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Old 10-31-2012, 07:54 PM   #1
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"Super Storm" Victims Beware


Be an Educated Consumer!

Please take a few minutes and Read this document!
Discounted or "free" insurance claim roofing work is AGAINST THE LAW.


Paying for deductibles, even partially, is illegal in many states.

Paying for placing a sign in an insured’s yard is in fact considered a rebate since the insured receive a betterment from their loss. When you submit an invoice to the insurance company to recover the depreciation do you show that you paid the insured? Do you show that you collected the FULL & required dollar figure? If not, & you stated that you collected hundreds or even thousands less than the correct deductible, the insurance company would reduce the recoverable depreciation by the amount you discounted the deductible.

I'm seeing language on claim summaries now that address this issue informing insured’s that it's illegal for them to not pay their fully required deductible.

Example:
Insurance claim for a roof is estimated by insurance @ $ 10,000.00.
Insured (homeowner) has a deductible for $ 1,500.00.
This means the insurance company's portion of "buying the roof" is $ 8,500.00.
However, along comes "Roofer X" who only charges the homeowner / insured $ 500.00 & *not* the full amount.
Roofer X then faxes off an invoice to the insurance co. stating that they collected $ 1,500.00 from the homeowner / insured.
Roofer X is telling the insurance co. they should send out the balance of the claim (the rest of the amount due) & the insurance co. now thinks they have satisfied their part.
If, on the other hand, Roofer X were to send in an invoice with the dollar figure of $ 500.00 paid by homeowner / insured & NOT $ 1,500.00, then the insurance co. would then back off their final check by the amount that Roofer X did NOT collect.
Homeowner / insured is happy, however, because they just paid less than they were supposed to ("hey, it's OK; everyone does it, right?).

WRONG.

Fact: The very moment Roofer X sends off a false invoice showing a higher dollar amount collected from homeowner / insured, then Roofer X has committed fraud.

Fact: If Roofer X provides an invoice (or receipt) to the homeowner / insured & they (not the roofer) then forward this off to insurance, both parties have now committed insurance fraud, however the homeowner has also committed wire fraud AND they are also committing collusion (conspiring to perform an illegal act). ...How nice; Roofer X has just dragged the homeowner down right along with them.

It's really quite simple:
Find a roofing contractor that has good references & one that you think will provide you with the highest level of service / do the best quality job. Pay your full & legally required deductible.
If you have a problem with your deductible, then maybe you need to rethink your premiums. A higher premium will mean a lower deductible, but YOU, the consumer, are the one who makes that choice.

Now, one scam ("on the behalf of the homeowner / insured") is that Roofer X could pay to place a sign in someones yard that they are not re-roofing, that's legal but it's also not very likely.

Since roofing is by its very nature dangerous and potentially deadly these kickbacks can be considered a first degree felony offense. At the minimum it's a state jail felony. If you get caught doing it multiple times they will aggregate the charges.

All it takes is an insurance companies SIU Department to audit an insured. Or the Department of Insurance to investigate.



BUSINESS & COMMERCE CODE
CHAPTER 27. FRAUD

§ 27.02. CERTAIN INSURANCE CLAIMS FOR EXCESSIVE CHARGES.
(a) A person who sells goods or services commits an offense if:
(1) the person advertises or promises to provide the good or service and to pay:
(A) all or part of any applicable insurance deductible; or (B) a rebate in an amount equal to all or part of
any applicable insurance deductible;
(2) the good or service is paid for by the consumer from proceeds of a property or casualty insurance policy; and
(3) the person knowingly charges an amount for the good or service that exceeds the usual and customary charge by the person for the good or service by an amount equal to or greater than all or part of the applicable insurance deductible paid by the person to an insurer on behalf of an insured or remitted to an insured by the person as a rebate.
(b) A person who is insured under a property or casualty insurance policy commits an offense if the person:
(1) submits a claim under the policy based on charges that are in violation of Subsection (a) of this section; or
(2) knowingly allows a claim in violation of Subsection (a) of this section to be submitted, unless the person promptly notifies the insurer of the excessive charges.
(c) An offense under this section is a Class A misdemeanor.

Added by Acts 1989, 71st Leg., ch. 898, § 1, eff. Sept. 1, 1989.

