Draft 2 – 30 March 2010
Zoom 360 Ltd
Surveyors’ Handbook and Operational Guidelines
Introduction 1.1 Who we are 1.2 What we do 1.3 How you help
Your Role and Responsibilities 2.1 Key activities 2.2 Training and communication 2.3 Holiday and sickness leave 2.4 Loss of contact
Customer Care 3.1 Making the right impression 3.1.1 Dress code 3.1.2 Vehicles 3.1.3 Essential equipment 3.2 Making contact with the policyholder 3.3 Data protection 3.4 About the appointment 3.5 Appointment changes 3.6 Policyholder unavailable 3.7 Guidelines for visits 3.8 Managing customer’s expectations 3.9 Service levels
Surveying 4.1 Photographic evidence 4.1.1 Why photographs are necessary 4.1.2 Ensuring quality images
Perils 5.1 What is a ‘peril’? 5.2 Insurable perils 5.3 Non-insurable perils
Understanding Insurance Policies 6.1 Common terms used by insurance companies 6.2 General policy guidelines
Roofing 7.1 Assessing roofing claims 7.2 Leaking roofs 7.3 Flat roofs 7.4 Additional roof defects 7.5 Redecorating
7.6 7.7 7.8 7.9
Considerations regarding decorating Halls and landings Additional considerations Risk of asbestos
General Considerations 8.1 Room dimensions 8.2 Property condition 8.3 Actual damage 8.4 Consequential damage
Repudiating the Claim 9.1 What are repudiations? 9.2 Common reasons for repudiations 9.3 Action to take with suspected fraud or misrepresentation
Writing the Report 10.1 To be completed on receipt of Zoom 360 report
Important Notice: This document has been developed by Zoom 360 Ltd, as guidance for our surveyors. The contents of this handbook do not infer or suggest agreement of any of our clients, nor is it an authorised representation of our Clientâ€™s opinions, principles or operational policies.
Who we are At Zoom 360 Ltd, we provide insurance companies with a specialist end-toend claims assessment and handling service. We deal principally with claims for damage to roofs and guttering. Through our innovative use of specialist aerial camera equipment and technologically advanced reporting procedures, we offer our clients a safe, fast and cost-effective alternative to traditional high level surveying methods. Our standard working hours are Monday – Friday, 8.00am to 4.30pm, excluding public holidays.
What we do Our key services include: • • •
Validations Arbitrations Audits
By providing a consistently reliable, thorough and highly professional service, our aim is to be the first choice for claims management services in the UK. 1.3
How you help As our trusted surveyor you are, in effect, the public face of Zoom 360 Ltd. As such we have certain standards and expectations which, as a professional, we are confident you will undertake as a matter of course. To assist you in your duties however, this handbook offers a comprehensive guide to our way of working and includes advice on approaching, conducting and reporting validation assessments. It also offers support on dealing with customers, instructions for completing forms and reports, and guidance regarding our expected levels of customer service. In fact it offers everything you need to carry out your role as effectively and efficiently as possible.
Your Role and Responsibilities
We rely on your skills and expertise to provide our customers with a high level of service at all times. All investigations should be carried out in a methodical and professional manner and reported accurately and clearly. 2.1
Key activities As a Zoom 360 surveyor, you are responsible for: 1.
Customer contact – often you will be the first representative of Zoom 360 that the policyholder meets. As a result, it is your responsibility to advise on certain issues (see section 3.8 Managing customer’s expectations, for more details). These can include: a. Your purpose while at their property b. How our process works, for example: i. What they can expect to happen ii. When they can expect it to happen iii. Who to contact if they have queries or issues
Establishing, inspecting and reporting damage – surveying involves inspecting a policyholder’s property to establish the extent of the damage. Your role also involves determining whether or not the damage is consistent with the claim. In other words, is it possible for the alleged circumstances (storm / escape of water / other) to have caused the damage. Importantly, you must record what you see and what you are told by the policy holder (see section 4.0 Surveying, for more details). It is not uncommon for the policyholder’s interpretation of the incident to differ from your professional opinion. By recording all information, we can confirm if, and to what extent, the damage is covered by the insurance policy.
