Adjusters should be soundly qualified to recognize the various ways that hail / wind and moisture can damage construction material, and other property.
Poorly trained adjusters, dishonest adjusters who minimize/ignore damage, or adjusters who fake their way through a damage assessment, cheat property owners of service, and indemnification dollars, they deserve.
One on-going claim estimation scam scheme, that affects both homeowners and contractors, is when certain insurers / their adjusters say something like;
\”We don\’t allow [builder-primary-general] contractor business overhead and profit mark-up to be applied towards roofing, carpeting and fencing replacement costs, in Texas.\”
What insurers in Texas have made that illegal / unfair claim?
Allstate / Pilot Claim Service, Farmers, USAA, State Farm, Safeco and the Texas Windstorm Insurance Association (TWIA) have.
What does the Texas Department of Insurance (TDI) say about that kind of deceptive construction estimation / claim settlement conduct?
__________
From TDI Bulletin B-0045-98;
\”– Indemnity is the basis and foundation of insurance coverage.
The objective is that the insured should neither reap economic gain nor incur a loss if adequately insured.
This objective requires that the insured receive a payment EQUAL TO that of the covered loss so that the insured will be restored to the same position after the loss as before the loss.
The calculation of this payment results in UNDER-compensation if an insurer deducts prospective contractors’ overhead and profit and sales tax in determining the actual cash value under a replacement cost policy.
Conversely, the inclusion of contractor´s overhead and profit and sales tax on building materials does not over-compensate an insured for the amount of the loss BECAUSE THESE ITEMS REPRESENT PART OF THE INSURED\’S LOSS.
Generally, the objectives of indemnity will be met if actual cash value is calculated as replacement cost with proper deduction for depreciation.
In the rare situation that defies calculation of actual value on this basis, such as cases in which the structure has historical significance or the materials cannot reasonably be replaced, other factors may be considered.
However, there is NO SITUATION in which the deduction from replacement cost of depreciation and contractor´s overhead and profit and/or sales tax on materials will be the correct measure of the insured´s loss.
–Premiums charged must not be excessive for the risks to which they apply.
Under a replacement cost policy, the liability limits of the policy and the premium paid by the insured are determined on the basis of the replacement cost of the structure.
The value of contractor´s overhead and profit, as well as sales tax on building materials, has been included in the limit of liability for which the insured has paid premium.
If the insurer in determining actual cash value EXCLUDES costs that are included in the determination of liability limits, ON WHICH THE INSURED\’S PREMIUM IS BASED, the insurer reaps an ILLEGAL windfall because the insurer receives premium on insurable values for which loss may never be paid.\”
Consumers / Contractors…don\’t fall for the following insurers / adjusters indemnification doublespeak;
1. \’Two or more specialty contractor trade work is needed before [builder-general-primary] contractor involvement, and their business overhead and profit costs is \”allowed\” \’.
2. \’Structural damage must occur before [builder-general-primary] contractor involvement and their business overhead and profit costs is \”allowed\”\’.
3. \’The amount of work doesn\’t \”require\” a [builder-general-primary] contractor\’.
4. \’A home owner / business owner can act as their own contractor\’.
5. \’We can get a contractor to do it for \”our\” prices\’.
6. \’Our claims manager won\’t allow the price to be higher\’.
7. \’We don\’t have to make the damaged (roof, siding, painting, flooring, etc.) look whole again\’.
8. \’Wind pushing a door inward, breaching the weathering strip seal, and allowing rain into a structure, is not a wind created opening\’.
9. \’Abrasive [hail / wind debris] action causing granular loss is not damage to shingles\’. (Manufacturers disagree).#
10. \’Wind broken / debris contaminated tar sealant bonds on fiberglass shingles is not damage to the shingles\’.#
11. \’Hail damage dents to metal roofs is not damage to metal roofs\’.
12. \’Hail damage dents to metal garage doors is not damage to garage doors\’.
13.\’Why would I underpay a claim, the more damage there is, the more I get paid\’. (Actually, job security is job #1).
Be on your toes, and report suspect fraudulent insurers / adjusters conduct to law enforcement agencies, city / county / state & federal officials, and regulatory agencies.
