Roofing Coverage, does carrier owe twice?

I am representing an insured who filed a claim in 2010 and was compensated for replacement of the front slope and repair on the back slope. She filed again in 2013, for a roofing claim, but did not replace the front slope, she just did a repair on the front slope. I am representing her as an insurance appraiser and heard from another appraiser that technically the carrier owes the ACV of the roof regardless of whether she replaced it or not because she paid her premiums. I was also informed although technically correct, it’s a hard argument to make and win, I just wanted to see if anyone else had some input. Thanks for your time in advance.

  • Brad

I’ve heard arguments both ways. For one, it may depend upon State laws. I would think the HO should take their policy to an Attorney to get the correct opinion. Even then, policies and insurance law is so ambiguous, there may not be a straight or unequivocal answer available.

In my own experience, any time we were involved in job/claim where something similar occurred, the insured was not paid again for the repairs previously paid for.

I would assume your HO did not receive the RCV portion of their claim in 2010?

Authentic_Dad,

I do not believe she received the RCV.

I appreciate your response. Thank you

I’ve heard some pretty strong arguments that she would be covered again. The Insurance continued to collect premiums so they may very well owe for it.

Recently went through this on a farmers claim. Insured had a hail claim three years ago and got paid acv then on a metal roof. This year, he was paid acv again and hadn’t replaced it from before.

Did the carrier willfully pay acv again or did a public adjuster get involved? I’m just curious what the arguments are back and forth.

The outcome and feedback are both obviously circumstantial to the judging party(s) and facts that have been presented.

Generally, the insurance company would and should have the documentation on whether a payment was ever issued to said Policy Holder. If, when a payment has been issued to the earlier claim, the insurance company will not owe to pay the second time for the same claim. Easily understandable.

On the second/later claim, when there’s no undetectable history in fraudulence on the policy holder’s part, if the adjuster deemed the claim is payable, the insurance would pay.

The monkey wrench here is that you are thrown into this by the homeowner knowingly and you are finding out about all of this to sort through. Unless you are a P/A and/or attorney in this field, you should consider stepping out immediately.

My answer to your question on money being paid to the insured is this:
If the carrier gets wind that the homeowner did not take care of the roof by the first loss, the carrier is liable to retract the second claim even after approving the later claim. Though not highly common, the insurance company may also cancel the policy with the insured.