Repudiating the claim – as damage is not always covered by a policy, it is our responsibility to decide whether the damage should be paid for by the insurance company. This is a vital part of your role as incorrect assessments can result in dissatisfaction for our client, the Insurer, or our client’s client i.e. the policyholder (see section 9.0 Repudiating the Claim, for more details).
Training and communication Regular training is provided at our regional seminars and annual national conference. This ensures that you will remain up to date with any new developments and procedures. We also provide one-to-one training as required.
All our surveyors will receive our regular e-newsletter. Monthly statistics, outlining quality of service, standard of reports, reliability, acceptance ratio and other performance indicators, are also published for each surveyor or practice. 2.3
Holiday and sickness leave To enable us to provide our clients with a reliable and professional service, please advice us, as soon as possible, of any dates that you will not be available â€“ for example, annual leave. This will allow us to arrange cover and provide an uninterrupted service. In the case of unexpected sickness, please inform the office as soon as possible so that we can make alternative arrangements.
Loss of contact Failure of internet facilities or phone coverage, may occasionally lead to loss of contact. If this occurs, please find an alternative way to contact us as soon as possible so that we can keep the client and policyholder informed.
Making the right impression Please remember that, in the eyes of the policyholder, you are also representing our clients, which are some of the UK’s leading insurance companies. 3.11 Dress code As a Zoom 360 representative, you should be smartly and professionally presented at all times. Jeans and collarless T-shirts are not acceptable. 3.12 Vehicles We expect you to keep your vehicle clean and tidy, and that you will drive considerately at all times when representing Zoom 360 Ltd. 3.13 Essential equipment While you are working, the following essential equipment should be carried with you at all times: • • • • • • • • • •
Vehicle mounted mast (min. 20m) Detachable mast (15m) Mobile phone ID badge Surveyors’ handbook Digital pen Survey forms Camera and accessories (i.e. memory card, spare batteries) Measuring device Binoculars, torch
Making contact with the policyholder In the majority of cases, initial contact with the policyholder will be made by Zoom 360 Ltd. However, when you arrive at the policyholder’s premises, please explain that you have been appointed by Zoom 360, on behalf of their Insurer, to inspect and report back on the damage to their property. Please ensure you are polite and professional at all times. Also bear in mind that the insurance claim may be the result of a traumatic event for the policyholder, for example an escape of water or a fire. As the policyholder or tenant may be understandably distressed, please treat them with the respect and consideration that you would demand for yourself.
Data protection In order to comply with the Data Protection Act, please ensure that you only speak to the policyholder named on the documentation you receive, or their appointed representative.
For data protection purposes, you must make sure that you are speaking to the correct person. We would advise that you follow the guidelines below when you first arrive at the policyholder’s house: • •
Ask the customer to please confirm his or her name, the first line of their address and their postcode Please obtain a brief description of the damage in question
Speaking to the policyholder’s spouse or partner is only acceptable if you first gain permission to do so from the named policyholder. Please note that a verbal confirmation is acceptable but only lasts for 24-hours. For longer timeperiods, written permission is required. 3.4
About the appointment When making the initial appointment on your behalf, we will aim to establish as much information as possible. This should help you to carry out the survey as quickly and efficiently as possible. We will aim to supply you with: • • • • • • •
Policyholder address confirmation Our job reference number Insurance claim reference number Position of the property within a road or identifying marks Anticipated height of damage Full access available Potential obstructions to viewing damage (for example extensions)
Although we will try our best to obtain as much useful information as possible, please be aware that the policyholder may have further information when you arrive on site. In certain circumstances, it may be necessary for you to make your own appointment. If this occurs, please ensure that you offer an appointment within our agreed service standards. If this is not possible due to the policyholder’s prior commitments, please make a written note of this and let the office know when you book the appointment. Please note that your workload is not an acceptable reason for missing our service standards. 3.5
Appointment changes If the appointment changes, you will be informed either by phone or e-mail as soon as possible. No fee will be payable in these circumstances. If you have to change the appointment, for whatever reason, you must inform the office on 0845 177 0781 as soon as possible. We are measured on
our conformity to agreed service standards and therefore have to record any exception to these so we are not penalised. 3.6
Policyholder unavailable If there is no one home when you arrive for the appointment, please try ringing the policyholder to see if they are simply running late. When an appointment period has been allocated, you must wait at the premises for at least 30 minutes. If the policyholder does not turn up, please record the time that you arrived, any attempts to contact the policyholder by telephone and also take a photograph of the front elevation of the property. Please return all information to our offices and we will forward it to our client. A fee will be paid in such circumstances.
