the insurance industry doesn't want you to know. Now, for the first time, the story covered in the legal edition of From Good Hands to Boxing Gloves is available to the public. Find out for yourself why insurance companies are improperly denying and delaying claims, then defending their behavior at trial. The book takes you from the ideas arising from the masterminds behind the Enron business model, through their impact on the insurance industry, and the resulting claim denials in everything from minor auto accidents to Hurricane Katrina claims.

Author David Berardinelli is the trial lawyer who diligently worked to become the first to obtain the McKinsey Documents unprotected. In this book, he discusses how these documents teach insurers to profit by denying or delaying claim payments. Learn how Allstate changed from dealing with policyholders with "Good Hands" to "Boxing Gloves" Discover how this has led to the highest profits in insurance company history during years with our country's largest natural disasters.

Media Coverage

11/07/2007 — Louisiana Attorney General bases anti trust lawsuit against Allstate, State Farm, McKinsey and others on information revealed in From Good Hands to Boxing Gloves Read Story
11/06/2007 — See Allstate director's response to From Good Hands to Boxing Gloves author's charge of putting profits ahead of policyholders—and the facts that discredit Allstate's answers. Watch Part 1 | Part 2
09/28/2007 — Houston Chronicle praises David Berardinelli Read Story
08/22/2007 — New Orleans' The Times-Picayune interviews David Berardinelli Read Story
08/17/2007 — PBS' series NOW features David Berardinelli Read Story, Watch Video
08/03/2007 — Bloomberg.com interviews David Berardinelli Read Story
03/15/2007 — CNN Money Magazine features David Berardinelli Read Story
05/01/2006 — Business Week interviews David Berardinelli Read Story

Reviews

"This book delves deep into the dark heart of the profit-boosting strategies that 'efficiency' consulting firm McKinsey & Company cooked up with Allstate, and the dramatic negative impact they have had on policyholders. McKinsey specializes in redesigning product delivery systems for Fortune 100 companies to maximize profits. It created a plan for Allstate's claims operations known as the Claims Core Process Redesign or CCPR. According to the authors, 'Since its implementation in 1995, CCPR has been the most controversial, and profitable, claim handling system in insurance industry history. To date, CCPR has generated between $15 to $25 billion in excess profits for Allstate's stockholders. It has also generated a national firestorm of bad faith litigation.'

"This estimate is based on Allstate's annual statements showing an increase in surplus from $4.5 billion in 1992 before CCPR to a staggering $21.8 billion in 2004 with an additional $14 billion distributed in that time as shareholder dividends. Allstate has consistently refused to state how much extra profit CCPR generated. However, in 2004 Allstate claims its net income rose to a record $3.1 billion, despite four hurricanes in the southeastern United States, due to what it calls 'Superior Claim Management.'"

—United Policyholders

"Allstate Corp., fresh from fending off criticism about its response to policyholders affected by Hurricane Katrina, faces another potential storm, this one from an author [David J. Berardinelli] who claims the insurer is forcing policyholders to accept prompt but lower payouts or risk time-consuming and expensive litigation... The book [tells how and why] the nation's second-largest home and auto insurer treats some policyholders with 'Boxing Gloves' during their time of financial and personal duress, rather than the reassuringly familiar 'Good Hands' highlighted in its advertising."

—Chicago Tribune, "Author throws punch at Allstate," May 3, 2006
"In great detail, the slides show how [Allstate] shareholders could profit from the new way of handling claims, according to Berardinelli's notes. Based on public financial reports, Berardinelli estimates that Allstate has made at least $15 billion from CCPR by fighting minor claims, which make up the bulk of payouts."

—Lexington Herald-Leader, "Allstate accused of cheating claimants," July 9, 2006

"It's a story Allstate doesn't want told."

—BusinessWeek, "In Tough Hands With Allstate," May 1, 2006
"My reaction to reading an advance copy of From Good Hands to Boxing Gloves is WOW!"

—Eugene R. Anderson, whom Business Week called "The Dean of Policyholder's Attorneys"

"Through many years of intense litigation against Allstate, Mr. Berardinelli has captured the essence of Allstate's, and for that matter, the entire insurance claims industry's business practices."

—Lawrence A. Anderson, president of the Montana Trial Lawyers Association

"This book is phenomenal in bringing the wrongdoings of a major company to light. It is about time that the truth be told!"
—Shannon Kmatz, former Allstate adjuster

"Through extraordinary effort, David Berardinelli has accomplished what insurance consumer advocates have been pursuing for a decade. He has uncovered the new corporate blueprint sweeping America that focuses industry on profit over customers. More importantly, he has exposed these principles, masquerading as trade secrets, as the smoking guns behind corporate malfeasance in the mold of Enron."

—Robert J. Hommel, Esq., Scottsdale, Arizona

THE END.
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Read the articles from these two links and you wil be amazed. Next time, you won't leave money on the table. These links are where State Farm and Allstate finally got caught with some of their internal documents.....I haven't bought the book yet, but soon.


