When Rod Buvens went to inspect Esther’s tile roof in 2019, he quickly discovered signs of damage.
Hurricane Irma tore through the area about 18 months ago, but the broken shingles still remain on the windward side of the roof — the one that took the brunt of the storm’s force. When Buvens tested other tiles by trying to lift them with three fingers, many of them were weakened.
Buvens, hired by St. Petersburg-based United Property and Casualty to evaluate homeowner claims, wrote a $70,000 estimate for a complete roof replacement.
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But that’s not what the homeowners got.
After reading Bouvens’ assessment, United Property and Casualty, known as UPC, sent engineers to the home. Engineers found six broken tiles, but did not report any damage. The final report — p Buvens name on it – said the claim is not covered and the homeowner owes $0.
The 2019 Bouvens case is the earliest known allegation of manipulation by an insurance company assessing homeowners to deny or limit a claim, a potential felony under state law.
In 2021, the state agency that investigates insurance fraud, the Department of Financial Services, was notified of the case, which emerged as a civil lawsuit.
But state investigators quickly dismissed the complaint without interviewing Bouvens. A spokesman for the agency’s chief, Florida Chief Financial Officer Jimmy Patronis, said the agency was closed. “in connection with the non-appearance of those taken.” However, this claim was refuted by Buvens during repeated observations emails to his office.
Since then, at least seven other regulators for insurance companies have issued statements their reports were similarly manipulated to pay homeowners less than they assessed. The four gave sworn statements in civil cases that can be used in criminal trials. Three others spoke during the Florida Legislature’s December session.
Patronis’ office reopened Bouvens’ case as part of a broader investigation into claims against United Property and Casualty, now insolvent.
The The initial response from state regulators shows how officials are handling fraud complaints from policyholders and their advocates, but not complaints about insurance companies, said Doug Quinn, executive director of the Insurance Association of America. Quinn’s association referred the case to Patronis’ office.
“There doesn’t seem to be any motivation to go after the insurance companies,” Quinn said.
An adjuster is dispatched to evaluate the claim
An Estero homeowner said contractor SFR Services urged him to file a lawsuit. The company saw the damage, prompting him to sign away his benefits in exchange for a deal with the homeowners insurance company, a subsidiary of United Property and Casualty.
“The contractors handled almost everything,” the owner said recently. He asked not to be named because he feared being in the news would make it more difficult for him to find homeowners insurance for his other properties.
(Lawmakers last year banned homeowners from turning over their insurance payments to a contractor, blaming the practice for driving up insurance costs.)
When she received the claim, United Property and Casualty passed on her an independent adjuster to assess the damage. Many insurers use contract adjusters after storms. Licensed adjusters document the damage, determine if it needs to be covered, and estimate repairs.
That contractor hired Bouvens, who was a licensed field adjuster after Hurricane Andrew in 1992. He also received his law degree from Louisiana State University.
With his experience, he was one of two field adjusters United Property and Casualty used to evaluate tile roofs in Collier and Lee counties, he later testified in depositions. Tiled roofs are often the most expensive type of roof.
Bouven saw that the wind had damaged the roof. He initially determined that the ceiling had water stains consistent with storm damage. He estimated that garage repairs and debris removal would cost another $1,376.30.
But an appraisal the homeowners later received from United Property and Casualty concluded there was no wind damage and they owed nothing.
The refusal triggered a lawsuit
The homeowners’ contractor, SFR Services, sued United Property and Casualty on their behalf.
In 2020, attorneys took Bouvens’ sworn testimony in the case.
When asked why he concluded the storm did not damage the home, Buvens said he was “told to put it on the report” by an adjuster who works for United Property and Casualty and the company that hired him. He said he was also told to shell out $1,376.30 for garage repairs and to remove trash. The company did not respond to requests for comment.
He added that the claims director approached him about the deposit and told him to “play ball” or “I’m not going to work for (United Property and Casualty) anymore,” Buvens testified.
“I said, ‘I’m telling the truth, the whole truth.’ If you don’t like it, I apologize. You’re going to have to do what you’re going to have to do.” »
Buvens said the assessment change orders didn’t stop at homeowners’ claims. United Property and Casualty was “The practice of handling claims is constantly changing,” he told the lawyers he knew of more than 1,000 cases “where they asked licensed adjusters to go against their statutory duty to handle claims in good faith with an insured.”