Guidelines for visits As a Zoom 360 surveyor, we assume that you will act in a manner that reflects our company’s professionalism. The following guidelines should be adhered to at all times: •
• • • •
Be punctual - always inform the customer by phone if you are going to be late, apologise for any inconvenience caused, advise them of your revised arrival time and check that this will be convenient. Survey appointments are designated as AM or PM (unless a customer particularly requires a designated time) Drive up to a customer's property in a slow and controlled manner, park your vehicle safely, in a place where it does not cause an obstruction and avoid parking on grass that could be damaged. Your radio should not be audible from outside the vehicle When greeting the customer you should be polite and courteous at all times. Please refrain from eating, drinking, chewing, smoking, or talking on the phone when you first meet the customer Always address the customer formally, in accordance with the information you are given, i.e. Mr, Mrs, Dr, Ms, etc On arrival note the type of property and ensure that it corresponds with the risk address in question Always show your identity card and introduce yourself, for example: "Hello, Mr Jones. I’m [your name] calling on behalf of Zoom 360 to survey the damage that you recently reported to your insurance company.”
Remember, never enter the property until invited to do so. Always offer to remove your shoes on entry, especially during wet weather, after exiting a roof void or other dusty environment and where floor coverings are light-coloured If you need to enter other rooms within the property, please seek permission first
• • • •
If you discover that only a minor is present at the policyholder’s premises, you should not enter the property. Instead immediately inform our office of the situation Unless invited, you should never request a cup of tea (or similar). However, if offered you may politely accept or refuse. Using customer's toilets should be avoided if possible, but if it’s absolutely necessary, prior permission must always be obtained It is preferable for mobile phones to be switched off or put on silent during a visit to a policyholder’s home. However, if it is necessary to take an urgent call, apologise for the interruption before taking the call
IMPORTANT NOTES TO REMEMBER: • Always follow best practice regarding Health and Safety, when on site • NEVER do anything to endanger the customer, the public, any property or yourself • NEVER compromise Zoom 360 or the Insurer, by suggesting the claim may be valid. While on site you should only advise that a report will be submitted to Zoom 360 for consideration • If however, you are going to repudiate either part or the entire claim you should advise the policyholder of the possibility that their claim may not be approved and the reason or reasons why. With regard to high level damage, for example roofs, showing the policyholder the pictures you have taken, along with a brief explanation (in layman terms) should give them a better understanding of why their claim may not be covered 3.8
Managing customer’s expectations It’s important that the policyholder or tenant knows what is happening with their claim. However, by managing the policyholder’s expectations, complaints can be reduced to a minimum and customer satisfaction improved. Always try to leave the customer with a good impression. As far as the policyholder is concerned, you are not only the public face of our company, but also of the insurance company. If the policyholder wants to know what happens next, please advise them that Zoom 360 will respond by letter in the near future. Do avoid giving an exact time, as this may cause problems if unforeseen issues stall the process, for example referring back to the Insurer before making a decision. You can refer them to the introduction letter that they will have received and inform them that further information can be obtained by contacting Zoom 360 directly, on the number given.
