UN-AFFORDABLE HEALTH CARE aka Obama Care!

By January 1, 2014 I'm sure there will be tens of thousands of individuals that will have a "story" to add to this Blog!  When you find out that you really do not have Health Insurance even though you signed up for it, please let us know how that unfolded in your life and what current and lasting effects it will have.

I'm hopeful that many of those that are members of my Virtual Insurance Adjusters Group on Linked In will read this Blog and become a regular reader and contributor.  While sharing your stories may not change the circumstances in your particular case, your words and stories might just inspire others.

Please Read and Contribute!

Jeff Weiss



DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Case Denied: B A D F A I T H

No this is not about "Religion!"  It is however about "Relationships."
Remember that PROMISE the Insurance Company sells you in exchange for your money and calls it a Premium?  Well "Bad Faith" is also a legal term used in Insurance Claims when your Insurance Company wrongfully and with possible "Malice" and a few other legal terms denies your claim.

Most insurance policies both Homeowners and Commercial have extended coverage for "legal liability" and in the event that you are sued, they (insurance company) should defend you.  There is a legal saying in this regard concerning you insurance policy that states "There is a Greater duty to Defend than to Indemnify!"  In essence even if there is a question as to coverage the Insurance Company will and should  provide you with a defense.  If the Insurance Company after starting your defense feels there is no coverage for your claim they can file a Declaratory Relief action with the courts.  This involves presenting your case to a Judge and asking the Judge to make a ruling on the merits of the claim and if in fact there is or is not coverage.  If the Judge rules no coverage, the Insurance Company will continue the defense but issue a Reservation of Rights letter informing the policy holder that if liability is found against them, the insurance company may not be paying for the claim.  This of course sets up all kinds of legal situations and it is highly recommended that before you proceed down this path you hire an attorney.
The Bad Faith part of the lawsuit against the carrier comes in when the claim and or the coverage or both is Denied by the Carrier.  If the policy holder (you) does not agree with the findings and you feel the insurance company acted in "Bad Faith" towards you, you can file a Bad Faith Lawsuit.  If you win this lawsuit, along with damages you are also awarded "Punitive Damages."  Punitive Damages normally set by the Judge or Jury are equal to a percentage of the worth of the company you are suing.  This award can be in the millions of dollars or as little as one dollar, so Bad Faith lawsuits are taken very seriously by the Insurance Company.

Here is the Definition of "Bad Faith" as found in Wikipedia: 
 "An insurance company has many duties to its policyholders. The kinds of applicable duties vary depending upon whether the claim is considered to be "first party" or "third party." A common first party context is when an insurance company writes insurance on property that becomes damaged, such as a house or an automobile. In that case, the company is required to investigate the damage, determine whether the damage is covered, and pay the proper value for the damaged property. Bad faith in first party contexts often involves the insurance carrier's improper investigation and valuation of the damaged property (or its refusal to even acknowledge the claim at all). Bad faith can also arise in the context of first party coverage for personal injury such as health insurance or life insurance, but those cases tend to be rare. Most of them are preempted by ERISA.[5]

Third party situations (essentially, liability insurance) break down into at least two distinct duties, both of which must be fulfilled in good faith. First, the insurance carrier usually has a duty to defend a claim (or lawsuit) even if some or most of the lawsuit is not covered by the insurance policy. Unless the policy is expressly structured so that defense costs "eat away" at the policy limits (a so-called "self-consuming" or "burning limits" policy), the default rule is that the insurer must cover all defense costs regardless of the actual limit of coverage. In one of the most famous decisions of his career (involving Jerry Buss's bad faith lawsuit against Transamerica), Justice Stanley Mosk wrote: "[W]e can, and do, justify the insurer's duty to defend the entire 'mixed' action prophylactically, as an obligation imposed by law in support of the policy. To defend meaningfully, the insurer must defend immediately. [Citation.] To defend immediately, it must defend entirely. It cannot parse the claims, dividing those that are at least potentially covered from those that are not."[6]"

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Introduction: New Book CASE DENIED ADJUSTERS

Case Denied

ADJUSTERS

By JW Mica

This is a work of fiction.  Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously.  Any resemblance to actual persons, living or dead, events, or locales is entirely coincidental. 

