Insurance Supplements: Part II


#21

This isn’t that much different than what I’ve listed here in the past. Here are what I consider are the fundamentals for effective supplementing.

It all starts with a thorough inspection with lots of pictures showing all the items that potentially should be paid for. It should show pipe jack boots, vents, valley metal, drip edge nailed down on top of shingles and felt. It should show any damage or deterioration of those items. It should show if mastic or caulk have been applied to those items. For most items, it is not possible to successfully supplement without pictures to illustrate and factually prove your request.

We attempt to go to every adjuster meeting with an estimate in hand. The most effective way to supplement is to do it before the scope of loss is written thereby eliminating the need to supplement. I realize the vast majority don’t do this and I’ve heard all the arguments for not doing this (which I disagree with by and large), but we’ve found this to be reasonably effective. And why does it matter? If we’re going to do much supplementing, we’re going to have to put together our estimate at some point anyway. Why not do it upfront where we can hopefully use it to get more items approved with the initial scope of loss. I’d rather be proactive than reactive. Our guys having the Adjuster Meetings are supposed to ask every Field Adjuster who we will supplement with and where we will send the supplement. The response we most often get is “What do you think you’ll need to supplement?” to which we respond “All the items on our estimate that you don’t approve.” That sends a very clear message. Most Adjusters would prefer to close the claim asap. We’re making it clear there is one way to accomplish that. Down the road, when we are supplementing, we can say we presented these items upfront and they were ignored. This works quite well with many of the regular, local adjusters we deal with. They learn in a short time that we aren’t kidding and their actions have shown they’d prefer to reach agreement, on the spot, with our Representative versus a protracted battle that often means getting the Homeowner involved and the HO’s Agent.

In the event all this fails, we want to supplement promptly after receiving the scope of loss. When possible, this is done with an email with documents and pictures as attachments to prove our points. I would suggest you create some email templates to use as most of the items you are supplementing for come up time after time after time. Send the email or fax supplement in, give it 24 to 48 hours, then call. Keep following up, in reasonable intervals, until you get to speak with either the field adjuster who handled the claim or a desk adjuster assigned to the claim.

If you do not get responses and/or if reasonable factual requests are denied, it’s time to get the Homeowner involved. If your Sales Reps are doing their job properly, they’ve set the HO’s expectations properly so they know they may need to call their Agent, call the Adjuster, call the Desk Adjuster or call the Desk Adjuster’s manager to get things done. An irate Policy Holder calling a SF Agent often works wonders. You, as the Contractor, have zero legal standing with the insurance company. If the insurance company wishes to attempt to reconcile the claim, so you can proceed with the work, great. If not, you need to get the HO involved as they do have a legal standing as the contract/policy holder with the insurance company. I cannot emphasize enough the value of involving the HO in supplementing efforts.

Now let me digress momentarily. Your contract should have clauses in it that state items not approved by the insurance (such as vents, pipe jack boots, etc. - we sometime call this our “State Farm Clause”) and/or items that are required by local Residential Building Code that are not covered by the insurance the financial responsibility of the Homeowner. Guess what, if the HO suddenly finds they may be coming out of pocket for an additional $200 to $1000 or more, their motivation to get involved goes up exponentially. Why do you think SF quit paying for PJ Boots, vents, etc.? IMHO, it is because they realize in most cases, the roofing contractor will go ahead and cover these. That’s great, right? HO gets a complete new roof, SF pays tens and hundreds of millions less for roof claims over the course of the year and the Contractor eats up their profit. This is another solid reason for why you want to get most supplementing approved prior to the work being done. If the HO has an issue with it, then just tell them you will reuse the old vents, pipe boots, etc. and will not warranty any of these items. If you’ve set expectations properly, you won’t run into many problems. If you don’t set expectations properly, shame on your Sales Reps.

If you employ these strategies properly, and are patient and persistent, I think you’ll end up getting 75% of your supplements approved, if not more. If you’re looking for 100%, pinch yourself to wake up. There is no such thing as 100%. However, if you take the average scope of loss, you should be able to increase it 20% to 50% or more with proper supplementing techniques and processes.

