advice**

We had hail damage to our rental home. Due to a disagreement between insurance and the roofer, in terms of repairing vs replacing, the roofer recommended a licensed public adjuster.

This adjuster sent a letter of representation to the insurance without my knowledge, forging my signature. Insurance sent a good-sized check to the adjuster with his name, my name, and the bank. The adjuster forges everyone's signature (including the mortgage holder) and cashes the check.

TX Department of Insurance Fraud is on the case; there are dozens of victims with similar stories.

My biggest issue right now is that insurance refuses to release the adjustor from my claim. Meaning, all future checks are still slotted to go to him, which is outrageous. They have asked me to call the criminal and request that he remove himself from the claim. We can't move forward with anything and are stuck.

Quote:

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I have also reassured ____ that due to the ongoing fraud investigation, should the public adjuster make contact we will advise him that we will not address any additional concerns with him. Unfortunately, without a release letter from the public adjuster any future payments must include the public adjuster.

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Damn. Can't help but that sucks.

Sure sounds like you need a lawyer. Maybe a reputable claims adjustor could help you with their lawyers?

harge57 said:

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Damn. Can't help but that sucks.

Sure sounds like you need a lawyer. Maybe a reputable claims adjustor could help you with their lawyers?

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I definitely 100% need a good, solid lawyer. This whole situation SUCKS.

AgsMyDude said:

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harge57 said:

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Damn. Can't help but that sucks.

Sure sounds like you need a lawyer. Maybe a reputable claims adjustor could help you with their lawyers?

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I definitely 100% need a good, solid lawyer. This whole situation SUCKS.

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If you're in the Houston area, Zak Patel

http://zakpatellaw.com/

Gaeilge said:

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AgsMyDude said:

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harge57 said:

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Damn. Can't help but that sucks.

Sure sounds like you need a lawyer. Maybe a reputable claims adjustor could help you with their lawyers?

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I definitely 100% need a good, solid lawyer. This whole situation SUCKS.

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If you're in the Houston area, Zak Patel

http://zakpatellaw.com/

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I'm in San Antonio, but I do appreciate it. Would prefer someone local, but will consider Zak.

A simple demand letter from an attorney should do the trick.

Scud Runner said:

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I would steer clear of any lawyers recommended by your roofer.

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Thankfully no work has been done yet so that roofer also lost this job.

But yes, good call.

This is a screwed up situation, lots of people involved. Approaching 1st degree felony territory.

I hate to hear that and hope you're successful in your recovery efforts.
6-7 years ago I had the exact opposite experience with a public adjuster for hail claim in which my carrier denied because "this can't be hail damage because the hail report from Hobby Airport indicates no hail on that date" (I live in far west Sugar Land). Carrier also blew their dates to accept or deny in writing, so they knew they had opened the door to extra contractual exposure. By the time he/we got finished with them I was made overflowingly whole.

Who is the PA?

When I was working at Bk of America insurance checks in joint names could not be deposited without both parties coming into the bank in person.
This is not helpful at all but the adage You Get What You Pay For really applies to insurance. That's why I ignore every thread slamming USAA for being too expensive.
You need to get off this site and start hunting for a good attorney.

OldArmyCT said:

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When I was working at Bk of America insurance checks in joint names could not be deposited without both parties coming into the bank in person.
This is not helpful at all but the adage You Get What You Pay For really applies to insurance. That's why I ignore every thread slamming USAA for being too expensive.
You need to get off this site and start hunting for a good attorney.

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Everyone involved is shocked whatever bank he goes to let's him cash these. He forged my name, my wife's and my mortgage company also. Probably has a guy who is getting kickbacks is my guess.

I agree and part of the reason for this post is looking for attorney recommendations.

OldArmyCT said:

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When I was working at Bk of America insurance checks in joint names could not be deposited without both parties coming into the bank in person.
This is not helpful at all but the adage You Get What You Pay For really applies to insurance. That's why I ignore every thread slamming USAA for being too expensive.
You need to get off this site and start hunting for a good attorney.

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OP said that the adjuster forged everyone's name

Who is your insurance company ?

Who is the mortgage holder ?

And what bank cashed the check ?

