Home Insurance Claims Advice and Help

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 Post Home Insurance Claims Advice and Help Question (below)

Or, get answers at your finger tips (including personal consultation and confidence building with Ron Cercone, a $150.00/hour value) with a home insurance claims advice and self help eBook from UClaim.com. You will find eBooks “a-la-carte ” for your particular claim issue, or “deluxe” versions eBooks that include most of the other eBooks. View the most popular home owner claim UClaim eBook entitledHOMEOWNERS INSURANCE CLAIMS ADVICE AND HELP – ALL ASPECTS – HOW TO PLAY THE GAME – DELUXE VERSION (W/APPENDIX) table of contents and description. There is currently a free 2nd eBook offer at UClaim.com.

 

Home Insurance Claims Are Disagreeable

Policy holders want insurer’s money and insurer’s adjusters want to save insurer’s money. That’s inherently disagreeable. The word “adjuster” as used in “insurance adjuster” means to alter or change. In insurance, it is usually a “downward” adjustment of your claim. The word “claim” as used in “insurance claim” means to ask for something. As national radio talk show financial advisor Bruce Williams has said “you don’t ask … you don’t get”. And, as “The Donald” says, “it’s not personal, it’s just business.”

Myths

While insurers have a legal duty to act in good faith and answer your questions about the policy truthfully, they are not obligated to tell you what to claim. The “agent” who sold you your policy is legally, not really “your” agent. He is, legally, the insurer’s agent. The only motivation for him to help you is the commission he earns on the premiums you pay. And those commissions are paid by the insurer after your check goes to the insurer.

Your Attitude and Morale

So, here you are in a motel or a rental house after your small kitchen fire or major house fire. It’s been six days and no one is returning your calls. Maybe it’s been six months and they are still “getting estimates” or doing investigation. Maybe they are investigating YOU. They may have advanced you some money, but it probably wasn’t enough. You never thought you would be sick of eating out. If you are unhappy, that’s a pretty good sign you need help.

But maybe everything is going great so far, so you think. Well let me tell you this: the difference between a good insurance company adjuster and a poor one. The good adjuster will walk into your house and within five minutes his eyes have seen ten things he could pay you for when your claim was only for two things: a water stain on your ceiling and a wet carpet. The good adjuster will add a couple more items to your claim and you will be very happy. A bad adjuster will also see ten things you could be paid for, but not only will he not mention the additional items, he will look for a way to reduce and deny your two items. But the real point here is that there is always money left on the table.

Still feel guilty? Look, there’s a pot of gold in your insurance policy, insurance law and construction knowledge. You don’t have to do anything illegal or unethical. I guarantee you when an insurance company executive or adjuster has a claim to his own home, he gets every last penny. They even call me for free advice (in confidence) if you can believe that!

Regardless of whether you are dealing with a good or bad adjuster, you need to arm yourself with the knowledge and the confidence you will get from a UClaim home insurance claims advice eBook.

 

1,863 Responses to “Home Insurance Claims Advice and Help”

  1. September 15th, 2008 at 9:39 am #gerry

    Need to know If Debri from wind is covered under the Allstate HO-3 policy.

    Part of tree on house.

  2. September 17th, 2008 at 12:37 am #admin

    The damage to the house from the falling tree should be covered. And the cost to get the tree off the house to access repairs should be covered. A “generous insurer” or adjuster will cover the cost to haul away the tree debris after the tree is cut up and removed from the roof. A “tight wad insurer” will leave the debris on the ground. If your lucky and your contractor makes a lump sum estimate for “tree removal” without separating the cost for cutting up the tree and hauling away the debris, the adjuster may pay it all without question. If the adjuster asks your contractor to break the costs apart, or “itemize it”, you will know what he is setting you up for – a partial denial of payment.

    Most insurers HO-3 policies don’t cover wind damage to the tree itself and I’m sure Allstate is the same. An HO-3 policy “covers everything” unless there is a named exclusion, so look at the exclusions in the policy booklet and the endorsements. Read about trees and landcaping coverage under “additional coverages” in the HO-3 policy booklet itself.

  3. September 17th, 2008 at 4:07 pm #Lynn

    My sister and I have spent many hours working on an insurance claim for our Mother who was injured in a house fire. Is there any reimbursement for time spent preparing and researching items for a fire loss? The insurance company paid for the inventory to be done, but would they pay anything to a 3rd party for the services mentioned above?

  4. September 19th, 2008 at 1:26 pm #admin

    Yes they should pay you as a 3rd party, unless you were “an insured” yourself (that is, a relative who was living in the house with your mother, the named insured, at the time of the fire), they should pay for your time “preparing and researching items for the fire loss” just as they would have paid the inventory company to do this. If they are denying to pay your time, then turn in a bill for your friend’s time who helped you do the research.

    Insurers routinely refuse to reimburse “an insured” for the time it takes to inventory a loss, which includes time to get pricing, do research, make phone calls, etc. They cite the policy language in “Your Duties After Loss” that says “you (the insured) will inventory and present the loss”. And sneaky adjusters often don’t make the denial until after the insured or “relative resident” has turned in the inventory.

    To get around this, I usually tell policy holders to get a friend or relative not living with them to perform the “duties after loss” like inventory, board-up, security fence, etc.

    If they do pay for these “your duty” items, the check should be in the insured’s name, unless the insured signed an assignment of payment form.

  5. September 30th, 2008 at 1:20 pm #Charles P Harrington

    After the storm the adjuster came out to my house an assest the property. the insurance company sent me the check which now has to be signed by the bank which holds my mortgage account. What happes to the rest of the money after repairs are made and finalized.

    Please write back this question is killing me. Niether the bank of the insurance company will give me a straight answer.

  6. September 30th, 2008 at 9:43 pm #admin

    Hello Charles,

    Unless the mortgage company can show you a specific clause in your loan agreement that lets them keep left over insurance money, the mortgage company (mortgagee) has to give any left over money to you. They cannot apply it to the balance on your loan. The mortgagee has a right to send their inspector out to verify the repairs were done. And it does not matter if you or a contractor did the repairs, you are entitled to the same money as a contractor.

    You should take five minutes to help your fellow man and give the adjuster and insurance company a rating on our “Rate Your Adjuster” page.

  7. October 10th, 2008 at 6:54 pm #Jolie

    Hello,

    I was wondering if you can clarify what the endorsements are on the State farm mobile home policies for Texas. I have the endorsement codes but don’t know what they cover.

    Thank you!
    Jolie

  8. October 11th, 2008 at 7:56 am #admin

    Hello Jolie,

    Sorry for the delay. I don’t have any Texas State Farm Mobile home endorsements on hand so I could not answer even if you gave the numbers. You could post those endorsement numbers and their titles (if available) in a a reply on this thread and maybe someone will have them.

    Your agent and or adjuster must not only tell you what those endorsement numbers are for, they must give you a copy if you request them. If they are being difficult, fax a letter to your adjuster. If no response, fax a letter to Edward Rust ceo for State Farm. Now you have documented your file in case they don’t comply.

    Don’t forget to make a rating on your adjuster and insurer on this website at some point and help build our new database for others to reference.

  9. November 7th, 2008 at 3:08 pm #Kelly

    If you have a home inventory done with digital photos, video along a list of electronics, appliances and computers with their make, model and serial numbers, would this suffice to a claims adjuster as “Your duties after loss” in the event of total loss due to fire?
    What about in the event of total damage due to flood?
    If you do not have a complete record of your belongings and you suffer total loss, does the insurance company pay the full limit of personal property under coverage B?

  10. November 9th, 2008 at 8:16 pm #admin

    Hello Kelly,

    In an over simple answer to the “Your Duties After Loss” question, No, not unless your adjuster really likes you. Most policies say that you, the insured, will supply the ACV, the actual cash value of the loss, building and contents. Actual Cash Value on contents is the replacement cost less depreciation (in most states). Most insurers will give you an inventory sheet to fill out and you enter the replacement prices and age of items claimed (A “low quality” insurer will tell you to enter original costs and depreciate from that figure). While you have the right to enter the deprecation yourself, most insurance adjusters will steer you to let them do it. There are many ways that a low quality insurer’s adjuster can outsmart you in a contents claim. For the best help in a contents claim, consider the UClaim.com product “CONTENTS INVENTORY LIST INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS” $29.95 at UClaim.com .

    If you don’t want to be troubled with doing your own inventory, give the job to a friend or relative and bill the insurer for their time. Note, most insurers will not reimburse you, the insured, for “your” time to do an inventory, but they will reimburse for your cost to hire someone else to do it. A few old fashioned insurers will even do the inventory for you (for obvious reasons).

    The photos, videos and list are good to help “document” and “prove ownership”. If you don’t want to be troubled with an inventory sheet, try just adding today’s replacement cost prices to the items on your list. If your fire loss was due to arson and the insurer suspects you, they may still do an EUO (Examination Under Oath).

    These same general guidelines apply to flood damage, as long as the flood is covered. However, while most homeowners policies cover water damage, they don’t cover flood. That requires a flood endorsement or federal flood insurance.

    In answer to the last part of your question: Assuming you have the most common homeowners all risk policy, the “special form”, while the legal burden to “disprove” your claim is on the insurer for the structure portion of your claim, when it comes to contents, the burden to prove ownership is on the insured, you. So if you can’t prove you had something, legally they don’t have to pay it. This is where it pays to have a “quality” insurer.

  11. December 9th, 2008 at 7:44 pm #LC

    Hello,

    My house burned in the recent California wildfires. The insurance company would like me to sign a “White waiver” before they will discuss settlements of any kind. Is this a smart move? It would appear on its face that this removes any recourse if they negotiate in bad faith (which after looking around the web, I expect them to do). Is this a tricky way to dissuade me from entering into a negotiation with them or is this pretty standard stuff?

    Thanks,
    LC in CA

  12. December 9th, 2008 at 9:32 pm #LC

    Thanks for the heads up. I’ll contact a lawyer. For the record, the insurance company is Fidelity National Insurance Company. I doubt very much they suspect foul play since my house when up with most of the houses in my neighborhood. I’ve been resisting itemizing the thousands of things in my home because it seemed unreasonable for me to remember every hair clip and every roll of toilet paper, just to get reimbursed. Before they will discuss a settlement that would preclude me from needing to create this list and providing receipts for everything, they want me to hold them blameless for negotiating in bad faith (if they chose to do so).

    I’ve heard that the better insurance companies will just settle for reasonable amounts and make it easy for me to replace my stuff as needed, instead of rushing to meet arbitrary deadlines before my house is even ready to move back into.

    Thanks again,
    LC

  13. December 9th, 2008 at 9:11 pm #admin

    Hello LC,

    A White Waiver is serious, not “standard stuff”. Don’t sign it! It does not stop you from negotiating with them.

    A White Waiver basically says that if the insurer makes an offer to cover your claim, or to settle your claim for x dollars, you cannot come back later and tell anyone, including a court, that the insurer previously offered you x dollars. A White Waiver is usually accompanied by a confidentially agreement.

    Insurers don’t normally ask you to sign a White Waiver unless they want to deny your claim or seriously cut it down based on a suspicion of fraud or arson. Insurers usually hire a lawyer to do it, and only after they have conducted an EUO (Examination Under Oath) with a court reporter present, or during litigation (after a lawsuit is filed). It usually comes just before they make their decision to deny the claim or “compromise” (seriously cut) the claim.

    Nothing in your policy says you have to sign such a document. I have been in insurance claims 28 years and it never ceases to amaze me the new stuff some of these insurers try to pull. Insurers usually try new abusive techniques like this in rural areas (like the San Joaquin Valley) before they try it in Metropolitan areas. Sounds like something Farmers Insurance would do.

    The only document you have to submit is a “Proof of Loss”. Which is outlined in your policy. (A “Proof of Loss” can also come with hidden “traps”.)

    If you have an insurer asking you to sign a White Waiver, you are probably in serious need of professional help. I would suggest that you consider hiring a “good” public adjuster for a percentage fee. You can read about how to find a good one at UClaim.com. Click on the link entitled “About Public Adjusters” on the Considerations page. You could also hire a lawyer to help you on an hourly basis for selected issues in your claim, like this White Waiver thing, or even to negotiate for you. If the claim gets denied, then I would suggest you seek a lawyer to work on a percentage (contingency).

    Please keep us posted on this.

  14. December 9th, 2008 at 10:04 pm #admin

    LC,

    You cannot get out of turning in an itemized list to the insurer. In fact, the California Legislature recently turned town a bill that would have forced insurers to just pay policy limits on contents (without an inventory list), if a house was total loss in a catastrophe situation, like wildfire. Some “savy insurers” might waive the inventory requirement, but this would be simply to draw a community into its confidence and deflect the initial onslaught of public adjuster solicitations.

    If the contents inventory was your only concern, for $29.95 you could get high quality information on the most efficient and legitimate way to do it in the UClaim.com product report entitled “CONTENTS INVENTORY LIST INSURANCE CLAIM ADVICE AND HELP” at UClaim.com . Most insurers will tell you that you won’t get paid for your time to do an inventory because it is one of “your duties”. This UClaim report will even tell you how to legitimately get get around that obstacle.

  15. December 15th, 2008 at 2:00 pm #cas

    Hello,

    Our house recently burned about a month ago. We were assigned the claim manager, contents adjuster, and dwelling adjuster. We have replacement on dwelling and contents. Anyhow the contents adjuster has been great, and very informative. He has kept us in the loop about everything on his end. However the dwelling adjuster hasn’t kept in good communication with us and hardly ever returns our phonecalls. Also when we ask him a question he acts like everything is top secret. I feel like we are gettin the run around. Also we never received a proof of loss statement. But yet they are already sending us an estimate not of total loss value. Everyone that has seen our home says its a total loss even the fire investigator. I’m so confused, what constitutes a total loss with a fire? Our home was completely gutted and burned through the floors, ceiling, attic and outer walls. All our contents were total loss and the cleanup alone will cost a 3rd of what they are wanting to do it all for. It took this long to get an estimate when we were told 2-3 weeks and the only way I found out what it is going to be is because we had to speak to a manager. What is going on, and what do we do?

  16. December 16th, 2008 at 12:13 pm #kara

    Hi, can an independant adjuster tell you that a claim is accepted, and then the office adjuster say the claim is under investigation? Even though a month prior the insurance company said the investigation was closed? Or would I have any grounds under esstoppel?
    (sorry for spelling)

  17. December 16th, 2008 at 3:32 pm #admin

    Hello Cas,

    You have a major loss. Before I start answering these questions, let me say that you are going to be having a lot more detailed questions and problems. The answers below are very general. And Cas, just because the contents adjuster has been nice, don’t let your guard down. The “smartest” adjuster is one who gives you 4 items (knowing that your policy covers 10 items), when you only claimed 2 items. Your dwelling adjuster ignoring your communications is one reason why our economy is in trouble today, lax law enforcement by government. But don’t get me going with that :)

    After reading my answers below, take a look at the product description and the table of contents for the UClaim report entitled “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe) at UClaim.com . Its a bargain at $79.95. It will give far more detailed discussions than my answers below. Or you could hire a public adjuster on a contingency fee basis, for example 10% on a $100,00.00 loss ($10,000.00 fee). A good public adjuster will more than cover his fee by an increased claim recovery settlement. See advice on how to hire a public adjuster on the Free Stuff page at UClaim.com. I would NOT recommend an attorney to handle your claim at this point, especially considering most attorneys would charge around 33% (without litigation) and be much less knowledgeable than a good public adjuster.

    Although you say your contents claim is going well, if you are not getting your policy limits, this UClaim report will be of immense value as well. Although you have RCV on contents, you don’t get the RCV unless you actually replace the stuff. So they will depreciate your personal property, and as you replace your stuff and submit proof, you will get another payment for the depreciated amount. Depreciation can be very arbitrary. One adjuster may take 30% while another adjuster will take 70% on the same inventory. If you have $100,000.00 coverage on contents, the RCV on your inventory should be well over that, if you want your policy limits without all the hassles.

    1. Most states require a written response to communications within 15 days. One way to document your communications is via fax. Act as though you are building your claim file to present in court.

    2. In my opinion, don’t worry about a formal “Proof of Loss” if they have not sent you their own POL form or requested that you submit one. Read about POL under “Duties After Loss” in your policy. I have handled numerous major claims where insurers never requested one. The POL only purpose, in my opinion, is to set you up for a denial based on fraud or a huge reduction in your claim. They can also be misused and misrepresented by insurers as being a release. If you really want to shake up a “bad boy” adjuster, provide the “POL” information on a roll of toilet paper :)

    3. “Total Loss” – generally speaking, when the cost to repair exceeds the value of the house, minus the salvage value, then it is not worth repairing, ie. a total loss. The insurer has the right to pay the lower cost, to repair or rebuild. So if they think they can rebuild your house, they have to have a building contractor who can back up their estimate. Some insurers contractors will always “low ball”, knowing that their buddy insurance adjuster will pay them a “supplement” after they get the job. There are ways to “scare off” the insurers contractor. For example, let them know what a picky son of a gun you will be to work for. Tell them you will sue them if one door does not close perfectly. And tell them that YOU will not sign any supplemental payment checks (so they better write an all inclusive estimate now).

    So if the fire went through the floor, what is the adjuster going to save, the concrete footing or slab? :)

    4. If they are delaying the investigation, pay attention to the time allowed by your policy to collect your additional living expenses. If the delays are theirs, then you need to have that documented, in case they try to cut you off. Keep in mind that even though an average home can be built in 3 months, most homeowners do not get back into a repaired or rebuilt home for a year or two after a fire. The delays are usually the insurers fault.

    If you want to help clean up the insurance claim industry (because government won’t), consider making some ratings in the Consumer Ratings section of this website. You don’t have to post your real name if you don’t want to.

    Keep us posted and good luck.

  18. December 16th, 2008 at 4:12 pm #admin

    Hello Kara,

    First of all, estoppel will not do you any good if you don’t have evidence, preferably in writing, or a tape recorded from an answering machine or voice mail.

    Second, regardless of who said your claim was “closed”, an insurer should reopen a claim file to review it again up to the time for you to sue them has passed (“statute of limitations”). That can be up to 3 or 4 years on property claims. Even though most insurance policies say “you have 12 months to file suit”, what most don’t tell you is that the policy is overridden by the law.

    If you think your claim was wrongly denied and they won’t reconsider or “reopen” their claim file, have an attorney or a good public adjuster take a look at your situation. You could also take a look at the UClaim product description entitled “DENIED HOME AND BUSINESS PROPERTY INSURANCE CLAIMS ADVICE AND HELP” and table of contents at UClaim.com .

    1. When you say “office adjuster”, are you talking about an employee in the independent adjusters office, or the insurer’s office?

    2. If the independent adjuster put in writing that your claim was covered, but the insurer who hired him said it was not covered, then you may have a legal action against the independent adjuster and the insurer who hired him under estoppel and agency.

    Insurance estoppel law says that once an insurer has made a payment, or even said they would cover a claim, they cannot later change their minds, even if they made a mistake and the claim was clearly not covered in the policy.

    The law of agency, “Respondent Superior”, says the superior, or the employer, is responsible for the acts of its agents. An agent can be a direct employee or an independent contractor. If Allstate sends out Service Master to clean your house and Service Master screws up, then both Service Master and Allstate are responsible for the damage.

    Consider making some ratings in the Consumer Ratings section of this website. You don’t have to post your real name if you don’t want to.

  19. December 17th, 2008 at 5:55 pm #cas

    Thankyou, we have already had a lawyer contact us, but maybe it wont come to that. As far as a public adjuster, we have one in line. He is a friend of my agent and will do it as a favor. However, @ this point I just dont know what to settle for. The Insurance company is the one who insured my house for that much and I tried to get less at the time but that was the minimum they would insure me for. So now they are wanting to give us less! I had about 65,000 worth of stuff so I guess now I will only get half of that in contents. The lawyer is wanting me to send some info. But not sign anything yet. They are wanting to see if it is worth it. Is that adviseable? BTW, thanks for answering my questions in detail.

  20. December 19th, 2008 at 3:20 pm #admin

    Hello Cas,

    If they are cutting your $65,000 in contents in half, is it with depreciation or are they just denying payment on some items?

    Is what advisable, sending some info.? If so, what info.?

    What is “it” in your comment “They are wanting to see if it is worth it” referring to?

    Don’t “settle” for anything less than what makes you happy, AND, what is not excluded and/or limited in your policy.

    I’m glad you are getting some help from a public adjuster as a favor. If you get a qualified public adjuster to give you full representation (meetings, letters, evaluation, negotiations, etc) for free as a favor, then you are very lucky. Send him some cookies for Christmas :)

    Some insurance companies are amazing. They want it both ways.

  21. January 5th, 2009 at 7:46 pm #beth

    In a Foremost CA mobile home policy, can a claim be denied as an intentional act if the homeowner is not competent and is being charged with arson?

  22. January 5th, 2009 at 7:49 pm #beth

    regarding the question for a mobile home in CA which was burned by the policy holder and since found incompetent..can Foremost Ins deny the claim “intentional act” if the person did not realize what they were doing at the time?

  23. January 9th, 2009 at 1:47 am #admin

    Hello Beth,

    Let me do a little research on this and make a post in a couple days.

    Off hand, I would say that the insurer should retract the denial after the homeowner is declared legally or medically or “reasonably” incompetent. I would think this would fall into the same category as a child or “mentally retarded” person intentionally starting a “play fire” that got out of control.

    Another important consideration would be “intent”. Did the insured intend to burn the place down, or was it an accident.

    Also, once the police drop their investigation for arson, then the insurer should pay up. The insurer’s own private investigator should not be allowed to take a month longer than the fire departments investigator.

  24. January 9th, 2009 at 2:17 am #admin

    And Beth, look at the legal definition of “Arson.” Someone who wants to burn their own house down, without some criminal intent, is not an arsonist.

  25. January 9th, 2009 at 2:13 am #admin

    Beth,

    Have you read the exact Foremost policy wording? You can download a copy for free at UClaim.com . Look under Policy Conditions “Concealment and Fraud”. Note that it does not list “Arson”. It lists “fraudulent conduct.”

    So, lets say an insured intentionally burned his house out of anger against a spouse for whatever reason, revenge maybe. Now while the police may be able to charge and prosecute him and send him to jail, the insurer could not deny the claim, since the arson was not with the intent to collect insurance money or to cheat the insurer.

    And then there is also the concept of the “innocent co-insured”. While this Foremost policy says “any of you”, some policies say fraud by “the named insured”. So any “unnamed insureds” like a wife or kids or relative residents can be covered.

  26. January 9th, 2009 at 4:34 pm #admin

    Beth,

    I posed your question to a group of public adjusters and attorneys and no one had any case law off hand, but there has to be some on it. You can ask an attorney to research it for you. You can also go to http://www.findlaw.com to search for it.

    The policy does have an exclusion for “any intentional act” under Exclusions in the policy.

    If I get any good responses on this, I will advise.

  27. January 9th, 2009 at 6:57 pm #Rube

    My brother has insurance from State Farm ins. and has a policy that says loss of rents. ( Actual loss) He would like to know if that covers tenets that do not pay the rent and we have to evict them through the courts that takes around 4 months..can we make a claim

  28. January 10th, 2009 at 12:59 pm #admin

    Beth,

    This is a little more elaboration to my post on January 9, 2009. Since the policy does state that intentional acts are not covered under the Exclusions section, arson would indeed be excluded, if it was “intentional”. If it was not intentional, since the policy holder was incompetent, then it may not meet the definition of arson. Also check to see whose opinion of incompetent is necessary, a doctor and or a court.

    Let us know the outcome and keep us posted on your progress. This is interesting.

  29. January 10th, 2009 at 5:37 pm #admin

    Hello Rube,

    I would say no, I have never seen such a claim payment in my 28 years experience.

    The State Farm Rental Dwelling policy available for free download at UClaim.com says the loss of rents is only for the time to repair during a covered loss, for example fire, wind. Note, thanks to your post, I discovered that the loss of rents pages were missing from that sample policy. UClaim has been notified and should have the file fixed within an hour.

    Now, if after the tenants are evicted, there is damage to the house from them intentionally, from anger at being evicted, then you have a covered loss called vandalism. All you have to do is make a police report. You or your representative will have to meet with the adjuster at the loss site and argue each item of damage line by line. If the damage is from them living like pigs, it’s not vandalism. Much of it is gray and will depend on how liberal your adjuster is. Is kids writing on the wall vandalism? Is allowing a dog to urinate on the carpets vandalism? A broken counter top ceramic tile is vandalism, in my view. Be willing to give in on some items just to make the adjuster feel better. For the items your adjuster does not cover, sue the tenant in small claims court and see how a judge rules on each item. Take pictures to show him. Whatever the judge deems to be vandalism, the insurer has to pay. Although you may get a small claims court judgment against the tenant, you will probably never collect the money from the tenant. But you will collect from the insurer. I suppose you could even try to name both the tenant and the insurer. But the insurer should pay up even if they are not named.

  30. January 11th, 2009 at 12:55 am #Scott

    Our house on the Gulf Coast was severely damaged by Hurrican Ike. When roofers went to replace wind damaged shingles, they found damage that we didn’t know about that had been present for years. This damage involved the roof flashing and dormers and may have resulted from prior wind or improper installation.

    The home was covered by a State Farm policy(s) for 25 years, including the time when the damage occured. But State Farmd dropped the policy about a year before this damage was discovered, as it did its policies on other properties on the Gulf Coast.

    So, if the damage occured during the time the property was covered by State Farm, but was not and could not have reasonably been discoverd until and the coverage ended, do we have a claim under the State farm policy?

    Thanks!

  31. January 11th, 2009 at 4:16 pm #admin

    I would say yes.

    The sample policy “State Farm Homeowners FP-7955 CA 6-96.pdf” for free download at http://www.uclaim/products.asp only says you will give immediate notice after the loss. But it is overridden by the law.

    The law in most states will state something to the effect “as soon as you become reasonably aware of the loss.” If there is no law on the books, then the judge makes up his own mind, and a competent judge is supposed to use what is “reasonable” in his decision.

    Also, any lack of clarity or ambiguity in the policy should favor the insured, not the insurer.

    For purposes of the legal statute to file a lawsuit against the insurer, some states have case law that says the “date of loss” is the date that you become aware of the loss and/or the date that the insurer denies payment.

    Most states also give 3 or 4 years to file suit against the insurer (this overrides the 12 months stated in most policies). The law overrides policy provisions, which amazingly, are often contrary to prevailing law.

  32. January 12th, 2009 at 7:27 pm #beth

    Thanks for the info on the home destroyed by fire. If I find out more, I will post the outcome. As far as I know the owner of the home was charged with arson and is awaiting trial..looks like also an intentional act setting the home on fire..we shall see…thanks for the info!

  33. January 14th, 2009 at 2:27 pm #Teresa

    I have two questions. A tree feel through our roof and we were advised to hire a public adjuster which we did. The insurance co sent a small claims adjuster, large claims adjuster and structural engineer and then cut a small check to get us started. A few months later they cut another check to the mortgage company, public adjuster and us.

    1) Our public adjuster told us that the insurance co. would pay for the roof, really 2 roofs, so that we would be whole, i.e., the roofs would match. The house looks terrible with a new roof and old roof and would probably affect the value of the home. Should I expect that the insurance company should cover this or will I have to take this out of my pocket to fix it?

    2) How does payment work? We received checks but found a contractor that could perform the work for less than the check amount. The public adjustor is asking for receipts that add up to the check amounts but we don’t have that. Do we return the difference to the insurance company?

  34. January 14th, 2009 at 5:16 pm #admin

    Hello Teresa,

    1. I don’t know what state you are in, but California law states:

    “When a loss requires replacement of items and the replaced items do not match in quality, color or size, the insurer shall replace all items in the damaged area so as to conform to a reasonably uniform appearance.”

    But even if your state has no specific law on this, you are still entitled to be put back where you were before, in your case you had a roof that was matching. It does not matter how old or in what condition, it matched. You may have to litigate since most insurers will disagree.

    Send a pic of your roof as it looks with the old and new to info@insuranceclaimhelp.org if you like, for me to see.

    2. First of all, you don’t have to return any money the insurer sent you, even if they discover a clerk added an extra zero to the check by mistake. That’s called estoppel. Second, I would assume the insurer wants proof of what you spent so that you can claim the “RCV holdback”, the amount of depreciation they took from the repair estimate. Either your public adjuster failed to educate you on this, or you guys have a communication problem. This kind of question should not be coming from someone with a public adjuster. It makes me sad.

    Your public adjuster should have prepared you for how to legally not only keep the money already paid (the depreciated value, the ACV), but how to claim the RCV holdback (and more!), even if you got the job done for less than what the insurer estimated it at.

    If your insurer is attempting to collect back based on a policy settlement provision that says “We pay the lesser of the following amounts … the amount actually spent …”, that is really sad, and its even more sad that this could happen to someone with a public adjuster. If your public adjuster can’t get you out of this mess, I suggest you get the consumer guide entitled “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe)” at UClaim.com and read the detailed discussion on this.

  35. January 15th, 2009 at 6:32 am #Teresa

    Admin,

    Thanks so much for your quick response. We are in the state of Pennsylvania and our insurer is Allstate. Our public adjuster said he thinks we should “sue” which made me nervous. If we sue, I am afraid our rates will go up (we already lost the claim-free discount) or we would have problems getting insurance from another company if we needed to.

    You’re right about getting the holdback but I am confused as to why the public adjuster is telling us that the receipts need to equal the amount of the checks. I don’t think he’s a bad public adjuster but he is definitely not a good communicator.

    The weather is not good here but I’ll try to get a picture to send you.

    Thanks again.

  36. January 17th, 2009 at 3:55 am #Kuykendall

    With many years of Ins experence, I did not read close enough until I lost my home by fire. My husband handled the policy when we built our new Log Home a few years ago. He was killed in an auto accident in 2005. My home was totally destoried by fire 10/2008. I was in another state with my mother while she was having hip replacing surg. so I lost everything since I am in a rual area, it was very dry, no rain in weeks, so it was gone before anyone even saw it and called fire dept. I had replacement cost on my homeowners, but do not intend to rebuild a large 3 story home when I live alone. The small clause I missed was A.C.V. decovery depreciation on home and contents both. In this very rual area, I paid a very high premium for the replacement cost. I’ve spent weeks researching to refresh my memory and changes in laws since I had been out of business. Im still going to submit All of my work and agruements to them, but I think that one clause has got me. Even though I probably won’t recovery the 60,000.00 I still believe Im right. How can they sell me that policy for such a high price but then dictate that I have ti rebuild to receive what I paid for. And what does my not rebuilding have to do with my contents. I guess I want you to tell me that I have overlooked something. They may do it, but it is not right. Everyone better watch out, replacement cost can be taken a lot of different ways in different states. One hundred people could read my policy and 50% would see it my way and 50% would see it their way. Im sorry this is so long, but if I don’t get any help from this, someone else may. Thank You

  37. January 17th, 2009 at 11:32 am #Kuykendall

    Sorry to bother you again, when you haven;t even had time to answer my first. Im on brain overload so I would like to ask the questions that I didnot before. 1. can I submit a second inventory list after already being paid A.C.V. -recovery depreciation with 180 days to recovery. I worked for a solid week on the inventory, but out of three stories (including basement) I could not begain to remember everything, besides so much had been moved around and boxed since my husband died. I had 96,500 on contents, but finally quite at 83,000, and they really knocked that down. they took it down to 70,000 with excluding items, then dep. to 50,000. 2. My ins. co. used an independant adjuster, He was very nice, even though I never saw him. When he called to ask for directions(had never been in this area before) and told me when he would come, I assumed he would contact me to go with him. He didnot. There is nothing there, except a crumbling basement wall, and part of the big roc chimney to the fireplace. When I got a copy of his broke down estimate to rebuild, It would not even cover half. He arrived at this using Xactimate estimating software, which I had never heard of. I did a lot of research on that. Im no computer whiz, but I got the concept, but you have to know what was there. He scoped it, I don’t understand that. This is a very small town, he didnot gt anything from tax acesseroffice, or contractors, or a copy of our floor plan. Ive made a lot of mistakes with this, just a very bad 3 yrs. and when I hav refered to my policy, I spoke that wrong. It burned. I have been working with last 4 yrs. declarition pages. I also requested investigator, I though they could tell almost anything. Adjuster said nothing for him to check. I kept thinking I would need to give some kind of statement, was never ask a question. Thanks, FOR WHAT EVER HELP YOU CAN GIVE ME.

  38. January 19th, 2009 at 1:52 am #admin

    Teresa,

    Your rates should not go up just because you sue on the same claim, IMO. And on homeowners insurance, it’s usually not the dollar amount of the claim, but the frequency of claims that triggers a higher deductible or outright non-renewal. So a theft of a $150.00 bicycle would be the same as your house burning down. However, if you made an adjuster angry at you, he could send a “risk advice” to the underwriting department and cite something as trivial as “poor housekeeping” to get your policy non-renewed.

    If you had a major loss, you should be looking for another insurer anyway. Many insurers will non-renew you, but not notify you until 30 days before the renewal date. That’s not much time to find another insurer. Also, if you find another insurer and switch before your policy is up for renewal, then you don’t have to worry about retaliation if you do sue. The adjuster could care less if you non-renew, and a smart agent will not put up a fuss if he hopes to get your business back in the future. Also, if you switch before your policy cancels, it looks better on the new application that you “are looking for a better premium” instead of “my insurance got canceled”. And Teresa, there are plenty of companies better than Allstate, and for a better premium.

    Unless you are providing receipts to show you spent more than the ACV, in order to claim additional RCV dollars that were held back pending replacement or completion of repairs, then NEVER provide receipts. That’s an open invitation for the insurer to demand some of their money back. I repeat what I said in an earlier post, you should never be in a position of having to pay back any money already paid by an insurer. And I have never heard of any company, especially Allstate, overpaying a claim and saying “just give us back the money you don’t use.”

    Don’t tell me your public adjuster’s name or company if you don’t want to, but tell me how many years he has been a public adjuster. And was he ever employed as an adjuster by an insurance company before becoming a public adjuster? Send me a copy of his resume if you like, black out his name and and company name if you like. And Teresa, go online to your state department of insurance and enter his license number or name to see if there are complaints on him. It sounds like this guy is hurting yo more than helping. Pennsylvania is a big state for public adjusters. Call some other PA’s and tell them what you have told us.

  39. January 19th, 2009 at 3:24 am #admin

    Teresa,

    Saw the pics. If you can see from the ground from any perspective where there is new roof and old roof, then I think everything “in view” should be replaced. In California they call it “the line of sight rule”. If one side of the ridge is new and the other side is old, then I don’t think you will get a whole new roof. The only way to see it not matching would be from the air, and a judge would not go for it.

  40. January 19th, 2009 at 2:31 am #admin

    Hello Kuykendall,

    In answer to your first recent post, generally speaking, insurers pay the ACV (depreciated cost of repair, or market value) on contents and structure first. You don’t get the “RCV holdback” until after the items are replaced. On contents you send in receipts to prove replacement. The same is usually true for structure, although some adjusters will just make an inspection to verify the house was rebuilt without asking for receipts or a contractors invoice copy.

    In answer to your second post, you have way too many details and problems for a free website like this to address. A post as lengthy as yours would not even get a response on most forums. Our best advice is to either get a good public adjuster and pay him a percentage of your claim (eg. 10% on a $100,000.00 loss is typical) or if you are going to handle it yourself, take a look at the table of contents for “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe) Subtitle: HOW TO PLAY THE GAME – DELUXE VERSION (W/APPENDIX) at UClaim.com . At $79.95, it’s a huge bargain.

    If the adjuster and or company are giving you a hard time, take the time to give them a rating on this website so you can help your fellow consumer. You don’t have to leave your real name.

  41. January 19th, 2009 at 3:59 pm #Kelly

    Kuykendall,
    Would your insurance allow you to rebuild on a different piece of real estate?

  42. February 5th, 2009 at 9:21 am #Laura

    My husband is a self employed painting contractor and we have had water damage and tree damage from a recent ice storm. Our adjuster told us to get a painting estimate. Can my husband provide the estimate for the repair and painting or do we have to provide a 3rd party estimate.

  43. February 6th, 2009 at 11:00 pm #admin

    Hello Laura,

    Get an estimate from a 3rd party and use that to negotiate your claim with the adjuster.

    Don’t tell the adjuster you are going to do your own repairs or that your husband is a contractor. Some ignorant adjusters will deduct 20% from your estimate for “contractors profit and overhead”, saying you don’t have a right to “profit” from your loss. While their argument is not legal, they think it is, and their supervisors and insurers keep them ignorant of the law.

    The other trap many adjusters set for you is not telling you until the repairs are done, when you are expecting to get the “depreciation hold-back” that they only owe “the amount actually spent”. So if you got the job done for less than their estimate, or did it yourself, you got trapped!

    If you have already fallen victim to the adjuster on this and want to know how to get out of it, or you want some real detailed information on how to avoid these type traps, go to UClaim.com and consider the Homeowners Loss Standard or Deluxe guide. You will learn the tricks that public adjusters use.

  44. February 14th, 2009 at 4:23 am #Russell Heard

    Here’s my dilemma, I refinaced 3-4 yrs. in a row, to take advantage of droppinng interest rates. I was persuaded to purchase insurance by my mortgage loan officer at the time of signing to make sure that my mom’s interest was covered since she was taking this equity loan (Refi) out for me. I didn’t know that I could purchase the identitical insurance coverage through my home owners at 90% of the cost that my mortgage loan officier charged me. Here comes the topper! Each time I refianced this insurance should have been pro-rated & the difference either taken off the loan or given back to me, it never happened & the total comes to around $20/25,000 big ones, plus the two loan officiers that handled my 3 refi’s were busted for emblezzing money from clients(me in perticular).

  45. February 15th, 2009 at 12:17 am #admin

    Hello Russell,

    Normally when a policy cancels during “mid term” the insured gets a prorated refund. If you request the cancellation, you get less back than if the insurer initiates the cancellation. Read the Conditions applying to “Section 1 and 2″ (the entire policy) in your homeowners policy. You can look at the wording within different company’s homeowners policies. There are 75 free policy copies from different insurers in the Products page of UClaim.com.

    What were your annual premiums if you don’t mind my asking? They must have been huge if 20-25K was the refund amount for 3-4 years. While 20-25k is not nearly enough to attract an attorney on contingency, you may be able to pay an attorney to write a few letters threatening litigation against the loan companies. Find out if the other victims have an attorney. There may already be a class action lawsuit you can join into. Also, do a Google search for example “class action Wells Fargo Dallas” to see if there are already any class actions in your local area.

  46. February 19th, 2009 at 12:17 am #Rick Osterhout

    My wife and I were married 6 months ago,and she has kept her house and I have kept mine. There was an accidental kitchen fire (faulty burner) at her house while we were out of the U.S. recently, the day before we returned. Her insurance is Allstate, and I am not on the policy. She has lived there for about 6 years, and her daughter continues to live there and is now in college. My wife lives at my house, but still has all of her belongings (except some clothes) at her house, pays all the bills and doesn’t charge her daughter rent. The personal property adjuster couldn’t identify my wife’s room because of not being able to find her closet. We told the adjuster most of her clothes were over at my house, and we are in a transition until we decide to continue to let her daughter stay there, rent it, sell it or we decide to move there. The risk profile hasn’t changed since last summer, yet it ssounds like we may have claim denial exposure, both to fix it and to cover personal property damage. What is your take? Thanks! Rick

  47. February 19th, 2009 at 5:18 am #admin

    Rick,

    I think you are ok. There is a vacancy exclusion for structure vandalism if the property is vacant over 30 days, but the daughter is there. I looked at an Allstate Homeowners policy at UClaim.com , and found no limitation there. And I think you are ok on the contents too. Let us know if something is denied and why.

  48. February 25th, 2009 at 4:59 pm #Kelly

    Hi:
    I am having trouble getting my insurance disbursments from my bank. I lost my home in a fire 9/07. It has taken me over 2 years to finish the claim, redesign the house (w/addition) and work my way through the Los Angeles building and safety for a permit (I am on a hillside. In that time my original lender (World Savings) was bought my Wachovia. I been received two different processes (on paper) for getting my disbursments, one was for three draws of 1/3 of total claim with the first disbursment upon reciept of required paperwork, the 2nd at 40% and the last @90%.

    I received a second letter 29 days later stating the the following disbursments: 20% to begin repairs,20% after 50% completionand the balance after upon approvals of completion of all repairs. Any help is much appreciated….

    After receiving one disbursment, I requested my 20% draw at 50% completion. I was then told that I needed only 40% for the next draw. When I called for follow-up on the inspection, I was told that I had been switched to a total loss claim and the requirement for 60%. When the inspection company called for inspection, I was told that they would be looking for 40%. This was confirmed by the inspector. When I called for follow-up from the inspection, I was told everything was fine, I was at 50% and a check would be disbursed by the end of the week. After waiting a week, I called for update and was told that I needed to be at 60% and since I was not there would be no disbursement. I have yet to receive any paperwork outlining a process requirinng 60%. In the meantime, I am out of funds, frustrated and do not know how to rectify this situation. Though I have followed the procedure led out by them, submitted receipts that exceed the current disbursed funds, I was told today that my account was being switch (again) from escrow to loss managment. This feels like a shell game inwhich I will never get out of. What are my rights in this situation.

  49. February 26th, 2009 at 12:01 am #admin

    Hello Kelly,

    Well, I’m about half confused myself. Regardless of what their stupid rules are, if you are a certain percentage done, then you are entitled to that percentage of the money they are holding. You could hire a lawyer just to send a letter or two to shake them up, maybe. If you can’t get a loan to use to finish the house, then try this: in California the small claims limit is $7,500.00. Sue them for the full 7,500.00. It does not mean you give up your claim to the rest of the money they are holding, but it does pressure them and makes you a squeaky wheel. And it only costs you 20-30 dollars. If that gets them to pay, then drop the case and file another claim later if you have to do it again. One thing is for sure, when the house is 100% done, they have to give you all the money they are holding. And you don’t have to give them receipts showing what you spent.

    And beware of giving receipts to your insurer. The homeowners policy says the insurer owes the least of the following: policy limit, replacement cost, or AMOUNT ACTUALLY SPENT. So if they are still holding depreciation money, “RCV holdback” pending completion of repairs, and you spent less than the amount they estimated for the repairs, ask for a visual inspection to confirm the job is done. Don’t supply receipts for a lower amount, or they will cut your claim.

    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.

  50. March 1st, 2009 at 4:03 pm #Neil Wesley

    Have you ever heard of foundation cracks being covered under a property policy, such as a Homeowners or a Dwelling policy? I have a client who was cleaning a sewer leak and discovered foundation cracks. The carrier declined using an engineer’s report stating there was evidence of long-term settlement, prior cracks repaired, and no way that cracks were sudden & accidental based on location of sewer pipe. The insured contends that the leak happened so suddenly that the property sunk to the degree that a lower level exterior door could open one day and not the next!

  51. March 1st, 2009 at 7:00 pm #admin

    Hello Neil,

    Is your client the plumber or roto-rooter guy? Is it a plastic or metal drain pipe?

    The cracks should be covered if the foundation settled due the the ground settling from water from the cracked sewer pipe, as long as the ground saturation was “sudden and accidental”.

    What made the sewer pipe crack? Tree roots? Tree roots can bend a plastic pipe underground and when it finally breaks, it splits big. Unless there were “hair roots” inside the pipe to indicate a long term crack, then I would say sudden and accidental loss.

    I would be interested to see the “old repaired crack” photos and what the cause was. Remember, if its an all risk policy, special form, the burden of proof is on the insurer to disprove the claim.

    It’s like a broken pipe in a bathroom, long term leaking is indicated by rot. Plywood delamination and discoloration is not “long term”, even though some adjusters say it is.

    You have to get your plumber to put in writing that it was a sudden loss and state the reasons. Then the insurer will have to get their own plumber or engineer to look at it. Be aware that many insurance engineers are really prostitutes, they will say and even lie about anything. If that happens, then get your own engineer, or go to small claims court with good photos, your plumber and a good common sense argument. And you will never win in appraisal or arbitration. If you sue in superior court, be aware that judges can be bought off with a password to an offshore numbered bank account, or some other favor (I’m obviously quite Jaded).

    Consider a letter to the insurer CEO before going to court. But have it well documented.

  52. March 3rd, 2009 at 2:15 am #Ali

    Hi,

    After the November 15th, 2008 wildfires, our home was deemed a partial loss. We had little fire damage, but because 5 homes next to us, our backyard slope, front yard slope, and side yard landscaping were on fire, we are noticing a lot of “structural” damage.

    Things like warped vinyl window frames as windows are not closing, aluminum windows aren’t closing, cracks in drywall, fine cracks in concrete, discoloration of concrete and rust stains. Is a contractor enough to document these losses for our insurance company, or do we need to get an engineer involved?

    Thank you,

    Ali

  53. March 4th, 2009 at 12:43 am #admin

    Hello Ali,

    Don’t spend money on an engineer unless your claim is denied. Let the insurer estimate the damage and see if they pay enough to meet your satisfaction. If not, then get your own estimates and submit them to the insurer. Insurers don’t normally hire engineers unless they want to deny your claim. If they use an engineer to deny your claim, then you can hire an engineer to refute their engineer. Most insurance company engineers are usually like prostitutes now days, they will say whatever the insurer wants them to say for a buck.

    Your claim sounds easy. But if it gets difficult, consider the eBook at UClaim.com entitled “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe)”.

  54. March 5th, 2009 at 8:35 am #Vee

    Home damged by fire 1 year ago…insurance company finally agreed on amount to give for rebuilding home. My question is… If I do most of the work myself, and do not use all the money the insurance company gives me can I pocket the remainder, or does the insurance company takes it back…

    ex. Insurance claims pays 100,000. I spend 70,000 to rebuild my house. Can I legally keep the remainding 30,000. Or do I return this money back to the insurance company.

    Some people tells me I have to use all the building money, if not its considered fraud…Is it fraud?

    Need help!!! Thanks.

  55. March 5th, 2009 at 8:40 am #Vee

    Sorry.. Just adding more info for you…
    My insurance company is The Massachusetts Property Insurance Underwriting Association (MPIUA).

  56. March 5th, 2009 at 9:35 pm #admin

    Hello Vee,

    The clause in most homeowner policies under settlement conditions says we (the insurer) owe the lesser of the following amounts: the policy limit, or the replacement cost of repairs, or the amount actually spent. If you tell them “you” did the repairs and only spent 70k, then they could ask for the money back. Is it fraud if you don’t use all the money? I don’t think so. You have to argue that you are entitled to the left over money for your labor. Most adjusters will say you are not entitled since you can’t “profit” from a loss.

    Typically, for example, an insurer figures 100k to repair the house. They give you 70k, the depreciated cost of repair, the ACV cost. And they say “when the repairs are done we will give you the 30k we held back”. What they don’t tell you is that if you spent less than the 100k, then you only get back what you spent over the 70k. And if you can’t supply receipts for the amount over the 70k, then you get nothing. I have never seen anyone dumb enough to tell an adjuster they spent less than the 70k. So why open that can of worms?

    You can recover all that 30k money that was held back, “if you work it right”. You can also get yourself in trouble if you don’t work it exactly right. There is a detailed discussion on this topic in the eBook product at UClaim.com entitled “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe or standard version)”.

    If you would like us to look at your policy free of charge, you can mail or email a scanned copy.

  57. March 10th, 2009 at 9:02 am #f. michael conte

    help,
    i have a homeowners policy in new jersey my dinning room chandelier fell and destroyed table. am i covered?

  58. March 11th, 2009 at 1:05 am #admin

    Hello Michael,

    Most Homeowner policies cover damage from “falling objects” to personal property. However the “falling object” must damage the roof or wall in order for the inside damage to be covered. So if a tree branch or something fell on your roof and damaged a shingle/s, and the impact knocked the chandelier loose and it fell, then it should be covered. Obviously this argument is stretching it, but its all I can think of right now.

    Read “Coverage C” in your homeowners policy, or get a sample policy from UClaim.com Products section to read.

  59. March 13th, 2009 at 4:07 am #Matthew

    I had a rather rare item destroyed in a house fire. It was a carbon fiber race car tub (the part the driver sits in). Erie insurance provides me with replacement cost and has done so with every other item destroyed. This tub was worth around $15,000 but they say I need to buy one in order to get the insurance money for it. I guess this is a way of proving the value of the tub but couldn’t I do that by showing examples of other people purchasing the same thing? Can they make me buy a replacement in order to get the money for it? Thanks for your help!

  60. March 14th, 2009 at 12:59 am #admin

    Hello Matthew,

    You don’t have to buy a piece of property to prove what the lost one was worth.

    What I think they should be telling you is this “you get the depreciated value of the car tub now. If you replace it, then we give you the amount we previously held back for depreciation.” Either there is more to the story, or they are jacking you around because they don’t to pay out that $15,000.00.

    And if that car part was “off” of the car then they cannot deny it as being a motor vehicle. This car tub is no different than a chair that burned up in your house. If the adjusters supervisor backs him up, fax a letter to the CEO of the insurance company. Be a pest.

  61. March 18th, 2009 at 8:21 am #Mags

    Hello,

    My house was burglarized and item were stolen and damaged. My claim rep at State Farm keep stating a depreciated value will apply in my claim, when I have a policy that should cover the replacement.

    I got loss as to how can I value my collection when I didn’t have time to have it priced. They also – stated that coin collection is considered as cash – which will subject to cash limitation. Is that true. I talk to my agent and she stated the same. I need help -

    Thanks,

    Maggie

  62. March 18th, 2009 at 3:14 pm #Mike Gaspar

    Hello,

    I recently found that I had a broken drain line in my house. The drain line for my washing machine and kitchen sink runs under the concrete slabs which covers a good part of the house. When the lines began to back up and we discovered water coming out of the floor in one of the rooms, we called a plumber. The plummer ran a camera through the pipe and discovered the broken pipe. We immediately called the insurance company and they would not tell us anything other then they would send an adjuster the following week. We needed to get the damage pipe fixed, so the plumber ripped up the floor and slab and repaired the pipe. The adjuster finally came out and from the time he walked through the door, told my wife (unfortunately I could not be home) that is was unlikely that any portion of the work to fix the pipe or the floor that needed to be ripped up would be covered. He stated that insurance does not cover worn /damaged drain pipes and since the floors were not damaged by the drain they would not be covered as well. This was an expensive repair (over $8,000) and we have not even looked into the cost to replace the floor. I have Allstate insurance – is this true that insurance companies do not cover drain pipe repairs? Thanks for your help!

  63. March 20th, 2009 at 12:10 am #admin

    Hello Maggie,

    The 1996 State Farm Homeowners policy at UClaim.com says the limit of $200.00 on money includes money that is “part of a collection”, in the Personal Property “Special Limits” section.

    Look on the declarations page, the cover sheet with your name on it, and see if there is an endorsement for contents replacement cost. If you do have replacement cost on contents, then most insurers will take depreciation, then refund the held back depreciation after you prove replacement of the property. The UClaim.com eBook “CONTENTS INVENTORY LIST INSURANCE CLAIM ADVICE AND HELP” will show you how to maximize your claim and not get trapped.

  64. March 20th, 2009 at 12:27 am #admin

    Hello Mike,

    Insurance covers “sudden and accidental” losses. If this was your case:

    1. Get your plumber to put in writing what caused the pipe to break.

    If your plumber does not know the cause, then let the insurer hire an engineer or whoever to find out the cause. Most homeowner policies say “we cover everything except” … . This means the burden to disprove your claim is on them.

    2. If you get them to cover the pipe, then they should cover the damaged floor. They don’t owe the cost to fix the cause of the loss. But they do owe the cost to get access to do the repair, in your case, the concrete floor damage.

    Some low quality insurers will say that since “the cause of loss is never covered”, the plumbers bill is not covered. If you argue that the $2.00 piece of broken pipe is the cause, then the plumbers labor should be covered on all but the 2 minutes to insert and glue the pipe.

  65. March 20th, 2009 at 5:48 am #f. michael conte,CPIA

    maggie,
    the coin part i agree is the correct method of settlement, only becuase i assume it was not a scheduled or itemized class.

    the other colletions part would also have had to be separately insured.
    this all should have been explain when you purchased the contract.

    read your contract all slmnt methods are outlined there.

    hope this help
    fmc ny,ny

  66. March 20th, 2009 at 6:13 am #f. michael conte,CPIA

    to mike gaspar,

    typically pipes under the foundation are not covered.
    however read your contract or ask your agent to read the contrat.

    fmc,ny,ny

  67. March 25th, 2009 at 8:50 pm #AR

    I recently got some settlement checks for my fire claim. If we decide to do the work ourselves, ie: sprinkler system replacement, painting, etc, how can we go about making sure we can still claim the recoverable depreciation? What would we have to do, as far as the paper trail goes?

    Also, we claimed some ALE expenses for two weeks, while we stayed with my parents. They are retired so my wife paid them $1200 cash for using three rooms and a bathroom in their home, food, and utilities ($100 a day). The cash came from our emergency pretty cash, which we keep with our passports, etc, which was all evacuated from the home when we left the day of the fire. What would I need to provide for my insurance company, as the cash wasn’t taken out from our bank account anytime recently, or at any one time… its more of an accumulation of extra cash over the year. I know I need a receipt from my parents, which is fine, anything else in this case?

    Additionally, I have a copy of the Farmer’s Next Gen insurance policy in PDF which might be helpful to your site…

  68. March 25th, 2009 at 10:24 pm #Val

    Thank you for this site! Never having had to file a claim before, I’m feeling quite lost. I really appreciate the link to the different insurance policies, since if I ever HAD a full copy of my State Farm policy it’s long since gone.

    I was burglarized last week, and given what’s been said so far I feel like I’m already being set up for the insurance company to deny my claim. I called the police immediately. The front door was unlocked but closed; the back door was wide open and there were no broken windows or pry marks. The officer who responded kept saying things like “You left the door unlocked, didn’t you?” I DON’T remember leaving the door unlocked, certainly not open, and said so repeatedly. He seemed determined to make me say I had. Would it matter if I had? Wouldn’t it still be theft? Would the insurance company refuse to cover me if I accidentally left the door unlocked?

    I called my State Farm office the next day, and gave them the police report #. The insurance adjuster called me the following day. HE kept trying to get me to give him a dollar amount of the loss. I kept telling him I didn’t know; I was still discovering things missing, didn’t have receipts for everything, still looking for receipts and hadn’t added up the ones I’d found, but I’d spent at least $4500 on a TV and camcorder that I DID have receipts for.

    I have Homeowners Policy FP-7955.CA with Loss Settlement Provisions A1 (Replacement Cost – Similar Construction) with Deductibles Section I All Losses $1000. Plus B1 (Limited Replacement Cost – Coverage B) plus OPT JF (Jewelry and Furs $1500/$2500)

    Of course I didn’t have an inventory of my property before the theft. I lost almost every piece of jewelry I’ve bought or been given since I was a child, and I’ve only been able to find about $1000 in receipts for recently purchased jewelry. I’ve been making a list with as much description as I can remember, along with sketches and looking for pictures of similar items on line. Any advice here? I was SOLD the OPT JF because I had quite a bit, some inherited from my grandparents and some I’d purchased on trips starting when I was a child. Does State Farm pay out for receipt-less jewelry or am I wasting my time making an inventory?

    Also, I’d set up a very nice system involving my (stolen) LCD HDTV with a beautiful picture, a LOT of connections that spanned RCA plugs through s-video to firelink and PC connections so I could use it with my older VCR and my newer DVD/VCR and my new HD camcorder, eventually adding a computer to the mix.

    The company I bought the TV from doesn’t make LCD TV’s any more. They have some huge laser TV now. The size that fits into my entertainment system is almost impossible to find; prices have collapsed, so a much bigger screen costs less than what I used to have but the TVs with the good pictures don’t have all the connections I used to use. THAT means I’ll probably have to replace components that weren’t stolen and furniture as well, just to be able to do what I used to do.

    There’s also a missing 35mm camera that worked FINE the last time I used it. I’m not sure they even MAKE them anymore. I’d buy a digital camera with the same features, but I don’t know if insurance covers that.

    Only my camcorder has a comparable model from the same company. I paid about$1300 for it; the new comparable model is only about $800.

    How do insurance companies deal with things like that? Do they refuse to pay anything saying it ‘cannot be replaced with other of like kind and quality on the current retail market’? Do they pay the replacement for as close as I can get? Would I be allowed to take whatever $$ they’ll give me and add my OWN money to get something I’ll really be happy with, or not?

    I’d really rather have an idea of what to expect before I call the claims adjuster or spend any more time on my jewelry inventory, or wander through any more electronics stores trying to figure out what my beloved TV’s repair/replacement/amount of loss today (without tax) is!

    Thanks!
    Val in sunny CA

  69. March 26th, 2009 at 4:00 pm #admin

    Hello AR,

    Yes, the policy would be most helpful. Please attach it to an email to info@insuranceclaimhelp.org .

    In answer to your first paragraph, how to do your own repairs without “getting burned”. It’s too detailed and tricky to explain here. You will get a very detailed explanation in the UClaim.com eBook “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (standard)”. If this and the ALE are your only problems, then you don’t need the appendix that comes with the Deluxe version.

    Regarding the ALE, you don’t have to prove where your petty cash comes from. You only have to give the insurance company receipts or evidence if you have it, and within reason. For example, you don’t have to go back to a store and ask them to reproduce a receipt. Let the insurer hire an investigator to do that.

  70. March 26th, 2009 at 4:21 pm #admin

    Hello Val,

    I will take your questions one at a time and see how far I get :) . This blog is for short questions. So please consider one of the comprehensive eBooks at UClaim.com to answer most of your questions in great detail.

    Unless your policy has a clause that says there must be evidence of “forced entry”, then they cannot deny the claim. The cop sounds over zealous.

    You know what Val, upon reading he rest of your questions, you definitely need the eBook at UClaim.com entitled “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe)”. Your claim is way too big and complex not to have professional help. you could hire a public adjuster for 10% of your claim, or a lawyer for 33% of your claim. Again you do need more help than I can give here. Sorry.

  71. March 26th, 2009 at 8:50 pm #New pipe dammage guy...

    Just had a 5 room food, carpets, walls, ceilings…and an espostos tile floor.

    In regards to a new claim, are relo-costs covered, adjuster said “just save receipts” How long can I stay away? Full time of deconstruction and reconstruction?

    Does adjuster actually check on every item on my list? She did a breif walk around…but had Service Master take pics…..not of Personal property from what I saw…just damage areas they were to demolish.

  72. March 27th, 2009 at 9:41 pm #admin

    New Pipe Guy,

    If your Homeowners policy covers ALE Additional Living Expense, then it is covered until you git back into the house up to the policy time or dollar limits, and “within reason” (You can’t stay at the Disneyland Hotel for example). You can ask the adjuster to send you a letter saying this if you can’t find your policy. You can get sample policies at UClaim.com.

    The adjuster has a right to check out everything on your list. Most make random checks for larger items. But if they catch you “intentionally” inflating something, they can deny the entire claim, so be careful.

    Get your own pictures also.

  73. March 30th, 2009 at 7:07 am #f. michael conte,CPIA

    to new pipe guy,

    thought i would chime in on the last reply i read. here in NY they will only pay for your additional cost to live. the amount they pay is the amount of time for the work to resonably done. so if the job is projected to take two weeks thats what you get. so be careful and have the conversation with the adjuster before you make arraingements. ( you might also ask what he or she reasonables asks you to spend per night)

  74. April 3rd, 2009 at 12:26 pm #yolanda

    Heres my question on january 29th 2008 i came home from work to find water leaking from my kitchen ceiling. there was water coming down the walls and dripping through my window frames. my pergo floor was soaked to the point if u stepped on it water came out. i filed a claim that day and had a contractor come the next day. the report was an ice damn. this ice damn ruined my upstaris bathroom wall all the way to the kitchen walls, ceiling and floor. two seperate estimates where done by seperate contractors each around 12,000. this includes the siding wich was damaged from the ice. adjuster came and questioned wether the walls where STILL wet. he then said he didnt think the walls where still wet and that he had to have them tested. meanwhile my bathroom walls are open with the planks exposed and no insulation and so is my kitchen ceiling. The ice has all melted and the siding doesnt look to bad. pictures where sent the dayafter the incident showing all damage. the adjuster had chemdry come to my house 3 days ago to measure if walls where wet. we just recieved there estimate for the whole damage at 2,555, thats a big difference. i dont understand why such a difference and what should i do. i really dont think that will cover it when the other estimates where so much higher. its almost a 10,000 difference… please advise.. very confused

  75. April 3rd, 2009 at 12:30 pm #yolanda

    also forgot to mention the walls where opened for 2 months before chem dry came to see if they where wet.. of course there dry now theres no snow or ice and they have been open for a couple months.. please help

  76. April 3rd, 2009 at 1:21 pm #Bhoffa24

    My mother in law’s house caught on fire a few weeks ago and she is staying with us in the meantime until her house can be repaired. (maybe up to 6 months) Her policy has Additional Living Expenses included in it. My wife and I are not trying to get money out of the Insurance Company but all of our bills will be going up not to mention we are saving them money by not putting her up in a hotel. My question is would we be allowed to charge her rent to recoup some of the cost of her living with us? Or would she have to actually be staying in a hotel for that part of the policy to kick in? I just wanted to check before I asked the adjuster.

    Thanks

  77. April 3rd, 2009 at 11:43 pm #admin

    Hello Yolanda,

    Well the good news is that at least its covered and all you are arguing is damages.

    Is the $2,555.00 the repair cost “after depreciation” and deductible, etc.? Make sure you know the repair cost that includes no deductions. Most home policies pay replacement cost, “after” the repairs are completed.

    Try to get the adjuster to “reach an agreed cost” with the contractor of your choice. And try to get your contractor to call the adjuster also. If your contractor thinks he has a chance of doing the work, he will be motivated to help with this part of the insurance claim.

    I don’t recommend going to appraisal. You are better off in small claims court in front of a judge.

    For that amount of money, $10,000.00, you won’t find a lawyer or public adjuster to help you. But if you want to know how a good public adjuster would handle your situation, consider the eBook at UClaim.com entitled “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe).

    You could also have a mold situation. Consider asking the adjuster for a mold test.

  78. April 3rd, 2009 at 11:58 pm #admin

    Hello Bhoffa,

    For ALE, the policy will say you have to “incur the expense”. Some policies give you a choice of ALE or FRV (fair rental value). So check that first. With FRV, you don’t have to incur the expense.

    Bill your mother in law for what it would cost for a rental house or what a motel would charge and submit that bill to the adjuster. The expense is “incurred”, even if your mother in law has not been able to pay the bill yet.

    For a detailed answer to this question and all the other issues you will encounter, consider the UClaim.com product “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe)”.

  79. April 5th, 2009 at 5:58 pm #f. michael conte,CPIA

    yolanda,

    i think it is important to name the carrier so that if others are having the same problem they can learn from your anwers.

  80. April 5th, 2009 at 6:01 pm #f. michael conte,CPIA

    bhoffa24,
    this is an acceptable alternative and you should not have a problem getting the adjuster to agree to help offset the expenses.
    go for it. good luck.
    fmc

  81. April 6th, 2009 at 10:24 am #admin

    Yolanda,

    Adding to Michael’s suggestion, you can rate your insurer and any of their representatives in the Consumer Ratings page of this website. You can leave your name as “anonymous” if you fear making a rating, but at least it will help all of us, as Michael says.

  82. April 7th, 2009 at 4:44 am #Mags

    Hello,

    Thank you guys – your information kept me sane in my claim processing. State Farm (SF) finanly settled my claim, however, I still noticing item was missing since my initial police report. I still forward lost item to the detective – but I am not sure if SF will considered them since they already settled them.

    Another question I have – if 1 item on the settlement I strongly desagree in there settlement amount could I decline that 1 item eventhough it was included in original settlement checks.

    Any information will be a big help-

  83. April 8th, 2009 at 8:56 am #admin

    Mags,

    As long as you did not sign a “release” paper with State Farm, you can turn in additional items for the next couple of years as you remember stuff. It’s illegal in most states for your own insurer to make you sign a release, unless it’s a “compromise settlement” and you both agree to the release.

    Even if SF paid you what they estimated the one item was worth, you can still request more money on that item (or the entire list of items for that matter). If they “closed” the file, then they have to “reopen” it. For the best detailed information on how to increase your contents claim settlement consider the UClaim eBook entitled “CONTENTS INVENTORY LIST INSURANCE CLAIM ADVICE AND HELP” in the Homeowner’s section at UClaim.com .

  84. April 10th, 2009 at 12:30 pm #DC

    Hello,

    I am the recent victim of an extremly large and very old oak tree which fell on my house. According to the guys hired to remove the tree it would seem that it was about 125-150 years old. I have never filed a homeowners claim with my insurer before but i am already not getting a good vibe about this already. i had the adjustor arrive at my home and he did his intial inspection during this intial inspection he told me “this is the largest claim i have ever done” because my one entire side of my home was pretty much obliterated. After a couple of days passed i got a call from another adjustor to let me know that he had been put on this case because the inital adjustor did not have the experince to handle this claim. Well after a that he gave a check to cover some of my internal goods (which was an advance) within my home so i could buy some basic items to move into an apartment. well after all this i have only seen adjustors but i have concerns about the structual integrity of the home being comprimised and i don’t think the insurance company has any intentions of hiring an engineer to inspect it. from what i gather they are dead set on fixing it. Can i request that an engineer look at the house before they start telling me what there gonna do? and will i have to pay for that myself to get a truly honest opinion of weather the house will ever be the same again. i know that the insurance company will want to bid it as low as they can but how can they say lets start fixing it now after a tree that was 8ft wide and 15ft in diameter lands on the house and not even have a enginner look at it to say weather or not the foundation is good and it would be worth rebuilding. My fear is that with this economy the way it is and the fact that housing contractors are not in high demand right now due to the housing market. That a contractor will “low ball” the bid to get the job and then after the insurance company has put 40 or 50 grand into rebuliding it they will discover more problems and the insurance company will keep paying out more because they have too much invested not to fix it at that point when it should have been written off as a total loss to begin with and i get stuck with house that will never be right. i feel like my concern of the structual viability will not be addressed properly as i feel like it should. any advice you could offer me would be great

    Thx

  85. April 10th, 2009 at 8:45 pm #admin

    Hello DC,

    I will try to answer your questions in order, then give you the best advice at the end of this reply :)

    If the adjuster refuses to hire an engineer to inspect the house before a repair estimate is made, fax a letter to the adjuster and whatever contractor who writes an estimate to repair the house that if he does not hire an engineer and architect to review the plans prior to doing the repairs, that you will sue him if any problems develop because of not using an engineer and architect. Also notify your local building inspector. The building inspector can insist that that the plans have engineering and architect approval.

    Will their engineer be biased? Probably yes. Unless you want to hire your own engineer, then you are stuck with theirs. But do the same thing with their engineer if you think he “cut corners”. Fax him a letter saying you will sue him if problems develop while you own the house or if you sell the house and the new owner sues you.

    If you fear they will waste your insurance money trying to repair the house, then run out of money after they discover it should have been totalled out, then do this, NOW: fax the adjuster a letter stating you prefer the house totaled out, but if the adjuster insists on repairing it, that your policy limits will be increased by the amount the adjuster wasted trying to repair your house. Now you have a record you can use later in court, if necessary. You also put pressure on the adjuster to total out the house. And if you really want the house totaled out, Cc the letter to the CEO of the insurance company.

    Now my best advice. For the money you are talking about, you need more than a couple of paragraphs of advice from this website. You need professional help. You could pay an attorney who knows nothing about property insurance claims 30% of your entire settlement. You could pay a “public adjuster” 10% of your entire settlement and maybe get an unknown result, or pay him 50% of anything he gets over what you got on your own (as a “guarantee” of no unearned fees). Get advice at UClaim.com on how to hire a good public adjuster.

    Or you could get all the information and techniques that a good public adjuster would use in an eBook in the Products page at UClaim.com entitled “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe)” .

    PS, if the house has not been covered temporarily while the negotiations proceed, get it done (and at their expense). Good luck.

  86. April 22nd, 2009 at 1:32 pm #PJean

    Our house was in NYS. We were renting it out while away on temporary, long-term assignment. Due to the tenant’s negligence, the house was destroyed by fire. We hired a public adjuster due to our locale and the extent of damage (total loss). We are wondering if we can go after the tenant’s liability insurance to recoup the PA fees, which are in the area of $25,000-30,000.
    Also, the tenant’s liability insurance was shy the required $500,000 by $200,000. We are hoping the fees can come out of that, or from the property management company that did not ensure proper coverage per the lease.

    Any thought you have on this are appreciated.

  87. April 23rd, 2009 at 11:26 pm #admin

    Hello PJean,

    1. The public adjuster will probably not be able to pursue the liability claim since in most states PAs are limited to handling property damage claims. But, he can “work for free” on this, if you get my drift.

    2. To cover myself, I will first say consult with a lawyer on this. In my opinion, the tenants liability insurance will not extend coverage, unless as you say there was negligence, and to meet the New York definitions of negligence.

    3. As to the property management company, you or your lawyer need to see if there is case law in New York on their responsibility in this matter. And the language of the lease itself is also very important. Have a lawyer look at it. You can also email us a copy of the lease language on the insurance, or cut and paste it here. Our email is info@insuranceclaimhelp.org .

  88. April 24th, 2009 at 10:30 am #f. michael conte,CPIA

    pjean,

    also keep in mind that the carrier who paid the claim may be persuing the tenant through subrogation. if you go to an attorney he should attempt to coordinate with the carrier. i would also review the fire report to see what the cause and origin of the fire was. the will give a better clue as to who caused it. if it was something apparent like using an outdoor grill inside(we had such a loss) you may attempt to contact the carrier directly to see what their humor is on this topic. be carefull though you cannot collet on the same loss twice.
    fmc

  89. April 26th, 2009 at 2:13 pm #Bob

    Dwelling Policy 3 Special Form 08 08

    Dwelling is a total loss. Is there additional coverage for debris removal?

  90. April 26th, 2009 at 2:18 pm #AR

    Hi,

    I just had a slab leak in my home. Some of the areas effected by this slab leak overlap with some damage we had incurred with a wildfire a few months back. Now the wildfire damage has not been replaced or repaired because the claim on that was just settled a few days ago.

    Now with this new water damage claim, I was wondering if the overlapping items will be covered by the water damage claim? Some of these items have already been covered for replacement from the fire claim, but this (water damage) claim is a separate incident.

  91. April 27th, 2009 at 2:48 pm #admin

    Bob,

    Maybe.

    We don’t have a copy of that policy. But you can scan and email a copy to info@insuranceclaimhelp.org if you like and we will review it.

  92. April 27th, 2009 at 2:56 pm #admin

    AR,

    While you may technically and legally be able to claim water damage to a fire damaged carpet that was not replaced, I suspect the adjuster will resist your efforts. But hey, give it a shot. it’s what you pay premiums for.

    Now had the carpet been damaged from fire and water on the same day, during the same loss event, I don’t think you could collect twice.

  93. April 27th, 2009 at 7:35 pm #PJean

    fmc,
    Thanks for the input. Interestingly, the same insurance company represents both us and the tenant. Not so sure how hard they will try to recoup our fees for us, since they would be taking their own money…except that I believe his liability insurance was exhausted through subrogation for both our claim and neighbors’ claims who sustained damage to property and vehicles due to debris.
    On another note, the property management company failed to ensure that the tenant obtain a set amount of liability insurance. They were shy by $200,000 per the lease terms. If this amounts to gross negligence on the part of the property management company, I think we could sue them for the fees if the tenant’s insurance is shy.
    We would not be collecting twice….the fees of the adjuster go above what we have settled for. Thanks for that tip though.
    Finally, the cause of origin indicates cause to be unattended candle or smoking, both a liability on the tenant’s part. Our fees are in excess of $25,000, so we will be looking to work with a lawyer to recoup. I just did not know if it is standard practice to pay out on someone’s public adjustor fees, since it was our choice to hire him. Only problem was that we are not local to where the fire occurred and were geographically disadvantaged to pursue the insurance process on our own. It necessitated our hiring of the adjuster (esp since we were both covered by one in the same carrier). I just hate to pay a lawyer $200/hour to potentially lose. Ouch…
    Thanks for your comments.

  94. April 29th, 2009 at 5:11 am #f. michael conte,CPIA

    PJEAN

    seems like the managing agent dropped the ball, i would go that route surely they have proffesional liability coverage.
    good luck
    fmc
    ps i trust deductible was waived?

  95. April 29th, 2009 at 7:41 pm #DC

    Have a question? After reading all these problems with the insurance companys, rebuilding (or trying), pay, not pay, brings us to the question whether all this is really worth the effort.

    Our house burned down a few months ago, and we are experiencing the same problems that others are facing with the insurance company’s. The lender called last week and asked what was going on with the insurance company and I explained where we were at. By the time the insurance company gets around to settling the claim, our home may be in foreclosure. I told them we plan on rebuilding, but now that is in question.

    Neither of us really want to even rebuild if we are to face the problems like we are reading, and the insurance company at max. will only pay out barely enough to rebuild. (We lowered our coverages, last year due to our resources at the time). Big Mistake!

    Here is the question. Our lender knows of the fire, and is telling us if the insurance does not act soon that the LETTER (foreclosure) will be generated. Im now unemployed, have spent all monies towards getting resettled, and being told we would be compensated accordingly by the ins. company. Now they are not paying.

    If we just drop the claim, let the house go to the lender, and move on…..
    Will we somehow be held liable to the lender for the house if they foreclose? Or will it haunt us later?

    At max our contents would pay 60K and we have the depreciated value.
    Sure we lose our contents, and alot of hurt, but is it really worth fighting the insurance company to the points of total loss of self, being angered, frustrated, humiliated,………..among a whole lot more? Listen to what they are doing! Its absolutely Insane. Yet, they ask for more money and percentage increases……………..

    After Months of this, we are OVER IT! AND FED UP!

  96. May 1st, 2009 at 10:33 am #admin

    Dear DC,

    1. Get yourself the ebook at UClaim entitled “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe)” for $79.95. It currently has a 30 day money back guarantee. Look at the table of contents online there UClaim.com .

    2. If your house burned and you have not at least been paid the ACV (depreciated value) upfront, then either they think you burned the house or they are one of those “low quality insurers”. In either case, you can’t handle this on your own. You either need the direction in the ebook recommended above, if you want to “do it yourself”, or you need a good public adjuster. The Free Stuff page at UClaim will give advice on how to get a good public adjuster. Get a public adjuster who will let you keep what you were offered and apply his percentage fee to any additional recovery. If a PA can’t help you, then seek out a lawyer. Lawyers are more expensive.

    3. As to whether you should “walk away”, definitely consult with a lawyer who handles foreclosures and bankruptcies. Pay the lawyer for an hour of his time.

    You don’t want to be penny wise and pound foolish here. It could haunt you for years to come, even if you declare bankruptcy.

  97. May 1st, 2009 at 11:16 am #f. michael conte,CPIA

    dc,
    not sure what state you are in i would suggest contacting the insurance department for that state. also i am not sure that the bank can move to forclosure in your situation. i would ask the bank to have their attorney get involved and i would also list the name of the carrier you are dealing with so people learn who not to do business with…….

    i would not walk away from this it will haunt you for a while.

    you might also ask you agent or broker to get involved afterall this is exactly why we earn a commision.

  98. May 5th, 2009 at 8:14 pm #BH

    I have recently filed a Home Owner’s Insurance Claim. The insurance company has cut me a check to cover the estimated value of the items damaged. I went to replace the items and was able to replace them at a cost less than estimated. My insurance company is requesting that I fax over the receipts to prove that I have replaced the items. My question is, if I did not spend the total amount alloted for the item, is the insurance company going to require that I give them back the money I did not spend? I have heard that I would have to and that I would not. Any help would be appreciated…

  99. May 6th, 2009 at 2:59 am #admin

    Hello BH,

    When you say “estimated value”, I assume you mean the depreciated value, not the replacement value. The only reason to turn in receipts is to prove you paid more than the depreciated value, so you can get the difference back (assuming you have replacement cost coverage). If you don’t turn in the receipts, then they don’t know how much to “collect back”. This is not something that adjusters waste their time on investigating or pursuing.

    One option to increase your contents settlement in your situation would be to renegotiate the depreciation taken on your contents.

    Take a look at the money back guarantee eBooks in the homeowner section of the product page at UClaim.com .

  100. May 11th, 2009 at 9:55 am #Tiffany

    I recently had hail damage to my roof. Well we just found out that our home loan was put in our bankruptcy so we aren’t going to be keeping the house. My question is can we keep all the money and not fix the roof or can we just do minimum repairs and keep the rest?

  101. May 12th, 2009 at 3:59 pm #admin

    Hello Tiffany,

    If the check is only in your name, then keep the money. Now as to your bankruptcy, you have to find out if the court requires you to report insurance claim proceeds as “income”. FYI, The IRS does not consider property insurance claim proceeds to be income. Check with your bankruptcy lawyer.

