RE: Question, I hope someone can answer
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RE: Question, I hope someone can answer - 5/10/2004 9:55:08 AM
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adjuster12
Posts: 10
Joined: 4/19/2004
Home base: London, KY
Status: offline
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Is the property claimed to be damaged insured?
Is the peril (cause of the damage)insured by the policy?
Was the property damaged by the insured peril?
Can you document the damage (see it and take a photo)?
Can you write a scope (description) of the covered damage? Usually an estimate!
Every claim stands by itself (no neighboritis)
Every policy has an appraisal clause if the insured disagrees with everybody else.
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RE: Question, I hope someone can answer - 5/10/2004 5:40:00 PM
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ClmGui
Posts: 39
Joined: 4/19/2004
Status: offline
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Hello Kile,
For reasoning sake I had to include the following from your last reply;
"As far as your statement about the manufacturer claiming something is damaged, that holds absolutely no merit when it comes to the evaluation of the loss. If I go out to a roof and look at it and see no damage but the manufacturer swears up and down that it is damaged but can't prove it to me, I'm not going to pay the claim".
The qualifier for your position of denial was for "seeing" no damage and the manufacturer not being able to 'prove the damage to you'.
Of course those claim disqualifying factors apply. I said nothing, that I am aware, of to indicate otherwise. Of course damage has to be proven.
But you made a couple of interesting comments along the way.
1.) 'The manufacturer claiming something is damaged holds absolutely no merit when it comes to the evaluation of the loss.'
On its face value, I believe consumers and manufacturers engineers would strongly disagree to that opinion.
2.) "I'm the one that makes the decision and unless someone at a pay grade higher than my own tells me to pay the claim, the claim isn't going to be paid".
I believe consumers feel that the covered "loss" is the initial decision maker.
I wasn't aware that someone receiving a "higher pay grade" helped determined how adjusters were to personally analyze and "adjust" a "loss". It would seem reasonable that 500 people telling you a given thing is damaged would trump any other outside influence
regarding a fair claim settlement being established.
3.) "Insurance is not there to insure the value of anything."
I thought that insurance is there to help recover the value of an indemnified something if the value of that something is "lost" during an "incident". 'Putting the indemnified person-property back to their pre-loss condition' inherently restores pre-loss value at the same time doesn't it, or shouldn't it?
4. "If a manufacturer decides to void a warranty but the material is not physically changed then there is no insurable loss".
The premise to the warranty being voided (reasoning) was based on the initial premise that hail and wind physically damaged the manufacturer warranted shingle to the point of legitimately voiding the warranty.
The manufacturer bankruptcy and a manufacturers seemingly arbitrary warranty cancelation scenarios you are describing does not seem to follow the logic trail the hail and wind damaged shingle-warranty scenario was on.
With all due respect, adjuster12 seems to be more in line with the thread.
Hello Czar,
Subtle damage to dark shingles was the hail / wind damage setting being considered. The hands and knees inspection scenario has been discussed by jlombardo 10/04/2003 and is not uncommon to have to consider to establish shingle damage.
http://66.102.7.104/search?q=cache:aV7qpXDYSh0J:www.catadjuster.org/forum/topic.asp%3FTOPIC_ID%3D618+hands+and+knees+shingle+inspection&hl=en
The "Tips and "How To"" topic was "Hail Damage Visibility". Hope the link works...
Also, larger hail can, by reason of the physical and dynamic stresses behind "kinetic energy", "tension bending" and "accoustical resonance" at work, can create blatant and micro-fracturing through out the internal body of a given "touched" construction product that has been subjected to "stress" beyond what it can tolerate.
Somewhat like what Kile is experiencing right now. Juuuust kidding Kile. 
Roofing tile and other materials so affected can be fractured, and yet still be a walkable surface, but the subtle micro-damage is done and maybe visible on the underside of the tile ONLY. Slate and asbestos tiles can also hide their damage to the naked eye.
A careful flipping of suspect concrete-clay tile products (checked on a visibly hail damaged area of the roofing or siding surface) coupled with a light water spritzing of the underside may produce a spider web like image that shows up as the tile body dries and leaves the micro-fractures moist and dark colored.
Wind lift / material movement can also micro-fracture stuff.
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< Message edited by ClmGui -- 5/10/2004 5:50:22 PM >
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RE: Question, I hope someone can answer - 5/10/2004 6:08:57 PM
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KileAnderson
Posts: 199
Joined: 4/19/2004
Home base: Baton Rouge, LA
Status: offline
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ConMan, you are either argumentative for the sake of argument or you simply don't know how the insurance business works. I believe it's a lot of both.
1. I stand by my statement. If the manufacturere of a product says it is damaged that doesn't mean it is damaged. The ONLY person who can decide it is damaged is the adjuster or another expert hired by the adjuster. That's the way it works. You can have a million outside opinions saying otherwise but unless I believe something is damaged or I am directed to pay a claim by the carrier I will never pay a claim that I don't believe is valid. I must believe there is damage to pay a claim. That's called integrity. Perhaps you've heard of it.
