Homeowners Insurance Question/Leaky Roof

[mainemike]

I trust everyone here and maybe one of you has experience w/this: my roof is leaking and dripping into my kitchen. VT Mutual says they will send an adjuster to have a look. How is this going to go?

[Chad]

In general, unless there is damage there will not be coverage. Damage defined as sudden and accidental. Like wind blowing off shingles or a tree branch falling on the roof in a storm or hail. If it is just a leaky roof due to age, then there is no "damage" to be repaired. Water damage to personal property inside is a little different, it depends on the type of coverage, if it is "all risk" it may be covered. If it is "named peril" i would guess leaky roof isn't a named peril and you won't have coverage.

Sound shifty enough? The adjuster is going to come out and try to determine the cause and scope of the damage. Until that's done, it hard to speculate on what is or is not covered. When I was in claims "leaks" were one of my least favorite, hard to know exactly how or why or where they are coming from. Leads to a lot of "why the hell do i have insurance?" comments.

Let me know how it turns out, glad to give any advice I can. In the mean time find your HO policy and see what it says. Policies differ greatly on how much/what is covered. A "Cadillac" homeowners policy is worth the $ if you can afford it. I have never heard a complaint from someone having too much coverage.

[mainemike]

In general, unless there is damage there will not be coverage. Damage defined as sudden and accidental. Like wind blowing off shingles or a tree branch falling on the roof in a storm or hail. If it is just a leaky roof due to age, then there is no "damage" to be repaired. Water damage to personal property inside is a little different, it depends on the type of coverage, if it is "all risk" it may be covered. If it is "named peril" i would guess leaky roof isn't a named peril and you won't have coverage.

Sound shifty enough? The adjuster is going to come out and try to determine the cause and scope of the damage. Until that's done, it hard to speculate on what is or is not covered. When I was in claims "leaks" were one of my least favorite, hard to know exactly how or why or where they are coming from. Leads to a lot of "why the hell do i have insurance?" comments.

Let me know how it turns out, glad to give any advice I can. In the mean time find your HO policy and see what it says. Policies differ greatly on how much/what is covered. A "Cadillac" homeowners policy is worth the $ if you can afford it. I have never heard a complaint from someone having too much coverage.

Thanks dude! Much appreciated!

[Rich Beaudoin]

I suggest getting a local roofing contractor to come and inspect your roof before the claims adjuster comes, and if possible, be there with the adjuster also. Their natural biases will be opposite and the adjuster has expertise about the subject which most homeowners like myself do not.
I had damage to my roof about 18 months ago (found by roofer when we were planning to add living space above garage).
It felt like the insurance company was trying to get us to say something that would clear them from covering damage. The adjuster was particularly interested in how I found the problem and I was questioned on the record about this in many ways, it was like a lawyer trying to get a witness to change their story. I maintained that I rarely go onto my roof, and I did not find the problem, the contractor found it and told me.
The contractor was able to show the adjuster what he saw (the adjuster disagreed, but took pics and made notes of the contractor's professional opinion in his report).
If it had been only the adjuster's decision, we would have had no claim. Insurance paid after six months of my pestering. Keep records of dates, names and what was said.
This is the only non-medical insurance claim I have ever made after paying car and home insurance for decades

[FSonicSmith]

In general, unless there is damage there will not be coverage. Damage defined as sudden and accidental. Like wind blowing off shingles or a tree branch falling on the roof in a storm or hail. If it is just a leaky roof due to age, then there is no "damage" to be repaired. Water damage to personal property inside is a little different, it depends on the type of coverage, if it is "all risk" it may be covered. If it is "named peril" i would guess leaky roof isn't a named peril and you won't have coverage.

Sound shifty enough? The adjuster is going to come out and try to determine the cause and scope of the damage. Until that's done, it hard to speculate on what is or is not covered. When I was in claims "leaks" were one of my least favorite, hard to know exactly how or why or where they are coming from. Leads to a lot of "why the hell do i have insurance?" comments.

Let me know how it turns out, glad to give any advice I can. In the mean time find your HO policy and see what it says. Policies differ greatly on how much/what is covered. A "Cadillac" homeowners policy is worth the $ if you can afford it. I have never heard a complaint from someone having too much coverage.

Substitute the word "occurrence" for "damage" and I agree with this. Think of an occurence as a single identifiable event that is unexpected and unforseeable. I also don't agree with the adjective "shifty". The insurance industry is far from perfect, but homeowners coverage is not a warranty.

