Interesting Statements from Adjusters!

Me "Do you see that all of the pipejacks and roof flashings are painted?"
Adjuster “Now your trying to get to me.” he said with a grin on his face…

I was just wondering what other roofers were hearing from the adjusters they run across…

I recently had:

  1. we don’t pay BSC & O&P together.

  2. need 8 hits per square

  3. my supervisor was with me at the inspection, we are not sending an engineer.

  4. we don’t cover window seal failure for storm damage.

  5. Michigan law does not require color match.

  6. (this was regarding a downspout) there is mechanical damage so we will only cover the Labor not the Material.

We are repeatedly told 10 hits per square.

Had a nice Christmas present from an adjuster.Paid base service charge,O&P,interior damage,light fixtures,umbrella,bench,siding(way too low ???$155??) and better per sq than usual.He started off giving me hard time but I waited THREE HRS for him and made him work everything.
Just be fair and be prepared for your meeting with adjuster.Remind him you live 2 miles from the roof and don’t want to call him back for 2nd inspection.
Remember,as LMB says,let the adjuster take it out on the other roofers,just not you!
My ROI (return on investment) with LMB’s package is paying off like crazy.
Be friendly but stand your ground with Adjusters.

LMB has been a huge help to me too. This new year I’m expecting to do better than I ever have before (I use to be a big shot in my area, before the economy changed)… might have to put him on my xmas list. :idea:

PS… I bought it after reading a referral by Authentic Dad. After reading many of his posts, I respected his opinion enough to spend my limited money on his word it would help. Just saying cause I think they both deserve the accolades.

Thanks guys!

Farmers Adjusters: Some time ago, “You can tell that Larry Burtis that we’re going to cut off his pony tail next time we see him.” On all inspections after that, because of the continued attempts by Farmers adjusters to deny legitimate damage, on order from the Farmers MN exective, a supervisor would appear on each claim from that storm.

Nationwide adjuster supervisor while on top of roof in suit and street shoes during 4th inspection: “Are you sure we’ve covered everything on Larry’s list cause I want to make sure he’s happy and I don’t want to hear from Steve Rasmussen’s (CEO) office again, lol.”

SF staff adjuster: “You f__ing #@%&*, there’s no *)&^#!@ damage, we’re gonna black ball you and make sure you never work in this business again.” A week later, after talking with Ed Rust’s office, two SF supervisors appeared on a third inspection (my 2nd after first contractor gave up) and within five minutes, approved everything (roofing, siding, gutters) that had previously been denied.

Guide One adjuster on big church: “Nope, there’s no damage on this one”. Re-inspect scheduled where HAAG’s hail guru Scott Morrison actually appeared. After receiving HAAG’s report, Pastor John called me to say that the adjuster was now saying that the (previously denied) hail damage was from an old storm several years ago and was therefore not covered. Pastor John’s comment to me; “What God didn’t get done, our attorney’s will.”

Farmer’s Cat adjuster: “It sure is nice to work with a contractor who know’s what the hell he’s looking at and talking about.”

Met Life adjuster: Thinking he would be done and gone by the time I arrived at the appointed time for the re-inspection of a previously denied roof (I always arrived early, just in case), he was half way down his ladder when I drove up. Upon seeing me as I got out of my vehicle he simply said, “Oh, it’s you, lol, how much is this one going to cost me?”

Farmers adjuster: On fourth inspection of large ranch property by a fourth adjuster, “Oop’s, must have missed that other nine square of Arch, I’ll go ahead and write that up.” Job started at around $35k and ended up close to $70k.

Allstate adjuster: On re-inspect of 24 sq of old Alside 8" aluminum with old Alside pre-formed fascia in a red zone I asked the adjuster what in the world it was that caused the first guy (staff) to miss all of the obvious damage? He just looked at me and said, “Aw, $*&#@ it, just give me your numbers and we’ll pay it.”

