Denied Insurance Claims
Have a question about a denied insurance claim? Post it here for our contributors to answer. Questions under 100 words are more likely to receive an answer.
Have a question about a denied insurance claim? Post it here for our contributors to answer. Questions under 100 words are more likely to receive an answer.
October 13th, 2008 at 9:50 am #Suzanne
we had a hotwater heater burst on vacation damaged our wood flooring,was denied, and we are pursuing the claim further but we just received interregotorie questions that need answering is this legal to ask for 15yrs of questions also list all receipt’s and contractors name address
that did work on the house when we have only had the policy with them for 2yrs.
October 16th, 2008 at 5:42 pm #admin
Hello Suzanne,
Wow, thats a lot of stuff. When you use the word “interrogatories” that implies your claim is in litigation. Has a lawsuit been filed? Whether or not a lawsuit was filed, the 2 key legal words to focus on are “Reasonable” and “Relevant.” Most insurance policies themselves in “Your Duties After Loss” say you (the policy holder) will provide the necessary information “that we (the insurer) ‘reasonably’ require.” The law is the same in most states. If it’s in litigation, you or your attorney have to file an objection to each question or request for information on the grounds that it is unreasonable, irrelevant, over broad, vexatious, annoying and whatever fancy legal words attorneys like to use. If its not in litigation, just state your objection and reasons in a reply letter. Give them only what you think is reasonable and relevant. If the adjuster, claim manager, attorney persist in an unreasonable, invalid or illegal denial, fax a letter to the CEO of the insurer. Now the insurer will be facing punitive damages if your claim was unreasonably denied.
As to the water damage from the hot water heater, I assume the insurer is saying the damage occurred over a long period of time resulting in rotted wood. If the floor is not rotted, but just delaminated or swollen, that does not constitute “a long period of time”. Adjusters also often call black or stained wood “rot”. If you can’t push a butter knife through the wood, its not rotted. A reasonable insurer should cover the claim.
Don’t forget to make a rating on your adjuster and insurer in the Consumer Ratings section of this website when the time is right.
December 14th, 2008 at 9:47 pm #Paula
I have a question about a claim. Can my homeowner’s insurance company deny my claim for a break-in if we did not put our alarm on when we left out, we were only gone for a couple of hoursMy company is ny central mutual.
December 14th, 2008 at 10:45 pm #admin
Hello Paula,
I have never seen such an exclusion in a homeowners policy. But there is always a first time. I have never seen a NY Central Mutual policy. Look in your policy under exclusions, conditions and provisions, etc. Also look at the endorsements to see if there is an exclusion.
If you don’t want to put the question to your local adjuster, you could place a telephone call to a NY Central Mutual claim office in another city in New York. Ask to speak to a property adjuster. You don’t have to give your real name or policy number if you fear being charged with a loss.
If you would like me to review your policy for free, either mail, fax or email me a copy of the booklet and endorsements. I could use a copy of that policy anyway for the “Free Policy Copy” section of this website. (Your declaration sheet would not be posted). Just let me know and I will send you an email with my contact info.
December 26th, 2008 at 8:32 am #Karen
We have a house that’s been on the market for over a year. We stop in about once a week to check on it, since our new house is in the same area. A few days ago we found that the heat was off (Minnesota -10 degrees F), and in contacting the gas company learned that the last LP tank fill had been July. They filled it again, the furnace started up on its own, and when we went over to check on it later it was obvious there was pipe damage and water damage over 3 levels on one side of the house. It seems there was miscommunication with the gas company; they have on record that we requested that service stop after July. State Farm claims dept is saying it is denied because we didn’t take proper precautions. Do we have any chance? We are already paying 2 mortgages!
December 26th, 2008 at 2:59 pm #Karen
Update to our situation: The claims agent set up a conference call with the gas co., and asked them what evidence they had. They said they have a record in their computer that we called to update our billing address and then a note saying “July fill only”. The agent asked if they sent any notification in writing regarding the understanding about a change in the standing contract, and they said no. The claims agent took the conversation as sufficient evidence for them to deny the claim. He then said we might want to take the gas company to court. Does State Farm ever not find a reason to deny a homeowner’s claim?
December 27th, 2008 at 2:13 am #admin
Hello Karen,
Take a good look at your own policy wording under Section 1-Loses Not Insured (If you want to fax, mail or email us a copy of your policy for review, send an email to info@insuranceclaimhelp.org). Most home and rental policies say damage resulting from a broken pipe due to freezing is not covered if the house was “vacant, unoccupied or being constructed.”
If you have a “special form” policy, the burden of proof is on the insurer to disprove your claim.
My opinion is this:
1. Unless the gas company has something in writing signed by you, or a tape recording requesting no more gas, a note on the gas company computer could have been a clerical error.
2. There was no motive to shut off the heat. No reasonable person would shut off the heat.
3. The definition of “vacant” is open to interpretation and the entire clause is ambiguous, when compared to the exclusion for vandalism, further on down the list of excluded losses. Note it says that “a dwelling being constructed” is not considered “vacant”. That clause also gives 30 days as a definition of the time period of “vacancy.” You could argue that “under construction” implies new construction, not remodeling or maintenance, and if you did any remodeling or maintenance on the house, no matter how small, once every 30 days, then the house would not be vacant.
It would also look better if you had a good reason for not shutting off the water to the house. (I myself am so paranoid about broken water pipes, for any reason, that I will shut off the water valve to my house even if I am gone for the night. I leave the lawn sprinklers on with a separate valve.)
This is a tough claim to fight, even for professionals, and usually requires threat of litigation and multiple letters, sometimes up to the CEO for the insurer. You will be lucky if you get it covered.
And yes, suing the gas company is a possibility, if it can be shown that they were negligent. Also take a look at your contract with the gas company. And also talk to a lawyer who knows Minnesota law regarding negligence, etc.
December 27th, 2008 at 9:03 pm #Karen
Thank you for your helpful comments. What a great service this website provides.
Our policy states that loss resulting from freezing pipes is excluded from coverage if the house is vacant, etc, unless the homeowner takes reasonable care to:
a)maintain heat in the house, or
b)shut off the water to the house and drain the system.
We didn’t have the water shut off because we’ve had trouble with the line to the septic tank freezing, requiring a service call that costs about $100. The first time we had this trouble we still lived there, but were on a week’s vacation in January. The condensation from the furnace drains out to the septic, and if there is no water usage in the house the flow is too slow and it freezes. So to prevent this we stop over in the winter every 4-5 days and flush a toilet. Maybe in the future we’ll have to shut off the water and just take a few gallon jugs over to pour down the drain to the septic.
Regardless, given the “or” statement in the policy we were not required to shut off the water. It seems to me we did take reasonable care to maintain heat in the house–I don’t understand why the claims agent can deny our claim when all conditions were met. The fact that the gas company did not take reasonable care does not seem relevant.
I guess we need to get a lawyer to find out if we have a better chance suing the insurance company or the gas company.
January 1st, 2009 at 4:55 pm #admin
Hello Karen,
If your policy says “reasonable care” then that’s what you hang your hat on. Most policies don’t say that. Fax a letter to the adjusters supervisor with your story. If he denies your claim, then the next letter should be faxed to the CEO of the insurer. Don’t waste time climbing the chain of command. If the home office denies your claim, then go to small claims court if its under the limit or close. If its over the small claims court dollar amount, then see if a lawyer thinks its worth his time to handle on contingency. Of course any lawyer will work for an hourly fee. If a lawyer can shake them up with a couple of threat letters, it may be worth it.
Talk to a plumber and see what they do in your area. Maybe pour antifreeze in the drain once, but don’t flush? Or blow the water out of the drains with a leaf blower (or compressed air). The septic lines won’t be damaged from freezing water if there is no water in them. And I did not know that a partly full drain line would freeze enough to break a drain pipe. I can see if a p-trap would freeze, or a water line full of water???
January 5th, 2009 at 1:12 am #admin
Karen,
For some in depth easy to understand help, take a look at the Table of Contents for the UClaim report entitled “DENIED HOME AND BUSINESS PROPERTY INSURANCE CLAIMS ADVICE AND HELP DELUXE VERSION (W/APPENDIX) at: http://www.uclaim.com/products.asp. Scroll to the Miscellaneous report section.
It would be appreciated if you could take a few moments to give a quick rating on your insurer and/or adjuster and/or other insurer’s vendors on the Consumer Ratings page of this website. You don’t have to show your real or full name if you don’t want to.
January 9th, 2009 at 10:14 am #Jane Pytel Insurance Expert
Just taking a moment to review some of the problems encountered by visitors to your site. Claim denial and claim delay are two of the most serious and common problems encountered by consumers. I know because I was in insurance investigator for 12 years.
Since my departure from insurance, I have taken a very proactive approach to assisting people who suffer from insurance company tactics.
I write a series of articles, the most recent dealing with unfair settlement negotiation tactics. Check this out, it may be of help. http://ezinearticles.com/?id=1856390
Or you can contact me through my website, http://solutionsforyourinsuranceclaim.com/
I’ll be checking with this site, insuranceclaimhelp.org on a regular basis. Nice job.
January 9th, 2009 at 3:31 pm #admin
Hello Jane,
Thank you for your nice comments and spread the word.
January 23rd, 2009 at 9:18 pm #Maricela
My auto was stolen in Mexico, within 25 miles of the border. Farmers Insurance has denied my claim.
My policy reads : MEXICO COVERAGE – LIMITED ]
Read This Warning Carefully ]
Auto accidents in Mexico are subject to the laws of Mexico only-NOT the laws of the United States of America. Unlike the United States, the Republic of Mexico considers an auto accident a CRIMINAL OFFENSE as well as a civil matter. In some cases, the coverage under this policy may NOT be recognized by Mexican authorities and the Company may not be allowed to implement this coverage at all in Mexico. You should consider purchasing auto coverage from a licensed Mexican Insurance Company before driving into Mexico. This coverage does not apply to trips into Mexico that exceed 25 miles from the boundary of the United States of America.
The coverages for your covered auto provided by this policy are extended to accidents occurring in Mexico within 25 miles of the United States border. This extension only applies for infrequent trips into Mexico that do not exceed ten days at any one time.
Additional Exclusions
We do not provide any coverage:
1. if your covered auto is not principally garaged and used in the United States; and
2. to any covered person who does not live in the United States.
The claims office obtained a copy of my crossings using the license plate reader from the port of entry. My auto had crossed 15 times in the past 30 days. Farmers has determined that I am a frequent crosser. Why are they allowed to deny a claim if the definition of infrequent is not defined in the policy?
?
January 24th, 2009 at 3:01 am #admin
Maricela,
If the policy does not define “infrequent”, then they cannot deny your claim. Insurance policies are “contracts of adhesion”. This means you can’t line stuff out or change stuff when you buy the policy. It’s a “take it or leave it” deal. Therefore the law says that any ambiguities or unclear language in the policy must be ruled in favor of the party who did not draft the policy contract, (that’s you).
Fax a letter to the adjusters supervisor. If he denies it, then fax a letter to Farmers CEO at their home office. If he denies it, then sue them either in small claims court yourself or in Superior Court (if you can find a lawyer to take it).
