Case Study:

Property Advocacy Increases Claim Coverage

Quick Facts

Community Type: Nursing Home

Number of Locations: 7

Resource: Claims Advocacy

Valued Client Since: 2007

Challenge

A Nursing Home client, in a southern state, sustained wind/hail damage to their roof from a large hail storm. The insurance carrier sent an Independent Adjuster to inspect the damage. Their photos showed no visible hail damage to the roof. However, they did not take any photos of the metal (gutters, vents…) at that time. The adjuster discovered a leak in the roof and wrote an interior damage only estimate for an amount below the insured’s $5,000 deductible and the carrier closed their claim file with no payment.

Because there was a significant amount of hail in the area the insured was unhappy with how the claim was adjusted and expressed dissatisfaction with the claims process. The AssuredPartners Claim Consultant became involved and contacted the insured. We suggested that sometime hail damage takes time to manifest itself and suggested that the roof be re-inspected in the spring. That spring, the insured had a roofer inspect the roof. The roofer reported wind and hail damage to several slopes of the roof. They also reported significant hail damage to the metal vents on the roof.

Solution

With this information, we asked the carrier to re-open the file and to send an engineer to inspect the roof. The Claims Consultant attended the inspection with the insured’s roofer and carrier engineer. The engineer was skeptical as to the extent of damage. However, upon inspection, identified considerable evidence of hail damage. He questioned whether the damage would affect the functionality of the roof, attempting to use the argument that there was no damage since there was no functional difference. We argued that even if we conceded that the roof was functional, which we didn’t concede the visible damage would negatively affect the value of the building and therefore the insured had a loss. We pointed out that several shingles, and in some areas entire slopes would need replaced, as a result the slopes would no longer match. We also pointed out that brittleness of the shingles would prevent the roofer from being able to make repairs without removing large amounts of undamaged shingles. This would increase the cost of a repair and the appearance of the building would be unacceptable due to matching issues.

Value

Eventually the Claim Consultant was able to convince the carrier to agree to a total roof replacement, replacement of the damaged downspouts, and to repair the interior.

The carrier’s settlement went from below the deductible to over $70,000 paid.