    If the insurance claim payment check includes the mortgagee, your bank, named on the check with you, then you will have to do the repairs. If you get the repairs done for less or do it yourself, then the bank may sign off on the check.

    If it’s a two party check, do not sign the check and mail it to the bank. Hold onto the check. Do the repairs first, then call the bank to have their inspector verify the repairs were done, then, mail the unsigned check to the bank for them to sign and return it to you so you can now cash or deposit the check.

  102. May 16th, 2009 at 11:13 am #Rob

    On March 14th 2009 my home burned. About half of the house was completely destroyed, and the other half was severely smoke and water damaged. The insurance co. started off by playing nice. They put us up in a rental house, got us rental furniture and housewares, and even got us a couple thousand dollars for incidentals.

    But lately, the adjuster has become impossible to deal with. He takes days to return an e-mail, a week or more to return a phone call, and he is condescending. He gave us the contents forms to fill out to start processing our contents claim, then after about 20 hours of labor on my part to fill it all out, he sends me a 5pm on Friday email saying that it wasn’t done correctly and quoting sections of my policy. This A: doesn’t help me correct it and B: is a slap in the face considering all the work I have already put into it.

    Should I get a public adjuster to deal with this? or maybe a lawyer? or just ride it out?

  103. May 18th, 2009 at 12:56 am #admin

    Hello Rob,

    Sounds like your adjuster did what many are trained to do now days – be super nice in the beginning to keep you from hiring a public adjuster or attorney. And actually that’s not so bad, because it does help to discourage some of the lower quality PA’s using hard sell tactics.

    I suggest hiring a PA (a good PA) before you hire a lawyer. Don’t shop for a lawyer unless the PA can’t get a fair settlement for you. For advice on how to find a good PA, look on the Considerations page at UClaim.com for the link “About Public Adjusters”, scroll down to the yellow highlighted area and read those 2 paragraphs. To find PAs in your area, look in the Yellow Pages and check http://www.napia.com. You can pay the PA a percentage of the entire settlement (10-15% is typical), or a percentage of the amount over and above what you were already offered (not over 50%). And read the post of 5-14-09 by Chris about public adjusters on the home page here.

    If you are inclined to continue to handle it yourself longer, consider the eBook entitled “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe)” on the Products page at UClaim.com . You can also use that eBook as a guide to see what your PA or lawyer should be doing for you.

  104. May 18th, 2009 at 9:48 am #Kelly

    I live in Wisconsin. My name is on a mortgage with my ex-husband who recently set fire to the home and is being charged with arson. The insurance company has agreed to pay the mortgagae comany for partial losses but has not yet due to lengthy investigation. Meanwhile the home is being foreclosed on and I am being told that I will be sued by the mortgage company’s private mortgage insurance. I am completely innocent. Is this even possible? Thanks.

  105. May 19th, 2009 at 4:53 am #Young

    While I am traveling for business, my wife discovered a lot of water on the basement floor. The entire floor was soaking wet. There was some evidence of water on the drop ceiling. The 1st floor floor right above the basement (hardwood) got buckled up. She immediately contact our handyman to find out what’s going on. Upon inspection the house, he raised two possibility: (1) rain water could have come through the wall or (2) there is some type of plumbing failure. He was leaning toward plumbing failure as there was no sign of water coming through drywall, and the buckling seem to become more severe. It also smelled really bad. Furthermore, he suggested the amount of water is too much for rain water coming. (For your information, our basement was never wet.) He suggested that we should get professional mitigation company to restore the basement and ask their opinion. The guy came and immediately suggested that it is some type of plumbing failure, based on the smell. He also pointed out the buckling. He suspect that it cannot happen because of water coming to the basement. Again, he did not see any sign of wetness or water stain on our drywall in the basement. He said we should get a plumber and claim to our insurance.

    Later a plumber came and looked. But, he could not find any plumbing problem, saying that everything is dry. He said, that water must have come from outside. He was not able pinpoint where it came from. But, he said our plumbing is fine.

    We called the insurance to make a claim. Insurance guy told us that they would not cover the damage if the water came from outside. But, he also agreed that it is strange to have severe damage on the first floor and no sign of water on the wall, given the amount of water we had on the floor. So, he said, “we will cover it if you show us plumbing problem. Hire a plumber and show us what he fixed. Then, we will cover it”.

    The mitigation came back yesterday. After hearing the opinion of the plumber and the insurance, he still believed that water must have come from inside. So, he tracked the damage area and found wet area in our basement ceiling which is connected to the vent from 2nd floor bathroom. The vent is on the floor. So, now he suggested that some water might have come from that vent. However, my wife did not see any overflow in the bathroom. But, he said, he is going to put it as a statement that we can submit to the insurance company to show as evidence of water coming from inside. However, we don’t have a broken pipe.

    What we now have is two theories, without any positive proof for either of them. We don’t have clear evidence of outside water coming (our sump pump is fine) – no stained wall, water mark or wetness of the wall. At the same time, we haven’t been able to locate the broken pipe. Yet, we have clear damage of water on the 1st floor and the basement. How should we present our case to the adjuster? Is this kind of case that we should get public adjuster?

    Any suggestions?

  106. May 20th, 2009 at 1:12 am #admin

    Hello Kelly,

    Check with an attorney in your state. Most states have laws protecting innocent spouses. Look at your policy to see if it says the claim will be void if there is fraud by “the insured” or “any insured”. “The insured” is the “named insured” on the declarations page, and may not include “non named insureds” like other relatives in the house. So “the insured” would assume that there would have to be fraud by all the insureds.

    Educate your bank foreclosure officer. Advise them that they will be in a better financial position to have a repaired house as collateral than just the amount of their loan. Also advise them that the insurer owes “replacement cost” to the homeowner, but only ACV (depreciated value) or loan value whichever is less to a mortgagee. Most policies don’t give RCV to the mortgagee.

  107. May 20th, 2009 at 1:59 am #admin

    Hello Young,

    It sounds like a small claim and I’m not sure a PA would be interested, but you can try. Definitely hire a PA if the claim is denied, and consider hiring a PA before a denial. Read “About Public Adjusters” on the Considerations page at UClaim.com .

    You probably have an “all risk” policy on structure. It says “we cover everything except …” with named exclusions. That means the “burden to disprove” your claim is on the insurer. That means they, not you, have to disprove the cause of loss if they want to deny the claim. That means they, not you, have to hire an engineer or leak detection service or whoever to find the water source.

    Has anyone cut a hole in the ceiling or opened the vent to look for water stains etc?

  108. May 20th, 2009 at 5:43 am #f. michael conte,CPIA

    Kelly,

    wow what a nightmare, get an attorney, i do not think they will persue you for arson, however i think they will be looking for their money as i assume you are a co-signer on the loan. fmc

  109. May 20th, 2009 at 5:52 am #f. michael conte,CPIA

    young,
    you mentioned you were away on business how long were you away?

    also was their waste in the water or was io t clean? finally a buckled floor is not a surprise, as wood acts like a sponge so in a condition of high humidity wood will absorbe the water in the air and then buckle.

    ideally you must pinpoint the problem. is it possible that some left a faucet on?

    finally keep in mind that overflow from a plumbing system may be an exclusion as well.

  110. May 22nd, 2009 at 9:51 am #kym

    may 19th our beach house had a pipe burst and flooded, the neighbors realized there was something wrong and used their key to enter. Upon entering the house they realized the mess, falling ceilings, mold up the walls and bucked hardwood floors just to name few. Currently the insurance company has a company serv-pro removing everything down to the studs, we do not have a mortgage and with current home values we might be better with a total loss. Can we suggest that? The mold is everywhere and they are saying that it may take days just to get the mold to an accessible range. I also have asthma and severe allergies and the thoughts of a home possibly having mold in the walls freaks me out. What should we do.

  111. May 23rd, 2009 at 4:34 pm #admin

    Hello Kym,

    This is one reason why I shut off the water valve to my house anytime I plan on being gone, even if for 1 night.

    1. Consider that your policy may have a limit for mold coverage, possibly as low as $5,000.00. Insurers got tired of trying to deny mold claims, so they found it easier to cover it, but put a dollar limit on it. Make sure that any agreements you signed with Servpro don’t leave YOU with the bill if they run over cost.

    2. Get as much covered or replaced using “non mold” coverage. For example, if wall paper is stained and molded, claim it as stain damaged, not mold damaged.

    3. If you prefer the house be “totaled out”, then put that in writing to the adjuster. Tell him the house is a total, in your opinion, and you don’t want your insurance money wasted on Servpro or others. And fax that in writing also to Servpro. This will force the adjuster to be the one to authorize Servpro to attempt remediation (and it is his right to do so). In other words, any failed attempts to repair or “remediate” your house will now not be applied to your policy limits.

    4. If Servpro screws up the remediation, now you have a liability claim against both Servpro and your insurer. And such a claim would not be subject to your policy limits.

    5. Is Servpro using blowers AND dehumidifiers? Most insurers are too cheap to cover dehumidifiers. So if they did not use the dehumidifiers, then you may have a liability claim against both Servpro and your insurer for negligence if your coverage on mold depletes.

    I suggest you run this strategy by an attorney, as the final decision will be yours. Insurance claims are often like a chess game and you may want to consider a “good” public adjuster and or attorney. See “About Public Adjusters” on the Considerations page at UClaim.com.

    A great reference for handling this claim is the eBook entitled “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe)” at UClaim.com .

  112. May 29th, 2009 at 4:26 pm #jackc21

    What is definition of vacancy under a DP3 policy. The dwelling was being repaired after tenants damaged it. insured was doing repairs himself but not living there. Water loss occurred but was discovered and mitigated within 48hours.
    Florida

  113. May 30th, 2009 at 10:48 pm #admin

    Hello Jackc21,

    The ISO Homeowners Insurance Special Form Policy DP3 7-88 (available at UClaim.com product section) does not define the word “vacant” in the Definition part of the policy, but it does say “a dwelling being constructed is not considered vacant” in the Perils Insured Against section of the policy. I would argue that this includes repairs and remodeling.

  114. June 1st, 2009 at 9:56 am #James

    In order to collect the balance of a claim which ins. adjuster referred to as “applicable depreciation balance” withheld by my insurance co., my insurance company is asking for receipts for the restoration & cleaning work completed by the contractor after a fire in my home. I have a final invoice from the contractor, however the contractor is refusing to provide receipts, says he does not have to and claims their demand is redundant and that the itemization for everything is in his estimate that the ins. company has already sent payment for (less depreciation). He says it is evident that ins. co. is attempting to get out of paying remainder & that they are acting in bad faith. Now the contractor has threatened to put a lien on my home for non-payment. If I am unable to provide these receipts the insurer is refusing to release the final monies of which I need to pay the final invoice. The work is complete and I am very happy with the work and my mortgage company is happy as well and have released the balance of the money in escrow for payment to contractor. I still owe the contractor money which I thought I would be getting from the ins. co. after contractor completed job. What is my recourse here?

  115. June 2nd, 2009 at 12:00 pm #jaws5738

    We had a storm come through our town on June 4, 2008. I immediatley called the insurance company who sent an adjuster out. I received a check from the insurance co on June 26th for the amount of $3676.00. I contacted a couple of contractors to replace the roof, however, there were so many roofs in town needing repair that they were all busy. They told me it would be a couple of months until anyone could look at my roof. Finally in September, a contractor did look at the roof and asked if I had any leakage. I told him no, I did not. He advised that because it was getting late in the season, that the roof would probably be ok through the winter. He told me that shingle prices would probably be lower in the spring and said since I had no leakage that I should probably wait until then to have the work done. That is exactly what I did. The contractor contacted me last week with an estimate of the repairs…$5865.00 to be exact. I still have the original $3676.00 that the insurance paid me. This is a difference of $2189.00. My question is, can I send the estimate to the insurance company and see if they will pay more on the claim, or will I have to eat the cost myself since the claim is now a year old? I understand that I will be responsible for my $500.00 deductible and depreciation costs, but those together only equal $1365.69. Am I responsible for the difference because I waited until spring to have the repair work done? Also, my insurance policy says the depreciation costs are not recoverable…is this right?

  116. June 2nd, 2009 at 12:01 pm #jaws5738

    This was a hail storm, by the way. I left that out of the original post!

  117. June 2nd, 2009 at 6:58 pm #admin

    Hello James,

    Your contractor is right, and since “he” is not “the insured”, he does not have to cooperate with your insurer. And if all you have is one general invoice from your contractor, then that’s all you can give them, and you have fulfilled “your” duty to cooperate with your insurer.

    Your insurer is really looking for a back door to cut down or completely eliminate the “hold back amount”. There are ways to verify the job is complete without looking at the contractors invoices, etc.. Have the contractor give you one piece of paper that states “Job complete, amount due $xxx.” Then if the adjuster wants to verify repairs were done, let him do his own inspection. How to handle this “safely” and all your possible questions is included in the eBook entitled “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (standard)” at UClaim.com .

  118. June 2nd, 2009 at 7:14 pm #admin

    Hello Jaws,

    1. If the original check was for 3676.00 and your deductible was 500.00 and your policy does not pay Replacement Cost, how much did your original adjuster figure for RCV of repairs, before depreciation? If that’s over 5865.00, then the only thing you can argue about is the depreciation, if you think that was too high.

    2. As to the time limit, most policies say you have “12 months to sue”, but the question is from when, the date of loss or the date payment was made? Also, most states laws override the policy language anyway and give you up to 3 or 4 years to file property damage claims (you can check that with your local small claims court or a lawyer).

    In my experience, you should not have a problem reopening the claim, unless you are with a “low quality” insurer.

  119. June 5th, 2009 at 3:58 pm #Michelle

    I have HO insurance in Florida. I experienced a flood due to a crack in my home’s concrete slab. Since I am new at being a landlord, as soon as my tenant told me about the flood, I had it fixed. I sent out a licensed and insured handyman to fix the crack, and later had a flooring company to repair the flooring. I did not call the insurance carrier prior to having the repairs done, nor did I make the workers take pictures. Like I said, I’m new at this.

    So I called my insurer and told them what happened. They wanted to send our an adjuster. But I told them the work was already done, so I wasn’t sure if they needed to send out an adjuster. Next thing I don’t I have my insurer calling me, asking me to fax them my invoices. I did so. Right afterward, they called me to tell me they were going to pay my claim minus my deductible, since it was a “small claim amount”. So they faxed me a “release to sign” that has to be notarized, which basically say that they will pay my claim, but I waive my right to future claims directly related to this claim/incident.

    Now, I might just be naive or too skeptical, but I feel this was too easy. I feel that there is an underlying reason they are so quick to pay my claim without ever having seen the property. Are they afraid of something? What do they gain from this? They have more experience than me, and I almost feel they have an feeling there will be more to this ordeal. Why???? Mold claim maybe???

  120. June 6th, 2009 at 11:29 am #nicole

    We have a Foremost Policy in Calif. We had lightning hit a tree near our house, which also transferred the energy into the house. We are contemplating putting in a claim, but are trying to assess if it is worth it. We would like an estimate on how much our insurance will go up without the claim free discount. Is there any scenario that can just give us an idea? ie, if our damage is only $5000, our insurance will go up approx $xx this much per year for 5 years?

    We are also concerned about putting in a claim because we are in a high fire area and are wondering if they could drop us. Many ins. companies are dropping people like crazy in our area (zip 92382). They are able to do this by stating any brush and trees need to be removed anywhere near the home by so many feet – but most peoples lots aren’t even that large and they can’t cut their neighbors trees. So they are able to do it with their exclusion that they invented after the last round of fires. Fire season is coming and we don’t want to lose our insurance for something like this lightning damage which is something we would struggle with, but could deal with – unlike fire damage or something more extreme.

    Another concern: will they cover removal of the tree that has been damaged and weakened from the lightning (it is 10′ away from the house and did not fall on the house)? The tree did transfer the energy to the house through another tree, which then touched the roof and went from there. It is a danger (broken branches are still hung up in the top of it) and could break off at the weakened point.

    Just trying to be educated in our decision and appreciate any help and incite. $1000 deductible and losing the discount- is it worth it?

  121. June 6th, 2009 at 11:59 pm #admin

    Michelle,

    Not enough info. to answer. Water source? Dollar amount of damages?

    1. Where did the water come from? If from a broken pipe under the slab, then its covered. If from ground water seeping through the cracked slab, its not covered. This is how most policies read.

    2. Unless there was a broken pipe, you are lucky your insurer is covering the claim, so sign the “release” and be happy you slipped through the cracks.

    3. If there was a broken pipe, don’t sign a “release”. Only sign a Proof of Loss, but safely. How to do it safely is outlined in the Homeowner Loss eBooks at UClaim.com.

  122. June 7th, 2009 at 12:23 am #admin

    Nicole,

    You will have to ask your agent about what would happen to the premium if you make a claim. We are claim adjusters here and adjusters are not trained in this regard. Get your answer in writing from your agent or Foremost, because I doubt they will “guarantee” what they tell you.

    When I worked claims for Farmers (who owns Foremost) in the 1980′s, they would not cancel a policy if you had 1 claim, but they might raise the deductible if you had 2 claims. If you had a third claim, then they would non renew the policy.

    They cannot cancel the policy if you have had it for so much time. But they can “non renew” it. So that gives you time to get insurance with another company before Foremost gives you notice of non renewal, 2 weeks before it comes time to renew. So if you do turn in the claim, consider shopping for another insurer in the meantime.

    Regarding the tree. Insurers will only pay to remove a tree that has fallen on a building in order to access the repairs. They will only cover fire damage to trees, and even then only to a stated amount, like $500.00 each, up to 5 or 10% of building structure limits. You have to remove the potential hazardous tree, the insurer won’t do that. And furthermore they could use your failure to remove the hazard as reason to deny the claim if it does fall on the house.

  123. June 18th, 2009 at 4:19 pm #PJean

    Have you ever heard of anyone prevailing in getting reimbursed Public Adjuster fees? We are temporarily living 6 hours from our family home which was being rented out. Tenant burned the house down by leaving a candle unattended. Tenant did not have the $500,000 liability insurance that was required by lease, but that was also not verified by the property management company listed as the “Landlord” on the lease. Such verification was to take place within 7 days of lease signing. Anyhow, we have been told that we will never get the fees refunded b/c we chose to hire a P.A. Is this true? If so, we are out $27000. Yes, we probably got a better settlement by having hired the P.A…just hurts to have the loss. Would suing the tenant get us that fee back (provided they have the cash)? Would a court award us the P.A. fees if we sue the property management company that was negligent in its review of lease requirements? How about out-of-pocket expenses? We have made 5 trips to follow-up on rebuild and such for a total of almost $1500. We anticipate another 5 trips, at least. Anyway to recoup those losses? Our property is in NYS.
    Thanks!

  124. June 20th, 2009 at 1:54 am #admin

    Hello PJean,

    I think you may have a chance of getting the PA fees in a liability claim against the property manager, but not from your own insurer. You have nothing to lose by including the PA fees in the claim (and litigation if it goes that far). I don’t personally know of any case law on that, but your attorney could check that. Most PAs would not know, since they only handle 1st party claims.

    And yes, include all your expenses. You are not limited by any policy provisions in a “3rd party liability claim”, as you would be in a claim against your own insurer.

    I have no idea what a court would award. Judges and jurys are unpredictable. It sounds like you need to hunt for an attorney to take your case on contingency. That can be a chore.

  125. June 21st, 2009 at 10:05 am #PJean

    Thanks for all the advice. To clarify, would we ask the property management company who insures them, and then contact their insurance company to file a third party claim? We are confused right now, since our insurance company (and the liable tenant’s insurance company–one in the same) wants us to sign a joint prosecution agreeement for the subrogation. They have said that there are anti-subrogation rules in NYS that preclude them from doing this, but no one has caught on yet, so they hope to prevail. We are afraid to do that, since we will only get pro-rata after the atty’s fees are paid, which at best would be $5000, when we are out of pocket close to $40,000 including the PA fees. If we go that route, we will surely get something, but if we file a third party claim with the property management insurance company, we may get denied. We are not gambling folks…we want to minimize our risk due to all we have been through thus far and for our childrens’ sakes. We are unsure how misleading our insurance company is being by saying the more they get for us, the less loss is showing for our policy and therefore, the less affect it will have on our future premiums. In other words, if we help them, it will help us. They have all the info they need to go ahead and subrogate on their own, while we take our own route. Note: the property management company, as “Landlord” failed to make sure the tenant secured the $500,000 liability insurance required by the lease. The $300,000 they did acquire will be exhausted by neighbors’ damage and the cost paid to us already. We are left with uninsured loss of $7500, personal out-of-pocket travel expenses…($1200 so far with anticipated $1200 more) and the PA fees of $28,000. We are afraid to file the third party on our own, get denied and then have to sue with the risk that the lawsuit could cost more than we could potentially recoup. Does any of this make sense? And we had to pay the deductible since the tenant’s policy limits were exhausted. We are living in another country, and had to retain the PA services, since the property management company could not answer any of our questions immediately after the loss. We had no other choice. We could not be present for the insurance process, claim, etc… due to our residence abroad. Many have said it was our choice to hire the PA, while we see it as having had no legitimate choice based upon the circumstances.
    Confused, angry, frustrated and ready to be done with all of this…
    Thanks for your site…and all of the great advice thus far.

  126. June 23rd, 2009 at 4:16 am #admin

    For PJean,

    If someone else out there wants to take the torch and give PJean some advice, please jump in.

    If no one jumps in here, PJean, you probably need to consult with an attorney and or a good PA in your area. Our admin time on this website is really intended for short questions and answers since it is all volunteer time. Thanks for your nice compliments.

  127. July 7th, 2009 at 2:01 am #Mary

    Our home was a complete loss on October 27, 2008. We were out of town, thankfully. Our insurance company, State Farm, had an engineer sent out to determine cause of fire and we were informed that he could not determine the cause because there was not enough left of the home. We rec’d a couple small checks early on for neccessaties but that has been all. We hired a PA early on and we also have an attorney (due to issues with the structure claim….our mortgage company foreclosed on house 6 weeks after fire and sold it for amount owed. When SF cut the structure check to us and mortgage co., the mortgage co said we did not owe them anything so SF did stop pay on check and are now saying they just don’t know who to pay for that portion of the claim.) My question is more on content portion. We did the EUO, content lists, and every other thing asked of us. The ins. company attorney stated he could see no grounds for not paying the claim but all we get from insurance co. is “we are still investigating”. What could they possibly still be investigating? We are getting close to being 3 months shy of 1 year and they have not denied but they are not letting us know anything either. Is there anything we can do to light a fire and get them to do something? anything? this life of limbo is getting to be almost too much to bear.

    Thank you for any advice

  128. July 8th, 2009 at 3:35 am #admin

    Well Mary, on the structure part, State Farm should issue the check in both your’s and the mortgagee’s name. You send the check to the mortgagee (without your signature), the mortgagee signs off and mails it back to you. Any competent public adjuster or attorney should be able to handle that for you, unless there is more to the story here. State Farm’s excuse is no good.

    I think the mortgagee may have screwed up by foreclosing too soon not allowing you to claim full RCV benefits, if SF only paid the ACV (depreciated cost). But then, State Farm is the only company I know of that normally pays full RCV up front without requiring replacement.

    Regarding the contents, if they put you through an EUO, and all is as you said, you have too many issues to address in a paragraph or two here. I suggest you consider one or more of the eBooks (currently on sale) at UClaim.com and learn how a competent public adjuster plays the game. They will also help you find out if your PA and lawyer are doing their job or just looking for an easy buck.

  129. July 8th, 2009 at 6:06 am #f. michael conte,CPIA

    Got to say it “like a good neighbor” guess who’s not there…….

    This story make my blood pressure go to 1000. I would consider filing a complaint with the Ins Dept of your state, Insurance carrier’s pay attention to these complaints you might include thm names of the comapny reps you have been talking to, i promise they will make this get resolved quicker than you can imagine. In my mind this has been mishandle from day one. This claim should have been closed about 7 months ago. Has your agent offered help? He is your first advocate in matter like this.
    fmc

  130. July 11th, 2009 at 1:51 am #Mary

    I’m not sure what agent you are asking about? If you are talking about our insurance agent….then the answer is a BIG NO. We cannot get any one at state farm to even return a call. We sent a letter to them via fax on the 8th stating we expected payment immediately, and just today, we rec’d one back from the attorney for state farm stating it was “still under investigation” and we would be notified when a decision has been made. (whatever that may mean). They also informed us in this letter that no more payments of any kind will be made until a decision has been decided upon. The ONLY payments they have been making are our additional living expenses for the home we rent and the furniture we are using. Are they honestly trying to inform us they are not paying these anymore? What grounds would they have to stop paying additional living expenses when they have not settled nor denied the claim? I am so stressed at this point, I just want to sit in the floor and cry…(but I guess that is exactly what they are hoping to cause.) Is there anything else I can do besides filing a complaint with the ins dept? We live in TN & I’m not sure how that works. Thank you so much for your help.

  131. July 11th, 2009 at 11:02 pm #admin

    Mary,

    I think Michael was referring to your sales agent.

    The good news is that at least SF is paying your additional living expense while they “consider/investigate”. Some insurers would resist doing that.

    If you have a competent PA, you should be getting answers to all your questions.

  132. July 22nd, 2009 at 6:59 am #Bill Green

    My wife and I purchased our home in July 2006. Our home was destroyed by fire as a result of Hurricane Ike on Sept 14, 2008. We were not at home at the time to save anything. Our home and contents was a total loss. Scott county was declared a federal disaster area. Ten months later we are still living in our RV. Is it ethical and legal for Cincinnati Insurance to file two claims for the same occurrence then cancel or “not renew” my policy, preventing me from acquiring insurance, making it impossible for me to rebuild my home at replacement cost and forcing me to take their “fair market value”?

  133. July 22nd, 2009 at 5:42 pm #admin

    Hello Bill,

    If the fire is directly connected to the hurricane, for example the wind blew a tree into a transformer that fell on your house and fire ensued, then that should be one loss and one deductible. Or if the wind knocked a tree into the house smashing the roof and cutting wires that later shorted and fire started, I would call that one loss, one chain of events.

    In most states, insurers need no reason to “non renew”. But they can cancel midterm for example due to fraud or change in risk of loss.

    I personally advise my clients to start looking for insurance after a major loss since its easier to get insurance while you have insurance than after cancellation. Insurers often cancel policies after major losses. And its not too ethical, IMO, for an insurer to only give 15 or 30 days notice of non renewal.

    If your house was a total loss and you are handling this on your own, consider the eBook on that at UClaim.com, currently 75% off on sale and guaranteed!

  134. July 22nd, 2009 at 6:14 pm #F MICHAEL CONTE

    HEY BILL,
    DID YOU HAVE A REPLACEMENT COST POLICY, WAS THE LIMIT ADEQUATE TO REBUILD, DID THEY PAY THE POLICY FACE AMOUNT?

    THE ONE CALIM TWO CLAIM ISSUES SEEMS IMMATERIAL, THE CANCELLATION PART, IS TO BE EXPECTED. HAVE TO ASK WHAT DOES YOUR AGENT OR BROKER SAY ABOUT ALL THIS?
    MIKE

  135. July 23rd, 2009 at 1:05 pm #michael

    I just received my check and my property damage estimate for a claim that I filed about 3 yrs ago. My house was burglarized and a great deal of tools and electronics were stolen. The total value they came up with was a couple thousand off and I intend to fight that. My question is on recoverable depreciation. Is there any way to fight this since this over 34% of my claim. I have replaced some of the stuff in the last 3 years but was only recently told of this and have not really kept my receipts? Or would it be possible to move or combine the depreciation on tools onto only select tools? Any help on this would be great. A lot of the stuff I had, I rarely used and do not necessarily need it all now that my life has changed some and I would like to get back most of the money I had to pay out on this. Also, would it be wrong to buy something and then return it for the receipt? An example would be movies, I lost a lot in movies and they are giving me only about %25 for the dvd’s I owned. i know do netflix, so I do not buy them anymore. Thank you for your help.

    Michael

  136. July 23rd, 2009 at 8:58 pm #Bill Green

    The high winds blew trees down on the power lines. Before power was fully restored, it reportedly came on and went back off several times. The fire marshalls suggested that this may have caused an electrical item in the home to overheat and eventually catch on fire. After posting this complaint, I was contacted yesterday by the Indiana Department of Insurance and informed that they were investigating why there were two claims filed.The independent adjuster has not made us an offer for the contents loss, but wants us to say what we are willing to accept, so that they can come back with a lower offer, i’m sure. Our last meeting with he and our attourney seemed more like a mediation, because he wanted us in a different room.

  137. July 24th, 2009 at 11:45 pm #admin

    Bill,

    I would say Indiana could save some tax dollars by trimming their Department of Insurance if they are wasting time on simple stuff like this. Glad to hear you have a lawyer helping you. I hope he is doing good for you.

  138. July 25th, 2009 at 12:04 am #admin

    Michael,

    1. I don’t know of any of any policy clause that says you cannot return an item you purchased.

    2. Since they did not tell you about supplying receipts to prove replacement, let them physically inspect the replaced items, and let them track down the receipts from vendors if they want receipts.

    3. For items not replaced, you can negotiate that 34% depreciation.

    Detailed information on how to properly do all this is included in one of the eBooks on Homeowner’s losses at UClaim.com.

  139. July 26th, 2009 at 9:18 am #Bill Green

    On the contrary, we don’t believe our lawyer is very skilled in this area, and it’s too late to hire a new one. That’s why i’m posting here, trying to get some straight answers. She had to call up the isn agent to ask what A.C.V and R.C. meant? If we have replacement insurance and the dollar figure on the declarations page for contents is $216,000, is that the maximum that they will pay even if the cost of replacing the contents excedes that? Also, if the dollar figure on the declarations page for structure is $288,000, the builders bid to replace the home is $316,000 and the insurance co’s estimated “fair market value” is $164,000, what is the maximum amount they have to pay to rebuild.
    Also, can you give me an example for normal depriciation of contents of different ages and types.

    Thanks
    Bill

  140. July 26th, 2009 at 9:24 am #Bill Green

    Hello Michael
    Thanks for your curteous response.
    Yes, we have carried replacement insurance with them for 18 years.
    They are not wanting to pay us the face amount of $288,000, they want to pay us their “estimated fair market value” of $164,000.
    Thanks

  141. July 26th, 2009 at 9:28 am #Bill Green

    Is their a difference between a policy limit and a policy face amount? If so, where can i find these figures?
    Thanks

  142. July 26th, 2009 at 6:55 pm #F MICHAEL CONTE

    please bill green, tell me who this inusrer is? are you saying that they are telling you they can pay the fair market value regardless of the rebuilding cost? if that is so it must be said in you contract. there must be an endorsement that gives them the right to do so. if that is the road they choose then i think it would be fair for you to ask for your premium back that was paid over the years for the replacement cost option. also did you use and agent or broker? if so have they excersised any influence here?
    i understand the state ins dept is now involved, put all these issues on the table and use the term”unfair claim practices” thats a buzz world that everybody is afarid of. do you have the policy and did you give it to your attorney? the question she had would have been explained in that document ask her if she read it, it is afterall a legal contract. finally here in NY we have a tv guy that does an spot called “shame on you” maybe you have a similar tv guy out there if so get him on the phone this sounds like a story for the six o’clock news. it is not supposed to be like this, unfortunatly my peers forget that we are in a business to help people when they need us most. good luck!

  143. August 3rd, 2009 at 10:42 am #Harry E

    I had a fire with total loss of dwelling and contents. There is no house to insure, and I find companies reluctant to offer liability, etc coverage that I would expect would satisfy the mortgage company during the long period that it is taking the old company to settle. Am I correct that “liability, etc” is the kind that I am likely to need, and that the mortgage company will require such, or is there a name for the kind of insurance needed after a loss and before rebuilding while property is in limbo during settlement? If it will be required, is there any ‘insurer of last resort’ that would offer such insurance. The property is in Massachusetts.

  144. August 3rd, 2009 at 5:57 pm #admin

    Hello Harry,

    Yes you would need liability insurance only, in case some kid, for example, gets hurt on the property. A good insurer would leave the liability coverage on and take off the fire property coverage. A low quality insurer would leave you in the cold. Talk to an independent agent to see if he can find liability only.

    Also note that most insurers will add “liability only” for a second property location, at no charge, if you have a homeowners policy. But you have to advise your agent that you want that and the property location. Its not automatic.

    For the best information on maximizing your rental or home structure insurance claim, consider one of the eBooks at UClaim.com. They are guaranteed and currently 75% off. You can also view their tables of contents before purchasing.

  145. August 13th, 2009 at 7:26 pm #admin

    Hello all,

    Check out our new discussion forum here at insuranceclaimhelp.org!

  146. August 16th, 2009 at 10:26 am #Danny

    Hi, a few months ago our house in Colorado suffered severe hail damage to the roof and siding. We at the time where filling for a home loan modification, and was told to sign our insurance check for the repairs and send it in along with three bids on the repairs. Since then we have worked out the modifications however never sent the check in. I was concerned because some of the repairs I would be able to do myself however without the funds from that check I could not afford to do so. Once I asked Litton Loans( the Mortgage company) on what funds I would get in return they stated they would keep them until I submitted receipts on the work plus labor. It’s a catch 22 on this so someone told me don’t sign the check, and just contact the insurance company tell them I can’t get the work done because the mortgage company will not release the funds. How do I handle this is there some sort of law I can send in with the check or should I just contact my insurance company and return the check to them? Thanks Danny

  147. August 19th, 2009 at 4:14 pm #admin

    Hello Danny,

    You and the mortgagee have to treat this as 2 separate business transactions. The insurance claim damage and repair should be separate from the remodel and corresponding loan. The mortgagee should have a “loss draft” department that holds your insurance check until the repairs are done. It does not matter if you got the repairs done for half the amount of the insurance payment, the mortgagee has to send you all that money when the job is done. They can send their inspector to verify the repairs were done. You don’t have to supply receipts or a contract for repairs. Go ahead and get this in writing from your lender “before” you sign over the insurance check.

  148. August 23rd, 2009 at 7:48 pm #Kay Mixson Jenkins

    Not sure if this makes sense but this is our timeline for what has happen with Foremost since our house was destroyed by fire.

    ON THE AFTERNOON OF SATURDAY NOVEMBER 10, 2007 KAY AND COLTEN WERE AT HOME WHILE MARTY WAS HUNTING IN SCREVEN COUNTY. KAY HAD SPENT THE DAY WATCHING CARTOONS AND PLAYING WITH THE COLT.

    AROUND TWO THAT AFTERNOON KAY STARTED WORKING ON CHRISTMAS ORNAMENTS IN THE KITCHEN. COLT WAS WATCHING TV IN THE LIVING ROOM. KAY HEARD A NOICE AND LOOK TO SEE WHAT IT WAS, SHE WALKED IN TO THE LIVING ROOM WHERE SHE SAW COLT STILL SITTING ON THE FLOOR WATCHING TV. AS SHE TURNED AROUND SHE SAW WHAT APPEARED TO BE SMOKE.

    ENTERING THE BEDROOM, SHE CONTINUED INTO THE MASTER BATHROOM WHERE SHE SAW THE CLOSET ENGULFED IN FLAMES. SHE DOES NOT RECALL FEELING HIT FROM FIRE.

    KAY TURNED BACK AND RAN TO LIVINGROOM PICKING UP SON SHE STARTED BACK INTO THE KITCHEN WHERE AT THIS TIME IT WAS FULL OF THICK BLACK SMOKE. THE SMOKE ALARMS WENT OFF.

    SHE COVERED COLTEN’S MOUTH AND NOSE WITH HER HAND AND RAN THROUGH SMOKE OUT BACKDOOR.

    RUNNING TO NEAREST NEIGHBORS HOUSE SHE SAT COLT DOWN AND ASK NEIGHBOR TO CALL 911.

    SUNDAY NOVEMBER 11, 2007

    ARRIVING BACK TO HOUSE KAY PLACED CALL TO FOREMOST INSURANCE LETTING THEM KNOW OF FIRE. SHE WAS ASKED IF THE HOME WAS LIVEABLE SHE ANSWERED NO. WAS TOLD ADJUSTER WOULD CONTACT HER WITHIN A FEW DAYS.

    TUESDAY NOV 13, 2007
    MET DEBRA CARRAHAN ADJUSTER FOREMOST INSURANCE AT HOUSE. SHE WALKED THROUGH HOME TAKING NOTES AND ASKING QUESTIONS. MARTY, KAY & MS CARRAHAN WALK TO BACK POARCH WHERE MARTY’S GUNS WERE LAID OUT ON TABLE.(PICTURE 1 & 2). SPOKE BRIEFLY OF HOW HOT FIRE WAS TO HAVE DONE THAT MUCH DAMAMGE TO GUNS.

    WENT TO SIDE ENTRANCE OF HOUSE WHERE MS CARRAHAN EXPLAINED TO MARTY & KAY THAT THEIR HOME WAS A TOTAL LOST. TOLD CLIENTS TO NOT WORRY ABOUT SERIAL OR MODEL NUMBMERS BECAUSE OF THE AMOUNT OF DAMMAGE TO PERSONAL PROPERTY.

    GAVE MARTY & KAY CHECK FOR $3,000 AND SAID SHE WAS GOING ON A FOUR WEEK VACATION.

    RENTED HOUSE FROM JOE RICHARDSON FOR $600.00 A MONTH.

    NOVEMBER 13 – DECEMBER 12 UNABLE TO GET IN CONTACT WITH MS. CARAHHAN OR HAVE ANYONE FROM FOREMOST RETURN CALLS.

    DECEMBER 12, 2007
    RECEIVED CALL FROM CUNNINGHAM INVESTAGATIONS ASKING FOR DIRECTIONS TO HOUSE. STATED HE WOULD BE OUT THE NEXT DAY AND IT WAS NOT NECESSARY FOR US TO BE THERE.

    WENT TO HOUSE THAT AFTERNOON AND SAW THAT SOMEONE HAD BEEN IN HOUSE, CALLED THE INVESTIGATOR TO TELL HIM ABOUT DOG IN HOUSE. HE INFORMED KAY HE HAD MET THE DOG THAT DAY. KAY ASKED HIM WHAT HE FOUND. HE STATED THERE WAS NO SIGNS OF ACCELLERATE IN HOUSE.

    KAY ASKED HIM IS THIS WHY FOREMOST WOULD NOT RETURN OUR CALLS, HE SAID “NO, THEY ARE NOT GOING TO TALK TO YOU BECAUSE YOU HIRED AN ATTORNEY”

    KAY STATED THAT WAS NOT TRUE, MR DOZIER IS OUR BANKRUPTCY ATTORNEY AND WE HAD TO LET HIM KNOW.

    INVESTAGATOR SAID “SOMEBODY TOLD THEM, YOU NEED TO CALL AND GET THIS STRAIGHTEN OUT” I WISH YOU THE BEST OF LUCK MRS. JENKINS

    JANUARY 4, 2008

    DEWITT INSURANCE FAXED 32 PAGES OF RECEIPTS TO MS. CARRAHAN
    TOTAL $ 7,313.00

    JANUARY 22 2008

    CALLED TO GIVE DEPOSITION TO MS CARRANAH AT MR DOZIERS OFFICE.
    KAY ASKED “IS THE INVESTIGATION OVER” WAS TOLD THEY SHOULD HAVE IT TODAY AND WOULD CALL THIS AFTERNOON OR IN THE MORNING”
    (LETTER TO INSURANCE COMM. STATES FOREMOST RECEIVED REPORT JANUARY 23, 2008.)

    KAY ASKED “WHEN ARE WE GOING TO GET OUR ADDITIONAL LIVING EXPENSES” MS. CARRAHAN REPLIED “MY BOSS SAID YOU WOULD NOT RECEIVE ANYTHING UNTIL INVESTIGATION WAS OVER”
    (LETTER TO INSURANCE COMM. STATES FOREMOST RECEIVED REPORT JANUARY 23, 2008.)

    GAVE MS. CARAHANN RECEIPTS FOR ADDITIONAL LIVING EXPENSES.
    NOV – JAN

    DID NOT HEAR FROM MS.CARAHAN UNTIL FEB 2008 SHE NEEDED SERIAL NUMBERS FROM GUNS AND ITEMIZATION OF FOOD LOST.(REFER TO NOVEMBER 13, 2007, ADJUSTER STATED HOME AND ITEMS WERE DESTROYED

    RECEIVED CALL FROM MS CARRAHAN:WAIITNG ON BOSS TO SIGN OFF
    RECEIVED CALL FROM MS CARRAHAN:STATING SHE WOULD FINISH CASE BY WEDNESDAY AND OVERNIGHT CHECKS.

    MARCH 10, 2008

    RECEIVED CALL FROM MS. CARRAHAN STATING WAIITNG FOR BOSS TO SIGN OFF AND WOULD CALL WHEN CHECKS WERE OVERNIGHTED THAT I HAD NOT UNDERSTOOD WHAT SHE SAID IN PREVIUOS CALLS

    MARCH 11, 2008

    FILED COMPLAINT WITH INSURANCE COMM.

    RECEIVED LETTTER FROM INSURANCE COMM.
    MARCH 25, 2008
    FOREMOST CLAIMS CHECK FOR 83,905 ISSUED MARCH 14, 2008
    AND CHECK FOR 4,195.27.

    PERSONAL PROPERTY CHECK DATED MARCH 26, 2008

    ADDITIONAL LIVING EXPENSE CHECK DATED APRIL 3, 2000
    NOVEMBER 2007-FEBRUARY 2008

    LETTER FROM ADJUSTER, APRIL 10, 2008
    STATING FOREMOST WAS STILL WORKING ON CLAIM

    LETTER FROM US BANK STATING NON RENEWAL OF POLICY 02/26/2009

    LETTER FROM DAVID HARRIS, ATTORNEY FOR FOREMOST DATED APRIL 1, 2008 STATING FOREMOST WAS CANCELING INSURANCE. REQUIRED THAT WE DISMIISS ACTION WITH PREJUDICE,SIGN A POLICY HOLDERS RELEASE AND CANCEL POLICY IN SIXTY DAYS. (LETTER FROM US BANK STATING NON RENEWAL OF POLICY 02/26/2009)

    Letter March 14, 2008
    Debra Carrahan

    $83,905

    Additional 2% 2,095.00

    Replacement Insurance is 20% $16,781.00

    Letter Dated March 26, 2008

    Personal Property Total:
    62,585.00
    tax 4380.95
    Total: 66,965.95

    $45,037.12 Policy

    Depreciation 16,781.00

    Is it not strange both amounts are $16,781?
    Is there bad faith involved?

  149. September 3rd, 2009 at 3:11 pm #Mary

    OK. Here’s a question! My husband and I had filed a chapter 13 banckruptcy April 08. By August 08, we had a mtg with the trustee due to unexpected circumstance we were unable to pay the monthly payment. The trustee assured us due to circumstances, we should refile when the circumstances were resolved, and she would approve for us to be re-entered into the chapter 13. Our bankruptcy attorney advised us when doing our personal property inventory to only list major items in the home (ie. living room furniture, bedroom furniture, jewelry, & clothes as a whole) and to list them at a price we would get if we put the items in a yard sale. Before being able to refile the bankruptcy, our house burned and was a total loss. We jumped through all the hoops and got all the paperwork. The insurance company paid nearly 10 months of additional living expenses and even paid the policy limit on the structure but did a stop pay soon after. Now 1 month short of a year they have denied the claim due to misrepresentation on the contents inventory because of the difference with the bankruptcy. I understand the difference but honestly with the bankruptcy, we were only following our attorney’s advice, and to my understanding they don’t require you to list everything down to curtains, food, etc. Is there any case law where this has been overturned in court? We are sueing the insurance company because we feel this is ludacris. But I am not naive to how all this must look but do honest people really suffer because so many try manipulation the system. We had every intention of keeping our home and no fear of loosing it because of the trustee mtg. This was a terrible thing….is there really nothing we can do now?

  150. September 5th, 2009 at 7:17 pm #admin

    Hello Mary,

    If you are saying the insurer is denying the claim saying you misrepresented the inventory because you listed more stuff than was on the inventory for the bankruptcy, then I think the insurer is wrong (and I would gladly give expert testimony to that effect). Make sure you get their denial in writing stating the exact reasons. In addition to suing the insurer, consider one of the eBooks on handling denied claims at UClaim.com. They are on a 50% off sale with money back guarantee.

    You and or your attorney could easily resolve this claim before a trial if you play it right. If the facts are indeed as you say, any insurer would be crazy to let this go to trial. But hey, there are some low quality insurers who will run up your legal costs and play you up to the morning of the first day of trial, just to see if you will go away.

  151. September 14th, 2009 at 8:00 pm #Jacqueline

    Someone ran into the front of our house and broke a gas line.To fix the line we had to call a plumber when he gave us the estimate he said he had to bring it up to code the codes have changed in our area and he said it would not pass city inspection. who is responsible for the repairs the estimate was for 4700.00 the insurance offered 100.00 to replace the piece of pipe? What should I do?

  152. September 16th, 2009 at 12:10 am #admin

    Hello Jacqueline,

    Well first check the endorsements to your policy to see if you have a “code upgrade or improvement endorsement” that covers replacement of “undamaged” parts of your home required by building departments. That would make it easy. You could argue that the insurance company bases its premiums on current construction, which includes bringing structures up to code, but it will be a fight.

    Now one option is to make the claim to the drivers insurance, which would not limit you to “policy exclusions” like your own insurance would.

  153. September 25th, 2009 at 5:25 pm #Larry

    I live in PA. Got cold out and clicked on thermostat for heat ( oil furnace, steam heat regularly serviced) I heard a, I guess i’ll call it a small explosion, in the basement approx. 15 to 20 minutes after turning heat on. Went in basement , felt furnace unusally hot, and noticed no water in water tube. Opened lever to fill and water gushed out from under furnace. Immediately hit cut off electric switch and called a furnace technician. He diagnosed low water cut off malfunction, burner “dry fired” , water tank ruptured ( no water in tank) and deemed furnace NON repairable.Need new furnace. Put in claim to my homeowners insurance State Farm, was denied, told not covered. Explanation was told to me like this ” well you have car insurance right? if the motor goes we don’t replace the motor?” I said we are not talking about a car we are talking about the heating system of my home !! Said i’ll recieve denial letter in mail. Does this sound right to anyone? I thought homeowners insurance, especially in a winter state, that would be a covered item> Is there any law in PA. that would say that the heating system is one of the basic items that would be covered, i’m confused on State Farms denial, considering the heating system is an intregal and necessary part of the home to be able to live in.

  154. September 29th, 2009 at 12:54 am #admin

    Hello Larry,

    If the furnace was damaged by a covered peril like fire, then it would be covered without question. They will probably deny the claim saying the thing broke down due to inherent defect or malfunction.

    Another angle for denial is this, in property insurance, the cause of the loss is never covered. So if a television malfunctions and catches fire and the house burns down, the house is covered, but not the television.

    The UClaim.com eBook on denied home and business claims has a detailed discussion on how to get around this “cause of loss and inherent defect not covered” issue. It’s currently on sale with a money back guarantee.

  155. September 29th, 2009 at 5:42 am #f. michael conte,CPIA

    Larry,

    if it is ok with moderatorr of this board i would like to review your policy, the last time i read a home owners policy the boiler portion was pretty broad, i would be looking for exclusions pertaining to the boiler itself. i agree with the moderators comments however, i am preety sure we have had similar claims paid. You might ask your agent to do some reasearch, to find out how the other carriers he represents would handle such a situation.
    f micheal conte
    ny,ny

  156. September 30th, 2009 at 11:30 pm #admin

    Michael and Larry,

    If you guys use the Discussion Board on this website, you can communicate with each other without displaying your email addresses to everyone. Larry should make a post there, from which you Michael can PM to him. Otherwise Michael you could post your email address on this blog and hope that Larry is following it.

  157. October 1st, 2009 at 4:10 pm #Brandon

    I recently had some issues with water damage in the downstairs of my bi-level home. I have hardwood floors and (rain) water seemed to have come through the door frame (underneath) and went under my floor and rotted a section of it. I had an estimate done and was told initially by the State Farm that if it was storm related, then it will be covered. I submitted my claim to State Farm (pennsylvania) and they are stating this is considered flood damage, since the water sat under the wood floor and rotted it. I do not have flood insurance.
    From what I can tell, our gutters overflowed from heavy rains and splashed down on our deck and made its way to the door frame.
    Anything I can do to get this resolved without having to pay for a new floor myself?

  158. October 3rd, 2009 at 3:16 pm #admin

    Hello Brandon,

    If you read the policy for yourself, under exclusions where it talks about rotted wood not being covered, it does not specify the cause. Most policies just say rot is never covered regardless of the cause. So it does not matter if it was from flood (surface water) or from rain leaking from the roof or window or door.

    Now where most adjusters confuse themselves and the policy holder is in what they deem to be rot. If you can push your finger through the “rotted” wood, then it is rot that occurred over time and therefore not covered. However if the wood is just black or discolored and or delaminated, but it is still too hard to push a butter knife through, then it is not rot, even though it may look gross. And if the water that caused that came from a source above ground or a leaking pipe, then it should be covered.

    It takes a lot of water over a long period of time to rot a hardwood floor, unlike pine framing. Hardwood floors usually buckle before they rot. And buckling is covered damage.

  159. October 6th, 2009 at 10:23 am #Don

    I have a question about a mother-in-law unit and landlord policy. I currently live in a single family home in Seattle, WA with a legal mother-in-law appartment/accessory dwelling unit in my basement. I put the unit into the house in 2001 with full permits with the city of Seattle.

    Now I’ve purchased another home and want to rent out the upstairs part of my old house along with the MIL unit. The issue is that the City of Seattle requires at least one of the units to be owner-occupied for the MIL unit to remain legal. Once we move out and have not lived in the house for 6 months in a given year, the certificate of owner occupancy is invalid and the MIL is an illegal unit.

    My question is about a landlord homeowner’s insurance policy as it relates to an illegal unit. I’m not concerned about the City of Seattle comming to fine me for renting an illegal unit, but the risk of my landlord policy being invalidated because of the illegal unit is not a reasonable risk to assume. Am I at risk of invalidating a landlord policy if I move out and rent both the upstairs unit and the MIL?

  160. October 6th, 2009 at 11:10 am #F MICHAEL CONTE

    don,
    this is a topic that i have preached on for many years, and i am happy that i have not had first hand experiance. i believe that any carrier in their right mind would deny a claim for any situation that was a result of an illegal occupacy. the exclsuion in the contract clearly excludes illegal activity, it also has wording about prior knowledge of a situation…. i would not take such a risk and i have held this opinion for years .the situation that i have seen more often is a legal two that is then turned into an illegal three. in the event of a wrongful death claim i cannot imagine how the carrier could offer a defense for an illegal occupancy, and as a result would be better served simply offering a denial.

    i have waited a long time to answer this question, and i thank you. excellent question!

  161. October 6th, 2009 at 11:11 am #admin

    Don,

    Just so a potential claim is not denied for misrepresentation, fax a note to your agents office advising you are moving to another location, and add that your mother in law is staying in the mil apartment. Or if you get insurance for your new location with the same agent, then he is now aware of the change in risk.

  162. October 9th, 2009 at 8:10 am #Tom

    I have Homeowners Policy H03 with endorsement H04 32. Rain water most likely enters my home where roof meets the side of the house and in a 2nd location where the deck meets the side of the house. Water runs down inside the walls of the house and rots the siding, sheathing, studs, sub-floor, joists, etc. The rot dammage most likely occurred over some time and was hidden until a rotted window was discovered. The highest estimate I have received from a Contractor is $44K. Insurance adjuster and insurance company indicate that this loss is subject to the $10K limit of the H04 32 endorsement which provides “Additional Coverage” for Fungi, Wet or Dry Rot or Bacteria.

    The endorsement adds paragraph 2.e.(9) to Section 1 – Perils Insured against, which basically states that Constant or repeated seepage or leakage of water… over a period of weeks, months or years… and the resulting damage is “covered” if unknown to the insured, i.e. hidden within walls or cielings, etc.

    That would indicate to me that my dwelling is covered for such a Peril under section 1 – Property Coverages. However because the “resulting damage” is indeed Rot, am I limited to the maximum of $10K as indicated in the Additional Coverages, which would appear to be “coverage ” in addition to the “Main Coverages” for the property? If this is the case, how can a home owner insure against the full extent of damage from hidden Rot? Also because of the limit, the adjuster indicates that my loss is $10K when it is actually significantly more and perhaps not eligible to be referred to a three member board of referees. Please help this is really bugging me!

  163. October 9th, 2009 at 2:40 pm #admin

    Tom,

    Insurers have wised up in recent years and found it cheaper to just pay a stated nominal amount on what used to me non covered claims instead of fighting and risking an adverse court judgment and costs of litigation.

    You have to be creative to get coverage with these type claims, and you write like a “creative guy.” Keep us posted, and email a copy of that endorsement to info@insuranceclaimhelp.org and Cc to info@uclaim.com, if you want a more “creative” answer :)

  164. October 13th, 2009 at 1:08 pm #admin

    Tom,

    In the case you sent and quoted from, rot was not excluded in that USAA policy. Most policies do exclude it and or limit it specifically. But in your case, you are right, your endorsement gives you coverage.

    I don’t see much room for creativity after reviewing your info. The only way to get past the dollar amount of the limit would be to show your insurer was negligent in its investigation by delay or other unreasonable handling that would have “added” to your damages. This would be looking for coverage via negligence, which is not covered in the policy, but does give you recourse against your insurer in the courts.

    And as I said in an earlier post on this website, make sure what you have is indeed “rot”. If any part of the wood “looks” like rot, but you can’t push your finger through it, it’s not “rot.” It’s sudden and accidental damage, and you can claim that under the main policy.

    Don’t waste time or money on “policy appraisal” (the referees you referred to) unless you get the insurer to agree to go over the 10k limit. Policy appraisal is not for coverage disputes. It’s for dollar amount of damages. don’t feel cheated, the 10K you got is way better than what most people have been getting for the last 50 years or rotted wood claims.

  165. October 13th, 2009 at 6:51 pm #f. michael conte,CPIA

    here is one for me…. i recieved a denial of coverage for a toilet back up. the adjuster cited exclsuion for back up of sewer and drain. any thoughts.

    f. michael conte

  166. October 15th, 2009 at 10:28 am #admin

    What caused the toilet to back up? Tree roots, stopped up toilet, backup from a septic tank on your property or backup from the city sewer? If from the toilet, call it a “toilet malfunction”, not backup. That’s always a tough one.

  167. October 29th, 2009 at 5:10 pm #Richard

    I live in Northern CA and have Farmers Ins for my structure and interior contents insurance. While away on vacation back east,the supply line on my toilet in the master bath broke and leaked water into the room. This caused major floor and wall damage along with mold issues. Farmers said they won’t cover the damage as it was a leak and not catistrofic failure of the line. The agent then told me that even if they were to pay for the damage, that as I live in CA, there would be a 30% increase of my premium due for the next 3 years because I made a claim. He informed me that this was for all insurance companies in CA as it is a CA law. What is this and when did this go into effect? Not only would I have to pay the deductable, but this incease in premium, all for making a claim.

  168. October 29th, 2009 at 9:30 pm #admin

    Hello Richard,

    Just my opinion, but it sounds like your Farmers agent is more interested in protecting his “loss ratio” than helping you. Ask your agent to cite the California law that he mentions. I have never heard of such a law and would be very interested to know of such a law.

    As to the “leak”, your adjuster is just dead wrong. Your loss was “sudden and accidental”. Now if they want to deny or apply a small policy limit for resulting mold, that’s ok. But cover all the other stuff, like buckled floors, swollen drywall, stained stuff, etc. Consider the UClaim.com eBook on denied homeowner claims to pursue the claim on your own and properly document the claim for possible litigation. If you get nowhere, then start hunting for an attorney to sue them.

    Oh, and FYI, every time I’m away from my home for more than one night, I shut off the water valve to the house, just in case … I’ve seen too many stories like yours.

  169. October 30th, 2009 at 5:49 am #f. michael conte,CPIA

    richard,

    i agree broken pipe is a standard coverage. please review your policy form for perils, i am sure you will find this in the coverage portion. Better yet ask your agent to read the section on coverd perils sounds like this will be his first time reading it……….

  170. November 3rd, 2009 at 8:07 pm #Jennifer

    I live in a manufactured home and my agent had our policy wrote up as frame built. I recently filed a claim and was wondering if this will cause us problems. i asked my agent and he said not to worry about it and he will just make some changes to the policy. I cant hardly sleep at night though. Should I be worried?

  171. November 4th, 2009 at 6:15 pm #admin

    Anyone want to take a stab at Jennifers question?

    Let the agent stick his neck out and see what happens? Just keep your own nose clean. Don’t YOU mislead anyone.

  172. November 4th, 2009 at 8:03 pm #f. michael conte,CPIA

    jennifer,
    you shoulkd be ok depending on who the carrier is and what were the building choices, on the application. i wouldn’.t worry

  173. November 5th, 2009 at 12:11 pm #Richard

    Can Farmers Ins Group charge me a “surcharge” for filing a claim? This is the “law” that the agent refered to when he told me that Farmers would charge me 30% of my premium for 3 years for filing a claim. I was told that it probably would be in my best interest not to claim this damage and “save” the surcharge for a larger claim, if and when that happens. I have found nothing that relates to a fixed or sliding charge for filing of any claims in my paperwork. What can I do? Any thoughts?

  174. November 5th, 2009 at 11:05 pm #admin

    Richard,

    Does this “law” have a statute number? I think it is probably just Farmer’s own policy, not the law, to charge the 30% extra for 3 years. Check with some other insurers to see how their premium compares to Farmers. If the accident was not your fault, you should not be surcharged anyway.

  175. November 6th, 2009 at 2:34 am #admin

    Hey folks, there’s some good people with claim problems needing your input in the Discussion Forum. Please jump in.

  176. November 6th, 2009 at 6:02 am #f. michael conte,CPIA

    richard,
    first lets do the math, what will the claim pay out?
    what will a 30% surcharge do to your premium?
    finally, go to your states ins dept web site and ask them the question, i think the whole comment is balony, as many agents use this type of scare tactics for some strange reason. the state will have a filing on the carriers practices that they should be able to review and explain.

  177. November 6th, 2009 at 11:05 am #Jennifer

    Thanks! The adjuster came out this morning and it didnt appear that it would be a problem that our home had the incorrect rating. I have Allstate. He said that they will pay me a depreciated value and then after the items are repaired and replaced they will cut me a check for the actual cash value. Will I have to show them the costs of the repairs? I plan to try to get it done cheaper than they estimate to help cover my $1000 deductible.

  178. November 10th, 2009 at 1:20 pm #admin

    Jennifer,

    That was the easy part. Now if you want to come out of this with money in your pocket and not get outsmarted by your adjuster, and hate your adjuster for it, and stay within the law, I can’t tell you how to handle all the possible moves to make in a couple paragraphs. It’s like a chess game and the moves change with every new letter and call from your adjuster. If you want to learn how to play the game, get the eBook at UClaim.com Homeowners Loss Deluxe.

    You can also try the Discussion Forum in this website for ongoing help from other visitors.

    If any of you visitors want to give Jennifer some advice here, please join in.

  179. November 12th, 2009 at 11:49 am #Alison

    I have travelers home insurance. My home had a fire. I hired a contractor. The contractor did not evaluate the plumbing in the whole house. The contrator drywalled over problems and installed new flooring. Well now there is leaking and damage. The contractor ask me to open another claim. I do not want to open another new claim. My premium went up $600 annual for the first came. I have only made 2 or 3 payments to the contractor. I have contacted the insurance company and told them I hold the contractor responsible for not checking the plumbing. No sure what to do if I have to open a new claim my deductible is 2500.

  180. November 12th, 2009 at 8:21 pm #admin

    Alison,

    If the contractor was one you chose, your insurer will probably deny your additional claim if the damage was due to his negligence. But it if the damage was part of the original loss and just overlooked, then it should be covered as a supplement to the original fire claim with no more deductible or premium increase.

    The sooner you turn it in the better, before the water causes “rot”, which is not covered.

  181. November 13th, 2009 at 10:48 am #Alison

    The insurance adjuster, who recommended them, stated I needed to open a new claim. I taked to his supervisor who said she would look into this further. This is the original statements from contractor when asked why they did not inspect plumbing prior to drywalling. “We would not normally check the whole house plumbing for a fire this size. We did inspect the plumbing that is in proximity of the fire. It appears the leak from the third floor might have been ready to leak for some time. We are assuming this due to discoloration around the pipe. The leak on the second floor looks like a problem from the original construction.” my home showed no visible signs of leaking prior to the fire. After the fire by house leaked water for days. How two unrelated leaks started at the same time is beyond me, both causing damage to newly installed floors.

    I have not heard from anyone in a week. I asked contractor to update check list questions on the status of the original work to be done including Electric, AC, Sprinkler system etc inspections. They have not answered me. Any suggestions of what I should do at this point? I don’t plan on giving them any more money until I am back in my home with everything completed to my satisfaction.

  182. November 14th, 2009 at 10:27 pm #admin

    Alison,
    IMO, unless you can get another contractor, plumber and or engineer’s opinion contrary to your contractor’s opinion, then you are in a tough spot.

    Anyone else want to chime in on this?

  183. November 17th, 2009 at 8:55 am #Dawson

    Our home sustained some damage due to a water leak. The insurance company quickly settled the claim and sent us a check to cover the repair work. The amount was based on an estimate from the contractor. However, the actual costs turned out to be lower than the estimate. Do I need to notify the insurance company and return the difference?

  184. November 17th, 2009 at 9:26 pm #admin

    Well, even though the policy says the insurer owes the lowest amount actually spent, I have never heard of an adjuster checking back to see what you actually spent, unless you were claiming held back depreciation. There is nothing in the policy that says you have to return any unused money. But if it makes you feel good, go ahead and return it.

  185. November 20th, 2009 at 1:05 am #WS

    Hi:

    We just suffered some water damange from malfunctioning washing machine. Basically, the insurance company is covering everything for the replacement value. But, I am finding out that when they do the estimates for the flooring replacement, they discount by 15% because their vendor can do it for 15% below the estimating software. In addition, they will not pay out 20% of the estimate for the overhead and profit (O&P) for the general contractor if I don’t do the work or if I manage the work myself. They are really pressuring me to use their vendor; but I don’t trust the insurance campany to do a quality job or identify

    Can you please tell me if the insurance company can basically knock off 35% if I manage the work myself? This doesn’t seem right to me. I read some postings that say that insurance comapnies cannot withold O&P. But, I didn’t see any postings from California. Do you know if the insurance companies can do that in California? I really don’t like them holding back 15% of the flooring cost either…. Thank you. I would appreciate the help.

  186. November 20th, 2009 at 1:50 pm #admin

    WS,

    In California, it is not against the law for insurers to withhold P&O from “owner builders.” However, the only major culprit, Farmers Insurance, ceased the practice in California in the late 1990s after settling
    a class action lawsuit out of court over this issue. Farmers feared they would lose and that the result would create a new legal and binding precedent for use in California and other states. There is statutory law in other states prohibiting the withholding of P&O, but not California.

    Its tricky and you can screw yourself if you don’t handle it right. For a detailed discussion on how to get your P&O in California without suing your insurer, consider the eBook at UClaim.com entitled Homeowners Loss Deluxe, on sale with a money back guarantee.

  187. December 7th, 2009 at 12:42 pm #Rachael Stuart

    Hello,

    I live very near (300 yards) from the “Station Fires” in Southern California. Although my house was not evacuated and we weren’t in immediate danger, there was tons of smoke ash.

    I was approched by a lawyer type who wants to “help” us make a claim to our insurance company for the smoke and ash. He says we should get a large sum of up to 10,000 for clean up, basically, and he will take 25%, but wont take any money unless we are granted a settlement. He also calims our rates will not go up, due to the damage source being a natural catastophey.

    Is this a scam? Also, is it true the insurance co. won’t raise our rates?

    Thank you for your help.

    Rachael Stuart

  188. December 9th, 2009 at 12:12 am #TRB

    I live a a 4 home townhouse complex covered by Allstate Commercial Policy for HOA and State Farm Insurance for personal property.

    In Nov 2007, our shared wall neighbor’s hot water outline broke in the 3rd floor attic. Water ran for up to 3 days down through the second and 1st floor of our home, as both parties were out of town and the leak was not noticed until then. A claim was filed and the loss was covered by Allstate and depreciated and personal property covered by second carrier, State Farm, including additional living expenses and replacement cost of many items. Work was complete that remodeled our entire kitchen, and living area as well as carpet on both floors and wall repairs in Feb 2008 and the claim closed in June 2008. We were out of the property for 3 months while being repaired. Repair and living costs = almost $50, 000.

    Recently (September 2009) our foundation cracked and settled in the kitchen. Allstate was notified and they hired an engineer. The engineer determined that he could not rule out the cause of the foundation crack being from the expansive soil under the slab being suddenly saturated at the time of the original leak and it taking up to 2 years to dry out, causing settlement and cracking. Allstate had no choice but to cover this loss under the original claim. The problem now lies with State Farm. Allstate states they will only cover to replace items original to t he building. We had travertine tile floor which replaced our previously tiled floor. Both companies bore the cost when the tile was replaced two years ago (Allstate for original to building and SF for actual replacement value). To repair the crack about 70 % of the tile must be removed. Allstate says they will only pay up to what is original to the building, and SF is saying they do not cover settlement damage regardless of the cause. So i am stuck with Allstate paying about 20% of what it would cost to replace the floor and SF saying it past 1 year to reopen the claim and they don not cover damage from settlement for any reason. This same response was given to other items that will need to be removed and replaced in kitchen. Basically, at this point I will end up with a settlement that wont even replace what they covered the first time around for a legitimate claim and a covered loss. Is this legal for both companies to do? Not pay for what they already covered if new damage is found based on the original leak. I doubt the engineering firm will get hired by Allstate again, since they basically forced them to cover the loss, but now they are throwing the cheap talk around…..

  189. December 9th, 2009 at 1:03 pm #Maureen K

    Just was denied a claim for water damage that has been hidden behind a wall for at least a year (studs actually rotted out)
    They claim the damage is considered “long term damage” and they don’t cover that. I can understand that, but if no one could SEE the water damage – hidden behind a wall, until one day when the hardwood floors near the wall start to show damage, how is anyone supposed to know to fix it?
    Storm damage and loose flashing let the majority of the water in and once the moisture barrier was compromised, water started coming in behind the dry stack stone outside.
    It just seems unfair to punish a homeowner for something they can not see. Any thoughts? I really want to fight this!!!

  190. December 10th, 2009 at 1:49 am #admin

    Rachael,

    1. You will have to ask your agent if your rates will go up or not. Not all companies are the same in this regard. I can tell you that many insurers raise rates and cancel policies after homeowner claims regardless of whether the damage was due to your fault or not.

    2. If the “lawyer type” you refer to is not a licensed lawyer or a licensed public adjuster, then they can’t legally represent you. And you can check for complaints on public adjusters at the DOI. I’m not sure where you go to check for complaints on attorneys, possibly the California BAR?

    3. And I would be real suspicious if your “lawyer type” was a really a lawyer. Most lawyers are not interested in such low dollar amounts.

  191. December 10th, 2009 at 2:21 am #admin

    TRB,

    The volunteers at this website are more likely to answer short questions if you want to condense it, but I’m posting your question anyway.

    Does anyone want to take a crack at TRB’s post?

  192. December 10th, 2009 at 2:32 am #admin

    Maureen,

    With most policies and insurers, you cannot fight this since this exclusion, although seemingly unfair, is clearly worded in the policy.

    However in recent years, some insurers have added wording in their policies that extend coverage if the damage was hidden from view. So read your policy to see if there is “an exception to the rot exclusion.”

  193. December 10th, 2009 at 11:21 pm #TRB

    TRB Condensed Version

    I live a a 4 home townhouse complex covered by Allstate Commercial Policy for HOA and State Farm Insurance for personal property.

    Questions

    1) What is the Statute of Limitation in California to open a previously covered claim when new damage is found. Original loss date Nov 2007, new damage found Dec 2009?

    2) New damage is foundation cracking. Allstate (primary) sent out engineer who could not rule out original leak did not cause soil saturation, hence settlement of foundation. They are covering loss under original claim, State Farm says the 1 year lawsuit period has passed and they wont cover it even if I file a new claim. Do they have an obligation to cover what they already paid for since new damage is from original cause? A second independent engineer determined the same as first, SF still wont budge.

    3) Allstate had an adjuster come and estimate what it would take to repair damage in Sept 2009. They withheld this estimate, even after asking in writing 3 times for a copy of it, until after a contractor estimate was submitted by myself. The contractor estimate did not cover to repair everything and was 1/3 of their adjuster estimate. Aren’t I entitled to the entire cost for repairs that their adjustor’s estimated at minimum. Even if I don’t do all the repairs at once?

  194. December 11th, 2009 at 6:32 pm #admin

    TRB,

    1. IMO, statute to sue is 3 years on property damage and 4 for breach of contract. I would say the statute runs from the time the claim is denied or paid. This is why most insurers will let you reopen a claim even though the policy may say 12 months from loss date.

    2. If that’s how Allstate wants to play, get a lawyer and and let Allstate have a bad faith lawsuit :)

    3. Well, you got outsmarted on this part, and legally, by Allstate. Now you have an uphill battle. If you want some detailed advice on how to proceed on this part, consider the eBook at UClaim.com “Homeowners Loss Deluxe”. (And a lawyer won’t be able to help you on this part).

  195. December 11th, 2009 at 9:55 pm #TRB

    3. How could it be legal, if even after being asked in writing 3 times over a 1 month period Allstate failed to provide the estimate that they prepared, and stated to me in writing they needed a written estimate from me before they would evaluate and pay on the claim? They ignored the request and never responded to it in writing or verbally. Basically they withheld information being used to evaluate the value of the claim and required an estimate from me to even evaluate and pay the claim. This seems like a double standard.

    As an update though, the claim representative left out the word “exterior” in her coverage letter and originally only stated “will return the interior and foundation to its pre-loss condition” The exterior was supposed to be included and it too here 3 weeks to rewrite the letter, and after my submittal of course. A revised letter was sent to me literally 2 hours after I submitted the contractor estimate. In her response email to the contractor estimate she included their estimate at 3 times as much.

    How is all that legal? I will check out the UClaim material. GREAT site by the way, best I have seen in my searches!

  196. December 11th, 2009 at 9:58 pm #TRB

    Last question

    3. Can’t I get another estimate legitimately, and submit it? To be honest, for all I know the contractor could be incompetent, his estimate was very vague. There estimate made me question the contractor and his estimate in all actuality….

  197. December 13th, 2009 at 11:29 am #Bill Green

    This would be a great website if not for the fact that you want to sell a book for everything. Your greed takes all the personality from your website.

    PS, Please don’t respond with another smart ass answer, and don’t tell me i need a book to read.

  198. December 16th, 2009 at 9:28 am #Julie

    Can you tell me what “applicable depreciation” is? What does it mean?

    I have a Full replacement/repair cost of 18940.00, Applicable depreciation is 5257.00, minus our 1,000 decutible gives us 12,682. Do we have the ability to claim that 5257.00? How do we go about doing so?

    Sorry if this has already been covered here somewhere – this site is very helpful.

    Thanks!

    Julie

  199. December 16th, 2009 at 7:07 pm #admin

    Mr. Green,

    Don’t dish it out if you can’t take it.

    1. It’s the folks who buy those eBooks that put the bread on our table, so we can take the time to answer questions for the ungrateful freeloaders like you. “Personality” (your words) doesn’t pay the bills.

    2. I recommend the UClaim eBooks because there is nothing out there even close in the quality and depth of information. I can say that after having purchased everything I could lay my hands on over the years. You and any visitor to this website are welcome to recommend and comment on other insurance claim eBooks and resources.

    3. And if you are an insurance claim expert … and … philanthropist, who is willing to give freely of his time to those in need, PLEEEEZE help me out here and add your comments to any of these Q and A’s.

    And even if you are not an expert and just want to voice your opinions and experience, please help get the forum going. We created the “Discussion Board” especially for people like you.

    4. And what about the “Rate Your Adjuster!” page? With all the problems you have had with your adjuster and insurer, why not alert your fellow consumer to those bad boys? If you fear your insurer, you don’t even have to use your real name. C’mon Bill, give us a bit of your time, for free, and don’t be, in your words, “greedy“.

  200. December 16th, 2009 at 7:16 pm #admin

    Julie,

    Depreciation was taken on your structure repair or on your contents. Either way, if you have RCV coverage, you get reimbursed that amount “after” replacement or repairs are made. If you want to be sure you don’t get outsmarted by the adjuster during the process and end up with nothing or far less than the depreciated amount, the topic is covered in detail in the UClaim.com eBook Homeowners Loss Standard.

  201. December 16th, 2009 at 7:26 pm #admin

    TRB,

    Anyone want to chime in on TRB’s situation? How about you Mr. Green?

  202. December 21st, 2009 at 11:39 pm #TRB

    Mr. Green

    I have to side with admin. The honest truth…I went to purchase the eBooks at UClaim. I did not complete my transaction with Paypal one day and the following day I received a very nicely worded email requesting any information of why I didn’t purchase the product (such as Paypal issue, or processing problem etc). The email was from Ron who assisted me with selecting the appropriate ebooks and they are tremendously useful and full of very good information.

    Ron and I communicated via email about 15 times and he was very helpful with many questions as well. Given the fact that at first I thought I was getting scammed or something, I truly believe Ron is out there trying to help consumers such as myself…and he is very honest and willing to help where he can…..and I an not in any way affiliated with this web site or Ron, I stumbled upon here accidently one day a few weeks ago and there is the story

    email from Ron

    Troy,

    You are welcome. People like you make my efforts worth while.

    And yes, please let me know how your claim ends up. And once you find that the cost of your purchase has paid for itself many times over, please leave some feedback at the Feedback link on the UClaim homepage.

    Best Regards,
    Ron

  203. January 4th, 2010 at 11:27 am #Alan Buckner

    I found your very helpful website and have a question. I had a leaky pipe in my slab and Allstate says my policy does not cover it. The plumber and a water damage contractor think that maybe it would not cover fixing the root cause, but should cover the water damage regardless of where the leak came from. Also, they mentioned that the slab leak exception was originally meant to exclude sewage issues yet mine was fresh water (hot). Do I have any grounds whatsoever to get Allstate to pay for anything? Thanks for the advice.

  204. January 4th, 2010 at 4:32 pm #admin

    Alan,
    The slab leak exclusion applies to fresh and waste water, any water that causes long term damage like rot and mold. Sudden and accidental damages are covered. Delaminated and black plywood subflooring can be “sudden and accidental” if you can’t push a butter knife through it.

    As to cause of loss, If you say the cause was the 50 cent piece of copper pipe, then the insurer should cover the plumbers 50 dollar or 500 dollar bill to get access to that 50 cent pipe. This is the kind of info you will get in the UClaim.com eBooks. Good luck.

  205. January 5th, 2010 at 6:17 am #f. michael conte,CPIA

    sorry to sound like a broken record, you need to review the exclusions section. If there is no specific exclusion, then look for the perils section to see any broken pipe limitations. You might also as your agent to do this research for you. If it is exluded then typically damage as a result will be excluded as well. Sometimes the exclusion will exclude the repair cost of the pipe but cover the coss of opening and closing.
    Good Luck
    FMC

  206. January 11th, 2010 at 4:31 pm #Alan Buckner

    Admin and Michael,

    Thanks for your responses. I finally received my official copy of my insurance policy (Allstate Texas Lloyd’s HO-A Plus Homeowners) and it is very clear that it excludes water damage due to leaks at or below the slab. I thought I may find a loophole some where, but the lawyers did a good job of being very comprehensive and clear. Thanks again for trying to help!

    Alan

  207. January 12th, 2010 at 2:15 am #admin

    Alan,
    Its unusual for a policy not to cover a sudden and accidental water “supply line” leak anywhere in the house, including under the slab, in most states.

    I just looked at a Texas Safeco HO3 policy and it has the same exclusions for plumbing leaks under the slab as your Allstate policy. But the ISO generic HO3 does not exclude it.

    I wonder if any insurers in Texas cover pipe breaks in the slab?

  208. January 12th, 2010 at 3:27 am #admin

    Attention please you Visitors who monitor this website via RSS feeds or other methods. Due to the increasing number of visitors with questions, your help is greatly needed. Questions will be posted, but Admin response may now be either delayed, or not given at all. Your involvement in the Discussion Forum page of this website is also necessary to its success or failure. Thank you.

  209. January 12th, 2010 at 9:32 am #Alan Buckner

    In an initial discussion with my Allstate agent, she mentioned that they had other policies that included this coverage. I’ll be checking on this and will report back.

    I heard that Texas was hit hard with mold claims before these policies were rewritten so maybe that’s why Texas companies are being more conservative in their coverage than other states. Just a guess.

