# Insurance Fraud?



## Steep Team (Sep 6, 2008)

Buildpinnacle, 
That was the BEST post I have read in a long time on this subject. I do not give the deductible away ever! When the homeowner buys his insurance policy he AGREES to paying the said amount of deductible. I use the same line with the homeowner, If the other contractor wants to play in the gray area with the deductible what will he do when there is a problem? I will not go to jail for your roof because I am sure you will not go to jail for mine. Next time you get into a fender bender tell the body shop that they will be paying your deductible because you refuse to and they will tell you to piss off.


----------



## Atfulldraw (May 1, 2009)

buildpinnacle said:


> I guess I will go ahead and let my voice be heard on this one. First off, we will NOT cover a deductible amount on any type of claim that we are acting as the insured's pre-contracted contractor.....you cannot do that and legally work the claim.
> 
> In an RCV (replacement cost value) policy, the insurance company will generally pay the claim in two seperate payments. The first payment is the ACV (actual cash value) of the claim less the deductible amount. Also known as the depreciated value. The remaining funds, or recoverable depreciation, are billed to the insurance company by our company with a copy of our contract, a certificate of completion signed by the insured, and an invoice/statement showing the total contract amount less all previous payments which leaves us with the recoverable amounts.
> 
> ...


You sure did save me a lot of typing!:thumbsup:

When in doubt, do the right thing.


----------



## BEAUMONT1 (Jul 8, 2009)

Ed the Roofer said:


> I wonder how much the website developer got for creating those custom websites? :whistling
> 
> (To the roofing contractor, I am NOT making fun of your sites)
> 
> ...


Not to detract from the topic at hand, but I thought that I should clarify issues from the discussion topic. I built the websites for Glick Construction and Gunner Construction, and they are completely separate companies. They are independently owned by brothers who are both in the industry. For your comments regarding website pricing and Yahoo SiteBuilder, I would reply as follows:

1. Yes, SiteBuilder is easy to use and is a drag n' drop application. For small businesses, I can build them a site for under $1000.00 that they can host for less than $20.00 per month. Unless you know some computer programming and dig into the computer code behind the sites, you wouldn't know that they were built using a free Yahoo CMS. 

2. Since SiteBuilder is easy to use, they can modify their content down the road on their own without paying someone to make the changes.

3. Paying $5,000, $10,000 or more for a website isn't a smart option for many small businesses, and a low-maintenance affordable option can be very effective.

4. Just to defend myself, I can build sites in more advanced CMSs (ex. mnrenewableenergies dot com), but some clients want an inexpensive option that they can maintain on their own without knowing computer programming skills or paying for licensing fees.


----------



## kse1221 (Oct 1, 2008)

this is just my 2 cents... i am trying to get into the roofing business here in the houston area.. i am working for a company that flat refuses to eat deductibles.. which is fine with me.. i hear of other companies giving the customer sign bonuses to reduce their deductible. and from what i hear everyone is eating some part of the deductible.. the problem is how can you eat a huge deductible.. i have seen people in $500k homes have to pay $10k deductibles.. how can anyone absorb a deductible like this.. most everything here falls under the named storm clause because of hurricane ike. that is usually a 2% deductible.. so even if you have a $150k policy that is $3k.. the problem down here is that people in a $150k home dont have $3k laying around.. so there are alot of roofs down hear that still have damage. look at the classified ads on this site for jobs.. there is a guy from texas looking for roofing salesman and he says he has a letter from the attorney general and can eat deductibles or something like that.. how is this done because if people can get a free roof then that is alot easier to sell. thanks again, this site is great and i enjoy hearing the responses.


----------



## ScaryLari (Jul 7, 2009)

Its widely use all over the country the insurance companies numbers are good for the most part. Not saying its right i have sold both ways as the one guy says people are broke.

As far as Tx goes you can have it been there done that the numbers suck people are eating deductibles all over the place. I worked and signed a deal in the hood, the lady was already turned down and they paid 1500.00. On that i called a re inspection got her 23k Legit not scamming anyone. This lay writes a bad check for 6,800.00 then tells us shes having someone else do it. The new guys was redoing roof all new flooring the whole house painted new windows new cabinets and counters you name it. Guys were Spanish you can pick them up at the Home Depot All Day Long. Thousands of them illegal id bet 90% of them. Things suck In Texas 190.00 a sq what i sold 30yr for and was getting beat by 145.00 a sq. 

