Tuesday, June 30, 2009

National Universal Health Care: Could It Work In The USA?


Let’s lay an important ground rule before we begin. Traditional insurance policies cover unexpected but predictable occurrences. For example, an auto policy covers an unexpected collision. But that policy does not cover maintenance costs which are a normal part of owning a vehicle. Health insurance has become maintenance insurance over the years, paying for everything from regular checkups and tooth cleaning to heart transplants. And, with some group insurance copays at $5 to $20, the concept of deductibles is becoming archaic.

So, in considering a single-payer cradle-to-grave government healthcare system, the old concepts of insurance and risk must be put aside. Single-payer healthcare is NOT INSURANCE in the strictest sense. It is a massive Social Security-type program, into which tax revenues flow and from which health care payments flow out to health care providers.

This article does not advocate a single-payer government-run healthcare system. But it does look at what a single-payer system might look like, and reasons why it will not work.

In December 2008 The McKinsey Global Institute issued an exhaustive 122-page report on health care costs in America, entitled “Accounting for the costs of US healthcare: A new look at why Americans spend more.” The best estimate of American healthcare costs is about $2.1 trillion annually.

Here is a summary list of its findings:

1. Administration costs in the US are much higher than in most countries around the world. This partly due to the privatization of some health care, resulting in profits for shareholders.
2. Pharmaceutical costs: Direct-To-Consumer Advertising encourages use of newer, more expensive drugs, a practice only allowed in the USA. Also, pharmaceutical lobbyists were successful in getting Congress to ban collective bargaining for Medicare Part D, resulting in the highest drug prices in the world. Also, the patent system for new drugs allows drug manufacturers to patent and charge more for non-novel medications.
3. The absence of a universal system that prevents risk-pooling, and the selective underwriting done by insurers. This leaves millions uninsured, and the uninsured avoid treatment until problems are more critical and more expensive.
4. Huge fees of specialist physicians for their procedural skills, rather than primary care that emphasizes preventive health care, early diagnosis and disease management.
5. Defensive medicine: Excess costs and duplication of health procedures in order to protect medical providers from malpractice lawsuits. Lawsuits and jury awards themselves don't cause a large amount of monetary damage, but the tort system creates a culture in which physicians are paranoid and make health care decisions with lawsuits in mind, rather than patient interests first.
6. ICU Care: The costs of care at the end of life are wildly inflated, many times eclipsing the health care costs incurred in an entire lifetime. This is partly due to heroic efforts of lifesaving, pain management, and poor records.
7. Electronic Medical Records (EMR) systems would be of great benefit in managing living wills, advanced care directives and previous treatment records. Without EMRs, doctors regularly order redundant tests and procedures because medical information management is so inefficient.

The McKinsey report doesn’t recommend a universal healthcare single-payer system. It simply tries to provide accurate information to those who will be making policy regarding healthcare in the USA.

Here is what a universal healthcare system might look like. This takes the best characteristics from healthcare systems around the world.

1. Funding through individual taxation for wage earners and self employed persons. Low income persons subsidized. Should tax be based upon age? Should the tax be calculated as a percentage of income, like in the IRS Tax Tables and FICA payments?

2. Medicare, Medicaid, the VA healthcare system and all other Federal healthcare systems would be rolled into the universal system. That would include the healthcare benefits for Federal workers and members of Congress.

3. No individual underwriting. All living persons of US citizenship are covered. Non-citizens with taxable earnings could be taxed and covered.

4. No deductibles. Copay for any doctor visit of $5-$20.

5. Prevention-based health care at the General Practitioner level. Compensation based upon health of the patients. Healthier patients, doctor makes more money.

6. Medical school 100% paid by government in exchange for 10 years service as a Federal employee. This would include additional training in medical specialties. Compensation levels could be set lower since there would be no school debt.

7. FedGov sets minimum standards for care. Insured persons are free to choose their own doctors. Patients can choose specialists without first seeing Primary Care Physician.

8. No insurance company precertifications necessary.

9. System includes mental health, nursing home and hospice care.

10. FedGov sets prices for pharmaceuticals, medical procedures and medical supplies. FedGov sets wages for all medical employees, including administrators, nurses, med techs and doctors.

11. Tort reform. If health care was universal from cradle to grave, torts would be limited since the patient would automatically be eligible for additional medical care required by malpractice, an unintended consequence of treatment or a medical complication. Doctors would still be liable for negligence, but awards would not need to compensate the individual plaintiff/patient for anticipated medical care into the future.

12. Electronic Medical Records, a database of all medical records for each patient, accessible by all medical providers. Would eliminate all duplication. Living wills and advance care directives would be part of every patient file. This has the potential to drastically reduce end-of life invasive care and duplication of procedures.

13. Individual health insurance policies would still be available for those that wanted a higher level of care, and would be excess insurance, like a Personal Umbrella policy.

14. Private medical providers, including doctors and hospitals, would still exist, offering custom care for those willing to pay extra for it.

I know this is a cursory look at universal healthcare. I know I’ve left out important features and benefits. But I’m trying to wrap my mind...and yours...around a concept that I fear is in our immediate future.

The big insurance companies have completely screwed up the health insurance marketplace in the United States. So, if they get left at the dock when this new ship sails, I won’t shed any tears. They get what they deserve.

Now, here is why I don’t think that the system outlined above will work.

1. The Federal Government is broke. They are already running trillion dollar annual deficits. In order to stave off governmental collapse, the Federal Reserve is printing paper money as fast as it can. Eventually, inflation will sink the ship of state. To absorb the healthcare system into the Federal Government which represents about one-seventh of the economy, is a bridge too far.

