More than a decade ago in Tampa, I presented my marketing workshop, Soft Selling Hardened Claims Adjusters, and among the group of typical restoration and mitigation contractors in attendance was a colorful husband and wife team from the east coast.

They introduced themselves as crime scene cleaners. It struck me as a novel concept back then. I knew it was an unusual expertise that the average adjuster doesn’t often encounter, even during a career spanning decades.

They loved the workshop and told me they wanted me to speak at their association’s annual conference, but they were having a hard time convincing the governing body that my unique program about marketing to and working with insurance adjusters could be an extremely valuable education resource.

Within a year or so I was speaking at their national conference and have continued to do so regularly. I’ll never forget during one of the conferences that a restoration contractor (who started out as a crime scene cleaner) said to me: “Something I learned from you last year made a difference in my bottom line to the tune of a couple hundred thousand dollars.”

I was pleased I could help individuals from this group. Now, I want to share some things that I’ve learned from them.

Bio-recovery lessons

Initially focused on crime and trauma scene clean-up, the scope of bio-recovery technicians and trauma waste practitioners has grown to include the decontamination of diseases associated with animal waste, bird waste, rodent waste, human waste, tissue and body fluids, mold, homes unfit for habitation, meth lab cleanup, communicable disease infection control, pickup and transport of medical waste and remediation of bio-terrorism related contaminants such as anthrax.

Many of them have also moved into restoration of fire or water damaged properties, and my observation is that the transition from crime scene clean-up to full-blown restoration contracting is logical, seamless and lucrative.

I’ve come to know their business model including their challenges in dealing with adjusters and estimating software companies that refuse to recognize the complexity and standards in pricing bio-hazardous clean up.

The first problem arises out of the language in most policies addressing mold and any other hazardous exposure that involves an element of bacteriological contamination. The following are excerpts from a standard homeowner’s policy that might be encountered:

“We do not, however, insure for loss caused by mold, fungus, or wet rot, birds, vermin, rodents, or insects; animals owned or kept by the insured;”

“We do not insure for loss caused directly or indirectly by intentional loss which means any loss arising out of any act an insured commits or conspires to commit with the intent to cause a loss. In the event of such loss, no insured is entitled to coverage, even insured’s who did not commit or conspire to commit the act causing the loss.”

When an adjuster has trouble covering a claim with a bio-hazard component, it’s usually because of such wording in the policy.

The adjuster’s first reaction to a claim for damages related to a suicide is “It sounds like an intentional act; therefore, no coverage.”

A reasonable adjuster could be convinced that the intentional act was not to spray the carpet and walls with blood and tissue.

The damage to surrounding property was not considered by the suicide victim. The only intent was to end one’s life. This is true even if the remains were discovered weeks later, allowing extensive contamination and the spreading of bacterial growth and the permanent staining of walls, ceilings and flooring.

But even after eliminating “intentional act” from a coverage defense, you may still have an adjuster who is hung up on the policy exclusions dealing with mold, fungus and other bacterial growth.

This is why I tell contractors to focus their estimate line items on removal, clean-up and repair of staining and actual physical damage to property. The fact that six inches of dirty syringes are piled on the floor shouldn’t be cause for denial because of their possible bacteriological contamination. The clean-up of such syringes should be covered because it was necessary in order to repair the surrounding damage.

The fact that special hourly rates are allowable is more related to possible injuries to workers and U.S. Occupational Safety and Health Administration (OSHA) requirements.

Your use of terminology is extremely important and closely scrutinized by the adjuster reviewing your itemized estimate or invoice.

Tragic lessons

A crime scene cleaner once wrote to me about a family that suffered a tragic suicide of their son and they were having trouble getting coverage for the clean-up.

You can learn from our dialogue. Here it is, in its entirety:

Dear Peter:

I have two questions. We had a situation where a 14-year-old appears to have committed suicide in his parent’s home. It has been a real task to clean and repair the damage. It was the worst I’ve seen in 25 years. The adjuster seemed cooperative but he kept referring to estimating software biohazard prices (about $110, and we charge $225) so I’m anticipating a problem. I’m not sure how to handle this potential problem with rates.

An even bigger problem is that the family is being told their closet contents (bio-residue splattered on every piece of clothing), are not covered.

Dear Crime Scene Cleaner:

First, I’d keep the man-hours close to my chest. Don’t cut the man-hours.

Before you reveal the man-hours you could argue that the estimating software bio-hazard rates do not match up to every individual job (they are just a guideline). That is, certain jobs are more intense than others and the hourly rate should be higher, etc. (you probably have your own arguments to support $225).

So he will probably negotiate the hourly rate up from $110. You and he might agree to an hourly rate of $195. This helps him save face and may be a rate you could live with. Maybe you’ve underestimated your man-hours. The actual man-hours are something the estimating software will not help him on because that’s a judgment call (or it’s what you have into it). But by no means should you reveal or modify the man-hours until after you’ve agreed on an hourly rate.

There are mixed signals on the contents. For him to say “contents coverage exists in the policy” is technically not the same as saying the “contents are covered from this incident.” But, it’s easy for people to become confused as to what they were told.

The adjuster should put in writing why there’s no contents coverage. Then you can figure what his thinking is. Frankly, if everything else is covered, I don’t see why the contents wouldn’t be covered. But on the possibility there might be a “bio-hazard contamination” issue I would emphasize that the contents were total losses mainly because of staining from blood and not as a result of a bio-hazard. That is the truth.

[End of dialogue.]

Protect yourself

Eventually this crime scene cleaner reported back to me that the adjuster had agreed that contents were covered and they were able to come to terms on the pricing.

But herein is a cautionary alert to readers: Make sure you legally protect yourselves to insure payment by the ultimate responsible party — the property owner.

You may be able to assist in their filing an insurance claim or, if there is no insurance, the Crime Victims Board may be in a position to authorize and pay for bio-recovery services.

 


 

Peter Crosa has been a licensed independent adjuster for more than 35 years, handling insurance claims throughout the United States and Latin America. Since 2000, he has traveled across the country conducting seminars and speeches on the topic of marketing restoration services to the insurance claims industry. He is author of the 2010 Restoration Contractors Guide to Insurance Repair. Visit his website at www.sshca.net or e-mail him your question at peter@sshca.net.