High Country Construction

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below [To assist us in bringing this matter to a close, we would like to know your view on the matter.] Regards, [redacted] Thank you for the response however this is incorrect Please contact Acuity as my mother's name- [redacted] and myself- [redacted] are both on the policyTo ensure this was correct, we spoke with Acuity yesterday[redacted] did NOT provide a itemized statement- see original complaintIf he did, this seems it would be easy to provide another copy to the Revdex.com This is very frustratingJason continues to avoid the requestRegards, [redacted]

Under MN Statute Subd The injured employee must submit to examination by the employer's physician upon the employer's request in order to prevent termination of benefitsAs stated in my previous responses if the doctor finds the present complaints related to the original injury which occurred on 5-11-Acuity will be responsible for treatmentIf Mr [redacted] refuses to attend the examination on 7-8-benefits will terminate until he decides to attend an exam.The proper venue to go thru for any disputes on a Worker's Compensation Claim is the Division of Labor and IndustryTheir phone number is ###-###-####Mr [redacted] may want to consider talking to someone in the Department to have his questions answeredThe reason for the second opinion is to determine causation of Mr [redacted] 's present complaints

Please see the attached response from Acuity, A Mutual Insurance CompanyThank you

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below [To assist us in bringing this matter to a close, we would like to know your view on the matter.] Regards, [redacted] The back and forth of the situation is ridiculousAcuity misrepresentation of the facts and evidence to this point are to continue to deny the claimWe do not accept acuity a option based on the evidence we have

We appreciate your feedback. We have reviewed the matter and determined that the policy was cancelled correctly in accordance with the policy provisions. However, due to special circumstances related to this case, we have decided to work with the customer and not pursue the... additional amount due. We have reached out directly to the customer to explain our position and trust that the issue has been resolved.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID 11786613, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.I cannot prove this, but my conversation with the claim agent, Kelly ***, always lead me to believe that they would cover my medical bills for up to one year At no time was it explained to me, that later I found in the FINE PRINT (too late) that theymay not pay themAlso I knew my condition had deteriorated greatly from before the accident so I didn't question that they would pay like my policy provides for bodily injurty for one year as I was told At no fault to mine, I hit a car in front of me (on the side of the car) at 15-20mph with no airbag released from my car Any Doctor or Chiropractor would agree that this jolt to my neck would set my neck condition back much worse than before the accident I was in much more pain after the accident than prior to the accident and went to a chiropractor much more often I did miss one month of work then went only because where I work allows me to relax on a couch and put ice on my neck plus I was on pain killers I missed out on many social events because of the pain that summer Accuity is just trying to get out of paying the bills I do not recommend this insurance company to anyone and plan to change companies soon
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
Janie ***