Don\’t follow the crowd and tire out, or walk away in disgust, or allow yourself to be bullied, before you receive service and dollars you were promised, paid for, and deserve.
Remember, insurance companies expect you to pay them every month, soooo, expect the same dedication from them when it\’s time for them to pay you…with ZERO tolerance for fraudulent claim settlement conduct.
The process of detecting and evaluating damage from hurricane exposure is subjective at best, and often everyone involved may offer a different assessment.
Damage can range from wind uplift, shingle loss, broken sealant bonds, granule loss, external sources, and may not be readily apparent. However, even small amounts of damage can harm the surfacing material, leading to deterioration of the shingles months or years later.
GRANULE LOSS
Regarding damage to the embedded granule surfacing in the asphalt top coating, hurricane wind exposure can result in varying degrees of granule loss. Hurricane wind exposure loosens the granules, potentially allowing the granules to separate from the coating layer and wash off the roof.
Without the granule surfacing, the asphalt top coating is exposed to ultraviolet radiation from ordinary sunlight and will eventually deteriorate, exposing the fiberglass substrate and creating a leak potential. If a shingle indicates outward damage, the underlying components may be compromised and affected to some degree.
The extent of granule loss resulting from hurricane exposure is influenced by, but not limited to, the following:
1. Age of the product.
2. Force and duration of winds and wind driven rain.
3. Type and amount of wind driven debris.
4. Orientation and slope of the deck in relation to winds.
5. Amount of foot traffic.
BROKEN SEALANT BONDS
When sealant bonds are broken due to hurricane winds, it is possible, but not likely, for shingles to reseal. The subsequent strength of resealing, if any, would not be as strong as the initial thermal bond and would be contingent on, but not limited to, the following:
1. Age of the product.
2. Time of year and amount of exposure to ambient temperatures.
3. Length of time before shingles are exposed to subsequent high wind events.
4. Orientation and slope of deck.
5. Stress and strain on the shingles due to exposure to sustained high winds and/or deck movement.
6. Number, placement, type, and length of fasteners.
7. Contamination to the sealant bonds by dirt, debris, or other foreign substance.
8. Condition of the underlying deck or underlying shingles if a roof over.
In accordance with the terms of the limited warranty, there is no coverage for damage caused by hurricanes. Shingles in hurricane areas will continue to carry the limited warranty for manufacturing defects and remaining limited wind warranty. Any damage relating to conditions caused by a hurricane, including granule loss, breach of the seals, nail tears and other structural damage, will not be covered by the limited warranty or limited wind warranty at any time.
Your comments are becoming very irritating, and your \”Cut and paste\” journalism is getting a little tedious, and do not add value to the topic that is being discussed. Thank you for wasting 5 minutes out of my busy life…please send a $40 check to my inbox…just slide it underneath the tombstone…
Certain insurers and adjusters prey on and victimize their own trusting clients, and are being exposed by their very own conduct in Texas, and nationwide.
Now why would anyone be irritated by those issues being exposed?
Why would anyone be irritated with support information that can help the general public, including themselves and their neighbors?
Sounds like a \’Tell-Tale heart\’ needs some attention…
We have updated our privacy policy to be more clear and meet the new requirements of the GDPR. By continuing to use our site, you accept our revised Privacy Policy.
As an agent in New Braunfels, I have to say I\’ve never seen anything like that hail in San Marcos before. It was amazing.
4-26-2006
Consumers / Contractors;
Be aware of underhanded claim settlement schemes practiced by certain insurers, and adjusters.
Be aware of all hail damage your property may have sustained.
SMALL-LARGE HARD HAIL DAMAGE AFFECTS;
1. Wood, Metal, Tile, Tar&Gravel, Modified Bitumen, Fiberglass Shingle, Poly Foam, Etc. Roofing Systems.
2. Roof decking / plywood.
3. Attic ventilation systems.
4. Fascia boards.
5. Rain guttering systems.
6. Vinyl, wood, stucco, brick siding.
7. Painted surfaces.
8. Windows, window frames.
9. Pool cage / porch screenage.
10. Entry doors.
11. Garage doors.
12. Wood, vinyl, metal fencing.
13. Exterior lighting.
14. Play stations.
15. Patio coverings.
16. Landscaping.
17. Out-buildings / sheds.
18. Boats / recreational crafts.
19. Pets, livestock.
20. Miscellaneous property.
Adjusters should be soundly qualified to recognize the various ways that hail / wind and moisture can damage construction material, and other property.