2. Most consumers are not qualified to decide when a covered loss has occured. That's what an adjuster does. As far as someone at a higher pay grade telling me to pay a claim, that's how the business works. I can swear on a stack of bibles a hundred feet high that we don't owe the claim, but if my boss says pay it, I whip out the check book and close the claim. That's how it works.
3. I repeat, insurance is not there to insure the value of anything. It is there to put something back into pre-loss condition. If after it is fully restored, for some reason, the value is reduced, insurance does not owe for that. Market value of a property has no bearing at all on insurance in the least.
4. If a manufacturer voids a warranty for hail damage and there is no hail damage, there is still no indemnity to be paid. That speaks for itself. The insurance company is not at the mercy of the manufacturer. We call 'em like we see 'em. Otherwise why would adjusters even exist? In a perfect world we wouldn't be needed, neither would policemen, prisons, security guards or armed forces. But you know as well as any of us, we don't live in a perfect world.
You say that adjuster12 is in line with the thread. He said exactly what I've been saying. If you read what he wrote and understand it, he said that nothing, other than what the adjuster sees for himself has any direct bearing on the claim at all.
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RE: Question, I hope someone can answer - 5/11/2004 9:26:01 PM
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Czar
Posts: 65
Joined: 4/19/2004
Home base: Columbus, Ohio
Status: offline
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ClmGui:
If I understand you correctly, if wind or hail damages a roof, thus voiding the warranty then the roof should be replaced. What if there is only hail damage to a small west facing slope, or 15 shingles damaged by wind on any slope of the roof. Does that warrant replacement due to the warranty being voided? I actually looked at a "wind" damaged roof today... four missing tabs. According to the insured's contractor they will not conduct repairs since they can not supply a warranty for the roof, does this make any sense?
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RE: Question, I hope someone can answer - 5/13/2004 10:35:51 AM
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ClmGui
Posts: 39
Joined: 4/19/2004
Status: offline
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Mr. Anderson,
quote:
ConMan, you are either argumentative for the sake of argument or you simply don't know how the insurance business works. I believe it's a lot of both.
Mr. Anderson, the ConMan obsession thing may be clouding your reasoning. Also, have you noticed how much you talk about yourself and try to put others down either directly or indirectly...? Could be a egotism thing based on low self-esteem... perhaps you've heard of it?
You seem to have a knack for simultaneously overstating and understating theoretical and hypothetical indemnity-fiduciary principles while calling someone else argumentive.
Is that your "integrity" in action?
1. quote:
I stand by my statement. If the manufacturere of a product says it is damaged that doesn't mean it is damaged. The ONLY person who can decide it is damaged is the adjuster or another expert hired by the adjuster.
Well, that rules out judges, juries and other thinking folks.
2. quote:
Most consumers are not qualified to decide when a covered loss has occured.
Agreed. Thus the real need for a comprehensive claim settlement guide.
3. quote:
I repeat, insurance is not there to insure the value of anything.
In the strictest sense of not indemnifying a given things "market" value, I would somewhat agree.
But doesn't commercial business insurance, crop insurance, financial insurance, etc. pay towards anticipated lost operational costs and profit values?
4. quote:
If a manufacturer voids a warranty for hail damage and there is no hail damage, there is still no indemnity to be paid. That speaks for itself.
Yes...agreed...to again, per the limited warranty voiding scenario context of your logic.
What manufacturer would arbitrarily void their warranty?
quote:
The insurance company is not at the mercy of the manufacturer.
And (especially) vice versa.
quote:
If you read what he wrote and understand it, he said that nothing, other than what the adjuster sees for himself has any direct bearing on the claim at all.
Agreed. Except the part about the what the adjuster sees "only" has "any" direct bearing on the claim "at all." That statement seems a bit presumptuous and overstated.
Adjusters are "there" to show they have "adjusted" their minds, and are subject to, other peoples knowledge and experience first. Not the other way around. Perhaps NFIP like claim settlement problems are linked to your kind of "adjusting" absolutes / attitude.
quote:
A person may make mistakes, but is not a failure until he or she blames others for those mistakes.
--John Wooden
Czar,
Not sure CZAR. I am sure the reasons behind why the manufacturer gives warranty protection adds indemnifiable "worth" to the roofing system.
Isn't physical, functional and market valued [financial] loss sustained when a indemnity covered cause "causes" the warranty to be voided?
Ask TDI / TWIA about how "valuable" manufacturers wind lift, etc. ratings, and accompanying warranties, are to their risk assuming calculation continuem.
If a covered cause takes the wind or other physical performance ratings-warranty away, is the indemnified consumer not financially damaged?
And can't the contractor supply a conditional warranty for his end of things?
