Here is an insurance claim question that we recently were asked to weigh in on as a contributing member of insurance claim experts for United Policyholders who advocates for property owners. 

Q. We received a question from a North Carolina consumer regarding a roof replacement due to windstorm damage. The carrier is claiming that only a "spot-repair" is required under the policy but the homeowner has requested a full replacement. This position is supported by the North Carolina Department of Insurance, yet I find scant case law to support it. Further, when I browse through the North Carolina Insurance Code, I find a reference to "like, kind, and quality" v. "functional" repairs but I'm not clear on what this means in practice. If you have had any recent experience with this type of scenario, I would be interested in your insight.

A. I would assume that unless there is any case law, fact specific regulations, or administrative rules/rulings from the N.  C. Department of Insurance, the insurance carrier may be correct. I say this of course without having seen the loss or having read any reports from experts etc. While it is common to ask for a replacement of the entire roof from the insured side, in fact, most carriers will not pay for this and offer a spot repair. 

There are exceptions to this however. The "line of sight principle,” which means that some insurance regulators have made rules that say that an item (roof) has to match in a line of sight. As an example, one slope of a roof has to match when looking at it, but this does not mean the whole roof has to be replaced. 

The other way around a roof dispute like this is if the policyholder has purchased law and ordinance coverage. If the L&O/Code staff at the building department may say that if 25% of the roof needs to be replaced, then the entire roof must be replaced (as is the standard in Florida). But of course there are two things that need to be in place; 1. The building code must require it, and 2. the policyholder must have purchased the coverage. Also, the insured will only get the ACV (actual cash value) until they actually do the work.

As to functional repairs (replacement with something that does the job but may not be exactly like the damaged item) and like kind and quality references, the carrier can probably get away with this for a spot repair. 

Finally, two other areas to explore may be asking for a guarantee from the roofer/insurance carrier that the work they are purposing will in fact work. Roofers hate to give guarantees (in writing) for this type of work. No guarantee, no settlement with the insurance company.  The other thing is to check to see if the damaged roof was still under warranty. If so, the warranty may be void and this may be an avenue to either ask the insurance company to take over the warranty or ask for the fair market value of the balance of the warranty as payment from the insurance company.  They need to read the warranty as it most likely is void if the roof is damaged. 

If you have questions regarding any property insurance claim related issues please call 800.321.4488 or contact us to submit a question to one of our public adjuster or insurance claim experts.