Poorly trained adjusters, dishonest adjusters who minimize/ignore damage, or adjusters who fake their way through a damage assessment, cheat property owners of service, and indemnification dollars, they deserve.
One on-going claim estimation scam scheme, that affects both homeowners and contractors, is when certain insurers / their adjusters say something like;
\”We don\’t allow [builder-primary-general] contractor business overhead and profit mark-up to be applied towards roofing, carpeting and fencing replacement costs, in Texas.\”
What insurers in Texas have made that illegal / unfair claim?
Allstate / Pilot Claim Service, Farmers, USAA, State Farm, Safeco and the Texas Windstorm Insurance Association (TWIA) have.
What does the Texas Department of Insurance (TDI) say about that kind of deceptive construction estimation / claim settlement conduct?
__________
From TDI Bulletin B-0045-98;
\”– Indemnity is the basis and foundation of insurance coverage.
The objective is that the insured should neither reap economic gain nor incur a loss if adequately insured.
This objective requires that the insured receive a payment EQUAL TO that of the covered loss so that the insured will be restored to the same position after the loss as before the loss.
The calculation of this payment results in UNDER-compensation if an insurer deducts prospective contractors’ overhead and profit and sales tax in determining the actual cash value under a replacement cost policy.
Conversely, the inclusion of contractor´s overhead and profit and sales tax on building materials does not over-compensate an insured for the amount of the loss BECAUSE THESE ITEMS REPRESENT PART OF THE INSURED\’S LOSS.
Generally, the objectives of indemnity will be met if actual cash value is calculated as replacement cost with proper deduction for depreciation.
In the rare situation that defies calculation of actual value on this basis, such as cases in which the structure has historical significance or the materials cannot reasonably be replaced, other factors may be considered.
However, there is NO SITUATION in which the deduction from replacement cost of depreciation and contractor´s overhead and profit and/or sales tax on materials will be the correct measure of the insured´s loss.
–Premiums charged must not be excessive for the risks to which they apply.
Under a replacement cost policy, the liability limits of the policy and the premium paid by the insured are determined on the basis of the replacement cost of the structure.
The value of contractor´s overhead and profit, as well as sales tax on building materials, has been included in the limit of liability for which the insured has paid premium.
If the insurer in determining actual cash value EXCLUDES costs that are included in the determination of liability limits, ON WHICH THE INSURED\’S PREMIUM IS BASED, the insurer reaps an ILLEGAL windfall because the insurer receives premium on insurable values for which loss may never be paid.\”
http://www.tdi.state.tx.us/bulletins/b-0045-8.html
__________
Consumers / Contractors…don\’t fall for the following insurers / adjusters indemnification doublespeak;
1. \’Two or more specialty contractor trade work is needed before [builder-general-primary] contractor involvement, and their business overhead and profit costs is \”allowed\” \’.
2. \’Structural damage must occur before [builder-general-primary] contractor involvement and their business overhead and profit costs is \”allowed\”\’.
3. \’The amount of work doesn\’t \”require\” a [builder-general-primary] contractor\’.
4. \’A home owner / business owner can act as their own contractor\’.
5. \’We can get a contractor to do it for \”our\” prices\’.
6. \’Our claims manager won\’t allow the price to be higher\’.
7. \’We don\’t have to make the damaged (roof, siding, painting, flooring, etc.) look whole again\’.
8. \’Wind pushing a door inward, breaching the weathering strip seal, and allowing rain into a structure, is not a wind created opening\’.
9. \’Abrasive [hail / wind debris] action causing granular loss is not damage to shingles\’. (Manufacturers disagree).#
10. \’Wind broken / debris contaminated tar sealant bonds on fiberglass shingles is not damage to the shingles\’.#
11. \’Hail damage dents to metal roofs is not damage to metal roofs\’.
12. \’Hail damage dents to metal garage doors is not damage to garage doors\’.
