Insurance Supplements


#1

Based on some of the questions I see posted here on a regular basis, it’s rather clear there are a number of readers here who could use some help with insurance claims. Since I’ve been writing a ton of supplements lately, I thought it might be helpful to share some of that experience. Let me add that it is equally obvious there are numerous posters here who are very knowledgeable with the insurance side so I’d certainly invite them to add their own advice. Clearly, there are numerous ways to make this work, it is a matter of each person/company finding what works best for them. For that matter, it can vary from adjuster to adjuster, insurance company to insurance company.

For the purpose of this discussion, let’s define a supplement as a charge or charges that need to added to a claim for items omitted, overlooked, under paid or discovered after work begins. There are far, far too many contractors out there who simply accept an insurance job, do the work, provide the extras then never bother to attempt to get paid for them.

First, supplement sooner rather than later. There is absolutely no guarantee you’ll get paid for work done if you didn’t first seek approval. The majority of the time, the toll free number for the claims center is on the scope of loss. The Adjusters number is often listed and in some cases, their email addresses. If you do much insurance work, develop a data base of this contact information, it will certainly come in handy and save you time.

A digital camera is your friend, use it liberally. You are often presenting your supplement to a desk adjuster who has and never will see the property. Your job when proposing a supplement is to provide images and documentation that will allow that adjuster to see what you’re seeing and find in your favor based upon the case you are able to put in front of them. Imagine you are sitting at a desk 500 miles away and have never seen this property. Now imagine what would you need to see in order to understand what is being requested and authorize the expenditure. Okay, that’s what you need to provide with the supplement you are presenting.

Let’s say you accepted a roof replacement from an insurance claim. You review the scope of loss and see steep charges, high (second story) charges, pipe jack boots and ridge vent were not paid for. Make sure your camera has the date and time settings correct. Go to the property. Take a picture of the mailbox showing the number. Take a picture of the front of the house (both of these to establish you’re presenting pictures from the right property). For two story high charges, take more ground pictures showing the eaves of the slopes where the high charges should be applied. Get on the roof and take pictures of your pitch gage showing the pitch of the slope. Take pictures showing the ridge vent and pipe jacks. Since you’re on the roof, look around and see if there was anything else overlooked. If so, take pictures showing the damaged and/or overlooked item(s). Drip edge and valley metal are often overlooked (or purposefully omitted). Take pictures.

Return to your office and put your supplement together. Prepare your estimate for the items you wish to supplement for. Add in your pictures. Write an explanation for each item. IMPORTANT: always have the claim number printed on each page of your supplement. Call the insurance company, have the scope of loss handy in order to answer questions. You’ll be asked for the claim number. When you get to the right person, explain who you are and that you wish to file a supplement. Ask for an email address if available, makes it a lot easier to send the pictures. When done, email or fax the supplement. Call 2 or 3 days later to see that it was received. Ask if it has been assigned and if so, get the contact information for that person (assuming you’re not put in contact with them immediately).


#2

After reading that, some of you are probably thinking “that’s sound like a lot of paperwork (which I hate), why should I do that?” The answer is easy. More profit. It is rare that I look at a scope of loss written by an Adjuster, who wrote the claim up without the contractor being involved in the inspection or having submitted an estimate, that doesn’t leave off anywhere from $250 to $2000 minimum that should have been included and paid for. That’s money that can go right to your bottom line. Anytime you’re doing insurance work, you should have an agreement with the Customer that you maintain the right to supplement and those supplements, if paid, go to you. By spending an hour or three, you can most often easily add $500 to $1,000 for items that should have been, and most often will be, paid for. I don’t know about everybody else but if I can make $250 or more per hour sitting at my desk, I’ll do it.

