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 Posted: Wed Dec 30, 2009 4:28 pm Post subject: Denied claim |
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I purchased a house last summer. I was turning it into rental house to make some additional income. While I was on vacation, a pipe in the upstairs bathroom began leaking. It has warped the floor and damaged the ceiling, walls. Now there is mold inside the walls and looks as if there maybe some damage to the basement. My insurance company is only covering the damage in the bathroom, mind you it is the least expensive part of the repair go figure. The adjuster who came out, is telling me that the mold and everything else is my responsibilty. BS!! I understand that I wasn't there to stop the damage, but thats what insurance is for. I have talked with my attorney who suggests going after the company for something called a fair claims practice (reading his letter of rep). What else can I do. I have prepared a list of expenses and quotes from 2 contractors. I am thinking of having them do the work and submitting the bill to the company. This is not my fault nor my responsiblity. I know the adjuster is getting a kick back from saving them the trouble.
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Gerry
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| Posted: Wed Dec 30, 2009 4:58 pm Post subject: |
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| Quote: | | mold inside the walls |
Policies do not cover mold. Mold is an effect not a cause.
| Quote: | | My insurance company is only covering the damage in the bathroom |
What was the cause of the leak?
| Quote: | | mind you it is the least expensive part of the repair go figure |
That would only be because the damages are a direct result from the leak in a specified area (bathroom). Need more info on the leak to help you out.
| Quote: | | The adjuster who came out, is telling me that the mold and everything else is my responsibilty. BS!! |
No BS. Whatever the cause of the leak was, only damage that was incurred by a direct result of the leak will be covered. Additional damages that were affected by the water that are an "after the fact" will not be. Example. If you wreck your car and continue to drive it, additional damages insued resulting from it's use will not be covered.
| Quote: | | I am thinking of having them do the work and submitting the bill to the company. |
The only person who will be stuck with that bill, will be you.
| Quote: | | This is not my fault nor my responsiblity. |
You own the house, why isn't your responsibility?
| Quote: | | I know the adjuster is getting a kick back from saving them the trouble. |
And you know this how? |
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Trench
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Joined: 16 Sep 2009
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| Posted: Sun Jan 03, 2010 2:27 pm Post subject: |
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How can it not cover mold!! Do you even know how mold is formed? It was caused by moisture due to the leak. According to the adjuster, he said that the leak started behind the wall of the vanty. He pointed out where someone at one time either fixed the wall or replaced the vanity base because was new. I think the this vanity was an after thout and I think the original sink was next to the toilet. All the water has collected underneath the vanity and nowhere else. I find it hard to believe the leak began in the wall, as there should be damage in the kitchen downstairs which there is not. Explain to me why you think this is my problem?? If this was a problem with the prior owner, there is no way it is my problem. The adjuster would not explain it to me and said I could get a copy of his report from the company. Well guess, what there is nothing in his report that says this. I am no expert, but I find it hard to believe that the company would trust his word because all it is a guess. It's still BS.
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Gerry
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| Posted: Sun Jan 03, 2010 3:59 pm Post subject: |
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There is no doubt that what could have casued mold, was nothing other than moisture, created by leakage (accidental or otherwise).
However, from insurance point of only direct damages because of insured perils are covered (under named peril policies) as rightly pointed pointed out by Trench.
In your case it appears that the water (or moisture) reached to other parts of your home through the wall, as a result of your bathroom problem, or some additional leakages (can help more if I get copy of report of plan of your house and details of damages) , causing molds (correct me if I am wrong), which is not expected under normal circumstances. This kind of damages are not covered under Insurance Policies.
However, if you can provide me report of adjusters, with your policy copy, may be I will be able to help you more.
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AryanOffshoreSolutions
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| Posted: Sun Jan 03, 2010 4:18 pm Post subject: |
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| Quote: | | If this was a problem with the prior owner, there is no way it is my problem |
(Just curious) DID the prior owner tell you of any problems, concerning the property? I would think, if there were problems BEFORE you bought it, and YOU now own the property, then the 'problems' are now YOURS. Remember....I'm NOT an expert....just my opionion. |
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sdchargersfan
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| Posted: Sun Jan 03, 2010 7:21 pm Post subject: |
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It's not a case of direct loss/direct and accidental, mold is a result of the water damage from the leaking pipe. The issue is that most HO policies will exclude coverage for constent seepage or leaking water unless it's unknown to the insured _and_ within the walls.
It sounds to me like the mold claim, and possible other parts of the water damage claim, is being denied as this was the result of the home owner not taking care of th issue in a timely manner (there was a another recent post about this).
Yeah, it sucks... but there needs to be some limitations on the policy. At some point it becomes in issue of not taking corrective action and allowing the small situation to become huge.
OP, if I were you I'd push this issue as much as you can. There is a possibility that someone higher up will make an exception and cover more of the damage. Problem is when the word "mold" is used. Insurance companies hate this as it can cost 10s of thousands of dollars to correct. |
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tcope
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| Posted: Sun Jan 03, 2010 9:34 pm Post subject: |
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| Yeah, I do know how mold is developed. Do you know what type you have? When mold forms on the inside of walls, thats a good indication that the problem has been there for a period of time. The way you have described this, sounds like seepage and not leaking water. If so, then thats the reason why the claim was denied. Whats with the adjuster pointing out "prior work" in the area of the damage? Was this prior work faulty? Was there evidence of a leak before? Any of those 2 things are spelling a denial to me. When did you notice this leak and how much mold are we talking about? If there is significant mold inside the walls and between the upstairs/down stairs walls, this is seepage and not a leak. Thats going to be denied almost all the time. You can push the issue, however based on what you have described, I would have to favor the denial, sorry. Do you have any pics? |
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Trench
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