The insured has an ACUITY Homeowners 3-Special form policy (***) which insures “against risks of direct loss to property.” Coveredproperty losses are settled at a replacement cost value for that part of the building damaged for “like construction and use on the same
premises.” However, we do not insure loss for, in part, for “Faulty, inadequate or defective: design, specifications, workmanship, repair…..materials used in repair, construction,renovation or remodeling.” The policy reads, in part, that we will “pay only that part of a covered loss which exceeds $1,000.” The insured reported a storm claim to ACUITY on 08/26/with a reported storm date of 06/29/2015. I made same day contact with the insured. Aninspection of the insured’s home located at *** *** *** *** *** *** *** *** *** *** was completed on 09/01/I met with the insured and theircontractor. The findings from this home inspection are as follows:This was a storm which came from the northwest and traveled southeast. The property is heavily covered by trees/tree limbs which face north and northwestThe home and detached garage have vinyl siding. I found multiple, focused mechanical indentations located along the west fascia of the home. These findings are notconsistent with hail damageThis is located above the west porch area. Inspection of the northwest facing wooden porch area revealed no evidence oflatent hail markings or splatterInspection of all exterior screens revealed no evidence of hail impact or, in fact, any hail splatterInspection of thehomes fascia revealed no evidence of hail damage or latent hail splatter. Organic growth and debris was found to be accumulated on the lower, north fasciaThis organic growth and debris was not disturbed by this stormThere was no evidence of latent markings/splatter from hail contact. The insured’s chosen contractor drew my attention to a lower section of fascia on the north side of the home toward the back. The insured’s fascia is white in colorThe contractor pointed to multiple dark grey spots on the fascia and said that it was "hail splatter." Of note, this area faces north and is quite shaded by the trees surrounding the northside of the home. It is my opinion that the dark grey spots were organic growth/mold accumulation. There is a detached three stall garage at the propertyThe west facing fascia on the garage shows no evidence of hail impact or damageThere is notable debris and dirt present on the fascia, none ofwhich is disturbedThe detached garage had a significant wood pile on the east sideThe siding in this area showed several mechanical locations of damagewhich is not consistent with hailThe wood is piled directly onto the east facing the sidingWhile present at the property, I observed a large garbage truckarrive and remove trash from a large, industrial, trash containerThe container is also located on the east side of the garageThe south side of thegarage has an entry doorThis door is wooden and paintedI observed no hail impressions or latent evidence of hail splatter on the paint or woodOn the south side of the garage, which is the direction which the garage doors face, I observed multiple pink chalk markings where the contractor had marked prior to my arrivalThe contractor stated that he marked all of the hail damageOf note, these were on the south side of the garageThe garage also has approximately a two foot eveNone of the markings that I observed were consistent with hailOf important note, one of the indentations which the contractor marked and said was hail had scratch marks impressed in the indentation and these scratch marks removed some of the paint on the south facing fascia Linear and vertical marking was present as well. Both are not consistent with hail, but rather mechanically causedOne marking, on closer inspection, also had scratch markings but also had a residualfragment/splinter of woodThere was a second marking which also had a residual fragment/splinter of woodThe insured was present during the inspection andconversation with the contractorI showed the insured what the contractor was saying was hail and the insured stated that it could be from his childrenthrowing acorns. I looked down on the ground and saw that there were several dozen acorns on the ground There is a small detached building toward theeast section of the propertyThis is the building on the property which is the most exposed to the elements. This has a wooden and painted fasciaThat fascia showed no evidence of hail damage, latent hail splatter markings, or recent removal of paint Inspection of the garage roof revealed the roof to have a CertainTeed fiberglass shingle product, architectural in style. The south slope showed significant installation issues which were identified, marked and photographedThe eve of the south slope had approximately two shingles missingCloser inspection showed the underlayment to be weathered and the roofs plywood was softThe east slope showed this same installation issue pattern This shingle had a significant amount of crazing and there are multiple areas where gaps have formed in theshingleThese are not storm related but rather a widely known product defect and manufacturing issueIn addition, there were multiple areas of thermalcracking presentI was unable to identify a single hail strike on any section of ridge, the most vulnerable to hailAfter inspecting the entire roof, I wasable to identify two potential hail hits on the shingle. Inspection of the residence roof revealed the identical product defect and manufacturing issues present on the shingles. I inspected the metal valleys and located no evidence of hail impressionsTwo of the metal valleys each had a single distinct crease which was not consistent with hail and in the opposite direction of this stormAfter inspecting the entire roof, I was able to identify a single hail hitAfter completion of the inspection, I met with insured and contractor and explained my inspection findings. The maximum number of shingles needed to address the property damage to the insured’s home is five. To assure the shingles were available; I completed an on-site test of the insured’s shingle and forwarded my test findings to *** *** *** *** *** *** is an unbiased and independent testing laboratory which determines like kind and quality material and finds matching replacement materials. The *** *** *** report (Control Number: ***) wasreceived and reviewed. The insured’s shingle was identified as a CertainTeed New Horizon, Horizon Blue in color and was available through Discounted Materials, Inc. The shingles needed to affect the repair are on hold for the insured through 10/03/15. I completed a repair estimate which accounted for the materials cost and labor to affect the needed repair. This estimate total was $562.48.I followed up with the insured on 09/03/by phone. I provided the insured with a detailed explanation of my inspection and inspection findings. The insured communicated to me that she understood. I explained the ITEL Laboratory, Inctesting, the report findings and that the shingles necessary to affect the repair have been identified, located, and reserved. I explained to the insured that the estimate to affect the repairs is less than their deductible. The insured stated that she understood. On 09/03/2015, I emailed the insured and thanked them for allowing me the opportunity to inspect their beautiful home. I attached a copy of my completed estimate and the *** *** report. I explained to the insured that the shingles necessary to affect the repairs to the home have been reserved through 10/03/ I explained the cost of the materials and directed their attention to the *** *** report for instructions on how they may secure theshingles. I explained also that the cost of repair to the home falls below their $1,deductible and that I would be closing the claim. I invited the insuredto contact me with any questions.There has been no contact by the insured to ACUITY which has not been responded to ACUITY is always available to our customers and would invite the insured to contact me with any questions or concerns they have

