"roofing is not a 'trade'"

I am at a stand still on this one. The ins co is paying o&p on everything except the roof. I’ve given them our price with the supplements, they’re being great except for the o&p on roofing. Any suggestions? How can this be resolved in my favor and why how do they justify this method?? Any help would be appreciated.
Scott

You need the HO to discuss this with the insurance company. Attempting to negotiate it yourself is likely a waste of your time.

If the insurance company is paying it on some parts of the claim, but not others, the policy holder is not getting the full replacement cost coverage they are paying for. It borders on bad faith claims handling, IMVHO. The insureds premium includes an amount for general contractor overhead and profit, so if its denied on a claim, the insured is being denied a benefit that they paid for and SHOULD have gotten. Explained that way, your customer should be VERY motivated to fight.

Paying “partial” GCOP is unacceptable and your customer should call them on it. Ive gotten this poo-poo before from adjusters and under no circumstances do we accept the “roofing isnt a trade” explanation. If you cant tell, this excuse really, really makes me angry.

Ask the adjuster who is gonna be responsible for:

-full inspection of the project and scope
-determining code issues and pulling permit(s)
-per OSHA, working up a safety plan, etc
-verifying all liability insurance on subs and licenses
-coordination of each repair trade
-obtaining multiple bids for each trade
-paying subs, billing, etc

etc etc etc.

The insured needs a general contractor to do the above work BEFORE the repairs even start!

Next time, just go into the claim as a general contractor and eliminate this tactic in one step.

Roofing or anything else doesn’t have to be a “TRADE”. The fact is that Xactimate if that’s what they are using doesn’t calculate O&P in the line items for replacement cost. So the insurance company is just playing off of your lack of understanding of the software to begin with.

Let me guess, the roof is the largest portion of the claim yes?

Had an adjuster tell me straight faced they don’t pay O/P on roofing.

So I sent him a previous claim on two where HE paid it before.
What nonsense they come up with.

Same guy that gets in arguments with other contractors.
(if you know what I mean AD!) LOL

[quote=“LowCarolina”]Had an adjuster tell me straight faced they don’t pay O/P on roofing.

So I sent him a previous claim on two where HE paid it before.
What nonsense they come up with.

Same guy that gets in arguments with other contractors.
(if you know what I mean AD!) LOL[/quote]

Yeah, I absolutely know what you mean!

I had a $40k claim that included: fascia, gutters, trim work, painting, interior patching, flat roof, & shingle roof. The adjuster paid O&P on everything except the roof.

When i asked why she wasn’t approving the O&P on the roof, she said it was because i was a roofing company. That O&P are for contractors that sub out their work. Since i was a roofing company im already making O&P by using my own guys.

She said that if i wanted O&P that i would have to show my invoice from my subcontractor for the roofing section.

One of my reps that ended up being an adjuster told me that if i submitted a general contractors license that they would have to approve O&P on roof. Surprisingly it worked for this insurance company.

Edit: added painting

“Roofing is not included”, “must have at least three trades”, “we don’t pay P&P unless a GC is involved”, “must provide sub invoices”, etc. B as in B, S as in S as our local Mayor of “Garage Logic” (local radio show) likes to say. All, as Ray aptly terms it, made up rules by the P&C ins industry over time.

The insured’s pay for O&P in their future cost priced premiums, therefore, it is always due on any claim. Adjusters and in house claim reps who may or may not know better are just following the P&C ins script not to pay that is in direct opposition to the implied promise made by P&C ins when the insured takes the policy - and that is a violation of the fiduciary duty they owe to their insured’s.

O&P no-pay nonsense first started by a State Farm rep in the late 90’s and had been attempted ever since. Most legal precedence that I have read says that this is not ok. Contractors with exp (maybe 10-15%) know the typical statements made by adjusters and in house claims reps (first paragraph) is BS. Even some of them still give in, however. P&C ins knows that the balance of contractors out their doing ins work are still intimidated by them and don’t know how to challenge their O&P and other denials.

However, once enough contractors from around the country get on the same page, meaning they know that P&C ins O&P denials are balony (sp) and they start demanding claims include O&P in every case because that is the right thing to do to fullfill their obligation to their insured’s, the number of claims where O&P does get paid will at least increase and should do so dramatically.

I show and teach those knuckle heads, whether adjusters, in house claim reps or their supers, that I know their program at least as well as they do as I also remind them that not fully paying their claims subjects them to potential penalties that may be costly. The above, although they represent multi-billion P&C insurance companies which causes some of them to think that, when dealing with contractors, they are in the power position, are still just people and most of them, when forcibly presented with the logic of why it is in their best interests to do the right thing, will do the right thing. Obviously, that is not always the case but ultimately, anything a contractor can do to honestly increase their percentages is a good thing.

“Kill them with kindness”? Never worked for me. No contractor should see themselves as subserviant to any P&C ins adjuster, in house claims rep, their supers or their CEO. Those folks - starting with the CEO, owe a duty to the insureds to serve them. All the knowing contractor does is assist in moving the process along and filling in the blanks for the unknowing insured’s and that’s the biggest value of a contractor whose knowledge of the process goes far beyond simply titleing themselves as an “insurance claims specialist.”

Seems as if 99% of ins adjusters (IA or staff) and in house people with any P&C ins co can’t ever get it right - low pricing, missed items, illegitmate denials, bad faith, etc. “Oh, they’re just trying to keep their costs down”, some will say. If I do a job for an HO where I promised Grade A products in exchange for X amount and I then installed Grade B products, I would be just as guilty of doing what P&C ins regularly does to their customers - cheating them. I would then have no credibility and would deserve none - even though I was just trying to “keep my costs down.”