If they aint got money what can you do they will sign with no out of pocket money 60% of the time. It is easy to eat them up north in the south we have Hurricane that run on avg 5% of home value and Tx has a hail dect. from 1-3%

I have a buddy in Boston right now eating 1k and still making 20% it really sucks to eat 1k but on a 26k claim its not to bad.


----------



## ScaryLari (Jul 7, 2009)

Steep Team said:


> Buildpinnacle,
> That was the BEST post I have read in a long time on this subject. I do not give the deductible away ever! When the homeowner buys his insurance policy he AGREES to paying the said amount of deductible. I use the same line with the homeowner, If the other contractor wants to play in the gray area with the deductible what will he do when there is a problem? I will not go to jail for your roof because I am sure you will not go to jail for mine. Next time you get into a fender bender tell the body shop that they will be paying your deductible because you refuse to and they will tell you to piss off.


 
Your looney I havent paid one ever on my car unless it was a total and i have been in around 15


----------



## ScaryLari (Jul 7, 2009)

BEAUMONT1 said:


> Not to detract from the topic at hand, but I thought that I should clarify issues from the discussion topic. I built the websites for Glick Construction and Gunner Construction, and they are completely separate companies. They are independently owned by brothers who are both in the industry. For your comments regarding website pricing and Yahoo SiteBuilder, I would reply as follows:
> 
> 1. Yes, SiteBuilder is easy to use and is a drag n' drop application. For small businesses, I can build them a site for under $1000.00 that they can host for less than $20.00 per month. Unless you know some computer programming and dig into the computer code behind the sites, you wouldn't know that they were built using a free Yahoo CMS.
> 
> ...


 
I have a site done with yahoo site builder, its a easy program yes but you pay double if not triple for hosting and you cant move it off yahoo or it messes your site up its wack. Web Builder 5 is just as easy and you can host it anywhere for 5 or less a month. I so regret using yahoo makes me want to puke.


----------



## BEAUMONT1 (Jul 8, 2009)

I completely agree that Yahoo Sitebuilder should now be avoided for new sites. As mentioned, it is expensive to host with Yahoo and it limits your options. 3-4 years ago when I built the sites it was one of the better free options. If any of you are looking to build yourselves low cost websites, I'd recommend JOOMLA or Drupal. I do most of my new work in Drupal, and am redesigning some of the old ones in Drupal, too. I'm currently redesigning my own site in Drupal.


----------



## tekwrytr (Sep 11, 2007)

*Insurance deductible*

The amount of insurance claim paid is normally a factor of a bidding process. The homeowner gets a number of bids (usually three) and the adjuster normally pays the low bid as the "amount of the claim."

It gets a bit murky when the deductible is involved, because MANY contractors arrange to cover it by inflating their bids (in collusion with the homeowner) so the insurance covers the entire cost. The amount of that entire cost is irrelevant to the HO, who is only concerned that they get a "free" roof.

Typical left coast process is for roofing estimators to "represent" three or four companies. One is the "real" company, the others are simply fronts, duly licensed, bonded, and insured, completely legitimate, and in existence purely to provide multiple bids on a single job. I have seen the same thing routinely done in Florida, and it is common throughout the midwest.

Call it fraud, call it unscrupulous, call it collusion, call it whatever you want. The people who do it call it "business."


----------



## ScaryLari (Jul 7, 2009)

MJW said:


> The scam is a bunch of flyers given out to homeowners with shingles that were believed to be a certain age. The Certainteed lawsuit is mainly for their Horizon line, but anyways......This company used this to get their greasy foot in the door. They would come in and say that the claim cannot be filed unless you 'sign this'.......We must check with your insurance company first to rule out any storm damage.
> 
> LOL
> 
> ...


 
I ran into one of these roofs in Indy was a 30 yr the shingle was jacked up there was huge cracks on every shingle i may even have pics on my exteranl drive if anyone wants to look at them.


