\n<\/p>\n
J.C. Hallman\u2019s recent article in The Nation<\/em>, \u201cState Farm Is Embroiled in Scandal\u2014and Things Just Got Worse<\/a>,\u201d 1<\/sup><\/a> comes at this controversy with a flamethrower. I generally prefer a flashlight followed by a subpoena. Fortunately, State Farm\u2019s own previously top-secret trade secret documents<\/a> shine a lot of light.<\/p>\n My previous post,\u00a0\u201cDid State Farm Turn Accenture\u2019s \u2018Industry Best\u2019 Into a Blueprint for Replacing Almost No Roofs?<\/a><\/em>\u201d focused on Accenture\u2019s unexplained \u201cindustry best\u201d benchmark suggesting that only 5% to 10% of certain wind and hail claims should result in full roof replacement. The benchmark is important. But Exhibits 3, 4, 6, 7, and 30 are even more revealing when read together and in chronological order.<\/p>\n The exhibits appear to show the evolution of an idea into a claims system designed solely to reduce roof payments. They identify roof replacements as a financial opportunity, create a management playbook aimed at replacement recommendations, track the changing results, and calculate the enormous indemnity consequences.<\/p>\n Exhibit 3 starts the story in June 2020. A State Farm executive wrote:<\/p>\n \u201cIf in fact Full Roof Replacements is our biggest bucket of opportunity, we think our best option is to first focus on small hail\/light wind.\u201d<\/p>\n<\/blockquote>\n The message then discusses developing an easier way to track hail size and wind speed against payment codes for total roof replacement, partial roof replacement, and other outcomes. \u201cBucket of opportunity\u201d is wonderfully bland corporate language. Opportunity to do what?<\/p>\n Exhibit 4 answers that question rather directly. It refers to the company\u2019s \u201cbiggest buckets of opportunity\u201d as \u201cindemnity spend.\u201d It then compares State Farm\u2019s roof-replacement frequency with the Accenture numbers and explains: \u201cWhen we ran the dollars, that narrowed our focus of opportunity.\u201d<\/strong><\/em><\/p>\n The same communication states that leadership would receive the indemnity spend associated with these opportunities. It offers a hypothetical example of a \u201c$50M opportunity\u201d if \u201cAccuracy improves.\u201d<\/p>\n There is nothing wrong with an insurance company studying its claim payments. Insurers should train adjusters, correct errors, prevent fraud, and avoid paying for damage that is not covered. Policyholders ultimately pay the price for sloppy claim handling in either direction. The concern is how \u201caccuracy\u201d was defined and pursued.<\/p>\n Exhibit 30 appears to transform the financial hypothesis into a nationwide claims playbook. It identifies State Farm\u2019s baseline full-roof replacement frequency as 63% for certain wind claims and 90% for certain hail claims. It places those figures next to an alleged \u201cindustry best\u201d of 5% to 10% and labels the enormous difference an internal \u201cquality improvement opportunity.\u201d<\/p>\n The playbook then calls for team-manager review when a claim handler recommends full-slope or full-roof replacement for specified light-wind and small-hail claims. It also includes structured phrases to measure adoption, weekly monitoring, targeted reinspections, dashboards, Haag training, and something called the \u201cArt of the Conversation.\u201d<\/p>\n What the exhibit does not appear to show is an equivalent management-review requirement when the adjuster recommends a repair, finds no damage, or closes the claim without payment. The asymmetry matters. If management is genuinely testing accuracy, it should be equally concerned about paying too little and paying too much. A review system that places special scrutiny on replacement recommendations but not on repair or no-payment decisions can operate as a one-way ratchet. The claim may move downward, but the system provides little institutional pressure for it to move upward.<\/p>\n Another Exhibit 30 slide compares February 2021 with June 2021. The percentage of manager-approved full-roof replacement recommendations reportedly fell from 80.9% to 42.7% for the wind categories shown, from 73.8% to 45.8% for the combined categories, and from 54.8% to 49.3% for the hail categories.<\/p>\n The category descriptions changed somewhat between February and June, so this is not a perfect apples-to-apples comparison. It also does not prove that every unapproved replacement recommendation became a denial rather than a partial replacement or some other outcome. Still, it is difficult to ignore what the slide appears to celebrate: that management involvement increased while approval of adjusters\u2019 roof-replacement recommendations decreased significantly<\/em>.