“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 similar to it, is something that I hear almost on a daily basis 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 actually recommended that the claim be paid against the carrier’s wishes, and I requested a copy of his report. Insurance companies almost always 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 of the other documents in the file will be in the hands of his attorney. He will recover all of 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 his claim, is what made him an adversary … and a worthy one, at that.
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 definitely be in need of replacement and there might definitely 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.
Not everything that is unethical is illegal. There are ways of stepping right up to the line without crossing it and no one can do it better than some insurance companies with their vast financial resources and lobby power at the state government level.
375.1007. Any of the following acts by an insurer, if committed in violation of section 375.1005, constitutes an improper claims practice:
(1) Misrepresenting to claimants and insureds relevant facts or policy provisions relating to coverages at issue;
(2) Failing to acknowledge with reasonable promptness pertinent communications with respect to claims arising under its policies;
(3) Failing to adopt and implement reasonable standards for the prompt investigation and settlement of claims arising under its policies;
(4) Not attempting in good faith to effectuate prompt, fair and equitable settlement of claims submitted in which liability has become reasonably clear;
(5) Compelling insureds or beneficiaries to institute suits to recover amounts due under its policies by offering substantially less than the amounts ultimately recovered in suits brought by them;
(6) Refusing to pay claims without conducting a reasonable investigation;
(7) Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed and communicated to the insurer;
(8) Attempting to settle a claim for less than the amount to which a reasonable person would believe the insured or beneficiary was entitled by reference to written or printed advertising material accompanying or made part of an application;
(9) Attempting to settle claims on the basis of an application which was materially altered without notice to, or knowledge or consent of, the insured;
(10) Making a claims payment to an insured or beneficiary without indicating the coverage under which each payment is being made;
(11) Unreasonably delaying the investigation or payment of claims by requiring both a formal proof of loss form and subsequent verification that would result in duplication of information and verification appearing in the formal proof of loss form;
(12) Failing in the case of claims denial or offers of a compromise settlement to promptly provide a reasonable and accurate explanation of the basis for such actions;
(13) Failing to provide forms necessary to present claims within fifteen calendar days of a request with reasonable explanations regarding their use;
(14) Failing to adopt and implement reasonable standards to assure that the repairs of a repairer owned by or required to be used by the insurer are performed in a workmanlike manner;
(15) Failing to promptly settle claims where liability has become reasonably clear under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
I recently read a touching and inspiring tribute written by an attorney who advocates for policyholders and who had recently lost a valuable partner and fellow advocate to cancer. Together, they would fight the good fight. There are not enough fighters like them in this arena, and in his tribute to his partner, he described her drive and enthusiasm for battling with insurance companies on behalf of their clients.
Being one who shares in the same fight (though not at such grand of a scale), I felt a great sense of personal loss. Even though I did not know her, personally, I know her heart and I have shared similar pain with the clients who had purchased insurance for peace of mind but found, when disaster came to their door, that this peace was only a temporary illusion.
Though Missouri law tasks an insurance company to provide prompt and fair assistance to its policyholders in exchange for payment of premiums, minimizing risk, and filing a claim only upon sustaining damage – some insurance companies, to protect their own financial interest, inflict more stress and financial harm upon their policyholders than the destructive event that prompted their claim, and at a time when the policyholder is most vulnerable with the least financial reserve. Instead of providing the warm professional care and assistance projected by their televised mascots, the policyholder is frequently met with fierce opposition and obstruction intended to exasperate, wear down, and break the resolve of the most committed policyholder defending his own rights under the very insurance policy he bought for “peace of mind”.
Fighting through a barrage of tactics used by insurance companies to delay, deny, and defend against the policyholder is certainly not an enjoyable experience for either the policyholder or his advocate. It is, however, something that must be done in order to receive a dollar-for-dollar payment for the incurred loss. That is the reality that is not shown on friendly and warm television commercials.
In search of an expert to provide them with a reason to deny a claim, many insurance companies will turn to the engineering profession.
