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在美國,讓保險公司理賠有多難?

在美國,讓保險公司理賠有多難?

方繪香(Erika Fry) 2021年08月28日
氣候變化和不斷增加的極端天氣頻率意味著保險公司與投保人之間的紛爭只會變得更加頻繁和激烈。

本文的報道得到了NIHCM Foundation的資助。

即便與過去18個月的大環境以及美國人遭受的巨大痛苦相比,約翰?菲利普和喬迪?菲利普夫婦的處境依然十分艱難。

他們都出現了非常嚴重的健康問題,喬迪是腦腫瘤,而約翰是四期癌癥(在經歷了數次中風之后于2019年11月確診)。自2020年年初新冠疫情爆發以來,這對夫婦位于艾奧瓦州的鄉村生意——2 Jo’s Farm和Periwinkle Place Manor莊園——因為旅游和聚會活動受限,也受到了很大的影響。隨后在8月10日,就在喬迪從艾奧瓦大學(University of Iowa)接到在那里完成癌癥治療的約翰,準備返回位于范霍恩的家中時,這個約有900人的小鎮遭到了罕見的德雷科風暴襲擊。當天發生的這場風暴在美國中西部留下了長達1200多公里的廢墟地帶,而且將被作為歷史上代價最為高昂的風暴載入史冊。

他們停下車,車輛在傾盆大雨和超級狂風(陣風高達140英里/小時)的肆虐下咯吱作響,喬迪說:“我們覺得自己要掛了。”當時,他們收到了兒子從農場發來的各種信息和多個電話,然后兒子那邊的信號斷了,發來的最后一條信息是:他們得為此“做好準備”。

這個通常50分鐘的車程最終耗費了數個小時的時間。一路上就像是在觀看有關風暴破壞力的完整預告片:目之所及全都是被毀的谷倉、吹倒的莊稼,和散落再馬路上的筒倉。

即便如此,喬迪在看到農場的情形之后還是感到一陣眩暈。他們的農場靠近30號高速公路(Highway 30,老林肯高速路),位于艾奧瓦州農村地區本頓縣,占地13英畝。

菲利普一家的農場并非是傳統的艾奧瓦州農場。這對夫妻數十年來一直在美國中西部地區的一些地方和節日聚會上扮演圣誕老人和圣誕老奶奶,飼養馴鹿,而且還養了一只名為克林格的駱駝。他們還在農場建造了一個西部小鎮,以及一個騎馬場。德雷科過后,農場建筑被夷為平地。大部分樹木都被吹倒了,房屋和車庫受到的破壞異常嚴重,一時半會也很難清點。她說,這個地方已經沒法住了,而且大多數受損的個人物品都已經無法維修。當我第一次與她交談時,她對我說:“我到現在依然無法接受這個事實。當我們回到農場后,只是走來走去,焦慮的想著下一步該怎么辦?”

這段對話發生在1月初,當時,喬迪一天要去范霍恩兩次,給動物們喂食和喂水。她和約翰住在驅車30分鐘以外的地方,照看著另一門生意Periwinkle Place Manor莊園,這里此前是一家殯儀館,他們在數年前將其買了下來,然后裝修成了一家提供住宿與早餐(或死亡與早餐,喬迪微笑著推銷道)的謀殺懸疑劇院。

這座莊園是一個維多利亞式的宅邸,修建于19世紀末,位于艾奧瓦州切爾西鎮,鎮里有300位居民。該鎮位于林肯高速路(Lincoln Highway)的另一側,地勢低洼,易發洪水。所以,在數十年前,城市議會曾經投票將切爾西鎮搬到地勢更高的地方,但未成功。德雷科風暴來襲時,這個小鎮也未能幸免于難,其圖書館成了犧牲品,但這座莊園僅遭到了輕微的破壞(其電力卻中斷了兩個半月),而這對夫妻、其26歲的智障女兒和一條狗就住在這里。72歲的約翰和62歲的喬迪是在去年11月患上新冠肺炎后搬過來的。喬迪很快恢復了,然后在12月又接了幾單扮演圣誕老奶奶的活,但約翰因為肺部血栓和肺炎,在醫院住了一個月的時間。這是喬迪去年第三次覺得約翰可能會不久于人世,慶幸的是約翰在圣誕前夜回到了家中。

然而,盡管一家人在2020年遭受了幾乎不可估量的損失,但喬迪并未覺得今年就能夠好到哪里去。在這些事情發生以及恢復舉措開始實施之后,事情卻變得越來越糟糕。

主要原因在于喬迪與其財產保險公司之間的糾紛。喬迪單方面稱雙方之間的較量已經成為了長達數月,且令人沮喪、疑惑、孤單以及越發絕望的拉鋸戰。到目前為止,圍繞與德雷科相關的賠償,保險公司向不動產支付了212,525.43美元,而這是被摧毀的騎馬場幾乎可以獲得的所有賠償,僅占損失總額的一小部分,而且喬迪及其聘請的專家也認為,根據她與約翰所簽署的這份67.3萬美元的保單,這筆賠償額也只是其中的一小部分。她在農場的住所依然破敗不堪,日曬雨淋,僅得到了不到29,663.13美元的賠償款。目前,一家人依然居住在Periwinkle Place Manor莊園,而莊園的周圍則是一片狼藉。

喬迪說:“我們曾經以為自己買了很不錯的保險,而且很多年來都是如此。今年的日子不好過,我們也已經向這家保險公司交了20多年的保費,而且從未出過險,但它卻徹徹底底地背棄了我們,在我看來,這種行為就是犯罪。”

去年,我偶然看到了一位家族朋友代表菲利普夫婦在GoFundMe的網頁上發布的信息后,才開始與喬迪接觸。當時,我在撰寫一篇報道,內容是我的家鄉艾奧瓦州是如何應對德雷科和新冠疫情這一雙重災害。由于約翰剛剛出院,我本以為這對夫妻與新冠肺炎的斗爭將成為我們討論的主題,然而即便約翰依然在忍受著新冠肺炎后遺癥的折磨,但很明顯,喬迪所面臨的最大壓力在于,其農場當前局面讓她感到異常的無助。

當我們在3月再次交談時,事情仍然沒有什么進展。6月依然是如此,不過,處于絕望邊緣的喬迪希望引起外界對其困境的關注(一位鄰近城鎮的汽車經銷商便成功地采用了這一策略),她用360美元定制了亮橙色條幅,然后將其張貼在自家沿高速公路修建的籬笆上。這些條幅上印著三個標語,控訴了本頓互助保險協會(Benton Mutual Insurance Association)以及負責理賠的第三方管理公司NCP Group在此事上的處理方式給她造成的不幸。這些條幅如今已經被摘了下來。

作為對菲利普一家控訴的回應,本頓互助稱自己無法對單個索賠案例進行評論,NCP Group亦稱自己無權進行評論,因為它只是第三方理賠管理機構,并不是菲利普一家的承保人。

漫長的恢復之旅

在艾奧瓦州,像菲利普夫婦這樣依然在努力解決風暴災害索賠問題的艾奧瓦人還有成千上萬,而行政賠償流程通常只是房屋所有者回歸正軌需要做的首項工作。他們還在與時間賽跑,因為在這個將自己標榜為美國新保險之都的艾奧瓦州,大多數保單理賠起訴的訴訟時效僅有一年的時間。一些人稱,盡管訴訟成本高昂,但這是消費者與承保人發生糾紛時唯一的求助途徑。

今年,艾奧瓦州的恢復進程因為全球新冠疫情、一系列自然災害和疫情導致的物資短缺而放緩,而且還變得更加復雜。喬迪和眾多艾奧瓦人不得不應對恢復過程中的重重官僚主義障礙,這些壓力給他們造成了第二次創傷。

但這個故事講述的不僅僅是一對夫妻的艱辛,或是與某家保險公司打交道時出現的一次不愉快經歷,亦或是一次恐怖的自然災害之后混亂不堪的狀況。德雷科,連同那些受損的房屋以及被掀翻的屋頂,暴露了整個保險行業存在的根本性問題。隨著氣候變化和導致銀行資源枯竭的災難給保險行業賴以生存的商業模式帶來前所未有的壓力,一些人認為保險行業已經變得越發不利于房屋所有者,而且無法提供普通人認為他們理應提供的保障。

災害過后出現的類似糾紛并不是什么新問題。受委屈的投保人正是羅格斯大學(Rutgers University)的法學教授杰?費恩曼《拖延,推卸,辯解》(Delay, Deny, Defend)一書的主角。該書認為,一些財險企業為了提振其利潤(根據管理層咨詢師制定的手冊),制定了多種策略來削弱人們的意志、情感能量和必要的資金,從而使其難以從承保人那里獲取理所應當的賠償。費恩曼對我說:“對于有效的索賠,現在獲得賠付的難度要高于25年之前。”

颶風“桑迪”(Hurricane Sandy)對道格拉斯?奎恩在水濱區的房產造成了嚴重破壞,在遭遇上述令人沮喪的不公平待遇之后,當時從事金融顧問工作的他成立了美國投保人協會(American Policyholder Association),旨在阻止保險行業的欺詐行為。他說,這些斗爭中的權力動態嚴重偏向了有著萬億美元規模的保險行業。奎恩說:“這是風暴后的風暴,而且在我看來,真正的狠角色并非是自然界的風暴。”他還表示,從險企使用老套的威嚇策略到嘗試通過在其Xactimate軟件(保險理算員用其來給理賠定價)上刻意錄入較低的實際價格來欺騙投保人,自己遭遇過的這些套路正在艾奧瓦州上演,更不用說那些曾經遭遇過自然災害的其他地區。奎恩說:“全美各地都能夠看到這樣的事情。”

從其涉及的范圍來看,保險行業對這類控訴根本不屑一顧,并將之視為原告律師的自私行為,而且通常根源在于消費者在災害來臨之前并沒有完全理解其保單條款。作為對本人疾呼的回應,各大險企強調自己是本著關愛的態度來處理索賠,并兌現其保單中承保事項的承諾。保險信息研究所(Information Insurance Institute)也鼓勵人們通過詢問問題和認真篩選,去了解保單中的具體內容;該機構還警告,即便選擇最便宜的保單,也要認真閱讀其承保范圍。保險信息研究所的媒體關系總監斯科特?霍爾曼對我說:“不要試圖買輛破車,還奢望在理賠后可以換一輛凱迪拉克(Cadillac)。”

