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Question DetailsAsked on 11/30/2017

I heard you have to have 25% of roof damage before insurance will pay claim

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3 Answers

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Ohhh - a tough question to answer, but I will try - maybe a Florida contractor will jump in with more precise info.


I suppose a policy could exist (basically like a "major medical" policy) which would only cover if you had more than 25% of your roof damaged, but I doubt it - all I have ever seen cover any % of damage, subject to depreciation/amortization terms and of course sujbject to the policy deductible on each claim. I think what you may have heard related to one of the following:


1) Many insurance companies will say if over 25% of the roof was damaged to the point of needing replacement (rather than repair) AND there is scattered damage over the rest, then they will replace then entire thin on the assumption that will be cheaper than piecemeal repair. Some companies also say if over 50% was heavily damaged, they will write off the roof and replace it all. Sort of the same philosophy car companies take on damage - if only a quarter panel is damaged repair it, but if several are unless the car is quite new may be cheaper to write the car off and pay for the whole value at the time of the wreck.


2) A totally different thing, which may well be your case, especially if in Florida (see article on this below) is in Florida if more than 25% of your roof needs significant repair or replacement in the course of a year, then the entire roof has to be brought up to current code. This is an attempt to get damaged roofs upgraded to current code rather than repairing the same roofs again and again over the years. (This law is under court challenge as being a taking without compensation - making you replace parts of the roof which have not been damaged - no telling how that will go.)


In this case, because the law says the entire roof has to be brought up to code if over 25% is damaged but does NOT say the insurance has to pay for it, there are several possible outcomes for building owners (aside from the partial or full replacement cost coverage minus deductible, depending on whether you have replacement cost or amortized/depreciated value coverage):


a) if you have code compliance coverage (costs extra on premiums - means any repairs have to be to current code, not just pay what the cost would have been to rebuild as it originally was), then they pay for the repairs to bring it up to code.


b) if you do NOT have code compliance coverage, then they only pay what it would be estimated to cost to replace it like it was - with YOU paying the additional cost for meeting current building code.


Now - that covers whether they cover the full cost of the repair to the DAMAGED part. As to replacing the entire roof when only 25%+ is damaged, that falls under a different rule, based on some recent court cases which have held that an insurance repair has to not only repair the damaged part, but also has to make it match or be compatible with the adjacent part. This originally came about in auto repairs, where a replacement hood or panel or door might not quite match the rest of the car - the courts held that if the color match is such that is would be readily noticeable or objectionable to the common man, then the entire car had to be painted to all match, at insurance company cost.


Extrapolating that to flooring in the houseing market (the first cases I heard of anyway), some courts began holding that a damaged flooring or cabinet product, if it could not be matched to the existing adjacent flooring or cabinet finish, then the entire floor or cabients had to be refinished or replaced with new so they all match. That has now been carried to roofs - in some areas the courts have held (probably most reasonably) that a reasonable match isnecessary on a given roofing face, but does not have to exactly match other faces (especially when dealing with front to back sides). But other courts (California, understandably, is the source of the first case I saw holding this) have since held that the entire roof has to be a reasonable match, so even if less than 25% of your roof is being patched or replaced, it may be one could argue (not without objection from the insurer, though) that their entire roof should be replaced by the insurance company at their cost.


A messy complexity comes in then - does the depreciation/amortization apply only to the damaged portion and they have to replace the rest of the roof at their cost, or do they have to replace it all but under the proviso that you pay the amortization/depreciation if you do not have replacement cost insurance (and the deductible, of course). Court cases will undoubtedly settle that issue, probably on a state-by-state basis.


So - the law can be a real catch-22 for homeowners for two reasons:


A) because of the 25% area rule, there is a very strong incentive for an insurance company to say the damage is limited to 25% of the area (and some are counting and repairing each damaged area square foot by square foot) to stay under that limit.


B) because the law does not say the INSURER has to pay for the complete new roof - just that it has to be done - you can be in a sitution where the insurer says it will pay for ONLY the damaged area (say 26% in worst case, roundoff the percentage - and maybe only the unamortized value) because that is all that was damaged - but then YOU are required by law to pay for the full replacement of the rest of the roof.


A couple of what-if examples -


C) say your total replacement cost is $20,000 and 26% (rounded off) was damaged and you have a $1000 deductible. With replacement value insurance they would pay 26% of $20,000 minus $1000 deductible = $5200-1000 = $4200 coverage payment, out of the $20,000 repair cost - leaving you with $16800 to pay ! Course, if you win on the entire-roof-match argument, then they would pay 100% of $20,000 - $1000 dedutible = $19,000, leaving you $1000 deductible out of pocket.


D) Now looking at depreciable/amortization coverage, where they cover only the remaining life of the roof. With a brand new roof being damaged, c) above covers. Take a case toward the other extreme - say a 20 year old roof rated at 25 year life. If they agree to replace the entire roof you would get 5/25 of the $20,000 repair - $1000 deductible = $4000 - 1000 = $3000, and you pay the other $17,000. At about 23.75 years your net insurance check would go to zero. Alternatively, they would cover (if they say they will cover only the damaged portion) 5/25 of 26% of $20,000 - $1000 deductible = $1040 - 1000 = $40. You would pay the other $19960 - going to the full $20,000 at a touch over 20 years into the 25 year life.


E) These numbers compare to (assuming 25% damage repair would cost $5000) to replacement cost coverage (Case C equivalent) of 100% of the damaged area cost of $5000, minus the $1000 deductible which you pay. In the amortized/depreciated coverage case, at 20 years into a 25 year life, they would cover 5/25 of the $5000 repair minus $1000 deductible = $1000 -1000 = $0, so your deductible covers their entire estimated remainging value of the damaged portion o the roof and you pay the full $5000 repair cost.


So - while you most likely do not have to have 25% damaged to get coverage, because of the full-roof replacement law you might potentially (especially if around 25% or less is damaged, or with a roof near its design life for depreciation-value insurance) end up paying for most or all the repair yourself. You need to run the numbers, becareful about the 25% cutoff if that applies in you area, and if in doubt get an accountant or better an attorney to run through the insurance and contractor numbers and policy to be sure what you are entitled to and how much you will be paying.


One other thing that has not been settled in court that I have heard - if you repair the roof yourself does the 25% rule apply, because generally some building code requirements relating to having to bring the entire system up to code if more than some code established percentage is being replaced or brought up to code (commonly 50% in many codes) does not apply to DIY jobs on owner-occupied properties. I think the ball is still in the air on that because some states like NY say it still applies, some others say not, most do not address it and may or may not enforce it depending on city or on which inspector or building permit clerk you are dealing with.


Good Luck

Answered 11 months ago by LCD

0
Votes

BTW - here are two links to articles explaining the Florida 15% rule if you want more detail on that:


http://www.2ndopinionpublicinsurancea...


http://www.saavlaw.com/blog/30040/

Answered 11 months ago by LCD

0
Votes

Oops - typo in my second, shorter response - when I said "explaining the Florida 15% rule" it should have read 25%.

Answered 11 months ago by LCD




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