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< Message edited by ClmGui -- 5/13/2004 10:40:44 AM >
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RE: Question, I hope someone can answer - 5/13/2004 10:46:23 AM
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JimF
Posts: 1305
Joined: 4/19/2004
Status: offline
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Here is a lovely poem by the French poet, Yves Bonnefoy, which I thought you all might enjoy. It makes a lot more sense than some of the nonsense posted by one of the other posters here.
Et alors un jour vint
Où j’entendis ce vers extraordinaire de Keats,
L’évocation de Ruth « when sick for home,
She stood in tears amid the alien corn ».
Or, de ces mots
Je n’avais pas à pénétrer le sens
Car il était en moi depuis l’enfance,
Je n’ai eu qu’à le reconnaître, et à l’aimer
Quand il est revenu du fond de ma vie.
Qu’avais-je eu, en effet, à recueillir
De l’évasive présence maternelle
Sinon le sentiment de l’exil et les larmes
Qui troublaient ce regard cherchant à voir
Dans les choses d’ici le lieu perdu ?
< Message edited by JimF -- 5/13/2004 10:47:18 AM >
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RE: Question, I hope someone can answer - 5/14/2004 1:32:11 PM
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Manmut
Posts: 11
Joined: 4/19/2004
Home base: Manitowoc, WI
Status: offline
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Both ISO and AAIS forms state that property is covered against "direct physical loss to property". The loss of a warranty is an economic loss, not a physical loss, therefore no coverage.
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RE: Question, I hope someone can answer - 5/15/2004 9:38:35 AM
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Czar
Posts: 65
Joined: 4/19/2004
Home base: Columbus, Ohio
Status: offline
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Thank you Manmut... that was my point. Now lets forget ClmGui and all get happy and play ping pong
< Message edited by Tom_Toll -- 5/16/2004 10:32:35 AM >
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RE: Question, I hope someone can answer - 5/16/2004 11:43:33 AM
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Stormdame
Posts: 17
Joined: 4/19/2004
Status: offline
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Just ignore me, just trying to see if I can do a post.
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RE: Question, I hope someone can answer - 5/17/2004 7:10:12 AM
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LarryW
Posts: 202
Joined: 4/19/2004
Home base: Grand Bay, AL
Status: offline
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Stormdame: We are too busy ignoring Claimgui/Conman.
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RE: Question, I hope someone can answer - 5/17/2004 11:53:07 PM
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janman
Posts: 14
Joined: 4/29/2004
Status: offline
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ClmGui,
I have this neverending curiosity on human motivation. I have had this curiousity since I delved into college level psych at the tender age of 13. This post may be somewhat in left field in regards to a contractor(I) posting on an adjusters site(which is well designed,useful,fruitful in increasing ones knowledge,many other attributes too extensive to list) to another contractor but I HAVE to ask a very important question. What exactly are you trying to accomplish here?
These folks are professionals in their chosen field and admitedly are eager to increase their abilities as any professional would be in their respective field. I personally have read the various insurance commissioners websites and also the NAIC site. I do believe they(these websites) would better serve you in respect to your needs as you have extensively displayed on this website. These guys and gals for the most part have to conform to rules and guidelines set by parties other than themselves and use their own fair judgement to arrive at a fair and hopefully equitable conclusion.
I am not defending these folks in hopes of gaining favor for personal gain but it's a matter of common sense. If you may have come across a bad seed in their field or seem to attract an unfavorable conclusion on a consistent basis I would personally have a serious period of self examination or remember that particular party and get a reinspect with a different member.
Again I am not meaning to step in the middle of your or their business but HAD to post what I feel and believe. I have 22 years in my chosen field with 7 of those in claims related work. I have yet to feel the frustrations of the system Ive seen in your posts on a consistent basis. Ive seen ethics at work and at the same time an absence of it on both the contractor and adjuster side. Fortunately the latter is an exception and NOT the norm. I will admit Ive seen bad calls and have made them personally but was quick to rectify the inequity with either a reinspect or an admission of making a mistake. i WISH YOU LUCK....and hope you find answers to the questions.
Sincerely,
janman
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RE: Question, I hope someone can answer - 6/9/2004 9:50:21 PM
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we2
Posts: 10
Joined: 6/4/2004
Home base: Port Richey, FL (now)
Status: offline
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I realize this is a belated reply, but . . . I just moved and it's taken me awhile...
Frankly, the answer is Yes . . . and No. Damage depends on the angle of the hail, the type and age of the shingles, and the actual and apparent denting to the surface of the shingle. 1" hail can cause damage, especially to lightweight aluminum vent covers, but not usually to shingles (loss of surface granules is common, but is not severe damage.) The variance in paying a roof is often in the criteria used by different insurance companies and the in the allowances of their adjusters. Specifics regarding damage and precise standards must come from what we know as adjusters.
We learn from others and pass on the knowledge...
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