North Ridgeville neighbors ask why some insurance companies pay hail damage claims and others don't

NORTH RIDGEVILLE, Ohio - A hail and wind storm battered northeast Ohio in May 2011. Fourteen months later, the images of that storm still flash through homeowners' minds as they are still dealing with the damage left behind.

Five on Your Side spoke with dozens of homeowners who are frustrated with the way their insurance claim was handled. Our consumer investigation looked at hundreds of records from the Department of Insurance. We found steps homeowners are not taking all they steps they can to settle a disagreement over a claim.

[PHOTOS: May 2011 storm in northeast Ohio http://5.wews.com/dfc ]

Bruce Harold worked in heavy and residential construction for 40 years. When he saw marks on his shingles at his Akron home, he filed a claim with State Farm Insurance. We asked what he was hearing from State Farm.

"Denial, denial, denial," Harold said.

North Ridgeville homeowner Jim Flanigan described a similar experience. Without any action from State Farm, he took action.

"I had been with them 42 years. I canceled my policies with them," Flanigan said. In his subdivision, residents mapped the homes that were approved and denied.

"My biggest complaint is that it's hit and miss. You get a new roof. You don't," Flanigan said.

State reviews complaints

117 northeast Ohio homeowners filed complaints with the Ohio Department of Insurance last year over summer storm-related damage claims. We dug through those documents. Most claims were for roof repairs and came from the North Ridgeville area.

"They paid us for damage to our skylight flashing metal, but yet it didn't damage the shingles," Flanigan said.

Nearly half of the complaints were from State Farm customers, the company that insures about a quarter of the state's homes.

"I would say from a numbers perspective, the number of complaints we received from that company is probably typical based on their market share," said Jana Jarrett, Assistant Director of Consumer Services at the Ohio Department of Insurance.

Homesite Home Insurance and Westfield Insurance had the next highest share of complaints, at 5 percent each.

"Three of us on this street from Westfield have been declined," Dottie Alberto said.

Alberto filed one of those complaints with the Ohio Department of Insurance. She lives in that same North Ridgeville neighborhood as Flanigan, just on a different street. Alberto told the same story of new roofs all around her.

"Do we have an umbrella over our roof? It doesn't make sense to us why ours is being declined," Alberto said.

In a statement, Westfield said its adjusters are trained and certified to spot hail damage from normal wear and tear. 

"We recognize that this becomes even more confusing when a roof is replaced near a home that did not sustain hail damage. It is important to understand that since we only inspect the roof of our customer, we cannot say why another homeowners roof was replaced. There are too many reasons why this could happen to speculate," the company wrote.

The state added that insurance is complex and what may seem hit or miss to consumers, may not be the case.

"Even if you have the same carrier, two insureds could have different policies so there are a lot of factors and variables that go into it that make it hard to understand at times," Jarrett said.

The state looks at each case to make sure the law and insurance policy are followed, but said it rarely finds violations. The state said it looks for patterns in the complaints, but won't confirm or deny if it's investigating any company related to last year's summer storms.

The process still helps consumers. Last year, the Ohio Department of Insurance recovered $11.6 million for consumers. Some homeowners hit by storm damage got new roofs or more money after the state got involved.

Others didn't get any satisfaction.

"We are not getting anywhere with this," Alberto said.

Experts weigh in

In letters, the state told many consumers that "While it may seem unfair that (your insurance company) denied your claim, please realize that based on the information provided by both you and the company, it appears (your insurance company) denied your claim based on the findings of (name of engineering firm)."

Even with an expert supporting the insurance company, Alberto is still pushing forward.

"We will turn it over to an attorney," Alberto said.

Others are fighting on their own.

"I think they wanted me to just walk away, and I just didn't do that. I was very persistent. There was no stopping me," North Ridgeville homeowner Neal Farrell said.

Farrell lives down the street from Alberto. His claim was denied by two State Farm appraisers, so he hired a roofing consultant. The report changed everything.

"Obviously they agreed with them. They paid my claim," Farrell said.