13.\’Why would I underpay a claim, the more damage there is, the more I get paid\’. (Actually, job security is job #1).
Be on your toes, and report suspect fraudulent insurers / adjusters conduct to law enforcement agencies, city / county / state & federal officials, and regulatory agencies.
Don\’t follow the crowd and tire out, or walk away in disgust, or allow yourself to be bullied, before you receive service and dollars you were promised, paid for, and deserve.
Remember, insurance companies expect you to pay them every month, soooo, expect the same dedication from them when it\’s time for them to pay you…with ZERO tolerance for fraudulent claim settlement conduct.
Fear-of-loss affects insurers too…
rogerpoegc@yahoo.com
__________
# TECHNICAL BULLETIN – HURRICANE EXPOSURE
The process of detecting and evaluating damage from hurricane exposure is subjective at best, and often everyone involved may offer a different assessment.
Damage can range from wind uplift, shingle loss, broken sealant bonds, granule loss, external sources, and may not be readily apparent. However, even small amounts of damage can harm the surfacing material, leading to deterioration of the shingles months or years later.
GRANULE LOSS
Regarding damage to the embedded granule surfacing in the asphalt top coating, hurricane wind exposure can result in varying degrees of granule loss. Hurricane wind exposure loosens the granules, potentially allowing the granules to separate from the coating layer and wash off the roof.
Without the granule surfacing, the asphalt top coating is exposed to ultraviolet radiation from ordinary sunlight and will eventually deteriorate, exposing the fiberglass substrate and creating a leak potential. If a shingle indicates outward damage, the underlying components may be compromised and affected to some degree.
The extent of granule loss resulting from hurricane exposure is influenced by, but not limited to, the following:
1. Age of the product.
2. Force and duration of winds and wind driven rain.
3. Type and amount of wind driven debris.
4. Orientation and slope of the deck in relation to winds.
5. Amount of foot traffic.
BROKEN SEALANT BONDS
When sealant bonds are broken due to hurricane winds, it is possible, but not likely, for shingles to reseal. The subsequent strength of resealing, if any, would not be as strong as the initial thermal bond and would be contingent on, but not limited to, the following:
1. Age of the product.
2. Time of year and amount of exposure to ambient temperatures.
3. Length of time before shingles are exposed to subsequent high wind events.
4. Orientation and slope of deck.
5. Stress and strain on the shingles due to exposure to sustained high winds and/or deck movement.
6. Number, placement, type, and length of fasteners.
7. Contamination to the sealant bonds by dirt, debris, or other foreign substance.
8. Condition of the underlying deck or underlying shingles if a roof over.
In accordance with the terms of the limited warranty, there is no coverage for damage caused by hurricanes. Shingles in hurricane areas will continue to carry the limited warranty for manufacturing defects and remaining limited wind warranty. Any damage relating to conditions caused by a hurricane, including granule loss, breach of the seals, nail tears and other structural damage, will not be covered by the limited warranty or limited wind warranty at any time.
TB-420 2/24/06 ELK P.O. Box 500 Ennis, TX. 75120 Toll Free – 1-866-355-8324 – http://www.elkcorp.com
Your comments are becoming very irritating, and your \”Cut and paste\” journalism is getting a little tedious, and do not add value to the topic that is being discussed. Thank you for wasting 5 minutes out of my busy life…please send a $40 check to my inbox…just slide it underneath the tombstone…
4-27-2006
Certain insurers and adjusters prey on and victimize their own trusting clients, and are being exposed by their very own conduct in Texas, and nationwide.
Now why would anyone be irritated by those issues being exposed?
Why would anyone be irritated with support information that can help the general public, including themselves and their neighbors?
Sounds like a \’Tell-Tale heart\’ needs some attention…
rogerpoegc@yahoo.com
Pseudo – a tricky word.
rogerpoegc@yahoo.com
5-1-2006
C,
It\’s hoped the information helps others.
Many, many others…
rogerpoegc@yahoo.com
Looks like you wanted to write your own story! Do we get CE Credits for reading the whole thing?
The thing asks for comments not a guide on how to!
Whew!
Thanks for posting article. I couldn\’t remember date of hail storm that caused damage to our car and needed the date to open our claim for repairs.