Allegations that some insurers have altered field-adjusted damage estimates have gained more national attention after The Washington Post reported and documented examples of the practice.
Leadership with Heritage Insurance Co. who is based in Florida and with Florida Peninsula Insurance, named in the Post article, could not be reached for comment Sunday by the Insurance Journal. Others quoted in the article confirmed their statements and suggested that criminal charges would likely be filed against some of the insurer’s officials in the coming months.
The Policyholders Association of America, which investigates allegations of fraud by insurance companies, said it found “compelling evidence of what appear to be multiple instances of systematic criminal fraud perpetrated to defraud policyholders of fair insurance claims,” according to the Post story.
“This is a thing we all know happens and we have seen it time and time again,” APA Executive Director Doug Quinn told the Insurance Journal.
The organization now plans to file criminal referrals with regulators in Florida and other states, but Quinn said he wasn’t sure the Florida Department of Financial Services would put much effort into it. He noted that APA in 2021 had provided evidence of very similar practices by United Property & Casualty Insurance Co. which is now bankrupt, but DFS is not aggressively pursuing criminal investigations.
The most recent allegations came to light in December, when three independent assessors spoke at a Florida House of Representatives hearing. All three said insurance companies had repeatedly made major changes to their inspection reports of homes damaged by Hurricane Ian.
Three field managers are hired under contract by the insurance company and they submit dozens of reports to the operators. A few days later, the appraiser billed, the operator had knocked down some estimates by as much as 80%, removed parts of the report and had changed the wording, but kept the appraiser’s name and imprimatur before sending the report to the policyholder.
State officials initially said such actions by insurers could constitute fraud and should be investigated. After that, however, little official action was seen. The Florida Department of Financial Services said in January it had examined the assessors’ statements, but the investigation was closed “due to a lack of witness participation.”
Two independent assessors, Ben Mandell and Mark Vinson, said they were never contacted by a DFS representative.
Mandell said Saturday he had spoken to one of the homeowners who said DFS investigators recently came to his home to inquire about his wind claims and adjuster’s report. The homeowner could not be reached Sunday by the Insurance Journal.
The three adjusters said they had provided copious amounts of documentation from the fabricated report to a Florida lawmaker, Rep. Bob Rommel, however, has declined to share the information with the Insurance Journal, on the advice of their attorneys.
Saturday’s Washington Post article shows excerpts from some of the documentation. In one instance, field appraiser Jordan Lee had estimated that a house in Venice, Florida, would need about $200,000 in repairs after Ian entered the area in September. The roof had been torn off, causing extensive damage to the interior. But a revised report from Tampa-based Heritage Insurance showed the damage was less than $25,000. Once deducted, the payment to the policyholder is a few thousand.
Lee’s language about blown roofs and interior damage was omitted from the revised report, the article pointed out.
The insurer has said that it is not unusual for the operator’s desk manager to work with the field manager in revising the damage estimate. But independent appraisers who spoke at the Florida Building committee hearing and who spoke to the Insurance Journal said that in recent months, insurers haven’t bothered to check their estimates before slashing repair amounts. The practice was becoming much more frequent and widespread, with major revisions being made without input from field regulators, they said.
Mandell, Lee and Vinson said the practice was fraudulent and hurt homeowners who had legitimate claims.
The Post article could put new pressure on Florida regulators to investigate or prosecute the alleged fraud. The article has received more than 4,400 comments from readers.
“I was expecting some arrests. It will happen,” Mandell said.
Quinn said that if Florida DFS did not proceed with the matter, his group could turn to other Florida authorities, including the Florida Department of Law Enforcement or local attorneys. More disclosures could be made in the next few weeks, he added.
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