You can compare your Farmers Mexican policy to a sample Mexican Auto policy for free download at http://www.uclaim.com/products.asp . You can also get much more detailed information on how to pursue a denied claim with the report entitled “DENIED AUTO AND MARINE PROPERTY INSURANCE CLAIMS ADVICE AND HELP Subtitle: STANDARD VERSION (W/O APPENDIX)” for $29.95 also at http://www.uclaim.com/products.asp
February 20th, 2009 at 6:41 pm #Kyle Larson
My question revolves around exclusions. I manage a large roofing company and we handle aprox. 1000 roofs damaged by hail each year. An issue that is coming up alot lately is if the insurance company owes the insured for roof decking when the old decking no longer functional due to age delamanation etc…. I know that all policies exclude losses wet or dry rot, bulging cracking of roofs walls etc… and defects, weakness in materials used in construction… However my argument is two pronged. 1. Since it is not possible to install the new roof over the old decking. The insurance company cannot fullfill thier contract of restoring the insured to thier pre event postion without paying for the cost to redeck the roof. My understnading of replacement cost is to pay for “equivalent construction for similar use” If we were to install the new roof over the old decking it would not adhere to code or manufature’s requirements. Thus the insured has lost because prior to the hail they had a roof covering that met code and manufactuer’s requirements. 2. Most of these policies have an endorsement for code upgrades which states that if an undamaged portion of the structure is required by code to be replaced the inurance company would then pay that cost to repair or replace. We have had building departments visit the job sites and put it in writing that it must be replaced and we still get denials based on the exclusions. By definition a roof assembly includes the decking and therefore if needed would be a part of the damaged loss as you can’t complete the roof covering without replacing it as well. The response I get most often is “what caused the decking to need to be replaced” and I say it is the hail that destroyed the roof. Insurance companies of course don’t agree. What are your thoughts.
February 21st, 2009 at 3:36 pm #admin
Kyle,
You are absolutely right in all you say. And guess what, even without a code endorsement on the policy, they still owe for the decking if the shingles can’t be removed and replaced without further damaging the decking. You can’t get the new nails exactly back into the old nail holes, right? So right there you have more holes, more weakness in the decking.
Yes, these insurers are still denying, even with the code endorsement. They do it either out of ignorance or intentionally, knowing you can’t afford to sue and no lawyer will take it because punitive damages on property cases are now restricted to 3 times the hard damage part (a “Bushenomics” supreme court legacy we will be stuck with for years).
How to deal with it? I just had a fire loss in Bakersfield, the building department said the non fire damaged crumbling foundation had to be replaced or the house could not be rebuilt. State Farm’s adjuster denied the foundation replacement, even though there was a code endorsement with clear language. His manager told me they had not paid on any code edorsement claim since 1991. I faxed a well written letter to Ed Rust, CEO for State Farm asking if State Farm had collected premiums for this endorsement since 1991 in Kern County, or California or the USA for that matter. In a couple days I got a letter from the local manager saying they would now cover this claim. I also got a letter from the head of State Farm Claims in California THANKING ME for bringing this to their attention. Now this is what I do like about State Farm. State Farm may be rotten, but it’s not “rotten to the core”. A lot of companies are rotten to the core.
Tell your clients to make ratings at the Consumer Ratings page on this website. This is what its for. I don’t believe the government can stop corporate abuse. Its got to be us, unselfish people. When you buy something on Ebay, do you check out the Sellers rating first? It’s got to be the same here if we want to get control of the bad boys.
April 2nd, 2009 at 7:11 pm #Evangela
Hello,
I recently let my friend borrow my car to pick up her kids from school and to pick up a friend from the hospital. While on her way to the hospital, she was rear ended by a driver that caused her to spin into another car. My car was a 2005 Saturn Ion 2 Four Door Sedan and fortunately Saturn makes quality cars because the trunk just folded up and her 7 yr old son was unhurt. My car is completely totalled now. The guy who hit my car (I didn’t have insurance at the time of the accident) had insurance through Preferred Auto Insurance so I called in the claim myself once I got the police report. He was deemed at fault on the report for following too closely. On Monday, 3-16-09, No one had called in a claim and the adjuster had no idea about the accident which had happened 3-13-09. My friend was taken to the Emergency Room with neck and back pain due to the impact of the hit snapping the driver’s seat back. I received a phone call from Preferred Auto Insurance saying that this was a non covered loss and that the details couldn’t be discussed due to their privacy policy. A letter was sent in the mail without anymore detail than what I was told on the phone. I proceeded to contact two lawyers so far who are telling me they can’t take the case but no one will tell me why. The Kelly Blue Book Value of my car is $7915 and my friend is now in physical therapy and I need to know what to do because this man has insurance and neither I nor my friend contributed to this accident in any way. Also now the person whom my friend hit is suing my friend when she would not have hit her if it were not for this guy rear ending her. My car and his vehicle sustained the most damage in this six car pile up.
Please Help!!!!!
April 3rd, 2009 at 11:19 pm #admin
Evangela,
It may be that Preferred Auto is denying the claim because your state does not allow victims to sue if they have no insurance themselves, regardless of who was at fault. It’s a way that some states penalize drivers without insurance. This may also be why the two lawyers would not take your case.
You may also be a risk of being sued by your friend who you loaned the car to.
Please let us know what state you are in, and if this is indeed the reason so that others may learn from your very unfortunate experience.
April 3rd, 2009 at 11:42 pm #Evangela
I live in the state of Tennessee and I’ve been in an accident in which someone hit me and I didn’t have Insurance then either and they paid for all the repairs through their Insurance. I was laid off Recently and that’s why I haven’t had Insurance.
April 4th, 2009 at 12:12 am #admin
Evangela,
Check to make sure the law has not changed. Laws get changed all the time and often the public never hears about it.
If indeed you can legally file suit and the situation is as you said, then there has to be dozens of lawyers who would love your case. Feel free to email a copy of the insurer’s denial letter to info@insuranceclaimhelp.org if you want better advice.
April 13th, 2009 at 4:30 am #Debra
Hello,
We had a flexible spending account in 2007 which we used to pay for approved medical expenses. We provided the fsa company with receipts which they say they did not recieve. They did not notify us about this denial until August 2008, at which time they asked for receipts again, which we provided again. In March 2009, they demanded money, claiming that they never recieved our receipts. We sent them proof (a dated fax receipt) that we did indeed send the receipts to them when requested.
The fsa company is not denying the viability of the medical claims. They are denying recieving the receipts.
After several conversations with the company’s service reps, who agree that we provided the company with everything they asked for, their “review board” still denies our appeal and is asking for money. I spent much of last week on the phone with this company and am at a loss as to how to proceed. What now?
April 13th, 2009 at 12:50 pm #admin
Oh Deb, you can have some real fun with this one
I normally suggest faxing documents to insurers (as you have already done) in order to get the “transaction report” as proof of delivery. And you can still use this in court if you have to. But in your case, I think I would scan the receipts and save as PDF’s, attach them to an email sent to whoever you are talking to at the insurer and Cc the email to several other addresses and get the insurance rep on the phone and ask him to open the email and attachment while you are on the phone. If you don’t have a scanner, have Office Depot or a friend do it.
And the fun part, Cc the email to your state department of insurance, 60 minutes and whoever you want to add.
And do this too, fax a copy of the receipts to the CEO’s office for the insurer.
April 16th, 2009 at 3:58 pm #patrick
ok here is my situation
i was out of town for ester break, friday through sunday night and when i took off i guess my garage didn’t close, the sensor must have triggered it back up.
now i work out of my garage which i am not really suppose to do but its the only space i have left to work in. i buy computers from apple and upgrade them and i had over $30k in units on the shelf in there that are now gone!
when i got home it was very late and i just drove 8 hours and the last thing i wanted to deal with was the cops there so i waited till the next day to deal with it. i live right by the manager and wanted to go into the police station to do the report because i didn’t want them making a major scene at my apartment. i didn’t want the appt. manager coming over and seeing whats going on and see that i have been working in my garage which i could get evicted for!
also i didn’t want my neighbors coming over or asking whats going on because then everyone will know what i do and keep in there. that would put me at risk even more with everyone knowing whats in there.
i got all the documents needed, the receipts, and went to the police station and waited to do the report and when the officer came out, a young rookie, he stated that i should have called them out when it happened and there is nothing he can do. i told him it was late and it didn’t just happen since i was out of town the whole weekend. i also explained my situation with the fact i am not suppose to be working in there and didn’t want to get in trouble with my complex manager who lives right by me!
his response to that was, well whats more important you place or your things? i said BOTH ! i dont want to get evicted and i also want to be covered for my things so yea
i said he can come out to investigate it as long as he can keep it quiet so i don’t get in trouble with the manager and draw attention to my garage. he said that is not possible and would talk to the manager and knock on my neighbors doors and make a scene.
now without a report and them not caring i have to deal with my insurance company who wants a report to file my claim. i might be screwed now since i can’t provide a report….
can the police do that and say no to making a report for me?
can my insurance company deny my claim if i CAN’T get a report for them because the police department wont make one?
if i try to get a report and can’t because the police wont do it then i think the insurance company should still cover me because its out of my hands and not my fault they won’t take the report…
any ideas or thoughts on the subject or help for me here
April 18th, 2009 at 1:22 am #admin
Hello Patrick,
Well, your story sounds “reasonable” to me. And that is a very important word in insurance law and in your insurance policy.
1. No, the insurer can’t deny your claim based on your story. But they may try like crazy to delay their “decision” for a couple of years until you just give up. Maybe they will deny it for “failure to cooperate.”
2. Nothing in most policies says you have to make a police report. Your policy says you have a “duty to cooperate”, “within reason”.
3. If the police refuse to make a report, then try to get that in writing, and sent that to your insurer. In fact, you should make your request for the report in writing and fax it. Any failure on their part to respond can in itself be an admission.
4. The insurer may make a false issue of this since they know you want to keep a low profile.
5. But consider this before you spend a lot of time pursuing a claim, unless you have a “business” policy, or an endorsement on your renters or homeowners policy to cover, or increase a small limit on “business property”, your renters or homeowners policy may not cover business property.
If you decide to pursue the claim, consider the eBooks “DENIED HOME AND BUSINESS INSURANCE CLAIM ADVICE AND HELP” and “INSURANCE CLAIM PRACTICES LAWS WITH UCLAIM COMMENTARY, ADVICE AND HELP” on the product page at http://www.uclaim.com/ .
April 21st, 2009 at 11:58 am #patrick
they tried to give me the lower business coverage which is only 2500 leaving me screwed on the 40k plus worth of lost equipment!
i told them that its not technically a business since i haven’t sold anything yet, don’t have a business name or license or web site. the lady who was not even in California said it doesn’t matter and told me that since i mentioned a business that there is nothing i can do about it.
i told her that we haven’t even done the recorded interview and that i will not state its a business because its not one yet and may never be one. i told her that its all mine and that i was thinking of selling some of the units or all of them but they are mine. same as buying a lot of furniture and turning around and selling it all for newer pieces.
she also said that i can’t get anything or continue with my claim unless i get a police report. so i am up sh#t creek here and very very upset!
so i have no idea what to do now and feel very taken advantage of by this insurance company being esurance
they wont even return my 266 dollars i paid 5 months ago for a year up front of coverage. i demanded it back since i am not getting the coverage i am paying for and they refuse to do it. they said i would get 160 back and thats all…
i really want to sue them but i don’t want to deal with it really but its a lot of money i am loosing that they aren’t covering!!!
can anyone help me out here?
