Author Archives: James H. Bushart

“No hail damage” Concluded Before the Roof Inspection?

April 21, 2021 By in Home Owner Insurance Issues, Property Insurance Tags: , , 2 Comments

no hail damage before roof inspection

 

The engineer’s report I read today concluded as follows:  “There was no functional damage due to hail observed on any of the roofs on the buildings at the subject property.  If hail occurred at the subject property, it did not have sufficient size, density, or speed to cause functional damage to the roof covering.”

My first reading of this conclusion sent up a red flag as I read, “If hail occurred at the subject property …” since the report contained weather data showing that hail greater than 1.25″ had fallen at the site of the fifteen-year-old shingled roof on the date of loss and observations of hail dents were reported on all metals on and surrounding the roof.  How could “if hail occurred” even be a factor in a conclusion about the damage clearly reported to be caused by it, I wondered.  Then, I began to look deeper.

My second reading of the report was an intense search for any mention of the engineer’s measurement or calculation of the density of the hailstones that he knew to have struck the roof or a determination of the distance or angle of their descent.  There was none.  Without that, how could the engineer, who had now come to question “if” hail had struck the roofing materials, conclude that the hail was known to have lacked the density or speed to cause damage?

I checked my files and found three other reports written by the same engineer from other claims I had represented.  Like this one, all of them were written at the request of an insurance company, and all of them concluded the same absence of “observed” damage to the roof.  Oddly, however, each of the four reports stated the same conclusion in the same words – verbatim.

2017 – “There was no functional damage due to hail observed on any of the roofs on the buildings at the subject property.  If hail occurred at the subject property, it did not have sufficient size, density, or speed to cause functional damage to the roof covering.”

2020 – “There was no functional damage due to hail observed on any of the roofs on the buildings at the subject property.  If hail occurred at the subject property, it did not have sufficient size, density, or speed to cause functional damage to the roof covering.”

2021 – “There was no functional damage due to hail observed on any of the roofs on the buildings at the subject property.  If hail occurred at the subject property, it did not have sufficient size, density, or speed to cause functional damage to the roof covering.”

2021 – “There was no functional damage due to hail observed on any of the roofs on the buildings at the subject property.  If hail occurred at the subject property, it did not have sufficient size, density, or speed to cause functional damage to the roof covering.”

Not one of these narratives was supported with information as to how or if the engineer measured the density and speed of the hailstones to conclude their insufficiency to cause damage.  Nor did they report the storm’s direction, the angle at which the hailstones struck the roofing materials, the speed or direction of the wind at the time of the storm or other relevant data required for scientific analysis of hail damage.  In other words, if one removed the boilerplate language apparently common to all of his reports, nothing appeared in the narrative requiring an engineer to cite.  A shingle salesman with poor marketing skills could have just as easily written the same ambiguous and noncommittal descriptions.

Last but certainly not least, please pay special attention to how this carefully worded boilerplate conclusion did not say there was no damage to the roof caused by hail.  Instead, the engineer stated that based only on his powers of observation, he didn’t see it.   

Could it be that these conclusions, like the language used to communicate them, had been predetermined before the inspection?

Copyright 2021, James H. Bushart, Licensed Adjuster LLC

 

 

This Blog/Web Site is made available by James H. Bushart, Public Adjuster LLC for educational purposes only as well as to give you general information and a general understanding of the work of a public adjuster, not to provide specific legal advice. The authors and/or site manager make no representations as to accuracy, completeness, currentness, suitability, or validity of any information on this site and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. By using this blog site you understand that there is no public adjuster/client relationship between you and James H. Bushart, Public Adjuster LLC.  The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.

Why Missouri Contractors Cannot Negotiate Your Insurance Claim.

April 18, 2021 By in Home Owner Insurance Issues, Home Repairs, Property Insurance Tags: , , , , , , , , , 2 Comments

missouri contractors cannot represent your claim

Missouri contractors cannot negotiate your insurance claim on your behalf with your insurance company.  On August 28, 2011, the Governor of Missouri signed into law Senate Bill 101, which prohibits home exterior contractors from representing a policyholder or negotiating with their insurance company for exterior work on their home as a part of an insurance claim.