Please be advised ACUITY, A Mutual Insurance Company, received the complaint filed by Mrand Mrs*** on September 3, 2015.ACUITY insures ***’s Four Season Yard Care and has coverage for their business liability under a commercial general liability policyMrand Mrs*** hired our insured
to do landscaping and put in a retaining wallMrand Mrs***’ home was a newer constructionDuring the course of our insured’s work damage was found to the drivewayMrand Mrs*** state our insured is the sole cause of this damage as in order to complete his work he had to drive his vehicles and equipment across the driveway.Our insured did drive on the ***’s drivewayHowever, after taking statements from Mr*** and our insured, we had the driveway inspected and it was determined our insured’s actions were not the cause of the damage to the driveway.Our investigation showed there were several issues with the concrete? When the driveway was installed it was not tamped properlyThis is evident by the air holes at the surface which the contractor covered up with a trowelImproper tampering could affect the strength of the concrete.? Industry standards for a driveway thickness are no less than inches thickThe ***’s driveway is only inches thick? The cracks to the driveway are typical with settling? The concrete in the ***’s back patio is also settling and cracking in a similar fashion as the drivewayThe inspection showed one isolated area of the driveway which was cracked at the cornerThere is a possibility this type of damage could have been caused by our insuredIn an attempt to resolve the claim with the ***’s we extended a compromise offer of $on June 30, to replace one of the 10xsections of concreteThe ***’s did not agree with our scope of damages and ACUITY increased out offer to $3,on July 16, ACUITY is still willing to resolve the ***’s claim for $3,in exchange for a release of liability.Mrand Mrs*** suggest that ACUITY has switched adjusters as a stall tacticThe claim was originally assigned to Monica TrottMrsTrott remained the primary adjuster on the file until it was assigned to me on August 5, The claim transfer was solely due to a staffing matter and was in no way a stall tactic.We spoke to Mrs*** on August 10, and discussed our $3,offerMrs*** stated she did not agree with our offer and asked what the next step was to get the claim settledShe was informed that would be her decisionShe stated she did not know how to proceed and that is why she was askingShe was informed that she could handle it several different ways and I could not give her that adviceIt would be her decision if she wanted to accept our offer, turn it into her insurance to subrogate us, or pursue other actions to remedy the driveway issues.The ***’s also stated that our insured admitted his machine caused the damageIt should be noted the only documentation provided by the ***’s which show our insured admitted to causing the damage was a text message which states “know my loader did do a little damage but that’s from a poor contractor and that’s out of my controlI will call insurance company tomorrow and they will deal with it.” This text cannot be seen as an admission of guilt as our insured is clearly addressing the poor work which was performed by the contractor who did the drivewayOur insured disputes their negligent actions caused the damage that the ***’s are claiming.Enclosed are photos of the driveway and patioShould you have any questions or concerns please do not hesitate to contact meThank you for your time and attention to this matter.Sincerely,Kyle ***Senior Claims Representative*** ***

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

ACUITY received notice of a claim on May 12, for an alleged date of loss of April 25, 2016. We inspected the property in question on 5/12/16. On 5/15/16, we discussed our inspection findings and scope of damages with *** regarding the roof damage and interior water damage
and hand delivered the estimate to *** on 5/17/16. We then attempted to make contact with our actual policyholders to discuss the claim. We first heard from our actual insured on 5/23/at which time we indicated we would need a signed policyholder's release before we could issue payment. We first received the Power of Attorney *** refers to on 5/24/at 8:48am even though *** was informed we would need this on 5/12/when the claim was originally filed. ACUITY then submitted the POA to our attorney to review and we had our typical policyholder's release revised to suit this unique situation and sent the revised release to *** for his signature today 5/25/at 10:29am and will issue payment upon receipt of the signed release being returned. As for the discrepancy with regards to the loss payment, our adjuster completed a thorough inspection of this property. The inspection revealed minor wind damage to the roof and some interior water damageThere were a couple of holes in the valley that we gave the insured the benefit of the doubt on. Despite the fact that the water damage and the roof damage did not occur the same day we did not require a second loss being set up and did not apply a second deductible even though our policy is a per occurrence policyThe roof warranted a minor repair and did not warrant replacementOur estimate was fair and reasonable. It should be noted that *** *** filed his complaint with the Revdex.com the same day he provided the Power of Attorney