I previously covered what to do about items you can easily supplement for prior to starting work. How about items you discover after you begin work or after the job has been completed? When you go to the job, take the scope of loss with you, especially the insurance contact information. If you come across something during the course of the job that wasn’t covered, again, take pictures. Make notes. If it is substantial, stop work and call the Adjuster. If you need to tarp the area in question, do so, take pictures of the tarp and supplement later for the tarp job. You often may not be able to make contact with the Adjuster. If you do, describe what you found and provide them with an explanation and cost of what you estimate it will take to make the repairs. Ask them what they want you to do. If they tell you to continue work and they’ll cover it, repeat back to the Adjuster what you heard “Let me make sure I heard you correctly, you want us to proceed with repairing the new damages and you’re approving $xxxx for doing so?” Assuming they agree, make clear notes of the time and who you spoke with. If it was a desk adjuster instead of the field adjuster who wrote the claim, get their full name and phone extension. When you file your supplement, make notes “supplemental charges for repairing xxxx xxxx xxxxx for $xxxx was authorized by what’s his face on 7/14/2011 during our phone call”.

Other charges you can supplement for? I am amazed at how many contractors don’t realize that the replace number on a scope of loss (the one that has the waste factored in) is to include the base shingles, starter and hip/ridge cap. So let’s say the scope paid for 38 squares and you find out it took 40.67 squares. What do you do? If you ordered materials based upon the scope of loss, once again, call the insurance company. Let them know how much more it will take to finish the job and request authorization to proceed. If you call the Adjuster and get his phone call, leave your name, phone number and claim number. Describe what has happened. When you supplement for this, provide copies of your material receipts and an explanation of what happened. As far as pricing goes, use the remove and replace numbers from the scope of loss for your estimate to include with the supplement. Will they always pay this? No. Will they often pay this. Yes. If they pay $300 2 times out of 3 for an hour worth of effort, that’s $600 you get to put in your pocket.

How about that building permit fee? Can you supplement for that? YES. I’ve only been denied getting paid for this once out of hundreds of claims where it was supplemented for. On the one they denied it, it was a small permit fee and the job paid really well, so I let it go. Provide a copy of your permit receipt with the supplement you submit.

Here’s the bottom line. The insurance owes the Customer, who has an RCV policy, for complete replacement of the damaged item(s). Unfortunately, it is generally up to the contractor to make sure all of these items are properly identified and paid for. If you aren’t asking for it, shame on you. If you aren’t properly preparing the supplement in order to get these items approved and paid for, double shame on you. Do I think it’s right the insurance companies and adjusters omit or overlook so many items, of course I don’t. Does it frustrate me? Absolutely. But here’s the deal. These companies spend more on toilet paper for their employees in any given week than most of our companies do in revenue each year. We’re not going to change them by ignoring the issue or getting frustrated with it. The way it may eventually get changed is if enough people supplement properly and essentially demand to get paid properly. Once the insurance companies see they are spending substantial money handling supplements, they may be motivated to do it right the first time. From the contractor’s end, just imagine if you could justifiably, morally and legally add $250 to $2,000 to every single job you do. How much more profit would you make at the end of the year?


#3

A few more tips relating to supplementing:

  1. Always be prepared when you submit the supplement and discuss it. Keep your files with you. If the Adjuster calls when you don’t have the files in front of you and wants to discuss details, don’t attempt to do this unarmed. Ask to schedule a time to have the discussion when you are prepared.
  2. Always, always be polite and professional. Passive aggressive is the name of the game. That doesn’t mean be a pushover, it simply means to maintain your calm, don’t lose your temper and remain professional. Argue your side with facts. Remember, you know 100x more about your trade than 99.9% of the adjusters you’ll ever deal with. That is very important to keep in mind because in many cases, they are reluctant to approve your request because they simply don’t understand. Be patient, attempt to educate them.
  3. Never, ever use profanity or lose your temper. Do that, they win, they are justified in hanging up on you and will likely call the HO whose claim you are working to let them know they tried to work with their contractor and was cursed at. Don’t be stupid and give them that out.
  4. Be persistent. If at first you don’t succeed, try and try again. Ask to speak to the manager. If it is a big insurance company, call a few days later, you may get connected with a different desk adjuster who is more agreeable. Obviously, you have to weight the amount of persistence against the value of the supplement.
  5. If you’re not getting anywhere, firmly request that an Adjuster meet you at the property to review this supplemental request. Now you’ve put them in a position of weighing the cost of sending out an adjuster versus paying your claim.
  6. If everything else fails, ask the Homeowner for their assistance. This obviously depends upon the relationship you have with the HO. Remember, they are the one who has the contract with the insurance company, they are the insurance company’s Customer. A few of the right words from them can go a long way.

