I once had a homeowner call me about problems he was having with his insurance company. The caller, who I will call “Bob,” described that his roof had been damaged in a windstorm to the extent that rain now got in his house. Bob then described that he reported the loss to his insurance carrier, which then dispatched an adjuster. The adjuster noted that the roof was not keeping out the rain and mentioned that the homeowner had an obligation to make temporary repairs to prevent further damage. Bob mentioned that he challenged the adjuster on whether he or the insurance company was responsible for paying for temporary repairs.
A day or so after the inspection, Bob received a letter requesting that he submit a certification that the repairs had been made and requesting his expenses in making the repairs to the insurance company. Bob said that he called the adjuster and left a voicemail indicating that he wasn’t going to make the repairs. After all, for what purpose had he been paying his premiums all of these years without a claim?
Some time not long after leaving the voicemail, Bob got another letter from the adjuster. This letter quoted the policy language that mandated the insured made temporary repairs. It pointed out that the insurance company would reimburse Bob for the cost of the repairs and requested that he submit his receipts.
Bob then got a certified letter from a lawyer indicating that the insurance company intended that Bob submit to an examination under oath (EUO). The letter went on to request that Bob tender a proof-of-loss on the claim. Bob’s voice shook with indignation in describing the contents of the letter.
“Now they’ve told me that there is no coverage on the claim,” Bob said.
“On what date did the loss occur?” I asked.
He responded, “Six months ago.”
“Did you make the temporary repairs?” I asked.
“Hell no I didn’t make the repairs, the insurance company hasn’t paid me,” he replied.
“Is rain still getting in?”
“Yes, and it has ruined the carpet in there now. There’s mold everywhere.”
“Did you sit for the EUO?”
“Hell no,” he snorted.
“How long since they asked for the proof-of-loss?”
“Two or three months,” he said angrily.
“Bob,” I asked, “Are you familiar with the phrase, “Seven ways to Sunday?”
“Hell no,” Bob replied, and hung up.
All property and casualty policies contain a section setting out the insured’s duties after loss. The obligations imposed are conditions of coverage. That is, the insurer is not obligated to pay a loss that would otherwise be covered if the insured fails to perform these post loss duties. A general list of common duties is found below and are linked to more careful consideration of each.
- Give prompt notice of a loss to the insurer or its agent.
- Report losses involving theft and dishonesty to the relevant authorities and companies.
- Protect the property from further damage. Make necessary repairs and keep an accurate record of your expenses.
- Co-operate with the insurer in investigating a claim.
- Prepare an inventory of damaged personal property.
- As often as the insurer requests, show the damaged property and provide it with records and documents it requests
- Send to the insurer, within either 30 or 60 days of its request, a signed, sworn proof of loss that sets forth relevant details about the loss.