2. Funding this new healthcare system would require increasing taxes significantly. Insurance premiums would be turned into tax payments. There is presently an IRS business deduction for insurance premiums for corporations. The business lobbyists won’t want to give up this deduction and will fight it.

3. Pharmaceutical companies lobby Congress. They will fight any system that controls drug prices and threatens their profits.

4. Trial Lawyers have a powerful lobby in Congress. They will fight medical malpractice tort reform.

5. Medical providers, the American Medical Association and other medicine-related groups have powerful Congressional lobbyists. They will fight reforms, just like they do now.

6. Insurance companies will be forced out of business if the Federal Government takes over the healthcare system. Insurance companies hold trillions of dollars in US bonds and other municipal securities. They will threaten Congress with the collapse of the bond market if Congress passed a new system that leaves them out. All the insurance companies would have to do to crash the bond market and cause the collapse of the Federal Government is to sell off a small percentage of their bond holdings all at once.

In conclusion, I recommend looking at any Obama Administration proposal for universal healthcare in light of the competing groups in the medical field. Each group must be bought off for their cooperation, and in turn each one will buy off Congress to get what they want. Some things never change.

The single payer healthcare system that emerges from Capitol Hill, the system that will affect the healthcare of each American, should adopt as its logo the duckbilled platypus.

That’s the animal that looks like it was designed by a committee.

Sunday, June 28, 2009

Automobile Accidents: Four Tips To Avoid Car Versus 18-Wheeler Accidents

Automobile accidents between cars and big trucks favor the trucks. It’s just a matter of physics, really. Cars weigh 2-3 tons. Tractor-trailers have a weight limit of 80,000 pounds, which is 40 tons. An 80,000 pound truck, traveling at 55 miles per hour, generates 1 million foot-pounds of forward energy. Getting hit by a moving object that weighs 20 times as much as your vehicle is a recipe for death and destruction.

Here are four tips on avoiding accidents involving your vehicle and “Big Rigs:”

1. When you’re driving near a big rig, make sure that you can see his mirrors. If you can see his mirrors, then you know that he can also see you. Big rigs have enormous blind zones. If your car is in his blind zone, the trucker doesn’t know you are there.

2. Don’t stay next to a big rig while you drive. Either get behind him or move forward of him. Give him the chance to see you, and you’ll lower your chance of getting hit by his vehicle.

3. Trucks need long distances to stop. If you are in traffic, do not merge into the lane directly in front of a big rig unless you are going faster than the trucker. I’ve handled many accidents...some which were fatalities...in which a small car darted into the lane in front of a big rig and then slowed down suddenly. The trucker didn’t have any chance to slow down and avoid striking the vehicle directly in front of him.

4. Turn on your headlights while driving. “Running Lights,” as they are called, increase your visibility. Tests done on cars with running lights by the Society of Automotive Engineers showed a 38% reduction in collisions. Test results by Avis Rent-a-Car showed a 64% reduction in car damages, and a 69% decrease in repair costs for cars using running lights.

If you’ll follow these four tips, you’ll drastically lower the chance that you will have a traffic accident involving a big rig.

Drive Defensively! Watch out for the other guy!


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Friday, June 26, 2009

Slip And Fall Accidents: What Should You Do When You Slip And Fall?

Slip and fall accidents happen much more often that you might think. Today’s article will deal with what happens to individuals when they slip and fall, and what you should do if you are a victim.

Slip and fall accidents usually involve premises liability. A person can slip and fall anywhere...home, business, church, playground, sports facility...anywhere. What happens AFTER the fall is where the problems come up.

The injuries that come from falling can range from a sore backside to severe lacerations, broken bones, internal injuries and even death.

In a slip and fall insurance claim, the burden is on the injured party to prove that the premises owner knew there was a hazard and did not remedy that hazard, which contributed in some way to the injury. Simply the act of slipping and falling does not automatically constitute negligence on the part of the property owner.

Accident Avoidance

The first and most obvious statement is to make sure you are aware of your surroundings. Be sure of where you are stepping, and the condition of that surface. If the surface is wet, you must move with caution. If the surface has other debris on it, move with caution.

Watch what you are doing while you’re walking. If you are distracted by some other activity, you are not looking where your feet are going.

If you see an obvious hazard in your path, attempt to go around it.

Do not wear shoes that have slippery or smooth soles.

Slip and Fall Injuries

One of the businesses that can actually be dangerous to visit is the grocery store.

Grocery stores invite the public to walk around in their stores. However, because of the thousands of products they stock, there are hazards everywhere. Bottles and jars get dropped and contents spill onto the floor. Produce gets dropped onto the floors. Refrigeration units leak water onto the floors. Roofs leak and make puddles. And there can be hazards lying around on the parking lots. So, they have high incidences of premises liability claims.

I have investigated hundreds of slip and fall claims in my career as a claims adjuster. So, based on that experience, here are my recommendations for proving a slip and fall claim:

1. After you fall, examine yourself to see if you are injured. If you already know you’re injured, notify the owner or manager of the property where you fell. You may not be able to complete and submit an injury report at that time, but you will have placed the property owner on notice that an injury occurred.

2. Try to determine what caused your slip and fall.

3. If there is a witness to your fall, get that person’s contact information right away.

4. If you need to, seek medical treatment. Don’t be in a hurry to reject medical treatment. I’ve seen many incidents in which a person fell one day, and did not begin feeling pain until 1-3 days later.

5. Seek the advice of a personal injury attorney. If you do not, you may inadvertently give away your rights of financial recovery through your cooperation with the property owner’s insurance company.