Try Steven Badger or Merlin Law Group. Both are heavily involved in claims litigation and take a lot of pro bono work to weed out bad PAs.

Merlin will for sure take care of things against the carrier. But they won't do anything with the PA. If you are wanting a lawyer to get the carrier to release the PA and then get you paid, they are great.

Badger lives to go after roofers and PAs. But he won't go after the carrier.

shalackin said:

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Merlin will for sure take care of things against the carrier. But they won't do anything with the PA. If you are wanting a lawyer to get the carrier to release the PA and then get you paid, they are great.

Badger lives to go after roofers and PAs. But he won't go after the carrier.

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I really don't care too much about going after the carrier.

Primarily want the PA off the claim

Secondarily want to go after the PA to try and get my money back. I don't see a way to get the carrier to pay me again, what they sent the PA already (that he forged and cashed)

But I'm no lawyer

AgsMyDude said:

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shalackin said:

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Merlin will for sure take care of things against the carrier. But they won't do anything with the PA. If you are wanting a lawyer to get the carrier to release the PA and then get you paid, they are great.

Badger lives to go after roofers and PAs. But he won't go after the carrier.

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I really don't care too much about going after the carrier.

Primarily want the PA off the claim

Secondarily want to go after the PA to try and get my money back. I don't see a way to get the carrier to pay me again, what they sent the PA already (that he forged and cashed)

But I'm no lawyer

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If you did not sign any form of a contract with the PA, or give any verbal agreement, you possibly could have the attorney get the carrier to pay you, and then they can go after the PA. I would call Merlin and ask them what they think. They will tell you how you should proceed. I don't think they have an office in SA, but cover all of Texas. Badger is only going to care if he can get a hold of a roofing company or the pa for a larger case. He represents carriers. Chad T Wilson is another firm that does a good job.

Who is the PA?

shalackin said:

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AgsMyDude said:

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shalackin said:

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Merlin will for sure take care of things against the carrier. But they won't do anything with the PA. If you are wanting a lawyer to get the carrier to release the PA and then get you paid, they are great.

Badger lives to go after roofers and PAs. But he won't go after the carrier.

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I really don't care too much about going after the carrier.

Primarily want the PA off the claim

Secondarily want to go after the PA to try and get my money back. I don't see a way to get the carrier to pay me again, what they sent the PA already (that he forged and cashed)

But I'm no lawyer

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If you did not sign any form of a contract with the PA, or give any verbal agreement, you possibly could have the attorney get the carrier to pay you, and then they can go after the PA. I would call Merlin and ask them what they think. They will tell you how you should proceed. I don't think they have an office in SA, but cover all of Texas. Badger is only going to care if he can get a hold of a roofing company or the pa for a larger case. He represents carriers. Chad T Wilson is another firm that does a good job.

Who is the PA?

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I signed an agreement directly with the PA, but it was directly related to their fee schedule. I did not send anything to the carrier authorizing him to represent me and send funds to him. He did that with a forged signature.

I'll give Merlin a call this week.

I'm not naming any names because this guy is still wanted and under investigation. He knows my address and I don't want to put my family and I at risk of anything. Feel free to DM me if you would like.

Merlin guys said they mostly likely will just recommend you call Ryan Fowler at Potts Law. So I would start there since I trust Merlin's guys.

https://potts-law.com/attorneys/j-ryan-fowler/

I would guess the "fee schedule" is also contract stating they are the PA on record. I don't know many PA's that separate the two contracts.

Also, I am not an attorney, or acting or representing myself as one. I am just a dude that knows some dudes and a few things.

The Maloney law firm in SA specializes in that type of Medical claims, from what I've heard in the past.

Sims said:

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If you're in contact with the Tx Dept of Ins, then I would find out who the adjusters GL coverage is with and file a claim.

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That's not how GL works. They open a claim if/when their insured submits it to them.

Ever heard of an AI claim?

Our GL policy is endorsed to add any party as an additional insured whenever a written contract specifies it.

Here's the thing, it's easy to make a claim. If they review coverage and deny it, whatever. If they review coverage and open a claim, he's got some potential backstop and it cost him a phone call. In the insurance world, even the threat of potentially being wrong when you don't think you have to cover something is enough to make you consider offering a settlement.