April 21st, 2009 at 3:32 pm #admin
Hello Patrick,
1. I still don’t think they can insist on a police report.
2. If their claim denial is valid, then I don’t think they owe you a full refund.
2. Read the definition of “Business Property” in the definitions section of your policy. If it does not exactly fit your situation, then they can’t deny the claim. If there is no definition, then look up the legal definition in Blacks Law Dictionary. Short of a clear definition, I think a judge could consider what the property was “intended” for. On the other hand, if the property was never offered for sale and you filed no business papers, then maybe technically it was not a business.
3. If the policy definition is not clear, then the benefit of unclarity goes to your favor.
4. If you want us to review your policy for no charge, scan it or have Office Depot scan it and email it to info@insuranceclaimhelp.org .
April 29th, 2009 at 10:48 pm #annmarie
We had parked our brand new Lexus in a commuter rail parking lot from 930AM to 905PM. When we returned the rear side of the car had been hit. We took it the next day to the body shop that the Lexus dealership uses and the insurance adjuster viewed the car I believe a day later. There was over $4000 of damage, being a new Lexus it is expensive to repair. The insurance company is trying to deny the claim, saying that the car was moving when hit. The car was in perfect shape when we parked it in the morning and damaged when we returned. Can you give me any help in what to do next.
May 1st, 2009 at 10:54 am #admin
Hello Annmarie,
I don’t know what difference it would make if your car was moving or not. Most auto policies cover collision damage to the car whether it was moving or parked. And if you have comprehensive coverage, most insurers require collision coverage as well. I would also think that you have uninsured motorist coverage with a Lexus?
Ask the adjuster to put the denial in writing and to quote the policy language that says collision to a moving vehicle is not covered. If they have more reasons for the denial, then it should state why.
If you don’t have your policy form copy, you can get a sample at UClaim.com.
May 6th, 2009 at 11:18 am #Zedition
We have a standard homeowners policy with a company that has an exclusion for “collapse”. A while back, we noticed damage to our well, and immediately contacted the insurance company with a claim. They denied it outright without sending out an inspector, and because the well was within 5 feet of our home (and a safety risk), we filled the well in. After contacting the State Department of Insurance, we learned that common practice is for a company to send out an adjuster/inspector before denying a claim – in our case it is possible that the well did not collapse – nobody really knows what happens because the only damage was the subsidence of a few cubic feet of soil and very dirty water in the pipes.
Now it sounds like they want to deny it based on several other factors, primarily that it “probably was a collapse”, “flooding”, and inferior construction because the well was brick-lined, not cased in modern concrete tiles. The brick-lining was state of the art before WWII when the well was probably built, and I just can’t see that “inferior construction” applies just because technology got better over the next 75 years.
My argument is that the company did not exercise due-care in investigating the claim, and that they should have either sent out an inspector before denying, or recommended that we have the well professionally inspected before we began to fill it in. What kind of responsibility to exercise due-care in the investigation of a claim does a company have?
May 7th, 2009 at 1:26 pm #admin
Hello Zedition,
Lots to consider here. Was the denial in writing? Was there a tape recorded statement? Is the well a “structure” below the casing or bricked in part? Or is that lower part just a hole in the dirt or clay or rock below the casing? Is this a wide well that you drop a bucket down?
The insurer has a duty to do what is “reasonable” in deciding how much investigating to do. And that depends on what information you gave the adjuster on the phone to describe your well and what questions you were asked. Well construction may vary considerably. At first I assumed you had a submersible type well with a steel pipe casing at the top. But when you said “brick lined”, then I started to wonder if it was a well like you drop a bucket down.
A collapsed well is a very unusual insurance claim, and in my 30 years living in a farming area, I have never has such a claim.
Most adjusters know nothing about how wells are constructed in different parts of the country. And if they do have knowledge, it is probably about how wells are built in their own area.
Even though you filled the well in, it may be possible to “exhume” enough of it to determine the cause and origin by an engineer.
As to denial for “inferior construction”, that sounds like an over zealous wishful thinking adjuster. Most policies exclude “negligent construction”. That’s not the same as “inferior construction”. If “inferior construction” was not covered, then there would be no coverage for old homes, right?
Read your policy wording and check it against the denial letter wording.
I think you could also say the well was an “appurtenant structure”, if part of the denial is that the well is not a structure or that the well is a hole in the land and land is not covered.
You can learn the basics of dealing with denied claims in the eBook entitled “DENIED HOME AND BUSINESS INSURANCE CLAIM ADVICE AND HELP – STANDARD VERSION (W/O APPENDIX)” at UClaim.com http://www.uclaim.com/products.asp .
May 7th, 2009 at 2:03 pm #Zedition
The well is a ground-water well, very common in older rural homes in the Midwest. My research on this tells me that today’s common drilled wells (diameter 12” or less) didn’t become common until the late 1940’s, and hand-dug tiled wells like mine were still being put in up to the early 1970’s. Concrete ring-cased wells become common to line the wide, dug wells like mine once truck-mounted dolleys and cranes were available.
The well was larger than 36 inches wide, and I bet you could drop a bucket down it. But mine had a submersible “push-pump” resting on the bottom – similar to a sump pump in a home, but designed for this kind of wide but shallow well.
I personally did not tape record the claim denial, but when I bypassed the claim adjuster and spoke with the claim manager, I heard the tell-tale pauses and clicking of a recorded conversation. I’ve documented that I was informed of the denial on day 1 to the company and the State Insurance Commissioner as well. What I do have is that the letter notifying me that they intend to investigate the claim is dated almost a week after I first contacted the company.
The entire well casing from top to bottom was “clay tile”, similar to field tillage tiles, but squared off and made for use in a well. The top 6 inches was a poured concrete cap. I believe the bottom of the well was sand, because it tapped into a subterranean mineral water spring. Putting concrete over this would stop the spring water flow.
It would be difficult to exhume the well, as it was within a few feet of my home’s foundation. One of the key problems right now is that what caused the well to malfunction is “unknowable”. It’s kind of like having your house bulldozed before the claim adjuster arrives to evaluate the fire damage. Maybe it was a total loss, maybe a partial loss, maybe the fire was not accidental, now that the house is gone – it’s impossible to be certain what happened.
Thanks for the link, I’ll check out the eBook!
May 7th, 2009 at 3:36 pm #admin
Zedition,
If it was “legal” (admissible in court) tape recording, they would have to have asked your permission.
1. What would it cost to replace the well:
A. exactly as it was built?
B. With current replacement to code?
2. What was the current “market value” of the well?
3. What was the demo cost?
Feel free to post the exact denial wording from the letter here if you like, or email a copy of the denial letter to info@insuranceclaimhelp.org for our review. Black out any id info. if you like.
May 7th, 2009 at 3:41 pm #admin
Zedition,
One more thing. Check out the wording on collapse exclusions in your policy. Some policies don’t clearly exclude “eminent collapse” (a sagging, leaning, slumping, cracked, etc. structure).
May 28th, 2009 at 7:44 am #Denise Lattin
My insurance company denied my claim by saying my loss is due to long term leakage at the water heater which is not true. I hired a plumber and the hot water heater is not leaking it is the pipe and valve that started to leak. At the first sign of water on my floor I contacted the insurance company they sent out an adjuster who just took pictures and didnot even check so see where the leak was. The hot water heater is in the wall in the bedroom so how am I to know something is wrong until I see water on the floor?
May 29th, 2009 at 2:48 am #admin
Hello Denise,
Unfortunately it does not matter if the damage was hidden from view. And it does not matter if the water leaks from a pipe, valve, or the heater itself. They are all “appliances”. But all is not lost.
Adjusters often mistake a black wood floor or buckled floor for “long term” damage. The key is whether you can push your finger or a dull butter knife through the “damaged” floor. If you can’t push your finger through the “rotted” wood, then it is not “long term” damage. A plywood floor can buckle over night and can turn black in a couple days. That’s sudden and accidental, not long term.
May 29th, 2009 at 10:25 pm #david
i was t boned by a taxi driver who ran a stop sign; there insurance in nationwide in ny. they wont pay claims as person was using car as a taxi and only had personal insurance on it, isnt there a way to get some payment for my car. i cant work as i use it for work
May 30th, 2009 at 10:56 pm #admin
Hello David,
Most personal auto policies exclude liability coverage if the vehicle was used as a taxi. Did the “taxi” have any passengers during the accident? If not, there may be coverage if the taxi driver argues the accident occurred during personal use of the vehicle.
And of course, you are still free to sue the driver and taxi owner, regardless of whether his insurance covers him or not. That could motivate the taxi driver to pressure his insurer to cover your claim.
June 10th, 2009 at 8:53 am #Tracey
My question is regarding health insurance, I have a claim that was denied stating that a procedure was “investigational”. My doctor did not inform me that the procedure was investigation and would not be covered by my insurance, if he had, I would not have had the procedure done. Shouldn’t the doctor assume the risk on any “investigational” procedures, or at least have the procedure pre-approved by the insurance company?
June 12th, 2009 at 12:09 am #admin
Hello Tracey,
In my opinion, common sense and decency would say that the doctor should have pre approved the procedure with your insurer, even if you did not ask them to pre approve it. They should know better because they do this every day. While you probably had no choice but to sign a paper that says you will be responsible for the doctors bill if the insurance company denies the claim, I say that a patient should have a “reasonable expectation” that the service provider will pre approve whatever their service is. “Reasonable expectation” is a legal concept that can be used to override an unreasonable or deceptively written contract.
Considering the unfriendly nature of explanations of medical procedures, coverages and billings, policy holders should not have to jump through a thousand time consuming hoops that no reasonable person can understand anyway, and therefore should get the benefit of the doubt if litigation ensues.
We all know that most medical providers grossly over bill for their services and “suck us in”, giving us as little information as possible when we are at our most vulnerable, when we have a health problem. When they engage in negligence and deception for the purpose of sticking you with the bill, they should be fined and have their license to practice revoked. Period! But the system is broken when our legislators are getting “contributions” and free game tickets from the medical lobbyists.
Want a little satisfaction? Go to http://www.RateMDs.com and rip your doctor up so everyone can see who not to go to. Medical providers hate this website, but it gives consumers power that failed government and the media lack.
June 19th, 2009 at 5:42 am #Mary
My laundry room floor caved in. Farmers sent an agent who said it was due to a leak from the A/C unit which was in the room. I received a check for partial repairs, but when the A/C was removed we discovered the floor was a 3 1/2 inch slab of concrete on a pier foundation in the laundry room (house is 65 years old) As my agent asked me to do I sent him a copy of the new proposal as the cost increased for the repairs due to the concrete and the size of the area to be fixed. No word…call…no word..call… agent on vacaton for 2 weeks. Meanwhile we have no A/C and in south Louisiana it is in the 90’s, the room is half way torn down, and the floor is tilting more each day. I called Farmers who sent another agent and he was a total jerk with an attitude. Told me if they had seen it I wouldn’t have gotten anything due to decay, and that I was lucky to have gotten what I did. In my policy under the collaspe cause it mentions hidden decay, water damage, weight of object. Now they say there was a change in the policy that I should have recieved due to some H114 endorsement which will not cover repairs for any decay no matter what the cause, and are refusing to cover the additional 5000.00 to fix it. What recourse do I have? It seems to me that since collaspe is a covered loss, that maybe the cost to repair the A/C that cause the damage would not be covered, but the damage to the floor should be. Should I file a complaint with the insurance commissioners office, or is the insurance company right?