It’s time for contractors to educate themselves so they can stand up to “Goliath” and cut him down to size.

State Farm always seems to go through cycles of naughty and nice. For example, last week I had an approval of a 15k supplement worth of missed line items on a 60 sq roof alone. This week, I did their next door neighbor’s house (82 sq) and state farm is feeding me the line “we don’t owe for flashings because they are not storm damaged,” to which I reply that they were damaged during the reasonable replacement of this roof, as seen in the pictures I sent in, and a replacement was warranted. Now I am sitting on close to 20K that they should have legitimately paid on this roof that was withheld, including O&P. To make it even more of a kick in the head, I subbed out the paint work and lost $800 because state farm holds that they have plenty of contractors that can paint a 1500 sq ft garage (walls and ceiling) for $250 including materials.

Veterans, it’s like talking to a brick wall. How do I escalate this and get paid?

I don’t deal with insurance companies per se so I am curious about something.

If you guys legitimately did work why don’t you just bill the homeowner and make them pay?
Why all this messing around with the insurance company?

The insurance company pays what they feel like paying and the homeowner pays the rest.
The people who did the work get paid, and the homeowner with the crappy insurance company gets to deal with them.
This seems painfully obvious to me so I feel that I must be missing something.

[quote="-Axiom-"]I don’t deal with insurance companies per se so I am curious about something.

If you guys legitimately did work why don’t you just bill the homeowner and make them pay?
Why all this messing around with the insurance company?

The insurance company pays what they feel like paying and the homeowner pays the rest.
The people who did the work get paid, and the homeowner with the crappy insurance company gets to deal with them.
This seems painfully obvious to me so I feel that I must be missing something.[/quote]

Most of the time, we’re working from a contingency and/or contract. These contracts generally have wording that reads something to the effect “will accept the insurance claim amount as payment” and also includes “the HO’s max amount out of pocket would be their deductible plus any upgrades”. Therefore, we have a vested interest in seeing the claim amount be as high as possible. There are numerous approaches but it often if not mostly ends up with the contractor speaking directly with the insurance company discussing the line items or other various aspects of the contractor’s estimate versus the insurance scope of loss. There is a great deal of competition with this business in many areas so you generally aren’t in a position to just “bill the homeowner” particularly when you have all the hacks running around offering to pay deductibles and free upgrades while working for the insurance proceeds.

There are situations where we do just as you said. We had an Angie’s List inquiry this past week from a higher tier Customer. 58 squares, all double steep and high. They already had their insurance claim approved and were adamant about just getting a cash bid. Our guy went through our sales pitch and felt like the guy wasn’t trying to make money off his claim. We put an estimate together as normal and came in over $19,000. We got the contract and then found out his claim was for $16,800. We’re going to attempt to get his claim amount where it should be but if not, he is agreeable to the difference.

Can you post the pictures?

What city and county is the house located?

It’s in Canton in Cherokee county. Just got off the phone with the adjuster, and even though I lost money on two trades (gutters and painting) they have denied the supplement outright. I will post photos later.

New plan for next time I work a state farm claim - Order off the scope, expose the damaged flashings, politely explain the situation to the homeowner, button the job up (and charge to do so), and call state farm. Resume work, run out of materials, politely explain once more how State Farm’s lack of indemnity is forcing us to button things up again (charge to do so once again), call state farm, finish job if and when state farm approves extra materials.

[quote=“ReroofGA”]It’s in Canton in Cherokee county. Just got off the phone with the adjuster, and even though I lost money on two trades (gutters and painting) they have denied the supplement outright. I will post photos later.

New plan for next time I work a state farm claim - Order off the scope, expose the damaged flashings, politely explain the situation to the homeowner, button the job up (and charge to do so), and call state farm. Resume work, run out of materials, politely explain once more how State Farm’s lack of indemnity is forcing us to button things up again (charge to do so once again), call state farm, finish job if and when state farm approves extra materials.[/quote]

That’s exactly what you have to do. That is following their process explained on their scope of loss. When the rubber hits the road, they’re not going to be happy about it but tough $hit. I’ll bet you a buck the adjuster will say “every other contractor we work with is able to finish the job with the materials allowed for on the scope of loss.” LOL Always the same crap from those people.

The key is getting the HO bought into the process. What works even better is to ask the HO to contact the Adjuster a few hours prior to you being finished, around the time you see you’re going to run short on materials. Have them ask to have the additional materials approved. See how frustrated they get when they don’t get a call back from the Adjuster. Chances are they now won’t get mad at you, the contractor, for the delays because they see where the root cause problem is.

Great advise! Thanks AD

My crews pay the laborers by the day.No matter the hrs.If the adjuster has to come out AGAIN the NEXT day you incur ANOTHER day of labor.AND cooridination which ensures O/P.And delivery charges etc etc,scheduling the additional material and all those involved.If they want to play those games you have them by the balls for expenses.I am having good luck with good takeoffs with my State Farm desk adjusters,blow past dealing with the adjuster who did the scope, and add starter/ridge requirements per code.Then I prove the square ft to them and they OK.Their problem is that DAMN EXACTIMATE 10 or 15% waste when we run into cut up roofs.Every perimeter needs ice/water and shingle trimmings.Raised roofs make us WASTE more material . Desk adjusters need something to add to scope and get around the waste %.Get a true takeoff with perimeter and code stuff for starter etc and back up with code IRC 2006 etc.They want to pay but need our help to prove it to their Supers. Ask them what WE can do to get it approved.