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Is it "insurance fraud" to get an insurance check & not do the repairs?
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quarterback:
Recently we had some damage to our home, roof, siding, mailbox, windows, deck.   Our insurance has been pretty cool with us but one sticking point is the 'cosmetic damage' to our deck.   Basically the cost of our deck (and potentially 'replacing' it) is more than the insurance wants to pay.

To find out the actual cost to replace the planks that need replacing, we called the builder to get an estimate.  Our insurance had already told us that it would be much more than they were willing to pay, but we wanted to check.  When we called the builder, they immediately wanted to set up a time to come replace the deck.  We explained that we just needed a quote for the insurance but we weren't necessarily going to have the work done.

At this point, the builder accused us of trying to perpetrate insurance fraud.


First off, that's not what was happening at all.  We had no intention of getting a check from the the insurance company for the work and then NOT have the work done.   We wanted to find out the cost to determine whether or not it was worth it for us to risk increased premiums or even being droppped from our insurance due to the cost.  That being said, even if that WAS what we were planning, I don't think that's actually 'insurance fraud'.

I hear, all the time, about people getting check to fix their car after an accident and then not spending all or any of the money to fix the car.    Is that really insurance fraud?  My impression is that you get an estimate and/or the insurance does an estimate and then they cut you a check.  At that point, is it really illegal to not get the work done or only get part of it done?    We haven't gotten checks for any of the other repairs, but if the check is $1 over the actual cost and we don't return that $1, is that somehow 'insurance fraud' ???   I didn't think so, but this builder certainly implied as much.
shmokes:
It's not fraud.  If your house burns down you're perfectly free to go on a European cruise rather than replacing each item you lost.

That's my understanding, anyway.  I know that when I got an insurance check after somebody broadsided me I used it as the down payment on another vehicle rather than to fix my car, even though I had to go get an estimate on the car before I could get the insurance check.
Dervacumen:
I believe the builder is trying to scare you into using his services rather than getting competing quotes and going somewhere else.  That's the only reason I can figure he would say something like that.  Considering you told him you weren't ready to purchase from him he figures he doesn't want to waste his time with an estimate if you're not going to buy.


Anyway to answer your question, in my totally unqualified poosition it is not insurance fraud, he's just a d***.  The whole deal with an insurance payment is to "make you whole" again.  In other words, you've got an agreement with the insurance company to give them some money over time and if something bad happens, they'll give you enough money to take care of it.  That's all.  Once they have paid you, their obligation to you is done.  There's no such thing as requiring you to actually use the money for anything.

You just can't file a claim about that same thing in the future.  So if they give you money to fix the cosmetic stuff on the left side of your deck, you don't do it, and then later a meteor crashes through the right side, you can only claim the meteor crash through the right side.  You can't lump the left side damage into the new claim.  Now That would be fraud.

shmokes:
Also, I remember when I was about 13 or so a truck had been left in neutral up the street and it decided to take a stroll.  It miraculously went about 200 yards without hitting anything (narrow street where everybody parked at the curb), then rolled across my neighbor's lawn and crashed into the corner of our house, doing some structural damage that required the garage door be replaced, as well as some beams in the ceiling and some exterior stuff.  My dad got the estimate and the insurance check and then did the repairs himself. 

I suppose it could be against the law, but I know that he never had any problems.
fredster:
You are being compensated for Loss of value.  Find a new freaking builder if that's what he says.

You can call a lawyer and ask him too. They do that you know.  (I guess you did, Shmokes is on his way to being a lawyer).

Your First mistake was volunteering more infomation than necessary. You wanted a quote from him, and you gave him way too much info.  You should have said that you needed the quote for the insurance and just smiled.  What you do with that is up to you, not him.  He doesn't know the facts and is a smart ass. Dump him.







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