Response from Acuity, A Mutual Insurance Company regarding Complaint ID *** The party making this complaint is not the policyholderAcuity claims representative *** *** sent a letter to explain the loss settlement directly to the policyholder and the agent on March 2, The
party making the complaint should obtain a copy of the letter from the policyholder

Please be advised ACUITY, A Mutual Insurance Company, received the complaint filed by Mr. [redacted] on March 11, 2016.ACUITY insures SM Trading Corporation and has coverage for their business liability under a commercial general liability policy. Mr. [redacted] is claiming his vehicle was damaged by our...

insured’s car wash. During the course of our investigation we spoke to [redacted], [redacted] (SM Trading Corporation) and [redacted] (Overhead Door Company.). Our investigation revealed the door was bent inward and appears as though the door was hit while it was in the process of going up. Mr. [redacted] stated once the door was repaired it ran properly and the photo eyes functioned correctly. With this information, we did not feel our insured’s actions negligently caused damage to Mr. [redacted]’s vehicle.However, at the request of our insured (SM Trading Corporation), we have taken care of Mr. [redacted]’s damages. Enclosed is a copy of the property damage release signed by Mr. [redacted] and proof of payment.Should you have any questions or concerns please do not hesitate to contact me. Thank you for your time and attention to this matter.Sincerely,[redacted]

Please
be advised ACUITY, A Mutual Insurance
Company, received the latest Revdex.com complaint from Mr. and Mrs.
[redacted] on October 2, 2015.  As
you are aware from our previous correspondence, ACUITY insures [redacted]’s Four Season Yard Care and has coverage for
their business liability under a commercial general liability policy. Mr. and
Mrs. [redacted] hired our insured to do landscaping and install a retaining
wall.  During the course of work, damage
was found to the driveway.  Mr. and Mrs.
[redacted] state our insured is the sole cause of this damage, as in order to
complete his work he had to drive his vehicles across the driveway.            Mr. and Mrs. [redacted] state ACUITY is making claims based on what we “feel” and not the facts.  As previously stated, it is ACUITY’s position the driveway was being
put to its intended use by our insured. 
Our inspection indicates the driveway contractor was negligent for
faulty installation.  Mr. and Mrs. [redacted]
have not provided any evidence to support our insured’s action was the proximate
cause of the damages.            As stated in previous correspondence, ACUITY feels our insured’s actions were
not the reason the driveway cracked. However, in an effort to settle a disputed
claim, we conceded to a crack in section 20 of the driveway.  ACUITY has
offered $3,000 to settle the claim.  At
this time, this offer remains open to Mr. and Mrs. [redacted]. Should you have any
questions or concerns please do not hesitate to contact me.  Thank you for your time and attention to this
matter.

...

