Silvia I. Cosenza, who lived in Gretna, La., until Hurricane Katrina roared through, says she's been caught in an insurance nightmare: Her flood claim denied because an insurance adjuster ruled that her neighborhood was not flooded.
That came as a surprise to Melmary Matheny, who lives across the street and has already received partial payment on her flood claim and has been told to expect another check soon.
What's the difference? Beyond the fact that different insurance companies handled the claims, neither knows.
"For sure, she flooded as much as we did," Matheny said. "Our whole entire neighborhood flooded."
As the insurance industry grapples with its largest-ever loss and a record number of individual claims -- 1.6 million from Katrina, another 1 million from hurricanes Rita and Wilma -- policyholders are learning that the opportunity to get their lives back in order often depends on which company is processing the claim. In many cases, homeowners living in areas that were equally flooded have had drastically different experiences.
Particularly puzzling to some homeowners is that all flood claims are ultimately paid by the federal government's National Flood Insurance Program, which is operated by the Federal Emergency Management Agency. Insurance companies merely administer the program as contractors, selling flood policies and processing claims for a fee. The government -- which hired 95 firms as flood program contractors -- sets the rules and is responsible for paying the claims.
"It's the same money," said Andreas Anderson, who owns two houses in New Orleans's Lakeview neighborhood and is still waiting for an answer from Allstate Corp. on whether his claim will be approved. He said the water in the neighborhood got so high a car floated into one of his houses.
Blaine Lecesne, a law professor who lives in Lake Terrace, an adjoining neighborhood that was also severely flooded, said representatives of State Farm Insurance Co. investigated his claim in a 30-minute telephone interview and sent a $250,000 check to his temporary home in Houston two days later, on Oct. 3.
The widely disparate treatment encountered by those and other Louisiana homeowners is a reminder of the secrecy that shrouds claim-handling in the $1.3 trillion insurance industry. Insurance companies, which are regulated by the states, are not required to disclose their claims practices, including how quickly claims are processed, how many are denied and for what reasons.
Relaxed rules open to interpretation
To speed the processing of hurricane-related flood claims, FEMA in late September relaxed its reporting guidelines and authorized contractors to perform investigations over the phone for claims in heavily flooded areas. The agency is using aerial photography and its own data on water depths to determine whether damage is so extensive that on-site visits can be waived. FEMA has also suspended its requirement that policyholders submit sworn "proof of loss" statements; instead, where the policyholder agrees, the agency will rely on an adjuster's report.
Not all insurance companies are interpreting the relaxed rules the same way. Some homeowners echoed Lecesne, saying that State Farm handled their claims over the phone. Ben Benton, a retired video store owner, said he has already received a $143,000 check from State Farm for his home in the Broadmoor neighborhood.
Phil Supplea State Farm spokesman, said the Bloomington, Ill., company is closely following FEMA guidelines and "moved quickly to begin work with satellite imaging technology that allowed us to expedite claims."
Other homeowners have reported greater difficulty with their claims. Several Allstate policyholders say the company has required adjuster visits, which, for displaced homeowners, can be difficult to arrange.
Don Cherrie, a pilot for Southwest Airlines, said he had so much trouble arranging an appointment with an Allstate adjuster, he finally offered to fly them both in a helicopter to his flooded house in the New Orleans East area, planning to land on a nearby golf course. The offer was declined, and the inspection took place weeks later.
Cherrie said he is still waiting for written confirmation of the loss, which he needs before he can close on a new house elsewhere in the city. "I pretty much call Allstate on a daily basis," he said.
William Mellander, a spokesman for Allstate, based in Northbrook, Ill., said Allstate is processing claims both over the phone and with on-site inspections. But typically, he said, claims involving both wind and flood damage need to be inspected.
"Those kind of subtleties can create a difference in how claims are handled," he said. "It varies from claim to claim."
There is some dispute over the status of Cherrie's claim. Mellander said Allstate's records show the claim was paid Nov. 5. However, Cherrie said Allstate told him Nov. 17 that the company's "major damage committee" was still reviewing the claim and he would hear in "a few weeks."
'It's still subjective'
FEMA does not yet have data on claims handling, according to spokeswoman Nicol Andrews. She said that she has not heard any reports of disparities in treatment of policyholders by the agency's flood-program contractors.
J. Robert Wooley, the Louisiana insurance commissioner, said the department has received 1,271 formal complaints involving hurricane claims. He said the figure is low considering his office has fielded 20,000 calls a month since Katrina hit, five times more than normal.
Wooley said it is understandable that flood claims might be handled differently, even on the same block, since water might have risen to different levels or an inspection might be needed to determine a house's value before deciding how much to pay on a policy.
"It's still subjective," he said. "Not everybody is just going to get a flood check. They still have to do some adjusting."
That has been the case with Cosenza, a 41-year-old U.S. Navy petty officer who had lived in a single-story house in Gretna, about six miles south of New Orleans, with her mother, husband and their two children and a grandchild since 1999. The family fled to Houston two days before the storm and is still there.
Cosenza said she first contacted a unit of American National Insurance Co., the Galveston, Tex., company that sold her the flood policy. Representatives at American National referred her to National Flood Services Inc., based in Kalispell, Mont., which referred her to a claims-handling contractor, Simsol Insurance Services Inc., based in Niceville, Fla.
In calls to Simsol and National Flood Services, Cosenza said, she received different answers regarding her claim. One person told her it had been denied Oct. 5 and closed; a second person said it had never been closed; and a third person told her that it had been closed but reopened.
Cosenza said an adjuster from Simsol inspected the property on Oct. 1, but she did not hear back from him for weeks -- though she did reach his wife, who works in the office and assured her he was still working on the claim .
The battle over her family's flood claim became so time-consuming that Cosenza said she had to turn down a new job as a government biologist. Her husband, who works for an oil-drilling company, was out of work for a month after the storm. The family is struggling to pay both the mortgage on the Gretna house and rent on their Houston apartment, Cosenza said.
"I'm already past the point of being upset and depressed, and it's a laughable matter now," she said. The family recently hired a lawyer to help with the flood claim.
Back-and-forth battle
To support her claim, Cosenza said, she sent Simsol photos of water damage, statements from neighbors and news accounts of flooding in the area. She also obtained a letter dated Nov. 8 from the Jefferson Parish flood plain coordinator, Tom Rodrigue, who attested to the flooding in the neighborhood.
Cosenza said a Simsol executive who reviewed the documentation told her that the area had not been flooded and insisted that she retrieve photos of the area taken by a neighbor who rode out the storm.
"It would be great if you sent the photos you claim to have which show the floodwaters in the home, rather than having several individuals send letters on your behalf -- none of which conclusively support your contention that the property flooded," the executive, Don Roberts, wrote, according to an e-mail provided to The Washington Post by Cosenza.
Cosenza said she drove several hours from Houston to Gretna to retrieve the photos and sent them to Simsol.
Roberts did not return messages left at his office. A woman answering the phone at Simsol said Roberts was busy and might not be able to respond to questions for "another couple of months."
Warren Dennis, the Simsol adjuster who handled the Cosenza claim, said he did maintain contact with Cosenza. He said that he denied the claim about a month ago based on an inspection of the property and the fact that flooding in the town had been "spotty."
"Gretna is not New Orleans," he said, adding that he wouldn't be doing his job if he paid claims that were not legitimate.
Dennis said that Cosenza has provided "new documentation," including photographs, and that he plans to meet her, her lawyer and a representative of the national flood program, at the property next week.
"I know she has an opinion of me, but I've been doing this a long time," he said. "Hopefully, we'll have a resolution next week that everybody is agreeable with."