----------



## ScaryLari (Jul 7, 2009)

tekwrytr said:


> The amount of insurance claim paid is normally a factor of a bidding process. The homeowner gets a number of bids (usually three) and the adjuster normally pays the low bid as the "amount of the claim."
> 
> It gets a bit murky when the deductible is involved, because MANY contractors arrange to cover it by inflating their bids (in collusion with the homeowner) so the insurance covers the entire cost. The amount of that entire cost is irrelevant to the HO, who is only concerned that they get a "free" roof.
> 
> ...


 
On a big storm 3 estimates do not apply the deal i sign has no amounts on it at all just states we will do it for insurance proceeds. But if your working a single claim on like a water line break in someones house they may ask you to get three.


----------



## Ed the Roofer (Dec 12, 2006)

3 Estimates NEVER apply.

I dare anyone to show me any home owners policy that instructs that.

Is it good advice for consumers to qualify their contractor choice? Yes.....But the insurance company can intimidate the home owner into feeling it is a requirement, but it is not.

You get a signed contract for your price, without gouging, for like kind and quality, then the insurance company is legally responsible to pay the Full Replacement Cost, minus the deductible.....Period.

Ed


----------



## buildpinnacle (Sep 2, 2008)

ScaryLari said:


> On a big storm 3 estimates do not apply the deal i sign has no amounts on it at all just states we will do it for insurance proceeds. But if your working a single claim on like a water line break in someones house they may ask you to get three.


Blank contingency contract.


----------



## ScaryLari (Jul 7, 2009)

buildpinnacle said:


> Blank contingency contract.


roger that


----------



## Steep Team (Sep 6, 2008)

ScaryLari said:


> Your looney I havent paid one ever on my car unless it was a total and i have been in around 15


 larry you appear to be the know it all on this site. Your posts are like a loudmouth at a bar. Maybe instead of name calling you should read a little more before you come out with your oh so incredible and valuable snips of knowledge. Now pat yourself on the back you have just found a new way to make friends online.


----------



## J F (Dec 3, 2005)

:w00t: :laughing:


----------



## ScaryLari (Jul 7, 2009)

Steep Team said:


> larry you appear to be the know it all on this site. Your posts are like a loudmouth at a bar. Maybe instead of name calling you should read a little more before you come out with your oh so incredible and valuable snips of knowledge. Now pat yourself on the back you have just found a new way to make friends online.


I said loony dont think that constitutes calling someone a name its more a frame of mind. And i dont remember asking you :clap::shutup:


----------



## catfish (Jul 19, 2007)

Yeah, texass will hire illegals and never think a thing about it but, God don't waive the deductible.


----------



## jmreaves (Nov 27, 2009)

In case some one was curious, here's the statue in Texas:

Sec. 27.02. CERTAIN INSURANCE CLAIMS FOR EXCESSIVE CHARGES. (a) A person who sells goods or services commits an offense if:
(1) the person advertises or promises to provide the good or service and to pay:
(A) all or part of any applicable insurance deductible; or
(B) a rebate in an amount equal to all or part of any applicable insurance deductible;
(2) the good or service is paid for by the consumer from proceeds of a property or casualty insurance policy; and
(3) the person knowingly charges an amount for the good or service that exceeds the usual and customary charge by the person for the good or service by an amount equal to or greater than all or part of the applicable insurance deductible paid by the person to an insurer on behalf of an insured or remitted to an insured by the person as a rebate.
(b) A person who is insured under a property or casualty insurance policy commits an offense if the person:
(1) submits a claim under the policy based on charges that are in violation of Subsection (a) of this section; or
(2) knowingly allows a claim in violation of Subsection (a) of this section to be submitted, unless the person promptly notifies the insurer of the excessive charges.​


----------



## RoofingPro (Dec 11, 2009)

Let's say the Insurance Company pays the loss, they will always depreciate the roof and take out the deductible. Now when the repairs are completed it is the contractor responsibility to send the Insurance company a Certificate of Completion along with a job invoice, If the repairs are any less that the TOTAL amount of the claim the difference will be taken out of the recoverable depreciation. With that being said if a contractor is absorbing the deductible, but sending in an invoice stating the full amount of the claim than they are committing Insurance Fraud. I just explain to my customers that they are responsible for there deductible and also inform them how recoverable depreciation works. I advise them to speak with there Insurance company if they question what I'm telling them. I Adjusted storms for State Farm for 8 years so I know all the BS roofing contractors try to pull.


