Big Insurance, Bigger Policyholders

_____,

I'm not sure where you acquired?your?adjuster's license, but you're?dangerously close to losing it with the grievance I'm ready to file with the state, independently?of The Insured.? No insurance carrier comes to my home state and abuses policyholders like this.? I have to imagine that you are working independently to now cover for your gross negligence in the handling of this claim, and that anyone at Lemonade that is considered a superior is not privy to what has moved from possible incompetence and/or gross negligence to blatant misconduct and policyholder abuse.

Whether you are acting at the behest of incompetence, negligence, or maliciously is irrelevant at this point.? Every attempt?you've made to circumvent the professionals on this claim?so that you?could manipulate a policyholder into giving you grounds for denial is documented.? I'll bullet?point our?process thus far, just in case, in your?delusions of grandeur, you've missed any of these steps

1) We made you aware, via your virtual agent, through?the policyholder's app, of our need to mitigate due to the type of water intrusion?we were dealing with, once discovered.

2) You responded to the homeowner with a claim?number and the maximum amounts allocated for each of his coverages.? I don't know what you?were taught at Lemonade, but that correspondence prompts?both the homeowner?and the mitigation company into action, with your proclamation?that coverage does exist

3) We moved forward in accordance with the S500, as any mitigation company?who understands state law in this regard?would, and all carriers who understand the liability?associated?with a mishandled mitigation process, would as well.? Every carrier assumes coverage?out of the gate to offset liability, as it pertains to mitigation, or states the lack of coverage to absolve itself?from the process.? You confirmed that coverage exists.? We moved forward as we do with every other carrier on the face of the planet.

4)? Through the process, we discovered that the?mitigation was?going to be more extensive than the homeowner wanted it to be, or than we thought it would be.? The Insured was especially adamant about wanting to save the tile in the bathroom.? We made our best efforts?to?do so by removing?the drywall on top of?the tile walls.? On day three, when the moisture?readings?were still over 16% on the tile, we were instructed?by our IICRC ?rep to commence?with the full teardown, as we were now fully confident that the moisture was between?the walls and the insulation.? You can't get more obvious?evidence?of the occurrence?than the water?trails on the walls, the moisture?readings and the instructions from our licensed IICRC representative.? We don't need an insurance?carrier's permission to act in the best interest of the policyholder.? Up until our?dealings with you, it is industry wide understanding, practice, law and ethics, that only varies?slightly from region to region, that carriers and mitigation companies?act in accordance?with the S500.? We followed protocol.??

5) On July 2nd, your IA, ______, made contact with me and the Insured.? At this point we were still making the attempt to both save the Insured's property and mitigate per industry and EPA standards.? We were fairly certain that we wouldn't be able to accomplish both simultaneously, but it was a holiday week and we figured everyone, with the exception of us who were stuck working through the holiday to mind the mitigation process, would benefit from our more laxed approach to the process.? ? We scheduled his inspection for July 5th.

6) Like any IA worth their salt, acting on the behalf of the carrier that contracted him, Lemonade, Richie performed an in depth, investigative interview with me.? Unlike you, Richie performed the interview without bias and understood the concept of mitigation.? Once he had established the facts, the interview shifted to concern for the homeowner, his predicament, the well-being of everyone in the home and the sentimental property we were trying to save.? Pragmatically he asked if the mitigation process would be completed by the time we met on July 5.? I responded, let's hope so.? If not, we'll have a traumatized and notably depressed homeowner in tow for the inspection.

7)? On July 3rd, we were instructed to perform a complete tear down of the bathroom and other affected areas where moisture could be trapped.

8) On July 4th we started that process. We knew that The Insured's house would be uninhabitable if we performed the complete tear-down, so out of respect for the holiday and everyone else's time, we demoed the crucial areas and quarantined the home to be inhabitable for a day or two maximum.??

At this point in the process I had no reason to believe that Lemonade would be the only insurance carrier in America that does not have a separate department for mitigation, that does not use ALE Solutions to relocate policyholder's whose homes become uninhabitable and that employs adjusters who have zero knowledge of the mitigation process, why the S500 is the standard, or the common sense to ascertain its functionality in terms of saving lives.? We already knew that we were going to wind up eating the cost of the extra days we spent there trying to salvage the homeowner's property, but unlike you, when someone tells me a story as heartbreaking as the Insured's. in regard to the sentimental nature of his property and that home, my human drive for compassion overrides any thought of a spreadsheet.

