Lightning Strikes Thrice!
In the quest for profits, Lemonade adopts the industry’s claim minimization strategies.
I intended to write the second post sooner, but life happened again. The logical next post after “The Genesis of the UNFAIR Act” would have been to continue the story from our original loss; however, now we need to quickly gloss over all of 2022 and 2023 and address the present.
After finding mold in home in November 2021 and having to discard everything, our family of 4 were quite sick. With nothing, we rented a VRBO in Scottsdale for 6 months to regain our footing and recuperate. Recovery was slow, so we decided to move back to Florida to be near the support of family. The simplest option was another furnished VRBO that we could move our few replacement clothes into and not have to think about anything else. I was fortunate enough to find a property in a nice neighborhood that I could negotiate an 18-month lease. We could rest and recuperate – no pressure, no decisions.
By January of 2024, 2 years later, our blood and urine tests began showing that we were nearly mycotoxin free. Indeed, we were feeling better and getting active again. We pulled our bikes out of storage and rode the Legacy Trail, a nearby rails-to-trails project. We were going out again. We began thinking about travel. We started looking for a home to buy. Health returns.
In late spring, we’d made an offer on a home. There was one thing troubling us, though. After the long recovery and feeling some relief, my wife started getting sick again. She became anemic to the point of passing out. Then my daughter got sick – a general malaise that just put her down on the couch for a week. Then I started to notice skin irritations and a return of intense allergies, every morning felt like a hang-over from a night of heavy drinking.
Alarm bells were ringing! I called the home inspector that had done the inspection on the home we had made an offer on (we ultimately did not make the purchase) and asked him to test our VRBO. He walked in and said “Oh no, I can feel it in my throat.” Looking in the AC vents, he found it. The lab test confirmed more mold – Aspergillus and Cladosporium. The air levels were considered “low,” but given we’d developed CIRS from our prior exposure, it was more than enough for us. I’ll add a post about our experience with CIRS later.
Lightning strikes twice.
Rewind to 2023 during Hurricane Ian. At 2am, a nearby transformer exploded, and the power spike fried the electronics in our AC unit’s air handler. It was promptly replaced, but apparently, the new unit had an excessive condensation problem. This home was built in the mid-90’s, so the air handler was in the garage and not indoors, providing plenty of humidity in the Florida spring to create dampness in the AC vents. Dark, wet, with old ducts providing cellulose – the perfect conditions for hidden mold growth.
On Friday, May 31st, we evacuated. We damp-wiped our phones, laptops, and otherwise walked out with the clothes on our backs, our dogs, their leashes (oops – we quickly realized the mycotoxin mistake here), and rented two rooms at the hotel down the street. At 10pm I’m walking through WalMart buying a change of clothes and toiletries.
We were promptly evicted with 7 days to remove our things. So, we moved the hard stuff to storage, bagged soft stuff for insurance claim and disposal. In a hotel, we found a new place to live and reserved an AirBNB.
It was a busy week.
Our business model precludes honesty
(a short AirBNB detour)
Two weeks later we’d accomplished much. An elderly neighbor my girls had been caring for over the past year jumped at the opportunity to host them. We’d seen our doctor and were prescribed antifungals, steroids, and given referrals to pulmonology and infectious disease specialists. We’d found a new place to live – bigger and better – but unfurnished. We’d been living “temporarily” so long while recovering, this felt like the time to start making the change. Our new home wouldn’t be available until July 1, and our new furniture couldn’t be delivered until July 8, so we needed an AirBNB for a month to hold us over.
Oh, AirBNB, I’m disappointed you took a page out of the Yelp playbook. We entered the AirBNB on June 18 and crashed on the bed. We were exhausted. The last two weeks had been a tremendous amount of work (on top of doctors, pack out, the day job, finding a new place to live, I was coding for work and trying to hit a court deadline for discovery for State Farm – see the previous post). Deadlines were missed.
The next week, I’m back at my doctor’s office asking for another round of steroids. Give me drugs! I’m not getting better. Worse, if anything. My wife, Angel, is still having intense facial rashes and feels terrible. We’re functioning like zombies 3 weeks after evacuating our VRBO home.
Lightning strikes thrice.
On June 26, the owner of this AirBNB unit came to replace the AC filter. Having been built to newer construction codes, the air handler was inside the unit. The owner pulled out the filter and set it on the floor, put the new one in, and my heart sank. The removed filter was black with mold growth. I discreetly snapped this picture and we evacuated minutes later.
I negotiated early access to our new place and wired funds, returned to WalMart to purchase two air mattresses, and we moved in early. No gas for hot water. No furniture. And most importantly, NO MOLD. I had crawled all over the home personally. (All the clothes we’d bought in the last two weeks are now exposed in the condo – trashed again.) I had asked the owner for a full refund of our stay to defray the cost of what we lost. Ultimately, AirBNB denied that, and the owners negative review lamented on how I neither gave him time to fix the problem, and that I demanded the entire stay be refunded.
