I have been involved in several commercial property claims where the insurer has agreed to pay the cost to remove and to replace roof shingles damaged by hail, but has refused to pay the cost to remove and to replace the decking, even though the condition of the decking is such that it no longer is in a suitable condition for application of the new shingles. The insurer’s reasons for refusing to pay for the costs of the decking removal and replacement are two-fold: (1) no coverage is afforded for the decking because it was not directly damaged by hail and (2) replacement of the decking is a code upgrade, and in my claims there was limited ordinance or law coverage. So, is the insurer right? Is replacing roof decking as part of replacing hail-damaged shingles a coverage or a scope issue? In my opinion, it is a scope of repair/replacement issue.
Continue Reading Replacing Roof Decking as Part of Replacing Roof Shingles: Coverage or Scope Issue?

Earlier this year, I wrote about a consumer friendly bill signed into law in New York allowing the "scope of loss" to be determined by appraisal. I received a comment to the post providing insight into how insurance carriers are treating appraisals where scope can be in dispute. I thought I would share with our readers and see if others have experiences with insurance carriers presenting similar arguments in New York appraisals.

Continue Reading Governor Cuomo Signed Bill Into Law On November 21st Allowing Appraisals In New York To Determine “Scope Of Loss” – Part 2

Appraisal in first-party property insurance claims is meant to resolve disagreements over the amount of loss. Appraisal is a contractual alternative dispute resolution process. But often the parties dispute involves some disagreement over the scope of the covered damages resulting from the loss. Insurance carriers often argue that disputes involving the scope of damages caused by a loss should not go to appraisal. Well, Governor Cuomo officially signed a bill into law on November 21, 2014, allowing appraisals in New York to determine the "scope of loss."

Continue Reading Governor Cuomo Signed Bill Into Law On November 21st Allowing Appraisals In New York To Determine “Scope Of Loss”

Yet another Colorado District Court ruled that “amount of loss,” as that phrase is used in property insurance policy appraisal provisions, means during appraisal, the appraisers and umpire must be able to determine the scope of loss resulting from the covered cause of loss. By necessity, that means appraisers must make some determinations as to causation.

My past blog posts on this topic can be found here.

Continue Reading Update: Appraisal Includes Scope Of Loss And Causation

My September 23, 2011 post, Is Scope of Damage or Scope of Repair Subject to Appraisal? examined several recent opinions from around the country which discussed whether insurers may deny policyholders their right to appraisal by simply claiming that scope of damage is not subject to appraisal. Since September, two different Colorado district courts have ruled that scope of damage is indeed subject to appraisal. Hopefully, the holdings discussed below will go up on appeal and become binding law in 2012.

Continue Reading Update: Scope Of Damage And Scope Of Repair Is Subject To Appraisal

Most property insurance policies include an appraisal provision that may be invoked by either the insurer or the insured to determine the value of a loss. Courts generally agree that “valuation” is the task of an appraisal panel, and “coverage determinations” are the province of courts. However, courts are inconsistent as to whether the scope of damage falls under “valuation” (which may be decided by appraisal) or falls under “coverage determination” (which must be decided by a court).

Continue Reading Is Scope of Damage or Scope of Repair Subject to Appraisal?