Here is a link to the law:   It is obvious.  

So why do insurance companies continue negotiating with residential contractors despite this law?  Perhaps it is because, when they do, they can get away with underpaying your claim.

An insurance adjuster can say things to your contractor that he cannot tell you, your Missouri attorney or your Missouri licensed public adjuster because, unlike you (and those who lawfully represent you), the contractor is not a party to the agreement (the policy) between you and the insurance company. 

Insurance adjusters will often withhold certain information from the contractor, misrepresent or not fully disclose your coverage to the contractor, and say things to your contractor such as, “We are not paying that much for that building material … Your estimate is too high for labor, and you need to revise that … We are not going to pay more than such and such dollars for this claim … We won’t pay your overhead and profit” … and so forth because they are not communicating with you or anyone lawfully representing you.

It would be an act of bad faith, and perhaps a vexatious act carrying severe penalties, for the adjuster to say such things to you or your lawful representative.  Why?  Because certain communications and actions between insurance companies, their policyholders, and their lawful representatives are regulated by the Missouri Department of Insurance. Such regulations, however, do not necessarily extend to their relationships with contractors and other vendors.  In their opinion, your contractor represents his interests and not yours. 

For example, when an insurance adjuster makes a statement of fact regarding your coverage to you or your lawful representative, he must respond with supporting language from your policy upon demand.  Not so, however, when your contractor makes the same demand.  Since the contractor is not a party to the agreement or lawfully representing anyone who is, he is not entitled to know all of the critical information the policy contains.  Withholding this information about your specific coverage from your contractor puts him in the dark and the insurance company’s adjuster in complete control. 

Some contractors mistakenly believe that since they have worked with certain insurance companies or adjusters in the past, all policyholders with that company have the same or similar coverage – which is not true.  The same insurance carrier can insure three or four neighbors living side by side on the same street and have different policies with different coverage. Some contractors quote what they believe to be “state law” regarding what an insurance company must pay for, which is also untrue.  In Missouri, state laws do not govern or control all of the information contained in an insurance policy, and policy interpretation disputes are settled in civil court and are generally not legislated.

I hold skilled and experienced exterior contractors in very high regard. They are essential advisors for you and your lawful representatives in settling a claim.  Their skillful and experienced input in determining the full scope of the damage and what they charge for restoration of that damage is often vital in settling your claim.  It is when they extend beyond their valuable construction skills and expertise and go beyond the “low hanging fruit” that the adjuster would pay anyway and (as some contractors advertise) “push” the adjuster toward a larger settlement, complete documentation, communicate with the carrier on your behalf and settle your claim, those and similar actions may not be in accord with the law and their results may not produce all of the money that you are entitled to.

On your own, reflect as to how an independent roofing contractor negotiating a claim for hail damage to shingles is likely to overlook and omit hail damage to windows, siding, screens, wood trim, decks, and HVAC equipment from his estimate as he argues with an insurance company’s adjuster for a complete roof replacement.  Then consider why an insurance adjuster would be willing to negotiate with him even though the law forbids it.  It could be a bargain for the insurance company at your expense.

Most damaging is the harm some do to your claim before you finally bring in qualified and lawful representatives, such as your attorney or licensed public adjuster, to assist you.  While their lack of ability to correctly interpret your coverage or communicate your rights under the policy may have limited their ability to help you fully resolve your claim, what they spoke to the insurance company (correctly or incorrectly) can interfere with a fair resolution and must be identified and resolved before progress can be made.

I work with many exterior contractors and help them operate within the boundaries outlined in Senate Bill 101, allowing them to focus on their areas of skill and expertise to serve their customers’ construction needs fully.  Their customers can recover from their insurers what they require to restore their home to its pre-damaged condition, and the contractor makes what he bids for the needed work.  When done correctly, all parties are served in a win-win position.  However, when done improperly, some or all come out on the losing end.

