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Discussion Starter · #1 ·
I should know this but I guess I have been out of residential too long because I'm feeling a little unsure...which is weird because normally I'd jump at the chance to fight an adjuster.

I have this claim that I was called to do way after the claim should have been handled. The lady was already on her third extension and last day of it at that.

So we tear it off and invoice for it the same day..the adjuster said the wk had to be completed and invoiced for that day or she wasn't going to get her depreciation.

Well that's the roof I shot myself on so needless to say the wk didn't get completed, but I still got the invoice in.

It was a HAIL claim, complete reroof and a ton of interior damage. The adjuster didn't pay for any wall, chimney or skylight flashings, there was a dead valley that required some sort of rolled roofing..we chose tpo because we wanted to run it 24 inches under the shingles on both sides without a seem and she didn't pay for any interior damage.

So remember she wanted this all done and invoiced for same day.. so we did what we had to do to complete the roof and I invoiced accordingly..

I emailed the adjusterhoe and said please call me to discuss difference in scope and invoiced amount and I would also like to discuss interior damage. I also wrote on the invoice "supplemental bill to follow for interior damage pending approval"

So she emails me back and says "all supplementals have to be approved prior to completion. I have released the recoverable damage and am closing the claim"

Is that not wtf I was seeking? Approval before construction? I'm not stupid. I don't just do work at my expense and hope they pay for it.

Aside from the required construction necessary to complete the roof on time.

I hardly think that is supplemental. Its forgotten and overlooked line items... and I guess ultimately I should have gotten approval or just not taken the job.. so if I have to eat the 900 $ big deal.. but come on.. technically it was my resp. Realistically...that's a cop out adjuster excuse to not pay. And what about the interior damage ? Since her claim was so overdue can I still request a reinspect? How much leg do I have to stand on here?
 

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Yes you can. Not only do you request extra you ask for o and p. It's silly for the adjuster to act like an ass. Just skip the adjuster and go to someone else. Also get the homeowner involved.

Why did she wait so long?
 

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Depends on the insurance laws in your state. Unless there is a law to limit time to complete after claim or it is in the insurance policy their time limit means nothing.

Check with your state department of insurance and have the client file a complaint with them. If nothing else it makes the insurance company respond.

There was a very recent Florida court ruling that allows for O&P. If they push back on the O&P use the new ruling in your defense. This balusters a previous ruling.

This is my parents home, insurance claim is still not fully resolved after 3.5 years. Original insurance appraisal for all the work was 31k.

https://picasaweb.google.com/tbadernwi/F2Damage

No pictures of the interior damage or broken rafters in the above link, they're in other albums.

Your client may have to go the route of a public adjuster.

Tom
 

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Tom is correct. At least in Ga it is not illegal for the contractor to act as an adjuster on the homeowners behalf. The law is not typically enforced but often brought up by insurance companies in disputed claims with contractors. Public adjusters are very useful in this regards. The $900.00 is nothing compared to getting the interior damage properly covered with o and p on the entire claim. Also, even if there is a time limit on depreciation this should not affect the wether the added items are paid on an ACV basis.

Did you take pictures of the items you added?
 

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From the insurance side of things, I can offer the following that might be helpful:

- Generally speaking, a contractor CAN NOT represent the HO in dealings with the adjuster. You can talk about your construction work and invoicing, but you can't negotiate the claim unless you have the appropriate insurance license.

- Re the interior water damage: there may be more to this story as it was mentioned that the HO was on their third extension. Sudden & accidental water damage that enters the home is covered, but continuous seepage that is left unaddressed or due to poor maintenance is not covered. Perhaps there was some water damage because of a hail storm, but then the HO did not do anything "as soon as practicable" to prevent further loss, and then further extensive water damage subsequently occurred at the next rain storm. Damage from the second storm would not be covered if there was sufficient time to temporarily cover the roof between the two storms and the HO neglected to do this. Is it possible the interior water damage is being denied because of this type of scenario?