----------



## larryb (May 23, 2008)

*Insurance Fraud*

After a good size hail storm comes through an area there is always enough work to go around. There's never a good reason to ""bury the deductible" no matter how many others are doing so - there is a better way to approach the situation and earn top dollar and every dollar on every insurance job - if the contractor has been properly trained. 

Larry Burtis BURCOS 3RSystems, LLC


----------



## buildpinnacle (Sep 2, 2008)

Larry, I got a bit of a tickle as I was reading through this old thread and noted that you posted the day after one of the largest hail storms in US history. I had actually gotten some rest the last couple years as our Amarillo, DFW, and OKC offices were a bit slow. Now it's back to five days on the road. Let me know if you're in the Sooner State.

Jett


----------



## mpd510 (Dec 21, 2006)

*New Texas law on Covering deductibles*

The State of Texas Penal Code, “Offenses Against Property”
Chapter 35 Insurance Fraud

The State of Texas Business and Commerce Code 
Section 27.02 Certain Insurance Claims For Excessive Charges

(a) a person who sells goods or services commits an offense if:
(1) The person advertises or promises to provide the good or service and to pay;
(A) all or part of any applicable insurance deductible; or
(B) a rebate in an amount equal to all or part of any applicable insurance deductible;
(2) the good or service is paid for by the consumer from proceeds of a property or casualty insurance policy; and
(3) the person (contractor) knowingly charges an amount for the good, or service that exceeds the usual and customary charge by the person for the good or service by an amount equal to or greater than all or part of the applicable insurance deductible paid by the person to an insurer on behalf of an insured or remitted to an insured by the person as a rebate.
(b) A person (Homeowner/ Property owner) who is insured under a property or casualty insurance policy commits an offense if the person:
(1) submits a claim under the policy based on charges that are in violation of subsection (a) of this section; or
knowingly allows a claim in violation of subsection (a) of this section to be submitted unless the person promptly notifies the insurer of the excessive charges.

Under the Insurance Fraud Chapter (35) of the Texas Penal Code “Offenses Against Property”, if you are a party to the fraud listed above then, you have committed an offense under this section. Specifically, under 35.02, Section B, number 3 or 4:

“(1) A Class A misdemeanor if the value of the claim is $500 or more but less than $1,500.00; or

(2) a state jail felony if the value of the claim is $1,500.00 or more but less than $20,000.00.”


----------



## jmiller (May 14, 2010)

happy thanksgiving to you too.


----------



## larryb (May 23, 2008)

*Insurance Fraud?* 
Never "buried" a deductible, never would and never had to!

In my humble but experienced opinion, "burying" deductibles is neither selling nor is it a "closing techique". Rather, it is and should be construed as fraud.

To clarify, say an insurance repair job which, at real, true and accurate (RTA) market rates, is priced at $10,000 (initially $8,500 by an adjuster using Xactimate or similar programs) and has a $1,000 deductible. Obviously, under this scenario, the insurance company has agreed per their policy (contract) to pay $9,000 and the insured has agreed to pay $1,000. 

Now, when a contractor (offerer) offers the insured (acceptor) to discount the job by $1,000 and the acceptor agrees to the discount, both parties have (in all states) defrauded the insurance company and in many states (per statute) violated the law. What determines whether or not a fraudluent act has been committed is intent. In the above scenario, the intent of the contractor (offerer) was to persuade the insured (acceptor) to award the contractor the job (the contractor, in effect, illegally "bribed" the insured). The intent of the acceptor was to save the $1,000 even though the acceptor had already/previously agreed with their insurance company per their policy/contract to pay the deductible.

Per the above scenario where the offerer and the acceptor agree to the discount, both are guilty of perpetrating a fraud against the insurance company. How? Since the contractor willingly offered to do the job for $9,000, the insurance company should have only paid $8,000 ($9,000 minus the insureds $1,000 deductible).