Service levels At Zoom 360, we adhere to the following service levels: • Initial contact o Zoom 360 will contact the policyholder or tenant within 30minutes of receiving the instruction o Inspections are arranged within 24-hours and Zoom 360 surveyors notified of the appointment details o Surveyors must complete a site visit within 3 working days of Zoom 360 making contact with the customer. o Surveyors must send their report within 24-hours of the site visit •
Repudiations o Following notification on site, a letter is normally sent by Zoom 360 within 48-hours (subject to all required data being available) o A report is provided by Zoom 360 to the Insurer within 48-hours of the information being received from the surveyor (subject to all required data being available)
Technical Issues As a surveyor, if you have a technical query please contact the Technical Department either by e-mail; firstname.lastname@example.org or telephone, 0845 177 0781
Photographic evidence Our ability to take high quality photographs at roof height, with innovative, vehicle mounted photography equipment, sets us apart from our competitors. These photographs will be used by the Insurer to inspect the damage and make decisions regarding the validity of the claim. For this reason, it is vital that we can provide the Insurer with high quality photographs at all times. Please note, before starting to take photographs, always ask permission from the policyholder and explain to them why the images are necessary. 4.1.1 Why photographs are necessary It is your responsibility to take quality photographs, which provide: • Evidence of the location and condition of the alleged damage • Supporting evidence for repudiating claims • Supporting evidence regarding matching item issues • Assistance for ordering goods from an approved repairer 4.1.2 Ensuring quality images To enable the policyholder’s claim to be assessed fully, certain images are required, which follow the guidelines below. However, please note that this list is a minimum requirement and we expect you to use your knowledge and experience to determine whether or not additional photographic evidence is required: • Always take a photo of the front and rear elevations • Take as many photos as necessary to illustrate the problem • Take at least one photo from a distance, which is sufficient to show the whole property, giving a general overview • Close up, high level photos of the actual damage are vital • If necessary use a ruler or object to illustrate scale • Photograph an overall view of the roof or damaged area, to enable the relationship between the initial damage and consequential damage to be determined • Photograph any estimates held on site • Photograph any internal damage, even if the damage is being repudiated, for example due to poor workmanship, when the policyholder does not have accidental damage cover • Avoid taking photographs of people or reflections of people – due to data protection issues
What is a ‘peril’? A ‘peril’ is an event or circumstance that can lead to or cause damage to a property. ‘Insurable perils’ are usually covered by an insurance policy, while ‘non-insurable perils’ are not.
Insurable perils The following are some of the more common insurable perils. Please remember that, while this list can be used for guidance, it is not exhaustive and insured perils will depend on the customer’s individual policy: • Storm • Lightening, fire, smoke, explosion, earthquake • Flood • Escape of water from tanks, fixed apparatus or heating installation, or pipes • Water freezing in tanks, apparatus or pipes • Heating fuel leaking from a fixed heating installation • Theft or attempted theft • Malicious damage or vandalism • Collision - from aircraft or other aerial device • Collision - vehicle or animals (domestic animals may be excluded) • Falling TV aerials, radio masts and satellite dishes • Falling trees or branches • Subsidence or heave on site • Accidental breakage of fixed glass, which form part of the building, for example, basins, splash backs, pedestals, lavatory pans, cisterns, baths, shower trays and screens
Non-insurable perils The following are some of the more common non-insurable perils. Please remember that, while this list can be used for guidance, it is not exhaustive and non-insured perils or specific policy exclusions, will depend on the customer’s individual policy: • Wear and tear • Frost • Storm damage to gates, fences and hedges • Damage to trees, plants or shrubs • Damage from domestic animals, vermin, insects, atmospheric conditions and fungus • Damage caused deliberately by the policyholder, paying guests or tenants • Loss or damage if the property has not been lived in (or left sufficiently furnished) for more than 30 days (please note, some policies state 60 days) • Settlement and shrinkage
Any gradually operating cause Damage from building work involving repairs, renovations, alterations or extensions to buildings
Understanding Insurance Policies