IDS/American Express P&C adjuster: Large house on golf course that was hit by then recent severe hail as well as a number of golf balls over time. Adjuster says, “those dents were all caused by errant golf balls - not an “act of God” so we are not going to pay.” Over $40 grand later, owner had a new roof, siding, trim, garage door and misc collateral damage repaired/replaced.

Allstate adjuster: 34 sq. steep and high hit hard by hail. Cat guy says, “I don’t care if all of the other homes…, no damage here on this roof”. On re-inspect by new cat adjuster, approves complete R&R including all flashings, DE, Ridge, etc. While sitting with owners, adjuster says to them, “both of us (me and your contractor) know that Allstate writes up their loss reports (non XM8, at the time) so that no one can understand them but your contractor knows what he’s doing and will make sure that everything gets paid and done right.”

Nationwide cat adjuster: On Certainteed Shangle roof (class action lawsuit then settled). “I don’t care if they tell us not to pay to replace Shangle’s because of the manufactuer defects and the law suit…if they (Nationwide) insured them and they’re damaged, I’m going to pay for them!”

AmFam adjuster: Aluminum siding originally denied as old damage by staff guy. On second inspect, new adjuster, reading from old report, made same claim. I said, “prove it”. He couldn’t and paid for new siding on house and garage, new fascia, new window trim, new roof, new skylite, new gutters, etc and HO was happy as could be.

Certified HAAG adjuster/engineer working for a different engineering inspection company sent by ins company: Obvious large hail dents on all elevations denied by this hard nosed wise guy on high/steep money maker. Female Asian HO accepted the no damage assessment and refused to pursue claim any further. Several years later on a different claim in a different city, same guy appeared where I was acting as umpire on a Shangle roof. He and original adjuster had denied the claim using the fallacious “Shangle” argument. Light but real damage on two elevations and material no longer made. I approved R&R on entire roof. I thought the guy’s head was going to explode when I told him and the HO the good news.

Erie Ins adjuster: With some effort, got entire high/steep roof with all parts paid, including DE. Upon realizing I had charged ins for it on my estimate but none existed (I would have installed it anyway) I called the adjuster and told him about my mistake (close to $1,000 on this big home). He said he appreciated the call but to just go ahead at the price quoted since it was not worth his time to back it out.

and it goes on and on and on…

When adjusters know you know what you are doing (not just claiming so), you’ll usually get better results overall and your reputation amongst adjusters (in general) will be strong and they will respect you as a pro (some of them anyway).

We’ll never completely eliminate the BS that many adjusters spout on a regular basis usually at the behest of their employers but as more and more contractors make the investment in themselves in learning more of how the process works = increased income, decreased time and decreased workload and stress - all boats will rise and P&C ins will reluctantly at least cut back on the attempts.

[quote=“ALLTEX Roofing”]Me "Do you see that all of the pipejacks and roof flashings are painted?"
Adjuster “Now your trying to get to me.” he said with a grin on his face… :badgrin:

I was just wondering what other roofers were hearing from the adjusters they run across…[/quote]

[quote=“Vexie”]I recently had:

  1. we don’t pay BSC & O&P together.

“Actually, I/my company has within our file records, numerous loss reports from past claims filed by other of your insured’s that do include payment for both BSC and GCOP. That being said, rather than jump to any conclusion that you might possibly be attempting to mislead me as well as the insured, which would result in a bad faith and unlawful underpayment on this claim, I’ll just assume that, in this case, you are simply mis-informed.”

  1. need 8 hits per square

“Actually, shortly after the storm hit, your company was approving payments for losses based on 5 hits per square. As usually happens though as the days after a storm go by and more claims come in, as a result of local pro contractors pricing repairs at realistic rates rather than the lower rates offered by your company, the prices have gone up. However, so has the number of hits required before your company approves the loss. Either you have decided on your own to “control” the number and dollar amounts paid out in the interest of job security which would be construed as bad faith or you are following your employer’s edict to increase the number of hits required which would also be considered as bad faith as well as unjust enrichment. You, being the representative fiduciary in the name of the insurance company, have an obligation to put the interests of the insured above yours or your employers. Doing either of the above would put you in opposition to the insured’s interest, wouldn’t they? Let’s look a little harder and I’m sure we’ll find all the hits we need to get this insured properly indemnified.”