Since the insured saved $1,000 on the job they achieved a betterment by that amount/value. The insurance company would be within its right to demand that the insured pay back to the insurance company the $1,000 the insurance company overpaid since the $9,000 (rather than the correct price of $10,000) is what the contractor agreed to do the job for.

Some contractors have tried to get around this "problem" by calling deductible discounts something other than what they really are. Using a separate "advertising" contract (a variation on "sign discounts"), the contractor agrees to "pay" the insured an amount equal to or nearly equal to the amount of the insured's deductible in exchange for the insured allowing the contractor to "advertise" their company on the insureds property, on a website, etc.

While several "attorneys" have opinied that the practice is technically "legal", it is unlikely that any court would come to the same conclusion. Again, it's a question of intent and obviously, while the method is different from simply subtracting the $1,000 deductible off the top, the intent is the same and the charge would be just as valid.

Add to that the potential for a tax audit when the IRS comes knocking at the contractor's and/or the insured's door asking why no 1099 misc. income paperwork was filed for the "payment" made to the insured for the advertising "service" they agreed to provide.:blink:

Texas and some other states have strict laws prohibiting any of the above practices. Minnesota recently added a new law prohibiting the practice. 
As a result of recent pressure put on insurance industry friendly State insurance commissioners nationwide by insurance industry lobbyists and the NAIC, more and more states are adding similar laws while others are considering such legislation. That means that, although enforcement overall has been somewhat lax in the past, all of the parties mentioned above are becoming more aggressive than ever and are starting to show their enforcement teeth.

There is a better way!

On all storm damage insurance jobs - no "free" estimates and always an open contingency agreement to be completed after the insurance company has agreed to pay ALL of the claim at current RTA market rates with full and correctly computed O&P regardless of how many trades are involved!

When it becomes apparent that a potential storm damage customer wants you to pay their deductible, remind them of the above. Let them know that such actions would likely be construed as insurance fraud and might also attract the attention of the IRS then sell them on your confidence in your abilities and your reputation. 

If they are adament re: getting someone to pay their deductible, remind them again of the above, let them know that your "legal" department will make note of their "attempt" (just for your protection) and if they still won't commit to you, move on to the next one and leave them to the "free" estimate wolves. 

Note: Free estimates are fine and the standard for retail work but when it comes to insurance repair work giving free estimates is a waste of time and money and it doesn't really serve the customer with insurance covered storm damage.


----------



## cleveman (Dec 28, 2007)

why would it be illegal to pay the guy's deductible to get his business?

You can also take him out to dinner if you like, and you won't end up in jail.

Offer to contribute to his children's college fund.

Plant some trees in his yard. Take his dog for a walk. Send him a Christmas card. Buy him a ham for Hannukah. Take him on a fishing trip up North. Send him a ticket to a convention.

I used to get coffee cups from the local buiding materials supplier. Then a few bobble heads. I think I got a fillet knife one year. Once a box of cookies. Now mostly yearly planners. I figure the bobble heads might be worth something someday. 

If you are looking for something to criminalize, go for the yearly planners.


----------



## jmiller (May 14, 2010)

cleveman said:


> why would it be illegal to pay the guy's deductible to get his business?


Because you told the insurance company you needed X to do the job, filed paperwork that says you in fact completed the job for X, then turn around and charge the customer X-$1000. At some point you had to lie or do some creative paperwork.

Most people we want to work for would see that as defrauding the insurance company and leading to raised rates due to inflated claims.

In a storm environment, people are going to have no less than five guys knock on their door and offer them 1k dollars to let them handle their claim. So how do these companies do it for $1,000 less than local companies? For one they usually don't have the overhead of covering warranty claims, because they're just following storm work. You can probably guess number two.

Makes it hard for the honest guys, legal or not.