Let me add at this point that IMHO, you’re also best served to use Xactimate and become as skilled as possible in utilizing this estimating software. While I know there are plenty of detractors, if utilized properly along with proper supplementing techniques, roofing contractors can do just fine from a profit point of view.

If all this fails, and if done properly it rarely will, you always have the option of suggesting third party appraisal or a Public Adjuster (in States where it is allowed) as a means to getting the claim properly reconciled. There are great PA’s, good PA’s and those that suck. Two guys that used to post here often, Ray C in TX and Dave S in IL, are off the charts good. It most often takes a fair amount of time but you won’t believe what these guys can get done.

I cannot possibly cover every little trick of the trade in this forum, I don’t have the time to write a book. Follow these principles and you should see big improvements. Purchase the appropriate International Residential Code Books (I do it in ebook format so they’re easy to reference as well as copy and paste). Understand where the codes apply. Remember that you’re dealing with multi billion dollar conglomerates that don’t do well with verbal BS and stuff scribbled on a napkin. Provide the person you’re working with the factual reasons, evidence and documentation to approve your line items in order that they can justify it to their management. Good luck!


#22

I have really enjoyed reading theses post on supplemental payments. I am new to the insurance world, but not new to construction. I know what it takes to preform the work professionally. I also know what the insurance company pay for the repairs of the properties. My concerns are how to get them to agree to paying us to perform the work in the professional manner the governmental oversight requires. Particularly OSHA. I have only attempted to supplement for 5 project. Only one came back with a positive response. But even that one did not allow for safety requirements. One of the supplements cost me the client. The adjuster contacted the home owner and told them that they could not use our services. They told the home owner we were overcharging and was “Out of line” with our proposal to perform the work. We were unable to convince the owner otherwise and they went elsewhere. Probably to an inferior contractor who performed the work in a illegal manner and accepted whatever the insurance company would pay and not charging the owner their deductible. All just speculation on my part however. I have tried two different approaches to supplementing. One: I have written a lengthy proposal itemizing everything just as the adjusters do but I also included quotes for the code and a citation for that quote, along with a photo copy of the page the quote came from to prove that this is a legitimate requirement. I then assessed a price for that item Example: OSHA requires fall protection around skylight. So I propose to cover the skylight with a 3/4" sheet of CDX install and remove then I assign a price. My second approach was to save myself some time on creating the estimate and simply email the adjuster requesting them to include the following items into their proposal for me. This saved me time with the estimating program and made them spend more of their time. This actually work to some degree. They included only items that; as they put it “items that can be justified”. But at least they included some of the items. Where as with the first option where I assessed the pricing they simply looked at the larger price for the project and didn’t even consider a single item in the proposal. For those who don’t know OSHA requirements there are a lot of requirements from OSHA that are never covered in the insurance proposals. These requirements cannot be performed without financial consideration. OSHA will not allow gutters to be installed off a ladder. How am I suppose to remove and replace gutters without a ladder, or scaffolding. I have tried to get the insurance company to pay for scaffolding but their response is either to accuse us of unethical acts, or simply state that “the request cannot be justified”. "what do they mean it “cannot be justified”? I provided them with the quote, citation, and a copy of the OSHA manual. What else can I do? Eat the cost to perform the work professionally? Not perform insurance work? Put my guys life at risk and not protect them? Ask the home owner to pay the cost above their deducible? I appreciate anyone’s advice and time. Again I really learned a lot from these post.


#23

I’m glad to see this thread sparks interest. I still refer to it from time to time. I created an app a few years ago for every field function in the company. The sales guys in particular are required to document most every part of the roof. We are able to clarify most insurance scopes and supplement prior to build. During the roof install process, our crews are also required to document items removed and items installed, making it much easier to supplement post install. Documentation is everything. Speaking the same language (Xactimate) also helps. I even supplement Simsol scopes with Xactimate and have good results