I hope this was helpful and allows many of you to increase your profits.


#4

Thanks A.D,some more irony with your posting when I am in a situation and visa/versa.

Friday I started a 2 layer (1 lyr Comp and 1 lyr shake.) This was an adjuster meeting project and we both came to an agreement pertaining to the layer count.Some insurers are not real
happy with tearing into a roof to see how many layers exist.(causing possible interior damage)

Most adjusters are content with pulling back the rake or lifting up at the gutter line for layer count.

Well needless to say I found 2 more layers on this project.The project came to a halt and out came the camera.I took lots of pictures then called the 800#.

I had my claim # and insurance summary on hand.It took a whopping 10 minutes and I was back in the ring.I was told that they would be in contact with us (HO and myself) within 72hrs to start the supplement process.Super simple.

I would also like to add to your post that prior to starting an insurance job anyone has access to the summary make sure the summary matches what you have.Like square count,ridge (Lin ft.) Proper footage of drip edge(also allowing for lap)

Like you said count vents,pipe flashing,counter flashing,step flashing,debris removal,pitch,height
etc.

I have found that if there is any discrepancies with your findings versus the summary its better to have everything in the works PRIOR to job commencement.

Great topic A.D,I agree that most contractors never pursue what they are entitled to.
Also make sure if you are providing multiple trades then a proper OP is justified.


#5

Great post AD!!

I’ll add that most insurance companies Ive been dealing with lately have been saying “we dont negotiate the amount of the claim. We pay Xactimate prices, and thats it. If you cant do it for that, I’m sure the customer can find several contractors that will.” I’ve gotten that from AAA, Allstate, State Farm, and Farmers last week, word for word, all say the exact same thing.

So one adjuster that I talked to, told me the only way around it, is to add in additional line items. Not just missing pipe jacks, HVAC caps, valley metal, ridge cap, etc… but things like limited material access, extra dumpster charges, along with ANY other line items that you can come up with, or make up that is needed. He told us about a company that was doing a big job, and line itemed for 2 supervisors (not roofers… but supervisors) at $500 per supervisor, per day, 2 lines for port a pottys, safety inspector, special ground clean up, dumpsters, and just a myriad of things, that brought their bid up THOUSANDS of dollars above the insurance bid.

So you add 20 line items to the bid, based on their “prices” and if they only approve 5 or 6 of them… you still got 5 or 6 more than you had before! Its all negotiating, and you might as well start high, KNOWING that they wont pay it all.


#6

Very nice job, AD. Professional and thorough. Ordinance and law would be another good topic to write on. I’d write it myself but right now I don’t have the time. Maybe when things slow down.

State Farm refuses to pay for sheathing on a redeck. When I get done with the code book they are more than happy to pay for it.


#7

Good, informative and helpful posts by all!


#8

[quote=“dstew66”]Very nice job, AD. Professional and thorough. Ordinance and law would be another good topic to write on. I’d write it myself but right now I don’t have the time. Maybe when things slow down.

State Farm refuses to pay for sheathing on a redeck. When I get done with the code book they are more than happy to pay for it.[/quote]

ive never once had them refuse sheathing on a redeck here. we do a couple a month with state farm at least.


