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Wind & Hail Claim Process

Wind Claim Claim How

Utilizing my claim experience as an adjuster we have assembled this wind claim guide providing an expansive overview of the process, this guide will help you navigate your wind claim in chronological order with a bulleted format of basic to detail information as it relates to your claim.

A Directory of Insurance Qualified Vendors is provided for your convenience. These companies are familiar with wind claims and communicating responsible pricing. They bring access to a network of skilled labor and are knowledgeable in working with the insurance carriers’ requirements to bring you back to pre-loss conditions!

See section 5 & 9 below.

Mediation “Florida”: Upon completion of your claim. If you have a claim dispute review Mediation and Neutral Evaluation.

NOTICE:  Section 817.234 of Florida Statutes provides in part: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

There are various options to consider based on your damage, we have provided some guidelines that may or may not apply to your situation.

WHAT TO DO IMMEDIATELY FOLLOWING THIS EVENT:

  • If a roofer is involved with the discovery of damage be sure to review any paperwork you are requested to sign. Keep in mind you are not required to sign any paperwork at that time with the roofing company.
  • The roofer may request to meet with the adjuster; however, it is a courtesy for the adjuster to meet with the roofer at the time of inspection. Having the roofer on-site to meet with the adjuster will provide no effective outcome regarding the potential damage found on your roof.
  • Tarping is not always required!
  • If tarping is required; Do Not Nail or Screw the Tarp to the Roof, this can cause damage in addition to the loss being reported. You may use sandbags to secure the tarp.
  • A tarp must be removed before inspection; this should be discussed with your adjuster.
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Report your cause of loss; Be sure to provide the best phone number/’s and email address. Share Date of Loss and exactly what happened to the best of your knowledge. This will help the carrier to determine potential service vendors needed to effectuate your claim.

The adjuster will contact you within 24 hours of receiving the assignment. Please share any current receipts, invoices or paperwork you have received as the result of this event.

Majority of the time nothing needs to be done before the adjuster’s inspection.

  • Ber sure to take good overview photos before covering or tarping the damaged area. 
  • If tarping is required; Do not Nail or screw the tarp to the roof as this can cause additional damage to the loss being reported. You may use sandbags to secure the tarp.

Important: The carrier must be allowed the “right to inspect” the damage for cause and origin.

The following may be directed by the field adjuster or the carrier desk adjuster:

  • Contractor – Board-Ups (cover & tarp openings in structure)
  • Contractor – Restoration, to rebuild the structure.
  • Mitigation company – To evacuate smoke and/or remove water.
  • Mitigation and/or Restoration company – To clean and inventory contents damaged. Many items can be saved. This allows your contents coverage to work for you by minimizing your cost of content replacement.

Most insurance carriers use qualified vendors; however, they allow the insured to choose vendors outside of the preferred vendors list.

The following information may likely not apply to this wind/hail loss.

If you have interior water damage:

The water mitigation company may arrive immediately for dry-out if required.

Do Not Move Anything accept ….

  • The insured (per policy) is permitted to protect damaged and undamaged property from further damage.
    • If you must move something, please take photos before disturbing the area!
    • Photos: Should be a wide overview and close-up of damage if possible
    • The exterior overview photo should include two corners of the roof before tarping.

For example:

A Roof Tarp may be necessary to prevent further water damage. Some forms of tarping may be used in different sizes to secure and protect your property. Tarping may be conducted by a 3rd party. 

Please keep all receipts to submit to the adjuster/carrier for board up and or tarping, even if you have conducted this yourself instead of another party. These expenses will be determined by your policy.

Conducted by the Adjuster – he/she will:

  • Photograph damaged and surrounding area to include all rooms.
  • Measure and document immediate and surrounding areas.
  • Conduct an interview with insured regarding the loss
  • Photograph all exterior elevations, and all interior rooms.

The Adjuster will discuss the scope of work required for repair with the contractor if involved. Each will submit an estimate to the carrier regarding the scope of work to replace and/or repair damage caused to your structure by this peril.

Note: In addition to the adjuster, a contractor may be involved depending on the damage.

Choosing a contractor who understands the insurance process can save you time and frustration, you will be required to sign a “Work Authorization” for them to begin work.  Always remember to read before you sign, there are other types of forms you will want to avoid!

