This is a lesson I learned from the underwriting department of a major insurance company over 50 years old. The adjuster is supposed to approve  losses  to be paid". What is made by a man and installed by a man can be repaired by a man".

Now you must approve the actual cost to repair or replace the damaged portions of the roof from the INSURED peril. Still having a problem, right.

You or a repair person must calculate how much to repair/replace the actual damage and any footfall and if it exceeds the cost of new for old you have your answer. Age or condition has NOTHING to do with repairs or replacement.  You must also apply 19/25 depreciation on the shungles and labor.    Big ONE. If they comply with replacement cost coverage(if any) IT"S A FORTUITOUS EVENT, but its not because "they paid for the coverage".

NEVER confuse replacement cost with coverage, you owe the cost of repair or replace.  Most auto repairs that exceed 75% of the fair market will total a crashed vehicle. This is not a rule on roof claims, but many carriers will not question the field adjuster  estimate.

"Some one will be paid to settle all of these, It might as well be me."

I agree Ray, but is there a point of wear on a roof where it would not be considered repairable?  This is something I see often dealing with lots of lower valued dwellings.  Most are TDP1 acv forms, but a few rcv are floating around.  

Of course roofers all the time say a roof is too old to repair and should be replaced.  If shingles are too brittle and falling off, how can a carrier propose to repair something that is clearly not repairable?

Go back to my post. I was lold by the insurance carrier that help write the first replacement endorsement to the EC coverage on a standard fire policy. This endorsement is not COVERAGE to replace old for new. IT is purchased coverage to be reimbursed for the DEPRECIATION only, AFTER tthe restoration is complete. Go to a DP! and take 99% depreciation if the roof is worn out from age.

I was working property claims in Texas when the "nailable surface" lawsuits were filed, they were really an Ins. commissioner strongarm for a higher office and all the carriers , but three went along. Guess who I worked for as an IA from 1992 until now, you are correct I still depreciate the nailable surface 99% (because it bwill not show up on the computer as a 0) and The carriers will not allow haul off on the 2nd layer if its a comp over a comp. And they are right , went to court and won.

Now all states are differant, but these 3 carriers won in Texas and the rest rolled over. Some very good adjusters still think a package policy(Homeowner) with RCC built into the premium structure give new for old coverage, this COVERAGE can NEVER total a roof that can be REPAIRED... I saw a Farmers Supt. in 1995 in a room with 100 Pilot adjusters(most from Texas) in Pleasanton, CA tell the whole room "any thing made by a man, can be repaired by a man", and I better never hear the words" It was too old to repair, therefore I totaled it". Yes we slipped a lot of 24 inch thick butt wood shakes into 40 year old roofs with green mold. That gig only lasted 7 months for the one.s who paid attention.

Do they still have these meetings with all the know it alls from Texas?  Is betterment involved yes or no. It is in 95% of all losses I have seen.

 Read the policy, it does not read the way YOU think it should. Get into law and have the law change the contracts to read your way of thinking.

 Kinda had a bad day with "No English" and they will get a letter in English ONLY.

We hear a lot about case law. But seems we never get to read the case law. Most of the "case law" I hear about is from water suckers, roofing salesman, public adjusters and people with a license and discredit our profession.

Posted By Ryan in Houston on 12 Feb 2010 12:59 PM

(1)...  Other adjuster says, repair because insured failed to maintain the roof.  He says carrier only owes for what was damaged and age and condition of roof have no bearing on if entire roof should be replaced.

 (2)... Can a roof be too old to repair?  

(3)... If a roof is too old and worn to repair, does the carrier owe to replace? 

1). Roofs become aged, brittle, and manifest thermal cracking, heat blisters, etc.  Maintenance is not typically needed to a roof, aside from proper ventilation (which begins with responsibility for the builder).  Think about the tires on your vehicle.  You can rotate them every 3,000 miles, but they are only going to last so long.

2). Yes.  It's a pliability issue, lack of.

3). You don't owe anything for non-damaged slopes.  Some carriers have criteria that can vary, and it is their sand box.  Assuming there is direct accidental damage to a specific slope, and the surrounding shingles are TRULY non-pliable, it can be non-repairable.  Run it by mgmt if you want to CYA and ensure that you are doing what your principle is asking

Posted By Ray Hall on 13 Feb 2010 01:48 AM
I agree with Bob H in his example, however I think betterment is in ever loss . The new slope would have betterment withheld by me and I think I am doing what the contract said.