#9

Make sure you fully understand how the “redeck” process is handled. If you claim it as a “building or ordinance issue/code upgrade/IBC2011 " yada yada yada typically the homeowner has seperate endorsement amounts for that certain policy. Unfortunately here in Texas we can not act as a public adjuster and discuss policy amounts or anything to do with coverage period. If need be ask the homeowner to find out what those endorsement limits are. On a typical HO3 RCV policy (homeowners not commercial) there are limits that usually max out at 5-10k. Which is typically not enough to redeck the house @ xactimate pricing for FRM-SH1/2 = 1.56 ft2 and RFG-SH1/2 = 1.71. TXDF7X_JUL11 Price Database. You can try to get insurance to pay for “non-nailable” surface and have the decking replaced that way since COW’s (comp/wood) are almost always on lathe (1 by’s). We even get redecks bought @ tear off on older roofs that have been reroofed a few times and the decking is “non-nailable” and have the salesmen or project manager take a video with their phone and provide an onsight uplift test laying 4-5 single shingle courses on a few strips of new felt paper (DONT RACK THE SHINGLES) and then yank the shingles up from the bottom course and if 2-3 of the fasteners on every course come up with the shingles it provides a non nailable surface fact proven. Obviously if the nails stay fastened the decking is good. We either sharkskin the roof or felt it and then charge the insurance for additional tear off of felt paper (mitigate damages), lost production time of our roofers (if the insurance wants an adjuster there for the inspection) RFG-LAB x # of Roofers on site (get video on the # of roofers present (preferably in your companies uniform) This is very typical of some old F&J homes. Alot of the time the adjusters will max out the code uprade endorsement. B/C the decking is less than the IBC nominal thickness of 7/16” for steep slope roofs. And if there is any extra above and beyond its applied to non nailable surface. Dont forget if the decking seems soft and the house is old there is a very good chance of getting a redeck b/c of minimum nominal thickness. (1/4", 3/8") Is not code here anyhow anymore. And no we are not insurance scammers or storm chasers we just want to make sure our work looks fantastic when its done. (eliminating warranty issues, waves in the decking) BTW Who wants to run warranty work for free on a few shingles blown off a couple of years later and get on the roof and say Damn I should have replaced this decking…


#10

On a side note, I would love to kick around ideas about supplements with some other contractors but just so everyone knows! My office is literally next to the State Farm Claims office/call center here in N. Texas We know alot of adjusters there and it was hilarious to me that a claims manager there said that they “LOVE to see what contractors are discussing publicly on THIS forum.” FYI!!! One more time FYI!!! message me privately and we can talk there :slight_smile:


#11

Authentic Dad is correct. Documentation is the key. If you document things it helps the insurance company understand what it is that they have missed.


#12

What’s wrong with them reading this site? I surely didn’t propose anything unethical, illegal or even remotely “gray” in what I posted about supplements. Assuming the insurance companies and their adjuster are moral and ethical, it is reasonable to assume they would like to see people take the proper and professional approach to working with their companies. While I think there are a lot of issues with the insurance companies and their business practices, I’ve said it before and will say it again, the bigger issue is the unethical and incompetent business practices of way, way too many contractors. When you’ve got way too many Chucks in Trucks agreeing to do the work on blatantly underpaid claims and morons who think they can simply add 4 squares to their invoice with no supporting documentation and expect to get paid for it, how to you think the industry is going to undergo any meaningful change? Given the incredible crap I’ve seen Adjusters get subjected to from HO’s and Contractors, I’m generally pleasantly surprised how the majority of them work with our guys in a professional and respectful manner.


#13

[quote=“Authentic_Dad”]

What’s wrong with them reading this site? I surely didn’t propose anything unethical, illegal or even remotely “gray” in what I posted about supplements. Assuming the insurance companies and their adjuster are moral and ethical, it is reasonable to assume they would like to see people take the proper and professional approach to working with their companies. While I think there are a lot of issues with the insurance companies and their business practices, I’ve said it before and will say it again, the bigger issue is the unethical and incompetent business practices of way, way too many contractors. When you’ve got way too many Chucks in Trucks agreeing to do the work on blatantly underpaid claims and morons who think they can simply add 4 squares to their invoice with no supporting documentation and expect to get paid for it, how to you think the industry is going to undergo any meaningful change? Given the incredible crap I’ve seen Adjusters get subjected to from HO’s and Contractors, I’m generally pleasantly surprised how the majority of them work with our guys in a professional and respectful manner.[/quote]

Dad;