June 19th, 2009 at 11:09 am #KC
I had a house fire almost four months ago. I met with state farm a week after the five and answered a lot of questions. I then received a letter from a law firm asking me to provide a great deal of information such as bank statements and tax records to them on the insurance companies behalf. I had to meet with them in person and under oath answer more questions. My lawyer told me to provide everything that was asked for. I know that this is normal in a case with a suspicious fire. However I do not understand why they never verified any where I was yet have questioned me about it several times. I know from the insurance investigator that me and my exhusband are suspects he told me that himself yet is this a normal tactic. I do not know what to expect next. Are they trying to find a loop whole in the contract and why so long. The house is now in foreclosure yet they still have not made a decision one way or another. I could use any advice that lets me know what they are doing or is going to happen?
June 20th, 2009 at 2:13 am #admin
Hello Mary,
When you said the AC was leaking, I thought you were going to say the claim was denied. But you said they covered it. The policy covers “sudden and accidental” not long term damage over time. And policies cover collapse, but there are more limitations and endorsements being attached to that kind of claim every day. The policy and endorsements that apply are the ones in effect on the date of loss, not after the DOL.
Without arguing over that issue, your best argument is that Farmers waived their right to deny any supplemental claim since they already decided to cover the claim and issued payment and told you to proceed with repairs. You relied on their actions and instructions. In insurance law this is called “estoppel”. An insurer can’t take back what it already paid, even if in error. And an insurer can “change its mind” after it already said it would take a course of action. I assume you have documents to prove that the insurer initially covered your claim, for example a check, cover letter, adjusters estimate, etc.
Yes, make a commissioner complaint
June 20th, 2009 at 2:34 am #admin
Hello KC,
Go to the UClaim.com Products page under Miscellaneous and consider the eBooks entitled “DENIED HOME AND BUSINESS INSURANCE CLAIM ADVICE AND HELP” and “EXAMINATION UNDER OATH (EUO) INSURANCE CLAIM ADVICE AND HELP”. If things get dirty, you may also consider the eBook “INSURANCE CLAIM PRACTICES LAWS WITH UCLAIM COMMENTARY, ADVICE AND HELP”.
Note, most attorneys know nothing about the differences between an EUO and a deposition. Most will handle your EUO as if it were a deposition. But even so, an attorney with you during EUO is far better than none at all. And the insurer can recall you for more EUO’s. So don’t assume its all over with.
If after all this “stuff” they put you through they put in writing that they will cover your claim, then you will need the eBook “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe)”.
If they deny your claim, you need to have an attorney and or good public adjuster take a look at your claim. In fact it’s a good idea to get them working for you now. The UClaim eBooks will also show you what your PA and or attorney should be doing. You can also get advice on hiring a PA on the Free Stuff page at UClaim.com.
Good luck.
June 23rd, 2009 at 11:51 am #G Willmann
Hello,
Any help/advice appreciated.
I rented a truck from Penske with the cargo insurance. In the truck was my motorcycle which was attached to the cargo “ribs” in the truck via very secure ties. (Drove from VA to RI). When I opened the back the “ribs” were broken and the bike was down with a very dented gas tank. After going through Penske I was eventually sent to Zurich (Empire Fire and Marine) who told me this wasn’t covered for 2 reasons:
1) Section A. Coverage – “We will pay for all direct and accidental loss or damage if caused by cyclone, ….upset or overturn of “truck”". I told them the truck was upset and resulted in the damage, they say NO.
2) Section E: Exclusions – We will not pay for damage sustained by 4-wheel, licensed vehicles to include motor vehicles, motorcycles…
– My issue here is that the contract says “Damage done by”, in my case it was damage done to…my motorcycle. They told me I didn’t know legal definition of “to” and “by”. My response was “If a crime is done BY domeone they are a criminal, if it is done TO someone they are a victim”. Am I wrong? Any advice is appreciated as I feel I am getting the once over. Thanks in advance.
June 25th, 2009 at 10:25 am #james b
We had a house fire Christmas eve 2008 and luckily we we at church.
The fire started in the basement and was contained there except for all of the smoke damage throughout the entire house. I will spare you with some of the details and get rigt to the point. Our insurance company has paid us for
the dryer ( the fire source) washer, and water heater . The heater is what I have been denied on. Our heater stopped working when the water heater did
and they paid for that and the heater is next to the dryer.
Is it worth pursuing?
June 26th, 2009 at 1:08 am #admin
Hello G,
1. Find out the definition of “upset”. If it is not defined in the “Definitions” part of the policy, then look in a Websters Dictionary, and look in a Blacks Law Dictionary (at your local county free law library, usually at the court house). Look for the legal definition before the common man definition, because that will carry more weight with a small claims court judge. If you want to see how court cases define “upset” either get the law librarian to help you search, or go to Findlaw.com “professional section” and search for case law in your state first. If none, check other states. To learn how to research the law for insurance claims consider the UClaim.com product entitled “INSURANCE CLAIM PRACTICES LAWS WITH UCLAIM COMMENTARY, ADVICE AND HELP Subtitle: Save HOURS of Research Time”. View the table of contents.
2. Your thinking about “damage to” and “damage by” is logical and reasonable. Theirs is what I call “brainwash brainlock” or intentional stonewalling (gambling you won’t sue them). In either case you will get nowhere with the individual who denied the claim. Advance to the supervisor, if no luck advance straight to the CEO. If no luck, then small claims court. You can learn the techniques in detail in the “standard” versions of UClaim home and auto eBooks.
(And we can thank George Bush and his supreme court for effectively getting rid of punitive damages against insurance companies.)
June 26th, 2009 at 1:33 am #admin
Hello James,
1. Most policies are “All risk” on structure, stating “we cover all perils except …”. This means the insurer has the burden to disprove your claim. So let “them” hire the engineer to find out why your heater failed. And they are supposed to give you a copy of the report. And the heater is part of the structure, not “contents”, like the washer and dryer.
2. Get a written statement from an HVAC person that the heater could have been damaged from the heat and or smoke.
3. If the insurer still denies it, go to small claims court for around $25.00 and no attorneys allowed in.
July 7th, 2009 at 1:51 pm #Archana
Hello
any help is appreciated.
2 weeks back my retaining wall (which retains my pool) collapsed. On the day of and the previous day there was severe rain and hail. The Insurance company(Nationwide – which is NOT on my side!) sent in a structural Enggineer to check it out and ultimately today I received a letter of denial. The reason being, no earth movement, faulty construction, etc is covered. The retaining wall has taken down a whole chunk of the fence, concrete patio, landscaping, irrigation system and landed on my basket ball court. The engineers report also mentions that it is not clear whether there was a leak in the irrigation system that might have caused it.(in which case, I think, the insurance should cover the peril). Since they are not sure of the reason, shouldn’t I reply back with the above said points and ask them to reconsider. Please let me know what you think. Thanks for your time.
July 8th, 2009 at 3:53 am #admin
Hello Archana,
Yes of course reply, and put it in writing. You have to build your own file so if you have to sue, you have good evidence, not just your word against theirs.
Get your own expert to state the cause in writing. Start with a plumber, or pool tech and if you can afford it, get your own engineer. Sadly, many experts will conclude whatever you want them to and make the facts fit their conclusion.
Your policy probably says “we cover everything except …” on structure items. That means the burden of proof is on the insurer. So if their engineer can’t rule out a plumbing leak, then the insurer has to pay you. Consider one or more of the products (currently on sale) at UClaim.com to teach you how handle this situation.
Is your insurer really Nationwide or “Allied in disguise”. Nationwide is normally generous. They bought Allied, a low quality insurer, for their claims infrastructure (see Recommended Insurers link on this website).
July 8th, 2009 at 4:50 am #Archana
Thanks. I I have sent a letter to the insurance. We’ll wait and see what they have to say about the claim. will keep you posted. Thank you.
August 1st, 2009 at 7:00 am #Honest Guy
My roommate called me while I was in school and told me he just got home and noticed the apt was broken into.I left school came home and called the cops and filed a claim.Allstate took 5 months to investigate my claim,including giving me a EUO with their big Attorney ,Looking at my bank statements for the last two years,incomtax records for the last two years,cell phone records,Renters history of 5 years,credit reports,loan history,school grades and attendance,and everything inbetween.After five months of finding nothing to discredit me….they still deny my claim stating….1.On the police report the officer said”The porch balcony door had pry marks on the outside but appaired to be in random places” and “the door jam was broken outward apairing as if it was kicked outward.”…2.My policy canceled in January and was reinstated less than 48 hours before the burgulary..3.Most of the items that were stolen from apt were bought with cash from local sellers on craigslist.org and I have no receipts so they say I didnt prove I owned the items(even though I have a video tape inventory of my entire apt specificly incase something like this was to happen)When the police was at my apt taking the report they couldnt conclude as to how the perps got into myapt….they say it could have been my roommate,maintnance,or anyone else but they couldnt conclude who or how.But Allstate concludes from reading the report.Allstate never came out tomy apt to see the door or anything.Early in the investigation,Allstate asked for my roommates phone number and they called him and asked him whatever…then coming to the end of the investigation they when I keep asking for a status on the claim,they start telling me that they need to talk to my roommate again and they been trying for over a month and he never answers the phone or reply back.Its very clear that Allstate simply doesnt want to pay.I plan on sueing them for handling my claim in bad faith.
August 7th, 2009 at 12:06 am #admin
Hello Honest Guy,
Well you are right, its suing time.
FYI, on a contents loss, the burden of proof is on the policy holder, whereas on a structure loss, usually the burden is on the insurer to disprove your claim. But Allstate has gone too far, IMO.
A court may have to decide whether your videotape is reasonable proof of ownership. I think it is. You could also get affidavits, written statements from people saying they saw the property in your home. If Allstate still denies your claim, it’s that much more angry it will make a court.
September 3rd, 2009 at 6:55 am #Trish
I have a rental property in Pittsburgh where the tenants destroyed my home. From allowing their dogs to urinate and crap all over the floor, kitchen cabinets ripped off, carpeting torn off, superglue to put on walls, holes in doors, ect. And my insurance company denied my claim based on normal wear and tear, deterioration and maintenance. Maybe for a zoo but this is my home. What should and can I do?
September 5th, 2009 at 4:36 pm #admin
Hello Trish,
You have to approach this as a vandalism. Make a police report, even if only by phone. You will have to argue each and every item claimed with the adjuster, preferably on site. Be prepared to give in on some items. For more details on how to handle this kind of claim, consider the eBooks at UClaim.com Homeowners Loss Deluxe and possibly Denied Claims. Look at the tables of contents for each product.
September 14th, 2009 at 2:41 pm #Darek
Hi. I’m a Restoration contractor in NY and I have a question as to how a denied claim affects “mitigation”.
We performed the mitigation on a water damaged home for a customer that has Insurance. The cause was determined to be a frozen/ruptured pipe in the bathroom sink. (water supply line)
Anyway, the claim has been denied due to lack of due diligence on the insureds part for not insuring his LP tank was full. (He was staying at his relatives due to being temporarily disabled from a previous car accident)
Now I believe that on most policies it is required for the insureds to “mitigate” their damages. If they do not, than the claim is likely to be denied. If they do, but the claim is then denied after mitigation has been performed by a contractor, wouldn’t the “mitigation” portion of the claim still be covered being that the insureds did what their policy (and an insurance rep)directed them to do?
