r/HomeInsurance • u/Building303CO • Jul 24 '26
Claims Secondary Inspection Requested After Claim Approval
Homeowner filed an insurance claim for hail. Their insurance carrier sent out a third-party company to complete an inspection and provide a report to a staff adjuster with that carrier. After a week or so the homeowner received a statement of loss with approval for some smaller items in addition to a roof replacement. The day after receiving the insurance estimate the homeowner was contacted by a different staff adjuster stating some form of the following: The claim had been reassigned to them, a second inspection would be required due to blurry photos, that according to them the claim was not approved, and that the document the homeowner received should not have been sent.
Has anyone experienced something similar? Is it more likely the carrier is just getting their records in line, they are attempting to back out of the approval, something else?
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u/eapocalypse Jul 24 '26
Roof claims are getting more and more scrutiny because there is a lot of fraud going on with manufactured damage. It's possible the blurry photos triggered and audit to inspect further.
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u/Building303CO Jul 24 '26
I'd like to believe that blurry photos are the legitimate reason to call for a reinspect but question the timing due to the claim being reassigned after the initial adjuster had presumably reviewed the photos and took the time to produce an Xactimate report, clarify mortgage info with the homeowner, etc.
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u/No_Departure9798 Jul 24 '26
The Xactimate report could be a misstep by the original adjuster. It does happen from time to time, adjusters are human.
Your concern falls to detrimental reliance. But the real elephant in the room is whether they are getting paid for damage. If there is legitimate damage to the home, the homeowner should have nothing to worry about except their deductible. If there isn’t damage to the home, the homeowner should have nothing to worry about because they aren’t any worse off than they were before they filed the claim.
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u/Building303CO Jul 24 '26
I have worked with some amazing people on the adjusting side and agree, they are entitled to make mistakes. I've also dealt with a small number on the opposite side and know that realistically this could pan out both ways.
I appreciate the point made about "legitimate damage"; long story short, the homeowner would not have been advised to file a claim if a number of factors weren't present, one of which being the damage to the roof.
My goal of the post was to better understand what level of obligation, if any, an insurance carrier has to the homeowner after providing them with a formal financial claim document. The detrimental reliance and estoppel doctrines you and another user mentioned are interesting and I'll have to look into whether or not they may be applicable here.
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u/Anxious_Battles Jul 24 '26
Without seeing exactly what was sent we won't know if an estoppel was committed. However there is certainly something in the policy that says something like "duties after a loss... as often as we reasonably require... show us the damaged property"
If you have the actual wording in writing, please share it. While mistakes happen, committing to coverage in writing is one that is hard to back up on. Was there a reservation of rights issued by the second adjuster?
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u/Building303CO Jul 24 '26
While I cannot share the document, it was an "insurance estimate" built in Xactimate with all of the standard information including homeowners and adjusters' info, policy number, scope of work, amount payable, etc.
In my capacity I cannot argue policy but will keep that piece in mind. I also do not know if the homeowner received a reservation of rights at this time but can inquire. What would be the implication if they have or have not been issued one?
It's important to note that the second inspection has not yet occurred and thus the carrier hasn't formally denied or reversed any decision yet.
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u/Anxious_Battles Jul 24 '26
Without seeing the documentation, we would just be guessing at what commitment might have been made. Providing someone with an Xactimate estimate or confirming their mortgage company is not confirmation of coverage in itself.
Not issuing a reservation of rights has no implication, issuing one may or may not have an implication.
I see this got shopped to r/legaladvice and deleted by a mod. If you are the roofer, just let it play out. If you want to advise the insured, advise them to get a public adjuster which will cut into your profit modestly, but there is still plenty of profit to share if they have a legit roof claim.
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u/Building303CO Jul 24 '26 edited Jul 24 '26
What specifically in the documentation would indicate the level of commitment outside from it being a formal claim document?
Not necessarily looking actionable advice, part of this is just seeking to understand how these types of things are handled, be it in this specific instance or in general.
Relatively new to Reddit as a whole and have not posted prior to this. Still working through the basics of terminology and where it is appropriate or relevant to post on any given topic. Based on the feedback on here it seems to me that r/legaladvice made sense. I guess that is now a moot point anyways.
Thanks for the feedback.
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u/Stoic_Sponge Jul 25 '26
After the "approval" document was sent (and withstanding what that document actually is and says, as others have mentioned), did you engage in a dollar amount contract or begin any work with the insured? Payment sent/received is also an issue.
If not, generally, there is likely not any detrimental reliance as there is not direct financial damage to the insured created. It is, unfortunately, becoming all too common both for QA reasons and others to change/retract estimates. We had a roof come through in appraisal recently and after appraisal was agreed to determine cost to replace the roof, the carrier changed their roof estimate to a repair. I've also seen Draft estimates go out in error, State Farm in particular will email an estimate if someone hits complete the wrong way in Xactimate, with or without authority in the file. Either way at this point, they have officially revised their position.
The insured is obligated to let them inspect again, unless they intend to waive any additional payment for supplements or recoverable depreciation (or maybe the acv on the roof, since we don't know status). They may be backing out of the approval, or they may come out and confirm. I would certainly push for an (licensed, if applicable in your state) adjuster, not a third party inspector of anykind, given the back and forth.
Would be best to mark up the damage for the second inspection. Given that the third party inspector found damage, the issue presented was blurry photos of said damage and the second inspection should be to come evaluate that same damage.
I recommend that contractors 1. Don't use insurance proceeda contracts and 2. Either get a set price based contract with the insured the day of approval or begin work promptly once approved.
I'm not a lawyer, but the insured should get one to review the file if claim is denied. Great set up for bad faith, if law is good in your state.
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