JW Mica

All Rights Reserved
 

What major industry other than Insurance charges you a premium for a promise and then tries hard to break that promise?  What if you knew the person making a life and or death decision regarding you and your future only had a High School Education?  What if that same person, known by most as “adjusters” only had about two weeks training before being given a case load in excess of 100 files and told to resolve them as new claims to the tune of about five per day were coming to their desk?  What if these adjusters were sitting at desks in rows that resembled an assembly line and were more concerned with breaks and lunch and quitting time than the proper handling of your claim?  What if these adjusters spent more time in meetings and socializing after work at the local pub, then trying to get caught up on their work and become more proficient at their job?  What if these adjusters could recommend denial of your claim, or tell medical professionals that they could not do the medical procedure that Doctors had recommended?  What if these adjusters could actually use their preconceived ideas about you, and prejudices’ in deciding when and how much to pay for your claim?  Do you really think that the insurance companies with slogans like “the Good Fingers people” or “like a Next Door Neighbor” or “the Stone” or “we got your Back” has any actual merit or semblance of reality when it comes to handling your insurance claim?  Cute icons, like Cartoon Characters, or the Blue Panther, are in place to make you the consumer feel more confident about the insurance company that is looking to take as much of your money as they can, and give back as little as possible.  How would you feel if you knew the Insurance Company that you were paying your hard earned money to was using that money to not only promote Political Candidates that you would never consider endorsing, or on elaborate meetings and parties that make the recent IRS events seem like a beach party?  What if that “security blanket” that you thought the insurance company was providing you was in reality nothing more than an elaborate scam trying to separate you from your money with a simple promise that they never intended to keep?  And then you must ask the question, how the insurance company makes me feel that I need insurance, and the simple answer is “FEAR”!  Get consumers to purchase as many things as they can, live the life they have always wanted, then implant the fear that without insurance they could lose it all.  Without fear, and manipulated by and with over reacted news coverage, most rational people would see through the fog of lies and misinformation that is presented on a daily bases.  Suggestion would be to limit your ownership to things you can protect without insurance and if you buy insurance do your homework and find out as much as you can about that company.  It will not be easy as they work hard to hide behind a wall of fabricated facts and so called real life testimonials from Hollywood actors!  In this book your will follow my path from college to sales jobs to adjusting with several major insurance companies. You decide your fate and future and don’t let some big insurance company fear you into submission!  Just as with the percentage of fraudulent claims that are reported, so goes the percentage of “bad” or “fringe” adjusters.  For the most part most insurance claims are above board as are most adjusters.  I have worked with hundreds of adjusters and would trust my life with most of them!  Not all of them, but most of them!  This book is actually dedicated to all those hard working, honest and well educated adjusters that are out there.  Unfortunately many of them are now either retired or out of work!  As I said at the introduction, this book is fiction, and I will add that any resemblance to actual people, companies, places, events or things is purely a coincidence and most likely the product of the authors’ imagination.




DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

Case Denied Kindle E Book completed and Published!

Well is seems that writing and getting the E book published was easy as compared to "Marketing" it!  Kindle is very supportive and has some excellent tools available to help you write, edit and publish your E book.  There are also a lot of information (most for sale) on how to get you E book noticed!  What I'm doing now is sending copies (that I purchase) to people that I not only think will like what I wrote, but might just recommend it to their friends!  The book sells for 99 cents and is a very short read.

Currently while marketing this book, I have started on my next book "Case Denied" "Fraud or Bad Faith."

It started out with JW Mica being somewhat of a Super (insurance adjuster) Hero, but I think it will take on a more true to life (while still being fiction) tone!

I have included a Link to Amazon Kindle should you want to purchase a copy!

Thank you!

Jeff

http://www.amazon.com/s/ref=nb_sb_noss?url=node%3D154606011&field-keywords=Case+Denied



DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

"Case Denied" the E book Introduction

Here is the "rough draft" copy of the "Introduction" or "Trailer" that will be used to promote the E book.

Whistle-blower pays the ultimate price, his life, to try and make things right. 