Not all claims require an attorney or a public adjuster to handle them.  Most can be taken directly by the policyholder with no representation if they understand their rights under their contract with the insurance company and have a skilled contractor they trust to inform them of their damage correctly and what must be done to restore their property to its pre-loss condition.

No one but you, your Missouri attorney, or your Missouri licensed public adjuster should be communicating with your insurance company on your behalf and remember that a “no” from the insurance adjuster to your exterior contractor is not the final word on your claim for damage.

 

 

 

This Blog/Website is made available by James H. Bushart, Public Adjuster LLC, for educational purposes only and to give you general information and a general understanding of the work of a public adjuster, not to provide specific legal advice. The authors and site manager make no representations as to the accuracy, completeness, currentness, suitability, or validity of any information on this site and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. Using this blog site lets you understand there is no public adjuster/client relationship between you and James H. Bushart, Public Adjuster.  The Blog/Website should not be used as a substitute for competent legal advice from a licensed professional attorney or for capable maintenance or repair advice from a qualified contractor licensed to perform work in your state.

The Need for a Personal Contents Inventory

April 18, 2021 By in Property Insurance Tags: , , , , ,
Need for a personal content inventory

Sifting through the ashes to write an inventory of personal contents to provide to your insurance company can be stressful.

 

The most cumbersome task required of a homeowner by their insurance company when filing a claim after a catastrophic fire or tornado loss is the preparation of a personal contents inventory. 

Test yourself right now.  Close your eyes and make a mental list of everything in the room you are in … then open your eyes and marvel at all you failed to include in your list. Think of doing this for every item in your home after a fire, tornado, or other tragic events then add to this overwhelming task your insurance carrier’s request that you also add to each item on your list the date you purchased it, its manufacturer, price, and more.

It’s hard.  It’s expensive to be wrong.  It seems unfair.  It will make you angry to be required to perform this task and it will upset you to be forced to revisit your loss and relive this tragedy each time you return to the task.  I’ve seen many of my clients experience this anguish repeatedly.

There is something you can do TODAY, however, that will help you to minimize this daunting effort should you ever be faced with such loss.  That something is to create and maintain your inventory right NOW.  Remembering all of your items can make the difference of thousands of dollars in your insurance claim.  Imagine being paid a thousand dollars per minute to file your claim.

The Missouri Department of Insurance provides a handy booklet you can download to get started, but I recommend that any written list of your belongings you create be supplemented with a gallery of photographs and videos.  When photographing your items for your inventory, including photographs of the data plates that record the serial numbers, manufacturer, and manufacturing date.  A digital recording of a slow span of a room, a drawer, a box of mementos, tools, and cupboards will assist you and your insurance company, as well.  There is also a phone app. 

It is important to keep your inventory and video/photographic record of your belongings in a safe place other than in your home where they could be destroyed along with the recorded belongings.  Keep it up to date when items are added or removed from the home … and may you never, ever have to use it.

For more information, contact James H. Bushart, Missouri Licensed Public Adjuster.

 

 

This Blog/Web Site is made available by James H. Bushart, Public Adjuster LLC for educational purposes only as well as to give you general information and a general understanding of the work of a public adjuster, not to provide specific legal advice. The authors and/or site manager make no representations as to accuracy, completeness, currentness, suitability, or validity of any information on this site and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. By using this blog site you understand that there is no public adjuster/client relationship between you and James H. Bushart, Public Adjuster.  The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state, nor should it be used as a substitute for competent maintenance or repair advice from a qualified contractor licensed to perform work in your state.

Engineer Speak – “Functional” v. “Cosmetic” Damage

April 18, 2021 By in Home Owner Insurance Issues, Home Repairs, Property Insurance Tags: , , , , , ,

 

Photo by Laker on Pexels.com

Here is a story about how an engineer might record the functional damage versus cosmetic damage in a fictional situation, first.

Once there was a maintenance man who worked in a famous art museum and was directed by his supervisor to touch up the white paint on the wall of a certain gallery within the museum.  As he was ascending his ladder he accidentally tipped over his gallon of white paint and it splashed across the surface of a 550-year-old painting from a world famous artist that hung in the gallery.