  1. my supervisor was with me at the inspection, we are not sending an engineer.

“Is your supervisor a qualified and certified engineer? I ask that because the implication of your statement is that your supervisor is a qualified and certified engineer. If that is indeed the case and the insured still disagrees with your and your supervisors opinion, keeping in mind that any ambiquity always falls in favor of the insured considering their bargaining position, and they decide to sue, you and your supervisor will likely be called to testify in front of a judge. If you have the time and money to do that, that’s fine with me. On the other hand, if you don’t have the time and the money to appear in court to defend your position/opinion and don’t want to miss out on many other likely profitable claim assignments, I strongly suggest that you reconsider your denial and do the right thing which is to properly and fully pay this legitimate claim in full.”

  1. we don’t cover window seal failure for storm damage.

“Actually, you do and we need no more than common sense to support that. If a property has a metal siding, for instance, that get damaged, such damage will usually not affect the function of the product but the ins company will still pay to make the repairs. It stands to reason then that when the seal of a window fails as a direct result of storm damage thereby destroying its function, window seal failure is indeed a covered loss.”

  1. Michigan law does not require color match.

“May not, but look for precedence. If MI insurance companies have been paying for full and complete match in the past, likely the courts will order them to follow precedence. AmFam, came up with their “match” endorsement several years ago which will replace up to $20 of unmatched material when the endorsement fee of $30 annual is paid. A class action is on the horizon…”

  1. (this was regarding a downspout) there is mechanical damage so we will only cover the Labor not the Material.[/quote]

*"Mechanical damage is not an insured peril. This is likely one where the adjuster is offering you a little while trying deny alot. Clueless adjuster, IMO

Obviously, no contractor should ever push for any damage unless they are certain that the damage is legit. But, when you are sure it is, you need to repsectfully but strongly stand your ground.*

Learn the rebuttals and learn the proper language to use in defending your position and your results will increase exponentially.

[quote=“LMB”]Farmers Adjusters: Some time ago, “You can tell that Larry Burtis that we’re going to cut off his pony tail next time we see him.” On all inspections after that, because of the continued attempts by Farmers adjusters to deny legitimate damage, on order from the Farmers MN exective, a supervisor would appear on each claim from that storm.

Nationwide adjuster supervisor while on top of roof in suit and street shoes during 4th inspection: “Are you sure we’ve covered everything on Larry’s list cause I want to make sure he’s happy and I don’t want to hear from Steve Rasmussen’s (CEO) office again, lol.”

SF staff adjuster: “You f__ing #@%&*, there’s no *)&^#!@ damage, we’re gonna black ball you and make sure you never work in this business again.” A week later, after talking with Ed Rust’s office, two SF supervisors appeared on a third inspection (my 2nd after first contractor gave up) and within five minutes, approved everything (roofing, siding, gutters) that had previously been denied.

Guide One adjuster on big church: “Nope, there’s no damage on this one”. Re-inspect scheduled where HAAG’s hail guru Scott Morrison actually appeared. After receiving HAAG’s report, Pastor John called me to say that the adjuster was now saying that the (previously denied) hail damage was from an old storm several years ago and was therefore not covered. Pastor John’s comment to me; “What God didn’t get done, our attorney’s will.”

Farmer’s Cat adjuster: “It sure is nice to work with a contractor who know’s what the hell he’s looking at and talking about.”

Met Life adjuster: Thinking he would be done and gone by the time I arrived at the appointed time for the re-inspection of a previously denied roof (I always arrived early, just in case), he was half way down his ladder when I drove up. Upon seeing me as I got out of my vehicle he simply said, “Oh, it’s you, lol, how much is this one going to cost me?”

