The claim that never gets decided

Hallowell sent the insured a letter indicating that the fire loss was a covered claim and that payments in the amounts of $58,824.05 under Coverage A - Dwelling, and $2,758.00 under Coverage B - Other Structures were being issued. On May 2, 2023, the insured obtained a fire damage new construction estimate from DBR Construction totaling $248,170.73 to re-build the fire destroyed home. On September 28, 2023, [name redacted] Claims Adjusting prepared an estimate totaling $246,447.32 for Coverage A - Dwelling alone, which exceeded the limits of the subject policy.

Given the denial and the scope and nature of the damage, the Insured retained a roofing contractor. 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. The Insurer based this denial on the rationale that the damage sustained was " a result of wear, tear, and deterioration." However, the Insurer never retained an engineer to ascertain the cause of damage to the Insured's roof.

Specifically, the Insured, with assistance from their public adjuster, submitted an estimate for $145,109.57, which was a fair and reasonable assessment for the repair/replacement of damages. J&S Restoration has an outstanding balance in the amount of $3,104.86 for their mitigation services. Carrier can cure the defects outlined in this Civil Remedy Notice and avoid a lawsuit for bad faith by immediately accepting full coverage under the subject insurance policy for this claim and by paying Insured's estimate of damages $145,109.57, and J&S Restoration in the amount of $3,104.86, less applicable deductible, which is the reasonable amount of the covered loss pursuant to the policy.