Of course, and an example would be replacing an entire run of fencing (even if it is only one of 3 long runs in the rear of the property).  If a slope is allowed to be replaced in the estimate, it will be depreciated based on age & condition.

ACV policy, that first settlement is all they will ever see.  Most homeowner policies are RC, so once a signed contract is presented (or work completed) they can collect full replacement cost for that slope (less deductible).

POSTED BY STEVE: Good point about interior paint - and of course virtually all carriers will allow paint of the room, not 2x2 Square Feet.  That is fairly uniform by virtually all carriers.  But with roofs (and fencing) it isn't the same.  Mankind has patched roofs and fencing for centuries, and it is a situation where matching is less of an issue (but SOME regions of the country do have matching statutes that can have local implications).

POSTED BY RANDY_C: Yep and that concept of allowing some additional shingles for damages that will occur to additional shingles is a "tool" that can be pulled out of the tool box prior to buying the whole roof.  I think the easiest way to visualize this dilemma is when there is a large slope with only a small area of damaged tabs.  What would a reasonable person do?  When you get up on a roof that is hammered with lots of missing shingles approaching 50% it is easier to justify totaling out that slope.  When you talk about failure to maintain a roof that has leaked before... that exclusion (improper maintenance, construction, etc.) is going to speak more to the claimed damage to the interior than "lack of maintenance to the roof".  Roofs simply deteriorate, and will be depreciated based on age & condition.  People that settle total loss vehicles will understand that the valuation of the vehicle will be "adjusted" if the paint is shot, tires worn, upholstery torn.  But you aren't going to deny the claim cuz the guy didn't wax his car & rotate the tires.

Well we now have 4 very experienced adjusters agree on a real world roof claim nd an interior ceiling loss(I am in the four)

My 99% depreciation on the wood shingle deck(nailable surface) is for the three carriers who filed the lawsuit and the policy is an ACV. All this blather can be elimated on this topic by the afjuster working the loss to explain WHY he scoped the loss this way. I can,t recall ever being over ridden by the carrier ot the coverage attorney, except one time on a large pollution clean up claim when motor oil leaked into the ground. (and they were correct)

We hear football words like "the ground can not cause a fumble" basket ball words like "dont foul a jump shooter. When working roof losses remember Its: "age alone can not total a roof"

Randy and others in his example the hail was a windfall, he was just praying for a hail storm and got his wish. It all works out you depreciate enough not to exceed the Ded. so some small check will be sent, and the hold back if he PAID for RCC which he did when he piurchased the HO. My argument is with adjusters who think-say "itwas so old.............now if its ACV I go 50-to 75% on non recoverable betterment like most adjusters. I work a lot of ACV losses and most insureds get the feeling I am doing my best for them.

If you start saying betterment, non recoverable and thinging this way life become much less stressful.

You may see this someday. The house is covered with double felt with disk and nail fastners and was blown away with high winds and the inside was wetted down extensivly, ceilings , walls, floors and UPP. You notice some of the felt has turned grey (age). The insured was roofing his own house, had illness or $$ problems. Yes the entire loss is covered as the felt membrane did its intended job, turning water for months before the windstorm.

Its human nature not to penalize honest insureds. I think most of us do that. We just can not interpret the written policy wrong. For the new people Just always keep in mind photographs, measurements, wind driven rain, surface water and not returning phone calls has ruined many adjusters reputation.

Well here I go again, I disagree with my bud Leland (Ithink for the first time). I don,t think the gate is covered under V &MM. It would have to be a casualty form of a theft policy (any act of stealing) (including damage by burglars) It would have a better shot at coverage if the dwelling policy has APP coverage on the Gate, but this peril of vehicle is though off as an automobile running of the road by a stranger or non insured, resident of the risk.

We beat the flying roof horse to death lets try this one.(Magnolia Oil Bld , roof sign iin Dallas, cica 1920-1980)

Posted By Leland on 13 Feb 2010 03:47 PM

...ACV Policy (might) pay only for the area that had "direct physical damage"

...an RCV policy might pay the cost of the whole slope because "we will pay the cost to reconstruct or replace the part of the building damaged..." AND VERY IMPORTANTLY notice that the RCV policy does not have the wording that says "direct physical damage".

