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Roofing Fraud: Don’t Get Nailed

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The “Roofing Fraud: Don’t Get Nailed” course teaches insurance professionals what to expect in genuine hail and wind claims, how to identify and recognize potential fraud, and how to address such claims. The module is presented by Jason Keen, Executive General Adjuster at Sedgwick; Shannon O’Malley, a partner at Zelle LLP; and Dan Parker, Senior Vice President at J.S. Held.

In Section 1, Jason discusses potential indicators of fraud on site, external factors relating to the contractors themselves that may give an adjuster pause, and how to leverage experts in your next hail claim. Next, Dan walks through some photographs and diagrams to help adjusters identify manufactured hail damage, uses diagrams to explain wind pressure on roofs, then zooms into the details of explanatory photos to explore potential signs of fraud. Jason examines the incentives to shift the date of loss, then dives into tools and tips for confirming when the loss occurred before shifting to what adjusters should look for on potentially fraudulent invoices. Finally, Shannon delves into statutes and case law on fraud, and discusses the insurer’s options in these claims.

After completing the course, the attendee will be able to:

 

notice potential indicators of fraud

visually identify expected hail damage or key markers of fraud

leverage online weather tools before going on-site

grasp how wind forces impact roofs of various shapes

identify discontinued shingle types

request appropriately detailed invoices

understand the realistic legal options available in fraud claims

 

The course is designed for insurance professionals working in the area of property adjusting.

What CE Credit is available?

Note: To qualify for credit, you must submit completion (including a passed final exam if required) within five days of completing the last quiz. No partial credits will be awarded.

State:
Adjuster General CE Hours:
Adjuster Ethics CE Hours:
Attorney General CLE Hours:
State's Course ID:
NH 2.0 6000156659
TX (classroom equivalent) 2.0 137461
NC 2.0 218920
FL * ( Provider Number: 364169 ) 2.0 - Optional 1187946
IL 2.0 528116
WY 2.0 35672
OK 2.0 6000157282

* This course has been approved by the Florida Department of Financial Services for insurance continuing education credit.

Course Content

Types of Fraudulent Roof Damage
Expand
Lesson Content
  1. Introduction
  2. Manufactured Damages
  3. Collateral Damage
  4. Weather Research
  5. Materials in Poor Condition
  6. Recognizing Patterns to Uncover Fraud
  7. When to Bring in an Expert
  8. Types of Experts
  9. Recap
Hail From the Technical Side
Expand
Lesson Content
  1. Introduction
  2. Indicators of Real Hail
  3. Hail Reports
  4. Manufactured Hail Damage
  5. Consistently Random
  6. Small Things on a Large Scale
  7. The Absence of Damage
  8. Oddly-Shaped “Hail”
  9. When to Be Especially Cautious on Hail Claims
  10. Recap
Wind From the Technical Side
Expand
Lesson Content
  1. ASCE-7 and Wind Forces
  2. Imitated “Wind Damage”
  3. Wind Reports
  4. Expected Wind Damage
  5. Discontinued Roofing Products
  6. Analysis of Example Roof
  7. When to Be Especially Cautious on Wind Claims
  8. Aerial Imagery
  9. Recap
Date of Loss Misrepresentations
Expand
Lesson Content
  1. Introduction
  2. Five Reasons to Misrepresent a Date of Loss
  3. Three Audience Questions
  4. Examining a Hail Report
  5. Tools to Confirm a Date of Loss
  6. Tips for Confirming a Date of Loss
  7. Recap
Fraudulent Invoice Submissions
Expand
Lesson Content
  1. Two Audience Questions on Determining Date of Loss
  2. Two Audience Comments on Estabilishing Date of Loss
  3. Defining Insurance Fraud
  4. Examples of Inadequate Invoices
  5. What to Look For and Ask For
  6. Reinspection to Confirm Claimed Repairs
  7. Recap
The Legal Aspect of Fraud
Expand
Lesson Content
  1. Remedies in Claims with Suspected Fraud
  2. Examining Policy Language
  3. Hurdles to Rescinding a Policy
  4. Statutes in Selected States
  5. Common Law Fraud
  6. Case Law
    1. Fulgham v. Allied
    2. Chavez v. Homesite
    3. William Penn v. Auto-Owners
    4. Wheatridge v. Auto-Owners
    5. Sunflower v. Owners
    6. Four Options in Fraud Claims
    1. Denying the Claim
    2. Filing a Lawsuit
    3. Reporting to the Department of Insurance
    4. Applying in Appraisal or Another Context
  8. Recap
Get CE Credit or Certificate of Completion (Roofing Fraud)

Submit within 5 days to get CE Credit or Certificate of Completion.

