Insurance Adjuster and Engineer Make a $69,000 Mistake at Policy Holder’s Expense

An expensive slate roof with copper flashing was severely damaged by hail.  The insurance company’s adjuster and his contracted engineering company agreed that it was damaged by hail … but still refused to pay for the repair.

The insurance company’s adjuster referred to a paragraph written on the third page of a letter that had been sent to the policyholder six months before which totally excluded hail damage to soft metals that did not result in leaks.  He told the policyholder that the vast majority of the $69,000 (plus) damage to his roof would have to be paid at his own expense.

The policy holder’s roofing contractor referred him to me for assistance with his claim.

My close examination of the policy, the letter, and the engineer’s report (in addition to localized weather reports) revealed that the exclusion the adjuster used to deny coverage did not take effect until four weeks after the hail storm. Accordingly, his denial of the claim was improper and he owed the insured for the damages.

When I brought this to their attention,  the insurance company reluctantly acknowledged their duty to pay.  The policyholder will be made whole and the contractor will be able to serve another homeowner in need of his services.

“No” is not always the final answer.  Have a licensed public adjuster review your claim before walking away from your money.

Home Insurance Claim Highlights – 2013

As a very busy summer draws to a close, here are some of the highlights from the season’s most interesting claims.

1. The insurance company had delayed a response to a fire claim for six months. The home owner called me and soon after received an initial payment of $111,000.00 which, upon further review, was underpaid. We recovered an additional $14,000.00 a few weeks later.

2. The insurance company denied the church’s claim for storm damage to its steeple and interior. Their roofing contractor referred them to me and we soon recovered the full amount to repair the steeple, repair the damage to the interior of the church and to replace a section of the roof.

Damaged by 100 mph wind, this steeple was allowing water to flow into the church.

Damaged by 100 mph wind, this steeple was allowing water to flow into the church.

3. The insurance company denied a claim for damages to a home caused by a dishonest contractor. His financial advisor referred his client to me and we turned that “no” into a check for $10,000.00 and a waived $5,000 deductible (total value, $15,000.00).

4. The insurance company denied a claim for hail damage to his roof and my client’s roofing contractor referred him to me. We turned that “no” into a new roof.

5. The insurance company had refused to address the storm damage to her home and my client was referred to me by a friend. In a matter of weeks, we turned that “no” into a several thousands of dollars and a new roof.

6. The insurance company had said “no” and denied coverage to a storm damaged deck. My client was referred to me by a real estate agent. We turned that “no” into $16,400 for a rebuilt second story deck.

7. The insurance company had denied his roof claim stating that the storm with golf ball sized hail did not damage his roof. My client called me after finding me on the internet. We turned that “no” into over $21,000.00 for a new roof and gutter.

We did well on many other storm, theft and fire claims, as well. I’m looking forward to Autumn.

 

Copyright 2013 James H. Bushart

Insurance Claims for Hail Damage

By James H. Bushart

 

Hail damage to a roof is a common occurrence and damage is often and routinely repaired at the expense of insurance companies.

For some insurance adjusters delaying, denying and defending a claim is also routine and are the three main strategies used to promote the financial interests of the insurance carrier at the expense of the insured.

As a part of this strategy when delaying, denying or defending a claim filed for hail damage to a roof, many claims adjusters (after making their own inspection and declaring that there is no damage to the roof) will arrange to provide an insured homeowner with a “special service” by having an engineer evaluate the roof for damage, as well.

Evaluating the condition of a roof covering does not require an engineering background, but it does impress many people to see an engineer’s seal and signature under an observation. While making an effort to appear to be objective, and while still fully aware that future referrals and fees are at stake, the hired engineer will sometimes seek ways to confirm the initial finding made by the adjuster.

Here is one of the methods used to minimize observed hail damage to a roof while appearing to be objective and “scientific”.

In spite of the damage that is visible to the naked eye many engineer reports that have been used by insurance companies to deny claims that I have personally read will refer to an opinion that a “rate of acceleration” and “velocity” of the hail strikes were insufficient to cause “significant” damage to the roof coverings.

Sounds like some real indisputable engineering stuff, doesn’t it?  At least, it does until one considers the following:

1.  The storm has passed by the time the adjuster and engineer have examined the roof.

2.  “Terminal velocity”, or the maximum speed reached by a falling object, is measured by a mathematical formula that takes into account the size of the hailstone and the high winds and gusts that can accelerate the speed of the hailstone.

3.  The actual size of each hailstone that struck the roof … and the speed of the wind and gusts that drove the hailstone into the roof … cannot be determined by simply looking at the roof days, weeks, months or years after a storm.

4.  Remarks that appear in the engineer’s report that address the sufficiency of the “velocity” or “rate of acceleration” to cause damage is pure speculation.  The fact that it is being “speculated” by an engineer does not make it more than speculation.  It is not factual.

The physical evidence of hail damage will speak for itself.  Speculations as to velocity and acceleration that are provided from observations made days, weeks or months after the event are not factual and should not be allowed to be used to deny a claim in the presence of actual damage.

If you find references to “velocity” and/or “rate of acceleration” in any engineer’s report that supports your insurance company’s denial of your claim for roof damage caused by hail, request in writing that you be provided with the factors and formula(s) used to calculate these rates.  Also, ask for the source of the data used to determine the size of the hailstones and the speed of the wind and gusts that drove the hailstones into your roof.

For more information about how some insurance companies use engineer reports to routinely deny valid claims, click on the following link and read:  https://missouripublicadjuster.org/2017/03/09/fraudulent-engineer-reports-and-your-homeowners-insurance-claim/

 

 

Copyright 2012 James H. Bushart

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