Farmers adjuster: On fourth inspection of large ranch property by a fourth adjuster, “Oop’s, must have missed that other nine square of Arch, I’ll go ahead and write that up.” Job started at around $35k and ended up close to $70k.

Allstate adjuster: On re-inspect of 24 sq of old Alside 8" aluminum with old Alside pre-formed fascia in a red zone I asked the adjuster what in the world it was that caused the first guy (staff) to miss all of the obvious damage? He just looked at me and said, “Aw, $*&#@ it, just give me your numbers and we’ll pay it.”

IDS/American Express P&C adjuster: Large house on golf course that was hit by then recent severe hail as well as a number of golf balls over time. Adjuster says, “those dents were all caused by errant golf balls - not an “act of God” so we are not going to pay.” Over $40 grand later, owner had a new roof, siding, trim, garage door and misc collateral damage repaired/replaced.

Allstate adjuster: 34 sq. steep and high hit hard by hail. Cat guy says, “I don’t care if all of the other homes…, no damage here on this roof”. On re-inspect by new cat adjuster, approves complete R&R including all flashings, DE, Ridge, etc. While sitting with owners, adjuster says to them, “both of us (me and your contractor) know that Allstate writes up their loss reports (non XM8, at the time) so that no one can understand them but your contractor knows what he’s doing and will make sure that everything gets paid and done right.”

Nationwide cat adjuster: On Certainteed Shangle roof (class action lawsuit then settled). “I don’t care if they tell us not to pay to replace Shangle’s because of the manufactuer defects and the law suit…if they (Nationwide) insured them and they’re damaged, I’m going to pay for them!”

AmFam adjuster: Aluminum siding originally denied as old damage by staff guy. On second inspect, new adjuster, reading from old report, made same claim. I said, “prove it”. He couldn’t and paid for new siding on house and garage, new fascia, new window trim, new roof, new skylite, new gutters, etc and HO was happy as could be.

Certified HAAG adjuster/engineer working for a different engineering inspection company sent by ins company: Obvious large hail dents on all elevations denied by this hard nosed wise guy on high/steep money maker. Female Asian HO accepted the no damage assessment and refused to pursue claim any further. Several years later on a different claim in a different city, same guy appeared where I was acting as umpire on a Shangle roof. He and original adjuster had denied the claim using the fallacious “Shangle” argument. Light but real damage on two elevations and material no longer made. I approved R&R on entire roof. I thought the guy’s head was going to explode when I told him and the HO the good news.

Erie Ins adjuster: With some effort, got entire high/steep roof with all parts paid, including DE. Upon realizing I had charged ins for it on my estimate but none existed (I would have installed it anyway) I called the adjuster and told him about my mistake (close to $1,000 on this big home). He said he appreciated the call but to just go ahead at the price quoted since it was not worth his time to back it out.

and it goes on and on and on…

When adjusters know you know what you are doing (not just claiming so), you’ll usually get better results overall and your reputation amongst adjusters (in general) will be strong and they will respect you as a pro (some of them anyway).

We’ll never completely eliminate the BS that many adjusters spout on a regular basis usually at the behest of their employers but as more and more contractors make the investment in themselves in learning more of how the process works = increased income, decreased time and decreased workload and stress - all boats will rise and P&C ins will reluctantly at least cut back on the attempts.[/quote]

Yah, you are pretty much my hero!
Been looking for someone to teach me more, alas, I still wing it most days. sad, but true story!

