This article about hail damage and insurance claims is the most popular article on First Party Property Insurance Blog for a reason…
What happens when a homeowner has a roof leak? Was the leak from the eventual wear and tear on the roof? Or did hail cause the damage to the roof and the roof leak? Is it covered by insurance, or it is not? How do I find out if it was hail? What if my roofer is saying hail caused it, but I am not sure? These are some of the toughest questions facing homeowners and homeowners insurers today.
You have heard it in the news whether you are in the insurance industry or not: hail claims are increasing in rapid numbers. Hail claims raise many insurance issues. What do you need to know about them?
Understanding the Issue: Could the Actual Roof Be Covered by Homeowners’ Insurance?
Here is the issue: when an aged roof leaks, people understand that the Florida homeowners insurers will not pay to replace the roof. Most people know that the Florida homeowners insurers specifically exclude wear and tear from coverage, and the only time a homeowners insurer will pay for a new roof is if there was a hurricane or some other event. So, when a roof fails, people report a claim for the damage that was caused by the actual water leaking through the roof, but not the roof itself.
Now, however, people are reporting more hail claims than ever, and homeowners insurers are seeing some suspicious hail claims.
Why is this an issue? Because if someone reports a roof leak as a hail claim instead of from wear and tear, the homeowner may be entitled to insurance coverage for the roof repairs (in addition to the damage from the water leak).
Thus, now you see where the suspicion comes in: when a homeowners insurer responds to dozens to hundreds of homeowners insurance claims where the adjuster cannot find hail damage on the roof … but the homeowners’ roofer is 100% certain that there is hail damage.
So, have homeowners insurers taken the suspicion too far?
Have the homeowners insurers’ attorneys taken the suspicion too far?
Florida Homeowners Insurance Claims and Litigation Handbook and Litigation Data Reports:
Before we go on, if you are in the Florida homeowners insurance claims industry and are looking for a guide with the key cases, strategies, laws, attorneys, and adjusters, or if you’re looking for Florida litigation data reports, please visit this page to learn more about our Florida Homeowners Insurance Claims and Litigation Handbook.
I am not going to say who is right and who is wrong, but I will take the chance to quickly point out some of homeowners insurers’ biggest mistakes when handling an insurance claim for hail damage, and how to fix them.
The Mistakes in Handling a Hail Claim
In my experience, the worst thing an insurer can do is simply hand a hail damage property insurance claim to an adjuster or attorney and ask them to have an engineer or roofer provide a cause and origin opinion. First, its expensive. Second, it will become even more expensive if the insurer relies solely on the expert without considering whether there is evidence of a hailstorm in that area.
Easy Ways to Avoid Costly Mistakes
Even if you don’t have your own database to evaluate similar claims in the area, similar claims from that roofer, or similar claims from that attorney, there are plenty of databases that reflect evidence of a hail storm, including online search tools (Hailstrike and StormIntel for example) and public records requests to see if anyone else in the neighborhood replaced their roof.
If there is evidence of hail reports in the area, it will be difficult and costly to defend against coverage, and the insurer should use the available technology to limit its loss adjustment expenses moving forward. If there were not any hail reports, then a cause and origin expert and attorney might be necessary to solidify a defense (wear and tear, marring, and oftentimes late notice).
As the author of the Claims Journal article noted, the only ways to actually stop suspicious claims would be to amend policies and statutes. Otherwise, insurers’ most likely method of defending this cases requires a costly jury trial on the factual issue of causation.
Remove the emotion and judgment from these cases and just focus on the facts. How do you focus on the facts? First, figure out what those facts are.
Next, once you have decided what you need to know about a claim to make a coverage decision, make a checklist, provide some guidelines, use software, or do anything. Just don’t leave these determinations up to a subjective decision without any structured evaluation prepared by your top management and top attorneys.
Software can make this issue much simpler. If you want to know more about how software is doing remarkable things to control hail claim litigation, please message me.
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