                                        ...⇄ 2, 2016  Revdex.com OF WISCONSINATTN STACY [redacted]10019 W GREENFIELD AVEMILWAUKEE WI 53214                      RE:         Our Claim Number:  [redacted]                                                    ...⇄ Our Insured:  Janie [redacted]                                                    ...⇄ Claimant/Consumer:  Janie [redacted]                                                    ...⇄ Your ID Number:  11786613                                                    ...⇄ Company Name:  ACUITY, A Mutual                         Insurance Company                                                    ...⇄ Dear Ms. [redacted]:             Janie [redacted] has submitted a complaint alleging Acuity, A Mutual Insurance Company promised to make payment for medical treatment under her Personal Injury Protection (PIP) benefits, and now we are refusing to do so.  Below is a timeline of the claim and documents supporting Acuity’s position.              Our claim system memorializes all claims activities, such as all correspondences including phone calls, mail, and e-mails.  Our electronic claim file reflects the date of loss as April 4, 2016, and it was reported to Acuity the same day.  The loss was a two vehicle intersection accident in which another vehicle pulled out from a stop sign in front of Ms. [redacted]. Ms. [redacted] was unable to stop, and the front of her vehicle hit the passenger side doors on the other vehicle.   We spoke with Ms. [redacted] regarding the accident within three hours of receiving the claim.  Policy coverage for both physical damage and Personal Injury Protection (PIP) were explained to Ms. [redacted] verbally at that time.  She indicated her desire to have Progressive handle her vehicle damage.  In regard to her PIP coverage, it was explained we would send out an Application for Benefits as well as Medical Authorizations for her to complete and return, so we could request any medical bills and records for review for payment. She was advised she could provide our claim information to any medical providers in the meantime.  At no time was it indicated to Ms. [redacted] that Acuity would automatically handle any medical bills for one year, or for any definite amount of time.             Acuity sent out an Application for Benefits along with a Medical Authorization and an Injury Information Sheet to Ms. [redacted] on April 5, 2016.  The cover letter addresses the Minnesota No-Fault statute, advising that eligibility for PIP benefits will terminate upon a one year lapse in disability and medical treatment.  This is not a statement that Acuity would pay all medical bills for one year.             On April 25, 2016, Acuity received an email from the agency inquiring about Ms. [redacted] changing medical providers.  We responded to the agency via email and to Ms. [redacted] via telephone, advising that where she chooses to treat is her choice.             The completed Application for Benefits and authorizations were received by Acuity on May 2, 2016.  Using Ms. [redacted]’s signed Medical Authorization, requests for bills and records were sent out to medical providers on May 7, 2016.  On this date, Acuity paid the single medical bill which had been received prior to the receipt of the completed Application for Benefits.             From April 4, 2016 through June 27, 2016, Ms. [redacted] sought treatment with five different chiropractic offices.  As records and bills came in to Acuity, they were reviewed and paid.  Based on the records coming in, it began to appear that the treatment Ms. [redacted] was receiving may be related to pre-existing conditions rather than to injuries sustained in the April 4, 2016 motor vehicle accident.               In an email with Ms. [redacted] and her agent on June 30, 2016, it was advised that Acuity would consider payment for any treatment if it was reasonable and related to the April 4, 2016 accident.  It was also advised that in order to consider payment, we would need written records and bills (or itemized receipts if paid up front) from the providers.               Also on June 30, 2016, a Reservation of Rights letter went out to Ms. [redacted] via certified mail to her new address in [redacted] Minnesota.  We received confirmation of her receipt of this letter.  The letter addressed Acuity’s right to investigate, what further information Acuity needed, the necessity for Ms. [redacted]’s cooperation and the possibility of Ms. [redacted] undergoing an Independent Medical Evaluation (IME).  All medical bills in Acuity’s possession as of June 30, 2016 were paid.             During this time, Acuity was attempting to obtain Ms. [redacted]’s vehicle photos and original estimate from Progressive, as they handled the vehicle damage.  After receiving no response from Progressive on the requests, we moved forward with having a nurse review completed.  The report was received on August 19, 2016. It supported Acuity’s concerns that the treatment Ms. [redacted] was receiving was related to her pre-existing conditions, not the April 4, 2016 motor vehicle accident.  Scheduling for an IME began on August 23, 2016. The IME was rescheduled in an attempt to accommodate Ms. [redacted]’s change of address and took place on September 28, 2016.  The IME report was received by Acuity on October 5, 2016, and a denial letter was mailed to Ms. [redacted] on October 10, 2016.  In this letter, Ms. [redacted] was advised of her right to demand arbitration.             Ms. [redacted] has recently claimed wage loss.  To date, she has not submitted any documentation to support this claim, nor do the medical records indicate her physicians giving her restrictions from working.  Acuity will gladly review any submitted documentation in regard to any wage loss benefits.              Ms. [redacted] continues to claim that she was told her medical bills would automatically be covered for one year.  Nowhere within the written correspondence to her is this indicated.  Additionally, there was no verbal statement made to her in regard to this matter at any time.                          Please let us know if you have any questions, or if you need further clarification or additional documentation.                                            ...⇄ Sincerely,                                   ...⇄ Kelly L. [redacted], INS AIS                                      �...⇄ Senior Inside Claims Representative                                 ...⇄ [redacted] Cc:  Janie [redacted] Tell us why here...