NCP Group的副總裁大衛?斯特靈在評論糾紛時籠統地說:“作為理算師,我們在這個非常脆弱、緊張、恐怖的時期參與處理投保人的理賠事宜,其中很多人以前從未提出過索賠。NCP Group希望我們協助的所有投保人都能夠獲得其保單允許的全部賠償額。有時候,理賠需要進行進一步的調查;有時候需要進行額外的勘驗;甚至有時候還需要進行額外的討論。這些舉措會給投保人帶來更大的失望感,然而,我們將盡自身所能,盡快地妥善做好理賠工作……在應對投保人方面,最大的一個問題在于他們會期待保險公司支付保單之外的賠償。NCP Group的委托方要求我們在給客戶做出任何推薦時必須遵守保單條款。我們將付出更多的努力,來確保不會出現任何遺漏,但我們無法更改投保人的保單條款。”

不管怎么樣,氣候變化和不斷增加的極端天氣頻率意味著保險公司與投保人之間的紛爭只會變得更加頻繁和激烈(更不用說與之相關的成本,以及各有關方面在面對新現實時的不知所措),而且越來越多的人有可能會得不到保險保障的保護。

當然,有關氣候風險破壞性的證據已經是異常明了。美國國家海洋和大氣管理局(National Oceanic and Atmospheric Administration)的數據顯示,2020年,美國遭受的破壞性天氣和氣候災害創下了歷史紀錄,損失超過10億美元的事件共有22起,“打破了之前16起的年度紀錄”。2020年因為此類事件而引發的投保人損失達到了730億美元,較過去20年的平均值高出82%(扣除通脹因素)。

霍爾曼在寫給《財富》雜志的電子郵件中稱:“我們看到,因為自然災害而引發的投保人損失的增速已經達到了警戒水平,自20世紀80年代以來增長了近700%。”郵件還指出,去年發生了創紀錄的亞特蘭大颶風和西部山火季(在加利福尼亞州史上最大的六場山火中,有五場就發生在去年)。“然而,保險行業在這些極具破壞力的事件中展現了領導力,向投保人支付了賠償。”

他注意到,盡管保險公司數年前便已經將氣候風險融入其業務模型,但“2020年展現了這種破壞性事件的發展態勢。”

事實證明,2021年也是一個多災之年。截至7月9日,根據美國國家海洋和大氣管理局的統計,美國今年已經出現了8起損失10億美元的天氣和氣候災害。除了經濟損失之外,這些災害還造成了至少331人死亡,其中包括此前無法想象的災害,例如得克薩斯州長達10日、造成巨大破壞的冬季凍災,以及太平洋西北岸創紀錄的熱浪。

德雷科的破壞力亦超出了人們的想象,去年8月數小時內就給美國中西部地區造成了約115億美元的損失,其對艾奧瓦東部的破壞尤為嚴重,在那里,高強度風力所導致的破壞遠超天氣預報員或保險精算師的想象。在這個有著近25.8萬人口的錫達拉皮茲,幾乎所有的家庭都因為風暴而出現了一定程度的損失。在酷熱的8月,很多人失去電力長達一周的時間,還有些人停電遠超一周。全球職業服務公司怡安(Aon)的災害洞見業務負責人史蒂夫?博文說:“德雷科真的是讓很多人大開眼界,原來雷暴也可以帶來颶風級別的損失。”他表示,該地區的不動產,不管是全新的還是數十年前的老建筑,在修建時都沒有考慮過這種級別的風速。博文稱:“它在提醒人們,即便在過去不大會被看作能夠造成重大破壞的危險如今正在越發成為一種更高級別的風險。這場風災讓眾多人感到措手不及。”

確實,艾奧瓦州并沒有為這種颶風級別的災害損失做好準備。與發生野火的鄉村以及颶風經常光顧的沿海各州相比,艾奧瓦人在大規模自然災害面前相對來說缺乏經驗,而且長期以來,有著豐富實戰經驗的美國各州在應對此類災害時已經積累了有力的基礎設施和專長,而這正是艾奧瓦州的短板。艾奧瓦州對保險理算員沒有許可要求,意味著任何人都可以從事為險企評估損失的工作。

尋求幫助

同時,支持投保人索賠,或與保險公司發生爭議時的資源很少。要從事公共理算或作為投保人(而不是保險人)的獨立辯護人,確實需要許可證,而且艾奧瓦州提供服務的人相對較少(佛羅里達則有數千人)。同樣,專門研究災害相關保險損失的律師也寥寥無幾。在非營利組織United Policyholders的網站上,艾奧瓦州的“尋求幫助”資源頁面只列出了一家公共理算師機構——斯威夫特公共理算師公司(Swift Public Adjusters)和一家律師事務所——拉魯律師事務所(Larew Law Office),資源頁的列表均由贊助商提供。

詹姆斯?拉魯曾經于2007年至2011年期間擔任艾奧瓦州州長切特?卡爾弗的法律總顧問,他發現很多人不會跟財產保險公司和意外傷害保險公司打交道,又無處求助(他們經常希望找州長反映問題),2011年他開始支持投保人。拉魯在艾奧瓦州出生長大,他表示當地人傾向于自行承擔責任,也就是說在賠付問題方面不太可能挑戰保險公司。他和其他人認為,即便真去挑戰,州政府也不愿意面對,因為法律和政策傾向行業(舉例來說,即便打贏官司,艾奧瓦州人也必須自行支付法律費用。州政府允許保險公司在合同中注明時效期限,最短只有一年,而州內書面合同常見時效為10年。)

此外,房屋受災的人們處境本就艱難,訴訟又耗時費力。拉魯說,保險公司知道自己被起訴的風險很低,所以才敢向投保人支付較低的費用還不擔心后果。

7月底我與艾奧瓦州保險部(Iowa Insurance Division)的專員道格?奧門交談時,保險公司已經為本州22.5萬起與德雷科有關的索賠支付了30多億美元。未決索賠約18000起,占總數8%。奧門說,從這一數量可以看出損失的規模以及勞動力和材料多么短缺。艾奧瓦州保險部已經收到392起與德雷科有關的投訴,其中大部分已經由該機構調查并結案。相關投訴中,110起被證實主要是由于“索賠過程延誤以及財產核查過程中的損失”,結果是向該州投保人多支付了30.7萬美元。收到《財富》雜志的詢問后,艾奧瓦州保險部還發布了一份公告,建議保險公司考慮保險理算員緊缺等拖累很多人恢復的各種情況,接受延期的請求。至少有一位公共理算公司表示,多數情況下保險公司會繼續拒絕延期。奧門表示,辦公室正在調查德雷科導致的問題,比如允許保險條款限期一年是否合理。

常見創傷

災難來臨時,房主保險應該是好事。保險信息研究所的數據顯示,20世紀50年代房主保險開始商業化,用來避免家庭受到火災和龍卷風等改變生活且破壞財富事件的影響,很快抵押貸款機構將之列入要求,如今93%的美國房主都購買了保險。雖然標準家庭保險并不涵蓋地震和洪水等災難性事件,但通常涵蓋風災造成的損失,意味著私人保險公司應該為多數艾奧瓦州的房主因為德雷科而遭受的損失負責。

1月,艾奧瓦州國土安全和應急管理部(Iowa Department of Homeland Security and Emergency Management)的恢復司司長丹尼斯?哈珀告訴我,正因如此,本州才可以迅速恢復。“[私人保險公司]能夠立刻介入并提供資金。”他告訴我,此舉幫助房主啟動維修和恢復過程。雖然由于新冠疫情蔓延,還有德雷科導致的大范圍停電,相關工作有些復雜,但對多數人來說,復蘇的道路相對清晰,資金充足(哈珀解釋說,相比之下,艾奧瓦州偶爾遭逢洪災影響時,60%到70%的受影響者往往損失險覆蓋不足,甚至沒有保險。)

事實上,很多艾奧瓦州人在風暴過后生活比較順利。例如,我的父母住在錫達拉皮茲,在保險公司拒賠而承包商挑戰成功后,獲得了新屋頂,他們覺得待遇還算公平。1月跟當地人和官員交談后,我感受到強大的保險保障和艾奧瓦州融洽的鄰里關系(人們手持電鋸幫助鄰居),受德雷科影響的社區做得相當好,或者至少在逐漸推進,只是由于破壞規模太大,恢復的過程漫長而艱難。

但隨著時間推移,很明顯我了解到的情況并不夠全面。有很多像喬迪一樣的房主,盡管付出了相當大的努力,還是發現自己困在過程中,保險公司的服務很差,然而保險公司至少理論上應該提供保障。有些案件涉及我的朋友和家人;還有很多像SOS求救信號一樣發表在Facebook頁面上,例如艾奧瓦州德雷科風暴資源頁面(Iowa Derecho Storm Resource Page)和艾奧瓦州保險索賠問答頁面(Iowa Insurance Claim Q&A),風暴后各種類似頁面形成了支持網絡。兩個群組都有數千名成員,除了正常交流,也跟美國州立農業保險(State Farm)、好事達(Allstate)、本頓互助、NCP Group和其他很多保險公司交換協議信息。當時很多人感到憤怒。在跟一些人交談中,我了解到人們的經歷各有各的復雜之處,但有共同的創傷:一種無力感,一種被大肆自稱好鄰居的行業背叛的感覺。人們感覺被困在保險公司制造的迷宮中。

在錫達拉皮茲,德雷科將樹木連根拔起。2020年8月13日,圖中的樹砸進一幢房子里。圖片來源:Joseph Cress/Iowa City Press-Citizen—USA Today Network/Reuters

52歲的寶潔(Procter & Gamble)員工麗貝卡?約德就是個例子,她和丈夫住在錫達拉皮茲,表示自己的經歷是“徹頭徹尾的噩夢”。為了財產索賠,她不得不跟五位現場理算員和好事達的很多內部理算員打交道,人數多到“數不清”。她的感覺是,理算員們根本沒有相互交流,也沒有人利用她提供的豐富文件,包括150張照片和一份詳細的損壞清單。整個過程中,她感到“被忽視、被欺騙、只感覺自己很愚蠢”。她表示,屋頂還在漏水需要更換,但好事達只同意修補(她說,到訪五名理算員中沒有一人真正登上屋頂認真檢查。)同時,好事達同意更換屋頂之前,承包商不愿意給她報價。即便后來她找到了愿意報價的承包商,但最終還是被放了鴿子,雇傭的油漆工和公共理算師也不見了(我了解到,對受德雷科影響的房主來說,相關人員突然消失是常見的問題)。剛開始,好事達為這對夫婦支付了略高于1萬美元的賠償金;經過不懈跟進,約德在一位公共理算師的幫助下收到了2萬多美元,還是不到公共理算師估算金額的一半。