I mean, if the insured did not mitigate, and the claim was valid and not deniable, then once the insurance company discovered all the additional damage from the insureds failure to mitigate, than I’m sure the insurance company would be very quick to now deny the claim. So, am I crazy to think that Mitigation would still be covered on claims that are later denied?
I can see the build back/restoration/repairs being denied, but the mitigation?
What say you?
Please allow me to thank you ahead of time…
Thank You……….
Darek
September 14th, 2009 at 3:29 pm #admin
Hello Darek,
Well first of all, to simplify communication, you should not refer to restoration services or mold remediation as “mitigation”, because that word has different meanings. In insurance policies, the word mitigation means the insured must do what they can to reduce their damages or chance of damage, for example, cover a roof if it has a hole in it and it’s about to rain. So if the homeowner in your case had a good reason (that a court judge would agree with also) for not keeping the heat on, or the propane tank full, then his claim cannot be denied. While insurance policies say “mitigation”, they are overridden by the law, which says “mitigation, within reason”. But it sounds to me like your client (and his relatives) just forgot, unless he was in a coma or mentally incapacitated from the accident.
I see no difference in “build back” and “mold remediation” (if that’s what you mean by mediation) when it comes to denying a claim for mitigation. Consider the UClaim.com eBook on denied homeowner claims if you need to play hardball with the insurer.
September 14th, 2009 at 4:02 pm #Darek
Thank you. Insurance companies have specifically divided “restoration” from “mitigation” and we are directed to refer to our services as either “restoration” or “mitigation” when either calling the claims center/dept to update the adjusters on the status of the job or to ask the adjuster questions,or even when submitting our emergency service estimates.
On most of our jobs in Florida, when we performed the “initial emergency services” ie: water extraction, contents manipulation, initial structural drying, etc, we were for lack of a better term, “protected” on performing those services even if the claim was later denied. It is those services that we refer to as “performing the emergency mitigation”. ie:stopping the damage from getting worse when it is above and beyond what most homeowners could perform themselves.
I guess the key here is when you stated “While insurance policies say “mitigation”, they are overridden by the law, which says “mitigation, within reason”. That, I think, answers my question..
Thanks again…
September 18th, 2009 at 2:58 pm #Ken
Greetings Admin,
The air handler in my house was somehow tilted the wrong way and ended up leaking out in my attic and down my walls rather than down the condensate line. I have no idea how long it was going on for, but I first noticed damaged when the carpet in my hallway was completely soaked. I called a contractor to come look at the damage. He saw the water damage in my walls and immediately recommended I open a claim with my insurance company. I called the same day and opened a claim. The adjuster wasn’t able to make it to my house until 8 days after I opened my claim. I tried to escalate the issue with my claims handler, stating that due to the closed-in environment and extreme amount of moisture, the water damage and mold would exacerbate. They were only able to send the adjuster a day sooner so it took a week for him to arrive.
By the time the adjuster arrived, my walls were covered in mold (it was a lot worse than at the time I opened the claim) and it had spread to the vanity cabinet in my bathroom. The adjuster concluded that due to the mold damage, the water must have been a constant seepage and must have occurred over a period of weeks, months or years. His verbiage was direct verbatim from the policy under “Losses we do not cover.”
I have filed a complaint with my state’s department of insurance and am in the process of appealing to my insurance company. The department of insurance has reviewed all documentation of my claim was not able to assist me.
I had an air quality expert inspect my house and state that there is no possible way to determine the genesis of the event and confirmed my suspicions that the issue was exacerbated due to the adjuster’s unwillingness to change his schedule and arrive sooner.
I am getting a written letter from the contractor and air quality expert that should help contravene the insurance company’s results, however, from conversations over the phone, I have a strong suspicion that it will still not be covered.
My question to you is, will this be worth pursuing in court as a bad faith claim? My arguments would be that the insurance company took no action (via hiring professionals) to prove that the damage has occurred over a period of weeks, months or years. The policy is also a contract of adhesion and the ambiguity of the policy should be refuted in court. The damage to my home is only about $5,000, so would it be worth the money to get a lawyer? I’ve gotten a quote from a lawyer already and he stated that $5,000 is usually the minimum for court fees, lawyer fees, etc.
I appreciate any assistance you can provide. Thanks.
-Ken
September 19th, 2009 at 5:46 pm #admin
Hello Ken,
You may want to condense this question. Way too many details for most contributors to take the time to read. You may also want to post it in our Discussion Forum and change a few words to avoid Google penalties to this website. And take a look at the “Denied Claim” eBook at UClaim.com.
September 22nd, 2009 at 7:24 am #Ken
Which words do I change to avoid google penalties?
September 22nd, 2009 at 5:25 pm #admin
Ken,
Thanks for asking. It does not matter. Make one word or grammar change for every 10-20 words. It could be a spelling change (like a misspelling), adding a comma or parenthesis, capitalizing a letter, changing a “the” to an “a”, etc.
September 22nd, 2009 at 5:49 pm #Ken
I’m confused… I have a little bit of experience with search engine optimization. Would the penalties be coming from the use of repetition?
September 22nd, 2009 at 5:55 pm #admin
Ken,
Not worth hiring a lawyer. Go to small claims court if suing. And no lawyer is going to take such a small case, even if it has bad faith. Punitive damages in property claims in recent years are now limited 3 to 10 times special damages, in all states. So those days are over, thanks to the George Bush supreme court legacy. Big business can do whatever the hell it pleases.
If you policy does not cover mold up to a stated amount, usually 5 or 10 thousand, then your only option is to sue the insurer for negligence, ie. their delay caused more damage. The eBook at UClaim.com on denied homeowner claims will coach you on how to build a liability claim against your own insurer on denied water damage claims.
September 22nd, 2009 at 5:59 pm #admin
Ken, you wrote:
“I’m confused… I have a little bit of experience …”
Answer:
Yes, absolutely.
September 23rd, 2009 at 10:22 am #Abisoye
I have farmers renters insurance. My apt had a fire accident some days ago and the insurance company is saying they cancelled my policy in Aug 10. I didnt know this change because i didnt think i had any problem with them as i had sent out a check for my premium for additional 6months way back in May. They are sying they didnt get the check hence the cancellation. What should i do in this situation because i have property damage.
Thanks
September 23rd, 2009 at 9:11 pm #admin
Hello Abisoye,
Well the easiest first step is to see if the check cleared. Look at your bank statements. If it cleared, then there is your proof.
If it did not clear, then there are other ways to show how the insurer screwed up. You can get details on how to pursue this kind of denial in the eBook at UClaim.com entitled “DENIED AUTO AND MARINE INSURANCE CLAIM ADVICE AND HELP”. Check out the table of contents. The eBooks are 50% off and have a money back guarantee.
October 7th, 2009 at 4:45 pm #Carl
I was in an auto accident in Florida. I went to the hospital and am now in physical therapy. The other car caused the accident and was cited for it. Their insurance carrier has now send me a letter that they will be denying all claims for this accident because their insured has not assisted in the investigation (which they say is required by their policy). What can I do? Is this allowed?
October 7th, 2009 at 10:12 pm #admin
Hello Carl,
Well then you will have to pursue your damages directly from the other driver, and sue him if necessary. And if he looses in court, then his insurer may not reimburse him. Its his loss. If you have insurance, then you should make your claim with them and let them chase the other driver. I’m not sure if your uninsured/under-insured coverage would kick in on this. Maybe someone else here knows.
October 25th, 2009 at 6:13 pm #lori damato
Can anyone help me…. I have h/o with additional collapse coverage. I have had the policy 8 years the house was built in 1977 and the family room adition in1984… I purchased in 1997 and the h/o company has been out 2 times in the 8 years to inspect and it was fine… My family room collapsed with 24 teenagers and sits in a state of collapse since 2/20/2009.. My claim was denied due to faulty construction… The company agrees it is a collapse and I am covered for weight, decay, insect…. I did not own the home when it was built and the building code says it only needed to be fastened??? I have had to get an attorney and now they have increased my policy by $1631.00
I have put complaints in and called my senators office…. I am wondering if a new insurance company would insure nme while this is going on?? and How can a insurnace company deny a collapse claim…when you have collapse coverage.
The homeowners expectation is they are covered… It is time the insurance companied are made to disclose and review entire policies to consumers before just handing a policy and taking a check….It is a total injustice and something needs to be done…… Can anyone help me….
October 27th, 2009 at 4:59 pm #admin
Lori,
IMO, the insurer wrongly denied the claim. Collapse like yours is covered, and the insurer can try to subrogate (collect back) from the builder for negligent construction. And your claim is for “collapse”, not negligent construction, so the claim can’t be denied for “faulty construction”, unless there is a specific clause in the policy saying collapse is excluded if faulty construction contributed to the loss.
Your claim was “sudden and accidental” which is what insurance is intended for. The intent of the collapse exclusion is to exclude coverage for dilapidated and rotting structures. If you have an attorney working on a contingency, he should be on top of it and perhaps should have filed a complaint in court? Ask the attorney for copies of EVERYTHING he has done, letters, pleadings etc. and show it to another attorney if you think your attorney has been doing nothing. And pay attention to the statute of limitations to file suit. Don’t let your attorney blow that.
November 7th, 2009 at 5:46 am #Tony
I am actually writing for my 78 year old mother who recently had a renter’s claim denied. The living arrangements there sound like something out of a bad soap opera, but need to be explained. My mother lives with my sister (her daughter) and her 3 kids as well as my sister’s ex-husband (yes, ex-) and his new wife and 6 year old son. My mother has her own renter’s policy. My sister has her own and the ex-husband’s family has their own (3 separate policies, 2 different companies). Told you it was weird. Anyway, my mother started her policy in January 2009 and it was in good standing in July when a fire destroyed the house they were renting while they were all away over the July 4 weekend. Although arson is suspected (and, IMO, probable), there is no evidence any of the residents are still considered suspects or had any involvement (residents are frequently the initial suspects). The apparent reason for the denial (she hasn’t received a written explanation yet) is inconsistencies in her “testimony” as to the location of various objects within the house. She claimed an item was in one room when it was apparently in another, for example. My questions: can an insurance company deny a claim based on an elderly client’s faulty memory? Can they deny based on lack of knowledge regarding an item’s value? How about lack of knowledge on the insurance company’s part. When told there were at least 2,000 DVDs in the house, one interrogator claimed “there aren’t 2,000 DVD titles available” (despite the fact that Netflix claims over 100,000 titles are available on their site). As an outside party, I realize my information on the case may be incomplete, but I have tried to give you what I have been told. Is there any info you can give me (or more you need) that I can pass along to her/them. P.S. the other 2 claims, which are both with the same company (but a different one from my mother’s) are still open.
November 7th, 2009 at 7:48 pm #Andy
About six months ago, my wife and her side of her family were on vacation in Florida. Her mom pulled out of a parking space after a White SUV passed and the coast was clear.
While she was pulling out, the White SUV stopped and reversed direction, hitting my wife’s car, which was only about two to three feet out of the parking space (we have the pictures to prove it).
There were multiple witnesses and the police report indicated that the driver of the White SUV was at fault. No citations were given since it was on private property.
A claims agent was working with us on the claim and we did get an estimate done at the shop of USAA’s choice, for around $650. USAA’s claims person indicated that the other driver was at fault at some point during the multiple conversations we had.
