The Post’s examination included interviews with dozens of policyholder advocates, attorneys and Hurricane Ian survivors as well as five insurance adjusters, who oversaw more than 100 claims for Heritage and Florida Peninsula Insurance Co., another regional carrier. The Post also reviewed 13 original and modified claims, which included hundreds of pages of estimates, photos and general loss reports, as well as internal records, final payment letters, emails and carrier guidelines.
The documents show that a dozen policyholders and their families had their Hurricane Ian claims reduced by 45 to 97 percent.
In one claim reviewed by The Post, a nearly $500,000 damage estimate on a house with a mostly tarped roof was reduced to about $13,000. In another, the desk adjusters blamed roof storm damage on past wear and tear, meaning it would not be covered.
In three cases, The Post obtained final determination letters, and the amounts sent to homeowners matched the altered claims. For two of those families, their original claims were cut below their deductibles, resulting in no payment.
The adjusters, attorneys and policyholder advocates allege that the independent adjusting firms were internally lowering estimates under the direction of the insurance carriers who contracted them. Emails obtained by The Post detail how independent adjusting firms followed orders from carriers to write claims in specific ways that significantly reduced payouts.
The people interviewed for this investigation decided to speak out because, they allege, the ease and scale with which Ian claims have been altered and gutted represents a tipping point for Florida’s insurance industry. The revised claims inaccurately represent their work, for which they said they still have not been fully paid, and they want more oversight, reform and accountability.
The Post made multiple attempts to interview and seek comment from Heritage, Florida Peninsula and Tristar, sending each company detailed lists of questions pertaining to the allegations and evidence in this investigation. Heritage did not reply to calls and emails. Representatives for Florida Peninsula said that “everyone is tied up at the moment” and that they would not be able “to help with this one.”
Tristar said that because of a “confidentiality agreement with Heritage Insurance we are unable to comment on Heritage Policy, procedures and/or estimating guidelines.” However, the company said that it has reasons for altering claims and that “estimates are revised/collaborated throughout the entire industry at the direction of the insurance carriers. They have the final say.”
Some in Florida’s insurance industry blame the flailing market on lawyers and contractors who they allege have taken advantage of the system to sue carriers, jack up estimates and use roofing scams as ways to profit off disasters. It’s actually the carriers, they argue, that have been the victims of fraud and bad behavior.
“Florida is the worst of all states when it comes to frivolous lawsuits and roof-replacement fraud schemes. Many claims are not legitimate,” said Mark Friedlander, the director of communications for the Insurance Information Institute, an industry association. To combat those issues, lawmakers have recently passed several pro-insurance industry laws that target attorneys and contractors, he said.
Friedlander also attributed the unusually long delays and lower payouts to “the complexity of the claims” and hurricane deductibles. For the most part, companies “have been taking care of their customers,” he said.
However, the American Policyholder Association, a nonprofit insurance industry watchdog group, disagrees. It said in a statement that it has found “compelling evidence of what appears to be multiple instances of systematic criminal fraud perpetrated to cheat policyholders out of fair insurance claims” and will be submitting criminal referrals to authorities “in Florida & several other states” in the coming months.
Four homeowners confirmed to The Post that they had received only a small portion of what they had been promised in their determination letters from Heritage and Florida Peninsula, or were struggling to get straight answers and considering taking legal action. Meanwhile, their homes are still heavily damaged or uninhabitable. And more than 33,000 Florida homeowner claims linked to Ian are still open without payment, while more than 125,000 were closed without payment, according to the Florida Office of Insurance Regulation. Nearly 56,000 claims were open with payment and 183,235 were closed with payment.