When I confronted the AirBNB owner, he didn’t see a problem. AirBNB did refund the remainder of our stay. In closing out the stay with AirBNB, they insist on a review. I carefully stuck to the facts, added the picture, and left it up to future guests to decide. The owner left a bad review on my profile. And we were done.
Or so I thought. A few days later AirBNB sent me a notice that they’d removed my review under a vague “not helpful to the community” policy violation. (I never checked, but I suspect they did not remove the owner’s bad review of me, which would have been my first. I try to be polite and fastidious. My Uber rider rating after hundreds of reviews is 4.98, so can hundreds of drivers be wrong? 🙂 ) A quick Internet search confirmed that other negative reviewers were similarly censored, and I realized this is how AirBNB plays the game and promptly deleted my account.
Now I understand why all the units on AirBNB are so highly rated – it’s not in their interest to be an honest marketplace.
We’re Denying Your Claim (Twice!)
That’s just our Policy.
Catching our breath, we filed a claim with Lemonade for the soft items (mostly clothes – we didn’t own the furniture), which we’d cataloged and bagged into storage. Looking back and writing this, I wonder how in the world we accomplished all of this in the short period of time. In support of the claim, I constructed a timeline with pictures and supporting documentation, including the environmental report, medical history with recent visits, numerous videos of reactions, and explanations. A huge data dump.
On June 20, 2024, I filed a loss claim with Lemonade, and I received an acknowledgement and documentation instructions the next day. I replied with all the requested documentation, and the next day on Jun 25 I received the first claim denial, stating the mold was caused by “humidity,” which is not a covered peril.
That fire was caused by a spark, and sparks are not covered perils. I’m at a complete loss for words to describe the absurdity of their argument.
So, on Monday, July 1 I filed this report with the Florida Department of Financial Services. It seems other Florida residents have enough insurance claims problems that the state operates a service for citizens. Less than 48 hours later I received a note from Lemonade: “after reviewing your claim, our legal team has determined that there is potential coverage under your policy for this loss.”
Imagine that.
If the first denial doesn’t succeed, deny again.
Lemonade dispatched a local company to pick up our items from storage to perform a value calculation for our claim. I met them Monday, July 29 at the storage unit to pick up all the plastic bags. We’d accumulated a surprising amount of replacement clothes over the last 2 years, so I’d expected the cataloging and pricing exercise would take a bit of time.
Three weeks later, on Tue, Aug 20, I ping Lemonade for an update and they confirm they’re waiting to hear back from the service provider. 45 minutes later I receive a copy of the June 25 denial email. Thinking it’s just a clerical error, I replied and received the following in response:
I tried to give you a call yesterday to discuss, and left you a voicemail, but unfortunately [redacted] was unable to identify any mold on your belongings, so we will not be able to assist with your personal property claim. We re-sent the original denial letter as we found no damage on your belongings.
My goodness. We even set aside a box of items we knew were out in the open and not washed so they could independently confirm the environmental report. We cleverly labeled it “Biohazard – Mold Samples” but their contractor wasn’t interested in taking that box of items.
My reply only took about 15 minutes:
In the instant: 1) What did they test, 2) how did they test it, 3) what lab did the testing, 4) where is everything now? Did they test for the same molds that were found in the original environmental test, that the owner hired a contractor to remediate, and for which our blood tests show a high level of antibodies? What’s your theory here to explain this? Did they wash everything first, which will remove the mold such that it will not show up on a test, but the soft items will still retain the mycotoxins which are still toxic to sensitive individuals?
Why are you not sharing the test results from the lab and chain of custody documents with us, which we’ve received with every other test ever done? If your intent was to ignore the existing environmental report and conduct your own test, it’s wholly inappropriate to not take the samples on-site but rather load them onto a truck with others’ items and tote them away, then do this testing on your own outside of the spotlight of full transparency. The test samples should have been taken right there onsite before anything was moved — now you’ve created a mess by not following a common-sense process.
Methinks in hindsight that it wasn’t in their best interest to actually find anything, so following a transparent process is not in their playbook. [Trust Us,] Forget Everything You Know About Insurance.” We have this problem in our lawsuit against the owner of the property in the Phoenix area: as soon as an experienced insurance lawyer got involved, the process changed and they did more testing. This time, their hired tester ran an air test less than the ICRC recommended time, with the collection plate that didn’t appear to be fully open, after the property had been aired out for a week. No surface testing at all. Guess what, they didn’t find anything, either. We received the “all clear – get your stuff out now” message.
Here’s what I grew from samples in our bedroom. Yep, “all clear,” nothing to see here.
Needless to say we discarded everything in 2021 after that “all clear” and we’re now arguing with State Farm over the presence of “alleged” mold, because what better way to deflect than debating what the definition of “is” is. Lemonade wants me to forget this experience and trust them?
Professional mold testing can be completed in 48 hours, including shipping time. I’ve done it myself in 72 hours – $8 pitri dishes with agar from Amazon, expose them to air for a few minutes or swab an item to collect the spores you can’t see, seal the agar dish and set them in the dark for 72 hours. Come back and see what you’ve grown. See the picture above of growth around the 10 day mark.
