My Claim Was Denied Due Wear & Tear

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Claim Denied due to wear and tear

My claim was denied due to Wear & Tear!! This is a phrase that I have heard more times than I care for. Insurance companies are making it a routine and business as usual this is their go-to policy language to deny a claim. Blame it on wear and tear, I worked as a desk adjuster for a large insurance carrier when I first started my career as an insurance adjuster. We had a paper-mill of canned responses that were not necessarily part of the insured's policy it was just general language from the policies that we sold. Fortunately and unfortunately I did not know what I was doing at the time. I was just doing what I was told to do.  It was not until years later that I learned what I was did was not proper claims handling and may have been illegal.

I often get arguments from Carrier adjusters now regarding wear and tear and I have to laugh. This is how the typical argument goes. We only saw 197 damaged shingles on the roof, and the policy only owes for direct physical loss. The damage to the surrounding shingles because the roof is not repairable is denied because they are not repairable due to wear & tear, and wear & tear is specifically excluded in the policy, so we are not going to pay for that.

While I wish I was making this stuff up, sadly I have seen this argument from 100's of adjusters and even some attorneys. Let's dissect this argument a little bit so that we can more fully understand what they are saying. They are implying that because wear and tear exists and there was wind damage they are arguing that the policy either has no coverage or limited coverage.

So I have to ask. When did wear and tear not exist on the property? The answer is from the very first day that property was built there was wear and tear on it. If they are going to exclude all other coverages because there was wear and tear on the property then they fraudulently sold you a policy promising coverage that did not exist, and they should be reported to the FBI for investigation and prosecution.

I like to assume, however, even if the evidence and pattern of behaviors may say otherwise, that the insurance company did not intentionally sell you an insurance policy in an effort to defraud you; but that this is an honest mistake by an un-educated adjuster or attorney. After all, they paid for a 197 shingle on your 30-year-old non-repairable roof, right?

So let's talk about this assuming that coverage was granted the carrier offered a repair to your old roof.  So they are claiming the denial of the rest of your roof due to wear and tear. However, what about the 197 shingles? Didn't they have wear and tear on them too? Why were they covered? Their very own argument undermines their denial of the consequential damages.

I think should be starting to get the point. Wear and Tear can only be denied as a cause of loss not a condition to the property. The insurance after all has been collecting your premiums without complaint, they are also at the ready to apply depreciation to your roof on any payments. This brings me to my next point. What does depreciation account for? Depreciation on your claim account for wear and tear!!!

Under an Actual Cash Value Policy(ACV) your 30 year or roof would be depreciated to $0.00 and you would not be owed for your damaged roof. Why? Because there was no life expectancy left on your roof and you did not pay an additional premium to be entitled to the Replacement Cost Value (RCV).

But what if you did purchase an RCV policy? 80%  of all homeowner policies are RCV policies. You are entitled to the replacement cost of the roof. Yes even though it is 30 years old and its life expectancy is pretty much over. If the carrier was still insuring it at the time of loss then it is should be covered even it is not repairable.

Your policy owes to repair your property to a pre-loss condition. Sometimes that repair includes the replacement of the damaged property.