Who’s Cheating Their Insurance Company?

Who's Cheating Their Insurance Company?

Who’s cheating their insurance company? There are abuses on both sides of the insurance cheating issue. There are high-profile attorneys with great expertise in detecting fraud. These attorneys regularly post on LinkedIn verdicts that they received from a jury, verdicts that far exceeded the original claim in many instances. There are insurance companies whose attorneys also win big cases against people who fraudulently file an insurance claim.

There are indeed legitimate claims to be made on both sides of the cheating issue.

But it’s not the big guys, the master planners whose blueprint is to deceive, that cause the egregious overpayment of claims. Nope. It’s the little guy. You know, like your neighbor. They have all sorts of justifications for cheating.

  • It’s not really cheating after all.
  • It’s a partial payback for the high premiums being charged in the marketplace.
  • It’s payback for the time and effort it took to gather the claim in the first place.
  • It’s payback for the personal loss that can never be replaced by insurance.

After all, it wasn’t their fault that the casualty occurred. That’s why they are insured. Thus, the list of justifications for cheating are long and wide.

There are times when my assignment takes me to the heart of that matter. Is the person filing the insurance claim attempting to defraud the insurance company? That answer relies upon copious amounts of homework, review of documents, and acumen in the field of the casualty claim.

But there are such things as honest mistakes. Nobody is trying to defraud anybody, but their claim is overstated, nonetheless. A desktop review can typically help with the issue of valuation matters. How much is my tree worth? How much is my landscape worth? (But a tree or branch failing and causing a wrongful death, or a personal injury is typically not fodder for a desktop review.)

Probably the single biggest honest mistake a claimant makes in a claim is not applying a pre-casualty condition rating to the tree or landscape. They just don’t think about that. They don’t even know the issue exists.

If the claim were for a 10-year-old car, the insured could not possibly expect a brand-new 2019 same make/model replacement car. With the car, there are obvious diminution in values that include its mileage, make, model, and general condition. There are even publications relating to cars that provide a quick reference for the claims adjuster. But the take-home lesson is that there is most always a condition rating that should be applied to the line item claim.

The same thing goes for trees and landscapes. With trees, the condition rating includes both health and structure. There is a diminution in value when replacing or appraising the subject loss. There are books written on the subject. There are seminars on the subject. A micro niche in the marketplace has been created for this subject. A pre-casualty condition rating is a must for any tree or landscape claim being made.

However, the person making the claim generally doesn’t know anything about a condition rating for a tree.  Therefore, no pre-casualty condition rating is applied to the metric of what is owed. It’s an honest mistake (they are not cheating their insurance company), but one that costs an untold amount of money in the overpayment of claims. A pre-casualty condition rating is typically obtained from photographs of the casualty tree or the before situation casualty tree.

A quick and efficient desktop review can apply the diminution of value due to the pre-casualty condition rating of the tree or landscape in a claim. A desktop review regarding condition rating is typically done as a professional courtesy in my shop.

There are additional “honest mistake” line items made in insurance claims for trees and landscapes. You may wish to consider having a desktop review conducted by a qualified consulting arborist. Regarding efficacy, a desktop review is the best investment, and it also bolsters your due diligence efforts as a professional.

As a claims adjuster, what issues do you have with claims regarding trees and landscapes? Let me know, and I will attempt to answer these concerns and conundrums. You can PM me, if desired.

I do wish you well, and I wish you and your family a thankful Thanksgiving.

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