  210. January 15th, 2010 at 3:12 am #mandy

    my daughter sat on the sofa and busted it can u claim of the house insurance

  211. January 15th, 2010 at 9:48 pm #Tina

    My rental property was vandalized and I have some questions because I have not been able to get the adjuster to return any of my calls, after he sent the initial check dated Oct. 6 2009:

    1. Can the insurance company make me return any unused amount from the initial check?

    2. Is the loss of rent paid separately or is that calculated as part of or deducted from the holdback amount? The adjuster estimated only 2 months as loss of rent, due to delays by the bank in their piecemeal disbursement, the construction completed on 1/13/2010. Can I request payment for loss of rent for the remainng months the property was under construction, as the contractor already let them know it would take much longer than the adjuster had estimated?

    3. The remediation took 3 weeks for cost of $6,000 directly paid by insurance company. Is this amount deducted from the holdback?

    4. The adjuster asked us to turn on utilities for the reconstruction and submit bills for separate payment. We called Metlife tonight and were shocked to learn that the case had been closed two days after the check was sent. We never received any letter advising that the case had been closed. Is this normal procedure for insurance companies?

    5. The adjuster did not pay for the fridge and garage door opener which were also vandalized. I have replaced these out of pocket after notifiying adjuster. How can I get reinbursement? Can I add the receipts of these items to what have to send to the adjuster?

    6. Can we be our own contractors because the man we hired wanted to be just a handyman to avoid tax issues? What are the implications and what do we submit to the insurance company?

    I would appreciate getting your number for more detailed explanation, if required. Thank you for your time

  212. January 21st, 2010 at 6:32 pm #joe

    We had a total loss house fire last year. Like many of the above post, our adjuster was great and compassionate at first, but now, is being a pain. I have many questions but will start with one. For our contents, there are several items such as clothing, that we had multiple of. We are not receiving any of the depreciated funds until the total given is reached. Example: we have 20 pairs of jeans. They valued them at $20 each for a total of $400. The depreciation was 50%. They gave us $200. We may not replace the 20 pairs. The way I look at it, they should break each individual pair and give us 50% of each pair of pants. They are saying if we only buy 10 pairs, we have just reached what they gave us so will not give us anymore. I look at it as if they should give us an additional $100. What is right? One other quick question: It has been suggested by some people for us to purchase items we dont intend to keep, turn in the receipts to get the depreciation amount and return the items. Is this ok to do.

  213. January 27th, 2010 at 3:12 pm #Chrissie

    Hired a PA to handle water damage in NYS. Received check for contents and rebuilding. The check for rebuilding also has mortgage company on it. Husband is a contractor. Mortgage company stated if we “self contract” we need to provide receipts. If we put our company as contractor receipts are not needed. Please advise if this is correct.

  214. January 27th, 2010 at 6:39 pm #admin

    Chrissie,
    It’s a very delicate line you walk when you do that because you don’t want the insurer to with-hold the “RCV holdback” because you did it yourself, even if you are a contractor. A good PA should be able to guide you through this. For $79.00 you can get the guaranteed eBook at UClaim.com “Homeowners loss Deluxe” that will guide you through the process and make sure your PA doesn’t screw it up. I’m sure you have a lot of money at risk.

  215. January 27th, 2010 at 9:25 pm #TINA

    Still patiently waiting for your response to my post of 001/15/10 @9.48pm.
    Thanks for your anticipated response.

  216. January 29th, 2010 at 4:41 am #admin

    Tina,

    No disrespect, and its like beating a dead horse in this website :) , but like most forums, you are asking for way too much information for Admins and other visitors to give you in one or two sentences. You can get very detailed discussions for your needs in one of the UClaim.com eBooks. You can’t beat the guarantees there.

  217. January 29th, 2010 at 6:05 am #f. michael conte,CPIA

    Ditto!!!!!!

    fmc

  218. February 11th, 2010 at 8:05 pm #Kelly

    Hi, my home was vandalized about 2 years ago. The only thing taken was some jewelry, and two doors/frames were damaged beyond repair. I called the police immediately, have a case #, and called my insurer (Travelers) right away. The person at the insurer wanted super-detailed information on what was taken, which it took me quite a while to figure out because the jewelry belonged to my daughters who were away at college at the time. She sent me a large stack of forms, and wanted photos of the items (which I did not have) and receipts (which I did not have, most of it was gifts from out of town family). I told her it was going to take me a long time to try to assemble as much info as I could. In 30 days, she sent me a letter saying my file was being closed since they didn’t have the forms back. I called and told her it was going to take me several months (till my daughters came home at least) to figure this out, she said that was fine, they would re-open the file automatically when I sent it in. Well, none of it was urgent, we were busy, and I know it’s my fault that time got away from me, but I figured I would eventually get it figured out. When I finally sent all the paperwork in, yes I know, 2 years later, they didn’t respond, and when I called they said the claim and been closed, too much time had elapsed, and therefore they had no obligation to pay anything toward the claim. They also said they never received the package I mailed, which I don’t believe. The total claim is about $5,000. Does this sound right? Do I have no recourse even though I called them within the first few days? I still have the same insurance by the way. Thanks for your advice!

  219. February 12th, 2010 at 9:27 am #Harry E

    At what point can insurance company ‘mistakes’ be used as proof of intentional or negligent Unfair Claim practice. For example, the company tried to pay Living Expenses at approximately 50% of actual expenses {the problems included (1) their crediting themselves with having made a ‘lost’ payment that they neither a. they described to me, b. had me sign the standared proof of loss for, c. had any evidence of having sent etc; (2) delaying payment by making the check out to the wrong recipient; (3) withholding approximately 2-3 times the actual dollar amounts for ‘now unnecessary utility costs’; (4) simply leaving out groups of invoices covering long hotel stays for which invoices were properly submitted; (5) not acknowledging receipt of invoices and waiting as long as 5 months to pay the parts of the invoices that they proposed paying. etc} In addition, strategies like agreeing to accept one type of follow-on policy, then charging the Escrow account for an unnecessarily more expensive policy — the unnecessary additional expense amounting to hundreds of dollars — and then making a refund very difficult to obtain. I think that a company would refuse to process a claim on the grounds of ‘fraud’ if a policy holder would try this kind of thing. Again, would the above mistakes and reluctance and slowness to prevent or correct them amount to Unfair Claim practices at some point?

  220. February 15th, 2010 at 7:23 am #F MICHAEL CONTE

    i always sugest that the person asking the question advise the name of the carrier. i do this for two reasons the first, it is easier to i dentify a pattern of poor claim practices when cites like these are available, hey you never know someone out ther may be getting the same treatment and now you can prove that this is no accident. Second i sell insuance all day long, and i know that as the consumers become more savy they conduct searches to determine how others are treated at claim time. Insurance carriers spend a lot of money to make you believe that they are concerned. an experiance such as yours speaks volumes, would you reccomend this carrier to someone else?

    i would suggest that you identify the regional vp for claims for whatever company you are dealing with and bring this to his/her attention. also mention that you will be alerting the media, i am sure there is some consumer oriented reporter that will grab this one. i would also suggest alerting you states insurance department and make the allegation of unfair claims practice, they will at least have to investige the complant.

    fmc

  221. February 15th, 2010 at 1:41 pm #Jeannine

    I think I have a slab leak in my garage. I live in So. Cal and have Farmers ins. I have been told, call your ins co., don’t call your ins co., get a plumber to look at it, don’t get a plumber to look at it, get a techinician that can listen for the leak…etc.

    I have had no previous claims on this homeowner’s ins policy. There is no water coming up but there are cracks in the garage floor which have always been there but now there is white powdery substance that has appeared on each side of the cracks and dark areas along side that a friend said was moisture.

    I don’t know if I should call ins co or not or start with a plumber, general contractor or ? I am most grateful for any advice you can give me. Thank you. Jeannine

  222. February 16th, 2010 at 11:29 am #Jon Dean

    I was recently married and went overseas for my honeymoon. While away my home was broken into and burned (apparently to hide the evidence according to the police). My new bride NEVER took residence in my home as we were planing on moving her in after we came back form our honeymoon. It has been going on 7 months now and Farmers has not settled. They requested and EUO from me which I complied, then came back requesting one from my wife. My question is if my wife never established residency, is listed no where on my policy or claim, can they request her testimony and can they deny the claim if she refuses?

  223. February 16th, 2010 at 7:33 pm #Destiny

    i was wondering if frozen pipss and water damamge covered bt insurance , my house was on the market with an agent who never weatherized the house and i moved out of state , came back to the home and the pipes were all broke, ceilings was down and mold everwhere

  224. February 17th, 2010 at 12:28 am #admin

    Jeannine,

    Call your agent and ask him/her what the current consequences are with Farmers for turning in a claim. When I worked for Farmers in the early 1980′s, your first homeowner’s claim did not change anything. Your 2nd claim got you an increased deductible, and your 3rd claim got you a policy “non renewal” (cancellation). Its probably tougher now.

  225. February 17th, 2010 at 12:41 am #admin

    Jon,
    Your policy probably says they can do an EUO as often as “Reasonably” Required.” Therefore this also means it must be relevant. You and your attorney should consider the eBook at UClaim.com about EUO’s. It comes with money back guarantee and information guarantee and with consultation.

  226. February 17th, 2010 at 12:52 am #admin

    Destiny,
    Most policies say water from freeze damaged pipes is not covered unless you had the heat on or had previously shut off the water and drained the water from the pipes. Kind of a waste of words, IMO.

  227. February 17th, 2010 at 7:12 am #Harry E

    F MICHAEL CONTE: Your February 15 advice (to name Insurance company) seems good. My claim and situation is identifiable, and the company unethical-seeming and vindictive, enough that I will get my attorney’s ok before naming carrier, but as soon as enough of the submissions to state, insurance company appeal attorneys, etc are made, I should then. at the latest, decide that it’s prudent to name names. In the meantime, I’ll work with my attorney to follow your other excellent suggestions.
    A detail that wasn’t crucial to the already long original post but which seems shocking to me: I am paying a Public Adjuster to ‘help’; he either hasn’t noticed or has tried to justify much of the insurance company misdeeds.

    FMC and Admin: Probably it’s hard for question submitters to properly appreciate the great amount of time and effort you are contributing to answering posts on http://www.insuranceclaimhelp.org. Thanks for a *very* valuable service to folks often puzzled by such new problems and / or being jerked around by what seems to be a group which should be (actually or almost) subject to RICO accusations.

    Original Post:
    February 12
    At what point can insurance company ‘mistakes’ be used as proof of intentional or negligent Unfair Claim practice. For example, the company tried to pay Living Expenses at approximately 50% of actual expenses {the problems included (1) their crediting themselves with having made a ‘lost’ payment that they neither a. described to me, b. had me sign the standard proof of loss for, c. had any evidence of having sent etc; (2) delaying payment by making the check out to the wrong recipient; (3) withholding approximately 2-3 times the actual dollar amounts for ‘now unnecessary utility costs’; (4) simply leaving out groups of invoices covering long hotel stays for which invoices were properly submitted; (5) not acknowledging receipt of invoices and waiting as long as 5 months to pay the parts of the invoices that they proposed paying. etc} In addition, strategies like agreeing to accept one type of follow-on policy, then charging the Escrow account for an unnecessarily more expensive policy — the unnecessary additional expense amounting to hundreds of dollars — and then making a refund very difficult to obtain. I think that a company would refuse to process a claim on the grounds of ‘fraud’ if a policy holder would try this kind of thing. Again, would the above mistakes and reluctance and slowness to prevent or correct them amount to Unfair Claim practices at some point?

  228. February 18th, 2010 at 7:40 pm #F MICHAEL CONTE

    thanks for the good words. please let us know the out come.

  229. February 20th, 2010 at 7:44 pm #John

    Can someone help me here?
    My home was broken into back in october. I did everything that was asked of me, and at the end of january, I was told that the SIU had closed its investigation, and that the case was free to settle. I recieved a check for my renters policy, and I was told that I was entitled to more money when I replaced some of the items that were stolen. I also had a personal articles policy, but I haven’t submitted the proof of loss yet, so it has not been settled. Well I faxed over some reciepts the other day, and then the next day I recieved a call from SIU saying they reoppened their investigation and that they would not pay anymore money on the claim. They want me to come in for an EUO. What happens if I say no? I probably spent 30 hours on this claim, and honestly, I don’t care about the few thousand that is unsettled. I am sick of these people. Can they ask for the money they already payed me back if I dont’ accept the EUO? I’ve spent it already, which puts me in a really bad spot if they can…..but I am so sick of dealing with this I just want to tell them to get lost. Also, I was told I would be reimbursed for things, so I purchased them, and now they are saying they wont pay on those items- is that allowed?

  230. February 21st, 2010 at 11:53 am #F MICHAEL CONTE

    First of all please tell us who is the carrier that is doing this to you?
    Second this is the old rock and a hard place. i am not sure but i do not believe they can ask you to sit for an euo at this time, as a proof of loss was presented and accepted. What is the issue they think that they should not have offered a selttlement. as far as i am concerned this is just an attempt to bully you into not persuing the personal article portion of the calim. if this is a legite claim then as a matter of conscience you must proceed. you might want to consult an attorney, in any event put your state insurance department on notice of this activity.

  231. February 21st, 2010 at 10:50 pm #TRB

    Alan

    I also had a sudden and unexpected water leak in a water line on second floor and almost two years later had slab damage that a hired Allstate engineer determined could have been caused by the water leak that occurred over 3 days, seeping through the concrete slab and finally drying out causing the expansive soil to shrink and crack the slab. Allstate covered the claim and repairs to the foundation slab and resulting cracking etc within the property. But State Farm ,a secondary insurer as Allstate is an HOA policy, will not cover anything period, they state their policy excludes damage to foundation slabs regardless of where the water comes from, internal, external, above ground, below ground, whether sudden or over a period of time, and then they deny your claim and tell you to stick it where the sun don’t shine!

  232. February 21st, 2010 at 11:03 pm #TRB

    Admin

    An update to a few posts I had several months back regarding the above mentioned water leak. State Farm denied my original request to re-open a Nov 2007 claim that they originally covered saying it was time bared by the 12 month policy verbiage that an insured has 1 year from close of claim to file suite. I was then told by my agent after his discussions with the claim representative’s manager that I should open a new claim for the newly discovered damage (foundation crack). I did so, and they denied this claim stating that is was time bared as it related back to the original leak and was past the 1 year period to submit new damage claims. They still denied coverage even after discussion regarding the LMI v Allstate Case. Question, if State Farm was required and did provide a Scope of Loss and an estimate for damages in the original claim and this damage was not noted or discovered by them is it time for me to sue them for breach? 3 separate engineers, Allstate, State Farm and personal have stated that water saturation from the original water leak or wood creep are the cause of the second floor sheathing sagging and other damage. SF said they also don’t cover floor sagging, even if caused by water damage (sudden or unexpected or not) if it causes floor “sagging”. They also said in writing the 3 year statute rule in CA does not apply as the 1 year suite language is in the policy. DOI said they could not assist as it did not have the legal authority over this portion of the law.

  233. February 22nd, 2010 at 12:56 am #admin

    TRB,

    Well, IMO, if they were dumb enough to put that 3 year statute denial in writing, you should be able to find even a junior attorney to take your case. But keep in mind, litigation is a huge ordeal and should be pursued only as a last resort.

    First, try faxing a letter to the State Farm CEO, Ed Rust, asking if State Farm always stands by their policy 1 year statute rule in California (He would be crazy to say yes). Unlike some other insurers, State Farm’s home office is usually good about correcting its claim department renegades at the bottom when they smell a possible class action.

    In fact, now that I think of it, I believe that most SF homeowner policies state on the last one or two pages of their policy that their policy is over ridden by state laws. So show that to those local wing nuts you are dealing with. See page 22 of State Farm Homeowners FP-7955 CA 6-96 for the section “Conformity to State Law” in Conditions applying to section 1 and 2 of the policy.

  234. February 22nd, 2010 at 9:54 am #TRB

    Admin

    From Denial Letter: “the damages you are currently claiming are related to t he November 12, 2007 loss, you claim is time-barred by th eone year contractual limitation period in your condominium Unitowners’ Policy. We have considered all the legal authority (LMI vs Allstate) in the Janaury 4, 2010 letter and other legal authority.”

    We disagree with the assertion that State Farm has waived or is otherwise estopped to assert the one-year suit provision as a defense. We specifically informed you of the one-year suit provision and State Farm’s intent to reserve all of its rights under the policy.”

  235. February 24th, 2010 at 12:19 am #admin

    TRB,

    I still stand by my previous comments. The excerpt you quoted is “stonewalling”, repetition without facts, and it sounds like it was written by some over zealous and ignorant claims people.

  236. February 26th, 2010 at 12:18 am #Sam

    Hi,

    Thanks for this site!

    I recently had wind blow a branch into a chimney on my roof. The chimney crashed down onto the roof and dislodged numerous shingles, which then blew off the roof, exposing the plywood underneath in multiple places in one general area of my roof. Water came in (we got 5 inches of rain that day) and did extensive damage to the interior.

    Travelers is the carrier.

    The problem is this: The shingles on the roof are very unique in design (tiger stripes), the manufacturer has long been out of business, and five professional roofing companies have tried to find shingles that come close to matching mine, with no success.

    They all say that, due to that, as well as the complex architectural design of my roof (numerous hips, valleys, cupulas, dormers, etc), they would not be able to repair the damage such that it would not stand out like a sore thumb and make the house look like a jigsaw puzzle. All five put this in writing and I forwarded it to the adjuster.

    Travelers is balking on a reroof but, according to these 5 professional roofing companies, it is going to be impossible to repair only the damaged areas and the areas that surround the damaged areas because one area leads to another and, no matter where you stand all around the house, you will see both the existing and the new contrasting shingles.

    The adjuster mentioned “line of sight”, but he seemed to think it only applied to the view from the front of the house, which is where the damage is. However, as I mentioned, that area can’t be repaired without impacting other areas, which then impact other areas, and so on.

    At one point, he said, “Well, what if we do the whole roof except for the back slope?” My reaction was to tell him I’d get back to him. It seems as though they are leaning toward replacing the roof, but are just trying to get a concession from me…?

    In California, is there a “line of sight” rule and, if so, how should it read, or be applied, and is Traveler’s bound to abide by it?

    Again, thanks for being here!

  237. February 26th, 2010 at 2:11 pm #diana

    I had move out of my house about 2 months, repainted and rent out. had a tenant ready to move in Jan. 2010. in Dec. 23 , freeze pipe was broken and water damage everywhere. insurance ajuster came out saw the heat switch was turn off, and immediatly said that because the heat wasn’t on so they will deny the coverage. The house was vacant and heat is the only that used gas , and gas bill still charge me during those months. I had forward my gas bill and the adjuster said the gas bill was too low so that meant heat was not maintained in home. what is your sugestion in this case.

  238. February 28th, 2010 at 3:41 pm #admin

    Diana,

    Get an exert from the gas company to write that it was enough gas to heat the house. And get an expert to see if the valve was faulty or in the closed position leaked enough to heat the house.

    And this occurred to me after my first post, perhaps the adjuster closed the valve then took the photo of the closed valve?

  239. March 1st, 2010 at 1:08 pm #Shelly

    My mothers house burned down a week ago. Allstate has not been exactly helpful. Her policy states that she has Mobilehome remplacement cost end form U10127. What is that? I called the agent and asked for a policy book and he stated that they did not have those in the office. I work in the insurance business I know that is not true. How can I get a copy of what all these endorsements mean?

    Thank you,

  240. March 2nd, 2010 at 2:26 am #admin

    Shelly,

    If UClaim.com does not show Allstate mobile home endorsements, consider the following. The UClaim eBooks tell you several ways to get the policies and endorsements from uncooperative agents and adjusters. Here is one suggestion, take some kids to the Allstate claim office lobby in your area. Give them ice cream cones, chocolate bars, etc. and let them play tag or hide and seek, etc, while you wait for the claim manager to get you a copy of that endorsement.

    And find out if that endorsement is for contents or structure.

  241. March 10th, 2010 at 1:05 pm #cm

    I have a rental and in two yrs the property only had two tenant for short times less than a yr each about half yr. inbetween a lamp wire was faulty and burned a whole in the floor,,first claim, then person was welding in bathroom and must likely an amber was in wall fire on second floor, accident second claim, recently notice someone broke in home and stole cooper pipes, made a police report and put up signs no trespassing and resecured home and next day or so someone broke in and started a fire in basement and still under investagation,,I even got questioned and I feel instead of the police or ins. investagor looking for the vacrant then look at the home owner I understand some people may do this in this economy but what about innocent people like me that have a bad luck on things..being a older home that is empty most of the time it is more likely things will happen,,I feel like I am the accused and I have been so cooperative and answering all questions and giving all papers as needed even though I am innocent and I am getting confussed on certain times and dates and how the events unfolded ,,I have never been behind in morgage or taxes or bills and I have never been questioned it is scary to me, and I got a letter which they call standard that says there may be a claim issue re read the policy if I did it or directed someone to,,,which is a slap in the face to me,,,the call this a standard letter ,,I feel at this point I am being accused of something so horrible,,and they have no reserve on acct or claim yet and it is almost two months ,,is this typical/ and any suggestions…thanks

  242. March 11th, 2010 at 6:45 pm #Needing Help

    Hi,

    I am so grateful for a site like this that is designed to help us with information insurers aren’t so forthcoming with.

    I have three short questions:

    Can I act as my own general contractor and hire and pay subcontractors to do the work my insurance has approved and sent money to my mortgage company for?

    If so, am I required to turn a W-9 along with a draw schedule? Is there anything else I should know, or additional paperwork I need to turn in?

    Thanks for your help

  243. March 12th, 2010 at 3:44 am #admin

    Dear Needing,

    You know, of all the people who arrived at this free website today with the same google search phrase as you, you were the only one patient enough to even type up your question. You just may have have a shot at not getting outsmarted by your insurer! Here’s your answers:

    Yes, no and yes, IMO (and with those over simplistic short answers, I must say, for liability reasons, consult with an attorney before making final decisions).

    There is a detailed discussion on how to handle your situation in one of the eBooks at UClaim.com entitled “Homeowners Loss …”. If this is your only problem with your claim, then the standard version will suffice. Look at the table of contents online. The eBooks have a money back guarantee and free consultation/s with the author.

    It explains in layman terms how to “act as your own contractor” and get that 20% P&O as well as doing the repairs for less than the insurer estimated, without getting yourself into legal trouble as well as getting outsmarted by the adjuster.

    Let us know how it ends up for you.

  244. March 12th, 2010 at 2:03 pm #Needing Help

    Hello again,

    This is “Needs Help” needing more…help!

    Ok, the insurance company says they need the name of the person/company who is going to do the work so they can put both our names on the draw checks.

    I was thinking about having the Home Depot do the work but they don’t deal with the insurance/mortgage company for payment, only me. But if I cannot turn their name and necessary information in to the mortgage company to get their name on the draw checks, and if the mortgage company won’t release the funds without their information, what am I to do?!

    Signed,

    Needs Help Again

  245. March 12th, 2010 at 5:30 pm #Reni Fulton

    3 story concrete block building on property,insured for removal only collapsed under snow weight. SF agent not cooperative in making a claim on my behalf. Says that he never should have insured it! Also have concern that SF will say that we did nothing to maintain it. But the building’s top two stories were were not usable. Same agent inspected and insured building for removal only. What are my options if agent continues to be uncooperative or SF refuses to pay claim? Thanks

  246. March 13th, 2010 at 3:20 pm #admin

    Dear Needing,

    How much money would you stand to gain by doing your own repairs? At least 20% for the contractor P&O, right? Plus whatever amount more by beating the insurance adjusters estimate, right? It could be many thousands of dollars, right?

    And guess what else you probably never thought of, most insurers only pay the “ACV”, the depreciated amount of the repairs up front. So the mortgage company may only be holding 60% of the money for the estimated repairs. When the repairs are done, the insurer will send the mortgage company and you the other 40%, right? Well the answer is MAYBE. What the adjuster never tells you (until the end), or buries, is the policy provision that says the insurer only owes the “lesser” final settlement amount, and the lesser amount is “the amount actually spent”. So if you busted your rear end to come out ahead with money in your pocket, then you got screwed! In effect you helped the insurance company save its money, and you worked for the insurance company, for free! Congratulations.

    Why would it not make sense to spend $79.00 on an eBook by a highly successful California public adjuster, with a money back guarantee, and free consultations by the author, at UClaim.com, that would answer all your questions and more to come on this one subject, as well as cover ALL the other aspects of a homeowners insurance claim that can add dollars in your pocket … and … keep you out of trouble with the law and your insurer??? Talk about looking a gift horse in the mouth. Where else on the internet are you going to find eBooks by an author who has laid it all out for everyone to see? How many fancy public adjuster websites have you seen that essentially tell you nothing more about the public adjuster than his membership in a trade organization with a logo that any public adjuster can buy for $500.00? And Needing, there are sadly many public adjusters out there whose only real prior “insurance claims experience” was cleaning wet carpets for Service Master! It’s a jungle out there dear Needing.

    I’d really like to know the answer, because most of the visitors to this website are exactly like you, looking for a couple of short quick “fix all” answers on the internet. Please, educate me, if for nothing else, call it a trade for the small bit of information I’m about to give you below.

    1. The insurer is legally bound to protect the mortgage company. It’s in your policy. Your mortgagee is (or should be) named on your declarations page. Without them named on your policy, you would not have gotten your loan. So a prudent insurer either will name the mortgagee or a contractor in addition to your name on large building structure checks.

    2. The mortgagee just wants to insure that the repairs are done so their collateral (“your” house) can be protected. The only way to get the mortgage company to release that money, without a contractor, is for YOU to complete the repairs in increments, then you call the bank to send their inspector out to verify the repairs for each increment. Then you get reimbursed, for that increment. So YOU front the money, or your subcontractors agree to wait for payment. Most won’t wait over 30 days.

    But Needing, there are a couple more pages of very important information on this issue I could give you, but just don’t have the time.

    And PLEASE give us your honest answer on my above question. We obviously need help in making people like you break out of that “penny wise pound foolish” mentality. We can’t write a treatise on every question and we can’t be everyone’s free personal consultant.

  247. March 13th, 2010 at 4:06 pm #admin

    Reni,

    I’ve never seen a policy or endorsement for “removal only”. If you want us to take a look, please attach to an email a scanned copy to info@insuranceclaimhelp.org .

    Get the denial in writing, and it has to state specifically the reason, for example policy clause xyz or such and such law. After that, if you are going to pursue the claim without a public adjuster or lawyer, then get the eBook on denied home and business claims at UClaim.com. Litigation should always be “the last” resort.

  248. March 15th, 2010 at 5:00 am #f. michael conte,CPIA

    I would love to see this policy or endorsement as well, as i have never seen such a policy either.
    fmc

  249. March 16th, 2010 at 2:02 pm #MATT GODDARD

    I HAVE AN INSURANCE CLAIM WITH FARMERS INSURANCE AND MY CONTRACTOR STATES THEY ARE PAYING TOO LITTLE FOR HIM TO COMPLETE THE WORK. I HAVE CONTACTED FARMERS TO DISCUSS THIS AND THEY CLAIM THEY ARE PAYING FAIR MARKET VALUE FOR THE DAMAGE AND EVERY CONTRACTOR I TALK TO DISAGREES WITH FARMERS. MY CONTRACTOR IS ALSO A GENERAL CONTRACTOR AND HE STATES THAT FARMERS IS REQUIRED TO PAY CONTRACTORS OVERHEAD AND PROFIT. IS THERE ANYTHING I CAN DO TO FORCE FARMERS TO SETTLE UP WITH MY CONTRACTOR SO I CAN GET MY HOME REPAIRED.

  250. March 16th, 2010 at 11:25 pm #admin

    Matt,

    If you are saying Farmers is denying P&O, even to licensed contractors, we would all like to know what state you are in. That is some pretty serious stuff. I thought Farmers was pretty cheap by not paying P&O to owner builders in some areas, but to not pay contractors? You can check this with your state DOI and hope for the best, but the fact is that most states DOI suck up to insurers.

    You can’t “force” an insurer to do anything. They can hire 1000 attorneys to beat down your one attorney and buy off the judge if they want to. You have to outsmart them if you want to beat them. That’s how good public adjusters and attorneys beat them.

  251. March 17th, 2010 at 5:31 am #cm

    rental home had a fire for third time within short time,,bad luck home,,vacant so it is more likely to have problem,,as a victim, I feel that my ins co is trying to get out of claim, I gave to fire marshall and ins investagator all ans. and paperwork that I could gather together,,they made me nerous and I am innocent and shouldn’t be but I have never been questioned before and it is understandable that in this economy that people are doing there jobs and checking all possibilities but they shouldn’t make the home owner who pays taxes and ins for yrs feel terrible,,do I need a lawyer and what is expected next? what type of lawyer would I need? this is a long process I assume and I never went through this before, so if anyone went through this maybe you can give me advice thanks

  252. March 20th, 2010 at 1:34 pm #F MICHAEL CONTE

    get a lawyer, someone who has experiance in insurance property matters.
    fmc

  253. March 20th, 2010 at 1:38 pm #admin

    CM,

    The most important advice is to keep the house “occupied”. Because vandalism and arson by vandalism will be resisted or denied by the insurer if the house is “vacant” or “unoccupied”, usually for over 30 days. You can “occupy” the house by having work or remodel work done on it. Stop by the place every few days and do a little something. If you want to make a stronger argument, spend the night there, you or somebody you know, every couple of weeks.

    It doesn’t matter if you are a decorated veteran and were in Disneyland when the fires occurred, they can still run you though the mill and encourage you to give up your claim. If you can’t afford a good public adjuster and or attorney, get the eBooks at UClaim.com on Landlord Rental Property Loss, Denied Homeowner and Businessowner Claims, and the one on EOU (if they demand EUO, and they probably will in your case).

  254. March 20th, 2010 at 6:24 pm #cm

    what if you were trying to sell it?

  255. March 21st, 2010 at 4:57 am #admin

    CM,

    Makes no difference. If you are suggesting that showing potential buyers the property might fit the policy description of the word “occupied”, I think you might be hard pressed to convince an insurer, judge or court of that.

    And if anything, a house for sale is a “red flag” indicator for fraud to insurers. So I would not even volunteer that information , unless asked.

  256. March 21st, 2010 at 12:55 pm #TRB

    Where would I find a good definition that would stand up legally in CA for
    what it means for an insurer to pay for “reasonable repairs to put it back to pre-loss condition?”

    And can an insurer be held responsible to pay for depreciated property value of a residence thats directly related to a covered loss if it cannot be returned to a pre-loss condition?

    Background info: The loss was a foundation crack in a residential house that Allstate Insurance is covering. I have had several experts in their own fields (engineers and real estate agents) state that returning a cracked slab back to a condition of wholeness (uncracked and capable of carrying the same bearing weight of the building as it did previously) is virtually impossible and the real estate side has said that since this has to be disclosed in a real estate transaction the property value will be depreciated on average 20% even if the crack is repaired by epoxy methods or other as most don’t offer more than a 1 year warranty.

  257. March 21st, 2010 at 4:17 pm #admin

    TRB,

    1. I don’t know of any case law off hand, but that doesn’t mean there is not any. You could hire attorney David Parisi in the Los Angeles area to search it for you. Or try any attorney or paralegal. Its just a matter of time to search for it. You could go to findlaw.com and search some of those search terms.

    IMO, if you have RCV, you are entitled to exactly what you had, not some repair or some aduster’s “industry standard” argument. “The construction industry” and “the city building code” is not part of your insurance policy contract. If an insurer has to pay for the cost to put a 1921 house exactly back the way it was, whats the difference with a cracked slab? Does your policy say it will repair your house according to “industry standards”? Does it say “reasonable” repairs?

    2. Now the insurer can take depreciation if you don’t do the repairs, so that’s to their benefit. So if they pay to put back true 2×4 framing lumber and you go back with 1.5×3.75 lumber, they get to take some depreciation that you cannot recover with the RCV policy.

    3. And TRB, you already have experts on your side, and, the burden of disproof is on the insurer, not you, if you have an “all risk” policy (a “special form” policy like a DP3 or HO3, a policy that says “we cover all structure losses except …”). You don’t need to find any case law. Let them find the case law to support their side. And I doubt they will find any. And be sure to read every case they quote, because there are plenty of “insurance whore attorneys” who will misquote and misrepresent case law, hoping no one ever checks on them.

  258. March 26th, 2010 at 6:09 pm #Patient

    Hi,

    Recently I have had a burglarly / vandalisim. The adjuster has disbursed a check for dwelling repairs. The loss of property,after sworn statement and police report,itemized list and receipts avaliable. I also supplied bank statements. The claims adjuster called today to inform me that she will only pay out items I have receipts for. She stated the bank statements do not specify the product just the name and date of purchase. The check will be mailed out today.

    My policy covers full replacement, how can they pay for items only with proof of purchase or manuals. Do I cash check or return and dispute.
    Receipts are now a policy requiremen ?
    If I don’t have receipts for gifts. Clearly this a bad faith claim.

    Sincerly confused.

  259. March 28th, 2010 at 9:01 pm #admin

    Patient,

    Well unless your policy says you won’t get paid on contents you don’t have receipts on, then your insurer cannot deny your claim. Yes, bad faith. I have never seen such a policy, but there is always a first. Now if you have receipts and refuse to give them, then they can deny the item. And no, you don’t have to go back to stores and gather receipts, let their investigator do that. If you can’t afford a lawyer or public adjuster, consider the eBooks at UClaim.com.

  260. March 29th, 2010 at 4:49 am #f. michael conte,CPIA

    You must let the readers know who this carrier is.. that being said, i beleive this is a hard lined position on the other hand i have not seen the list of items. typiclly i would ask for receipts when i thought a claim was being inflated. look for photos that may have the affected items included. look through credit card statements etc. or order copies from your carrier i believethe cost if any is reimbursable.
    fmc

  261. March 29th, 2010 at 10:24 am #Robin Varghese

    I had Travelers of Massachusetts for my insurance carrier when I had a fire at my home. After 2 years of fighting with them I have asked for mediation and they have denied my request insisting that I am beyond the two year statue of limitation. I was told that I had 2 years to submit a claim, is it also true that after that time I cannot request arbitration? Also, the adjuster will not provide his supervisors name or contact information.

    Help, please.
    Robin.

  262. March 30th, 2010 at 2:03 am #wondering what to do

    I recently filed a hail damage claim my residence, then sold the residence two weeks later. didnt think anything of it until i recieved a two party check from travelers insurance to me and the bank. i figured why not try and cash it. It just so happens the bank i had the mortgage through also financed the new buyer, so they say they still have an interest in the property even though i dont own it anymore and are undecided on whether to cash it for me without it being repaired. they requested the adjustors report, I dont think this is a good idea. i think i have a worthless check on my hands, and a wasted claim. wondering if the bank is legally bound to cash it or should i just cancel the claim send back the check. could this be considered fraud.

  263. March 30th, 2010 at 7:30 pm #F MICHAEL CONTE

    dear wondering what to do,
    what were the terms of the sale did yo make a concession for the unrepaired damage? or did yo promise to pay for the repair.
    please advise.
    fmc

  264. March 30th, 2010 at 7:36 pm #admin

    Robin,

    Well, regardless of what your policy says, it is over ridden by state law, the statute of limitations you need to find out is the time to sue them for property damage in your state. Call your small claims court clerk. In most states it’s 3 or 4 years on property damage and 1 or 2 years on bodily injury. How to use this information to get results is in the UClaim.com eBook mentioned below.

    Just the terminology you use and the way you write your question and tells me you are totally being outsmarted by your adjuster. “Mediation” is used in litigation. It’s not in your homeowners policy. If you meant “appraisal”, that clause will not help with “coverage” issues, only valuation issues.

    If your claim has been open this long, and you can’t afford a public adjuster and or attorney, start with the eBook at UClaim on homeowner claims.

  265. March 30th, 2010 at 7:44 pm #admin

    Wondering,

    If you sold the house “as is”, and the buyer was aware of the hail damage, and not expecting the roof to be repaired, or, if the buyer made their inspection after the hail damage date, I would say the money should be yours, as long as the amount of the mortgage was less than the value of the house minus the cost of hail damage repair. Just my opinion. You can check with an attorney and have him send a “shake em up” letter to your mortgagee to sign that check and send it to you!

  266. March 30th, 2010 at 10:59 pm #wondering what to do

    continuing from the previous issue, the roof inspection was done before the hail storm, buyer was not aware of hail damage or claim. i should never had made the claim, however do you think it would effect my future premium price if i was to give the check back to travelers and show it as filed unpaid, and in your opinion what could the consequences be for getting the check cashed.

  267. April 4th, 2010 at 11:16 am #Ali

    Hi,

    I filed a fire insurance claim (partial burn from wildfires and smoke / firefighter entry damage) a year ago and after 3 adjusters I finally agreed on the scope of repairs. Since the repairs have been going on several other other items have come to our attention and been replaced. Will these items be covered if presented with the receipts.

    My claims rep at Farmers Insurance has assigned a local contractor who will contact me for the building portion of the claim we have noticed, mainly exterior brick damage and concrete damage. Is it a good idea to have my own estimates ready when he arrives or just to work with him?

    Lastly, my rep wants receipts for the repairs done at this point for depreciation purposes. I have finished all the repairs and the mortgage company signed off on it. A lot of the repairs were done under my “owner-builder” permit because I also did some mandatory remodeling at the same time. Do I need to show any documents if I am not looking to claim further depreciation except on a few items?

  268. April 4th, 2010 at 9:14 pm #admin

    Wondering,

    Regarding the premium increase, ask your agent. If you cash the check without the buyer being made aware of the damage, after their inspection, you might get sued by the buyer, imo. Check with a lawyer. If you got all the money you asked when selling your house, ethically, why should you get more and the buyer less after the sale?

  269. April 4th, 2010 at 9:35 pm #admin

    Ali,

    If any visitors can answer Ali’s questions in a few paragraphs and keep him out of trouble with his insurer and the law, please do so here.

    Otherwise Ali, if you won’t get a public adjuster and or an attorney, get the eBook at UClaim.com on Homeowners Loss Advice Deluxe for in depth discussions on all your questions.

  270. April 5th, 2010 at 7:43 am #Carmine

    I have the HO 04 77 04 91 “ORDINANCE OR LAW COVERAGE” endorsement on my policy. I have the HO 00 03 04 91 policy as well. What is the limitation on coverage for the HO 04 77 04 91 endosrement?

  271. April 7th, 2010 at 8:50 am #Tom Moser

    A frozen gutter pipe next to my house ruptured during the winter. During a recent spring storm, the same faulty gutter allowed water to accumulate in a flower bed adjacent to my house. The flower bed filled with water and resulted in some water in my basement (enough to moisten the carpet). We have never had a water problem in our basement before. The faulty gutter obviously caused the problem. Should the $2600 carpet replacement be covered by my home owner’s policy in NJ.

  272. April 7th, 2010 at 6:37 pm #admin

    Carmine,

    It should say in the endorsement and your declarations page.

  273. April 7th, 2010 at 6:48 pm #admin

    Tom,

    Well if you have a “quality insurer”, they may agree that the cause was a broken plumbing device and the water was not from the thawed ice. But it’s a stretch.

  274. April 18th, 2010 at 4:08 pm #Reqestor

    After the insurance company approved my claim, the mortgage company sent a draw check TO THE CONTRACTOR made payable to both he and I. He gave me the check but now he wants to deposit it into his account. I don’t trust him to deposit and use the monies properly and/or do the work in a timely fashion.
    Should my bank allow me to deposit the money into my account and pay him as he does the work. And why would the mortgage company take a risk by sending him the check instead of me.

  275. April 20th, 2010 at 10:47 pm #admin

    Requestor,

    Don’t give him over 1,000.00 to get started. You can give him incremental payments, usually in thirds, “after” each third of the work is completed. It does not matter who your mortgagee sends the partial payment checks to as long as it has both your names on it. Just don’t sign the checks until that portion of the work is done. Get a free brochure from your state contractors license board to see how to manage a contractor.

  276. April 23rd, 2010 at 3:35 pm #James

    Hello again! Thank you for your response to my orig post #114 in June, 09. Fast forward; I finally received the check for my claim from my former ins company approx 14 months after the fire. Since I posted in June, because of this debacle, my home (of 21 years) went into foreclosure, and I am basically homeless, living day-to-day with whomever will help me. Re final payment; although I no longer own the property, (thanks in great part to ins. company) and the insurance company knows this, of course the check is made out to former mtg. company & myself. This was final payment for “applicable depreciation balance” which was held back by ins. company. I contacted my former mtg. company regarding this check and basically asked if they would sign off on the check. They said that I should bring them the check and they would give me $1,000 if I would sign off on it!!! (The check is near $8k) Huh? They are aware that I could not make my house payments because I paid the contractor out of pocket what was due to him, which was the money that took 14 months to get from the ins. company.
    1. Do I have any recourse with any of this?
    2. Must I even give the check to former mtg. company?
    (At this point, I’m so fed up & insulted, I would rather burn the check than sign off for $1k because the entire amount should me mine!!) Not only am I homeless because of the thieves, thugs & liars that make up my former ins. company, after all this, the mortgage company wants to play like a street gang!
    Thanks in advance.

  277. April 26th, 2010 at 2:35 pm #Donna

    Allstate sent a check made out only to me for hail damage to my roof. If I choose to not repair the roof and use the money for bills, is this legal?

  278. April 26th, 2010 at 3:52 pm #admin

    Donna,

    I would say it is legal, as long as there is no clause in your mortgagee contract that says you have to use all insurance claim money on house repairs. But check with an attorney. Most mortgagees don’t care about small insurance claim payments.

  279. April 26th, 2010 at 4:01 pm #admin

    James,

    Yeah, I sympathize. My 79 year old Dad got suckered by Countrywide into one of those negative adjustable loans and lost the home I grew up in.

    See if you can find a plaintiffs lawyer to take your case and give him that check as security toward his fee, but don’t sign it unless he gets a recovery of at least 16K, with his fee being 50%.

  280. May 2nd, 2010 at 3:34 pm #James

    Thank you, Admin, using check for security was something I had not thought of – awesome advice. I do wish I would have known of your site, and bought your literature b-4 making a claim with the thugs at my ins. company. When it comes to dealing with such outlaws & wanna-be street gangs, anyone/everyone should BEWARE!! Insurance companies are not your friend. If one does not think like a thug, if one does not have experience being a thug, they will just be easy prey and more than likely end up as I did, road kill. Thank you for this site, and for all you do.

  281. May 4th, 2010 at 4:37 pm #Barrie Elliott

    AAA has “guaranteed replacement” on my house, but my Dwelling Coverage seems low (@ $149 per square foot). I got a quote from Farmers who says my replacement cost is around $180/sq ft, but they only offer a 25% extension on the coverage limit. Should I stick with the AAA guaranteed replacement? The Farmers Agent says I better double check with AAA if there is anything that could VOID my “guarantee” …. (like not keeping the house insured 100% to estimated replacment costs) …. or (like not upping my limits when I put a new floor in or re-do my kitchen counter tops).

    If my AAA “guarantee” was voided, I know they’re not insuring me for enough with just the limit shown on the policy. Is this a worry?

    Thanks.

    Barrie

  282. May 4th, 2010 at 9:53 pm #admin

    Barrie,

    Just fax the AAA agent a letter stating you think they undervalued your house and see if they up the value (and the premium). If they ignore the letter, at least you have something to hold them to if they try to penalize you for being under insured. Most policies have a “coinsurance clause” that say you have to be insured 80% to value, or you get penalized if you have a claim.

  283. May 6th, 2010 at 3:52 pm #Jason

    Hi, I had water overflow from gutters at a storage unit in which I had my personal property stored. This damaged much of my personal property because it was not discovered until I removed the contents. The insurance company agrees with me entirely about how the damage happened and they even agree with the amount of damage that occurred. Everything is good except they have denied coverage based on their impression that there is not a covered peril. I have sent them letters expressing that the coverage is available from the policy that reads, “accidental discharge or overflow from within a plumbing … system”. I assert that the gutters and down spouts are a plumbing system. And if there is any ambiguity in what a plumbing system is, then it should be decided in favor of the insured. They relied on the definition of the word “plumbing” only, and said it refers to pipes, apparatus, etc to distribute water inside a building. Emphasis on “in a building”. I think there is a term that indicates they can’t just take a word and put a definition on it and then put the definition in place of the word and use it. I think this is called noscitur a scoiis. I cannot find a definition of, “plumbing system”.

    I’ve pleaded with the insurance company that pipes, apparatus, etc can be found underneath a home (and not in a building) if the home is built on a slab. I also indicated that a water supply well is many times contained in the ground away from the building and connected to the home only by electrical wires and pipes. Then, I also brought up the fact that a home’s sprinkler system is almost entirely not “inside a building”. In each of these scenarios, the insurance company provides coverage for these items if they should be damaged under the physical damage part of the homeowner policy.

    I also found a case which was ruled by a court to be covered and affirmed by appeal that there should be coverage for the damage in NY, Potoff v. Chubb Indem. Ins. Co, 2009 NY Slip Op 01833.

    The personal property is covered on a named perils basis under an older version of a fairly simple policy. Newer versions of the homeowner’s policy have wording in it that are written that provides coverage for water that overflows from the same items but it namely indicates that overflow from a gutter, down spout, etc is not a covered cause of loss.

    I have sued this insurance company and would like to make a motion for summary judgment but would like to go in with more support that this coverage should be a matter of law based on the wording, or lack of wording, in the policy. Also, this loss occurred in WI and the above Chubb case is in NY. Do you have any advice you can provide? Thanks.

  284. May 6th, 2010 at 5:12 pm #admin

    Anyone want to answer Jason’s long question?

  285. May 6th, 2010 at 8:35 pm #Suds

    In Texas a total Loss due to fire requires the Coverage A policy limits to be paid in full as liquidated damages. What about a rider that increases Coverage A by 20%? Does this fall under the same total loss interpretaion? Example: Coverage A is for $300,000 with a Rider that increases coverage by 20% ($60,000), the insurance company has agreed the home is a Total Loss and policy limits will be paid($300,0000) but is going through an itemized estimate to determine how much of the $60,000 should be paid. Is this correct claims practice?

  286. May 7th, 2010 at 8:03 am #Jason

    I don’t want to be a nuisance to anybody so I will update what I have done. I drafted a summary judgment and addressed the 1. appellate ruling above, 2. that gutters, downspouts, etc are classified as a topic within the Universal Plumbing Code (edition 6) and are therefore part of the “plumbing family”. 3. and I made reference to a newer version of a homeowner’s policy that specifically addresses gutters and downspouts by defining “that a plumbing system … does not include … a roof drain, gutter, or downspout or similar fixtures or equipment.” This is the first time I’ve done this and I want it to work so I’m hoping for some good input. Again, thanks.

  287. May 13th, 2010 at 12:58 pm #Orly

    Thanks in advance for all the advice. We have our house listed for sale. On april 5th we had some hail damage on the siding of the house and we had a claim that is now approved and the check has been send to the mortgage company for endorsement. On april 29 we got a buyer and signed a contract, an inspection was performed on may 7th. and we have agreed on minor repairs to be done, nothing to do with the siding. The mortgage company told us that they will hold the check until repairs are done because it is over $10,000. we don’t want to do any repairs because the house is already sold and we lower the price counting on this money being paid to us. I beleive that since an inspection was done and the mortgage company will be paid in full once the sale takes place, we are entitle to the money. Please advice. Thanks.

  288. May 16th, 2010 at 5:24 pm #Matt

    Hi. A month ago our townhome flooded because the hose from the wall to the ice maker in the fridge split in the middle of the night and ran about 5 hours of water into the kitchen, dining room, bathroom and entry way. I called my insurance company and they called ServiceMaster who dried everything out, ripped all the floors out, etc to the tune of $3,700. We come to realize my HOA’s bylaws state that their insurance policy supercedes mine.

    Now, the new insurance company’s balking on the $3,700 ServiceMaster bill. I signed a piece of paper the morning this all happened with ServiceMaster authorizing the work and it says that my insurance co. will pay them directly. But my name is on the bill, and my insurance co. says they can’t pay the bill because they are not primary, and that the HOA’s insurance co. should.

    What is correct?

    I am also trying to stop the HOA from paying that ServiceMaster bill from the $7,500 that their insurance co. sent them to restore my place. That budget is supposed to be for restoration but ServiceMaster is trying to convince them to pay it for their services, which I believe should be separate.

    Thanks for any help.

  289. May 18th, 2010 at 10:19 am #admin

    Orly,

    Easiest thing to do is wait until the mortgage company is paid off. Then they have to sign the check and send it to you.

  290. May 18th, 2010 at 2:41 pm #Jason

    Matt,
    I’m not admin but your situation seems to be rather simple. If your policy contains language that says your policy is secondary to any other collectible insurance, the other insurance (HOA) will pay first. Your insurance company can pay for it and then get reimbursed by the HOA insurance. These insurance companies can figure out the accounting later after you are back to normal. The main priority should be your as the policyholder and you should not be in the middle of these minor details.

    Since your insurance company is closest to this loss with you and they were involved from the very beginning, they should pay your claim and let you get on with your life.

    The next thing your insurance company will do is send a request to your HOA insurance company to reimburse your insurance company for the damage because your HOA insurance is primary. It’s all a matter of contract language and it sounds like who ever started addressing and paying the claim with you should handle it through completion. (This reimbursement stuff is not something that a policyholder usually deals with because the insurance companies do it behind the scenes to make sure the right company has paid for their responsibility in the end.)

  291. May 18th, 2010 at 2:49 pm #Jason

    Admin,
    I hope it was ok to address Matt’s situation.

    An update on my situation with water damage to my property from water that ran out of gutters and down spouts…. I filed a summary judgment motion supporting the facts why a gutter and down spout is part of a plumbing system. (If the damaging water came from a plumbing system, my policy will pay for the damage). I supported with the NY ruling that determined that gutters and down spouts are part of a plumbing system, I provided the respective chapters, tables, and diagrams from Universal Plumbing Code, International Plumbing Code, and National Standard Plumbing Code that explain the codes and requirements for dealing with storm water drainage on roofs, and a few other side notes of support that it is in fact a plumbing system.

  292. May 22nd, 2010 at 8:17 am #admin

    Jason,

    Thanks for your input. Most valuable!

  293. May 25th, 2010 at 3:26 pm #Veronica

    Had hail damage – adjuster saw barely visible dents in garage door (which functions fine) gave me $3000 towards new door, hardware and paint job. If I choose not to do this do I need to return the money? I will definately be doing the roof and siding issues.

    I’m not looking to rip them off or anything but feel like OK I had this damage you compensated me for it (which is why I pay home ins) but on this particular item I choose not to do it but to put the $ into my home in another fashion. Is that legal? The check was made to me and mortgage company and they signed it and it is now waiting to clear in my account.

    Also if I don’t do it does it hinder any future repairs to garage door if something should happen?

  294. May 26th, 2010 at 1:37 pm #Angela B.

    Can State Farm deny reimbursement on the peronal item that was the cause of a fire? In my case, my Clothes Dryer started a fire and caused approx. 40k in damage. Everything up to this point has been ok except they denied my reimbursement for the value of the Clothes Dryer. I live in PA and would like to know if this is correct, there is nothing in my policy stating this exclusion.

  295. May 27th, 2010 at 11:35 pm #admin

    Veronica,

    Well, unless your mortgagee will sign off on the check without you doing the repairs, then you may have to do the repairs. Without repairs, any future claim payment will just deduct more for depreciation.

  296. May 28th, 2010 at 11:03 am #Jason

    Angela,
    I am not admin but I will attempt to answer your question. You are correct that there is not anything in your policy that indicates your clothes dryer should be excluded from reimbursement since it was the cause of the fire.

    There are basically two approaches that insurance companies apply to this type of situation. The first it that the insurance company will exclude the reimbursement for the item that caused the fire. The premise for this is not very well understood but I will try to explain it.

    The clothes dryer in your case failed to function without causing damage, and set in motion the reason that your other property was damaged. The clothes dryer was essentially not “worth anything” at the moment of it’s failure to function safely. I know it doesn’t really make sense but this is the thought (or thoughtlessness) that goes into these decisions.

    The second approach is that the insurance company will exclude the specific and isolated part of the clothes dryer that failed to function safely and caused the resulting fire. In this approach, the specific part item is excluded as covered and the rest of the entire dryer will be reimbursed.

    In both examples, the item (either the entire clothes dryer or the specific part of the clothes dryer) are not allowed for reimbursement. The insurance company has to follow their procedures so they follow correct (or established) claim settlement practices.

    Obviously, just excluding the specific part of the clothes dryer will yield the most favorable outcome for you. The practice to exclude coverage for the item that caused the fire is entrenched in the insurance industry.

    The best approach it probably to agree that the part that caused the fire should be excluded (hopefully the part and not the entire clothes dryer). If the specific item that failed and caused the fire is unknown, nothing should be excluded from reimbursement.

    I suggest that you politely ask for specifics why the insurance company is refusing reimbursement.

  297. May 28th, 2010 at 11:19 am #Jason

    Veronica,
    I am not admin but will supplement the answer provided by admin. Your specific question was, “Is it legal to spend the insurance money on different parts of your home that was paid for the slight visual damage to your garage door?”

    Since your mortgage company endorsed this check and you have deposited the check, you can use the money for anything you wish. (including going to Vegas and spending it on the blackjack tables).

    Your suggested use of the funds to invest in different parts of your house is perfectly legal and justified. This benefits both your and your mortgage holder by increasing the value of your home.

    There is really no reason to replace a garage door that functions properly and has only minor blemishes.

    Now, please keep in mind that if your garage door is damaged again and you have not replaced it, the insurance company is justified to deduct the amount they have already paid you for the door.

  298. May 31st, 2010 at 6:48 am #Mr. Smith

    Back in Sept. 09 I had a fire at my home witch is still being investigated. I was staying in temporary housing paid by my insurance company (farmers) until one of their investigators popped up at the house and checked my mail box. Since then I’ve have been staying at hotels during the week. My question is I also own another house, which I also reside at on the weekends. Can I still submit my hotel receipts even though technically I have a place to stay if I chose?

  299. May 31st, 2010 at 1:26 pm #admin

    Mr. Smith,

    IMO, yes you can.

  300. May 31st, 2010 at 7:06 pm #Mr. Smith

    Thanks for the quick responce but is it possible you can tell me why you feel it’s ok the submit my hotel receipts?

  301. June 1st, 2010 at 12:36 pm #Angela B.

    My home is being partially renovated due to a fire, instead of staying at a hotel, one of my relatives offered me room/board for $100 a week. I took him up on the offer since this is much less money than staying in a hotel and much more comfortable. So, I submitted the receipts for the first 6 wks and my adjuster contacted me to say he can only reimburse me the cost incurred by my relative for the extra utilities. He stated unless she is running a Boarding house and has a tax id#, she cannot rent me a room?? I live in PA and have State Farm homeowners coverage. Can State Farm refuse this claim because the room is a private home vs a public hotel? Should I start staying in a hotel for the duration or should I force the issue?

  302. June 2nd, 2010 at 10:35 pm #admin

    Mr. Smith,

    1. I’m sure your Farmers policy probably says it pays “incurred” ALE expenses.

    2. I doubt there is a policy condition in your Farmers policy that you have to stay in other residences you own if you have a fire.

    Now if you want to know how to properly and “legally” pocket that ALE money, get the details in the Homeowners Loss Claim Advice eBook at UClaim.com.

  303. June 2nd, 2010 at 10:40 pm #admin

    Jason,

    Thank you so much for your participation. We hope you will continue to contribute your time and expertise!

  304. June 2nd, 2010 at 10:42 pm #admin

    Angela,

    They are jacking you around. See our advice to Mr. Smith above.

  305. June 4th, 2010 at 1:24 pm #BOBBI

    I have a public adjuster working on my home owners claim for damage to my roof. My question is, am I able to repair the roof before the claim is settled? or must I wait for the claim money?. It is hurricane season and I am unprotected at this point…

  306. June 5th, 2010 at 12:41 am #admin

    Bobbi,

    As long as you and or your public adjuster have documented the damage, you should be ok to proceed. But consult with your PA and make sure you don’t create more headache for yourself if you are doing the repairs for less than you think the claim will settle for.

  307. June 6th, 2010 at 1:00 am #jen

    We filed a claim for burst pipe in slab in march. The adjuster came out three times to remeasure. The insurance sent out a check based on wrong measurments. we sent an estimate and the insurance wants to send the adjuster out again. He is not licensed in Calif. what can we do? It’s been three months. Never had water damage clean up either.

  308. June 8th, 2010 at 11:35 pm #admin

    Jen,

    If not licensed, file a complaint with the Calif. Dept of Insurance. And get your own estimate and fax it to the ceo of the insurer. Make a pest of yourself.

  309. June 9th, 2010 at 12:07 am #Jen

    Thanks! We did fax an independent estimate. Now they insist that the same adjuster and the contractor hash out the charges in the estimate. I have never heard that before. We are the insured. Since when does the insurance company haggle with the contractor at the insured’s home, as they are suggesting? As far as the adjuster being unlicensed, the insurance company stated that as long as the co. he works for is licensed – it’s no problem. Is that true? Does this reach the level of bad faith?

    Jen

  310. June 9th, 2010 at 6:37 pm #Jason

    Jen,
    The contractor and the adjuster should be able to work out the charges in the estimate. Sometimes there is some disagreement but that should not affect you at all. This is not something they should do in your presence, but perhaps by the phone when they are at their respective offices.

    The insurance company isn’t in the business of making sure that contractors are licensed but usually contractors, or the company they work for, will be licensed.

    It would take a significant act or lack of action to amount to bad faith. With almost no doubt, this does not amount to bad faith. The level to reach bad faith is rarely reached by anybody.

  311. June 17th, 2010 at 7:56 am #Jason

    g.l.,

    If you are too busy with family responsibilities and other commitments, it would be wise to seek help especially since most of your documentation for your property has been destroyed.

    Regardless of the 10% or 20%, you should choose based on who will do a better job for you and maximize the amount you receive from your claim. I am not familiar with either company or person. What will this person do that you hire? They can’t make your list because they don’t know the items as intimately as you do.

    Make your list and submit the most information that you can that supports your claim. If the documentation burned, it would be difficult and costly to reproduce that information. Do your best.

    You should be as detailed as you can. For example, if you indicate 4 large boxes of maternity clothes, that may not be specific enough. “Large” is not very specific. Were the large boxes tightly packed or loosely packed? Are these maternity clothes off-brand or high-end brand items? Those details are important for anybody to determine it’s value and how it should be settled. Also, it is important to provide the approximate age of all the items.

    You ask: “Does the insurance under circumstances pay a % of the policy value without all this detailed work?” This probably would be the appropriate method of settlement for your claim but it depends on your adjuster.

    As far as the suits and the stored items, you simply have to list the items to the best of your ability and make the claim. Every claim is different but the majority of families have certain items and clothing depending on their lifestyle. Pre-purchasing gifts is a common practice for some families so it would be appropriate to claim those gifts. Some policies exclude obsolete or stored items so you would have to review your policy for that. Sometimes the only proof you can provide is a list so make it as detailed as you can.

    Yes, possibly showing your lifestyle can be part of your claim proof. Families who have a wealthy lifestyle will have different possessions than blue collar working families. The clothing’s depreciation will generally be based on when it was purchased, not based on the time it was used. Maybe the people who packed would assist your claim but may not benefit you as much as the hassle of gathering that information.

    Simply provide as detailed a list as you can. The largest U-Haul cannot contain more contents than it can physically contain, no matter how good it is packed.

    It is difficult for you to make an accurate claim without expense and replacement receipts. Regardless if you kept receipts, they are valuable to support your claim. The best thing in your case is if you get an understanding adjuster that is settling your claim. Whether your were told to save receipts, saving receipts is an understood course of action when you expect to be reimbursed. Would an employer reimburse your business expenses without receipts?

    You should attempt to complete your claim as soon as possible. You will have 1 year from the date of loss to make claims for replacement items. If you don’t get the list in before a year, the insurance company may not have to contractually honor your claim.

  312. June 17th, 2010 at 1:26 pm #Kelly

    g.l.

    I am not in the insurance business but I do home inventories for people and have been enlightened by many insurance agents. These are the things that you might look out for. Replacement cost usually means they will give you depreciated costs until you provide proof the items have been replaced. Make a detailed list by imagining each room, then each wall of the house (spread sheet will work best). The insurance company will pay you as you’re list grows as you will constantly keep remembering items for the next year so you will receive numerous checks. The insurance company may give you two years. Do not sign off that your list is finalized till the end of the time frame they give you because you will remember items after that. Everything from your dresser down to your shampoo bottles can be listed.

    I have heard that if you are wealthy and can substantiate it, they may just cut you a check for the full amount but that’s usually a company like Chubb that insures the wealthy (over $1 million homes).

    Good luck and at a bare minimum, video tape the contents of your home including inside closets, drawers and cabinets at least every two years and send a copy to grandma’s house for storage.

  313. June 22nd, 2010 at 6:49 am #f. michael conte,CPIA

    kelly,
    good advice except for the chubb comment. Chubb is a quality carrier that insures those who apply for coverage, there is no “wealthy” requirment.
    most people only care about who they are insured with at the time of claim. Many people only buy the ceapest policy they can, these are usually the ones that end up with claim trouble.
    i have represented chubb for many years, each year i get calls from people who say “i want chubb” when i ask why they say because my neighbor had a claim with them and they did the right thing!
    can you imagine doing the right thing and selling more insurance…..wow how simple!

  314. July 4th, 2010 at 2:41 pm #margie

    neighbors tree fell in my inground liner pool. insurance company took 8 days to send out sub contractor who looked at other property damages, but only collected my outside estimate for re-doing pool and would send to insure company. going on 12 days from original damage to pool,still have not heard anything. insure company is not local. how do i go about getting pool back to original state if i have no word from insurance company. What are my rights? I want to get back to living life like before damages. THANKS

  315. July 5th, 2010 at 9:52 pm #Jason

    Margie,
    Call your insurance company and talk to your claim handler. The insurance company pays for the damage of covered property less your deductible. It doesn’t matter if this tree belonged to your neighbor or if it was your tree. You will need to find someone competent to actually do the repairs but if you want cash in hand prior to doing the repairs, simply communicate with your insurance company.

  316. July 6th, 2010 at 8:16 pm #suzanne

    We have an insurance claim in progress due to water damage in the master bath (Shower, dry wall outside of shower…not flooring). The contractor can not find the matching tile. The insurance adjuster is saying we have to pick out something close to match the floor and will not replace the floor. Is this acceptable, allowable. The shower, shower step, outside shower wall, and flooring all touch starting with the shower and working its way outward…Our policy does not say it covers or will not cover matching replacements. Thank you for your help. Suzanne

  317. July 7th, 2010 at 7:50 pm #Tim

    Hi,

    I have a major problem. I was having my roof replaced, and after roofer did tear-off, I found that I need new roof decking as well. My insurer is refusing to pay for decking, and I can’t afford it either.

    I was planning on doing a short sale after roof was completed as my income is only a third of what I was making before. Now I have a roof covered in felt that has partially blown off twice already, and has caused some flooding damage in my house. What steps should I take? I believe my roofing company is somewhat negligent for not protecting home from water damage during job, but understand they can’t endanger themselves working up there on bad decking.

    Please help, any advice is appreciated.

  318. July 8th, 2010 at 6:08 am #Jason

    Tim,
    It is correct that your insurer will not pay for roof decking. This does create a bind for you because as a homeowner you are responsible for the maintenance and upkeep on your house.

    From the circumstances you provided, it appears the roofing company is doing what they can given the circumstances. They cannot proceed unless you pay for the decking work.

    If there is interior damage, you can make a claim for that but I don’t think the roofing company is negligent for a job that has stalled because of the homeowner’s lack of funds to pay for the project to continue.

    Also, with a short sale, that is basically a voluntary foreclosure and if there is not a roof on the house, bad decking, and water entering the home, the amount your bank will receive from a sale is lower than it otherwise would be. You may want to talk to you bank about your situation to see if they want to become involved. But don’t get your hopes up.

  319. July 8th, 2010 at 6:22 am #Jason

    Suzanne,
    The insurance company owes for direct damage and if the floor isn’t damaged, then the floor is not something that will be paid. The mentality of any job is that wall tile, step tile, and floor tile are all separate items that make your claim one that will be difficult because of the lack of matching tiles. The insurance adjuster is doing what is both allowable and acceptable in this circumstance.

    Try to be creative and either accept that you have to pick a similar matching tile, change the tile that is being replaced with a complementing tile to the floor tile, or contact the insurance adjuster’s manager by phone, letter, or both to express your concerns.

    You are correct about your policy not addressing matching but the policy does indicate it covers “direct physical damage” and if your floor is not damaged, they will only consider what is damaged.

  320. July 9th, 2010 at 9:31 am #Mr. Smith

    What happens once an insurance company denies your claim? Are you responsible for any funds that they paid on your behalf? I.E. Living expenses?

  321. July 9th, 2010 at 2:16 pm #Jason

    Mr. Smith,
    That is a very good question. If it is a matter of the insurance company paying for living expenses and lodging from a fire that was being investigated which may be one of the primary reasons for payments being advanced before a coverage determination is made, then it may depend.

    It may depend upon their finding of arson, for example. If that is the case, then they may ask that money is repaid.

    However, if their conclusion is that the premium was not paid on time, and coverage is denied because coverage lapsed, then they probably would not ask that money is repaid.

    For both examples, the insurance company probably won’t ask the money to be repaid or initiate suit to recover the money they advanced especially if the amount advanced is a small sum.

  322. July 16th, 2010 at 4:17 pm #Andi

    Our finished basement was destroyed by water due to some very wet weather this spring. We received a nice settlement. We suspect that the adjuster was very sympathetic, as we had just moved into the house and there was a lot of damage. He even “threw in” a wind damage claim to help cover some of the expenses since we had maxed out the water damage claim. We saw this as an opportunity to really maximize the basement’s potential, since it appeared that no one had given it a thought since the 70′s. We hired a great contractor to replace the damaged walls, tile the bathroom and patch the fence (wind damage claim) and we bought new carpet from Lowe’s. I am painting myself. I’ve had our contractor who is also a plumber and electrician do other little things for us in the basement, like install shelving, help fix electrical issues, etc., but we’re still coming in under the claim amount. The house needs a lot of work. Would it be appropriate for us to use the remainder to retile our kitchen floor (which is a disaster) or replace our front and back doors? (The adjuster’s report included replacement doors for the basement. They turned out to be fine. So could these be “the doors”?) We also have another bathroom with major issues that really needs to be overhauled. Our mortgage is with CitiMortgage. They seemed to indicate to me a while back that they didn’t really care what we did with the money as long as it went into fixing the basement and enhancing the property in some way. Is this the case? If not, what will happen to the remainder of the money? It would be such a shame to lose it.

  323. July 18th, 2010 at 1:29 pm #Jason

    Andi,
    This is the way claims should be settled so people can fix what is damaged without skimping along the way. If your mortgage holder is flexible in what you are doing, then you should be fine with your plans to fix and update other parts of your house. The insurance company accepts that your damage was outlined in the estimate by the adjuster and that is what your claim is based upon. There is nothing preventing you from fixing your damages for less than the amount allowed because you appear to have hired workers in an economical way and you are even doing some of your own painting so there is nothing inappropriate for you to be compensated for your time and labor. Good luck with the updates.

  324. July 18th, 2010 at 1:59 pm #kara

    Hello,

    Could you tell me if it is standard procedure for an insurance company to do a background investigation after a total loss fire? Also, what do they look for? We do not have any kind of criminal history whatsoever, but we do have negative credit. How does a negative credit history affect the claim?

    Our home was a total loss…burned so badly that the fire chief, fire investigator, SBI & even the insurance company’s investigator were not able to determine the cause.

    They did speculate on possible causes and location of where the fire started….none of which pointed to arson. We were also out of town at the time of the fire.

    All investigations (fire dept., investigator, SBI) have been closed except our insurance company’s.

    Thanks for your time and response.

  325. July 19th, 2010 at 9:30 am #Jason

    Kara,
    Yes, a background investigation is standard procedure if the insurance company believes it is necessary. What do they look for? That would be any type of situation where it would be advantageous for you to burn your house or have someone do it for you. A background check may be vague and involve a review of your criminal record and credit history or may become more involved to include interviews with your neighbors, family, friends, and/or co-workers.

    These interviews by these other people are not required by law or contract but many people provide information freely because they believe it is important. If the investigation does not reveal new avenues to uncover, it should be completed rather quickly.

  326. July 21st, 2010 at 3:23 pm #Public Adjuster

    Jason; referring to Suzanne’s post regarding matching tile.

    I don’t entirely agree with your position. It depends on the policy and the regulations in that particular state. In California (and many other states) for a replacement cost policy the carrier would most definitely owe for the floor tile even if it did not receive direct physical damage. The Fair Claims Settlement Regulations in California basically state that the carrier owes to return the property to a “reasonably uniform” appearance. If the tiles matched before.. they have to match when being replaced.

    Even beyond a Replacement Cost Policy – the policies (excluding named peril/acv) are designed so that when the insured suffers a loss – that their property be returned to the pre-loss or better condition without a constant visual reminder that the loss ever occurred.

    I believe in this situation, unless Suzanne has a Named Peril – ACV policy.. that the carrier owes and is in a bad position.

  327. July 22nd, 2010 at 6:34 pm #Jason

    Public Adjuster,
    Thank you for your input; I appreciate your post. If Suzanne’s policy is the most liberal one available, that is what we have to assume because that practice is followed in many states and not just California.

    If the wording is “reasonably uniform appearance” then that would mean just what is says but this wording isn’t a black and white variable. I do not disagree. I merely indicate that term for the situation she describes could fall into the category of replacing all the tile including the floor or simply replacing the tile of the property that is damaged. If I was adjusting this claim, I would replace it all. The problem is the the position has been made that they believe that the property can be replaced to a reasonable uniform appearance by not replacing the floor (the floor is not damaged).

    The nick-picky position that they seem to be holding is that the tile surround or step is just that, a tile surround and/or step and is not the floor – but simply a tile surround and/or step.

    Although I believe this could and should be settled to the satisfaction of Suzanne because she paid for the coverage, the insurance company is not necessarily in a bad position because it is very difficult to change the perspective of the insurance company unless a judge would indicate that it should be changed. If this is a California claim, perhaps there is a method to dispute the insurance company position short of a legal action.

    An approach that has been used frequently is the “line of sight” perspective and it is based on the principle that at any given moment a slightly different shade of shingle color on a two connecting roof slopes, for example, cannot be distinguished because of angles, light direction, and visual perception differences. It is an approach that can apply to many things.

  328. July 23rd, 2010 at 9:59 am #Public Adjuster

    Jason,

    In CA the “line of sight” doctrine has been tossed out in lieu of the “reasonably uniform” appearance. In Suzanne’s case she states that the wall tile and shower step touch the floor. The insurance company is aware that the contractor cannot get a matching tile so they are demanding that she pick out something similar. Similar is not reasonably uniform. They are asking her to alter the visual appearance of her property under a covered loss just so they can save a few bucks. There are so many factors that weigh against the insurance company in this situation – this is why I stated they are in a bad position. I’m not talking bad in the sense of legal action. I can’t imagine this is something that would ever see the light of legal action. What I mean is that their position has no substance.

    If their position was solid – then they could ahere to this position on all claims that for instance involved 10 square feet of damaged tile in a 3000 square foot house – only replacing the 10 square feet. I have successfully fought these cases time and time again even with 1 broken tile that could not be reasonbly matched. In fact, in a case we are working on right now the carrier actually wants to remove 1 broken floor tile, take a floor tile from under the stove, move it to where the broken tile was, and then replace the one under the stove with a “similar” tile.

    While I agree that is what I might do if I didn’t have insurance and wasn’t filing a claim, the carrier doesn’t have this right. They have the right to repair or replace – but not the right to alter the property.

    My recommendation to Suzanne parallels yours; speak with the supervisor, have the contractor speak with the supervisor, and if that doesn’t work then ask for the claims manager.

  329. July 24th, 2010 at 9:47 am #Jason

    Public Adjuster,
    That is great that we agree on the approach to this matter involving Suzanne. Just like your remedy, I would replace the entire floor as well because I would not want Suzanne calling my supervisor or claim manager. Claims should be “settled” and that means both the insurance company and the customer agree about all the issues rather than forcing it upon someone.

    Now in your comparison with 1 damaged tile or 100 sf of damaged tile, it is likely that tile was all on the floor and that would change the appearance of the floor so I buy into that every day.

    Let me just say this. I understand the adjuster’s position that the wall tile and shower step are not part of the floor and to address what is damaged and what is not. I don’t agree with his position that he should not include the floor as well since it is easier to pay for the floor and close the claim than it is to not pay for the floor and keep the claim open with calls to supervisors and managers.

  330. July 27th, 2010 at 2:58 pm #Celena

    My home was built in the thirties and has a cinder block and brick foundation. Last week, torrential rains caused a “sudden and accidental” build up of water pressure behind the foundation and it blew a six foot wide hole in the foundation.
    The insurance company has denied the claim because it was “water pressure” from the saturated ground and the inadequate foundation wall. How shall we proceed.

  331. July 28th, 2010 at 10:48 am #Public Adjuster

    Celena,

    Set aside the fact of the inadequate foundation because if the foundation served its purpose for 70 years and would have continued serving its purpose for another 70 then the insurance company is just throwing that in there to try to bolster their denial. Generally speaking damage from pressure exerted on a structure by water, tree roots, earth movement etc. is excluded from coverage. However, there may be an extremely remote chance for coverage if there are any other factors that contributed to the loss. The best way I can explain this is by giving an example of another claim that I covered as an adjuster for an insurance company many years ago.

    A homeowner files a claim for exactly what you filed for. The insurance company denies the claim for same reason. I review the claim file and interview the homeowner. During my interview I note they have lived there for 15 years with no problems. I also note that about 100 yards from their home is a fire hydrant that had been damaged. I asked them about this and they stated a car had struck the fire hydrant a few weeks prior. Further investigating this I realize that a channel had been created by the flow of water from the fire hydrant that led right the home. So, when the torrential rains came it allowed the rains to be diverted to the house and cause severe flooding in the home. I overturned the denial and covered the claim.

    So, you need to think if there are any other factors that may have contributed to the loss occurring which set the chain of events in motion which would not otherwise have occurred. Such as, was the city working on the street nearby, was there a recent fire in the area that burned away the vegetation, did a neighbor do construction on their home that caused water to be diverted to your home, were the drains clogged because a tree trimmer cut trees and left the branches in the drain… etc. etc. etc. Like I said, it is REMOTE that your claim will be covered. Very REMOTE. But it’s worth you taking the time to think about other factors.

    If not, then unfortunately we all must realizes that there are exclusions in a policy and not all damages are covered whether or not they are sudden and accidental.

  332. July 28th, 2010 at 6:46 pm #Jason

    I happen to concur with Public Adjuster. Good luck!

  333. July 29th, 2010 at 5:43 am #f. michael conte,CPIA

    to PA

    excellent comments one of the reasons i enjoy reading this blog it is always informative.
    fmc

  334. July 29th, 2010 at 7:53 pm #Jason

    If anyone has any general insurance questions that relate to this site, you are welcome to post your questions and we will certainly provide you with the insight we have. My brother had his sump pump that did not click on during a heavy rainstorm and filled his finished basement. He had no idea it would be covered by his insurance until he talked to me about it and I gave him the insight that in many insurance policies, that coverage is not there unless the additional coverage is provided through “water, sewer, and sump pump overflow. He simply read his policy and found that it was not covered but did not read the additional riders he had on his policy. We reviewed his entire policy and he did indeed have that coverage, limited to $5000 and a $500 deductible. Instead of him dealing with the situation by himself, he was able to get a restoration company to deal with it and he paid his deductible and all was taken care of to his satisfaction.

    The homeowner policy is not an easy read and my brother works in the construction business, not insurance so he had no idea what is in his policy and unless something happens, he really doesn’t care.

  335. August 6th, 2010 at 7:17 am #Ruth

    I have had recent hail damage. There is water damage to the living room and the family. The insurance company is holding back coverage citing “overlapping claims” from 1998 and 2002. I cannot remember the 1998 claim, but am certain that that any work related to the claim was done. I do have receipts for work done, but not all was contract work. I probably can substantiate the work being done (once I receive a copy of the claim that is referred to), however I am wondering if the insurance company can ask for that. There is no reference in the policy of anything of that nature and when I asked the adjustor, he outright said that it was not in the policy, but that the state of ND concurs with their position.

  336. August 6th, 2010 at 3:15 pm #Public Adjuster

    Ruth,

    This should be fairly simple. An insurance company should not be required to pay for damages to an item more than once. I think we can all agree for example that if they paid you to replace your flooring in your living room from a prior loss, and you didn’t do it, and you suffer damage to the same exact flooring again, well… there hasn’t been any additional loss.