Common terms used by insurance companies Terms and conditions within insurance policies and the wording used by insurance companies can sometimes differ to the layman’s understanding of such terms. The following list is designed to give you an overview of the terms used by insurance companies, along with a brief explanation of their meanings. Please note that the list is not definitive and should be used for guidance only. Damage and breakage When the term ‘damage’ is used, this refers to an item that while damaged will still function normally. For example, a cracked roof tile, which doesn’t leak. The term ‘breakage’ however, refers to damage that means an item can no longer be used for its intended purpose, for example, a cracked roof tile, which leaks. Storm damage: Commonly associated with roofs, storm damage is damage caused by, or the result of, high winds, possibly coupled with rain, hail or snow. To be an insurable peril, the damage must have been caused by a single storm or by two or more storms occurring before it was reasonable to expect that repairs from the initial damage could have been made. Insurance companies will often check local weather conditions to determine whether storm conditions have occurred in the area on the date in question. Storm conditions are usually classed as constant wind speed exceeding 45 knots, heavy snowfall or torrential rain and subsequent flooding. Please be aware that the actual wind speed noted is not a definitive guide to a storm, as ‘storm force’ can vary between insurers. In other words, claims should not be based on wind speed alone. Please note: due to the nature of the work we undertake at Zoom 360, we often deal with claims for ‘storm damage’. The authenticity and validity of such claims will vary from case to case. Lightning: Structural damage may occasionally be caused by lightning strike. Internal damage may also be caused by power surges to internal fixtures and involve smoke damage to decorations. Poor design or workmanship:
This relates to damage caused by incorrect installation, incorrect use or incorrect design of the item, product or fixture. Although usually excluded, sometimes the consequential damage from such claims may be covered if the policy includes accidental damage. Latent defect: A latent defect is a problem or failure that may not be identified for a length of time, sometimes years, after installation. Such claims can be subjective and cover for this type of event will depend on the circumstances, the insurance company and the individual terms of the policy in question. Lack of maintenance: Damage to the property resulting from lack of maintenance, is not usually covered under the policy terms. Duty of care: Policyholders have a duty of care to their property. In other words, it is the policyholderâ€™s responsibility to reduce the risk of loss to prevent an initial claim or the escalation of a claim. If, for example, a roof is obviously leaking, yet the leak is left for a considerable period of time, which results in further damage to the property, the policyholder would have failed in his duty of care to lessen or mitigate the loss by repairing the roof when it was first noted. If the policyholder has failed in his duty of care, damages are not usually covered by the policy. However, please be aware that duty of care and lack of maintenance is very subjective. However, obvious neglect will be taken into account when assessing a claim. Fire: Fire generally involves combustion of the building or a flame ignition at a source, which causes damage to the building. Cover may also be provided for damage caused by scorching or smoke damage, providing it has been caused by a one-off event. Accidental damage: Accidental damage refers to damage caused by an unforeseen event. While standard policies usually exclude accidental damage, it is a common, optional extension taken out by policyholders. If the policyholder has accidental damage cover, it is usually the Insurer who must prove that the damage is not covered due to wear and tear. There are some common exclusions associated with accidental damage, including, damage caused by demolition, alterations, repairs or settlement,
some chemical reactions and natural erosion. If in doubt, please contact our Technical Department for further assistance on 0845 177 0781. Please note, accidental cover has particular relevance with roofing claims, when the roof damage is repudiated due to wear and tear, but resulting damage to the internal building may be covered by accidental damage extension in the policy. Wear and tear: All products and materials will eventually wear out and fail, even with regular maintenance. Such loss is always excluded from a policy and insurance companies will not be found liable. Gradually operating causes: This is damage, which has been sustained over a long period of time, which eventually causes damage to the property, fixtures or fittings. While gradually operating causes are not usually covered by a policy, the insurance company may agree to the claim, if the policyholder was unaware of the problem. For example if a leak from a buried pipe caused floorboards and joists to rot, but was not apparent until the floor collapsed. In this situation, the word â€˜fortuitousâ€™ is used to denote a valid claim, as there would be no way for the policyholder to know about the cause until the loss occurred. However, if the initial damage or likely cause of the damage is not addressed and this exacerbates the loss then the claim may be repudiated. Consequential loss: This relates to the damage caused to other items as a result of an insurable peril. For example, damage to paintwork, when repairing a floor or replacing a bathroom suite if a match cannot be found for individual damaged items. While consequential loss isnâ€™t always covered by policies, the insurance company will often use its discretion on determining suitable compensation. Insurable peril This is usually a one-off event, resulting in damage which is covered by an insurance policy (see section 5.0 Perils). Cover will vary depending on the insurance company concerned and the individual policy. Only the Insurer can make the final decision on whether or not a loss is covered. Please note, as a surveyor for Zoom 360, you do not have the authority to approve or authorise claims. Please do not suggest or indicate to the policyholder that a claim will be covered as you may be liable for any costs incurred if the claim is then repudiated. In this situation, your liability may include the cost of all work undertaken.