6. Notify the property owner IN WRITING, CERTIFED MAIL, of your intention to file a claim. Note that I placed this action AFTER seeking legal counsel.

7. Notify your own insurance company, such as your homeowners or business owner’s carrier, about your loss. Failure to notify them might violate your policy terms, and make you ineligible for legal defense.

8. Don’t sign ANYTHING that the property owner’s insurance company gives you without having an attorney review it first.

9. Don’t give the adjuster a recorded statement unless your attorney is present, or at least involved on a three-way phone conversation.

10. Then, work with your medical provider, your personal injury attorney or a claims consultant to settle your claim.

All premises injury claims are not due to the negligence of the property owner. But, if you’ll follow these ten tips, you have a better chance of proving your claim.


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Tuesday, June 23, 2009

Summer Parties: How To Avoid Lawsuits

Summer Parties, Graduation Parties, Pool Parties, Cookouts, July 4th bashes, and Labor Day Parties are all good reasons to gather friends and families at your home and have fun. But behind the fun lurks the possibility of guest injuries that could ruin the party and ruin your finances.

So, here are some tips for making sure you are ready for the arrival of the guests.

• Read your homeowners, renters or condominium owners policy many days before the party. Discuss your liability coverage with your agent.

• Few people have liability limits that are high enough, and liability coverage is very inexpensive. Increase your limits to at least $500,000...$1 million is better. Consider buying a Liability Umbrella policy.

• Will you be serving alcoholic beverages at your party? Or, if not, will you allow guest to bring their own booze? Then, I suggest that you make guests hand over their car keys when they arrive.

• Never serve alcohol to a person under the legal drinking age. If you do, and you are sued, your insurance company will probably deny your claim or refuse to defend you.

• Serve lots of food, but not salty snacks. Bars serve free salty snacks because it makes people thirsty.

• Serve non-alcoholic beverages, like exotic punches. You can find no-booze cocktail recipes on line that taste just like the originals.

• Buy a breath alcohol analyzer. You can buy one for about $50 on the Internet. Then, when each person prepares to leave, make them blow in the analyzer. No blow, no keys. Alcohol level too high, no keys. No exceptions.

• Is your guest too drunk to drive home? Either drive them home, make up a cot for them, or call a cab.

• Be sure your home is safe. Fix broken walkways, handrails, etc. Clear away debris, such as leaves and grass clippings. If you have a deck, be sure that the surfaces are smooth and free of slivers. Walk around your home and look for tripping hazards.

• If you have ANY KIND of a backyard pool, be extra careful with who has access to the pool. Drowning is easier than you think. Having a lifeguard for the party is a pretty good idea.

Now that you’ve taken care of all of these tips, have a GREAT party!!

Swimming Pool Safety: Have a Fun and Safe Back Yard Pool

Swimming pools are wonderful to own, but danger is built in.

The Consumer Product Safety Commission states that each year, over 300 American children under age 5 drown in swimming pools and spas. 2,000 more have near-drowning incidents. Additionally, hundreds more over age 5 drown each year.

Medical care costs for near-drowning victims are very high. Dealing with brain damage issues can cost hundreds of thousands of dollars. Then, if that person lives, there are brain damage issues and/or disability for the rest of their lives.

If you are found liable for the injuries or death, you’d better be sure your liability limits are as high as possible. A million-dollar jury verdict against you could ruin your financial life forever.

Don’t allow your home to be the location of a drowning. Take the following precautions to prevent a tragedy.

• Most building codes require a pool to be fenced in. Make sure yours has a fence around it that is at least four feet tall. If your house forms one side of the barrier for the pool, doors leading from the house to the pool should be protected with alarms that sound when the doors are unexpectedly opened.

• Make sure that all your gates are self-closing and self-latching. Latches should be high enough that small children cannot reach them.


• Consider installing a power safety cover, a motor-powered pool cover placed over the water area, to prevent access to the water.

entanglement hazards. Plainly mark the location of the electrical
cut-off switch for the pool or spa pump.

• Instruct babysitters about potential pool hazards to young children and about the use of protective devices, such as door alarms and latches. Emphasize the need for constant supervision.



• Learn Cardio-Pulmonary Resuscitation (CPR). Keep rescue equipment and a phone near the pool.

• If a child is missing, look in the pool FIRST! Seconds count when saving a life. 75% of drowning victims are missing for five minutes or less.

• Knowing how to swim doesn’t drown-proof anyone. Accidents can happen, and a small amount of water in the lungs can cause death.

Be safe FIRST, and then you can really enjoy your pool!

Monday, June 22, 2009

Insurance Quotes: Save Hundreds Of Dollars, Prevent Financial Disaster






An increasing number of people are allowing their insurance policies to lapse, or they are cancelling them outright. They simply made a decision that they cannot pay the premiums anymore.


“Cancel my home’s electrical service??” I hear you sputter. “Have you lost your mind?”




In addition, if your home, business or vehicle is financed, your lender requires you keep Property coverage on the property at all times. If the lender finds out that you have cancelled your coverage, they likely have the right to declare you in default on your loan, and require payment of the balance. They could repossess your car, home or business. At the very least, they could purchase coverage on your car, home or business property for the loan balance and charge you for it. This is called “forced-placed coverage,” and is very expensive, inferior coverage.


The process of getting insurance quotes is simple and IT COSTS YOU NOTHING! All you have to do is go online and use the search term “Insurance Quotes.” You’ll find hundreds of quote websites, all eager to get that quote for you.


An Insurance Quote website will get you great insurance quotes. Don't delay!!

Directors and Officers Liability: Bleak Days For Directors and Officers

These are bleak days for corporate directors and officers.