State Farm did an additional inspection after Farrell hired a roofing consultant, and replaced Farell's roof.

Stare Farm said in a statement, "We are always willing to listen to customers who are not satisfied

with the resolution of their claim."

As a homeowner, understand your rights. Don't rely solely on a roofing estimate from a roofing company. Hire your own engineer or roofing consultant if you disagree with the insurance company's findings.

State Farm said it paid what it owed. The company said 20,000 claims were filed in Ohio from May 2011 storms, and less than one percent led to complaints with the Ohio Department of Insurance.

Some homeowners are tired of fighting. Harold paid for a new roof out of his own pocket afraid of what might happen to his shingles in the next storm.

"I have a pretty good investment here and I want to protect it," Harold said.

State suggests some consumers file a formal appeal

Homeowners can hire their own expert, like Farrell did, to protect their interests against the insurance company. You may also be able to file a formal appeal called an appraisal. The state recommended to homeowners in letters that they invoke this right that's laid out in most policies.

The state wrote, "The appraisal provision provides that each party will select a 'competent and disinterested' appraiser and that these two appraisers will then select a 'competent' and 'disinterested' umpire if the two appraisers do not agree. You pay the cost of your appraiser and share the cost for the umpire. The decision is binding on all parties and is the final step in the resolution of your claim. You will need to check with the company about the availability of this option."

In our review of documents, several insurance companies engaged in the appraisal process. However, several did not.

In response to the state's recommendation of the appraisal process to one homeowner, State Farm responded, "In regards to the department's suggestion that appraisal may be a possible remedy to our current position on this claim, we would like to provide clarification that appraisal is a policy condition that either party can request when there is a dispute over the amount of loss, not the scope of loss. Our current position reflects a disagreement over scope of damages."

Westfield said in a statement to NewsChannel5 that appraisal is used when there is agreement that there is damage but the issue is the cost to repair.

"This differs from the situations surrounding hail losses as the disagreement is over the existence of damage and not the cost to repair damages," the company wrote.

While some insurance companies are not in agreement on whether appraisal is a viable option for consumers, the Ohio Department of Insurance said it will support the consumer and fight for you.

"In those situations I wish the consumer would come back to us for our assistance in that. If we are suggesting that then that's something we feel is a viable option for them and we would work with them to have the company recognize that," Jarrett said.

For Jarrett, it all comes down to interpretation of the words "amount" and "scope."

"They kind of coincide. You can't have one without the other so in certain situations that would be our arguments. If you argue one you can argue both," Jarrett said. "I can't say every single time the company would be willing to turn over and say now we'll do it. It's worth coming to us and having us look into it so we can look into if the company is acting in the best practices."
 
State Farm full statement:

It is always our goal to pay what we owe. We evaluate each claim on a case by case basis based on the facts of the claim. State Farm received over 20,000 claims across the state of Ohio as a result of severe storms in May 2011, and paid out more than $191 million in claims payments to Ohio customers.

Of those claims, less than one percent led to a complaint with the Department of Insurance.

We are always willing to listen to customers who are not satisfied with the resolution of their claim.

Coverage of roof damage from a State Farm homeowners policy does not include damage resulting from normal weathering and deterioration or from lack of maintenance.
 
We handle each claim according to its unique circumstances. Damage to a roof caused by a recent hailstorm and damage caused by normal weathering and deterioration have distinctly different appearances. State Farm claims representatives are trained to identify hail damage.

The extent to which roof shingles are affected by weathering can vary depending on the grade and age of the shingle, the direction the slope faces (east, west, north, and south) and the quality of the attic ventilation.

Roof damage inflicted by hail varies by slope according to the wind direction during the storm along with the pitch and condition of each slope  

The size, shape, hardness, density and number of hailstones from the same hail storm can vary even between two adjacent homes hit by the same storm.

Westfield full statement:

We understand the frustration and confusion it causes consumers  when they are led to believe they have hail damage only to be told differently by their insurance