Of course, the painting was insured and the curator immediately filed a claim.  The insurance adjuster took a few photos and shared them with his boss who said “We need to send out an engineer.“

The engineer arrived to examine the painting and noted that the framed canvas was designed and intended to hold paint of various colors.  Since the canvas and frame were still intact and obviously able to retain paint, he recorded that the painting was still “functional”.  The painted surface had white paint splashed across the smiling face of a woman named “Lisa” or something, but he reported the damage was only “cosmetic” in that it did not interfere with the “function” of the canvas to hold paint.  It was, after all, paint on a painting … and the gallery was filled with various paintings with random splashes and colors.  He concluded that there was no “functional” damage and the insurance company denied the claim.

This story is fictional, of course … but the actions described are quite common.

Let’s look at the shingles on your roof, for example.  The manufacturer of your shingles produces them in a wide variety of colors, shapes, and styles.  When you selected them (or selected a house that already had them), you noted their color and design in context with the features of the rest of the structure, didn’t you?  Of course, their designed purpose is to protect the roof from wear and water intrusion but they also were carefully and creatively designed to enhance the beauty of the home.

When a sudden Missouri storm erupts and pounds them with hail, along with the metal appurtenances, gutters, downspouts, and other surrounding materials, they will often be damaged.  When they are damaged, you might contact your insurance carrier to file a claim for direct physical damage or loss to your roofing materials.  The insurance adjuster will arrive, take a few photographs, and return to speak to his boss.  When the boss does not want to pay you for your damage, he might send an engineer.

The engineer will often look at your shingles and the surrounding metals for holes.  Finding none, he declares that the shingles and metals are still shedding water as they were designed to do, and the damage to them is not “functional” but merely “cosmetic”.  Based on this report, the manager may deny the claim, depending upon the language in your policy.

Denying the claim because of an engineer’s definitions of “functional” or “Cosmetic” damage rather than the insurance policy’s definitions of damage can be improper.  Try as some might, engineers neither write nor interpret Missouri insurance policies and, when they attempt to do so, they are often incorrect. Some insurance companies have been successfully sued for such actions when it happens, as in the case of North-Shore Co-Owner’s Association versus Nationwide Mutual Insurance Company.

When you believe that your insurance carrier is trying harder to deny your claim than pay your claim, you may be the victim of improper claim handling, bad faith, or vexatious actions on the part of your carrier.  When this happens, seek the advice of your Missouri attorney or a Missouri licensed public adjuster. 

 

 

This Blog/Web Site is made available by James H. Bushart, Public Adjuster LLC for educational purposes only as well as to give you general information and a general understanding of the work of a public adjuster, not to provide specific legal advice. The authors and/or site manager make no representations as to accuracy, completeness, currentness, suitability, or validity of any information on this site and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. By using this blog site you understand that there is no public adjuster/client relationship between you and James H. Bushart, Public Adjuster LLC.  The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state, nor should it be used as a substitute for competent maintenance or repair advice from a qualified contractor licensed to perform work in your state.

Were You Sold a Homeowner Policy with “Functional Replacement Cost” Coverage?

April 18, 2021 By in Property Insurance

 

To save dollars and reduce insurance premiums in a competitive insurance market, some Missouri homeowners are offered insurance policies that provide them with “functional replacement cost.”  What does this mean?

If your policy pays you for damage based upon “actual cash value” or “ACV,” you will be paid for the cost to replace the damaged item after subtraction for depreciation.  Depreciation is commonly determined by age and/or condition.  Ultimately, you will be paid some, not all, of the total cost to replace the damaged item.

If your policy pays you for damage based upon “replacement cost value” or “RCV,” you will be paid for the cost to replace the damaged item.  The money is typically delivered in two payments: the first payment is the actual cash value (see above), and the balance is paid after the item has been replaced or restoration work has been completed.  In the end, you should be paid all of what it costs to restore you to where you were before the covered damage occurred.