Escape of water: Depending on why the water escaped, will depend on whether or not the damage is covered. While the consequential damage caused by escape of water from a fixed internal source is usually covered, ‘wear and tear’ may cause the claim to be repudiated. However, an overflow of water from a bath or sink is classed as an escape of water and would be covered unless the act was determined to be deliberate. Leakage: This is a financial term, relating to the amount by which the actual settlement exceeded the amount which was required to make a proper settlement under the policy. In other words, paying more than is necessary. This could be due to repairing an item that has failed due to wear and tear, for example, a flat roof not damaged by storm, or replacing a whole brick wall when only partial rebuilding was needed. Proximate cause: This is the underlying cause of the damage. For the entire claim to be valid, the cause must be an insurable event or ‘insurable peril’, and often (but not always) a one-off occurrence. If the event is a ‘non-insurable peril’ the consequential damage may still be covered if the policyholder has accidental damage cover. 6.2
General policy guidelines While insurance policies vary significantly depending on the scheme and insurance organisation concerned, there are certain common elements regarding the extent of cover offered by the majority of policies, as detailed in the table below. Please remember however, that while the following table can be used for general guidance, to be absolutely sure if damage is covered by a particular policy, you should contact our Technical Department on 0845 177 0781.
Cause of damage
Usually covered by most policies
Usually covered by most policies
Comments The damage must have been caused by a single incident of weather. You are entitled to question the policyholder if you have doubts and also use your knowledge of local weather conditions, when deciding on the validity of claims. If the property has been left unoccupied for a period of over 30 days before the event, cover may be excluded. Please contact our Technical Department for further guidance. Although this usually relates to the explosion of domestic boilers or gas ovens, it can include domestic appliances
Usually covered by most policies
Escape of water from a fixed internal fixture fitting or pipe
Usually covered by most policies
Theft and attempted theft
Usually covered by most policies
Malicious Acts or Vandalism
Usually covered by most policies
Usually covered by most policies Often an optional extra â€“ please check instructions to see if cover is available
Scorching or singeing is also usually covered, providing it was caused by a flame and not a result of smoke damage over a period of time, as in smoke from a fire or cigarette Includes incidents such as overflowing bath or basin, accidental puncture of pipes or if an overflow leaks back into the property. If the property has been left unoccupied for a period of over 30 days before the event, cover may be excluded. Please contact our Technical Department for further guidance. If the property has been left unoccupied for a period of over 30 days before the event, cover may be excluded. Please contact our Technical Department for further guidance. If the property has been left unoccupied for a period of over 30 days before the event, cover may be excluded. Please contact our Technical Department for further guidance. This usually includes collision by the policyholderâ€™s own vehicle. If the property has been left unoccupied for a period of over 30 days before the event, cover may be excluded. Please contact our Technical Department for further guidance.
As we specialise in high-level work at Zoom 360, we deal with a significant number of claims for damage to roofs. This section will provide more detailed information on handling and surveying roof-related insurance claims. 7.1
Assessing roofing claims Generally, unless they have been recently installed, all roofs will show signs of wear and tear. For storm damage to be accepted as a valid claim, it should be clearly visible and have been caused by gale force winds or severe weather event, in the local area. It is also reasonable to assume that other properties in the neighbouring vicinity will also show signs of structural damage due to this same weather event. If there is no sign of damage consistent with a storm or severe weather event, then the proximate cause (underlying cause) is not storm damage. It’s worth noting that it is highly unlikely that a single tile or ridge tile could be dislodged due to storm conditions without any other tiles being affected. This is worth considering if the policyholder alleges that a falling tile punctured a flat roof, which was showing signs of wear and tear.