In a June 18th webinar sponsored by Zurich Financial Services in London, a forum was held to discuss Director and Officer Liability exposures.

In 2008 there were over 150,000 insolvencies in Western Europe alone. In the first quarter of 2009, the United States had over 5,000 corporate insolvencies. Mario Vitale, CEO of Zurich's Global Corporate Division, predicts over 62,000 American corporate insolvencies for 2009, an increase of over 56% from the previous year. And the bankruptcies are not limited to the financial sector. They are widely spread over every type of business.

Vitale asserts that there is a direct relationship between corporate insolvencies and lawsuits filed against corporate directors and officers. In one American court jurisdiction alone, considering all the public company bankruptcies filed in 2008, 77% had a class action lawsuit filed against them.

One of the other daunting challenges to today's corporate officer or director is the massive change that has occurred in securities law. The Securities and Exchange Commission is holding officers criminally responsible for what they say regarding the financial health of their companies, including the information in their annual reports, financial statements and 10Ks.

Today's economic uncertainties are dangerous for corporations. They must consider:

-whether their line of credit is secure now and in the future
-whether their bank, who issues the line of credit, is financially healthy
-the financial health of the companies in their supply chain
-the financial health of their customers. Can they pay their invoices?

So, for public corporations seeking investors, what can they tell prospective investors about the financial health of their company when the future cannot be accurately forecasted in any substantive way?

What you can be absolutely certain about is when there is a corporate insolvency, the shareholders, hedge funds and the "vulture funds" will be picking the bones of the company's financial documents to find the slightest half-truth for their basis for lawsuits.

Francis Kean, attorney at partner at the UK firm Barlow Lyde & Gilbert, boldly stated that the worst event "by a country mile" that could happen to a director or officer is the insolvency of the company upon whose board they serve. A director's responsibility is to the company he serves and helps to control. However, in a bankruptcy, the Court takes control. It must not only settle financial claims against the company, but analyze the reasons for the insolvency, including whether or not directors can be found liable.

The other wild card is that the potential claim can be "sold" to the highest litigating bidder because the claim can be perceived as an asset against the directors.

German corporate securities law stipulates that once a company's directors decide that the company should be liquidated, the directors only have 21 calendar days to place the company into insolvency. Failure to meet this deadline can result in criminal charges against the directors with a maximum jail term of three years.

Anything like that here in the United States? Are you sure?

Why would anyone choose to be a corporate director in this sort of business and regulatory climate?

So, how do directors and officers of corporations protect their own assets in this hostile business environment? The corporate director or officer cannot be certain that the company they serve will be there to defend and indemnify them in case of insolvency and subsequent legal challenges.

Can the director simply resign from the board? Not really. The director must eventually prove that he did everything humanly possible to minimize the losses for the creditors. Anything short of that effort could be considered a claim against the director.

The director must plan ahead, and prepare for the worst.

First, know your liabilities. Know who might be a plaintiff and the reasons they might file a lawsuit against you.

Second, buy a Directors and Officers (D&O) Liability insurance policy at the time you are either a director or officer. But buy the coverage while your company is still solvent. Buy from an insurance company that also has a strong balance sheet, and is going to be there when you need the protection.

Here is a new complication for directors, though. Some insurers are coming out with Insolvency Exclusions. Some are broadly worded, some narrowly worded. Be very careful of the wording of your policy.

Also be aware that most of these policies are "Claims Made" policies, which means that the trigger event must have happened within the policy period. But, is the bankruptcy the triggering event, or is the claim date the trigger? The claim may be made months after the bankruptcy filing and by that time, the policy may have expired. This question will be determined in the courts.

I recommend carrying your D&O policy for a couple years after you leave the Board of any company. I also recommend high policy limits.

Protect your assets with Directors and Officers Liability insurance.

Saturday, June 20, 2009

Department of Insurance Complaints: How To File A DOI Complaint

State Departments of Insurance report that dissatisfaction with claim settlements is the top reason consumers file complaints with them. Sometimes it is the fault of the insurer, and sometimes it is the policyholders’ fault for not having the right coverage.

Today, I’m going to walk you through the process of filing an insurance claim complaint. I’m going to use the process here in the state of Georgia, where I live. The process in your home state will be very similar, and can be found at the website of any state’s Department of Insurance. Or, you can phone your Department of Insurance and they will likely either tell you how, or send you printed information on the complaint process.

You may file a complaint with the Department of Insurance if you cannot resolve your dispute directly with your company. You can even file your complaint if you haven't been through the appraisal process (found in your policy).

The Consumer Services Division of the Department of Insurance provides consumer information and investigates complaints about companies and producers. They handle most insurance problems involving home, business, auto, health, HMO, life, credit, dental, etc. Those problems may include coverage issues, claim disputes, premium problems, sales misrepresentations, policy cancellations, and refunds, just to name a few. They will also investigate a complaint against a Public Adjuster.

The Consumer Services Division will not:

• Give you legal advice or act as your attorney;
• Recommend an insurance company, agent or policy;
• Resolve a dispute when the only evidence is your word against the word of the adjuster, producer or company;
• Make determinations related to the facts of a case. For example, they will not conclude who is at fault in an accident or determine the disputed value of damaged or stolen property;
• Resolve complaints against service providers, like body shops and restoration contractors unless the complaints involve the action of the insurance company. For example, they could resolve complaints against a restoration contractor that the insurance company required you to use;
• Make medical judgments.

The Department of Insurance recommends:

• Read your policy carefully. It is important to know what your policy covers prior to having a loss. If you have questions on the coverages you have purchased have your Agent provide you an explanation.





