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Property Insurance Fraud

Where the damage is in water-damage claims

finger in dike

What happens when you let a third party handle your insurance claim? The answer, in a symbol, is $. Insurers have been sounding alarms about assignment of benefits for a couple of years now, and the issue is ever more in the spotlight. A recent editorial suggests it is time to bring water damage abuse under control.

Here’s what’s been happening: A homeowner with a water damage claim is convinced by a contractor to assign the insurance benefits to him. The contractor stands in the shoes, so to speak, of the insured and deals directly with the insurance company. The problem with that is it can make the claim needlessly more expensive because it links in (sometimes needlessly) additional contractors and leads to (oftentimes needless) litigation.

Assignment of Benefits: A sign of a scam?


They make it sound so simple. You have a sudden water leak in your house. You call a plumber who makes an emergency repair. He tells you there is water damage because it was a sneaky leak that went undetected for long enough to mess with pipes or cabinets or kitchen tile – or the balance of the cosmos. “Let me call my buddy,” he says. “He handles the dry-out process so you won’t have more troubles. Sign this form that transfers your insurance claim, we’ll get you a lawyer to work with your insurance company. Don’t have to worry about a thing.” This is the point at which you should commence to worry.

Signing over your insurance claim means you’ve agreed to step away and let a stranger handle things. And, you may have NO idea what goes on behind the scenes. Here’s a peek: The plumber got a nice referral fee for inviting the water dry-out company to your house, and that guy got money for looping the building contractor in, who also brought in a friend to handle the carpentry, and the attorney figures out a way to file a lawsuit …. Get the picture? You’ve heard the phrase, “Too many cooks spoil the soup.” What do you think too many non-essential people do to the cost of an insurance claim? And, when hundreds of people are roped into this type of scenario, what do you think happens to the cost of homeowners insurance? Yes, easy questions.

The cost of insurance is the cost of claims. Claims go up, insurance goes up. The Consumer Protection Coalition has a number of resources to explain this phenomena called Assignment of Benefits (AOB). Florida insurers have been trying to rein in the practice for a couple of years. There are a couple of bills circulating in the Legislature. Interestingly – or maybe predictably – other states don’t seem to have this as an issue. That tells you something.

Look at the water claims data from Citizens Property Insurance. Their analysis shows that the frequency of water damage claims is up by 45 percent from 2010 to 2014. And, the average cost of each claim rose by 43 percent over that time frame. No, water leaking from pipes has not become over 40 percent more forceful in that four-year time-frame.

Plugging that leak is what the AOB issue is about.

More eyes needed on insurance fraud, including consumers’

It’s a fact that Florida’s no-fault auto insurance system is flush with fraud. Recently, the Florida Agency for Health Care Administration validated that with a three-day sweep of pain clinics in Miami-Dade County and found regulatory violations in 90 percent of them. In one documented case, an insurance company providing personal injury protection coverage was charged $19,000 for massage therapy. That accident “victim” must have had one heck of a pain in the neck. And, all drivers are paying the bill.