ETA: Even putting the adjusters GL on notice is going to gain OP additional leverage over the adjuster he didn't have before.

Sims said:

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Ever heard of an AU claim?

Our GL policy is endorsed to add any party as an additional insured whenever a written contract specifies it.

Here's the thing, it's easy to make a claim. If they review coverage and deny it, whatever. If they review coverage and open a claim, he's got some potential backstop and it cost him a phone call. In the insurance world, even the threat of potentially being wrong when you don't think you have to cover something is enough to make you consider offering a settlement.

ETA: Even putting the adjusters GL on notice is going to gain OP additional leverage over the adjuster he didn't have before.

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I am familiar with it, I work in the space. Blanket AI endorsements aren't setup for these types of customer relationships. Regardless, he already said he doesn't have a contract, so I'm not sure what your point is.

P.H. Dexippus said:

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Sims said:

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Ever heard of an AA claim?

Our GL policy is endorsed to add any party as an additional insured whenever a written contract specifies it.

Here's the thing, it's easy to make a claim. If they review coverage and deny it, whatever. If they review coverage and open a claim, he's got some potential backstop and it cost him a phone call. In the insurance world, even the threat of potentially being wrong when you don't think you have to cover something is enough to make you consider offering a settlement.

ETA: Even putting the adjusters GL on notice is going to gain OP additional leverage over the adjuster he didn't have before.

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I am familiar with it, I work in the space. Blanket AA endorsements aren't setup for these types of customer relationships. Regardless, he already said he doesn't have a contract, so I'm not sure what your point is.

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My point is play to win.

Re: the insurance discussion, I have a few thoughts if you really want to take a deeper dive. If not, then totally ignore my text wall below

1) A typical GL policy is not set up to cover liability associated with purposeful misrepresentation or fraud committed by the policy holder. In fact, it will specifically exclude these events. Same with the adjuster's E&O policy.

2) It was correctly stated that you do not typically just file a GL or E&O claim directly to the carrier like you would an auto liability claim. You would need to send the policy holder a demand and they will then report that as a potential claim to be investigated and hopefully to have legal defense provided.

3) In certain legal processes, you can bypass the named insured and attempt to file directly with the GL or E&O carrier but that is not common. That said, you would still need to have knowledge of the carrier and policy number. It's unlikely a COI was issued for a PA job so that information is usually not know in these cases.

4) I'm not sure how any party being an additional insured or not will impact whether a fraud accusation will be picked up as a covered claims event or give them the ability to bypass the named insured while issuing a demand. The AI endorsement does not broaden the coverage already offered to the named insured. It is also very unlikely a client of the PA would qualify as there what not be a written contract or requirement to list the client as AI.

5) There is also a real possibility that even if an AI where granted by contract, then that might make matters worse in the situation. Many policies include a "Cross Suits Liability" exclusion. The verbiage on that endorsement is key however as it's not terribly uncommon for the definition of "insured" to be broad enough to include any entity named as Additional Insured. This exclusion endorsement could mean that anyone listed as AI that submits a loss (whether valid or not) would not have any relief from the GL or E&O policy. In short, for this case anyway, an insured cannot sue another insured on the policy and expect the GL or E&O policy to respond.

6) Specific to fraud activities, you as the individual most take the responsibility to protect yourself either with good practices and/or purchasing some form of identity theft insurance, though as we all know that is not remotely fool proof. There is no policy that a business can purchase (even a commercial crime policy) that would respond to the owner directly and purposely committing an illegal act.

Thanks for listening, I'll hang up now

Roofer is in on the scam. I'd separate from both parties. Most roofers are crooks. Not some, but most. That's my take.

Investigator looked hard into him and has no belief the roofer is involved

I won't use him though

Reloadags1998 said:

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Re: the insurance discussion, I have a few thoughts if you really want to take a deeper dive. If not, then totally ignore my text wall below

1) A typical GL policy is not set up to cover liability associated with purposeful misrepresentation or fraud committed by the policy holder. In fact, it will specifically exclude these events. Same with the adjuster's E&O policy.

