Coral Gables Homeowner

The Insured's property was affected 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 received nothing.

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 $18,568.

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 parties concerned.

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 replacement.

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 business.

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. 


 


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