Justifying a cause of loss to a tile roof
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Justifying a cause of loss to a tile roof - 9/22/2006 7:56:03 AM
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navigator
Posts: 10
Joined: 8/20/2006
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What if you scoped a Spanish tile roof that was about 40 years old, lots of loose tiles and some cracked or chipped. Then in one small area there are several broken, damaged tile. First the insured said he had not done any roof repairs. Then he admitted that he tried to patch the damaged area when asked about it, and also admitted that he botched it up. He cannot give an exact date or reason for the damaged area, but says water started to pour in during TS Alberto (which made landfall about 150 miles away). Actually I have not had any claims for TS Alberto, have you? He cannot remember any flying debris striking the roof. There was 33 mph wind gusts and rainfall of 1.22 inches in his area on the date of TS Alberto. Remember this is a Spanish tile roof, about 40 years old. The rest of the structure had a major lack of maintenance problem. One more thing, it is not occupied currently because he is going to remodel, and he lives out of town and bought the property 2 years ago.
If the homeowner cannot or will not give you a reason for the damaged area on the roof, how can you justify any cause of loss?
< Message edited by Admin -- 9/23/2006 7:58:49 AM >
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RE: justifing a cause of loss to a tile roof - 9/22/2006 8:56:34 AM
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Russ
Posts: 96
Joined: 4/19/2004
Home base: Saint Petersburg, FL
Status: offline
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I assume you are speaking of a roof in Florida. The roofing paper below the tile is the problem. It starts to deteriorate after 25 years. Any tile roof over 25 years is going to have leakage problems, even though all the tiles are in place. I have seen losses that the entire interior is water damaged and no tiles are broken or missing. I recommend denial on these losses and in most cases the roof is 25+ years old. It sounds as if the cause of loss is old age. 33 mph winds wouldn't lift most tile. I let the Carrier make the call.
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RE: justifying a cause of loss to a tile roof - 9/22/2006 9:19:57 AM
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tiwiii
Posts: 116
Joined: 6/3/2004
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Seems as if there are multiple occurrences, wear and tear, lack of maintenance. Whole lot of coverage issues here. Take a recorded statement and send ROR immediately. Get with the carrier rep or your manager, if you do not make the decision.
R/S should be detailed in questions not only about the claim but history of his ownership, prior insurance information, etc.
If he tried to repair the roof himself and if you are saying it is a 40 yr old Spanish tile, he may not know how to walk without breaking the tiles. There may not be anyway to walk those tiles without breaking. Is it possible the damage could be from foot traffic?
< Message edited by tiwiii -- 9/22/2006 9:23:20 AM >
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RE: justifying a cause of loss to a tile roof - 9/22/2006 8:14:32 PM
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Wendy
Posts: 41
Joined: 11/21/2004
Home base: Fort Worth, TX
Status: offline
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Have you inspected the interior of the risk? Are there old water stains? Have the ceilings/walls been painted recently?
If I could not document the cause of loss and there is general neglect to the entire stucture I would deny the claim. There is a clause in the policy that requires owners to properly maintain/protect the property. The reason for the denial would be neglect.
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RE: justifying a cause of loss to a tile roof - 9/22/2006 10:40:03 PM
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cflclaims
Posts: 17
Joined: 8/30/2006
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I have twice this year gone out on tile roofs that were old and neglected and recommended denial of claim. both times insured hired a P.A. and I was told to pay it. I am of course speaking of South Florida. Until they crack down on P.A.`s it will be difficult to deny claims for neglect especially in Florida. The public adjusters know that most carriers will pay to make it go away. It is a shame.
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RE: justifying a cause of loss to a tile roof - 9/23/2006 5:05:32 AM
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TourneyKit
Posts: 8
Joined: 9/15/2006
Status: offline
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You say he is not living in the house. Has it been vacant for over 30 days? Wouldn't that be grounds for a denial under the Florida Policy?
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RE: justifying a cause of loss to a tile roof - 9/23/2006 8:26:03 AM
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jlombardo
Posts: 340
Joined: 4/19/2004
Home base: clearwater, fl
Status: offline
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TourneyKit,
There is a big difference between "Vacant" and "Unoccupied" ...also is the policy a HO-3 or a DP-3 in the above scenario.........
< Message edited by jlombardo -- 9/23/2006 8:28:32 AM >
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RE: justifying a cause of loss to a tile roof - 9/23/2006 11:35:22 AM
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TourneyKit
Posts: 8
Joined: 9/15/2006
Status: offline
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In Michigan, vacant or unoccupied for over 30days and they would not cover damage to the roof unless it was caused by weight of ice or snow.
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RE: justifying a cause of loss to a tile roof - 9/24/2006 1:44:19 AM
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racko
Posts: 241
Joined: 2/17/2006
Status: offline
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I have seen policy forms with loss due to vandalism/malicious mischeif/theft/fire/freezing/water being excluded due to "vacancy or unoccupied" issues, but not due to weather (hail, wind, etc).
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RE: Justifying a cause of loss to a tile roof - 9/24/2006 8:00:16 AM
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navigator
Posts: 10
Joined: 8/20/2006
Status: offline
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No one has been living in the dwelling for about 1 month or better when tenants moved out because the elec. co shut off the service, according to 4 of the neighbors. The electric co. could not state any detail except there was no service on currently. The water is still on and in the property owner's name. The neighbors also stated that none of them had any wind damage from Alberto, it was a bit windy but definately no damages. No one noticed anyone making repairs to the roof. And the policy is a DP-3. This is in FL.
Does any of this change anyone's minds?
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RE: Justifying a cause of loss to a tile roof - 9/24/2006 10:26:13 AM
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jlombardo
Posts: 340
Joined: 4/19/2004
Home base: clearwater, fl
Status: offline
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Navigator,
If the policy is a standard ISO DP-3 7/88, then how can you deny the water damage to the interior?? Insured admitted trying to repair roof, and botched it....no lack of maintenance there....besides, the lack of maintenance would apply to the roof and not the interior water damage, if it was recent damaage.........The vacancy issue is a non event for this occurrence and it really does not matter that the neighbors do not have any damage....you are not adjusting their claim......I think that you need to read the policy very carefully and check FC&S for more info....
As far as YOU sending an ROR....unless that authority has been given you, I would strongly urge that you do not....It is not YOUR call......at most, you should have taken a non-waiver prior to inspection and immediately advised the carrier that there was a potential coverage problem and let them decide to send or not send an ROR...also, the coverage question info should have been gleamed from the insured during your initial conversation with the insured and that would have been the time to advise the carrier, so that an ROR could have been sent in a timely fashion, prior to you visiting the property.
You will also find that carriers will not pay for the deterioration of the roof due to age/wear and tear, etc., but most carriers will in fact pay for the interior water damage on a one time occurrence basis when the risk is insured with an "all risk" policy such as the standard ISO HO-3 4/91 or the DP-3 7/88..
< Message edited by jlombardo -- 9/24/2006 10:28:33 AM >
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RE: Justifying a cause of loss to a tile roof - 9/24/2006 11:29:16 AM
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trader
Posts: 1203
Joined: 4/19/2004
Home base: Houston, TX
Status: offline
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The vacancy clause only comes into play if an increase in hazard come into the picture. Cant see any increase of hazard by an act of god. Fire, V&MM, freezing yes.
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