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This section provides real world examples of various insurance claims that we have resolved. Each claim has a brief summary and includes attachment of relevant documents and pictures.

OKLAHOMA CITY CLAIM

This claim was for a rental property in Oklahoma City. The house had been placed on the market, resulting in the real estate agent observing multiple water leak stains and signs of exterior wind damage. The tenants had chosen not to inform the owners (stationed in Colorado Springs) of damage out of concern that repairs would disrupt their lives.

A claim was immediately filed with USAA, EagleView satellite pictometry was used to calculate dimensions, and images provided from the real estate agent facilitated drafting a scope of repair without performing an on-site inspection. The assigned adjuster conducted an inspection within days and approved a significant amount of repairs.

Record flooding and damaging storms in the area had overwhelmed the schedule of known contractors and the “roofing” contractor recommended by the real estate agent was quickly discovered to be a gutter installer looking to make a referral fee. En route to Oklahoma City, the project manager placed a material order for delivery the following day and coordinated with a crew licensed and operating in Oklahoma City. A Texas based gutter company was then willing to travel to Oklahoma in order to complete gutter replacement. The entire project, including extensive tropical storm delays and mortgage company inspection, took a total of 2 weeks to complete with the house selling less than one week after repair completion.

The original insurance claim, contractor estimate (sans pictures due to large size), and final insurance documentation are attached for review. This demonstrates that an adjuster’s estimate is nearly a starting point. The assigned adjuster is known to be thorough in his work; however, this claim had an original insurance estimate of $38,177.91 and a final settlement amount of $52,186.27 following supplemental actions.

PRIVATE SCHOOL SYSTEM

The client’s initial estimate for repairing five (5) school buildings was less than $68k. Two buildings had been denied coverage and upon the carrier receiving our detailed report, an independent adjuster was requested to inspect the property with our assistance. Final resolution of the claim resulted in payment of $147,902.17 in addition to upgrades purchased by the client. The client’s prior contractor was terminated due to unsafe practices and oddly enough, they had simply agreed to perform the repairs without confirming the accuracy of the insurance estimate or even observing that two buildings had been omitted from the insurance scope of damages. Our project manager obtained payment representing a near 118% increase over the original claim amount and incurred no unforeseen  hardship. In fact, once errors or supplemental amounts were presented to the carrier, all requested changes were made without need for discussion.

Eight crews completed the roof replacements and other major repairs over the course of a weekend, thereby preventing interruption of classes and avoiding the presence of small children. In an effort to protect the financial interests of the client, final contractor estimates and invoicing containing additional charges have been redacted. The identities of all clients and former contracting partners have been redacted regardless of authorized use. Due to the cumbersome process of redacting large PDF files, the contractor estimate for one location is provided. The scope of repair presented by the contractor and adjuster were ultimately identical upon final revision.

WOOD SHAKE / COMPOSITE SLATE CLAIM

The following claim replaced heavy 3/4″ wood shakes with Cambridge Slate Bellaforté by DaVinci. Wood shakes are highly flammable and the increased cost of composite material is offset by significant reductions in insurance premiums. Contact your insurance agent to determine what discounts are available for various roofing materials. Further, many municipalities have enacted codes forbidding installation of wood shakes and require alternative material. Upgrade costs are greatly minimized when a contractor is able to maximize your claim by merely ensuring proper compensation for losses. The initial insurance estimate for this claim was $83,346.33 and final settlement following our services was $122,668.28. This is a 47% increase from what insurance had initially estimated and such increases are extremely common.

IMPROPER DENIAL OF CLAIM

We were requested to review the claim of a family friend due to the possibility of improper denial. The policyholder had requested an adjuster inspection following a catastrophic storm; however, her inspection resulted in  a letter from her insurance carrier demanding replacement of her roof at her own expense or have her policy terminated. Further, the letter states that they “will consider continuing the coverage on” her policy after the conditions are corrected. It should be noted that this was only the second time she has filed a claim in over 20 years with the same insurance provider. We agreed to pursue the matter and upon reviewing the elderly client’s information and property damage, we volunteered to pay for the roof replacement if unable to prevail against her carrier.

We created a detailed CAD report containing photographic evidence and communicated with known adjusters of that carrier regarding the matter. A second adjuster was assigned to meet with us in order to perform a re-inspection, at which time all damages were properly covered. An insurance estimate was immediately produced by the adjuster in addition to furnishing the first check so that repairs could be initiated. The roof was replaced without issue and the matter was resolved with underwriting.

ENGINEERING FIRM REFUTES DENIED CLAIM

A rental property claim of a prominent local attorney was denied while two of his other properties with less damage were approved by the same adjuster.