Since then, the claim was transferred to another claims agent who says the file did not show any history or claim that the other driver was at fault. They then indicated that they were working with the other driver’s insurance company and would contact us soon.
USAA claims that the liability is 50% our fault and 50% the other driver’s fault since my mother-in-law was supposed to wait until there was ‘reasonable’ safety to exit the parking space. It is quite reasonable to believe that the driver of the white SUV would not throw it in to reverse and go in the wrong direction in the wrong lane without looking, which is exactly what happened – as evidenced by the testimony of the passengers of the white SUV.
Since when is it ok for an insurance company to contradict a police report that states the other driver is at fault?
We have pushed this for months now and are at our last resort, and are considering arbitration. However, USAA says that they only offer 0%, 50% or 100% liability. In other words, if the arbitrators say that it is 51% our fault, then it rounds to 100% our fault and then our rates hike and it stays on our records for a few years. With the 50%/50% option, that would not happen.
However, if we take the 50%/50% option, we must pay our entire deductible and wait for USAA to obtain the other driver’s half of his deductible prior to us then getting a refund of half our deductible. Is this common insurance practice?
Is it even legal for them to contradict a police report?
November 10th, 2009 at 1:42 pm #admin
Tony,
Way too complex for a couple of paragraphs of answers. You either need a lawyer (if you can find one or afford one) or get two of the publications at UClaim.com: Homeowners Loss Deluxe (it covers renter claims) and Denied Home and Business Claims. If the insurer is going to do an EUO (Examination Under Oath) then you need the eBook on that as well. The insurer will slaughter your mom in a EUO, so don’t go through it without a lawyer or the UClaim eBook on that.
Any visitors to this website are welcome to counsel Tony on this, either here or in the Discussion Forum, if Tony wants to post without delays.
November 10th, 2009 at 1:54 pm #admin
Andy,
I don’t know the liability laws in Florida, but that is possibly correct, on the 51% part. Call one to those big yellow page ad accident attorneys in Florida or the Florida DOI.
If it was me, I would just go into small claims court with my evidence and tell your insurer to drop the claim so you don’t risk the premium increase.
November 12th, 2009 at 9:17 am #Andy
I guess my main question is about the deductible. Is it normal to pay an entire deductible to the insurer, then wait on them to obtain the funds from the other insurer before giving half of it back to us?
November 12th, 2009 at 10:17 am #Sherella
My Automobile insurance company denied my claim, stating that the fire was intentionally set. What should I do?
November 12th, 2009 at 8:01 pm #admin
Andy, yes, that’s normal. And it can take months to get it back from the other drivers insurer or years or never to get it from a driver without insurance. That right of “subrogation” to your insurer is in your policy contract. Now if you can find a way to “encourage” the other driver or his insurer to pay up sooner, then go for it.
So take some kids with drippy ice cream cones into their plush claim office and let em run wild while they “find an adjuster” or manager to find your file and discuss it with you. You may not have to wait very long
Or sit outside their claim office, or their best agents office on the “public” sidewalk with a sign saying you got screwed by xyz insurance company
Oh, and you may as well put a hat out there for donations while you are at it 
))
These “Guerrilla tactics” are one kind of minimal effort “last resort” strategy, short of litigation, you will find in the eBooks at UClaim.com.
November 12th, 2009 at 8:13 pm #admin
Sherella,
Unless they have evidence it was YOU who set the fire, they can’t deny the claim. All they can do is drag out the investigation in hopes that you will just fade away. Short of hiring a lawyer and or public adjuster, get the eBook from UClaim.com on denied auto claims. And if they demand an EUO (examination under oath) both you and your attorney should get the eBook on that subject. You can view the tables of contents online free. The eBooks are on sale with a money back guarantee.
December 7th, 2009 at 10:28 am #Jon Casey
I have a question. Does the insuarance company request for a deposition means that they are preparing to deny my claim? I had a breakin/fire while I way away on my honymoon (I was out of the country actually). Although I had an alarm Im not sure if it was set or not. I have made a claim before for theft (unfortunately I dont live in the best area). Just wondering what’s the run around with the insurance co. They interviewed almost everyone I have ever come into contact with. Any suggestions?
December 10th, 2009 at 1:30 am #admin
Hello Jon,
What they usually request is an EUO (Examination Under Oath), which the policy gives them the right to do. “Depositions” are done in litigation. There is a huge difference. An EUO should be non adversarial. A deposition is adversarial (all out war). However some “low quality” insurers instruct their attorneys to handle their EUO’s the same as depositions anyway. If you (and your attorney, if you hire one for this EUO) want to be fully prepared for an EUO, you can get an eBook on EUO’s at UClaim.com in the Miscellaneous product section. And if you hire a good attorney to represent you in your EUO, he will keep a 2 hour EUO from turning into a 16 hour EUO.
And yes, the purpose of an EUO is to either deny your claim or cut it down. Most insurers look for ways to deny coverage, not ways to cover claims.
January 12th, 2010 at 10:33 am #Al
Situation – Husband/Wife separate, divorce proceedings start. Children remain with wife in the jointly owned home. Weeks later a house fire causes extensive damage. Wife was the only one home at the time of the fire. Months later the PA State Fire Marshall rules the fire “undetermined cause”. Insurance co. denied the claim stating fire was intentionally set by wife. Wife sues the insurance company. Husband tied into the suit because name remains on mortgage/deed. Divorce can not be finalized until the suit is settled.
Questions- If the insurance co. proves in court fire was intentionally set by the wife can charges of both arson and insurance fraud be brought against her?
Approximately how long until suit goes to trial?
If the insurance co. loses the suit and pays the claim are the home owners responsible to hire contractors to repair the home and how are they paid (check directly to contractors or owners)?
The house uninhabitable for over a year. Contents were saturated with water and now house has mold issues. If the insurance company pays the claim would they be responsible for the additional mold damage because it took so long to settle?
Children live with different families. Are those families entitled to any compensation from the insurance company for temporary living expenses?
January 13th, 2010 at 5:30 am #Craig
I purchased a wood boiler for outside use that comes enclosed in an attractive shed like fasade. The mental roof was badly bent and rippled in shipment along with multiple dents and damage around the perimeter of the boiler. I made a claim for damages against the shipping company that delivered the wood boiler. I received a letter from there claims department that the claim was denied. They said that containers must be such as to afford reasonable and proper protection of its contents, these goods wood require crating or boxing. These are large units, like a small automobile, weighing 2000 lbs plus and all vendors ship hundreds of these uncrated as standard procedure each month without damage. When my unit was delivered the driver tried twice to open the rear overhead door only to bang against the boiler. A fork lift had to push the unit back enough in order to allow the door to be opened. The boiler was not secured or tied down and had wedged itself into the right corner of the truck against the door. The driver assured me that the boiler was insured and all I had to do is make a claim. Do you have any advice on how to answer this denial.
January 19th, 2010 at 4:29 pm #admin
Please you Visitors who monitor this website via RSS feeds or other methods. Due to the burden of increasing visitors with questions, your help is needed. Questions will be posted, however Admin responses may now be delayed, or even not given at all. Your involvement in the Discussion Forum page of this website is also requested. Thank you.
February 4th, 2010 at 11:23 am #francine cain
my lawyer says that the definition of ‘flood’ is ambiguous and that a policy is a contract of adhesion… what does this mean?????
February 4th, 2010 at 11:28 pm #admin
Look up “Contract of adhesion” in the insurance claim glossary link at the top of this page.
Your lawyer should have no shortage of business for flood claims. Ask him why its ambiguous and post here please
February 9th, 2010 at 10:54 am #Seetums
My brother died in a single-vehicle accident. He was the only person involved. There were no witnesses but, the accident report says he was driving too fast and failed to make a curve. He had a suspended license and was driving my mom’s car without her knowledge. Mom’s insurance company denied the accidental death benefit because he “did not have a valid drivers license and was therfore using a motor vehicle without a good faith belief of the legal right to do so.” Is there anything she can do?
February 9th, 2010 at 7:56 pm #admin
Seetums,
I don’t know. Anyone else want to comment?
1. What does the policy say? I doubt that the policy requires a driver’s license.
2. He may have been driving “without her knowledge”, but that does not necessarily mean “without her permission”.
3. Most auto policies don’t have a “death benefit”, just Medical Payments coverage for the living. So if its and endorsement, then read that.
Sorry about your brother.
February 11th, 2010 at 2:15 am #Tracy
In January of 2009 we had a leak around a vent in our roof. While the roofer was fixing the leak he stated that we might want to call our Homeowner’s insurance(Selective) because he noticed major hail damage.
Selective sent out what they call their “expert”(took one month for him to come out) who stated that it was not hail damage but just normal wear and tear/sun damaged shingles and that we just needed to replace the roof.
We saved our money all year and started getting quotes a few weeks ago. The two different roofing companies that came out documented(with pictures) severe hail damage.
Once again we called our insurance agent to tell him what the two roofers had documented. He stated that most roofers in this tough economy are just looking for work(money). We were going to replace roof anyway we never even spoke to roofers about insurance company, so I don’t believe this statement. The agent stated that the only other thing to do would be to go to arbitration, but it would be with his same”expert” and our roofers were not experts in the field….so we should just go ahead and replace the roof on our own. He also stated that he would be sending highlighted policy notes on arbitration for us to read before we made a final decision.
Just wondering: we don’t really have money to hire a lawyer to fight claim.
Isn’t arbitration suppose to include an independent 3rd party and not just the insurance company? We just really don’t know what to expect and what our rights are?
February 15th, 2010 at 9:30 pm #noman
I installed a water supply line (plastic) about 3 months ago. I never do the plastic but in this case I didn’t have a hose long enough to fit. Anyways I came home and water was all over the floor. I want to file a claim, will the insurance company comply with this claim?
February 17th, 2010 at 12:31 am #admin
Yes because your claim was sudden and accidental.
March 3rd, 2010 at 8:01 am #Timo
I had a ski accident and injured my knee. Before going to the emergency room I called my health insurance, told them what happened (explicitly stating I had a ski accident) and asked for pre-approval. The woman said I can go to the hospital. But now the insurance denies my claim saying that ski accidents are excluded. I checked the fine print and it’s correct.
However, I must be able to rely on the information I received by phone. They cannot expect me to double-check the fine print after having an accident. The problem is that I cannot proof that I told them that I had a ski accident, because I have nothing in writing. What can I do?
March 3rd, 2010 at 10:45 pm #Mr. Smith
9 months ago my home caught fire. The insurance company has yet to settle and I am being treated as prime suspect. Ive submitted any and all financial records they requested as well as completed and EUO. Recently an investigator showed up at the home that the insurance company is covering for displacement unannounced. I was away on business and the guest I had staying there didn’t answer his questions correctly. He didn’t identify himself. She informed me that he also went into the mail box. My question is can they deny my claim based on the fact that she told them i didn’t live there? (she thought it was someone sent from my ex-wife) Aside from my lease I cant prove otherwise.
March 3rd, 2010 at 11:42 pm #admin
Timo,
Unless you can get the woman who told you to go to the hospital to admit that’s what she said, then I think your only argument would be a legal principal called “Reasonable Expectation”. Basically, a person should be able to reasonably expect that certain things will be covered without having to read every word in a policy. And the more buried or small print the exclusion is, the less reasonable it becomes. You may need an attorney to help you research the law in your state and to write a threat letter, or more.
