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The Truth Behind Denials

Insurance Coverage | Anatomy of a Hurricane| Damage Preparation
Insurance & Disaster Survival | Interpretation & Assessment

Truth Behind Denials 

Well, it certainly isn’t due to financial problems. The information below is taken directly from AllState’s 2004 Annual Report. The truth is that if they can get around paying, they will.

2004 Summary Annual Report
Chairman’s Letter
Market + Strategy = Value

Financial Highlights Highlights:
In 2004, Allstate incurred $2.0 billion in losses related to the
four hurricanes in the Southeastern U.S. Nevertheless, net income grew to $3.2 billion. Operating income* increased by 16.1 percent to $3.1 billion. We generated a record $33.9 billion in total revenues. And we delivered a 15 percent return on equity.

Net Income Per Diluted Share Year %
$3.83 2003  
$4.54 2004 18.5

Net income per diluted share, which increased 18.5 percent in 2004, divides net income by the number of weighted average diluted shares outstanding. It demonstrates the growth of net income during the year that is attributable to each share of stock. >

Operating Income ($ in millions) Year %
$3,091 2003  
$2,662 2004 16.1

In 2004, operating income rose to a record $3.1 billion. This is a common measure used by the investment community to analyze our results. Operating income reveals trends in our insurance and financial services business that may be obscured by business decisions and economic developments unrelated to the insurance underwriting process.

Revenues ($ in millions) Year %
$33,936 2003  
$32,149 2004 5.6

Revenues rose 5.6 percent to $33.9 billion in 2004. Revenues indicate Allstate’s total premium and investment results.

Return on Equity Year %
2003 15.0%
2004 14.2%

Return on equity, which measures how well Allstate used shareholders’ equity to generate earnings, increased to 15.0 percent in 2004 from 14.2 percent in 2003.

Book Value Per Diluted Share Year %
$31.72 2003  
$29.04 2004 9.2

Book value per share, which rose 9.2 percent in 2004, is shareholders’ equity divided by the number of diluted shares outstanding on December 31. This demonstrates an increasing ownership interest in Allstate on a per share basis.

Shareholders’ Equity ($ in millions) Year %
$21,823 2003  
$20,565 2004 6.1

Shareholders’ equity, which is the company’s total assets minus total liabilities, indicates the value of the ownership interest of Allstate shareholders. It increased 6.1 percent in 2004 to $21.8 billion from $20.6 billion in 2003.

* Measures we use that are not based on generally accepted accounting principles (non-GAAP) are defined and reconciled to the most directly comparable GAAP measure, and operating measures we use are defined in the “Definitions of Non-GAAP and Operating Measures” section.

Chairman's Letter | Financial Highlights | Metrics | Leadership | Product Overview
Definitions of Non-GAAP and Operating Measures | Download 2004 Summary Annual Report (PDF, 1.2 MB)

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Claims Catastrophe 
Florida’s First District Court of Appeal has just issued a Catastrophe Claim decision in a First Party Bad Faith case. The decision does not represent new law but it is significant. The results are a reminder to people who have handled Claims of this kind and a caution to people who have not.
Pictures of Destruction

Hurricane Ivan totaled the residence of Mr. and Mrs. Roy and Kerry Golmon in 2004. Vanguard is the Golmons’ Homeowner’s Insurance Company. Vanguard paid part of its policy limits for the residence, a fact which is buried in the opinion, but left unpaid much of the loss to Mr. and Mrs. Golmons’ dwelling, and Vanguard did not pay any part of the Golmons’ other claimed losses such as Other Structures, Personal Property, and Loss of Use among others. Vanguard denied any remaining Coverage on the ground that is at the heart of many, many CatClaims Coverage disputes: Vanguard refused to pay the full policy limit(s) “because the loss to the Golmons’ property was caused by both wind damage, which was covered under the policy, and flood damage, which was not covered.”

The Golmons sued Vanguard for breach of contract and for Florida Statutory Bad Faith. Vanguard filed a motion to dismiss the Statutory Bad Faith counts which the Trial Court denied. On appeal, Florida’s First District applied settled Florida law to hold two things: First, in Florida establishing Insurance Coverage is a necessary first step or condition to pursuing Statutory Bad Faith Claims and, in addition, the Insurance Company would be prejudiced if it was forced to defend itself simultaneously on the Contract Claim and on the Bad Faith Counts. The First District reached these twin holdings regardless of the fact that “Vanguard’s attorney conceded at the hearing that the insurer had some liability under the policy”. (Vanguard paid part of its policy limit for loss that Vanguard apparently admitted is covered under its policy.) The First District held that the Trial Court’s finding that Insurance Coverage is undisputed in this case, is erroneous: “Both the existence of liability and the extent of damages are elements of a statutory cause of action for bad faith that must be determined before a statutory cause of action for bad faith will lie.”

Although the First District was forced in this case to quash the Trial Court’s Order, the First District strongly suggested, regardless, that the Trial Court should consider abating but not dismissing the Bad Faith Claims against Vanguard while the case goes forward on the Contract Claims in which the issue of Coverage will be determined.

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Insurance Company Tactics and Your Hurricane Damage Claim

 

You’ve already lost your home.  If you rent or own your own site-built or manufactured home, you are a good candidate for hurricane insurance anywhere in Florida.  The level of coverage you are recommended to carry, and your premiums, are determined by past hurricane activity.  However, no matter how good you think your insurance company or policy is, you should prepare for resistance by your property insurer to cover what you think should be replaced in the event of hurricane damage. 

Perhaps the most difficult thing people have had to deal with in the last few years is the refusal of many insurance companies to pay for water damage that the insurance adjusters are increasingly blaming as the cause of your hurricane damage, rather than the winds that blew off your roof and toppled your trees.

Insurance companies are in the business of making money, so it is not in the best interest of adjusters to be generous.  Be sure as you go into a hurricane season that you have an up-to-date and accurate record of your belongings.  This should include fresh pictures of your property taken each year.  If the worst should happen, you’ll want your insurance company to know that you’re prepared to restore your home and property to its original condition. 

Even if your expenses are already high, be prepared to ask your insurance agent about sewage backup, inflations costs, changes to your home or family structure, living expenses and additional flood insurance when you have your yearly review of your property and hurricane insurance.  Even renters that live on upper floors should inquire about separate flood and hurricane insurance coverage.  You should also consider making sure your most valuable items, such as electronics and jewelry, are covered in your policy.

When damage occurs, it’s up to you to make sure the adjuster that shows up gets a good look at every aspect of your home and fairly assesses what can be repaired and what must be replaced.  Even if you don’t have flood insurance, interior damage that’s secondary to wind damage may be covered, and this is especially important when drywall becomes moldy.  Flareups of mold spores from a wall that was sodden, even once, can cause serious health problems. Many policies do not cover mold damage, so you need to specifically ask about this coverage.

Another way insurers try to wiggle out of claim monies is to nickel and dime people to death on small issues you might not have thought of.  For instance, water-soaked carpets might be estimated to be cleanable, even when they clearly are not.  If they do replace the carpet, they may not pay for the price of how wide an actual roll of carpet is, leaving you the cost of paying for all the useless remnants.  They are also responsible for the cost of mouldings and carpet backing.  When painting is required, they may try and claim they’re not responsible for all the labour required.  When walls are damaged, they may argue that they don’t need to replace the insulation behind. 

Do not automatically accept an adjuster’s assessment of what is or is not covered. Demand that they provide you with the specific policy language that excludes that item from coverage. If you are still in doubt, consult with an attorney.





Truth Behind Denials

Catastrophe Claims

Florida Bad Faith

Insurance Trickery
 
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