If your policy pays you for damage based upon “functional replacement cost,” you are not entitled to be restored to where you were before the covered loss.  Instead, the insurance company will decide what to replace the damaged item(s) with.  For example, suppose you have an expensive slate or tile roof that is severely damaged by a storm and requires replacement instead of replacing the slate roof with a material of like kind and quality. In that case, the insurance company can pay to replace the expensive slate or tile with less costly but “functional” shingles.  If you must have slate or tile to maintain the style and quality of the home’s appearance, it will be out of your own pocket that the difference in cost will be paid.  This type of settlement is rarely satisfactory to the homeowner, but failure to carefully read the policy when shopping for the lowest possible premium could result in long-term regret.

Talk to your agent and know what you are buying.  If you are learning about this type of coverage for the first time as you read this post, talk to your agent and know what you purchased… BEFORE you incur damage that can permanently change the value of your home.  You may find that a policy with more complete coverage is still available for a comparatively negligible difference in cost.  That option will not be available to you the day after the storm or fire.

Caveat emptor.

 

 

This Blog/Website is made available by James H. Bushart, Public Adjuster LLC, for educational purposes only and to give you general information and a general understanding of the work of a public adjuster, not to provide specific legal advice. The authors and site manager make no representations as to the accuracy, completeness, currentness, suitability, or validity of any information on this site and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. Using this blog site lets you understand there is no public adjuster/client relationship between you and James H. Bushart, Public Adjuster LLC.  The Blog/Website should not be used as a substitute for competent legal advice from a licensed professional attorney in your state, nor should it be used as a substitute for competent maintenance or repair advice from a qualified contractor licensed to perform work in your state.

Warning – War Exclusion Being Used to Deny Business Claims for Cyber Attacks

April 1, 2021 By in Property Insurance Tags: , , ,
War Exclusion

Photo by Yan Krukov on Pexels.com

I received the following news in my email this morning from Joel A. Appelbaum, Executive Vice President & Chief Content Officer of International Risk Management Institute, Inc.  I thought it was important enough to share.

Dear Jim,

Insurers have recently invoked the “war exclusion” to deny coverage for a cyber-security incident that caused policyholders significant damage. Specifically, Merck & Co., Inc., one of the largest pharmaceutical companies in the world, said its insurers denied claims related to the NotPetya cyber-security incident under commercial property insurance policies. Some of Merck’s insurers denied coverage principally based on the war exclusion.

Whether insurers will routinely invoke the war exclusion to deny coverage for cyber-security incidents comparable to NotPetya is essential—especially since these cyber attacks will likely become increasingly prevalent. Indeed, NotPetya reportedly affected companies such as conglomerate Maersk, FedEx’s European subsidiary TNT Express, French construction company Saint-Gobain, and British consumer goods company Reckitt Benckiser. Other companies with substantial international operations, such as Roche, Marriott, and Lion Air, also confirmed that they were targeted.

Policyholders should take the steps necessary before being affected by cyber incidents to preempt a denial of coverage based on the war exclusion. To enhance the predictability of how the insurer will attempt to use the exclusion, carefully review the exclusion in proposed policy forms and inquire how the insurer intends to apply the exclusion before buying the policy. This proactive approach will also serve to define the scope the parties understand the exclusion to have.

Joel’s warning is a resounding “caveat emptor” to a business reviewing its coverage or considering a new policy.  Consider discussing this with your agent the next time you meet.  Before then, however, visit IRMI.com to find more about IRMI and the valuable insurance risk information they provide.

 

 

 

 

This Blog/Web Site is made available by James H. Bushart, Public Adjuster LLC for educational purposes only as well as to give you general information and a general understanding of the work of a public adjuster, not to provide specific legal advice. The authors and/or site manager make no representations as to accuracy, completeness, currentness, suitability, or validity of any information on this site and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. By using this blog site you understand that there is no public adjuster/client relationship between you and James H. Bushart, Public Adjuster LLC.  The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state, nor should it be used as a substitute for competent maintenance or repair advice from a qualified contractor licensed to perform work in your state.

