# Struggling getting O&P on insurance claim!



## Timmyd (Aug 31, 2011)

I'm new to the storm damage claims process in Minnesota and having alot of trouble getting the O&P added onto the repair cost. The adjustor states that I need to send him the reciept slips from my subs before he will even consider it!! I have damage to one side of siding, the whole roof, broken exterior light, mailbox, and a sliding screen door. I informed him that I would need siders, roofers, and an electrician. I can't produce the slips without doing the work, and I cant do the work without signing the contract with the homeowner with the cost, and I won't do the work until i know i'm covered for my costs! anyone have any advice to working with the adjustor to get this prior to me doing the work?
Thanks in advance,
Tim


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## Tinstaafl (Jan 6, 2008)

Your contract is with the homeowner, not the insurance adjuster. It's up to those two to hash out what's covered and what's not.


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## BamBamm5144 (Jul 12, 2008)

Tinstaafl said:


> Your contract is with the homeowner, not the insurance adjuster. It's up to those two to hash out what's covered and what's not.


Second this. Who cares what the insurance pays? It has no effect on what your pricing is.


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## FremontREO (Sep 30, 2009)

I 2nd the posts. I go through this also in Mn...mainly with state farm adjustors. I just tell adjustor to have fun explaining to their client why they don't allow p&o. 99% they fold.


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## CompleteW&D (May 28, 2011)

Sounds like an American Family claim. I second what the others say. Write up the proposal, including specifically what you are going to do and with which trades. be sure to include specifics like using an electrician to do the electrical work. Once the HO signs the proposal/contract.... the adjustor should agree to the O&P. If it's an American Family claim, you will likely still need to provide receipts to get your final payment. It's just the quirky way they pay claims.


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## Timmyd (Aug 31, 2011)

yeah its a pain to deal with this adjustor. I think any reasonable contractor that wants to do a good job and make the homeowner happy would require O&P for this job. This adjustor has been pretty hard to work with he was even able to talk the local inspector into not replacing tyvek on elevations with 2-3 hail hits on them which would bring them up to code.

CompleteW&D----you will likely still need to provide receipts to get your final payment. It's just the quirky way they pay claims. 

he said he would consider it afterwards. I just hate to stick it to the homeowner after the fact when the insurance company denies it when the work is done already. makes us look bad for not getting it straight beforehand


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## CompleteW&D (May 28, 2011)

Timmyd said:


> yeah its a pain to deal with this adjustor. I think any reasonable contractor that wants to do a good job and make the homeowner happy would require O&P for this job. This adjustor has been pretty hard to work with he was even able to talk the local inspector into not replacing tyvek on elevations with 2-3 hail hits on them which would bring them up to code.
> 
> CompleteW&D----you will likely still need to provide receipts to get your final payment. It's just the quirky way they pay claims.
> 
> he said he would consider it afterwards. I just hate to stick it to the homeowner after the fact when the insurance company denies it when the work is done already. makes us look bad for not getting it straight beforehand


The thing is, O&P is covered in the fine print of most insurance policy's claims sections. I have State farm and I know it's in mine when a claim is filed. You should contact your local insurance commission and ask if insurance companies are in fact required to pay O&P in your particular situation. 

I think the reason insurance companies require proof in these kinds of claims, is a lot of times, a HO may hire a contractor to do the roof, then do the siding, new wiring or other miscellaneous stuff themselves. Which would then bring into question if the work is done to code.

But the bottom line, what others have said is correct. It's up to the HO to make sure they get fair compensation for their repairs. You are there to help of course, but don't waste too much time on it. You could end up negotiating with this adjustor for days, and without a signed contract before hand, the HO could still walk when you finally get the adjustment they deserve. You will be hard pressed to get ANY movement from the adjustor until you have a detailed signed contract. Explain this to the HO and let them go to battle with the adjustor if need be. Sometimes a call by them to the local insurance commission will do WONDERS to fix the adjustor's "attitude."


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## Timmyd (Aug 31, 2011)

Thank you for the advice! been going round and round today on it! he stated that each trade needs to have a significant amount of work to be considered for GC O&P... now isnt the premium price for the homeowner including GC O&P? that would make this whole 3 trade bs irrelevant, and what this adjustor doing fraud.


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## MJW (Jan 27, 2006)

Let's ask this. Are you going to hire a licensed Roofer, a licensed sider, and a licensed electrician? Yes, legally, each of them MUST be licensed in MN, not just you.

If so, they should be able to provide you with estimates you need to submit.


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## smalpierre (Jan 19, 2011)

I never have this issue with ins cos. I submit an estimate, and do work for my price. Nobody gets receipts. Do you give your customers reciepts from the lumber yard and supply houses? I dont. Had one lady ask for reciepts for materials, I told her she gets an invoice from me. Do you ask mcdonalds for reciepts for the meat, bun, and condiments? Anybody that does is trying to screw you.


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## larryb (May 23, 2008)

Timmyd said:


> I'm new to the storm damage claims process in Minnesota and having alot of trouble getting the O&P added onto the repair cost. The adjustor states that I need to send him the reciept slips from my subs before he will even consider it!! I have damage to one side of siding, the whole roof, broken exterior light, mailbox, and a sliding screen door. I informed him that I would need siders, roofers, and an electrician. I can't produce the slips without doing the work, and I cant do the work without signing the contract with the homeowner with the cost, and I won't do the work until i know i'm covered for my costs! anyone have any advice to working with the adjustor to get this prior to me doing the work?
> Thanks in advance,
> Tim


This one's on me...

Property & Casualty insurance companies must pay contractor Overhead and Profit (O&P) on all claims (not just when two or three or more trades are involved) without deductions for roofing, carpet, etc. Any Independent Adjuster or staff adjuster and/or in house claims representative and/or claim department supervisor and/or executive level claims management personnel who is a part of and/or supports any refusal to pay O&P on 100% of each claim, regardless of whether or not a GC is involved, has likely committed a bad faith act and a violation of fair market trade practices. Not paying O&P on 100% of every claim when it has been charged for as part of the insured’s premium payments results in an illegal windfall to the insurance company in the form of unjust enrichment. Such acts may also be construed as and may constitute fraud on the part of all parties representing the insurance company whose actions result in non-payment of full O&P. 

Even if an adjuster and/or in house claims representative and/or their supervisors are simply following orders to attempt to withhold O&P payments from their insured’s, the responsible parties are still culpable for any wrong doing and are also therefore subject to the appropriate legal remedies which may include prosecution and/or substantial fines and/or imprisonment, if convicted. In addition, sub-contractor invoices are not required in order for O&P to be paid and are therefore not a valid reason or excuse for withholding O&P payments from the insured(s).


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## piper1 (Sep 11, 2014)

*Fase*



MJW said:


> Let's ask this. Are you going to hire a licensed Roofer, a licensed sider, and a licensed electrician? Yes, legally, each of them MUST be licensed in MN, not just you.
> 
> If so, they should be able to provide you with estimates you need to submit.


The only person required for a License is the GC and the electrician if he is the GC.

Roofing requires a license if they do roofing only and not under the GC.

Siders do not need a license if they are under the GC permit or it is a single trade.


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