There are highly respected and valued professional licensed engineers who design and build bridges and skyscrapers, who safely and efficiently channel waterways through and around large cities, who design and test the durability of aircraft and automobiles, who meet and overcome construction and building challenges around the globe – and then there are those who market themselves to insurance carriers for the purpose of providing written reports for them to use to deny insurance claims for wind and hail damage to homes and businesses. There is money in it. Insurance companies will pay them upwards of $2,500.00 per report. Most of these reports provide little more than boilerplate narratives regarding simple roofing materials and most of them contain little or no scientific or engineering data – but aside from their apparent lack of relevance, how accurate is the information that is provided?
As a public adjuster representing business and homeowner policyholders with their insurance claims, I read many of these reports and too often find errors, misrepresentations, and ambiguities salted among information intended to present a “scientific” spin on what are usually simple, routine observations that virtually anyone can make.
Much of what you will find in these reports, sometimes as much as two-thirds or more of the entire report, is a boilerplate filler of generic information that could be (but not always) relevant to their observations. It looks impressive at first glance, just as it is intended to, but is it even correct? Not always.
An engineer in several of his recent reports used by various insurance companies to deny claims includes the following language: “According to the National Roofing Contractors Association (NRCA), the lifespan of a roof is 20 years.” His report was peer-reviewed and stamped by another engineer with his firm – an engineering firm widely used by insurance carriers throughout the country. This claim by the engineer caught my attention because he was writing about a certain type of roofing material that carried a 30-year warranty and, as most people familiar with roofing materials know, various roofing materials have various lifespans – some as high as over 50 years.
I did not believe that the National Roofing Contractor’s Association would be so uninformed as to publish what he claimed they did, so I wrote to them and inquired as to where I could find the information from them that this engineer was quoting in his report used to support a denial of a cliam. The Vice President of Technical Services for the NRCA responded to me, as follows: “The 20-year figure is not from the NRCA. Lifespans vary greatly.” Thus, the engineer was not only wrong in his peer-reviewed statement of fact regarding the lifespan of a roof, but he also misrepresented the source for his errant facts.
Some engineers will provide comments and conclusions about the density or speed of hailstones as being less than required to damage roofing material and provide absolutely no information as to how they were able to measure the density or speed of the hailstone that melted away months or years before their observation. We are to simply take their word for it, like the quotations from the NRCA, perhaps.
The engineer paid by the insurance company might use ambiguous language that appears to say something but doesn’t. For instance, did the engineer say that large hailstones did not strike your roof, or did he simply say that he did not observe evidence of large hail strikes? There is a difference. Could there be evidence that he did not “see”, such as bruised indentations on weathered asphalt composite material that is soft to the touch? Did he say this, or did he leave it to the insurance company to use in the manner of their own choosing?
Insurance carriers, being corporations who have a fiduciary duty to protect the financial interests of their shareholders as well as a contractual duty to fulfill their promises to their policyholders, will often find this conflict of interest resulting in their wrongful actions of grossly underpaying or wrongfully denying their policyholders’ claims. The misuse of engineer reports is one of the ways they do this.
Often, insurance companies will knowingly allow the engineer’s errant attempts to interject policy interpretations into his report to be used to deny a policyholder’s claim. I have personally reversed an attempt by an insurer to deny an insurance claim because the engineer reported that the damage to the roof “could not be seen from the ground” when there was nothing in the policy to exclude damage for that reason, as one of many examples.
An expert witness in court must present his credentials, provide his testimony under oath, and be subjected to cross-examination, but insurance companies present biased hired guns as experts in the claims process and deprive vulnerable policyholders of necessary funds to restore their homes and businesses, with impunity.
The advice to not believe everything you read should be extended to engineer reports paid for by your insurance company to deny your insurance claim. Have them closely reviewed by your own expert for accuracy, relevancy, and truth before accepting that your claim should be denied as a result of an engineer’s report. Whatever you do, do NOT let the insurance company’s engineer be the final word on the validity of your claim.
There are two kinds of roofs on Missouri homes and business structures. There are those that have storm damage and those that will have storm damage. Understandably, the various insurance companies from all over the country that sell policies in our state will offer a wide variety of coverage options that are not always fully understood by the property owners before disaster strikes.
Learning after the roof has been damaged that you have been saving pennies per year by NOT including coverage to match replacement shingles or siding, or learning that hail dents that destroy the appearance of your metal roof is not considered “damage” by your insurance company, can result in costly out of pocket expenses that you thought were covered by insurance.
