How do I dispute a partial denial of a homeowners insurance claim?
Friday, October 24th, 2008 at
2:29 pm
Lisa asked:
There was a hail storm in our area and may (most) homes had roof damage, including mine. 95% of the homes in my subdivision have gotten new roofs from homeowners insurance claims. However, my adjuster said my roof was not damaged “enough” to warrant a new roof, only repair/patching to the back side of the roof. I have Allstate and so do several neighbors. Their claims were paid, in full, with now questions asked. The difference between my claim and theirs is the adjuster. They all had a different one than me. I have called and written the main office locally and the corporate office in Illinois, to no avail. They tell me my only recourse is to take them to court.
There was a hail storm in our area and may (most) homes had roof damage, including mine. 95% of the homes in my subdivision have gotten new roofs from homeowners insurance claims. However, my adjuster said my roof was not damaged “enough” to warrant a new roof, only repair/patching to the back side of the roof. I have Allstate and so do several neighbors. Their claims were paid, in full, with now questions asked. The difference between my claim and theirs is the adjuster. They all had a different one than me. I have called and written the main office locally and the corporate office in Illinois, to no avail. They tell me my only recourse is to take them to court.
Tagged with: Insurance • Insurance Claims • Neighbors
Filed under: Homeowners Insurance
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unfortunatley they are probably right. the adjuster has the decision power…you can try calling the insurance commissioner in your area and file a complaint. if you cannot get them to replace the roof, be sure you have something in writing as to the damage, and repairs, so that if you have a leak in the future you can bring the same adjuster back out to re-evaluate it under the same claim so you do not have to file another one. keep the adjusters name, phone number and claim number with your records!
Your best bet is to get 3 or 4 estimates from contractors that say you have damage where the adjuster said you did not. If you submit this to Allstate, they will have to either inspect the roof again, or call the contractor to verify. If a contractor can back up their claim of hail damage, than you have an option to use an arbitrator. The arbitrator is an objective 3rd party, that will look at your side and Allstate’s side. What ever they decide is the final word. Most all homeowners policies have the option to use an arbitrator.
In your state there has to be a place were you can report what you Inc. company is doing and what you can do.
OK, do you have a roofer that says your damage is extensive enough to warrant the replacement of the roof? Do you have damage outside of the back side of the roof? If only one section of your roof is damaged, I would have to agree. If the damage is NOT limited, it’s time to call your agent, and have him 1. get you switched to a different adjuster and 2. talk to the new adjuster about the new roof.
So, you are complaining that your roof wasn’t bad enough to be replaced? Would you have been happier if the hail had destroyed your roof and leaked water into your home? If only 95% of homes got new roofs then why do you think you aren’t part of the 5% that didn’t? Go ahead and sue. Believe me, they aren’t afraid of your two-bit lawyer. You better read your policy, sister.
You should first try to resolve this through your insurer….appeal the decision of the adjuster and the claims person to a claims supervisor….explaining your case honestly and thoroughly.
If this doesn’t work there is one more important resource for people in your situation…
They are called “public adjusters” who are specialists in your kind of case.
If you hire a public adjuster….they work with the contractors….your insurer…and you to get you a better claim than what the insurer offered.
Since they get paid a percentage of whatever you get from the insurer….they have an incentive to maximize your payment.
You also have the possiblity of launching a formal complaint with your state insurance regulator. Each state has a law called the Unfair Claims Settlement Practices Act (or a variant) that calls for insurers to properly pay claims and if they don’t they face certain enforcement penalties. Just call your state’s insurance department to start the process….but NOT before you try to handle this first with your insurer.
There may be a very good reason why they won’t pay your claim….like maybe since you aren’t a roof expert…maybe they are telling the truth and your roof didn’t sustain enough damage.
Each claim is paid according to it’s merit. Each claim is different and has a different set of conditions. It is unfair to compare your damage to the damage of your neighbors because the damage is NEVER identical, and sometimes, the policy is different, and THAT is what determines what and how your claim gets paid.
Whether it’s Allstate, Farmers, State Farm, Joe Blow down the street–the 1st method of repair is just that, repair. If your roof can be fixed by repairing the damaged portion, that is what they pay for. If the only way to “repair” the roof is to pay for an entire new roof then they will pay for a new roof. Your roof would need to be so far beyond repair as a result of the harmful event that it would be cheaper to replace it with new than to repair it.
Look at it like this…..your child is playing soccer with his friends and your kid kicks the ball and it hits your neighbors car denting the bumper. You tell your neighbor you will pay to repair the bumper. Your neighbor wants you to pay for a new bumper. What do you do? Which would you pay for? Most likely you’ll pay for the repair because 1) it’s repairable and 2) it’s less expensive to repair a bumper than replace it with a brand new one.
Insurance is to cover items that are damaged as a result of a covered loss. Insurance is NOT a means of maintaining your home. By no means am I suggesting you haven’t properly maintained your home, but what I am suggesting is for you to put this in the proper perspective.
Knowing Allstate as well as I know them, I’m seriously surprised your letters to Northbrook have fallen on deaf ears. You could take them to court, but you would need to PROVE your roof was beyond repair AS A RESULT OF THE HAIL STORM and nothing else.
You can file a complaint with the Department of Insurance in your state, but they won’t get Allstate to pay for a new roof. What they will do is investigate how YOUR claim, and YOUR CLAIM ONLY, was handled and if they find your claim was mishandled then Allstate could suffer some serious fines. But it still won’t get you a new roof.
From what you write, your claim was paid. You just didn’t get what you thought you were supposed to. I strongly suggest you read your homeowners policy. Look and see if you have a “Right to Appraisal” clause. If you have one, use it.