<\/strong><\/p>\n Exhibit 6 then provides the scoreboard. In January 2023, State Farm\u2019s Nicole Manduca wrote that the Wind\/Hail work began during the summer of 2020 and expanded in December 2020. She reported \u201cabout a $1.4B decrease in indemnity from 2020 to 2021.\u201d She also noted that claim volume was down while severity was up.<\/p>\n Exhibit 6 does not prove that the Wind\/Hail initiative caused the entire $1.4 billion decrease. Weather patterns, claim volume, geography, catastrophe activity, deductibles, inflation, and other factors may have contributed. But the same email immediately discusses another result. When the work began, State Farm reportedly replaced 5.6 roofs for every partial roof replacement. The ratio fell to 2.0-to-1 in 2021 and remained at 2.2-to-1 in 2022.<\/p>\n The email puts the rollout, the $1.4 billion indemnity decrease, and the dramatically lower total-to-partial replacement ratio in the same conversation. The document is not conclusive proof of causation. But it is an awfully good roadmap for discovery follow-up.<\/p>\n Exhibit 7 may be the most candid of the group. While reviewing the metrics, Manduca asked: \u201cWe have gotten better, right? Or am I just snowing myself.\u201d<\/em><\/strong><\/p>\n She then asked whether the \u201cresults (that matter)\u201d proved improvement. A State Farm colleague responded by calculating the financial significance of a single percentage point. He estimated that one percentage point represented approximately 5,000 claims. At an average severity of $15,769, that amounted to $78.8 million.<\/p>\n State Farm\u2019s stated position within that communication was that these were claims involving undamaged and uncovered roofs that might previously have been paid because of insufficient employee \u201cskill\/will.\u201d That may be State Farm\u2019s explanation, and it deserves to be stated fairly.<\/p>\n The question that still remains is, \u201cHow did State Farm determine that the claims no longer being paid were truly uncovered rather than merely caught in a system designed to reduce the replacement rate?\u201d When a single percentage point is worth almost $79 million, definitions matter. Audits matter. Incentives matter. The direction in which errors are measured matters enormously.<\/p>\n Did State Farm measure underpayments as aggressively as overpayments? Were repair recommendations reviewed with the same intensity as replacement recommendations? Were managers rewarded, formally or informally, for lowering replacement approvals? Did State Farm track how frequently its initial repair decisions were later reversed through supplements, appraisal, litigation, or complaints from its own agents?<\/p>\n Those questions cannot be answered by calling the program \u201caccuracy.\u201d The documents do not yet conclusively prove a nationwide scheme to wrongfully deny roof claims. They do, however, appear to show a financially measured and potentially asymmetrical claims-management system directed at reducing full-roof replacements.<\/p>\n The most troubling evidence is not that State Farm tracked money. Every insurance company does that. It is that State Farm may have started with a desired replacement frequency, subjected replacement recommendations to special management review, measured the decline in approvals, watched the replacement ratio fall, and calculated the results in tens of millions and ultimately billions of dollars.<\/p>\n The policyholder\u2019s roof is not a \u201cbucket of opportunity.\u201d It is somebody\u2019s home or business. Whether that roof should be repaired or replaced must be determined by the policy, the governing law, the damage, and a good-faith investigation and not by how much one percentage point is worth to the insurance company.<\/p>\n Hallman calls this a scandal. I will continue examining the documents before reaching final conclusions. But Exhibits 3, 4, 6, 7, and 30 raise a question State Farm and Accenture should be required to answer:<\/p>\n Was the Wind\/Hail initiative designed to improve the accuracy of individual claims or to engineer a lower roof-replacement rate and measure the money saved?<\/em><\/strong><\/p>\n Thought For The Day<\/strong><\/p>\n \u201cThe most important one\u2026is always do the right thing.\u201d\u00a0<\/em><\/strong> 1<\/sup><\/a> J.C. Hallman. \u201cState Farm Is Embroiled in Scandal\u2014and Things Just Got Worse.\u201d The Nation<\/em> (Aug. 24, 2026)<\/a>. Available online at https:\/\/www.thenation.com\/article\/society\/state-farm-oklahoma-scandal\/<\/a><\/p>\n<\/p><\/div>\n\n
\u2014Julie Sweet, Chair and CEO of Accenture<\/em><\/p>\n