| Q&A of the Week |
Wind Damage to Roof
A Maryland subscriber recently asked the following question:
I have a homeowners claim in Maryland with an HO 03 10 00 policy.
The risk sustained wind damage to the roof, fascia, soffits, and gutters on April 2, 2016, and a claim was filed April 17. Prior to my involvement the insured's contractor met the independent adjuster for the inspection. The adjuster allowed for replacement of the back slope of the roof and some damaged soffits, fascia, and gutters.
The contractor and homeowner thought the entire roof should have been covered due to damage. The contractor advised me that he pointed out wind damage to the front slope of the structure and the adjuster told him that wind could not simultaneously damage both front and back slopes of a structure.
My initial inspection showed wind damage on the front slope and a failure of a brittle test that would show whether a roof was reparable.
After submitting my supplemental estimate the independent adjuster contacted me to schedule a re-inspection. He stated that he had photos of the front slope and that it did not have damage at the time of the initial inspection. He also agreed that the roof was not reparable.
At the re-inspection on September 20, 2016, I showed the adjuster additional damage on the front slope. He stated that it was "prejudiced" against the insurance company because it had been too long since the initial inspection and that the policyholder would have to file an additional claim. I asked him for the photos showing the shingles in question had not been damaged. He said it was ridiculous for me to ask that question and that I should show him photos proving when all of the damage occurred on the roof.
My first question regarding this claim: if he has no photographic evidence from his first inspection showing whether or not the damage had occurred, wouldn't that kill any argument he has that the damage occurred after the initial inspection? Isn't it the policyholder's burden to prove a loss occurred, but the insurer's burden to show why the loss is not covered under the policy?
There was also damage to both the metal soffits and the wooden soffits to which the metal soffits had been attached. I advised him that both the metal and wooden soffits should be covered. He stated that only one or the other should be covered because the wood soffits are an "abandoned surface." There is no mention of abandoned surfaces in the policy. It is my understanding that it was a term that someone made up and has no legal or policy basis whatsoever.
My second question: is there any basis for an insurer to deny payment due to the concept of an "abandoned surface"?
ANSWER: Wind gusts can easily occur in both directions on the same day, even within the same storm. The National Weather Service can confirm wind speeds and direction if necessary. You are correct in that the carrier must prove its reason for denial, so it is on the carrier to prove that there was no damage to the front, especially since the contractor pointed it out.
We found no reference to "abandoned surface" in an internet or Westlaw search other than that which applies to mining and underground or surface mines. This has no use as far as roof is concerned, so the adjuster needs to explain the term and show where it is being used in the industry. Read More |
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| Litigation Watch |
Consent Judgment
Following a settlement by the bar and the administrator of an auto passenger's estate of a wrongful death action, the estate filed a petition against the insurer of the bar. This case is Auto-Owners Insurance Company v. J.C.K.C., 2004 WL 2244484.
In 1994, Horton and Supple were patrons of J.C.K.C., dba K.C.'s Lakes Lounge. The two consumed an unknown amount of alcohol and they eventually became intoxicated. The employees of the bar placed Horton in the back of Supple's vehicle and allowed Supple to drive from the premises. Supple lost control of the car and collided with trees, resulting in Horton's death. Read More
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| Fraud of the Week |
Contractor Fraud – Florida
AMOUNT: $7,760
A woman in Florida was affected by contractor fraud when a roofing contractor took over her insurance claim, collected nearly $8,000 in claim money, and disappeared without beginning work on the roof. Read More
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