9) On July 5 our appointment was rained out with ______, Lemonade's IA.? I updated ______ on the status of the mitigation and informed him that we were going to have to relocate the Insured.? Assuming what every adjuster in this country should assume, _______ instructed me to reach out to the mitigation department.? I informed him that, unlike any mitigation I had ever worked on in my life, the mitigation department had made no contact with myself or the Insured.? I asked him for the contact info for the mitigation department.? He said he wasn't given contact info for the mitigation department either.

I found all of this to be strange, but not alarming.? In the age of AI, carriers are testing its functionality in the realm of claims.? Lemonade is a new player claiming AI functionality.? I assumed that AI and the holiday were the reason for this lapse in communication.? Keep in mind the only human voice we'd heard from Lemonade, now 5 days into the mitigation process was Richie's.? He's competent, knowledgeable and compassionate.? As Lemonade's representative in the field, I had zero cause for concern.? There was nothing over my entire lifespan thus far in this industry, that could have prepared me for the complete deviation from protocol, insurance ethics and law that we and the Insured are now experiencing. The worst part is that it's happening at the expense of the Insured's health, both mental and physical, and his property.

10) On July 6, we met with your IA.? We walked him through the property.? We explained why we hadn't performed the complete demo in the areas that still required mitigation.? The Insured stayed in his room the entire time and asked us to handle the inspection.? This is not uncommon.? Most homeowners don't understand why protocol is what it is and get uncomfortable when they are asked questions they can't answer, especially the technical one's.??

As a restoration contractor I am well versed in the traps that carriers like State Farm Agent , Allstate , Farm Bureau Insurance of Michigan , Auto-Owners Insurance , etc., will set to trigger denial when certain words are uttered innocently by the uniformed homeowner.? My advice to homeowners is to let the photos and the physical inspection speak for themselves.? In this case, the Insured was noticeably shaken by the state of his property and was not emotionally prepared to walk through the house.? Both your IA and I supported that decision out of compassion for the homeowner, and for the sake of functionality and an emotionally unbiased inspection.

We finished the inspection.? We agreed that the roof was the source of the water intrusion, to the scope of the damage as a direct result and the work we could could reasonably assume would be needed to remedy the loss in its entirety, minus any unforeseens, such as law and ordinance requirements, or? issues that might present themselves upon completion of the mitigation process.? He informed me again that he was not overseeing the mitigation process and to have the Insured or myself reach out to the desk adjuster in regard to housing.

Every adjuster or carrier employee that operates without bias or malintent loves working with me.? I make their job easy.? A lot of times I'm called in to overturn claims that have been underserved, which, by its nature is confrontational.? When a policyholder contacts me prior to making the claim, I operate as the carrier does on the homeowner's side.? My estimates are done in xactimate.? I never adjust the numbers.? If I can make my margin without adding O&P, I don't add it.? I exist simultaneously in the world of the adjuster and the builder, so I understand the plight of both and serve as a good medium between the two that, for the unbiased, often leads to prompt resolutions

I understand insurance law and ethics, but more importantly, I understand and fight to enforce the foundation of our judicial system, truth justice and liberty, as it pertains to both.? I actively work to eliminate anything that stands in antithesis to our foundation.? That often makes me an enemy to the carriers who put the spreadsheet over the well-being of their policyholder, or to the policyholder attempting to run a claim for profit.??

I know all of the carriers tricks for manipulating language to present policies as law to policyholders who are not the slightest bit versed in law or protocol, as a tool to enhance its profit margins by mitigating its payout on claims at the expense of the policyholder. Conversely, I see an insurance scam coming from a mile away.? I always do my best to assume that, in either direction, the tactics being used to capitalize are from a? place of blissful ignorance.? Before I assume malintent, I will attempt to educate rather than denigrate.? In? either case, what that typically does is it forces either party to show their cards.? In the case of the policyholder attempting to run an insurance scam, they just go away.? They know their money is no good with me and, since I've versed them on the consequences of what their attempting, they have a decision to make that doesn't involve me.

For the carrier its different.? If the Insured has brought me in, the carrier can't make me go away.? If the carrier is unbiased, free from malintent and in alignment with its primary function, to pay claims, they don't want me to go away because I've already done most of their job for them.? In the case of the carriers functioning as profit centers rather than claim payment centers, they'll show their cards.? They resort to policy semantics, that have no baring over anything and usually stand in direct antithesis to state law, so I'll tell them where to shove their policy language.??

Policy language means nothing to me.? Law and ethics do and, unfortunately the carriers who would like to believe their policies have the supreme governance over their internal operating procedure and the final outcome of their claims, they find out rather quickly that they are bound by the same law and ethics. When the carrier's semantics and manipulation tactics fail with me, the adjusters who aren't criminal and soulless will often acquiesce to a certain degree.? The adjuster will reason with me, tell me how their employer has their hands tied and we'll find a work around.??

