Two claims on same house with two deductables within weeks

i have a job that on first claim was denyed after tornado but they gave 7100 for repairs. with a 3700 dollar deductable and i made arrangement to do repair and a hail storm hit and totaled the house before repairs could be done. there was less than 2 week window from time recieved check and next hail storm. So i got homeowner to make another claim which i met diffrent ajuster and it was totaled . this house is 66 sq with 9/12 pitch. the insurance deducted the first claim off the second one which gave homeowner paying 8000 dollars in deductables.my argument is there was not ample time to do repairs considering it rained in between storms. libert mutual is insurance. can anyone help

There is not much you can do. This is clearly two separate claim events with two separate deductibles. The insurance company was well within their right to deduct for non repaired prior damage. I am presuming that this is a percentage deductible that applies. Most of the time this applies to wind/hail or earthquakes.

It certainly puts a hurt on the homeowne. Many times the policyholder shops price of their premium and these are the types of things that happen. Of corse, there are some insurers in some of the coastal areas especially who do not give you the choice,

I keep hearing more and more carriers going to these types of deductibles because less and less people are maintaining their home. Many people will let their roof go and would just rather wait for mother nature to take care of it for them. Roofing is becoming a maintenance policy for the insurance industry which means changes will be coming.

Next time rather than filing a second claim call for a reinspect of the first claim saying the adjuster missed the hail damage…If it will fly great! If not youre in no worse situation than you are now

For someone who calls himself roofsmart you are offering some pretty dumb advice. I will give you the benefit of the doubt and make the assumption that was a tongue-in-cheek comment.

[quote=“jtdew”]There is not much you can do. This is clearly two separate claim events with two separate deductibles. The insurance company was well within their right to deduct for non repaired prior damage. I am presuming that this is a percentage deductible that applies. Most of the time this applies to wind/hail or earthquakes.

It certainly puts a hurt on the homeowne. Many times the policyholder shops price of their premium and these are the types of things that happen. Of corse, there are some insurers in some of the coastal areas especially who do not give you the choice,

I keep hearing more and more carriers going to these types of deductibles because less and less people are maintaining their home. Many people will let their roof go and would just rather wait for mother nature to take care of it for them. Roofing is becoming a maintenance policy for the insurance industry which means changes will be coming.[/quote]

I call BS on that. Yeah, there are some people doing that. The vast majority of the people in non frequent hail areas aren’t even that aware of insurance paying for roofs as they do. The simple fact of the matter is, with the state of the economy, most people don’t have the money to go out and purchase a new roof.

What I wonder is, why wouldn’t you have questioned the insurance that paid $7,100 for repairs without failing the entire roof? Are you trying to say that doesn’t sound like a bunch of crap? Obviously, they sloped this guys roof. How does that properly indemnify the HO and make them whole?

I spoke with a Liberty Mutual Adjuster in the their Central Claims Unit today. She explained to me how they had decided they weren’t paying the remove line item for steep and high as they determined there is no loss of productivity for the roof on the remove portion. I asked her if she’d ever been part of a roof replacement or if she’d ever been on a 12/12 pitch 2 story roof. She had not. I suggested she go place a piece of decking on a something that would allow her to achieve a 12/12 pitch and to simply stand on it, facing down, for 10 minutes. When done, please call me and then tell me she’d be able to be just as productive on a 12/12 as she would a 4/12. She then went on to attempt explain that’s why they’re not paying the remove on pipe jacks, turtle vents, etc… She said, I quote, “you just scrap them off like you do the shingles and felt”. LMAO!

I asked her if she used Xactimate. She said yes. I asked her if she had it open on her computer. She did. I asked her to open any claim, type in RFG 220 and then click on the remove line item. She did. I then asked her to click on the details to pop up the explanation for that line item. I asked her to read it. I then asked her where the remove line item for Xactimate said anything about pipe jacks, turtle vents, valley metal or anything other than asphalt shingles and felt. She then told me it didn’t matter, that’s the way LM operates.

I then thanked her and said goodbye. She said we hadn’t finished yet. I told her we most certainly had.

[quote=“dstew66”]

For someone who calls himself roofsmart you are offering some pretty dumb advice. I will give you the benefit of the doubt and make the assumption that was a tongue-in-cheek comment.[/quote]

Im guessing you dont handle many insurance claims? Why is that dumb advice? Whos to say there wasnt hail with the tornado and subsequent rain that came with the following hail storm washed away granules and made the existing damage more apparent? Im just saying its worth a shot having a reinspect you have nothing to lose… dumb? :roll:

I would also go after a reinspection of the first claim, as my approach.