...4)MOST IMPORTANT: Figure out how your carrier interprets the policy for the specific facts in your loss. (Ask!)

I have worked ACV only policies for the off-shore folks, and it doesn't sway me on how to repair something in the least.  They simply don't have recoverable depreciation.  The first check is the final check.

RCV policies do typically have "direct physical damage" language (unless otherwise excluded, as opposed to named perils).

I have not seen a policy that gets into granular detail about "you estimate a roof this way, or a fence that way, and if it's interior carpet you owe the whole room".  So it gets left up to us, and as you mention in point 4), the people we may report to. 

What if the claim involved damage to the carpet over a 4 sq foot area?  An ACV policy does not mean you cut out only the damaged area.  Reasonable and normal repair practices will prevail, and if the house gets updated carpet, a full run of fencing, a complete slope of roofing, that will be depreciated because it is not simply a "patch" repair and betterment has occured by doing the scope you write.

A). Most roofs are repairable.

B). If a roof is not repairable (and has direct physical damage related to your claim) and you feel the correct scope = replacement of that slope, it matters not if it is a DP-1 or what carrier.  You do run into individual claims mgr's who may act like a dictator, but in general it really doesn't matter if the depreciation is recoverable or not in terms of the way you write your sheet (partial slope or complete slope that needs replacement).  It is what it is, and if the slope is toast - it is toast.

I came up with a new answer.

At least this is how it's been going down lately....

1.Adjuster says roof can be repaired and damage is not that bad.  Insured gets their ACV check for repair.

2.Insured never calls adjuster or carrier to say scope was not enough or request appraisal.

3. 8 months go by and adjuster thinks the file is closed.

4. Adjuster is out mowing his yard one day and process server gives him lawsuit papers for the claim.

5. Lawsuit accuses adjuster of being the worst person in the world, conspiring with carrier to keep money from insured.

6. As all suits in Harris County go to doc exchange and mediation.

7. Insured gets their new roof paid in full, attorney gets thousands in fees.

8. Adjuster is left scratching his head.

Carriers figure out it's cheaper to pay for a roof and atty fees than pay for defense costs, engineers, etc.

Texas will not be that different from Florida after a few years.

When you get real jaded about insurance adjusting and think about all the things that don,t seem right to you your mind will wander all the way to the backside of your thinking about the needed changes; you may then realize with out good public adjusters and attorneys we would not be needed.

How many of us adjusters think what we could have done to keep a storm claim from being re opened. I do ever time I hear that one of mine reopens. In my background of many years I did not have very many bodily injury claims go to attorneys after I got the file, thats what we called "controlling the claimant". Many had attorneys when I got the file and 99% were settled, some with a large defense lawyer bill, most without a defense lawyer expense. That was our job, investigate and settle claims.

In hurricane Ike about 3-4 % of all losses in 4 counties have suits filed. I worked about 150 losses and have been sued one time (so far) What could I have done better to keep this case from going to an attorney? apologize more for the agent loosing the report for several weeks. Leave as soon as I got the loss instead of the next day. Ask the insured to make a list of all the damaged property and give it to me when I arrived. Listen to their story longer. Showed more compassion. Do not request the TV be turned down. Explain the coverage better. Explain why we were both bound by the contract. Explain why I could not consider some of the items on the list as storm damage, as it was not consistant with any storm damage I had seen before. Not asking the insured to have an advocate with them like a contractor, PA or relative with construction knowledge.

Thinking back now I did not do any of the above and I did not get an agreement on the scope and the cost of repairs with them or a contractor. I just mailed them a copy after I sent it to my vendor who approved the file and they sent it to the carrier who was 3 weeks hehind on approving files, and it took me one day after my vendor got word and then it took me another day or so to get the mailed copy to the homeowner.