• Ask the adjuster for an itemized explanation of the claim settlement offer. For homeowners claims, this should include sales tax, depreciation, and holdback depreciation for policies with replacement cost coverage. Holdback depreciation is an amount of money withheld from your claim settlement until repairs are finished or the items are replaced. Ask how the adjuster determined the estimate amount.

If you do have a claim dispute, contact your insurance company first.




The DOI Complaint Form

The DOI Complaint Form is a document that can be completed, printed and submitted with copies of documents that support your complaint. Obtain this form at the DOI website or phone them and request a copy be sent to you by mail. This will enable them to set up a case and eliminate the need for them to request documents, and reduce the delay in providing a response. Always keep your original documents for your records.

To help ensure that the Department of Insurance receives all necessary information to investigate your complaint, include the following information with your complaint:

* your name, address, daytime telephone number and email address
* the exact name of the insurance company
* the full name of any agent or adjuster who may be involved
* your policy number
* your claim number and the date of your loss, if applicable
* a copy of both sides of your insurance card
* a concise description of your problem
* copies of all supporting documentation, including invoices, canceled checks, advertising materials, and any letters between you and the company or agent.

What will the Department of Insurance do to resolve your complaint?

* Send a copy of your complaint to the entity you complained against and request a detailed written response.
* Determine if your issue was handled appropriately under the terms of the policy or certificate of coverage.
* Review your file to determine if the insurance company, insurance agent, or adjuster violated state insurance laws.
* Take enforcement action when laws are violated.

Even though they may not always be able to help you resolve your complaint, your complaints and inquiries help the DOI to assist other policyholders by identifying issues of concern and may help identify potential problems with insurance companies, agents, or adjusters. Their involvement can also cause insurance entities to look more closely at your concerns.

What happens after you file a complaint with the Department of Insurance?

* You will receive an acknowledgment letter, advising who the investigator is and their contact information. Your Case Number shown on the letter is for the issue submitted to the Department. The case number should be used to send additional information to the Department on your case.
* If you have future complaints you will get a new case number, acknowledgement letter and the new investigators name and contact information.
* The DOI will notify the company of your complaint and ask for a detailed response. They will send you a copy of the company's response, with their formal letter regarding the completion of our investigation. The review will result in one of the following actions:

o If the complaint has been resolved, they will send you a letter explaining the resolution.
o If an insurance law has been violated, they will request corrective action by the company.
o If the company is not abiding by the policy, they will request corrective action.
o If the insurer or producer has not responded to all questions or has not investigated the complaint thoroughly, they will require them to do so.

What happens if you are not satisfied with Department of Insurance results?

If you disagree with the Department’s response to your complaint, contact the Consumer Services Division and ask to speak with a Supervisor.

You may wish to consult an attorney to discuss your concerns. You may also request alternative dispute resolution (ADR) to settle disputes with your insurance company on property claims. ADR uses techniques such as mediation with a neutral third party to help settle a dispute outside a formal court of law. Please consult your telephone book for listings for attorneys and mediation services.

Now you have a basic knowledge of the complaint process. Remember, the Departments of Insurance exist to regulate insurance companies and protect consumers. Don’t be shy about enlisting their help. That’s why they exist.

Forensic Accountants: How To Choose The Right Forensic Accountant

Forensic Accountants are accounting professionals that specialize in calculating insurance claims. Customarily, they work on the side of insurance companies. When the insurance company retains them, their task is to calculate the claim with an eye toward minimizing the claim amount. After all, who is paying their fees?

You may be a business that has suffered a disaster or significant insured loss. In these types of losses, business owners typically have Business Interruption and Extra Expense coverage in their Business Owners Policy. This covers the loss of income and extra expense incurred by the business when their business operations are interrupted by a covered loss.

The biggest challenge for a business owner after a loss is keeping the business operation alive and moving forward. The disruption of operations makes that job very difficult. Then, when you add on the responsibility of preparing, documenting and submitting an insurance claim, it can be overwhelming for the business owner. Remember that your job as claimant is to submit a very accurate claim that maximizes your recovery.

So, my recommendation is to make your life easier by surrounding yourself with claims experts that are working for YOU, not working for the insurance company. And that team of experts should include a forensic accountant.

I do not recommend using your in-house accountants or your everyday business accountant to calculate your claim. Although they will likely assist a forensic accountant with your financial data, they do not know the methods of calculating an insurance loss. That could cost you hundreds of thousands of dollars.

To find a competent forensic accountant in your area;

1. Use your computer and search for “Forensic Accountant” and your city or zip code.
2. Contact some of the larger accounting firms in your area and ask them if they do forensic accounting. If they do not, ask for a referral to firms that do.
3. Contact the Certified Public Accountant Society in your area for a referral.

Once you’ve found forensic accountants in your area, call them and interview them with the following questions:

1. How many years have they done forensic accounting?
2. Ask for a list of satisfied customer with phone numbers for verification.
3. Ask about their fee schedule.
4. Ask to meet them to see if your personalities are a good fit.
5. Do you have any conflict of interest with my insurance company?

The fees incurred for a forensic accountant are usually considered covered expenses for claim preparation.

With this information, you should be able to retain the best accountant possible to calculate your business loss.

Public Adjusters: How To Choose the Right Public Adjuster



The biggest challenge for a policyholder who has had an insured loss is the calculation, preparation and submission of his claim. Most people do not have the expertise to submit an insurance claim, and they end up leaving hundreds or even thousands of dollars “on the table” that they are entitled to collect...but don’t collect. A PA will maximize your claim settlement.



