Amfam not paying to remove asbestos tile


#1

I had a roof estimate that I found hail damage on and amfam agreed. Customer was thrilled as the other roofer never even mentioned the hail as being payable by insurance.

I told the cat adjuster at time of inspection that this tile roof had asbestos. She said if it tests positive that they would pay additional.

I get it tested, document all steps including a dnr permit for hauling. Conversation with osha rep on how to remove. Which required cutting nails- bagging-lowering into dumpster via electric elevator.
I bill accordingly and now amfam says no payment will be made for asbestos abatement per exclusion in policy

I say it’s not asbestos abatement, it’s simply removal of hail damage removal per osha standards.

I’ve got alot of capital tied up in this job, any ideas how to go about getting this covered?


#2

If the insurance company is going to deny anything they have to put it in writing to the homeowner. I would be surprised if there is an exclusion for asbestos.

I haven’t delt with amfam on asbestos but all I do is get an abatement company to give me a hard bid and send that in to the insurance companies and I don’t have any problems.

I would call again and if you get the same results ask to speak with their supervisor. I haven’t heard of any policy not covering asbestos abatement when there is covered damage to it. You will need water and electric connections for them to use though.


#3

I worked as a property adjuster for 15 years. 10 for State Farm and 5 as an Independent. In all those years, I never encountered an exclusion for asbestos abatement. I can tell you with absolute certainty that the current HO-3 (ISO form most HO policies are written on) does NOT contain exclusionary language for “asbestos” or “asbestos abatement” in its _Losses Not Insured Section.

Before I comment further, I wish to emphasize I am not a licensed Public Adjuster. My comments on this matter are strictly from my personal experience. I’m basically suggesting what I’d do if I were in your shoes.

My initial concern is that the Field Adjuster made a verbal confirmation of coverage to you. I hope you still have that person’s name and contact information. If you do, I’d start pressing the matter from there. In certain states, this is considered detrimental reliance. Basically, you acted with good faith on the instructions provided by an agent of the insurance company.

Did the Field Adjuster make the same verbal coverage confirmation to the homeowner? If yes, your corroborating information could be very important in swaying a claims supervisor to change the coverage decision. Insurers are estopped from pressing exclusions if they’ve already committed to coverage and somebody acted on that decision (as you did).

There’s a possibility the homeowners policy might contain an endorsement which amends the Losses Not Insured section and thus writes out coverage for asbestos and abatement. If that’s the case, you may find yourself in a difficult situation.

Also, repairability is a big factor in this matter. If they extended coverage for hail damage, how do they expect you to restore the property to its pre-loss condition without lawfully addressing contaminated material?

I think you have a strong hand here. Educate your customer on what’s taking place and involve them in the process. Reach out to the agent as well. If the agent is reasonable, they can be an influential ally in this matter. And I’ll echo what someone else previously mentioned - what does the denial letter say? It’s critical to find this out. They cannot deny a claim without providing a written explanation.


#4

Am I aloud to post the denial on here? Of course I’d cover names and address.


#5

Post away. Just leave any identifiable stuff hidden/covered.


#6


#7


This was what I invoiced for. I don’t have xactimate but have seen the 123/hour on a few rare roofer per hour estimates on other loss estimates. I really need to learn and get the program but for now I just barrow the missing numbers from other estimates. I’m thinking I’ll just remove the word asbestos from my invoice, and replace with word ‘tile’. Around here everyone calls them slate roofs but in reality they’re asbestos-cement tiles.
One thing I have no clue on is what the value of a suitable replacement is, I feel I took a low guess at 4500. Paid all requests other than anything relating to the asbestos/ slate/ tile


#8

In Xactimate asbestos is rated at 50 year life span. The most common replacement that the insurance company gives is concrete tile but this is rated at 25 year life span in Xactimate. The apples to apples comparison is slate tile and they are rated at 50 year. I’m going off of memory on all of this though.

I’m not an adjuster but I think they are denying coverage when they shouldn’t be. I’ll give an example.

Mold is not covered in most policies but when there is a covered loss such as water damage nearby and in the process of repairing the covered loss the mold will incidentally be repaired. However, there is no coverage for the mold remediation ie testing, hepa vac, containment etc.

The same scenario would apply in your roof. In my opinion they would owe to remediate because the proximate cause of loss is a covered loss that is otherwise not excluded within the policy.

What state are you in? The state insurance code supersedes the insurance company policies.


#9

Agreeing with J_Medina. The fact that they called the roof a total loss requiring replacement and it being illegal for you to remove the asbestos in any other manner than that allowed by law, forces their hand in being responsible for paying for the removal in conformity to the laws. Those laws may be local or state, but are definitely, in accordance with, the EPA standards, which make them federal also. The insurance company cannot make the home owner or the contractor to do anything illegal.

Definitely keep fighting them. Ask for the next supervisor, they will not to give you the info and then that supervisor will most likely also deny the claim. Inform them that if the home owner needs to involve a lawyer, they will be also responsible for the attorney fees, usually their attorneys will advise them that it will not be worth the added attorney fees and to pay the claim. With AMFAM, contractors have also been known to contact the CEO’s office with their common sense complaints (with all the proper documentation) and have the problem resolved quickly.

Hope this helps.


#10

If you did the roof without any kind of documentation from the Insurance Company, shame on you. I don’t understand that. At this point, I would say your best option is a Public Adjuster. They are supposed to be competent on coverage issues and also legally allowed to discuss them with the IC.


#11

Yes I guess I took the word of adjuster and assumed to much… seemed so simple I didn’t think anything of it based upon my conversation with adjuster. She was one of those that would only pay what she could visibly see on initial estimate but said coverage for any 'hidden’items would be no problem with pictures and documentation. Which was true for every other item I requested funds for