There are insurance Preferred/Qualified vendors familiar with communicating a written itemized estimate and providing timely service to brining the insured back to whole.

Since each contractor is looking at the same scope of work, the pricing should also be the same between these vendors, it boils down to who you feel comfortable with completing the task.

  • An agreement will be established between you and the vendor on a printed form. This agreement should explain the expectations of each party.
  • The carrier usually does not dictate which vendor to use.
  • If your roof qualifies for the coverage your settlement will include an estimate for replacement or repair.
  • The roofer usually follows the estimate exactly as it addresses the damage.
  • Any upgrades you choose to make will be an additional expense not covered in the settlement amount. (The Insured may choose better ventilation, higher quality shingle and/or lead plumbing jacks that last 30-Years instead of flashed plumbing jacks that wear out in 12-Years.)
  • If a supplement is required a “Preferred/Qualified Roofing Vendor” knows how to document and file the request on your behalf.

See #9 below:

WORKING WITH PREFERED/QUALIFIED VENDORS:

The majority of vendors are independent and do not work directly for the insurance carrier. Preferred/Qualified vendors are a curtesy recommendation.

Understanding the contracts presented by the vendors:

  • Review and read all paperwork before signing, the carrier and/or adjuster can provide further insight if needed.
    • Avoid signing agreements that give the contractor the right to act on your behalf.
    • Protect yourself; Do Not Sign any contracts that use the “Assignment of Benefits” language without fully understanding what an AOB is. Read what the Florida CFO shares AOB info.
    • By signing an AOB you surrender your rights to the vendor. They can then receive a check directly from the carrier without performing any work, they can also hold your job hostage demanding more monies above the actual scope of work. This can snowball into a real tangled mess leaving the insured to pay out of pocket.
  • What is a “Work Authorization or Service Authorization”: This is required to begin work, this is a normal business practice so that all parties are in agreement to the terms of service offered. Typically, this agreement gives your vendor permission to provide services immediately and continue the project to completion following collaboration through the Adjuster or insurance carrier Desk Adjuster.
  • What is a “Direction to Pay”: This gives authorization for the carrier to pay the contractor directly following completion of the work. Many carriers stipulate specific requirements before submitting payment to the vendor such as “Certificate of Completion”.

Example: Sample Contract Wording: To start our emergency and restoration service, you must sign the “Service Authorization Form.” This allows mitigation/restoration company to act immediately. We do not know your insurance coverage; therefore, we can’t know exactly what your insurance will cover. It is important to understand you are financially responsible for our services. Your deductible is payable before we start work. If for any reason insurance coverage cannot be verified at the time of our emergency service, an additional deposit may be required.

The following information may or may not apply to this wind/hail loss.

WATER MITIGATION: Depending on the type of water damage; It is important to dry out your property as soon as possible, this may take 3 to 5 days by an IICRC, WRT Certified Technician.

  • There is a science to drying out different types of material, some items will not be salvageable.
  • Long term health issues can be diverted by having your property professionally dried out to prevent Mold and Mildew issues that can ultimately affect your respiratory system or more.
  • What is a “Peer Review”: Sometimes the carrier will request a Peer Review; This process is when another company for example: will duplicate the Water Mitigation process through measurements and dry out log sheets to determine the appropriate equipment was used in the drying process of your property.

RESTORATION / ROOFING CONTRACTOR:  are (Licensed Contractor/Roofing Contractor) a specialist in their field; in addition to knowing the requirements to conduct the appropriate repair they also understand the insurance format requirements such as documenting “Scope of Work” and “Line Items”.

  • They will discuss the “Scope of Work” with the adjuster and provide a “Line Item” estimate to the carrier reflecting the removal and replacement to effectuate the damaged area to pre-loss conditions
  • Please understand – Not every contractor is familiar with the insurance environment as it relates to your coverage!
    • Estimates recognized in this industry are based on-line items; utilizing linear feet, square feet, and item count and/or squares. These are similar to procedure codes in health insurance.
  • What is a Line Item? A specific price applied to a unit of measurement. It is similar to Procedure Codes in the US Health Care System.
  • Written Estimate: A summary of each effected room in the dwelling and/or Other Structure-Fence, Workshop, Shed, Barn, etc., will be grouped separately; each reflecting a unit of measurement representing labor and materials as it applies to the repair or replacement of a covered item, which is summarized in a “Line Item”; additional Line Items may include service hours and dry-out equipment. Estimates are created from 3rd party software such as Xactimate, Symbility, Simsol, etc… 

Important: The initial estimate can only be written for damages seen (based on your policy contract); if there are additional damages discovered or components required during the repair or replacement process a supplement can be applied for by the vendor/contractor through the Desk Adjuster for additional coverage. Insurance vendors know how this process works.