“情緒上的影響非常大。”她在給我的信中說。“先是讓我們滿懷希望,為了會面和電話打亂日程安排,很不方便。最后有些工作都是自己做的,因為自己掏腰包雇不起人,實在令人沮喪。”約德還在盼著好事達可以幫忙修房頂。整修完成之前,很難想象未來。“現在,我們身陷困境。”

在一份電子郵件聲明中,好事達表示已經根據客戶索賠“及時全額賠付”,并且“正積極努力解決余下異議,徹底調查所有未決索賠,以確保準確及時地賠償客戶。”該公司指出,已經解決了艾奧瓦州98%與德雷科相關索賠,為客戶提供的損失補償超過1.2億美元。

瑪麗?漢考克位于錫達拉皮茲東南部的家中,風暴將一棵樹砸在了她的房上,導致車庫和住所受損,比起多數人,她對自己駕馭局勢的能力信心更足。作為房地產經紀人,她非常了解保單的細節和繁瑣的索賠流程。但近一年后,她驚訝地發現處境與約德相似,車庫仍然無法正常使用,屋頂需要維修。一下大雨,水就會滲到家里,導致破壞情況更嚴重。收到1.2萬美元賠付款后,她和丈夫感覺相當不容易,因為第一位理算員告訴她,財產并沒有問題;第二位探訪后支付了4000美元,還是也遠低于她認為根據保單應得的金額。“我們不在佛羅里達。”她說,對眼前情況還是有點驚訝。“多年來一直在收保費,(現在)支出卻很少。”

漢考克來自西非的多哥,她認為歧視導致自家斗爭更加艱難,于是她專門聘請了一位公共理算師,她注意到自己幫助過的移民家庭也有類似做法。至于她自己的戰斗,幾乎要認輸。“我沒有精力去對抗結構非常完善(且對保險公司有利)的體系。”7月底她告訴我,并補充說她和丈夫計劃為房子再籌集資金,用來填補保險賠償金不覆蓋的部分。

約翰和喬迪的故事是另外一個具體而復雜的案例。兩人損失和處境都很極端,但據處理過德雷科案件的人說,兩人與保險公司的斗爭方式跟其他人差不多。20多年來,約翰和喬迪通過本頓互助保險協會(Benton Mutual Insurance Association)購買了認為價值100萬美元的房主保險,該協會1872年就已經成立,是眾多服務于艾奧瓦州農村社區的農場小型互助社之一。協會總部位于艾奧瓦州基斯頓,在范霍恩西面10英里,為艾奧瓦東部19個縣提供家庭和農場保險。德雷科當天,超過一半的投保人受到影響。像許多房主一樣,約翰和喬迪對保險沒有太多考慮,剛開始保險通過附近另一個城鎮文頓的代理商購買,并且每年續保。保單的年保費為1718.30美元,涵蓋了夫婦的住宅、車庫、騎馬場和個人財產。

2021年1月,艾奧瓦州本頓縣范霍恩附近菲利普農場的約翰?菲利普。他身后的玉米垛是去年德雷科風暴中受損的房屋之一。圖片來源:Danny Wilcox-Frazier—VII/Redux Pictures

夫婦從未提出過索賠,因此在德雷科發生后喬迪驚訝地發現實際上有一份價值67.3萬美元的保單,但對屋頂附有限制性說明,聲明本頓互助“不支付風暴或冰雹造成的屋頂損失,除非進行了可接受的維修或安裝了新屋頂。”《財富》雜志看到關于屋頂的說明日期為2017年8月,約翰?菲利普的名字已經印上,還有保險代理人的簽名,寫著“上午10點18分通話確認。”約翰和喬迪都對跟代理人就相關說明談話毫無印象,更別提同意。(多次評論請求均未獲保險代理人回應;本頓互助也拒絕對個人索賠發表評論。)

菲利普聘請的公共理算師和律師表示,該合同是糾紛的關鍵,因為本頓互助認為,已經免除了對屋頂損壞或房屋內因為屋頂受損而影響物品的賠償責任。這也反映了律師、United Policyholders的執行董事艾米?巴赫稱之為保險業“有問題”的趨勢,即悄悄修改房主的保單。United Policyholders是非營利組織,1991年成立,艾米?巴赫是該機構的聯合創始人。

“由于與氣候變化相關的風暴和水災事件越來越多,保險公司越發積極限制屋頂損壞和屋頂維修費用。”她解釋說,這一做法開始于2013年左右。“這一問題在艾奧瓦州引起廣泛關注,因為類似德雷科的情況下,既涉及風暴又涉及大雨。”

巴赫說,調整通常不會與投保人明確溝通,而且實施得太迅速,房主和監管機構都跟不上。條款調整實際上降低了房主保單的價值,成本卻很少降低(奧門說,這是艾奧瓦州保險部根據德雷科正在研究的另一問題。)2020年巴赫的組織發起了一項全國性倡議,即重建保險安全網聯盟(Restoring the Insurance Safety Net Coalition),希望呼吁監管機構、官員和法院意識該問題并制定標準,防止保險公司過分縮小范圍。畢竟,如果房子沒有屋頂,那價值何在?

根據NCP Group(總部位于佛羅里達州,本頓互助委托該公司評定和處理索賠工作)編寫的報告,菲利普夫婦發現其實價值很少。保險公司認定三層農舍賠償金或實際現金價值僅為16786.17美元。“簡直滑稽。”喬迪告訴我。“他們愿意(賠的錢)只夠給天花板塌著的屋子刷刷墻。”盡管進行了上訴,也有喬迪聘請的公共理算師的幫助(理算員評估保險賠償金超過67.3萬美元的保單),但據喬迪和代理人所知,NCP Group并未另派理算員重新核查。第一位理算員已經不在NCP工作。(NCP不評論個人索賠。)

公共理算師為該房產爭取了幾筆額外賠付,但與巨額估算相差甚遠。種種努力停滯不前時,喬迪與公共理算師的關系也迅速惡化,而雙方合作曾經是給了他們巨大的希望。她從公司也得不到答案。

和我采訪的其他人一樣,喬迪讓我感覺到,理賠過程中最令人不安的部分是缺乏人性:個人遭受巨大損失和創傷時,可依賴的人不回電話也不回短信;溝通也很差,甚至無法溝通;理算員、承包商或公共理算師會突然消失,有時還會被隨意換人重新走流程。大災難之后似乎都是此種模式,就像這一次,然而明明時間和資源都很匱乏。

就在此時,喬迪返回Facebook上的一個德雷科群組,找到了年輕而精力充沛的律師格雷格?厄舍,厄舍在錫達拉皮茲地區長大,后來從事財產和傷亡索賠。到2021年年初,他每周都要接8到10個求助電話,每晚等到年幼的兒子上床睡覺后仍然要工作。回顧諸多問題后,他得出了令人沮喪的結論:“幾乎每個人情況都很糟。”6月初,當我們談起過去一年時,他顯得筋疲力盡又很憤怒,他滔滔不絕講述了大保險公司糟糕的做法,還有遇到令人不安的事。他有一位名叫貝基?哈德森的客戶,房子被壓在樹下,經營家庭日托中心的地下室也被污水淹沒。她跟好事達的多位理算員打過交道,其中一人建議她好好清理,而不是更換污水泡過的日托用品。厄舍認為,好事達少賠了她至少10萬美元。(好事達表示,已經迅速支付了索賠中無爭議的損失,并且“所有未決索賠都經過徹底調查,以確保客戶及時準確收到賠款。”)

現在他通過評估指導菲利普一案,走的糾紛解決流程,雖然并非沒有風險,但比訴訟更快成本也更低。他說,準備在對菲利普家的財產聯合檢查時,與本頓互助的律師積極溝通下。雖然喬迪的案子離解決還有點遠,但現在由于厄舍介入,感覺有些希望。而她描述的悲慘篇章,也是“最糟糕的一年”,似乎慢慢走向尾聲。最近幾周,喬迪獲得了切爾西市議會的批準,駱駝克林格和馴鹿搬到了Periwinkle Place Manor莊園。她正在整修房子,方便夫婦二人搬回去,又開始主持謀殺懸疑劇院活動。她開始接受可能再也不會住在農場,只是努力記住,除了保險大戰和過去一年的困境,前方還有未來。(財富中文網)

譯者:馮豐

審校:夏林

本文的報道得到了NIHCM Foundation的資助。

即便與過去18個月的大環境以及美國人遭受的巨大痛苦相比,約翰?菲利普和喬迪?菲利普夫婦的處境依然十分艱難。

他們都出現了非常嚴重的健康問題,喬迪是腦腫瘤,而約翰是四期癌癥(在經歷了數次中風之后于2019年11月確診)。自2020年年初新冠疫情爆發以來,這對夫婦位于艾奧瓦州的鄉村生意——2 Jo’s Farm和Periwinkle Place Manor莊園——因為旅游和聚會活動受限,也受到了很大的影響。隨后在8月10日,就在喬迪從艾奧瓦大學(University of Iowa)接到在那里完成癌癥治療的約翰,準備返回位于范霍恩的家中時,這個約有900人的小鎮遭到了罕見的德雷科風暴襲擊。當天發生的這場風暴在美國中西部留下了長達1200多公里的廢墟地帶,而且將被作為歷史上代價最為高昂的風暴載入史冊。

他們停下車,車輛在傾盆大雨和超級狂風(陣風高達140英里/小時)的肆虐下咯吱作響,喬迪說:“我們覺得自己要掛了。”當時,他們收到了兒子從農場發來的各種信息和多個電話,然后兒子那邊的信號斷了,發來的最后一條信息是:他們得為此“做好準備”。

這個通常50分鐘的車程最終耗費了數個小時的時間。一路上就像是在觀看有關風暴破壞力的完整預告片:目之所及全都是被毀的谷倉、吹倒的莊稼,和散落再馬路上的筒倉。

即便如此,喬迪在看到農場的情形之后還是感到一陣眩暈。他們的農場靠近30號高速公路(Highway 30,老林肯高速路),位于艾奧瓦州農村地區本頓縣,占地13英畝。

菲利普一家的農場并非是傳統的艾奧瓦州農場。這對夫妻數十年來一直在美國中西部地區的一些地方和節日聚會上扮演圣誕老人和圣誕老奶奶,飼養馴鹿,而且還養了一只名為克林格的駱駝。他們還在農場建造了一個西部小鎮,以及一個騎馬場。德雷科過后,農場建筑被夷為平地。大部分樹木都被吹倒了,房屋和車庫受到的破壞異常嚴重,一時半會也很難清點。她說,這個地方已經沒法住了,而且大多數受損的個人物品都已經無法維修。當我第一次與她交談時,她對我說:“我到現在依然無法接受這個事實。當我們回到農場后,只是走來走去,焦慮的想著下一步該怎么辦?”

