Residential Flat Roof Claim
Initial Assessment and Claim Filing
In the competitive world of insurance claims, maxing the settlement for property damage requires expertise, persistence, and a unique strategic approach. Eddy Garcia, our senior public adjuster, has consistently illustrating these qualities. This blog series will walk you through a detailed case study of a claim handled by Eddy, showcasing his unique and effective strategies that have led to significant claim increases. This case study will be an excellent training resource for new public claim adjusters.
Case Overview:
- Location: 4919 W. Cuyler Ave., Chicago, IL
- Date of Loss: June 13, 2022
- Peril: Hail/Windstorm
- Initial Claim Estimate: $930.96
- Final Settlement: $81,454.84
- Claim Increase: 8,651%
- Policy: Actual Cash Value
Initial Inspection and Policy Review
Eddy Garcia our public adjuster visited the property at 4919 W. Cuyler Ave., Chicago, IL, to assess the damage caused by hail and windstorm on June 13, 2022. The damage included significant roof deterioration, gutter issues, and potential structural impacts. Eddy meticulously documented the damage with detailed photographs and notes.
Before proceeding, Eddy verified the coverage details of the insured’s insurance policy. Key points checked included the policy period, replacement cost provisions, ordinance of law coverage, and any relevant endorsements or exclusions. Ensuring the policy’s alignment with the damage scope was crucial for building a robust claim.
Filing the Claim
With the initial assessment complete, Eddy promptly filed the claim with the insurer on behalf of the insured. The claim included a comprehensive First Notice of Loss letter and the required documentation.
Early Challenges
Despite submitting a thorough initial claim, the insurer’s adjuster initially denied coverage for the roof, attributing the damage to wear and tear rather than hail. This setback did not deter Eddy, as an experienced public adjuster Eddy promptly requested an engineer’s inspection to provide further evidence supporting the claim of hail damage.
Strategizing and Supplementary Documentation
Following the initial denial, Eddy Garcia intensified his efforts. He collected additional evidence, including a weather report corroborating the hail event and detailed photographs showing hail impact marks consistent with storm damage. Eddy also compiled a comprehensive repair estimate, highlighting the costs of necessary repairs and replacements.
Supplementary Documentation
Eddy submitted the supplementary documentation to the insurer, emphasizing the necessity of repairing the roof gutters and addressing underlying issues like mold and water damage caused by the storm.
Eddy’s estimates were about more than just the visible damages. He included necessary overhead costs, permits, and compliance with city requirements. His detailed approach ensured that nothing was left to chance, and every potential cost was accounted for in the claim.
Utilizing Policy Provisions for Maximum Coverage
A key aspect of Eddy’s strategy was leveraging the full extent of the policy’s provisions. For instance, when mold and rot were discovered due to water damage from the storm, Eddy referenced the policy’s mold remediation clause to secure additional coverage. His deep understanding of policy details allowed him to argue effectively for these inclusions, significantly increasing the claim amount.
Ensuring Comprehensive Coverage
Eddy maintained frequent communication with the insurer throughout the process, ensuring all additional findings and repair needs were documented and justified. This meticulous approach helped address potential policy coverage gaps, such as mold remediation and ordinance or law compliance costs.
Negotiations and Further Inspections
Eddy’s persistence paid off as negotiations continued. He conducted additional roof inspections, documenting every damage uncovered, such as multiple layers of deteriorated roofing materials and parapet wall issues. Eddy’s reports consistently emphasized that these damages were directly attributable to the hailstorm, contrary to Inurer’s initial assessment.
Detailed Reports
Each inspection was followed by a detailed report, including photographic evidence and expert opinions from licensed contractors. Eddy’s thorough documentation and expert validation fortified the claim, making it increasingly difficult for the insurer to deny the extent of the storm-related damages.
Leveraging Professional Networks
Eddy leveraged his professional network, including licensed contractors and engineers, to substantiate the repair needs. This collaborative approach ensured that every damage aspect was professionally assessed and documented, enhancing the claim’s credibility.
Overcoming Insurance Resistance
Despite the insurer’s continued resistance, Eddy’s strategic persistence and well-documented evidence gradually turned the tide. The insurer began acknowledging the legitimacy of the extensive damage claims, leading to more constructive negotiations.
Final Adjustments and Claim Resolution
Achieving Agreement
By August 2023, after months of detailed negotiations and multiple inspections, Eddy successfully secured an agreement from the insurer to cover the comprehensive repair costs. This included roof replacement, gutter repairs, and addressing structural issues like the parapet wall and water damage mitigation.
Final Invoice and Settlement
The final invoice, submitted by Eddy, detailed all repairs completed and associated costs, amounting to a significant increase from the initial estimate provided by the insurer. The insurer’s final settlement offer reflected this detailed invoice, marking a substantial victory for the insured and a testament to Eddy’s relentless advocacy.
Percentage Increase
The final claim settlement was substantially higher than the initial offer from Allstate. While the insurer’s first estimate was conservative and limited, Eddy’s comprehensive approach and evidence-based negotiations resulted in a final settlement that was approximately 8,651% higher than the initial estimate, underscoring the effectiveness of his strategy.
Lessons Learned and Best Practices for Public Adjusters
Key Takeaways
Eddy Garcia’s handling of the claim offers several critical lessons for public adjusters:
- Thorough Initial Assessment: Start with a meticulous property inspection and detailed documentation.
- Policy Mastery: Understand every insurance policy detail to identify coverage opportunities.
- Persistent Follow-Up: Continuously engage with the insurer, providing supplementary evidence and expert opinions.
- Leverage Professional Networks: Collaborate with licensed contractors and engineers to substantiate claims.
- Invoke Policy Provisions: Use appraisal and other policy clauses strategically to resolve disputes.