Excerpt from Estimate

  • Any upgrades and improvements will be at an additional cost to the insured and worked out between you and the contractor.
  • SUPPLEMENT: Request for additional funds needed that relate to the loss. The restoration company knows how to document and file for a supplement if needed, saving you tremendous time in the process!

Important: If the estimate received from the contractor is higher than the settlement amount, you should notify your carrier before work begins. The carrier must have the opportunity to review and/or view the additional proposed damages.

Download our Contents Worksheet here.

The following information may likely not apply to this wind/hail loss.

Avoid moving items from the place they were damaged unless it is necessary to protect from further damage. If applicable photograph and start making a list of items damaged by this event.

  • Content sheets may be provided by the field or desk adjuster, whether you have a mitigation company coming in or not.
  • List the items with the required information to the best of your knowledge.
  • If there are multiple content items damaged, you will likely be contacted by another vendor that specializes in High Volume content handling.

A deductible applies to every policy. Policy language follows individual State Statutes. Most states consider it a Felony if a vendor offers to pay your deductible.

 

Read more about Florida hurricane detectable here 

The following information may not apply to this loss.

ALE is additional costs incurred by the policyholder if you are temporarily displaced and required to be out of your home residence. During a catastrophic event, other housing options may be limited and not available in your immediate area.

  • To qualify – The property must meet specific attributes to render the home unlivable.
  • Most carriers utilize a housing location service.
    • Their goal is to find a location comparable to your current housing.
    • Please understand this is not a vacation plan.
    • Depending on each circumstance; You may be relocated to an Extended Stay with a kitchen or rental home if repairs will be ongoing for multiple months.
    • Notify your carrier of any special needs/medical needs you may have and/or if pet boarding is required.
    • Based on your circumstance it may be necessary for you to stay in a hotel before the carrier can respond; in this case, your receipts can be submitted as incurred costs.

Incurred expenses: is when the policyholder pays out-of-pocket for food and lodging known as an upfront cost to the policyholder and then submits for reimbursement per policy guidelines. These are out-of-pocket costs considered for reimbursement.

Food Expense/Receipts:

  • Reimbursement of food
  • Save your ITEMIZED receipts from eating out.
  • Alcoholic beverages are not permitted.
  • Credit Card Statements are not acceptable as they do not show detail.
  • Label your recipes, Breakfast, Lunch or Dinner.
  • Receipts are only applicable to the area of your home policy address (if you are going on vacation or a business trip you would be eating out anyway). These receipts would not be permitted.
  • Expenses for snacks, coffee, breaks, and meals during your workday are not considered additional expenses.

Download your Additional Living Expenses worksheet

Important: There is a limit to your ALE coverage, I have seen a few people spend their entire coverage before they were able to get back into their home. Yes, they had to stay with other family members.

Choosing a contractor who understands the insurance process can save you time and frustration, you will be required to sign a “Work Authorization” for them to begin work.  Always remember to read before you sign!

Restoration vendors know how to submit accurate line-item pricing, so the insured receives the appropriate coverage for their damages.

  • After the contractor and adjuster discuss the scope of work (damaged items and quantity) they each will provide an estimate to the carrier for review of coverage as it relates to the policy you purchased.
  • If the estimate received from the contractor is higher than the settlement amount, you should notify your carrier before work begins. The carrier must have the opportunity to review and/or view the additional proposed damages.
  • Once your contractor is finished, they will provide a “Certificate of Completion” to the carrier triggering Recoverable Depreciation based on your specific policy type (See Recoverable Depreciation under “Estimate” section below

It is important to hire a contractor that understands insurance industry practices such as line items. (A Line Item places a standard in value as it relates to the repair process; for example, replacing Drywall).

