Roof: the denial record

On June 17, 2024, the public adjuster notified AXA of its involvement, on July 8, 2024, submitted an estimate for repairs along with photographs of the damages, and then on July 9 2024 submitted a Sworn Proof of Loss that totaled $1,124,547.66.

On June 17, 2024, the public adjuster notified Underwriters of its involvement, on July 8, 2024, submitted an estimate for repairs along with photographs of the damages, and then on July 9 2024 submitted a Sworn Proof of Loss that totaled $1,124,547.66.

Therefore, UNDERWRITERS should tender $462,240.10 (less any prior payments, depreciation, excess policy limits, and/or deductible) in insurance benefits at this time.

However, when the Insurer conducted its inspection of the insured property, the Insurer's representatives failed to conduct a thorough and adequate investigation, or the representatives intentionally ignored the damage observed and failed to make truthful and unbiased reports of the facts after inve

Shortly after being notified of the loss, Western sent a Field Adjuster determined that the cost to repair the property was minimal in nature and provided a small undisputed payment in the amount of $16,966.55 after application of the deductible and prior payment.

The insurer acknowledged minimal coverage of $1,390.85 after application of the deductible.

Tender payment to the Bhaghanis in the amount of $180,929.99, which is the amount to return the Bhaghanis' home back to pre-loss condition.

Whereas, the carrier furnished a wrongful estimate and, having withheld the deductible, offered a deficient payment in the amount of $13,285.14 only, leaving a remainder in the amount of $135,461.66 to be paid in order to cure the breach, less any applicable policy deductible.

On behalf of the insured, an estimate totaling $127,925.19 was prepared and submitted to the desk examiner on January 29, 2025, along with a fair and reasonable settlement offer.

AND MRS. [name redacted] damage estimate in the amount of $122,127.99 (less any prior payments, depreciation, excess policy limits, and/or deductible), which accurately reflects the true nature and extent of the damages to the Dwelling / Other Structures; (2) Agrees to reimburse MR.

The insured retained the assistance of a public adjuster who provided an estimate in the amount of $115,830.76.

After inspection by Universal's representatives, coverage for the loss was afforded and a paltry payment of $399.39 was made after application of the $1,000.00 deductible.

The Insurer sent an adjuster to inspect the damages and although the Insurer acknowledged damage to the roof and jack and jill bathroom totaling $23,941.00.

The Insured obtained representation from a public adjuster and an estimate for repair of dwelling and other structures for $89,362.52, with supporting documentation and photographs.

The Insureds obtained representation from a public adjuster and an estimate for repair of dwelling for $86,214.85, deductible subtracted, with supporting documentation and photographs.

The insureds submitted a comprehensive estimate for $83,538.03, accurately reflecting the necessary cost of repairs.

The Insureds obtained representation from a public adjuster and an estimate for repair of dwelling and other structures for $76,540.97, deductible subtracted, with supporting documentation and photographs.

The Insureds obtained representation from a public adjuster and an estimate for repair of dwelling for $76,446.22, deductible subtracted, with supporting documentation and photographs.

On or about March 26, 2024, the PA submitted a comprehensive and detailed estimate of damages to the Insurer, totaling approximately $68,917.43.

Additionally, on July 25, 2024, notwithstanding carrier's previous denial to the roof portion of this claim, the carrier made the decision to open coverage for remediation services provided by ACE Restoration Services, LLC ("ACE") in the amount $9,990.00.

Preferred Claim Solutions, Inc. has prepared a comprehensive estimate for the necessary repairs, totaling $66,167.07.

Universal did not include an estimate or otherwise explain how it determined the loss was only worth $27,500 before applying the policy deductible. $25,000 is the exact amount of the at fault driver's insurance coverage for the accident, which Universal eventually collected from the at fault driver'

The insureds submitted a comprehensive estimate for $59,928.25, accurately reflecting the necessary cost of repairs.

The insured submitted a comprehensive estimate for repairs totaling $59,230.57, reflecting the necessary costs to restore the property.

Tender payment to the Stewarts in the amount of $56,355.27, which is the amount to return the Stewarts' home back to pre-loss condition.

The Insured's public adjusting firm, Sky Property Claims Adjusting inspected the property, took photographs and prepared an estimate of $54,816.15 to put the property back to its pre-loss condition.

An estimate found damage totaling $54,431.00, emphasizing the actual total damage there is to the Property.

After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $54,211.56 in covered damage to the dwelling.