Nothing at all is wrong with posting detailed information on this site. It is every contractors right to know how to properly write a scope on Xactimate and after thinking about it maybe I shouldnt be so guarded about the information. Its just been trial by fire over the past 11 years of being in business finally being able to supplement properly, then be able to teach 3 in house claims processors the same information learned the first 8 years. It has become an art form to me on how we present our xactimates with attachments on almost every line item to describe to these uneducated adjusters on why it has to be done. And the pictures with detailed annotations showing that the drip edge is ran over the felt and etc. etc. etc. Just like you said in the beginning the devil is in the details and I have learned over the years if your estimates can explain themselves with pictures, annotations, attachments on your line items etc. its less explaining over the phone which equals more productivity in the office more claims being processed and more money being made. Every one on here has wonderful suggestions from LMB to Authentic Dad (even though yall fight on here like little girls :)) But the most important point made on this subject is to Photograph, Document, Explain all the details on your estimate. Make these adjusters understand that 1.3 squares of Modified SA has a 3-4" lap coverage and 10% waste does not equal 1.3 off and 1.43 on. It equals 1.3 off and 2squares on 1 roll coverage. We cant fax our distributor an order for 1.43 rolls of Mod Bit .Dont let them cheat you with no waste on steep and high. Break it down then explain to them that our roofers dont cut the hip, ridge, vally etc. from the ground. Its cut on the roof!!! Let them know true waste on Felt. They have been getting away with millions and millions of our dollars on BS like that. I could go on and on and on but now I feel like I’ve let out too much.


#14

Billy, obviously, you’ve got a lot of it figured out and could contribute greatly to people’s knowledge here. I think a big part of the solution is to have more contractors educated on the proper way to work with the insurance companies. I could care less whether it is Xactimate or LMB’s program, if things are put together properly, they can work. You can have a hundred Xactimate licenses and still lose money if you don’t know what you’re doing.

Just imagine for a second though what would happen if just 50% of the estimates provided to the insurance looked like the ones you do? And 50% of the supplements. Or better put, what if 50% of the jobs that warranted supplementing were actually sent in to the insurance and prepared properly? Can you imagine the havoc and gridlock that would cause? But guess what, if that were to happen, before long the insurance companies would figure out it is a lot cheaper to properly scope and pay the claim correctly the first time than it is to deal with the administrative costs and additional adjuster visits to the homeowner’s properties.

Now that’s highly unlikely to ever happen or approach those kind of percentages. Which is too bad. In my opinion, in the end, the Homeowner, Contractors and Insurance Companies lose as it works today.

Let me play Devil’s Advocate briefly. Let’s suppose the insurance companies did scope and pay all the claims properly. You know what would happen? You’d still have all these scumbag, low life contractors who would conspire with the HO to commit insurance fraud and still end up putting on inferior roofs, siding, gutter, etc… The only difference is those Contractors and HO’s would be pocketing more illegal money than they presently are.


#15

I know this is an old post but… what do you do when you’ve prepared and the Adjuster just says no, we will not pay for anything more than what we’ve priced already? Or in the case of one insurance company, will not pay over $220/sq? And that price includes everything (drip,iws, step, etc)?


#16

Why are you wasting your time talking with him then? The policy is a contract between the HO and the Insurance Company. Have them inform this Adjuster they have chosen a Contractor, it is you and they want him to approve your estimate. If he refuses, have them go over his head and discuss it with his Manager. Prepare them so that when this Adjuster inevitably tells them they need to get more bids, they respond by asking him where in the policy it says they are required to accept his estimate (the scope of loss) or are required to get multiple bids.

Just start preparing the HO’s expectations and getting them involved, see how the tone changes in your dealings with these scumbags.


#17

After “not complex enough for O&P”, “just say no” seems to be the latest attempt to dissuade contractors from standing their ground. Adjusters say no all the time and then I just “say yes” to paying for all of the damage and at realistic pricing that any self respecting business person would charge for their work - whether to the adjuster or in house claim rep. Outside of a supplement for a permit with the final invoice or some other minor end of job item, there really should be no need to supplement anything else if the contractor or contractor sales rep has covered all bases.

Sales reps should always be responsible for making sure that there are little to no supplements on their jobs and, at least IMO, they should be wholly responsible for handling all aspects of the job from start to finish - including making sure items that should not need to be supplemented are not - if they want to be wholly paid. The sales rep who covers all bases and includes everything up front will, in the long run, spend less time per job and make more money for themselves and the company.