- I suggest getting the insurance agent/broker involved. Brokers do more than just sell policies. They are licensed and can help mediate claims with the insurance company. At the very least, they should find out why certain parts of a claim are being denied and provide satisfactory explanations. After all, the broker should be earning their commission and this is how they do it; by answering questions, helping with risk management and assisting with claims.

- If the broker is no help, then the HO can go to the state/provincial Department of Insurance. I found the Texas Dept. of Ins. website for your reference:
Texas Dept of Insurance Complaint Form
You can direct the HO to this site.

As for the O&P question, I recall this being a discussion last year. I'll try to find that previous thread and post a link to it. Short answer is that you can't be denied O&P.
 

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It is more to do with insurance contract law which is pretty much standardized in the USA and Canada. However, taking an insurance company to task may require involving the courts and that is done on a state-by-state basis. Insurance professional associations have for the most part already agreed that O&P is payable, not only where replacement is actually made, but homeowners can even collect estimated O&P when accepting an ACV cash settlement.

I think the link to the Colorado bulletin in the old thread isn't working anymore, so here is the official bulletin:
Colorado Bulletin B-5.1

If you need documentation for another specific state, let me know and I'll try and find it for your use.

Unfortunately, it is often a case of the adjuster in question not being properly trained, and they are following outdated adjusting practices.
 

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How would I go about finding this for GA? Any help would be very much appreciated. For better or worse I deal with adjusters quite a bit now and almost give up on o and p unless I have plenty if free time.
 

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How would I go about finding this for GA? Any help would be very much appreciated. For better or worse I deal with adjusters quite a bit now and almost give up on o and p unless I have plenty if free time.
Who cares your moving to Texas and living like BC:whistling
 

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http://www.adjustersinternational.com/ATpdf/3032_Overhead_and_Profit.pdf

Try the pdf link above with the adjuster giving you grief. It is long (8 pages) but I would simply hand it to them to read. Adjusting Today is their professional adjusting association trade magazine. So if Adjusting Today writes an 8 page document on why O&P should be paid, then the adjuster will be hard pressed not to honour it without appearing unprofessional and against the ruling of their own professional association.

As for Georgia Department of Insurance specifically, I don't seem to have anything on that (after all I am in Canada, so my USA "bag of tricks" is limited). I see the original poster is in Dallas and it was just mentioned you might be moving to Texas (joke or not?). I do have the Texas Dept. of Insurance bulletin:
http://www.tdi.texas.gov/bulletins/1998/b-0045-8.html

Hope this helps. I would say you need to get the insurance broker involved. If in Georgia, that Georgia broker should be up to speed on your area. If the HO's broker can't help, then ask your commercial insurance broker who handles your roofing coverage. As mentioned above, we brokers earn our commission by providing this type of service.
 

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Roofcheck said:
Who cares your moving to Texas and living like BC:whistling
Ha. I'm in Galveston now. That was one long drive. Every time I'm here I miss the north ga mountains. I'm not sure I could ever live here.
 

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Discussion Starter · #13 ·
Astrix, thanks for that. Very well written. I do understand the senerio you gave and at this point that very well might be a legit excuse for them to deny the claim, but as far as I know the adjuster only came to the house once, right after the claim was filed and she denied it at that time saying it was old damage.

I haven't responded to the adjuster yet. 1 because I'm trying to put the story I'm getting from the HO together and 2 I have not reviewed the policy..the HO did not have a copy so I asked her to have one sent before I move forward with it.

I told the HO that if it was determined that the damage was not from the hail storm it should still be covered although it may be another claim and another deductible. Is that wrong?

I did not think the adjuster had the authority or expertise to determine the age of the damage. (Aside from the blatent obvious)

After looking at interior damage and the scope, I try to find the entry points and also the cause...take my pictures and take it up with the adjuster if more needs to be paid out, I've never had a prob w getting something necessary but forgotten, paid for after the fact. Is it acceptable to re use flashing?
 

