Recently one of the big insurance companies took some heat in the news for not paying claims. When I heard the coverage, all I could think was — this is a basic story. Big bad insurance company not paying claims. Sure, that’s true and we have been a part of a few and we do feel bad for the homeowners going through those.
But what about all the other scenarios homeowners face every single day that never make the news? What about the inconsistency between insurance adjusters on the same storm? What about roofing companies that will have you file a claim whether you have damage or not? What about insurance agencies selling policies that aren’t even worth filing a claim on?
And yes — what about the homeowner who never reads the policy and doesn’t want to pay their deductible and never asks questions about their new roof? This blog is not about fraud or lawyers or taking anyone to court. We are talking about the day-to-day issues that affect most homeowners.
Understanding all the parties involved, I think we give you the reader the 60,000-foot view of all the issues on why a claim was denied or not paid out the way you had hoped.
The Adjuster
There seems to be an endless supply of adjusters but not a consistent diagnosis of damage or whether that damage is enough to file a claim. This makes knowing whether to file a claim or not an unknown. The claim that has clear damage is denied. The claim that had borderline damage is approved.
The Roofer
Roofers are typically all about the sale. That is what they have been taught. File a claim on nearly any roof and hope something sticks. If the claim is denied, they just move on to the next one.
The Insurance Agent
Do they know what building code coverage is and how it affects homeowners? Policies that are ACV in value and with high deductibles are unusable policies but are often sold by agencies.
The Homeowner
Sorry, you’re not off the hook. What does the policy cover? No clue? I’m guilty as well. “It is just a roof mentality…who cares! Yet the roof is the most important part of the home. If you have ever had a leaky roof, you know.
What a Good Claim Looks Like
A consistent claims process is what happens. Only reasonable claims are filed because contractors know what adjusters are looking for. Roofers stopped recommending filing a claim on every roof. Homeowners have the proper coverage that is usable and protects them. Educated homeowners are a part of the process.
This is why I have a problem with only calling one part of the claims process out. Everyone has their hand in the cookie jar and doesn’t want to admit it. Let’s talk about each one a little more in depth.
One more thing — I’m not saying that every roofing company or every adjuster or every insurance agency is a bad actor. I would think it’s fair to say everyone should be looking for ways to improve but there are some, as they say, that give the rest a bad name.
Orange adjuster paint on a heavily dented box vent. When the adjuster marks it, it is confirmed damage. The disagreements start when marks are left off property that clearly took hits.
Two dented vents, same storm, same block. Inconsistent adjuster decisions are one of the most frustrating parts of the claims process for homeowners who did everything right.
The Adjuster
In all my years doing this I have found that most insurance adjusters are looking to help the homeowners and often take care of the contractors as well. Honestly what is weird is that I often hear homeowners say insurance companies just don’t want to pay. I literally just heard it this week. But what I said, “Well maybe,” but my first thought is: Well, do you have damage where the claim should be paid for? True thought. I didn’t just start blaming insurance companies. I said, “Hey it could have been just a bad adjuster appointment — let’s take a look.”
There seems to be some inconsistency between their appointments. I’m not 100 percent sure why that is. Is it the training or the lack of training? It is years in the field vs being one year into the job? Is it supervisors that make it tough for adjusters to do their job without the fear of something happening if they approve the wrong claim?
You see what happens is you have two houses next to each other with the same damage and one gets approved very easily and the other takes 6 months to resolve. Why is that but it happens all the time. That is the inconsistency with adjuster appointments. One appointment there is great communication, the adjuster knows exactly what he needs to get the claim approved. The other adjuster is the complete opposite. He seems a little off or he doesn’t want to communicate at all and as you try to communicate, all he says is no to everything.
With inconsistencies in adjuster appointments like the examples above comes confusion on our end. We know that the claim should be paid for — but now it’s like we just don’t know who is going to show up.
Consistency may be hard given everything storms bring — but whether a claim gets approved shouldn’t depend more on who shows up than on whether the damage is there.
