Florida insurance adjusters claim Hurricane Ian fraud, allege companies underpaying policyholders

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As reported by Greg Fox, WESH 2 on April 27, 2023

Hurricane Ian was the third costliest storm ever in the U.S. and the costliest in Florida history at $109 billion.

Independent licensed field adjusters are providing evidence to state regulators of alleged fraud, affecting thousands of homeowners in south and central Florida. They say it could top $25 billion or more of the estimated $67 million in insured losses.

The result: property owners, mostly homeowners, being underpaid.

WESH 2 Investigates has been examining these claims for months, and obtained documents that illustrate what the adjusters allege.

Hurricane Ian devastated central Florida homes and left 134,905 local insurance claims, according to the latest March 9 report from the Florida Department of Financial Services.

Nearly half a million claims have been filed in southwest Florida, where the monster came ashore in Punta Gorda.

Of the 708,255 total statewide claims,

179,998 have been closed without payment.

WESH 2 Investigates talked with Steve Johnson, whose Ft. Myers Beach home still needs repairs and money to pay for them.

“It adds insult to injury over all of the calamity that the hurricane brought,” Johnson said.

He joined others at an “insurance village” arranged by DFS last week, demanding answers from carriers about delayed payments.

WESH 2 Investigates has reviewed documents from insurance adjusters detailing the alleged fraud, including from Ben Mandell, an independent adjuster licensed in 11 States to provide estimates to insurance companies following major natural disasters.

“They (the insurance carrier) reduced the estimate to defraud the homeowner,” Mandell said.

During the December legislative special session, called by Republican Florida Gov. Ron DeSantis to address the escalating crisis of rising insurance premiums and companies going insolvent, he and two other adjusters, Jordan Lee and Mark Vinson, dropped the bombshell allegations that insurance companies were manipulating field adjuster damage estimates, and underpaying homeowners.

Mandell provided WESH 2 Investigates photos and documents: underwriting reports, photos, adjuster damage reports, and insurance company final reports to support his allegation.

For example, he examined Hurricane Ian damage at one home, and estimated damage, mostly to the roof at $40,468.54.But in the final report from the insurance company, which we are not naming because the state’s investigation is ongoing, the payment to the policyholder was $2,524.62.

The company further left his name on the final report, which he alleges is a criminal act under Florida statute 817.234 addressing insurance fraud.

“We believe that the insurance companies are underpaying Florida homeowners by $25 billion. They need to get these folks (insurance company executives) in handcuffs and let’s get this stopped,” Mandell said.

Adjuster Jordan Lee showed us one report reading “roof has significant damage” and recommended that it be replaced. But on the final report, the insurance company changed the recommendation to repair “missing shingles” and drastically reduced the payment amount.

In March, three months after the allegations during the special session, DeSantis acknowledged two state investigations are underway, from DFS and the Office of Insurance Regulation (OIR).

“Look, I believe it’s criminal,” said Florida Chief Financial Officer Jimmy Patronis to WESH 2 Investigates April 18 at the insurance village. As head of DFS, his office is leading the probe says if the allegations are proven, insurance executives be charged.

He also says a bill (SB 7052) is being debated right now by lawmakers that, if passed, will increase fines and other penalties for insurers.

“It’s putting more teeth into the Office of Insurance Regulation when it comes to any of those practices if they do come true, that they are manipulating the adjusters’ findings, reports even if their signature is on it,” Patronis said.

To be clear, an insurance company can change a field adjuster’s recommendation, but the field adjusters say it must be clear that any reduction in payments is the carrier’s decision.

Heritage Property and Casualty has 11,000 Ian claims in Florida. Ernie Garateix is the CEO. He said Heritage changed policy in March to add the name of a company-employed “Quality Assurance” adjuster to any final claim report, if it differs from a field adjuster report.

He admits he’s been asked to provide information for the state’s review.

“So we can’t speak to it directly because of privacy issues and the ongoing investigation that is going on, but we stand by that we do adjust every claim fairly, and equitably according to our policy language,” Garateix said.

Florida insurance regulators under the OIR are also conducting forensic exams of company actions, which could result in fines or other penalties.

If you believe you have been underpaid in your claims from Hurricane Ian, or Nicole, you should immediately file a complaint with the Florida Department of Financial Services and the Office of Insurance Regulation.

DFS can pursue criminal action, and OIR can fine companies and suspend or revoke licenses.

See the full report and WESH 2 Video here

If you feel that your claim has been unfairly denied or underpaid, Contact Claims Aid Consultants at 954-482-5246 or 772-249-7988 for a free, no-obligation property damage inspection throughout the state of Florida. We ONLY work for you, not the insurance company! Our public adjusters will help you navigate through the entire claims process to get you the best settlement and your home renovated and repaired as quick as possible.

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