這段對話發生在1月初,當時,喬迪一天要去范霍恩兩次,給動物們喂食和喂水。她和約翰住在驅車30分鐘以外的地方,照看著另一門生意Periwinkle Place Manor莊園,這里此前是一家殯儀館,他們在數年前將其買了下來,然后裝修成了一家提供住宿與早餐(或死亡與早餐,喬迪微笑著推銷道)的謀殺懸疑劇院。

這座莊園是一個維多利亞式的宅邸,修建于19世紀末,位于艾奧瓦州切爾西鎮,鎮里有300位居民。該鎮位于林肯高速路(Lincoln Highway)的另一側,地勢低洼,易發洪水。所以,在數十年前,城市議會曾經投票將切爾西鎮搬到地勢更高的地方,但未成功。德雷科風暴來襲時,這個小鎮也未能幸免于難,其圖書館成了犧牲品,但這座莊園僅遭到了輕微的破壞(其電力卻中斷了兩個半月),而這對夫妻、其26歲的智障女兒和一條狗就住在這里。72歲的約翰和62歲的喬迪是在去年11月患上新冠肺炎后搬過來的。喬迪很快恢復了,然后在12月又接了幾單扮演圣誕老奶奶的活,但約翰因為肺部血栓和肺炎,在醫院住了一個月的時間。這是喬迪去年第三次覺得約翰可能會不久于人世,慶幸的是約翰在圣誕前夜回到了家中。

然而,盡管一家人在2020年遭受了幾乎不可估量的損失,但喬迪并未覺得今年就能夠好到哪里去。在這些事情發生以及恢復舉措開始實施之后,事情卻變得越來越糟糕。

主要原因在于喬迪與其財產保險公司之間的糾紛。喬迪單方面稱雙方之間的較量已經成為了長達數月,且令人沮喪、疑惑、孤單以及越發絕望的拉鋸戰。到目前為止,圍繞與德雷科相關的賠償,保險公司向不動產支付了212,525.43美元,而這是被摧毀的騎馬場幾乎可以獲得的所有賠償,僅占損失總額的一小部分,而且喬迪及其聘請的專家也認為,根據她與約翰所簽署的這份67.3萬美元的保單,這筆賠償額也只是其中的一小部分。她在農場的住所依然破敗不堪,日曬雨淋,僅得到了不到29,663.13美元的賠償款。目前,一家人依然居住在Periwinkle Place Manor莊園,而莊園的周圍則是一片狼藉。

喬迪說:“我們曾經以為自己買了很不錯的保險,而且很多年來都是如此。今年的日子不好過,我們也已經向這家保險公司交了20多年的保費,而且從未出過險,但它卻徹徹底底地背棄了我們,在我看來,這種行為就是犯罪。”

去年,我偶然看到了一位家族朋友代表菲利普夫婦在GoFundMe的網頁上發布的信息后,才開始與喬迪接觸。當時,我在撰寫一篇報道,內容是我的家鄉艾奧瓦州是如何應對德雷科和新冠疫情這一雙重災害。由于約翰剛剛出院,我本以為這對夫妻與新冠肺炎的斗爭將成為我們討論的主題,然而即便約翰依然在忍受著新冠肺炎后遺癥的折磨,但很明顯,喬迪所面臨的最大壓力在于,其農場當前局面讓她感到異常的無助。

當我們在3月再次交談時,事情仍然沒有什么進展。6月依然是如此,不過,處于絕望邊緣的喬迪希望引起外界對其困境的關注(一位鄰近城鎮的汽車經銷商便成功地采用了這一策略),她用360美元定制了亮橙色條幅,然后將其張貼在自家沿高速公路修建的籬笆上。這些條幅上印著三個標語,控訴了本頓互助保險協會(Benton Mutual Insurance Association)以及負責理賠的第三方管理公司NCP Group在此事上的處理方式給她造成的不幸。這些條幅如今已經被摘了下來。

作為對菲利普一家控訴的回應,本頓互助稱自己無法對單個索賠案例進行評論,NCP Group亦稱自己無權進行評論,因為它只是第三方理賠管理機構,并不是菲利普一家的承保人。

漫長的恢復之旅

在艾奧瓦州,像菲利普夫婦這樣依然在努力解決風暴災害索賠問題的艾奧瓦人還有成千上萬,而行政賠償流程通常只是房屋所有者回歸正軌需要做的首項工作。他們還在與時間賽跑,因為在這個將自己標榜為美國新保險之都的艾奧瓦州,大多數保單理賠起訴的訴訟時效僅有一年的時間。一些人稱,盡管訴訟成本高昂,但這是消費者與承保人發生糾紛時唯一的求助途徑。

今年,艾奧瓦州的恢復進程因為全球新冠疫情、一系列自然災害和疫情導致的物資短缺而放緩,而且還變得更加復雜。喬迪和眾多艾奧瓦人不得不應對恢復過程中的重重官僚主義障礙,這些壓力給他們造成了第二次創傷。

但這個故事講述的不僅僅是一對夫妻的艱辛,或是與某家保險公司打交道時出現的一次不愉快經歷,亦或是一次恐怖的自然災害之后混亂不堪的狀況。德雷科,連同那些受損的房屋以及被掀翻的屋頂,暴露了整個保險行業存在的根本性問題。隨著氣候變化和導致銀行資源枯竭的災難給保險行業賴以生存的商業模式帶來前所未有的壓力,一些人認為保險行業已經變得越發不利于房屋所有者,而且無法提供普通人認為他們理應提供的保障。

災害過后出現的類似糾紛并不是什么新問題。受委屈的投保人正是羅格斯大學(Rutgers University)的法學教授杰?費恩曼《拖延,推卸,辯解》(Delay, Deny, Defend)一書的主角。該書認為,一些財險企業為了提振其利潤(根據管理層咨詢師制定的手冊),制定了多種策略來削弱人們的意志、情感能量和必要的資金,從而使其難以從承保人那里獲取理所應當的賠償。費恩曼對我說:“對于有效的索賠,現在獲得賠付的難度要高于25年之前。”

颶風“桑迪”(Hurricane Sandy)對道格拉斯?奎恩在水濱區的房產造成了嚴重破壞,在遭遇上述令人沮喪的不公平待遇之后,當時從事金融顧問工作的他成立了美國投保人協會(American Policyholder Association),旨在阻止保險行業的欺詐行為。他說,這些斗爭中的權力動態嚴重偏向了有著萬億美元規模的保險行業。奎恩說:“這是風暴后的風暴,而且在我看來,真正的狠角色并非是自然界的風暴。”他還表示,從險企使用老套的威嚇策略到嘗試通過在其Xactimate軟件(保險理算員用其來給理賠定價)上刻意錄入較低的實際價格來欺騙投保人,自己遭遇過的這些套路正在艾奧瓦州上演,更不用說那些曾經遭遇過自然災害的其他地區。奎恩說:“全美各地都能夠看到這樣的事情。”

從其涉及的范圍來看,保險行業對這類控訴根本不屑一顧,并將之視為原告律師的自私行為,而且通常根源在于消費者在災害來臨之前并沒有完全理解其保單條款。作為對本人疾呼的回應,各大險企強調自己是本著關愛的態度來處理索賠,并兌現其保單中承保事項的承諾。保險信息研究所(Information Insurance Institute)也鼓勵人們通過詢問問題和認真篩選,去了解保單中的具體內容;該機構還警告,即便選擇最便宜的保單,也要認真閱讀其承保范圍。保險信息研究所的媒體關系總監斯科特?霍爾曼對我說:“不要試圖買輛破車,還奢望在理賠后可以換一輛凱迪拉克(Cadillac)。”

NCP Group的副總裁大衛?斯特靈在評論糾紛時籠統地說:“作為理算師,我們在這個非常脆弱、緊張、恐怖的時期參與處理投保人的理賠事宜,其中很多人以前從未提出過索賠。NCP Group希望我們協助的所有投保人都能夠獲得其保單允許的全部賠償額。有時候,理賠需要進行進一步的調查;有時候需要進行額外的勘驗;甚至有時候還需要進行額外的討論。這些舉措會給投保人帶來更大的失望感,然而,我們將盡自身所能,盡快地妥善做好理賠工作……在應對投保人方面,最大的一個問題在于他們會期待保險公司支付保單之外的賠償。NCP Group的委托方要求我們在給客戶做出任何推薦時必須遵守保單條款。我們將付出更多的努力,來確保不會出現任何遺漏,但我們無法更改投保人的保單條款。”

不管怎么樣,氣候變化和不斷增加的極端天氣頻率意味著保險公司與投保人之間的紛爭只會變得更加頻繁和激烈(更不用說與之相關的成本,以及各有關方面在面對新現實時的不知所措),而且越來越多的人有可能會得不到保險保障的保護。

當然,有關氣候風險破壞性的證據已經是異常明了。美國國家海洋和大氣管理局(National Oceanic and Atmospheric Administration)的數據顯示,2020年,美國遭受的破壞性天氣和氣候災害創下了歷史紀錄,損失超過10億美元的事件共有22起,“打破了之前16起的年度紀錄”。2020年因為此類事件而引發的投保人損失達到了730億美元,較過去20年的平均值高出82%(扣除通脹因素)。

霍爾曼在寫給《財富》雜志的電子郵件中稱:“我們看到,因為自然災害而引發的投保人損失的增速已經達到了警戒水平,自20世紀80年代以來增長了近700%。”郵件還指出,去年發生了創紀錄的亞特蘭大颶風和西部山火季(在加利福尼亞州史上最大的六場山火中,有五場就發生在去年)。“然而,保險行業在這些極具破壞力的事件中展現了領導力,向投保人支付了賠償。”

他注意到,盡管保險公司數年前便已經將氣候風險融入其業務模型,但“2020年展現了這種破壞性事件的發展態勢。”