----------



## buildpinnacle (Sep 2, 2008)

Larry, although I agree with your opinion, I don't agree with your reasoning. The fraud comes in when a contractor or HO attempt to collect the full amount of withhedl depreciation. If the claim was 10,000 with a 1000 deductible and a 3,000 holdback, the ACV check would be 6,000. In order to collect the 3,000, the insured has to show the ins co that they spent the entire 10,000. Any variation other than the truth is where fraud comes in. If the roof was completed for 8000 and they tried to recover the full 3,000 in depreciation a fraudulent contract or invoice would have had to be submitted at some time. The original offer of 10,000 from the ins co is only an agreement to pay up to that amount. It is not a guarantee of funds.....only if said funds are spent.


----------



## Synome (Jan 9, 2011)

This strange, around here it is standard for the contractor to do the job and eat the deductible on a roof. My insurance agent even told me this. And on a side note: when our car was messed up by a deer (or the driver depending on the perspective), I was talking to the adjuster and he actually told me which shop to go to because they would do it and not charge me the $500 deductible (and they did an excellent job).


----------



## buildpinnacle (Sep 2, 2008)

Synome said:


> This strange, around here it is standard for the contractor to do the job and eat the deductible on a roof. My insurance agent even told me this. And on a side note: when our car was messed up by a deer (or the driver depending on the perspective), I was talking to the adjuster and he actually told me which shop to go to because they would do it and not charge me the $500 deductible (and they did an excellent job).


This is very typical and supports the problem. Most adjusters actually will tell roofers or HO's the same thing. There is very little enforcement but the law is very clear in certain states. Here is Texas'.

*BUSINESS & COMMERCE CODE*

CHAPTER 27. FRAUD 

§ 27.02. CERTAIN INSURANCE CLAIMS FOR EXCESSIVE CHARGES.
(a) A person who sells goods or services commits an offense if: 
(1) the person advertises or promises to provide the good or service and to pay: 
(A) all or part of any applicable insurance deductible; or (B) a rebate in an amount equal to all or part of 
any applicable insurance deductible; 
(2) the good or service is paid for by the consumer from proceeds of a property or casualty insurance policy; and 
(3) the person knowingly charges an amount for the good or service that exceeds the usual and customary charge by the person for the good or service by an amount equal to or greater than all or part of the applicable insurance deductible paid by the person to an insurer on behalf of an insured or remitted to an insured by the person as a rebate. 
(b) A person who is insured under a property or casualty insurance policy commits an offense if the person: 
(1) submits a claim under the policy based on charges that are in violation of Subsection (a) of this section; or 
(2) knowingly allows a claim in violation of Subsection (a) of this section to be submitted, unless the person promptly notifies the insurer of the excessive charges. 
*(c) An offense under this section is a Class A misdemeanor. *

Added by Acts 1989, 71st Leg., ch. 898, § 1, eff. Sept. 1, 1989. 

*PENAL CODE CHAPTER 35. INSURANCE FRAUD *

§ 35.02. INSURANCE FRAUD. (a) A person commits an offense if, with intent to defraud or deceive an insurer, the person, in support of a claim for payment under an insurance policy: 
(1) prepares or causes to be prepared a statement that: 
(A) the person knows contains false or misleading material information; and 
(B) is presented to an insurer; or 
(2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information. 
(a-1) A person commits an offense if the person, with intent to defraud or deceive an insurer and in support of an application for an insurance policy: 
(1) prepares or causes to be prepared a statement that: 
(A) the person knows contains false or misleading material information; and 
(B) is presented to an insurer; or 
(2) presents or causes to be presented to an insurer a statement that the person knows contains false or misleading material information. 
(b) A person commits an offense if, with intent to defraud or deceive an insurer, the person solicits, offers, pays, or receives a benefit in connection with the furnishing of goods or services for which a claim for payment is submitted under an insurance policy. 
(c) An offense under Subsection (a) or (b) is: 
(1) a Class C misdemeanor if the value of the claim is less than $50; 
(2) a Class B misdemeanor if the value of the claim is $50 or more but less than $500; 
(3) a Class A misdemeanor if the value of the claim is $500 or more but less than $1,500; 
(4) a state jail felony if the value of the claim is $1,500 or more but less than $20,000; 
(5) a felony of the third degree if the value of the claim is $20,000 or more but less than $100,000; 
(6) a felony of the second degree if the value of the claim is $100,000 or more but less than $200,000; or 
(7) a felony of the first degree if: 
(A) the value of the claim is $200,000 or more; or 
(B) an act committed in connection with the commission of the offense places a person at risk of death or serious bodily injury. 
(d) An offense under Subsection (a-1) is a state jail felony. 
(e) The court shall order a defendant convicted of an offense under this section to pay restitution, including court costs and attorney's fees, to an affected insurer. 
(f) If conduct that constitutes an offense under this section also constitutes an offense under any other law, the actor may be prosecuted under this section, the other law, or both. 
(g) For purposes of this section, if the actor proves by a preponderance of the evidence that a portion of the claim for payment under an insurance policy resulted from a valid loss, 
injury, expense, or service covered by the policy, the value of the claim is equal to the difference between the total claim amount and the amount of the valid portion of the claim. 
(h) If it is shown on the trial of an offense under this section that the actor submitted a bill for goods or services in support of a claim for payment under an insurance policy to the 
insurer issuing the policy, a rebuttable presumption exists that the actor caused the claim for payment to be prepared or presented. 

