Ins.fight like no other, roof approved and now not?

Roofing/Construction Questions
#1

I have a job that got approved through Southern Trust, the independent adjuster did everything in exactimate as cheaply as possible and I couldnt build the job for the total they arrived at (like 187 a sq with accessories)

They claimed 20 year shingles even though they are 25s so that was my main gripe with the nastiest adjusted ever. Ive gone round and round in the most professional way possible with the independant, the adjuster and her boss.

She talked to the homeowner and decided that she didnt like how we did business by just knocking on customers doors around our other jobs so this thing was tainted from the begining.

I went above her head and shed already discussed the claim with her supervisor and tainted me there as well. So last night I decided to just send in the suppliment for the accessories they forgot to see what I could get as I have 3 other jobs in the area of this one and was just going to build it regardless.

This morning I get this email:

Thank you for your supplement, however we have not made our final decision as to whether the roof requires a full replacement or not. A second inspection for this roof has requested and is in process. Our insured is aware of our position and of our right to a second inspection. Upon receiving the final appraisal, I will review with my management team and will be in touch with our Insured.

At this time, you wish to hold off on any repairs until our second appraisal is completed.

Thank you,

Tasha McEldowney
Claims Representative
Southern Trust Insurance Corp

IS THIS EVEN LEGAL? what can I do? I have another company in the area that i could switch all the paperwork to and still do the job, i was thinking that may be best before all this anyway but damn, ive never seen anything like this.

the customer has an recieved an xactimate for a total replacement for the roof. at what point did the roof undamage itself from the time that the self proclaimed lifetime adjuster that has been doing this all his life decided to buy the whole roof?

#2

All I can say WOW, Never heard of this ever happening I don`t even know where to start. Public adjuster? than may be a strongly worded letter from a Lawyer to the Ins. company. Good Luck keep us all informed.

#3

Just because an outside adjuster totalled a roof, doesnt mean the insurance company has to pay for it. They do have the right to re-inspect ANY adjusters report.

good luck. this may be one of those deals where its best just to walk away, and spend your time and efforts on the next one.

ive seen guys work for hours and hours on deals like this, and in the end, they would have been MUCH better off just going down the street and selling a different roof with none of the BS.

Time is money.

#4

ive got a 50 sq steep a quarter mile away. the whole this went to shit when the adjuster took offense to how we approached the home owner via door knocking. The lady is a cunt, i hope no one here ever has to deal with her. apparently she pays 165 a sq off and on all day with a lifetime warranty down in south georgia.

#5

Call the Insurance companies consumer complaint division, file a complaint. Go to the highest person that you can and fight relentlessly until they submit.
Has worked for me in the past, and will continue to do so if I feel the homeowner is entitled to a new roof.

Persistence is key! As long as the homeowner is on board with you.

I hate A. Family
I hate Allstate.
They both suck.

#6

This sounds like a really fun claim!

Have seen a few claims go the other way from what the adjuster said.

I did a re-inspect on a house roof this Spring with an independant adjuster. As soon as he got to the house he got out of his van and looked up at the garage roof and said that it wasn’t hail damaged but curled shingles, that’s why he denied it. Not knowing that was the case told him we’re here to look at the house roof as the home owners insurance company had already bought the garage roof. He was too afraid to go on the 12/12 so he gave me the chaulk and camera. Just like with other adjusters I did the test squares and he said he’d send it through for hail damage which it clearly had. The home owner got a letter in the mail a few weeks later stating the house roof was denied.

#7

There is a few items that aren’t consistent with normal claim handling practices. Is there any other information that is being left out?

  1. Insurance adjuster committing to buying the roof and now it is under review.
    Once the roof was totaled by the insurance company and an estimate issued to the homeowner, whatever is included in the estimate the insurance company is acknowledging is a covered by the loss. It doesn’t matter if anyone else in the company agrees or doesn’t agree with the field adjuster finding. The field adjuster made the call and the insurance company is now committed to pay for the damages that are in the estimate. If the insurance company doesn’t pay for all of the damages that are on the estimate that the homeowner has in their possession they can be held for detrimental reliance.

  2. The insurance company sent you an e-mail.
    This confuses me because the insurance company contract is with the homeowner only. I can’t understand why they would send you an e-mail.
    This all by itself in my opinion is bad faith practices.

Buy a shingle gauge take a picture of the shingle with the gauge inserted and send it to the insurance company. The insurance company won’t have an argument anymore about the thickness of the shingle.

I am have trouble understanding the 4th paragraph. Can you explain further.

Hope this helps.

#8

Hi empireRCS

I deal with these warm and wonderful insurance companies everyday they are not all this way as you know. I do not understand why they state they want to do a 2nd inspection and yet send the homeowner and xactimate that says they bought the roof? WTF
If they are 25 year shingles prove that to them show them some documentation or use a Haag shingle gauge and take a picture.
The best thing you could do is use xactimate and submit it to them that’s what they use.
The adjuster is not the final word the claims office is. Although he bought the roof it still has to go to his supervisors for approval.
I would go to the roof and make test squares and circle the damage or the missing shingles and take photos to send them.
Prove your point.
I would not touch this roof until I had a check in my hand.

