Adjusting the adjuster defendants in Katrina qui tam litigation…

While the 5th Circuit reinstated the Branch Consultant’s qui tam claim reasoning Rigsby was no longer the “first to file” after dismissing a defendant named in both suits, I see a clearer distinction in the two cases based on the composition of the group of named defendants in each.

The Rigsby sisters, for example, cite only their employing adjuster, E.A. Renfroe; but, include a group of engineering firms associated in the claims handling process:

Defendant Structures Group, Rimkus Consulting Group, Inc, Haag Engineering Company, Jade Engineering, Exponent Failure Analysis, Forensic Analysis Engineering Corporation are all collectively referred to herein as “Engineering Defendants.”

Earlier this year, Judge Senter granted the Relators’ motions…to dismiss this action as to Rimkus Consulting Group, Inc.; Jade Engineering; Exponent, Inc.; and Structures Group – leaving only Haag and Forensic as named “Engineering Defendants” as the case moves forward.

The qui tam claim filed by the Branch Consultants, on the other hand, names no “engineering defendants” but has a named group of “adjuster defendants”:

Defendant Pilot Catastrophe Services, Inc…Defendant Crawford & Company…Defendant NCA Group, Inc…Defendant Simsol Insurance Services, Inc…Defendant Allied Claims, Inc…Together, these are the adjuster defendants.

Colonial Claims Corp., the sixth of the named defendants was cited by the 5th in the footnote listing of Appellees; as was Allied Claims, an adjuster defendant dismissed by Branch in October 2007 [a]fter due diligence investigation and discussions with Allied.

What little I know about the group of Plaintiff adjusters is a patchwork centered with this information from their qui tam claim.

Branch Consultants is an insurance and construction consulting firm that has been retained by numerous insureds to re-examine adjustments done by the WYO insurers’ in-house adjusters or other adjuster agencies employed by them following Hurricane Katrina. The principals and consultants of Branch Consultants include experienced adjuster and construction personnel with many decades of construction and construction-estimating experience.

One source added there are four unidentified adjusters known as the Branch Consultants; another referred to them as former adjusters; and a third indicated they were retired.  A group of Zorro-wannabe plaintiff adjusters might bear more scrutiny if I weren’t so interested in the  capacity of the remaining five “adjuster defendants”.

The Rigsby claim states with “particularity” how the false claims were developed and includes this step in the process:

instructing adjusters to overstate the amount of damage when using the XACT Total program in order to “hit the limits” of the flood policies in order to appease homeowners and maximize revenue for adjusting claims.

Renfroe’s website confirms the Company’s use of the technology.

The Renfroe team is continually dedicated to the advancement of adjusting efficiency and reliability through technology.  The property loss estimation software Xactimate™ produced by XactWare™ is a current tool deployed by Renfroe that effectively helps accomplish this goal.

Defendant Pilot Catastrophe Services, Inc., also an Alabama company, operates what it calls the claims handling center of the future, a Claim Interaction Center, from a facility in Dallas.

The CIC links Pilot adjusters, working remotely from home-based offices, in a virtual call center, connected through a common computer system housed at Pilot’s Dallas Facility.  Claims are routed from the client (over a secure data link, via E-mail or fax) to Pilot, where they are assigned to a Pilot claim representative based on individual skill sets and state licensing status.  The adjuster accesses a claim through his/her assignment queue, reviews the loss, contacts and works with the insured to develop a scope of damages over the telephone.

From an insured’s perspective, the CIC communications solution is seamless.  They call a client-dedicated, toll-free number to reach their claim handler.  The call is routed, securely, directly to their adjuster’s desktop. Pilot’s CIC support staff, based at our CIC Hub in the Dallas Facility, is available to assist them as well.

The CIC Admin System is the backbone of Pilot’s electronic file capabilities.  Designed in-house by Pilot’s MIS department, CIC Admin takes loss report data directly from a client (sent electronically or manually) and provides adjusters with the tools needed to do their job.  This secure, server-based data management system contains a paperless claim file for each assignment Pilot receives.

Links on the Company’s website indicate Pilot adjusters have access to both Xactimate and IntegriClaim software.

Defendant Crawford & Company is an international company based in Georgia.

Based in Atlanta, Georgia, Crawford & Company is the world’s largest independent provider of claims management and related solutions to the risk management and insurance industry as well as self-insured entities, with a global network of more than 700 locations in 63 countries.

Crawford’s command of technology is most evident in the Company’s education and training programs.

Crawford’s commitment to education and associate development is unmistakable. In many areas, we offer comprehensive, industry leading in-house training. In the United States, we train both associates and clients from around the world through Crawford Educational Services (CES). CES is the most innovative training facility in the industry and provides a full complement of general and specialized training in all areas of claims and risk management. Crawford also promotes associate growth and development through external professional industry-related education and certification provided by nationally recognized organizations.

KMC On Demand delivers a wide variety of claims training to your desktop, eliminating the time and expense of travel. Whether you select individual courses or sign up for a complete custom program, KMC On Demand can deliver the information you need, when you need it, at a price you can afford.