The foulest players in the industry will revert to manipulation tactics where they circumvent the experts in the field and engage the Insured, the individual who has the least amount of knowledge in the claims process, is the most innocent and unsuspecting that a carrier would use their duress as a bargaining chip, and the easiest to manipulate into innocently saying words that can be used, feebly at best, as grounds for denial.? Does that tactic sound familiar?? It should.? Because you did it yesterday.? And after 20 minutes of the Insured describing his emotional state, the only thing a homeowner should be able to describe, you commenced with your manipulation tactics which, for all intents and and purposes, it appears you were hoping would provide you grounds for denial.??

You stated to the homeowner you are performing an investigation.? Investigation for what?? The claim is valid, so you're investigating what?? Grounds for denial?? You couldn't investigate your way out of wet paper bag.? Everything you're doing is an obvious and pathetic attempt to deny a valid claim.? My guess is you know that you dropped the ball completely on the mitigation process and now have your employer exposed to the possibility of a massive lawsuit, so rather than show compassion for the homeowner's plight, you selfishly want to hide your incompetence.?

I could be wrong. There could be several reasons for your choice to act in bad faith. I don't think that reason is Lemonade though. There are several things I've never had happen on a claim that I feel Lemonade, or any carrier for that matter, would never intentionally put into practice.

a) I've never had a mitigation claim with a carrier that didn't have a separate mitigation department.?

b) I've never had an adjuster completely disregard an IA's report and offer no apparent reason.

c) I've never had a desk adjuster lie to me about having received the IA's report.

d) I've never had it take 21 days from the date of the claim being filed for me or the Insured to hear a human voice from the carrier on a claim that required mitigation. In fact, on most mitigation claims, someone from the mitigation department is consistently on top of collecting photos and and dry out logs.

e) I've never not been asked for my estimate or all of my documentation. Typically the desk adjuster wants to examine all of the available information

f) I've never been told to stop mitigation once informed that coverage is available. Not only was it stopped, but it was done so without an explanation. You say you're investigating but no indication for what's being investigated, other than a reason to deny. If an investigation was going to be launched on a policy, wouldn't that have to be concluded prior to stating the coverages that are available to the homeowner upon giving him a claim number for the damage he made a claim for. That's odd.

Asking to speak homeowner's roommate after stating that his roommate was not covered on the policy and was on his own. That's odd.

Asking to speak to his neighbor about bringing a blown up shingle to the homeowner's attention. That's odd.

There's no logic to any of this. There's absolutely no reason, if there were any questions of coverage that those questions should arise 11 days into the mediatization. There should be no day 11 on a mitigation job this size. That makes it extremely odd that a human voice wasn't heard from Lemonade until 21 days in.

g) I've never had an adjuster, to my knowledge anyway, attempt to manipulate an IA into calling a claim something other than what he saw with his own eyes. Then, when he doesn't acquiesce, she completely abandons his report.

h) I've never seen an adjuster refuse to work with a mitigation contractor.

i)I've never had an adjuster tell a policyholder that he could not work with the contractor of his choice, refuse to communicate with the contractor, with the only apparent reason being the contractor started to hold those causing gaps in the process accountable.

j) I've never experienced bad faith carried out this sloppily with seemingly zero concern for the homeowner's suffering.

I digress...

11) If I'm not mistaking, the homeowner notified you of his need to relocate on the 8th.? You responded with zero concern for his health and instead told him how coverage had not yet been determined and that his roommate would not be covered even if it were.

12) On July 11th, 11 days into the mitigation process we hadn't heard a peep from you.? Keep in mind that the real players in the insurance industry, all of which have separate mitigation departments, would have been emailing me every other day for my documentation of the process? I had and still have all of the documents you see. I assumed I'd be handing them over throughout the mitigation process. On day 11 I notified you of another area of the roof where water was getting in still and notified you that we needed to tarp. I stated that I didn't want to tarp without permission due to the confusion thus far I sent photos, hoping it would prompt you to ask for he rest. Rather than ask for further documentation or agree to the tarp, you told us to abandon the process.

On July 11th, I sent photos unsolicited for clarity and rather than prompt you into action, you tell me to stop the mitigation process, while simultaneously attempting to manipulate the IA into calling this a mold claim to give you grounds for denial.? At this point I know you're only drive is to find grounds for denial.? I know you're one of the bad ones. For what reason, I have no clue.

13) On July 12th I intentionally give you the benefit of the doubt and attempt to educate you on the damage you're causing and the risk involved.? You ignored everything and instead commenced with telling me what wasn't covered because you hadn't done your job yet.? The email is copied and pasted below for your reference.