Insurance greed, and Medical Cover-ups, contributes to the lack of faith in not only Corporate America, but in the entire medical profession.  How much is your life worth if you suffer a catastrophic injury?  Can "Cost Benefit Analysis" be used to see if you live or die?  Is the value of life changing into what's best for the bottom line?  Does your living or dying have an impact on the company you are working for?  Have we been transformed into walking, talking, breathing ATM machines for our employers?  Do others have more control over your future than you do?  Has greed taken the place of common sense, living and family?

It is one aspect of life in our society, to expect any sized company or organization to make a profit!  How far can or should the company go to maximize those profits.  Companies that actually take out million dollar life insurance policies on young employees, where the company is the only beneficiary!  Companies that actually have meetings to be sure they are maximizing on those policies, as those employees life or death is part of the Profit and Loss Statements.  The company. also can keep the life policy in force even when the employee leaves or is fired, and the company never has to tell the employee or their family about it!

 

High ranking Doctors testifying before Congress that they lied on Medical evaluations, denying coverage to people in life threatening situations by finding “loop holes” in the coverage, to benefit the Insurance Company!

 

The bottom line, is the bottom line, are you worth more dead than alive?  Would the insurance company pull the plug on you if it added dollars to their quarter results?  Do you think the “Shareholders” care how the company made its profit as long as it did?

What would you do if you knew these things to be true?  Hide your head in the sand, just ignore it?  You don’t know these people that have been put on Death Row based on an Accounting decision.  And then what happens one day when you wake up on the table, the surgery table, and realize your “Cost Benefit Number” is up!  How well do you know your close friends?  Is there a difference between telling the truth and not telling the entire story?  Does your own life measure up to those in the real world around you?  When you are down to your last true friend, the only one you can trust, and that friend betrays you, what next?  Will you embrace capitalism because you think it is the best in the world, or is it? Will capitalism survive with all the corruption from the top down?

While this story is Fiction, do your homework! Know how you will react when the letter comes stamped "CASE DENIED."

Wake up now before it is too late!

You have been warned!

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

<a href="http://www.hypersmash.com">HyperSmash.com</a>




DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

New Insurance Exclusions for "Terrorism"

Here is a copy of an interesting article written by David Dybdahl, CPCU, ARM MBA Senior Consultant, American Risk Management Resources Network, LLC

The reason I post this is because of the recent "fire" that took place at the Big Bear California Cabin where it is believed that the ex-cop Dorner was held out.  At one point the news and or LAPD stated that Dorner was considered a domestic terrorist, thus my feeling that the carrier might consider denial of the fire claim?  What are your thoughts?
Terrorism and Mold are new exclusions in many HO policies, and it will be interesting to see if the carrier tries to use it.

Jeff

"New Insurance Exclusions for Terrorism and Mold
Create Unprecedented Levels of Uninsured
Risks for Property Managers, Property Owners and Lenders.
Or
Sorry We Forgot to Tell You…
By:  David Dybdahl, CPCU, ARM, MBA
Senior Consultant, American Risk Management Resources Network, LLC
Faced with rapidly increasing and unpredictable claims costs, the insurance industry has
over the past year methodically excluded insurance coverage for mold and domestic
terrorism losses on virtually all of the property and general liability insurance policies
sold in the US. The impact on the risk management community from either of these new
exclusions individually would be significant. Together they leave a broad cross section of
insurance buyers including property managers, property owners and lenders with
unprecedented levels of newly uninsured risks.
In light of the magnitude of these loss exposures, it is surprising how complacent
insurance buyers, insurance agents and lenders have been in dealing with them. One
reason for the complacency could be that it is very difficult for insurance consumers to
put these new sources of uninsured loss exposures into perspective.  Maybe insurance
consumers would have reacted differently to the unilateral changes in their insurance
coverage if the following cover letter had been sent out explaining the new mold and
terrorism exclusions."




DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

"DID I DO THAT?"

I’m sure most of you remember the phrase “Did I do that?” by the TV character Steve Eurkel!  If not it centers around “responsibility” and of course “liability.”  In essence whenever there is an accident, someone or something caused it!  Trick is trying to figure it out especially when you were not there and are just gathering information from the various people involved.