事實證明,2021年也是一個多災之年。截至7月9日,根據美國國家海洋和大氣管理局的統計,美國今年已經出現了8起損失10億美元的天氣和氣候災害。除了經濟損失之外,這些災害還造成了至少331人死亡,其中包括此前無法想象的災害,例如得克薩斯州長達10日、造成巨大破壞的冬季凍災,以及太平洋西北岸創紀錄的熱浪。

德雷科的破壞力亦超出了人們的想象,去年8月數小時內就給美國中西部地區造成了約115億美元的損失,其對艾奧瓦東部的破壞尤為嚴重,在那里,高強度風力所導致的破壞遠超天氣預報員或保險精算師的想象。在這個有著近25.8萬人口的錫達拉皮茲,幾乎所有的家庭都因為風暴而出現了一定程度的損失。在酷熱的8月,很多人失去電力長達一周的時間,還有些人停電遠超一周。全球職業服務公司怡安(Aon)的災害洞見業務負責人史蒂夫?博文說:“德雷科真的是讓很多人大開眼界,原來雷暴也可以帶來颶風級別的損失。”他表示,該地區的不動產,不管是全新的還是數十年前的老建筑,在修建時都沒有考慮過這種級別的風速。博文稱:“它在提醒人們,即便在過去不大會被看作能夠造成重大破壞的危險如今正在越發成為一種更高級別的風險。這場風災讓眾多人感到措手不及。”

確實,艾奧瓦州并沒有為這種颶風級別的災害損失做好準備。與發生野火的鄉村以及颶風經常光顧的沿海各州相比,艾奧瓦人在大規模自然災害面前相對來說缺乏經驗,而且長期以來,有著豐富實戰經驗的美國各州在應對此類災害時已經積累了有力的基礎設施和專長,而這正是艾奧瓦州的短板。艾奧瓦州對保險理算員沒有許可要求,意味著任何人都可以從事為險企評估損失的工作。

尋求幫助

同時,支持投保人索賠,或與保險公司發生爭議時的資源很少。要從事公共理算或作為投保人(而不是保險人)的獨立辯護人,確實需要許可證,而且艾奧瓦州提供服務的人相對較少(佛羅里達則有數千人)。同樣,專門研究災害相關保險損失的律師也寥寥無幾。在非營利組織United Policyholders的網站上,艾奧瓦州的“尋求幫助”資源頁面只列出了一家公共理算師機構——斯威夫特公共理算師公司(Swift Public Adjusters)和一家律師事務所——拉魯律師事務所(Larew Law Office),資源頁的列表均由贊助商提供。

詹姆斯?拉魯曾經于2007年至2011年期間擔任艾奧瓦州州長切特?卡爾弗的法律總顧問,他發現很多人不會跟財產保險公司和意外傷害保險公司打交道,又無處求助(他們經常希望找州長反映問題),2011年他開始支持投保人。拉魯在艾奧瓦州出生長大,他表示當地人傾向于自行承擔責任,也就是說在賠付問題方面不太可能挑戰保險公司。他和其他人認為,即便真去挑戰,州政府也不愿意面對,因為法律和政策傾向行業(舉例來說,即便打贏官司,艾奧瓦州人也必須自行支付法律費用。州政府允許保險公司在合同中注明時效期限,最短只有一年,而州內書面合同常見時效為10年。)

此外,房屋受災的人們處境本就艱難,訴訟又耗時費力。拉魯說,保險公司知道自己被起訴的風險很低,所以才敢向投保人支付較低的費用還不擔心后果。

7月底我與艾奧瓦州保險部(Iowa Insurance Division)的專員道格?奧門交談時,保險公司已經為本州22.5萬起與德雷科有關的索賠支付了30多億美元。未決索賠約18000起,占總數8%。奧門說,從這一數量可以看出損失的規模以及勞動力和材料多么短缺。艾奧瓦州保險部已經收到392起與德雷科有關的投訴,其中大部分已經由該機構調查并結案。相關投訴中,110起被證實主要是由于“索賠過程延誤以及財產核查過程中的損失”,結果是向該州投保人多支付了30.7萬美元。收到《財富》雜志的詢問后,艾奧瓦州保險部還發布了一份公告,建議保險公司考慮保險理算員緊缺等拖累很多人恢復的各種情況,接受延期的請求。至少有一位公共理算公司表示,多數情況下保險公司會繼續拒絕延期。奧門表示,辦公室正在調查德雷科導致的問題,比如允許保險條款限期一年是否合理。

常見創傷

災難來臨時,房主保險應該是好事。保險信息研究所的數據顯示,20世紀50年代房主保險開始商業化,用來避免家庭受到火災和龍卷風等改變生活且破壞財富事件的影響,很快抵押貸款機構將之列入要求,如今93%的美國房主都購買了保險。雖然標準家庭保險并不涵蓋地震和洪水等災難性事件,但通常涵蓋風災造成的損失,意味著私人保險公司應該為多數艾奧瓦州的房主因為德雷科而遭受的損失負責。

1月,艾奧瓦州國土安全和應急管理部(Iowa Department of Homeland Security and Emergency Management)的恢復司司長丹尼斯?哈珀告訴我,正因如此,本州才可以迅速恢復。“[私人保險公司]能夠立刻介入并提供資金。”他告訴我,此舉幫助房主啟動維修和恢復過程。雖然由于新冠疫情蔓延,還有德雷科導致的大范圍停電,相關工作有些復雜,但對多數人來說,復蘇的道路相對清晰,資金充足(哈珀解釋說,相比之下,艾奧瓦州偶爾遭逢洪災影響時,60%到70%的受影響者往往損失險覆蓋不足,甚至沒有保險。)

事實上,很多艾奧瓦州人在風暴過后生活比較順利。例如,我的父母住在錫達拉皮茲,在保險公司拒賠而承包商挑戰成功后,獲得了新屋頂,他們覺得待遇還算公平。1月跟當地人和官員交談后,我感受到強大的保險保障和艾奧瓦州融洽的鄰里關系(人們手持電鋸幫助鄰居),受德雷科影響的社區做得相當好,或者至少在逐漸推進,只是由于破壞規模太大,恢復的過程漫長而艱難。

但隨著時間推移,很明顯我了解到的情況并不夠全面。有很多像喬迪一樣的房主,盡管付出了相當大的努力,還是發現自己困在過程中,保險公司的服務很差,然而保險公司至少理論上應該提供保障。有些案件涉及我的朋友和家人;還有很多像SOS求救信號一樣發表在Facebook頁面上,例如艾奧瓦州德雷科風暴資源頁面(Iowa Derecho Storm Resource Page)和艾奧瓦州保險索賠問答頁面(Iowa Insurance Claim Q&A),風暴后各種類似頁面形成了支持網絡。兩個群組都有數千名成員,除了正常交流,也跟美國州立農業保險(State Farm)、好事達(Allstate)、本頓互助、NCP Group和其他很多保險公司交換協議信息。當時很多人感到憤怒。在跟一些人交談中,我了解到人們的經歷各有各的復雜之處,但有共同的創傷:一種無力感,一種被大肆自稱好鄰居的行業背叛的感覺。人們感覺被困在保險公司制造的迷宮中。

在錫達拉皮茲,德雷科將樹木連根拔起。2020年8月13日,圖中的樹砸進一幢房子里。

52歲的寶潔(Procter & Gamble)員工麗貝卡?約德就是個例子,她和丈夫住在錫達拉皮茲,表示自己的經歷是“徹頭徹尾的噩夢”。為了財產索賠,她不得不跟五位現場理算員和好事達的很多內部理算員打交道,人數多到“數不清”。她的感覺是,理算員們根本沒有相互交流,也沒有人利用她提供的豐富文件,包括150張照片和一份詳細的損壞清單。整個過程中,她感到“被忽視、被欺騙、只感覺自己很愚蠢”。她表示,屋頂還在漏水需要更換,但好事達只同意修補(她說,到訪五名理算員中沒有一人真正登上屋頂認真檢查。)同時,好事達同意更換屋頂之前,承包商不愿意給她報價。即便后來她找到了愿意報價的承包商,但最終還是被放了鴿子,雇傭的油漆工和公共理算師也不見了(我了解到,對受德雷科影響的房主來說,相關人員突然消失是常見的問題)。剛開始,好事達為這對夫婦支付了略高于1萬美元的賠償金;經過不懈跟進,約德在一位公共理算師的幫助下收到了2萬多美元,還是不到公共理算師估算金額的一半。

“情緒上的影響非常大。”她在給我的信中說。“先是讓我們滿懷希望,為了會面和電話打亂日程安排,很不方便。最后有些工作都是自己做的,因為自己掏腰包雇不起人,實在令人沮喪。”約德還在盼著好事達可以幫忙修房頂。整修完成之前,很難想象未來。“現在,我們身陷困境。”

在一份電子郵件聲明中,好事達表示已經根據客戶索賠“及時全額賠付”,并且“正積極努力解決余下異議,徹底調查所有未決索賠,以確保準確及時地賠償客戶。”該公司指出,已經解決了艾奧瓦州98%與德雷科相關索賠,為客戶提供的損失補償超過1.2億美元。

瑪麗?漢考克位于錫達拉皮茲東南部的家中,風暴將一棵樹砸在了她的房上,導致車庫和住所受損,比起多數人,她對自己駕馭局勢的能力信心更足。作為房地產經紀人,她非常了解保單的細節和繁瑣的索賠流程。但近一年后,她驚訝地發現處境與約德相似,車庫仍然無法正常使用,屋頂需要維修。一下大雨,水就會滲到家里,導致破壞情況更嚴重。收到1.2萬美元賠付款后,她和丈夫感覺相當不容易,因為第一位理算員告訴她,財產并沒有問題;第二位探訪后支付了4000美元,還是也遠低于她認為根據保單應得的金額。“我們不在佛羅里達。”她說,對眼前情況還是有點驚訝。“多年來一直在收保費,(現在)支出卻很少。”

漢考克來自西非的多哥,她認為歧視導致自家斗爭更加艱難,于是她專門聘請了一位公共理算師,她注意到自己幫助過的移民家庭也有類似做法。至于她自己的戰斗,幾乎要認輸。“我沒有精力去對抗結構非常完善(且對保險公司有利)的體系。”7月底她告訴我,并補充說她和丈夫計劃為房子再籌集資金,用來填補保險賠償金不覆蓋的部分。

