Right out of the gate I do want to say that I personally and professionally help people with this particular issue, But this article is simply to help you do it yourself from the beginning or help you try to get a denied claim overturned simply by being very good at documentation and having the proper resources to provide the insurance company.
Disclaimer: Due to licensing requirements, I will not be providing legal advice, you will need to speak with your attorney about anything like that. I will be providing the proper ammunition that you or your attorney need so that you can interpret / enforce your policy. I will show you what has worked for me as a homeowner on my own claim with my own policy as well as ways that I have helped hundreds of others see successful results.
Different types of claim challenges may require different approaches
You may have a situation where the insurance company says your policy wont cover the damages that you presented?
Maybe you have proof that wind or hail damaged your roof but the insurance company doesn’t have any verified weather data for the date range you submitted?
Perhaps the insurance company says your roof has minor damage or is repairable but you believe it is not?
Lastly, you may simply have a pricing disagreement with the insurance company.
Who is this article for?
- This is for anyone having trouble getting an initial claim approved or an older claim overturned in reference to damages to the roof.
- This would be fantastic for roofing companies, public adjusters or attorneys that assist clients with insurance claims on their roof.
Who is this article NOT for?
- People that aren’t involved in a property claim in reference to their roof.
- People that are having a great experience with their claims adjuster/company and there is no delay, underpayment or denial of claim.
My background where I learned these effective tactics.
I have held and led teams as an Insurance Agent, Insurance Adjuster, Insurance File Reviewer, Insurance Estimate Supplementer and Contractor since 2008, that’s like 200 years in contractor years). I worked for most of the largest insurance companies as an adjuster, handling thousands of insurance claim files each year.
It’s safe to say that I have seen the claims business from nearly every angle and have had the unique opportunity to gather a wide array of knowledge and tactics that have served me and mine quite well.
My intent is to pass this information to others to help them get a fair shake when it comes to their next insurance claim. Please do not use these tactics unless you are receiving poor service or feel you are not getting a fair settlement, they won’t be necessary.
The following tactics are not necessarily in order of effectiveness, they all have different use cases.
- The Squeaky Wheel- This is a tactic that’s been used universally for centuries. The plain truth is that insurance adjusters are busy and if you call or email them constantly, you can eventually break them down or get them to reassign your claim to another adjuster. This one is simple but not easy because you are busy too and don’t have time to sit on the phone all day either. Id say this one historically works the majority of the time to at minimum, get the claim reassigned Or potentially get the claim completely overturned and approved.
- Get your local agent involved- This approach has mixed effectiveness because some agents are more experienced or hands-on than others. This one seems to be especially effective if you as a client have a lot of policies with that agent, they do not want to see your business leave and they will be more likely to help you apply pressure on the claims department to get them to take care of you. You might say things to your agent like “ I have paid thousands and thousands of dollars over the years with you and your company and I have a lot of policies that have brought you guys a lot of money over the years, I need you to step up to the plate and go to bat for me and get this thing handle so that I don’t have to look for insurance elsewhere.”
- Get everyone involved- I’d say this is a best practice regardless of what the situation is with your claim. The approach is to make sure you include every possible party involved in the claim on every single email correspondence. This Is very helpful when you have one insurance representative telling you one thing and another representative telling you another this hold everybody accountable and keeps everything in front of everyone’s eyes. An example would be including all of the following parties on a question or comment about your claim, make sure to CC them in the email so that all parties know that everyone can see it. To: Claims adjuster, field adjuster, Insurance Agent.
- Notifying The APA– Everyone should sign up for a free consumer account with the APA this is short for the American policyholder association. This organization is in its infancy stage and needs a lot of participation with policyholders and contractors like to be involved so that they can begin to help regulators in force policy and proper claim handling from not only homeowners and contractors but specifically the insurance companies themselves. I you can file a formal complaint on their website and they will investigate for fraud if you believe that fraud is occurring in your claim handling situation. Sending a screenshot or copy of the formal complaint that you filed to the insurance adjuster and Agent can sometimes light a fire underneath them to get things right and get your claim handled quickly. If you can out document the insurance company, many times you win by default.
- The department of insurance for your state– Googling the department of insurance for your state and then filing a formal complaint on their site can definitely ruffle some feathers, but it can also result in a fair claims payment situation for you. Make sure when you file the complaint that you list every adjuster by name, their contact info and if you have their license info put that in there as well. You will need to include time and date information of any delays or any times you contacted them or they contacted you and you will need to be very specific on what you feel they have done wrong. You can find their license number by looking up on the national producers registry online. Once the complaint is filed make sure to again copy the agent, all adjusters and inspectors involved on the email letting them know that you filed a complaint and you want this handled ASAP.
- Social Reviews-This particular approach can be effective at getting a call from a manager pretty quickly. Keep in mind that you want to be very accurate and specific with your review on any Facebook, Instagram, Twitter, Google rating system for the insurance company. Do you want to make sure it is not emotional, but it is very factual because it could be legally held against you if you included anything that was not based on fact. Typically when you provide a one star review and a lengthy explanation of what exactly happened in the insurance company was not taken care of you on, corporate will escalate that complaint to a manager to quickly call you or reach out to you online because they do not want those negative reviews posted. You may be able to work out a deal where they settle your claim and you take the review down.
