The Matching Game and Pre-Loss Conditions
Patching Can Preclude Indemnity
By Christine G. Barlow
From the May 2012 issue of Claims Magazine
One of the most common questions I receive regards matching. Typically what happens is there is a loss on the premises that affects a portion of the roof, carpeting, flooring, siding, or other material, and the carrier wants to replace only the damaged section. This is acceptable if matching components can be found. However, it is not uncommon for that particular type of shingle or carpeting to be discontinued so an exact or even close match is unable to be made.
Often the carrier wants only to replace the damaged section of roof or carpeting, while the insured wants to be restored to what he or she had before—namely, a matching roof or carpet. The carrier bases its argument on a few sections of policy language. The first is under Section I: Perils Insured Against, where the policy states that “we insure against direct physical loss.” The second part of language is under the loss-settlement section of the ISO homeowners' policy, where it refers to “that part of the damaged building.” Certain carriers maintain that these two sections of language indicate that only the damaged portion needs to be replaced, thereby excluding any undamaged portions that would make the property match.
Settlement Options
Another section of language in the loss-settlement options is where the policy pays the lesser amount of policy limits—either the amount actually spent to repair or replace the property, or the replacement cost of that part of the building damaged with material of like kind or quality. Again, carriers use this section to pay for only the damaged portion of the building. However, the like kind and quality statement does present an issue. For instance, if the type of shingles or carpet is no longer available, then it is impossible to replace just the damaged section with “like kind and quality.”
None of these arguments comply with the principle of indemnity where the insured is restored to what he had before the loss. If the insured had a matching roof or carpeting before the loss, and after the loss the roof or carpeting is mismatched, then the insured is not properly indemnified.
In Mastin v. Sandy & Beaver Ins. Co., 461 N.E.2d 332, an insured filed suit against the carrier to recover the cost to replace the kitchen floor. The insured's property was damaged by a storm and the kitchen floor had to be cut through in order to make repairs. The insured had a vinyl kitchen floor, which is not satisfactorily repaired by a patch. The court ruled that vinyl flooring cannot be considered “repaired” when an obvious patch is left and that the whole floor should have been replaced.
Similar, Not Identical?
Not all courts see it this way, though. In Greene v. United Services Auto. Ass'n, 936 A.2d 1178, part of the insured's roof was damaged, and matching shingles could not be obtained. The insureds wanted the entire roof replaced, while the carrier repaired only the damaged areas based on the “replacement of that part of the building damaged” policy language. The court reviewed the language and stated that it was unambiguous and that the carrier owed only to repair the damaged part of the roof, and not replace the roof. Couch on Insurance 176:65 points out that not all versions of the replacement-cost provision invoke requirements that the new property be identical or even similar to what was damaged. Couch states that when similarity is required, all that is necessary is functional similarity to replace old property with new property.
In Greene v. United Services Auto. Ass'n the result is the same as in Mastin v. Sandy & Beaver Ins. Co.: There is an obvious difference in the roof, carpet, or other material that has been repaired with nonmatching material. The insured has not really been indemnified.
Let's look at some examples. A recent question involved an insured couple who sustained hail damage to their roof. After inspection, the insurance company decided that only half of the roof was damaged—and therefore it would replace half of the roof. The insureds, of course, were extremely dissatisfied and wanted the entire roof replaced.
A similar situation occurred when a falling limb that struck the roof during a winter storm damaged an insured's home. The limb punctured the cedar shake roof, damaged a portion of the exterior, and damaged carpet in the room below that portion of the roof.
The insurer wanted to replace only the damaged cedar shakes, to paint a portion of an elevation, and to replace only the carpet in the open area of the home that has no break of any kind. There is a one-foot break by the entry tile to the carpeted stairs and upper hall that have matching carpet. There is a three-foot break by the entry tile between the carpet they are willing to replace and a living room with no doors separating it that has matching carpet. All of the carpet is line of sight.
Line of Sight
This brings up the line of sight issue; what exactly is line of sight? According to The Free Dictionary, line of sight is an imaginary line from the eye to a perceived object, a straight line along which an observer looks or a beam of radiation travels, or an unobstructed path between sending and receiving antennas. Merriam Webster Online defines it as a line from an observer's eye to a distant point, or the straight path between a transmitting antenna and a receiving antenna when unobstructed by the horizon.
Generally, doorways and entryways are considered breaks in the line of sight, even if there is not an actual door there; it is a break in the floor and space of the room. If the insured has wall-to-wall carpet throughout the home and the carpet is damaged in the living room, only the living room carpet needs to be replaced; doors separate the bedroom carpet from that in the hallway, even though when the doors are open the difference in the carpet can be seen. A room leading to a doorway is not an unobstructed path; from points in the room you cannot see beyond the doorway, therefore the doorway breaks the line of sight.
So there you have it. Courts, carriers, and insureds disagree on the topic of matching. Some courts and insureds believe that the insured is entitled to be restored to pre-loss conditions, with roofing, carpets, or siding that actually matches. Other courts and carriers feel that only the damaged property needs to be replaced, and a repair that leaves the insured with mismatched carpet or roofing is acceptable. The principle of indemnity is still the basis for insurance; the insured should be restored to what he or she had before the loss…and pre-loss is matching. Until policies are constructed around a different principle, the insured should be restored to the pre-loss condition, with matching carpet, roofing, or siding.
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