The insured's representative prepared a detailed estimate for repairs totaling $53,744.37, accurately reflecting the cost of addressing the hail damages.

After assessing the damage and the true scope of repairs, the roofing contractor prepared an estimate identifying $50,820.00 in covered damage to the roof and $5,213.00 in covered damage to the solar panel system.

After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $50,400.47 in covered damage to the dwelling.

Specifically, the policy language that Universal incorporated into their denial letter is regarding diminution in value, which is not being alleged in this claim.

In addition to the estimate, Insurer sent Complainants and their agents a Summary of Loss Statement that included this new value of damages less the deductible and prior payments and issued payment of $21,482.47 to Complainants.

After sending an adjuster out to inspect, Heritage Property & Casualty Insurance Company acknowledged that they found damage to the roof of the home but claimed that this damage is not covered under the policy, and applied inapplicable exclusions.

After assessing the damage and the true scope of repairs, the public adjuster prepared an estimate identifying $48,357.47 in covered damage to the dwelling.

After assessing the damage and the true scope of repairs, the public adjuster produced an estimate identifying $47,444.51 in covered damage to the dwelling.

The insurer's estimate for damages stands at $2,830.61, an amount that fails to account for the full scope of necessary repairs, while the insureds' comprehensive estimate for restoration totals $47,379.88.

Tender payment to the Robinsons in the amount of $46,744.64, which is the amount to return the Robinsons' home back to pre-loss condition.

After assessing the damages, the Public Adjuster produced a photo sheet and an estimate, totaling $46,403.30.

The Insurer informed the Insureds that they are unable to issue payment as the damages to the property totaled $776.20, which is less than the policy deductible of $ 6,580.00.

After receiving a roofing report the Insurance Company did open up coverage on January 12, 2024, but failed to fully indemnify their insured from loss, issuing a payment of only $2,207.03.

To cure this civil remedy notice and avoid further legal action, Farmers must immediately acknowledge full coverage under the insured's policy, and issue payment reflective of the full scope of necessary repairs which is estimated at $43,917.23.

The estimate reflected a purported covered amount of $836.42, which, after subtracting the $1,000 deductible, resulted in no coverage whatsoever.

Claims as to the damage to the property and generated a true and accurate estimate of the damages in the amount of $38,838.91.

Whereas, the carrier furnished a wrongful estimate and, having withheld the deductible, offered deficient payments in the amounts of only $3,239.86 and $2,938.47, leaving a remainder in the amount of $32,416.37 to be paid in order to cure the breach, less any applicable policy deductible.

The requested amount represents the Insured(s) roof estimate $38,274.54 less the applicable $13,000 deductible.

It prepared a good faith estimate to replace the roof that totals $34,384.41.

Thereafter, an estimate was provided in the amount of $1,297.94, which was below the insured's deductible.

Merely 8 days later, on or about May 5, 2022, Insurer issued a coverage denial letter solely basing the denial on the field inspection.

Therefore, to cure the defects outlined in this Civil Remedy Notice, the carrier must: 1.) Pay the complete covered loss in the amount of $30,748.58 (after application of the deductible); and 2.) Pay the statutory interest on the amount of unpaid damages from the date the loss was reported to the da

Following an inspection of the home, Carrier agreed with Complainant's review of the damage that it required a replacement, leading to the issuance of $10,962.86 in ACV funds.

Hicks photographed the property and prepared an estimate of damages for $2,593.27 in replacement cost value which included roof and interior repairs as well.

Carrier subsequently underpaid the claim on March 11, 2024, paying only $1,136.57 after deductible.

On March 15, 2024, Homeowners' Choice issued its' coverage decision and advised the Insured that if the roof was replaced and documentation shown the depreciated value of $2,449.86 would be paid.

On January 14, 2025, the new desk adjuster emailed both the insured and me, stating that the inspection supported a supplemental payment of $7,177.76.

During the course of American Integrity's investigation, the Insured made the property available for inspection, provided facts and information surrounding the loss, and complied with American Integrity's adjustment of the claim.

The estimate was so low it did not eclipse the deductible and no payment was issued.

AMERICAN SECURITY INSURANCE COMPANY can cure the violations contained herein by issuing a payment for all contractual damages owed, per estimates of $33,986.[address redacted]us interest, costs, and attorney's fees.

To date, after several requests, [name redacted] has failed to provide any policy of insurance covering its liability.

The Insured has submitted clear and compelling evidence, including photographs, estimates, and weather data, supporting the claim that the roof sustained damage due to a covered peril.