Coverage question
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Coverage question - 5/29/2004 9:15:52 PM
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DEMIGOD
Posts: 43
Joined: 4/19/2004
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I was wondering about something the other day about a course of action for repairs that I have run across in the past. I do not currantly have a cliam on this matter but wanted to pose the senario to see what peoples perspectives are on it.
It goes like this. Home owner has a house that had two elevations of it's aluminum siding damaged. The course of action that the insurance company decides upon is to replace existing damaged sides and paint the new sides and undamaged sides so the home owner can paint the whole house one color. In this case the existing aluminum siding has not been painted as we know some people do.
Does this course really restore and indemnify the insured? Does it place them back into a true pre loss condition? Is it indemnity to perscribe repairs that will with no doubt cause the insured increased and additional maintance costs that they would not under normal or preloss conditions have to spend money for?
I do not believe it does. If you do not agree that my line of thought is correct please tell me why you feel it's not and elaborate as to why. I just want to learn about this subject if I'm wrong and who knows I could be right perhaps.
Thanks,
DG
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RE: Coverage question - 5/30/2004 10:02:03 AM
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DEMIGOD
Posts: 43
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34 hits and no replies is this a loaded question?
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RE: Coverage question - 5/30/2004 11:01:59 AM
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Todd_Summers
Posts: 86
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Home base: Lubbock, TX
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DG, the carrier does not owe for paint and they do not owe to "match".
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RE: Coverage question - 5/30/2004 12:05:54 PM
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Linda
Posts: 24
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Home base: Houston, TX
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It depends on which state you are working. Some states say you owe for a "reasonable" match but not for natural weathering or oxidation. Remember Minnesota??
It is my personal opinion that when you paint metal siding, you have just created a maintenance issue. You cannot duplicate the original finish which was baked on. If the damaged siding had been painted and was not the original finish, then painting is a reasonable repair.
_____________________________
Linda Asberry
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RE: Coverage question - 5/31/2004 7:46:31 AM
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TomS
Posts: 116
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Home base: Texarkana, TX
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Linda,
wasn't Minnesota, sort of changed, after all the insureds and everyone griped on how the claims were being processed. If memory serves, I thought that the original claims were no match and then after "griping" the words reasonable match gave the carriers an out to pay the gripers,etc. Of course, my ole memory doesn't serve me too well these days.
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RE: Coverage question - 5/31/2004 8:50:34 AM
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DEMIGOD
Posts: 43
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I recently read the findings in the case in MN. The Insurance companies lost becuase it was found that they practiced deceptive trade practices and false advertising. Thus being it undermind public confidence in the Insurance Industry.
As I stated before I can see this clearly as every commercial you see for insurance is so FEEL good, that if you need to file a claim your of the immpression from the advertising that everything is covered so you have no worries. Then the adjuster comes out like in the MN storm and all of the sudden it looks the opposite. Wouldn't you gripe? Wouldn't you feel that you were paid less then you were owed based on the advertising efforts you see on TV from Insurance companies?
Anyways this is off topic from my original question. Which I don't see anyone directly addressing as of yet.
PS: I realize the carrier makes the rules and you the adjuster just has to play by them so don't take my responce about the MN thing personally.
Linda you said that if you paint the siding a maintance issue has just been created. Isn't this also a loss financially then? Could it be understood in this light? Painting promises the spending of future funds that the insured would not have needed to spend otherwise.
Therefore the repairs endorsed by the adjuster has created a situation whereby the insured is left no choice but to have to now maintain the painting job on his home does this indemnify the insured?
DG
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RE: Coverage question - 5/31/2004 11:50:46 AM
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trader
Posts: 1200
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Home base: Houston, TX
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I have seen the word "Indemnity". Indemnify" more in the last few months about matching shingle color, paint, pattern etc. I was introduced to this word over 40 years ago in adjuster training classes.
The word and definition never had been issue on handling Homeowner losses before 1990 when I began handeling energy claims for the London markets. The broad manuscript policies were pure indemnity contracts. That is: the assured would suffer a loss, repair/restore the loss, submit a claim, and the adjuster would recommend an indemnity payment subject to coverage for the monies spent.
If indemnity means the monies be spent first, then the insured has proved his claim, subject to coverage language.
If I was working a claim and found the Homowner had paid a tree on house bill, that I though was out of line, I would recommend indemnity with a copy of the cancelled check.
Just ask for documentation and keep the file open a few days longer, the carrier is entitled to know why they are paying.
< Message edited by trader -- 5/31/2004 12:21:00 PM >
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RE: Coverage question - 5/31/2004 5:47:26 PM
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trader
Posts: 1200
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Home base: Houston, TX
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Just dug out an old State Farm, extra form 5 fp-7925 (12/90). In the definition section it states; "occurrence" when used in Section II of this policy, means an accident, including exposure to conditions, which result in:
bodily injury; or
property damage.
then under losses insured: accidental direct physical loss... is recited. sounds very plain to me.
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RE: Coverage question - 5/31/2004 9:21:29 PM
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Czar
Posts: 65
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Home base: Columbus, Ohio
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Demigod:
I would agree with Todd… matching is not owed and if the carrier addresses the non-damaged sides in this manner, then they are going above and beyond what is owed and the policy of insurance. This being the case your question would be a non-issue, however I would agree with your assessment of the issue there would be added expense down the road to the homeowner.
Over the years I have worked for 150 or so different carriers, and each handle the matching issue differently. Some carriers will fold to insured’s complaints addressing the matching issue and others will stick their guns and the policy and pay for what is owed. It seems to depend on the situation, the insured, the carrier, the inside handling adjuster, the appearance of the home (both new and old), how much complaining is done, to whom the complaining is done to, and so on…. How does that saying go, the squeaky squirrel gets the nut… or is that the blind wheel gets the grease.
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RE: Coverage question - 6/1/2004 3:24:25 AM
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Catmandale
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Home base: Bakersfield, CA
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It is important to remeber that these policies are impacted by laws and interpretations beyond the strict literal meaning some may give them. In California, reasonable uniform appearance is the DOI guideline. Even with that, reasonable is subject to interpretation.
The elevations affected and the architecture can make the difference. My rule of thumb is this --be fair and use common sense. It goes a long way.
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RE: Coverage question - 6/7/2004 8:43:52 AM
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DEMIGOD
Posts: 43
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Ok so the wording might not allow for complete replacement, but if not having a good match on the siding lowers the value of the home how does this restore the home to a pre-loss condition? And more specifically how can the insurance company say it's indemnified the insured if after prescribing the repairs the home is left with something less then what was insured before the damage?
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RE: Coverage question - 6/8/2004 9:06:44 AM
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LMLinson
Posts: 21
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Home base: Elkhart ,Texas
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DG,
I hear "pre loss condition" a lot, however I dont recall seeing that terminology in writing. I have seen " Reasonable comparable appearance" and "Reasonable repair" in writing. I have a friend of mine who is a PSP contractor for State Farm who has told me that there is a paint with an outstanding warranty that continues to make the home maintenance free. I dont recall what paint but I can find out.
Besides, with 2 new sides of aluminum and paint all the way around you should be close on being able to wrap it w/ vinyl.
< Message edited by LMLinson -- 6/8/2004 9:11:57 AM >
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