Back to the present, Lemonade’s testing took 3 weeks. They claim there “was no visible contamination” (because they have microscopes for eyes) and that the item (singular!) tested “found no evidence of mold in any way.” I have no idea what item they tested (certainly not the samples we set aside, knowing they hadn’t been recently washed, because the service provider left that box behind for disposal), who tested, or how, or if it was even my item. Every test I’ve seen has a documented chain-of-custody. Not here. And Lemonade doesn’t have a policy to share. While they have not explicitly refused to share, they have chosen to ignore repeated requests and have withheld any other helpful information that could resolve this issue.
Lemonade has carefully avoided outright refusal to test the items we suggested—they simply ignored the items we set aside and disregarded our subsequent guidance on what to look for. Instead, they used a single undisclosed test to conclude: ‘…based on the tests [which we will not share with you] and inspections [we didn’t observe mold in the storage unit or on your clothes] that we have conducted, there is no mold on your items. At this time, the burden is on you to prove your loss. We have done all we can in this matter, so the responsibility now falls on you to provide any legitimate proof [though we will not specify what that is] to support your claim, as needed to change our determination.“
…In other words, we found an item without detectable spores that we can hang our hat on, so why would we weaken our position by actually trying to find something.
Part of my response to Lemonade upon learning this:
So that I’m clear here: you don’t have a standard policy in place to share the results of testing to support your basis for the denial of a claim? You are the final arbiter of a claim, and what you say goes without any need to provide any supporting evidence, even though you require full disclosure from insureds? “We didn’t find mold, but we’re not going to tell you what we tested, how we tested it, or that we even reviewed or considered the other documentation we insisted you provide as part of your claim. And, we’re not even going to tell you what we require to support your claim — you guess, and we’ll decide if you guess right.” A denial in this scenario is fait accompli.
I recall a recent trial in Russia of a Wall Street Journalist reporter for treason that employed these same tactics with an identical predictable result.
To the best of my knowledge, this is allowed by law, regulation, and custom.
The Lemonade claims process starts up front with you making a pledge that you know that false claims are insurance fraud and a criminal offense (implying they will prosecute). Lemonade is not the only insurance company that records your statement (audio or video). It’s helpful for claims processing, but it’s also useful for later impeachment and reduction/denial of claims.
One would think that submitting a mold claim where there’s no mold constitutes fraud. I have to wonder if this is suddenly going to turn around on me with fraud charges for filing a false claim.
How can no mold be detected?
It’s not as surprising as you might think. Considering the timeline of events and the speed that mold grows, the environmental test detected what it termed “low” levels of aspergillus in the air. If you don’t have CIRS or an immune system that’s still recovering from a prior event, you possibly wouldn’t even notice as early as we did. So, if you think about how often your clothes are washed, or how some are stored in drawers out of direct air flow, you’re highly likely to have some items without detectable spores on them.
Given that, if you have a vested interest in not finding mold, it’s not too hard not to find it. Our renter’s insurance company in 2021, HomeSite, seemed to know this and were surprisingly knowledgeable and helpful (!) about our situation.
The problem is two-fold: mycotoxins that do not wash out that trigger CIRS responses, and the craps-shoot of knowing which item(s) are going to get you. This is why we set aside items in a box marked “Biohazard – mold samples” because it contained hanging items we knew were exposed, and why in one of my responses to Lemonade I gave them a list of closet items they could test for spores and mycotoxins. If this mysterious “item” they tested was in a drawer or had been stored out of air flow, then it probably wouldn’t test for mold spores. And who knows about mycotoxins.
We lost at craps several times in June and July: our dogs’ leashes, our pool cue cases that usually remained in our cars but did enter the home, the steering wheel and seats of my truck (oh, cross contamination!), and all the plastic HDX bins we brought into the house to load up, when we unpacked them later. We had to wash the outside of the bins with a hose and wear gloves and masks as we wiped the hard items we rescued ourselves.
I’ll redact and share the entire history provided in the future so you can evaluate for yourself.
The Inmates Run the Asylum.
This quote and article recently caught my attention:
Mr. Buffet succinctly and elegantly stated the key problem with this industry. You pay the inmates for coverage, and they act as sole judge, jury, and executioner deciding whether your claim is valid. Additionally, they control the process and do not reveal it before you go through it, so you’re left wondering if you’ve collected enough evidence to validate your claim – really, can you convince them that you can beat them in court. If not, your claim is denied or diminished, and your only appeal is the legal system. And, you’re playing this guessing game under extreme duress (we were suddenly homeless, sick, and given 7 days eviction notice to get our stuff out and return the home to its prior condition), all while having to work a day job.
It’s the very definition of bad faith by design.
And the industry defends its practices by crying “Fraud!” I don’t doubt there’s fraud because it’s everywhere, but really, if it’s this pervasive, we’d see a deluge of criminal charges. Think shoplifting and retail loss prevention – the police are always called and charges pressed. Take a look at your county’s court docket and I suspect you’ll find only a small amount of insurance fraud in the criminal docket.
There must be something we can do…