    With this being said, if the insurance company is stating that you failed to make repairs from a prior claim, have them pull the file along with the photographs from that file, and prove it. If the damages are exactly the same – for instance… same stains on the ceiling, walls, same flooring.. then there you go… they made a correct decision.

    Carriers were generally working with paper files back in 1998 – so chances are they archived the ’98 file and the adjuster didn’t see those photos. But in 2002 carriers were jumping on board with electronic files and it is a high probability the adjuster could see those photos and reproduce them for you fairly quickly. So ask to see them. If they cannot produce them, and you are reasonably certain you made the repairs, then let the adjuster know that the burden is not on you… it’s on them. Just because you didn’t save receipts for 8 years doesn’t mean you didn’t do the repairs. I think it’s unreasonable to request receipts from 8 – 12 years ago. People suffer damages in the same areas often. Water from a roof often runs to the same or similar low points. But I suspect that the adjuster has the photos and if he/she was diligent in their investigation of the claim would have reviewed those photos.

    Also, look through your own photographs from a year or so ago. You must have photographs of your living room during a birthday party or the holidays or something. Confirm for yourself whether you did the repairs and if so, then show the adjuster.

  337. August 6th, 2010 at 9:05 pm #Jason

    Ruth,
    The insurance company simply does not want to pay for the damage twice. If they paid for the damage in 98, they don’t want to pay for it again if it was not repaired or replaced from the last claim. If the same property was damaged again and they paid for it already, then they have met their contractual obligation, even if there was no need to replace it after the damage from 98 (since damaged property will still function or service it purpose even it was visually damaged or suffered a reduction in it’s serviceable life). If you have the receipts and documentation for the repairs or replacement, you should be fine.

  338. August 11th, 2010 at 6:30 am #Heather

    We had a small flood in a carpeted room. When we pulled back the carpet we discovered damage to the hardwood floor underneath.

    Adjuster says that because the hardwood was covered it is an “abondoned surface” and repair to it is not covered (they will pull it out and put in plywood and carpet).

    Also – there is still a musty smell in the room even though they say it is all dry.

    Any advice?

  339. August 11th, 2010 at 8:33 am #Maggie

    Hello-

    I just experience a water damage due to clog aircondition pipe in my attic. It was an old system that was build in the attic. I am concern now that celling damage are escalating to 7 days drying and removal of small portion of the celling foundation (plank) and plaster. The adjuster did not confirm if the damage is cover or not the damages, at this time they just recommending contractor to look at it and determine the cause of the leak. Which it did – clog pipe and blockage. The adjuster did not came into my house to even look at the damage. Yet, they been nice to accommodate us for hotel stay because of the noise in the house and we are not able to get a decent sleep. Its confusing us –

    Because of the work will take 3 – 6 weeks, would the insurance pay for all the loss wages? I am skeptic allowing people coming and going without us being home. I have so many question – the BIG IF something happen / loss / damage and what else can go wrong. What will be the insurance do / I also have alarm which will be disconnect while people and coming and going. “would I need to let them know?

    Questio:
    1Would clog pipe that cause the water damage are covered benefits?

    2Would the Insurance pay for loss wages – FYI they told me that they will not reimburse me for any loss wages due if I stay home while the house is in
    construction.

    3What should I spect if I use a lock box key. Letting people come and go without us being home. Which I am back to the BIG IF -

  340. August 11th, 2010 at 3:31 pm #Public Adjuster

    Heather,

    That’s a popular tactic by the insurance company to consider the flooring below carpet “abandoned”. I don’t agree with them. The reason is because many times I see people move into houses just like yours, pull up the carpet, and re-sand the wood floors, finish them, and they look fairly nice.

    To put back plywood where there was once wood floor is not the way you had it. What I would agree with is to replace the wood floor where damaged with the same floor.. sand the surface, and seal it. I don’t believe they owe to “refinish” the floors to a perfect condition, but at least put back what you had. Explain to them that doing the repair their way doesn’t put you back the way you were and removes the option from you if you ever wanted to pull up the carpet and refinish it which is a common practice.

  341. August 11th, 2010 at 3:39 pm #Public Adjuster

    Maggie,

    The claim should be covered assuming you have a standard homeowners policy. Most policies cover a sudden and accidental discharge of water from within a plumbing or heating/air conditioning system.

    The insurance company does not owe you for your lost wages. Damages to your home is unfortunate, but it is your home and it is going to take some time and effort on your part. Your homeowners policy is not related to employment/business.

    I assume they have paid you enough to allow you to hire a general contractor. You should hire a very reputable contractor that is willing to complete the work for the amount that the insurance company has paid. Check references, speak to others that have used the company, and so forth. This should cut out the need for you to have to be home while workers are there.. and also ease your mind about having a lock box on the door. All security systems that I am aware of allow you to change the code or even allow multiple codes. Give the contractor a code and he/she should be responsible for opening up and securing the property each day.

  342. August 11th, 2010 at 7:07 pm #F MICHAEL CONTE

    Heather,
    I have never heard of such a thing. insurance contracts are contracts of indemnity, that means they need to put you back into the position you were in prior to the loss. therefore if they take out hard wood and reinstall plywood your are not in the same position and therefore not indemnified.

    Please tell the readers who is doing this to you and what state you are in, also, please read your insurance contract, and i believe you will find wording that says “repair or replace with like kind and quality”. as for the musty smell have you hired a clean up crew or did you do it yourself? if you did not hire a clean up crew perhaps it is not too late. this should also be covered by insurance. and finally please ask you agent to get involved and guide you accordingly, this is why he/she earns a commission (you might need to remind them of that).

    good luck and let me know how you make out.
    f michael conte

  343. August 11th, 2010 at 7:14 pm #Jason

    Heather,
    The hardwood floor is technically the underlayment and the adjuster is correct about that. The top layer of the floor is the one that is being used and apparently the hardwood was abandoned for the carpeting on top.

    If the remedy is to remove the hardwood and carpeting to replace it with a new subfloor and carpeting, that should take care of the issue involving the musty odor.

  344. August 11th, 2010 at 7:24 pm #Jason

    Maggie,
    The situation sounds like it would be covered because it escaped from a plumbing system and air conditioners do have a drain on them for the water that condenses in the unit.

    Insurance is there to pay direct damage. I don’t have a solid understanding of your lost wages but it is very unlikely that lost wages would be considered by any insurance company.

    There is a certain amount of trust you have to have in the contractors that are doing the repairs to your home. If something happens, then that would be another issue you have to deal with. It is very difficult to answer what-if questions because there are so many what-ifs that the answers could go on and on.

    I will address two what-ifs. The first being the contractors doing an inappropriate job or repair and then that would have to be a claim against the contractor since your insurance policy likely excludes faulty work by others. The second would be if a contractor stole some valuables from your house. If that happened, you would be dealing with a theft and that is not a direct action to your water damage so it would be another claim and subject to another deductible.

  345. August 12th, 2010 at 7:50 pm #Jason

    Dear moderator,
    Please note that our answers are very similar in context. Can you please allow the comments to pass through without moderation review because I would not be answering the questions if I can see that others have already posted their answers? Thank you.

  346. August 13th, 2010 at 5:29 am #Maggie

    Thanks – because I will be dealing with 3 different company to fix the damages in the house, I will be making sure that everything I condisered deem important will be lock up and pray for the best.

    Thank for your advice, I do love this site for all insurance muble jumble confusing information, just for the sake of being covered. :)

  347. August 13th, 2010 at 6:02 pm #Jason

    Maggie,
    I hope the damages are fixed to your satisfaction. The world of insurance can be a rough world and it seems to be stacked in the favor of the insurance companies at every turn and curve. Information and knowing what they can and can’t do is the best tool to deal with them when the time comes for a claim.

  348. August 14th, 2010 at 12:32 am #admin

    Jason,

    So sorry for the delay. Excellent suggestion regarding pass through of your comments. We hope to be able to do that for you and the other active contributors very soon. Your contribution is most appreciated. :)

  349. August 17th, 2010 at 7:11 pm #admin

    Jason,

    Comment pass through is now set up. I think activity may be down the last few days due to “back to school” activities? Thanks for your patience.

  350. August 17th, 2010 at 8:28 pm #Jason

    Admin,
    Thanks for the pass-through on our comments. That will help a lot to prevent duplication because the answers are very similar from a lot of us posting. I really appreciate you having this site available for the people who are having issues and concerns with insurance companies.

  351. August 23rd, 2010 at 1:14 pm #Marti

    My son had an arson charge dropped and was charged with criminal damage (which unintensionally caused a house fire) in a neighbor’s house. We were told that our home owners insurance would pay the claim as long as there was no arson charge. Can they still consider a charge if it was dropped. Before I make a claim, I need to be certain that arson cannot be considered since we could loose our insurance. Thanks for your help.

  352. August 23rd, 2010 at 8:33 pm #Jason

    Marti,
    That is probably a very good question for an attorney to address. You really would need to provide more information for that to be address with any accuracy. The insurance company does not charge arson nor criminal damage. There are no certainties in life when it comes to arson, criminal damage, etc. A claim can be denied for arson though. If arson is proved, that can be a reason to deny a claim but we don’t have enough information about your circumstances and it can be rather complicated. If you lose your insurance, then that may be something out of your control no matter what if it involves arson or something similar.

  353. August 24th, 2010 at 7:16 am #f. michael conte,CPIA

    Marti,
    you need an attorney as stated previously. there is wording in the contract that speaks to criminal acts, my spin is there is never coverage for a crimianl act as it would be against public policy.

  354. August 24th, 2010 at 10:27 am #Marti

    Thanks for your input. Some details I did not state:

    We have State Farm as well as the victim. There was a State Farm lawyer in the restitution hearing for the victim’s damages. We negotiated on an amount. They found out that we owned a home and also had State Farm and we were told by the judge that we could submit a claim and have St. Farm pay it. We decided not to pursue this until we researched further so we told the court that we would decline to submit to our insurance for now. I called my local insurance rep and she put in a call to State Farm to get more details. She told me that because we have been good clients for over 10 yrs., that they would pay the claim without raising our rates provided the charge was criminal damage. They said if the charge was arson then they would still pay the claim but immediately cancel our insurance and we would most likely have a hard time replacing our insurance through another company. Like I mentioned, the arson charge was dropped but it still remains in the records for the attorneys to view. I don’t believe they can legally consider it and can only consider the actual charge of criminal damage. I am currently awaiting a call from my son’s attorney to see what she may know about the legal implications of this.

    Thanks again for your input. It is much appreciated!

  355. August 24th, 2010 at 3:29 pm #Jason

    Marti,
    Thanks for the additional information. It seems that a criminal damage charge (or conviction) requires the “intent” of the person doing the damage. otherwise it would be called “accidental damage” and would not be a crime involving a prosecutor. The insurance contract does not cover criminal acts or intentional acts, just fortuitous and/or accidental acts. Arson is an intentional and criminal act just as criminal damage to property is a criminal act. I don’t understand how criminal damage is unintentional so this one is probably best to be handled by an attorney.

    If you are concerned about losing your insurance coverage, your insurance company, State Farm, already is aware of this situation whether a claim is filed or not so you have to weight the pros and cons of submitting the claim including the amount you have to pay for settling, being reimbursed, or hoping the best happens from the entire situation.

    Something gives me an idea that State Farm will pay regardless if you make your claim or not. If this was intentionally committed by your son, State Farm may seek restitution or subrogation from your son for any amount, if any, State Farm pays for the damage.

  356. August 26th, 2010 at 2:15 pm #Ron

    I am preparing a homeowners claim after being broken into. Any advise on how to get the value of things missing or broken. Before I even made a claim I got a letter from Kemper Insurance saying they may drop me……. sad isn’t it?
    Thanks in advance.

  357. August 26th, 2010 at 6:53 pm #Jason

    Ron,
    The advice about the valuation is make a list of the items stolen or broken and find out the cost of these items new. Then on the same list, determine the age of the items. Everything has a useful life. For example, if you have a television that was stolen and it was 3 years old and cost $500 when new, you would determine its value by subtracting the “used” portion to come up with a value of the television. In this example, a useful life of the television is 8 years so 3 of the 8 years are used up and there was 5 useful years of value left.

    Simply take 5 and divide it by 8 to come up with 62.5% of the television’s value was left ($500 x .625 = $312.50).

    This is a common approach that many adjuster’s and insurance company’s use. Of course, the television you purchased for $500 three years ago may cost $400 today so the valuation would be a little less. Good luck.

  358. August 27th, 2010 at 7:50 pm #Lori

    we recently had a water pipe break due to a frozen pipe in our basement. Before the water main could be shut off, our treadmill, a flat screen monitor, remote controls and other electronics were soaked. They did not sit in water, but the water ran through them. Our adjuster says that as long as they still start up no claim will be made because they still work. Is this right? In our opinion, if we try to sell the equipment, we will need to reveal they have water damage, thereby reducing their value.

  359. August 27th, 2010 at 8:54 pm #Jason

    Lori,
    Keep up your insistence that these items are damaged due to the water incident. If remote controls were in water, that only makes sense that they would be damaged or corroded in some manner. The treadmill’s motor is at least a few inches off the floor and that seems to be the only thing that would be affected on the treadmill. The flat screen monitor, if subject to water, may interfere with it’s performance. It is hard to imagine the flat screen monitor being affected by water since most people have those at an eye level height. Perhaps the water sprayed or was dripping down the wall that the flat screen monitor was mounted. I don’t know the details with the information provided. If you sell the equipment, you don’t have to reveal water damage if they don’t have water damage. Not all things exposed to water will be damaged just by the exposure to water.

    Avenues you have available to you include discussing your concerns with the claim manager of you insurance company or simply having an electronics repair person inspect the items of concern so you are at ease that they are not damaged, or so they can provide their expert opinion that the items were affected and/or damaged by water exposure.

  360. August 28th, 2010 at 11:37 am #F MICHAEL CONTE

    Sorry no claim.
    Who is buying used flat screen tv’s, they are almost giving them away now.
    Be thankful they work and get on with your life.
    Enjoy!

  361. August 29th, 2010 at 8:18 am #josh

    I have extensive water damage in my house. Allstate has sent the remediation service and they have so far taken apart approx. 50% of my house.

    There were personal items that were affected and some are a no-brainer destroyed. Some I am not sure. Specifically, I am concerned about electronics.

    I have a tube tv that had water and dry wall on top of it. The TV may still work (dont know yet). My concern is water is inside, and corrosion could take place a year from now and it wont work then. So is the TV (or stereo, or Wii) covered or will I have to accept it isnt covered if it works now?

  362. August 29th, 2010 at 9:37 am #Jason

    Josh,
    Discuss your concerns about the tv, stereo, and Wii with your adjuster.

  363. September 7th, 2010 at 10:04 am #Maggie

    update – my house is turning out to be a war zone after the water damage. I found that my insurance have a PSP programmed that helped me to elevate all the worries. Through State Farm, if you have home damage – they have PSP programmed that if you hire the water remediant/contractor/flooring/windows all this service and they are participating the insurance program, they help you out with you processing of the work. This give the insurance a guarantee work and contractor will not get paid until the job is done, and the homeowner is satisfied of the job. The payment however will be made direct contract and not to me and the job has a warantee of 5 years after the work is completed. Everything is in detailed and so far I am very satisfied.

  364. September 7th, 2010 at 11:05 am #Public Adjuster

    Maggie,

    “elevate” or “alleviate” all the worries? Based on your last sentence it seems that you are satisfied so I assume you mean “alleviate”.

    I am very familiar with State Farm’s PSP (Preferred Service Provider) program. If it is working out for you then that is great. However, I have run into many situations where things were not so great for insureds and I would never recommend going this route to a client until AFTER the claim has been settled.

    On one particular case through my office a PSP contractor estimated the water damages at approx. $8,500.00. We assessed the loss and settled the case at $183,000.00 with State Farm. I later met the contractor on another claim and asked him how in the world he missed it by so much. His response to me was that he didn’t believe they were going to get the job so he just whipped through his estimate. If they did secure the job then he would just supplement the claim by “discovering” hidden damages.

    I say this because it is important to have your loss properly assessed by a professional and not leave it up to the PSP contractor. There is no reason why you can’t hire the contractor after the fact. If you hire them up front, then in my opinion you are not making an informed choice as a homeowner with all of your options available to you.

    I realize the case I refer to is a little extreme, but this situation arises all the time on some level for a variety of reasons. Especially if a PSP contractor is lowballing so that it essentially forces the insured into using them. Many may not believe something like this would happen.. but it does! And then after you sign and go with them, the PSP contractor is supplementing a claim for much more money then the original quote was. I believe this is unfair to a homeowner because had they known the “full value” of the claim then they may have made different choices having more options available to them.

    Being knowledgeable is the key. Always get all information, make sure you get the loss properly assessed by someone other than your insurance carrier, and then make an informed decision.

    With that being said, I am glad your repairs are going well and you are satisfied.

  365. September 7th, 2010 at 12:19 pm #Maggie

    Now that you put the doubt back into my mind, I will contact my adjuster and make sure the contractor did not jack up their price. Thanks for the warning…

  366. September 7th, 2010 at 12:46 pm #Public Adjuster

    Maggie,

    I certainly didn’t intend to put doubt in your mind. If things are going great – then awesome. The intent of my message is to make people aware that they should be fully informed of what they are entitled to BEFORE they begin making decisions with what is most likely their most valuable investment. Doing this would involve having an alternate assessment done by someone that is knowledgeable in construction as well as insurance policies. I would imagine that a good PSP contractor would appreciate this approach making sure that all damages have been recognized.

  367. September 9th, 2010 at 11:45 am #Joe

    We received an insurance claim check made out to me and the mortgage company for water damage to the kitchen hardwood floors. The bank said they will hold the check in escrow and pay the contractor directly. The insurance adjustor assumed that all the hardwoods on the first floor should be replaced to ensure all the floors match.

    We are considering replacing the kitchen wood floors with ceramic tile. Per square foot about the same cost but the area would be contained only to the Kitchen. The tile would be much better suited for a kitchen in terms of durability and less susceptible to water damage.

    Since there is less square footage to replace; the total price will be less. Am I entitled to keep the balance?

  368. September 9th, 2010 at 12:51 pm #Public Adjuster

    Joe,

    Over the years, especially with many people being behind on their mortgage or in foreclosure, the mortgage companies have become tougher and tougher about releasing money. I deal with this issue on a daily basis.

    The bottom line is that they want to see that the house has been repaired and they are not left holding the bag on a damaged home if someone were to default. They will more than likely want to send an inspector out to verify the home is in good condition after the repairs have been done.

    Your question is in one of those gray areas. You’re not entitled to profit from a homeowners claim. So, “keeping the balance” for profit purposes say to go on a vacation or something.. no. Do people do it? Of course. But, you are entitled to keep the money and apply it to other areas of your home (e.g. paint/new countertops/etc. etc.)

    But, I have to caution you on future matters. The insurance company paid to replace your hardwood floor throughout. It seems like you are only going to replace just the kitchen leaving other areas as is. 1. If you have a similar loss again… and it damages the now undamaged areas.. they are not obligated to pay you again. 2. Although probably not significant, you may be waiving any depreciation withheld on the flooring that you would have been able to recover otherwise.

    There is nothing saying you have to make the repairs as outlined in the adjusters estimate. However, your mortgage company may take issue with this. If they do, then that becomes an entirely different battle in and of itself.

    Hopefully others are able to provide their opinions on this matter.

  369. September 9th, 2010 at 9:09 pm #Jason

    Joe,
    The insurance company paid to match the undamaged portion of your home but they have settled your claim in the way that they have and if you wish to do it another way like you suggested, then you can do that.

    If you have another claim for the undamaged floor that you left as wood, that would be an entirely different claim and in no way related to your current claim. As for the prior advice that indicated the insurance company is not obligated to pay for the now undamaged areas, that is not entirely correct. In fact, you would be fully insured for the tiled and the wooded areas and there would be nothing held against you in the form of depreciation based on what you do with this claim. The insurance company insures your property for replacement cost and if you do not replace undamaged material, you are fully covered and your choice to make a matching decision different from your claim proceeds is perfectly ok to do.

    Your choice of repairs for damaged areas does cause you to waive any depreciation withheld or considered.

    I agree entirely with Public Adjuster on all other parts of their advice.

  370. September 9th, 2010 at 10:31 pm #Public Adjuster

    Jason,

    That is not what I understood Joe to say. He stated the adjuster paid to “replace” all the wood floors on the first floor so that they would match. Now, rather than replace them.. Joe wants to tile the kitchen but leave the remaining wood floors alone. If he has another claim.. with the same insurance company.. they do not owe to replace them again if he chooses not to replace them now. Although that portion of the floor did not receive direct physical water impingement.. it was continuous with no effective break or stopping point. So the adjuster paid to replace those areas also to achive a reasonably uniform appearance throughout. Joe is taking advantage of the situation by only replacing the “damaged” portion which is the kitchen with a different flooring obviously breaking it at a doorway. With your train of thought, Joe could have a water loss in each room and have the insurance company pay for the “continuous” flooring over and over again multiplied by the number of rooms he has on the first floor. So, lets say the dining room is damaged next… he replaces that with tile but you say he is owed for all the wood flooring again minus the kitchen. Then the next loss he is owed for all the wood flooring again minus the kitchen and dining room.

    I stand by my original advice that if he does not replace the flooring now which they have paid for, and he has another similar claim that involves the unreplaced wood flooring, they will reject his claim for the overlap. Obviously that is if the adjuster pulls the previous file and confirms this. If not, or if he switches carriers, then the chances of getting paid twice on for the same item are pretty good.

  371. September 9th, 2010 at 11:06 pm #Jason

    Public Adjuster,
    Thanks for you input.

    Joe is taking a matching “hit” by going with tile instead of going with a continuous match of the wood floor. He is not required to replace undamaged flooring if he can accept the “match” issue.

    I do say that Joe is welcome to do his proposed plan and it will be repaired to a pre-loss condition without replacing the undamaged flooring. Joe doesn’t need to be concerned with the unrealized depreciation that you have mentioned because it won’t concern him if he has another loss involving the flooring because the insurance company will look at a new situation if there is now tiled flooring and wood flooring. The continuous nature of the wood floors is being eliminated by his repair resolution and he will be fully insured for tile flooring and the wood flooring that is adjacent.

    I stand by my advice that the insurance company will not settle a future claim by holding this over his head. If an insurance would pick a battle over something this trivial, then perhaps their claim settling methods should be reviewed and refined so they don’t merge current claims with prior claims that have already been settled but not done exactly as outlined in their settlement estimate. Reading too much into this would be a disservice to Joe, who posed the question.

    Since Joe’s original question inquired whether or not he is entitled to keep the left over funds if he makes the correction to the damaged flooring by doing a tile floor instead of full wood floor replacement, I think we both agree he is entitled to keep that extra amount if not used in his method of repair since he is ok with the match issue between tile and wood. I also think we both agree that it is reasonable not to replace undamaged flooring if he can endure a flooring surface change that is acceptable. Joe also shouldn’t be concerned that the insurance company won’t pay for flooring that may become damaged in the future because the insurance company will pay for flooring that may be damaged in a future loss. Losses are considered fortuitous and if damage occurs to either the undamaged flooring or the replaced flooring, the flooring is nevertheless undamaged prior to any future loss.

  372. September 14th, 2010 at 8:24 pm #steve

    I signed up with a new insurance company for my rental unit on the same day we had a torrential rain here in Wisconsin. W had 7 inches of rain in 1-1/2 and our flat roof caved in and all the water rushed down into the units below. They are denying the claim because they found a football stuck in the drain for the downspouts and that’s what caused the water to back up and the roof collapsed from the weight. I had no idea it was up there, can they do this?

  373. September 14th, 2010 at 8:38 pm #Jason

    Steve,
    I don’t know what exact policy you have for your dwelling unit and unless that is known, it is difficult to address. Is your insurance company denying because coverage did not exist at the time of the damage? Is your company denying coverage because there is no peril that provides coverage for the damage? Is collapse from the weight of rain or water excluded? Do you know the form number of your policy such as DP-1, or HO-003 or similar to this? This information can be found on all pages of your insurance policy. That may be helpful if that information was known. Thank you.

  374. September 20th, 2010 at 3:52 am #Chris

    Back in March of this year i was making a delivery to a residential home and ended up being bite by the homeowners dog in his driveway. I had a significant bite to the left underarm area, and was clawed on the side of my chest. I was able to drive my truck home that evening, though it was very painful. As soon as i got off work i went to a local patient first. they gave me a tetunus shot, and cleaned up my injury. I didnt need any stiches or anything like that however 6 months later and i do have 2 scars from the teeth of the dog. Puncture marks from the dogs teeth. After having to run around and get medical release forms from patient first and print photos of the dog bite to the insurance compnany they have offered me 1250.00 for my bodily injury. Since i did miss 2 days of work they will cover that also but its a seperate check with workers compensation. I felt that 1250.00 was a bit low initally. What are my options, can i argue for more, or is this a fair amount? Ive never been through anything like this so i dont know whats a fair offer and whats not. Thanks you for your time.

  375. September 20th, 2010 at 5:41 am #Jason

    Chris,
    You questioned if $1250 is a fair offer. Based on what you indicated, the review of your claim is based on your pain and discomfort, scratches/scars, lost wages, and medical bills directly related to this incident.

    An adjuster is there to facilitate the settlement of claims and they review each claim based on it’s merits. They also review prior claims similar to yours and base their offer of settlement using the prior claim settlement numbers as a guide to know what amount is fair.

    Only you can determine if the amount they offered is fair. If you don’t, you can express that concern to the adjuster but you should back up the amount you want by explaining how it affected you. For example, dog bite scars on a face will usually require a higher offer for settlement than scars below the neck-line. A scar on a woman’s face will generally settle higher than a scar on a man’s face, for another example.

  376. September 21st, 2010 at 12:07 pm #jan

    I recently moved into an apartment complex that requires renter’s insurance. I called the number that they gave me to obtain the required insurance and was told that the total amount that they would insure for the policy was $25,000 which was not enough coverage for my personal property. The agent helping me, Michelle, referred me to another agent, Andy in her company to see if he could get me more coverage. Andy wasn’t able to help me and when I called Michelle back to let her know, she said that I could get two policies, one in my first name and last name and the other in my middle name and last name. She signed me up for both policies. I met someone out who was experiencing the same dilemma and I told them what I had to do and they questioned whether or not it was legal. I honestly did not consider it when I was talking to the agent because I had so much going on and I just needed to get it done. It was absolutely not my intention to do anything illegal, have I?

  377. September 21st, 2010 at 12:56 pm #Public Adjuster

    I’m not an attorney nor do I claim to be one or extend legal advice. I can give you my opinion based on similar situations and a vast knowledge of the insurance industry. Just an opinion okay?

    1. Stop worrying. You didn’t do anything wrong. I think your agent should be worrying.

    2. Probably let go of the 2nd policy. There are going to be insurers out there that will give extended coverage or add “riders” to raise specific policy limits where needed. For instance, if you need additional coverage for art work, jewelry, rugs, etc.

    If you had a claim where you needed both policies to kick in I would imagine you would most likely get paid eventually. But I don’t think that is the situation you want to be in because it’s going to get weird. I just don’t think you need to be in this situation at all because there are policies out there that will cover you under one policy. Your agent would have some answering to do I would imagine – but basically you did what you were instructed to by your agent.

    But, just get out of that situation. Once a claim is filed and you try to get coverage under both policies it’s just going to turn into chaos. You’re paying for two separate policies – it’s not like you’re trying to be doubly insured for the same items.. you’re just trying to get “full coverage”. It’s just the way your agent is going about it by creating another entity using your middle name making it as if it is your first name. Very peculiar.

  378. September 21st, 2010 at 7:22 pm #K Peak

    I have not been able to live at home due to water damage for a week now. So I have had to board my dogs. Is this something that I can claim as part of expenses incurred due to loss of use?

  379. September 21st, 2010 at 7:38 pm #F MICHAEL CONTE

    Yes it sounds reasonable

  380. September 22nd, 2010 at 9:46 am #Jennifer

    We own an 8 yr old home and have extensive water damage and rot in the entire front door frame (frame consists of side transoms and top transom with double pane glass). Just realized our HUGE foyer window above has rot all along the bottom frame on the inside! Wondering if any of that would be covered with our ins?
    Thanks for any info!

  381. September 22nd, 2010 at 10:04 am #Public Adjuster

    K Peak,

    Yes – you should be able to claim the costs for boarding your pet under “ALE” – (additional living expenses) assuming where you are living now does not allow for pets.

  382. September 22nd, 2010 at 10:14 am #Public Adjuster

    Jennifer,

    Most likely no. Most homeowners insurance policies do not cover things like “deterioration” or “rot” or damage caused by repeated seepage. Read your policy over carefully though. I did come across a policy a few years back that actually did cover “hidden decay”. This was a Hartford Insurance Homeowners Policy. That is the only policy I have ever come across that I have ever been able to get coverage for damages that would be long term in nature involving rot.

    Basically the insurance policy is designed to cover “sudden and accidental” damages and not damages that occur over an extended period of time – whether or not you are aware of them.

    You did state that your home is 8 years old. You may have recourse against the home builder. If the wood has rotted out clearly the leak has been ongoing. Have a contractor/leak expert/roofer inspect the area and determine where the leak is coming from that is causing the rotting. If it is due to improper construction/design – then that may be your best avenue.

    But first read your insurance policy.

  383. September 22nd, 2010 at 2:49 pm #Jason

    Jennifer,
    It is difficult to assess coverage for your door condition especially when it is referred to as “rot” because that is a prominent excluded item in almost every insurance policy. Public Adjuster has a good point in that hidden water damage may be covered if it is hidden and unknown in some insurance policies.

    The only way to determine if there is coverage for the damage is to make a claim and have the insurance adjuster investigate to determine if it’s covered. We are not able to inspect and determine coverage over this forum for you and the only definitive way you are able to know for sure is to make a claim and have the adjuster determine if coverage is afforded by your policy. A good adjuster will look for coverage when presented with the facts of the loss. Good luck in whatever you decide to do.

  384. September 23rd, 2010 at 5:51 pm #Caroline

    Hi all :)

    I have an present claim with my insurance company (nationwide). My whole 1st floor (kitchen, dining, living room) and the basement. At first they were great coming out assessing the damages within a day, actually had someone go through my lost things in the basement and document them, and then asked me is there anything else, at that time my head was so flooded with thoughts, i had no clue what else was covered in this lvl 3 water damage. We were pulling things out of the water and throwing them in the garage at 4 am in the morning. After waiting 2 weeks to hear from them, i called and they said oh were sorry your adjuster is on vacation for 2 weeks?? So i have no choice but to wait till he returns? I called a private adjuster and now he is involved. 2 weeks later the same adjuster is on vacation again?? 2 – 2 weeks vacations within 2 months? (i want that job). Any way i have a questions. The adjuster is negotiating the building part of it. and that is fine. But i also have alot of personal property damage. I also understand although i have RCV, i only get the ACV up front and when replaced, the rest.

    Questions:
    1. I have other items when finally going through things that were damaged, can they still be added? I took photos and all that jazz.( i recieved a check ACV for the items the adjuster saw that day if i deposit that am i giving up any rights for additions?)

    2. Do i have to replace the item with the same??
    For example, I had 2 Jeep cabin tents valued at 299.99 a piece, Fact is we don’t really “tent” camp anymore, we bought a travel trailer a few years back. Do i have to replace the tents with tents or can i buy some other camping item equal to its value? Or like i had 2 tv’s downstairs that were damaged. do i need to buy 2 of them, or can i buy one at the value they gave me for both.

    3. Can I have Like a flooring company do the floors and a general contractor do the kitchen, (cabinets, walls, painting , etc.)

    Thank You so much in advance, I have read through alot of the posts but none really answered my questions. So if i’m duplicating I apologize.

    I want to replace my items I don’t want the ACV cash out amount.

  385. September 24th, 2010 at 9:43 am #Jason

    Caroline,
    You can add other things that were damage. Just coordinate getting those things added with the adjuster. Cashing your first check should not infringe upon you adding additional items.

    Yes, you have to replace the items with the same. If you have a 10 person tent, you could replace it with an 8 person tent, for example. If you purchased binoculars and a portable camping grill in place of the tents, then you would not receive any additional payment.

    If you take the money you received for 2 tv’s and purchase 1 tv, you will be paid the recoverable depreciation for 1 tv, in this example.

    Regarding your question 3: Yes.

  386. September 27th, 2010 at 1:32 pm #Lisa

    I live in Texas adn last week our neighbor’s very large oak tree fell and landed on our house and into our pool. There was nothing weather related that caused it to fall but it had already lost most of it’s leaves so it was probably dead or dying. They contacted their insurance company (State Farm) who told them that they would only cover any damage up to their fence line and that we were responsible for filing for our damages with our insurance company (also State Farm). Their only damage is a tree trunk and part of the trunk in their yard along with a broken fence.

    It looks like we have damage to our fence, roof, gutters, pool and decking in addition to the cost of removing a large tree from the pool and house. When I called State Farm, they said that we would be responsible for paying $1,000 deductible even though it wasn’t our tree or from our yard. Don’t the neighbors have some liability for their insurance to pay for this even if we both are with the same company? I’m not sure why we should be out $1,000 for their tree!

    In the meantime, we are now on the 4th day of having the tree there with no end in site of having it removed since one of their claims representatives told us to go ahead and have it removed (at our cost) and another one said they needed to inspect it. It’s all very confusing and nothing is getting done. Any advice on how to proceed with this?

  387. September 27th, 2010 at 2:15 pm #F MICHAEL CONTE

    lISA,
    IF THE NEIGHBOR KNEW THAT THE TREE WAS SICK OR DYING AND DID NOTHING TO MITIGATE THE SITUATION, YOU WOULD HAVE FIRST DOLLAR PROTECTION, BY PROVING NEGLIGENCE. SINCE THAT APPEARS NOT TO HAVE BEEN THE CASE THE DEDUCTIBLE IS YOURS TO ABSORB. AS FAR AS THE CLEAN UP, TAKE A PHOTO OR TWO AND GET SOMEONE IN TO REMOVE THE DEBRIS. KEEP IN MIND THAT YOUR CONTRACT PROBABLY HAS A DEBRIS REMOVAL LIMITATION, WHICH YOU AGENT SHOULD BE ABLE TO TRANSLATE FOR YOU. ALSO SINCE YOU ARE HAVING TROUBLE GETTING THE STRAIGHT ANSWERS ASK YOUR AGENT TO GET INVOLVED, I AM AN AGENT IN ny AND I DO THIS ALL THE TIME FOR MY CUSTOMERS. FINALLY GOOD LUCK.

  388. September 27th, 2010 at 2:34 pm #Jason

    Lisa,
    F Michael Conte has some good information about your situation. The mere absence of leaves on a tree does not indicate your neighbors are liable for your damage to your property. However, if the tree was dead, decaying, or to the point where your neighbor’s should have taken action to remove the tree but didn’t, then they may be liable for the damage to your property. However, sometimes trees fall without having an outward appearance that they will, especially large oak trees that can crack from their own weight. I don’t know what the tree looked like before it fell but since you didn’t indicate its condition as obvious, the its fall was likely unexpected and unforseen.

    You should take actions to prevent further damage or to protect your property as much as you can, if needed. This would be at your expense and should be reimbursed by the insurance company. If a representative indicated they want to look at it first, simply do what is absolutely necessary before they arrive so they may inspect it first. If the insurance company is sending someone out to inspect, that adjuster may be looking at the tree to determine if the damage to your property should be covered due to your neighbor’s negligence but don’t count on it. Your insurance is there to protect you and it doesn’t matter if the tree is yours, your neighbor’s tree, or one that was blown in from a tornado that belongs to a neighbor 20 blocks away. The insurance covers damage to your property no matter whose tree caused the damage.

    This is one you may want to ask your agent to become involved with because agents are not only there to make sure you have the right kind of coverage, they are also there to make sure things go smoothly when you need your coverage to respond.

    Mr. Conte is correct that there is likely a limit on tree removal so don’t go overboard on this coverage. Make sure you stay within your limits to get the tree debris removed. Now, the coverage for your fence, roof, gutters, pool and decking should be more adequate for the damage that occurred to those items.

  389. September 28th, 2010 at 9:40 pm #Misty

    Recent storm caused damage to my home. This was considered a catastrophic event do to number of homes damaged. My insurance company was responsive and called in asjusters from out of state. They came out and lolled at my house 3 days later. The adjuster called me the day after he was at my house and gave me the results and told me I would receive my check and information packet in the mail. I received the check 5 days later. 4 days later I received a call from someone that said they were with my insurance companies catastrope audit department and they would be at my house within 5 days to review the asjusters estimate and measurements. I have nver heard of this and I talked with several others and no one has ever heard of this. Since on the same day i got the audit call I received a “nice” letter stating my homeowners INS rate was increasind due to claims paid in our state, I’m nervous they are gonna say in the audit they made a mistake and ask for funds back. My roof is scheduled to be replaced in 3 days. Any ideas on what the audit is or what can come of it?

  390. September 29th, 2010 at 9:17 am #Public Adjuster

    Misty,

    This is fairly normal for an insurance company to do this especially when the catastrophe team is called in. Often times the catastrophe unit comprises of independent adjusters that are not employees of the company but rather hired on a temp. basis to assist in meeting the demands of the high volume of claims.

    So, what the insurance company will do they will select certain claims to review on each adjuster which is generally done randomnly and have their audit team review the claim and make sure the adjuster is not overpaying or underpaying. More than likely you will never even hear of the results – especially if they underpaid.

    If there is any recourse to be had, it will be against the Independent Firm they hired. If the adjuster did not measure correctly or if they overpaid something, they could possibly ask for money back from the independent company – but not you. If the adjuster is an actual company employee, then of course the adjuster could lose a bonus or be reduced a pay scale or something like that. But the issue is not with you, it’s with the adjuster.

    You should proceed with the repairs as planned.

    Hope that helps.

  391. September 29th, 2010 at 5:24 pm #Jason

    Public Adjuster,
    Nice job. That answer is better than the one I was going to post. While answering her question, you also provided her with the appropriate amount of comfort regarding the matter.

  392. September 29th, 2010 at 8:19 pm #Misty

    Thank you so much. That really puts my mind at ease. Not only have I been worried about record but fraud also since no one I have talked to has ever heard anything about this. We of course,have several scam companies in town and I was also worried about more strangers around my house!! You guys are wonderful!!! I will also post for a good company. American Family has been great. This is the 2nd cataastophe I’ve been in in 5 years and 2 different homes. They have been quick to respond and have never given me a hassle on the claims!!

  393. September 29th, 2010 at 9:02 pm #grant

    My wood roof was total loss from hail storm. I have paid premiums for 14 yrs to insure wood roof. Roofer estimated new wood roof at approx 17k as did the insurance co. I may decide to go with a less expensive comp roof. They are agreeing to pay approx 13k now and the other 4k when work is done. If I go with the comp roof am I not entitled to the remaining 4k ? I understand the comp roof will be less than the 17k but I have been paying premiums for wood roof. Should I not be paid the cost for replacing with wood even though I am probably going with a lesser expensive comp. Or is the insurance co only responsible for what is put on even though I have been paying for wood replacement. Would that be considered profiting from an insurance claim ? Again I paid premiums for a wood replacement.
    Thanks

  394. September 29th, 2010 at 9:33 pm #Public Adjuster

    Grant,

    Although you purchased what is known as an RCV (replacement cost value) policy, the policy states that your insurance company is permitted to pay ACV (actual cash value) and withhold the depreciation until the item is replaced with like, kind, and quality.

    You are entitled to the entire $17K when the policy conditions have been met. However, if you choose to replace the roof with a lesser expensive roof, then no you are not entitled to the depreciation withheld.

    Read Jason’s post above in response to Caroline who had a similar situation.

    I would consider simply going back with a roof that is of like, kind, and quality since you will be losing out on $4,000.00 that you are entitled to which would add a better roof to your home and value. You don’t necessarily have to go back with a wood roof, but you would need to go back with a roof that is of the same value.

    Whatever you pay for the new roof above the $13,000 – up to $17,000 is the balance the insurance company would owe you.

  395. September 29th, 2010 at 10:48 pm #grant

    Thanks so much for the info. Your site is great and thanks for the quick reply. I will look at some more expensive high impact or class 4 shingles that should get me close to the cost and value of the wood shakes.
    Take Care,
    Grant

  396. October 2nd, 2010 at 2:27 pm #debbie

    We had a house fire over Christmas Eve. Our Insurance company has covered everything with the exception of our furnace which was located very close to where the fire broke out. They say the fire didn’t cause the furnace to fail. This happened in December and the heater was on when we left the house to go to church and fire happened when we were gone. We arrived back and upon being let back into our home a few days later the heater was not working. It is obvious the fire had something to do with that. Do we have any recourse?

  397. October 2nd, 2010 at 4:55 pm #Jason

    Debbie,
    There are one of two things that may be going on here concerning you furnace. The first thing is that the insurance companies don’t cover the cause of the fire. If they are excluding your furnace as the cause of the fire, then that is common industry practice to do that. My outlook on the situation is that the entire furnace doesn’t cause the fire, but only a part of it that did (and that part also damaged the rest of the furnace too). If the insurance company wants to exclude the part that caused the fire, then they need to isolate the part so they may exclude it. If they exclude the entire furnace, they are excluding the part that caused the fire and all other parts of the furnace. If you need a better understanding of this, I can explain further. I am not sure this is the reason for your concern because the way you posted the question.

    The second thing is that they appear to believe the fire did not damage the furnace. Simply have a heating contractor examine your furnace to see if the fire caused the furnace to fail. If the reason for the furnace’s failure is the fire, simply ask the contractor to write up a statement that the furnace was damaged as a result of the fire and have him detail why he comes to that conclusion. For example, a melted switch or melted wired that caused a capacitor or fuse relay to become damaged, or whatever reason or reasons he finds.

    It is more than likely that you have a open perils homeowner policy and the burden of proof that the furnace failure wasn’t caused by the fire, heat, smoke is theirs to prove. Simply make it easy for them and do the necessary leg-work so they have documentation why it failed so they can pay for the repair or replacement of the furnace. Good luck.

  398. October 2nd, 2010 at 4:57 pm #Public Adjuster

    If you are so certain that the heater went out because of the original fire, call an expert out and request an inspection of the heater and have them tell you why it isn’t working. You will have to pay out of pocket for the report. Then you will know or be relatively certain why it’s not working. Then present this to the insurance carrier if of course it is not working due to the fire. They may call out their own expert at that point but at least you have your report. If they end up relying on your report they should pay for the report as well as pay to have the heater fixed or replaced.

    Once again, if you are so certain this is the cause, then you have little to lose. It seems like it’s going to be something you have to do anyhow in order to get the heater fixed. Right?

  399. October 3rd, 2010 at 2:31 pm #c wilson

    had house fire , 2 boys inloved , can i sue other family for half of loss and should there homeowners ins pay , live in nv

  400. October 3rd, 2010 at 5:07 pm #F MICHAEL CONTE

    Mr. Wilson,
    You need to give us more information. Did the boys start the fire? is one of them your boy? did your insurer pay for your damage? what happened, how did the fire start?
    thanks
    fm conte

  401. October 3rd, 2010 at 6:09 pm #c wilson

    on the 30th of may 2009 we started gettin txts that our house was on fire we were out of town due to hospitalization . the fire marshal was called it was deemed feloney arson , both boys were 10 at time , next mornin were arrested , one use mine and other a family in town on feb 17th of 2010 and on march 17 of 2010 they were charged with public nusiance fined 10$ and 6 mo comunity service and on sept were declared finished , since then there was resitution on our half we only rented , no we didnt have renters ins , but i do now , not understanding nv law , my landlord said they had really good ins and paid dearly for it . the other family denies the child had any doins in it , we lost every thing we had , we started over new address and had to purchase everthing from our own pockets , they own a house 3 vechiles and recently did upgrades . he i know makes more then 80th a year , can i go and file against them and there home owner ins as it was half there fault . it cost me time ,loss of house and contents , homelessness, mental anguish , and my car in shop as it was melted and my car ins paid for all of it wich i think was not fair

  402. October 3rd, 2010 at 6:12 pm #c wilson

    oops , from statement last entered , sorry there was no restitution at all judge said it was a accident comitted by 2 kids

  403. October 3rd, 2010 at 6:22 pm #Debbie

    Thanks for your responses. I should have been more clear. The fire happened 2 years ago so we have already replaced the furnace. The furnace had nothing to do with the cause of the fire, that was from a utility lamp being left on in the basement and clothing falling on top of it. We thought the insurance was going to cover it but when we submitted all of our reimbursements they said that because it was a cracked heat exchanger that it couldn’t have been caused by the fire. All I know is that it was working fine when we left the house that evening before the fire and was not working at all after the fire. The technician who replaced it said it was probably caused by extreme cold (the electricity was off for several days and it was the end of December and the house stayed at about forty degrees on the main floor, probably colder in the basement). Do they have to give us their denial in writing and if so, what can we do to appeal their decision? I’m not even sure I can find the technician that put it in, he was an independent contractor and if I could he would even remember. Hopefully I can and he will remember and put it in writing for us. The cost is $3000 and definately significant to us.

  404. October 3rd, 2010 at 7:02 pm #Public Adjuster

    Debbie,

    In my opinion your chances of recovering in this situation are slim to none. What you needed to in regards to getting a report wasn’t done. You verified the heater part didn’t crack due to the fire but rather extreme cold. That could have possibly been submitted as consequential damage to the loss but that’s a long shot. Finally, if the claim happened 2 years ago, depending on when the claim was formally closed you have one year to submit any additional claim or your statute expires.

    The carrier does need to put in writing why they are denying this portion of the claim though. So, if they haven’t, I would ask them for the reasoning and put this reasoning in writing and how it is applicable to the policy provisions.

  405. October 3rd, 2010 at 7:04 pm #c wilson

    opps wrong comment i think i got wrong response from who ever , they emailed a response from someone else

  406. October 3rd, 2010 at 7:07 pm #c wilson

    dear public adjuster plz send comment to debbie at her email as iam getting them on my email thank you much

  407. October 3rd, 2010 at 7:28 pm #Public Adjuster

    cwilson,

    I don’t control who gets responses or where they get them. I post just like you do. I think the way it works is that when you subscribe to the thread you get notified of all new posts and not just the ones that are related to you.

  408. October 3rd, 2010 at 7:30 pm #Jason

    c wilson,
    No, there is nothing you can do. It was accidental, the children are minors, and the parents who have insurance didn’t have anything to do with it. You may get different answers but chalk this up as your loss and move on with your life.

  409. October 3rd, 2010 at 7:42 pm #c wilson

    i do know that in the state of nv that age 8 is accountablity for what they do wrong , but as u say move on thank you

  410. October 3rd, 2010 at 9:48 pm #javier mora

    I My house burned, The insurance company would like all contractors bill me and sign work authorization before for all repairs. Don’t they have to bill the insurance directly?
    They want me to pay the tax as well.
    What shall I do??? need help.

  411. October 3rd, 2010 at 10:28 pm #javier mora

    One more question, two townhomes next to the fire got damage,
    the insurer want me to agree for payment with contractor before work is done…..isn’t this a insurer duty?

  412. October 4th, 2010 at 5:20 am #F MICHAEL CONTE

    Your final comment says it all.
    i donth think there is anything you can do. Protect yourself in the future and move on.

  413. October 4th, 2010 at 5:47 am #Jason

    javier mora,
    It is appropriate for the contractors to bill you. The insurance companies presence is to pay for the repairs. The insurance company doesn’t actually hire the contractors to work on your property since you are the one that has authority over your property and who works on it.

    Yes, the insurer should be taking care of the townhomes with the townhome’s owner and not you. You should have nothing to do with those properties.

  414. October 7th, 2010 at 3:10 am #song eavey

    Hi my home is destory by fire and later I found out my husband set the fire. He has bipolar dease for last 6 years and has been in and out of jail. Insurance company will pay my share of helf of total cliam. My question is my husband have to pay back insurance company for my cliam? I just lost about $200,000 because of fire.
    Please let me know
    Thank you
    Song Eavey

  415. October 7th, 2010 at 9:43 am #Public Adjuster

    Song,

    That’s a tough situation you are in. In my opinion I think you should seek out a qualified attorney that is very knowledgeable with insurance law and quite possibly also a public adjuster to assist in assessing the full value of the damages. The two should have no issue working together. There are a multitude of issues that would need to be sifted through that I seriously doubt could be gone through in this forum.

    You state that the insurance company is paying half of the claim. You need to clarify this. Are they paying only for 1/2 of your personal property or actually paying 1/2 of the value of the damages across the board – meaning the structure also? If this is the case, do you have a mortgage or is the house paid off? If you have a mortgage then the insurance company cannot get off the hook that easy to only pay 1/2 of the structure because at the very least the have an obligation to the mortgage company for the structural portion of the claim.

    There are other issues also that need to be weeded through. You state your husband started the fire. Then you state that he has been diagnosed with bi-polar. But you never state whether he started the fire intentionally or was he doing something that started the fire like smoking, etc. I assume he started the fire intentionally since the carrier is only paying 1/2 the claim. But.. I’ve seen stranger things done by an insurance carrier.

    Like I said, seek legal help. Maybe Jason can add some more insight to your situation.

  416. October 7th, 2010 at 6:54 pm #Jason

    song eavey,
    Thank you Public Adjuster. You have provided the best information concerning this.

    Your question was whether your husband will have to pay back the insurance company for your claim. Had it not been for your husband intentionally setting the fire, the claim would not have materialized. He seems to be the reason that the insurance company would pay half of the your total claim. It seems very logical that he would be asked by the insurance company to pay back any payments made because of his actions.

    I am not an attorney and this is not a legal opinion, just my personal perception of the situation. There is case law that goes both ways concerning payment of a claim caused by the intentional acts of an insured. One specific case law stated that no insured could collect because of the intentional act of another insured that caused the damage. Payment by insurance companies is based on accidental, not intentional acts. I believe this was a claim involving Allstate Insurance Company but I don’t recall the specific state of this case law.

    Subsequent case law has changed so the innocent insured does not suffer the consequences of the insured who caused the damage. This seems to be a very controversial position concerning innocent insureds and insureds who intentionally damage the property. Public opinion and public outcry seems to have swayed case law so innocent insureds receive the protection of their policy while allowing the denial of the rest of the claim for the insured who intentionally caused the damage.

    Again, Public Adjuster stated it very accurately by indicating you should contact an attorney about the entire situation. I would contact an attorney even if you are under the perception that the insurance company will pay your half of the total claim. You seem to be in a very complicated situation.

  417. October 8th, 2010 at 5:13 am #song eavey

    Thank you for fast response. My home worth 350,000 and I made down payment 70,000 so I have mortgage about 280,000. I File for personal property for 75,000 and they divide that by helf minus depreciation so I received about 15,000 for personal property in July. I have seen the lawyer for help but lawyer said since my husband set the fire I can only get helf of total cliam. I received phone call from insurance company ask me to send payoff mortgage paper work so I send and received e-mail saying that its going to take about one week for his boss to approve. So I think end of the month I should be settle with insurance company. My husband in the jail since May and wait on Grand Jury. Before house fire, I had one house is paid for and another house is he just bought last year when he had bipolar symptom, but we didn’t have any death, we had three vehicle is allready pay for and I have a small business. After fire he loss his retire pay from Army and VDOT. I’m came from another country and I don’t speak minimun English. I try to find information on internet for months luckly I found your site and I’m very thankful for this site.
    Thank you
    Song

  418. October 8th, 2010 at 10:08 am #Public Adjuster

    Song,

    I still recommend getting legal counsel on this matter. From what you stated the insurance company is going to pay the structural portion of the claim which is the correct thing to do since they have an obligation to the mortgage company also. If you only received $15,000.00 of $37,500.00 for personal property – it seems to me whoever calculated the depreciation was a little excessive. When I was an adjuster for insurance companies I never went over 50% and that was for items like old clothing or magazines or something like that. If it is recoverable depreciation then fine – but you need to replace your items fairly quickly so you don’t lose out on the $22,500.00 they withheld. There are time limits you need to comply with.

    I wish you the best in your situation.

  419. October 17th, 2010 at 2:20 pm #Gary

    I was injured in a fall on a neighbor’s property. I was helping him tear out an old porch when I lost my footing and injured my shoulder and foot. This was a “free” neighbor helping a neighbor type of situation and not for any kind of payment. Would my neighbors homeowners insurance cover my out of pocket medical expenses and my loss of income ( I can’t work until I heal and my doctor will let me go back to work).?

  420. October 17th, 2010 at 5:33 pm #Jason

    Gary,
    If your neighbor has insurance, it is very likely that his insurance would pay your out of pocket medical expenses. I don’t know about loss of income though. From your explanation provided, it sounds as if a simple accident and the insurance company would not pay for more than medical expenses.

    Some employers provide (or allow the option to buy) disability insurance and this may be the type of insurance that you could utilize if you have had it at the time you were injured.

  421. October 24th, 2010 at 12:54 am #Mike

    I had wind and hail damage to my rental home in Ohio (it’s actually 2 homes joined by a deck, counted by the ins co as 1 home) that my contractor I’d signed with said would cost $40-$45,000 to repair, and submitted the evidence to the ins. co. The ins. co. sent out a guy who, IMO, basically made up a lot of stuff and then they made out a check for all of $3,578.40. The contractor I signed with saw the guy do his examination and noted that he didn’t even follow the Hague standard to which he was supposedly applying. He told me their whole process was extremely peculiar, one in which he’d never seen any other ins co do, and he has homes approved every day with far less damage. The ins. co. hired guy even noted guy even wrote that the garage wasn’t even damaged when there isn’t even a garage attached anywhere or any kind of garage door anywhere. I wasn’t born yesterday, and my dad and brother were both into construction, roofing, etc, my dad for almost his entire life, and I know I can’t possibly make the place livable for this amount, no matter what their “expert” claims. This was the contractor’s opinion as well. Do I have to accept or cash this check? Do I have any recourse? I did have damage to my own home which they repaired earlier in the year (they used an entirely different process then), so I know they don’t want to cover another one, and I sympathize, but I didn’t cause the hail or wind and thought this was why I paid my premiums.

  422. October 24th, 2010 at 8:17 am #Jason

    Mike,
    The $40,000 to $45,000 is fairly vague. What does the estimate your contractor wrote indicate the cost of repair would be? There are different ways to repair things when it comes to roof damage. Are all slopes damaged by hail/wind or just some slopes?

    Are you referring to the Haag method for checking for hail damage? If so, that method can be modified a number of different ways to achieve the same end result.

    Insurance is not a get-rich-quick thing and the damage done by hail/wind is fairly definite. $45,000 and $3578.40 have quiet a bit of variance and it is impossible to determine the extent of your damage though this forum.

    No, you don’t have to accept or cash the check. You can ask for another opinion from the insurance company.

  423. October 25th, 2010 at 11:50 am #Public Adjuster

    Mike,

    I agree with Jason that we need more information. I don’t read anything into you trying to “get-rich-quick”, so I’m not sure what thats about.. in fact you mention you cannot make the home livable since you can’t make the repairs for the amount they gave you. So, taking you at your word, request that the adjuster and supervisor, and a contractor of theirs come back out and re-inspect the property with you and your contractor present. Go over their estimate and compare their estimate to yours. See if their own contractor agrees with them. In many states if a homeowner is unable to have the repairs done for the price and scope that the insurance company has issued, then the insurance company is required to provide the insured with the name and contact information of at least one licensed contractor that is willing to do the repairs for that amount. You can pin their contractor down at the meeting and put him on the hot seat and see if it can be done.

    You need to figure out why there is such a difference. You need to figure out what “physical damage” they did not include in their estimate that your contractor did. If your contractor is simply stating something like “replace the entire roof, felt, decking, gutters, etc.” and they are only replacing one slope – then find out why they are only replacing one slope. Is it because that is the only slope that received direct physical damage? If so, are there matching issues with the roof? Possibly the adjuster thinks that the shingles can be reasonably matched and your contractor doesn’t.

    These are all issues that need to be resolved with another meeting at the property.

    I don’t know how the insurance companies operate in Ohio – but in most states that I am aware of you can deposit the check from the insurance company and it does not prejudice your rights to further recovery. I would imagine this is the case, but simply ask the adjuster and get it in writing that you are permitted to deposit the check while still retaining your rights to additional recovery if of course it is warranted.

  424. October 25th, 2010 at 5:21 pm #Jason

    Mike and Public Adjuster,
    I didn’t mean that to come across in the way it did by using that term. That was inappropriate of me. Sorry. I should have started my statement out with, “…the damage done by wind/hail is fairly definite”, without that reference since it certainly doesn’t belong.

  425. October 29th, 2010 at 1:53 pm #liz

    I had a house fire (TN) and my insurance company is not renewing my policy because of ‘total fire loss’. My policy ends 11/3 but my house is not expected to be done until January. I’m finding that no one will insure my house until the repairs are complete. Right now the new roof is on and the inside is down to the studs and they are working on the electrical. What do I do???
    I really don’t want to own what’s left of my house without insurance. I’m also confused about how this is called a ‘total fire loss’ when we are having to rebuild/repair?? (Everything had to be gutted as a result of really bad smoke damage, but the frame was fine)
    Also confused about contents claim. Have spent many hours working on this inventory, no where near done, and just recently found out that we get replacement cost on things we actually replace if we turn in receipts. How similar does an item have to be to be ‘like kind and quality’.
    For example:
    Can I replace Mizuno running shoes with Saucony and get the depreciation back?
    Can I replace a loveseat with 2 armchairs?
    And what if I upgrade an item? Can I get depreciation back for what it would have cost to get the lower quality item?
    Also, I have 2 small children and can’t get hardly anything done without a sitter. Is that a covered ALE?
    Thanks!!!
    Exhausted and confused

  426. October 29th, 2010 at 3:17 pm #Public Adjuster

    Liz,

    I have seen F. Michael Conte post on this site and as I recall he is an agent. Hopefully he can answer your question regarding the renewal of the policy. I think you need to look into a “Course of Construction” policy rather than your standard homeowners policy. These can be purchased through various agents. I’m not sure if the most popular names sell these such as State Farm, Allstate, Farmers, etc. But I know companies like Markel and Lloyds do. Check into that and see if that will meet the requirements. Otherwise your mortgage company will issue a “Forced Policy” which is going to be costly and cover only their interest in the property. Hopefully Mr. Conte can elaborate and let me know if I’m on target with this info or if he has better suggestions for you.

    As far as your contents; replacement should be similar. A shoe for a shoe. The brand should not matter. But don’t buy snow boots intending to replace slippers. You are exactly correct that if you buy something that is an upgrade, you would receive the recoverable depreciation on the lesser item. Not on the difference of the upgrade. Jason addressed this item in a very good post recently.

    When you are replacing items that are similar in likeness and cost, you shouldn’t be overly concerned. When there is an item that may be different and more costly, simply ask the adjuster if it is okay. Lets say you are going to replace a love seat with two chairs. You don’t want to run into any potential disappointment, so just ask. And when you are replacing something that is vastly different, lets say a microwave for a television, well…. you can probably save yourself some time by not raising your expectation that the adjuster is going to be that open. The adjuster has to document their file properly and generally has QA (quality assurance) review files for discrpencies.

    Regarding the child care; I would say that is a deep stretch and you’re probably not going to get that. You can ask the adjuster. But I doubt it.

    Sorry to hear about your loss and hope you are able to get things back together for you and your family.

  427. October 30th, 2010 at 9:12 pm #James

    We filed a home insurance claim due to the water damage to carpet and wall, our insurance company sent us a check with ACV. We need to submit all the invoices and recieves from the repair to get RCV back. We want to do a hardwood floor instead of carpet. My questions are: 1. can we use the insurance money to put a hardwood floor? 2. will it jeopardize getting RCV back?

  428. October 31st, 2010 at 7:47 am #Jason

    James,
    You should be able to use the money to put a flooring in that was damaged and it doesn’t need to be the same. If the cost of the hardwood is more than the carpeting, you should be able to get RCV back.

    Now, just so there is open communication between you and your adjuster, this question should be asked directly to that person so you can have the answer from that person. Although the answer will be the same, we don’t settle the claim details with you, your adjuster does.

  429. October 31st, 2010 at 10:50 am #F MICHAEL CONTE

    liz,
    Public adjuster is correct.
    you need a builders risk contract, or a homeowners with the cost of construction endorsement. you will not be able to get either from a captive agent company, as they only sell their products. you need to seek out and indepndant broker or agent who represents many carriers. the cost of this replacement contract will be higher that what you are used to paying, but i think you see how important coverage is.

    best of luck. i am not licensed in TN, so i can not offer more direction.

  430. November 10th, 2010 at 11:53 pm #Kls

    As I was searching the web for answers to questions I had, I a came across a very well written question which really addresses so much of the confusion we face with insurance and insurance claims. It was posed by Val in March 2009, #68, with your response #70. I was disappointed to see you just dismissed this question. Rather than even attempting to answer it, to help those you have sought to assist, you found the answer to be too involved, too detailed and told him to go read a book about it. Your answer would have provided many people very useful, insightful information from a person of expertise. Maybe you would be willing to readdress his question. I am very interested in his situation as I am sure many others are too.

  431. November 11th, 2010 at 9:32 am #Public Adjuster

    Kls,

    I re-read the post and response. The admin did answer the question by telling the OP to go get help. The situation that Val was in was far more complex to try to answer on this site. This is a bog where people like myself freely jump in and attempt to answer or discuss certain situations that are fairly straight forward and brief. Clearly 20 years of claims handling expertise on how to deal with a theft claim that appears it’s going down a bad path cannot be effectively spelled out on a blog. You make it seem like the OP was asking yes/no questions. That was hardly the case. The response was appropriate for the circumstance in my opinion and your verbal shots at the admin alluding that he/she did not want to help are out of line and unwarranted. This site provides a wealth of information to the public – and I’m sure a great sense of relief in some circumstances.

  432. November 12th, 2010 at 8:16 pm #Jason

    KLS, Although there is a lot of information in the original post by Val, there are essentially 3 questions and I will answer all 3 of them. The first question is, “Would the insurance company refuse to cover me if I accidentally left the door unlocked?” No, they would not refuse to cover you in that situation. The second question is, “Does State Farm (or any insurer) pay out for receipt-less jewelry or am I wasting my time making an inventory? All insurance companies pay for damaged items regardless if you have a receipt of not. The third question is, “Would I be allowed to take whatever $$ they’ll give me and add my OWN money to get something I’ll really be happy with, or not?” Yes, you would be able to take the allowance they gave you and add your funds to it and buy what you are happy with. ==== A question in that post by Val asked, “Wouldn’t it still be theft?” I know none of us on here want to address legal, law enforcement, or subjective issues because of their complexity so these questions are not the kind we will address on this forum.

  433. November 13th, 2010 at 2:01 pm #FM CONTE

    since this ball is back in play i would like to add two points.
    although i agree with jasons comments to val, it is important to realize that some carriers will still stand on “sign of forced entry”. second they may not honor a claim with out a reciept.
    there is no hard fast rule follwed by all, it depends on the carrier at the table, and the mitigating sircumstances surrounding the event.
    (just thinkiing out loud)
    fmc

  434. November 17th, 2010 at 7:13 am #Tony

    Looking for any expert advice.

    Tornado came through my neighborhood in Aug. Didn’t appear to be any damage to the house, but basketball poles and other large, heavy items were picked up and thrown into cars, causing a lot of damage.

    State Farm paid car claim without issue and we thought we were done, but a few weeks later houses all around began getting roof inspections and approved claims for entire room replacement.

    We weren’t even going to have an adjuster come out, but after every house around us (literally each and every house) was approved by insurance for new roof due to hail and wind damage, we thought it prudent to at least check.

    Roofer’s opinion was that there was enough damage to also warrant replacement. Insurance adjuster agreed that there was damage, but not enough to warrant replacement. Then he immediately approved the house 20 feet away (whose owner has a daughter that works for the insurance company –coincidence?).

    We are literally the only house in a two block radius to be denied. It seems somehow that Moses came down to part the storm just over our little section of the neighboorhood (never mind the car damage and tree damage on my property).

    Fast forward 3 weeks. Insurance company claims to have lost adjuster’s report (they found it eventually) and did nothing when we asked for another opinion.

    When second adjuster finally came out he claimed that there is no storm damage at all to the roof and it’s wear and tear of cheap roofing (house is 8 years old and roof is builder’s original).

    We’re at a loss. How could first State Farm adjuster admit damage but claim somehow our damage was less than every single house around us and second adjuster claim there is no damage at all other than wear and tear.

    Final insult to injury: The second adjuster approved fixing a leaking window that the first adjuster denied — but first adjuster showed us why he denied it and it totally made sense. It was not caused by storm but showed up because of unusally strong storm.

    Even my local agent admitting in a roundabout way that it seems like the second adjuster was throwing us a bone before he even got on the roof because he wasn’t going to approve it regardless of what he saw.

    We don’t know who to trust anymore. Maybe the roofer is exaggerating the damage (ok, not a huge leap there), but how can one adjuster admit hail damage to metal roof vents and cut a check on the spot and a second adjuster claim no damage at all?

    We’re still fighting. Looking into maybe a public adjuster. Trying to be honest here — not looking for a new garage door like neighbors who admit to us on the sly that the dent was from them hitting it with the car (besides, what kind of adjuster mistakes hail damage to a garage door with a car bump).

    Appreciate any and all thoughts on the situation.

  435. November 17th, 2010 at 10:10 am #Public Adjuster

    Tony,

    I think that you would need to first take the damage to your home and your claim on it’s on merits rather than trying to base what you feel you should be compensated for on the entire neighborhood. During the San Diego Wildfires in 2003 (I think) I inspected many homes burned to the ground while others 20 feet from each other were untouched and/or had little direct physical fire damage. Some claimants wanted their houses which were only partially burned completely replaced because all of their neighbors in the entire neighborhood had theirs replaced. So you have to stick to the facts of your own home and base the claim on it’s own merits. Each insurance company is different and each and every claim is different. Some insurance companies may just auto-pay these claims while others want more diffinitive proof.

    You state that you didn’t file a claim until every other house was approved. Which to me means that even you weren’t convinced at the onset that there was damage. In fact, you were convinced that there wasn’t damage because you didn’t file a claim. As I understand it a roofer looked at the roof and advised you that there was in fact damage and that the damage warranted replacement of the roof. Did the roofer put this in writing – give a written report?

    This is important. Let’s remember what an adjuster is. An adjuster technically is supposed to a.) verify coverage – often through visible damage b.) advise of coverage and how it applies to the policy and your particular loss c.) pay for and “adjust” indemnity to the benefit of the policyholder for a covered loss.

    An adjuster should basically be basing decisions off of experts and adjusting the loss accordingly (e.g. paying for damages, reviewing estimates, balancing out estimates, issuing payments, etc.)

    The work of an adjuster even though streamlined has broadened greatly over the years. Somehow adjusters are now often relied on as experts by management. Management will often take the adjusters opinion over an experts. This is a very poor approach by insurance companies.

    In your situation the roofer’s expert opinion should be carrying much more weight than the adjusters. I don’t care if the adjuster holds a license for roofing, that is not the capacity he is working in. So, if the adjuster has doubt for some reason that the roofer is correct, say for instance he believes the roofer is just stating the roof needs to be replaced because he wants the work, then he should call in another roofing expert to confirm the damage. I am assuming that the adjuster did not call the roofing expert but rather the roofer was there on your behalf.

    Anyhow – your approach should be to get the report from the roofer. A well written report with photos if it has not already been done. Then demand that the insurance company send out an unbiased “local” roofing company to meet with the roofer that wrote the report. If they refuse, then you call out another roofer and get another roofing report. Then, submit what is known as a “Proof of Loss”. This will get their attention and set the clock ticking on them to take further action. If the roofer bills for their report, include this in your demand for payment.

    But, I believe once you demand another roofer come out that they will comply. Make sure your roofer is there when their roofer is so they can discuss the damages together. Then follow up with the insurance company.

    Hope all works out well for you.

  436. November 17th, 2010 at 10:27 am #Tony

    Thank you for the reply. Makes sense. If the original roofer said you really don’t have enough damage we would have ended the conversation right then and there. But with the roofer and the first adjuster agreeing to damage from the storm (just not how much damage) we thought it worth following through on.

    I’ve got the first roofer’s written report and will have a second roofer come out tomorrow.

    Appreciate the advice.

  437. November 21st, 2010 at 11:53 am #sherri

    My son and i are in temporary housing in nyc, due to flood while our coop is fixed. My ex husband (co-owner with me, resides elsewhere), refuses to sign insurance claim check made out to us both or to cooperate . I suggested putting it in our joint fidelity thats still open . My adjuster says i may need lawyer.
    Questions: would there be anything in my chubb policy to address this issue.? What if ex gets lawyer? What can chubb do legally?

  438. November 21st, 2010 at 1:07 pm #Public Adjuster

    Sherri,

    I’m not an attorney nor am I giving you legal advice. Just my opinion/observations from facing this situation previously as an inside adjuster and also as a public adjuster;

    If you both had a divorce attorney go back to your divorce attorney. This issue should have been addressed in the divorce stipulation. Maybe not specifically but in general terms.

    There is nothing Chubb can do. You shouldn’t burden them with this situation. They are actually doing the right thing by listing you both on the check. Certainly there has to be someone in this small world of ours that could talk some reason into this guy. Anyone?

    Otherwise, yeah.. its a legal issue. If he is still on the insurance policy, and still on the title to the home, and it has not been addressed in the stipulation as to where any proceeds go to or who has care and custody of the home.. then as frustrating as it is you are more than likely going to have to have an attorney deal with this. If any checks are for personal property then that check may need to be split with him depending on what the items are and what the stipulation was.

    I wish in these situations people would just come to a reasonable solution. Especially since you have a son involved and more than likely Chubb will expire on your living situation – and rightfully so. See if a mutual acquaintance of yours can mediate the situation since clearly we don’t know the specifics of why he won’t sign off whether he is just bitter, he thinks you will pilfer the money, he wanted the house and you got it.. or whatever.. which none of it matters in this forum. But my first thought is there must be SOMEONE that could mediate this between you.

    I wish you and your son the best.

  439. December 3rd, 2010 at 3:57 pm #Jen

    In the past two years, we have had two homeowner’s claims. Both involved replacing the floor in the same room due to separate plumbing issues in the walls. On the first claim, the insurance company sent a contractor to assess the source of the damage. The adjuster came out within a couple of days to measure the room, make calculations, and cut us a check on the spot for the damage. One the second claim, we had water coming up through the floor that seemed to be coming from the dishwasher draining in the kitchen above. We shut off water to the kitchen immediately and called the insurance company. They sent a contractor out the next day to find the source of the problem. In doing this, they had to jackhammer through the floor of the room. The contractor was there for 3 days doing what we thought was still working on direction of our insurance company, but when they showed up with drywall, I grew concerned. I called the adjuster, who had showed up the day the contractor did, but still had never yet given us an estimate or cut us a check for repairs. The adjuster told us the contractor was doing the repairs. I told him that we had never received an estimate, and never authorized the contractor to do the repairs. I told him we had a contractor that we wanted to use, not theirs. My husband told the contractors that we weren’t having them do the repairs and they took everything and left. The adjuster sent a check to our house and told me that we did not owe any payment to the contractor. Four months later we received a bill from the contractor. We called the insurance company and they said that we didn’t owe anything to the contractor, that they would take care of it. Today we received a certified letter from the contractor stating that we have 15 days to pay them or they are taking us to court. We called the adjuster and he now says we owe the contractor. We called the agent, and and they told us that this is between us and the contractor. I don’t see how this is our responsibility for payment when we never engaged the contractor to do any work. Can you please advise?

  440. December 4th, 2010 at 7:37 pm #Jason

    Jen,
    The only person that can authorize work to be done on their house is the homeowner. This adjuster seems to have brought in a contractor, right? Who called this contractor in? It seems the insurance company coordinated the contractor to be out there and determine damaged and make exploratory demolition to determine the damage and it’s cause.

    It seems the insurance company is responsible for any expenses and charges that were incurred by the contractor.

    That is my assessment of your situation. The agent and adjuster associated with your insurance company may need to get involved until this is solved to your satisfaction.

  441. December 6th, 2010 at 9:47 am #Public Adjuster

    Jen,

    To further elaborate on Jason’s message;

    While it is true that in most cases the insurance company cannot authorize repairs be done to your home – I say in most cases because sometimes the policy has a clause that they can.. even though they never would.. they are permitted to investigate the claim by bringing in their experts to determine cause and origin and extent of the damage. Clearly you had knowledge that some type of work was being done at your home. The moment the jackhammer starts whacking away had to have been a pretty good clue. So, in moving forward I don’t think its the best approach to claim that you had no idea and never authorized repairs. At the very least you permitted some structural materials to be removed even if you didn’t sign a contract (which would be a completely different issue).

    The issue at hand basically boils down to whether or not the insurance company paid you directly for this work that was completed. Each time a payment is issued the insurance company is required to provide you a basis of the payment which is generally an estimate completed in some form of estimating program – Xactimate, MSB, Simsol or something like that or a written explanation of the basis of the payment. If you were not provided an explanation of the basis of their payment, then you need to request it. If you were provided an estimate then review the estimate and compare it to what the contractor is claiming you owe them. If you cross compare and it turns out the insurance company paid you for this work, then you are going to owe it. For instance, if you see on the estimate “open slab” or “jackhammer slab” and they paid you $750.00 – and the contractor is billing you for jack hammering the slab – then the insurance company fulfilled their obligation and you owe the contractor. Now, if you don’t see the items on the estimate that they paid against, then call the contractor up and explain it to them. Let them know that you don’t dispute that they worked at your home and they deserve to be paid, “so let’s call the insurance company and figure this out so you can get paid”. It could be an oversight on their part or possibly the contractor just never bothered billing the insurance company since they were under the impression that you were paid for it. This seems fairly simple to resolve. The only snag I can see is if the insurance company never paid for the work and claims they don’t owe for the work. If that is the case, then find out why they feel they don’t owe and post back here so someone can try and help with that situation.

    Hope this helps – take care

  442. December 6th, 2010 at 4:18 pm #Jason

    From Jens post, it seems the contractors were brought in to investigate with/for the adjuster.

    If the adjuster told the homeowner that they did not need to pay for what the adjuster used the contractor for (investigative and exploratory work), then the homeowner would not even be sent a payment for the contractor that the adjuster brought in. The homeowner should not be involved in payment for any type of adjusting which it seems the contractors was assisting. That would be similar to a homeowner having to pay the independent adjuster for coming out to their house, write an estimate, take photos, and submit a report to the insurance company. That doesn’t happen.

    The independent adjuster is hired by the insurance company, just like any experts, C&O people, or accountants as needed. Putting the homeowner between the insurance company and these people is not something an insurance company would do.

    For this case, any jackhammering is considered exploratory work (not demolition or removal because it is done with the adjuster there) and is not the responsibility of the homeowner.

    I have a feeling we don’t have all the information we need to provide more accurate help. That is why it is important to communicate with your agent and your adjuster until this is resolved to your satisfaction.

  443. December 7th, 2010 at 12:00 pm #Patrick

    Question: I have a Met homeowners claim (replacement cost) from a recent burglary. There are some items that I have no need for, though they have depreciated significantly. Is it illegal/fraud to purchase these items, submit the claim and then return them? I certainly don’t want to do anything fraudulent, but I also feel I’m untitled to the full value of what was stolen. Any advise would be greatly appreciated.

  444. December 7th, 2010 at 12:38 pm #Jason

    Patrick,
    If the items weren’t stolen, could you take the items back and return them?

    If you would purchase the items to get the recoverable depreciation, you would be in a better position after the burglary occurred.

    If you have to ask if it is illegal or fraud to do that, then you are on the right track. If you feel like you are entitled to the full value of the items that were stolen, please refer to my initial question above.

  445. December 7th, 2010 at 12:58 pm #Public Adjuster

    Patrick / Jason

    That’s actually a very interesting question. I interpret Patrick to be saying that the items were stolen and he wants to recover the depreciation by purchasing certain items that he really no longer wants or has use for.. and then return them to the store he purchased and keep the money.

    Would you mind elaborating on your response Jason because I’m a little confused? I am not clear on what you mean by “refer to my initial question”. Thanks.

    My initial thought was that there was nothing wrong with this.. but then thinking it through… there actually may be. Patrick.. if you received the ACV for the item it’s because you actually were able to use that item for however many years.. which brought you value.. then you were paid the current market value of that item that was stolen. So that is the “full value” of the item. If you are purchasing the new item with full knowledge that you are going to return the item and pocket the cash.. then like Jason said you are in a better position (monetarily) then you were before. In a homeowners claim you are entitled to be restored but not entitled to profit from a loss (except for very rare circumstances). In this case you would be profiting from the loss and therefore I think you could create a potential situation for yourself if it was discovered. It’s doubtful it ever would be.. but that’s not the question or issue you posed.

