insurance fraud

[alaric]

undefinedTexasWhat is the name of your state?Texas
I am a general contractor working on a home damaged by hail. The catastrophy adjuster that did the 1st assessment really shorted the client. We called for a reinspection and the home owner wanted me to deal w/adjuster. I went over all the damages, came to an agreement w/adjuster, submitted proposals to the insurance co. under my company name, now the home owner will not sign the proposals and is looking to find someone to do the work for less so he can pocket the extra money. Since the owner introduced me as his contractor and my com. letterhead was used to fax the proposals I feel that I was used to defraud the insurance com. since the owner should not be collecting the profit and overhead added to the proposals as per insurance regs. This being 29% for the sub contractor and an additional 20% for myself as the general contractor. Since he has represented to All State that I was the contractor and had me do all the negotiating and paperwork why should he be allowed to take the extra money for my proposed work and get another person or com. to do it for less without paying me anything? Help!!!!

 

[claimlaw]

You have learned a valuable lesson in dealing with insureds. If the additional proceeds that your expertise added to the claim were legitimate issues, there is no fraud. However, any contractor that participates in a sceme to convert proceeds of a structure loss back to the insured, commits insurance fraud.

If you had an assignment executed authorizing the insurer to pay you for your services, you would not be in this boat. Even if you only did the board-up you can let the insurer know that your company's name needs to be on the draft. Advise them that any failure of theirs to include your company' s name on the check will give Allstate the opportunity to pay this loss twice. You can be pretty sure that Allstate is not interested in that. As a result, demand that they issue a stop pay on the draft, if already issued, and re-issue a draft with your name, the insured's name and the lien holder and mail it directly to you. Using this approach, you should be able to persuade the insured to go with the program. Otherwise the insurer will be left with no choice but name all parties in a Declaratory action and leave a judge to determine the extent of everyone's interests -the dec action will take time and money and may also exceed the 180 day replacement cost benefits provision.

Don't sign the check with out a contract with the insured and a guarantee in writing from the mortgage company since they will escrow the proceeds and pay you on your progress.

Allstate will likely cooperate with you if you were to point out the intentions of the insured. Allstate wants to make sure the money goes were it is supposed to and that is not in the insured's pocket.

You should pay me for this. Oh yeah, the FreeAdvice thing.

Claimlaw