The insured’s property sustained damage as a result of wind. As a result of missing shingles water penetrated the roof causing interior water damage. After the insured discovered the interior water damage he discovered the damage to his roof.
The insured reported the loss to his insurer and retained the services of a local roofing contractor to inspect the damage to his roof. The insurer retained the services of one of their preferred vendors to inspect the damage. The insured’s preferred vendor retained a local roofing contractor to inspect the roof. The insurer received a report from their vendor stating that the roof could not be matched and the roof required replacement. However, after two months post inspection the preferred vendors estimate did not consider a full roof replacement. Rather, the estimate only considered the replacement of two slopes along with the interior water damage. The insurer confirmed coverage and made an offer to conclude the claim which was based on their preferred vendors estimate.
The insured retained our services as he was not happy or impressed with the way his adjuster was handling his claim. After we announced our involvement the adjuster retained the services of an Engineer to reinspect the roof damage. The Engineer retained the services of another roofing contractor to inspect the roof. We made arrangements to attend the property with the insurer’s expert along with the policyholder’s chosen roofing contractor.
Initially, the insurer’s experts were not going to go onto the roof to inspect the damage. Rather, they began inspecting the roof from the eaves. When the insured’s expert arrived he quickly got on the roof and invited the insurer’s experts to join him. The insured’s expert gave the Engineer and roofer a tour of the roof and showed them the damage to the roof. After the inspection was complete we had a meeting with the policyholder in front of his home. During this meeting it was agreed by all that the insured’s home suffered wind damage and that the entire roof needed to be replaced.
A couple of days later we were informed the adjuster was retaining another expert to inspect the roof. After their fifth expert inspected the roof the insured denied coverage to the claim. We escalated the claim to a Manager. We discussed the claim with the Manager and raised issues such as Estoppel and Bad Faith. After a couple of rounds of negotiations the insurer agreed to pay the claim in full but for $519.00. We find it interesting that the insurer comes within 98% of the claimed amount but refused to acknowledge the amount claimed by their policyholder was not reasonable. The insured was able to recover over $25,000 as opposed to less than $6,000 as per the initial offer.
The way this claim was handled reminds me of the bad faith case of Whiten vs Pilot where the insured was awarded punitive damages. In the Whiten case the insurer went through a number of experts until they got the answer they were looking for so they could deny coverage to the claim based on the allegation of arson. In this case the insurer’s first 4 experts concluded that the loss or damage to the roof was caused by an insured peril, wind. The insurer’s job is to determine coverage and determine if the amounts claimed are reasonable.