Insurance - Customary & Necessary

Have submitted revised estimates to the insurance companies using some of the Xactimate line items I have seen in the estimate writing contest

  • renail deck sheathing
  • OSHA compliance issues
  • waste factors (showing them hip, ridge, valley, and starter strip calculations)

The general response I have had back is “those are not customary and necessary” items that we pay for, or on the waste factors “we think our number is enough to do the job”

I have asked them if they have ever built a roof, and decided not to renail all of the nails that are disturbed by the tear-off process and do they have any idea what the roof would look like if that was not done. Of course, they are clueless.

Their response on the other issues is just as clueless.
[Our company recently hired a former desk adjuster as a salesman. Went out to help him estimate a roof, and he did not know what a hip or a ridge was. That should give you some idea of the level of ignorance we are dealing with].

My question is this: putting these additional line items on the estimate is one thing; what arguments do you make to convince the adjuster that they are necessary even though they are not customary items the insurance companies write up.

Sir,

You forgot to put customary & necessary before the line items. For example: Customary & Necessary Deck Renailing…$2.00 per square foot. That way they must approve LOL!

Well gollyeeeeeeeeeee… I’ll try that next time. :smiley:

I’m about 50/50 on putting the renail sheathing into the estimate. I personally think putting the OSHA stuff in doesn’t make sense. IMHO, that is part of being a roofer. It SHOULD be built into the prices provided by Xactimate … SHOULD being the key word and frankly, very doubtful.

I’ll go back to what I’ve stated here recently numerous times. If you want to have much of a chance of success with the P&C Insurance Companies at this time, you best be getting the HO on your side with proper expectations set from the very start. We go through the waste factor calculations with the Adjuster. If they don’t want to buy into it, we simply tell them to be prepared because we are ordering materials based upon the scope of loss and when the materials are gone, we stop work at that time and will be calling the Adjuster for supplemental authorization. We also tell them we are going to be informing the HO it is our belief the scope of loss is clearly allowing less materials than is required to complete the job and explain how we will proceed if we run short on materials. This is setting expectations with the Customer. When the day comes and material is short, we first attempt to call the Adjuster. If we can’t reach them or they do not call back in 15 minutes, we ask the HO to call them. If that doesn’t work, we ask the HO to contact the toll free number to speak to a desk adjuster. If we don’t get approval, we button up and leave the job site until the proper approvals are gained. It is very important to get all the contact information from the P&C employee who authorizes the supplement so you don’t get screwed later.

The fact that you showed the Adjuster upfront your estimate and made every attempt to get the appropriate amount of materials approved often helps when reality hits. When you call the desk adjuster, one of the first questions is “why didn’t you cover this in your estimate”? Our answer is “We did, in great detail, look in your claim file folder.” You have to be firm and tenacious but most often, you can get what you need approved and taken care of.

With all that said, we have changed our method of estimating in the past month. The whole “bundle it into waste” thing is a huge amount of BS IMHO. Starter and ridge cap is easily calculated with today’s estimating tools and techniques. The labor rate on starter and ridge cap is different than it is for field shingles. It is wholly inappropriate to bundle starter and cap into the base. We are putting our estimates together using 5% waste for the simplest of gables, 7.5% for cut up gables and 10% for really complex, multi level gables. Add 2.5% to those numbers for hips. We then break out starter and cap as separate line items. In Xactimate, we insert pre developed template notes from the attachments tool to note these items are separate from field shingles, have a different labor rate and need to be paid for separately. We explain to the Adjusters this is by far the most accurate way of estimating roofs and will go a long way in minimizing supplements. We have had moderate to good success with this.

Well the insurance company called my homeowner the night before the build, told them we had sent them an estimate for thousands more than they had paid, and that the homeowner would be responsible if we proceeded with the build before they sent an adjuster out there to review.

I had a conversation with the adjuster over the phone and presented my rational for all the increases.
Got the song and dance about why State Farm doesn’t pay for drip edge anymore.
Had him tell me he had never in his 20 years had anyone ask for renailing the decking.
And on and on.

I just presented my case, kept my cool even when he threatened to “send another roofer out there and let the homeowner decide”, and finally told him to see what he could do and the customer and I would decide where we would go after that.

Three hours later he sent a revised report increasing the claim 40% after spending 30 minutes on the phone telling me why my charges were ridiculous. He didn’t pay the line items I asked, but he increased the claim more than the amount I requested.

So thanks to all those who have posted on here about how to properly estimate and price a claim.
Your input has been invaluable.