PENAL CODE CHAPTER 35. INSURANCE FRAUD

§ 35.02. INSURANCE FRAUD. (a) A person commits an offense if, with intent to defraud or deceive an insurer, the person, in support of a claim for payment under an insurance policy:
(1) prepares or causes to be prepared a statement that:
(A) the person knows contains false or misleading material information; and
(B) is presented to an insurer; or
(2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information.
(a-1) A person commits an offense if the person, with intent to defraud or deceive an insurer and in support of an application for an insurance policy:
(1) prepares or causes to be prepared a statement that:
(A) the person knows contains false or misleading material information; and
(B) is presented to an insurer; or
(2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information.
(b) A person commits an offense if, with intent to defraud or deceive an insurer, the person solicits, offers, pays, or receives a benefit in connection with the furnishing of goods or services for which a claim for payment is submitted under an insurance policy.
(c) An offense under Subsection (a) or (b) is:
(1) a Class C misdemeanor if the value of the claim is less than $50;
(2) a Class B misdemeanor if the value of the claim is $50 or more but less than $500;
(3) a Class A misdemeanor if the value of the claim is $500 or more but less than $1,500;
(4) a state jail felony if the value of the claim is $1,500 or more but less than $20,000;
(5) a felony of the third degree if the value of the claim is $20,000 or more but less than $100,000;
(6) a felony of the second degree if the value of the claim is $100,000 or more but less than $200,000; or
(7) a felony of the first degree if:
(A) the value of the claim is $200,000 or more; or
(B) an act committed in connection with the commission of the offense places a person at risk of death or serious bodily injury.
(d) An offense under Subsection (a-1) is a state jail felony.
(e) The court shall order a defendant convicted of an offense under this section to pay restitution, including court costs and attorney's fees, to an affected insurer.
(f) If conduct that constitutes an offense under this section also constitutes an offense under any other law, the actor may be prosecuted under this section, the other law, or both.
(g) For purposes of this section, if the actor proves by a preponderance of the evidence that a portion of the claim for payment under an insurance policy resulted from a valid loss,
injury, expense, or service covered by the policy, the value of the claim is equal to the difference between the total claim amount and the amount of the valid portion of the claim.
(h) If it is shown on the trial of an offense under this section that the actor submitted a bill for goods or services in support of a claim for payment under an insurance policy to the
insurer issuing the policy, a rebuttable presumption exists that the actor caused the claim for payment to be prepared or presented.

Added by Acts 1995, 74th Leg., ch. 621, § 1, eff. Sept. 1, 1995.
Amended by Acts 2003, 78th Leg., ch. 605, § 1, eff. Sept. 1, 2003.

Amended by:
Acts 2005, 79th Leg., Ch. 1162, § 4, eff. September 1, 2005.

§ 35.03. AGGREGATION AND MULTIPLE OFFENSES. (a) When separate claims in violation of this chapter are communicated to an insurer or group of insurers pursuant to one scheme or continuing course of conduct, the conduct may be considered as one offense and the value of the claims aggregated in determining the classification of the offense. If claims are aggregated under this subsection, Subsection (b) shall not apply.
(b) When three or more separate claims in violation of this chapter are communicated to an insurer or group of insurers pursuant to one scheme or continuing course of conduct, the conduct may be considered as one offense, and the classification of the offense shall be one category higher than the most serious single offense proven from the separate claims, except that if the most serious offense is a felony of the first degree, the offense is a felony of the first degree. This subsection shall not be applied if claims are aggregated under Subsection (a).

Added by Acts 1995, 74th Leg., ch. 621, § 1, eff. Sept. 1, 1995

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Old 10-31-2012, 07:56 PM   #2
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"Super Storm" Victims Beware


Hail Loss Claims

Suspected cases of insurance fraud, often by roofers and other contractors, after hail damage rose 136% from 2006 to 2009, according to a new report.


Joe Wehrle

The fraud reports increased more than twice the rate of hail insurance claims being filed. Claims for hail losses rose 61%, to 413,000, during the same period, according to the National Insurance Crime Bureau (NICB), a nonprofit insurance crime education and awareness organization.

“These statistics back up what our agents have been experiencing in their field investigations,” said NICB President and CEO Joe Wehrle. “There are a lot of unscrupulous fly-by-night roofers and repairmen who are what we call ‘storm chasers.’ They follow the storms and deliberately try to rip off unsuspecting home owners and their insurers by making unnecessary repairs or deliberately inflicting intentional damage to a roof or siding to try to get insurance money.”