Example Line-Item:

A DRAW may be required by the contractor if the job exceeds $10,000.00 this helps cover initial expenses such as permitting, dry-out, storage cost, restoration, materials, and labor.

  • A settlement check or advance may come with all insurable interest names (required by law) printed on the check including your financial institution.
  • A Loss draft from the Mortgage company will provide multiple releases during the project based on the levels of completion.

If you have a mortgage and/or an additional insured listed on your policy; your settlement check will be sent with all insureds and additional insureds name printed as Pay To.

  • All payees on a claim check must endorse it before deposit.
  • You will need to contact your financial institution for instructions on depositing (cashing the check) with other party names listed.
  • Accepting/cashing/signing of the check does not release or surrender your rights as the named insured.

Note: A separate check will be issued for each Coverage Category:

            Coverage A – Dwelling

            Coverage B – Other Structures

            Coverage C – Contents

            Coverage D – (ALE) Additional Living Expense

Example: ABC Contracting and John & Mary Smith. The contractor may have you (the insured) sign the check so he can deposit funds for his company to do the work. The insurance carrier can provide more detail and suggestions for this process.

Example: Bentworth Mortgage, Inc and ABC Contracting and John & Mary Smith.

Every financial institution has specific guidelines. You will want to contact your mortgage company for specific instructions on depositing the check and how the funds will be distributed.

Understanding the estimate and how Recoverable Depreciation is applied. (Recoverable Depreciation may not apply to some policies and/or specific coverages).

    • When the adjuster and contractor have an agreed-upon scope of work; each will provide a separate estimate to the desk adjuster for review. The estimates will be reviewed by the carrier examiner and considered with your policy for coverages.
    • A line-item estimate will be provided with your Settlement Check from the carrier.
    • Every line item describes a cost factor based on “unit of measurement”; Square Feet, Lineal Feet, Square or individual item. This process reflects the costs incurred to bring you back to pre-loss conditions.
    • The estimating software used is provided by a 3rd party, who gathers regional labor and material pricing. They operate independently and are not controlled by the insurance carriers.
    • A policy will either be an RCV – Replacement Cost Value or ACV – Actual Cash Value. 
    • If your policy states RCV Recoverable Depreciation will likely apply.
      • This means a depreciated amount will be withheld from the original settlement, upon completion of work the depreciated amount is recoverable to the insured.
    • Example: The contractor submits the “Certificate of Completion” to the carrier, the carrier sends the remaining settlement check. (Insured will receive the remaining “Recoverable Depreciation” check made out to Insured and/or other insurable interests listed on the policy or work agreement.)

    • If your policy states ACV “Actual Cash Value” – Depreciation will apply and is not recoverable. (You will receive no additional monies.)

Note: Some items may be ACV only, based on the individual policy.

Special Note: If the rebuild cost is less than the original estimate. The final check will reflect the difference (as the insured is not permitted to profit from a loss).

 

Sometimes ACV only applies to specific line items within an estimate.

Request for settlement/supplement to carrier/adjuster for additional damage not previously discovered regarding the same loss, that was not addressed on the prior estimate.

Supplement considerations:

  • Newly discovered damage relating to this claim that was not considered in the original estimate.
  • Incurred cost is an expense you have to pay-out on before it is considered for coverage such as permits.
  •  

The vendor should follow Line Item format for Invoicing to submit a tree invoice for reimbursement.

  • How do I submit a tree invoice for reimbursement?
  • Invoice Line items should have debris removal (from the Dwelling or Other Structure) listed separately from (haul to the curb).
  • Add claim umber to invoice.

What is FAILURE TO REPAIR?

The term is specific to the cause; if the insured has received a settlement for repair or replacement and not effectuated the completion for which insured received coverage; the carrier can deny any future claims that may be related regarding the failure to repair.

Example: Named insured receives settlement to replace or repair the roof shingles and chooses for whatever reason to NOT replace roof shingles and additional damage occurs, the carrier has no responsibility to place coverage for additional damages that occur, as the insured did not provide due diligence in protecting the property with timely repair or replacement.

Example: Failure to Repair because insured chose $2,500.00 deductible and damages total $2,600.00.

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