Nora,

We are now well over ten days from the date of the occurrence?on this claim.? I'm not sure what the hold up is at Lemonade, but this is a perfect example for why emergency mitigation is always done first and handled separately?from the claim.? Aside from the fact that there are two humans and two animals that inhabit that dwelling, that are all noticeably?congested, lethargic and anxiety ridden, the likelihood of areas of the home that we were forced to leave intact for the health of the inhabitants who were, for whatever reason, denied accommodations?to better serve their health, being further contaminated is almost 100%.??

I'm not sure if you're privy to how rapidly the organic process of growth and the spreading of contaminates takes place after a building is compromised from the roof down, but it's fast.? Very Fast.? We have approximately three days after the initial occurrence?to do our best preemptive work.? After that, all of the worst?case scenarios begin their transition?from possible to probable.? This includes?the consideration of compromised health for the inhabitants, which is now my primary concern.

Material things can be replaced.? The longer Lemonade?drags its feet, the more expensive?it gets for the carrier through, what we may deem unnecessary, red-tape, corporate? considerations and the contractors having to repeat mitigation steps twice as a result.? If the carrier opts to traverse?that course, the carrier has the money to do that.? It's frustrating?for the policyholder and contractors, but at the end of the day, if the carrier is willing to pay, it's a minor?frustration.

Humans and their health, as it pertains to contamination through the growth and spreading of the organic?contaminants that the mitigation process?was invented to thwart off, oftentimes cannot be replaced.? I know firsthand the dangers of this? type of contamination because?I almost died from it.? Literally. And the scariest?part of that is that I owned?a very successful restoration company , had been through the process of mitigation?on a multitude of claims, and was still oblivious to the growth in my own home, due to the lack of an event, such as this, to point to the possibility that it could even?be a problem.? ?

I'll spare everyone the details, but I'll just say my daughter?and I are blessed for me to have had the symptoms?of a brain tumor, which, when cleared, led me to a mold specialist who confirmed the contamination. Once the breeding ground for the more dangerous organic?contaminants?is established, and any scent or visible representation?of it eliminated from human perception, it becomes potentially fatal.??

Trapped moisture in walls and ceilings, concealed by insulation, once the surface damage is mitigated, will not make its presence known through sight or smell.? This is that breeding ground and is the one most dangerous to unsuspecting?humans.? That is why the professionals in this industry that do what we do, move in accordance with the S500 without question.? We know that if we don't eliminate the possibility of this breeding ground for being established, unnecessary?illness, suffering and?even death are possible.? That is why mitigation?is done separately, swiftly and with rigid compliance to the S500, and is typically free from the reckless?profiteering tactics that carriers invoke to enhance?their margins on property?losses.??

When I told you that I've never had a carrier stop me in the?middle?of the mitigation process, by forcing a homeowner?to inhabit a home on the verge of contamination, and then attempt to pass the buck back to the homeowner for its refusal, for whatever reason, to allow for mitigation to be carried out in its entirety, I wasn't exaggerating.? It has never happened, and for two very good, self-serving reasons for the?carrier.? First, the homeowner's responsibility?to mitigate ended when he signed with us to perform and further solidified the claim number offered by the carrier. To attempt to deny knowledge of this is an act of bad faith carried out6 via blatant misconduct. Second, the liability associated with the possibility that any growth is left behind far outweighs?the cost of doing it right on the front-end.

The?positive for the carrier and the?Insured?is that, at the?point?that the carrier and the Insured uphold their contract with one another, a company like ours becomes responsible, and therefore liable, for protecting the health of the Insured, to the extent we can, and preventing the possibility of future liability?for the carrier, to the extent we can.? When a carrier forces us to stop performing the only tried and true method for achieving?the responsibility we have to the insured and the?carrier, it's concerning, to say the least.

I understand?that insurance carriers are profit driven and that?that drive for profit can oftentimes override?the best interest?of the policyholder.? When it comes?to property, although I don't agree?with the tactics?employed by the larger carriers, compromises can be achieved without any major detriments.? When it comes to the well-being of the policyholder(s), there is no compromise.? The S500 was written?specifically to expedite?the process in the best interest of all parties involved.?

I'm not a licensed?adjuster, so I cannot speak on the details of the?Insured's?policy with?Lemonade. I can speak?in terms of overriding insurance law, code and ethics, as it pertains to the state of Michigan.? First I'll state that I'm confused as to what the hold up is in regard to the mitigation.? Mitigation is mitigation.? Damage is damage.? Direct and physical loss is direct and physical loss, a claim number,? is a claim number.? There is no possible scenario that does not stand in antithesis?to state law that would allow Lemonade or any other carrier to absolve itself from responsibility?for covering this loss.? I understand that?there may be policy provisions that could alter the financial?outcome, but there is no question of coverage.