Leaking roofs Policyholders often report leaks from roofs following heavy rain, where often there is no visible sign of damage. As heavy rain does not, in itself, constitute storm conditions, the repair is unlikely to be a valid claim. However, if the policy includes an extension for accidental damage the internal works might be covered. Another possible exception is where exceptionally heavy rainfall may have flowed over gutters or over the top of a lead valley. However, for such a claim to be considered, the items must otherwise be in good working order, without any obstructions and capable of coping with a normal levels of heavy rainfall. It’s worth remembering that the following items rarely fail due to storm damage alone. Instead it is often underlying conditions such poor workmanship, as a design fault, a lack of maintenance or wear and tear that results in damage: • Slipped slates or tiles due to nail sickness • Flat roofs • Lead flashing and valleys • Pointing • Rendering • Barge, soffit or fascia boards • Guttering or down pipes 20
Verge or ridge tiles displaced due to the mortar bed becoming friable
Flat roofs Depending on their location, flat roofs can be expected to last approximately 8-12 years. As a result, wear and tear is often the cause of problems, especially if the roof is showing signs of deterioration due to age or is leaking without obvious signs of damage. If the policyholder is claiming that accidental damage has occurred, for example, if the flat roof has been damaged from a falling branch, then it is your responsibility to look for evidence to confirm the facts. In other words, is the damage consistent with the event, is there evidence that the roof has been leaking for some time, prior to the alleged incident. If you are in doubt about the validity of such a claim, please detail this on your report and state the reasons why you came to your conclusion.
Additional roof defects Always identify any other possible defects, which may cause leaks or failures in the future, when reporting roof damage. For example, if storm damage has occurred and dislodged roof tiles or bricks from the top of a chimney, a claim to repair these items would be valid. However, if some tiles were already cracked or missing, or the chimney’s lead flashing was already split, then these details should be noted but not included in the claim. This also applies to pre-existing damage to valleys, box gutters and other elements. It’s also worth considering that if for example, a chimney’s pointing was in poor condition the underlying cause of any damage may be due to wear and tear as opposed to storm damage.
Re-decorating Decorating should only be included when the existing decorations have been damaged. When it forms part of the consequential loss, it should always be shown as a separate cost. Any decorating covered by the claim should be the minimum needed to return the property to its pre-loss condition. Please remember to show dimensions for each affected room in metric measurements and also to illustrate the area damaged. To give you an idea of the extent of re-decorating required, please consider the following situations: Situation one An escape of water from a radiator has resulted in stain damage to the kitchen ceiling.
Only the ceiling would be covered in this situation. Stain block would be applied to the damaged area and the whole ceiling painted. Situation two Water ingress due to a storm has damaged a bedroom ceiling, causing it to sag. Patch repair to the plasterboard, skim, and paint, preferably, or the whole ceiling replaced. If the replacement of this ceiling affects the decorations to the walls, the cost of making good the walls should also be allowed. 7.6 Considerations regarding decorating It’s worth remembering that gloss work is rarely affected and should only be included if the gloss work is damaged or affected by other works carried out to rectify the insured loss. Even if gloss work is needed to skirting or door frames it does not necessarily mean that the doors should be included, unless they have also been affected. If redecorating is required, cut off points for the decorations should be noted, for example: • Above or below a picture or dado rail • Archway or door • Different room • Different carpet 7.7
Halls and landings If a hall ceiling is affected by the damage and requires redecorating, it is not necessary to paint the landing ceiling. However, it may be necessary to change the paper on the stairwell and landing or paint the walls to ensure consistency of decoration. In this situation, the damaged area should be identified as being different to the consequential damage to the remaining area. This situation also applies if a lounge and hallway have the same wallpaper. If only the lounge was affected by the damage, even if the wallpaper cannot be matched, the hallway wallpaper is not necessarily covered by the policy, even if it is requested by the policyholder.
Additional considerations Do not underestimate the cost of repair or replacement when damage has occurred to ornate mouldings or covings. While specialist firms can recreate most mouldings, this can come with a high price tag. Floor coverings however, are only considered part of the building if they form a fixed part of the structure. Laminate, wood, ceramic, marble, stone tiles and glued vinyl are usually classed as building elements, while carpets or loose laid vinyl fall under the contents policy.