Wehrle said the increase in reports of suspected fraud show word is getting out.

“The increase in questionable hail loss claims shows that insurers are on the lookout for these scam artists, and home owners need to be leery of companies offering a free roof without first checking with their insurer to ensure there is legitimate damage and the repair company is reputable,” he said.

Texas led in both categories. The Lone Star State had 298,798 claims from hail losses and 521 questionable hail loss claims.

Ten states recorded 75% of all hail claims, as well as 82% of the questionable ones, the NICB reported.

The state with highest ratio of questionable hail loss claims to claims was Illinois, with 881 questionable hail loss claims for every 1,000 hail loss claims. In other words, nearly nine of every 1,000 claims filed for hail loss were deemed suspicious enough to forward to NICB for further

Frauds and Scams;



A roofer who hadn’t seen much business lately went neighborhood by neighborhood, offering to do free roof inspections. He offered a story about how the original builder used inadequate roofing materials and that he has personally come across three houses in the neighborhood that would have had serious damage if not for his free inspection. He of course indicates that there is no cost for the inspection, but if damage is found, he can give phenomenal prices due to his crew already being in the neighborhood.

So an elderly woman, who has nothing to lose, agrees to his offer. After all, the man seems nice and sincere, and of course, the inspection was free. Who wouldn’t take advantage of a free offer like this? If such repairs were necessary, it only makes sense that this roofer would be able to give better pricing because of volume within the neighborhood. Allowing him to do this would certainly save her tons of misery if there was damage and the next rain storm caused the roof to leak.

You guessed it; the roofer found that the shingles were weak and poorly attached. A good wind and rainstorm and there would most certainly be major damage. How lucky could she be that this nice man had come along when he did? The $7500 price tag seemed somewhat high, but what did she know about prices? And how ungrateful could she be to question this nice man who’d come along with his free offer and had saved her home. As he kept telling her, he was giving her a 20% discount for signing up right now and ordering the same shingles as the other 3 families.

Again, he had his crew in the neighborhood next week and it only made sense that he could get some quantity discounts if he could purchase triple the usual number of shingles.
Just a few problems:1.The elderly woman’s house didn’t need shingles.
2.Not only was her roof in good condition, the quoted price was about twice what it should have been.
3.Since there was no grade of shingles specified, the roofer was free to put on the cheapest grade he could find. In the end, the woman ended up with a worse roof than what she started with.


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Fraud type I: The repairman/free inspection One of the most common frauds that is perpetrated on seniors is one that is committed by those who wish to perform upgrades or repairs on or within the home. Seniors are often short of or trying to retain their cash and are fearful of impending consequential damage.

They also want to maintain their household but are ill equipped to make certain judgments as to the necessity of such repairs. An elderly woman is not likely to follow a roof repairman up on top or navigate the crawl-space to determine the integrity of the foundation. Even if she did, she probably doesn’t have the expertise to determine the accuracy of the assessment. A fraudulent contractor depends upon these facts.


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Fraud type II: The willing participant Another type of contractor fraud actually pulls the homeowner in on the scam. The contractor usually approaches potential victims whose homes are in need of repair and suggests that he can help them get their home repaired at no cost. It sounds simple.

The contractor comes in and creates additional damage to the property and tells the homeowner to file a claim with the insurance company, saying that wind, hail, broken pipes, or some other accident damaged the property.

The contractor and homeowner agree that in exchange for the contract, the contractor will perform all repairs and not charge the homeowner the deductible.

Again, it sounds simple. The homeowner gets a much needed repair done at the expense of the insurance company who would never miss the money anyway. In essence, it is thought that there is no crime or victim. No foul, no harm? Hardly!

What isn’t explained to the homeowner is that by signing a fraudulent claim, they in fact are committing a crime, insurance fraud. Insurance companies are often hit this way and are taking this problem very seriously. They will prosecute, and guess who they will prosecute. Not the contractor. He has given an estimate that doesn’t indicate anything illegal and can easily place all the blame on the homeowner.

Filing a false claim with an insurance company is serious business and doing so can cause unbelievable hardship. Insurance companies are also on the lookout for such scams and they are experts at finding them. The name of the contractor alone could trigger an investigation.

If you run into one of these shysters, get far far away!


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Fraud type III: Take the money and run These contractor swindles are quite prevalent and yet it’s so easy to stay out of their way. Merchants who have been in business and want to stay in business seldom run these scams. It usually starts with a knock at the door by someone claiming to be a contractor who is doing work in the neighborhood and willing to work quickly and cheaply.