Too many guys think that accepting what is offered, starting the job and then supplementing after the job has started or at the end with the expectation reaching their $$$ goal is the way to go. I disagree. Scenario 1: Adjuster inspects without a contractor present. Get loss report from HO, audit then call for re-inspect and make sure all items are covered. Scenario 2. Contractor has met with adjuster at 1st inspect, pointed out all damage but adjuster still fails to include all damage as determined from reviewing HO loss report. Call for 2nd inspect, make sure all legitimate damage is accounted for then review 2nd LR from HO upon receipt. If all items accounted for, send in complete quote - w/o “supplements” at RTA pricing + MST + 100% O&P. If not, “demand” ins pay as submitted per contract with HO or have HO call for 3rd inspect. Also, understanding that time is money, add charges that compensate you for your time.

Here’s an example on a job I recently helped a contractor process. Insurance adjuster turned estimate for $23,500 with 0 O&P and a No to paying anything more - ever. Using my own construction industry standard estimating program as opposed to the “industry standard” estimating program, my total price was $35,700 - with full 100% O&P. I also included the following charges: Estimate charge = $275. Fall protection = $295. Supervisor = $572.94. General site cleanup = $295. Re-inspect fee = $295. Total additional quoted on my program = $1,732.94. Although I “gave back” the re-inspect fee of $295, I still ended up with an ADDITIONAL PROFIT THAT MOST CONTRACTORS NEVER THINK TO ASK FOR of $1,437.94.

I’ve made great money on 2nd and third inspects and even several 4th re-inspects - $35,000 job to $75,000 job, for example, customer knew (I informed) up front about P&C ins games and was therefore ready for their BS and on my (and their own) side to make sure they would be paid for everything and all at prices relative to the premiums they paid rather than to some so called pricing survey.

Always remain “business friendly” but stand your ground. If you know it is damaged, include it - up front. If you are not sure but sincerely believe at least 51%, include it. If you don’t really believe something should be included, don’t! If sales reps continue to have unnesscary supplements one their jobs, a bit of retraining and possible slight temporary pay reduction will take care of that. No need for a “supplement department” at any co, IMO.

Anyone who does this business should be able to determine how many layers of roofing is on the roof, what kind of backer is behind the siding, etc., etc. Those items should always be part of the original quote. Obviously, there are those occassional items that need to be supplemented such as a short sheeted roof deck, gapped deck and other problems that can’t typically be seen until the roofing, siding or whatever has been removed.

In some cases, initial adjusters just “say no” then turn the claim over to in house reps which is fine. Either way, the contractor or contractor sales reps who cut back on the supplements that are really not supplements will find themselves ultimately wasting much less time and earning much more money.


#18

Larry, recently with the larger P&C Insurance Companies, the Field Adjusters are pretty much all saying they can’t approve certain line items or O&P. Period. They direct you to supplement with the Desk Adjuster. This is quite consistent at this point. I guess they assume a great many Contractors don’t understand the process and will simply take the job for what is a tremendously underscoped amount. Very shady and unethical tactics IMHO but it is reality right now.


#19

I’ve heard the max price per square and the answer is simple, it is what it is and my response is this, “Those prices are compiled on an obviously simple roof, not with these line items”.


#20

Marc,

You guess (you know) they do assume a great many contractors don’t understand the process and will simply take the job for a tremendously underscoped amount. The unfortunate truth is that they are right, at least about that. Can’t imagine why those contractors don’t put more thought into it though. Leaving millions in potential profits on the table cumulatively, every year??? Reminds me of that show “Restuarant Impossible” where so many owners have no idea of their costs or profit margins and therefore find themselves nearly bankrupt.

“They direct you to supplement with the Desk Adjuster.” Supplement may have two meanings here. Example adjuster estimate is for $10,000 but when all items are included, price is $12,500 @ XM8 or $14,500 at RTA. Option 1 is where contractor to agrees to do job for $12,500 and then supplements on the final invoice for the additional - hoping they will be paid the additional. Option 2 is to simply include the “extra” items on my initial quote to the in house people, up front and then settle prior to starting any work so that no supplements are necessary on the final invoice outside of the occassional surprise.

Sales reps should, IMO choose Option 2 in every case and see it through from A to Z in order to earn their full commissions.