Risk of asbestos It should be assumed that any surface, which has had a textured coating applied (trade name Artex) before 1999, may contain asbestos. Within the observation part of your report, always highlight recommendations for repairs to a ceiling that may contain asbestos materials. Similarly, identify recommendations for any works that may involve the disturbance or removal of any asbestos type product. In these circumstances, if it is possible, please note the product, type and location, for example, pipe lagging or vinyl floor tiles. It should be noted that asbestos may also be present in the following: • • • • • • •
Fascia and soffit boards Roof coverings (corrugated roof sheets, roof tiles – very rare) Pipe lagging in loft spaces Vinyl floor tiles Artex Boiler cupboards and stair bulkheads (fire protection products / retardants) Boiler flues
Please note, this is by no means an exhaustive list and is for guidance only. Do not discuss this issue with the policyholder, unless they are already aware of the situation and request guidance. At this stage, there is no need to attach a cost to this part of the claim. It is just important to flag up the potential problem.
Also remember that the Insurer does not have an automatic liability to meet the full cost of repairs, where underlying defects or other factors are involved. For example, only a contribution to the overall cost, may be payable if only a few tiles are damaged due to a storm. 8.1
Room dimensions To enable us to quantify repair costs, always note the basic dimensions of any rooms affected. This is especially important if we are relying on a contractorâ€™s estimate. Dimensions should be given in metric in the form 1.9m x 2.4m (always include a height measurement). Even if you are repudiating the claim, please include the approximate dimensions of the rooms or roofs involved. This enables us to verify the cost savings we are providing for the insurance company.
Property condition Always include a brief comment on the general condition of the property. This can be helpful to us and the Insurer when determining liability in subjective claims, when loss may be due to gradually operating causes and duty of care is a consideration.
Actual damage Itâ€™s important to detail exactly the item or area affected by the claim. This is especially relevant if accidental damage is not covered by the policy.
Consequential damage This involves listing items that, while not damaged by the loss, will be damaged as a result of the loss. Please detail these items separately in your report along with the costs of any consequential damage. This also applies to the cost of any non matching items.
Repudiating the Claim
What are repudiations? Repudiate literally means to reject; to refuse to accept the validity, truth or authority of something. In this context, it means to reject the validity of an insurance claim.
Common reasons for repudiations Insurance companies will only provide cover for incidents that occur while the policy is in force. However, there are many more reasons for repudiating an insurance claim, examples include: • Wear and tear - insurance policies expressly exclude liability for damage caused by wear and tear or a pre-existing condition • Poor workmanship – if the reason for the damage has been caused by a previous contractor or poor design and construction, then it is not an insured peril. In this situation, the customer should take the issue up with the contractor or workman in question. However, if poor workmanship has caused additional damage – for example a poorly tiled roof has caused internal damage to decorations due to escape of water, this could be covered by accidental damage cover. In this situation, it is important to highlight on the report if a workman is at fault as the Insurer may decide to recover their costs. • Possible fraud or misrepresentation – the claim will be rejected if it is suspected as fraudulent or a misrepresentation of the facts. For example, if the customer reports damage stating that it was recently caused but on examination it is clear it occurred some time ago and before the policy was taken out (known as pre-inception)
If fraud or misrepresentation is suspected Fraud is defined as 'a deliberate attempt to mislead or falsify an insurance claim’. If you suspect that the claim is fraudulent or has been misrepresented, please adopt the following guidelines: • Do not say anything about your suspicions to the customer • Survey the job as usual, taking specific photographs that illustrate your suspicions and why you have reached this conclusion • Afterwards, complete a full report on your findings and send this to Zoom 360, clearly identifying your suspicions and reasons for them • We will then refer the case to the Insurer, as they will make the final decision
10.0 Writing the Report Your report will form the basis on which the claim is upheld or repudiated. It is important that you include as much information, relevant detail and evidence to support your findings as possible, including digital images, as they may be required should the claim be disputed. Wayne, Iâ€™ll write this section from scratch when you send me through the forms as it needs to be relevant, specific and a step-by-step guide to your form.