State FaRm admits to deep hail gauges on AC fins but notes how easy they are to damage, agrees there is granular loss and bruising to shingles, BUT the mat is not “fractured”. wtf is THAT? good lord. Hence, no roof on 2nd inspection. Prop owners getting some new ACs tho. sigh

Liberty Mutual - Denying all claims for storms over a year but the adjuster still wants to meet. I ask Why? He says in case there is damage from other storms. I show up to appt, 3 guys up there n just little old me. They inform me they are buying the roof for wind, closing the claim and reopening a new one with a different storm date. Humph? ok, thank you. :slight_smile: interesting

Liberty Mutual - Same scenario, same property owner, different adjuster. Refuses to inspect. We call in a new claim for different storm date, taking a cue from the above guy. LM now screaming fraud. Oh MY! Still trying to sort this one out. frustrated

Allstate - 8 bldg apartment, 5 prop owners, 5 bldgs bought, diff adj on 4 bldgs and 1 bldg. 2 other bldgs same adjuster in denial of any damage. When I ask how is it that I can get up on a 10 or 12 bldg apt community n all roofs get bought but in this scenario the same old bs argument comes out of their mouth. His response: NONE! baffled

I live in Michigan and have never had a problem with an adjuster giving me the run around. I have had all covered and color match no problem. Remember when dealing with an adjuster its just like selling the home owner. It helps with software but here is a story i got from farmers a few years ago.

I got their price list and final payment sheet on the roof that had severe damages since it was a flat roof. They offered 12 bucks for 1/2 inch plywood and i told the adjuster tell me where i can get it at and when i do you can 1 get it there 2 get it on the roof and go from there. it was a small job i went from 1500 to 4k with a signed contract from the home owner made her pay the deductible and all was well. No money was given to the home owner. Maybe i got lucky but i did have to fight tooth and nail with this person.

[quote=“LMB”]

[quote=“Vexie”]I recently had:

  1. we don’t pay BSC & O&P together.

“Actually, I/my company has within our file records, numerous loss reports from past claims filed by other of your insured’s that do include payment for both BSC and GCOP. That being said, rather than jump to any conclusion that you might possibly be attempting to mislead me as well as the insured, which would result in a bad faith and unlawful underpayment on this claim, I’ll just assume that, in this case, you are simply mis-informed.”[/quote]

  1. need 8 hits per square

“Actually, shortly after the storm hit, your company was approving payments for losses based on 5 hits per square. As usually happens though as the days after a storm go by and more claims come in, as a result of local pro contractors pricing repairs at realistic rates rather than the lower rates offered by your company, the prices have gone up. However, so has the number of hits required before your company approves the loss. Either you have decided on your own to “control” the number and dollar amounts paid out in the interest of job security which would be construed as bad faith or you are following your employer’s edict to increase the number of hits required which would also be considered as bad faith as well as unjust enrichment. You, being the representative fiduciary in the name of the insurance company, have an obligation to put the interests of the insured above yours or your employers. Doing either of the above would put you in opposition to the insured’s interest, wouldn’t they? Let’s look a little harder and I’m sure we’ll find all the hits we need to get this insured properly indemnified.”

  1. my supervisor was with me at the inspection, we are not sending an engineer.

“Is your supervisor a qualified and certified engineer? I ask that because the implication of your statement is that your supervisor is a qualified and certified engineer. If that is indeed the case and the insured still disagrees with your and your supervisors opinion, keeping in mind that any ambiquity always falls in favor of the insured considering their bargaining position, and they decide to sue, you and your supervisor will likely be called to testify in front of a judge. If you have the time and money to do that, that’s fine with me. On the other hand, if you don’t have the time and the money to appear in court to defend your position/opinion and don’t want to miss out on many other likely profitable claim assignments, I strongly suggest that you reconsider your denial and do the right thing which is to properly and fully pay this legitimate claim in full.”

  1. we don’t cover window seal failure for storm damage.

“Actually, you do and we need no more than common sense to support that. If a property has a metal siding, for instance, that get damaged, such damage will usually not affect the function of the product but the ins company will still pay to make the repairs. It stands to reason then that when the seal of a window fails as a direct result of storm damage thereby destroying its function, window seal failure is indeed a covered loss.”

  1. Michigan law does not require color match.

“May not, but look for precedence. If MI insurance companies have been paying for full and complete match in the past, likely the courts will order them to follow precedence. AmFam, came up with their “match” endorsement several years ago which will replace up to $20 of unmatched material when the endorsement fee of $30 annual is paid. A class action is on the horizon…”

  1. (this was regarding a downspout) there is mechanical damage so we will only cover the Labor not the Material.