[BShow]

I suggest getting a local roofing contractor to come and inspect your roof before the claims adjuster comes, and if possible, be there with the adjuster also. Their natural biases will be opposite and the adjuster has expertise about the subject which most homeowners like myself do not.
I had damage to my roof about 18 months ago (found by roofer when we were planning to add living space above garage).
It felt like the insurance company was trying to get us to say something that would clear them from covering damage. The adjuster was particularly interested in how I found the problem and I was questioned on the record about this in many ways, it was like a lawyer trying to get a witness to change their story. I maintained that I rarely go onto my roof, and I did not find the problem, the contractor found it and told me.
The contractor was able to show the adjuster what he saw (the adjuster disagreed, but took pics and made notes of the contractor's professional opinion in his report).
If it had been only the adjuster's decision, we would have had no claim. Insurance paid after six months of my pestering. Keep records of dates, names and what was said.
This is the only non-medical insurance claim I have ever made after paying car and home insurance for decades

I agree... get a contractor or two to come out and provide an estimate first before your adjuster gets there. That way you are armed with at least one other assessment of damages and you've also got a clear picture of the expense involved with making things right. Make sure you consider all internal damage as well and look for damage away from the immediate area of the leak. Water will run downhill away from the leak itself and can make its way a lot farter than you might think - down rafters, down wall studs, into the basement, etc. think outside the box... often times its not as simple as water dropping straight through a hole and into your kitchen. If you have a preferred contractor, try to have a representative there with the insurance adjuster and make sure the contactor knows its a meeting with an adjuster so he can prepare accordingly.

Hopefully your adjuster is in a good mood... have your wife bake some cookies or something (kidding). The adjuster that inspected my roof seemed to have a chip on his shoulder and I think I'm the only house in the neighborhood that didn't get a completely new roof (hail damage). Nothing my contractor said even made a dent in the adjuster's stance and I got a check to repair damage, which was a bummer.

[Chad]

Substitute the word "occurrence" for "damage" and I agree with this. Think of an occurence as a single identifiable event that is unexpected and unforseeable. I also don't agree with the adjective "shifty". The insurance industry is far from perfect, but homeowners coverage is not a warranty.

Would you agree that the "occurrence" must cause "damage"? With no damage, there is no claim.

With regard to shifty, I was being sarcastic, kind of. The insurance industry has always made me go hmmmm. Sold by an agent that wants a happy customer, claims paid, but doesn't want claims paid as it defines his book of business, companies may either find coverage or find exclusions, the policy is written so that it can only be understood by experts, difficult for the average person to understand.

I've been in the business my entire adult life, moved out of claims 8 years ago. My attempt to explain damage was precisely to your point that insurance is not a warranty.

But it always comes down to this: "This is the only non-medical insurance claim I have ever made after paying car and home insurance for decades"

Going without a claim for a long time is great, unfortunately is has nothing to do with coverage/damages/liability/etc.

[FSonicSmith]

Would you agree that the "occurrence" must cause "damage"? With no damage, there is no claim.

With regard to shifty, I was being sarcastic, kind of. The insurance industry has always made me go hmmmm. Sold by an agent that wants a happy customer, claims paid, but doesn't want claims paid as it defines his book of business, companies may either find coverage or find exclusions, the policy is written so that it can only be understood by experts, difficult for the average person to understand.

I've been in the business my entire adult life, moved out of claims 8 years ago. My attempt to explain damage was precisely to your point that insurance is not a warranty.

But it always comes down to this: "This is the only non-medical insurance claim I have ever made after paying car and home insurance for decades"

Going without a claim for a long time is great, unfortunately is has nothing to do with coverage/damages/liability/etc.

I do Insurance Litigation for the largest insurer in the U.S. Yep, wish I had a quarter for every claimant who told me that they had been insured by my client for ten plus years and this was their first claim, as if that were a consideration. It's just human nature that when people don't understand something, they appeal to concepts that they do understand like their belief that past premium payments should have some bankable value.
The average consumer loses sight of the fact that insurers are regulated in every State and for the most part, policies of insurance conform to standardized ISO forms. As someone else said, with insurance you get what you pay for. Policies of insurance are not as complex as tax returns or investment/stock market research-the average consumer simply does not have the interest or inclination to sit down and read the policy to see what is covered and what is not. In Ohio and most other States, the agent has zero duty to make sure that the customer has adequate coverage but if the customer asks the right questions, the agent or insurer has a duty to provide correct answers. Let me give an example; over and over again I run into claimants or Plaintiffs that are provided a work car to drive and they get in accidents caused by uninsured or underinsured motorists. Police officers for example. 99.9% of the time, the employer carries liability coverage on the fleet vehicle but no UM/UIM coverage. The employee then turns to his personal insurer and there is no coverage due to the standard exclusion for vehicles "available for regular and frequent use". Now let's say the insurance agent knows damn well that his customer is a cop to keep my example. The agent has no duty to warn said cop that he is lacking coverage is he gets hurt by an uninsured motorist. But if the cop asks, the agent has a duty to inform him correctly that there is no coverage under the standard policy but that a rider is available at extra cost to cover the gap. You would think that the agent would be motivated anyway to sell extra insurance and to some degree this does happen, but the cop can't complain if it never came up and he/she never specifically asked.