約翰和喬迪的故事是另外一個具體而復雜的案例。兩人損失和處境都很極端,但據處理過德雷科案件的人說,兩人與保險公司的斗爭方式跟其他人差不多。20多年來,約翰和喬迪通過本頓互助保險協會(Benton Mutual Insurance Association)購買了認為價值100萬美元的房主保險,該協會1872年就已經成立,是眾多服務于艾奧瓦州農村社區的農場小型互助社之一。協會總部位于艾奧瓦州基斯頓,在范霍恩西面10英里,為艾奧瓦東部19個縣提供家庭和農場保險。德雷科當天,超過一半的投保人受到影響。像許多房主一樣,約翰和喬迪對保險沒有太多考慮,剛開始保險通過附近另一個城鎮文頓的代理商購買,并且每年續保。保單的年保費為1718.30美元,涵蓋了夫婦的住宅、車庫、騎馬場和個人財產。

2021年1月,艾奧瓦州本頓縣范霍恩附近菲利普農場的約翰?菲利普。他身后的玉米垛是去年德雷科風暴中受損的房屋之一。

夫婦從未提出過索賠,因此在德雷科發生后喬迪驚訝地發現實際上有一份價值67.3萬美元的保單,但對屋頂附有限制性說明,聲明本頓互助“不支付風暴或冰雹造成的屋頂損失,除非進行了可接受的維修或安裝了新屋頂。”《財富》雜志看到關于屋頂的說明日期為2017年8月,約翰?菲利普的名字已經印上,還有保險代理人的簽名,寫著“上午10點18分通話確認。”約翰和喬迪都對跟代理人就相關說明談話毫無印象,更別提同意。(多次評論請求均未獲保險代理人回應;本頓互助也拒絕對個人索賠發表評論。)

菲利普聘請的公共理算師和律師表示,該合同是糾紛的關鍵,因為本頓互助認為,已經免除了對屋頂損壞或房屋內因為屋頂受損而影響物品的賠償責任。這也反映了律師、United Policyholders的執行董事艾米?巴赫稱之為保險業“有問題”的趨勢,即悄悄修改房主的保單。United Policyholders是非營利組織,1991年成立,艾米?巴赫是該機構的聯合創始人。

“由于與氣候變化相關的風暴和水災事件越來越多,保險公司越發積極限制屋頂損壞和屋頂維修費用。”她解釋說,這一做法開始于2013年左右。“這一問題在艾奧瓦州引起廣泛關注,因為類似德雷科的情況下,既涉及風暴又涉及大雨。”

巴赫說,調整通常不會與投保人明確溝通,而且實施得太迅速,房主和監管機構都跟不上。條款調整實際上降低了房主保單的價值,成本卻很少降低(奧門說,這是艾奧瓦州保險部根據德雷科正在研究的另一問題。)2020年巴赫的組織發起了一項全國性倡議,即重建保險安全網聯盟(Restoring the Insurance Safety Net Coalition),希望呼吁監管機構、官員和法院意識該問題并制定標準,防止保險公司過分縮小范圍。畢竟,如果房子沒有屋頂,那價值何在?

根據NCP Group(總部位于佛羅里達州,本頓互助委托該公司評定和處理索賠工作)編寫的報告,菲利普夫婦發現其實價值很少。保險公司認定三層農舍賠償金或實際現金價值僅為16786.17美元。“簡直滑稽。”喬迪告訴我。“他們愿意(賠的錢)只夠給天花板塌著的屋子刷刷墻。”盡管進行了上訴,也有喬迪聘請的公共理算師的幫助(理算員評估保險賠償金超過67.3萬美元的保單),但據喬迪和代理人所知,NCP Group并未另派理算員重新核查。第一位理算員已經不在NCP工作。(NCP不評論個人索賠。)

公共理算師為該房產爭取了幾筆額外賠付,但與巨額估算相差甚遠。種種努力停滯不前時,喬迪與公共理算師的關系也迅速惡化,而雙方合作曾經是給了他們巨大的希望。她從公司也得不到答案。

和我采訪的其他人一樣,喬迪讓我感覺到,理賠過程中最令人不安的部分是缺乏人性:個人遭受巨大損失和創傷時,可依賴的人不回電話也不回短信;溝通也很差,甚至無法溝通;理算員、承包商或公共理算師會突然消失,有時還會被隨意換人重新走流程。大災難之后似乎都是此種模式,就像這一次,然而明明時間和資源都很匱乏。

就在此時,喬迪返回Facebook上的一個德雷科群組,找到了年輕而精力充沛的律師格雷格?厄舍,厄舍在錫達拉皮茲地區長大,后來從事財產和傷亡索賠。到2021年年初,他每周都要接8到10個求助電話,每晚等到年幼的兒子上床睡覺后仍然要工作。回顧諸多問題后,他得出了令人沮喪的結論:“幾乎每個人情況都很糟。”6月初,當我們談起過去一年時,他顯得筋疲力盡又很憤怒,他滔滔不絕講述了大保險公司糟糕的做法,還有遇到令人不安的事。他有一位名叫貝基?哈德森的客戶,房子被壓在樹下,經營家庭日托中心的地下室也被污水淹沒。她跟好事達的多位理算員打過交道,其中一人建議她好好清理,而不是更換污水泡過的日托用品。厄舍認為,好事達少賠了她至少10萬美元。(好事達表示,已經迅速支付了索賠中無爭議的損失,并且“所有未決索賠都經過徹底調查,以確保客戶及時準確收到賠款。”)

現在他通過評估指導菲利普一案,走的糾紛解決流程,雖然并非沒有風險,但比訴訟更快成本也更低。他說,準備在對菲利普家的財產聯合檢查時,與本頓互助的律師積極溝通下。雖然喬迪的案子離解決還有點遠,但現在由于厄舍介入,感覺有些希望。而她描述的悲慘篇章,也是“最糟糕的一年”,似乎慢慢走向尾聲。最近幾周,喬迪獲得了切爾西市議會的批準,駱駝克林格和馴鹿搬到了Periwinkle Place Manor莊園。她正在整修房子,方便夫婦二人搬回去,又開始主持謀殺懸疑劇院活動。她開始接受可能再也不會住在農場,只是努力記住,除了保險大戰和過去一年的困境,前方還有未來。(財富中文網)

譯者:馮豐

審校:夏林

A grant from the NIHCM Foundation helped fund reporting for this story.

Even against the backdrop of the past 18 months, and epic levels of American suffering, John and Jodi Philipp have had a rough go.

They both struggle with serious health issues—she a brain tumor, and he Stage 4 cancer that was diagnosed in November 2019 after experiencing a couple of strokes. As the pandemic began in early 2020, their rural Iowa businesses—2 Jo’s Farm and Periwinkle Place Manor—took a hit, since both depend on visitors and gathering for events. Then, on Aug. 10, as Jodi was driving John home from a cancer treatment at the University of Iowa to their farm in Van Horne, a town of 900-some people, they were caught in a freakishly intense windstorm—a derecho, or straight-line wind event—that wreaked havoc that day on a 770-mile swath across the Midwest and would go down in the books as the most expensive thunderstorm in history.

They pulled over, but as the torrential rain and hurricane-force wind blasts—gusts peaked at 140 mph—rattled their car, “we felt like we were going to die,” said Jodi, who was receiving a stream of texts and calls from her son at the farm until his signal went dead. His last message to her was that they should “be prepared.”

The drive, normally 50 minutes, took hours. As they passed silos that had blown onto the highway, and barns and crops that had toppled to the ground, they took in what seemed like a full preview of the storm’s destruction.

Even so, what Jodi found at the farm, a 13-acre property off Highway 30 (the old Lincoln Highway) in Iowa’s rural Benton County, left her dazed.

The Philipps’ farm is not a traditional Iowa farm. The couple, who for decades have played Santa and Mrs. Claus at venues and holiday parties around the Midwest, raise reindeer and have a camel named Kringle. The property, which hosted events, also had a mini Western town and a riding arena. Their farm buildings were demolished. Most of the trees were down, and the house and garage had too much damage to quickly process. The place was uninhabitable, she says, and most of their personal belongings damaged beyond repair. “It’s still unbelievable,” she told me when I first spoke with her. “When we go there, we just walk around and stare and wonder, what are we going to do?”

That conversation was in early January, when Jodi was making trips to Van Horne two times a day to feed and water the animals. She and John were living 30 minutes away, at their other business, Periwinkle Place Manor, a former funeral home that they bought and restored several years ago before converting it into a bed-and-breakfast (or dead-and-breakfast, as Jodi winkingly markets it) that hosts murder-mystery theater.

The manor, a Victorian mansion that dates to the late 1800s, is in Chelsea, Iowa, a low-lying, flood-prone town of 300 residents on the other side of the Lincoln Highway (so flood-prone that the city council voted to move Chelsea to higher ground decades ago; it hasn’t). Chelsea got crushed by the derecho, too—its town library was a casualty—but the manor sustained only minor damage (though it did lose power for 2.5 months), and that’s where the couple were staying with their intellectually disabled 26-year-old daughter and dog when both John, 72, and Jodi, 62, came down with COVID in late November. Jodi recovered quickly enough to take on a few Mrs. Claus jobs in December, but John, who had blood clots in his lungs and pneumonia, was in the hospital for a month. For the third time in a year, Jodi thought John was going to die. He came home on Christmas Eve day.

Yet, for the almost boundless trauma the Philipps faced in 2020, Jodi would argue that this year hasn’t gotten better. In the aftermath of these events, and the effort to recover, things have only gotten worse.

That’s largely because of a battle with her property insurer, which by Jodi's telling has been a frustrating, confusing, lonely, and increasingly desperate months long slog. To date, their insurer has paid out $212,525.43 for derecho-related claims to the property—almost all of it for the demolished riding arena—a small fraction of the total cost of the damages and of the sum that Jodi and experts she has hired argue she and John are owed under their $673,000 policy. Her home, on which the insurer has paid out just $29,663.13, remains in tatters and exposed to the elements. The family remains living at Periwinkle Place Manor, in an austere limbo.

“We have good insurance, or we thought we did, for many, many years,” said Jodi. “It’s been a rough year, and for the insurance company to completely turn their back on you after you’ve paid for insurance for 20 some years and never had a claim—in my opinion that should be a crime.”

