Confused About the Deductible Process and Getting Conflicting Info

[mark1210]

What is the name of your state (only U.S. law)? Texas

Due to a recent hailstorm about 2 months ago I needed to file a homeowners claim (first time doing so) - the home was 5 months old before the hail damaged the roof. The adjuster viewed the damage and said the entire roof and gutters were shot and needed to be replaced. He cut a check on the spot for $9K (less my deductible of 4K) - I shopped around for roofers and submitted a final invoice to the insurance company - that invoice indicated the roof and gutters and came to $12,879.00. The work has since been performed but I decided against having the gutters replaced since the damage was mainly on the back of the home where no one could see and they were still functional. A paid-in-full receipt was submitted to the insurance company at their request that showed $9134.00 and also indicated the gutters were no longer included in the price.

3 days later I get a phone call asking why a final invoice showed a much higher figure while the paid in full receipt showed much less - I explained that the gutters were removed from the repairs at my request. The insurance company then asks where the deductible was applied and proof it was paid. There is where I get confused - given that the initial insurance check that (which was less my deductible) satisfied the roof replacement I wasn't aware I needed to pay anything else. Obviously if I moved forward to replace the gutters it would be out of my pocket. The call sounded very accusatory and apparently I'll be getting another call to re-explain the entire chain of events.

Is it that unusual to have a final invoice submitted and then to have proof of paid in full for a lesser amount? The roofing company said normally an initial check isn't so large but given it was a newer home with a roof that was less than 6 months old (minimal depreciation) allowed it to be paid in that manner when the gutters were removed from the work.

A little confused on what went wrong, where, and how to correct.

 

[tammy8]

You were paid for the gutters to be replaced, correct? You didn't replace them. That is likely why your insurance company is questioning and honestly I can't really blame them.

 

[justalayman]

they gave you the money to fix the gutters. You didn't have them repaired so you owe the insurance company that money. What you are doing is called insurance fraud and you really don't want to go there.


Unless you paid your deductible (as in you wrote a check for it or whipped out the cash), no, your deductible was not satisfied. You reducing the amount of work performed does not qualify as you paying your deductible.

since you only had $9134.00 worth of work done and your deductible is $4K, the insurance was required to pay $5134.00. Since they gave you a check for $9k, you owe the insurance company a refund of $3866.

 

[mark1210]

they gave you the money to fix the gutters. You didn't have them repaired so you owe the insurance company that money. What you are doing is called insurance fraud and you really don't want to go there.


Unless you paid your deductible (as in you wrote a check for it or whipped out the cash), no, your deductible was not satisfied. You reducing the amount of work performed does not qualify as you paying your deductible.

since you only had $9134.00 worth of work done and your deductible is $4K, the insurance was required to pay $5134.00. Since they gave you a check for $9k, you owe the insurance company a refund of $3866.

I think you may be jumping the gun a bit - not trying to get away with anything...trying to determine the correct course of action. All the items they listed were damaged by the hail. The more I ask around the more confused I get - several companies have told me that "you can pocket the check and not do any repairs at all (though the mortgage holder/servicer may demand the repairs be performed to maintain the value on their collateral. Obviously items you do not get repaired this time cannot be claimed for any future damage"

I'm expecting a call on Wednesday from the insurance company so hopefully I can get to the bottom of it. My main concern is that from how I understand things I thought I needed to pay my deductible to someone - that's where I am getting confused. Obviously, it's a new home so the roof had to be fixed and it was - the gutters I'm not concerned about even though they were dinged up.

 

[justalayman]

mark1210;3260753]I think you may be jumping the gun a bit - not trying to get away with anything...trying to determine the correct course of action.

ok. It's real simple. Send the insurance company $4000 (your deductible) since the way you worked the deal, it was paid out of the money they sent you. You are required to pay your deductible and then the insurance pays the remainder of the bill.

My main concern is that from how I understand things I thought I needed to pay my deductible to someone - that's where I am getting confused.

it's just like any other insurance with a deductible. The insurance company pays based on the total bill. If there is a deductible, you pay that to the service provider. That is what you didn't do. Instead you changed the amount of work being done so the check the insurance company sent you covered the work without you paying your deductible.

 

[ecmst12]

Except that there is absolutely nothing illegal or fraudulent about not getting all of the work performed to avoid putting out the deductible. You are allowed to do that. Your property value takes the hit instead of your bank account. Your insurance company does not care about this except they also have an obligation to your lienholder - and the lienholder probably DOES care about the damage to their collateral. So you may be required by them to complete the repairs. Or, it might just be that the insurance company wants to note that the repairs were not completed, in case there is another hailstorm in the future that causes more damage.