    My recommendation would be that you find similar items that you would like to keep or use and get them approved by the adjuster prior to purchasing them. You shouldn’t approach this situation with the mindset that you are losing something if you don’t get the Replacement Cost Value. Like I said above, you were able to utilize the item for X number of years.. and then you were paid the current market value of the item. So you have been fully restored.

  446. December 7th, 2010 at 1:57 pm #Public Adjuster

    Patrick,

    I think you posed an excellent question and I was somewhat stumped to be honest. I even ran it by a couple other public adjusters and got varying responses.

    I retain legal counsel for my business and decided to give him a call and posed the question. He is stating that it would flat out be insurance fraud because of your intent. Your intent in this circumstance would be to represent to the insurance company that you are purchasing these items with the intention of keeping them. He stated that they would have a hayday with this if they discovered it. I even posed the question if you were to sell the items on your own and the situation is unchanged.

    Think about it this way – what do you think your insurance company would state if you wrote them a letter ahead of time and told them of your plan? They would immediately reject any claim that you have.

    As I stated before, I think your best approach is to seek for items that are similar to what you are replacing and see if the adjuster would approve those items. Generally adjusters are reasonable if you are being reasonable.

    I know it’s probably not the answer you were hoping to hear.. but I hope it helps in your situation.

  447. December 7th, 2010 at 1:57 pm #Jason

    The initial question is, “If the items weren’t stolen, could you take the items back and return them?”.

    The thing is that insurance is there to make you “whole” again, not to improve your position after a loss. If Patrick was able to get the recoverable depreciation back and then return the items, he would be in a better position than he was prior to the loss. (By having cash in his pocket and no longer in the possession of unneeded items)

    Of course, there is the position that if you replaced the stolen items with new items, you would be in a better position too. But that is a contractual benefit you pay for in your premiums when you get a replacement value policy.

    Public Adjuster, your recommendation is excellent to get the approval from the adjuster prior to replacing any of the items for which he has no need.

  448. December 7th, 2010 at 2:00 pm #Patrick

    Jason,
    I think it’s questionable, hence the reason I asked the question. But if it’s technically not against the rules, then it’s an option I’m considering. My concerns are:

    1. Not breaking the law. If it’s illegal it’s not longer a consideration.
    2. Not triggering an investigation. Certainly don’t need that headache.
    3. Not positioning myself to be “uninsurable”

    Adjuster,
    When you say it’s doubtful it would be found out, please elaborate. Do insurance companies actually follow up on the submitted receipts to see if items were returned (do they have the means and/or capacity to do this??. Truthfully, we were 100% accurate with our claim and replaced 95% of the merchandise. There’s 4 items we just don’t need which is the reason for my inquiry, and in this enconomy the cash value would be far more beneficial. At the end of the day, it’s the same cost to the inurance company if i keep the item or not.

    Thank you both for your responses!

  449. December 7th, 2010 at 2:12 pm #Public Adjuster

    Patrick,

    See my response above if you haven’t already read it.

    Do insurance companies follow up to see if the items are returned?? I’m really not even sure how they would be able to. I mean.. I suppose if they opened an SIU (special investigation unit) and went in and questioned the store – then yes they could. But now you’re getting into hypotheticals and attempting to assess your risk. I can’t really help you with hypotheticals. I’m sure it’s done everyday.. but that doesn’t make it right.

    Although you could use the cash in this economy – you need to realize that if the insurance company discovers that you have committed fraud in one aspect of a claim for any one single item.. they can demand that ALL the money be returned.

  450. December 7th, 2010 at 2:16 pm #Patrick

    I have my answer. Definitely not worth the risk. Thanks again for your input!

  451. December 8th, 2010 at 8:37 pm #deb

    I am insured with Sterling insurance, and we had a water leak in the bathroom that went through the wall into the bedroom. we called a plumber and had the work fixed and called our insurance company, they sent out an adjuster, all seems ok. same day the adjuster was out we found another leak in the adjoining bedroom on the floor. we called out the plumber again and he said he needs to send out a leak detecter and the leak could be coming from under the slab. My question is…is this going to be on the same claim considering the original claim is still not done? and if not and they file it under another claim how will this affect my insurance premiums? I live in Calif. I have tried to call my insurance agent but he is out of the office for the next several days.

  452. December 8th, 2010 at 8:56 pm #Public Adjuster

    Deb,

    The insurance company is going to consider the losses as 2 separate claims since there are two areas that sprung a leak on 2 separate days in two different areas. The question you pose is similar to asking if you had a car accident on one day… and then 10 days later you had another car accident if the insurance company would consider this 1 or 2 claims simply because you had an open and pending claim. They would consider it 2 claims.

    From past experience 2 water damage claims within the same year will most likely trigger the insurance company to refuse to renew your insurance on the anniversary date of your renewal.

    The good news is… there is no shortage of insurance companies out there willing to take your $ to insure your home. You are with Sterling right now.. and in my opinion almost any carrier is an upgrade from them for various reasons. Sterling takes a ton of “forced policies” which means the mortgage company forces this policy on homeowners when they don’t have coverage on their own… or it is part of the overall payment of the mortgage. I don’t know your particular situation but from past experience you shouldn’t lose too much sleep over switching to another carrier.

    Take care

  453. December 8th, 2010 at 9:08 pm #deb

    thank you for your quick response. As for insurance companies we just accpeted this one when we got our mortgage and never checked other companies or rates. So I am sure we will be checking now. I am hoping at least for a good outcome with this incident, as reading some of the other posters issues on here I do consider myself lucky at least at this time.

  454. December 8th, 2010 at 9:39 pm #Public Adjuster

    Deb,

    That’s what I figured about how you were insured with Sterling. That is typical and means you are probably paying too much for what you get. Here in CA Sterling utilizes an estimating program named “Simsol”. It’s the bottom of the barrel of estimating programs in my opinion compared to Xactimate and MSB. So, when they provide you payment make sure you have a min of two contractors provide you bids so you can compare.

    Also remember that the insurance company owes for access to make the repair and repair of the items removed to make the repair but generally not for the repair of the pipe itself. So if it is a slab leak they would owe lets say $750.00 to acess (jackhammer) to get to the leaking pipe.. putting everything back (concrete slab, flooring, paint, etc.) but not the repair of the pipe itself which is usually something minimal like $50 or $100 bucks.

    If you think you have been lowballed by the insurance company then get a public adjuster involved. My experience has been that most insurance companies lowball (or else I wouldn’t even own a successful company in L.A.).. but out of these Sterling is at the bottom. So make sure you get estimates on your own and get a Public Adjuster involved if you feel you are really getting taken advantage of.

    As far as renewing insurance – State Farm requires 3 years claims free. So you can’t go with them. But Mercury should take you on as well as Liberty Mutual. If it was my choice I would go with Mercury since they cover rain water intrusion without having to have a storm created opening like most carriers do and also have “fair rental value” included in the policy which saves a ton of hassle if you are ever displaced from your home.

    Best to you and your family and Happy Holidays

  455. December 17th, 2010 at 12:28 pm #Brian

    I was recently approached by a contractor who is doing a lot of work in my neighborhood here in New Jersey due to a hailstorm. He had me sign a paper stating that he would be doing the work, however there were no dollar amounts filled in. He asked me to contact my insurance company and have their adjuster come out to the home, which I did. The contractor wanted to attend the appointment with the adjuster, to which the adjuster would not agree to (he gave a valid argument in that he didn’t want to have the contractor “sell a claim” to him). Here is my dilemma….I got the insurance company’s contractor’s estimate/scope of services. It lists some charges/services on it that they would do that are on the contract that I signed that the original contractor stated that were my “obligations” (such as contacting the utility services, removing exterior fixtures). The contract states that if he doesn’t do the job there is a $1,500 penalty that I must pay him for time spent (seems to me to be a great hourly rate as he didn’t do anything that day…not even measuring the house!!). First off, am I still obligated to use this contractor rather than the insurance company one? and 2) does the first contractor have to folllow the scope of services exactly as written? My concern is that I don’t have any dollar amounts from this original contractor and they will just do the work taking the entire claim amount for some extra profit!! Thanks.

  456. December 17th, 2010 at 2:37 pm #Public Adjuster

    Brian,

    You probably realized pretty quickly that signing an open ended contract like this is a bad idea. I see a lot of people do this because the contractor convinces them that they will do the work “as per insurance settlement” and since they don’t know what the settlement amount will be, then they can’t put a dollar figure on it.

    To me, that’s a bunch of bologna. If you’re in business its about doing the work right. And in the process you have labor, materials, and overhead and profit of which all are able to be calculated. I never not once as a contractor submitted a bid without the costs being calculated. With insurance claims I didn’t care because I wasn’t going to do the work “as per insurance settlement” but rather do it right!

    The questions you ask are really of a legal nature so I personally can’t answer them. Let me ask you… if the contractor was really doing the work per insurance settlement (which I am making an assumption based on past experience), and the insurance company agreed to replace your roof, siding, light fixtures and some windows… but only wanted to pay $100.00 – would your contractor hold up his end of the agreement? Not a chance!

    I find it very disturbing that your adjuster wouldn’t allow your contractor to be there. Seriously.. who is he to say who you can have on your property? It’s your home. And for him to say that he doesn’t want your contractor to “sell the claim” seems like he is indicating that your contractor would be requesting items that shouldn’t be included. He’s pre-disposed himself. But then he brings his own contractor? So, he is permitted to have someone advise him of the necessary construction activities to properly restore your home.. but you aren’t? A good adjuster would have welcomed a meeting to openly discuss the repairs so he could take care of the damages for you and settle the claim. Although you would have been better served with a public adjuster, you were completely within your rights to have your contractor there and he was out of line to say you couldn’t. It seems to me like he was the one doing the “selling”.

    I would discuss the contract with your contractor. Try to come to resolution on it. He may still be able to assist you to get more money if it is owed to you by providing his estimate. If you can’t come to resolution let him know you are going to discuss the contract with the Contractors Board in New Jersey just to be certain your rights are protected. In all likelihood the issue is going to end there. But maybe not. At least then you will know whether contractors are permitted to utilize these types of open ended contracts in your state. I am almost certain here in CA the contract is not valid until a dollar amount is agreed on.

  457. December 17th, 2010 at 3:04 pm #Brian

    Public Adjustor,

    Thanks for the quick reply. I did do some background based upon the scope of services material amounts and the number that I got back from the insurance company does land in the range that would be within the typical amounts to do the restoration. But my next thought is that this contractor is determining his coat based upon what the insurance company’s builder has put down for their cost. So when I send this scope of services/repair estimates to the “contracted” contractor, does he have to provide me with his scope of services/costs before he can start the job? My concern is that he will take a look at the estimate, and tell me he needs more money, and bot tell me what he needs. By the way, this scenario happened to my next door neighbor. They got the scope/estimate from the insurance company, they forwarded it onto this same builder, and they told them they needed more money to do the job without stating to the homeowner how much more they needed!! I’m thinking at that point, the “contract” is nonlinger valid as they cannot do the job for the amount given and the contract is rescinded. Just trying to cover all my bases as you know first-time property claims are new to us. Thanks again.

  458. December 17th, 2010 at 3:50 pm #Public Adjuster

    Brian,

    You’re welcome. Glad to be able to provide some insight. I understand it’s difficult and you move forward the best you can.

    My opinion as a prior contractor is that this contract would never hold up unless the contractor was willing to keep his end of the bargain. This is where contractors run into big problems because they expect you to keep your end of the agreement but of course their end is ever changing. This is what I was saying was that even though they say they agree to do the work per the insurance company settlement, if the insurance company is only paying $100 – there is no way they would do it.

    A couple years back here in California there was a very well known company doing a similar thing and they got slammed by the CA Department of Insurance. I have known several people in this company for years and several that have moved on and started their own company duplicating this similar process. I always wondered how they could get away with what they were doing. What they would do essentially is do an “as per insurance settlement” contract. They would discuss the damages with the insurance company – and then once the settlement came in if they didn’t do the work they would charge 20%.

    Think about this.. would you rather do X number of homes and make 20% profit (roughly) – or do NONE of the homes and make 20% profit? I’d personally rather not have to undertake the repairs and all the risk and headache of managing employees or sub contractors on top of dealing with client complaints… and still make on average the EXACT same amount.

    Well.. the Department of Insurance agreed and basically stated that this company was essentially acting as public adjusters and they fined them hundreds of thousands of dollars amongst other sanctions.

    Your situation sounds similar. Especially if they are coming back and saying that they need more money. I don’t know if the contract becomes null and void because they ask for more money. But I do know this other company that I speak of would use this tactic just so they didn’t have to do the work… and STILL get their 20%! Some food for thought.

    If the contractor is willing to do the work then his scope would be per the insurance company scope – so he wouldn’t necessarily need to give you a separate scope but rather agree to the scope the insurance company’s contractor outlined.

    Hope this helps – Happy Holidays (from a former South Jersey Native)

  459. December 22nd, 2010 at 12:49 pm #Brian

    Yes it did. I guess I’ll just send the insurance company’s contractor’s scope of services/cost estimate to this contractor and maybe hold him to match the scope line by line as far as services to be provided, sub-contractors needed, etc.

    Happy holidays to you too!! (BTW-Olga’s in Marlton is closed. Getting rid of the 70/73 circle).

  460. January 8th, 2011 at 11:07 pm #Tracy

    My house burned down 6 months ago. My insurance adjuster wrote the check out to me and the contractor (my house was paid in full). I was told by the adjuster to sign the check over to the contractor, which I did (to the tune of well over 100,000.00). Now it seems there will be funds left over from the repairs. Do I get to keep the extra money? The contractor is trying to tell me that I have to pay to repipe some of the house out of my own pocket, yet there is enough money left over to cover that.

    Thanks.

  461. January 9th, 2011 at 10:05 am #Public Adjuster

    Tracy,

    Basically your issue is for the most part to do with your contractor. Although I have no idea why the adjuster would instruct you to sign over the check to the contractor. It should have been just the opposite. The contractor should have signed the check over to you and then you should have paid the contrator progress payments as work went forward. Otherwise you risked the possibility the contractor could 1. take off with the money 2. not complete the proposed work 3. possible delays with little leverage to get the company to move forward. So, that is a very bizarre request of the adjuster to tell you to sign over the check to the contractor.

    Your question of whether you can keep any remaining money is contingent on a few things. So, since I don’t know all the facts I will have to assume that all of the damages have been repaired to your home and all items are back to or better than before. With that in mind the answer would be no. You are not entitled to profit from a loss. The insurance company owes exactly what it costs to repair the home to its pre-loss or better condition. No more – no less.

    I suppose the contractor is telling you that you have to pay to re-pipe part of the house because it was not on the original scope of repairs.

    It’s a little bit difficult to understand your situation because of a few things. 1. Why was there money left over? If the contractor did all the repairs exactly how the scope of work (estimate) was written, it’s odd there would be money left over. Is it because the adjuster just paid the policy limit without any estimate being written? That doesn’t seem to be the reason because you stated you have to pay to “re-pipe” part of the house which means some of the house was still standing. 2. Was the contractor working on what is known as a “cost plus” basis (cost of sub contractors plus 20%) and there just happened to be money left over? 3. What does the contractor plan on doing with the money left over? Giving it back to the insurance company?

    I suppose whatever the reason any money remaining unused should be returned unless the contractor claims he is entitled to this money for additional profit.

  462. January 9th, 2011 at 4:28 pm #Tracy

    Thank you for the response. I will be a bit clearer this time around and maybe it will make more sense.

    I had no clue who to hire to rebuild (partial) my home. Several rooms were torn down and rebuilt from the ground up, but part of the home still stood and was basically gutted with just the walls standing. My insurance adjuster suggested a contractor he uses on a regular basis, so, while still in a state of shock and not knowing what my rights were, I went with him.

    The adjuster cut a check with my name and the contractor’s name on it and told me to sign it over to the contractor for the amount of the estimate (My policy pays full replacement value). Since my house is fully paid for, the contractor took the check, cashed it and has been rebuilding (very slowly), but it should be done soon (next month probably). I have never seen a single bill or receipt for any products or items used to fix my house, though I have asked for them repeatedly. They did finally give me a complete estimate, but it does not total the amount of the check. I tried to contact my adjuster, however he hasn’t bothered returning any of my messages.

    I was told part of the house (that was not rebuilt) should be replumbed, but I had to pay out of pocket for it, yet while the electrician was in there, he tripped over, and broke part of the plumbing. The job site boss actually told me about the sub-contractor breaking the pipes.

    The prices shown on the paperwork they gave me shows highly inflated prices (almost 800.00 more for a bathtub I picked out for 500.00 and they agreed on installing). There are several places like that in the paperwork.

    I have read in other posts here that folks got to keep the rest of the check that wasn’t used. Why is this claim different? I don’t know a lot about insurance and I am trying to understand as best as possible.

    Thank you for your time and patience.

  463. January 9th, 2011 at 4:31 pm #Tracy

    P.S. (forgot this part)
    Oh, and in the beginning, the contractor asked me to pick out stuff like new doors, handles, etc and then turned around and decided I can’t have them, that he would use the old doors in the house (3) and then match the rest of the doors with similar ones.

  464. January 9th, 2011 at 5:17 pm #Public Adjuster

    Tracy,

    I’m not knocking you because I understand that policyholders just put their trust in adjusters and insurance companies. But this situation should stand as a warning to homeowners that suffer losses to make sure that they do their due diligence when hiring contractors whether or not that contractor was recommended by the insurance company or not. I used to HATE recommending contractors when I worked for insurance companies and would stray away from it as much as humanly possible. Even as a public adjuster I still virtually NEVER recommend contractors. Generally only specialty contractors like asbestos or emergency services.

    When the adjuster told you sign over the check to the contractor that just throws up a huge red flag to me. It’s just not prudent in any sense of the term and just leaves you completely vulnerable and at the mercy of a contractor that sounds like he is doing to you exactly what people (insurance companies alike) preach about not falling victim to. I can think of no “good” reason for an adjuster to do that.

    But most of your issues really are contractor/client issues. Not insurance related issues. But yes calling the adjuster and letting him know you’re not getting a fair shake is probably at the bare minimum a good approach.

    Back to whether you can keep the money or not…. in my opinion if your home has been rebuilt 100% pre-loss or better.. and you didn’t participate in any of the re-build… then no. You are not permitted to profit from a loss. You are entitled to be made whole (or better). I’m not sure about the circumstances of the other people that posted here and someone elses opinion. I’m giving my opinion based on numerous other claims with similar fact patterns. Do homeowners keep money leftover from losses? I’m sure they do. That doesn’t make it right in my opinion. Your situation becomes even more unique because you would essentially have to force the contractor.. who knows the adjuster.. to give the “unused portion” of the money back to you. I can’t imagine the insurance company not requesting the money back if that situation ever arose. It would be kind of crummy for them to do so… but…

    But sure.. someone else may have a varying opinion. I recall an inside adjuster for a company back east posting here before. I’d like to hear his opinion.

    And remember, mine is based on you not participating in ANY of the work, coordinating subs, and so forth, and the work being 100% complete putting you back to pre-loss or better I would assume. And you (your contractor) having received the full replacement cost value.

  465. January 10th, 2011 at 10:17 am #Jason

    Tracy and Public Adjuster,
    I read the questions about 6 hours after they were posted and stayed away from this scenario. There was not sufficient information to answer the questions and now with the additional information about the adjuster recommending the contractor and the adjuster indicating you should sign the check over to the contractor is completely backwards.

    Public Adjuster is correct that you do not control the work, it’s timeline, or the funds when the contractor already has the money. A contractor should be paid partially for the work before it is completed and money should be held back as an incentive to complete the work in a timely and appropriate fashion.

    As far as money left over from this claim, I don’t see any money left over and I don’t think you will either. So the question about do you get to keep any left-over money is immaterial because there is no left-over money.

    You probably need to involve the adjuster and perhaps the adjuster’s manager or supervisor on this one. You should be the one involved in payment of the work as it’s completed. Your example of the incorrect tub and existing doors and hardware being installed is one of the obvious reasons why the contractor should not have the rebuilding funds with absolutely no checks and balances.

  466. January 19th, 2011 at 8:47 pm #deb

    I recently asked a question about filing insurance claim and you were very quick and accurate with your response. I now have another question I hope you can help me with.
    I had 2 seperate bathroom leaks, both of which an adjustor was out and my insurance company sent me a checks for the repairs. The problem I am having is that the insurance agent said he won’t accept the bill from the plumber because it is not itimized, it states in detail what was done but not broken down. I have called the plumber several times and so far he has not sent me any breakdown. the plumber is licensed and had good standing with the BBB. My question is twofold, any advice on how to get the plumber motivated and does the insurance company need a fully itimized bill?
    thanks

  467. January 19th, 2011 at 9:13 pm #Public Adjuster

    Deb,

    If I understand your loss correctly its a pipe break or leak. The insurance company claims they owe for “access” to the pipe but not the pipe itself. So to answer your questions; 1. That’s pretty lame of your plumber not to help you out. Call him again and just ask him kindly you are trying to get reimbursed and need his help. Remind him that you promptly paid him and would love to continue to refer him… :-) 2. No the insurance company does not need the bill broken out. It’s not like they haven’t been around the block before… they have been faced with this situation hundreds of times. So, they know what it costs to gain access, and what it costs to make the repair itself. I would tell the adjuster exactly that. It costs about $50.00 to make the actual repair to the pipe. That’s it. The rest is to gain access to the pipe whether it’s a slab leak, shower stem valve leak, or whatever… it’s about $50… no more than $100. Everything else should be paid under the policy. Tell the adjuster your situation and tell him to make a reasonable reimbursement and close his claim. A closed claim.. is a good claim. As an inside adjuster I did this every day of the week. I’d call the plumber up and get a verbal on what the charges were… close the claim and move on. It’s that simple and it’s a shame you have to get an adjuster that doesn’t want to pick up the phone. If that doesn’t work try a 3 way call with the adjuster and plumber and get a verbal over the phone explaining the charges. Just be persistent.. I’m confident you will get it resolved!

  468. January 19th, 2011 at 9:31 pm #deb

    wow thank you SO much for your advice. The problem was a slab leak and quite pricey, when the plumber left he told me if the insurance company had any questions to call them. When I told our agent he said it was not his job to pick up the phone and call anybody so please have the plumber itimize the bill. I have the detailed written statement and can email it to the adjuster at any time if he will accept it. I have called the plumber 3 times in 6 weeks and have been more than polite about this but at this time I am just wanting to get it over and done with. Your advice has given me the courage to just move forward and hopefully everything will work out.
    thank you very much.

  469. January 19th, 2011 at 9:56 pm #Public Adjuster

    Deb,

    You’re welcome. I am truly offended at your agents response and lack of service to you. That’s just sick. Take your hard earned money and business elsewhere. This agent does not deserve your loyal business.

    With a slab leak nearly everything is gaining access to make the repair.. and then of course repairing the slab itself. The pipe repair is nothing compared to the overall bill. Like I said – $50 – $100.00. You should have no issue. Get your money.. what you deserve.

    If you need more assistance just write back. But I think you’ll be fine and get your money back.

    Take care

  470. February 7th, 2011 at 4:39 pm #Autumn

    My Apartment building had an electrical fire. When I signed up I was never asked if I was selling my apartment building at the time I signed up I was looking into to selling it b/c of being robbed and a few other things. Part way through my sign up they asked some questions I didn’t know the answer to so I gave the phone to my fiance they told us it would be better to add him even though that was not my plan. He believes he was not asked about the house being sold but I am sure I was not. I was never sent any paperwork just given a policy. Being the owner of the apartment building I feel I should of been asked this b/c my fiance is now saying I may be denied my claim about the fire due to me trying to sell the house. I have no mortgage and I am a first time home owner ( I live in the apartment building this is the building/house I own) so I did not exactly know what I was doing. Should I have been asked about selling when I signed up? Will I get denied due to the fact I was never even asked the question? I already made my claim. I may have lost up to 85% of my house I need help… I am covered through Allstate

  471. February 7th, 2011 at 5:29 pm #Public Adjuster

    Autumn,

    Given the situation and suffering a devestating loss I can understand your extreme concern. But I think you’re overly concerned and worried about an issue that really has to do with underwriting (whether they would approve you for a policy or not). Obviously Allstate issued the policy and you didn’t lie on the application for insurance. So its a non-issue. I know of no exclusion in the policy that does not allow you to sell your home within 12 months or something like that. Don’t worry. Just focus in on getting your life back together.

    Since it’s such a large loss you should consider hiring a public adjuster to provide proper guidance and deal with the insurance company directly. It would take a huge load of stress off of you and you will know for certain you are getting all you are entitled to. Go with someone you are comfortable with, has a solid reputation, and solid references.

    Take care

  472. February 7th, 2011 at 6:31 pm #Jason

    Autumn,
    You asked if should you have been asked about selling your property at the time of application. That answer is yes. That is a fairly common question on an application for insurance.

    It would not make any sense if you were denied because you didn’t answer a question about your intent to sell your property or not. That would not be a viable reason for denial. So the answer to that question about you being denied for not being asked that question is no.

  473. February 17th, 2011 at 12:21 pm #SEAN

    We had water damage on our 1st floor laminate and the insurance will cover the replacement. We also have a leaking pipe from the 2nd floor bath and has ruined the 1st floor ceiling and a part of the wall on the 1st floor. I reported the leaking pipe to the insurance and they said they will not cover the damage the pipe caused because it is not a “sudden and accidental” occurence.

    The check the insurance gave me is more than enough to fix the flooring and to fix the leak and the damage ceiling and wall. There will be a little extra left over from the check. Can I keep that $ or do I have to return it to the insurance? How can I show them a receipt if I only have one contractor to do both jobs? The adjuster wants a copy of a receipt and pictures that the repair was actually made. I was planning to repair only the flooring that buckled and not the whole area, so that I can have the leak fix, like put tiles on the area that buckled since it is the kitchen area and leave the rest of the floor as it is. Will the adjuster have a problem with this? I am also trying to get back the holdback money they took off.

    The contractor said it will take him 2-3 days for the job, do I claim ALE with the insurance? since on the estimate they will be painting the whole house and fix the kitchen floor so we won’t have access to the kitchen for 2-3 days.

  474. February 17th, 2011 at 2:35 pm #Public Adjuster

    Sean,

    You don’t have to return the money and you are entitled to do whatever you wish with your home. If you want to put in tile then put in tile. If you want to make a repair to the ceiling then make a repair.

    However, if you are attempting to get the recoverable depreciation back then you will need to make repairs that cost as much or more than the adjusters estimate. Ex. if the adjuster paid $10K .. withheld $1K and you spend $8K – then the insurance company would not owe you. As long as you spend more than whatever the check was they will owe the balance assuming you are not including the areas not covered.

    As for ALE – whatever the time frame related to not having a kitchen due to the covered damages would be the time frame you can submit for ALE. If you are doing extra work then do not include that time frame.

    Hope this helps.

  475. February 26th, 2011 at 7:25 pm #Dee

    Hello, I just had a fire at my rental property. The kitchen was totallydestoyed. Smoke damage is present throughout the house. I am waiting for the adjustor to submit me a estimte or scope of work for the damages. This property is in Detroit. I have heard lostof things about claims. I have replacement cost, and loss of business,insured for slightly over 100k.
    I have a senario that I am confused about. If the Insurnance Company decides the cost to repair replace is too expensive and they decide to give me cash value of lets say 75K. My mortagage is 45k. What happens to the 30K???? Does it go to me or the bank. The house is actually collaterol for a business loan with my company?

  476. February 26th, 2011 at 8:21 pm #Jason

    Dee,
    The “what if” scenarios are difficult to address because there are so many variables that could happen and we don’t have all the information to make those assessments.

    Now, in your case, you have a kitchen that is totally destroyed and the rest of the property has extensive smoke damage. If the insurance company determines that the cost to repair is $75,000. then your mortgagee would be included in the check to you and it is expected that you would make the repairs to the property. Do you have to make the repairs? No, but then you would need to pay off the mortgage and the remaining funds would belong to you.

    If the property is repairable, then repairing it would probably be the reasonable thing to do especially if you have a replacement value policy. The insurance company would use new materials and use current labor costs to repair the property.

    When it makes sense to not repair is if it is a total loss and you have no incentive to repair the damaged property. The property will still belong to you so what will you do with a piece of property that you still are required to pay taxes upon and maintain it (snow removal, etc)?

    Now, your last question is technically a legal question but I am going to answer it to a degree. The business loan is really another lien on the property to ensure that you repay the business loan. Is it a true lien? No, not really but it could be in the event the bank wanted to enforce the collateral arrangement if you defaulted on that obligation. So, a quick and simple answer is that the $30,000 you referred to would go to you. You are the next party in line for it and your bank that did the business loan is not in that capacity right now.

  477. February 27th, 2011 at 4:00 am #dee

    Actually the business loan is the only lien I have on the investment property. The estimated expenses seem to be from 50k to 100k. I heard that you can rebuild somewhere else which seems like a better choice. I guess I should pay bank off first before negotiatin.g with insurance co. I don’t have any prepayment penalties fees. The real question is th Amount of the cash value. Is more than the mortgage will the ins. Co. Cut. The bank and me one check and I have to fight with the bank for my change. Or will the ins. Co. Write. 2 checks one for amount of balance the other 2 me left after amount.

  478. February 27th, 2011 at 6:33 am #Jason

    Dee,
    Those concerns are very valid that you have. The best way to learn the answers is to talk directly to your claim handler and ask him questions and express you concerns to him.

    I am not certain you can build elsewhere because I have not researched that option in Michigan. That may be something an attorney can address with you.

  479. March 11th, 2011 at 2:22 pm #Ally

    I had a house fire I was told that day it was an Electrical fire and the House was turned back over to me that afternoon. I got the fire report it stated it was an electrial fire, no human involvment, no arson, etc. 4 days after the fire I got a call that the personal property and fire investigator from the insurance co. were at my house, I had a clean up Co. there so they let them in. The following day I got a call that the police were there, I was confused. My clean up crew told me that the Fire investigator from the insurance co went back in the house the following day.. 5 days after the fire took stuff from the house went outside and called the police to turn over stuff. The police are telling me that they never went in my house even though my neighbor said they were there for a few hours. I called the city law department to get a police report because I wanted to know what the insurance co took and handed over to them, I was told by the city law department that there was no police report because there were no findings and that it seems just like it has been blow out of proportion. What I want to know is can an insurance co. do this? Go in your house take whatever they want call the police and just hand whatever they want over I dont know the laws so I dont know what is legel and what isnt. Thanks

  480. March 11th, 2011 at 2:30 pm #Ally Ann Hert

    my question got posted twice sorry

  481. March 11th, 2011 at 2:49 pm #Jason

    Ally,
    Sure, the insurance company can investigate any claim made. Can they call the police? Sure they can. Can they hand over things to the police? Sure, they can. Is this the most appropriate way to handle a fire investigation? Probably not. Not only did you endure a house fire, but you seem to be facing some miscommunication involving the entire claim process. If there is a fire investigator hired to investigate the cause and origin of the fire, then you should be fully aware of their involvement. And that investigator should be involving you in their process (to a certain point) that involves respect and adequate communication.

  482. March 12th, 2011 at 6:18 am #Ally Ann Hert

    Jason,
    The orgin has already be determined I found out yesterday as a light but the stuff they took does not even really pertain to the fire. There was no communication with the insurance co to me that they were even coming back that. PLus the house was turned back over to me and the scence was no scured so to come take my property out of my house without contacting me doesnt seem right.

  483. March 12th, 2011 at 6:23 am #Ally Ann Hert

    Not secured*

  484. March 12th, 2011 at 6:49 am #Jason

    Ally,
    It doesn’t seem right but what do you want to do about it? It seems there was a lack of communication. You seem to know what stuff was removed if you are aware it doesn’t pertain to the fire. You know more about your situation than I do and you’ll just have to move forward. It doesn’t make sense to dwell on this situation.

  485. March 12th, 2011 at 2:18 pm #Ally Ann Hert

    jason thank you I understand it is just frustrating that insurance companies can come and do what they want. thank you for your help

  486. March 28th, 2011 at 7:33 am #Kari

    I am seeking some help. I am insured with Travelers on an HO3 contract. We received our water bill that noted a potential leak. We immediately called the plumber out who confirmed a hot water slab leak. He installed shut off valves, and provided an estimate….a huge estimate. They informed me that insurance covers this. So after questioning others, underwriters, agents etc, they were all on the fence. (I’m an agent that actually sold this to myself….) I don’t handle claims, and this isn’t so black and white, so I was unsure. I filed my claim last week. The adjuster came out and immediately denied the claim stating “I am not able to locate any coverage for this in your contract.” OK, then point to me where its excluded…he said its not excluded, but since I haven’t suffered a direct physical loss by a covered peril, as we stopped the water from going everywhere, by having the valves installed, we didn’t have a loss. So I ask my husband what the adjuster did and he said nothing. I asked if he saw the warped baseboard behind the water heater and he said no, he didn’t look. So the next day I called his manage, advised that I actually sell his product daily, and am quite upset. He appeared very understanding and said we’d get a new adjuster and they would pay for the “investigation”. So a restoration company and another plumber will be out tomorrow to report their findings. Do I have any hope in having this covered? Like my uninsurance saavy husband says, how do they know we don’t have damage to our home without looking at the slab, interior dry wall, under floor etc? The plumber seems to think there damage and even told the adjuster that if he didn’t do the valves there would be.massive damage. Any advise you can spare would be.great. thanks.

  487. March 28th, 2011 at 8:04 am #Public Adjuster

    Kari,

    You have suffered a very common loss. As an agent I can tell that you are aware that you have an All Risk Policy – so you are looking for the “exclusion”. There are a couple of exclusions – one which may surprise you.. which is water. That’s right.. water damage is excluded.. UNLESS.. there is a “sudden and accidental” discharge of water from within a plumbing, heating, or air conditioning system or a named peril caused damage to your home allowing water to enter in. Then, the ensuing water damage would be covered, but they do not cover the part or appliance from which the water escaped. However, if it was sudden and accidental AND caused damage to the structure, then Travelers would owe for access to the pipe and repair of the areas accessed – but not for the pipe itself. The pipe is excluded from repair under the “wear, tear, deterioration” exclusion.

    This is what I see you are going to face with the inspection. 1. You stated that you were alerted to a leak due to a high water bill. That might be an issue. Water damage will more than likely be denied if the pipe has been leaking over a period of time. The carriers consider this to be more than a week – whether you knew about it or not. So, they are going to look at when the bill arrived, how long you took to do something about it, etc. 2. Are you able to attribute the interior damages to the burst pipe in the slab? In other words is the warped baseboard behind the water heater attributable to the slab – is it in close proximity?

    I think what the adjuster might have been thinking was that if the pipe that was leaking didn’t cause any damage to the structure then you have not suffered a direct physical loss to be able cover in the first place. Keep in mind that the pipe itself is not covered.

    Now, if coverage is extended then go back to what should be paid for. Any interior damages, access to the slab pipe (tearing out flooring, slab) and then putting back the flooring and slab, base, drywall, painting, and so forth. Technically the insurance company would still owe for the flooring even though you chose to re-route or bypass the leak somehow. But, at the very least you should be able to get them to pay for the re-route in lieu of the flooring.

    Remember, sudden and accidental – the pipe needed to be causing damage to the structure.. for a very short period of time.

    I hope this helps. Let me know if you need additional info.

  488. March 28th, 2011 at 8:24 am #Jason

    Kari,
    With a H03, there is coverage for everything unless it is excluded (generally). From what you posted, I fail to see damage. If there is a leak within your slab, that falls under the category of maintenance and the homeowner should repair it as routine maintenance.

    Many insurance companies will take the approach of covering the cost to to get to the leaking plumbing to determine if the leak occurred from a covered loss. This might be the best approach for an insured because this investigative action can be more costly than the actual plumbing repair itself.

    You can’t really take the approach that if you didn’t do the valves that there would be massive damage because you DID do the valves and there is not any major damage. An insured must do what is reasonable and necessary to prevent or reduce damage.

    Warped baseboard likely would be covered. Concrete that becomes wet is not damaged. Perhaps the best approach would be for the insurance company to expose the damaged plumbing to see if it’s covered. Some insurance companies will not cover the repair to the plumbing (maintenance or not covered damage) and then covering the pipe again to the condition before the area was exposed.

  489. March 28th, 2011 at 8:25 am #Kari

    Thanks! The restoration company just left, and took pictures of the damaged base boards- We actually read the policy word for word (as an insurance agent myself, I was blown away- and can’t imagine how some one who didn’t know insurance would feel…) And yes, the “sudden and accidental” is what may get us. But then again, I’ll keep arguing, and that any “normal” person wouldn’t know they needed to look under their slab. The baseboard wasn’t damaged prior to the notice. I am okay with paying for the repair to the pipe ( the plumber today said he would cap both lines off and lay new lines to stop any other leaks from happening) and only would have to tunnel the foyer. I feel like we should have just let the water destroy our floor and not abide by the insurance contract and stop any further damage from happening… But being an agent I can’t, nor would I ever do that. I don’t want to damage my home. But that seems to be the damage they were looking for. So we’ll see. I called the claims manager, and left the restoration companies phone number on his voice mail, because quite honestly, I am not sure what my roll is at this point. I mean, we had the plumber (times 2) out, diagnosis was the same- restoration company out, took pictures of damage- I don’t feel like being the middle man– so hopefully they will communicate and see whats going to be covered… if anything. Interestingly, Auto-Owners just paid this exact claim (client had little hot water- have always thought it to be a bad hot water heater- called American Home Shield to repair is under the home warranty, and the tech advised them it wasn’t the hot water heater, but most likely a slab leak) no visable damage- but they covered it. I’m not familiar with their contract, but I am pretty sure the “average” Ho3 covers/excludes the same… What a crazy week it’s been!

  490. March 28th, 2011 at 8:26 am #Kari

    Sorry, let me add- the home was closed on NEW 12/09/2002- so it’s a new home.

  491. March 28th, 2011 at 8:33 am #Kari

    Jason- They told me that I could (on my dime) have the pipe exposed and see if it would be a covered loss. (this was before I spoke with the claims manager- this is what the first adjuster said) We’ll see. Thank you for all of the input! Like I said. My concern would be if they paid to “investigate” the cause and dug up that pipe, I wouldn’t be in a position to lay put my house back together if they don’t find any loss. Therefore leaving a hole in my floor and a pipe that is exposed.

  492. March 28th, 2011 at 8:44 am #Jason

    Kari,
    With an all-risks policy, it’s the insurance company’s obligation to to “prove” exclusion. The all-risks policy provides coverage unless it’s excluded so you have coverage unless and until the insurance company proves it’s not covered with an exclusion. So, it would be the insurance companies cost to determine if the leak to the pipe is a covered loss. (Most cases it’s not but there may be some circumstances that the damage to the pipe may be covered). There is a cost to get to the pipe and that cost is also the cost of covering it back the way it was before they opened it the hole. The insurance company needs to restore the destructive investigation activities they do while inspecting a claim.

  493. March 28th, 2011 at 12:22 pm #MJ

    My home, Insured by ERIE insurance for 19 years, burned down last year and was a total loss. My policy states ERIE would increase my insurance every year to keep up with inflation and construction costs. The upper limits of my policy was $100,000. A friend who is a contractor did a cost estimator says the replacement cost for the home would be $160,000. ERIE did not increase the Insurance enought to keep up with inflation and construction costs. My insurance agent told me they were only responsible to keep my homeowners insurance at 80% of it’s reconstruction cost and they were under no obligation to tell me. It does not say this anywhere in my policy. He told me that was the law but he would not provide any proof this is the law. I submitted a proof of loss to my adjuster (at his request) for $160,000. He called me and told me I was only allowed to claim the limits of my policy on the proof of loss or $100,000 and returned it to me to be “corrected.”

    Also, I work approximately 80 miles from my home and rent a sleeping room for $100.00 per month (from an elderly man) so that I do not have to drive home when the weather is bad. My adjuster told me they would not pay rent for a home because I had a place to stay. I told him this was only a sleeping room and I had no place to put any of my things that I would be replacing. He told me that was not his problem. He may pay for a motel room in my hometown for the nights I returned but only after I submitted the bill. A motel room is about $90 per night which I can not afford to pay on a regular basis until my home is rebuilt.

    I can’t afford a lawyer. What do I do?

  494. March 28th, 2011 at 12:50 pm #Jason

    MJ,
    The information you provided may not be based on accurate information. If you had your home insured for 19 years and it’s adjusted insured value is $100,000 now, it must have been insured for an amount considerably lower 19 years ago. The adjustment insurance companies do per year is fairly accurate so that means your coverage may have been lacking for 19 years.

    But, that is not where it ends. You said your friend who is a contractor did a cost estimator based on this house. If a house that was insured correctly 19 years ago and adjusted for increases in inflation and construction costs, the valuation should be closer to $100,000 than $160,000. I am at a loss because I don’t have all the information about your house.

    Your adjuster likely has his own cost estimator based on your house. You may want to ask him for a copy of that so you may make an informed proof of loss claim. As for claiming only your limits of your policy, that is not correct. You can claim any amount you want. The policy coverage limits happen to be the insurance company’s limiting parameters, not yours. For example, if you make a claim for $1 million dollars, they can accept that and pay policy limits, which happen to be $100,000.

    Also, if your house is insured to 80% of it’s replacement cost, your policy should have written into it an allowance for 20% more than your insured value if the cost of replacement exceeds your insured value. This is assuming your policy is a standard HO-003 policy.

    As far as the sleeping room, that seems to be out of the additional living expense parameters. It really has to make sense for the policy to be able to cover it. If you don’t have the funds for $90/night, work with your insurance company in order that they provide you with a cash advance for those expenses or for the hotel to send the insurance company a direct bill for your additional living expenses.

  495. March 28th, 2011 at 7:07 pm #kari

    Jason,
    thanks for clearing that up. That’s what I thought, but I felt like they didn’t want to be overly clear in their explanation. I understand the pipe isnt covered. My concern is the broken pipe caused unseen damage and the first adjuster basically said because they can’t visibility see anything right now, there was a loss. We argue that there may be damage to drywall etc that can’t be seen until floors are pulled up etc. Seems silly that they would pay to dig the pipe, bust the foundation, make repairs to the foundation that they worked on, new carpet, floor etc and deny it. They would be doing exaclty what I think they should. Aside from fixing the pipe- but I know we have to fix that. Water is such a gray area. I think you asked about the location of the baseboards….they are right behind the water heater. Thanks again. Ill be anxious to here the outcome…hopefully prior to Friday as we are leaving on vacation.

  496. April 3rd, 2011 at 8:30 pm #Chuck Herbel

    Has anyone taken out an insurance policy on a property located at 9821
    Sadie Ave ,St Louis, Mo 63125-2757 in the 2007 – 2008 time frame.because
    we are the Mortgage holders on said property. Occupants. no forwarding
    address.

  497. April 3rd, 2011 at 8:53 pm #Chuck Herbel

    to add to comment 496
    unknown fire caused total destruction of property,. and fire damage not
    only destroyed this property but also incurred many thousands of dollars
    to neighboring houses.
    Fire department report confirms extensive fire damage.

  498. April 5th, 2011 at 5:00 pm #Dennis Johnson

    We had a house fire recently when my microwave caught on fire while heating up some chicken.

    We own a three bedroom townhouse.

    The majority of the damage was from smoke and from water from the fire department making sure there was no fire in the walls.

    We have been put up at a nice local hotel in two connecting rooms (Myself, Wife, three young children).

    We are now being moved to a rental home in the area. We said no to the first place which was in a bad drug infested neighborhood.

    The second place we are being sent to this week will be a one bedroom apartment. (it has a living room and a den where the kids could sleep) but I am wondering….

    What type of replacement living accommodations is to be expected? How much should I push for something equal to my house?

    We have no timetable to get back to our own home. It’s been two weeks already and at least a month more as no work on fixing the walls, floors etc etc has even been started yet.

    Is there anything else I should be aware of that could help me make sure I don’t get abused by the system? I am really naive about what is normal and what to expect from the insurance company. I have a fairly nice townhouse but with three children and with work being scarce (I work days, my wife works nights) it’s stressful right now living without our stuff or in our home.

    We are very grateful that we have insurance and do not want to be greedy and push for more than normal but I am very much aware that an insurance company is looking out for themselves primarily and I’d like some help in knowing how to look out for my family.

    Thank you very much in advance for any help anyone can give.

    PS) We have State Farm insurance and honestly they have been helpful and nice but we have had to push a little to get a 2nd motel room and we had to push not to be placed in such a bad neighborhood. I just don’t want to push too much and maybe have it backfire on me.

  499. April 5th, 2011 at 7:05 pm #Public Adjuster

    Dennis,

    State Farm has always been one of the more reasonable insurance companies that I have represented clients for. Not all have the same experience but my experience is that their adjusters are trained better than most, have a stronger interest in caring for insureds, and many I know have been with the company 20+ years which says a lot in this industry. That being said, I have had issues very similar to yours that needed to be resolved.

    Assuming you have adequate coverage for additional living expenses, you are not being treated anywhere remotely close to fair in your situation. You have a great attitude, one that insurance companies love, but in order to benefit from your policy you are going to need to tweak your thinking just a bit.

    Your insurance policy is a contractual obligation wherein you agree to perform certain duties and your insurance company also agrees to perform certain duties if you suffer a covered loss. I often tell my clients to “re-think” of this to be akin to a contract you have with a general contractor that is putting a second story on your home.

    While building the second story, the contractor gets all the framing, electrical, plumbing done and installs the drywall… at what point do you say “well.. I don’t want to push too hard to have him finish because I don’t want it to backfire on me”? Would you ever say after you paid him… “you know.. don’t worry… I’ll finish putting in the cabinets, flooring and paint ’cause I don’t want to take advantage of you”? You don’t!

    And you shouldn’t with your insurance policy. You paid your premiums as agreed so you should expect to receive every single thing that you are entitled to under the contractual agreement (policy).

    What are you entitled to? Well, almost all policies state something to the effect “we pay for Additional Living Expenses so that you can maintain your normal standard of living”.

    Your normal standard of living is a 3 bedroom townhome in a community that has certain characteristics (close to school, church, work, etc.). So that is what you are entitled to under the contract. A one bedroom apartment does not represent “your normal standard of living” and does not fulfill the contractual obligation of the insurance company.

    You of course cannot have the same home, same neighborhood etc. But you are entitled to something similar in a nearby area if that is available.

    What should you do? You should call the adjuster and explain that it seems unreasonable and is causing you hardship to live in a 1 bedroom apartment. Ask the adjuster what you are entitled to under the policy. If the adjusters cannot answer, will not answer, or does not give you a reasonably satisfactory answer for the reason they have stuffed you in a one bedroom apartment, ask to speak to the supervisor.

    I’m confident though that once you ask what you are entitled to, the adjuster will answer you correctly, and then you can ask if he(she) would like to assist you to find a place (they have housing relocation companies on their vendor list) – or if he/she prefers you find something of like, kind and quality on your own.

    Keep you chin up… you should not have any problems getting what you are entitled to. You’re not pushing too hard and there is nothing to backfire on you anymore than if you asked the contractor to finish the 2nd story of your home that you agreed to with him.

    Let me know how it goes and if there is anything else I can help with.

    Take care

  500. April 5th, 2011 at 8:13 pm #Jason

    Dennis,
    The normal standard of living is big. I agree with public adjuster that the 1 bedroom is not sufficient if you were in a 3 bedroom. These arrangements will be inconvenient but it should not be unbearable for you.

    Open communication with your adjuster is important. Ask questions and if it doesn’t sit well with you, speak to their manager.

    Also, you are entitled to a normal standard of living in regard to other things such as electricity, cable, etc. If you have to pay for utility hookups, save your receipts because costs that you incur because you are displaced from your home are reimbursable to you.

    A good thing to do is to save all your receipts during your entire time you are out of your place in case you may want to be reimbursed for something that you were not aware was allowed. It is common that people have more food related expenses because they have to eat out rather than eating in because all the spices, cooking utensils, food supplies are not available at your temporary residence. Check with your adjuster about what is acceptable in regard to this.

  501. April 6th, 2011 at 8:56 pm #Messed UP!

    My husband and I unknowingly bought a nightmare of a house in August of 2007…previous rental property (in TN owner’s of rental property don’t have to disclose anything that they know is wrong), bad real estate agent, bad inspection, bad advice, BAD timing. We had previous termite damage that the previous owner had “fixed” with two loose cinder blocks and some loose 2x4s stacked on top of one another holding up the floor in our son’s BR that the home inspector “missed”. When the floor started to buckle, my husband found the damage and we contacted our insurance company and while they were out I also noted that the floor in our kitchen had started sagging. Of course, the insurance wouldn’t cover the BR floor because of termite damage and pre-existing condition. And the adjustor said that he didn’t see any water damage to the kitchen floor. He thought it was the weight and positioning of our new frig.

    A couple of months later, I started to straighten up under the sink and picked up a bottle of jet dry in our “cleaner bucket” and noticed it was wet. After further investigation, the entire bottom of the cabinet was wet, but had been hidden under mesh lining and our cleaner bucket. The water had been leaking into the bucket which had tiny holes that would then leak onto the bottom of the hardwood cabinet. The mesh was protecting the rest of the items in the cabinet. We had cardboard boxes under the cabinet that were dry as a bone.

    Our insurance policy says that slow leaks are covered if they are hidden in the walls. Would under the cabinet in had a hidden leak under our kitchen sink in the base cabinet?

  502. April 7th, 2011 at 6:54 am #Jason

    Messed Up,
    This sounds like a bad investment and one that you may want to extract yourself from.

    The leak under your sink is no longer hidden. You did not indicate there was any damage from the leak, which if there was, it is probably minimal. The remedy is to stop the leak, dry the cabinet and move on.

  503. April 7th, 2011 at 5:50 pm #Messed UP!

    We never would have bought the house if we had known about the problems that were missed by the inspection. And now we are stuck in it.

    The leak has been unknowingly going on for some time and has resulted in damage to the cabinet and adjacent cabinet, and more frightening, the subfloor. This is why the floor started to dip.

    What do you think should the insurance cover this?

  504. April 8th, 2011 at 5:11 pm #Jason

    Messed Up,
    The insurance company doesn’t help you with your business decisions regardless if they are good or bad. They address direct damage as the result of an incident that is not otherwise excluded. In your case, The policy WILL provide coverage for mold, fungus or wet rot if the damage is hidden in the home’s walls, ceilings or floors. However, the hidden damage has to be due to the accidental discharge or overflow of water or steam from a plumbing or air conditioning system, a household appliance, or a fire sprinkler system. Coverage for hidden damage from accidental discharge and overflow also exists when caused by several sources located away from the residence premises, such as storm drains, water pipes, steam pipes, or sewer lines.

    Now, the way you describe the water intrusion, it seems there could be coverage up to this point. If your policy contains the previous wording, it likely also covers this additional wording which is very important since there is a loss that is already in play that is not covered.

    EXCLUSIONS—SECTION I
    This section is of extreme importance in determining if something is covered or excluded. “Is this covered by my policy?” One of the places an an adjuster looks is in the Exclusions section of the policy. There is no insurance protection for either direct or indirect loss that is due to any of the sources of loss that appear in this policy section. The loss is excluded:
    -regardless of any other cause or event contributing concurrently or in any sequence to the loss, and
    -regardless of whether the damage is localized or widespread.

    An exclusion will trump any coverage if they happen at the same time or around the same time and the excluded item, event, or occurrence causes any part of the loss.

    Adjusting a loss cannot be done without examining the loss, gathering the information, and applying it to the policy. This information is only my opinion of what may be the result of your claim. I am not the person who determines if coverage applies from your policy based what you have explained and you may not know the answer unless you file a claim, and investigation is completed, and a determination is made.

    I am not aware if there is any termite damage to the cabinets and whether the cabinet water damage will or will not be concurrent with the termite damage. I won’t know unless was able to examine the claim personally.

    So, in direct response to your question, “Do I think the insurance policy will cover this?” I do not know, and I believe I’ve provided information why this is difficult to determine without actually inspecting the claim.

  505. April 11th, 2011 at 5:35 pm #Alaine

    My father in law had commited suicide by gun shot and we were advised to have a trauma clean up company clean up the blood. The work was done on a weekend and the insurance company was not able to be verified until Monday for coverage. The insurance said it was not covered and the cleaning company feels that we should dispute the issue because other insurance companies pay with similar policies. The insurance said there are “named perils” which only include fire, lightning, internal explosion and a few others (unrelated). I found an article that said “shooting” is not a named peril but “explosion” is thus providing cause of loss. If the insurance still disagrees and denies what can be done before investing in an attorney. Is there anything that I can say or do to get coverage? If I get an attorney what is the chance I will win?

  506. April 11th, 2011 at 6:35 pm #Jason

    Alaine,
    Sorry about your loss. The cleanup needed to be done regardless, and now someone has to pay for it. The way you indicated the policy provides for coverage is a named peril basis. The other option for a policy is an all-risks policy which covers everything, unless the cause of loss is excluded.

    A named peril policy covers 9 or 10 listed perils and explosion is one of them. The burden with a named perils policy is that the insured needs to prove coverage before coverage applies. In an all-risks policy, it is assumed that coverage exists unless proven by the insurance company that is does not.

    If the cleaning company advises you to dispute this with your insurance company, they may be able to assist you with your approach to getting this covered. Trauma cleanup is generally expensive and is commonly paid by insurance.

    I am sure coverage has been provided under the peril of explosion in cases very similar to yours even under named perils policies but I have not verified this. I have not reviewed any case law in any states to confirm this. I am not an attorney either so my interpretation of the law is not the same as you would receive from an attorney.

    Make attempts to work with your insurance company (and the trauma clean up company) to see if you can get the insurance company to cover this as explosion.

    As far as coverage, the trauma clean up company can probably provide you with better information than I can because they encounter it more than I do.

    If you get an attorney, I don’t know what the chances of success for you would be.

  507. April 12th, 2011 at 6:33 pm #Messed UP!

    Thank you for your clear explanation. The insurance company informed me today that it will be covered. We were denied initially, so I am relieved!

  508. April 12th, 2011 at 6:47 pm #Jason

    Messed up,
    I have empathy for the customers who have to battle with large insurance companies and you seem to be in the middle of a battle. I hope it works out for you. It is true that the squeaky wheel gets the grease. Sometimes paying a claim is easier that denying it. I don’t know what they are covering, do you? Will they cover the flooring, the cabinets, or what?

  509. April 15th, 2011 at 10:20 am #Jackie

    I have a State Farm homeowners policy. My refrigerator leaked under it on the floor, damaging the floor and the neighboring wall. I believe it may have been from the icemaker. Would this be covered?
    Thank you.

  510. April 15th, 2011 at 10:24 am #Jason

    Jackie,
    From your brief description, yes, this would be covered.

  511. April 19th, 2011 at 1:33 pm #Dennis C

    In discussing my personal asset coverage with a possible homeowners agent for my property we were discussing coverage amounts and the claims process if one was ever needed to be filed. I was told that if I have replacement cost on my personal property and I have to file a claim I would not have to provide a list of what was lost, since they use a percentage of the coverage amount. It just doesn’t make sense to me not to provide a list on what was lost. I don’t see an insurance carrier taking out there check book and writing a check say $75K because that is what I said I had lost. They also said they have never had a claim denied due to lack of supporting information (i.e. receipts, pics, etc.)

    I am leery of this because I would think that the insurance carrier would want a complete itemized list to insure that they were not paying more than required even if I had $300K in personal coverage. I am keeping a record regardless of all my assets to make sure if I ever had a claim I would be protected. But for my own reference can you explain how having replacement costs coverage prevents me the insured from having to provide info to the carrier in the event of a loss, and how the claims process for a situation like this is handled?

  512. April 19th, 2011 at 1:46 pm #Jason

    Dennis,
    You are correct. The insurance company does require an itemized list for the items damaged in the event of a loss. You would need to provide this list regardless if had replacement cost or and actual cash value policy.

    What seems to be a little confusing here is that your personal property coverage is based on (for example) 75% of your home’s coverage. That generally is an adequate amount of coverage for a typical homeowner. The insurance company doesn’t need to know specifically what they are insuring, but when a claim occurs, they need to know what they are paying for. If everyone had to provide a list of all the things they wanted covered by a homeowner policy, that would be time consuming for every new or renewed policy issued. To do a percentage coverage saves time and provided adequate coverage for 95%, or more, of the homes that are insured this way.

    I think you agent may have not fully understood your question when you and he were discussing your “what if” claim.

  513. April 20th, 2011 at 6:47 am #F MICHAEL CONTE

    I agree with jason and i would suggest that you continue to talk to agents.

  514. May 7th, 2011 at 12:24 pm #JOYCE A. BUTLER

    HOPE YOU CAN HELP ME WITH THIS. I HAD A FLOOD IN MY BASEMENT A FEW WEEKS AGO. I HAVE TWO SUMP PUMPS DOWN THERE. ONE MALFUNCTIONED AND STOPPED WORKING; THE OTHER ONE ALSO. I CALLED AND GOT A GUY THAT DOES A LOT OF WORK FOR US TO COME AND PUT IN A NEW ONE. (THIS WAS ON A SUNDAY). I SPOKE WITH MY STATE FARM AGENT ON MONDAY AND HE HAD THE ADJUSTER CALL ME. I PROCEEDED TO TELL HIM WHAT HAPPENED, AND ALSO TOLD HIM THAT I HAD MANY OF MY BELONGINGS DOWN THERE THAT WERE RUINED. HE BEGAN TO TELL ME THAT MY INSURANCE WOULD NOT COVER IT AND THAT THE ONLY THING THEY WOULD DO IS BLOW IT OUT AND DISINFECT IT. PLUS, I HAD A $1000. DEDUCTIBLE, AND THEY MIGHT PAY FOR MY SUMP PUMP. HE SAID THEY WOULD NOT COVER ANYTHING I HAD IN MY BASEMENT BECAUSE IT WAS NOT FINISHED OFF. I LOST COUCHES, LOVE SEAT, REFRIGERATOR, DVD’S,
    AND A LOT MORE. I WENT BACK TO MY AGENT- HE WAS QUITE RUDE TO ME, AND STATED THAT NO INSURANCE AGENCY COVERS A BASEMENT UNLESS IT IS FINISHED, BECAUSE THEY JUST DO NOT KNOW HOW TO WRITE THAT UP. I CALLED A COUPLE OF OTHER INSURANCE COMPANIES- THEY SAID THEY DO COVER THIS. I ALSO RECEIVED A LETTER FROM STATE FARM SAYING THEY HAD GOT MY CLAIM BUT I REFUSED TO SUBMIT IT- IT WENT ON TO STATE THE TIME FRAME THAT I HAD, IF I WANTED TO FILE A CLAIM. I CALLED THEM AND WANTED TO KNOW WHY THEY WOULD SEND A LETTER LIKE THAT. THE REPRESENTATIVE STATED THAT YOU COULD NOT HAVE RECEIVED THAT- I PROCEEDED TO READ THE LETTER THAT I HAD RECEIVED TO HER. SHE SOUNDED VERY UPSET AND TOLD ME I SHOULD NOT HAVE RECEIVED THAT LETTER. MY POINT IS THIS-SOMETHING IS WRONG HERE. I HAVE BEEN HAVING TROUBLE WITH STATE FARM FOR THE LAST FEW YEARS AND WILL BE TAKING ALL OF MY BUSINESS TO ANOTHER INSURANCE AGENCY EFFECTIVE MAY 13, 2011. CAN YOU TELL ME IF THEY WERE RIGHT IN THIS- THAT DAMAGES TO AN UNFINISHED BASEMENT ARE NOT COVERED? IT SHOULD NOT MATTER IF YOUR BASEMENT IS FINISHED OR NOT. I THANK YOU IN ADVANCE FOR ANY HELP THAT YOU CAN GIVE ME.
    JOYCE A. BUTLER

  515. May 7th, 2011 at 1:57 pm #Jason

    Joyce A Butler,
    Posting in all capital letters is not very easy to read. Using sentence style writing is a lot easier to read. This information is provided in the event you post again.

    There are a couple of things at hand here. The first is that a sump pump overflow and sewer backup endorsement generally is required to be attached to a homeowners policy for coverage to apply for damage from the situation you indicated. If you have that coverage, it is in most cases limited to $1000, $5000, or $10,000 in damage. You would have to review you policy to see if this coverage is there. Also, generally, the deductible for this coverage part changes to $500 per occurrence. (Even if your policy has a $1000 deductible). Personal property in a homeowners policy is covered anywhere in the world (restrictions may apply). The issue of finished basement or unfinished basement is not relevant. What is relevant is what caused the damage (failure of sump pumps). Depending on how the sump pumps are damaged, the damage to the pumps may be covered by your main policy and subject to your $1000 deductible. The damage to your personal property is dependent upon whether or not you have the sump pump overflow and sewer back up endorsement.

    Short of knowing if you have that endorsement, it is difficult to speculate if this is covered and it doesn’t matter if you basement is finished or not.

    For example, the damage to your sump pumps would be covered if damaged by lightning. Sump pumps certainly do not cost more than $1000 so that is where your claim may end. Do you know if you have a sump pump overflow or sewer backup endorsement?

    And a good rule of thumb is to check around for different insurance companies and coverage every 3 years whether you switch or not. It sounds like you may have reached the point in time to switch. During the time you are checking for different insurance, it is also a good time to discuss with your new agent if you have the types and kinds of insurance necessary to protect your property the way you want it protected

  516. May 8th, 2011 at 6:28 am #F MICHAEL CONTE

    Dear Joyce,
    Jasons comments are dead on pertaining to the sump pump exclusion/ endorsement. Here is what i suggest.

    Let me start off by saying i am an indepenant agent and have been for my entire life. Most people do not realize the differance that an independant agent should bring to the table. First we represent many companies and must be familiar with the various products offered by those campanies, second most independants are rather savy when it comes to claims, and in my case have no problem going toe to toe with an adjuster or claim rep.

    Many companies deal through captive agents (the company you mentioned is one) a captive agent represents one (yes one) company, so right wrong or otherwise you end up with that company’s product. additionally one might question who that agent really answers too, his customer or the only company he/she represents who could cancel their contract at any time?

    So the next question is does your carrier (assuming you do not have the sump pump endorsement) offer such coverage? if they do, was it offered to you? did someone inspect your home? if they did, did they note the sump pump? If they noted the sump pump, did they review your contract to see that you had the proper endorsement? Also if they inspected and did not note the sump pump, the question becomes what were they inspecting, and why didnt they identify the potential gap in coverage. If they offered the coverage to you and you did not take it, game ends here. If they have the endorsemnt and no one offered it then game on.

    Although this is a small property damage claim you might suggest this path to an attorney, attornies typically do not like to take property damage claims. Keep in mind there is always small calims court. if you go that route follow my rational and i think you will be successful. when you shop for insurance ask the broker if he/she is an independant, also ask what type of claims services and expertise they offer, after all you only need insurance when there is a claim…..Good Luck, and sorry if this sounds like a commercial for independants, but truly we are going the way of the neighborhood drug store…..non existant.

  517. May 8th, 2011 at 10:18 am #Jason

    F Micheal Conte,
    I appreciate your posts. I believe all insurance should be sold by independent agents. Independent agents have a magnitude of companies they can utilize and they can support good companies by writing policies through good companies and avoid companies that are not so good. That only makes sense in this free market system we live in.

    A simple example is a person who is looking for the best car for goes to a Ford only dealership. This Ford dealership can be compared to the captive agent who sells only one make (or the insurance coverage of that single insurance company). There are likely many, many cars more capable of matching a person’s needs and wants that are not Ford makes but the Ford dealer is only able to offer those cars.

    This does not translate to customer service at all by limiting your products to only one company. Keep up the good work as an independent agent. I hope independent agents are here for good because we need agents like you.

  518. May 9th, 2011 at 11:02 am #Emma

    I had water damage to half my kitchen which included a row of kitchen cabinets/countertop. The rest of the cabinets are not damaged but since the home was built in the 60′s there is no way to match the cabinets/or counter tops. Is it reasonable that they reface them or replace them even though they are not damaged, so they will match the rest of my kitchen.

    Also, what is the typical requirement for insurance companies to pay for building requirement/compliance issues when fixing items. For example, to fix the water leak they opened up the wall that has the dryer vent. It is piped to my attic, I am told by my contractor that is now considered none compliant and we will have to re-route vent to outside. Should insurance pay for this since they are paying for that wall to be fix?

  519. May 9th, 2011 at 1:39 pm #JOYCE A. BUTLER

    Jason,
    Thank you for letting me know about the capital letters. Will remember.
    I also thank you for the advice you have given me. Will try to find my policy. We have had our home with State Farm for over 20yrs. and my
    husband cannot find the policy. The sump pumps were put in when we had this home built in 1991. Will try and get the policy from them. Again I thank you very much for your advice.
    I called State Farm today and requested the whole policy and not bits and pieces. They said they would look it up and send to me. Only time will tell if they do.
    Joyce A. Butler

  520. May 11th, 2011 at 6:13 am #Steven Wright

    My house flooded several months ago. I had flood insurance and they agreed to settle for 80k. They cut the check to me and my mortgage company Wells Fargo. They are holding the money and releasing it in 1/3ds and they said whatever is left after the work is 100% complete and inspected will be given to me, the homeowner.

    I am just trying to figure out how much I should spend on the repairs. If I can get it done the same as it was before with a professional contractor for lets say 60k, will the $20k left be a problem for them to release to me? Also do I have to have 50% of the price in receipts or quotes before they will release 50% of the funds?

    I am just wondering if I actually would get any of the money left over from my insurance claim after the work is completed, or would I be better off just to spend the entire $80k. Will they actually give me the $20k if it was left after the repairs are done or should I just find something to spend it on and end up with nothing left over? They said I would get what is left but does this actually happen? This is my first house an flood claim and I have no idea what to do about this. Any thoughts feedback or experiences would be greatly appreciated. Thanks!

  521. May 11th, 2011 at 8:25 pm #Jason

    Emma,
    That is correct. There is no possible way for the insurance company to match you cabinets. They cannot make cabinets that are 50 years old. So nothing will match what is existing. You policy indicates that it provides coverage for direct damage for property that is damaged. The policy repairs or replaces with common building materials that are new. Does the insurance company owe to replace cabinets that were not damaged but will not match the existing ones? No, but some adjusters will allow that. Your concerns could be brought up with your claim adjuster to see if they will allow all to be removed and replaced.

  522. May 11th, 2011 at 8:30 pm #Jason

    Steven Wright,
    Proof of completion can be done by receipts, invoices, etc. Also, a visual inspection could be done to determine the extent of completion. It depends on what you lender wants for verification before they will release the funds.

    Will you receive the left over funds when 100% of the work is completed? Sure, if that is your arrangement with them, you will. The lender wants to make sure they have the same collateral for the loan that they did before the damaged. If there collateral is resumed, they will provide any left over funds to you.

  523. May 12th, 2011 at 10:03 am #Ronnie

    I had a flood in my kitchen from a dishwasher hose that apparently has been leaking for awhile but must have just burst Monday night.. apparently my floor slopes to the left of the DW and all of my cabinets are elevated on a false bottom that has supports that run front to back on the cabinets to elevate them.. the water emerged Tuesday morning under a cabinet 3 and 4 sasections away from the DW .. the cabinet where the water emerged is warped and I know that the company that made my cabinets is out of business becuase I had to replace a builtin refrigerator a couple of years back that was cabinet faced and I could not get replacement panels.. the insurace adjuster keeps asking how old the DW is and I really am not sure maybe 8 or 9 years .. why does this question keep coming up?

  524. May 12th, 2011 at 7:34 pm #Jason

    Ronnie,
    An adjuster will write an estimate to replace the damaged items. A subsection of the estimate will include depreciation which is adjusted from the total estimate. Generally, a wide-accepted way to apply depreciation is upon the item’s age compared against the useful live of an appliance. Another part of the same estimate will show the actual cash value (ACV) of the items damaged which is the replacement cost less the depreciation of each item.

    Your policy likely is a replacement cost policy but there are 2 stages of claim settlement of the policy that the insurance company can choose to use to settle the claim. The first part of the claim will be payment for the damaged items based on their ACV cost. This amounts to a down payment to complete the full repairs or item replacements. When the repairs or replacement have been completed, you are allowed to make a claim for the recoverable depreciation which is the amount subtracted for the depreciation of the items in the estimate.

  525. May 17th, 2011 at 12:57 pm #Mandi

    Hello,

    I have an ice dam claim that started in on Feb 4th 2011…. he came out Feb 17th and inspected the property and agreed it was significant damage, him and my contractor agreed on a bunch of stuff at that time.
    March 9th rolls around and we have not received anything from him so i called and he told me he forgot to do my estimate. we finally got it March 16th along with payment. He missed a whole room along with the ice dam removal, lead testing, and replacing carpet where he removed it and such.

    My contractor wrote him a suppliment including everything they discussed in the intial meeting. he recieved that March 30th. I called him April 4th with him only telling me he hates my contractor and to go with someone else and he refused to come back out and reinspect.

    I called him April 21st and asked him why nothing has happened he said he would agree to talk to my contractor over the phone. my contractor has called him or emailed him every day since then with no reply. I called HIS boss May 12th and was assured he would get him to contact my contracor. Still no contact. What should i do?? this is getting drawn out i would like to start repairs.

  526. May 17th, 2011 at 1:08 pm #F MICHAEL CONTE

    Mandi,
    What insurance company is this?

  527. May 17th, 2011 at 1:47 pm #Mandi

    Travelers Insurance. We are in MN.

  528. May 17th, 2011 at 4:26 pm #Jason

    Mandi,
    Call the adjuster’s supervisor and request that the supervisor handle your claim until it’s concluded.

  529. May 17th, 2011 at 6:21 pm #maceo

    my adjuster to 33% of my insurance check, now i can’t repair my house. is there a cap on how much an adjuster can charge in florida.

  530. May 19th, 2011 at 3:42 pm #Vickie Blankenship

    We had a house fire that was ruled as arson. We were not involved and are horrified about this. Our home was on contract to sale to a buyer. Now we are being told that the insurance company may not cover the claim since it was ruled arson?

  531. May 19th, 2011 at 3:58 pm #Jason

    Vickie,
    There are two types of arson. One is criminal and caused by someone who doesn’t have an interest in the home. The other is fraud when a the owner or owner sets fire to their property and makes an insurance claim. You have to be careful not to believe everything you hear. Who told you this would not be covered by your insurance company? If it’s someone like your neighbor, that is not a good source. If it’s your insurance agent, your attorney, or the insurance company claim representative, then that likely may be true. Although you had a question mark on your last sentence, you didn’t ask a question so none have been answered.

  532. May 19th, 2011 at 4:50 pm #Vickie

    Jason,

    Our insurance adjustor told us that she has never dealt with any cases involving arson but that she doesn’t think it is covered…. The question is just if this is true?

    The home had been sold and we were to close this month.
    Thanks,
    Vickie

  533. May 19th, 2011 at 7:38 pm #Jason

    Vickie,
    It’s either covered or it isn’t. There is no “thinking it isn’t covered”. That doesn’t work that way. If this is criminal arson and you have no involvement in it, this should be a covered loss. This adjuster should not be making comments like that since it appears she is not qualified to be interpreting an insurance policy. If this was my claim, I would ask for another adjuster who is capable of handling your claim. I have my doubts about your current adjuster.

  534. May 19th, 2011 at 7:57 pm #Vickie Blankenship

    Jason,

    We definitely have NO involvement in this. We had sold the house and it was getting ready to change hands, but now it can’t go to settlement as is.

    She said that it could take months to complete the Arson investigation and that was her exact words to my husband this morning.

    She said that she has had no experience with Arson in the past. She said that from what she has read that she doesn’t think it would be covered.

    The only problem is… when we call and ask to speak to somebody else, they always transfer us directly to her voicemail. She NEVER replies to voicemails and we have to constantly call until she picks up the phone.

    The fire marshall’s office has rulled it as arson. Our insurance fire investigator agreed with these outcomes. However, as stated before, we had no financial gain and no motive to do this.

    We are now having to pay an insurnace deductible as well as maintain the house payments, insruance, electric, etc until the house is acceptable for settlement.

    I am ready to pull my hair out. My husband is on military deployment in Missississippi preparing for Afghanistan and we want some sort of closure, so that we can determine if this house will go to settlement or not.

    Thanks,
    Vickie

  535. May 20th, 2011 at 5:25 am #Jason

    Vickie,
    There are a couple of things at play here. First, people who are inexperienced (claims adjuster) are making statements they should not be making at this point. It is critical that qualified people are handling your claim.

    I would say your claim is in limbo while the arson investigation is completed. What it appears they agree upon is that the fire was started intentionally. Their investigation has to continue to either rule you or somebody working at your direction caused the fire, or rule you had no involvement in the fire.

    Because of the circumstances, you are the main subject of the arson investigation until you are cleared of that role. You may be asking if you need to get an attorney. It probably would be a good idea to talk to one. There’s a big stake at risk which is a substantial amount due to your house fire.

    Your insurance company should be paying for your added living expenses at this time including rent, extra utilities, extra food expense, etc. That is what insurance is for – so you don’t have to pay for 2 households. Your claim at this time is neither accepted nor denied. It is in a limbo status while they make a determination of coverage. Your extra expenses should be paid by the insurance company while in the limbo state.

    I hope your closure comes quickly but it could be months to conclude an arson investigation. It’s not so important that they find out who started the fire, what is important to you is that they rule out any involvement by you. And ruling you out could occur quickly but I don’t know all the circumstances.

    Please post the name of this insurance company so we all can take note that this company utilizes untrained and inexperienced adjusters on complex claims.

  536. May 20th, 2011 at 6:38 am #Vickie

    Jason,

    Thank you for your assistance. Believe me, we have already retained an attorney! This entire situation is ridiculous! The house was SOLD!

    Our insurance company is USAA!

    And further advice would be greatly appreciated. I’m pretty much on my own battling the insurance, with my husband’s deployment.

    Thanks,
    Vickie

  537. May 20th, 2011 at 7:27 am #Jen

    Hi,
    I have had a house fire of one of my rental properties. The insurance check was for over a hundred thousand dollars. My bank wants me to deposit and get payments on as repairs are done.
    My question is after repairs are done and they send an appraiser out what happens if it does not appraiser for as much as it did when I bought it( we all know the market now is not good). ( house appraised at 147000 then, mortgage at 112000 now) Can they keep any of the money that was from the insurance check?
    Can I get my own appraisal? They said they use theirs.
    Thanks for any help
    Jen

  538. May 20th, 2011 at 8:03 pm #Jason

    Jen,
    The matter of the bank providing your funds as the repairs are completed is a matter of them making sure they get the same collateral as they had before which happened to be an undamaged property. They should not be sending an appraiser to inspect or value the property. All they want to know is that the repairs are completed so they can release the funds to you. That is your money but the damaged house is their collateral for your loan. There is no need to be concerned about the market value of this property. If anything, after the repairs are completed with new materials, the property will be worth more than in the pre-fire condition. Oh, and another thing – the bank has no desire keep any of your money. They will gladly release it back to you as the repairs are completed. It’s not an adversarial situation at all.

  539. May 20th, 2011 at 8:15 pm #Jason

    Vickie,
    I agree with you that the situation is ridiculous. The insurance company should be updating you with information about what is going on so you have all the answers. I don’t care if the information is good, bad, or indifferent – you still need to be told the entire process. You are their insured and their customer. Sure it’s going to be stressful either way but knowing the information about what is going on can alleviate a lot of stress.

    I’m not an attorney and your attorney knows you situation a lot better than I do. I can tell you that they will probably want to take a recorded statement from you or a maybe even a deposition which is a video recorded statement usually with an attorney asking you questions. Your attorney can better advise you on these things.

    It is a good sign for you that the house was sold and the closing was coming up. That is a lot better than if the house was on the market for over a year and no offers had been submitted. In all likelihood, I really don’t see the buyers sticking around to buy your house after the fire. You may have to get the house resold after your claim is settled and the repairs are completed.

  540. May 23rd, 2011 at 1:13 pm #JoAnn

    We have a finished basement-now a total mess-water– ground water they say- I would like to know how Ins. places can say something is covered on one page and 6 pages later they state it is not. And in the end they go with of course page 6 and you are left paying them for the policy and for the total clean up of the damage? How is this right and legeal??? We have Nationwide–belive me they are not on your side….

  541. May 23rd, 2011 at 5:01 pm #Jason

    JoAnn, ground water is something that insurance companies don’t want, and don’t intend to cover. They base their coverage on where the water source came from. If it’s a broken pipe, leaking appliance, overflowing bathtub, etc, they provide coverage for those causes. Ground water is one that they don’t provide coverage for. That and flooding. That what flood insurance is for and I believe the flood insurance is available through many insurance companies but is supported by the government.