From all the lawsuits filed today on hurricane Ike (in the thousands) it will take 50,000 court room days to try all the cases (about50 years) in the affected counties of Texas. But I do know what it cost the insurance carriers to settle the cases and the incurred defense legal expense without a trial(and none of the cases will go to trial)

If I had controlled this claimant(insured) like I have 3rd party bodily injury claims for years, by me not being so ridgid along with the 2 level,s above and getting an agreed settlement with a contractor or insured and submitting a signed proof of loss form this loss MAY not be in the hands of an attorney who will not settle for less than $100,000. (the going settlement rate) and an additional $30 to $50 K defense legal cost. This is about 20 times more than my mailed out first offer. The law firm kept thier promise.Texas and Florida will have wind/hail settlement problems for a genaration.

Catastrophe losses have to be controlled better,its not the software, its not a shortage of adjusters, the 4% will have to be controlled better. We need to have a check in hand and slow down. The other 96% will not stand for the increase in cost for windstorm insurance.

So, if I understand your story correctly, Ray, you are single-handedly responsible for making claim settlements difficult for the entire next generation. That's the counselor in me pointing out the absurdity of second guessing oneself.

On the other hand, here are some observations gleaned from my half a generation of adjusting:

1. Some insureds make up their mind that you are a hired gun sent out by the insurance company who wants nothing but to deny you all that to which you are entitled. They determine this before an event happens, before a claim is filed, and before they ever meet you. There will always be some of these insureds and whatever you offer will never be enough.
2. Some claims will go to suit, whatever you do and however competently you handle the claim. (See number 1.)

Those two things having been said,

3. First impressions are paramount.
4. Treating people as people, listening to them, and treating them fairly will cost less in the long run. Those who do not operate in this way are straining at gnats and swallowing camels.
5. The insured will not neccessarily get more money after everyone take their cut with an attorney than without one, but a claim where the insured believes they need an advocate in order to be treated fairly will cost more than one that is handled between the adjuster and the insured.
6. Time spent listening to the insured and explaining just what you are doing and why (I think politicians call that transparency, a term they use much and practice little) will be rewarded. (See number 4.)

This is the beginning of the list.

medulus, you made all my rants worth while, but created a larger problem, we will have to re-train thousands of roof thumpers into bodily injury adjusters for 2-3 years to see the real world value of settled claims.

I agree with you Ryan. I saw Homeowners go up 150 to 200% after the mold gold area 1999-2003. If Ike lawsuits cause another 100% increase, we will return to fire insrance only coverage at my house.

Posted By BobH on 12 Feb 2010 11:42 PM

Posted By Ryan in Houston on 12 Feb 2010 12:59 PM

(1)...  Other adjuster says, repair because insured failed to maintain the roof.  He says carrier only owes for what was damaged and age and condition of roof have no bearing on if entire roof should be replaced.

 (2)... Can a roof be too old to repair?  

(3)... If a roof is too old and worn to repair, does the carrier owe to replace? 

1). Roofs become aged, brittle, and manifest thermal cracking, heat blisters, etc.  Maintenance is not typically needed to a roof, aside from proper ventilation (which begins with responsibility for the builder).  Think about the tires on your vehicle.  You can rotate them every 3,000 miles, but they are only going to last so long.

2). Yes.  It's a pliability issue, lack of.

3). You don't owe anything for non-damaged slopes.  Some carriers have criteria that can vary, and it is their sand box.  Assuming there is direct accidental damage to a specific slope, and the surrounding shingles are TRULY non-pliable, it can be non-repairable.  Run it by mgmt if you want to CYA and ensure that you are doing what your principle is asking

I would know how that 'adjuster' determined failure to 'maintain' a roof. Especially asphalt shingles. The roof does its job until it fails. Most people cannot tell a roof is beyond its useful life from looking at it. Just handle the claim on its merits and you will be doing your job.

Assume ever thing that is built into a house has a span of life. If all of a major area needs repairs; roof,exterior paint, siding, windows and so forth. The interior walls, floors, ceilings, appliances, paint etc. Take reasonable BETTERMENT and settle the loss. The age has nothing to do with the ACV loss amount. It is what it is. The type of coverage has not one thing to do with the amount of loss. Forget about the coverage work the loss up, insured or uninsured, flood/wind/fire/terrorism/locus etc.

I allow for replacement of these type roofs alot, due to non-pliability. However, my carrier ask's for the depreciation to be 75-85%.

75 to 85% BETTERMENT sounds fair, because it is fair. My point is the coverage(recoverable depreciation) does not make the loss any greater than ACV. (some adjusters and contractors think it does)