You may be interested in these two classic articles from Bloomberg http://www.bloomberg.com/news/marketsmag/mm_0907_story1.html
http://www.bloomberg.com/news/marketsmag/mm_0907_story1.html

http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aIOpZROwhvNI


w.bloomberg.com/apps/news?pid=newsarchive&sid=aIOpZROwhvNI


If you are a stand-alone company, you must decide where you want to make a stand.........jump through hoops for the carrier and minimize your profit margin, or take a stand and play hardball. To play hardball or the insurance game, you have to know what the rules are........there are none.

Florida Consumer Advocate Site (pay attention to the 4 clips listed.........play clip 3, where the general manager of Xactware, tells that Xactimate is only a tool, providing data of prior costs that have been used and reported current costs.........that are subject to change at the discretion of the user.

http://www.myfloridacfo.com/ica/news/default.asp

Yet, when the prices don't work for the carrier, they change them......when they do, they tell staff and field adjusters that the prices are in stone.

Of course, if you alter pricing for you, keep in mind that there will be repercussions, but if you are right, you must decide on your position.

#1 priority is to educate your customer from the moment you meet them. When I am adjusting, I hate when I see techs show up for Emerg Svc and they tell the insured that an estimator will show up in 3-5 days. Someone intelligent should be there 1st thing to explain how the entire claims process will work. You should be the first one answering questions for the insured, not the adjuster. If you don't get the insured on your side from day 1, you may become the bad guy down the road..........enough of that for now.

Without knowing the details of your job, your line items would have been:
---RR shingles
---Demo Pick up 1-2 loads or dumpster
---debris pickup of nails if needed
---chimney flashing
---gutter mn unless the dollar amount in LF was over $250

---windows scratched or broken??
If broken, did the glass go inside...if into carpet, the carpet could be replaced........you can never get broken glass out of carpet and it must be replaced to the doorways.
---if the windows broke, any water damage?

The above items are Cov A.

---Shed (total)....This is an "other structure" under Cov B.

A roofing Min should be about $500 and if over you can calculate in SQ.

As you said, your numbers must work for you.

This is why it is important that you communicate with the insured from day 1 and make sure they are confident in you and comfortable. Let them know these are your prices, so they will back you.

Just like the carrier says that our customer is the insured..........well, Dido.

YOUR OTHER POST

If you are not familiar with the ISO, go to www.ISO.com. They have very close ties with the insurance industry. Now they own Xactimate.

Read any insurance policy and show me where it says that Emerg Svc does not pay P&O. Also, where does it say that you must have 3 trades to get P&O..........NOWHERE.

Really, on roofing, your P&O should be built into your SQ price.

As for the 10&10, who operates a business off of that.........do you think Xactware operates off of that........do you think the carriers operate off of that........so why us, the most important person in the claims process.

Now, at 2 AM, you got me started.

When the carrier takes longer than 30 days to pay, do you charge the insured or the carrier interest? While you save the day and wait months to get paid, the carriers (see links and articles above).

You have to have a markup of at least 53% on your line items to get a 33% profit margin. So, minimum of 33% markup on line items and 20% at the end........to do this, you must stay on your subs and job cost in-house personnel.

Since Florida government nor I can bring back all of the big carriers they chased away or solve the $18 billion deficit for claims if another CAT happens now, I am approaching things differently.

The main problem is that with all of their committees, no one has ever been out of an office.

My first report hinges on the question, "HOW CAN YOU SOLVE THE PROBLEM, IF YOU DON'T KNOW WHAT THE PROBLEM IS?".......Understanding and explaining what is involved in the entire claims process from the time of loss till the property is restored. If you explain this to the insured from day 1, you are way ahead of the game.

I hope this helps and gives you some insight.

While there are tons of people smarter than me across the country, I am trying to build a consulting site where any contractor can call me 24/7 across the country to get advice. After hearing the question and telling of my services, whether by phone or in person, I would charge a reasonable dollar amount. If estimates or heavier consulting are involved,
there would be an additional fee.

I am trying to work on this program to present to the FHBA for regular contractors, who don't want to learn all of the in/outs of the insurance world, but occasionally need help.

What do you think?

I guarantee people results, and, yes, I can actually be reached 24/7 or a call back in minutes........
 

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Discussion Starter · #10 ·
How much is the tuition?

I'm glad I was able to get you riled up at 2 a.m.!!:clap:

Again, I won't fold in the future! I'm glad to know my numbers are where they should be. On this claim I left about 8-10% on the table. Go ahead and let me have it.

By reading the above post and lecture it helps drive home the reason I am doing what I do. Still a pup in the industry, but I am all about the education.

I think your consulting idea is a good one. Would you still post on this site after you begin charging? Either way I have some issues I would like some assistance on.

Again thanks for the info.
 

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Well, it's 12:28 am in SW Florida. I am leaving Starbucks and heading home with my dog.

We are beat. Yet, send your other concerns.......be home in 30-40 minutes and will reply to your other issues........posssibly general in nature..........but let's see the issues first.

Signing off till about $1:15 - 1:30 AM.