  542. May 26th, 2011 at 3:33 pm #Vanessa

    I live in Texas and a winter storm killed 5 very large palm trees on my landscaping. I called my State Farm Insurance and the lady informed me that homeowners insurance does not cover trees or shrubs in Texas? Are you aware of this? Can you direct me to where I might find clarification as well?

    Thank you for any help,

    Vanessa

  543. May 27th, 2011 at 9:44 am #Jason

    Vanessa,
    trees are likely covered in your homeowners policy but for limited causes of loss like from lightning, fire, vehicle damage, and a few other causes of loss. I am not aware that freezing is a covered cause of loss. Your tree loss appears to not be covered.

  544. May 31st, 2011 at 1:08 pm #William

    My house got flooded on boxing day, i submitted my contents claim, now the insurance company want to take 25% off my claim, for ware and tare etc, and the fact they can get big discounts from suppliers is this correct.

  545. May 31st, 2011 at 1:23 pm #roofclaim

    My insurance company is paying to reshingle my roof due to wind/hail damage that happend oct 2010, they finally inspected it may 14th. They did not get out in time in 2010 before snow fall to check the damage. Now the decking is compromised from water seeping in all winter. Will they write a suppliment once they get pictures of the damage to the decking and bring it up to code since it is damaged?

    we have 1/2 inch sheathing i believe code in MN is 5/8ths or more.

  546. May 31st, 2011 at 1:41 pm #F MICHAEL CONTE

    William,
    What caused the flood? broken pipe tidal water overflowing bounds? advise
    does you policy provide for replacement csot on contents?
    Who is your insurer? Where are you tha they celebrate Boxing Day?

  547. May 31st, 2011 at 4:02 pm #Jason

    William,
    This depreciation (25%) in your case is common when settling claims and has already been discussed in this forum several times. Your policy pays for the ACV (actual cash value) of the items. When you replace the items, you can submit an additional claim for the recoverable depreciation (25%). That is just how the policies are written.

  548. May 31st, 2011 at 4:05 pm #Jason

    Roofclaim,
    In regard to your question, that is correct. Your questions and concerns should be directed to your adjuster because that person will do the supplement estimate.

  549. June 2nd, 2011 at 11:12 am #Maria

    I severly cut my thumb last week in the kitchen of my home. The bills are adding up very quickly and are currently already over $1100 and I havent even gotten the stitches removed yet. I have already spent $200 out of pocket and my parents keep telling me I need to file a claim with my home owner’s insurance……..is this a wise idea?

  550. June 2nd, 2011 at 11:39 am #F MICHAEL CONTE

    Maria,
    There is no reason to file a claim with your homeowners carrier. Home insurance covers your home and a component called liability covers you for harm you do to others, and medical expense for non residence. for example if i were at your home and i cut my finger while helping in the kitchen, i would be able to seek coverage from the medical expense portion of your poliy. if you cut me whil you were cutting fruit or some typoe of food i could also seek remedy from the liability portion, but i am afraid that there is no coverage for your situation.

  551. June 7th, 2011 at 3:43 pm #Tim

    I am working through a claim for water damage due to a leaking pipe. I called a restoration company, (it was early on a Sunday morning) to clean up the mess. Then I called the insurance company to start the claim process. The restoration company bill was $12,000. The insurance company sent me a check for $7,000 stating that is what is “reasonable”. Do I have cause to go after more from the insurance company?

  552. June 8th, 2011 at 5:10 pm #Jason

    Tim,
    If you owe the restoration company more money because of what they did, then the insurance company should be paying more for what the company did to protect and restore your property.

    If you are asking if you have a legal position to sue the insurance company, we refrain from provided input about that and refer you to discuss with an attorney.

  553. June 9th, 2011 at 5:19 am #Tim

    I do not plan on taking any legal action. The restoration company billed for 28 hrs labor. (which I think is fair) The insurance company quote was for 8 hours. (which I think is crazy) The insurance company is also having an issue with “drying time for equipment rental” and other charges that the insurance company deems excessive. I didn’t think I should be required to pay the difference. I was curious if this was typical or legal for an insurance company to pay only a portion of a clean up bill, etc.

  554. June 9th, 2011 at 7:04 am #Jason

    Tim,
    You were there and you are aware what this restoration company did. 28 hours is basically 3 full days of work.

    If the amount is billed, the insurance company should be dealing directly with the restoration company to get the bill adjusted or simply pay it. They don’t have any other options than these.

    If you have the check of $7000, it may be wise not to cash it or use it to pay the restoration company until everybody can agree with the total amount that is going to be paid for the restoration work. The insurance company, the restoration company, and you all have to agree with the charges and what is paid for those charges.

  555. June 9th, 2011 at 7:39 am #Tim

    If the restoration company and the insurance company cannot agree, should I be stuck with the balance? They are now refusing to speak to one another. The delta a few days ago was $5400. We are now down to $1000 difference. The restoration company issued its final number. Do think I should eat the $1000 and move on, or push the insurance company to cover the difference?

  556. June 9th, 2011 at 8:11 am #Jason

    Tim,
    Do you want to eat the $1000 bucks? Let these two companies figure it out. They compromise and work things out every day. You should not be in the middle. You pay your premium to get coverage for things like this. Do you pay your premium so you can pay an extra $1000 because the billing company and the paying company can’t agree?

  557. June 9th, 2011 at 9:01 am #Tim

    These two gentlemen really dislike each other. Negotiations are at a standstill. (name calling) Unfortunately, I hired the restoration company. The insurance guy is telling me he is up to his “max” allowed compensation for the cleaning. Can this be true? Do I have any recourse with the insurance agent? (I don’t want to get involved in the legal system at all. I am looking for a negotiation point.)

  558. June 9th, 2011 at 9:12 am #Jason

    Tim,
    You are the only one that can hire the restoration company. It’s your home and you are the only one that can hire someone to perform work there. The insurance guy is not maxed out on anything. There is no set amount for the insurance you have except those numbers found on your declaration page in which you likely have your home insured for at least $150,000. When the insurance person exceeds this $150,000 (for example) he still won’t be maxed out because usually policies have language that increases the stated limit by 5% (or more) for misc. things such as fees, code upgrades, ect.

    Do you have any recourse with you agent? Sure, you can find another agent and insurance company with which to insure your home.

  559. June 9th, 2011 at 9:37 am #Tim

    I am looking into a new company. However, homeowners insurance is difficult to come by in south Texas. Is there someone higher up the food chain that can approve the additional funds to keep me whole?

  560. June 9th, 2011 at 10:27 am #Jason

    Tim,
    Yes, there is someone higher up. Talk to a claims manager of this person that cannot seem to approve a restoration bill well below you policy limits. If that doesn’t work, speak to the claims manager’s manager. Usually, a call to the first manager will resolve things. However, this really isn’t your battle and it is between the insurance company and the restoration company to get the bill resolved.

  561. June 9th, 2011 at 11:57 am #Tim

    Unfortunately, that ship has sailed. I sat down and reviewed the Restoration Company bill line by line and agreed on a fair number. In good faith, I have paid the restoration company. It was the right thing to do. My negotiation now is with the insurance company.

  562. June 9th, 2011 at 1:30 pm #admin

    To all of our great contributors:
    You may show your company name and website address at the end of each post if you think our visitors might benefit from your services.

  563. June 9th, 2011 at 10:16 pm #Jason

    Tim,
    Good luck with the insurance company. I believe they owe for the total amount of the bills, except for your deductible. For you, this is the right thing to do. For the insurance company, this is business which includes profits.

  564. June 9th, 2011 at 10:20 pm #Jason

    Admin,
    Thank you for your consideration. I have no employer or company I represent. Also, I have no web site address to post.

  565. June 9th, 2011 at 11:04 pm #admin

    Jason, thank you for your selfless contribution.If all adjusters were like you, this website would not be needed!

  566. June 12th, 2011 at 5:54 pm #Justin

    Hello,

    The tile feels warm in front of our bathroom sink and in the small laundry room on the first floor of our house. Does this mean we have a water leak. How do we report it to insurance?

  567. June 12th, 2011 at 7:06 pm #Jason

    Justin,
    Generally the presence of water is around when there is a leak. I have no idea why your tile feels warm. You may want to do a little more review of your situation to determine if you simply have warm tiles or if there is a water leak. If there is a water leak, it may be wise to determine that and correct that condition as soon as possible. At this point and until you find out more, I don’t think the agent or insurance company would want to have a claim concerning a warm tile floor.

  568. June 14th, 2011 at 1:15 pm #Tim

    Negotiation with Agent has ended. He refused to pay any more money to the restoration company. He feels he has already paid more than is reasonable. I ended up paying $1,000 over the deductable.

  569. June 15th, 2011 at 5:54 am #samr

    I had a “total loss” house fire in Feb. SF paid me $350k, the “policy limit” on my structure, but estimated it would cost in excess of $560k to rebuild. (it was a renovated church built in 1852)

    I would be possibly be able to acquire an additional $35k in Law & Ordinance and another $70k in “option ID”… if needed. (350 + 105 = 455)

    After speaking with architects and engineers, they believe it would cost at least the $560k, or more. I have decided not to rebuild, I can’t afford it, and buy another home with the $350k.

    My question is.. I did not set the policy limit of $350k. SF said it is up to the insurer to tell them what limit to set the policy, not their responsibility. Is there anyway to prove that my home was undervalued and try to get SF to give me more money… or would it be too difficult to pursue?

    Thanks!

  570. June 15th, 2011 at 6:30 am #F MICHAEL CONTE

    Dear Samr,
    This is an excellent question and one that i do not know the exact answer to and hopefully someone on this board does, but here is what i can offer.
    I am abroker in new york state, if i prescibe a limit of insurance to someone, which turns out to be wrong i can be held accountable. When you deal with a captive agent are they free of this responsibility? I do not think so. Many times the carrier that i represent will do an inspection which comes in lower that that which the insured beleives to be correct. I have always said to these customers that they now poses the best insurance protection ever. i say this becuse if the cust wants to insure at 100K and the company insists on a lower amount which turns out to be inadequate, i belive the carrier would have a hard time in court, justifying thier position. So here is my question to you , did you initially insure the building for a higher amount? did you insure it for a lower amount and they conducted an inspection and then advised that you needed to meet their level?
    Bottom line, i think you need to be able to show that either you tried to insure it for the proper amount and they refused to take your direction, or they insisted based on thier report, which if relied upon by you and turned out to be wrong would make them accountable. they pd you the policy amount so quickly to get rid of you, there are people on this board that have small claims that have been trying to get paid for years. I hope someone can offer better insight to this point, much of this is based on how i belevei it should work perhaps someone can show where this was tested in court.

  571. June 15th, 2011 at 6:31 am #Jason

    Samr,
    Obviously your home is under-valued because it will take at least $560,000 to rebuilt it to the prior condition. The market value of the home was likely less than $350,000 so it was insured for a range in-between the market and the replacement value. With $455,000 available to you to rebuild, you would have funds to bring it very close to a home without having to first make it a church.

    As far as the valuation of the home, you are the owner, you have the vested interest in the home. It makes more sense that YOU would want to make sure it insured to a proper replacement cost rather than the insurance company. Think about it. Your home was under-valued. You received a check for your policy limits in which you paid your premium to receive that limit. You can’t go back in time and pay a higher premium to get higher limits because there are no do-overs when it comes to this. Whether you are successful in “proving” it was under-valued or not, it is going to be extremely difficult to pursue. What will be the end result? All I know is that you would have to pay an attorney for their efforts and they will get paid whether you recover nothing more from the insurance company or if you recover $500 more or $20,000 more. If you have to ask if it would be too difficult to pursue, then your attorney fees will likely consume any additional you would receive, if you received any at all. So, the worst case scenario is you receive nothing and pay your attorney their entire bill. This is a question only you can decide.

  572. June 15th, 2011 at 6:41 am #F MICHAEL CONTE

    Jason,
    i agree 100% with your comments, i have however been in the situation where the carrier dictates the rebuilding cost despite our objections.

  573. June 15th, 2011 at 7:08 am #Jason

    F Michael,
    I agree with your comments too. The thing is I don’t want to do is send this person on a mission where the odds of success may or may not exist but are very, very costly regardless of the outcome. Only an attorney could provide advice about this situation; however, since the attorney gets paid regardless of the outcome, who knows if the attorney is providing accurate information?

  574. June 15th, 2011 at 8:12 am #samr

    Thank you for your comments. Never being in this position before, it is very hard to get an honest intelligent response to my questions from people who might actually know something.

    The original HO policy was taken out 14 years ago. The agent came to the property and worked up an amount. He is no longer with SF and I don’t have any documents related to the estimate. It’s hard even to remember that long ago:) The policy limit does go up a minimal amount each year for cost of living increases to cover building materials/labor etc.

    I have a friend that tried to lower their HO policy limit to save money and their ins. co. would not let them. Shouldn’t the ins. co. want to have an accurate estimate in what they insure anyway?

    .. and I do believe I was paid quickly to get me out of the way…

  575. June 15th, 2011 at 8:37 am #F MICHAEL CONTE

    Samr,

    I am an independant broker/agent, we try to look at each renewal for rebuilding values, we try to engage the costomer in discussion surrounding improvments they are making or have made. Most people look at insurance as an evil cost and do not want to have an honest discussion. people look to cut cost on their biggest asset becuse they do not see an immediate return on this asset. i think you have seen the value of having this talk with an independant agent, most people do not see or understand the added value, and many independents fall short as well.
    Sincerely.

  576. June 15th, 2011 at 8:45 am #Jason

    Samr,
    You don’t have to believe you were paid quickly to get you out of the way. You were definitely paid quickly to get you out of the way. F Michael indicated that, you indicated that, and so have I. Insurance is a business and they won’t make any more money off that property. It is all expenses for them after a loss so they figured the best and fasted thing to do was pay you policy limits, let you know about what is available for code upgrades and such, and move on to work with and settle the next claim. Good luck with your endeavors.

  577. June 26th, 2011 at 12:03 pm #Tim Moss

    I had a tree fall on my house over a month ago. The claims adjuster has been out to my home three times. I have a custom built home and the builder is going to do the repairs. The third time the adjuster came out he had another contractor, he said, ” He’s only here for the scope of work”. It appears to me the adjuster doesn’t know what he’s doing. My builder and the adjuster are going back and fourth on the price for repairs and I’m stuck in the middle. I just want my home fixed. Please help me on what I can do to remedy this situation. I have over $375,000 in dwelling coverage, whats the problem?

  578. June 26th, 2011 at 4:59 pm #Jason

    Tim,
    That is what it sounds like. The adjuster doesn’t have the ability to write an estimate for your damage. Take a proactive approach, find the contractor you want to do the repairs, and then coordinate that with your adjuster. This should not be taking that long.

  579. June 27th, 2011 at 8:23 am #James

    If my 16 y/o son accidentally lit his bed on fire, but still saved the house ,would insurance cover that? and could he be charged with arson if i was an accident?

    please get back soon insurance agent coming today.

  580. June 27th, 2011 at 6:33 pm #Jason

    James,
    Insurance covers for fire damage and fires happen all the time. Now the important point here is did your son intentionally light a fire on the mattress and it got out of control? Just because you indicated he lit his bed on fire accidentally, doesn’t mean that is what happened. Did your son light the bed on fire to burn the house? There are many questions to be asked about this. They range from what did your son light his bed with? When did he do this? Has this happened before? It’s likely your financial situation will be investigated too.

    The thing is that it’s rather difficult to light a bed on fire without actually wanting to do light the bed on fire.

    I don’t need to know the answers to any of the questions but those will some of the questions (and very many more) that will be asked of your son and you. An attorney can best assist you if this is more than an accidental fire.

    Arson requires intent to burn something for financial gain. I doubt your son had that intention. I don’t know all the circumstances but your son and his actions will be looked at rather intensely.

  581. June 29th, 2011 at 8:24 am #Maggie Mae

    Have had excessive rain and wind and an F1 tornado hit where I live in Arkansas…. on April 14, 2011 .we have pressed board siding/painted/ on our home…we noted that wallpaper was starting to peel off the wall in downstairs bath/adjacent to the outside wall of house…there is guttering but the excessive rain for 2 months would have been hard for any gutter to handle at times….the wall paper started to peel and we peeled back and have discovered moisture from the outside..adjustor is coming out to look with a contractor, we have HO3 Cincinnati homeowner’s insurance..do you feel there is any problem with coverage on this?
    The guttering is 3 years old, as is the roof… (slopes, roof does down to theguttering next to the house…thanks, Maggie

  582. June 29th, 2011 at 9:26 am #Sarah

    In late december, there were confirmed tornados in the St. Louis area as well as dangerous thunderstorms. On this particular evening, my tree was struck by lightening. As a result, this tree has significant damage and is dying. can I make a home owners claim? If so, what particular “wording” must I use in order for a claim to be successful?

  583. June 29th, 2011 at 9:38 am #Amy Tanlim

    I had a water damaged on a section of my house when my water pipe burst. The homeowners insurance company finally sent me a check for the structural repairs. A few days after that I also received a notice of non-renewal to this policy. I still have an outstanding content claims with them. This is my FIRST claim with them and have been paying my premium on-time for many many years (maybe 20 years). Is this normal? With this non-renewal notice, will it affects the premium of my next homeowners insurance? Also can I terminate my current homeowners policy before it expiration date and buy a new homeowners policy from a different insurance company. Will this affect the payment of the outstanding claims with the old insurance company?

    Any advise will be greatly appreciated.

  584. June 29th, 2011 at 10:16 am #Mary

    We’re in Massachusetts and the exterior of our house has been damaged, the damage has been attributed to ice damage. (Roof shingles lifted and water ran down behind the clap boards and caused big (size of a fist or forearm) water bubbles under the paint – sometimes the paint bubbles burst, sometimes they just hold water indefinitely.) Cosmetically, it’s a mess with peeling paint everywhere. Physically, the trapped water is rotting the wood.
    The insurance company is finally, presumably, cutting a check this week and just today my husband told the insurance co. that he is a self-employed contractor and is hoping to do some of the work himself.
    Will this effect the amount of the settlement?
    Do we have to show receipts if we are not pursuing the holdback?
    I read conflicting info about doing the work yourself. Is a homeowner, who is a contractor, entitled to the same rate for doing the repair – or is this viewed as benefitting from a loss?
    And if you can only answer one question – please answer this one:
    If my husband does not do any of the work, does the amount of an insurance settlement get reported as ‘taxable income’ come tax time?
    Thank you!

  585. June 30th, 2011 at 7:01 pm #Jason

    Sarah,
    Simply make a claim for lightning damage to your tree.

  586. June 30th, 2011 at 7:05 pm #Jason

    Mary,
    The cost to have repairs completed to your home are defined in the estimate. That is what your claim is based upon. If your husband does some of the work, that should be fine. Talk to your adjuster to make sure that is ok and then proceed. Insurance funds paid to you are for something you already own and is not considered income. It is to repair or replace what you already had and is not taxed. And typically you can show receipts to show the work has been completed to recover the hold back but you agent or another insurance associate maybe able to document the repairs are completed by personally inspecting, accepting photographs, or some other verification so you can collect that recoverable deprecation.

  587. June 30th, 2011 at 7:10 pm #Jason

    Amy,
    I had a water damaged on a section of my house when my water pipe burst. The homeowners insurance company finally sent me a check for the structural repairs. A few days after that I also received a notice of non-renewal to this policy. I still have an outstanding content claims with them. This is my FIRST claim with them and have been paying my premium on-time for many many years (maybe 20 years). Is this normal? With this non-renewal notice, will it affects the premium of my next homeowners insurance? Also can I terminate my current homeowners policy before it expiration date and buy a new homeowners policy from a different insurance company. Will this affect the payment of the outstanding claims with the old insurance company?

    A general rule of thumb is to shop for a new insurance company every 3 or so years. You are long overdue and chances are you will find the exact same coverage for a lower premium. Will this non-renewal effect you insurability or the cost of insurance? No, not at all. Insurance companies can non-renew for any reason they want. So, yeah, it is normal. Don’t lose any sleep over it.

    Yes, you can cancel you insurance anytime you want and switch. It doesn’t have to be on the renewal date or the cancellation date at all.

  588. June 30th, 2011 at 7:13 pm #Jason

    Maggie,
    Your claim appears one that would be covered in a typical homeowners policy.

  589. June 30th, 2011 at 8:50 pm #Ami

    Hello, we recently had our septic pump struck by lightening in which it was charred and when the septic specialist attempted to plug it back in it began to smoke. Becasue of this lightening strike our basement was filled with level 3 water when our water softner emptied during the night. My agent informed me that if it was lightening or electrical it would be covered in full. The adjuster, who called the restoration company who was at our home hours before he came to our home ( and never called me) stated that it is not covered under lightening and that there is a $5000 cap due to it being a septic back up. I am really struggling with how this can be a septic back up when the septic was clear and working properly and had it not been struck by lightening it would still be working and I would have carpet and drywall in my basement. Thanks

  590. July 1st, 2011 at 3:59 am #Cinde

    I hope I post this in the right area to help someone. First of all, i’m not saying to not tell the truth on a claim…Wear and tear and old things you let go are not covered. Had a customer this week, who I believe was done wrong in my 30 yrs in Insurance. He had been with 1 company over 8 yrs with not one claim. He had a refridgerator that was installed in a wall unit…The unit was only 2 yrs old, so not old. He found out the back had been leaking and he was honest and said he did not know how long…that was it for the adjuster to be able to turn this claim down. Sudden discharge is the only way something like this would be covered under most homeowner insurance so by saying he did not know how long, maybe a year as a guess, his insurance was denied. Again, i’m not saying to lie, but the adjuster listens to what you say, never say you know something has been going on “awhile” unless you know it has. Alot of times they will argue with you and say they think it had gone on awhile but they don’t know that 100%…sometimes the less you say the better. I truly feel sorry for this customer, there was no way he knew this was leaking in a unit as he had and the adjuster should have paid this claim for a long time customer. Thats how I feel after 30 years in Insurance. I did not write this policy, I just service it now but luckily the customer likes me well enough to stay with the agency and not blame us and just let us shop his insurance with another carrier. Thats how insurance loses good customers. He may not have ever turned in a claim again.

    Good luck to everyone.

  591. July 1st, 2011 at 6:13 am #Jason

    Ami,
    You posed no questions so none will be addressed.

  592. July 1st, 2011 at 7:30 am #Ami

    Ok, is there a way to challange the company and make then accountable to cover the loss of my basement that was caused by lightening? How are they able to place the covereage under septic when it was caused by the lightening the struck the pump in which it was not able to do his job? What resources are out there to help? Is it common practice that the adjuster communicate with the restoration crew before myself or even come to our home to assess what happened? Thanks

  593. July 1st, 2011 at 8:42 am #Mary

    Our home was a total loss in a house fire nearly three years ago. Our insurance company paid out additional living expenses for nearly 7 months then denied the claim in full claiming misrepresentation of contents. Their claim was due to a bankruptcy case my husband and I filed prior to the fire. We have been in court several times regarding the validity of their claim. Recently the Judge over their case ruled for judicial estoppel stating we could only claim the contents we listed on our bankruptcy. Unfortunately, our bankruptcy attny advised us to ONLY list major items and list them at “yard sale” value. Obviously, this is significantly lower than our actual contents. I guess our next option is an appeal in the 6th district court of appeals. We live in TN…how to we go about finding a good attorney to appeal this judge’s decision. Any advice would be greatly appreciated.

  594. July 1st, 2011 at 2:43 pm #Jason

    Ami,
    Sewer backup and water overflow are excluded by your policy. Concurrent causation is the non-covered event occurring at the same time a covered loss occurs and it doesn’t matter if the covered loss cause was 99% and the non-covered cause loss was 1%. Now, because you have the septic coverage, you purchased back some of the excluded cause of damage. The stipulation is that you get the coverage for that cause of loss but you have also have a limit. Those limits generally are $5000 but there can be other amounts of this coverage purchased.

    Yes, the adjuster can communicate with the restoration company before they arrive at your house.

    I don’t know of any resources out there for your reference. If you don’t understand your claim, the best contact is your adjuster and if that doesn’t provide the answers to your questions, then a manager at your insurance company would likely be the next person.

  595. July 1st, 2011 at 2:52 pm #Jason

    Mary,
    An insurance company is going to have enough information to deny a claim before it actually does so. If your items are misrepresented, regardless how they got that way, the insurance company can deny your entire claim. From what you indicated, the judge ruled against the insurance company because of estoppel. The way I understand it is that you are then allowed to claim the items that you had listed in the bankruptcy. That may be the best alternative to this entire situation you are in.

    Appeals are expensive. They take a lot of man hours and those man hours are expensive ($100-$250 and hour). You may want to look at the end result of an appeal which is likely not going to be ruled in your favor and then all the appeal attorney fees that you will have to pay regardless of the appeal outcome.

  596. July 5th, 2011 at 11:17 am #Victoria

    We received about $80,000 to repair our home after a tree fell on it and construction is about to begin. If there is left over money because we find deals or something like that, can we keep the left over money? If so, how do we get that from the mortgage company who is keeping the money for us to draw from? Will we get in trouble with the insurance company and/or can they make us repay them?

  597. July 5th, 2011 at 7:15 pm #Jason

    Victoria,
    The mortgage company will release the funds as the word is completed and will release the total of the funds when the repairs are completed. The mortgage company just wants to make sure their collateral is the same or in better shape than when the damage happened. If you are able to do the repairs for less, then that is great. The insurance company has determined the damage to be $80,000 and if you get it done for less, then that is you managing the work and the funds properly. They will not require you to pay it back.

  598. July 6th, 2011 at 2:41 pm #Amy

    Thanks Jason for your answers.

    Please tell me whether if I terminate my old homeowners policy now, will my outstanding claims be affected? That is will they still pay me for my damaged contents which I think is under $10K. It has been more than 6 months and no technicians from the insurance company has come to check out my damaged appliances etc. I like to throw them out but was told not to.

  599. July 6th, 2011 at 8:43 pm #Jason

    Amy,
    Your welcome. Your claims will survive if you switch to a new company. If it’s been more than 6 months, that is way too long for your claim to be on-going. You may need to contact your adjuster, that adjuster’s manager, or your agent. Maybe you need to contact them all to get your claim settled. Even 1 month is too long to have a claim open.

  600. July 7th, 2011 at 4:02 pm #Linda J. Hys

    my contractor who is anderson mitchell would like to know when he’s going to get a check and for how much, since he has 10,000.00 into the garage already. My account # is 0014002557, address is 3911 Lyndale Ave N. Mpls, Mn, 55412 last 4 numbers of S.S. 4802

  601. July 7th, 2011 at 7:03 pm #amanda

    I was wondering, we have hardwoods all through our home that we installed when we moved in 2 1/2 years ago. The carpet is still in the bedrooms from the previous owners. As soon as i step foot in the bedrooms my nose and throat itches me like crazy. I do have allergies anyway but they get worse! I am allergic to cats. I am not sure if the previous home owner had a cat. I was wondering if our home owners insurance would cover to have hard floors put in due to this problem?

  602. July 7th, 2011 at 8:06 pm #Jason

    Linda,
    That is a fairly specific question and I don’t know if any of us can answer that. That might be a subject you want to discuss with your adjuster.

  603. July 7th, 2011 at 8:10 pm #Jason

    Amanda,
    Insurance is to repair or replace damaged property because of something that caused it to be damaged during the time you have it insured with them. The cat odor issues that are coming from your carpet was there before you insured this property. The other thing is that damage caused by household animals is excluded by the any homeowners policy. Another thing is that nothing is damaged because that is the natural occurrence from having cats in the home.

  604. July 8th, 2011 at 8:36 pm #amanda

    well shux! not really the answer i was hoping to hear! That stinks. im not even sure if the previous owners had cats. i was thinking it may have been mattress allergens..and we purchased a new one, but i still have same problems. Its crazy how you can accidently spill paint on ur carpet and have it replaced but they wont after it holds a bunch of microscopic grundge! lol i looked up to see if health ins would cover that, but thats a “no go”. guess i better start saving to get rid of my problem! :) but thank you kindly for taking the time to respond. :)

  605. July 14th, 2011 at 6:28 am #Randy

    I have a broken waterpipe under my tiled floor (concrete slab) in Fl. Insurance paid to excavate (including tile replacement) to get to pipe. Tille is not damaged, but runs through out the home. I do not want to destroy the tile because I can re-route waterpipe and solve the leak without affecting the tile. The insurance adjusters report only indicates actual damage to exterior masonry, and no damage inside. Mortgage company released initial portion of money and said repairs must follow adjusters report, and be satisfied through inspection for final payment. Do I have to intentionally damage the home unnecessarily to fix the pipe just because that is in the report , or can I satisfy the issue by re-piping the affected pipe through re-routing? The masonry damage is minor and is already repaired– there is no other damage remaining.

  606. July 14th, 2011 at 10:16 am #Jason

    Randy,
    You apparently got the initial payment for the damage. In order to get the remaining funds which is called recoverable depreciation, you would have to do the work as outlined and prove that the work was done. If you are satisfied with the results right now or have some other method of repair, you can do that but you risk only getting the amount for the alternate method’s cost. If there is no other damage remaining, your claim may already be concluded if you are ok with not doing any additional demolition and repairs.

  607. July 16th, 2011 at 10:34 pm #stuart

    We had a major fire last year and fortunately had very good insurance coverage (Chubb). Our mortgage was significantly paid down to about 20% of the total value. We were issued a check for the mortgage amount in ours and the lenders name, as is standard, that we signed over for the lender to hold. We had a second check issued to us for the remaining value (about 80% o the home value).

    The question is how much is the bank allowed to hold back and when do they need to issue us a check?

    The house was about 80% rebuilt and we asked for them to issue us 80% of the money they were holding (which was only 20% of the value of the house – i.e. loan-to-value of our mortgage was 20%) to pay the contractors for the remaining 20% of work to be done. However, the bank would not issue us 80% of the money they were holding. Instead, for reasons unclear, they thought it appropriate to hold back 20% of the total cost of the construction, which was equal to nearly 100% of the money they were holding. We explained to them that they were holding back 100% of the mortgage, and that we needed the remaining funds to finish the project. They said they understood and agreed that our loan to value of 20% was not as common and was lower than the 80% that is the norm. They said it was the computer program that was not flexible.

    We have been asking for weekly inspections from the bank to eek out funds from them, but this is very frustrating, and we are convinced the firm they are hiring to do the inspection is purposely reporting lower % completion so they can continue to come out and charge for weekly visits.

    What can we do? What are the rules here?

    Thanks.

  608. July 19th, 2011 at 6:22 am #mike

    I live in tenn long story short,i helped my foreman after work put up some siding, a 20 ladder i was standing on kicked out & i fell 15 foot breaking/crushing my wrist.went to urgent care & then operated 2 days later putting a steel plate & 6 screws. prob off 2 months from work. He turned it in too his homeowners.how much should they pay. They have a adjuster that suppose to call me from frontier adjusters in 24 hours it happened 10 days ago.what should i expect. thanks mike

  609. July 19th, 2011 at 10:11 am #Jason

    Stuart,
    Sounds like a bank issue to me. How do you think this is related to insurance?

  610. July 19th, 2011 at 10:16 am #Jason

    Mike,
    Injuries are all not the same. This adjuster may need to determine if the howeowner is liable for your injuries. If there is no liability by the homeowner, there may be medical payments available to assist with your medicals if the homeowner has medical payments insurance. If there is liability by the homeowner, then they may want to obtain a medical authorization from you so they can obtain your medical records to evaluate and arrive at an appropriate offer to obtain a signed release from you.

  611. July 22nd, 2011 at 3:56 pm #brian

    Hi-

    I noticed some water in my basement after a very substantial rainfall (5 inches in under 3 hours). I tried to snake the outside drain and it didn’t work–so i had to dig it up. I’m in the process of tearing down my garage, replacing the driveway (on the other side of the house where the water entered the basement) and planned on replacing the drain pipes under the driveway while the driveway was removed. They dug up the drain tile on the other side where the water entered and discovered an absolute trainwreck of a situation. Apparently NONE of the drains were properly installed. They don’t tie into the street or anything for that matter. Everything flows to the back of the house for some reason. They were even installed upside down. Obviously, whatever they did, it wasn’t done even close to code. We can’t even figure out where the drains go without digging up my entire yard. Whoever did this clearly didn’t pull a permit. Now i need to replace ALL of my drain tiles and run new pipes out to the street and tie them in to the sanitary and storms sewers, not to mention the city is going to require me to waterproof the entire house. $15,000.

    Is this something that would be covered by homeowners insurance? I have Erie insurance. PLEASE SAY YES!!

  612. July 22nd, 2011 at 6:20 pm #Jason

    Brian,
    Unfortunately, water that enters your home at or below ground level is generally excluded. There are a few exceptions but nothing you reported would go in that direction.

    Insurance is a reactionary tool. When there is accidental damage, the policy springs into action to repair the damage. There doesn’t seem to be any sudden and accidental occurence that happened to trigger insurance to step in for you.

    In your case, there is no damage. Sure it’s going to cost you $15,000 but what your are doing are preventative measures to keep water out of your basement from this point onward. And that brings us full-circle to the fact that water that enters your home at or below ground level is nearly always excluded.

  613. July 23rd, 2011 at 8:13 pm #Darla

    I had purchased a home with my now ex-boyfriend. He currently has the house which is still in both of our names. About 2 years ago, the home was vandalized which the insurance company covered.
    My problem is that I am currently wanting to purchase a home myself, but when I began looking for insurance for my new home, I am getting denied due to the claim on the home we had together is less than 5 years old.
    Do you have any suggestions on insurance companies that will cover me? I live in Indiana.
    Why are insurance companies denying coverage because of a claim? Isn’t this what insurance is for…to cover things like this.
    Thank you!
    Darla

  614. August 2nd, 2011 at 12:00 pm #Anthony

    We had a storm one night and the next morning my heat pump would not work. I was told to get a contractor to say that lightning ran in on it and send up an estimate. Two separate guys looked at it from Trane and wrote a statement saying hit by lightning. Now my insurance company has had 3 of separate people of their choosing look at the heat pump and ordered a lightning report. We keep jumping thru hoops and its been 3 weeks in the July heat and still nothing. What is the problem? Thanks.

  615. August 2nd, 2011 at 12:18 pm #Kelly

    Roofing contractors just want to see your insurance papers and will magically repair it for exactly what the insurance paid plus your deductible. Since my insurance carrier does not require that I submit bids, what’s the best way to approach contractors without turning over the insurance papers to them?

  616. August 2nd, 2011 at 12:31 pm #Kari

    Call and get estimates. You don’t have to show the contractor anything to get an estimate and you shouldn’t have to show your insurance company an estimate to get the money they agreed to pay per their estimate. However you won’t be able to collect any additional money that you are not out. We got several estimates prior to our adjuster even coming out.

  617. August 2nd, 2011 at 4:00 pm #Jason

    Anthony,
    There doesn’t appear to be a problem. What your insurance company is attempting to do is to determine why your heat pump failed. The information provided by the Trane individuals may not have been convincing. Insurance will only pay when there is a covered loss. If a heat pump fails during a storm does not automatically mean it was damaged by lightning.

  618. August 3rd, 2011 at 6:48 am #Anthony

    Jason,
    I dont have a problem with that, its just that even if it was a power surge of some kind it is still covered under the policy and Ive seen the pump and it is burnt up. There have been 5 other people in my town with the same claim and its been fixed by other companies no questions asked. Thanks for the insight and information.

  619. August 3rd, 2011 at 11:51 am #admin

    Anthony,
    Why not help other consumers, give 2 minutes of your time and rate the adjuster and insurer on our Rate Your Adjuster page. You don’t have to give your real name if you fear them.

  620. August 3rd, 2011 at 12:40 pm #Desiree

    We have Homesite by Progressive for our Insurance and live in WI. We filed a claim due to a torndao on June 21, 2011. We have been fighting with our Claim Associate and Adjustor. The largest damage was to our rubber roof which blew off the house and as a result we had water damage to 3 rooms. The first adjustor determined replacement value of roof at $4800. Every quote that we have gotten is $15k or more just for the roof. We have invoked the ‘appraisal’ process and are scheduling a meeting with our contractors and a inspector to meet with the new insurance adjustor. My questions are the following: 1) Where would I find a ‘Code Upgrade/Endorsement’ in my policy? The Claim associate says that it is covered but I cannot find it. 2) What happens when the new adjustors report is submitted for ‘File Review?’ Can they change his assessment? 3) If we (Homeowner & new Adjustor) agree to a dollar amount for repairs to our home, is it a done deal? 4) Can you recommend picking an ‘umpire’ in case the appraisal process goes badly? 5) Is there anything more that I can do??? It looks like I have a day to figure this all out.

  621. August 3rd, 2011 at 2:52 pm #Jason

    Anthony,
    A heat pump is an expensive component. Not all policies provide coverage for power surges. Also, what is the extent of damage? If it is a covered cause of loss, what needs to be repaired? Is it the circulating motor, a fan motor, lines, condensers, etc. Even if it’s covered, there has to be a known scope of what is damaged and what needs to be repaired.

  622. August 3rd, 2011 at 3:06 pm #Jason

    Desiree,
    In your policy, it will be under the topic of Codes/Ordinance but what is more broad are the wisconsin statutes that dictate what can and can’t be done when repairing a home. If a current item on a home is damaged and the codes have been updated, there is a requirement to follow the new codes.

    The insurance company’s contract with you is to repair your damaged property and in order to do that, they need to follow the codes for those repairs. It’s very likely in your policy but what it says is that code updates will be allowed during repairs.

    A rubber roof is basically a rubber roof. If the estimate is for $4800 for a rubber roof and the other estimates are for at least $15,000, it is clear these two roof products are not the same.

    Some people confuse different roof materials and all call it the same. There is rolled asphalt roofing, bitumen roofing, and rubber roofing. The rolled asphalt is the least protective and least costly while the rubber roofing is the most protective and most costly. The bitumen is in the middle somewhere.

    If you didn’t have a rubber roof and your local building code requires that you have rubber roofing when it is repaired, then you need to be able to convince those on the other side of the issue that what you are required to put on is rubber roofing.

  623. August 5th, 2011 at 5:53 pm #thedudeinthetree

    What is the typical depreciation holdback percentage on contents? Does it vary by insurer/adjustor/or by condition of items in home?

    Thanks

  624. August 5th, 2011 at 6:38 pm #Jason

    thedude,
    It varies by insurer, adjuster, and condition of the items. Another factor is that it is based on age too. You can be looking at between 0-100% depending on the factors involved.

  625. August 8th, 2011 at 7:17 pm #Wendy

    I had a piece of jewelry that I thought had been stolen, although I wasn’t sure. My insurance had a rider for jewelry and I made a claim and replaced the piece. Now it has been found and I have two of the same thing. What should I do? Do I report this? Try to sell the piece and reimburse the insurance company? What?

  626. August 8th, 2011 at 8:59 pm #Jason

    Wendy,
    What has happened is the insurance company replaced the piece of jewelry for you. Their action of replacing it places them in the position of rightful owners of the piece of jewelry that was stolen (lost or misplaced).

    The insurance company fulfilled their portion of the contract by replacing that piece of jewelry based on the presumption that it was lost or stolen. Your obligation at this point is to let them know of the circumstances. They will likely ask that you send the found piece of jewelry to them so they my sell it as salvage.

    It happens that jewelry is misplaced and a claim is made because it cannot be found. Your situation is not unique. Just call the insurance company and let them know and ask them what you should do. They will provide you with the appropriate information to take care of this.

  627. August 10th, 2011 at 11:04 pm #J.J.

    Am I required to provide the claims adjustor with a requested copy of the home inspection (for the lender) I got 9 months ago when I bought the house. I think they will try to find a way to use it against me.

  628. August 11th, 2011 at 1:01 pm #Jake

    Finalized divorce. Ex got house but let it foreclose with my name still on note. Name also on ins. policy. Sheriff sale scheduled for next week. Wind blew fence down last week and ex made ins. claim. I spoke to the adjuster and was told her claim will affect me. Who has a right to the ins. proceeds?

  629. August 11th, 2011 at 2:17 pm #Sean

    Neighbor’s AC caused a big leak in one of my basement’s rooms.
    Had to change floors and paint walls. When water remediation people pulled baseboards off they saw mold had been growing for a while, so there was leakage for a while which ended in a big gushing leak.
    We filed a claim with our insurance and he filed acclaim with hiS, but his insurance won’t pay ours because they say he is not negligent because he didn’t know about the leak.
    What can we do to recover our deductible?
    Can we sue him in small claims if insurance companies can’t sort it out

  630. August 11th, 2011 at 2:27 pm #Jason

    J.J.
    You don’t have to provide the inspection to the insurance company if you don’t want. That was something required for financing, not insurance. If you believe they will use it against, you don’t share it. If you didn’t get one, they would have to pay for one just like you did so don’t let them overlap the finance agreement with the insurance agreement.

    I don’t specifically see why you don’t want to provide it. But, then again, I also don’t see their need for it. You can politely decline to provide it and ask them specifically what it will do to help them with insurance? If they have no reason for it, then they just answered their own question.

  631. August 11th, 2011 at 2:33 pm #Jason

    Jake,
    How ever the names appear on the insurance policy. Generally the first named insured has more rights, like the ability to change or cancel the insurance, but the proceeds from the claim should include the names as they are listed on the policy.

    It is possible that your wife could get the check without your name on it but that is quite a hassle and would require sending a lot of information to the insurance company and having the insurance company agree that it should be made out without your name. Also, it will definitely include the lien holder’s name on the check too. Especially since it’s in foreclosure.

  632. August 11th, 2011 at 2:39 pm #Jason

    Sean,
    Your neighbor isn’t negligent. If he is not negligent, their insurance won’t pay for your damages. Also, they won’t pay for your deductible. You won’t be able to recover you deductible just like your insurance company won’t be able to recover what they paid out for your damage.

    If you sue your neighbor, you will have to prove to the judge that your neighbor was negligent. Since that is the required burden of proof to succeed, you won’t succeed because your neighbor is not negligent.

    Your best bet would just be to ask your neighbor to reimburse you for your deductible. He might or he might not. That would be your best option to recover your deductible.

  633. August 11th, 2011 at 2:45 pm #Sean

    Jason,
    Why is he not negligent if I can prove the mold growth was weeks old?
    Shouldn’t ge have realized at some point that there was a leak?

  634. August 11th, 2011 at 4:31 pm #Jason

    Sean,
    Please dont’ take this to be legal advice. If you can prove that mold growth was weeks old, you would likely need to have an engineer to support that finding. Let’s assume that the mold is 3 months old. Now how does that tie your neighbor into your damage? Remember that negligence is based on what a person does or does not do that causes damage.

    No he shouldn’t realize there is a leak at some point. People don’t assume anything is wrong with their AC unless it’s not working. Since in your earlier report, the neighbor did not know about the leak, he did what a reasonable person would do in that circumstance which is nothing. It’s very difficult to prove what someone knows or doesn’t know unless they come out and admit it. Do you have a way to prove that your neighbor knew this was happening (before it was discovered) and your neighbor did nothing about it?

  635. August 17th, 2011 at 9:23 am #charleen

    Can I file a claim for a broken sewer pipe? I have a sewer pipe that is leaking raw sewage into my basement. Im not sure of the cause, but it is completely blocked, we have rented the machinery to clean the clog but nothing has worked so far. I have never filed a claim before, so any info would be greatly appreciated! My tenants are threatening to sue if it is not fixed soon. We also have a disabled child in the house. Im from Massachusetts and have Massachusetts Fair Plan. Thank you!

  636. August 17th, 2011 at 10:43 pm #Devi

    My house caught on fire 1/15/2011 and I had my insurance company come out American Family Insurance, they referred me to a restoration company. Well that restoration company has only completed the rough ins and have received $65k from my insurance and to this day have not completed the work. The owner is ignoring my calls, only when it came to the money he would call me to make sure he got it but never did anything. (I am aware now that I am not the only one this restoration company has done this too, who can I report them too for fraud and running off with my money and other homeowners’? he also closed his business so they no longer exist) it is now August 2011 and my house is no where nearly complete and the insurance is saying that i have passed the deadline, but I had no control over the work being done, I was getting the run around from the restoration company the owner never answered my calls. Is there anything I can do? I have 6 kids and have been evicted from the rental home the insurance was paying on. I don’t know what to do.

  637. August 17th, 2011 at 10:45 pm #Devi

    sorry forgot to tell you I am from Illinois.

  638. August 18th, 2011 at 6:01 am #Jason

    Charleen,
    File a claim. We are not able to determine if something is covered from you explaining it on-line. Perhaps when the adjuster is out, they can determine what is wrong and what needs to be done to remedy the situation. Regardless if this is covered by insurance or not, you need to fix what is wrong.

  639. August 18th, 2011 at 6:13 am #Jason

    Devi,
    You have control over the restoration company. They are hired by you and nobody else. Sure, you may have gotten their name from the insurance company but you are the one that hired them.

    As for the money, the work should be completed to a certain stage before the restoration/contractors get paid for the work. They should not be getting paid before the work is completed.

    If you need to get a different contractor in there to do the work, that is what you need to do. I don’t know the extent of the damage or the time frame given to you to get the repairs done but if the insurance company indicates you have taken too long, then the work should be completed by now. I don’t know how much more funds you have left or how much more the insurance company is going to pay but you need to get someone in there that can get this work done and get it done in a timely manner.

    As for the rental home, the insurance company has nothing to do with an eviction. You may need to call your insurance company and indicate to them what is going on to see if they have any suggestions for you.

  640. August 18th, 2011 at 10:12 am #Steven Powell

    I filed an renter’s surance claim more that two months ago. My company (Amica) wants me to alk to their attorney after i met with an investigator representing their company two times for extensive interviews. What can iIdo? I feel another interview and delay of my claim is unreasonable.

  641. August 18th, 2011 at 10:48 am #Lianna Bodine

    My father passed away a year ago and we are working through liquidating his estate. We were set to close on his cabin set on a Federal Land Lease tomorrow for $120,000 and the cabin burnt to the ground (total loss). He had it insured for dwelling $85,000, contents $69,000 and loss of use $17,000. The adjuster is willing to give us $85,000 for the cabin, but won’t give anything toward loss of use, and he hasn’t disclosed contents. We are unsure if the Forest Service will let us rebuild, and if not, we will be required to tear out not only the damaged home, which the insurance co has allowed $4000 for, but also the septic tank, well, dock, shed etc. Our cost will far exceed the $4000 and we will no longer be able to use the property. Do we have any arguement for loss of use? In a total loss fire, do they give your the insured content amount or do we need to itemize. No one in my family has been in the cabin for over a year so the “handy man” filled out a content list with only 30 items listed. Thanks for any advise.

  642. August 18th, 2011 at 12:07 pm #Jason

    Steven,
    It’s required for you to make it through the claim process. Whether you think it’s a delay or not, that is something you are required to do if they request it.

  643. August 18th, 2011 at 12:11 pm #Jason

    Lianna,
    These questions are best suited for your adjuster. Ask him what they will allow for loss of use, how long they will allow that, and what dollar amount. If there are personal items besides the ones your handy man listed, then do an inspection and present that information to your adjuster.

    The insurance doesn’t guarantee that you will be able to continue to use your land, it insured the building, contents, and loss of use. If you need to remove the septic tank, well, dock, and shed, those items will be at your cost because they likely were not damaged as a result of the fire. If they were, then the insurance should be addressing those items as well.

  644. August 19th, 2011 at 6:41 am #Carla

    What happens if you lose a piece of jewelry and the ins co reimburses you for it under homeowners and then you find it 3 years later? Should you turn the jewelry in to ins. co?

  645. August 19th, 2011 at 7:25 am #Jason

    Carla,
    That is what you should do. Perhaps a call to them first to find out exactly what they want you to do with the found piece of jewelry.

  646. August 19th, 2011 at 8:05 am #craig

    Dont feel bad, my heat pump estimate was $5900 and I have a 500 deductible. The insurance company sent me a check for only $2000. Now that is a rip off.

  647. August 19th, 2011 at 9:18 am #Jason

    Craig,
    We don’t feel bad. We don’t know the detail of the estimate, nor what is required to fix your heat pump. We cannot confirm it’s a rip off when we don’t know the details. I have to assume since you have a $500 deductible, the total of $2500 should fix what was covered by insurance. Let us know if that is correct.

  648. August 19th, 2011 at 10:43 am #Marissa

    My family and I have been out of our house for about 3 weeks due to water damage. We’re at the point in our claim where AAA has given us an amount for the settlement based on their adjuster. The $ amount they gave us is low for the damage that has been done, therefore we had a general contractor come in and estimate. We sent the proposal to AAA and now they want a more detailed estimate from the contractor since the contractors estimate is higher. In the mean time, the insurance agent said he is going to send out the check for the amount their adjuster estimated. By him sending the check, does this mean there is no negotiating the settlement afterwards? Or there is? Are we waiving any rights by AAA sending the check. I heard the insurance companies underestimate and the home owners end up having to pay more for the repairs.

  649. August 19th, 2011 at 10:51 am #craig

    I feel bad though. MY heat pump was covered by peril. Estimates showed 5900 damage but insurance paid 2,000. There isnt anywhere I can get a heat pump for 2500. The whole system was fried so who knows where the 2500 came from, just pulled out of the air. Thats the way it is nowadays though. Peace.

  650. August 19th, 2011 at 11:05 am #Jason

    Craig,
    Again, we don’t know the details of your claim, the damage, or any information on the estimates. Apparently the heat pump can be repaired but that is only an assumption. The good thing is that if the $2500 doesn’t repair it is that there can be a supplement added for any additional costs that are needed above the $2500 amount. I would be glad to compare the estimate for $5900 and the one for $2500. There may be things in the $5900 estimate that is not needed or unrelated to the damage for your claim. Again, we don’t know. If you want you can forward the estimates to me at kroll.ron@gmaill. com so I can review. You have my have raised my interest in the difference. Thanks.

  651. August 19th, 2011 at 12:02 pm #JesseeTidwell

    i think jason is a company man…lol

  652. August 19th, 2011 at 1:37 pm #Jason

    Marissa,
    If everything is accounted for in the estimate, then the estimate should be adequate. The general contractor will have to provide more details in his estimate for the insurance company to be able to evaluate the difference. The check should not waive your rights to have all the covered parts of your claim covered.

    A supplement can be forwarded to the insurance company for payment if things that should have been addressed in the estimate were not originally accounted for.

  653. August 19th, 2011 at 5:15 pm #JACK

    I RECENTLY HAD A CLAIM AND SETTLED WITH UNIVERSAL. I HAVE SINCE FILLED A CLAIM FOR LOS. HOW DO I CLAIM LIVING IN ANOTHER HOUSE WE OWN THAT IS SUPOSSED TO RENTED OUT AS A EXPENCE.
    THANKS

  654. August 20th, 2011 at 5:40 am #Jason

    Jack,
    The house that you own and lived in had you in it so could not be rented. Simply present that information to the insurance company. Support the amount you claim for living there by providing the insurance company the documentation of how much you received in the recent past that others have paid for rent to live there.

  655. August 21st, 2011 at 3:10 am #Gerry

    On August 13th, my house was struck by lightning and caused a house fire that made the residence uninhabitable. The emergency crew the insurance hired came out that night and tarped the roof and boarded the windows. It wasn’t until I had to fax a supervisor that the insurance sent out an adjuster and restoration crew on August 19th. The adjuster told me he was midclaims and they would have to send out a large claims to handle my claim. The restoration crew removed all the hardwood and carpets. I live in a 2 story house and because of the water damage, the celing has been falling daily onto the first floor. My hardwoods have been covered in wet insulation. Nothing in my house has received any preventive maintaince against the water damage. Is the insurance reliable for the long wait in getting an adjuster out to the premises and can I demand to have the entire house gutted to prevent mold?

  656. August 21st, 2011 at 8:48 am #Jason

    Gerry,
    The insurance company is responsible for the time it takes to get the adjuster out there. There has been immediate damage to you home. Because of that immediate damage to your home, other damage will arise or become worse. That is all part of what needs to be addressed by the insurance company when it settles your claim.

    You can demand anything you want. Whether the insurance company does it will be up to the adjuster. You as the homeowner and insured, have the responsibility to mitigate the damage to your home. If you are not getting the appropriate direction from your insurance company, you will need to take the lead and take property saving actions.

  657. August 21st, 2011 at 2:38 pm #Tanya

    Hi,

    We have water coming into our converted room that used to be part of the garage everytime it rains. My mom wants us to call the insurance company. How do I word my claim so that they don’t drop us from coverage?

  658. August 21st, 2011 at 6:49 pm #Jason

    Tanya,
    Tell your insurance company that you have water coming into your converted room that used to be part of the garage every time it rains. They shouldn’t drop you for making a claim. If they do, find a different insurance company.

  659. August 22nd, 2011 at 9:05 am #Cajunell

    I suffered a loss off my home due to fire in August 2010. My insurance company assessed the damage and settled my claim for the maximum amount allowed by my homeowners’ policy. I endorsed the initial insurance check and forwarded it to the mortgage company (US Bank) along with documents they required to be filled out and signed by my contractor. The initial draw (1 of 3) was forwarded to me and signed over to my contractor. The mortgage company required an inspection at the 60% complete mark in order to release the 2nd of 3 draws. The inspection was down over 3 weeks ago and the 2nd draw has still not been released. I have called and literally been on hold for an hour before speaking to anyone. Every time I call I get a different person on the phone. It does not appear that my filed has been “assigned” to anyone in specific to handle. Construction has haulted on my home for the last 2 weeks. My contractor is out of pocket $25,000 and I am out of pocket $28,000. Is there a legal time limit that the mortgage company can hold your insurance proceeds during the construction process after you have meet all their necessary requirements. I am at the end of my rope. We have now gone over our limit for loss-of-use on our insurance policy and have to pay $2000 in rent next month and a $1600 house payment. I live in Louisiana and the mortgage company is US Bank.

  660. August 22nd, 2011 at 1:29 pm #Jason

    Cajunell,
    Your situation is related to banking, not insurance.

  661. August 23rd, 2011 at 6:44 am #Dena

    We’ve had an extended drought here in Texas. We’ve kept soaker houses around the slab foundation going to keep clay soil from shrinking from the foundation.
    However, we have noticed the interior walls are separating from the floor and it appears the center of the foundation is cupping. We have a limited slab or foundation access endorsement on our policy. Is foundation damage due to this drought covered by our homeowners policy?

  662. August 23rd, 2011 at 11:07 am #Jason

    Dena,
    I am not familiar with the limited slab or foundation access endorsement but it sounds like that endorsement is to open up or gain access to something damaged (like pipes) within the foundation or below the foundation.

    A drought is an event that occurs over time and although the condition of the foundation and walls is accidental, it doesn’t appear to have the element of sudden.

    The only way you will know is if you present a claim for the condition of your floors and walls.

  663. August 23rd, 2011 at 6:34 pm #Charlene

    It has been a long process but finally we received the word that our insurance company is covering our vacation home for the water and mold damages we found this spring. Now as we have had the opportunity to relax and start through with the rebuilding process we now are at another snag. It seems after the water and mold removal as they prepared to start the rebuilding of our home they found out the water damage has caused a problem with the foundation. My question is my insurance company has allowed and authorized the general contractor to call in a foundation specialist for an estimate which sounds great. So here is my dreaded question…is there anyway they can legally back out and refuse to remedy this so we can’t proceed with the prior authorized repairs? I guess I assumed since the water damaged the home and they are fixing it why wouldn’t automatically the damage the standing water caused to the foundation be a go ahead?
    Any advice would be appreciated…I have felt so stressed over the past 4 months since the problems initial discovery…the waiting to find out it would be covered was horrendous and now this hiccup in the painful process is overwhelming to say the least…Truly sleepless here in Seattle.

  664. August 23rd, 2011 at 7:45 pm #Jason

    Charlene,
    If they are having the foundation checked by a foundations specialist, that should not affect the other parts your claim – just the foundation. You should be fine with the repairs they already authorized.

    As far as the foundation, not much, if anything will be included in that for water and mold damage. I don’t know what the foundation issues are but water generally won’t affect a foundation. Good luck in the repairs.

  665. August 23rd, 2011 at 8:24 pm #Charlene

    Thanks Jason,

    I do appreciate the feedback, but with no other issues going on I must say that I firmly believe it was the pooling of the leaking water which created this foundation problem. I hope the specialists are able to concur and make that connection because in the “perfect” world I would find this also included under my claim. I certainly need to believe its possible.
    Thanks again,
    Charlene

  666. August 24th, 2011 at 12:10 pm #Shay

    Hi, I have a brand new home buillt in 2005 and have been living in it for 4 years. I filed a claim 2 months ago for water damage in my kitchen ceiling, and was told that water came through the outside vent and was paid a check for plaster and paint only, pipe and plumbing is not covered. The problem is that we had more rain and now my son’s room also has water damage. My question is can I file another claim for this? and if so will my home insurance go up?

    Thank you.

    Shay

  667. August 24th, 2011 at 12:16 pm #Jason

    Shay,
    Call the insurance company and let them know that you discovered more damage relating to the water that they did not address. Ask them to come out and re-evaluate the claim so it is all encompassed under the original claim.

    Claim frequency can make a premium increase.

  668. August 24th, 2011 at 12:50 pm #Michelle

    We were in tornado in Missouri. We had a previous claim on roof 6 years ago for hail damage. Adjustor says it doesn’t look like roof was redone at that time because vents look the same. Can they subtract off the previous claim?

  669. August 24th, 2011 at 2:07 pm #Sally

    Is there an obligation to replace contents at the lowest possible price? Everytime we replace some of our contents the adjuster sends us a quote from a cheaper store and says he’ll only pay that amount for replacement cost. We’ve already put out a higher amount for our furniture, appliances and electronics. I don’t feel that’s fair.

  670. August 25th, 2011 at 1:02 am #Yelkitza

    I own a rental duplex in Anch. AK. My next door neighbor refuses to remove 3 large trees that are on his property. The roots have been traveling towards my foundation so I hired and paid a handy man twice to remove roots from my side of the property. Trees are on his property but 12 feet from my foundation about 10 feet from his foundation.
    My question to you is, (1) would my neighbor be responsible if his trees fell on my duplex? (2) is he responsible if his trees roots cause problems to my foundation -sewer lines – water lines or would this be “the act of God” like my neighbor is saying? He said that he will remove the trees if I pay for half of the cost, if not, the trees stay… Like I said, the trees are on his property.
    Yelkitza, WA

  671. August 25th, 2011 at 11:25 am #Theresa

    my house was on fire on the 9th of June, my son was accused of putting the house on fire. Now the insurance company are refusing to pay for the house. Is it right for the insurance company to refuse to pay for the damage caused in the house?

  672. August 25th, 2011 at 6:48 pm #Jason

    Michelle,
    Yes.

  673. August 25th, 2011 at 6:53 pm #Jason

    Sally,
    This adjuster seems to be a bit picky. You should be able to replace something locally with minimal delivery costs and whatever that price is should be what is allowed. Technically, you don’t have to replace it with the cheapest and this adjuster should be a little more flexible.

    Now, if you are talking about replacing a 32 inch flat screen with a 40 inch flat screen, the allowance should be for what the 32 inch flat screen costs.

    Talk to this adjuster’s supervisor and express your concerns to that manager.

  674. August 25th, 2011 at 6:58 pm #Jason

    Yelkitza,
    It doesn’t matter whose tree falls on your property. That is why you have insurance. He is not responsible if his tree does damage to your property whether from the branches or the roots.

    This also is not an act of god because trees grow taller and their roots expand out and downward. That would be an act of nature.

    Now, if he is offering to remove the trees if you pay half, that seems to be a reasonable compromise.

  675. August 25th, 2011 at 7:02 pm #Jason

    Theresa,
    There is such a thing as an innocent insured and there has been case law involving one spouse burning down the house and the other spouse being able to collect for their ownership interest in the house. It has not always been like that. This involves your son and there is a difference between your son intentionally burning the house, intentionally burning something and the fire getting out of control and burning the house, or your son accidentally burning the house. We simply don’t have enough information and if we did, we likely would not become involved. This is really something for an attorney to be involved with.

  676. August 28th, 2011 at 6:08 pm #Chad

    My house is a total loss due to fire. I do not want to rebuild but was informed that I would lose a substantial amount of what the insurance would pay by not rebuilding. Can anyone give me a ballpark percentage on how much insurers deduct for not rebuilding? Thanks for any insight!

  677. August 28th, 2011 at 6:41 pm #Jason

    Chad,
    Why don’t you ask them? They would probably pay you ACV for your house which is the replacement cost of the home less the home’s depreciation. We don’t know the age of your home so it’s very difficult to give you a percentage.

  678. August 29th, 2011 at 9:03 am #Ed Clark

    We have Allstate and are being informed that the damage in my basement due to the sump pump not operating because of power failure is not covered. some friends have told us that they cant turn down the claim due to that there was a state of emergency declared in my state due to Hurricane Irene. Are there any grounds to fight Allstate since i have an estimated 5-6 thousand dollars in damage in my basement.

  679. August 29th, 2011 at 4:42 pm #Jason

    Ed Clark,
    Sump pump overflow and sewer backup are excluded from you policy unless you specifically add that coverage to your policy and it would be called a Sewer Back Up/Sump Pump Overflow Endorsement.

    Your policy likely has wording very similar to this:
    Water Damage Water Damage means:
    c. Water or water-borne material below the surface of the ground, including water which exerts pressure on or seeps or leaks through a building, sidewalk, driveway, foundation, swimming pool or other structure; caused by or resulting from human or animal forces or any act of nature.
    Direct loss by fire, explosion or theft resulting from water damage is covered.

    It may even specifically state that Sewer Back Up/Sump Pump Overflow is excluded.

  680. August 30th, 2011 at 2:55 pm #Tanya

    On June 1st 2011 Rent a Center installed a washer in my new construction home we had moved into in January 2011. The installer did not put the drain hose in the drain pipe but left the drain hose on the floor under the washer. My husband started a cleaning cycle on the washer (this was our washer that had been away being repaired for over 4 months). A clean cycle fills the entire washer with bleach water and then allows that water to sit. Once the cycle is complete it drains all the water. Because the hose was not properly installed all water drained into the hall and down into the basement. We have a ranch home so Service Master found water in all three rooms and clear out into our living room. Service Master pulled the carpet up to dry the carpets and the floor. Here it is 3 months later and we are still fighting with the insurance company. The carpet was damaged and the insurance adjustor that finally came out a few weeks ago said that all carpet should be replaced. It has been over 30 days since we heard anything from the insurance company. I sent an email two days ago demanding a response but have yet to receive anything back. What can I do to force this insurance company to resolve this issue? What type of lawyer would I seek if this has to be taken to that level. Our homeowners insurance (state farm) will come in and replace the carpet but then we have to pay our high deductible and wait for the lawsuit to be settled with the insurance companies before receiving that money back. Can some type of mediation help bring this issue to a close? Any advice would be greatly appreciated.

  681. August 30th, 2011 at 3:49 pm #Jason

    Tanya,
    Have your insurance company come in and replace the carpeting and pay your deductible. I’m sure it’s not any higher than you selected it to be when you got your insurance with them.

    There won’t be a lawsuit between the insurance companies. If there is a disagreement whether the RAC insurance company is liable or not, it will go to arbitration and be settled there. If your insurance company is successful with the arbitration, you will likely receive your deductible back from state farm.

    You can’t force the insurance company to do anything. You have insurance and that is what you can do right now. You would only muddy the waters if you sued the RAC insurance company. Not only that, you would be spending money with an attorney that you will likely never see again.

  682. August 31st, 2011 at 7:26 am #Bridget

    Hello. We had some water damage to our house from the driving rains in Hurricane Irene. The interior damage is minimal and our insurer said that it would definitely be covered. We don’t know to what extent the roof is damaged but it was in need of replacement before the storm hit.

    The insurance company wants us to get a roofer to come out, inspect the roof and send them a report. We’re afraid that the exterior damage won’t be covered if a roofer reports that the roof needed replacement in the first place.

    How should we proceed with a roofer to make sure that the insurance company will cover some of the roof repairs?

    Thanks!

  683. September 1st, 2011 at 5:24 pm #Jason

    Bridget,
    The insurance covers your roof regardless if it is brand new or 50 years old. If the roof is doing it’s intended function before the loss, you should have no worries. The roof was doing it’s job and now it’s damaged. That is what insurance addresses.

  684. September 1st, 2011 at 5:40 pm #Les

    I have State Farm homeowners insurance in Maryland. What does endorsement FE-5480 Amendatory Debris Removal cover?

  685. September 2nd, 2011 at 1:57 pm #Jason

    Les,
    This endorsement changes some definitions of your policy and changes your coverage relating to debris removal. I don’t have access to view one of those endorsements and it is likely related to a state, county, or city ordinance that describes how and what you have to do with debris if it meets certain conditions.

    You should have a copy of this endorsement so you can read it and try to understand what it changes. If you don’t have a copy, get one from your agent. Perhaps your agent can explain it to you in layman terms.

  686. September 3rd, 2011 at 11:45 am #Neal

    We had water damage in our basement due to the sump pump not being operable during the power outage, all of the carpeting was soaked as well as the bottom of the drywall and insulation. We already have an estimate from a trusted contractor to remove the bottom 24″ of dryway and insulation and replace, I removed all of the carpeting immediately as it began to smell of mildew. I have 5k of sump pump overflow coverage on my NJ Manufacturers policy, we have an inspector coming out tomorrow. I also have 10k of mold/fungi/mildew coverage which kicks in if a covered peril causes mold, my logic is that the sump coverage is a covered peril therefore the mildew coverage should also kick in. My hope is that I can collect the 5k sump pump and 10k mildew coverage as my damages will total 15k with carpet replacement and drywall. I see in the policy that the sump endorsement does say it will not kick in as a result of a flood, but flood is not a defined term and the water came in due to the inoperative sump. I am correct in my thinking that I can expect the 15k provided the insurer agrees that I would have mold problems if I left the drywall in place.

  687. September 9th, 2011 at 12:40 pm #Jason

    Neal, if you have mold because you would leave the mold in place, you are not adhering to the conditions of the policy that indicate you have an obligation to reduce or minimize the damage. So, if you left the drywall in place to mold, then you are intentionally allowing a loss to occur. Don’t count on that $10,000 mold for any part of your claim. That is not how the policy works. You can count on $5000 and they will probably also absorb your deductible (meaning they won’t reduce the $5000 by your deductible amount.)

  688. September 10th, 2011 at 9:00 pm #Jennifer Cooper

    Hi, last week my kitchen caught fire due to a grease fire. One side of my kitchen is burnt up but the other side was untouched. Will the insurance pay to re-do the entire kitchen so the new cabinets and counter tops match the other side? Also, all the insurance adjuster said was that he was sending a contractor to get a better estimate, but what about personal items that were lost, like groceries, rugs, curtains, blinds etc…

  689. September 11th, 2011 at 12:37 pm #Rob

    My contractor agreed to an xactamate scope and price for my damaged home. In xact the materials and labor are broken down. Is my contractor required to pay a sub the labor money that he received for those line items from the insurance company. Ex. the contractor receives 1000 in labor for drywall yet he only pays the drywall sub 500 in labor. Does he owe the insurance company the 500 balance?

  690. September 11th, 2011 at 3:53 pm #Jason

    Jennifer,
    The insurance company and your contract is to repair the direct damage. If it is not damaged, the insurance company doesn’t have to cover it. And insurance companies don’t owe to match what you have.

  691. September 11th, 2011 at 3:54 pm #Jason

    Rob,
    What is likely gonna happen with that $1000 in your example is that he will pay the drywall guy $500 and he will keep the other $500. The insurance company isn’t going to get it back.

  692. September 11th, 2011 at 6:42 pm #Jay

    I have a few questions regarding BSREL (Building Structure Reimbursement Extended Limits)coverage. From what I understand of this, I am entitled to an extra 20% of my policy limits, IF my costs to rebuild exceede my regular policy limits. How does this work? Do I have to spend the $ to get the $? Or, can I exhaust all policy limit monies and report to the insurance company that I need my extended limits to complete building? Should i provide my insurance company/adjuster an estimate that reflects the need for the extra 20% during negotiation?

    How does BSREL come into play in regards to building a different, bigger home than what I had originally had? If the insurance company sees that I am building a larger home that exceedes the cost of what it would cost to rebuild my original home to pre-loss condition, am I still entitled to BSREL for the remaining costs to finish the larger, more expensive rebuild?

    -Jay

  693. September 11th, 2011 at 6:43 pm #Jay

    Hi,

    I have a few questions regarding BSREL (Building Structure Reimbursement Extended Limits)coverage. From what I understand of this, I am entitled to an extra 20% of my policy limits, IF my costs to rebuild exceede my regular policy limits. How does this work? Do I have to spend the $ to get the $? Or, can I exhaust all policy limit monies and report to the insurance company that I need my extended limits to complete building? Should i provide my insurance company/adjuster an estimate that reflects the need for the extra 20% during negotiation?

    How does BSREL come into play in regards to building a different, bigger home than what I had originally had? If the insurance company sees that I am building a larger home that exceedes the cost of what it would cost to rebuild my original home to pre-loss condition, am I still entitled to BSREL for the remaining costs to finish the larger, more expensive rebuild?

    -Jay

  694. September 12th, 2011 at 4:38 am #Don

    I have Allstate and am in NJ. I have no additional coverages beyond Homeowner’s. I had water in the basement as a result of a door being damaged (glass pushed out). Door is partially below ground level and faces east and winds were from the east during the hours Irene was upon us. Is there any hope my policy will cover?

  695. September 12th, 2011 at 8:50 am #ames

    needing advice on how to deal with our insurance company – my father and sister were murdered in the home owned by my father, the house was set on fire and burnt to the ground. The only thing left standing were 3 wall of the basement. He had homeowners insurance and my name was listed on the policy.

  696. September 12th, 2011 at 11:37 am #Maggie Mae

    I have an HO5 insurance policy with Cincinnati…..we had F1 Tornado winds where we live in April of this year..the roof was new in 2008..we
    had no leaks until this April….we noticed in June of 2011 that the wall paper was peeling up high near where the roof meets the outside wall of our downstairs bath. Discoverd water in the wall and some siding damage
    to the outside wall…Insurer says they will cover the inside, but had Donan Engineering firm come out and they determined some shingles were not
    sealed well and tried to say it was from the laying of the roof…well, for almost 3 years, there was no damage to the walls untill this F1 went
    through the neighborhood, took down 80 trees, sucked water out of a neighbor’s swimming pool and others lost shingles..they are saying if it was the F1, it would have taken the whole bunch of shingles and not just unsealed them….I say it could have blew them loose without them flying off…what say you? Thanks…

  697. September 12th, 2011 at 1:01 pm #fslapar

    I have had issues with water seeping into my mostly-finished, partially below grade basement since we moved into our house 3 years ago. During the recent heavy rains from Irene and Lee, the seepage got worse (water was spraying out of the wall, about 5” above the basement floor like a water-balloon with a pin hole in it) and so I decided to file a claim. The claim was denied because ground water entering the house is not covered.

    Am I correct to assume that this claim would have been covered had I had flood insurance? If I purchase flood insurance (say, tomorrow) and file a claim later on, since this is an ongoing water problem, what are the chances the claim will be accepted?

    Thanks for reading.

  698. September 12th, 2011 at 2:33 pm #Carol

    I live in Kansas.Almost three years ago,I was robbed and almost beaten to death. I was hit in the head three times with an axe and numerous other places,broken jaw,nose,arm,two steel plates in my jaw, and five in my cervical spine, plus many more injuries. I was told they lost me once in the air ambulance,and three times in surgery. I was in a coma over a month.paralyzed face,because of all the injuries and nerve damage,my mind and memory was messed up for a long time. Due to the brain injuries,I never even thought about my homeowners insurance, until one of the court officers brought it up. This happened in September of 2008. I did not file a claim on my stolen items until October of 2009. The second time the insurance company called me, I explained about the pre-meditated first degree murder attempt,and trouble with my mind, and memory. The insurance company told me they never received my first claim, so I could resubmit it and not to worry about the receipts,there was a message that said all their conversations were recorded,) so just send pictures,which I did,as the sheriff’s department had taken many pictures of my slashed up clothes that weren’t taken, things that can never be replaced from my son’s dad, shoes,etc. I told the agent I talked to,it might take me a while,as I still have trouble remembering to do things,she told me not to worry about it,just try to get it in in the next few months,which I did.I sent it in in the last part of August,but forgot to certify it. My sis asked me if I certified it,which I’d forgot to,so I called my insurance agent and he said he still had it,so my sis took me over and I took it across the street to the post office and did it right. I went to the post office on September 2,2011 and had it certified. I was already on permanent disability ($674.00) when I was attacked, and have to replace my clothes,shoes, as my attackers partner was his daughter and my size and was left in my house that night.Am I still eligible for my homeowner’s insurance? I have lost almost 70 lbs. and sure can’t afford to replace my clothes or wear the pair of shoes she left.Thank you and God bless you.

  699. September 12th, 2011 at 3:44 pm #jane fite

    We have a cabin on a lake and a basement bedroom. The floor joists gave way and floor fell in one corner at least a foot. Upon tearing up the floor, we discovered the floor joists had been wet and that section of flooring were rotten. Our homeowners policy shows coverage included in our policy – Property Coverage Limitation for fungi, wet rot, dry rot and bacteria resulting from a covered cause of loss; limits $14850. I don’t know what this means but we have a serious problem. Do you think we could submit a claim for this?

  700. September 12th, 2011 at 8:35 pm #Jason

    Jane,
    Yes, submit a claim for that. We don’t know the outcome of your claim because it has to be investigated first.

  701. September 12th, 2011 at 8:39 pm #Jason

    fslapar,
    This is vegas, so we don’t know odds. If you think you could get coverage for this, spend the premium and find out. If you want to play it safe, just remedy the situation without expecting someone else to take care of it for you. What is the remedy for being in a water saturated area anyway?

  702. September 12th, 2011 at 8:41 pm #Jason

    Maggie Mae,
    I will take the engineer’s answer.

  703. September 12th, 2011 at 8:43 pm #Jason

    Don and Ames,
    File a claim. Contact your agent and file a claim.

  704. September 13th, 2011 at 6:26 am #Maggie Mae

    Jason,
    I am glad to to report that after the engineer checked our roof and determined that shingles in the area where the F1 winds hit at full force had loosened and reported to the insurance adjuster, Cincinnati is going to include all in the fix and it will be covered………. the shingles to be sealed, the outside siding and of course the inside of the bathroom all to be in the claim. This works out well to our satisfaction and speaks well of Cincinnati Insurance. Very informative site here!

  705. September 13th, 2011 at 7:15 pm #wendy kay

    I am a homeowner, I hold the deed and all the proper proof that it is my home, the home was burned down. My mother while she was alive got home insurance on the home and after she passed my step father continued the payments since he has met a woman online and has refused to give us our part of the estate which we were awarded. When i refused to sign over my home to him things got ugly and he sent me a email stated if I was going to be a “B” watch and see what a “B” he would be, needless to say 2 days later the house was burned to the ground and they fire chief ruled it as unknown and closed the case. Now he will receive the money, even though it is my home and my property? how is that fair. I think the fire was set by him I cant prove it, but I am calling the fire chief Monday morning to see if he can reopen the case, I am trying to recover the email he sent showing that there may have been some suspicious intent to recover the money hes out because he wanted me to sign it over so he could sell it? Please help me understand how this is legal? I live in the state of Louisiana so the laws vary. Am I over reacting? So I am thinking if he did get a check from the insurance company is he obligated to repair or rebuild with that money he has possibly gotten from the insurance company? Please help me. Thank you so much for your time.

  706. September 13th, 2011 at 9:52 pm #Jason

    Wendy,
    Whether it’s legal or not, it happens all the time. Yeah, you are probably over-reacting. No, he can take the money and do whatever he wants with it. Why do you care if the case is re-opened. Just move on with your life and stay away from this step father guy. He sound like trouble.

  707. September 14th, 2011 at 4:41 am #Don

    Follow up-

    Claim was filed on the 1rst of Sept. Did not have the ability to use the agent that earns his living off our insurance premiums, as I was referred to an “800″ number for filing. Did that and 13 days later, spoke to an adjuster who informed me over the phone, that I had exclusions of drain and sewer that made the claim invalid for my policy. No coverage, and never spoke in person or saw someone from ALLSTATE. I will be contacting my mortgage company to see how they feel knowing such major exclusions exist, and also will try and find out when those exclusions took effect. I was not aware that any major change had taken effect on the policy. Could not get a copy of my policy emailed either. Have to wait 10-12 days for paper version. GOOD HANDS?????

  708. September 14th, 2011 at 4:20 pm #Jason

    Is it illegal in NC to put a “release and payment authorization” on the Proof Of Loss form on a home claim? It states that it would be in full satisfaction and settlement of the above claim. We were told we had to sign this proof of loss form within 60 days or our claim would be denied. There is only one space to sign, so we were forced to sign this release in order to submit our required proof of loss.

