Complaint Review: Windsor Mount Joy Mutual Insurance Co. - Ephrata Pennsylvania

As one who is very knowledgeable about this insurance carrier I can and will say with certainty that they operate within the laws and regulations as governed by the states they operate in, but just barely. It is widely known within the inner sanctum of the operation that pushing things to the limit and cheating without getting caught is routine and a code they live by. Their policy forms are written in such a way that they offer coverage to insured's who otherwise cannot obtain it from other larger carriers, equating to somewhat of a captive market condition or as one person put it, "A license to steal". Their primary book of business is built upon risks that are secondary or seasonal dwellings and vacation homes in areas that are near the shoreline or in areas prone to storms or risk types that other carriers do not wish to insure. As such, they have written policies tailored to their advantage which have all been approved by the states they operate in. There are special forms and endorsements included in the policy packets which stack the deck against the insured, citing requirements that few are aware of until they submit a claim for coverage. Most agents do not take the time to explain in great detail the limited coverage that the policy affords nor do they explain the areas of the policy that limit the coverage available, especially the special forms and endorsements that are present on these types of policies as mentioned above. An example would be that an insured must make a "reasonable" effort to "maintain heat" in the residence while absent, or turn the system off all together and drain the water from the systems within a specified time-frame or risk no coverage being afforded to them. First of all, it makes sense to do so for anyone (shutting off the water when you leave) but who defines "reasonable" and "maintain" with regard to the heat? Numerous claims have been denied over the years for this loophole approach and several they have denied for this reason have been challenged in the court system in at least three states, some with success for the company and some with no success, meaning the verdict was against them. So again, the deck is heavily stacked against the policyholder because the courts often lean to the carrier because of their highly paid attorneys who build a defense for them. As to my earlier comment that things are pushed to the limit, the president of the company often referred to this which was interpreted by many to mean push it but don’t get caught. Routinely claims were denied that should not have been because the language of the policy was vague or could be interpreted differently or was ambiguous. Many, but not all carriers lean to the insured in situations such as this but not at Windsor. They take a very black and white approach to policy coverage and interpretation often citing it is a contractual issue between the parties involved. When questions of coverage arose and were researched and discussed, they always leaned to the side of denying coverage rather than affording coverage to the policyholder, again holding a firm line on denying rather than paying claims. In addition, the upper management level were comprised of persons that had a mixed and also somewhat limited knowledge of insurance. None had ever worked for any other carrier than Windsor so they had no gauge on how the rest of the industry really worked. It was in effect a very small shop (under 30 employees in the entire company) and their experience levels varied greatly but were heavily weighted toward no or little insurance background. The president had the most tenure in the company and assumed the throne from his father who passed away. The CFO had zero background in insurance and not much more in accounting practice. He was handpicked after the prior CFO passed away and another, more qualified candidate internally was passed over in the process. The COO was groomed out of college but had little understanding of the claims process and admitted he was more of “a numbers guy”. The underwriting manager is a 20-something who roomed with his predecessor’s son in college. His grades were allegedly so poor that he was unemployable to most but Windsor hired him and groomed him for the job. Daily intervention into the day to day operation of the claims department was routine and those aforementioned players made many of the decisions for the department. Because of their narrow minded approach of leaning to the insured, it was routine to have insurance complaints filed against them by the insured and to even have hearings with the insurance department and even the Attorney General at times. This didn't seem to faze them though as they see themselves as invincible and their cavalier attitude and mindset was ever-present and guided them on their path. Their arrogance and greed were self-evident and that attitude carried through in all areas of the business. A portion of their business income was derived from a book of business that was antiquated but still in operation; a policy that was a "benefit" to those who needed burial assistance. It was not a life policy but it was a benefit to beneficiaries left behind. These types of policies were very popular in the 1940's, 1950's, and even into the 1960's but fell out of favor because most people realized the benefit was not so good. The policyholder paid a few dollars a month for a term of years for an ultimate death benefit of $1000.00 or more. An accidental death would yield the survivors a "double indemnity" award worth twice the face value. The problem is, the policyholder paid into this for years and netted only $1000.00 or so for many, many years of payments. Imagine paying into a policy for a benefit that unlike a homeowner's policy that is fixed at a specified amount when you perish. A very small amount at that, unlike a traditional life insurance product. With enough people investing and the limited payout known by the issuer of those policies, it was like an ATM for the company building equity time and time again and over and over again. Over the years they allegedly took in so much money they didn't know how to hide it or spend it. It's legal, but in my opinion also criminal form a moral standpoint. States often perform audits on carriers to ensure their practices and methods are within the law and conform to the principles and guidelines established for entities doing business in those states. This company, a part of many other entities under the corporate umbrella, have come close on some occasions to being caught in lies and deceitful behavior but seem to have always escaped any serious retribution. They have bent the rules, they have hidden things electronically from the audit teams, and they have deceived on many levels up to and including their own employees. There is so much more that could be added but the space here is limited. Suffice it to say, this is NOT the company that they claim to be and when pressed, they do not pay claims in a cheerful and willful manner and if you are unfortunate enough to be caught in a situation where your claim has even a hint of a coverage question, they will find a way to deny it rather than finding a way to afford coverage. Beware.

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