The Roofer
I’m sorry to my fellow roofers, but are we the main problem?
I’ve been in the roofing industry since 1996, and roofers can be very interesting. I tell my customers or potential customers if you talk to 10 different roofers then more than likely you’ll get 10 different answers. Think about inconsistent adjuster appointments and now you have every roofer saying something different — how does a homeowner know who to trust?
The roofing industry seems like there are more salesmen than actual roofers. Go ahead and search for roofing installation training and what comes up is how to get your roofing license. Geez! More training on how to get a license and trust me there is endless sales training than actual installation training. Kind of sums things up.
The roofing industry is based upon numbers and not always based upon quality. Just as quick as a roofer says to file a claim, they will be even quicker to move onto the next claim once yours is denied. This is not every roofer but sure seems like it’s a lot. Vet your roofing contractor carefully — a roofer who leads with “I’ll cover your deductible” is not looking out for you, they are looking for a sale.
The Insurance Agent
Think about this. An insurance agency sells you a homeowner’s policy. One day you need to file a claim and for whatever reason a problem comes up. You call your insurance agent, and they say sorry, but we don’t get involved in the claims process. Wait what? Are you serious? You sell the policy and take the money, but you don’t help if there is a problem. Good or bad business model?
How about this one? Not knowing what law or ordinance coverage is. Really? This is extremely common for agencies. Law or ordinance or building code coverage–it simply allows for items to be covered in your claim if required by building codes. If you don’t have this building code coverage, then these become an out-of-pocket expense for you the homeowner. Even if your home is brand new you still need building code coverage in my opinion.
My last issue is selling policies that are not usable. Whose fault is this — the homeowner or the agency? Maybe it depends on who is shopping at the cheapest price possible. ACV policies with high deductibles are not usable. The claim costs $20,000 and the payout on an ACV policy is $12,000 because the depreciation is non-recoverable and the deductible is $7,000. You get $5,000 on a $20,000 claim. Are you filing a claim?
Shopping and getting new policies every two years for the cheapest rate is a big no-no.
If you are shopping for new insurance, ask the agent if they get involved in the claims process. If no — move on.
The Homeowner
A finished roof and a new fence — this is what a properly handled claim looks like. New roof, code upgrades included, fence replaced. Everyone did their job.
Caption: A finished roof and a new fence — this is what a properly handled claim looks like. New roof, code upgrades included, fence replaced. Everyone did their job.
This blog is for you homeowners but man oh man I can’t let you off the hook here. Your home is so important, and you pay so much for insurance but to not know what homeowners insurance covers and not know how much a claim is going to cost you is a little rough.
I’m sorry — I’ve seen the claims where the payout is nothing and now, you’re in a bind, or you filed 4 claims on the roof trying to get them approved.
Or you went with the contractor who said he would cover your deductible, and you were good with that and didn’t ask any questions and now he is nowhere to be found.
I realize you don’t get much help from anyone. Where are you able to get unbiased information in the claims process? What about the adjuster, contractor or agent–were all of them thinking about your best interests? Sounds like a good question, but if your claim was denied — whose fault is that? Yours?
It is all about details. Sit down for a weekend and read the policy. Ask questions.
What a Good Claim Looks Like
Think of this utopia type of world where only the good claims are filed so insurance companies don’t have to pay for armies of adjusters to chase every bad claim, contractors know the facts and know what adjusters are looking for–no more wasted time, and you have the right policy in place and know the facts. In this world there is still fraud and problems but a much smoother claims process for sure.
One last comment for everyone involved in the claims process. There seems to be this revolving door of spending more on marketing for more customers. As more customers come in, it’s likely an equal number leave because of a denied claim or not having the proper policies.
If all who are involved step back and take care of the customer, provide unbiased information and provide quality work just maybe the insurance company won’t have to spend so much on advertising.
Really, I hope this helps bring a big picture view into the claims process for you. Unfortunately, your denied claim might be based upon many things and just not one specific area. Green Country Roofing — 918-607-7409