As travis 1 said:
Persistence is key! As long as the homeowner is on board with you.

#9

the roof is 16 years old, and like all 16 year old roofs shows some signs of weathering, in addition to light hail damage.

there isnt much dobut that its a borderline claim but the adjuster that the company subs to did approve it and that was several weeks ago. He took pictures of his shingle gauge on a damaged, worn shingle with the granules half gone. Haag said that the gauge wont be accurate at all in this situation and so I went out with mine and took pictures of it on a shingle that isnt worn and on a shingle from the starter row and they both read 25.

He left all the pipe flashings, valley metal, 10 ft of ridge vent and the meter mast off the estimate too and justified it to me on the phone by saying that it would only cost me a few dollars anyway and i should just eat it if i wanted the job.

I called southern trust to discuss the shingle issue and missing accessories and the lady still wanted to be an ass, so I called the independant and he informed me of how educated he was and how he has been doing this for 20 years and that we both knew it was only a 20 year roof because thats all they used 16 years ago.

I got frustrated and set the job aside for a few days, sunday night I picked it up and faxed and emailed the insurance company a suppliment just showing all the things they missed planning on just eating the diffrence on the shingle part. The customers are super nice but wont bother fighting for the claim, i explained everything to them this morning and they are old and really dont give a crap.

This morning is when I got the email from her that I posted above.

I work directly with the insurance companys to get the claims where they need to be for my customers and for myself, which is why she emailed me (to the poster wondering why that was happening)

Nothing about this deal has been smooth as far as the insurance co goes, this has been an exercise in head butting the entire time, and the lady doesnt know her ass from a hole in the ground.

This isnt my first rodeo, I have done hundreds of claims and have been in this business a while, this whole mess is just personal now, she doesnt want to deal with me so shes screwing up the whole thing, including the homeowner.

I have the option of firing myself from the job and resigning the customer with a company im affiliated with and trying to patch things up with them, having someone else call may be all this dumb hoe wants to hear.

#10

Do you use the same “colorful” language when talking to the insurance company? This could be the reason you are having trouble settling the claim. No one wants to be cursed at.

This claim is an easy, I mean really easy one to settle with the insurance company. If you can’t negotiate/settle this simple one then I would use the option and fire myself from this one and not pursue any future insurance claims.

My only suggestion is to clean up your language. In both posts that you have submitted each one has some cursive in it. When I was taking college level writing courses, the only thing that I really remember is that writing is an extension of the way we talk.

Anyway, I’m starting to ramble now… so I will finish up.
This is intended to be pure constructive criticism and I hope it is taken that way.

#11

[quote=“Stormer”]Hi empireRCS

I deal with these warm and wonderful insurance companies everyday they are not all this way as you know. I do not understand why they state they want to do a 2nd inspection and yet send the homeowner and xactimate that says they bought the roof? WTF
If they are 25 year shingles prove that to them show them some documentation or use a Haag shingle gauge and take a picture.
The best thing you could do is use xactimate and submit it to them that’s what they use.
The adjuster is not the final word the claims office is. Although he bought the roof it still has to go to his supervisors for approval.
I would go to the roof and make test squares and circle the damage or the missing shingles and take photos to send them.
Prove your point.
I would not touch this roof until I had a check in my hand.

As travis 1 said:
Persistence is key! As long as the homeowner is on board with you.[/quote]

Or hire a consultant that also does court testimony. Insurance companies usually listen to a consultant if they know what they are talking about. In fact, insurance companies often times use consultants to review claims for hail damage and such when a claim is in dispute. I do it quite often from both sides of the fence.

#12

[quote=“828br”]There is a few items that aren’t consistent with normal claim handling practices. Is there any other information that is being left out?

  1. Insurance adjuster committing to buying the roof and now it is under review.
    Once the roof was totaled by the insurance company and an estimate issued to the homeowner, whatever is included in the estimate the insurance company is acknowledging is a covered by the loss. It doesn’t matter if anyone else in the company agrees or doesn’t agree with the field adjuster finding. The field adjuster made the call and the insurance company is now committed to pay for the damages that are in the estimate. quote]

This is not accurate when independent adjusters are used. As independent adjusters we only have the ability to recommend to the insurance company if we believe that the roof needs to be replaced, but the final call ALWAYS comes from the insurance company. I always tell the HO that I do not have the authority to extend or deny coverage. It is written into our contract and into the estimate that NO ADJUSTER has the ability to commit payment. I have been in the independent insurance industry for around 8 years and I have had a few roof claims sent back to me that I felt like needed to be replaced and the insurance company did not agree… Guess who won?? Insurance company always has the final decisions, not the adjuster 100% of the time!! Granted 99% of the time they go with what we recommend, but if they don’t feel that the roof is damaged, then our opinion is void at that point…

Good Luck[/quote]

#13

Hey Cerberus

You are right IF the homeowner did receive the estimate! But if no documentation has been received by the HO, then its still under review by the insurance who does have the final word. Just wanted to clear up my above post.

TJ

#14

In response to tj post.
I disagree and here is why.