The Missouri Department of Insurance has created an informational and interactive website that helps you to understand your roofing coverage for each insurance carrier. While I recommend that you visit their site, I urge you to take the time to read and understand your insurance policy, as well. Have your agent clearly explain to you, when necessary, what it does and does not provide and ask lots of questions.
Considering that when an insurance company’s claims department is on its absolute best behavior, its job is the same as any corporation that is run by a board of directors. That job is to put the monetary interests of their shareholders (not their policyholders) at the top of their priority list. Their duty to you, as a policyholder, is not fiduciary (as it is with their shareholders) but contractual. Thus, even when you are dealing with a fair and reasonable adjuster, you need to know what your contract with them says. That contract is your insurance policy.
Your insurance company is prepared and well-practiced to fight and defend their rights under that contract. How prepared are you? Don’t let the first large claim be the first time you read it. Caveat emptor.
Shareholders or policyholders. Who matters most? Take this quiz:
The Board of Directors of my insurance company has a lawful duty to protect:
a. the financial interests of the policyholders.
b. the financial interest of the stockholders.
c. both of the above.
d. none of the above.
The answer is (b). The Board of Directors of an insurance company’s first (or fiduciary) duty is to the shareholders that elected them.
This means that the financial interests of the shareholders come before those of the insured policyholder when that corporation is an insurance provider. Profits come to a business from paying out less than what they take in. Shareholders demand this in return for their investment. Insurance companies comply. Know this as you shop.
The National Law Review has published a list of the “eleven worst insurance companies” and I encourage you to read it. Before you take too much comfort in finding that your home insurance provider did not make the list, you should consider that many that made the list are providers of health insurance. The factors that were used for the home and business insurers that made the list, however, are not unique to them but are commonly shared among smaller companies that would have at least made “dishonorable mention” if the list did not include other types of insurers.
What this list should teach those of us who buy insurance is the need for us to carefully select an insurance provider based on something other than cute or funny television commercials. Sweet talking lizards that collect your insurance premium can quickly become vicious and vexatious crocodiles defending the company against your valid claim. If you can learn this before you become vulnerable as a result of catastrophic loss, the better off you will be.
The Missouri Department of Insurance publishes a complaint index to help Missouri consumers determine how likely they may find displeasure with an insurance company’s claim handling process. Considering how few unsatisfied policyholders will actually go through the red tape to file a complaint with the State government , when an insurance company exceeds the normal rate of complaints under such circumstances – it really says something.
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 exact same conclusion in the exact 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 density and speed of the hailstones were measured by the engineer to conclude their insufficiency to cause damage. Nor did they report the direction of the storm, 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 were to remove the boilerplate language apparently common to all of his reports, nothing appeared in the narrative that required an engineer to cite. The same ambiguous and noncommital descriptions could have been just as easily written by a shingle salesman with poor marketing skills.
Last, but certainly not least, please pay special attention as to how this carefully worded boilerplate conclusion did not say there was no damage to the roof caused by hail. Instead, the engineer simply stated that based only on his powers of observation, he didn’t see it.
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.
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 on their behalf with their insurance company for exterior work on their home as a part of an insurance claim.
So why do insurance companies continue to negotiate with residential contractors in spite of 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 say to 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 to 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 is representing his own 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 the same demand is made by your contractor. 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 important 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. Three or four neighbors living side by side on the same street can be insured by the same insurance carrier and have different policies with different coverage. Some contractors quote what they believe to be “state law” as to what an insurance company must pay for which is also not true. 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 important advisors for you and/or 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 helpful, 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.
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 communicated 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 that are set forth in Senate Bill 101, allowing them to focus upon their areas of skill and expertise to fully serve their customers’ construction needs. Their customers are able to 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 work that is required. When it is done correctly, all parties are served in a win-win position. When it is done improperly, however, some or all come out on the losing end.
Not all claims require an attorney or a public adjuster to handle them. In fact, most can be handled directly by the policyholder with no representation at all, if they understand their rights under their contract with the insurance company and have a skilled contractor they trust to correctly inform them of their damage 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 be the final word on your claim for damage.
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.
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.