There is now a way you can put your cell phone on your vehicle dash and record a 30 minute loop of the activities in front of you.  This has been designed as an App to help in the apprehension of potentially drunk drivers that you might see in front of you while driving.  With this, law enforcement will have a much better chance of securing a DUI conviction if that is the case.  On the other hand, I think that all vehicles should have this running at all times, not just for potential DUI’s, but in the event you are involved in a vehicle accident.  Just think how much better your case will be, that is if you are not at fault, if you have it recorded.  Also another plus would be to see the condition of the vehicle in front of you that you just rear ended before the collision.  How many times do people who have been rear ended say there was no prior damage to their vehicle.

As to fault, one carrier I worked for used the DBCD method for determining liability.

D for duty

B for breach of that duty

C for casual connection  

D for damages

What duty or obligation did the drivers have just prior to the accident?

Did any driver breach that duty?

What was the casual connection between the duty and the breach of that duty that contributed to the accident?

What were the damages?

Simple scenario would be a vehicle backing out of a parking space, versus a vehicle passing behind it.  Both have duties, and in this case what would they be and who has the greater duty.  Of course the person backing up has the greater duty to be sure the road way is clear.  Yes the driver going behind has a duty to watch for cars backing up and also needs to maintain a safe speed.  However the greater duty and in the case of the collision would rest with the vehicle backing up. 

There was a duty, a breach of duty and a casual connection with damages that resulted!

Of course this is a very simply liability determination, and coming up will present you with some more complex situations.

“Did I do that?” by

Frank Rogers

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.

So you want to be an Adjuster?

Not sure if anyone actually sets out in life to become an Insurance Adjuster!  During my early days in High School and College (60’s and 70’s) I don’t recall any classes or topics or discussions about that particular career path.  Yes there were courses designed for those that wanted to sell insurance or possibly do Risk Management, but again don’t recall any specifics about becoming an Adjuster.

Fast forward to mid 70’s when I working in sales and contemplating marriage, and then came along a company that replaced Electronic Equipment and Tools (Craftsman) for one of the big carriers.  As I was in sales, they offered me a job which was my introduction to adjusters and claims adjusting.  Next thing I know I’m sitting behind a desk handling first party property claims.  The company did send me to a two week training course where it seemed socializing was more important than actually learning how to adjust a claim.  In particular was this one guy from New York that did not seem to be interested in learning anything about adjusting.  When I asked him why he was not actively involved in the studies his reply was that he would use the “contractor” who not only wrote the estimates for him, but would put the most cash in his pocket.  Interesting way to handle claims, and little did I know that this was more the “norm” for adjusters, mostly those in the field even to this day!

Another interesting side note was that most of the Managers in the 70’s and 80’s could be found during the Christmas Holidays in the parking lot picking up their cases of alcohol and turkeys from the various vendors.  Even into the late 90’s I recall one contractor that would leave envelops with cash in his office top drawer and on Fridays adjusters would come by and pick them up.  Maybe this is why there were never any legitimate adjuster courses.  Like a person getting introduced to low level drugs, and then moving up the drug ladder until you were finally addicted.  Bottom line was that you could take two paths in becoming an “adjuster.”  The one path would be the adjuster that actually did their job, took the classes and was not only looking out for the best interest of the company, but making the insured or claimant whole after the loss.  Than of course there was the path to riches, or at least perceived riches, which reminds me of the claims manager that had a swimming pool put in his home at a much reduced price.

So you want to be an adjuster?

Frank Rogers

DISCLAIMER: All Blogs and Blog Posts written by, created by, edited by, reviewed by and published by the Owner, Editor or Designer, Jeff Weiss, Jeffrey M Weiss or Weiss, are just "opinions! There is absolutely no "legal" bases or claimed legal bases for any of the statements. These "Blogs" and "Stories" are posted only for the enlightenment of the readers. When actual names are used the Reader should verify all the statements before formulating an opinion of their own. Nothing in any of these Posts should be considered "FACT" until the reader has verified it for themselves. Those who Post a response or reply do it at their own peril and this Blog Post and its owners do not share in or carry any liability or responsibility for their comments.