Some insurers alter claims with impunity, Florida adjusters say

TALLAHASSEE

When Rod Buvens climbed to inspect the tile roof of the Estero home in 2019, he quickly found signs of damage.

Hurricane Irma had churned through the area about 18 months earlier, but there were still broken tiles on the roof’s windward side — the side that bore the brunt of the storm’s force. When Buvens tested other tiles, trying to lift them with three fingers, many were loose.

Hired by St. Petersburg-based United Property and Casualty to assess the homeowners’ claim, Buvens wrote an estimate for a full roof replacement, at $70,000.

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But that’s not what the homeowners received.

After seeing Buvens’ estimate, United Property and Casualty, known as UPC, sent engineers to the home. The engineers found six broken tiles but reported no damage. A final report — with Buvens’ name on it — said the claim wasn’t covered and the homeowner was owed $0.

Buvens’ 2019 case is the earliest known accusation that an insurance company manipulated a homeowners’ assessment to reject or lowball a claim, a potential felony under state law.

The case, which came out in a civil lawsuit, was reported in 2021 to the state agency that investigates insurance fraud, the Department of Financial Services.

But state investigators quickly dismissed the complaint without interviewing Buvens. A spokesperson for the head of the agency, Florida Chief Financial Officer Jimmy Patronis, said it was closed “due to lack of participation by witnesses.” Yet that claim was refuted by Buvens in repeated follow-up emails to his office.

Since then, at least seven other adjusters for insurance companies have come forward saying their reports were similarly manipulated to pay homeowners less than their claim estimates. Four have given sworn testimony in civil cases, which can be used in criminal court. Three others spoke during the Florida legislative session in December.

Patronis’ office has reopened Buvens’ case as part of a larger investigation into claims against United Property and Casualty, now insolvent.

The initial response from state regulators reflects how officials pursue complaints of fraud by policyholders and their advocates but not complaints against insurance companies, said Doug Quinn, executive director of the American Policyholder Association. It was Quinn’s association that referred the case to Patronis’ office.

“There appears to be no motivation to go after insurance companies,” Quinn said.

Adjuster sent to assess claim

The owner of the Estero home said he was encouraged to file a claim by a contractor, SFR Services. The company had seen the damage, and it encouraged him to sign over his benefits in exchange for dealing with the homeowners’ insurance company, a subsidiary of United Property and Casualty.

“The contractors pretty much handled everything,” the owner said recently. He asked that his name not be used because he feared appearing in a news story would make it harder for him to find homeowners insurance for his other properties.

(Lawmakers last year banned homeowners from assigning their insurance benefits to a contractor, blaming such practices for driving up insurance prices.)

When it received the claim, United Property and Casualty assigned an independent adjuster to assess the damage. Many insurers use contracted adjusters after storms. Licensed adjusters document the damage, determine whether it should be covered and estimate the repairs.

That contractor employed Buvens, who had been a licensed field adjuster since 1992′s Hurricane Andrew. He also had a law degree from Louisiana State University.

With his experience, he was one of only two field adjusters that United Property and Casualty used for assessing tile roofs in Collier and Lee counties, he later testified in a deposition. Tile roofs are often the most expensive type of roof.

Buvens saw that wind had damaged the roof. The ceiling had water stains consistent with storm damage, he originally determined. He estimated repairing the garage and removing debris would cost another $1,376.30.

But the estimate that the homeowners later received from United Property and Casualty concluded there was no wind damage, and they were owed nothing.

Denial triggered lawsuit

The homeowners’ contractor, SFR Services, sued United Property and Casualty on their behalf.

In 2020, lawyers took Buvens’ sworn deposition for the case.

When asked why he concluded that there was no storm damage to the home, Buvens said he was “told to put that in the report” by a desk adjuster working for United Property and Casualty and by the company that hired him. He said that they also told him to remove the $1,376.30 to repair the garage and remove debris. The company did not respond to requests for comment.

He added that the claim director approached him about the deposition and told him to “play ball” or “I wouldn’t be working for [United Property and Casualty] anymore,” Buvens testified.

“I said, ‘I tell the truth, the whole truth. If you don’t like it, I’m sorry about that. You will have to do what you have to do.’ ”

Orders to change estimates didn’t stop at that particular homeowners’ claim, Buvens said. United Property and Casualty was “constantly changing claim-handling practices,” he told lawyers, saying he knew of more than 1,000 instances “where they asked licensed field adjusters to go against their statutory duties to handle claims in good faith with the policyholder.”