The scam comes when he claims to need money to go out and pick up the supplies but will be right back. He even says that he doesn’t want complete payment until after the job is completed.

The problem? He never comes back with supplies. Occasionally, these guys even start some demolition work before they leave, but once the money is in hand, they’re gone. Not only are you out the money, but they’ve often left damaged property behind which may cost more to repair than the original job would have.

Avoiding these scams is easy. If you need work done, call a legitimate contractor instead of trying to save a few dollars. Make sure that you get a written estimate or proposal and make sure that you fully understand the terms before you agree to anything.

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Old 10-31-2012, 07:56 PM   #3
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Good post RM! Better believe him folks!
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Old 10-31-2012, 08:08 PM   #4
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"Super Storm" Victims Beware


What Do I Do If My Home Is Inhabitable ?

If your policy provides for Additional Living Expenses, you may be reimbursed
for the increase in cost that is necessary and reasonable to maintain your normal
standard of living when your home is uninhabitable due to a covered loss.

The period of time which you will be reinbursed will be determined by allowances in your policy.

Payments made under the Additional Living Expense provision are in addition
to the applicable coverage policy limits. Ask your agent or catastrophe claim team
member if your policy has this provision.Keep reciepts for additional living expense consideration.

WHAT SHOULD YOU DO?

Should I Wait Until Someone Inspects Before Doing Repairs ?

If temporary repairs are needed to prevent further loss to your property, you do
not have to wait for your adjuster to inspect your home or settle your loss.
Temporary repairs must be made to prevent further loss to your property. Most
insurer property policies have a reimbursement provision for reasonable and
necessary temporary repair costs (up to a specified limit) that you incur while
trying to protect your covered property from additional damage resulting from a

What If I Have Damage To My Personal Property ?

If your claim involves personal property and your policy provides coverage for
personal property damages that result from a covered loss, make a list of all
damaged items to give to your claim adjuster. Be sure to include the manufacturers’
names, model numbers, purchase dates and purchase prices. Indicate whether
the items are repairable. To help you organize this information, you can request
a home inventory form from your agent.

The Catastrophe Claim Process

There are many variables that determine how quickly a catastrophe claim can
be resolved. But each claim will typically follow these basic steps:

Step 1: Make a claim
You report a loss and we assign a claim number to track your claim.

Step 2: Talk with a catastrophe claim
team member

A catastrophe claim team member contacts you to answer your questions
and determine the best way to handle your loss.

Step 3: Evaluate the damages for an estimate
Your adjuster evaluates the damages and determines needed repairs and/or
replacement, and prepares an estimate for covered damages.

Step 4: Review your estimate
Your adjuster discusses with you the damage estimate and settlement based
on your policy provisions, terms and coverage.

Step 5: Wrap up your claim
Your adjuster wraps up your claim by sending you appropriate documents
and/or applicable payments and by answering any questions you may have.

After you reported your claim, you received a claim number from your insurer.This number
is how you can access information about your claim.Write this number on all
documents you submit to your insurer, including receipts and descriptions of damaged
items, to help keep important information together with your claim records.

The Claim Process;

When Will Someone inspect My Damage ?

Once a catastrophe claim team member contacts you, they will determine if an
inspection of your damage is needed or if your loss can be settled by phone.

If a damage inspection is needed, a catastrophe claim team member will schedule a
convenient appointment time.

Since catastrophes typically involve many severe claims, appointments are scheduled
based on severity.

How Long Will It Take To Settle My Claim ?

The length of time it takes to complete the claim process depends on several
factors. Although most insurers bring in additional staff to handle the increased claim
volume following a severe weather event or catastrophe, there may be hundreds
or even thousands of customers affected. This, along with the complexity of your
damages,availability of adjusters and safe access to damage areas will contribute to
the length of time it takes to settle your claim.

Your Claim Status;

How Can I Check The Status Of My Claim ?

There are two basic ways to see what is going on with your claim once you’ve
reported it.

On the phone
You may check the status of your claim by calling your insurer to speak with a catastrophe claim team member.

Online

You can also review your claim status online once you’ve registered and logged in
via Customer Log in at most insurers websites. There you can securely check your claim status,view qualifying claim payments, upload claim documents and exchange
communications with your adjuster.

