An adjuster starts to close the file on a roofing claim. The adjuster had worked closely with the roofing contractor and saw the claim through to its resolution, with the contractor getting paid in full. Then the adjuster receives an invoice with a supplement, from a company in another state. Upon calling the insured, they had no awareness of this company. Today Steven Badger from Zelle LLP will address these and other topics as we continue our discussion on "hot topics" in hail claims.
Notable Timestamps
[00:01] - Some in the industry describe the "reclaim game" as when an insured gets paid on a prior roof claim, never fixes the roof, then years later submits a new claim for the same unresolved damage.
[02:52] - On every new claim, adjusters can ask if the insured has ever filed a prior claim for the same damage, as opposed to relying solely on industry claim-history reports.
[03:45] - Early investigation often includes reviewing historical aerial and street-view imagery plus a low-cost hail history report to understand the roof's actual damage timeline.
[05:32] - Establishing coverage for business or goodwill reasons can open the door for supplementation.
[06:29] - Permit records, especially for commercial roofs, can confirm whether a claimed roof replacement really occurred and reveal the value and scope of prior work.
[07:35] - Is a supplement being submitted by the contractor who actually did the work or by a third-party supplement firm?
[13:08] - When contractors waive or absorb deductibles, insurers can request proof the deductible was paid.
[14:48] - Contractors who take over the claim process without a public adjuster license may be committing the unauthorized practice of public adjusting in certain circumstances.
[17:19] - Even in contentious claims, both sides can resolve disputes fairly and professionally.
Your PLRB Resources
Steve Badger's LinkedIn
https://www.linkedin.com/in/steven-badger-467b0322/
Recorded Webinar: Resolving High Estimates and Post Work Supplementals
https://members.plrb.org/education/courses/resolving-high-estimates-and-post-work-supplementals
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
Subscribe to this Podcast
Your Podcast App - Please subscribe and rate us on your favorite podcast app
YouTube - Please like and subscribe at @plrb
LinkedIN - Please follow at "Property and Liability Resource Bureau"
Send us your Scenario!
Please reach out to us at 630-509-8704 with your scenario! This could be your "adjuster story" sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: "Piece of Future" by Keyframe_Audio. Pixabay. Pixabay License.
Font: Metropolis by Chris Simpson. SIL OFL 1.1.
Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription).
Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