Additionally, how could anything be questioned thoroughly without the input of the entity responsible?for mitigating the loss.? It would seem that my findings?would be a key component?in that determination.? I can assure?you that if you had asked for my documentation, there'd be nothing for you to consider?in this regard.? This is about as textbook a loss as one could be. This loss is told so clearly through the damage left behind by the storm event, and reflected in the photos, that there is no negating how things?transpired.? That would have saved?us a lot of time, but that's neither here nor there now.

The bottom line is we have to finish mitigating, both in the best interest of the Insured as well as Lemonade.? In order to do that, the Insured needs to be relocated.? Lemonade has already exposed itself to significant liability?if it doesn't alter its course?in the name of good faith immediately.??

The Insured, who wanted nothing to do with any of this claim, is actually traumatized by the altering of his childhood home and now finds himself? trapped?in?a powder keg.? It's the powder keg where the carrier imposes the threat?of further?financial?duress upon the Insured by creating the illusion that the carrier's fiduciary responsibility?is the Insured's upfront.? I'm not saying that that is yours or Lemonade's intent here, but because?it has?become the standard MO for the larger carriers on?the grand?scale, good carriers?have fallen into the trap of acting in this manner without realizing the abuse it inflicts on the policyholder. Citing Salesin vs. State Farm, it is??"unconscionable to require insureds to procure from their own funds, which they may not have, replacement property prior to receipt of full replacement cost since the insureds expected to receive such coverage by purchasing replacement value coverage." See?Gilderman,?supra?at 223.? This applies to any and all costs that are the proximate causation of the loss.

The Insured's responsibility?to mitigate is complete.? Any ensuing damage that may occur, as the direct result?of?his inability to allow the mitigation?process?to be carried through to completion at the behest of his carrier, is the carrier's burden to bear.? For everyone involved, I'm trying to prevent that liability from happening.?

Please enact your process to have the Insured relocated into a comparable property?to the one he currently inhabits, until this is all sorted out.? I will help in any way I can.? I am yours and the Insured's?most valuable resource with?which to navigate?this process.? In the interest of saving everyone involved time and stress while navigating this tumultuous?path, make me your first?stop when?you have questions.? I probably?have the answers.?

The Insured is cc'd on this correspondence.? Please advise.

Thank you,

--

Vince Orlando - Founder/CEO

Insurance Restoration Advocates of America

Troy, MI 48083

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It is crystal clear now that you are operating with malicious intent to deny. If Lemonade supports this behavior, it is operating that way too.? ?I'm not going to allow you to pollute the state of Michigan with your reprehensible disregard for your policyholders. Its bad enough they suffer a loss.? Hiving to deal with soulless, greedy adjusters and carriers like you and Lemonade who see the homeowner as a number and a means with which to achieve maximum profit margins, not humans suffering, is pouring salt on the wounds.? Not on my watch.?

Every offense, infraction and deviation from protocol, ethics and law you've committed is in writing.? I'm gong to provide you with photos of the damage.? I already provided you and the public with a clear and concise video showing the source of the damage and how it ensued.? I dare you to attempt to deny based on frivolous grounds.? ?

You can use this as a teaching moment, do? an immediate about-face and get the Insured relocated in something comparable today.? Today.? If you don't, you'll want to go back to The Meme School of Adjusting you got your license from and demand a refund, because your career will be over.

I've attached your pathetic attempt to look official that you used to try to manipulate?the Insured into giving you information you could use as grounds for denial.? Try to explain that away.? Explain how you circumvented the two experts on the claim, myself?and your IA, to ask the homeowner to provide?documents?you already know a homeowner has no knowledge?of.? Whoever told you this letter has legal implications?should get a refund from The Meme School?of Law.??

If the homeowner isn't relocated today and his?ACV released?in accordance with the IA's estimate, both you and Lemonade are going to have problems you don't want. If you attempt to circumvent?me or your IA again, your run in Michigan will be over.? The only reason I'm giving you this one opportunity to fix what you've broken is for the client.? So you better take it.

I'm not going to bother?proofing this.? You've already wasted enough of my time.? All the information will be coming in as a sworn proof of loss.? You know what that is right? If you do know what one is, why haven't you advised the policyholder that it exists and the deadline to get it in?

Make this right today, or I'm going to make you and Lemonade examples in a very public fashion.? This is not a threat.? It's full disclosure.? I don't believe in sucker punching