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I haven't responded to the adjuster yet. 1 because I'm trying to put the story I'm getting from the HO together and 2 I have not reviewed the policy..the HO did not have a copy so I asked her to have one sent before I move forward with it.
I'm a bit confused by your involvement in this claim. Are you acting as an appraiser a/o adjuster? Or are you the GC a/o roofer? You mention reviewing the policy; but you need to be licensed as an adjuster in order to confirm if there is coverage is not.

I told the HO that if it was determined that the damage was not from the hail storm it should still be covered although it may be another claim and another deductible. Is that wrong?
Not wrong, but not necessarily right either. The key word is "should". Without knowing the full circumstances of the claim, I can't comment as there are many exclusions and clauses that could affect whether there is coverage or not. I would be more inclined to say "it might still be covered....."; but not should.

I did not think the adjuster had the authority or expertise to determine the age of the damage. (Aside from the blatent obvious)
Correct. The adjuster determines if there is insurance coverage and authorizes payment. The appraiser determines the damage (cause, extent, etc.)

I've never had a prob w getting something necessary but forgotten, paid for after the fact. Is it acceptable to re use flashing?
It is common for additional damage to be discovered and supplementary payments authorized as a claim proceeds. As long as the HO has not yet accepted final payment and signed a "release of further liability", then the claim can be re-opened and further adjustments made.
 

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Have had a couple claims that have gone SOUTH. Strange thing about them is same insurance company and same IA on both claims.

Next time going to have the homeowner sue the adjuster, heard that really gets thing moving. Met a lot of IA's and they all get really nervous when they tell stories about getting sued on claims.

Another trick is to have the homeowner send all paperwork on your behalf to the insurance company. You are simply a contractor working for the policy holder. The policy holder is under contract with the insurance provider.
 

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Discussion Starter · #16 · (Edited)
I'm the roofer/gc. My company deals mostly with storm restoration and we like to handle the entire claim for our customers.

I'm not an adjuster but this is pretty standard involvement where I'm from. The IAs deal with the contractors for the most part..unless they really don't want to pay..I call my public adjuster as a last resort, & ive only HAD to call him once.

I guess when I first started doing storm restoration, I took a lot of business other people didn't want..ie claims that you had to fight for, after all I had the time and was willing to spend it in order to get the biz.

I'm not talking about claims that needed a few line items...I was working claims that 4-5 roofers had already worked and gave up on. So I was pretty much forced to learn how policys read and how to interpret the lingo...

You mentioned the adjuster approving the claim and the appraiser estimating the damage?? Do 2 ppl from the ins company go to look at the claim where you are?

Oh and thank you for reminding me to tell the HO not to cash the check..I called her right away last night after reading your post..but I was too late...
 

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http://www.adjustersinternational.com/ATpdf/3032_Overhead_and_Profit.pdf

Try the pdf link above with the adjuster giving you grief. It is long (8 pages) but I would simply hand it to them to read. Adjusting Today is their professional adjusting association trade magazine. So if Adjusting Today writes an 8 page document on why O&P should be paid, then the adjuster will be hard pressed not to honour it without appearing unprofessional and against the ruling of their own professional association.
That is not correct. Adjusters International is a large Public Adjusting firm with franchise offices all over the country. Adjusting Today is a trade magazine they put out for the promotion of the public adjusting industry, not the insurance industry. Although the information is useful and I tend to agree with most of their assessments since I am a PA, it will hold no weight with the carrier. O/P is a topic with many opinions and no clear answer. There is not enough bandwidth on this site to debate if and when it should be paid.

Insofar as your dilemma, document everything with good photos. If any of the work was necessary due to regulation or ordinance, provide the appropriate paperwork. Send the package to this gal's claim supervisor as well as the TPA (if one is involved), and the desk adjuster for the carrier. Write a nice, detailed, professional letter outlying your issues and your requests. If you get stonewalled, recommend the HO discuss the claim with a qualified PA. You are not violating any rules in my opinion by discussing claim specific work and what it will cost to do such. Do not get into any policy issues, etc and you will be fine.
 
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