Civil fraud vs Criminal fraud?

I am a Katrina disaster victim. Basically, my insurance company sold me a hurricane policy on which I could never make a successful claim of any significance.

Is it criminal fraud to sell someone a piano, but lock the piano up so the buyer cannot get to it? This seems to be what the insurance company did to me. I would appreciate any comments.

Thanks

What do you mean by "...successful claim of any significance?"

I mean the full value of the policy or a half, third, or even one fourth of that value. Quite possibly it could be the case, given my deductible, that I could never recover anything!

Here is a link to my web site that offers a more thorough explanation:

http://www.vstretch.net/truth%20or%20fraud.htm

Thanks again for your comments.

Hello there!

Regretfully, your insurance provider has taken the correct interpretation (as far as I can see). The overwhelming majority of hurricane and general homeowners' insurance products cover non-flood related damange (for hurricane insurance, this largely implies wind damage). If you did not have a *separate* flood insurance policy to adequately cover your assessed damage and have a filed a claim for damages specifically caused by flooding, your insurance company is not at all liable to fulfill your claim.

I should note that you are hardly alone in your scenario. There are thousands upon thousands of claims currently in the system from victims of this past year's hurricane season whose hurricane and homeowners insurance policies did not cover flood damage. In these cases, the issues being reviewed are not whether the policies cover flood damage (as virtually all such general homeowners and hurricane insurance products disclaim this liability) but whether the assessed damage was caused by flooding or by wind conditions. Depending on how much you have already detailed in your claim, you should probably consider this route; also, if you have filed for particularly large damages, you may also consider seeking a local insurance attorney to help in your situation.

Brad

Thanks for the reply; however, you seem to have missed the point.

I am not arguing that the insurance company's exclusionary statement is ambiguous with respect to "flood" or "wind." In fact, I will give you the point that it reads as is, which is to say that they have no liability, if there is any damage that is "contributed to" or "aggravated by" spray from the surge.

Given “surge” and “spray” from that water ALWAYS accompanies a "hurricane," my point is simply that there is no situation where I would be in a position to recover anywhere near the value of the policy for which I, in good faith, paid full premiums!

We lived on the second floor of a six story building overlooking the beach. Even if a door was compromised and a gust of "wind" did come into our condominium, it would certainly be blowing "spray," because "hurricanes" are ALWAYS accompanied by "surge" and "hurricane" force "winds" are ALWAYS going to blow "spray" from the surge! (If you cannot envision “spray,” think of a windstorm in the desert - sand everywhere.)

We left Biloxi on Sunday morning (Katrina hit on Monday), and the surge was already moving up the beach. There were no significant "winds" on shore yet, but the surge was already present. By the time the winds were at "hurricane" force (the reason for the policy) there would have to be significant "spray" coming off the surge. Remember, we are overlooking the beach! In fact, even with less than Category three surge figures, our building would be surrounded by water. So, even if your “wind” blew the entire contents of our condo out of the building, everything would end up in the surge!

To get you on the right track, please remember my issue concerns "contents" and "contents only." I believe you have confused my issue with the larger issue of insurance on the building.

Given what you know about my circumstances (geographical), the fact that winds must be “hurricane” force, the fact that to damage our contents the building must be compromised, and the surge figures associated with the Saffir-Simpson scale (you can cut and paste this url: http://www.nhc.noaa.gov/aboutsshs.shtml), what possible scenario could you dream up where I would be in a position to collect the full value of the policy for damaged "contents" and the full value of the policy for "loss of use?"

If you (or anyone for that matter) cannot come up with a reasonable scenario to cause the damage we believed we were covered against when we purchased "hurricane" coverage, then are you not suggesting the policy sold to us by MetLife was a fraud?

Thanks for your response.

Hello again!

The policy you purchased is virtually identical to that sold in every other state where MetLife is licensed with at best a few subtle changes in verbiage to account for differences in state insurance regulation. That said, any mention of coverage for hurricane damage is taken to be coverage of hurricane damage in general, without specific considerations for higher-risk areas. In fact, the only true difference in an insurance product across geographies is the premium, which is valued to account for higher or lower risk factors in different regions across the country.

Given the overwhelming prevalence of water damage (caused by both flooding and structural leaks), insurance companies have found it difficult to include water damage coverage in their policies; therefore, this higher-priced coverage is usually included as a separate product which carries its own premium and its own policy.

Since it does not sound like any water damage coverage was purchased in advance, your insurance company is entitled to deny any claim in which water damage is an apparent factor in the damages you are claiming. The verbiage you reference in your policy about a hurricane deductible is only intended to imply damage clearly caused by a storm's wind factors (e.g., your roof is peeled away, some windows are broken, etc. -- note the coverage specific to "Dwelling" and "Private Structures") --- if you filed a claim about damage in which water COULD have been a factor (e.g., disabled electronics, etc.) and spray/water was/is present on/in the items, then the disclaimer against water damage in your policy takes effect and excludes your insurance company from fulfilling your claim.

