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Adjusters: Insurance Companies Preventing Policy Payouts

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(credit: KTVT/KTXA) Ginger Allen
Ginger is the Senior Investigative Reporter of the CB...
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FORT WORTH (CBSDFW.COM) - Tuesday’s tornadoes steered clear of Kirk Dinkins’ home in Ridglea, but he can relate to the battle some homeowners may now weather with insurance companies.  “When they get their insurance claim, they shouldn’t accept it.”

Three moths ago, Dinkins’ air conditioning unit flooded his floor. It destroyed parts of his hardwood floor. His insurance company offered  him $394. “I was really close to thinking that is all there was and I should just accept that.”

Like many policyholders, Dinkins didn’t know how to fight a claim. But David Lee did. “He knows how the system works and what you have to do to get a fair claim.”

After Lee re-negotiated Dinkins’ claim, the insurance company agreed to pay Dinkins more than $21,000.  “We have seen, where we believe, people were not treated properly,” says Lee.

Lee and his partner, Heath Wakeland, both used to work as adjusters for insurance companies. They say they had to deny claims that policies should have covered. “There had been times we needed to pay the customer for the damaged property and the carrier would tie our hands and deny a portion of the claim that we know was a covered loss,” explains Lee.

Wakeland says his experience is the same.  “There were things I thought I should be paying for based on the contract and they wouldn’t allow me to or they would tell me to reduce the amount of money.”

Today, Lee (license #1687111) and Wakeland  (license #1674138) work as public adjusters. They say they opened their Arlington business, Cobalt Claims Services, Inc., out of frustration. (license #1725803)

A public adjuster reviews a policy, helps document damage, and negotiates the claim for the policyholder. A policyholder pays the public adjuster up to 10-percent of the final settlement.  An insurance company adjuster works for the insurance company.

Lee and Wakeland both say the insurance companies have an internal system that prevents policyholders from being paid everything they are owed. They both worry that tornado victims will not get what they deserve right now.

They say storm victims with damage should save all of their repair receipts and document their labor and time spent working on their homes. They say policyholders should particularly watch what they are offered with carpet replacements, roofs, and damages caused by broken glass. They say these are areas where insurance companies may not reimburse you for all that your policy likely covers.

Dinkins says it’s very simple. “I would say don’t accept the first claim that comes in. Get a second opinion to make sure it’s a sure claim.”

North Texans should also check out anyone who knocks on the door and offers help right now. The National Association of Public Insurance Adjustors tells CBS 11 there is a “big issue” with contractors, accountants, and other professionals trying to help you with claims. Only attorneys and public adjusters are licensed to negotiate a claim for you. You should always ask for a person’s license number and contact the Texas Department of Insurance to verify it.

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