The Bias of “Independent” Insurance Adjusters

April 20, 2020 By in Property Insurance

When you file an insurance claim for damage to your home or business, your insurance company will investigate your claim.  They will either send out an employee of their company (their adjuster) or they will contract with an adjustment firm that works for a variety of different insurance companies (independent adjusters).

Both, the insurance company’s own adjuster or the independent adjuster hired from another company, are required and expected to protect and act in the best interests of the insurance company – the party that is paying them to investigate your claim.

Some independent adjusters have been known to misrepresent themselves to policyholders as being “independent” from any duty to the insurance company and non-biased.  To gain trust with the policyholder and attempt to uncover underlying “facts” that they believe might help them deny a claim or save their company money by underpaying a claim, some independent adjusters will say things like “I don’t work for either side” or “I’m an independent adjuster and do not work for the insurance company.  I just write checks”.  There have been cases reported to me by policyholders where the independent adjuster has told them “I’m on your side.  I’m independent.”  Nothing can be more false.

Telling the contracted independent adjuster sent out by your insurance company something that you are not absolutely certain about or sharing with him a passing and unsubstantiated thought,  while mistakenly believing that he is objective and unbiased, could result in having that simple conjecture documented by him as “fact” and used against you.  I’ve seen it happen many times.

Photo by Pixabay on Pexels.com

It is important for a policyholder to know the different insurance adjusters who investigate claims.  Here they are:

A.  Insurance company adjusters are employees of your insurance company.  They are usually not licensed and their sole duty and fiscal responsibility are to the insurance company that employs them.  They have no duty to you.

B.  Independent insurance adjusters are contracted employees of your insurance company.  They are usually not licensed and their sole duty and fiscal responsibility are to the insurance company that has contracted them or their firm to assist them with your claim.  They have no duty to you.

C.  Public insurance adjusters are contracted by policyholders to protect and act only in the policyholder’s best interest.   They are licensed by the state in which they operate to represent only you to your insurance company in proving your loss and negotiating the cost to restore you to your financial condition prior to your loss.  Their duty is to you under the requirements of their license and not to your insurance company.

Know who you are speaking to and whose interests they serve.

 

 

 

 

Who Can Represent You With Your Hail/Wind Damage Claim

July 2, 2019 By in Home Owner Insurance Issues, Property Insurance Tags: , , , , , 1 Comment

Your contractor will be valuable to you as you present your insurance claim to your adjuster.  Without his skill and expertise, you will have a tough time communicating all that has been damaged and the work necessary to restore your home to its original condition.  

You might have read the Missouri law that states that a roofing contractor cannot represent you with your insurance claim when communicating with your insurance company about the condition of your roof. Your insurance company’s adjuster certainly has.

Specifically, it reads in part, “A contractor shall not represent or negotiate, or offer or advertise to represent or negotiate, on behalf of an owner or possessor of real estate on any insurance claim in connection with the repair or replacement of roof systems, or the performance of any other exterior repair, replacement, construction, or reconstruction work.” [Missouri Revised Statute Title XXVI, Trade and Commerce, 407.25]

You can represent your hail damage claim by yourself, or you may decide to hire an attorney or Missouri-licensed public adjuster to represent you with your insurance claim. However, if you choose to have your roofing contractor do the talking for you, he represents only himself and his company’s financial interests in restoring your storm-damaged roof. Not you.

Accordingly, your insurance company’s adjuster will often disregard much of your contractor’s input as being self-serving … unless it serves the insurance company’s best interest to do otherwise. For instance, if your roofing contractor is willing to compromise and agree to the adjuster’s lower computer-generated estimate, the adjuster may strike a deal with you based upon his agreement to work for the lesser amount. However, a roofing contractor’s opinions or arguments calling for more money or materials that differ from what the adjuster has already decided to pay will likely be dismissed. As the governing regulations state, the contractor cannot negotiate your claim.