Please accept
the following as Acuity, A Mutual Insurance Company’s (“Acuity”) response to [redacted]
[redacted]’s position submitted to the Revdex.com on June 11, 2015.  Mr. [redacted] continues to inaccurately represent
the facts of the claim and particularly, his conversations with [redacted],
the Acuity representative assigned to his claim. His personal attacks toward Ms.
[redacted] regarding her professionalism, and claims that she ignored information
and falsified information are unfounded. 
As explained below, Acuity relied on information from independent
sources, including weather data and opinions of experts in deciding to deny Mr.
[redacted]’s claim.  All of that information
was provided to Mr. [redacted].  Further, Ms.
[redacted] did not discourage Mr. [redacted] from filing a claim.
 
 In addition, Mr. [redacted] mischaracterizes his
interactions with Ms. [redacted]’s [redacted] Scott B[redacted].  Mr. B[redacted] has never spoken to either Mr.
[redacted] or Mr. [redacted]’s contractor, Chuck H[redacted] from [redacted].  Mr. B[redacted] only emailed the hail and wind history
reports to Mr. [redacted] in Ms. [redacted]’s absence.
 
In sum, Acuity
carefully reviewed Mr. [redacted]’s claim for alleged damage to his roof in light of
the relevant policy, effective May 19, 2014 to May 19, 2015.  After investigation, which included two separate
inspections, Acuity determined the damage to the roof occurred outside of the
relevant policy’s coverage period.  Acuity’s
position to deny the claim is unchanged.    
 
After first receiving
a notice of a loss from Mr. [redacted] on March 9, 2015, Acuity carefully reviewed
the claim. Acuity hired an independent adjuster, Ryan C[redacted], to inspect Mr.
[redacted]’s roof. Mr. [redacted]’s contractor, [redacted] from [redacted], was present during
the inspection on March 13, 2015.  Mr.
C[redacted] was unable to conclude that any of the damage was from wind or
hail.  Nevertheless, since any
discernable damage to Mr. [redacted]’s roof was minimal and below the applicable
deductible, Acuity initially denied Mr. [redacted]’s claim by letter dated March 24,
2015.  In the denial letter, Mr. [redacted]
was advised that if he was not in agreement with Acuity’s assessment, the next
step would be to implement the “appraisal clause” of the policy. 
 
On April 17,
2015, [redacted] called and informed Ms. [redacted] that Mr. [redacted] wanted a second
opinion based on the “appraisal clause” in the subject policy.  Mr. [redacted] misinterprets and misrepresents the
operation of this clause.  As explained
in Ms. [redacted]’s March 24, 2015 letter to him, the policy provides that when an
appraisal is demanded “each party will choose a competent and impartial
appraiser.”  If the appraisers disagree
on the amount of the loss, the differences will be submitted to “an umpire” who
is selected by the appraisers or a judge.
 
          Therefore,
the policy did not require that Acuity select an appraiser that was mutually acceptable
to Mr. [redacted].  Acuity retained CSHQA
architect Ted I[redacted] and construction professional Tim H[redacted] to inspect the
roof.  Both of these individuals have
significant experience in roof inspections related to wind or hail damage and
have various certifications for such work. 
Mr. [redacted] had the opportunity to select an appraiser, but did not do
so.  Thus there was no information to
rebut the findings of CSHQA. 
 
As a result of
the inspection on April 28, 2015, CSHQA found that the roof had some evidence
of hail and wind damage, but also had evidence of installation defects to the
shingles. Nevertheless, based on the inspection and review of historical
weather data from NOAA, CSHQA concluded the damage occurred prior to Mr. [redacted]’s
purchase of the property and effective date of his Acuity policy.  The weather data was emailed to Mr. [redacted] on
May 7, 2015.  The report from CSHQA was
provided to Mr. [redacted] on May 13, 2015.  On
that same day, Ms. [redacted] also spoke to Mr. [redacted] advising that he was going
to pursue legal action and that his attorney would contact Mr. [redacted] the next
day.  Ms. [redacted] did not advise Mr.
[redacted] to get an attorney as he claims. 
 
After reviewing
the report from CSHQA and obtaining additional historical weather data from
Verisk Climate, Acuity determined there was no evidence of a storm that could
have damaged Mr. [redacted]’s roof during the relevant policy period. As a
result, and based on the new information discovered during the appraisal process,
Mr. [redacted]’s claim was denied again by letter dated May 29, 2015.  
 