2) It was correctly stated that you do not typically just file a GL or E&O claim directly to the carrier like you would an auto liability claim. You would need to send the policy holder a demand and they will then report that as a potential claim to be investigated and hopefully to have legal defense provided.

3) In certain legal processes, you can bypass the named insured and attempt to file directly with the GL or E&O carrier but that is not common. That said, you would still need to have knowledge of the carrier and policy number. It's unlikely a COI was issued for a PA job so that information is usually not know in these cases.

4) I'm not sure how any party being an additional insured or not will impact whether a fraud accusation will be picked up as a covered claims event or give them the ability to bypass the named insured while issuing a demand. The AI endorsement does not broaden the coverage already offered to the named insured. It is also very unlikely a client of the PA would qualify as there what not be a written contract or requirement to list the client as AI.

5) There is also a real possibility that even if an AI where granted by contract, then that might make matters worse in the situation. Many policies include a "Cross Suits Liability" exclusion. The verbiage on that endorsement is key however as it's not terribly uncommon for the definition of "insured" to be broad enough to include any entity named as Additional Insured. This exclusion endorsement could mean that anyone listed as AI that submits a loss (whether valid or not) would not have any relief from the GL or E&O policy. In short, for this case anyway, an insured cannot sue another insured on the policy and expect the GL or E&O policy to respond.

6) Specific to fraud activities, you as the individual most take the responsibility to protect yourself either with good practices and/or purchasing some form of identity theft insurance, though as we all know that is not remotely fool proof. There is no policy that a business can purchase (even a commercial crime policy) that would respond to the owner directly and purposely committing an illegal act.

Thanks for listening, I'll hang up now

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Excellent Ted Talk.

What a terrible thing. Sorry to hear this has happened.

I have used the same Ag PA for a LONG time and never had any issues like this. What a shame. If I send it to PA, it gets bought, my customer gets the check. No other way.

I can't stress enough how important it is to know your roofer and his team. In a decade, I have yet to send or need to send any roofing to a lawyer. My toolbox is deep enough with enough experience it's not needed.

These guys make this job harder and harder. The sentiment that 'most roofers are crooks' is most unfortunate.

I've gone to a direct referral model. I am on the 'list' with most all of the local insurance carriers. If you call my local area insurance, odds are you'll be placed in contact with me directly. Everyone is tired of this no regulation, fly by night, roof out of your car horse crap.

I live and operate in San Antonio, BCS, Houston, Austin, etc which is why I try to encourage people to call. You don't have to use me, but I can put you in the driver's seat with information to avoid this kind of trash. Everything is by the books. Paper trails are clean and legit. This is 2025. You can't take chances. It's got to be by the book. It will save so much headache.

I hope you are able to get all of this sorted and cleaned up and I hope the crew is punished heavily.

It did not go to appraisal but allegedly that was coming soon.


Ironically he sent me a text asking if we could have a call so he could update me

First time in 6 months he's tried to contact me. Up until now he's dodged me with various excuses when I've tried to get a hold of him. I ignored him.

He probably caught wind of the second check he recurved being cancelled by my insurance company. And maybe he attempted to call them about something but they've been directed to not issue any more funds.

I really just need someone to right a demand letter to get him completely off the claim. They say he has to release himself, which he obviously won't do

I'm really sorry that happened. The entire thing is completely out of order on how I have had these handled. Shalackin gave good advice and I completely trust his experience and expertise. Do that. In the meantime, if you'd like, I can reach out to the Aggie Appraiser I use and see if he has any wisdom that will be of use.

So sorry this happened, and while it's no help at the moment, I personally feel the entire industry...roofing, insurance, etc is about to get a big overhaul to help keep this kind of thing from happening. Every time I get frustrated with a difficult customer I sit back and think of situation like yours where it's really hard for me to blame a customer for not trusting a contractor of any kind.

There is nothing legally I can help you with, but please don't hesitate to call me (contact in profile) if you want to vent or if you have any questions how how I have done things historically. Anything I can do the help information wise or contact wise, just reach out. Really hate to see anyone have to deal with this, especially fellow Ags. I'm on the west side, so if you get in a pickle or spring a leak while you navigate this, just give me a ring and I'll take care of it to whatever extent i can. Just call.