Insurance claim denials and disputes involving “matching” are frequent. I received this recent comment on the topic of matching:

Hey Chip

Back on 5/17/09, Cat adjuster posted a comment regarding matching of aged paneling and tile floors. You advised that maybe the adjusters were relying on Texas Case Law regarding causation. In my experience, the adjusters and appraisers I am dealing with in Texas simply don’t feel they owe for match. For instance, I am dealing with an adjuster who agrees that the siding on this Galveston Home was discontinued in the 1930’s and is obviously unavailable and can not be matched. He agrees to replacement of the two damaged sides, but insists the carrier does not owe for match of the two remaining sides.

I have argued that failure to replace all 4 sides will not completely indemnify the Insured. He is not moving at all. I have not found any case law or statutes dealing directly with this issue.

Any thoughts??

My first thought is that readers to my blog with questions should do a “keyword” search. If you were to put “matching” into the keyword search form, a number of posts would come up on the topic. One post, Provide the Right Proof so Your Insurer Will Pay Costs to Repair or Replace to Match Texture, Color and Likeness, had particular application to the question with cases—public adjusters should not be arguing case law because it is practicing law. Another post, Texas Hold ‘Em": Merlin Law Group’s Seminar for Texas Public Insurance Adjusters, indicated that we covered this topic at a previous seminar. Nobody falls asleep at my seminar, so the person writing the comment must not have been there.

Since this is a frequent question and Texas insurance adjusters seem to have a “we just aren’t gonna pay for matching” attitude, I will address in detail what you can do about it at the Hurricane Ike-What a Difference A Year Makes? Seminar on September 11 for public insurance adjusters.

For what it is worth, the FC&S Bulletins also noted that the topic of “matching” is a frequent coverage dispute. A question was posed to their editorial board:

I have an insured with a homeowners (3) policy who had a wind loss that took a few strips of aluminum siding off the front of his house and few from the back side of the chimney. The siding can not be matched color or grain and the carriers solution is to take a few strips off one of the lower sides of the house put those in where the damage is, where it will not be so noticeable and put the new ones back on the lower sides. What thoughts do you have on this claim?

The answer may be helpful to many with these issues:

The solution offered by the insurer is not in keeping with the HO 00 03 (such as the standard ISO form), which promises to pay "replacement cost of that part of the building damaged with material of like kind and quality and for like use; or the necessary amount actually spent to repair or replace the damaged building." By putting on old siding to replace old siding, the insurer is effectively providing an "actual cash value" settlement, which allows depreciation.

But that is not what the insured has been paying for. The replacement cost policies have traditionally been sold to give "new for old." Yes, this violates the principle of indemnification, but that is how the policies are marketed and that is what the insured pays additional premium for.

So, in this case, the insured had matching siding prior to the loss, and is entitled to new matching siding following the loss.

I am going to have a lot more about this at the seminar, and do not ask for the materials if you cannot go. Just be there.

For policyholders that read this, I hope it is useful. You should also get the feeling that only attorneys and public adjusters that subscribe to the on-line edition of the FC&S should represent you. Those people will go the extra mile for you because they know the value of investment in knowledge regarding a very specialized area of insurance.

For insurance company claims managers and their attorneys reading this, pay my clients while you have the chance!

  • Mark Phillips

    My experience in northern Minnesota years ago dealt with American Family, with huge market share in the upper midwest, trying to bully homeowners into a “firm settlement corner” by saying they only owed for the damaged elevations of the house after huge wind and hail storms hammered a large region.

    The final outcries from many towns effected, along with community and political leaders, led to a referendum up to the State House. This led to a slap down on the carrier’s behavior and stringent adjustment of what rightly was to be interpreted replacement in “like kind and quality” – exactly what the consumers had paid extra premiums for.

  • Mike Rump

    Ouch!!! I did do a keyword search and I did attend your seminar.

    I even read the associated blogs and your entire blog (which is wonderful)

    This is why I wrote the question the way I did since the blog (all of them) are silent on this very specific issue.

    I have found all of the old tried and true arguments about loss of value, line of site, the acv arguments etc. etc. I don’t believe the courts have touched on this and I guess you feel I am being sarcastic with the question (hence your response). However, it is extremely frustrating here in Texas to make all of these arguments and have an adjuster stand in front of you with their mouth open (catching flies) and say “NOPE, we don’t owe for match”… My question was an attempt to secure an answer (which may not exist) that would be irrefutable.

  • Mike,

    If you would say nothing other than to give your reasons….

    And then, if you would come visit me….

    And, we “…..” them…..for treating their own customers wrongfully….

    And should the next adjuster know what happened….

    The next adjuster would not just look at you with a mouth, open, saying “Nope.”

    Stop practicing law and suggest your client needs good legal counsel. You do too!

  • Tim

    State Farm will pay for full replacement of roofs or siding if it’s determined the existing material on home no longer exists but do they have that written anywhere and where can I find it? Seems lately they pick and choose when they use this policy.
    Thanks,
    Tim