An adjuster was handling a smoke and ash claim in California, which was reported a year after the claimed wildfire. The inspection found ash in the home, with a cleaning estimate at $5,533.00. The claim was paid.
The claim was made by a public adjusting (PA) firm, which stated the cost to clean the home was $30,000. The adjuster held strong, noting that the insured had not yet provided a statement. The investigator finally obtained a statement. The insured said she hired the PA firm, but her description of the man she met with was not consistent with the licensed PA who signed the representation form, which is a violation of California law. The insured could not recall when or which fire caused the loss, and said she already personally cleaned her home. Our adjuster denied further payments, and the claim file was closed.
In these types of cases, we are seeing claims of extensive dry cleaning of clothing. The estimates have come from cleaning companies that have no office. Insisting on insured statements or Examinations Under Oath, the insureds have routinely denied that they ever reported their clothing was dirty or that anyone ever inspected their clothes for ash. Many said they never made an insurance claim, and that the salesperson said they would get money for them from a government fund. Some insureds said they had no smoke or ash damage. The salesperson also said they would get them money for a new roof. Not one homeowner said they had signed a contract with the licensed PA whose signature is on the form.
Cases have been referred to law enforcement, and the DOI licensing division has filed a civil case against one public adjuster. They are also conducting a criminal investigation. By standing strong and insisting on insured statements, ACM is fighting to keep loss ratios low, helping make California home insurance more affordable.
Investigation Solutions has investigated more than 100 smoke and ash claims, pursued by attorneys and public adjusters.