Although Acuity
invited Mr. [redacted] to provide additional information that could assist in
Acuity’s coverage determination, neither he or [redacted] have provided any
information to Acuity to rebut the findings of CSHQA. Throughout the claim
process, Acuity invited input from Mr. [redacted]. 
 
Since [redacted]
is neither an insured nor an attorney representing Mr. [redacted], Acuity was not
required to speak with him, but initially did so as a courtesy to Mr.
[redacted].  Ms. [redacted] left a voicemail for
[redacted] on May 31, 2015 advising him that she would be happy to discuss the
claim with Mr. [redacted].  Thus, Ms. [redacted]
has not been “passive” about speaking to Acuity’s insured, Mr. [redacted], as
alleged.       
 
The first time
that Acuity was made aware of any additional information regarding weather data
was when Mr. [redacted] filed a complaint with the Idaho Department of Insurance and
included a letter  addressed “To Whom
This May Concern” from [redacted] dated June 10, 2015.  It is disingenuous for Mr. [redacted] to claim
that Acuity did not consider information when he did not provide the
information directly to Acuity. 
Nevertheless, a review of that information does not change Acuity’s
decision to deny coverage. The data only indicates a period of rain between
8:53 pm and 10:11 pm on August 30, 2015. 
There are two wind gusts reported between 8:51 pm and 8:53 pm. There are
no indications in the report of hail. 
 
Further, whether
other roofs in the area may have been repaired is speculative and does not have
any bearing on Acuity’s coverage obligations under the applicable policy.  This is not evidence that Mr. [redacted] sustained
covered damage to his roof as claimed. 
The reasons that repairs were made to other roofs in the area are
unknown. In addition, it is unknown what type of insurance coverage the other
property owners may have and, importantly, the applicable coverage terms of
their policies.
 
In addition, Mr.
[redacted]’s position that the damage occurred after his purchase of the home based
on inspections prior to his purchase is also has no impact on Acuity’s decision.  Acuity’s position to deny coverage for the claim is based on the evidence analyzed by CHSQA
regarding the condition of the roof and weather history.  Acuity was not required to consider any
pre-purchase inspections.  There is no
evidence of “bias” with the information relied on by CHSQA and then confirmed
with the weather history obtained directly by Acuity.    
 
We trust this explains our position
in this matter. We believe there are no grounds to support Mr. [redacted]’s
complaint and request the matter be closed.

We appreciate your feedback.   We have reviewed the matter and determined that the policy was cancelled correctly in accordance with the policy provisions.   However, due to special circumstances related to this case, we have decided to work with the customer and not pursue the...

additional amount due.   We have reached out directly to the customer to explain our position and trust that the issue has been resolved.

Under MN Statute 176.155 Subd 1 The injured employee must submit to examination by the employer's physician upon the employer's request in order to prevent termination of benefits. As stated in my previous responses if the doctor finds the present complaints related to the original injury which occurred on 5-11-2009 Acuity will be responsible for treatment. If Mr. [redacted] refuses to attend the examination on 7-8-15 benefits will terminate until he decides to attend an exam.The proper venue to go thru for any disputes on a Worker's Compensation Claim is the Division of Labor and Industry. Their phone number is ###-###-####. Mr. [redacted] may want to consider talking to someone in the Department to have his questions answered. The reason for the second opinion is to determine causation of Mr. [redacted]'s present complaints.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.First of all, "understanding" does not me the same as "agree". The adjuster went into the reasoning of why Acuity would not pay for the roof but I did not agree with the outcome.  And I did follow up directly with the adjuster via email ( on Sept 14) and did not get a response.  My rates continue to increase each year with 0 claims and when I actually have a legitimate claim I get the resolution of fixing it myself with "defective" shingles that he claims is why there is damage to begin with.  
Regards,
[redacted]

Please see the attached response from Acuity, A Mutual Insurance Company. Thank you.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted]
 Thank you for the response however this is incorrect.  Please contact Acuity as my mother's name- [redacted] and myself- [redacted] are both on the policy. To ensure this was correct, we spoke with Acuity yesterday.[redacted] did NOT provide a itemized statement- see original complaint. If he did, this seems it would be easy to provide another copy to the Revdex.com.  This is very frustrating. Jason continues to avoid the request. Regards, [redacted]