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JC wannabe
USA
1 Posts |
 Posted - 04/15/2003 : 10:57:40
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The homeowner has a 25 yr laminate roof. It was overlaid upon wood singles 12 years ago. There are no manufacturer defects. There is, however, a lot of wear and tear. Granular loss in some areas is a little extraordinary, but nothing I haven’t seen before.
There are also 9-10 hail bruises in several test squares. Inspection of the shingle underside clearly shows the fiberglass membrane has been fractured in most of the bruises.
The carrier wants to deny the claim. Their reasoning is the roof was already substantially worn and needed to be replaced anyway.
The homeowner’s position is that he’s got a 12 yr old 25 yr laminate that would have survived another 6-7 years. Now, because of the hail bruises it won’t last another two.
The carrier accepted his premium and issued a policy on this roof… should they now be able to deny the claim on the basis that it is old and needed to be replaced anyway?
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Justin
USA
137 Posts |
Posted - 04/15/2003 : 12:43:34
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Absolutely not! Of course, this assumes that the hail impacts are legitimate and the number so stated. You also did not mention they type of policy on this property.
They could have run an inspection on this property prior to issuing a policy and then denied issuing due to condition. This is a classic example of a carrier trying to wiggle on replacement of roof and probably a re-decking. |
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kengel
USA
2 Posts |
Posted - 04/15/2003 : 17:07:06
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From a Policy standpoint age/condition of shingles is NOT a basis in and of itself, to deny a claim. Typically, Homeowner Policies simply require payment when there has been "physical damage to property." There is no exception or qualification with regard to condition of the property. The policy would however, typically allow for taking into account the depreciation of the materials, which IS based on age and condition. Obviously, an ACV coverage would require payment of replacement cost(RC) MINUS the depreciation. An RC policy would require payment of the cost of repair, but may only require ACV payment intitial with the remainder paid after actual replacement is completed.
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Kyle Engel |
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Newt
USA
657 Posts |
Posted - 04/22/2003 : 07:24:25
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They accepted the premium, therefore it is insured and must be paid, according to policy. Also depending on the state. Texas requires a nailable surface. The way I see it, if they deny the claim it would be an "Unfair Trade Practice", the insured would have legal recourse and win.
Any property or item insured and is damaged or destroyed by a covered peril, the insured must be indemnified regardless of age or condition. No where in any policy I ever read does it have any exclusion for condition of an insured item.
If they denied the claim, there must be a reason in their mind other than condition. I doubt they would ever state this on a denial, that would border on stupid. |
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JimF
USA
1014 Posts |
Posted - 04/22/2003 : 07:56:04
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Those roofs which are aged out and then damaged by wind or hail, are what we call 'lucky roofs'.
And like it or not, carriers pay for them. |
Edited by - JimF on 04/22/2003 07:56:52 |
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fivedaily
USA
258 Posts |
Posted - 04/22/2003 : 15:13:10
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Newt, I recall seeing on a TX policy recently that the carrier can chose to handle a loss acv if the property hasn't been properly maintained. Specifically it says:
We do not pay replacement cost for:
a. property which can not be replaced.
b. property not maintained in good or workable condition.
c. property that is either obsolete or useless to the insured at the time of loss.
This may or may not apply to the roof in question on this thread if the roof was performing adequately its job of shedding water off the roof. So, whil enot immediately applicable, still interesting and food for thought.
Jennifer |
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CCarr
Canada
1200 Posts |
Posted - 04/22/2003 : 17:03:18
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Hurricane, what you mention in your last post, in itself, is not a denial; just a loss settlement 'type' provision or the parameters of idemnity for the given property.
Was 'JC Wannabe's' phrase technically correct? Did the carrier in fact want to deny the claim with the reason given, or did they just not feel any indemnity was owed?
Tough sledding either way, but the latter is more mathematically supportable; if there is sufficient depreciation and a deductible.
I just can not imagine an insurer saying or doing what 'JC' eludes to in his opening post. |
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fivedaily
USA
258 Posts |
Posted - 04/22/2003 : 20:31:08
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Clayton, I think you are right about what JC's carrier was attempting to do. Sometimes, I get moved when I have an insured who wins the roof lottery. I think the only way to fairly approach a situation like this, especially if you have the above referenced "loss settlement" option is to depreciate it appropriately. I don't think there would be any way to make a "fair settlement" out of a denial of this claim. The carrier chose to insure the roof and had the option to put a renewal clause that the roof be replaced. They didn't.
It does offend my sense of decency when people view their homeowner's insurance as a commodity. I also have to admit, that without my experience in the world of claims, I would probably have the same view, ie. I paid for 20 years you owe me a roof. This isn't a matter of educated vs non-educated insureds. I think sometimes the wealthiest insured's can be the hardest in this respect. I just try my best to educate where I can without taking it personally.
Back to topic... my answer to JC's very first question - No for reasons already stated.
Jennifer
and if you are wondering why Clayton calls me 'hurricane' check out my bio on my husband's website: http://www.brucesabin.com |
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Newt
USA
657 Posts |
Posted - 04/23/2003 : 07:19:48
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That policy, the way it is written gives the carrier an unfair advantage. If they can make the determination that something has no value.
Trial lawyers could have a field day.
If something is insured, the policy holder pays the premium, the carrier accepts, the carrier must have thought it had value.
In my oppinion, we don't have all the facts here to determine a right or wrong. |
Edited by - Newt on 04/23/2003 07:48:37 |
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Darryl
USA
36 Posts |
Posted - 04/23/2003 : 15:23:55
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Its nice to be able to agree, if they insure it, its there roof. If an acv policy they may not owe any money, but even that is a far stretch. If it was keeping the weather out it has value. With the advent of the popularity of bad faith suits I find it difficult to believe a carrier would take that position unless there is something else we don't know.
Darryl |
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Poor Condition Valid Reason To Deny Coverage?
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