Defendant NCA Group, Inc., is a catastrophe insurance adjusting firm headquartered in Indianapolis that will process your claims your way.

NCA’s staff is proficient on the industry standard estimating platforms and delivery systems. Have your own way of doing things? Not a problem. We learned long ago that no two clients are alike and have a full-time IT staff.

Adjuster performance monitoring and evaluation begins the minute we are deployed to a site. NCA will work with you to develop on-demand reports that will allow you to track any performance metric of your storm site.

  • Track contact times, inspection scheduling, and closing rates.
    An up-to-the-minute status on any claim is a click away.
  • Track all activity claim-by-claim or storm-wide with on-demand reports.
    NCA Reports are 100% customizable to suit your needs.

NCA’s staff is proficient on the industry standard estimating platforms and delivery systems. Have your own way of doing things? Not a problem. We learned long ago that no two clients are alike and have a full-time IT staff.

  • Xactware’s Xactimate ® and Xactanalysis®
  • MSB’s IntegriClaim ® and CommCentral®
  • Full-time development team to build customized solutions.NCA has had a full-time staff of developers and programmers longer than some of our competition has been in business.

Defendant Colonial Claims Corp. is a Florida company with a real policyholder-friendly website.

Through technology and training, we constantly enhance and upgrade our operating capabilities.All losses are immediately assigned to an adjuster. Contact within 24 hours is mandatory, and a 48-hour inspection is expected if conditions permit. Before being submitted to the carrier, every loss is examined by either our Home Office staff or on-site field supervisors. The file is reviewed for timeliness of insured contact and inspection, accuracy of coverage interpretation and damage assessment. We’ll verify that the loss was reviewed with the insured and that an agreed-upon settlement was negotiated.For further quality control, 10% of losses are reinspected by our staff supervisors or general adjusters.

Training for adjusters includes direction to bring your laptop with adjusting software already loaded to Basic Estimating Software Adjuster Training; but, no software product is named.

The fifth and final “adjuster defendant” named by the Branch Consultants is another Florida firm, Simsol Insurance Services, Inc.,

Simsol Inc. – Simsol, Inc. (Simultaneous Solutions, Inc.), founded in 1987 is a leading provider of property estimating and data analysis solutions to the insurance industry.  Simsol is dedicated to providing insurance carriers, independent adjusters and restoration contractors with leading edge technology through its software applications.  The company’s current suite of products include both PC and web based applications for structure repair estimating, contents valuation, structure appraisal, electronic claim assignment and data analytics.

Simsol has its own software products and provides adjusters and insurance carriers with a complete end-to-end solution for the electronic assignment, estimating, claim documentation and data management for property claims. One of those products is ClaimsWire™.

ClaimsWire™ (CW) is Simsol’s web-based solution for the electronic assignment, tracking and exchange of property claim data for the mobile field adjuster. Insurance Carriers, adjusting firms and contractor networks (i.e. assignment originators) with the capability of web-services output the first notice of loss and assignment information in a pre-defined WSDL data packet to CW.

Loss notices may also be manually entered in the system. All participants in the claim life cycle are monitored for timeliness of reporting and automatically contacted by ClaimsWire™ if any days of service requirements or other claim handling milestones are upcoming or late.

ClaimsWire™ screen shots are on the website and well worth a visit if you’re interested in technology – and, no, Sop, it’s not a slabberator. Also on the site was a press release dated June 2008 for those with an interest in NFIP claims management.

Simsol announced today it has completed the interface between its flood claim damage estimating product, Simsol for Adjusters™ and the claims processing software of the EDS Write-Your-Own Flood Services unit, a leading provider of flood insurance services to insurance carriers participating in the National Flood Insurance Program’s (NFIP) Write-Your-Own (WYO) program. The interface now enables Simsol-equipped adjusters to electronically upload all of the NFIP required flood forms , reports and XML data directly into the web services of EDS.

EDS Write Your Own Flood Services, provides a range of high-quality, competitively priced administrative services for property and casualty insurance companies participating in the National Flood Insurance Program (NFIP). Their services include policy administration, claims examination, remittance processing, and statistical and financial reporting. They deliver a full business process management solution that accelerates entry into e-enabled business while improving current processes to achieve more efficient, lower-cost operations, improve service delivery and reduce administrative costs.

EDS and the EDS logo are registered trademarks of Electronic Data Systems Corporation.

So, there you have  a view of the six “adjuster defendants” in the two Katrina qui tam cases – one named in Rigsby and the other five in Branch. We’ll take a look at the remaining “engineering defendants” a little later.

    8 thoughts on “Adjusting the adjuster defendants in Katrina qui tam litigation…”

    1. One thing you are not understanding is those are adjusting firms not “adjusters”. Also, they are independent adjusting firms. Independent adjusting firms do not dictate which estimate software is required of independent adjusters. I believe the news articles say that Branch Consultants was a group of public adjusters.