I have worked as an independent adjuster and have settled thousands of claims and have issued ACV payments. Most of them while parked in front of the house. The main difference between a staff adjuster and independent adjuster is job security for the staff adjuster. The same rules apply in the eyes of any states insurance commissioner in regards to coverages. As an independent or appraiser you are a representative of the insurance carrier.

The E/O premium is also much cheaper for an appraiser vs. adjuster.

I have also also been labeled and independent adjuster when in all actually I was doing an appraiser job.
Which includes writing an estimate and submitting it to the insurance company. Working as an appraiser is the only time that I couldn’t commit to coverage and settle the claim in the field.

Working as an appraiser is much easier then working as an adjuster for the simple reason that you don’t have to commit or deny coverages.

In my years as an adjuster I have never had the insurance company take back any coverage after I have extended it to the homeowner. That is called detrimental reliance.

This has been my experience. I’m not saying that it is the same everywhere. :smiley:
.

#15

[quote=“828br”]In response to tj post.
I disagree and here is why.

I have worked as an independent adjuster and have settled thousands of claims and have issued ACV payments. Most of them while parked in front of the house. The main difference between a staff adjuster and independent adjuster is job security for the staff adjuster. The same rules apply in the eyes of any states insurance commissioner in regards to coverages. As an independent or appraiser you are a representative of the insurance carrier.

The E/O premium is also much cheaper for an appraiser vs. adjuster.

I have also also been labeled and independent adjuster when in all actually I was doing an appraiser job.
Which includes writing an estimate and submitting it to the insurance company. Working as an appraiser is the only time that I couldn’t commit to coverage and settle the claim in the field.

Working as an appraiser is much easier then working as an adjuster for the simple reason that you don’t have to commit or deny coverages.

In my years as an adjuster I have never had the insurance company take back any coverage after I have extended it to the homeowner. That is called detrimental reliance.

This has been my experience. I’m not saying that it is the same everywhere. :smiley:
.[/quote]

I have done several thousand estimates also (close to 1,500 last year alone). I have also written estimates and settled claims in the front yard. This is not what I am referring to. If you have to send the claim in for review then it is subject to change. I tell every homeowner this on every inspection, that way IF the insurance company does not agree with my opinion, the HO can call the insurance company directly, not me…
If you do not think that this happens, work for Liberty Mutual or Safeco<<(which is now owned by Liberty Mutual) They do not have any problem in taking a total roof replacement and turning it into a repair at THEIR discretion. Allstate is another Co. that did not agree with my opinion that a roof was damaged by a covered peril and did not cover the roof even when I adamant expressed that it was… Each and every company out there is different and I can assure you and everyone on this forum that the insurance company has the final word, NOT the adjuster…

#16

second reply in this thread:

[quote=“Agape”]Just because an outside adjuster totalled a roof, doesnt mean the insurance company has to pay for it. They do have the right to re-inspect ANY adjusters report.

[/quote]

is there an echo in here? lol

#17

[quote=“Agape”]second reply in this thread:

[quote=“Agape”]Just because an outside adjuster totalled a roof, doesnt mean the insurance company has to pay for it. They do have the right to re-inspect ANY adjusters report.

[/quote]

is there an echo in here? lol[/quote]

Very true! :mrgreen: LOL

Just one more example and I will let this topic die down. Two of the companies I am working for now specifically states in our instructions that we are in NO WAY able to discuss the scope of work with the HO or their contractor. I am not talking RCV vs ACV, I can’t even comment on if the roof is wind damaged or not. All I am allowed to tell the HO or their contractor is that I have been hired by the ins. co. to inspect their property and I will submit my findings to the company and the company will get back with them… How’s that for customer service… LOL I don’t agree with it but in this business it is and will always be "different strokes for different folksâ€Â

#18

I think our definition of adjuster and appraiser are different.

I thought in the original post that the homeowner was given a copy of the estimate. If the homeowner was given a copy of the estimate then the adjuster has made the decision not the insurance company.

#19

[quote=“828br”]I think our definition of adjuster and appraiser are different.

I thought in the original post that the homeowner was given a copy of the estimate. If the homeowner was given a copy of the estimate then the adjuster has made the decision not the insurance company.[/quote]

ive seen outside adjusters give homeowners their estimate for repair, and then the insurance company denies the claim after reinspect.

#20

While it is reasonably rare, I’ve seen the desk adjuster or adjuster manager over ride the decision of the field adjuster on multiple occasions. Seems to happen less often when the field adjuster is staff versus from an independent adjusting firm.

If I’m at an adjuster inspection and they are willing to talk, I make certain they state their findings to the HO and ask questions to try and tie them down on what their recommendation is going to be and why. I make notes. That way, if the insurance company comes back with something different, I’m equipped to argue their change of attitude.

Let’s face the facts, we’re nearing the end of the year and it’s been a tough year claims wise for most of the insurance companies. I’m sure you’d never get any of them to admit it but I’d bet money that a number of the insurance carriers have hit “their budget” on paying claims for fiscal year 2009 and are tightening up the standards. I’ve seen roofs get denied in the past 2 to 4 weeks that would have gotten bought all day long in June.