- Hire your own consultant to investigate and report- Many times during catastrophic events like hail or wind storms, insurance companies send out very inexperienced adjusters due to the sheer magnitude of the claim volume that they have. This results in your initial claim being underpaid or denied improperly. This is a situation where you can reach out to a local building consultant, certified roof inspector or Forensic Engineer, or extremely knowledgeable roofing company that handles a lot of insurance related work. You would ask this entity to thoroughly investigate the damages and provide a very detailed photo and written report on their findings and recommendations. Send this to all parties involved in the claim in an email and ask them to reconsider their position, approve the claim or send out a different inspector for another look at the property. If you can get an engineer to confirm functional damage due to a storm on paper, this is extremely strong to present to the insurance company before they hire their own forensic engineer.
- Unfair Claims Settlement Guidelines- Most states have their own unfair claims settlement guidelines or laws that protect the policyholder from unfair claim handling practices. Google and review your states guidelines to see if there are any clear examples that your claim has not been handled fairly. Highlighting this info with specific instances in emails to multiple parties can many times result in a quick settlement for you.
- Appraisal- Appraisal is a very little talked about approach that nearly every property owner has access to. The appraisal process is used not when you’re being fully denied, typically it is used when you have a pricing disagreement between you and the insurance company or your contractor and the insurance company to do the job properly, according to building code and manufacturer specifications. So if you are having a pricing disagreement with your insurance company I would recommend finding a property claims appraiser in your area and speaking to them about your options. There typically is an upfront fee for an appraiser and a final fee that is based on the additional amount of money that they get you. Generally speaking, even though there are fees involved, you the client still come out in a better position than you would by not hiring them.
- Hiring a Public Adjuster- In the event that you have a coverage disagreement with your insurance company, hiring a public adjuster might be something you want to look into. A public adjuster works for you directly as the property owner not for the insurance company they are kind of like an attorney but not quite. Yes there are fees very similar to the appraisal fees but if the public adjuster wins, you typically have additional funds in order to pay the PA.
- Hiring an attorney- If a public adjuster is unable to get the coverage enforced for you, hiring a property claim attorney maybe the way that you have to go. Finding these attorneys that specialize in insurance claims for property damage can be challenging it’s a very specialized field. The fees are like appraisal or public adjuster fees but generally the attorney gets you a substantial amount of more money and the fees are taken care of in that way. Keep in mind that when you hire an Attorney, generally the claims process will be delayed by months but it will be your best shot at getting the insurance company to turn it around if you have no other choice.
- Hiring a material verification company- Sometimes the insurance company does not know or cannot confirm if your current building materials (shingles, siding) are recalled or discontinued which affects their decision. There are companies that verify material make and model as well as availability for replacement. Ordering and sending the report to your insurance company can be extremely affordable and effective if your building materials are defective or non repairable.
- Manufacturer and Distributor representatives– Reaching out to the shingle manufacturers or distributors and requesting technical bulletins on what is considered, damaged, repairable, availble, recalled, etc and forwarding to the claims department is great for 3rd party verification of facts to support your claim.
- Building code enforcement– Speaking to your local code enforcement officer and asking them to sign off on a repair document where you are deliberately going against a building code guideline due to the insurance company instructing you to can be a seriously strong approach. They will usually be happy to write back in reply to an email stating that you cannot perform the repair or replacement in the way suggested by the insurance company without violating building code. Provide this to the claims department and you should see some positive movement.
- Line of sight state laws– Many states have Line of Sight laws stating that do not allow homes to be repaired if the material used does not match in profile or color. This documentation provided to your claims adjuster should require them to reconsider a repair and more than likely allow a full replacement. This does require 2 things, that you live in a state that has a line of sight law and you must have the additional coverage on your policy to claim this.
- HOA Ordinance- This is almost the exact same situation as items 13-15, the HOA has ordinances in many cases that require homeowners to replace roofs and not repair them due to the unsightly look of a repair in the neighborhood. If you can have the president of the HOA write a letter and provide the ordinances where repairs are clearly not allowed, provide this to the claims adjuster. If you have the additional ordinance and law coverage, it could be approved for full replacement instead of a repair.
- Have a real estate broker review- If there is a dispute on the storm damages to the roof being functional or cosmetic, one great approach is to have a real estate broker write a letter explaining that if there were 2 houses for sale identical to yours and one had a new roof and the other had yours with the visible storm damage, which would sell easier or faster? If the answer is the one with a new roof, this shows clear loss of value to your home. I’ve seen this be successful several times.
Referrals for you
I am not being paid for these, I just know they are quality companies or people to work with. Many of these parties are licensed in many states so feel free to reach out to them.
The APA– https://apassociation.org/join-the-apa/ sign up, it’s free and this is a website where you can file complaints against insurance adjusters or companies if you believe fraud is taking place.
Building consultants
PCG – 615-802-7020 https://www.consultpcg.com
IFS – 402-682-8755
https://www.secureclaimpayments.com/consulting/building-damage-consulting.php
Roofing Material Identification and availability experts
John Senac – NTS 812-650-2424 info@ntsid.com
Appraisers
Nick Spost – 888-908-5759 nick@allianceconstructionservices.com
Steve Patrick – 800-878-1427 steve@lplossconsulting.com
Forensic Engineer
Apec Engineering- 512-989-9805 https://www.apec-llc.com/
Todd Stern – 214-883-5116 todd@tsa.group
Public Adjusters
Jack Hanks- 800-466-8231 info@vpa.claims
TJ Ware- 800-419-3994 TJ@ParadiseClaims.com
Attorneys
Chad T. Wilson – 832-415-1432 https://cwilsonlaw.com
Evan Wolfe – 855-MR-WOLFE evanwolfelaw@gmail.com
My hope is that your claims experience is good and smooth but if it’s not, hopefully this guide will help you in some way.
Mikel Miller, Co-Owner.