      I am very curious if the state regulations of the insurance department under the ethics regulations for public adjusters allow them to share private documents from insureds (similar to Code of Conduct violations the Rigsby’s are alleged to have violated in their contract with their independent adjusting firm). I’ll have to check also at the www,Napia.com and the Florida public adjuster’s groups as well to see if this meets the ethics of those public adjusting associations. Chip Merlin may be able to address that as he is a member per info on the NAPIA site.

      The insurance company sets the requirements and adjuster’s not trained in using the carrier’s preferred software cannot deploy with them (in addition most national carrier’s require independent adjusters take carrier certification exams and they also set a minimum number of year’s experience required. When a major disaster hits, sometimes exceptions are made such as indicated in this article containing comments from the TX Windpool recently:

      While I don’t always agree with Slabbed’s analysis of the insurance and/or claim industry, I do find it most informative from a consumer advocate perspective,

      Your site also does an outstanding job posting claim litigation documents we usually do not see from the independent adjusting community side of things as suit files are normally processed by staff claim managers and staff adjusters. I find those documents very educational for new adjusters to view so they learn the importance of properly handling claims.

      Thank you for all of your hard work. Running a blog for adjuster’s myself, I understand all the hard work and do not know how you post as much as you do!

      It is a good thing keeping the lines of communication open between all of us in the claims industry as I have said before so we each learn from the other’s perspective to improve service in the claims industry.

      http://www.dimechimes.wordpress.com

    2. Thank you so much for these helpful comments – and for the article. I pulled documents today for an Ike post and will put it to good use.

      The Branch lawsuit calls them “adjuster defendants” but your point is well taken.

      Do all carriers specify the software? Do some use more than one type? Do any not use software?

      Is there a “standard contract” between an adjusting firm and a carrier? If so, I’d love to see one and post it. Sop’s email address is in the upper right and he could send you a fax number if needed – that is if there is a general “standard” and you don’t mind sharing.

      As to the ethics of adjusters “sharing documents” under qui tam law, those documents are “evidence” and exempt from an employment agreement . In Branch, the claims “shared” belonged to their clients. So, I don’t think there were any ethics issues involved with the conduct of the Branch adjusters or the Rigsby sisters.

      I’m glad the legal documents are helpful. Unfortunately, there seem to be an endless supply of folks who feel they weren’t provided the coverage they purchased.

      Very few cases have been tried but as we see more evidence, we should be able to separate the “good guys” from those that show a consistent pattern of shortchanging their policy holders.

      Thanks again for your comments and the really helpful information. Hope you have time for my questions.

    3. There is not a standard contract. Heck- there isn’t even a standard contract for independent adjusters with adjusting firms and they do have to be very careful of what they sign. To view one of the types of contracts, you will see the Citizens of FL contract with their contracted adjusting firms on the Closed documents on the purchasing link on Citiizens home page at http://www.citizensfla.com. You will be absolutely amazed at how many regulations apply to accept their claims.

      Even If I did have copies of contracts I couldnt release private info of my clients.

      I do know in one of the Rigsby/ EA Renfroe topics either here or on Dave Rossmiller’s blog some of the legal documents uploaded included a copy of the EA Renfroe contract with State Farm. I don’t remember which of the hundreds of articles had it now it’s been so long ago.

      There are a few regional state carriers that may let an adjuster use any of the major software vendors but they are few and far between if so.

      From my experience, I think it is a good thing that all adjusters for one carrier use the same estimating software as that way all insureds estimates are adjusting using the same unit cost (material and labor) for each trade. To use multiple software programs would result in pure mayhem with insureds comparing estimates and wanting to know why one got paid X per square foot and the other got Y.

      As far as I know, the unit costs are all determined by the software manufacturers who do the research and establish the local prices based on surveys with the construction industy. Adjusters do not set those prices.
      Matter of fact, should they manually override a unit cost on an item they must explain how they based their estimate on the adjusted price.

      Hush on the “no software”…..I was raised up in the claims industry in pre-estimate software pricing days where we had to handwrite estimates. The estimate software greatly speeds up the process of estimating losses with estimating software making all of the calculations and setting prices on unit costs adjusters would otherwise have to search weeks for in order to complete an estimate.

      Carriers understand a software estimate is an “estimate” and I have never worked with a carrier who would not consider a supplement if it is justified in cost and with coverage under the policy but the insured must notify the carrier and let them reinspect the property to determine any diferences.

      I hope this helps. Hopefully more folks in the claims industry will reply. I feel sure they do not as most carriers forbid staff adjusters from participating on blogs and forums,etc. Also independent adjusters have to be equally careful so they don’t get on a “blacklist” of independent adjusting firms for fear they may violate carrier code of conduct requirements by not sharing private carrier information.
      .

    4. By the way the RFP on the Citizens Purchasing cllosed documents you are looking for is RFP 08-0016

      Also, here is an example from one of the major software services showing how they notify you that price lists are available to update your price lists which are based on an insureds zip code. Those who have purchased the software (yes it costs independent adjusters thousands annually to purchase a key code to use the software for estimating …another good reason it is virtually impossible for independent adjusters to use any software as they’d have to pay for multiple software licenses):

      http://www.xactware.com/news/release20090202.html

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