3. Go to: www.napia.com which is the website for the National Association of Public Insurance Adjusters and get referrals in your area.


1. Are you licensed in your state?
2. How many years have you been a PA?
3. Do you have a specialty?
7. Please explain your fees and how you are paid.
8. Please provide a copy of your retainer contract.


Property Damage Attorneys: How To Choose The Right Property Damage Attorney








1. Are you licensed in your state?
3. Do you have a specialty?
7. Please explain your fees and how you are paid.
8. Please provide a copy of your retainer contract.


Personal Injury Attorneys: How To Choose The Right Personal Injury Attorney

Personal Injury Attorneys are lawyers that provide legal representation for individuals who claim to have been injured as a result of the negligence of another person, commercial or government entity. As such, personal injury attorneys specialize in “tort law,” which is the area of law dealing with civil legal actions. This could include economic damages to a person’s body, their property, civil rights or reputation.

In any incident in which you have been injured due to the negligence of any other person or entity, I recommend that you consult with a Personal Injury attorney. I further recommend that you consult the attorney before you notify your own insurance company of your loss.

Failure to gain competent legal counsel can result in complications in your claim, or restrict your full recovery in a negligence incident. You could find that you have unknowingly given away important rights you did not know you had.

Do not trust your financial future to a General Practice attorney. Choose a personal injury specialist to protect yourself.

Here’s how to choose the right Personal Injury Attorney:

1. Using your computer search engine, look for “Personal Injury Attorney” and your zip code or state.
2. Note which personal injury law firms in your area are advertising on TV and radio in your area. A big advertiser is usually having some success.
3. Ask friends and business associates for a referral to a PI attorney.

Once you have located two or three PI attorneys in your area, interview them with these questions:

1. How many years have you been a Personal Injury Attorney?
2. Do you have a specialty?
6. Please explain your fees and how you are paid.
7. Please provide a copy of your retainer contract.


Body Shops: How To Choose the Right Body Shop

Automotive Body Shops are everywhere. Most auto dealers have one, as well as most commercial vehicle dealers. Then there are the shade-tree body shop guys that repair cars in their garages in their spare time. Finally, you’ll find many independent body shops sprinkled throughout your area.

So, how does a person who is not an expert in automobile repairs determine what body shop to choose?

In the insurance claims field, the choice is even more complicated. Many insurance companies have relationships with certain body shops that they call “preferred vendors.” The insurers will try hard to steer you toward their favorite repair facility. Customarily, these preferred vendors have made a deal with the insurance company to repair vehicles at a discounted labor rate. They will also agree to use aftermarket auto parts in the repairs.

But remember...you own your car. The insurance company does not own your car. It is YOUR responsibility to make sure your vehicle is repaired correctly.

I recommend three important strategies in dealing with body shops.

1. Take your damaged vehicle to YOUR chosen body shop, not necessarily the preferred vendor of the insurance company.
2. Insist that the body shop write an estimate using Original Equipment Manufactured (OEM) Parts. Aftermarket parts, favored by the insurers, are characteristically inferior parts that do not go through the same inspection and screening that OEM parts undergo. So, while they may FIT your car, they can compromise your safety as well as the value of your car.
3. The insurance companies are required to return your vehicle to pre-loss condition. That is impossible using cheap aftermarket parts.

So here’s how to choose a body shop.

1. Seriously consider getting at least one estimate from a dealer of your make of vehicle. For example, if you have a Toyota, get a Toyota dealer body shop estimate.
2. Ask your friends, neighbors and business associates for referrals to body shops they’ve used in the past.
3. Use your computer search engine to find body shops in your city or zip code.

When you narrow it down to about three shops, interview them asking these questions:

1. Are you licensed in your state?
2. How many years have you been an Auto Body Repair specialist?
3. Do you have a specialty?
6. Have you ever had a complaint filed against you with the Better Business Bureau or State Office of Consumer Affairs?

Once you get two or three estimates, negotiate with the insurance company based upon the HIGHEST estimate.

Based upon the information you glean from your interviews, you can make a choice of the best auto body shop to use.

Restoration Contractors: How To Choose The Right Restoration Contractor






3. Ask friends and business associates for a referral.


1. How many years have you been a Restoration Contractor?
6. Please explain your fees and how you are paid.
7. Please provide a copy of your repair contract.


Thursday, June 18, 2009

Property Insurance Claims: Take Photos









Get a camcorder, or digital camera, or even disposable cameras. Go through your home or business and capture your personal property “on film.” Do it once a year, and then remember to update after every major purchase...like a new computer or flat-screen TV. Don’t leave anything out. Even photo inside drawers and closets.





Dog Bite Attacks: Six Warning Signs of a Dog Attack

Any person who owns a dog is potentially liable for damages if their dog bites another person. Your homeowners liability or business owners liability insurance will defend you from lawsuits attributable to dog bites in some cases.

If you have a dog that has already bitten or injured another person or animal, your insurance company may exclude coverage for subsequent incidents. I’ve even seen insurers cancel or refuse to renew policyholders with dangerous dogs.

This follows the old “First-Bite Rule.” That means that if your dog has never caused injury before, you as the owner are not deemed to be the owner of a dangerous dog. However, after the first bite, you can’t say that anymore.

But what if you don’t own a dog? You must know the common sense issues about dogs and how they behave. That is crucial whether you own a dog or not.

So let me share with you six danger signs that should warn you that a dog attack may be about to occur. If you commit these to memory, you will have a better chance of protecting yourself and your children.