Scenarios in which you could have a claim fulfilled may include the following:

- Loss/Damage of property due to theft
- Inland storm (including a hurricane) that causes structural failure resulting in damage to your dwelling's contents PROVIDED that moisture can be excluded as the cause of damage

You may naturally ask, therefore, why your policy does not cover water damage even though you reside on the shoreline. As mentioned earlier, water damage is a very prevalent issue, and is particularly problematic in high risk areas including: a., locations below sea level (e.g., New Orleans); b., locations in direct proximity to a shoreline (specifically in areas at-risk for hurricanes); and c., areas with a known history of flooding. This kind of coverage is considerably more expensive than other insurance products and given that a sizable portion of insurance customers have no need for it, it is is sold as a separate product to those who express an interest. While it is surprising that your insurance sales representative did not recommend a flood insurance product during your sales call given your location, the fact remains that your insurance company is not liable for the kind of damage you describe under the coverage you purchased. If you anticipate this being a problem in the future, you should consider purchasing some solid coverage against water damage; if the premiums for this kind of insurance in your area are too high for your budget, you may even consider seeking an alternative residence farther inland.

To better help you in your present situation, please post a reply itemizing the claim(s) you filed (i.e., item description and item valuation) to better determine if your claim can be presented as non-water related.

Brad

Once again, I appreciate your reply, and (once again) it appears you have missed the boat.

Clearly, there are many issues to discuss; however, we need to get the “fraud” issue out of the way first (then I will be happy to discuss other issues you seem to think are important)!

To keep you on track, I will repeat the same two questions I asked in my last response. Please remember, these questions are asked in the context of our having purchased “hurricane” insurance. You know we had “hurricane” coverage (whatever that means) because we had an additional “hurricane loss deductible of $500." Consequently, any answer you give must activate the “hurricane” deductible” and be relevant to our particular circumstances.

1.Given what you know about our policy exclusion (no “contribution” to or “aggravation” by “spray” from surge); what you know about our circumstances (we overlook the gulf and live on the second floor of a six story building); the fact that winds must be “hurricane” force (otherwise there can be no “hurricane” damage from anything); the fact that to damage our “contents” and to be eligible for “loss of use” the building must be severely compromised (very powerful winds); and the fact that surge of varying levels is associated with “hurricane” force winds according to information posted by the National Hurricane Center relating to the Saffir-Simpson scale http://www.nhc.noaa.gov/aboutsshs.shtml ; what possible scenario could you dream up where I would be in a position to collect the full value of the policy for damaged "contents" and the full value of the policy for "loss of use?"

In your last response, you suggested we could collect for “theft” or an “inland storm.” Unfortunately, your scenarios failed to meet the criteria of being relevant to the “hurricane deductible” in the first case and our particular situation in the second.

2. If you (or anyone for that matter) cannot come up with a reasonable scenario to cause the damage we believed we were insured against when we purchased "hurricane" coverage, then are you not suggesting the policy sold to us by MetLife was a fraud?

Thanks again for your efforts to answer these two questions!

Hello again!

My apologies if the length of my response muddled the part where I addressed the hurricane deductible! :-) In any case, here's a quote from where I addressed it (third paragraph in my prior post):

It is not the responsibility of your insurance company to tailor any product to your location and the risks that exist there --- it is up to you, as the owner, to determine which products you need given your circumstances (an insurance sales agent may guide you to a particular product, if they feel it is appropriate, though they are not required to do so).

Let me know if this clears things up!

Brad

Once again, you refused to answer my questions. It would seem you are incapable of describing a “hurricane” scenario in which I could collect the full amount of my policy for either loss of “contents” or “loss of use.” I am not surprised, because I do not believe one exists, and that is the issue.

I paid full premiums for “hurricane” coverage of some sort, yet you cannot come up with a reasonable scenario in which I could collect full benefit. I suspect that IS your answer to my first question (if not please provide a reasonable scenario that is relevant to “hurricanes” and our particular situation), which leads us to the second question:

2. If you (or anyone for that matter) cannot come up with a reasonable scenario to cause the damage we believed we were insured against when we purchased "hurricane" coverage that would not be excluded by the policy, then are you not suggesting the policy sold to us by MetLife was a fraud?

Hopefully, you will answer the questions this time. You could start your response with “my answer to your first question is . . .” and then follow that statement with “my answer to your second question is . . .”

Thanks again for directing your response to what is being asked.