Added by Acts 1995, 74th Leg., ch. 621, § 1, eff. Sept. 1, 1995. 
Amended by Acts 2003, 78th Leg., ch. 605, § 1, eff. Sept. 1, 2003. 

Amended by: 
Acts 2005, 79th Leg., Ch. 1162, § 4, eff. September 1, 2005. 

§ 35.03. AGGREGATION AND MULTIPLE OFFENSES. (a) When separate claims in violation of this chapter are communicated to an insurer or group of insurers pursuant to one scheme or continuing course of conduct, the conduct may be considered as one offense and the value of the claims aggregated in determining the classification of the offense. If claims are aggregated under this subsection, Subsection (b) shall not apply. 
(b) When three or more separate claims in violation of this chapter are communicated to an insurer or group of insurers pursuant to one scheme or continuing course of conduct, the conduct may be considered as one offense, and the classification of the offense shall be one category higher than the most serious single offense proven from the separate claims, except that if the most serious offense is a felony of the first degree, the offense is a felony of the first degree. This subsection shall not be applied if claims are aggregated under Subsection (a). 

Added by Acts 1995, 74th Leg., ch. 621, § 1, eff. Sept. 1, 1995


----------



## Darin (Dec 24, 2007)

I know this is an older thread but its a good one. I have read all 4 pages. There only seems to be a couple guys who "get" why it's fraud. 
I think they feel it's the act of giving away the deductible. It's actually sending the receipt in to the insurance company that you actually got paid the RCV. When you didn't. You got paid the RCV minus the deductible. 

It should be a mute point. Why do it? Why do bid work? You are cutting yourself and the companies profits way down. You will start to cut corners too. 

I have seen one way to do it that I think is reasonable. Pay your customers for referrals. I know one contractor that has a homeowner give him 40 jobs a year at $75 per referral. Good money for them and better money for you. Of course the best and most legit referrals are the ones you don't pay for. You only pay out when the claim is paid in full. The key is you write them a check. Nothing taken off insurance portion. 

If you don't believe guys get arrested for it. Here is a news cast proving it. http://bcove.me/ukpz05rg

Somebody said it would be great to have an alliance in this thread. I have a friend that says, "it's on it's way".


----------



## RandyB1986 (Jan 2, 2009)

Darin said:


> I know this is an older thread but its a good one. I have read all 4 pages. There only seems to be a couple guys who "get" why it's fraud.
> I think they feel it's the act of giving away the deductible. It's actually sending the receipt in to the insurance company that you actually got paid the RCV. When you didn't. You got paid the RCV minus the deductible.
> 
> It should be a mute point. Why do it? Why do bid work? You are cutting yourself and the companies profits way down. You will start to cut corners too.
> ...


That's right.....You pay them for referrals, sign advertisement in yard, feedback on your website or Angie's List, etc.


----------



## DFW Roofing (Mar 4, 2011)

RandyB1986 said:


> That's right.....You pay them for referrals, sign advertisement in yard, feedback on your website or Angie's List, etc.


While all these items can be very legitimate, often these items are only used to be a more sophisticated way of covering a deductible.

