Forums

Here are a couple of roofing forums that may be able to provide some assistance in this matter.  Some of the users of these forums may have had the same type of experiance and be able to provide first hand information.

http://www.roofingtalk.com

http://www.roofing.com/

 

Insprojohn, I agree with Roy in that this is something that you can probably get better advice from some of the roofing forums out there. You are correct in that it is a civil matter between you and the insured, and I would guess that your contract with the insured will cover you to get your remaining amount paid (assuming that there is a valid contract in place). If your contract really does just say "full scope of your insurance proceeds plus your $1,000 deductible" I wish you a lot of luck in collecting what you are wanting as that has ambiguity written all over it. To begin with, you didn't complete the full scope of the work involved, as it sounds like you didn't do part of the roofing work, the interior work and unknown if you did the tarping. The fact that the insured refused to sign the Job Completion/Lien Release form is an indication to you and others that there was some dissatisfaction with the work or costs.
In another thread you mentioned that theory of indemnity on the claim, and claimed that it was fraud on the insured's part as they were over indemnified in this case, or something along those lines. It may well be the fact that they have received more money they they have paid you (assume they paid you the ACV amount so far), but that does not relate to an over indemnification on their part. If they had an estimate for $9,000, a contractor for the repairs for that amount, repairs are completed by the contractor that wrote up the contract, verification that there repairs are done (or a substantial portion of them), then the insured is entitled to the with held depreciation. The insurance contract is between the insured and carrier and the contractor is not party to that contract. If the insured refused to pay the contractor for the withheld depreciation, that is an issue between the insured and the contractor alone, and not the insurance carrier. I take it there is no "authorization to pay" involved wherein the carrier is requested to add the name of the contractor onto the check, so basically your battle is with the insured.
If the insured did forge your signature to the satisfaction/lien release form, that could/would be a civil and criminal matter between you and the insured, and may constitute ins. fraud when it was sent into the carrier, but for the amounts involved (only the withheld dep on the metal roofing, and interior repairs), I can almost guarantee no carrier would deal with it. After all, those are the only areas that it appears were not repaired by you, and if they were actually repaired, any fraud to obtain unwarranted monies would be difficult to prove.
I'd do what Roy suggested and check the other forums on your options. I'd also suggest that you get a little more specific in your contract language also (not the part about adding paragraph you mentioned elsewhere), as if the carrier seriously under-valued the damages the insured could enter into the contract and you would be on the hook for what the carrier estimated the loss at.

 Sbeau - The carrier did a good job of estimating the part of the roof that I did with the exception of being 2 squares short but at this point a supplement will never happen due to the criminal nature of the insured.   The only thing that I see going for me regarding the ambiguity of my contract is that I might (maybe) can argue that I was talking about the full scope of insurance proceeds specifically regarding the comp shingle repair. Which means that I am acknowledging the ambiguous nature of the contract and I am hoping for the best outcome.

However, I do have a very strong case for the forgery charge.  If I can prove that the signature on the job completion form is not mine then the insurer does not matter at all regarding forgery. As I am the victim of the forgery crime and I fully intend to prosecute this person to the full extent of the law.

At this time my plan is to document my claims of insurance fraud and forgery. Present them to law enforcement and the  DOI.

I am also going to contact all of the major carriers claim supervisors about a win + win relationship for the carriers and contractors.  If the contractors can create a job completion form and/or a sales contract that protects (reduces the exposure of  insurer) from insurance fraud and the contractor from not being paid I see that as a great thing.

What you need to know is that I am an agent and adjuster in FL and I was an active agent selling insurance for 12 years before I quit selling for 5 years.  So I understand the concerns of both agents and carriers.  I have been thinking about getting an agent license in GA and have been talking to agency owners in GA about selling insurance for them.  Many of these agents have expressed negative opinions and hostility towards the contractors knocking on doors for hail claims.

So I understand this issue from all sides.  I appreciate your feedback.  I will post my proposed contract language that I am going to send to several insurers to get your feedback before I send it.   Thanks for your help!

 Sbeau - Where I know you are wrong per the lady at NICB is on the indemnification issue.  The insured is not supposed to profit from the loss. Many insured's get the ACV money, keep it and do not have the repairs made.   This results in them not getting RCV money or needed repairs done. It also results in them getting entered into the CLUE database and possibly ISO claim search as well.  The insurance company is happy that they have settled the claim permanently for the ACV money.  However, if the insurer could have settled for the ACV money but the insured gets paid the RCV and does not pay the contractor then according to NICB, the insured has committed insurance fraud.  By telling the insurance company that the cost of repairs were $3500 ACV + $4500 RCV = $7000 then the insurer was ripped off for $4500 due to repairs not being paid for and the insured profited from the loss by putting $4500 into their pocket.

National Insurance Crime Bureau =NICB considers this issue to be a fraud issue.  I am designing a new job completion form that includes an insurance fraud warning on it.  All of my customers that commit insurance fraud will be prosecuted by me.