I believe the original poster stated it:

Granted, a storm that produces tornados will generally produce hail also. It doesn’t mean the hail and the tornado are in the same spot. If we make the assumption that the original poster is competent enough to identify hail damage he would have discovered it after the first storm. He said he made arrangements to do repairs but he doesn’t say anything about there being hail damage from the first storm. He specifically says the hail damage came with the second storm. Having those facts at your disposal why would you recommend asking for a first storm re-inspect when you know the hail damage was caused by the second? That requires a certain level of dishonesty which has no place among honorable men.

[quote]The Definition of Insurance Fraud:

Insurance Fraud occurs when people deceive an insurance company or agent to collect money to which they aren’t entitled. It is a criminal act requiring a material and intentional misrepresentation in order to obtain a benefit, . . .[/quote]

I believe, based on the facts, that what you recommended fits within that definition. I would not call it “smart” at any time to recommend anything that might be viewed as insurance fraud.

There is sure no need for anyone, trying to give helpful advice here, to get defensive. I almost never see a thread here that has enough information for anyone to conclude definitely what to do.

I recommend a reinspection because nothing was touched on the roof. I sure would not touch it now, and leave the homeowner with $7400 of deductible to pay.

Instead, I’d ask for a reinspection of the first claim. If you want to think asking for a reinspection is insurance fraud, go right ahead. Sure, filing a second claim did not help the matter, but that is just hindsight.

I’d make the insurer prove the damage was not present on the first inspection. Adjusters miss damage all the time. After all, there was some damage, or the repair would not have been approved. Did the subsequent storm just damage an already weakened structure?

None of us was there, so all our ideas are nothing more than an attempt to help the guy make up his mind what to do.

A $3700.00 deductible is a big fat sloppy pig to have to deal with.Is this a commercial job?

I have dealt with some large deductibles but nothing like $3700 for residential.

I had an adjusters meeting and assisted the customer with a hail claim on a particular property a while back.I received the entire claim with a contingency.(Roof,siding,gutters)

The customer and I agreed on a start date. I believe it was a week and a half later.In the mean time a tornado came thru and removed the roof,windows and completely soaked the entire interior.

I received a call from the adjuster and the customer the morning of and was asked to tarp the roof A.S.A.P.During the tarp installation the adjuster showed up.Upon the assessment of the damage another claim was filed and another deductible was applied.

The first claim was already processed and it does not seem practical that a reinspect could make a difference with the deductible process.If the claim has been filed and additional damages have incurred from a completely different storm system on a completely different date from the first damage date then a deductible should be added.

Most adjusters take photos of roof damage so if new damage is present compared to the old pictures then its in the open.I have really noticed that the insurers are making and twisting the “rules” to best fit themselves rather that being for the insured.But it has been happening for a while now so who really knows.

Needless to say the first claim went from $30,000.00 to a little under $100,000.00.

i did call for reinspect and insurance would not grant to homeowner and would not speak to me about claim. they also got on my ass because legally i canot
represent the homeowner unless public ajuster or lawyer.one of the thins that pisses me off is on first claim they paid ridge but on 2nd claim they didnt so the ridge is being deducted from total .

could we reject the first claim and return the money therefore only be one deductable

No

[quote=“dstew66”]

I believe the original poster stated it:

Granted, a storm that produces tornados will generally produce hail also. It doesn’t mean the hail and the tornado are in the same spot. If we make the assumption that the original poster is competent enough to identify hail damage he would have discovered it after the first storm. He said he made arrangements to do repairs but he doesn’t say anything about there being hail damage from the first storm. He specifically says the hail damage came with the second storm. Having those facts at your disposal why would you recommend asking for a first storm re-inspect when you know the hail damage was caused by the second? That requires a certain level of dishonesty which has no place among honorable men.

[quote]The Definition of Insurance Fraud:

Insurance Fraud occurs when people deceive an insurance company or agent to collect money to which they aren’t entitled. It is a criminal act requiring a material and intentional misrepresentation in order to obtain a benefit, . . .[/quote]

I believe, based on the facts, that what you recommended fits within that definition. I would not call it “smart” at any time to recommend anything that might be viewed as insurance fraud.[/quote]

Dstew are you an advocate for your customer or the insurance company? And who are you to suggest I am not honorable? You are obviously ignorant when it comes to insurance work. There is nothing illegal or fraudulent about asking for a reinspect. Whether there was a second storm or not who’s to say there wasnt pre-existing damage from the first storm that was missed? Ill answer that question for you Einstein : the insurance adjuster. So call for a reinspect and at least give him a chance to make the call in your favor. Sounds like you got a lot of stock in a major insurance company or something you should be looking out for your customer!

Let’s just analyze the facts here for a moment.