Take the "sign allowance" for example. What is the true value of that sign allowance? How much is the company giving for sign allowances to people not buying a roof from them? The reality is a sign allowance is likely worth very little - so a contractor who is giving $1,500.00 off for that sign allowance is still being fraudulent .... just doing a better job of not getting caught.


----------



## MJW (Jan 27, 2006)

How do you think these companies get such good reviews and testimonies? 

All of that is now illegal in MN, and I believe some other states too. No covering deductibles period.

Does it slow down the fraud? Not one bit from what I see. It's not just the contractors, the homeowners are just as guilty and are blatantly using it as black mail.


----------



## larryb (May 23, 2008)

Darin said:


> If you don't believe guys get arrested for it. Here is a news cast proving it. http://bcove.me/ukpz05rg
> 
> Somebody said it would be great to have an alliance in this thread. I have a friend that says, "it's on it's way".


The guy's that were arrested were arrested for causing damage and claiming it was legitmate hail damage which properely resulted in fraud charges. The other guy's who were caught offering payment of deductibles were simply warned.

Sign allowances? Any objective person would agree that they are deductible buy downs dressed up as something else. No deductible laws are good for all in that they level the playing field. On the other hand, the "no negotiating" legislation showing up in many states these days does nothing to help anyone other then the P&C ins industry and those carrying their water like GA Commissioner Hudgens. 

For more on him and his ilk and more on the "no negotiating" legislation weed that is growing across the country, goto www.iccoa.com and read the "Sausage Makers" Exposed articles.


----------



## RandyB1986 (Jan 2, 2009)

So what do you all say.....fraud or true parlaying?

http://www.brewcrewrestoration.com/images/docs/deductible-assistance-worksheet.pdf


----------



## DFW Roofing (Mar 4, 2011)

RandyB1986 said:


> So what do you all say.....fraud or true parlaying?
> 
> http://www.brewcrewrestoration.com/images/docs/deductible-assistance-worksheet.pdf


Here is a quick test.

How many from contractortalk.com are you going to send $50.00 to if we go to your Facebook page and hit "Like"?


----------



## RandyB1986 (Jan 2, 2009)

DFW Roofing said:


> Here is a quick test.
> 
> How many from contractortalk.com are you going to send $50.00 to if we go to your Facebook page and hit "Like"?


I don't have Facebook but if I did I would gladly give you $50 rebate if you are spending money with me, which is the only way you can get a rebate (a return of part of the *original payment* for some service or merchandise) in other words you have to spend money to get a rebate.

BTW....That rebate program is not mine, it is a competitors who has been in business many years and always offered this.


----------



## twill59 (Aug 14, 2009)

buildpinnacle said:


> I guess I will go ahead and let my voice be heard on this one. First off, we will NOT cover a deductible amount on any type of claim that we are acting as the insured's pre-contracted contractor.....you cannot do that and legally work the claim.
> 
> In an RCV (replacement cost value) policy, the insurance company will generally pay the claim in two seperate payments. The first payment is the ACV (actual cash value) of the claim less the deductible amount. Also known as the depreciated value. The remaining funds, or recoverable depreciation, are billed to the insurance company by our company with a copy of our contract, a certificate of completion signed by the insured, and an invoice/statement showing the total contract amount less all previous payments which leaves us with the recoverable amounts.
> 
> ...


Please note.....these guys doing this are not salesmen, or contractors. They are, at their very best, canvassers or solicitors. BAD for the Roofing Industry.


----------



## twill59 (Aug 14, 2009)

Darin said:


> I know this is an older thread but its a good one. I have read all 4 pages. There only seems to be a couple guys who "get" why it's fraud.
> I think they feel it's the act of giving away the deductible. It's actually sending the receipt in to the insurance company that you actually got paid the RCV. When you didn't. You got paid the RCV minus the deductible.
> 
> It should be a mute point. Why do it? Why do bid work? You are cutting yourself and the companies profits way down. You will start to cut corners too.
> ...


it is just too easy to take it out of your labors' a$$ets. Especially when they are too.......... well fill in the blanks......

Is it any wonder roofing rates keep going down


----------

