Posted : 01/09/2013
Sometimes disaster destroys everything in sight, but often misfortune causes damage here and there.
A pipe bursts and water ruins a corner of your Brazilian cherry wood floor. A windstorm tears off half of the vinyl shingles on one side of the house. Or a fire burns a couple of kitchen cupboards. Home insurance generally covers partial losses such as these. But the extent to which the insurer must go to make everything look just the way you'd like is a thorny issue.
What happens, for instance, when the new siding contrasts with the older, weathered siding? Or you can't find replacement kitchen cupboards that precisely match the others?
"Most commonly we see the question come up with roofs," says Ronald Reitz, president of Quality Claims Management Corp. in San Diego and president of the National Association of Public Insurance Adjusters (NAPIA).
Sometimes insurers propose replacing only the broken shingles. That's a problem if the end result is a roof that looks like a patchwork quilt, Reitz says.
"If your claim is settled properly it should put you back to pre-loss condition," says Art Jansen Jr., CEO of Jansen International LLC in Houston and first vice president of NAPIA.
In other words, Reitz says, the new part shouldn't stick out like a sore thumb; the appearance should be uniform within the line of sight. Inside, that could mean replacing the entire floor of a room even if only a portion needs repair, or repainting all the walls even if only one was damaged.
In some states you have case law or state statutes on your side. In Florida, for example, if replaced items don't match in quality, color or size, the insurance company must make "reasonable repairs or replacement of items in adjoining areas."
Other states, such as Colorado, don't have specific laws on matching. Carriers in some of these states have added non-matching language to policies and introduced endorsements to cover matching.
American Family Insurance, for instance, now offers the "Matching Undamaged Siding and Roof Coverage" endorsement, which covers up to $20,000 of the cost to update with new materials the undamaged siding or roofing if there's a mismatch when repairs are made. The endorsement costs $20 to $30 a year.
Even in states where insurance companies are required by law to make everything match, company adjusters often push for less-expensive patching and resist full replacement, according to United Policyholders, a San Francisco-based consumer advocacy group.
"It's not a slam dunk," Reitz says. "They balk all the time, but when you press, they'll give in. The argument I generally make is it all matched before, so it should match now." (See: "Hidden dangers of filing a home insurance claim.")
Reitz says there's less push-back from insurers about replacing an entire counter or floor than for replacing a roof or all the siding.
Jansen says besides varying by state, insurer and policy, the issue of patching versus full replacement depends a lot on individual insurance company adjusters. Some are more flexible and willing to accommodate customers more than others.
If you can't make any headway, Jansen says consider going over the adjuster's head to a supervisor. Still think the insurer is treating you unfairly? Contact your state's insurance department to file a complaint. Another option is to hire a public insurance adjuster, who works on your behalf through the claims process. Public insurance adjusters generally charge about 10 percent of the final settlement, so you'd pay about $2,000 if your claim settlement is $20,000. If they're able to recoup more than you would by filing a claim by yourself, a public insurance adjuster's service pays for itself. (See: "Public insurance adjusters work to streamline claims.")
Overall, with most insurers, Jansen says, "If you make a compelling argument, typically they listen."
However, the issue of full replacement after a partial loss gets a bit tougher with flood insurance claims. Say, for instance, flood water ruins the bottom kitchen cabinets, but not the upper cabinets. Flood insurance generally doesn't pay to replace anything that didn't get wet, Jansen says. (See: "Five ways flood insurance may soak you.")
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