Buvens said such instances included the insurance company “ignoring damages” and “removing estimates that the field adjuster wrote.”

United Property and Casualty offered to settle the case. The company paid $117,000, including $19,000 in SFR Services’ legal fees, according to SFR’s president, Ricky McGraw. The homeowners’ roof was replaced.

Under Florida law, it’s a third-degree felony for someone to produce a loss estimate for an insurance claim if they know the estimate contains false, incomplete or misleading information. The penalty is up to five years in prison. If the fraudulent amount is more than $100,000, it could be a first-degree felony with up to 30 years in prison.

Quinn, with the American Policyholder Association, was told about Buvens’ testimony by the lawyer handling the case, John Tolley. The association uses membership dues to report fraud by insurance companies and promote best practices among state regulators.

Investigators with the association, including a former prosecutor, felt Buvens’ statement in the deposition was legitimate. In 2021, they alerted the FBI and Patronis’ office — which investigates insurance fraud.

The allegations had a precedent: In 2016, New York’s attorney general secured guilty pleas against an engineering firm and a former executive on charges of falsifying engineers’ reports on flood claims after Hurricane Sandy.

The association’s complaint went to a fraud investigator at Florida’s Department of Financial Services.

The investigator asked Buvens to come to Fort Myers, where the department has a field office, he told the Herald/Times. Buvens was working in Texas at the time and asked to talk virtually.

Buvens said he never heard anything more about it. The department closed the case “due to lack of participation by witnesses,” department spokesperson Devin Galetta told the Herald/Times in December.

Buvens disputed that he wouldn’t cooperate. As evidence, he forwarded multiple emails sent to Patronis’ main address asking why he had received only “one, single initial communication” in response to his complaint.

“Very plainly, the department has not followed up on the numerous UPC complaints that have been filed,” he wrote to Patronis.

Eight adjusters have come forward

Since then, at least seven other independent adjusters working for United Property and Casualty and other Florida-based insurers have alleged their reports were similarly manipulated to reject claims.

In depositions, two adjusters said they were told only to go to the home to document the damage — someone above their head would fill out whether the claim was covered.

In December, three other adjusters told a Florida House committee that insurance companies were routinely altering inspection reports. They followed up with records showing how one Venice homeowner’s 2022 claim was reduced from $37,258 to $2,524.

After The Washington Post wrote about their allegations in March, state lawmakers changed the law to require insurers to document changes to an adjuster’s report and include the name of the person who ordered the changes.

Quinn forwarded to Patronis’ office a complaint by another independent adjuster working for United Property and Casualty. That adjuster, Niles Wood, testified that the company had manipulated his claims. He shared a voicemail left on his phone from a United Property and Casualty employee telling him that they need one homeowner’s estimate “zeroed out.”

“This is again UPC standard on these Hurricane Irma claims,” the employee says, according to the voicemail obtained by the Times/Herald. “The general loss statement needs to be changed to, ‘We cannot determine the damage or the date of loss of the damage.’ ”

Text messages sent to a group of adjusters show a supervisor telling them that on Hurricane Irma claims, United Property and Casualty “no longer want you to turn in any estimate whatsoever for any damages.”

“They are going to be doing denials on all of them,” the supervisor wrote. The messages were included in a federal racketeering lawsuit filed by SFR Services against United Property and Casualty and adjusting firms last year.

Patronis’ office said they referred the cases to the state Office of Insurance Regulation, which can assess civil fines, not criminal charges.

Office of Insurance Regulation spokesperson Samantha Bequer said they received the referral on Buvens’ case in January 2022. The office “reviewed the complaint in-depth,” but Bequer noted that United Property and Casualty’s financial condition was deteriorating as the investigation got off the ground.

By October, company officials told regulators they were pulling out of the Florida market, Bequer said. The company is in state receivership, although its parent company still writes policies on commercial buildings.

When asked about the adjusters’ cases in March, Patronis said his office was investigating. Buvens confirmed that an investigator has reopened his case.

“If there’s criminal acts being found, we will prosecute to the fullest extent,” Patronis told the Herald/Times.

But he cautioned that “there’s two sides to every story.”

“Contractors can suck. Public adjusters can suck. Insurance companies can suck,” Patronis said. “But I can’t stress enough: It’s a disaster. There’s a reason why they call it ‘disasters.’ They’re not going to go smoothly.”