*"Mechanical damage is not an insured peril. This is likely one where the adjuster is offering you a little while trying deny alot. Clueless adjuster, IMO

Obviously, no contractor should ever push for any damage unless they are certain that the damage is legit. But, when you are sure it is, you need to repsectfully but strongly stand your ground.*

Learn the rebuttals and learn the proper language to use in defending your position and your results will increase exponentially.[/quote]

Do you have a book or guide that you have written LMB?

I love the ones that say, We don’t cover for mechanical damage or damage the doesn’t cause functional failure.

I politely ask them what the policy definition of direct physical damage is.

They end up capitulating and pay.

I also love the guys who say the mat isn’t fractured, I ask them where they got their bionic eyes from. To truly know if the mat is fractured, if the whole shingle hasn’t been penetrated you have to have the shingle sent to the lab to be de-laminated and inspected.

The list goes on and on with the excuses and BS I’ve heard from adjusters trying not to pay a claim.

[quote=“WindowsonWashington”]

  1. need 8 hits per square

“Actually, shortly after the storm hit, your company was approving payments for losses based on 5 hits per square. As usually happens though as the days after a storm go by and more claims come in, as a result of local pro contractors pricing repairs at realistic rates rather than the lower rates offered by your company, the prices have gone up. However, so has the number of hits required before your company approves the loss. Either you have decided on your own to “control” the number and dollar amounts paid out in the interest of job security which would be construed as bad faith or you are following your employer’s edict to increase the number of hits required which would also be considered as bad faith as well as unjust enrichment. You, being the representative fiduciary in the name of the insurance company, have an obligation to put the interests of the insured above yours or your employers. Doing either of the above would put you in opposition to the insured’s interest, wouldn’t they? Let’s look a little harder and I’m sure we’ll find all the hits we need to get this insured properly indemnified.”

  1. my supervisor was with me at the inspection, we are not sending an engineer.

“Is your supervisor a qualified and certified engineer? I ask that because the implication of your statement is that your supervisor is a qualified and certified engineer. If that is indeed the case and the insured still disagrees with your and your supervisors opinion, keeping in mind that any ambiquity always falls in favor of the insured considering their bargaining position, and they decide to sue, you and your supervisor will likely be called to testify in front of a judge. If you have the time and money to do that, that’s fine with me. On the other hand, if you don’t have the time and the money to appear in court to defend your position/opinion and don’t want to miss out on many other likely profitable claim assignments, I strongly suggest that you reconsider your denial and do the right thing which is to properly and fully pay this legitimate claim in full.”

  1. we don’t cover window seal failure for storm damage.

“Actually, you do and we need no more than common sense to support that. If a property has a metal siding, for instance, that get damaged, such damage will usually not affect the function of the product but the ins company will still pay to make the repairs. It stands to reason then that when the seal of a window fails as a direct result of storm damage thereby destroying its function, window seal failure is indeed a covered loss.”

  1. Michigan law does not require color match.

“May not, but look for precedence. If MI insurance companies have been paying for full and complete match in the past, likely the courts will order them to follow precedence. AmFam, came up with their “match” endorsement several years ago which will replace up to $20 of unmatched material when the endorsement fee of $30 annual is paid. A class action is on the horizon…”

  1. (this was regarding a downspout) there is mechanical damage so we will only cover the Labor not the Material.

*"Mechanical damage is not an insured peril. This is likely one where the adjuster is offering you a little while trying deny alot. Clueless adjuster, IMO

Obviously, no contractor should ever push for any damage unless they are certain that the damage is legit. But, when you are sure it is, you need to repsectfully but strongly stand your ground.*

Learn the rebuttals and learn the proper language to use in defending your position and your results will increase exponentially.

Do you have a book or guide that you have written LMB?[/quote]

Yes. See it at burcos.com