March 4th, 2010 at 12:13 am #admin
Mr. Smith,
I have a hunch there are a ton of more details that go with your story, more than can be dealt with here. If you don’t hire a good public adjuster and or attorney, your next best bet is to at least get some eBooks from UClaim.com on Homeowner claims, Denied claims and EUO.
Is there a policy provision requiring that you live in the house? If they are saying you lied or misled them on the application to insure the house and are trying to void the policy on that, then it has to be a lie that is “material”, relevant to the loss. For example, if you lied about smoking cigars, but the fire was started with gasoline, then the denial won’t stand, in most states, IMO.
March 4th, 2010 at 10:18 am #Mr. Smith
Sorry I wasn’t too clear. The home that the fire took place at is not so much in question right now although I’m sure its being investigated. The special investigator showed up at the temporary housing that Allstate is paying for while they decide to settle. problem is, when they came I wasn’t there and the person who answered the door told them I didn’t stay there. She didn’t know who was asking and as I mentioned she thought it was someone from my ex and wasn’t giving up any info. My question is can they deny my claim based on the fact that she told them i didn’t live there? somehow try to prove misrepresentation. The only prove I have to show I was living there is the lease.
March 4th, 2010 at 6:24 pm #admin
Mr. Smith,
Allstate owes for at least one temporary residence, the cost of which they owe to reimburse your incurred expense. It doesn’t matter if you stay there or not. And even if they used their own house placement service and are paying them direct, the policy says they owe ALE expenses incurred. You don’t owe them any explanation at this point. And if they later try to deny your claim by calling this misrepresentation, then give them the same reasonable explanation you gave here.
March 4th, 2010 at 7:28 pm #Mr. Smith
Thanks for the responce! One last question, maybe two. Does it matter if the temporary house I chose was rented from a person I know? Allstate didn’t supply the home. Reason I’m asking is they are trying tooth and nail to find a reason to deny. Can they go through my mail? Secondly what eclaim book will specifically help me in my situation. Unfortunately I don’t have a lot of confidence in my lawyer.
March 4th, 2010 at 8:16 pm #admin
Mr. Smith,
You can rent from anyone you choose. And FYI, although Allstate may tell you that the words “incurred expense” in the policy means you have to present a canceled check or credit card receipt, that’s just their procedure, not necessarily the law or policy wording, meaning or intent. Once you present a copy of a bill stating “amount due”, then it’s “incurred”, even if you can’t make the payment until later.
As to going through your mail, I’m sure that’s a crime, unless they have a warrant. You should check with your postmaster and local police. And if you want to give Allstate a reason to drop their delayed investigation, make a complaint with your local police and/or FBI on this mail thing.
As to the UClaim.com eBook, start with the Homeowners Loss Deluxe, just to make sure you are covering all the basics properly. You and your attorney could have greatly benefited from the eBook on EUO, before it was taken. If the claim is denied, then get the eBook on denied claims, and if it was denied based on something in the EUO, then get that eBook also. Considering the dollars at stake, the cost is nothing (and they have money back and “information” guarantees). Keep us posted.
And Mr. Smith, you should line up another insurer while you are currently insured, because you will probably get a “non-renewal” notice from Allstate just 10 or 15 days before your policy renewal date.
March 6th, 2010 at 8:24 pm #Miquel
If a total loss is denied (house fire) after euo will the mortgage company be paid off? This company states that while they can’t prove this person set the fire, there is some evidence that they did, or had a hand in the fire. Will the insurer subrogate after paying the mortgage, or will the mortg co not be paid, and they sue the insured?
March 7th, 2010 at 6:52 pm #admin
Miquel,
1. Yes, if the claim is denied for the insured, the mortgagee still has to be paid up to the amount of their loan.
2. Doesn’t matter what the insurer has, if they can’t get you arrested by the cops, then they have to pay your claim.
3. You need a good public adjuster and or attorney. If you can’t get those, get the eBook at UClaim.com on denied home claims.
May 12th, 2010 at 9:44 pm #Cheryl
I own a multifamily home with rental units. I was away when a fire started and the insurance co won’t pay stating I did not live there because there were rental units and has denied the claim. The attorney on the case seems reluctant to go forward with the case. What is my recourse?
May 13th, 2010 at 1:41 am #admin
Cheryl,
Can you clarify the part about you living there?
May 13th, 2010 at 5:27 pm #Lita B.
Recently,was a victim of 3 break-ins back to back. Have State Farm for insurance. They have came out took recorded statement about items that were taken. Some didn’t have reciepts for because 1 item was purchased from friend. But item is expensive to replace if have to buy from store. Can insurance company deny claim if you don’t want to involve others in it? But still have box that it came out of. And can insurance company ask for credit report? What do this have to do with stolen items. And are they obligated to pay for items that are rented? Thank-you in Advance!!
May 18th, 2010 at 10:25 am #admin
Lita,
You have a duty to cooperate “reasonably” within the policy and the law. You have to give the names of your friends you bought the stuff from for example, but your friends don’t have to “cooperate” or talk to them if they don’t want to. Let the insurance company get the credit report. It shows your possible motive for a phoney claim if you are in great debt. They don’t owe for rented stuff.
May 25th, 2010 at 5:52 pm #Cheryl
My garage is a 2 1/2 on a slab, built 1977. Problem is that the garage is leaning almost 6″. No neglect, no cracks in floor, no water damage. I am afraid to use the garage. Will homeowners cover the repair??
May 26th, 2010 at 1:34 pm #Angela B.
Our home was partially damaged by a fire in the Laundry room, it was determined the Clothes Dryer was the cause, simple enough. However, State Farm has denied reimbursement for the Dryer based on this being the cause of the fire? I wasn’t able to find anything in my policy stating this and when I contacted claims dept I was advised “that is our policy”. Would this be listed on my policy? I live in PA, is there anything I can do to get this reimbursed?
May 28th, 2010 at 12:05 am #admin
Cheryl,
Most HO policies don’t cover “settlement”.
May 28th, 2010 at 12:18 am #admin
Angela,
Most policies cover “resulting” damages, not the cause of the loss.
May 30th, 2010 at 7:05 am #Jason
Angela,
See answers in “Homeowner Insurance”. Because of the long-standing policy of the insurance companies, probably the best approach is to accept that the responsible clothes dryer part is the cause of loss, not the entire clothes driver, and see if the insurance company will modify their position on that premise.
June 1st, 2010 at 7:36 am #Jorge
We got water damages in our laminated floors due to a water pipe breakage, damaged floors are in the dinning and living room but these are connected to a small office and my kids rooms, there are no transitions between rooms so the floor looks like one piece; insurance company says they will only pay for the dinning and living room and since we are not able to find the same floor we will not be able to match what we currently have and basically obligated to put transitions and install a different type and look of floor; our house will look really ugly and of course the value of our home will take a substantial drop.
The insurance agent said I can call the insurance commissioner and they will give me the same answer.
Is this actually true? Do I have to take a lost of value in my home and make it look basically like a collage? I would not buy a house like that.
Should I seek for legal help?
Thanks in advance for your help.
June 1st, 2010 at 1:18 pm #Jorge
Forgot to say I’m in GA
June 2nd, 2010 at 10:50 pm #admin
Jorge,
You are entitled to what you had before, matching floor covering, even if there was a doorway. Unfortunately you may have to sue your insurer since most insurers will not give in on this. California used to have a “line of sight” law that forced insurers to go past the doorways. But that law got repealed thanks to our current insurer friendly insurance commissioner Steve Poizner.
June 9th, 2010 at 7:34 am #Bobby
Here is my situation.
Im sure this is probably one of the more common questions, but i have not been able to find any answers.
I Have renters insurance on my home through Liberty Mutual, the same company we have our auto insurance through. 5 weeks ago ( may 6,2010) we were gone from around 6pm till midnight. We came home to find we have been broken into!
There were about $13,000 worth of items and electronics taken. The police came out, did a report. Everything they have asked for, we have provided , i.e. pictures, invoices, receipts etc. After the 3rd week, Our claims rep continuously gave us contridictory statements like . the first day i reported the claim a police report was being requested, after three weeks, he told me they still have to do that, order a police report. After he kept giving me conflicting statements and not returning my calls/emails. I requested my claim be re-assigned to another agent.
It was re-assigned to another claims agent. He called, informed me the claim has been turned over to there SIU ( Special Investigation Unit) and that an investigator was assigned to the claim and would be in contact with me to follow up. Any questions i had would need to be addressed to him!
2 weeks ago, the special investigator came to our home and completed a recorded interview. Very shrewed , elderly man. made it a point to state he was a retired detective with the police force for 20 years. The home belongs to me and my boyfriend, also on the policy. we are “two gay males”. The reason i state this is because you could tell the whole time the investigator was there, he was uncomfortable.
The investigator went through the items on the list that were taken. However, there were many items he didnt even ask about that were on the list. We could tell that he was anxious to get out of our presence.
He requested i send him some information that i had present with me at the time of the interview. i offered to give them to him at that moment to speed the process up. He declined and informed me i could email them.
That same evening, i emailed him copies as he requested. With every email i sent, i was very cordial, always starting out with a greeting and something to the effect, “hope you are having a great day, it was nice talking with you earlier”, etc etc..all the greetings and salutations! haha
I had asked him in the email, if he had an idea of how long the claim may take to finish, if he had an idea or estimate he could share, that would be great. I informed him in the email my boyfriend is a type 1 diabetic and had an expensive legg massager he used to help his circulation in his legs. It was stolen and we are anxious to replace alot of items as soon as feasible.
He replied to the email stating this, and ONLY this in the email:
“As i told you, i cannot give you an exact date”!!
Every since then, i have been emailing him, called the assigned claims adjuster for an update. The claims adjuster informed me very rudely that he would not give me any information and that he told me if i had any questions, i needed to contact the investigator.
I have emailed the investigator again, ive sent a complaint and request for an update to the claims adjusters supervisor, ive even emailed the home office to Liberty Mutual Insurance SIMPLY asking them, if they know a rough timeframe. We are still just as in the dark as we were in the begining of the first conversation when we filed the claim.
It is now 5 weeks. Ive never had this happen, i have no clue how long it takes. Some people may think 5 weeks so far is hardly enough time, others i have spoken with have told me this is too long to wait.
They have all the information i have provided them with. I have told them in all emails, “if you require further information, please let me know now as to not delay the claim in the future with telling me there was something i forgot etc”..
We had a Flat screen tv taken, blue ray dvd player, bose entertainment center, expensive projector, high end digital camera and alot more. 5 weeks without them, is a long time.
Yet again, every person i have emailed for an update or status report cannot give me one. Since the begining, we havent spoken to anyone kind, no sympathy or empathy, rather, we get talked to like we are the criminals vs the victims. we feel as though we are being victimized twice, once by the burglars and 2nd, by liberty mutual.
The investigator asked for our income records, wanted us to sign a paper giving him the right to do a background check. we submitted that information and encouraged him to do so. We have never EVER been in trouble, no criminal record, nothing of the sort. It just seems to us, this should be a smooth claim but im not sure.
any information you can provide is GREATLY appreciated.
regards
June 9th, 2010 at 4:30 pm #admin
Bobby,
Start with the eBook Homeowners Loss Deluxe at UClaim.com. If it goes to EUO, then get that eBook as well. Your claim is too small for a public adjuster or attorney. The insurer has some red flag on you. And its not the gay thing, IMO.