  1. First claim was denied.
  2. $7100 for repairs.
  3. Arrangements were made to do repair.

At this point in the process we have to assume this contractor has done an inspection himself and did not find any roof damage. If he did, he most certainly would have asked for a second inspection instead of making arrangements to do repairs. He does not have a crystal ball telling him a hail storm is going to hit in 2 weeks totaling the roof. At this point there is nothing further that can be accomplished. This contractor knows there is no further damage.

  1. Contractor has inspected.

  2. No damage found or reinspect would have been suggested to homeowner.

  3. Knowing there was no further damage, the contractor scheduled the repairs.

  4. A hail storm hits.

  5. Contractor tells homeowner to file a second claim.

  6. Insurance paid for roof.

This set of facts, as submitted by the original poster, clearly shows two claims. The first claim clearly had no roof damage. If it did, the contractor would have requested a reinspection at that time. The roof was totaled by the second storm. Did it not occur to you that the insurance company knows whether or not there was hail in that area from the first storm? Did it not occur to you that the insurance company knows about the second storm which did have hail? These are facts that are known by the original poster.

Since the original poster has these as known facts it would not be proper for him to misrepresent the facts. Insurance fraud is defined as “a criminal act requiring A MATERIAL AND INTENTIONAL MISREPRESENTATION IN ORDER TO OBTAIN A BENEFIT.” Attempting to attribute the damage from the second storm to the first storm is definitely material. Knowing that the second storm caused the damage and claiming that it was the first storm is intentional. The benefit to be obtained is only one deductible.

Now, to answer your questions:

As an advocate for my customer I am not going to suggest to them they commit insurance fraud nor am I going to knowingly participate in it myself.

Actually, if you would reread all of my posts in context, I was suggesting just the opposite. I was suggesting that you were honorable and were just misunderstanding the facts at the least.

Well, you may be right here. I have only done a couple of these. Lots and lots of work involved. I hope to get less ignorant with a couple more though. Crossing my fingers.

I never said there was. However, based upon the facts that were presented in the original post it would have been a material and intentional misrepresentation in order to obtain a benefit in regards to this particular claim.

You are assuming facts not in evidence. The original poster stated the claim was denied. He never claimed there was damage from the first storm. In fact, he had already scheduled to make repairs. Had there indeed been damage from the first storm it would be safe to conclude that he would have asked for a reinspection at that time instead of scheduling repairs.

Now you want to get into a pissing match. I prefer to remain professional.

I believe I have addressed this in sufficient detail.

No, but with what I make off of insurance claims I could certainly afford to buy a lot of stock in one if I was so inclined.

Your motives are admirable (eliminating a second, large deductible), however, there is a time and a place for each battle you fight. The war will never end and each battle will be different. Knowing which weapon to use in each battle will increase your odds of winning the battle. Taking a knife to a gun fight puts you at somewhat of a disadvantage.

In golfers parlance, I was merely attempting to correct a flaw I noticed in your swing.

Had the initial payment from the first claim been received at the time of the hail storm that resulted in the second claim?

Correct me if I am wrong but if the homeowner had not received payment repairs could not have been made so therefore the new damage would be filed under the initial claim. As an example we have had claims where we had tarped the roof and there was not interior damage at the time of the storm but because we had not received payment or had reasonable time to complete the roof repairs we were able to supplement the interior damage that occured after the approval for replacement/repairs.

Just food for thought…

[quote=“Authentic Roofer”]Had the initial payment from the first claim been received at the time of the hail storm that resulted in the second claim?

Correct me if I am wrong but if the homeowner had not received payment repairs could not have been made so therefore the new damage would be filed under the initial claim. As an example we have had claims where we had tarped the roof and there was not interior damage at the time of the storm but because we had not received payment or had reasonable time to complete the roof repairs we were able to supplement the interior damage that occured after the approval for replacement/repairs.

Just food for thought…[/quote]

If I understand your example correctly the interior damage was in the same location as the initial exterior damage. In that case I would agree with you. But for the exterior damage, the interior damage would not have occurred. We could discuss an infinite number of scenarios.

Now suppose we take your example one step further. You get a second storm 2 weeks later that drops a tree limb through another part of the roof causing exterior and interior damage. Do we still try and attribute that to the first storm? I don’t think any of us could argue that with a straight face.

What if the second storm dropped a tree limb through your tarp on the previously damaged section of roof, causing the interior damage? Would your answer be the same? Is this from the first storm or from the second?

Each case has to be approached separately. In one case it may be attributable to the first storm. In another it may be a totally separate cause and effect. Fortunately we don’t have to deal with that problem too often (although I had one myself this year which I am still dealing with).