Monthly Archives: June 2021

Do You Become the Enemy When You File an Insurance Claim?

June 19, 2021 By in Home Owner Insurance Issues Tags: , , , 1 Comment

   “I have paid my premiums on time for twenty years and have never filed a claim.  Now, it is difficult for me to tell who has caused me more damage — the storm or my insurance carrier.”

     The above exclamation, or words like it, is something that I hear daily from Missourians who have had the misfortune of needing to file an insurance claim for damage to their homes and businesses.  Do you really become “the enemy” of your insurance carrier when you file a claim?  Do they really consider you more as an adversary than a customer?  

     I received an email today from an attorney representing an insurance carrier from out of state and who sells insurance policies in Missouri who provided a clear and convincing answer to those questions.

     My client, a commercial business, had incurred extensive and obvious hail damage to multiple buildings and filed an insurance claim.  Their insurance company hired an independent adjustment firm to inspect the damage who reported their observations to the carrier.  The carrier, after receiving their report and photographs, decided to hire an engineer who regularly assists insurance carriers in denying coverage for hail damage to properties in Missouri.

     With the hail damage being as obvious as it was, there was no legitimate reason to have an engineer look at the same dents, gouges, and tears that their independent adjuster had just seen and photographed.  I suspected that the independent adjuster had recommended that the claim be paid against the carrier’s wishes, and I requested a copy of his report.  Insurance companies will share their reports when their report supports a claim denial.  For some reason, the carrier did not want to share this one and I was suspicious of their intention.

     When I submitted a formal written request for a copy of the report from their independent adjuster that I believed supported my client’s claim for damages, I received a letter from the carrier’s attorney in response that confirmed my suspicions.  In part, it read as follows:

     “Under Missouri law, the relationship between an insured and the insurer with regard to first-party claims becomes adversarial when a claim is made on the policy.  Therefore, the insurer is entitled to assert work product privileges to prevent access to materials found in the claim or investigative file.”

     Because my client had filed a claim, he became an “adversary” to his insurance carrier and was not entitled to see documents in his file that might support his claim.  In return for his annual premiums exceeding $80,000.00 per year, this is what his money bought for him.  An adversarial relationship.

     Of course, we’re suing.  Soon, that report and all the other documents in the file will be in the hands of his attorney.  He will recover all the money owed to him by his insurance carrier along with (most likely) punitive damages and his attorney fees.  He is, indeed, an “adversary” to his insurance company – but not because he filed a claim.  Rather, it was the insurance carrier that decided to vexatiously withhold money that was due to him under his contract rather than to pay him what he was entitled to.  That action taken by them, and not their claim, is what made him an adversary … and a worthy one, at that.

“My Contractor Says My Roof is Shot but My Insurance Company Won’t Pay”

June 14, 2021 By in Home Owner Insurance Issues, Home Repairs, Property Insurance Leave a comment

   

Reporting damage and hoping for the best.

 

     I will get at least one phone call this week, as I do every week, from someone who is upset with their insurance company for denying their claim for a “leaky roof”.  It usually goes something like this: “My contractor told me my roof must be replaced.  There is hail damage to it, but my insurance company refuses to pay for it.  I need your help.”   Before they call me – actually, before they call their insurance company and file a claim – there are things they should know.

     The first thing an insured home or business property owner should know is their duty to prove their loss when they file an insurance claim.  Simply reporting damage to their insurance company does not fulfil their duty under insurance contract to prove they have a covered loss.  Most policyholders are unaware that they have this burden of proof and will merely report damage to their insurance provider and then leave it to the insurance company and their adjuster to prove their claim for them. 

     As one can reasonably expect, the effort to prove the policyholder’s claim is not always accomplished to the satisfaction of the insured policyholder, when expecting their insurance company to be zealous in proving that the policyholder is entitled to money.  Instead, they find that the insurance company has sent their adjuster to the damaged property primarily to fulfil their duty under the insurance agreement – the duty they have to prove that an exclusion to coverage under the policy exists and payment should be denied.

     The contractor may have told the policyholder the truth.  The roof might need replacement and there might be hail damage present.  Neither of these two facts, however, sufficiently prove that the loss is covered under the insurance policy.  

     Before filing the claim, the prudent insured property owner will first determine the following:

     1. When did the hail damage occur?  A shingled roof can last twenty to thirty years and, over its lifetime, will be struck by many hailstorms and can be insured over that same period by many different insurance companies.  Which hailstorm is being reported to be the one that caused the damage and what company insured the roof on that date?

     2. How significant is the hail damage?  Roofs will age and incur damage from normal wear and tear, a condition that is excluded under the insurance policy.  Is the hail damage to the roof significant enough by itself to warrant a replacement, or are there only a few selected shingles damaged by hail and the rest of the roof needs replacement for other natural (and non-insurable) reasons?  

     3. Is there evidence of hail damage to exterior surfaces other than the shingles?  While resilient composite shingles are designed to deflect hail strikes to minimize damage, other surfaces are not.  Damaged shingles should also be surrounded by other evidence of hail strikes to soft metals such as appurtenances, gutters, downspouts, fascia, mailboxes, HVAC units, patio furniture, wood deck surfaces, lawn furniture and other surfaces struck by the same hailstorm.  Not only can these additional damages be included as part of the claim but will also serve as proof of the severity and (sometimes) the date of the storm. 

     These are a few of the things that one must consider when proving their coverage for a loss to a roof due to hail damage.  There are more, and a good roofing contractor can assist a policyholder in compiling evidence to provide to the insurance carrier as evidence. 

     Needing a new roof and having a valid insurance claim for damage to an existing roof are not the same thing.  Policyholders who file insurance claims have the duty to prove their covered loss.  The best time to prove it is to themselves before they file the claim so that they may, in turn, prove it to their insurance company when the adjuster arrives.

To prove a covered loss in the manner required for a successful insurance claim is not always easy to do.  When in doubt, consult with a licensed public adjuster.  Don’t get mad … get paid.

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