A policyholder called me for assistance recently and told me that he had three different roofing contractors speak to his insurance company’s adjuster on his behalf, and all three told the adjuster that his roof required replacement. According to him – and to his dismay – the adjuster disregarded the arguments from all three of them and refused to pay him to replace his roof.

Of course, the policyholder was convinced that the adjuster acted improperly and unfairly. He believed that his insurance company had a duty to accept these arguments, particularly since they came from three different contractors, as definitive proof of his loss, but he was wrong. What the policyholder’s three contractors presented to his adjuster were three other sales presentations for replacing his roof – none of which proved to the adjuster that the roof had been damaged by hail on the reported date of loss to the extent that it needed to be replaced.

Simply put, the insurance company’s adjuster was not convinced by the three different contractors, each of whom is in business to sell new roofing systems, that the home required a new roofing system as a direct result of the claimed hail event.

Sometimes, the roof’s overall condition may require the roof to be replaced. The roofing contractor is doing his job by correctly informing the homeowner of that need and can undoubtedly observe and communicate that to the insurance adjuster. The adjuster might even agree with him regarding the roof’s overall condition. However, one item usually required to recover money from the insurance carrier to pay for the roof replacement is physical proof that the reported damage is the only cause of that condition.  Another is to prove that the damage occurred under conditions covered by the insurance policy in effect on the date of the loss.  I have observed that this is where many roof claims presented by roofing contractors, prohibited by law from negotiating the claim on behalf of a homeowner, fall short of those limitations.

Consultation with a reputable roofing contractor or expert is crucial as you prepare to present your claim to your insurance company. Suppose you know what to request from your roofing contractor so that you can acquire and present proof of your loss to your insurance company; you can present that proof to your adjuster, who, under the state rules that govern insurance claims, must respond to you on the record to the evidence that you present. This is what your licensed public adjuster would do on your behalf, as well.

There are a select few high-end roofing companies in Missouri that are staffed with experienced professionals who have proven to be able to acquire and provide convincing evidence that I have used to turn claims that the insurance company initially denied into recoveries of $80,000.00 to $925,000.00 – but the collected evidence was presented to the insurance company by me.

In the absence of such proof of loss or if the adjuster is simply not accepting the sales presentation from the roofing contractor as being definitive, the policyholder will likely be unsuccessful in his attempt to obtain more than what the adjuster initially values the loss to be – whether the adjuster is correct or not.

Since the roofing contractor does not officially represent the policyholder with his claim, the adjuster can disregard anything that the contractor directly presents to him. Where the insurance company’s adjuster must respond to your written requests in writing, he can reject arguments presented by your roofing contractor without justification or explanation. In certain instances, the insurance adjuster will go as far as to ignore or refuse to communicate with the roofing contractor on site since he is not required to do so.

Keep this in mind when you decide to ask your roofing contractor to present your roofing claim to your insurance company. A “no” to your roofing contractor from your insurance adjuster is not always the final word.

 

 

 

This Blog/Web Site is made available by James H. Bushart, Public Adjuster LLC for educational purposes only as well as to give you general information and a general understanding of the work of a public adjuster, not to provide specific legal advice. The authors and/or site manager make no representations as to accuracy, completeness, currentness, suitability, or validity of any information on this site and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. By using this blog site you understand that there is no public adjuster/client relationship between you and James H. Bushart, Public Adjuster LLC.  The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state, nor should it be used as a substitute for competent maintenance or repair advice from a qualified contractor licensed to perform work in your state.

2019 – Our Most Interesting Claims

May 24, 2019 By in Property Insurance

I have handled many different kinds of insurance claims for policyholders. These are some examples of the situations I encountered and the outcomes I achieved. I did not violate any privacy or confidentiality agreements when writing these descriptions. My goal is to inform policyholders of what they can expect from insurance claims and that an alternative exists other than walking away from a denied or underpaid claim. These examples are not meant to imply that similar results are guaranteed.

