felix is a property claims adjuster for a large property insurer. janet is a policyholder who recently notified the company that the roof of her home incurred substantial damage because of a recent hail storm. janet owns her home and is insured under a standard homeowners policy with no special endorsements. what questions should felix ask before the claim is approved for payment by his company?
The correct answer and explanation is:
Felix should ask Janet the following questions before approving the claim for payment:
- When did the hail storm occur?
This is important to determine if the damage falls within the policy’s coverage period. Most insurance policies have a specific timeframe in which claims can be made after an incident. - What is the extent of the damage?
Felix needs to understand how much of the roof is affected. This includes asking about visible damage, such as dents, holes, or leaks. The severity of the damage will help assess whether the roof needs minor repairs or a complete replacement. - Did you take any immediate actions to mitigate further damage?
Policyholders are often required to take reasonable steps to prevent additional damage after an incident. Janet should confirm whether she covered any openings or made temporary repairs to prevent further issues. - Have you had any previous roof damage or repairs?
Felix needs to know if there was prior damage or repairs to the roof that may have weakened its structure. This could affect how the current damage is assessed and whether any pre-existing conditions played a role. - Do you have photographs of the damage?
Visual evidence will help validate the claim. Pictures of the hailstorm and the resulting damage will serve as supporting documentation for the claim. - Was the damage caused directly by hail, or was there any other contributing factor?
Felix must confirm that the hailstorm was the direct cause of the damage. If other factors, like wind or fallen branches, contributed, the claim may be handled differently under the policy. - Are there any other insurance policies or coverage that might apply?
If Janet has additional coverage or endorsements (like a separate windstorm policy), Felix needs to confirm whether those would affect the claim’s payout.
Felix’s goal is to gather all necessary information to ensure the claim meets the policy’s requirements and guidelines. This helps avoid fraud and ensures that both the insurer and the policyholder are treated fairly.