Is this legal

by brilar » Wed Feb 15, 2012 12:18 am
Posts: 8
Joined: 14 Feb 2012

As most-insurance put words in your contract without your knowledge of their language. Filed a claim 2011. Denied. The adjuster said the water damage to my daughter's window sill was caused by water getting into the fireplace. Not true. So, I got a letter stating that I must get the painting chip fix and the window pane repaired(double pane) and contact them once its done and they might consider keeping me insured. Never address the damage to the sheetrock and rot. Of course, doesn't cover the water seepage. I challenge the decision, so the head adjuster came out and said it wasn't coming from the fireplace but probable two places thru the back door where the wood frame has rotted and seeped down and hit the metal plate and got behind the bricks or because the deck was done improperly before I moved in-it could have gotten through the spaces of the deck floor and enter into the bricks. I asked them why would they insure me if they inspected the home before they gave me insurance. This happened over a period of time behind the wall. I was denied the same day the adjuster's boss sent me out a letter without really knowing the exact location last year. What can I do now?

Total Comments: 10

Posted: Wed Feb 15, 2012 05:45 am Post Subject:

This happened over a period of time behind the wall. . . . What can I do now?


Nothing. At least as far as your own homeowner's insurance is concerned. This is a classic example of a failure to maintain the dwelling properly.

I realize most of the damage is not of your making, but you "inherited" the problem when you bought the dwelling. If you had the home inspected prior to purchase, there may be coverage under the inspector's professional liability policy. That would be the company to file your claim with.

Posted: Wed Feb 15, 2012 06:38 am Post Subject:

without your knowledge of their language

No knowledge because the never gave you a copy of the policy or because you never read it?

Rot is an indication of an ongoing issue with water. If water is seeping into the home from the ground then it's usually not covered and the premium for this type of coverage is not being charged.

Insurance addresses sudden and accidental losses. It sounds like you have ongoing issues with the home where water is seeping in. Like it or not, homeowners policies don't usually address this as it's more of a maintenance or building issue.

I asked them why would they insure me if they inspected the home before they gave me insurance.

I doubt the insurance company inspected the home prior to issuing the policy.

Posted: Wed Feb 15, 2012 06:45 pm Post Subject: Inspection

Why give a policy without checking the merchandise? If one adjuster comes out in 2011 and says its because of this and hes wrong and can't prove where the water is coming from and put it in writing than another adjuster comes out this week and say probably it can be 60% here or 40% there. How can you change in the game plan?

Posted: Wed Feb 15, 2012 07:10 pm Post Subject:

Why give a policy without checking the merchandise?

It's not the insurance companies responsibility to see what work the home needs. The policy covers certain things and not things that it does not cover. A main exclusion is wear and tear. They _do_ have underwriting questions that tell them a lot about the home. They are just not going to inspect a few million homes.

How can you change in the game plan?

It sounds to me like the claim is being excluded due to water seeping into the home. If this were the case, it would not matter where is was seeping into the home through... it's still excluded.

What is the denial for (specifically) and how is the damage occurring?

Posted: Wed Feb 15, 2012 09:03 pm Post Subject: letter I got stating claims

Dear BRIDGETT MILLER:

I am responding to your request for the claims history on the above numbered homeowners policy. Thank you for your call.

Our records indicate there have been five losses on the policy since the policy inception on 03-19-08 until the policy cancellation on 03-19-11. The loss history is as follows:

DATE AMOUNT TYPE LOSS DESCRIPTION
02-05-09 $00 Water Damage, non-weather related The insured sees mold in the bathroom.
Possibly coming from showering and steam is causing mold. Wall and caulking around tub area.
09-10-10 $00 Physical Damage The house has shifted due to the soil
underneath the house. Resulting in cracks
in foundation and walls, ceiling and the front bricks are coming apart.
10-26-10 $2,851.00 Water Damage, weather related Ceiling is holding water, looks like it is about to collapse from the weight of the water, not sure where the water is coming from, said it happened after the rain. Carpet is damaged, wall to wall. Dresser is also damaged.
11-29-10 $00 Physical Damage Insured’s son broke porch on the deck and the insured has to place boards on it. Insured believes that this may have caused a window seal to become damaged.
03-06-11 $00 Windstorm Water damage in daughter’s bedroom near window. Damage to windowsill, sheet rock and porch outside as well.

Posted: Wed Feb 15, 2012 09:18 pm Post Subject: damage

The damages are occurring either through the two inch spaces on the deck floor running down the brick wall or through the upper back door through the opening at the bottom of the frame door through the metal that's above the brick which sits on the outside of the brick

Posted: Wed Feb 15, 2012 10:19 pm Post Subject:

The damages are occurring either through the two inch spaces on the deck floor running down the brick wall or through the upper back door through the opening at the bottom of the frame door through the metal that's above the brick which sits on the outside of the brick


So what part of the claims report do you disagree with that the house is shifting on its foundation? This is the root cause of all your "clams" issues, and NONE ARE COVERED BY YOUR HOMEOWNER'S INSURANCE.

Your insurance company did you a favor by non-renewing last year. They sent you a WAKE-UP notice that if you don't act responsibly as the property owner, you will lose the property.

Fix all the defects, then you can expect your next insurance company to pay for your COVERED losses.

OH . . . be sure to read the contract to know what is and what is not covered. Do not submit claims for losses that are not covered, or you will suffer the same fate as above.

Posted: Thu Feb 16, 2012 12:57 am Post Subject: wake up

my home is pd for and maybe the foundation is the cause for all problems thanks

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