ORGANIC 3-TAB SHINGLES

This claim is also worth discussing due to involving “organic 3-tab” shingles. This material was marketed as a “green” roofing solution and gained popularity among builders. Designated as a “heavy weight” shingle and lacking the industry standard fiberglass reinforcing mat, they generally last 10 years if you’re lucky whereas they dry out and start to curl due to the absence of reinforcement. The production/use of organic asphalt shingles is virtually non-existent and insurance carriers paid higher “heavy weight” prices before reclassifying them as general 3-tab shingles in 2013. People paid a premium for this item which has been eliminated by the simple expedient of deleting the item from insurance estimating software. Most people with organic shingles needed their failing roof replaced anyway so pricing differences are seldom a topic of discussion.

Older organic shingles are generally not replaceable due to their brittle nature. Lifting one in an attempt to replace a lower shingle will usually result in the shingle breaking and almost never properly sealing if successful replacement is accomplished. Attempts to replace older organic shingles present the significant risk of jeopardizing the integrity of the entire roofing system. Most carriers approve full roof replacement upon indication that a single organic shingle has been damaged. (This is no exaggeration.) A similar scenario is presented with “T-Lock” shingles common to Colorado Springs. In both cases, they are no longer manufactured and obtaining a matching replacement is all but impossible even if there was a willingness to attempt repair.

UNFEASIBLE EXPECTATIONS OF THE ADJUSTER

This claim consists of an extremely small 9 square (900 sq.ft.) roof which had more hail impacts than almost any roof in the region. However, there is a caveat to inspecting organic shingles and identifying hail impacts which played a role in the previously discussed claim denial as well. Due to being dry, brittle and quite thick, a hail impact generally causes surface granules to flake off rather than evidencing the typical bruising. The loss of granules alone looks more like blistering as opposed to storm damage, for which a claim will be denied. Seasoned adjusters will rarely argue an organic claim, but rookie adjusters can be hard to convince. The only sign of impact is usually missing granules and not a single claim has failed following proper explanation. Simply educating the uninformed can be extremely beneficial to successful resolution.

The multitude of hail impacts were readily apparent on this roof and we submitted our findings to the adjuster. The adjuster then contested our professional opinion and declared that replacement shingles could be purchased from a company that buys used shingles from homeowners. Thus, the adjuster wanted the contractor to purchase 10-15 year old organic shingles (that were purchased after sitting that long in someone’s garage) in order to attempt a futile repair. Facts were presented that reduced his idea to nothing more than a terrible and uniformed idea, so he hired an out-of-state engineering firm to travel to the property location for inspection. The engineer quipped that he saw enough damage from the ground to warrant replacement of the entire roof and marking all the impacts with chalk resulted in him running out of chalk. The claim was approved for full roof replacement and it should be observed that the adjuster spent more money hiring an engineer to travel from South Dakota than it would have cost to just approve the claim. Several adjusters told him that prior to him pursuing his ridiculous quest of personal vindication. The Bar licensed property owner understood that we are the experts he would rely upon if litigating the claim, so full control was given to resolve the issue without need for legal proceedings. There is no explanation as to why the claim was vehemently challenged by a field manager as you’ll see from the following pictures. The contractor estimate we submitted contained 125 images which are omitted from the below attachment due to size limitations.

FAST RESULTS

Communication with an adjuster and effective estimating practices by a knowledgeable contractor can have a substantial impact when resolving differences. The following claim occurred in a rural area and the payment doubled from $13,278.71 to $27,276.10 without any effort on part of the homeowner. The interests of our clients will always be our first priority and we work to ensure fair compensation for your loss. Whether you choose to keep the cash value of nonessential repairs or desire completion of all repairs, we will not deviate from our commitment to you.

ASBESTOS ABATEMENT

Some claims are heavily dependent upon subcontractor bids for which insurance estimating software cannot be utilized. The following claim is one such example wherein asbestos abatement and extensive plaster repairs involving lead paint were indicated. Upon the contractor submitting documents for deviation from the original estimate, the insurance carrier simply replaced its pricing columns with the contractor’s name and issued a check for the requested amount.

AMBIGUOUS CLAIM

Sometimes a claim settlement is simply beyond understanding and this is why it’s beneficial to have a contractor present during your adjuster inspection. One client merely received an initial check the day of her inspection, followed by a single sheet of paper with a settlement amount that “should” cover repair of any damages. There was no estimate or identification of damaged items, so we generated a detailed CAD report with  attachment of 114 evidentiary images. A month later, a second adjuster met with us for re-inspection and nobody understood what exactly had occurred with the previous adjuster.

This indiscriminate disbursement of money was not in favor of the client either. A total of $8,725.21 was paid, $4,278.56 declared as recoverable depreciation, and a new ambiguous “settlement amount” of $3,858.51 that should have already been released. Recovering depreciation would prove challenging because it’s unknown what was even depreciated. The claim was ultimately settled for $30,070.73 and demonstrates the necessity of securing the services of a contractor experienced in claim resolution.

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