I had initially gotten in touch with Jodi when I came across a GoFundMe page that a family friend had made on their behalf last year. At the time, I was reporting a story about how my home state was coping with its dual disasters—the derecho and the pandemic. With John just out of the hospital, I had assumed the couple’s battle with COVID would dominate our discussion, but even as John struggled with the lingering effects of the virus, it was clear the source of greatest stress for Jodi was the utter helplessness she felt about the situation around her farm.

When we spoke again in March, there had been little progress. It was the same story in June, though Jodi, at a breaking point and hoping to call attention to her plight (a car dealership in a neighboring town had successfully deployed the strategy), had custom-ordered for $360 bright orange banners, which she then tacked up to their fence that runs along the highway. The banners, which are no longer displayed, trumpeted out over three 10-foot-long signs the distress she felt due to the treatment by her insurer Benton Mutual and NCP Group, the third-party administrator working on the claim.

In response to the Philipps’ allegations, Benton Mutual said it could not comment on individual claims, as did NCP Group, which as a third-party claims administrator, and not the Philipps’ insurer, noted that it did not have authority to do so.

The long road to recovery

The Philipps are among thousands of Iowans still struggling to resolve claims related to the storm, an administrative task that is often just the first step for homeowners trying to get back on track. They’re also up against the clock: In Iowa, a state that promotes itself as the nation’s new insurance capital, most policyholders have just one year before the statute of limitations runs out for filing suit over claims—the only recourse (albeit an expensive one), some argue, that consumers have in disputes with their insurers.

In a year when the recovery process in Iowa has been slowed and complicated by a global pandemic and a slew of natural disaster and pandemic-induced shortages, those pressures add to what many, including Jodi, describe as a second trauma: navigating the red-tape-ridden obstacle course to recovery.

But this story is about more than one couple’s travails, or one bad experience with an insurance company, or even the messy aftermath of a single horrible natural disaster. The derecho, along with damaging homes and blowing the roofs off buildings, exposed the fundamental problems of an entire industry. As the business model that undergirds the insurance sector faces ever more pressure from climate change and bank-breaking catastrophes, some argue that it has become increasingly stacked against homeowners and fails to provide the safety net that ordinary people believe they have paid for.

Such battles in the wake of disaster are hardly a new problem. The story of wronged policyholders is the animating force behind Delay, Deny, Defend, the 2010 book by Rutgers law professor Jay Feinman. The book argues that some property and casualty insurers, in an effort to boost their bottom lines (following a playbook developed by management consultants), have developed tactics to sap people of the will, emotional energy, and financial wherewithal it takes to collect what they’re rightfully owed by their insurers. “It’s much more difficult to get paid for a valid claim now than it was 25 years ago,” Feinman told me.

The frustration and injustice of that experience is what led Douglas Quinn, a then-financial adviser whose waterfront home was badly damaged by Hurricane Sandy, to found the American Policyholder Association, an organization aimed at stopping fraud in the sector. The power dynamic in these battles is heavily tilted in favor of the multibillion-dollar insurance industry, he said. “It’s the storm after the storm, and in my experience the storm was the easy part,” said Quinn, who added he’s seen the same patterns he experienced—from insurers using age-old intimidation tactics to trying to shortchange policyholders by swapping in artificially low material prices on their Xactimate software (which adjusters use to price claims)—play out in Iowa, not to mention every other place where there’s been a natural disaster. “We see these things all over the country,” said Quinn.

The industry, to the extent that it engages, is dismissive of such characterizations, which it sees as self-serving messaging of plaintiffs’ attorneys, and often the result of consumers not fully understanding their policies before disaster strikes. In response to my outreach, companies emphasized their commitment to handling claims with care and honoring the coverage they set out in their policies. The Information Insurance Institute (III) also encourages people to know exactly what’s in those policies by asking questions and shopping carefully; it cautions people against choosing the cheapest policies without scrutinizing the coverage provided. “Don’t buy a junk car and then expect a Cadillac of a product when you have a claim,” III Media Relations director Scott Holeman told me.

Dave V. String, a vice president at NCP Group, the administrator that processed the Philipps' claim, commented generally on disputes: “We as adjusters are involved in handling claims in very tenuous, stressful and scary times for insureds, many of whom have never filed a claim before. NCP Group wants every insured we assist to be paid every dollar their policy allows. Sometimes this takes further investigations; sometimes it takes additional inspections; and sometimes it takes additional discussions. These add to insureds’ frustrations, but we do everything we can to get it right as quickly as possible…One of the largest obstacles to overcome with insureds is when they expect coverage for something their policy does not provide. NCP Group’s clients require that we follow the language of the policy in any recommendations we make to our clients. We will go out of our way to make sure nothing is missed, but we cannot change the terms of an insured’s contract.”

Regardless, climate change and the increasing frequency of extreme weather events—not to mention the mounting costs associated with them, and the underpreparedness of all involved for this new reality—suggest these battles between insurers and policyholders will only become more frequent and bruising, with a growing number of people likely to fall through their insurance safety net.

Evidence of those forces, of course, is already in plain view. The U.S. faced a record number of devastating and costly weather and climate disasters during 2020—a total of 22 events in which losses exceeded $1 billion—according to data from the National Oceanic and Atmospheric Administration, or NOAA. The government agency noted last year’s count “shattered the previous annual record,” which involved 16 such events. Insured losses due to those events in 2020 stand at $73 billion, 82% above the (inflation-adjusted) average figure for the past 20 years.

“We’ve witnessed insured losses caused by natural disasters increasing at an alarming rate, growing nearly 700% since the 1980s,” Holeman wrote in an email to Fortune, adding that last year brought record-breaking Atlantic hurricane and Western wildfire seasons (which included five of California’s six largest ever wildfires). “Still, the insurance industry has demonstrated leadership through disruption, paying claims for the insured.”

He noted that while insurers have built climate risk into their business models for years, “2020 illustrated how the disruption continuum is evolving.”

And 2021 is proving to be disruptive too. As of July 9, NOAA had tallied eight $1 billion weather and climate disasters in the U.S. this year, which, beyond economic losses, resulted in the deaths of at least 331 people. They include events that were previously simply unfathomable, like Texas’s crippling 10-day winter freeze and the Pacific Northwest’s record-shattering heat wave.

The derecho, too, outdid the imagination, racking up in a matter of hours last August an estimated $11.5 billion in damage across the Midwest. The devastation was particularly severe in eastern Iowa, where the intensity of the wind led to destruction well beyond what weather forecasters or actuaries ever thought possible. Just about every home in Cedar Rapids—a metropolitan area of nearly 258,000 people—sustained some sort of damage in the storm. Many people in the very hot month of August lost power for more than a week, and some for far longer. “The derecho really opened a lot of eyes in terms of the fact that thunderstorms can end up leading to hurricane levels of losses,” said Steve Bowen, head of catastrophe insight for Aon, the global professional services firm. He noted that properties in the region, whether brand new or decades old, weren’t built to withstand such wind speeds. “It was a reminder that even perils that historically haven't necessarily been massive drivers of damage are increasingly becoming higher risk,” added Bowen. “This is an event that caught a lot of us off guard.”

Indeed, Iowa was not ready for hurricane level losses. Compared to wildfire country, and hurricane-prone coastal states, Iowans are relatively inexperienced when it comes to widespread natural disasters, and Iowa lacks the robust infrastructure and know-how that more practiced states have developed over time to deal with such events. The state has no licensing requirements for insurance adjusters, meaning just about anyone can do the job of assessing damage for insurers.

Finding help

Meanwhile, resources to support insureds with the claims process or in disputes with their insurers are few. Public adjusting, or working as an independent advocate for policyholders (rather than for insurers), does require a license, and there are a relatively small number of them providing the service in the state. (They number in the thousands in Florida.) Similarly, lawyers who specialize in disaster-related insurance losses are extremely few. On the website of United Policyholders, a nonprofit that aims “to level the playing field between insurers and insureds,” the Iowa “Find Help” resource page lists just one public adjuster, Swift Public Adjusters, and one law firm, Larew Law Office. (The listings are sponsored.)

James Larew, who served as general counsel to Iowa Gov. Chet Culver from 2007 to 2011, started his practice to support policyholders in 2011 after realizing there were many people in the state who had issues with property and casualty insurers and nowhere to turn (they often tried to meet with the governor about their problems). Born and raised in the state, Larew noted that Iowans tend to take their lumps, meaning they’re culturally unlikely to challenge their insurers over claim payments. Even when they do, the state is not hospitable to such challenges because of laws and policies that bend in favor of the industry, he and others contend. (Iowans have to pay their own legal fees, even if they do win, for example, and the state allows insurers to write into their contract a limitations period as short as one year, compared to the 10-year statute of limitations that is presumed for written contacts more broadly in the state.)

Add to that the vulnerable circumstances of people whose homes have been been stricken by disaster, and the fact that lawsuits are wearing and expensive. Insurance companies know the risk they will be sued is low, a dynamic that allows them to underpay policyholders with little fear of consequence, Larew said.

When I spoke to Doug Ommen, commissioner of the Iowa Insurance Division (IID), in late July, insurers had paid out more than $3 billion on 225,000 derecho-related claims in the state. Roughly 18,000, or 8% of those claims, remained open, a volume that Ommen said reflected the scale of losses as well as shortages of labor and materials. The IID had received 392 derecho-related complaints, most of which have been investigated and closed by the agency. Of those, 110 of the complaints were confirmed—largely over “delays in the claims process as well as damages missed during inspections of the property”—resulting in an additional $307,000 paid to policyholders in the state. After Fortune asked about the issue, the IID also issued a bulletin advising insurance carriers to accommodate requests for extensions given the circumstances, including a shortage of insurance adjusters, that have slowed the recovery process for many in the state; at least one public adjusting firm says, in most cases, insurers continue to deny extensions. Ommen said his office was investigating issues raised by the derecho, like whether allowing one-year limitations in policies made sense.

A common trauma

Homeowners insurance should be a blessing when disaster strikes. Commercialized in the 1950s as a product to protect families against life-altering, wealth-destroying events like fire and tornadoes, mortgage lenders soon made it a requirement, and today 93% of American homeowners have a policy, according to the Insurance Information Institute. While standard home insurance doesn’t cover all catastrophic events—see earthquakes and floods—it does generally cover wind damage, meaning that private insurers were on the hook for the majority of derecho-related losses suffered by homeowners in the state.