June 9th, 2010 at 5:00 pm #Bobby
Yes, ive actually spoke to an attorney today who is jumping on this. Last week, i filed a complaint with the NC insurance commission. Today, I received a response from Liberty Mutual In reference to the complaint and it was SO full of lies.
1. In the response, the “senior” investigator stated that i first told them the items were stolen during my move from SC to NC which was a big lie. Today i even sent a copy of my last 2 years rental leases showing where ive lived. 2. The insurance investigator replied that several items i had listed stolen in fact did NOT belong to me. yet, ive showed verification they were mine. After i received that notice today is when i contacted an attorney and stated i should also request a transcript of the recorded conversation to which i have..
June 21st, 2010 at 12:41 pm #Clark
My house was robbed, police came and investigated etc… said to record all items stolen as I realize them missing. My insurance adjuster said no item will be reimbursed without proof of ownership ie…pictures or receipts. Is is legal?th
June 21st, 2010 at 3:22 pm #admin
Ok ICH visitors, who wants to help Clark with this?
(Clark, if you don’t have an answer in a week, please repost)
July 14th, 2010 at 10:07 am #Public Adjuster
Clark,
In this situation you are required to provide documentation. You need to document and substantiate your loss. There are many ways you can do this. First, create a detailed list of all items that you recognize as being stolen. This can be a lengthy task. I suggest going room by room – area by area. Keep it orderly both for your benefit and the adjusters benefit. You will need to provide approximate dates of purchase (m/y), place of purchase (best buy, sears, gift, etc.), and approx. cost of purchase.
You now need to substantiate that these items actually existed. This can be done a number of ways. First – receipts. If you have receipts, credit card statements, debit card transaction (bank statement) then great. If not … 2nd – warranty manuals. Warranty or instruction/ownership manuals can prove ownership of electronics and some household items. For other items – photographs. Go through old photos that you may have.. birthdays, Christmas, events at your home etc. Often the items taken are verified in the photographs! I recently verified a diamond bracelet and an expensive gown for a client through a photograph that was taken when they dedicated their baby at church.
The more proof of ownership you can provide the better. Being well documented and detailed also makes the insurance adjusters job easier. If you cannot prove the item existed, then depending on the item, it may be that the insurance company denies coverage for that item. However, as the admin advises over and over.. the carrier must act in a reasonable manner. Meaning – if you claim your flat screen tv was stolen and the adjuster can see a wall mounting brace that was torn off the wall… with cables laying on the ground.. they need to pay for that item regardless if you have a receipt or not. But if you claim your Iphone was stolen but can’t even produce a phone bill… well…. hopefully you get the point.
July 14th, 2010 at 5:10 pm #Tony
To: Public Adjuster
I am just curious how a person is expected to produce evidence of the existance of an item in the case of a fire? My mother’s house burned down last year and she was never allowed back into the place, even to retrieve items that were NOT damaged. Any receipts, photos, etc. were either destroyed by the fire or inaccessable. Any evidence was IN the house and was therefore destroyed (even if it wasn’t physically damaged by the fire). How was she was expected to provide this information (which she, of course, couldn’t)? Needless to say, HE wasn’t going to verify any evidence he may have found in the house. That’s contrary to his job.
July 16th, 2010 at 11:33 am #Ms. K
DATING BACK TO HURRICANE KATRINA I CALLED MY INSURANCE CO. THEY CAME OUT AND I DONT RECALL ADJUSTER LOOKING AT THE ROOF. I CALLED INSURANE AROUND SEPT OF 2009 B/C MY CEILING IS STARTING TO GET BROWN. I CALLED THEM AGAIN THIS YEAR BECAUSE IT IS NOW MOLD. AN ADJUSTER COMES OUT AND LOOK AT THE ROOF FROM THE GROUND AND STATES I HAVE HAIL DAMAGE. SHE GIVES ME 2 NUMBERS TO CALL FOR ESTIMATES B/C SHE SAYS THAT HER INSURANCE COMPANY USE THESE PEOPLE ALL THE TIME AND THEY HAVE THE BEST ESTIMATES. WITHIN A MATTER OF DAYS SHE THE ADJUSTER CUT A CHECK OF MY PERMISSION TO THE PERSON SHE REFERRED ME TO , BUT I ASK HER IF I COULD GET A FEW MORE ESTIMATES. AFTER I SENT HER AN ADDITIONAL ESTIMATE SHE TELL ME THAT SHE MADE A MISTAKE AND I AM NOT COVERED. SHE SAID MY CHECK IS NO GOOD AND THEY ARE NOT COVERING MY DAMAGES. MY CHILDREN HAVE BEEN TO THE DOCTOR ON VARIOUS OCCASIONS FOR RESPIRATIRY INFECTIONS AND THEY HAVE TO TAKE BREATHING TREATMENT WHEN THE INFECTIONS REOCCUR. PLEASE HELP.
July 16th, 2010 at 11:35 am #Ms. K
MS LAST POSTING I MEANT TO SAY THAT THE ADJUSTER MADE THE CHECK TO ME AND MY MORTGAGEEE FOR THE REPLACEMENT OF A NEW ROOF. AND SHE NOW SAYS THE CHECK IS NO GOOD.
July 18th, 2010 at 6:40 pm #Public Adjuster
Tony,
It sounds like it was a devastating fire. In this situation I would assume policy limits were reached. What an adjuster should be looking for in this situation is a list that makes sense. Your mother would need to recollect room by room what was in the house and provide a comprehensive list. If something sticks out like a sore thumb to you… it’s probably going to stick out like a sore thumb to the adjuster.
Your question was one of verification. General items will more than likely not be questioned. Food, the run of the mill clothing, televisions, dvds, players, general electronics, refrigerator, books, and so forth. Questions come in when a policyholder has a list of 200 items from Sears or Target etc., and then all of the sudden they have a painting by Picasso. While it may be true – they’re gonna want to verify that item.
Verification of items while difficult is not impossible. While irritating, it’s not as hard as one might think. Most stores like Best Buy, furniture stores, Sears, keep records of what you purchase and you can go back to them and get a print out. You can also go back over debit purchases, credit card statements, etc. Generally the items that you purchase with cash are not the items that the insurance company is going to want to question.
The adjuster does have to assist in the process. The adjuster may need to hire a demo or salvage company to assist you with verifying items. The adjuster is required to act in an advisory capacity to help you obtain the benefits you are entitled to. But generally in devestating fires like this.. insureds hire a public adjuster to assist them. You should consider doing so. I recently came to this site but it also appears the owner of this site has ebooks to assist in the process which are inexpensive. This is a big loss – get help. There are many more issues besides verifying personal property that might just be beyond your understanding.
Finally, before its too late for your house.. and this goes for everyone – take a half an hour on a Saturday and video your entire house. Take the dvd and copy it and have a friend and a family member hold it for you. Make sure to note items that are unique in your home. This is your best preparedness technique to prove your loss for fire and theft if one of those does occur.
July 18th, 2010 at 6:56 pm #Public Adjuster
Ms. K,
You definitely have some issues on your claim. Most homeowners policies carry a 1 year statute for you to be able to file suit against your insurance company. Generally the insurance company also considers this the limit in which you can make a claim against them – although that is not entirely true. Unless your claim for Katrina was improperly closed or there is some other mitigating factor, the adjuster is correct – the claim is done. However, the adjuster said you had hail damage. Okay – when? What is the date of loss for the hail damage? Was she saying it was hail during Katrina?
Does your policy exclude hail? I can’t imagine it does. So, you need to find out why it is not covered or why the check was issued in error. I seriously doubt it was retracted because you went out and got other estimates. Homeowners get estimates all the time. This is why adjusters are called adjusters…. because they “adjust” the differences.
Finally, during the time that you were getting estimates, and prior to the adjuster advising you that they were withdrawing the payment, did you do anything such as sign a contract with a contractor, begin work to your home, purchase materials or anything of the sort? If so, it may well be that you can hold the insurance company responsible for “detrimental reliance” in where they acknowledged coverage and caused you to rely on them to your own detriment.
July 19th, 2010 at 9:32 am #Tony
Public Adjuster,
Thank you for your response. As stated, this is not my policy or case, so my information is second hand. More info can be obtained by reading item #71 in this forum. That was posted in November and more info has come to light since then. For example, ALL claims have been denied based on inconsistencies in EUO testimony (such as locations of items) and, according to at least one of the insurance companies, “irrefutable proof” (their words) that at least one of the occupants had something to do with the fire. Keep in mind it has been over a year since the fire and NONE of the occupants has so much as been questioned by police or fire investigators beyond the initial interrogations. If the insurance company’s investigator uncovers “irrefutable evidence” (that, apparently, the police and fire departments missed), are they not required to turn this evidence over to the police? Obviously it is not that irrefutable.
I admit this is a very complex case and I do not have all the specifics. However, I believe I have sufficient information to draw the following conclusions:
1. Their house burned down.
2. The authorities (police and fire departments) have investigated it.
3. Although I believe the cause has officially been ruled arson, the authorities have thus far uncovered no evidence the residents were involved, otherwise someone would be in jail.
4. Considering modern forensics, the residents, neither individually nor collectively, are intelligent enough to “beat the system”. Therefore the fact that no one has been arrested definitively clears them in my mind.
5. The insurance company has not, apparently, released their “irrefutable proof” to the authorities, otherwise someone would be in jail or it is not that irrefutable.
6. It is a well known FACT that the last thing an insurance company wants to do is pay out a claim, no matter how legitimate. This appears to be one of those situations. The claim amounts exceed what the companies were expecting (especially from renters), therefore they have elected to completely deny the claims as opposed to paying an “adjusted” amount.
BTW, it is my understanding that the fire department’s report is still open.
July 20th, 2010 at 4:56 pm #Christine
My husband and I moved from NV to TX in Jan 2009 and needed to put all our belongings in storage. We have a renters insurance policy and made sure that it covered our stored items. The roof leaked and all our furniture was damaged. When reporting the claim they tried to tell us nothing was covered without even looking at anything. They finally said that if the damage was caused by water getting/ leaking into the building everything would be covered. They sent someone out to look and take pictures and he told us that everything would be covered. I took tons of pictures and submitted them to him with a letter. He processed the claim and submitted it over three weeks ago. Now USAA is saying the claim has been denied because there is no wind damage to the building. Also the storage facility told us that they just put a new roof on about 9 months ago. I don’t understand how they can say it is covered and then now say it is denied and for different reasons. What do I do now?
July 21st, 2010 at 3:06 pm #Public Adjuster
Christine,
If you have a copy of your renters policy – read it over. If not, get a copy and read it. Many policies require that a “storm created” opening occur first prior to extending coverage for the ensuing rain water damage to the contents. More than likely the policy is what is known as a “named peril” policy for the contents. This means that the item originally causing the damage has to be listed under the “Perils Covered” section of the policy. I surmise that carrier is correct in denying the coverage (assuming it was rain water damage) even if the adjuster/inspector originally stated it was covered. This happens quite a bit believe it or not. Adjusters are often dealing with many different policies and could have believed you had a certain policy.. or simply could be untrained or not knowledgeable of that particular policy and on and on… it’s disappointing but it happens.
If all the facts are as you stated and are correct then I would see what the storage facility is going to do about it. You may have a claim against their roofer for liability.