The owner of a condominium building suffered damage to an expensive copper and slate tile roof and filed an insurance claim. The adjuster from the insurance company inspected the damage and determined that there was no damage associated with the storm. He added extra weight to his denial of the claim by paying an engineer to inspect the roof and agree with him, and the engineer he paid dutifully complied with his request. The owner’s roofing contractor recommended that he contact me to see if I could assist him. After a close review of the engineer’s written report, I found that the engineer did NOT say what the insurance company interpreted and that the report supported the owner’s claim.  In a matter of a few weeks, we negotiated a payment of over $21,000.00 to repair his roof.

The owner of a 125-year-old building in a historical district suffered hail damage to a unique roofing system made from materials that have not been manufactured since 1945. Using an engineering report that they had acquired from a young man who had graduated engineering school eighteen months prior to this inspection, his insurance company offered the owner a small amount of money to make insufficient repairs that were not consistent with the design of the roof or with the ordinances enforced within the historic district. After several months of fruitless debate with his insurance company and with the recommendation of his roofing contractor, he contacted me. I negotiated an agreement for a settlement of over $236,000.00.

The owner of a commercial building that had suffered severe damage from wind and hail filed a claim with his out-of-state insurance company in Florida. Although the roof was damaged to where it was leaking water into the businesses below, his insurance company hired an engineer to agree with their decision to deny the claim, refused to pay him anything for his damage, and did not answer his numerous inquiries for over six months. At the end of his rope, he contacted me for assistance. After three months of negotiations and using nothing more than the language in the engineering report that the insurance company had used to deny the claim, I negotiated an agreement for them to pay my client over $682,000.00 for the replacement of the destroyed roof for which they had previously refused to pay anything.

A church in a major metropolitan area in Missouri sustained substantial damage from hail, wind, and a lightning strike in the spring of 2018. While the insurance company was going through the motions of adjusting the claim and promising payment, by the summer of 2019 the church had yet to receive any of the money that had been promised from the insurance company to begin the repair and, additionally, the most substantial and expensive part of their loss had not been addressed at all. Their contractor suggested that the church leaders contact me for help. Within a matter of weeks, I negotiated the release of over $70,000.00 of past due funds owed to the policyholder and initiated recovery for an additional $180,000.00 for damages that were overlooked and not included in the original settlement.

A family in a large city in western Missouri suffered a devastating fire that destroyed most of their home. Their insurance company paid them slightly over $94,000 to rebuild their home. They could not find a contractor willing to do all the work for that amount of money, so they contacted me for help. I negotiated with their insurer on their behalf, and we agreed to a total settlement of $171,201.00 so that the home could be restored to its original condition.

Computer Generated Estimates from Insurance Adjusters

March 15, 2019 By in Property Insurance Tags: , , , , Leave a comment

computer generated estimates

 

It may surprise you that the overwhelming majority of insurance adjusters, no matter which insurance company they work for, use the same computer software to generate estimates from which they pay insurance claims.  The corporation that owns and manages the software that creates the computer-generated estimate that your adjuster is using to settle your claim is called Verisk Analytics, Inc.

When you visit this page of the website for Verisk Analytics, Inc., you will see something very interesting about its managers and Board of Directors.  Most of them, including the director who bears the title of “Lead Director,” are from the insurance industry and/or have professional backgrounds in the very closely associated financial investment industry.  Very few, if any, have backgrounds or practical experience in the industries or trades related to performing the restoration work or providing the materials represented in these computer-generated estimates.

This could lead a reasonable person to question whether the computer-generated estimate provided by the insurance adjuster represents the financial interests of the insurance industry managing and producing it … or the interests of the policyholder who is presumably expected to have enough money to fully restore his property from the amount estimated by the software program.

Prudent policyholders, however, will carefully read their policies and discover that their payments from their insurance companies are to be based upon the actual … and not the “estimated” … restoration cost.  They will know that they are not limited to receiving only the insurance adjuster’s home-grown estimate generated by his own industry’s managed computer software program but are entitled, instead, to the amounts that it will actually cost to replace or restore the destroyed or damaged property.

If they don’t know this and settle for what the computer-generated estimate guesses that their payment should be, they are likely to be underpaid for their loss.