Mark
 

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Interesting. I'm fairly new to the insurance game but I have found Allstate to be very fair and profitable jobs. Handling disputes with them and scheduling re-inspections seems to work well.

From my view, it seems the problem is the shady contractors, the ones who chase storms, only do part of the claim, take their money, do their crappy work and split. I call them the contractors that put the "con" in contracting. On a profit point of view, I applaud them but if that's what I have to do in the industry to make money, I'll change industries.

Unless you have relationships with insurance companies, it's harder for them to believe you because of all the national storm chasers that try and rip them off everyday, all day, all year.
 

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Interesting. I'm fairly new to the insurance game but I have found Allstate to be very fair and profitable jobs. Handling disputes with them and scheduling re-inspections seems to work well.

From my view, it seems the problem is the shady contractors, the ones who chase storms, only do part of the claim, take their money, do their crappy work and split. I call them the contractors that put the "con" in contracting. On a profit point of view, I applaud them but if that's what I have to do in the industry to make money, I'll change industries.

Unless you have relationships with insurance companies, it's harder for them to believe you because of all the national storm chasers that try and rip them off everyday, all day, all year.

:eek:
 

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We are not a super high profit company, but can say that Allstate pays squat compared to others in the last few years. The storms 5-10 years ago proved State Farm to be about the worst, but they have changed since to be one of the best.
I only have experience with 3-4 big local storms so far. The info here is very valuable. Thanks 'Insuranceclaims'!
I agree with 'Steelers' about the shady Contractors, but there is almost nothing we can do about it. The homeowners slowly learn. With multiple storms in the same area, people learn. The ones I don't like are the ones who advertise like a National Company, but all their work is done by $2/hr workers!
 

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Hello, Steelers:

I just wanted to make a few comments on your quote below:

Interesting. I'm fairly new to the insurance game but I have found Allstate to be very fair and profitable jobs. Handling disputes with them and scheduling re-inspections seems to work well.

Welcome to the insurance game. I have to tell many GC's over and over that the insurance restoration field is a specialized field.......it is more that "sucking up water and plugging a machine in the wall."

Your comments on Allstate are common if you are new to the field....a carrier will pay a restorer more than a regular contractor, because billing is very specific, as is the ability to restore first, and replace last.

From my view, it seems the problem is the shady contractors, the ones who chase storms, only do part of the claim, take their money, do their crappy work and split. I call them the contractors that put the "con" in contracting. On a profit point of view, I applaud them but if that's what I have to do in the industry to make money, I'll change industries.

While I am sure that your comment above is generalized, every disaster always brings out the rip-off artists.

There are many restorers, who make millions from storm chasing, and do quality work. I always getted frustrated at local governments and agencies that promote only using local contractors..........First of all, most local contractors don't know how to perform emergency services or restoration for insurance claims....a large amount of GC's don't want to deal with insurance adjusters/carriers..........it becomes a matter of supply and demand.

There are pros and cons to chasing storms full time......you know the saying that "you have to have money to make money!" Storm chasing requires a fair amount of capital, and there are a lot of variables involved such as: 1) is the loss covered.....Katrina is a good example.....2) is the insured current on their policy.....3) what kind of vibes do you get from the potential customer......4) will they pay you..........etc.

If your just getting started, I would stay local if you are in a heavy market.....build a foundation of your equipment, rules of the game, technicians, continuing education, experience. Feel free to ask questions.

Unless you have relationships with insurance companies, it's harder for them to believe you because of all the national storm chasers that try and rip them off everyday, all day, all year.
I am going to clarify your statement above. During the 1994 Northridge Earthquake, we use to be on 5 preferred vendor lists. Relationships were pretty fair during those times. After mold arrived in 2001, and preferred vendor programs began to rapidly increase, I, no longer, wanted to be part of their programs.

There is no loyalty with the big vendor programs.

Your credibility is: knowing how to write a scope, how to dry a structure, people skills, general knowledge of understanding policy coverage..........and, most important, is documentation and photos.

"If it's not in writing, it didn't happen!"....Also, photos don't lie.....there is a proper way to take accurate photos for a loss.......remember, the in-house adjuster is making decisions on the documentation provided.

It can be an exciting and frustrating field, at the same time. Yet, stand for what you believe and ask questions if you are not sure.
 

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MJW: Your welcome.

Yes, unfortunately, there are some vendors who try to pass as part of a national program. But, this happens in all forms of advertising.
 

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most everything can be written up in Xact and I have dealt with most major insurance companies as well there is a field for you to pop in your O & P and everything gets calc'd for you and the adjuster, I have only had a couple of issues along the way with adjusters but they seem to settled down once you drag them up on the roof again and revisit the site
 

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Re: Insurance claims post.

Sounds like you know what you are talking about. I appreciate you taking the time to post.

As for myself. I quit bidding insurance jobs years ago. I do think you can make money, you just have to have someone dedicated to each job. Extremely careful accounting of materials, labor, and square footage could be the key.

My motto for insurance jobs is: Everyone has the best insurance until they have a claim.
 
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