1. A new dog in the house. New adult dogs can be dangerous for the first 60 days or so. In the same manner, a person who is new to a household where a dog lives is in danger of attack for about the first 60 days. Statistics show that 20% of fatal dog attacks involved a new person or a new dog in the same household for two months or less. (new husband, new wife, new step-kids, new girlfriend/boyfriend, new baby)

2. Gender of the dog. Un-neutered male dogs are the most dangerous of all. But any male dog is far more dangerous than a female dog.

3. Breed. The Pit Bull, Chow, Akita and Rottweiler breeds are the most dangerous. Pitt Bulls have the most fatal attacks of any breed.

4. The Pack. The more dogs in the pack, the greater the danger of attack. Dogs that are normally calm and docile can become violent when they are in a pack. The pack mentality is strong in dogs. Statistics show that 39% of the dog attacks in 2008 were by multiple dogs.

5. Dog is his own yard, with no owner present. Dogs are protective and territorial. Don’t go in his yard. Warn your children of the danger of going into a yard where a dog...or multiple dogs...are alone.

6. Dog on a tether or chain. Chaining up a dog is cruelty, and over time, it changes the dog’s personality. Chained dogs committed 9% of fatal attacks in 2008.

Any one of these factors alone is a danger signal. The more factors that exist at the same time, the higher the danger of a dog attack. All of the factors should be avoided at all costs.

Tuesday, June 16, 2009

Restoration Contractors: Liability Issues That Can Affect YOU!











Friday, June 12, 2009

Insurance Jokes: You May As Well Laugh

Here are some insurance jokes to help you keep some perspective while you are dealing with insurance agents and insurance adjusters.

Q: What’s wrong with Claims Adjuster jokes?
A: Claims Adjusters don’t think they’re funny, and nobody else thinks they’re jokes.
Q: What do claims adjusters use for birth control?
A: Their personalities.
Q: What is the difference between a dead skunk lying in the road and a dead claims adjuster lying in the road?
A: There are skid marks in front of the skunk.

As he passed sulfurous pits and shrieking sinners, he saw a man he recognized as a claims adjuster making love to a beautiful woman.

"That's not fair," he complained. "I face torment for all eternity, and that adjuster gets to spend it making love to a beautiful woman."





The doctor replies, "Marry an insurance agent."

"Will I live longer?" asks the woman. "

A drunk wanders into the bar of a hotel where an insurance convention is being held. He yells, "I think all insurance agents are crooks, and if anyone doesn't like it, come up and do something about it."


The drunk sneers and replies, "Why, are you an agent?"

An insurance agent, a lawyer and a used car salesman are traveling in the countryside. Weary, they stop at a small country inn. "I only have two rooms, so one of you will have to sleep in the barn," the innkeeper says.

The used car salesman volunteers to sleep in the barn, goes outside, and the others go to bed.

In a short time they're awakened by a knock. It's the used car salesman, who says, "There's a cow in that barn. I'm a Hindu, and it would offend my beliefs to sleep next to a sacred animal."

The lawyer says that he'll sleep in the barn.


It's the lawyer who says, "There's a pig in the barn. I'm Jewish, and cannot sleep next to an unclean animal."

So the insurance agent is sent to the barn.

It's getting late, and the others soon fall asleep.

Last night as I lay sleeping, I died or so it seemed,
Then I went to heaven, but only in my dream.

Up there St. Peter met me, standing at the pearly gates,
He said "I must check your record, please stand here and wait."

He turned and said "Your record is covered with terrible flaws,
On earth I see you rallied for every losing cause.

I see that you drank alcohol and smoked and used drugs too,
Fact is, you've done everything a good person should never do.

We can't have people like you up here, your life was full of sin,"
Then he read the last of my record, took my hand and said "Come in."

He lead me up to the Big Boss and said "Take him in and treat him well,
He used to work in Insurance, he's done his time in hell."


An insurance agent said to a customer, "Thank you, Mr. Smith, for your patronage. I wish I had twenty customers like you."

"Gosh, it's nice to hear that, but I'm kind of surprised," admitted Mr. Smith. "You know that I file many claims and always pay premium late."

The insurance agent said, "I'd still like twenty customers like you. The problem is, I have two hundred like you."
The applicant for life insurance was finding it difficult to fill out the application. The agent asked what the trouble was, and the man said that he couldn't answer the question about the cause of death of his father.

The agent wanted to know why. After some embarrassment the client explained that his father had been hanged.

The agent pondered for a moment. "Just write: 'Father was taking part in a public function when the platform gave way.'"
Two insurance claims managers are discussing business one day. One manager asked "How many adjusters do you have working for you?"

The other manager replied "About half of them."
An insurance adjuster was teaching his 16-year-old daughter to drive when the brakes suddenly failed on a steep, downhill grade.

"I can't stop!" she shrieked. "What should I do?"

"Brace yourself," advised her Dad, "and try to hit something cheap."
The other day my house caught fire. The insurance agent said, "Shouldn't be a problem. What kind of coverage do you have?"

I said, "Fire and theft."

Insurance agent frowned. "Uh oh. Wrong kind. Should be fire OR theft."

Apparently, the only way I can make a claim with this coverage is if the house is robbed WHILE it's burning down.
Two insurance agents were driving down a country road at high speed and passed a pickup truck with an old couple inside. "Look at those fools, Pa! Must be a couple of insurance agents and they will surely meet their maker soon, I tell you."

Well, sure enough, a little while later the couple comes across a bad accident involving the two insurance agents. "Well Maw, we got to do what any good folk would do and give'm a decent burial."

So the couple dug a hole and buried the insurance agents. Just as they were putting their tools away, a cop drives up. "You folks see this accident?"