That helped the state bounce back quickly, Dennis Harper, recovery division administrator for the Iowa Department of Homeland Security and Emergency Management, told me in January. “[Private insurers] were able to get in and get checks written right away,” jump-starting the repair and recovery process for homeowners, he told me. While the pandemic and widespread power outages due to the derecho complicated the job somewhat, the path to recovery for most was relatively clear and well-funded. (By comparison, explained Harper, 60% to 70% of people affected in the state’s occasional flood events tend to be under- or uninsured against losses.)

Indeed, many Iowans had a fine experience in the aftermath of the storm. They may have had to jump through a few hoops—my parents, who live in Cedar Rapids, for example, got a new roof after their contractor successfully challenged the insurance company’s denial for one—but they feel they were treated fairly. After talking with people and officials in January, my sense was that between robust insurance protection and Iowan neighborliness (Iowans helping Iowans with chain saws), the state’s derecho-impacted communities were doing pretty well, or at least moving forward in what would necessarily be a long and arduous recovery due to the scale of damage.

But as the months have worn on, it's become clear that that's not the complete picture. There are lots of stories involving homeowners like Jodi, who despite considerable effort feel they are stuck in the process and poorly served by the insurance companies whose policies, at least in theory, were supposed to protect them. Some of these cases involved my friends and family; scores of others are posted, SOS-like, on Facebook pages—such as the Iowa Derecho Storm Resource Page and Iowa Insurance Claim Q&A—that were formed as a support network after the storm. Both of those groups have thousands of members who, among other things, exchange information on their dealings with State Farm, Allstate, Benton Mutual, NCP Group, and any number of other insurers. Many, at this point, are exasperated. Their experiences, as I’ve learned in talking with a number of them, are uniquely complicated, but they share common traumas: a feeling of powerlessness and a sense of betrayal by an industry that so prolifically advertises itself as a good neighbor. They feel trapped in a labyrinth of their insurer’s making.

Take Rebecca Yoder, a 52-year-old Procter & Gamble employee who lives in Cedar Rapids with her husband; she describes her experience as “an utter nightmare.” For her property claim, she’s had to deal with five different field adjusters and so many desk adjusters at Allstate that she’s “lost count.” She has the sense that none of them talk to each other or make use of the copious documentation—150 photos and a detailed list of damages—that she provided them. Throughout the process, she has felt “ignored, lied to, made to feel stupid.” Her roof is leaking and, she argues, in need of replacement, but Allstate has agreed only to patch it. (She said none of the five adjusters who visited actually got on her roof to properly inspect it.) Contractors, meanwhile, were unwilling to give her quotes unless Allstate approves a full roof replacement. She finally found a contractor who would, but he disappeared on her, as have a painter and a public adjuster she hired (ghosting is a common problem for derecho-impacted homeowners, I’ve learned). Initially, Allstate paid the couple a little over $10,000 for the claim; through dogged follow-up, Yoder, with the help of a public adjuster, has gotten the total to a little over $20,000—less than half of what her public adjuster estimates she is owed.

“The emotional toll of it has been very tough,” she wrote to me. “Getting our hopes up, shuffling our schedules around meetings and phone calls has been inconvenient. Doing some of the work ourselves because we can't afford to hire someone out-of-pocket is frustrating.” Yoder is holding out hope that Allstate will come around on her roof; it’ll be hard to contemplate the future until the repairs are complete. “For now, we are trapped.”

In an emailed statement, Allstate said it “promptly paid all the agreed upon amounts" from the customer’s claim and that it was “working actively to resolve any remaining differences and thoroughly investigate all open claims to ensure accurate and timely payments to our customers.” The company noted that Allstate has settled 98% of its Iowa derecho claims and provided customers over $120 million to recover from their losses.

When the derecho caused a tree to fall on Marie Hancock’s southeast Cedar Rapids home, resulting in damage to her garage and dwelling, she felt more confident than most in her ability to navigate the situation. As a realtor, she understood the fine print of policies and the tedium of the claims process. But nearly a year later, she’s surprised to be in a situation similar to Yoder’s, with her garage still not functional and her roof in need of repair. Water seeps into her home anytime it rains heavily, worsening water damage within. The $12,000 she and her husband received for their claim feels hard-won—a first adjuster told her there was nothing wrong with her property; a visit from the second yielded a payment of $4,000—but also far less than what she believes she is owed under her policy. “We’re not in Florida,” she said, still a little stunned by what she’s witnessed. “They’ve had years of collecting premiums with very little payouts [here].”

Originally from Togo, in West Africa, Hancock feels discrimination has made her family’s battle tougher—she hired a public adjuster for that reason—and she’s noticed a similar pattern with immigrant families she’s helped through the process. With her own battle, she is close to conceding. "I don't have energy to spend fighting a system that I know is very well structured [to the benefit of insurers],” she told me in late July, adding that she and her husband plan to refinance their home and use that money to fix what the insurance money hasn’t covered.

The story of John and Jodi Philipp is another specific and complicated case. Their losses and circumstances are extreme, but according to those who have dealt with derecho cases, the battle with their insurer follows the patterns of others. For more than 20 years, Jodi and John Philipp had what they thought was a $1 million homeowners insurance policy through Benton Mutual Insurance Association, which, founded in 1872, is one of many small farm mutuals that serve Iowa’s rural communities. Headquartered in Keystone, Iowa (pop. 600), 10 miles west of Van Horne, it offers home and farm insurance in a 19-county area in eastern Iowa; more than half its policyholders were affected on the day of the derecho. Like many homeowners, John and Jodi didn’t think much about their policy, which they originally purchased through an agent in Vinton, another nearby town, and renewed every year. The policy, which has an annual premium of $1,718.30, covered the couple’s home well as the garage, the riding arena, and personal property.

The couple had never filed a claim, and so in the wake of the derecho Jodi was surprised to learn she actually had a $673,000 policy with a restrictive roof endorsement stating that Benton Mutual would “not pay for loss to roofs caused by windstorm or hail until acceptable repairs have been made or a new roof is installed.” The roof endorsement, which Fortune has seen, is dated August 2017, and John Philipp’s name had been printed in for a signature by an insurance agent, with the note “by phone 10:18 a.m.” Neither John nor Jodi remembers a conversation with an agent about the endorsement, or ever agreeing to it. (The insurance agent did not respond to multiple requests for comment; Benton Mutual declined comment on individual claims.)

That piece of paper is key to the Philipps’ dispute, as Benton Mutual argues it absolves it from covering roof damage or anything inside the house that was damaged because of a faulty roof, according to the public adjuster and attorney hired by the Philipps. It also reflects what Amy Bach, an attorney and the executive director of United Policyholders, the nonprofit she cofounded in 1991, calls a “problematic” trend in the insurance industry: the quiet modification of homeowners’ insurance policies.

“Because of the increasing number of wind and water events associated with climate change, insurers have gotten more and more aggressive in limiting what they pay for roof damage and roof repairs,” she explained, dating the start of the practice to around 2013. “That’s a problem that’s come home to roost in Iowa, and in a situation like the derecho because it involved wind and rain.”

Bach said such changes, which reduce the value of homeowners policies but rarely the cost of them, are usually not communicated clearly to policyholders, and have been implemented too quickly for homeowners and regulators to keep up. (Ommen said this is another issue the IID is examining in light of the derecho.) Bach’s organization launched a national initiative, Restoring the Insurance Safety Net Coalition, in 2020 to bring to regulators, officials, and courts an awareness of the issue and to institute standards that prevent excessive coverage-shrinking policy rewrites. What, after all, is the value of a house with no roof?

Very little, the Philipps would discover, according to the report prepared by NCP Group, a Florida-based company that Benton Mutual had hired to adjust and process claims. The company determined covered damages, or the actual cash value of damages to their three-story farmhouse, to be $16,786.17. “It was almost comical,” Jodi told me. “They wanted to give us [a payment] to the paint the rooms in the house when the ceilings are caving in.” Despite appeals and the help of a public adjuster Jodi hired (which assessed the covered damages as exceeding their $673,000 policy), NCP Group hasn’t sent another adjuster to reinspect the place to the knowledge of Jodi or anyone representing her. The first adjuster no longer works for NCP. (NCP does not comment on individual claims.)

The public adjuster secured a few additional payments for the property, but nothing close to the firm’s huge estimates. And when those efforts stalled, Jodi’s relationship with the public adjuster—once a source of so much hope—soured. She couldn’t get answers from the firm either.

As with others I spoke with, my sense from Jodi was that the most upsetting part of this process was its lack of humanity: the fact that at a time of extraordinary personal loss and trauma, the people they depended on for help didn’t return calls or texts; that they communicated things poorly, if at all; that an adjuster or contractor or public adjuster would just up and disappear, sometimes replaced by another one, restarting the whole process, and sometimes not. It’s a pattern that seems to happen after widespread disasters, like this one, where there’s a scarcity of time and resources.

It’s at this point that Jodi returned to one of the Derecho Facebook groups, which led her to Greg Usher, a young and energetic attorney who grew up in the Cedar Rapids area and eventually found his way to property and casualty claims. By early 2021 he was getting eight or 10 calls a week and working nights after putting his young son to bed. After reviewing so many issues, he had reached the depressing conclusion: “Almost everyone’s getting screwed.” When we spoke in early June, he seemed both exhausted from the past year and freshly outraged by it, rattling through the worst practices of the major insurers and the upsetting things he had come across. There was his client Becky Hudson, whose house had been crushed under a tree and her basement—where she ran a home day care—flooded with sewage. She had dealt with multiple Allstate adjusters, including one who suggested she just clean, rather than replace, the day-care items that had been contaminated by the sewer water. Usher believes Allstate has underpaid her claim by more than $100,000. (Allstate said it had promptly paid all undisputed damages from the claim, and that “all open claims are thoroughly investigated to ensure our customers receive accurate and timely payments.”)

He’s now shepherding the Philipps’ case through appraisal, a dispute resolution process that, while not without risk, is quicker and less expensive than litigation. He says communication with Benton Mutual’s attorney has been positive as they prepare for a joint inspection of the Philipps' property. While Jodi’s case is far from resolved, she is feeling more hopeful now that it is in Usher’s hands and that this miserable chapter—“the worst frickin’ year,” as she described it—seems to be inching toward an end. In recent weeks, with Jodi having secured the Chelsea city council’s approval, Kringle and the reindeer moved to Periwinkle Place. She is fixing up a structure on the property for her and John to move into, and she has begun hosting murder-mystery events again. She is coming to accept that she will probably never again live at the farm and is instead trying to remember that beyond this insurance battle and the limbo of the past year, there is a future.

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