Coral Gables Homeowner
The Insured's property was
by 2 hurricanes – Katrina & Wilma. The original loss from
Katrina 8/05 was initially assessed by the insurance carrier to be
approximately $11,000. Since the amount was under his deductible he
The carrier was then called out to
assess his property after sustaining damage from Wilma 10/05. The
company claimed the damage was approximately $23,500 and after applying
his deductible submitted a check to the insured in the amount of
At this point the homeowner and
carrier agreed to the appraisal provision of the policy. See Appraisal 101 for more info
on initiating this portion of a policy and what it means for all
We believe the carrier used what
we term an “outcome oriented" engineer to assess the roof1.
The insurance company's engineer assessed the roofing damages at just
under 25% of the cost to replace the entire roof2.
The engineer report the carrier obtained, allowed the carrier to cite
policy language relinquishing them of any payment obligation with
respect to the roof by intentionally undervaluing the percentile of
damages the roof actually sustained. We prevailed on this portion of
the claim by providing detailed documentation including a report by a
roofing contractor that performed a “drop hammer” test3.
It was proven that the “field tiles” were loose and warranted
After receiving our estimate of
the damages the carrier was “shocked” and engaged an attorney to stop
the appraisal process, which they had originally agreed to, from going
forward after months of wrangling. The carrier’s attorney issued a
letter inferring fraud and misrepresentations and stated that the claim
was being referred to their SIU (Special Investigations Unit). This is
a common threat and carefully crafted delay tactic. Carriers routinely
use this to scare and intimidate policy holders as well as
intentionally delay the progress of a claim. The insured engaged a
defense attorney to go to court and file the necessary papers required
for the appraisal process to continue. On January 22, 2007 when one of
three post-appraisal hearing “offers” was made to us by the carrier’s
appraiser we refused it. A total of three offers were made – 1/22/07,
2/8/07 and 3/15/07. The final offer was $196,890.72, quite a bit more
than the original $23,568.30.
Ultimately the claim went to the
appraisal and in a final hearing an award was issued by the Umpire, on
April 20 2007.
1.Outcome oriented vendor/engineer – One
who would write a favorable report as a continuing thank you for repeat
2. Miami Dade County requires a full
replacement of all roofing if the damages exceed 25%.
3. Drop-hammer test - determines how much
pull or lift has been applied to a roof system.