  709. September 14th, 2011 at 5:00 pm #admin

    Jason,

    Take a look at these two documents at UClaim.com for some good info on your issue:

    http://www.uclaim.com/docs/img086.gif

    http://www.uclaim.com/docs/img085.gif

    Its a deceptive practice, so that makes it illegal in the insurance code and the business and professions code in most states and probably yours also.

    Wouldn’t it be nice if there was a Federal insurance code so there were not 50 different states with 50 different sets of statutes and case law repeated 50 times? Think of enormous waste of time and money spent on duplicated litigation in 50 states. But hey, this is one way that the insurance industry keeps a grip on consumers. And its a way for most state legislators to get campaign contributions from insurers. It’s a vicious cycle. This is one of those areas where the smoke screen of “states rights” benefits big business over the consumer and small business.

  710. September 15th, 2011 at 6:28 am #matt

    After a tree crushed my garage and tore down utility lines on the back of my lot, I had to spend two days home from work dealing with several utilities crews and boom trucks in my backyard as well as mitigation efforts. Is the time I had to take off from work covered by my insurance?

  711. September 15th, 2011 at 3:30 pm #Tonya Hemsley

    I live in the state of Delaware, I had a house fire on June 3rd of this year. I was assigned a content adjuster and a structure adjuster. The content adjuster was the first one I met, she immediately gave me a debit card with $2500 on it. The Monday after the fire, I met the structure adjuster, he took no measurement, immediately wanted me to go to his car and do a take recorded interview and sign some papers, one asking for permission into my financial world. Of course I was offended. Nevertheless, I cooperated. A month and a half later, they had one of their investigators contact me to do another tape recorded interview, and to investigate, oh did I mention that by the time they send the investigator out, there was nothing in the house, the walls and everything had been removed. He took pictures and then did another tape recorded interview. Now three months later, I recieved money for my structure, but have not recieved anything as far as my property content. But the property content adjuster keeps wanting to give me an advancement. Right now they have had a third party contacting me to find out, if I am going to restore the property. This third party gentleman is a company they hired to help to do the personal property inventory. Oh by the way, the fire marshal ruled the fire as an accidental unattended candle fire. I am at a loss for words. I am in temporary housing, and the third party told me that I only had a year to restore the home. I checked the living expense part of my policy, and it is $200,000, and I am positive that this temporary house I am living in, can only be $2200 a month at most. Please someone advise. I am confused.

  712. September 15th, 2011 at 6:38 pm #Jason

    Matt,
    You policy covers direct damage to your insured property. Your time away from work is not direct damage and is not a covered loss by your insurance policy.

  713. September 15th, 2011 at 6:40 pm #Jason

    Tonya,
    Do you have a question or questions that you want addressed? We don’t just provide random advice. Can you narrow down what kind of advice you are seeking?

  714. September 16th, 2011 at 5:25 pm #Tonya Hemsley

    Sorry, I am just frustrated. My question is, how long does it take to recv’d your inventory list from the content claims adjuster? She also had an external company helping with the inventory.

  715. September 16th, 2011 at 5:26 pm #Tonya Hemsley

    It has been three months, since the fire, and I have nothing as far as my inventory, How should I proceed?

  716. September 16th, 2011 at 10:02 pm #Jason

    Tonya,
    Contact you adjuster and ask that question to that person. They would be able to tell you more accurately than we can. Also, ask you adjuster how you should proceed. They are there to assist you.

  717. September 17th, 2011 at 2:53 pm #shri

    Hi,

    Thanks for putting up this wonderful , very informative resource.

    We live in NJ and had a fire few months back and we are in process of getting final settlement thru appraisal. We have a public adjuster representing us.

    My question is ,can we make changes / additions to the house within settlement amount during repair work ?

    Can insurance company insist on scope of work even if we are within settlement amount ?

    Thanks

  718. September 17th, 2011 at 4:49 pm #Suresh

    I am seeking some help I have had recent hail damage. There is water damage to the garage and couple of other rooms that need drywall repair and paint. Insurance accepted the claim of the internall damage and the drywall repair.

    Because the amount claimed is enough to cover the damages and possible additional stuff. Considering to use for the same property like deck and siding wash and stain. Fixing the fence doors and stain,…

    Adjuster mentioned that i should be getting a check in the mail to start the job and remaining will get upon subbmiting the invoice.

    My question:
    1) Can i use the claimed ampount to the additional work on the same property?
    2) Does the insurance needs the invoice with amount to claim the remaining amount? If that is the case how should i manage my contractor accountable for the additional work?
    3) One of my other property roof damage due to the same hail damage is denied. My contractor insists it should be replaced. What is my next course of action?

    Thanks in advance.

  719. September 17th, 2011 at 10:24 pm #Jason

    Shri,
    If you want to do changes, that should be fine to do just as long as you are essentially repairing the damage in a similar fashion to what is was before. If you have questions about how much modification you can do and still recover the recoverable depreciation, you might want to check with your adjuster to have that clarified.

  720. September 17th, 2011 at 10:30 pm #Jason

    Suresh,
    You really have to follow the estimate to get the recoverable depreciation. However, if your contractor will work from the estimate, and do the additional work on the other items (or however you arrange it with your contractor), you should be fine. Just make sure the outlined work is completed and the dollar amount to do that work was what was allowed in the insurance estimate.

    With the other roof, insist on a re-inspect with your contractor there to point out the damage from hail. In this case, the squeaky wheel gets the grease. However, if you didn’t have hail damage there, then the policy will not pay for a roof that just needs replacing and wasn’t damaged by hail

  721. September 18th, 2011 at 2:39 am #Tracy

    Hi,
    I hope I’m doing this correctly. I can’t find a place to post a question only submit a comment? Sorry if I interrupting conversations.

    We decided to rent our house. We had an insurance adjuster come out and value the home. After a few months of repairs and upgrades we called 3 times, over the course of a couple years, and asked them to come out and revalue the home. They did not do this and subsequently the house has burned down. We were insured for 188,000 and the insurance company has agreed to pay that amount. They also estimated it will cost 220,000 to rebuild. The insurance adjuster said it was our responsibility to to increase the value of the home. What do you think? Since the home was undervalued and no one would come out to revalue do we have any chance of receiving more funds for a rebuild.

  722. September 18th, 2011 at 8:52 am #vernida

    My question is why does it take so many step and interviews and repeat form filling out to resolve my claim after a burglary. My premiums were paid timing w/o hesitation and now it is if I am the bad person here – loss occurred June 2011 and still today having now to fill out yet another confusing form called sworn statement of loss which in title makes sense however form itself is mind boggling so would someone out there with any claim knowledge help me out with these two questtions – thank you

  723. September 18th, 2011 at 7:04 pm #Eric

    My sister has just gone through a divorce and her ex husband pretty much gutted the inside of the house while they were separated. Now she has the house and can’t afford to fix it. Is this something insurance will cover?

  724. September 18th, 2011 at 9:59 pm #Jason

    Tracy,
    No, the insurance company doesn’t make sure you insure the home to the correct amount – that is your responsibility. You are the home owner and you have the direct stake in the home so that falls into your area of responsibility. Take the insurance proceeds and do what you can with it. There is no way you are going to get anymore than that.

  725. September 18th, 2011 at 10:02 pm #Jason

    Vernida,
    I would be happy to help you with the questions you have and the statement of loss and/or the Sworn statement in proof of loss that you have. What questions do you have?

  726. September 18th, 2011 at 10:03 pm #Jason

    Eric,
    It’s very, very unlikely the situation you described would be covered by insurance.

  727. September 19th, 2011 at 12:44 pm #John

    Concerning mitigation costs. Are mitigations hours that I put in to stop furthur damage claimable such as further water intrusion and mold damage, or does it have to be through a contractor?

  728. September 19th, 2011 at 12:58 pm #Nicole

    I talked with my agent’s team member at Liberty Mutual who stated that my policy would cover a busted pipe which has caused water damage in my air duct system and my house to smell like sewer. The claims adjuster states that my claim will be denied based on the fact that it doesn’t cover water damage to the foundation, slab or heating and cooling system. I’m so confused right now that my head is spinning. I keep getting different answers from agents and claims adjusters, even supervisors. I just want my pipe fixed and my house to not smell like sewage. What can I do?

  729. September 19th, 2011 at 2:37 pm #Karmen

    Insured w/ State Farm and am finally getting to end of a claim dispute after 2 very long years. I acted as our own General Contractor. Am I entitled to the GC overhead and profit?

  730. September 19th, 2011 at 4:51 pm #vernida

    Hi Jason

    wow you much quicker than my insurance Co but thank you they finally did respond its just been a frustrating ordeal since it began 3mos ago – paper work after paper work

  731. September 19th, 2011 at 7:44 pm #Jason

    John,
    Present your efforts, hours, and what you did to the insurance company/adjuster. Sometimes contractors are not available to do protective work. It’s reasonable that your efforts should be reimbursed or allowed to be paid by the policy.

  732. September 19th, 2011 at 7:52 pm #Jason

    Nicole,
    While your insurance company tries to figure out if it’s covered or not, why don’t you get the issue fixed? Regardless what the insurance company does, that is what you have to do. You can’t let your life revolve around the insurance company that gives you conflicting information.

  733. September 19th, 2011 at 7:56 pm #Jason

    Karmen,
    That’s a very good question. Some insurance companies will allow that and some won’t no matter what. Then there are some that allow overhead but won’t allow profit. All you can do is present the overhead and profit, while demonstrating that you did act as the general, and hope state farm pays this reasonable charge when a general really does orchestrate and coordinate the activities of all the sub-contractors.

  734. September 21st, 2011 at 6:54 pm #Holly

    We came home on Thursday from a week vacation to find a water leak in the attic. Immediately called insurance agent and plumber to fix the leak… Adjuster came out next day. We had approximately 2″ water in home and caved in ceilings in 3 rooms, plus the kitchen has to be torn out. Water restoration started and here comes the problem, the Adjuster told us that we had to live in the home even though the restoration company was wearing masks in our home. I should mention here that I have a 2 year old and 4 year old. Needless to say, the Adjuster came out today (Wednesday) and an argument started between my husband and the Adjuster in which he told us our kids weren’t his problem and he didn’t care if there was mold in our house or not. About an hour later I spoke with the Adjuster who told me he would no longer be handling our claim and a new Adjuster would be out in a few days. Does this mean that the whole process has to start over? Is there anything I can do speed the process along? We just want to be back in our home. Any advice is appreciated. Thanks.

  735. September 21st, 2011 at 8:30 pm #Jason

    Holly,
    If your home is not habitable, then your insurance company should provide you with additional housing expenses to set up a temporary residence while the repairs are being completed. If it affects only a small part of your home and you can live in it as the first adjuster seemed to think then that would be reasonable to do. We don’t know your home’s current condition just by what you posted so we don’t know if you can reasonably remain there or not.

    An important thing to do is to work with your adjuster and they will work with you. Keep your requests reasonable and don’t argue with them. Arguments just slow down the process and nobody wins in that type of situation. The adjuster didn’t cause the leak. It happens and everybody has to deal with it.

    Now, will the entire process have to start over? Not entirely but when you bring in a new adjuster, they have to pick up where the last adjuster left off and it might seem as though they are starting all over again.

    Personally, I would think if the kitchen is affected, then it would be reasonable to put you up in temporary housing while the repairs are being done. I indicate that because a kitchen is a commonly used part of the home many times during the day.

  736. September 25th, 2011 at 3:42 pm #Norris

    I pissed off my brother so he decided to destroy my drum set. As far as I know it is totally useless and most parts are broken. Since this is vicious vandalism using major violence, can this possible be covered under homeowners insurance? And he lives with us. He is 31 and as far as I know my parents did not claim him on taxes as a dependent.
    Thanks

  737. September 25th, 2011 at 6:36 pm #Jason

    Norris,
    Since you are living with your folks you are insured under their insurance for damage that occurs to your property. Unfortunately, your brother also lives in the same household and he is also an insured under your folks insurance policy. The limitation there is that the policy has a restriction in it that damage caused by an insured is excluded.

    If your brother is 31 and living with his folks, he needs to get a job and move out. He may also need some anger management classes.

  738. September 25th, 2011 at 8:09 pm #John

    Hi Jason, Great site with tons of useful information. I just went through the entire site and couldn’t find anything close to my question, so here goes.

    First some background: On July 26, 2011 we lost our home and outbuildings to the largest wildfire in New Mexico history. State Farm was quick to cover additional living expenses and as of this writing they have paid the policy limits on the dwelling, dwelling extensions, debris removal and even compensated for trees and landscaping. We are now in the process of dealing with the personal property and so far I expect that process to go well and “hit” our policy limits there too.

    Here comes the question: I recently received a call from a Public Insurance Adjuster that is very interested in talking to myself and my other neighbors who lost everything about what he can do to help. I said that I felt that my relationship with State Farm was going well and that we in fact so far we had received our policy limits. At that point I was surprised to hear him say that he could get us “more” than my policy limits. I feel that the policy limits are fair, but have agreed to meet with him to just talk next week. My neighbors are excited but I am very nervous. Could he really get us more than our policy limits and will that ruin our relationship with State Farm? Thanks in advance.

    John

  739. September 26th, 2011 at 6:33 am #Norris

    As of now he has had a restraining order for imminent threat of bodily harm put on him. He is also using drugs and alcohol and we had just tried to get him to stop abusing substances. Will this make any difference?

  740. September 26th, 2011 at 8:02 am #Kathy

    I filed an insurance claim for a gagage fire on setp 6th 2011. How long does it take to settle the claim and receive the insurance money? The adjuster has been out and the report has been filed.

  741. September 26th, 2011 at 7:25 pm #Jason

    John,
    I’m not particularly favorable of public adjusters but yeah, they may be able to get you more than your policy limits. Be careful to understand their fees to you. For example, their fees may be 30% and that might include the parts of your claim that are already settled. I don’t know each specific contact out there involving public adjusters so this may not apply at all.

    People who have things going well between themselves and the insurance company probably doesn’t need one to assist. There are times when public adjusters do a great job and that is helping an insured get their claim money when the insurance company is not being fair to the insured because of the insured’s lack or insurance knowledge.

  742. September 26th, 2011 at 7:31 pm #Jason

    Kathy,
    You can probably expect it to take up to a month. Hopefully it will be sooner but that is the deadline many insurance companies attempt to meet at the latest. If settlement happens sooner, than that is good for everybody. Those are run of the mill and uncomplicated claims. Claims that involve many other people such as various experts, arsonists, lawyers, public adjusters, etc. will take longer.

  743. September 26th, 2011 at 7:35 pm #Jason

    Norris,
    No those things won’t make a difference. The only things that will make a difference is if he is both a vegetarian and someone with frequent heartburn.

    I didn’t mention that before because, as we all know, vegetarians rarely, if ever have heartburn. So, that would be a long-shot to have frequent heartburn if you are a vegetarian.

  744. September 27th, 2011 at 7:53 am #Norris

    What exactly does being a vegetarian with heartburn have to do with it? Although he does have horrible heartburn. If you mean it’s because of the drugs we know for a fact he is on drugs and mentally ill.

  745. September 27th, 2011 at 8:14 am #Jason

    Norris,
    That is basically the question I was asking you – what does him being on drugs and alcohol have to do with whether or not coverage would apply for your drum set?

  746. September 27th, 2011 at 6:54 pm #Norris

    I was hoping there might be a clause or something that would apply to mentally ill people or someone on drugs.

  747. September 29th, 2011 at 12:38 pm #Cynthia

    I am looking for help. I had a pipe block and water from the softeners backed up through the kitchen sink and in to the kitchen cupboards and floors. There was severe water damage done to the kitchen and to the basement. This happened on September 5th.

    The restoration crew cleaned up the mess and removed the kitchen floor and half on my kitchen cupboards.

    I am now in my fourth week of walking on a cardboard kitchen floor with my three children and it is getting to me. The adjuster has just asked for another estimate to have the kitchen refaced now and not replaced….Firstly, she wasn’t happy with the software that is used by State Farm, now she is not happy with the two estimates to have the kitchen replaced and now she is talking about getting it refaced.

    What are my rights….I had the crew scheduled next week to start getting my house back in order. My house is very unhygienic with a kitchen out of cardboard and people wearing shoes because there are nails that pop out underneath the card board….what can I do???????

  748. September 29th, 2011 at 6:22 pm #Jason

    Cynthia,
    With the nails that are popping through the cardboard, you can take a hammer and pound them in so they won’t stick up through the cardboard.

    Get a claim supervisor involved and tell them your situation and what you want done. If you have to get the cabinets refaced, get an estimate as soon as you can. If that is what the insurance company is requesting of you, you should supply that through a contractor you’ve chosen so you can get your kitchen back to order.

    What is really odd is that state farm should be able to write your estimate for the work that is needed and then cut you a check for the estimate of damage.

  749. October 2nd, 2011 at 5:04 am #Donald MacIntyre

    Hi

    We had saturation to a bedroom wall so took up the floor and found a leak in a heating pipe. We called a plumber who came and repaired the pipe and we then called our insurance company who sent out a loss adjuster. The loss adjuster sent out a plumbing specialist who met with the plumber over two days to inspect our plumbing. They both said there was no more leaks. The loss adjuster then sent out an engineer who established that the entire ground floor was saturated and to wait to hear back from the loss adjuster. We contacted our own engineer and loss adjuster who said everything on the ground floor should be removed to facilitate drying out the concrete sub floor. The insurance company did not beleive this and over a year sent out various engineers to back up their claim and when none of them would they backed down and said everything should be removed. Over this time the house became progressifly worse. The floors upstairs buckled as well as doors and the stairs and mould is growing throughout the ground floor. This involved more engineers who all said the moisture from the ground floor could not have caused this. We have now been in a legal battle for three years and just recently the tarmac at the rear of the house has given way and potholed in many areas. I contacted our engineer who informed me that there must be another leak, he told me to turn of the water supply and to check the water tank levels to see if any drop. After 2.5 hours the two 60 gallon tanks had droped by half indicateing that we are loosing 24 gallons per hour if you add that up over the past few years it amounts to over a million gallons of water. Could you tell me who is responsable

  750. October 2nd, 2011 at 6:19 am #Jason

    Donald MacIntyre,
    Responsible for ..? It appears your question is not complete. Responsible for your home, the piping, the delay, water consumption, checking pipes, fixing damage?

    Also, your assumption with the water loss is not necessary correct because there is no indication that the water has been leaking at the same rate during the entire time it was leaking.

    Also, I may be mis-understanding your loss rate over the past few years but roughly using the information you provided, and assuming a constant loss rate of 24 gallons an hour, that amounts to roughly 210,000 gallons a year. That would mean in 3 years, that would be around 630,000 gallons and not over 1 million gallons.

  751. October 2nd, 2011 at 8:07 pm #Ann

    Allstate recently phoned us back after we claimed for hail damage to house and vehicles…they claim that the roofing company is over-charging and that they are not willing to pay for the estimate submitted by the roofer….this roofer was used by the whole neighborhood and we waited 4 months for him to finish other claims first….everybody around us is happy with his work, quality and costs…on what basis can Allstate make such a claim against a reputable company? Is this ethical? I told them to sort it out with roofer since I am not an expert and cannot belief they can make such an accusation to me without proof or some substantial evidence.

    Allstate short paid us on the vehicles – we had to remind them that the checks issues were for incorrect amounts – three different adjusters had to visit the vehicles before it was written off after the 1st adjuster totally underestimated the damage and costs of the repair….complaints to Allstate resulted in an excuse of they had to hire a lot of inexperienced people due to the widespread damage of the April storms….seems to me that they are constantly trying to cheat us out of money. They also short paid on several outside items – which we fought for and got quotes of the actual items we purchased.

    Any info regarding the legality of how they are approaching this is appreciated

  752. October 2nd, 2011 at 9:47 pm #Wati

    Hi,

    My question is ” are policy holders restricted after settlement on what you can and can not do with settlement money.

    E.g If I want put up an extra room or a deck which was not there when fire happened.

    Thanks

  753. October 5th, 2011 at 4:02 am #LQ

    Hi I posted a question last night and now I dont see it. Did you get it? Should I repost?

  754. October 5th, 2011 at 4:40 pm #admin

    Dear website visitors,

    Most of our questions and answers for October 3rd and 4th were lost as a result of a malware attack on our website. In addition, some of our pages were “redirected” to malware websites. We have now incorporated stronger security measures.

    While we have no proof as to the original source of the hackers, suffice to say that this website had never experienced hacking problems until shortly after we posted the page “BOYCOTT FARMERS INSURANCE?” which exposed criminal acts by Farmer’s CEO and their Los Angeles based attorney Richard O Knapp.

  755. October 5th, 2011 at 8:36 pm #aNYmouSE

    HA – Imagine that! A corporate giant committing criminal acts and then behaving as cowardly street thugs!!
    No you have no proof, however you really need none. Of course that is what happened. Not to make light of your site being hacked, the criminal acts of these companies not only devastate individuals, they have a major impact upon our entire economy.
    Let’s see – there is currently a march/protest on Wall Street which has spread to protests in other cities across America, because of the crimes committed by Wall Street, which no one has been held accountable for. I have joined the protest in my city. Tomorrow I will suggest to my group that the protest be extended to include insurance companies, banks and of course our ‘representatives’ in Washington. These types of cowardly acts only happen because they can.
    To anyone paying attention; until an insurance company has ruined your life, (which happens to individuals every day) you will never understand (or perhaps even believe) not only the immense greed that drives their criminal behavior, but also EVERY claimant is a potential victim.

  756. October 8th, 2011 at 2:20 pm #Jimmy Link

    First off.. I have replacement cost Homeowners Insurance with State Farm on my primary home. I’ve been insured with them for over 20 years with only one claim which was less than $700.. I also own an unoccupied house about 15 miles away that I have no insurance on due to it being unoccupied. I mainly used that house to store some of my belongings. This past week someone broke in the unoccupied house and stole almost everything that was stored there even down to the stove and refridgerator. Should my Primary Home’s homeowner’s insurance cover any of my loss?

  757. October 8th, 2011 at 7:31 pm #Jason

    Jimmy,
    The duration of time being insured with a company has no affect on claims.

    Personal property is covered anywhere in the world so you should have coverage for what was stolen. There are some limitations to that coverage and that may be to items that are stored, not used, and obsolete, etc. The only way you will know for sure is to make a claim. Applying the limitation of stored, not used, etc. is rather broad and difficult to apply to anything because most things we own are stored or not used for long periods of time.

  758. October 9th, 2011 at 5:38 pm #Earl

    I am at my wit’s end! I had storm damage to my roof back in April of this year and got a good reference from a friend about a roofer to inspect and give an estimate on repair/replacement. The roofer suggested that I file a claim and even offered to help me with the process. I have never (in the 20 years I have been out of my parent’s home) had to file an insurance claim of any kind, so I took them up on the offer. They were very helpful and even met the adjuster when he did his inspection. I received the initial check from the insurance company and (because of the reference from a trusted friend and my obvious trusting nature) I gave it to the contractor . . . you can guess what happened. I saw them on the news a week later, they were being investigated for insurance fraud. They have cashed the check, not done any work, and the owner has lost his license and gone to jail. He is out now, and the Sheriff’s department told me he was told by the judge to make restitution for all of the hundreds of people he defrauded, but I shouldn’t get my hopes up. I called my Insurance Co. (Allstate) and they told me there is nothing they can do. Is this true? I explained that I cannot afford to have the work done on my own and the roofer is obviously not going to do it or give me a refund, but there is still the damage to my roof that gets worse each time it rains! What recourse do I have to get Allstate to fix the roof? Any? Thanks, I know this is a long question, and I was naive . . .

  759. October 9th, 2011 at 9:47 pm #Jason

    Earl,
    You’ve had your recourse with your insurance company and they did what they promised they would do. Their obligation to you is over. You’ll just have to get the repairs done by some other means.

  760. October 10th, 2011 at 4:45 pm #Kristie

    We received water damage from a bad storm water pentrating the stucco from cracks. This damaged our living room carpet also we had water damage in our bedroom which has laminate flooring. Does the insurance company ( state farm) have to pay to replace all the floors so they will match? Can we request for them to replace the carpet in the living room instead of cleaning it. Water extraction was out today to dry out.

    Adjuster will be out tommorow. Any Help would be appreciated we have never filed an Homeowners insurance claim.

  761. October 10th, 2011 at 8:57 pm #Jason

    Kristie,
    The policy is for direct damage to property and matching isn’t damage. So, they don’t necessarily have to match. They just have to allow for the direct damaged items to be repaired or replaced.

    You situation raises more concern than just matching. Water coming through walls or building materials absent damage from a storm may no trigger coverage for the interior water damage.

    Of course you can request replacement instead of drying. However, they don’t have to honor your request. And the main thing is if this is a covered loss that you policy provides coverage for.

  762. October 10th, 2011 at 9:23 pm #Jason

    *may not trigger coverage

  763. October 11th, 2011 at 11:08 am #Kent Campbell

    We recently had a battery leak in a portable stereo that permanently damaged a $5,000 counter top. Our Traveler’s homeowner insurance is denying coverage based on an exclusion for “seepage of any pollutants or acid”. This does sound pretty specific, but just in case, do we have any kind of recourse or alternative with the insurance company?

  764. October 11th, 2011 at 11:21 am #Jason

    Kent,
    The language of your policy is likely written much like this:

    2. We will not pay for loss or damage caused by or resulting from any of the following:

    1. Discharge, dispersal, seepage, migration, release or escape of “pollutants” unless the discharge, dispersal, seepage, migration, release or escape is itself caused by any of the “specified causes of loss.” But if the discharge, dispersal, seepage, migration, release or escape of “pollutants” results in a “specified cause of loss”, we will pay for the loss or damage caused by that “specified cause of loss”.

    It appears the denial of this loss is appropriate and I don’t envision anything happening other than a denial.

  765. October 11th, 2011 at 11:43 am #admin

    Kent, consider a 3rd party claim against the radio or battery mfg. if there was negligence on their part?

  766. October 11th, 2011 at 11:53 am #Kent Campbell

    That’s kind of what we figured. Maybe time for a new insurance company.

  767. October 12th, 2011 at 8:28 am #Jason

    Kent,
    That exclusion exists in every single policy that is out there. Switching to another insurance company won’t remedy that. However, you should be reviewing your coverage and insurance costs about every 3 years. Most insurance coverage is pretty much the same but premium costs can vary substantially.

  768. October 12th, 2011 at 4:09 pm #Melissa

    Hi.
    I had a house fire back in Feb 2011. At the time I did not live there and had a renter. The house caught on fire and destroyed most of the house. The insurance company Michigan farm bureau came out and the adjuster was nice at first. She said that I could rebuild it and the back two bedrooms would be saved and the house would be taken down to the studs and then rebuilt. I told her( adjuster) I didn’t want to rebuild it since I didn’t live there and didn’t want to deal with another renter. I just wanted to get any money owed to me and pay off the mortgage and clear out the property. The adjuster stated that she didn’t think I could do that. After calling her several times with no answer I was getting mad about the situation. Two months or so went by and I had gotten a letter in the mail from a public adjuster. I called them and decided to let them deal with the insurance company which was a good thing for me since my insurance adjuster never told me that I had sixty days to get in my proof of loss and by the time I contacted the PA I had only 14 days to get it in. So, I got that in and it has been a waiting game ever since. The insurance company is supposed to be giving me a rent check to cover the lost rent they gave me three checks so far and have stopped giving me the rent check. I called the PA and they told me to deal with my insurance adjuster myself when dealing with the rent check. I have called and called sent emails and no response from farm bureau. Farm Bureau sent me one check for the actual cash value of the property and I haven’t cashed it because the PA told me to wait. That check won’t even be enough to pay off my mortgage. My house was insured for 95,000. the check is for 31,000 and my mortgage is 49,000. On the 31,000 check it states that it is for actual cash value of the property and that I had 120 days to ask for replacement value and I am assuming this means to replace the house since I didn’t have any contents in there only the stove, refrigerator and the dishwasher. I am wondering it has been eight months and I am still waiting to get money from farm bureau. They were supposed to do an appraisal back in June 20011 and the PA says they are still waiting for numbers to come back from that. well it has been four months since the appraisal and it seems like farm bureau just wants to drag their feet. I’m getting really mad because I have to pay a house payment on a house that I don’t even live in and I am working full time going to school and raising three kids and it’s a struggle to pay that extra house payment. How long does this whole process take??? What should I do just stop paying the house payment? I called a lawyer and they said just wait and see what the PA can do and to me it seems like it’s taking forever and farm bureau is stalling with them too. How much longer?? I can’t wait forever! HELP!! oh and Michigan Farm Bureau…..U SUCK!!!

  769. October 12th, 2011 at 5:46 pm #Jason

    Melissa,
    I don’t believe Michigan is a stated value state. If it was a stated value state, then they would pay you the policy limit for the property in the event of it being totaled. Now the check they sent you is for the actual cash value to repair the damaged portion of the home.

    Within 180 days from the date of loss, you need to have the repairs completed and then submit a claim for the amount that it cost over what they initially paid you up to the policy limit (or the replacement cost estimate amount).

    I don’t know what the public adjuster is doing for you but they probably are content collecting their percentage of the agreement they have with you in regard to your settlement amount.

    Because of the time that has passed, what has and what hasn’t occurred, and all the rest of what you indicated, this claim is basically settled with the checks that you have already received and there is probably nothing else that is going to happen.

  770. October 12th, 2011 at 6:35 pm #Scott

    Hi,
    I live in Pennsylvania. My insurance company sent me a check to replace my hail damaged shingle roof after taking a contractor of their chioce to inspect and estimate the damage. The check was for about %70 percent of the total and the balance would be paid upon completion of the repairs. I performed the work myself and notified the adjuster. The adjuster said that in PA the law is written that you cannot profit from an insurance loss and that all the figures need to be adjusted lower. I wished they would have made that clear upfront. Someone told me that the PA law does not allow the insurance company to withold a portion of the claims check until the repairs are completed. Also, the contactor that the insurance company brought to estimate the damage sent me a bunch of papers to sign which appeared to be intentionally confusing contract documents. I can see where alot of older people may have signed the papers not knowing they were locking themselves in to one contractor. I am not sure sure where to get advice. Can anyone give me some insights or direction?

  771. October 12th, 2011 at 6:45 pm #Jason

    Scott,
    I fail to see how you would profit from replacing the roof yourself. When roofers remove and replace a roof, they get paid for their labor. Just like you should. The roofer gets paid for labor and materials just like you should get paid for the materials you purchased and the labor you expended to remove and replace the roof.

    If they are saying you can’t profit, they are literally taking away the reimbursement for your labor. Is that profiting? No, it’s you doing your own work and knowing how to do it properly. There is no law anywhere that indicates that a homeowner cannot make their own repairs (well there are some limitations) but you should be able to do your repairs and be paid the full cost of doing that. It’s called payment for labor and materials. You should be paid the same rate as a roofer if you do all the same functions as a roofer.

    This insurance is getting too carried away because you are not profiting. The work is now done and you need to be paid for the material costs and reimbursed for your labor. Good luck. I back your efforts.

  772. October 14th, 2011 at 6:02 pm #Justme222

    I have a claim for my home by way of fire. The home is pretty much damaged and the insurance adjuster wants to make sure I could prove that I could afford the remodeling that was done to the house. Can she deny my claim if that can’t be proven? Also, I have alot of contents in the home that was from a previous business that was shut down at least 3yrs. ago. Are those contents considered personal property now or still business? Is my insurance company required to pay for those contents too?

  773. October 14th, 2011 at 6:56 pm #Jason

    Justme,
    I don’t know if that is the reason for their requested information. We don’t know enough about your claim to provide you with any information. They are probably doing a financial review of you and that may be a little bit more complicated than asking a question on here and receiving an answer.

    Your financial situation, a prior business, and a fire claim may require a lot of investigation before a coverage determination can be made.

    Again, we don’t know enough about the property you referenced to provide an answer.

    Also, we don’t know the origin or cause of the fire and that still may in the discovery stage. Not to cause alarm but you may want to discuss your claim with an attorney.

  774. October 14th, 2011 at 7:13 pm #Justme222

    Jason,

    Based on what the insurance adjuster told me, that is the reason. She was actually up front about that. The question is: can a claim be legally, or rightfully denied based on finances if you can visibly see the contents even after the fire. Question 2 is: If a business is shut down does the inventory become personal property if it’s in your home?

  775. October 14th, 2011 at 7:42 pm #Jason

    Justme,
    Those are not simple yes or no questions. We don’t know enough about your claim and if we provide information based on not knowing enough about your claim, it is very likely we may provide wrong information and that will not benefit you. That applies to both of your questions.

    We don’t know if the business was a individually owned, a corporation, a partnership, or a non-profit. We don’t know anything. And even if we knew some of the limited information about your situation, we still would not have enough information to provide you with an accurate answer. The information we would need to answer those questions would be the type of information only a qualified attorney could address. The questions you pose are very complicated. We cannot carelessly provide information on this site no matter how much we want to help.

    In a way, the questions you pose are legal questions.

  776. October 14th, 2011 at 7:49 pm #Jason

    Justme,
    If you want to review a different claim question posed that involves a business, look under category of “Denied Insurance Claims – post # 216, 218, and 227. The answers provided to those questions were vague as well because we don’t know enough about the claim or the situation. We aren’t able to get involved to the extent required to answer all the questions submitted.

  777. October 14th, 2011 at 8:25 pm #just me222

    Jason,

    Thanks for your honesty. I knew it was a difficult question, but I was trying to avoid the costs of a lawyer. Sometimes we just gotta give in and you helped me with that.

  778. October 16th, 2011 at 1:41 pm #justme222

    Jason,

    Exactly what type of lawyer should I contact to help me with my claim?

  779. October 16th, 2011 at 1:47 pm #Jason

    Justme,
    One that handles contract law. Most will be able to assist you but chose wisely. Lawyers are expensive. Use the benefit of a free consult with these attorneys if they offer you that so you can review them before you commit to one.

  780. October 16th, 2011 at 1:49 pm #Jason

    Justme,
    One that handles contract law or insurance law (which is basically the same thing). Almost any attorney will be able to assist you but choose wisely. Lawyers are expensive. Use the benefit of a free consult with these attorneys if they offer you that so you can review them before you commit to one.

  781. October 18th, 2011 at 11:05 am #David

    We have liability claim against a A/C contractor that caused a severe water leak that damaged our hardwood floor. The home is a single floor house with a continuous hardwood floor throughout. The contractor’s insurance company refuses to cover replacing the floors for any rooms that can be blocked from line of sight by closing their doors. Even a room that has double french doors which are meant to be open has been refused. The company says this is an industry standard, but I’ve been told that standard applies to carpet and not hard surface floors. They have offered a settlement price. Should I hire an attorney? If i keep pursuing this, can they retract or lower their settlement offer?

    David

  782. October 18th, 2011 at 11:42 am #Gina

    Ours is a long story but will keep this in brief. November 8, 2010 we lost our home and entire contents to a fire. Insurance check was issued (after a bit of a fight) and signed over to mortgage company so we could set up our draw account when we started construction of the new home. Finally in late July this year the 1st draw was collected and 1st phase of work done. 2nd phase involves a modular home (which was most affordable with the insurance money received) and home is set on foundation. Now the mortgage company is not releasing the funds saying the investor doesn’t approve the structure change. Could I get the insurance company involved regarding this money? I am using the Atty Gen office, OCC, BBB and many other organizations to get Bank of America to release the funds. Just wasn’t sure if involving the insurance company would help… Thanks :)

  783. October 18th, 2011 at 8:56 pm #Jason

    David,
    You have a couple of choices. Settle this claim with this contractor’s insurance company or turn the claim into your insurance company, pay your deductible, and get the damage fixed.

    Your insurance company likely has a contract with you to address damage based on replacement cost.

    Any liability that arises because of negligence, all that insurance company is obligated to pay is ACV.

    Why do you want to get undamaged flooring repaired? If the contractor didn’t damage it, then he and his insurance company is not responsible for items they didn’t damage.

    You can pay an attorney if you want. That is your option. Besides your options to get this resolved by either insurance company, why would you want to pay the hourly fees of an attorney?

    Just like you have the option of not accepting their offer, of course this insurance company can reduce or withdraw their offer.

  784. October 18th, 2011 at 9:07 pm #Jason

    Gina,
    If your lender doesn’t want to finance a home you are constructing, then that is a borrower/lender issue. It has nothing to do with insurance.

  785. October 19th, 2011 at 3:42 am #Gina

    Jason –
    It does have everything to do with insurance. We were given the settlement check for our home loss. Turned it over to our mortgager to “hold” while we forego construction. They approved the draw schedule, disbursed the first draw and now are dragging on the 2nd draw. We have an insurance check from the loss and its not being returned. I was asking, although I know its our mortgage company holding the money, that if it would be wise to involve the insurance company since they gave us the money for loss and obviously also want to see the home rebuilt.

  786. October 20th, 2011 at 3:31 am #Jen

    Jason,
    A few weeks ago, my house burned resulting in what appears to be a total loss. Is one tactic of the adjusters to just leave you hanging in limbo? They (Frankenmuth) put me up at a motel now. I stayed at a friends for 9 days. I gave them slightly more than the 25.00 per night recommended by the adjuster. I’ve received minimal info about what to expect as far as time-lines, or sequence of events. I’ve been in process of moving to Florida, but I don’t dare leave till this is settled. I had replacement cost on contents and structure. I live in a small depressed community with many houses on the market. They advanced me 2500. on contents about 10 days after the fire. I had essentially no furniture here with quite limited personal effects. Mainly tools, clothes, computer and home repair items. My move has been 2 years in the making. This 100 year 2-family had my undivided attention over the past 4 months. I also had some assistance. I had just listed the house on Friday, though it wouldn’t hit the MLS till the following week. Monday night the neighbor called. Need I continue?
    The insurance and fire inspectors found where arcing had occurred. I’m presuming that caused the fire. After about a week the contents people came out and did an inventory. I just mailed that back after reviewing. Do I understand I’m not locked in to that being a final accounting of items? I know there are more, but I (at least) am trying to expedite, or not further slow the process. Listing price was 37,500.The adjuster made comments like that minus 6% commission gives us the value we’re dealing with. I said nothing. Some people came to submit a bid for site clean-up / debris removal. They measured structure, rooms, windows and doors. Maybe for hopeful rebuild, or maybe a half-a….reconstruction estimate? It is a 1700 sq ft structure. Finally, my concern is in determining acv. The real estate market here is poor to crappy. There aren’t good 2 unit comps in this price range. The policy limits are 144,000 plus an additional 25%. I did mention my intent to move South and not rebuild here. Of course, nothing was offered to me about building offsite, or even buying a replacement in Florida. Imagine that! So, how will acv be calculated and should that check be expected in the near future? Frankenmuth mailed me a copy of my policy within a week! But, when I went to the agency and tried to get a copy I could only get a dec sheet of my coverages. When I tried to explain I wanted the policy that delineates how those are applied, or the rules, the agent smiled and said he didn’t know what I was talking about!
    And I thought I had blonde roots. I’m just getting into your book now. The longer this takes the more educated I am becoming with policy in hand . Thanks in advance for all your help.Jen

    Having recently purchased your book, I’m slightly more hopeful of handling my claim without a public adjuster. This

  787. October 20th, 2011 at 3:33 am #Jen

    Forgot to mention, I’m in Michigan. Jen

  788. October 20th, 2011 at 8:55 am #David's Wife

    Hi Jason,

    Thanks for taking the time to respond. I just wanted to clarify an issue. Our hardwood flooring is unique, and according to both our own hardwood contractor and the insurance company’s adjuster, it cannot be matched. That’s why they have to replace all the floors (even the areas that are not damaged). The problem is that they won’t replace bedrooms or the study, both of which have the continuous hardwoods. So, what we’ll end up with is two different hardwoods butting up against each other at the bedroom doorways and study entrance. Hope that makes sense.

    We have not wanted to go with our own insurance company b/c of our $$ deductible and possibility of increased premiums (plus the fact that the air conditioner co’s insurance has already accepted liability). We’re considering an attorney to force the other insurance company to include the bedrooms and study. It doesn’t make sense that they would repair 2,000 sq feet of hardwoods because they can’t match the very small area that is actually damaged, but then exclude other rooms.

    Thanks again.

  789. October 20th, 2011 at 10:58 am #Deb

    Nationwide recently denied a claim on our homeowner’s policy due to “earth movement”. This earth movement has claimed our home. We had to abandon it because it is structurally unsound. We thought originally we had a sinkhole and a sinkhole and any damage caused to the structure by a sinkhole was covered under our policy. They originally wanted to deny our claim without even sending out an adjustor, but we insisted on an assessment. They sent out a forensic engineer who declared that it was not a sinkhole that the damage was due to “earth movement/slope failure” and since our land is excluded under our policy any damage resulting from the movement of the land is excluded. They estimated repairs in the amount of $250,000. We had preliminary work done while waiting on their report in the amount of $25,000, trying to save the structure. After receiving the denial, we determined we could not afford to make the repairs on our own and are now in foreclosure with the lenders. They are attempting to shortsale the real estate, but the house will need to be demolished. I just can’t believe that Nationwide cannot be responsible for this situation. They have abandonded their obligation to us and the lenders. Do we have any recourse?

  790. October 20th, 2011 at 2:31 pm #JM

    We have a a home in one state that has current homeowners insurance on it including an additional rider that covers jewelry (and some other types of items.) It is our understanding that this cover loss and theft regardless of where the loss/theft happened. Here is where it gets tricky… we recently moved (still own first house and insurance policy) and now own an additional house in another state that is also insured but because we were rushed in getting the policy in place before closing, the insurance salesperson said we should just get the basics and add additional coverage later. We have not yet had an opportunity to add the additional coverage and a day and a half ago my bag containing my engagement ring was lost/ stolen. We have filed a police report and hope (for obvious sentimental reasons) that the ring is recovered but are thinking that we should go ahead and file a claim. My question is this: Are we in danger of having the claim denied because we are not currently residing in the house with the rider full-time?

    A little additional info: I have done done anything here to establish myself as a resident such as get a driver’s license, library card, car tags or job. Also, I am not not listed on the mortgage here but am on the deed because this is a common property state.

    The two houses have homeowner’s policies with different companies; Travelers for the first house (with the additional coverage) and Allstate for the second house.

    Thanks so much for any advice!

  791. October 20th, 2011 at 4:57 pm #Jason

    JM,
    You have insurance for loss/theft of your ring. There may be some coverage limits for jewelry unless you have the ring specifically insured to a certain limit. With the information you provided, your claim appears to be covered and there is no reason it should be denied.

    There may be a need to make a claim with both your insurance companies but that may not be required unless they ask if you have any other insurance. I

  792. October 20th, 2011 at 4:59 pm #Jason

    Deb,
    No.

  793. October 20th, 2011 at 5:30 pm #Jason

    David’s wife,
    I understand the situation. I’m under the impression that wood is a natural item, and there is variance in every wood species. That is what makes wood unique because there is so much randomness to it and no 2 pieces will ever match each other.

    So, since 2 pieces in your current floor already do not, never did, and will never match anything you put next to it, the issue of matching will never be solved. That is because wood is not able to be matched.

    So, if you are trying to match something that cannot be matched, I hold the position that direct damage should be addressed and leave the undamaged items alone.

    You can hire an attorney if you want. Attorneys can’t force anybody to do anything. If you wanted to force them to do a certain thing, you would have to sue them and secure a judgment. When you have that judgement, you would have to enforce the judgment to get the other party to complete the requirements of the judgment.

  794. October 20th, 2011 at 5:51 pm #Jason

    Gina,
    The money may be from insurance but the bank is holding the money, not the insurance company. This has nothing to do with your insurance company (other than where the money came from).

  795. October 20th, 2011 at 6:13 pm #Jen

    Hi Jason,

    I emailed you earlier this a.m. #786. Is this where I should hope to find a response? Thanks, Jen

  796. October 20th, 2011 at 6:50 pm #Jason

    Jen,
    I didn’t really notice if a response was needed to your post. I don’t know when you should expect a settlement. They will determine ACV by what your place is expected so sell for at this time or based on the cost of replacing the damaged parts of the home after applying depreciation to those items.

  797. October 21st, 2011 at 7:17 am #Deb

    Is that really all I get is a no? What do other people do in this situation? We’ve lost everything through no fault of our own. We couldn’t have predicted it or prevented it. Is there some other organization out there that helps in these situations? How are we suppose to recover?

  798. October 21st, 2011 at 7:37 am #Jason

    Deb,
    There is no need to be at fault in order to lose everything. Sometimes that happens. Somethings are neither predictable nor preventable. However, in your case, your insurance did not want to cover earth movement so it excluded it from coverage. In a way, they prevented their liability from that type of event.

    Sometimes there is no recovery. This loss is not transferable so it remains with you. Habitat for Humanity, Red Cross, Salvation Army, etc.

  799. October 22nd, 2011 at 8:46 am #Niolani

    My house was burned down yesterday and everything was ruin. My owner have homeowner insurance. I do not know yet what cause the fire but no one was at home and the gas was already turned off. Last week the landlord changed the locks to the house, with all my stuff still in it. So I believe someone set the fire or it was faulty wiring in the because the kitchen light do not have a switch to turn off, so it is on all the time. Now can the landlord claim this fire and receive any money or am I entitled to any compensation for my stuff that was in the home?

  800. October 22nd, 2011 at 8:56 am #Jason

    Niolani,
    From what you posted, you don’t seem to have renters insurance. Any insurance the landlord would have is for his benefit and not yours. So, if you don’t have an insurance policy, you have suffered this fire loss by yourself.

  801. October 23rd, 2011 at 2:55 pm #jenny

    my homeowners association is trying to get any left over money from a claim for a loss in my unit, is there any hoa law/ruling you can give me?

  802. October 23rd, 2011 at 3:12 pm #Jason

    Jenny,
    Why are they involved with damage to your unit? If they don’t have the funds, how can they get them?

  803. October 23rd, 2011 at 3:16 pm #jenny

    because it’s the HOA insurance, i have my own homeowners but being in a condo the HOA insurance is the primary insurance

  804. October 23rd, 2011 at 3:39 pm #Jason

    Jenny,
    It’s their claim so it’s their money for the repairs. Many people don’t understand the relationship between the association policy and their own policy and what each one covers and doesn’t cover. If your unit is fully restored, don’t worry about any left over money.

  805. October 23rd, 2011 at 4:01 pm #jenny

    thank you for the quick response, i do understand what you’re saying but i do pay for that insurance too with my association fee.

  806. October 23rd, 2011 at 4:19 pm #Jason

    Jenny,
    Then any left over funds should go to the association fund for the benefit of all the unit owners, not just you. Think about it.

  807. October 23rd, 2011 at 4:30 pm #jenny

    thank you, you’ve been very helpful, i wish i can tell you more details that’s why i feel the way i feel but i can’t, just the same i really appreciate the time
    jen

  808. October 24th, 2011 at 12:28 pm #David's Wife

    Jason,

    The wood in question is about 130 years old – We found it in an 1870s barn, cleaned/repaired/restored it, and had it installed throughout our home. It is not a typical “Bruce Hardwood” or “3/4″ handscraped” version – It is truly original/unique. We have enough extra boards to replace about 1/2 of the water-damaged area.

    Please don’t think me rude (not my intention at all), but do you mind if I ask if you are an adjuster or work in claims? If not, what is your insurance background? Just trying to figure out if these are issues you have dealt with on a professional basis, or if the answers are a layperson’s opinion.

    Thanks again for your help.

  809. October 24th, 2011 at 4:07 pm #justme222

    David’s Wife,

    If I may: I am contractor that deals with insurance claims all the time. From my personal experiences, if the floor cannot be matched the insurance company would normally replace the whole floor, but only if you fight nicely. The important factor too is “HOW” the contractor draw up the estimate for damages. This is not an impossible task, but be careful how you go about it. Good luck finding a lawyer that would take such a case. It is my feeling that you can handle this yourself….smile!!!

  810. October 24th, 2011 at 6:48 pm #Jason

    David’s wife,
    That is ok, you can ask my insurance background. I am perfectly fine with that. With my education, knowledge, and experience, I am qualified to answer every single question submitted on here. I never provide opinions but I do provide straight forward answers about every situation presented.

    Now, to address your question – the policy is frankly very rude when it comes to repairing or replacing items that are damaged. In your case, the insurance company can buy new hardwood floors and install them in your house. However, they cannot age the wood to be 130 years old. That is not possible. The policy addresses this with antique or outdated items in that they will be replaced with items that are new because it is basically impossible for the insurance company to buy an antique or aged item since that requires the passage of time and because of that, there is not a readily available market for those kind of things. There are policies that have wording that dictates that the insurance company can use common and current methods and materials for repairing damage to a home.

    Now, the other aspect of this is matching. There is case law all over the board that indicates what a reasonable match is. For example, exterior siding does not have to match any further than an inside or outside corner (variance in shade due to differences in color lots). The insurance company will both win and lose arguments about this and other items (flooring, walls, construction methods) involving the repair of a home. The insurance companies can hire dozens of lawyers and spend tons of money defending their position just because they have so much of it at their disposal. And if they want to get something tangled up in court to prove a point or get their way, they have the time, resources, money, and attorney’s available to them that a typical insured does not have at their disposal.

    So, David’s wife, work with this adjuster. They are your direct link between your insurance company and you. They can bend for you and make things go smoothly or they can make it very difficult. Be polite about your position, provide the adjuster with solutions, options, and assistance. The thing is that you don’t want to be pushy, demanding, or otherwise difficult to work with. Basically what the adjuster recommends is what the insurance company generally goes along with.

  811. October 25th, 2011 at 5:34 am #Leah

    We have a detached garage that collapsed on 9/28/10 because of wind. File claim with allstate, almost a month later we were denied the claim where the adjuster were saying that the garage itself is already deteriating and that it needs maintenance. Can I appeal this? and if so what would be the route to go?

  812. October 25th, 2011 at 7:51 am #Jason

    Leah,
    It’s odd that you used the term collapse when referring to an action caused by wind because wind, for the most part, does not collapse things.

    Your policy is probably very similar to most policies which contain a concurrent causation clause. To put this term in simple words, it means if a non-covered cause of loss (deterioration, in this case) happens at the same time a covered cause of loss (wind) takes place, then coverage does not exist for the entire event. It also has wording that it doesn’t matter in what proportion each event contributed to the loss.

    Sure, you can appeal it. You may want to bring this to a claims manager’s attention by calling and/or writing. Point out that there are many garage conditions from brand new to very old and that wind damaged your garage just like it would have damaged any garage in this range. However, if your garage indeed collapsed, you may not want to waste your time or that of anybody else.

  813. October 25th, 2011 at 8:00 am #Jason

    Leah,
    Also, since you have a specific date when this loss occurred, you can go to a site called weatherunderground.com and do a historic weather search (which has weather condition reports in 15 minute increments) for your specific location and provide this data as support for the strength and/or duration of wind on that date. If there are reported winds or wind gusts 40 mph or higher, this will bolster your case. However, if there was hardly any wind conditions or the wind gusts were not very high, then it’s very likely this will not help. If you need more details about this site, just ask, but please review the site first before re-posting.

  814. October 25th, 2011 at 11:04 am #David's Wife

    Just Me,

    Thank you for that insight. =) We have tried being polite but firm, but our patience is wearing thin, as this has now been going on for four months. The adjuster will not budge, and states that the company which actually caused the damage has a policy with them that simply doesn’t include repairing areas that can be “blocked off with doors.” ie. bedrooms, the study, etc. Not fun.

    Jason, if you don’t have any experience working directly with/for insurance companies, you should probably state that in your replies; it would be a shame if you gave someone the wrong advice and they took your word for it. I know you are only trying to help, but I think you might want to be more careful with the way you word your answers.

    Thanks again !

  815. October 25th, 2011 at 3:53 pm #Jason

    David’s wife,
    If this has been going on for 4 months, what you are presented with by this insurance company is likely the best arrangement you will get from them.

    You have 2 options. The first is to accept what they offer and move on with life or the second option is that you can present this to your insurance company and see if their remedy is any different than what this insurance company is offering.

    When all is said and done, your insurance company will recover the ACV value from the at fault insurance company (including your deductible) and forward your deductible to you. Don’t worry if your premiums will go up because sometimes claims cannot be avoided.

    I have plenty of experience working with contractors, insurance companies, and attorneys for and against insurance companies. (Please see the last post concerning adequate education, experience, and knowledge). If people want relevant and reliable information they will get it here and I am not going to justify every single detail why my information and replies are accurate. The information I provide is accurate and reflective of the information I receive about each circumstance. Luckily, you have the option to disregard any and all information I post.

  816. October 25th, 2011 at 6:54 pm #justme222

    David’s Wife,

    You should actually ask your insurance company for a copy of the pamphlet which state claims about the doorways, etc. . Sometimes adjusters will flat out tell a lie if they feel they can get away with it. Sad, but true. It happens all the time. I had an adjuster even tell a client that they did’nt even have insurance with them because he knew all the paperwork had burnt in the house. Sounds crazy, but that’s a true story. So I said all that to say: Have the insurance company show you what they say in writing, cause they may be lying to you….but maybe not. Just check it out. Good Luck!!!

  817. October 26th, 2011 at 7:09 am #David's Wife

    Just Me,

    *Wonderful* idea to ask the insurance co for a copy of the info and exclusions the adjuster is spouting! I wouldn’t have thought of that – Thanks! =)

    I’ll post the result here when all is said and done – Perhaps it will help someone who is in the same situation.

  818. October 27th, 2011 at 6:35 am #J Hicks

    My patio door leaks and has caused damage to the floor and the room below. The insurance company has covered the water damage below. I have had a contractor in to make a repair to the door but it still leaks. Should the insurance company cover the costs to replace the door with a new one. It appears the design of the current door is poor and cannot be repaired.

  819. October 27th, 2011 at 8:18 am #Jason

    J Hicks,
    The design of the door seems inadequate not to be causing damage to other parts of the house. That is a manufacturing issue with the company that made the door. Insurance doesn’t pay for poor design or defects in products.

    If you want to get a new patio door, you would have to ask the homeowner to replace it with a new one.

  820. October 27th, 2011 at 12:46 pm #catherine mcnciol

    I phoned my insurance company about my brick exterior wall , I found that the brick walll was cracked from top to bottom , I put in a claim , and I am waiting for the enspection of the wall to take place soon , can anyone tell me the chances of the wall being repaired My frind told me that they will just tell me that it is wear and tear of the property and this will get them off from covering my claim thank you actherine

  821. October 27th, 2011 at 2:28 pm #justme222

    Catherine,

    If the wall is broken from just wear and tear then no you are not going to get coverage for this claim. It would be different if it was hit by a car or was caused by a storm or something, but if that’s not the case you are out of luck.

  822. October 27th, 2011 at 2:46 pm #RyanL

    We have Farmers Insurance (Yikes!) and we had a exterior fire that started in our garbage can on the outside of our house and ruined part of our siding. Our adjuster seems to think they will be able to exact match our siding even though our existing is 6+ years old. He even tried suggesting that if it was a close match they could shuffle some of our existing siding around so that it blends. We are not happy! We live in IL. Any advice?

  823. October 27th, 2011 at 5:45 pm #Jason

    Ryan,
    At minimum you should be provided an allowance to remove and replace the damaged siding from inside/outside corner to inside/outside corner. That way if the shading is a little bit off in the same siding product, it won’t be noticed.

    Work with this adjuster to arrive at a plan that you can accept. When all is said and done with the repairs, you should have to pay no more than your deductible and you should not know there was ever any damaged siding on your home.

  824. October 29th, 2011 at 1:55 pm #zagyzebra

    My home was rented to a high-profile person (regularly in headlines) who was extremely negligent with candles (thousands of candles in combustible places found after the fire) and the home burned in a large loss fire in November 2010. Her renters insurance company has accepted liability. She also has a general liability umbrella policy. My insurance company is about to pay to term limits, but still, the damage was so extensive it will not cover complete restoration of my home.

    My questions:
    1) In your experience, under such circumstances, would I be advised to take an attorney to deal with her two insurance companies to handle the “many forthcoming negotiations and discussions?” (Their words.) Will I stand to gain more as a result of an attorney intervening on my behalf? Will the gain be sufficient enough to offset the 25% paid to my attorney?
    2) I personally estimated the value of my contents and expect to be compensated for my time (I rented the house to the tenant fully furnished). I also expect to be compensated for my time spent meeting with contractors and that which will be spent supervising the construction and interior design, because this fire happened as a result of her negligence and these are responsibilities I would not otherwise have. Is this something her insurance companies will pay for, or will I have to take her to court and sue her personally for this?
    3) I will have to move from one state to another in order to supervise the restoration of a special historic home. I expect to be compensated for my increased costs resulting from this move. Is this something the insurance companies will pay for?
    4) I cannot start construction until her insurance companies pay out, because my insurance is not paying enough to cover complete restoration. I expect her insurance companies to pay my loss of rent while I wait for them to pay out, and yet, her primary insurance company has said I have a responsibility to mitigate my damages. How can I mitigate damages caused by their client to my home when I do not have enough money in hand to complete the construction? I refuse to start and stop construction midway through, just as they refuse to pay me until subrogation has been finalized. Additionally, since I will be losing rental income while they evaluate the claim, I expect her insurance companies to reimburse me for interest I would normally collect on monies I will have withdrawn from my personal investment portfolio. Is this something insurance companies will pay on?
    5) Pain and suffering. This loss has consumed me and my family for the past year and will continue to for at least another year or two. I expect to be compensated on some level for pain and suffering and have kept a daily journal documenting my hardships. How do insurers view pain and suffering pay-outs? What requirements must be met to be entitled to a pain and suffering pay-out?

    I realize these are many questions. However, your answers will benefit not only me but others in the future presented with similar difficult circumstances.

  825. October 29th, 2011 at 2:24 pm #zagyzebra

    I have one additional question: Under what circumstances would an insurance company that is accepting a third-party liability claim offer Receipt for Advance Payment?

  826. October 29th, 2011 at 3:00 pm #Jason

    Zagyzebra,
    1. You will have to evaluate how much benefit you can gain from an attorney doing this for you. That is not an analysis we can do for you.

    2. Her insurance company won’t pay for your time to estimate anything. If you sue this person, the courts will award you nothing for your for time to estimate the value of your property.

    3. Your expectation of being reimbursed for increased moving costs will not be fulfilled.

    4. Your expectations will fall short of reality concerning this as well.

    5. You will not meet any of the requirements needed for pain and suffering. First, you have not been injured and because you have not been injured, you have not suffered. There will be no compensation for this unrealized condition.

    6. The receipt for advance payment is just that – a receipt.

  827. October 29th, 2011 at 3:48 pm #Marty

    We have a homeowner’s claim on-going to restore kitchen damage. The independent adjuster told us he recommended to HARTFORD that all cabinets be replaced and priced his est that way to them. But the version we got from HARTFORD had only half of the cabinets replacement. And HARTFORD tells me to have my contractor submit a separate estimate to do what we think is the complete job. So they need double verification before they will be convinced what the total job involves?? And of course they don’t admit scrubbing the adjuster’s est. Is this low-balling the est std practice?

    Thanks

  828. October 29th, 2011 at 5:04 pm #Jason

    Marty,
    We don’t have enough information to determine what happened with your kitchen. The policy coverage you have with your insurance company is for direct damage to your cabinets. Sometimes it’s easier for an adjuster to replace the entire lot of cabinets than do part of the kitchen so that is likely what happened.

    I don’t know what they are requesting you to do to get another estimate from your contractor because the existing estimate should be sufficient to work from.

    There is no indication that “scrubbing” occurred. There is also no indication that low-balling occurred.

  829. October 29th, 2011 at 5:24 pm #Marty

    Thanks for the reply.

    The indication that scrubbing occurred is my personal conversation with the adjuster who said “replace all cabinets” and submitted same to HARTFORD and the resulting est I got from HARTFORD WITH THE ADJUSTER REFREENCED saying replace half of the cabs. Something happened in between. The cabs in question have bubbled and smoke damage AFTER Servepro did their cleaning work.

    Also, I was told there is a 2 yr window for reopening a claim. How does one allow for that flexibility without giving up that right?… not sign any “everything is done” paperwork (whatever form that will take)?? Thanks again.

  830. October 29th, 2011 at 5:31 pm #Marty

    The cabs NOT on the list for approved replacement had bubbles and smoke damage AFTER Servpro did their cleaning.

    The claim arose from a grease fire the tenant had on the stove (the cab side not slated for replacement) who then dribbled boiling oil on the lino to the sink where it flamed up and scorched cabs on that side, as well as the vinyl window and recessed light.

    My understanding is there is a 2 yr window for keeping a claim open. What paperwork should one sign or not sign in the form of a release to preserve that option?

    Thanks again!!

  831. October 29th, 2011 at 5:34 pm #Marty

    …and the adjuster told me personally he said replace all cabs and the output from the ins est summary was for partial replacement. So something got dropped in between…call it scrubbed…lo-ball…take your choice…or oversight.

  832. October 29th, 2011 at 5:52 pm #Jason

    Marty,
    I am not there to determine what needs to be replaced and what doesn’t.

    You may want to get a better understanding about the time frame you have for your claim to be completed. That is especially important if you have replacement cost coverage because it is common for that time period to be 180 days.

    I don’t know to what you are referring when you ask about what to sign or what not to sign. That might be a question for an attorney.

    The adjuster may have over-extended the required scope to repair what needs to be repaired in the kitchen. Again, nothing in your post indicates there was scrubbing or low-balling.

  833. October 29th, 2011 at 6:05 pm #Marty

    The adjuster was the ins co arm for determining what needed to be done to restore the unit. The ins co paid him good $ to make the assessment. For the ins co to short the est would have required a 6th sense on their part.

    On the limitations to reopen a claim, I anticipate I will have to sign a “satisfaction” form, like I did with Servpro, and if I do that will I lose future capability to open the claim again if something unforseen is discovered? Seems like there should be some standard procedure where you either buyoff what has been done, or you defer until a period has passed that convinces you nothing was missed in the restoration estimate.

    Thanks.

  834. October 29th, 2011 at 6:22 pm #Jason

    Marty,
    The insurance company likely paid the adjuster for his assistance. That seems reasonable. The statement that the only way an estimate can be corrected is to have a 6th sense is an inaccurate conclusion. I can accurately settle a severe claim if I have sufficient photographs and measurements. That doesn’t require any special skills – just experience and know-how.

    Don’t worry about opening the claim in the future. Make the effort right now to make sure everything is completed as it should be. Then stop worrying about opening it in the future because you should have no need to do that if your claim is completely settled right now.

  835. October 29th, 2011 at 6:34 pm #zagyzebra

    Jason – You’re in the insurance business, right? In your experience, do attorneys generally help their clients boost the settlement amount for third party insurance claims…yes, or no? And if yes, by how much generally?

  836. October 29th, 2011 at 6:43 pm #Marty

    Jason,

    So apparently the adjuster the ins co paid did not provide sufficient info to validate his complete claim that all cabs should be replaced. So, guess I get the priveledge. Perhaps more interaction between the ins co and their hired adjuster would have been warranted so I wouldn’t have to fill in??

  837. October 29th, 2011 at 6:47 pm #Jason

    I have adequate experience and knowledge in construction, business, insurance, and law that I know what I am doing.

    If you want a yes or no answer, the one I will provide is no, not with property claims.

  838. October 29th, 2011 at 7:01 pm #Jason

    Marty,
    I don’t know how many cabinets need to be replaced. I don’t know to what extent they are damaged. I don’t know what remedy would make things better regarding your claim. I don’t speculate on things such as communication levels, I provide information about insurance.

    Some insured’s are more involved in their claims than others. You seem to be more involved than others but that is just an observation. If you have cabinets that are damaged that are not being replaced, have those cabinets addressed. I’m sure you will but you have to relay that to your insurance company, not us because we’re not handling your claim.

  839. October 30th, 2011 at 7:14 am #(Alexis) David's Wife

    To Zagyzebra,

    I read your post and would like to offer some advice. In my opinion, you have way too much to lose to *not* have an attorney present at each step of this process. If possible, I would recommend hiring an attorney who charges by the hour instead of taking a contingency fee. I can’t stress enough the value of finding a really good/knowledgeable attorney for this situation; there is so much at stake here and so many unknowns for you that I think it’s an absolute must.

    With all due respect to Jason’s ‘expertise’ – I disagree with part of his response. It is impossible to say for certain what verdict a jury and/or judge would find in your case. It is also impossible to say with finality what an insurance company will or won’t pay for (of their own accord or compulsorily). These are not questions that can be answered with common sense (too many loopholes, legalese, and simply too many variables in your case). I think this forum is a hobby for Jason and I wish that he would stop answering questions as if his answers are the final word; I think he is doing a disservice to some of the people seeking help here, regardless of his “education, knowledge, and experience.”

    Regarding suing your tenant. You may or may not qualify for Pain and Suffering damages (honestly, probably not), but if the tenant literally had hundreds or thousands of candles burning in your home, I think you have a good chance of recovering in the form of punitive damages. There is also the publicity factor; if this person is indeed in the headlines regularly, she probably will not want a suit made public and might be motivated to settle in your favor quietly.

    I hope this helps (again, it is only my opinion), and I wish you the very best of luck. I can tell from the tone of your posts that this has really taken a toll on you and your family.

    Regards,

    Alexis

  840. October 30th, 2011 at 8:44 am #Jason

    Alexis,
    There is not a single attorney in the country that will accept a case of this nature on a contingency basis. Attorney’s are not necessary for a contract to be entered into and completed by 2 parties. Contracts are made everyday and attorney’s are not necessary for the end result to be reached. (Some exceptions apply but Zagyzebra has provided no information to conclude that one is needed.)

    I don’t provide opinions, just facts based on the information presented. Now to indicate that someone may or may not qualify for pain and suffering when it is clear that they don’t is completely reckless. In order for pain/suffering to be a factor, there needs to be an injury. With Zagyzebra, there is no injury. Absent the principle requirement for pain/suffering, it will not even be considered. That is a fact.

    Punitive damages are awarded to prevent a future activity from being repeated. There is nothing illegal or even unethical when a person lights candles. This applies to 1 candle or thousands of candles. To suggest to someone they may recover punitive damages is careless and that in itself will cost thousands of dollars if a person follows your advice.

    If you want to support that Zagyzebra would have “a good chance of recovering in the form of punitive damages”, please post case law or at least one published legal opinion that supports your statement. I know nothing will be posted because there is absolutely no case law and no published legal opinions to support this.

  841. October 30th, 2011 at 9:57 am #(Alexis) David's Wife

    Jason I’m not going to argue with you, as I believe you tend to make up your ‘facts’ as you go along (rendering an intellectual discussion with you impossible). Basic layperson’s knowledge of the law, combined with your trusty thesaurus, does not make you an attorney, or an expert on insurance claims.

    I took Just Me’s advice and emailed the insurance company’s adjuster (ins co for the company that damaged our hardwood floors) for a copy of the exclusions section in that company’s policy, and also let her know that we were probably going to secure counsel. The adjuster called me back within 24 hours; they are going to pay the full amount of our contractor’s original estimate for full replacement of *all* hardwood floors. If I had listened to your advice about the impossibility of matching hardwoods, and further, to just let the insurance company replace the damaged portion only, we would have been out thousands of dollars to continue the repair to the ‘excluded rooms’ ourselves. This is why I don’t think you should be giving absolute advice. Really, it’s as simple as making a notation that it’s *your opinion only* and should not be relied on as the ultimate answer.

    I logged on to thank Just Me for the great advice – Saved us a lot of $$. =) Thank you so much!!

  842. October 30th, 2011 at 11:36 am #admin

    Alesis, Jason, and contributors,

    Thank you all for your participation and expertise. Agree or disagree with Jason, no one can deny the selfless contribution of his time here. While the inclusion of “IMO” might not be a bad idea in his posts, it’s not a huge flaw, IMO” :) , considering his contributions.

    So often there are several strategies in proceeding with a claim, and the strategy can change with every communication. All one can do is pick one and hope it works, “a judgment call”. The fact that there are differing opinions can only improve this website.

    Thank you all for your participation. You are welcome to include links to your own websites and business contact info. at the end of each post.

  843. October 31st, 2011 at 7:51 am #Paige

    We recently had our second house fire within 4 years. The fire started in a basement closet. From what State Farms fire investigators finding he believes arson(no cause). We hired our own fire investigator to see if he had the same conclusions. Our fire investigator said that there was no know causes for the fire in the closet (ie arson)… however he went on to say that in his opinion my husband and sister started the fire. Which is not true, noone was even home that day. We just submitted our proof of loss and now the insurance company wants to do an examination under oath. They also want authorization to speak with the fire investigator we hired, and I was told by state farm if I do not give then autho they will deny the claim. I have given everything they have asked for except I hate to give them autho to speak to the person I hired who thinks we started the fire based on his “opinion”.

    Additionally State Farm has set our EUO for the end of next month can I do anything to get it moved up since this is taking forever I am running out of savings replacing my children clothes, toys and additional living exspenses since state farm will not approve or deny my claim for contents.

  844. October 31st, 2011 at 9:16 am #Jason

    Paige,
    You have provided a lot of information in 2 short paragraphs. A fire investigator’s basic goals are to determine cause AND origin. Apparently they have the origin narrowed to the closet. From the information you provided, I can’t determine if origin is more defined than that.

    The other aspect of what these fire investigators do is determine the cause. (example: What caused the fire?). In your case, and with the information you provided to us, the State Farm investigator has determined cause. His conclusion is arson (arson, meaning intentionally started).

    Does the State Farm investigator know exactly how the fire was caused? We don’t have enough information to determine that. However, he concluded it was not accidental so we can rule out all accidental causes based on that conclusion.

    You hired another investigator for your piece of mind. He has concluded the same thing that the fire was intentionally set, and it originated in the down stairs closet. This 2nd C&O (cause and origin) person has theorized that your husband and sister started the fire. (He opined that both your husband AND sister started the fire, which is indicates he has more information than he has presented to you.) This is a very specific conclusion because the origin of this fire literally rules out all persons who did not have interior access to your home and focuses at 2 people, but not you.

    In reference to your C&O person, you may want to provide authorization to State Farm. A professional’s opinion has more weight and bearing than a lay person’s opinion. In fact, your C&O person’s opinion is likely the same opinion as the State Farm’s C&O, but you just haven’t been notified of that yet.

    Fires are very difficult to start in a home. Two fires occurring in a home within 4 years is nearly impossible, unless one or both fires are started intentionally.

    Concerning your savings – based on the information you provided, you may want to prepare for a denial.

    If you had nothing to do with this fire, you may want to review information concerning an innocent co-insured. A brief introduction to this concept can be found at http://www.tedfordpond.com/hot-topics/the-innocent-co-insured/

    Additionally, having an attorney in your corner is a good idea. You may want to secure an attorney for yourself. (The attorney you retain should represent only you, and not your husband.)

  845. October 31st, 2011 at 10:23 am #bob

    .

  846. October 31st, 2011 at 11:42 am #Morgne

    I bought a house in poor repair several years ago. After I purchased the house it became evident that it passed “poor repair” and became a “reasonable tear down”.

    I had been renting it out inexpensively to some college kids while waiting for the market to raise enough to get me in the clear to put it back on the market.

    There was a chimney fire last week. I refinance the property for 175,000 six months ago, with the property alone equating to 100,000 of that value. The initial vague estimates for repair are in the 50,000 – 80,000 range but only repair about 60% of the house. The rest would remain in “tear down” status. Rather than put all that work into a house that is still extremely not-so-good (it was badly built 100 years ago with little to no upkeep since then) I’d rather just tear it down and rebuild later when I have the money to kick in to build a nice house.

    That could be years down the road however.

    My two questions are: If I don’t want to rebuild, can I just give the mortgage company whatever the settlement would have been to pay down the mortgage to a “lot” only amount? That way they remain secured by the lots equity. If so, and the insurance company would pay 50,000 to rebuild can they pay that 50,000 to the mortgage company or would they only pay ACV to the mortgage company?

    Two: If they do pay ACV only my fear is that it will be a very small amount because the house wasn’t so great to start with. What type of percentage do they usually depreciate older houses that didn’t recieve a lot of upkeep?

    Thanks everyone!

  847. October 31st, 2011 at 12:05 pm #Jason

    Morgne,
    If this is a rental dwelling, the coverage on it is likely only for ACV. That means whatever the cost of repairing will be depreciated to arrive at an ACV repair. On an old, un-maintained house, the depreciation could be 75%. So, if the repair to the home is $50,000, you will be provided with $12,500 to make the repairs that cost $50,000.

    Talk to your mortgage company about your options.

  848. October 31st, 2011 at 12:10 pm #Morgne

    Jason,

    We have Replacement coverage on the home. Does that change anything?

    Morgen.

  849. October 31st, 2011 at 12:24 pm #Jason

    Morgen,
    Yes, it does. You will be allowed to make the repairs with an initial AVC value payment to you and then you can collect up to the full cost of repairs indicated on the estimate when the repairs are completed. You will have to make the repairs within a certain time period. Also, you have to make the repairs to collect the replacement amount.

    Getting half your house updated with new materials rather than collecting $15,000 (in the example) makes much more sense. The mortgage to the bank will not just go away. It will need to be paid and a good way to do that is if you have this property producing rental income to do that.

  850. October 31st, 2011 at 1:19 pm #rob

    I have builders risk insurance on a home that I am building with a $1000 deductable, but I never received a copy of the policy or the endorsements — just a declarations page. I renewed the policy this September (2011), but still no copy of the policy or endorsements. Now I have a wind damage claim, and I am finding out that there is a $4000 deductable on wind damage. I reside in massachusetts, but the home I am building is in north carolina. I was really suprized at the amount of the deductable for wind damage. Is there any rule that says that they are supposed to provide a copy of the policy and endorsements to the insured?
    Thanks
    Rob

  851. October 31st, 2011 at 1:50 pm #Jason

    Rob,
    I’m not aware of any rule. It does make sense to get a copy of the contract that you enter into with someone or a business.

    If you don’t have a copy of the policy or endorsements, why don’t you ask for a copy so you can review your coverage.

  852. October 31st, 2011 at 2:09 pm #admin

    Paige,

    In addition to whatever opinions you may get on this website, you and or your attorney would be well advised to get the special eBook on EUO (Examinations Under Oath) Deluxe from UClaim.com.

    As to your own investigator, if it was me, I myself would not “volunteer” that I had my own investigator, or his opinion. However if you are asked if you had your own investigator, then you have to disclose the information. You should ask a lawyers opinion on that. I’m just telling you what I would do if it was me. The final decision is yours.

    Now if the fire was “arson” and it was indeed set by your husband or sister, was it with the intent to defraud the insurance company and to get insurance money? Was it revenge? Was it for fun? Was he mentally ill? There is all kinds of case law in most states that may or may not override the insurance policy in your case. So getting an attorney will be of help in many ways. And an attorney can stop a 2 hour EUO from becomming a 2 day EUO.

    And is there an “innocent spouse” clause in your policy that would cover your interest in the property even if your husband set the fire? And if not, there may be case law that overrides the policy in your favor. Get an attorney and get the eBook on EUO. And by the way, 99.9% of attorneys don’t know the important differences between EUO and depositions.

  853. October 31st, 2011 at 3:15 pm #rob

    Thanks Jason…

    I did that the minute that I found out that the deductable was higher than I believed… It’s going to take weeks to get a copy……It just seems sort of deceptive that they never sent the policy or the endorsements to me… I guess I sort of relied on the fact that in every other instance where I bought insurance, they sent that type of info to me. I feel like I was taken advantage of. I think it is unfair that they are bringing up a deductable that is 4 times higher than what I thought it would be, and this is the first time that it was brought to my attention (other than in the fine print i.e. “this policy is subject to endorsement #hb1253…”). Maybe I’m stuck with the deductable, but it seems that there should be a rule requiring insurance companies to automatically send a copy of the policy and any endorsements to the purchaser… I guess I’m just confusing the familiar with the necessary.. thanks, Rob

  854. October 31st, 2011 at 5:55 pm #Jason

    Rob,
    A home ideally should be built in 3-6 months. If it takes longer than that, there may be problems. The odds of a claim being submitted on a new home construction is higher than for homes that are completed within 6 months..

    It may just be the approach the insurance company takes to reduce or eliminate claims for their risk of this type when a renewal is needed.

    Your agent should be telling you this because it’s kind of important.

  855. November 1st, 2011 at 9:20 pm #Jazzmen

    I have ins with farmers and my home was burgalrized in aug of this year i went thru all of the procedures they ask of me i even did an EUO and when i went to the mediation the lawyer was concern about me filing bankruptcy chapter 13 in 2010 and ask me why i didnt list my items i had on my ins list for bankruptcy i told him i didnt think i had to put my personal items down..Can farmers deny my claim for filing chapter 13? and i dont have any items on my bankruptcy form my policy is 30,000 for contents but my lost was for over that limit

  856. November 1st, 2011 at 9:45 pm #Jason

    Jazzmen,
    No, they can’t deny your claim for filing bankruptcy but they can deny it for not accurately claiming something or providing false information. We don’t have enough information about your situation to provide any further details to you.

