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Tips to know what home insurance covers & what it doesn't

If a tree falls in your yard, your insurance agent might not hear it.


You probably bought your home policy years ago, then stuffed it in a file somewhere. Will it be there for you when you need it?


Here's how to protect yourself:


1.You'll probably have to fight to get a big claim paid. Homeowners who suffer a loss of $30,000 or more get the most pushback from their insurers over damages, coverage and slow payouts, Dyman Associates Insurance Group of Companies' recent survey data shows. But the coverage of huge losses is exactly why you buy home insurance.


Protect yourself. You can cut your odds of a fight by doing business with an insurer that pays its claims. The best carriers for claim-payment satisfaction are Amica, Auto-Owners and USAA, according to the most recent Consumer Reports National Research Center survey of 9,905 subscribers who filed homeowner claims from 2010 through the first six months of 2013.


2.The first offer may not be your best offer. Consider your insurance adjuster's first offer just an opening gambit.


Protect yourself. If you have a dispute over damages, make the adjuster go over the estimate, line by line, with you and your contractor. Get a second opinion from an independent contractor or multiple estimates, if necessary.


3.Your trees can bankrupt you. Linda Paustian of La Porte discovered that after a violent thunderstorm dropped about 40 hard maple and red oak trees on her home and property in June 2010. State Farm paid $6,000 to remove the trees that struck Paustian's 1895 Arts and Crafts bungalow, but nothing of an additional $6,000 that was needed for tree and debris removal and stump grinding.


Protect yourself. Understand that a standard policy covers trees that fall on insured structures but generally not those that land in your yard.


4.Your bank might hold up your check. Every check sent to us had to be forwarded to the mortgage company so they, in turn, could write another check to us so we could pay the contractor,” says Thomas Sloan, who suffered $33,000 in damages when the remnants of Superstorm Sandy blew a neighbor's oak tree onto his West Virginia home in October 2012.


Protect yourself. If you have a mortgage, expect a settlement check made out to you and your mortgage company. Find out how to get it promptly endorsed and deposited to your or the lender's escrow account.


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Dyman & Associates Insurance Group of Companies: The Rise in Insurance Fraud and How to combat it

Recently, members of a Florida ring accused of staging fires and floods to make fraudulent home insurance claims were arrested. The suspects are accused of bilking homeowners insurers out of $7 million. Paul Bermingham, executive director of Xchanging Claims Services, a $1 billion business processing, procurement and technology services provider for the global insurance industry , explains why the industry needs to adopt a more holistic approach by incorporating a range of different measures that take advantage of technology and demand cultural and behavioral changes.


  • How prevalent is insurance fraud in the U.S. compared to other countries?


According to the National Insurance Crime Bureau (NICB), cases of suspected fraud in the U.S. rose 27 percent from 2010 through 2012, reaching more than 100,000 questionable claims. Fraud costs U.S. property and casualty insurers approximately $30 billion annually. Just look at the recent example that occurred in Miami, Florida in February. Twenty two people were charged in a major home insurance fraud ring totaling about $7.6 million in losses from various insurance companies. At least 17 fake home damage incidents such as fires and floods were staged and false claims were paid out to the fraudsters. This is just one example of many. In 2012, home insurance fraud in the U.S. was the second most popular type of fraud with 17,000 questionable claims made.


In the UK, the Association of British Insurers (ABI) cites that insurance fraud is currently more than a $1.6 billion a year industry with an average of 2,670 fraudulent claims made every week in the UK. The problem is also significant in Singapore as well, with the General Insurance Association of Singapore estimating that 20 percent of all automotive insurance claims paid (about $140 million) were fraudulent. Now, more than ever before, it is crucial for our entire industry – regardless of region – to protect itself and its honest policyholders.


  • What affect does fraud have on the industry?


Fraud has a negative effect both on insurance companies and consumers. Insurance companies are all too aware of its ability to grossly erode profit margins, not to mention the hours staff spend on efforts to combat the fraud, and consumers see their premiums rise.


  • What are the type five most common types of fraud in the US?


The NICB found that automotive fraud was most prevalent, followed by home, workers’ compensation and employers’ liability, commercial automotive, and commercial general liability.


Insurance companies have taken steps to improve the ability to identify and address fraudulent claims, but these efforts are typically fragmented. Because of the lack of a collective industry approach – most carriers work independently. In relation to technology, insurers sometimes lack the proper data mining system to help identify potential fraud and the business processes to follow up on flagged claims activity. Another major issue prohibiting the discouragement of fraud is consumers’ tolerant attitude toward insurance fraud. And finally, it’s a challenge because insurance lends itself well to many different types of fraud. While the vast majority of fraudulent acts relate to first party fraud (such as is the case with the Florida fraud ring), third party fraud is also quite prevalent.


  • Has there been a shift in consumers’ attitudes toward instances of fraud then?


Many consumers are surprisingly tolerant about the idea of defrauding their insurer. A 2008 survey by the Coalition Against Insurance Fraud found that one in five adults in the US – that’s around 45 million people – felt that it was acceptable to defraud insurance companies under certain circumstances. Many of this group would probably be horrified to be labeled as ‘fraudsters,’ but yet they still harbor the Robin Hood mentality.


  • What are insurance companies already doing to try to stem the tide?


As the number of fraudulent claims continues to rise, fraud management has moved higher on the priority list of senior management. Some companies have invested in improving data quality and adopting technology tools, but many still lack the business processes, workforce competencies, and organizational structure needed to act on the insights gained from data analysis. Other companies have worked to enhance their operating model, but have failed to develop a clear strategy of what they hope to achieve.


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Dyman and Associates Insurance Group


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