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 the following key questions before approving the claim:
- Is the roof damage covered under the policy?
Felix needs to determine whether the damage caused by the hailstorm is covered under the terms of Janet’s standard homeowners policy. Standard policies often cover hail damage, but exclusions or limitations may apply based on the age, type, or condition of the roof. - When did the hailstorm occur?
The timing of the hailstorm is crucial. Felix needs to establish that the damage occurred during the event Janet claims and is within the coverage period outlined in the policy. If there is any ambiguity about the storm’s timing, Felix might need to check weather reports or request further documentation from Janet. - What is the extent of the damage?
Felix should inquire about the severity of the damage to the roof. This includes the size and number of hailstones, the area affected, and whether any other parts of the home were impacted. A professional inspection or estimate from a roofing contractor may be required to assess the damage. - Has Janet made any previous claims for similar damage?
It’s important for Felix to verify whether Janet has had prior claims for roof damage or similar issues. Multiple claims may indicate a recurring problem that could be addressed in the policy terms, potentially affecting the payout or eligibility. - Was there any maintenance or repair work done on the roof recently?
Felix should ask if Janet had any recent repairs or roof maintenance that could affect the damage assessment. If there were prior issues that weren’t properly addressed, the damage might not be fully covered. - Is there any evidence of negligence or lack of upkeep?
If the roof was in poor condition before the storm, Felix may need to verify whether the damage was exacerbated by pre-existing conditions that could affect the payout.
These questions help Felix confirm that the damage is legitimate, assess the extent of the loss, and ensure it meets the policy’s terms for reimbursement.