Puerto Ricans fight insurers for cash

Delays, denials of claims a year after Maria strains the finances of thousands

DORADO, Puerto Rico — Thousands of Puerto Ricans have been forced to drain their savings, close their businesses, or resign themselves to living with structural damage as they fight insurance companies over millions of dollars’ worth of claims that have gone unanswered or unpaid more than a year after Hurricane Maria.

Experts say the Category 4 storm caught insurance companies off-guard and left them reeling financially after they were hit with nearly 279,000 claims, a number that one expert called “extraordinary.” One major insurer has already folded, leaving more than 1,500 claims worth a total of $70 million up in the air. Many worry other companies might follow.

“The industry has never faced such an astronomical number of claims,” said Iraelia Pernas, executive director of Puerto Rico’s Association of Insurance Companies. “No one was prepared for that, not the federal government, not the insurance companies, no one.”

The Office of the Insurance Commissioner of Puerto Rico has already issued fines totaling more than $2.4 million against at least seven companies for delays in resolution and payment of claims. All companies in the U.S. territory had bought reinsurance, but it was insufficient for some.

Commissioner Javier Rivera said it’s too early to say what will happen with Real Legacy, the company that folded. But he believes the other company that exceeded its reinsurance limits, Triple-S, has enough capital to avoid a similar fate.

“There will definitely always be a risk that some claims might not be addressed,” he said. “But we will do everything that is possible.”

Michael Barry, with the New York-based nonprofit Insurance Information Institute, said that exceeding reinsurance limits is highly unusual: “It tells me that was an extraordinary event that even in the companies’ worst case scenario, Hurricane Maria was difficult for them to envision.”

Two insurance companies in Puerto Rico are also under review with negative implications, said Brian O’Larte, director of the property and casualty ratings division for A.M. Best, an insurance rating firm.

Hurricane Maria was the strongest storm to hit Puerto Rico in nearly a century, and it did so amid a 12-year recession, causing more than $100 billion in estimated damage, destroying the power grid and forcing businesses to remain closed for months. Overall, Maria was the most expensive catastrophe for the insurance industry last year, with losses amounting to $32 billion, higher than hurricanes Irma and Harvey, according to a report from Swiss Re, a reinsurance company based in Switzerland.

Insurance companies in Puerto Rico have paid a total of $4.4 billion in claims, but more than 13,600 claims have not been closed, according to a report from Puerto Rico’s government. The report shows that 65 percent of overall claims were closed with payment and 30 percent without payment.

The commissioner’s office recently launched an audit into all companies, and Rivera said he is looking at some more closely than others, although he declined to name them. His office has received some 1,600 complaints, which is

nearly three times the number it reports receiving in a normal year.

Pernas, of the insurance association, said that it took insurance companies two years to pay a total of $1.2 billion in claims following Hurricane Georges, a Category 3 hurricane that hit in 1998. She also said the pending claims from Maria are complicated and involve mostly businesses, municipalities, government agencies and condominiums.

“They have to be reviewed with great care because they’re big,” she said.

According to Barry, the number of pending claims is normal for a disaster of such

size, but lawsuits are already being filed.

“We’re talking about businesses that have disappeared,” said attorney Lee Sepulvado, who has filed a class-action lawsuit. “This obviously impacts people’s lives.”

Edwin Rosario is among those who were forced to close a business: He shuttered a restaurant in the northern coastal town of Dorado that he opened four years ago. The 48-year-old reported damages exceeding half a million dollars, but has received only $93,000 from the insurance company and has used up all his savings, sold his home and transferred his daughter to a more affordable school.

By December, he expects to decide whether he will leave Puerto Rico and join the estimated 155,000 people who fled to the U.S. mainland after the hurricane.

“It’s been an incredibly frustrating process,” Rosario said as he recalled the moment he entered his restaurant and saw the damage. “That day was one of the few times where I sat down and didn’t stop crying.”

Last month, the administration of Gov. Ricardo Rossello sued various insurance companies after officials said they did not respond quickly enough to claims filed after Hurricane Maria. They said the lawsuits aim to prevent companies from dropping claims because they have allegedly expired. The lawsuits also seek $2.6 billion in damages for those who have not been compensated.

“What is happening in Puerto Rico is very, very serious,” said attorney Francisco Amundaray, who is representing several clients pursuing a response from insurance companies. “The companies, since they were not prepared for an event of this kind, are refusing to pay claims that are of absolute merit.”

Among those still waiting for a full payment is Lilliana Sanchez, who owns a pharmacy in the southern coastal town of Salinas. Her husband lost part of his hand trying to fix a broken generator, which is insured for $30,000.

Sanchez reported $50,000 in total losses after Maria, and she has since been forced to refinance her house, cancel her daughter’s university housing, cut her staff at the pharmacy by half and reduce operating hours. She has called the insurance company several times about her claim to no avail.

“They only tell me that it’s being processed,” she said.

By law, insurance companies in Puerto Rico have 90 days to resolve a claim. Sanchez said she filed her first claim 10 days after Hurricane Maria hit on Sept. 20.

Pernas said companies are making changes to their contingency plans and expect to fly in claims adjusters ahead of any major storms in the future.

GERALD HERBERT/AP 2017 Nestor Serrano walks on the upstairs floor of his home, where the walls were blown off, in the aftermath of Maria.

CARLOS GIUSTI/AP Edwin Rosario holds a photo of his damaged restaurant. Only $93,000 of his $500,000 claim has been paid.