Your Summary;

After your damages are evaluated, an adjuster will create an estimate. Your estimate
includes what needs to be repaired and/or replaced, as well as what is covered
under your policy. Your adjuster can answer any questions you may have about your
estimate.

Why Is There Depreciation On My Claim ?

Depreciation is typically shown on all estimates for items that are not brand new.

Depreciation is a decrease of the item’s value due to age, wear or market conditions.
Your estimate may include depreciation for items and materials that are being
replaced.

However, once the replacement of your covered loss has been completed,
you may be able to recover the depreciation amount that was withheld depending
on your policy terms, conditions and exclusions.

What If I Don't Agree With My Insurers Summary ?

Sometimes differences can occur. If you disagree with our damage estimate, please call your claim adjuster. In many instances it could be can resolve the over the phone when warranted for covered damage.

WHAT’S A DEDUCTIBLE?
The deductible is the portion of a covered loss that you are responsible for under your
policy. For example, if your covered claim is $4,500 and your deductible is $500,
your insurer pays $4,000.

When Do I Need To Pay The Deductible And To Whom

The settlement check you receive from your insurer is based on the amount of
your covered loss from the estimate minus your deductible and any applicable
depreciation.

In most cases, you would pay the amount of your deductible directly
to your contractor once repairs are completed.

When Can I Expect a Settlement Check From My Insurer ?

In some cases, the adjuster will provide you with the estimate and check at the time
of inspection. In most instances, however, the adjuster will inspect the damage and
prepare the estimate and, depending on the extent of damages, submit the repair
estimate for approval. Once the estimate is approved, your check and the estimate
will be mailed to you separately.

Why Does The Check I Recieve From My Insurer Include The Name Of My Mortgage Holder ?

If you have a mortgage on your property, the mortgagee usually requires that they
be named on your policy and included on claim payment checks for damages to
your home. You will need to contact your mortgagee to find out how to obtain their
endorsement on the check.

Contractors And Repairs;

How To Select a Contractor.

Selecting a qualified service to handle repairs is important. Here are a few tips
to help you select a contractor.

Ask around

Talk to friends and family members who have had recent repair work done.

Interview contractors

Ask contractors for references and check them.

See that they’re insured

Ask if the contractor carries liability and workers’ compensation insurance.

Check work history

Get information about your contractor’s work history from your local Better
Business Bureau.

Get it in writing
Require a written contract, including payment terms, and do not sign until
you fully understand the terms.

Can My Claim Adjuster Recommend a Contractor ?

Most insurers will not recommend contractors following a catastrophe because
contractors are often overwhelmed by the number of properties needing repairs.

We recommend you talk to your family and friends to request reliable,
local contractors.

What If My Contractors Estimate Is Different Than The
Insurers Estimate ?

If there is a difference between an insurers and your contractor’s estimates, you or
your contractor should immediately contact your catastrophe claim adjuster. They
will do what they can to resolve the differences and make any necessary adjustments
when they are warranted and only for covered items.

What If Additional Damage Is Found During The Repairs ?

If additional damage is found during the repair process, call your catastrophe claim
adjuster or your insurers immediately to report this.Your caim adjuster will determine if the damage needs to be re-inspected or if it can be resoved by phone with your contractor.

Now That I Have This Claim, Will My Premium Increase ?

There are many factors that go into answering this question, including your policy
coverage, prior claim history, your loss type and how long you have been with
insurer. The best source for the answer is your local insurance agent.

Be aware that these are typical claim issues.Always contact your insurer for a complete list of necessary actions taken by you and your insurer in the event of a catastrophe.
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Old 11-01-2012, 09:21 AM   #5
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"Super Storm" Victims Beware


This posting is incredibly important that anyone who has experienced storm damage should read BEFORE signing any papers.

Lots of words, don't let the ADD kick in. If you have storm damage to your roof or siding READ THIS. Thanks for the great post roofmaster!
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Chicago Roofing Chicago Gutters

Sometimes the savings that comes from doing it yourself can be blown away with one mistake.

The information found in this post is not to be considered legal advice. All information should be considered relative, not specific. Never attempt any repairs you are not comfortable with. Always maintain safety! The author of this post takes no responsibility for any losses that occur. Use at your own risk.
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Old 11-01-2012, 01:52 PM   #6
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Quote:
Originally Posted by Grumpy View Post
lots of words, don't let the ADD kick in.


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