Bouvens said such cases included an insurance company that “ignored the damage” and “deleted the assessments that the adjuster wrote.”
United Property and Casualty offered to settle the case. The company paid $117,000, including $19,000 in legal fees to SFR Services, according to SFR President Ricky McGraw. The owners of the house have had their roof replaced.
Under Florida law, it is a felony of the third degree for someone to submit a loss estimate for an insurance claim if they know the estimate contains false, incomplete, or misleading information. The sanction provides up to five years of imprisonment. If the amount defrauded exceeds $100,000, it can be a first-degree felony, punishable by up to 30 years in prison.
Quinn of the Insurance Association of America was briefed on Buvens’ testimony by the attorney handling the case, John Tolley. The association uses membership fees to report fraud by insurance companies and promote best practices among state regulators.
Investigators from the association, including a former prosecutor, found Bouvens’ statement in the deposition to be legitimate. In 2021, they alerted the FBI and the Patronis office, which investigates insurance fraud.
There was precedent for the charges: In 2016, New York’s attorney general secured a guilty plea for an engineering firm and a former executive on charges of falsifying engineer reports on flood claims after Hurricane Sandy.
The association’s complaint was referred to a Florida Department of Financial Services fraud investigator.
the investigator asked Buvens to come to Fort Myers, where the department has a field office, he said the Herald/Times. Buvens was working in Texas at the time and asked to talk virtually.
Bouven said he had heard nothing more about it. The department closed the case “due to a lack of witnesses,” department spokesman Devin Galetta told the Herald/Times in December.
Buvens protested that he would not cooperate. As evidence, he forwarded several emails sent to Patronis’ primary address asking why he had only received “a single initial communication” in response to his complaint.
“Very clear, department did not respond to the numerous UPC complaints that were filed,” he wrote to Patronis.
Eight adjusters came out
Since then, at least seven other independent adjusters working for United Property and Casualty and other insurance companies in Florida have claimed their reports were similarly manipulated to dismiss the claims.
In testimony, two adjusters said they were only told to go home to document the damage — someone over their head would fill in whether the claim was covered.
In December, three other adjusters told a Florida House committee that insurance companies routinely changed inspection reports. They tracked down records showing how the 2022 requirement for one homeowner in Venice was reduced from $37,258 to $2,524.
After The Washington Post reported on her allegations in March, state lawmakers changed the law to require insurers to document the changes in the regulator’s report and include the name of the person who ordered the changes.
Quinn forwarded a complaint to Patronis’ office from another independent adjuster who works for United Property and Casualty. That adjuster, Niles Wood, revealed that the company had manipulated his claims. He shared the voicemail left on his phone from a United Property and Casualty employee who told him they needed to “reset” one homeowner’s assessment.
“This is again the UPC standard on these Hurricane Irma statements,” the employee said, according to a voicemail obtained by the Times/Herald. “The general loss statement should be changed to: ‘We are unable to determine the damage or date of loss of damage.’ »
Text messages sent to a group of adjusters show a supervisor telling them that due to Hurricane Irma claims, United Property and Casualty “no longer wants you to submit any damage estimates.”
“Rejections will be written on everyone,” the manager wrote. The messages were included in a federal racketeering lawsuit filed by SFR Services against United Property and Casualty and regulatory firms last year.
Patronis’ office said it had referred the cases to the state Office of Insurance Regulation, which can assess civil penalties rather than criminal charges.
Samantha Becker, a spokeswoman for the Office of Insurance Regulation, said they received a referral in Buvens’ case in January 2022. The office “thoroughly reviewed the complaint,” but Becker noted that United Property and Casualty’s financial condition is deteriorating when the investigation got off the ground.
By October, company officials told regulators they were pulling out of the Florida market, Becker said. The company is state-run, although its parent company still writes commercial building policies.
When asked about the adjusters’ cases in March, Patronis said his office was investigating. Buvens confirmed that the investigator reopened his case.
“If criminal activity is discovered, we will prosecute to the fullest extent,” Patronis told the Herald/Times.
But he warned that “there are two sides to every story.”
“Contractors can advocate. Public adjusters can advocate. Insurance companies can advocate,” Patronis said. “But I cannot emphasize enough: this is a disaster. There’s a reason they call it “disasters.” They will not go smoothly.”