"No sir, but we knew them dang fools were going to have it when they passed us doing a hunnert miles an hour. Well, we finally come across the accident and gave them insurance agents a decent burial"

"You were sure that they were dead??"
"Well, they said they weren't, but you know how those insurance agents exaggerate!"
Two women are playing golf when one of them asks the other, "Do you and your husband have mutual climax?"

The other woman replies, "No, I think we have Allstate."
A traveler wandering on an island inhabited entirely by cannibals comes upon a butcher shop. The shop specialized in human brains differentiated according to source. The sign in the shop read:

Laywer Brains ... $9/lb

Doctor Brains ... $12/lb

Engineer Brains ... $15/lb

Claims Adjusters' Brains ... $1,000/ounce

Upon reading the sign, the traveler noted, "My, those claims adjuster's brains must be something."

To which the butcher replied, "Are you kidding! Do you have any idea how many of them you have to kill to get an ounce of brains?!"
What do you get when you cross a monkey with a claims adjuster?
Nothing. There are some things even a monkey won’t do.
Q: Do you know the difference between a claims adjuster and a whole life insurance policy?
A: A whole life insurance policy eventually matures.

There! Now, go finish your insurance claim!

Wednesday, June 10, 2009

Personal Property Claims: The Depreciation Trap








Now...think about the same example if your entire contents claim is $100,000.



Do you see the trap?




3. Challenge any and all incorrect depreciation amounts.






Fight back and WIN!

Monday, June 8, 2009

Hurricane Preparedness: Prune Your Losses




Here are some tips for lowering your risk exposure:

• Cut down unhealthy trees on your property.



You DID update your policy, didn’t you?

Sunday, June 7, 2009

Automobile Blind Zones: Checking Your Mirrors Is Not Enough




• 954 children were involved
• 204 died as a result of their injuries
• Most backover incidents occur in home driveways and parking lots




Here are 5 tips to help prevent backover incidents:



Electrical Fires: 10 Ways to Prevent Electrical Fires At Home

Electrical fires occur in American homes with great regularity. According to the US Fire Administration:
• Over 28,300 residential electrical fires occur annually, causing nearly 350 deaths, 1,000 injuries and over $995 million in damage
• Fifteen percent of residential fires start in bedrooms
• Nearly half (47%) of the residential electrical fires where equipment was involved were caused by the building’s wiring
• Twenty-two percent of residential electrical fires occur in December and January. (Christmas lighting and decorations)
• Extension cord abuse accounts for a large percentage of losses

Electricity is like water. You’d have a hard time living without it, but it can also kill you if you abuse it. So, here are 10 tips on how to prevent electrical fires, prevent insurance claims, and save lives.

1. When you buy extension cords, only buy cords approved by Underwriters Laboratories. You will find the “UL Approved” label on the cord.
2. Be sure the extension cord’s capacity matches the appliance or device you plug into it.
3. Don’t use extension cords that are frayed or cracked or coiled up.
4. Don’t run extension cords under rugs or carpets.
5. Feel the extension cord while it’s in use. If it is warm or hot, replace it with a cord of greater capacity.
6. Don’t overload extension cords. The wattage of all devices plugged into the cord should not exceed its rated wattage. Usually the rated wattage is printed on the cord or attached by a tag.
7. Install light bulbs with wattages that are equal to or below any fixture’s maximum wattage. For example, a light fixture tag may say “do not exceed 75 watts.”
8. Dispose of or repair appliances or devices that blow fuses or trip circuit breakers.
9. Don’t leave a pan cooking on an electric stove unattended.
10. Homes built before the 1970s are more prone to electrical wiring fires. With the modern use of more powerful appliances and electronics, your system may require an upgrade. Call a licensed electrician for an evaluation. An upgrade may get you a discount on your homeowners insurance.

You can eliminate most electrical risks by following these ten tips.

Live better, live more safely!

Monday, June 1, 2009

Hurricane Season 2009: Seven Tips To Be Ready

Today marks the beginning of the Atlantic hurricane season, and early predictions by NOAA suggest that this will be an average season with as many as four to seven hurricanes.

The National Hurricane Center says there is a 70 percent chance of having 9 to 14 named storms, of which 4 to 7 could become hurricanes, including one to three major hurricanes (Category 3, 4 or 5).

Hurricane season runs from June 1st through November. Tropical systems all get names, and the first one will be named “Ana” when it reaches sustained winds of at least 39 mph. Tropical storms become hurricanes when winds reach 74 mph, and become major hurricanes when winds increase to 111 mph.

Here are seven tips on getting ready for hurricanes or tropical storms:

1. If you have property in a hurricane-prone area, seriously consider buying flood insurance from the National Flood Insurance Program. Buy the coverage now, not when storm clouds gather. Go to www.floodsmart.gov for more details.
2. Dig out your property insurance policy and read it. If there is anything you do not understand, call your agent and get your questions answered.
3. Make sure that you are insured 100% to replacement value. In this economy, market value has dropped, but replacement value is still high. A good average for replacement value is $80.00 per square foot.
4. Make sure that you have the replacement cost endorsement on the building and the contents.
5. Be sure what your deductible is. In many hurricane-prone areas, the insurance companies assess a deductible which is a percentage of the building policy limit, such as 2%, 3% or 5%.
6. Contact a Public Adjuster (PA). Have a conversation about the services a PA can perform for you when you have a major loss. Knowledge is power, but knowledge can also get you a lot more money at claim time.
7. Remember that if a civil authority issues an evacuation order, your homeowners policy will cover your Additional Living Expense while you’re out of your home. Read the policy for the details.

Let’s hope that this hurricane season will pass without even one storm striking land!