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Question
With the recent Super Storm Sandy in the NY area I had roof damage to my home.  My insurance company approved the claim and sent me a payment.  About 60 days later I got a letter in the mail saying the claim was denied due to normal wear and tear of the roof.  I have already had my roof repaired.  My question is can they do this legally -- Approve a claim then deny it and also do I have to send them the money back?

Answer
April,

In all likelihood, the letter you received was a mistake simply due to the volume of claims that the carriers are handling in this event. Many of these letters are computer generated when a code is punched in on a particular policy number and it might have just been a situation where a couple of policy numbers were switched.

You do NOT have to return the claim payment, especially in light of the fact that you relied on their initial determination of the loss and had the repairs done.

I would suggest that you send a non-threatening letter explaining that you had moved promptly to repair the damages in order to protect your property from further damage after their adjustment of the loss and that you had relied upon their original decision. Be sure and use the term "relied" in your letter because that is kind of a catch-word. Include the information you received with the original adjustment/claim payment. Also send a copy of their letter along with yours and point out that they may have mistakenly sent it to you. (There may be someone else out there that is still waiting to hear about their claim that it was intended for.)

This will likely end your worries.

Hope this helps.

Kevin Hromas
JD, EGA, RPA, PLCS, HCRI-R/C, CPIU, WINDŽ Umpire
Kevin Hromas & Associates
... A Division of US Insurance Information LLC
www.KevinHromas.com

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Kevin Hromas

Expertise

I am a licensed, executive general adjuster currently holding a Texas resident P&C license (614250), New Mexico non-resident all lines license (248774), Oklahoma non-resident P/F/M license (A299561), Florida non-resident P&C license (E117051) and a National Flood Insurance Program certification (06040100). My areas of expertise involve property and casualty issues in both residential and commercial policies with regards to claims practices and issues. I deal extensively with Lloyd's of London commercial policies and various domestic carriers for residential policies.

Experience

After a 20 year career as a General Contractor, I was employed by Allstate Insurance as an adjuster in Texas, holding various postitions within the property claims department. After leaving Allstate, I specialized in handling losses associated with major catastrophes through-out the country. (Hurricanes Isabel, Charlie, Wilma, Katrina, Ike, etc., hail storms, floods.) I am currently retained as an expert by multiple insurance defense firms in Texas for issues in litigation. I am also a certified Umpire for formal appraisals.

Organizations
Member - Society of Registered Professional Adjusters Fellow - Council on Litigation Management Member - Property and Casualty Association Member - Texas Independent Insurances Adjusters Association Member - National Association of independent Insurance Adjusters Member - Houston Claims Association

Publications
Claims Magazine (www.ClaimsMag.com and then search 'Kevin Hromas' for a full listing of articles and quotes.) www.ClaimsPages.com, www.ProAdjuster.org, www.KevinHromas.com

Education/Credentials
JD - University of Houston Law Center - 1992 BA - Southwest Texas State University - 1980 AA - South Plains College - 1977 PLCS - Personal Lines Coverage Specialist

Past/Present Clients
Certain Underwriters at Lloyd's, London, Fulbright & Jaworski (Law Firm), Bracket & Ellis (Law Firm) Thamm & O'Briant (Law Firm) Sheehy, Ware & Pappas (Law Firm) Walker, Wilcox and Matousek (Law Firm) Financial Guarantee Underwriters

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