Recent Updates

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June 26, 2024 By Dan Hartweg QUESTION: For a roofing project in Kaysville, Utah, does the residential building code require ice barrier underlayment? RESPONSE: Yes. The 2021 Utah State Residential Code (USRC) does not require ice barrier underlayment unless there is a history of ice forming along the eaves causing a backup of water, which is left to local jurisdictions to determine and adopt the requirement. 2021 USRC § R905.1.2. Utah did not complete Table R301.2, “Ice Barrier Underlayment Required” column, leaving it to local jurisdictions to complete the table. 2021 USRC Table R301.2. While the Kaysville City Code does not contain any amendments to Table 301.2, according to the Kaysville City Community Development website, ice barrier underlayment is required.  FACTS: Roof repairs at a private residence located in Unincorporated, West Jordan, Utah. DISCUSSION: Utah adopted the 2021 International Residential Code (IRC), including Appendices AE and AQ, with amendments, as the uniform statewide residential code known as the 2021 Utah State Residential Code (USRC) and is part of the mandatory statewide building code, the State Construction Code (SCC). Utah Code § 15A-2-101. (Adoption of SCC); Utah Code §§ 15A-2-103(b), (d), and (m) (adoption); Utah Code §§ 15A-3-101 through 206 (IRC amendments); Utah Code §§ 15A-4-201 through 207 (IRC local amendments); 2021 USRC (ICC page).  The State and its political subdivisions are required to follow the SCC. Utah Code § 15A-1-204(1)(a). The Division administers the SCC, but it is not within the Division's responsibility to enforce it, the responsibility for inspections and enforcement under the SCC fall on the compliance agency. Utah Code § 15A-1-205 (Division duties); Utah Code § 15A-1-207(1) (compliance agency with jurisdiction over project shall inspect and enforce SCC). A compliance agency is defined as an agency of the State or any of its political subdivisions which issues permits for construction regulated under the SCC. Utah Code § 15A-1-202(6). The compliance agency must follow the Division’s established standardized permit system, may charge a fee but must impose a 1% surcharge to help fund Division education efforts, and must promptly review plans and inspect properties. Utah Code § 15A-1-209 (building permit requirements and surcharge); Utah Code § 10-6-160 (municipality may charge fee and must review plans and inspect properties promptly); U.A.C. R156-15A-220 (standardized permits). A search of the subject property on the PLRB address search page indicates that it is located within the City of Kaysville, Utah.  2021 USRC Reroofing Section R908 of the 2021 USRC on Reroofing requires that recovering or replacing an existing roof must comply with the materials and methods outlined for new roofs: 2021 USRC § R908.1. Therefore, the provisions concerning ice barrier underlayment and drip edges in Chapter 9 must be considered.  ICE BARRIER UNDERLAYMENT Ice barrier underlayment is required under Section R905.1.2 where there is a history of ice forming along eaves causing a backup of water as designated in local amendments in Table R301.2: 2021 USRC § R905.1.2.  Utah did not complete Table R301.2 as follows, in relevant part: 2021 USRC Table R301.2. Because no amendment to IRC Table R301.2(1) was made by the legislature, the need for ice barrier underlayment is left to local jurisdictions. Utah Code §§ 15A-3-101 through 206; 2021 USRC Table R301.2. Kaysville City adopted the current version of the International Residential Code adopted by the State of Utah. Kaysville City Code § 18-2-2. The City did not adopt any amendments to Table 301.2. Id., see also, Kaysville City Code Title 18, Chapter 3. However, according to the City’s website, ice barrier underlayment is required. Kaysville City, Community Development, Roofing Requirements.  DISCUSSION: Utah adopted the 2021 International Residential Code (IRC), as amended, as the 2021 Utah State Residential Code (USRC) and part of the 2021 Utah State Construction Code, a uniform statewide code. The state did not complete Table R301.2, leaving the decision to require ice barrier underlayment up to local jurisdictions where there has been a history of ice forming along eaves causing a backup of water. While the Kaysville City Code does not contain an amendment to Table R301.2, according to the Kaysville City Community Development website, ice barrier underlayment is required.

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