The decision made without a real look

The insured promptly reported the claim and fully cooperated with the carrier's investigation. Then in a letter dated April 19th 2024, the carrier notified the Insured that it had completed its investigation into the loss and had fully denied the claim. Given the vastly underestimated cost of repairs, the Insured's disagreement with the coverage decision, and the scope and nature of the damage resulting from the loss, the Insured through its retained representatives disputed the coverage determination and submitted an estimate prepared by Hunter Claims for $166,493.64.

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. Thereafter, the Insurer sent another claims determination letter dated December 12, 2024, advising that it was maintaining its denial of coverage for the Insured's roof damage but extending coverage in the amount of $916.42 for some unknown damage. According to the claims determination letter, the Insurer's engineer observed damage to the roof but attributed the cause of this damage to several causes excluded under the policy.

Moreover, CCS determined that at least $90,152.17 worth of repairs would be required to return the property to its pre-loss condition as a result of the windstorm loss. Thereafter, the Insured sent correspondence to FRONTLINE enclosing the supporting CCS report outlining the cause, scope, and cost of the loss along with other supporting documents and requested FRONTLINE to reconsider its coverage denial. On December 18, 2024, the insured sent correspondence to FRONTLINE enclosing the Sworn Statement in Proof of Loss, the supporting CCS report outlining the cause, scope, and cost of the loss along with other supporting documents, the Notice of Intent to Initiate Litigation, and requested FRONTLINE to reconsider its coverage denial.