    I can understand why the insurance company did an EUO. Generally burglaries are specific and carried out in a short amount of time. In order to remove over $30,000 worth of property from your house does not meet the typical conditions of a burglary.

  857. November 2nd, 2011 at 4:12 am #Ana Stanic

    Hello,

    First of all, thank you soooo much for helping all of us. Since I had to move from Florida I had to rent my condo, which has been insured by Fidelity for years now. I noticed that one of the categories under premium is for Personal Property-30K, and that makes my premium go up quite a bit. When I called to lower that category to 15K a couple of years ago, a very pushy rep told me that personal property is everything that is not the walls itself inside(condo association covers the outside of the building), such as bath tab, kitchen cabinets, appliances…I just do not understand how that could be considered personal property? The place is rented, and I have no personal property in the condo. Am I right to doubt that a toilet bowl is considered personal property or am I being lied to? Thank you so much in advance.

  858. November 2nd, 2011 at 9:13 am #Al

    I have Allstate insurance for my home owners insurance. I recently suffered a major water damage loss. Allstate has recommended using their preferred contractor who will be paid using their alacrity system. I’m wondering if there is any benefit by finding and using my own contractor rather than the preferred contractor. The Allstate adjustor makes it sound so easy since they would pay the contractor directly through the alacrity system and I won’t have to worry about setting up my own account and dealing with possible liens. The Allstate adjustor says that the work is guaranteed for 3 years and with no possibility of liens when work is completed.

  859. November 2nd, 2011 at 9:40 am #Jason

    Al,
    It’s entirely up to you. You have the option of using their preferred contractor or your own. This is a matter of personal preference.

  860. November 3rd, 2011 at 6:55 am #Deborah

    I have homesite insurance , I have the sump pump endorsement that will max out at $5000.00, our basement was fully finished, our 18 year old daughter lived there, and then we were hit with Irene. We lost power for three days and the sump pumps turned off. When we got home the floor was almost dry but our walls and furniture , clothing and appliance were wet and started to developed mold ( we also have the mold limited fungi, wet and dry rot or bacteria coverage) . We think about 1 to 2 feet of water entered the house due to the sump pumps being off. now my question, is my damaged property ie. clothing, furniture and appliances covered under the property coverage endorsement, and the Sump Pump Failure/Sewer Backup Loss cover the walls and the amount it is going to cost to fix the place back again? or is the $5,000 the max on everything in the basement?

  861. November 3rd, 2011 at 7:16 am #Jason

    Deborah,
    Jumping right to the sump pump endorsement isn’t the right process to figure out your policy. We don’t know enough about your situation to provide an answer. If your policy didn’t have a part in it that said if a covered cause of loss AND a non-covered cause of loss occur at the same time, regardless of either one’s contribution, then the entire loss is not covered, it would be much easier to address your question.

    The mold, fungi, and bacteria coverage is triggered if these conditions arise from a covered cause of loss that is not excluded. We don’t know enough about your claim for this either.

    Irene occurred some time ago. What feedback are you getting from your insurance company?

  862. November 3rd, 2011 at 7:37 am #Deborah

    I just had a second adjuster out yesterday, the first one didn’t include my damages to the basement as he said he didn’t know we had the sump pump insurance in the policy. Although he did see the basement and take pictures.
    I have called them and dont get an answer, always the answering machine , I leave messages and no one calls back. I have even emailed them.
    I have HO 04 90 0491 Personal Property Replacement Cost

    and this is the page for the sump pumps

    THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
    WATER BACK UP AND SUMP OVERFLOW
    1. For an additional premium, we insure, up to
    $5,000, for direct physical loss, not caused by the
    negligence of any “insured,” to property covered
    under Section I caused by:
    a. Water which backs up through sewers or
    drains; or
    b. Water which overflows from a sump even if
    such overflow results from the mechanical
    breakdown of the sump pump. This coverage
    does not apply to direct physical loss of the sump
    pump, or related equipment, which is caused by
    mechanical breakdown.
    This endorsement does not increase the limits of
    liability for Coverages A, B, C or D stated in the
    policy Declarations.
    2. Special Deductible
    The following deductible provision replaces any other
    deductible provision in the policy with respect to loss
    covered under this endorsement.
    We will pay only that part of the loss which exceeds
    $250. No other deductible applies to this coverage.
    This deductible does not apply with respect to
    Coverage D – Loss of Use.
    3. Section I – Perils Insured Against
    In Form HO 00 03, paragraph 2.e.(2) under
    Coverage A – Dwelling and Coverage B – Other
    Structures is deleted, with respect to coverage for
    loss caused by overflow of sumps, and replaced by
    the following:
    (2) Inherent vice, latent defect;
    In Form HO 00 15, this is subparagraph 1.b.(4)(b);
    in HO 17 32, this is subparagraph 2.e.(2).
    4. Section I – Exclusions
    3. Water Damage is deleted and replaced by
    the following:
    3. Water Damage, meaning:
    a. Flood, surface water, waves, tidal water,
    overflow of a body of water, or spray from any
    of these, whether or not driven by wind; or
    b. Water below the surface of the ground,
    including water which exerts pressure on or
    seeps or leaks through a building, sidewalk,
    driveway, foundation, swimming pool or other
    structure.
    Direct loss by fire or explosion resulting from water
    damage is covered.
    (In Form HO 00 03, this is item 1.c.)
    All other provisions of this policy apply.
    This is a Policy Snapshot
    Limit
    Property Coverage

    Dwelling
    Your dwelling is protected against Extended Incidents

    $375,000

    Other Structures

    $37,500

    Personal Possessions

    $187,500

    Your computer(s) are protected against Extended Incidents
    All other possessions are protected against Standard Incidents

    Full Replacement Cost Coverage

    Included

    Temporary Housing Expenses

    $75,000
    Liability Coverage

    Personal Liability

    $300,000

    Defamation of Character Liability

    Included

    Medical Payments to Others

    $3,000
    Additional Coverages

    Water Backup & Sump Overflow Protection

    $5,000

    Mold Property Coverage

    $10,000

    Mold Liability Coverage

    $50,000

    Identity Theft Expense Protection

    Included

    Earthquake Protection

    Included
    Deductibles

    Regular Loss

    $2,500

    Sump Pump Failure/Sewer Backup Loss

    $250

    Identity Theft Expense Loss

    $250

    Earthquake Loss

    $18,750

    I hope this helps, I asked the adjuster when he came out yesterday what is the hold up and he just shook his head and said he is Independent and knows they have a lot of work.

  863. November 3rd, 2011 at 12:22 pm #Jason

    Deborah,
    It’s not necessary to post your policy on here.

    The best person to ask questions you have is your adjuster. We don’t know how the damage occurred. We don’t know if the water is flood water that entered your home, water that backed up from your sump pump, or water seeping through your foundation. Not all water entry into a home is covered.

    What I’m saying is that we cannot adjust and settle your claim on here. That is why the adjuster(s) visit your home. The adjuster also provides the insurance company with an estimate and recommendation about what they suggest to settle your claim.

  864. November 4th, 2011 at 11:48 am #Judith

    Hi,
    I had ash and soot damage to my property after SoCal wildfires and filed a claim with a public adjuster in to Fidelity in order to have the home properly cleaned, since my house was supper dusty and I did not want my newborn breathing the air. Unfortunately I could no longer make the payments of the home and was foreclosed on with the claim pending. I received the check for the cliam after I was no longer the owner and status that they were still trying to negotiate for additional losses and I could enter into a litigation. Could I get in trouble? What should I do? I dont own the house anymore but my personal belongings apparently still are contaminated.

  865. November 4th, 2011 at 1:56 pm #Mike Wahl

    I live in NYS. My question pertains to the ACV of a structure. In NYS carriers use “broad evidence” to determine the ACV. As of late they are using the appraised valve of the home prior to the loss. The problem I find with this is being in a depressed economy they, come in with very low ACVs. Any suggestions.

  866. November 4th, 2011 at 2:12 pm #Jason

    Judith,
    Just by you posting the question on here, you know it may be a gray area. I wish there was a clear-cut answer to provide. Your personal property cleaning and/or damage is probably mixed with cleaning and/or damage to the dwelling.

    If the check was issued properly, then it would be drafted to your mortgage company and you. The way you describe the check, it seems the insurance company wrote the check only to you . At this point the check is not worth anything so the check needs to be cashed so funds can be drawn out of the insurance company’s bank. Are you able to cash a legally binding check? Yes you are.

    You have a contract with your insurance company in the form of an insurance policy. You also have separate contract with your mortgage company in the form of a loan and mortgage. There is a little bit of overlap in that the insurance company also has an obligation to protect the interests of the mortgage company by including their name on the check so the mortgage company and you can work out things concerning damage, collateral, and in this case, entitlement.

    Once the check is cashed and you have the proceeds, you will then have to figure out what should be yours and what should the mortgage company’s. For this, you may want to consult with an attorney.

  867. November 4th, 2011 at 2:23 pm #Jason

    ACV is the “actual” cash value. It can and does fluctuate with the economy. An appraised ACV value is one component of the broad evidence rule. The broad evidence rule simply means they look at many different valuation measures to arrive at the ACV. Looking at the appraised value is just one component to arrive at the ACV and more valuations could be used if appropriate.

    I would assume you are looking for suggestions about other ways to value a property. Recent past sales of the home or recent sales of comparable homes are a couple of ways.

  868. November 5th, 2011 at 6:11 am #mari

    i AM ABOUT TO RECEIVE replacement value my question is

    after receiving replacement value money. i will go to store and purchase items lost. If i decide to return items can i keep the cash? what are the fine print?
    is it legal?
    I do not want cash value it dont pay enough , CAN I GET A ANSWER PLEASE SENT TO MY EMAIL ALSO WOULD BE APPRECIATED

  869. November 5th, 2011 at 6:28 am #Jason

    mari,
    What you are indicating is illegal. There has been case law that supports that you should not do that. Do people still do it? Yes, they do. What you do is entirely up to you.

    There is no fine print, it’s based on the principal of what the contract is intended to do. You pay more in your premium to get the amount of value over ACV which is replacement.

    Just replace your damaged items. If you don’t want the items, then it’s apparent that their value is not very much.

  870. November 5th, 2011 at 1:21 pm #Mike

    I live in Northern New Jersey. My homeowners insurance is with Travelers. We never had a claim since we purchased our home in 2001, until this year.

    On Aug 29, we were affected by Hurricane Irene. This was declared a disaster area by President Obama. The power was off for 4 days, many large tree limbs fell onto the driveway, one tree is at a 45% angle OVER the driveway. A lot of flooding, ground water and underground water washed away the front slope of my property, driveway, belgium bloc and mold has started to grow in the shed from water entering it. The shed is a structure covered on my policy. Travelers gave me a $100 check for food spoilage after a $100 deductible and then closed the file.

    On October 29, we experienced a noreaster snow storm that dropped 16 inches of snow. This was declared a disaster by Governor Christie. The power was off for 5 days. LARGE limbs fell onto the driveway and blocked our exit. My pump in my koi pond short circuited, 7 koi fish died, my electrical panel’s MAIN breaker is “frozen” in the ON position, have about $500 in spoiled food, had to stay in a hotel for 1 night and buy food at a diner, fast food & restaurant to eat. Because we have well water, electric baseboard heat, electric hot water, we could not stay in the home. It was about 45 degrees in the home. We could not take a shower, flush the toilets or wash our hands in the home. Sanitation became a major concern. I have opened a claim with Travelers and know they will be very aggressive in trying to minimize the claim. Obviously insurance is a business and they are trying to maximize profit with limiting risk. Any direction with this will be helpful.

    Should I hire a “Public Adjuster” for help? I also questioned the claim rep about my premium and insurability with having 2 claims in 2 months. She did admit that there will probably be an underwriting review after the claim is closed.

    Any help and direction is appreciated.

    Thanks,
    Mike

  871. November 5th, 2011 at 6:01 pm #Dave

    You’re situation is typical. I am a Public Adjuster and I recommend you contact me to get the help you need.

  872. November 5th, 2011 at 8:41 pm #Jason

    Mike,
    As Dave indicated, you could contact him (no contact information to do that) and see if he can help you.

    You’ve indicated that you had some food spoilage, some fish die, additional living expenses, and some extra food expenses.

    First, we all have to eat so if your food cost you $70 instead of $30, your loss was $40 in this example. You still are paying for your house so any extra housing costs are extra expense (or your loss), the food spoilage is pretty easy to figure out. Trees damaged by wind (unless specific criteria are met) are not covered if wind causes the damage. Fish and pets are not insured under your policy.

    I don’t necessarily suggest you contact a public adjuster but you will have to decide what is best for you.

  873. November 6th, 2011 at 2:57 am #Mike

    Hi Dave,

    Tree damage is from the snow. The heavy wet snow so early in the season destroyed the trees and other landscaping. The landscaping is expensive to replace, would this be covered? Also the pond and fish are part of the landscaping, would this be covered?

    Thanks,
    Mike

  874. November 6th, 2011 at 6:50 am #Jason

    Mike,
    Trees are covered for only a handful of causes of damage that include lightning and vehicle (for example). Snow, wind, and rain are not included in those covered causes. -This can be found in your policy.

    Landscaping, regardless of it’s expense, is not covered for damage from heavy wet snow.

    Public adjusters may be appropriate to consider if the insurance company is not being fair with you concerning the value/amount of covered damage that you endured. When there a lot of uncovered damage and you can handle the rest of claim by yourself without concern, then hiring additional help you don’t need doesn’t make sense.

  875. November 6th, 2011 at 6:48 pm #Kathie Godbolt

    My house burned up last year. My adjuster did not and would not tell me how much money I had to actually fix my house. I feel like I was actually coerced into using a State Farm contractor because she kept telling me how I would run out of money and be stuck. Well, the State Farm contractor was a real mistake from the start. No protocall was followed from the start. The next day after the fire I was set up to meet 4 people at the same time, fire chief, restoration people, and 2 contractors. Nobody is in the right frame of mind and they do this to keep you even more confused. You are not able to make rational decisions. If they had been upfront, things would not have been so confusing. Now they are playing the buy it and I’ll give you half until you replace it..Dont they have to pay me fo rwhat my policy states? I thought it was the same as a

  876. November 6th, 2011 at 7:17 pm #Jason

    Kathie,
    A policy pays AVC initially. If you have a replacement policy, when you replace the items, the insurance company will pay you the rest of the funds above the ACV originally paid, and up to the full cost of the replaced item.

    This same principal applies to building parts like the roof and siding as well as a couch, tv, or lawn mower.

    Please post questions if you have them and we will address them as soon as we are able to.

    You may need to bring in someone to assist you with this process that is able to deal with the demands of getting the restoration completed.

  877. November 7th, 2011 at 5:40 am #Maureen

    I recently had a kitchen fire in my house. I have been told I’ll need to replace my kitchen. My policy provides for replacement cost value not actual cost value. The adjuster provided me with a copy of the statement of loss. There are estimates on the report that I believe are under valued. I have proof I paid more for the items than he stated on his report. In addition, he has provided for the detaching of my granite counter top and re-attaching to new cabinets. I have explained to him that the countertop was custom cut to fit the current cabinets that were damaged in the fire. Further, I’m not sure the counter top can be detached without being broken. He advised that my contractor should attempt to detach the countertop and if it breaks let him know. My contractor has already advised me that he cannot reuse the old countertop when he installs replacement cabinets. The adjuster is telling me that I should accept the check from the insuance company so that I can begin to replace my damaged kitchen. I am reluctant to endorse the insurance check because I’m afarid that to do so will prohibit me from seeking additional funds for items not covered or under valued on the statement of loss. What should I do?

  878. November 7th, 2011 at 7:16 am #Jason

    Maureen,
    Discuss these concerns with your adjuster. If you have proof that you paid more than the allowances provided, provide that proof.

    Counter tops can be attached without being broken. Counter tops can be re-attached without being broken. This should not be a concern of yours. If the counter tops become broken while being detached and reset, do you think the insurance company is going to leave the broken counter tops in your home? If your contractor is not able to detach and reset granite counter tops, then you may want to check if he’s a qualified contractor to do this work for you. If he is telling you of his lack of ability to do something, that should be a red flag to you.

    To clarify, your policy provides ACV and when you get the repairs completed, then you can make a supplement claim to recover the difference between the ACV and the replacement cost.

  879. November 7th, 2011 at 7:33 am #Maureen

    Thanks for answering my questions. To clarify, my contrator’s concern was that the current countertop was custom cut to fit my current cabinets. Unless I buy cabinets that the exact same dimension, the countertop may not fit. If by chance the countertop breaks while being detached I did not want to be in a situation where the adjuster is telling me that the contractor is liable for replacing the countertop since he broke it. I paid $3,200 for the countertop and the adjuster has allowed $336.00 to detach and reset the granite. I also wanted to make sure that by endorsing the insurance check I wasn’t agreeing that it reflected full settlement of my claim.

  880. November 7th, 2011 at 8:34 am #Jason

    Maureen,
    Contractors that install cabinets and counter tops commonly use shims. It is very likely shims were used to install your current counter top. You don’t see the shims because they are not meant to be seen; they are only meant to perform a function.

    If the contractor is not able to carefully detach and reset the counter top, then you should look for a contractor that is qualified to complete this task without breaking the granite.

    If the counter top breaks, the contractor should be liable if he broke it. Granite will not break on it’s own. Your counter top has been mined, worked, handled, shipped, and installed without breaking. It would require being dropped or hit fairly hard with an object to break. Absent dropping it or hitting it with another object, the granite should not break.

    If the granite sustains damage during this process, the insurance company would have to become involved in what needs to be done next. Did you confirm your contractor is licensed and has professional liability insurance?

    You are likely being asked to sign either a sworn statement in proof of loss or a statement of loss, or maybe both. These documents lay out the cost to repair your kitchen on an ACV and replacement basis and amounts to your formal claim. If you don’t agree with the allowances provided, discuss that with your adjuster. You need to be able to sign the document(s) with the assurance that your kitchen will be restored to it’s condition before the fire.

  881. November 7th, 2011 at 8:04 pm #Rachel

    hello,

    i currently live in condo and my property walls and floors were damaged by a tree root and after two years my HOA finally open an insurance claim. While my claim is consider a third party liability claim. The adjuster with traveler is using an estimate that i got back a year ago for my hoa to kind get an idea of what the damage will cost. The insurance sent out their own contractor and i never got an estimate telling ME what The estimate the cost of damage is, when i asked the adjuster what his contractor estimate was, he said that it was confidential and couldn’t tell me. He wants to settle but i didn’t agree because i only got one estimate and that one contractor that came out isn;t one that i want to hire to do the work. i told him no, that i;m going to contact another contractor to give me an estimate, because i really don’t know if that will be the total price of repair and that i don’t want to end up paying out of pocket. oH, another thing i asked was, if they were going to pay for my loss of use, because according to the contractor that came out, he said that i couldn’t live in my home for over a month. The adjuster relpyed with its all include in your SETTLEMENT. i had a contractor come out and he said he didn’t feel comfortable giving me an estimate with out an artchiture engineer. i notify the adjuster and again he said it all include in my settlement offer. I was able to receive a copy of the estimate from the contractor he sent out to do an estimate and it turns out that he was charging 25,000 more,. need some help! ca

  882. November 7th, 2011 at 9:12 pm #Jason

    Rachel,
    Can you be specific? Do you have a question? We cannot address an open-ended situation and provide information.

  883. November 8th, 2011 at 9:14 am #RACHEL

    does my loss of use consider as part of settlement when its a third party liability, if not do i figure out how much it will cost me to rent a hotel, food and traveling expenses or does the insurance.

  884. November 8th, 2011 at 9:45 am #Jason

    Rachel,
    If we understand your question correctly, you want to know about additional expense reimbursement or loss of use of your home.

    Simply ask the insurance company how they want to address that.

  885. November 8th, 2011 at 11:48 am #Fran

    In one corner of our garage the foundation is settling. However, the settling is being caused by the downspout leaking underground in this corner of the garage. The downspout goes underground at this corner and joins a pipe that takes it to the street.

    My question is this….should my insurance company pay for this repair. ($3600) to jack up that corner of the garage.

    My insurance doesn’t cover settlement. The house is 26 years old. I really think it may be past it “settlement” phase.

  886. November 8th, 2011 at 1:21 pm #Jason

    Fran,
    No, this very likely would not be covered by your policy. The exclusion for settling is not just for new home settling but for any and all settling.

  887. November 9th, 2011 at 1:11 pm #Teresa

    I have had the same Homeowners Insurance Policy for 20 years and have never been late of never filed a claim. Last week a pipe broke inside the wall and leaked out all into the walls and pretty much wrecked the entire house’s flooring and walls. We decided on Vinyl Flooring but the old stuff had to be scraped up and cleaned off first. The contractor said the wall mounted Flat screen TV was fine and they would even cover it with plastic before they began. The workers were scraping up old tiles making a giant dust storm and they never covered the TV at all. I asked them to stop working until the TV was covered properly and they did but 3 days later when it was uncovered, there is a 1/2 inch gash in the screen. Flooring people took responsibility and we are suppose to be given a new T.V..

    My question is….”Does the insurance company have the right to take my old TV I bought and paid for away from me just because they are righting a wrong they did and giving me a new TV.??? I have an emotional attachment to my old TV because of who gave it to me and I don’t want to give up on it. Please help me What do I do???

  888. November 9th, 2011 at 1:12 pm #Sarah

    We recently had damage to our home due to wind storm. Just a little info…due to recent storms earlier in the year all local roofing contractors are well booked into the spring. Repairing on worse comes first bases…back to my story. Our insurance company came out with their own adjuster and took pics and sent us a check for repairs little over 8000.00..then they came back out about 30 days later and the roof handt been repaird.. now they have started a fraud investgiation on us. We told them all the other repairs had been done. The fraud investigator wants to meet with both of us but every time we give him a date he cant make it for what ever reason. Says he wants to have a recorded statement from us. The Claim was done in Sept and check issued in october..now it will be december before he can work us into HIS schedule. My husband is a truck driver and its not easy finding time to be available at the drop of a hat..which we have told this guy but he insist. We have since started repairing the roof ourselves. I ahve sent before and after pics during the stages of repair. I have reciets for the roofing material but i did not keep any for the paint and intiror stuff we purchased but it is obivious of what was repaired. Can they get us for fraud? Make us repay or put us in jail? I mean we have tried to corporate with them but life just doesnt revolve their schedules. What should we do? I asked him if he wanted me to send the roofing reciets nad pics he said no..i also asked if we needed to stop repairs till he got out there and could see the old roof and he said no..so if we cover up old roof hows he gonna judge anything??
    BTW all i reported was a few loose shingles, water damage on kitchen ceiling and laundry room celiling as well as damage to my front storm door.

  889. November 9th, 2011 at 2:00 pm #Jason

    Theresa,
    If you want to keep the old tv, you can. But then you will forego getting a new television. This choice is entirely yours. If you want a damaged tv, you can have it or you can have one that’s not damaged.

  890. November 9th, 2011 at 2:24 pm #Jason

    Sarah,
    I don’t understand why you are being investigated for fraud. You seemed to skip that part. The answers to your questions are, can you be found to have committed fraud? Yes, you can.

    The insurance company, at this point, appears to be investigating fraud concerning a civil agreement and misrepresentation, etc. concerning your contractual agreement with the insurance company and yourself. It may be a monetary resolution, a criminal resolution, or both. We don’t have enough information to comment any further.

    You ask what you should do. I don’t know. Set up an appointment with the investigator and provide the information they ask for.

  891. November 9th, 2011 at 11:38 pm #Lindsey

    I have a home fire loss insurance claim in CA and the insurance company has issued the claim checks and it is with the public adjuster. Insurance company has asked me to hire any licensed contractor and pull permits. The public adjuster is telling me that he cannot give me the check unless the contractor is finalised and the check has to be deposited with the mortgage company. Yes, I still have a mortgage and therefore I guess the check might even bear the mortgage company name. My public adjuster is trying hard to get this reconstruction project into his contractors hands. My question, is can he insist or even require me to reveal to him the name of the contractor I am considering for this project? If I write a personal check for the public adjusters commission amount won’t he have to release the checks to me or is there any clause by which he can hold onto the check. Then it is between me, my contractor and the mortgage company. Does the insurance company need to see the contract I am signing with the contractor(of my choice)? If this contract amount is less than the insurance payout, can they revoke the check or reduce the payment? If I am able to complete the reconstruction and there is money left over won’t the mortgage company hand over the remainder of money to me. Is there any contingencies the public adjuster or the mortgage company or the insurance company can place on me to deprive me of this money? Thanks for your advise.

  892. November 10th, 2011 at 6:56 am #Jason

    Lindsey,
    You may need someone in your corner to protect you from the public adjuster, but that is just a gut reaction. The agreement between your public adjuster and you can be contracted any way you set it up and asking us questions about that specific arrangement is not something we can answer. I won’t address any questions you presented that concern the public adjuster.

    First, you can hire any contractor you want. If you receive pressure from anyone to hire someone they know, you should resist that at all costs. See my very first sentence.

    Sometimes your insurance company may need to see an estimate. What they generally want to confirm is that the work has been completed so they can reimburse you based on replacement cost.

    Technically the insurance company could reduce the payment for the specific item and/or process that cost less to do they they originally estimated but that doesn’t happen very often.

    If there are remaining funds, the mortgage company has no reason to hold the funds and should release them to you. The mortgage company simply wants to make sure their collateral for the loan has been repaired so it’s value does not remain reduced.

    I don’t know what you mean when you ask about “contingencies”.

  893. November 10th, 2011 at 12:54 pm #roof claim blues

    Hi,
    I have a question on a roofing claim. We had a hail storm in the spring, and most of my neighborhood had new roofs done from the damage. We filed our claim, had our inspection done and an estimate was given for $6900, which included about $700 for gutters and downspouts ($6,200 was for the roof). The roofing company we worked with told us they would charge $6,200 for the roof, and after our $1,000 deductible we would owe about $300 to them (6,200 – 5,900), because the money for work on the gutters etc could be used toward our deductible.

    We proceeded with the work, and a few weeks later received our depreciation check, which was reduced from the original amount to make the total we received from our insurer $5,200 ($6,200 our $1,000 deductible), instead of $5,900. Since the job cost $6200 it’s all our insurer released. I did not put two-and-two together until a few days ago that our final payment was reduced and wouldn’t cover as much as we thought. Our roofer is asking for the additional $1000 now, which we do owe them. But I was angry because they said we would only have to pay $300. They led us to believe our insurer would give us the entire amount of the estimate (I know better now, they can’t speak for my insurer!). Now they say they will try to get our insurer to give me the rest of the money, but I’m not optimistic.

    I’m not sure who to be upset with, my roofer, my insurer, or just myself! I’ve gone back-and-forth on it and have boiled it down to the following questions I need some help on:

    1. Did my roofer attempt to commit insurance fraud with me by telling me I could take ACV money for my gutters and downspouts and apply toward my deductible? (This isn’t the same as them “paying” our deductible by overstating their invoice, but is in a sense the same idea)

    2. If my insurer had given the full $5,900 to me, would I be committing fraud by paying money to my roofer that was supposed to go to gutters and downspouts? (or in a different scenario just pocketing it without making any repairs). Or, are they just being tight about my claim payment, and that money should be mine whether I get repairs done or not?

    3. Is there a legitimate way I can claim the rest of the money in my estimate? Do I have any chance with my insurer on this? My roofer is already trying to contact them, but I know the money still goes through me.

    Thanks for the help!

  894. November 10th, 2011 at 5:55 pm #Jason

    Roof,
    1. Your roofer didn’t commit fraud. He replaced your roof for you and you owe him what he charged.

    2. If you used your gutters and downspout ACV money for your roof, that is fine but then if you don’t replace your gutters and downspouts, you give up the depreciation funds that were withheld for that aspect of the damage.

    3. If you replace your gutters, you can claim recoverable depreciation for that part of your claim. In the end, you will endure your $1000 deductible. The insurance only pays when you have incurred your deductible and they pay the damages above that.

    Please be aware that you generally have 180 days from the occurrence date to make the repairs and make any claims for recoverable depreciation.

  895. November 11th, 2011 at 8:16 am #LeeAnn

    HELP! We went through a major wind and hail storm 3 months ago. We are still fighting the insurance company (AllState). We rent, so our insurance covers only our contents and cars. Our cars have been settled. Each car had a different claim number and was handled by a different person. So 2 cars, 2 adjusters. Both were from Colorado and we live in Kansas. The contents adjusters were from Texas, Virginia and now our most recent one is from Alabama. No one from All State has ever been to our home, what use to be our home. It was so severely damaged in the storm that the owner does not plan to repair or rebuild. We have paid the extra for replacement insurance for 15 years now. Yet they say they will only give us the deprecated value until we can prove with recites that we have replaced the items. I don’t understand! What is replacement insurance?? We are now on our 3rd contents adjuster. I am getting so frustrated. They have told us our beds and sofa are fine just vacuum off the glass and use them when they dry out. On the electronics they told us to plug them in and try them, if they come on they are fine. I explained that when you picked them up water runs out of them. They again said plug them in, if they come on they are fine. His tools which are in the garage that no longer has a roof at all, they say they are a little rusted but are fine. We had a Basset corner sectional which has a replacement value of $6,000. They refuse to pay a replacement value even if we prove replacement. What is the rules on replacement cost insurance?

  896. November 11th, 2011 at 2:23 pm #Sceptical

    After a strong storm, I noticed some water infiltration in my ground-floor condo. My condo insurance wouldn’t cover it, so I placed a claim with my personal insurance. They will cover it, and will refinish the floors in the entire condo (it’s all natural hardwood of the same type) EXCEPT one bedroom. They say that this is because the “wood laths run parallel to the door in this room”. WHAT? According to the adjuster, this “isn’t covered in my policy”. When I told the adjuster that I could not understand the jargon of my policy, and he could not adequately explain, I told him to send a copy to my lawyer. He FLIPPED OUT and yelled at me and told me that he was “from the insurance company and would not try to screw me because they were on my side”. He said that I was “not smart” to consult a lawyer and that if I wanted to “do things the hard way” that he would “not help me anymore”. I tried my best to play innocent and be polite – of course I sent everything to my lawyer anyways – and regain his trust, but he is being a HUGE jerk. Are adjusters paid on commission? Do they get extra to screw people out of what they deserve and have paid for? How should I proceed? Should I ask to be transferred to a new adjuster? Or would that make the situation worse since I’ve become a “problem client”? I would appreciate any advice! Thanks!

  897. November 11th, 2011 at 3:50 pm #Jason

    Sceptic,
    Your policy covers direct damage. Of course the insurance is going to replace the flooring that was affected and the non-affected flooring around the water damaged flooring because you can’t just repair limited pieces of a floor, it basically has to all be done – except- where there is an appropriate stopping place to end the replacement.

    A simple example that should be very illustrative is if a person sets a hot pan on their counter by the sink and burns the counter. To repair it, you can’t just cut out the round burn spot in the counter and replace that small piece. Rather, you have to replace all the contiguous counter top. Now, the homeowner decides instead of the orange counter top, they are going to replace it with a nice looking green counter top. Well, this example also includes counter top on an island in that same kitchen that was not damage by the hot pan. This island counter top will not be considered for replacement by the insurance policy. Replacing the island would be at the expense of the homeowner if the homeowner wanted that island counter top changed.

    In this case, your bedroom doorway is basically an ideal cut off point. Let’s put this into perspective. Let’s say there was no insurance money to replace the flooring and you had to pay for it all. If you could reduce the cost of not replacing the bedroom flooring because it’s a good ending point (and it’s not damaged), then that makes perfect sense and you would do that to save yourself some money. That is what the adjuster is doing.

    Regarding attorneys, different expectations, and the heated argument you to got into, I have no comment for that because I wasn’t there and I only have your side and not that of the adjuster.

    Adjusters are not paid on commission. They likely are paid a salary and they cannot spend insurance funds carelessly. They are held accountable for spending the claim funds in an appropriate manner. All repair decisions may be reviewed by management or during an internal or independent audit. If something doesn’t make sense, he may be asked to support why he replaced undamaged flooring that should not have been replaced. It’s a bit of accountability to make sure things are being done correctly.

    If you want to have a new adjuster, you may request that. If the only concern is the issue regarding undamaged bedroom flooring and everything else is in order, it may be overboard getting an attorney involved. Attorneys are somewhat expensive.

    You probably aren’t a problem insured because not everybody agrees with every single detail that other people may agree with. You have priorities that differ from the priorities of other people.

  898. November 11th, 2011 at 4:11 pm #Jason

    LeeAnn,
    Replacement insurance provides you the opportunity to replace the items you were already paid ACV for and then request reimbursement by your policy for the additional funds you had to pay above the ACV allowance you were already paid. The steps to recover the replacement value are pretty clear.

    We don’t know the extent of any of the damage to your personal property. It’s impossible to provide specific advice on your electrical items or your furniture. Items have to be damaged for insurance to address those items. Items can be dried or cleaned and they may not be damaged. Again, I state, we don’t know all the details to provide any further information.

  899. November 11th, 2011 at 7:07 pm #Erica

    I currently have home insurance with Farmers I recently had a break in August of this year my adjuster ask me for receipts or manuals but i only could provide a few because my claim was large so they had me to do a proof of loss form and have it notarized and also a release for a credit and background check, after i did that Farmers switch my adjuster to one in CA and im currenty in Alabama and my investagator is in Tenn I spoke with the investgator and he wanted to talk to my friends who were with me the night of the burglary which they did speak with the investagator after that I had to do a EUO.. I told them i had filed chapter 13 last year cause i was being sued for being a co signer on a car and the attorney was concern about the contents i listed for chapter 13 which was i hardly listed anything cause i was just tryin to stop the garnishment ..later my transcript came and i signed that everything was acurate the attroney told me they may have to do a follow up he will keep me in the loop..I recently received a call from another investigator wanting to meet with the persons that was with me on the night of the burglary and they meet with the investagators my question is are they trying to deny my claim for that chapter 13 and why they wanting to meet with the persons who were with me instead of a interview over the phone like the first time they spoke with them. i talked to my claim adjuster she stated that we are very close to closing my claim if the persons come in quickly so they can rap it up.

  900. November 11th, 2011 at 7:59 pm #Jason

    Erica,
    It’s not that you filed bankruptcy, it’s what you reported in that bankruptcy that matters. It’s all about if your claim is legitimate or not. I can’t tell you if it is or isn’t. That is why you are doing affidavits, EUO, and they are interviewing your friends. You have to understand that not all burglaries are burglaries.

  901. November 11th, 2011 at 8:29 pm #Erica

    so you are sayin that Farmers is trying to say that my home was not burglarized thats why their doing this investigation on me? I didnt put really anything down on my chapter 13 because it was my computers and x box and etc i didnt know i had to put those things in my chapter 13 the next question is can farmers deny my claim for not puttin all of my electronics on the list for chapter 13 all though they are firmly investgating my claim and im fully coroperating with them?

  902. November 11th, 2011 at 8:54 pm #Jason

    Erica,
    No, I’m not saying that. If you wanna see what I said, please re-read my last post.

    The items that you put on your chapter 13 are supposed to be every single asset that you own. If you don’t include all the items you own and they magically appear on a notarized document just a short time later, that raises suspicion that 1. You don’t own the items you are claiming or 2. You have misrepresented (lied) in one or both of the documents that you swore are truthful. It’s a double edged sword. If there are items of any concern that are not listed, it makes the entire situation very awkward for you. I’m sure I don’t have to tell you that.

    It doesn’t matter if you knew you were supposed to put those on your bankruptcy or not. You are supposed to and not knowing you were supposed to list something is not an acceptable excuse.

    Can farmer’s deny your claim? Yes, they can. They are in a very good position to do that based on the information you provided. If they deny your claim and you happen to sue them for denying your claim, they will bring the court’s focus to the errors in your documents and they will be in a position to persuade the judge that some documents that you have prepared (bankruptcy list and claim forms) may not be entirely accurate. They will use this cloud concerning your credibility as long as they can.

  903. November 11th, 2011 at 9:02 pm #Erica

    thanks jason

  904. November 13th, 2011 at 6:54 am #Cheryl

    I live in PA and I had a house fire in Aug 2011 and the insurance company still has not settled my claim. We do not know how the fire stated so we had to sit through a deposition that lasted about 8 hours, it felt more like an interrogation. They even called my husbands 80 year old grandparents and interrogated them and asked them if they would hire someone to burn our house. ( The fire started upstairs in a storage area which was also the roof of the front porch). The insurance company had two investigators, and did not even approve the claim until February of 2011, so the house sat all winter and more damage was caused due to it sitting. The adjustor still does not have the dry wall, insulation, front porch and a lot of other things in any of the estimates ( we have 10). The adjustor we had just retired and now the adjustor for my personal property is also taking over the dwelling who stated she does not have experience in dwelling claims. in the last year we had only heard from the adjustor 3 times and that includes the first meeting with him after the fire, the other 2 times was by phone and we had to call his boss to get him to call us back the last time. At this point what options do we have? I just want to be back in my home.

  905. November 13th, 2011 at 7:02 am #Jason

    Cheryl,
    We don’t understand. You had a fire in August of 2011 and your claim was approved February 2011? I will assume your claim investigation is not approved as covered yet. The insurance company is attempting to determine how the fire started. They appear to have a suspicion that it could be arson and they have to either rule that out or confirm it.

    It’s been about 2 months since the fire. At this point, you have to let the insurance company determine if there is coverage for the fire or not and you will have to wait. I don’t know if you have any other options.

    Who is your insurance company?

  906. November 13th, 2011 at 8:15 am #Cheryl

    Sorry the house fire was Aug 2010

  907. November 13th, 2011 at 11:19 am #Jason

    Cheryl,
    Your house fire was in August of 2011 and your claim was approved in February 2011. I assume that then to mean that your claim was investigated and the insurance company accepted the liability of the damage and repairs are being made or have been completed. What kind of options are you looking for? We don’t have enough information to provide you options because we have no idea what’s going on other than you had a fire, the insurance company thoroughly investigated the fire, and you apparently are not yet back in your house.

  908. November 13th, 2011 at 4:46 pm #Cheryl

    The house fire was Aug 2010 and the insurance company still does not have all the work that needs done approved. All the dry wall in the house was damaged either by the fire, smoke or water. The same with the insulation and the insurance company is saying that they are not paying for it. They also are saying they are not going to pay for the front porch, they said it was damaged prior to the fire. The fire started over the front porch so all the items that were stored above it was on fire and ended up on the porch along with the gallons of water. What options do I have to get the insurance company to get my claim moving and get me back home

  909. November 13th, 2011 at 5:01 pm #justme222

    Cheryl,

    You can either try to deal with your insurance adjuster and get them to cooperate or you can hire a public adjuster. Note: you should also send your insurance adjuster e-mails as much as possible, because they will claim that you never tried to contact them.

  910. November 13th, 2011 at 5:27 pm #Jason

    Cheryl,
    It is true that the squeaky wheel gets the grease. Call the insurance company. Talk to the claim supervisor. Make sure they know you are not content with the speed and lack of attention to the items that are damaged. And don’t just call one day and stop. Your calls should be frequent until you see the progress you want with your claim. If there are items that should be covered by your policy, ask that the adjuster come out again to specifically identify what should be repaired, replaced, or not addressed by your policy. This is another example of being the squeaky wheel.

    Was the front porch damaged by fire prior to this fire? Was the front porch damage by some other peril and not repaired when this fire occurred? We simply don’t have enough information to address that part of you claim concerns. I am not convinced your claim requires the assistance and expense of a pubic adjuster.

  911. November 14th, 2011 at 1:43 pm #Tamara

    I recently had an issue where my basement flooded. The basement is occupied by my sister in law. I intially filed a claim including her possession (clothes and personal articles). The insurance company told me that they would not cover he items as she was not listed on the policy. I resubmitted the claim for my furniture and some articles I had stored in the basement. The insurance company is now insisting I supply photos of the items with me in the photos. Can they demand this?

  912. November 14th, 2011 at 4:43 pm #justme222

    Cheryl,

    I’m not convinced you need a public adjuster either, but I gave you what you asked for: OPTIONS

    Tamara,

    They can ask you for photos if they want. The problem for them is if you can’t provide them, then that’s just too bad. They would have to actually prove you are lying about the contents. If they cannot do that then I would guess that they are gonna pay after a while because they have too much to loose. If they can’t prove you are lying(not saying you are)and deny your claim then google “bad faith insurance lawyers” and hire a lawyer right away. Keep in mind that you may have a deadline to file suit, so read your policy carefully.

  913. November 14th, 2011 at 4:53 pm #Prince Sam

    My condo unit has a water damge from upstairs apartment. My condo association filed claim to the condo insurance and they paid only part of the money. While association was in discussion with insurance, I went ahead and filed claim against my own home owner’s insurence. At last my insurance paid most of the money. and in between condo association was able to get the remaining amount from condo insurance company. Do I need to return either of the money and if yes which one should I?

  914. November 14th, 2011 at 5:07 pm #Jason

    Tamara,
    It appears they are asking for receipts of the items in your photos. Many people don’t have receipts for items they purchased just a few days ago.

    What the insurance company is doing at this point is making sure there is no overlap of ownership because you presented items in your claim before that didn’t belong to you.

    Somehow you are going to have to provide them the assurance that the things you claim are actually yours so they aren’t paying for someone else’s property. You can probably discuss this with your claim adjuster to determine exactly they want from you so your claim can proceed.

  915. November 14th, 2011 at 5:18 pm #Jason

    Tamara,
    I see another comment indicated your insurance will have to pay if the insurance company can’t prove the items don’t belong to you. In your case, it appears that your insurance company has documentation that supports misrepresentation of your claim since your claim included property not owned by you already. That is likely why they are placing these requirements on you.

    The thing is that your entire claim can be denied because you have presented your sister in law’s property for coverage under your policy. Property not owned by you is not covered by your policy. Misrepresentation in any part of your claim can result in a denial of your entire claim. And, you need to know this because the information provided to you on this site will be as accurate as it can be based on the information you provide to us.

  916. November 14th, 2011 at 5:29 pm #Jason

    Princesam,
    Generally when there is a claim in a condo association, there will be a master policy and individual unit owner policies that become involved in damage that overlaps.

    It is common practice for the insurance companies to coordinate and communicate with the other insurance companies concerning coverage, payments, and who has what obligations for which damage.

    If funds were provided to you, the funds should have been adequate to make the estimated repairs. If all the repairs are completed, then the claims files will be closed. Insurance companies don’t pay extra to have work completed with the anticipation they will have money returned to them. So, if you have remaining funds, it is very likely the insurance company or companies are not looking for any funds to be returned.

  917. November 14th, 2011 at 5:52 pm #Tamara

    Thank you so much for all your replies.
    As far as misrepresentation goes, there is also an issue where the insurance company had informed me that anyone who lived in the house was covered, which they later decided was misinformation.
    As far as the claim goes, since they did not deny the initial claim but informed me that certain items would not be covered and an amended list was then submitted, is that a valid reason for denial?
    Ie, would they not have just denied it rather than say ‘hey xyz is not covered?’
    As for what they want, they are insisting that photos of me with the items is the proof they need….

  918. November 14th, 2011 at 9:32 pm #Jason

    Tamara,
    Perhaps a resident relative would be covered but I have not reviewed that. However, I don’t think a sister in law would be considered a relative as it would be intended or insurance purposes.

    I don’t know how strict they may be when it comes to allowing a correction to the initial claim or if they will stick to a stern denial. That is where it may be appropriate for you to call your adjuster and find out what you can do so you are within the appropriate guidelines for them to accept you claim for coverage review. If they ask for receipts, provide them with as many as you can and then ask for other things you can do to support your claim. You have to build their trust back up so they know they can rely on the things you submit.

    Hopefully, they are giving you another chance to submit it with only your items being claimed. If they want photos of you with the items, by all means, send that to them.

  919. November 15th, 2011 at 11:30 am #Teresa

    I live in PA, I have State Farm Insurance. We had a storm this spring with hail the size of golf balls. I received much runaround from State Farm adjusters. State Farm states I had damage to my siding, gutters, and roof ridge vent (my car also sustained damage). But hey are denying any damage to my roof even though my contractor pointed out the hail damage and there is black streaking which appeared on my roof after the storm. I have contacted the Insurance Commission but received another letter from State Farm which they continue to state there is no damage to my roof. I’m still waiting to hear from the Insurance Commission, but is there any other recourse I can take? I can’t believe my house (and car) suffered such damage from the hail, but the roof miraculously remained unharmed, according to State Farm.

  920. November 16th, 2011 at 9:58 am #Jason

    Teresa,
    Hail does not automatically cause damage to a roof. It can cause damage to components of you home like gutters, siding, etc but the mere presence of hail does not mean it damages the various component of a home.

    You mentioned black streaking. That condition is not the result of hail contact with your roof. I don’t know what that is but it may be algae that has always been there but you didn’t notice it until this hail event.

    It may be correct that your car and parts of your house sustained damage but your roof did not.

    Also, to be direct, the insurance commission will do absolutely nothing for you other than making sure state farm addresses your concerns.

  921. November 17th, 2011 at 7:10 am #Teresa

    Jason, though I do appreciate your response, I feel you did not actually read my post. I did say that my contractor pointed out damage to my roof as a result of the hail – they sent photos to State Farm and were present when the adjuster was at my home.

    As I mentioned in my post, the black streaking was NOT there before the hail storm. I walk up and down my street daily and look at my house and roof. My neighbor also noticed the black streaking on my roof immediately after the storm which he can see through his window. I don’t appreciate you telling me it was there previously, I pay alot of attention to my home.

    I’m not an idiot, I don’t appreciate you responding like I am. I was looking for an answer from you in what recourse I can take. You provided me with no help.

  922. November 17th, 2011 at 7:57 am #justme222

    Teresa,

    I understand your frustration with Jason, but you have to look over him as he is just arrogant and mouthy at times. He provide good answers from time to time when he’s feeling good, but at times he’s just a little insecure with hisself. He has too much pride to just say he don’t know about certain situations. So he make things up to make you look like the stupid one……please forgive him!!!!

    Anyways, I have had plenty of claims where insurance companies have paid for roofs as a result of hail damage. You are taking the correct steps. Also make sure you stay on them but at the same time…be nice and respectful to your adjuster. Hint: If your contractor draw the bid to show the damage they will fix it. He just have to make sure he can back his claims.

  923. November 17th, 2011 at 9:21 am #Jennifer

    Theresa- ask for another adjuster. We had a bad hail storm too and when the first adjuster came out he didn’t look at any of our damaged personal property- and the detached garage that is 30 feet from the Home somehow wasn’t damaged. Our contractor said there was damage but our adjuster kept pushing and denied it- our original adjuster allotted for just about $8000 in damages, and when the second adjuster came out, all of the sudden our payout was close to $20000 including our detached garage. So it pays to ask for supervisors and even a second adjuster. Sometimes during cat claims they outsource the adjusters so you army working with someone who is an actual employee of your insurance company. Good luck!

  924. November 17th, 2011 at 9:30 am #Jason

    Teresa,
    Sometimes there are no reasonable choices of help available. I won’t provide anyone with a response that gives someone false hope. That is about as bad as giving someone the wrong responses to their questions.

    Haag Engineering is the unquestioned leader regarding the subject of hail. This firm was established in Texas about 80 years ago and has a country-wide presence. Haag engineers can determine if a condition on a roof is hail related or not. The determination that Haag will provide is, without a doubt, what anybody will believe concerning hail. Haag will convince any contractor, the insurance company, any judge, or any jury panel panel whether or not the condition on a roof is hail. You may ask why I’ve mentioned this company; I will address that shortly.

    I am going to offer you assistance beyond the exchange we can do on this forum. It’s up to you whether or not you want help from me. I will always be up-front with things and probably be more direct than people are used to. But the biggest tragedy is when people take a course of action not knowing what the end result is when I could easily tell them and save them time, money, and frustration.

    When someone indicates their contractor pointed out hail damage, I am aware most people do not know how to identify hail damage from other conditions on a roof. I’m sorry you are offended by my response that hail will not cause black streaking; that is just being direct.

    There are a number of things you can do. To tell you everything you can attempt would make this post more than triple the length is already is. For now, I will tell you the most certain way to confirm your roof has hail damage. You can hire a Haag Engineer to inspect your roof. They will inspect and report their findings to your insurance company and I can guarantee the insurance company will act on their findings no matter what.

    There are consequences to this option. If their findings conclude hail damage, that confirmation from the premiere hail authority in the world, would guarantee your insurance company will pay for any hail damage Haag has defined. If Haag concludes there is no hail damage to your roof, then you can rest assured there is no hail damage. Because you hired this company, the only thing left to do is pay for the services they provided without any option to be reimbursed. Their charges to you may be more expensive than the cost to replace your roof.

    I’m not entirely convinced this approach is reasonable for you because of the cost to obtain the the services of this company. Here is another option: If you want to send hail damage photos (including close-up photos) of the hail damage to me at complete.insurancehelp@gmail.com , I will review those for you and intervene as appropriate. I will need to know more information as well but I will ask for that information later if you wish to pursue this with any assistance from me.

  925. November 17th, 2011 at 2:19 pm #Ty

    My insurance approved a claim on my house for roof and AC replacement. The storm was in 10/10, I put the claim in 04/11. I am trying to put my AC on now 8 months after the claim, they are saying since 1 year has past from 10/10 they do not have to pay on the claim, how can this be?

  926. November 17th, 2011 at 4:09 pm #Jason

    Ty,
    It’s based on the contract agreement located in your insurance policy.

  927. November 18th, 2011 at 8:59 am #justme222

    Ty,

    In most policies you have a year to replace. I am almost certain that that’s the case with yours. Ufortunately you can’t do anything about it if they don’t wanna grant you more time, but you can ask. Sorry, but that’s just how they do things.

  928. November 18th, 2011 at 7:01 pm #Melinda

    Several months ago we had a severe hail storm in Tennessee that resulted in many property damage claims in the area. Our home had roof and gutter damage that caused a ceiling leak in our bedroom. We filed an insurance claim; however, due to the number of claims in our area, it took several weeks for an adjuster to assess the damage.The insurance company approved the claim and issued a check made out to us & our morgage company (GMAC). The morgage company stated they would release the funds in thirds with the final third released after inspection of the work. The morgage company has had the check for 4 weeks and has yet to release any funds. It is now approaching winter and we must go ahead with the roofing work before the winter weather prohibits it from being done. How long can the morgage company delay releasing the initial third of the money? Do we have any recourse for further damage from leaking ceiling during the delay of receiving funds from morgage company? If the delay in receiving funds from our morgage company continues and the roofers are not able to work due to freezing weather, what can we do?

  929. November 18th, 2011 at 8:12 pm #Jason

    Melinda,
    Please see the situation of Ty immediately above? If you have been paid AVC and there is an amount you can claim after the repairs have been completed, you need to know that.

    You really need to be discussing this with your bank. It’s been about 4 weeks since you should have been released the initial 1/3 of money. Are they waiting for you to submit an accepted contractors estimate? Because the bank is not releasing your funds, it seems to be a bank issue and not insurance an insurance issue.

    If the repair required to the damaged ceiling increases more than what they have already estimated, someone will have to pay for that. The roofers should be working on this job already and you should not be dependent on the bank holding you hostage. This is your home and you need to get it repaired because if you don’t, nobody else is going to.

  930. November 21st, 2011 at 2:57 pm #Deborah

    I have homesite HOMEOWNERS insurance
    HO 04 95 11 92

    I have sump pump coverage of $5,000. My adjuster just allotted us the max which is the $5,000. I just don’t understand , does this amount include my “personal property” too?

    I don’t understand this statement which the adjuster told me to read .

    This endorsement does not increase the limits of
    liability for Coverages A, B, C or D stated in the
    policy Declarations.

  931. November 21st, 2011 at 8:22 pm #Drenched

    Last month a storm dropped 18″ of snow, several trees and 5 days of power outage in NJ. After several days of no electric I walked into 4″ of water in my finished basement. The fairly new toilet was spewing water for ??days?? The water to the toilet is shut off and the adjuster is the only one who examined the toilet. Allstate is denying the claim due to Mechanical breakdown. I’m having a very difficult time accepting their decision. I’ve used the same insurance company for over ten years and have never submitted a claim. Your thoughts???

  932. November 22nd, 2011 at 2:16 am #Jason

    Deborah,
    Yes, that is the total amount for your home and your personal property.

    This endorsement does not increase the limits of liability (insurance company obligation) for Coverages A-home, B-other structures, C-personal property, D-additional living costs.

  933. November 22nd, 2011 at 2:21 am #Jason

    Drenched,
    You indicate the water was not being supplied to the toilets yet water was coming out of them. That would be water backup. If you have water back up and sump pump overflow, you may have limited coverage. Otherwise that condition is excluded in your policy.

  934. November 22nd, 2011 at 9:45 am #Mike

    I had a homeowners claim, I have been living together with the same woman for over 5 years but we are not married. Can her property be covered on the claim?

  935. November 22nd, 2011 at 10:18 am #Jason

    Mike,
    Technically her property is not covered in the policy. This is likely what your policy reads:

    Property of roomers, boarders and other tenants, except property of roomers and boarders related to an “insured”

    If she is not related to you, then that would apply. The only other thing depends how her property because damaged. If it is your fault, like you running the items over accidently with your car, then the following would apply:

    Damage To Property Of Others – 1. We will pay, at replacement cost, up to $1,000 per “occurrence” for “property damage” to property of others caused by an “insured”.

  936. November 22nd, 2011 at 10:26 am #Drenched

    Jason,

    Thanks for your prompt reply – I apologize for being unclear. Water was being supplied to the toilets until I found the one spewing. That’s when I turned off the valve. It’s still off so I have no idea why it overflowed. My focus has been on emptying, tearing out,drying and insurance coverage. This was clean not sewer water in the basement – My neighbor said it may have been a valve. This was not my idea of minor water damage but 1500 sq feet of carpet, three rooms of furniture, and now smelly sheet rock & floor board. The denial letter said Mechanical Breakdown.

  937. November 22nd, 2011 at 10:34 am #Jason

    Drenched,
    To provide an example, if water escaped from your toilet by means of a water supply malfunction, I don’t believe that was the intent of the mechanical breakdown language in the policy. The wording in your policy refers the exclusion concerning mechanical breakdown in the surrounding context:

    (a) Wear and tear, marring, deterioration;
    (b) Mechanical breakdown, latent defect, inherent vice, or any quality in
    property that causes it to damage or destroy itself;
    (c) Smog, rust or other corrosion, or dry rot;

    Mechanical breakdown concerning a toilet would be if the porcelain was old and it crumbled causing it to “breakdown”. The insurance company appears to be using the intent and wording of the policy incorrectly.

    I would need to know exactly what broke down (allegedly) for them to rely on this exclusion.

  938. November 22nd, 2011 at 10:37 am #Jason

    Drenched,
    If you wanted to send me specific details of your claim without posting at all the details on this forum, send it to complete.insurancehelp@gmail.com

  939. November 26th, 2011 at 3:43 am #Desperate

    Jason,

    In 2008 we took in a foster son, Roger, after Child Protective Services removed him from his drug addicted parents. For 4 of the 5 years he was with us, he did well. He was captain of the football and lacrosse teams in our town, had perfect attendance and was an honor role student. However, that all changed overnight when his older brother was released from jail (where he’d been for entire time we had Roger) and he quickly started to decline. Within a few weeks he’d become extremely unmanageable. He lied, stole, refused to follow rules, did whatever he wanted to and when he was punished, he would just runaway. Finally in June, he got caught stealing from his teammates and friends at school. Not just ONE item, but COUNTLESS items – from their backpacks in the locker room. Roger was a popular student, and as their Captain, they trusted him. Once he was caught, it was decided by the parents of the other students that he needed to admit what he’d done to the whole team. Well, he couldn’t do that. He didnt want to ever face his peers again, so he had asked his previous law guardian if he could be placed in a different home. Her answer was no. So he ran away. He was gone for 5 days, and when he finally came home he was totally stoned, and had been with his mother running the streets and decided that was the life he wanted. He made more calls about how he could get out of our home, but he was consistently told he couldn’t. Well, the final straw came on July 11th. At 2am we notified that Roger, was caught looking in the bedroom window of a 13 year old classmate. We had spoken to him countless time about this because he had been stalking her for weeks. We had done our best to control him but there wasnt much left we could do. That day he ran away for the last time and made it clear that he wouldnt be back.

    Just before the July 11th episode, we had been trying to get assistance from ANYONE. Counselors, the state, the county with a PINS petition and various Family Asset teams, however, none of those were able to help. Once he ran away this last time, we were done. We had done everything to help the kid and we knew Roger was with his biological family in the inner city. His mother is a crack addict and a prostitute. We knew that she had been giving him drugs since he was 7, except for when he lived with us. But after he ran away, we learned he had joined their gang (the mother, brother and sister are all members of the same gang), he was carrying a gun, he was back to doing drugs with them and burglarizing people. We decided that we needed to protect ourselves so we gave him about 2 weeks to come to his senses. When that didnt happen, we packed up his belongings, changed the locks and went down to the courthouse to rescind legal custody and request an order of protection. On August 1, 2011 I had that paperwork notarized and brought it to the court house to file it however, We were told that as long as we couldnt find Roger, we couldnt serve him and therefore the court couldnt do anything. We were told we would just have to wait for the police to pick him up. What a joke. They dont look for runaways in this community because “they dont have the resources.”

    Anyway, on Sept 11, 2011, I came home and found that my house was burglarized. There were multiple windows and door kicked in, and the most valuable things we owned were stolen. We knew exactly who did it. First of all, we live way out in the country and our house is surrounded by farms, we also have a rather large dog and no one would’ve come in with him in here, and finally there were things stolen that no one else would’ve known existed. For instance, in a sea of books there was one very rare and valuable book that I hid rare cash in. It was the only book that was touched, and it was missing. We immediately filed a police report and called the insurance company and I explained to the claims rep exactly who I believe burglarized our home. One of the things stolen were my medications. Since I needed those to survive, the homeowner’s insurance cut us a check for that immediately.

    During the time it took me to complete the rest of the claim we located Roger and he was taken into custody. He was placed in an unsecured living facility while the court tried to determine an alternative living arrangement for him since he was no longer welcome here, nor did he wish to come back here. He was charged and admitted to burglarizing our home. However, before the judge can release us from custody, Roger has to be in someone else’s custody. First they tried another foster care home, where he stayed for under 15 minutes then ran away. He was placed back into custody and the judge again tried placing him on house arrest with his aunt. It was to be a 7 day trial period, at the end of which we would be released from custody. He didnt make it 48 hours. He is currently on the run again.

    In the meantime I submitted my claim to the insurance company and we were denied! We received a letter stating that Roger (who is not listed ANYWHERE on our policy) was technically considered an “insured” because he “was in our care.” While technically, yes, we did have legal custody, he did NOT reside with us any longer, and hadnt for over 60 days. But more importantly we did EVERYTHING within our power to protect ourselves from him and be released from legal responsibility for him. The insurance rep also claims that even though we’ve spent the last 6 months going to court to get released from custody, that we are currently still uninsured if HE were to rob us again because he ran away again before the judge could relieve us. I have done everything I can to protect us, but I can’t live in a bubble. I need to have the repairs made to my home, as winter is COLD in upstate NY. We have not been able to replace the windows or doors due to financial reasons. What can I do? How can I fight this? And what can we do to protect ourselves while he’s on the loose?

    Thanks
    Desperate

  940. November 26th, 2011 at 8:34 am #Jason

    Desperate,
    Roger is legally your relative and your insurance policy excludes theft by family members. It is based on the principle that the family is one unit and that is what the policy protects – the family unit. Technically, a family cannot steal from itself because the items remain in the family and for the family’s benefit. Also, the damage to windows and doors is intentional damage by an insured of your policy. That is also excluded.

    So you ask “what can you do and how can you fight this”. There is absolutely nothing you can do. Even if Roger had an accomplice when he did this to your home and property, the entire act is being done at the direction of an insured and still not covered by your policy.

    I have no suggestions for what you can do to protect yourself from him.

  941. November 26th, 2011 at 4:39 pm #Jim Reardon

    I filed a claim for a fire loss ten months ago and my insurance company originally came in and started to dry the house out. After a couple days they pulled the plug and investigated the claim for ten months. The just agreed to pay a couple days ago and want to go in and mitigate damages. I boarded the house up and did what I could to prevent future loss, but didn’t have the resources to do anything else. There was mold from the water from the fire department and sense they waited ten months it’s spread, they also want to test for asbestos in case the there is asbestos where the mold is. My question is that since they waited so long didn’t they drop the ball on mitigating damages. Mitigating damages should be done right away and they didn’t do it. Now that it’s been so long I just want to get paid for the loss and the additional mold clean up. I don’t have a mortgage and I might just buy another property. Since it’s been so long can I request that they just pay the total claim and let me deal with the house? I understand them cleaning the mold and water right after the loss, but now that it’s been 10 months I don’t think a couple weeks will make a difference. Should I be able to request payment and deal with the house myself. I want them out of the equation so I can move on.

  942. November 26th, 2011 at 5:14 pm #Jason

    Jim,
    I don’t know the specifics of what your all your options are. Do you have replacement coverage for the property? You can ask if they will pay the total claim. Unless we know more about your policy, the state in which you live, and other factors, we don’t know what your options are.

  943. November 26th, 2011 at 5:25 pm #Jason

    For more specific insurance claim help, simply e-mail your situation and questions to: complete.insurancehelp@gmail.com We will submit and post your insurance situation and answers on this forum without any identifying information about you. To provide more detailed claim solutions, we may need to ask more specific information from you so provide your e-mail for that purpose. Submit your questions only once.

  944. November 26th, 2011 at 7:50 pm #Jim Reardon

    I live in Syracuse, NY and I have a deluxe policy which covers replacement cost. There are ready to pay and just want to do the mold clean up and test for asbestos. Also, my public adjuster said we have to remove the asbestos if there is any, but I just want them to pay the claim and pay for the additional cost of this removal. I don’t want it to be done now, because I might buy another house or rip this one down and rebuild. I would have let them do this if it was right after the fire, but it’s been 10 months and I just want the claim payment.

  945. November 27th, 2011 at 6:09 am #Jason

    Jim,
    What does your insurance company say when you posed these questions to them? What advice are you receiving from your public adjuster concerning your intentions?

    Out of respect to you, I’m going to refrain from adding anymore confusion to your situation. Right now you have too many people involved in your claim for me to add my guidance. You have yourself, your insurance company, and your public adjuster. To add one more person would be of no benefit to you.

  946. November 27th, 2011 at 9:10 am #Jim Reardon

    Jason,
    I’m just trying to get an outside opinion. My public adjuster is new to the field and seems like he just wants to please everyone. He says we have an obligation to mitigate damages so we have to do these things, but I don’t think he has asked the insurance company if we can just get paid the full claim and deal with everything ourselves. I emailed an attorney I worked with for my EUO to get his opinion, but he hasn’t emailed me back yet. I boarded up the house and did my best to clean up after they pulled the plug, so I did what I could to mitigate damages. The summer dried the house out and now that it’s been 10 months it seems crazy for them to want to pick up like nothing happened. I might sell the property as is and buy another property or tear it down and build new, so I really just want to get paid for the claim and get them out of the picture. I appreaciate any help you can give and I just want an opinion so I have an idea where I stand.

    Thanks

  947. November 27th, 2011 at 9:27 am #Jason

    Jim,
    I won’t do that to you. There are way to many people involved in your claim to add any more opinions, ideas, or strategies. Besides the all the people involved in your claim that I’ve already mentioned, there is also an attorney. Even before I knew that, I mentioned there were too many involved in your claim.

    The simple advice I will render is to eliminate any involvement with your attorney. He has served his purpose with the EUO. He cannot help you any further. Anything to do with that attorney will only complicate your claim and allow him to charge you more billable hours.

    Then, get rid of this unqualified public adjuster. (That likely being impossible because of a contract you have with him.) You have to realize if your intent is to get rid of the insurance company after being paid, that is contrary to the objective of the public adjuster because he wants the insurance company there for every single step of this phase so they can pay for everything, including all the unknowns and those things that can be added later.

  948. November 27th, 2011 at 6:25 pm #justme222

    Jim,

    Yes, you have the right to take the money and buy or build if you want. You must understand that you need to find the property and then they will pay you the full amount. Your adjuster can show you how that’s done. If you just want the money then they will deppreciate. You have to talk to your adjuster about how much. Since your adjuster don’t seem to be giving you all your options you have to deal with him boldly. Tell him what you want and and be direct. Also, the best way to deal with him is e-mail so that you can document all communication and hold him accountable for his actions. Keep your phone conversations limited cause he can always say they never happened…..trust me, they will do it. Further, the insurance company or you adjuster can’t tell you who to hire for your damages, but keep in mind that if you have them pay the claim and buy another property you are still responsible for the cleaning of the mold, etc., and the city will make sure you do it. It has nothing to do with your insurance company.

  949. November 28th, 2011 at 7:49 am #Kathy

    My 15 year old grandson stayed over night at my home. I should mention he is ADHD, forgot his med that morning. It was summer so he was outside while i was doing some work in the house. He came running in to tell me he caught our large barn on fire accidentally trying to make a “potato gun”. It was a total loss. Contents and barn recovery from state farm ins. was around 63,000. My grandson was so upset about the whole thing he spent every day helping clean up. About 2 months latter my daughter received a letter they were being sued for the amount. I am so depressed over the whole situation. What can we do? My husband and I also received a letter stating we should sue for deductions. We live in Pennsylvania. My daughter and her husband don’t own anything but a car. He was wounded in Iraq and just recently found a job.

  950. November 28th, 2011 at 11:22 pm #car insurance

    whoah this blog is excellent i really like studying your posts. Keep up the good paintings! You realize, a lot of individuals are searching around for this info, you could help them greatly.

  951. November 29th, 2011 at 2:59 pm #Jason

    Great forum. I have a question that I am very frustrated about.

    We had a cash value policy on a rental property that was damaged in a tornado. The insurance company issued a partial settlement after 2 months. The reimbursement did not nearly cover the cost of repair, even given depreciation.

    We pursued a more reasonable settlement.

    In the mean time, we sold the property (at a substantial loss). I have continued to pursue settlement with the insurer, which I began prior to the sale.

    Now the insurance company is telling me that I am committing insurance fraud by pursuing a claim on a property I no longer own.

    Is this true?

  952. November 30th, 2011 at 4:14 pm #Minivel

    I made a claim for roof damage. The adjuster estimated my loss to:7,273.08
    with a deductible of 2,200 and less Depreciation of 3,534.. I called them and they said they will send me the 3,534 when the roof is replace and the contractor send them a letter saying it was replaced.. question is Does the contractor have to be certified? My father will be replacing my roof and he is not a contractor are is certified.. And what kind of letter would i send?

    Thank u!

  953. November 30th, 2011 at 4:43 pm #justme222

    Minivel,

    No, he don’t have to be certified, but i suggest you call your adjuster and be up front with him and ask him how he wants you to handle the situation. I’m sure he will work with you on this one.

  954. November 30th, 2011 at 4:44 pm #justme222

    Jason,

    Yes, this is true.

  955. November 30th, 2011 at 4:47 pm #justme222

    Kathy,

    you can’t do anything. I am sure it’s in your policy. ask for a copy of it. whenever a situation like this one happens you must allow them to sue if they want to…..sorry

  956. December 1st, 2011 at 12:50 am #Christina

    Hi there,
    I am hoping that someone will be able to shed some light on a matter related to property owners insurance that has been ongoing for 11 months now. My parents live in a rural area and reside within a property that encompasses approximately 12 acres of land. They have lived here since 1988. As of January 2, 2011, the roof of the barn collapsed due to snow. My mother called the insurance broker to report the incident and was advised that our insurance policy does not cover damage to a barn. She had alleged that my mother had ‘turned’ down coverage on the barn back in August 2010 (when the policy was up for renewal) and had been changed from property homeowners to farm liability insurance, with a 50% increase in her premiums. My mother only answered questions pertaining to the use of the barn (ie. if income is generated from use of the barn, etc). My mother only answered survey questions that were posed to her and proceeded to renew the policy under the assumption that any/all structures would be covered. She did NOT (at any point) turn down coverage. That same day, I took the phone and argued that the terms/conditions of the policy state that ‘detached private structures’ are covered under our current policy and I demanded that we have this claim further investigated . She proceeded to look into the matter further. On January 6, 2011, a claims adjuster came out to the property to assess the damage to the barn and review the circumstances surrounding the occurrence. We were then sent a blank Proof of Loss form (in the mail) several days later. Several months had gone by and we had not heard from the claims adjuster and/or the insurance company. I proceeded to make several inquiries (on separate occasions over a period of 9 months) to inquire about the status of our claim. We were informed on a continual basis that the claim was ‘well passed’ the initial stages and entered the final stage and were advised that this matter would be settled by the end of September. Another month passed and I made an attempt to contact him again and was advised on November 2, 2011 (verbally) that our claim was being denied due to the fact that the barn was originally registered with the township office as a “agricultural building” and its original owners/builder intended to use it as such. We as residents of this property are not commercial farmers and only use the barn as personal storage. We were told that the fact that it is completely irrelevant that we do not use the building for anything agriculture-related. We were informed of this decision in writing from the claims adjuster, as of November 28, 2011 (with only 1 month left to challenge this decision within a 12-month period). This is the primary reason as to why the claim is being denied, coupled with the fact that our insurance broker is “claiming” that my mother did not want coverage (which is a total lie) and is as a result of failure to perform her due diligence when dealing with my mother on this matter. We were not officially informed (in writing) of this exclusion until May 31, 2011 when the renewed policy, for the period August 10/11 to August 10/12, was mailed to us. This was the first time that we were informed of this change to our policy. As of now, we only have one month left to challenge this matter. We feel that we have been dragged through the mud and are at our wits end as to what course of action to take. I don’t know if it is advisable to contact a public adjuster to assist in this matter or if we should proceed with legal action against the insurance company or broker. I realize how limited we are in terms of the deadline (January 2, 2012 – 1 year from date of claim) to proceed any further and if there are grounds to fight this. My parents are both retired people on a fixed income and I personally feel that they are being taken advantage of due to the circumstances and the fact that English is not their first language. Any advice or additional insight would be greatly appreciated. I don’t know what to do to help them at this point…..I do apologize for the length of this question…

  957. December 1st, 2011 at 12:02 pm #Jason

    Christina,
    What it sounds like is the policy insuring your folks property is a homeowner policy. That policy does have coverage for related private structures. It’s likely an HO-03 Homeowner policy. The HO-03 is a very common insurance form used. If they have a policy that is similar to FO-3, then the barn would have to be listed in the declaration page of your policy for it to be covered. The FO-03 is a Farm/Country Home Owners policy.

    One way to extend that 12 month time period is to file a lawsuit against your insurance company. Doing that will extend the amount of time to continue to pursue this. We will need to know more about your parent’s claim that will be too detailed for this forum. If you want to discuss this further, simply send an e-mail to complete.insurancehelp@gmail.com and provide the name and number of the insurance policy (generally found on the bottom of your insurance forms), and the state in which this barn is located.

    That way we can converse with more specifics in the e-mail exchanges. The answer/response will be posted on this site and won’t contain any personal information about you.

  958. December 1st, 2011 at 12:26 pm #Jason

    Jason,
    No, you are not committing fraud. What you are doing is negotiating for more compensation in regard to your damages. You are doing nothing against the law when you disagree with someone about the ACV of your damaged property.

    Insurance fraud occurs when an insurance company, agent, adjuster or consumer commits a deliberate deception in order to obtain an illegitimate gain. It can occur during the process of buying, using, selling or underwriting insurance.

    You are doing nothing deceptive when you do not agree with the ACV of damage. From what you posted, you are not doing anything deceptive and that is apparent because the adjuster is aware you no longer own the property.

  959. December 1st, 2011 at 1:12 pm #Ric del Rosario

    My question is how long does it take for claim adjuster/or the claim examiner to give you a idea of the settlement and can we request a copy.

    we had a water damage in my home. And its been 3 weeks now since the accident and we have’nt heard any information about the settlement. I called the adjuster to follow up the case. And he replied ” i’m to busy with my other case and i need to finish them and then you” is that a right response for them.

    All we need is an idea for us to prepare and to get a quote (contructor) for the repair of the damage.

    thank you very much

  960. December 1st, 2011 at 1:40 pm #Jason

    Ric Del Rosario,
    Sure you can request a copy of the estimate. Your home damage is the subject of the damage in that estimate.

    Sounds like your adjuster is too busy and/or doesn’t have good time management.

    Whether you have the information from the adjuster, you need a contractor and the contractor’s estimate, so get that right now. You have to get that no matter what.

  961. December 1st, 2011 at 5:32 pm #Edward Dent

    I live in NJ and I recently discovered a severe mold problem in my basement (professional tester and lab confirmed it). I filed a claim with my insurance company since I have a specific mold rider. They sent an inspector and they told me that the inspector showed that the mold was initiated by seepage through the basement walls and that seepage was not a peril insured against.
    The mold rider SPECIFICALLY says that mold caused by seepage is covered as a peril insured againt. When I pointed this out I was then told that the TYPE of seepage is not covered because it came from ground water and in the general policy WATER DAMAGE is excluded when it results from seepage due to ground water AND mold is considered water damage
    My position is two fold. First, the specifics around ground water seepage should have also been put into the mold rider if they did not intend to cover that SPECIFIC type of seepage. By specifying a specific cause of seepage in the general section, but not on the rider, implies that all forms of seepage that cause mold are covered (lest it should have been excluded).
    Do you think this makes sense and that I have a good shot at appealing this. The mold remediation costs $5000, but the rebuilding will max out the $10,000 limit. Also, my family has been sick all year and our doctors believe it is due to the mold in the house.

  962. December 1st, 2011 at 7:27 pm #Jason

    Edward,
    Had it not been for the water seepage at or below ground level, there would not be mold in your house. Since the damage from water seepage is excluded in the base policy form, it carries that exclusion forward to you mold coverage form. It is possible some limited coverage exists (for example if mold results because of a fire and the water the fire department uses to extinguish the fire.)

    You can appeal this but you will only be successful if there was a covered cause of loss that caused the mold.

  963. December 1st, 2011 at 7:56 pm #claims solicitors

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  964. December 1st, 2011 at 8:20 pm #justme222

    Ric,

    request the copy of the estimate from your insurance company via e-mail.

  965. December 1st, 2011 at 8:28 pm #justme222

    Ric,

    DO NOT get an estimate from your contractor first. Why: simple, your contractor may give you cheaper estimate than the insurance company’s. why would you show your hand before you have to. keep in mind also that the insurance company may be intending to fix other things that you did not realize they were….but not if you present them with the first estimate. Note: you do not even have to get an estimate from a contractor if he agrees to do the work according to the scope(estimate) that your insurance present which would more than likey be more than what he would have quoted it. joke: then your contractor might share a little bit of the wealth with you….get it!!!!! (free one)

  966. December 1st, 2011 at 8:31 pm #justme222

    Ric,

    I forgot to answer you other question. the time limit varies from adjuster to adjuster and so on. in my opinion you should be like a month before you get things squared away, but that’s just a guess. i may be wrong, it could be a little sooner, but not much later.

  967. December 2nd, 2011 at 7:39 am #Deb

    About 4 years ago we had an addition put on our house, above the main area of a split level home. A few months after the addition was completed, we had water coming in through the walls right into the electrical box in the heater room. The builder came and “sealed” the area around where the wires came into the house which wasn’t the actual source. We found this out more recently when I took table leaf out of the coat closet by the front door and the whole wall is moldy along with the closet contents. Of course I called the insurance (Travelers) and I live in Pennsylvania. While the agent was inspecting the front, I mentioned that the corresponding area in the back of the house, that all is where the old and new sections of the house meet, has water damage too.
    About 2 years ago, we had filed a claim when water was coming in right through the window in the kitchen (back side of the house). The claim adjuster, withdrew the claim at that time because there wasn’t enough damage. The water stopped leaking through the window but then tracked to a different area and has eaten away at the corner wall of the kitchen near an exhaust fan.
    Today he emailed me and is having another inspector come to see if they can determine the cause of the leak that caused the mold in the front closet but the adjuster said that the kitchen area is not included in his claim as it is part of the claim from two years ago that was withdrawn becuase the loss date was from 2 years ago for that part of the house. I don’t understand why that is the case when the damage now was not there 2 years ago. I’m worried that maybe now they will say that the back part of the house isn’t covered since too much time has passed.
    Do I need to go after the builder of the addition, since that was when all this started?

  968. December 2nd, 2011 at 6:20 pm #Jason

    Deb, if the water is coming in at or below ground level, the damage won’t be covered. Perhaps you should have the builder correct these issues.

  969. December 3rd, 2011 at 7:09 am #Ric Del Rosario

    @ justme222 thank you very much for the advice. Yesterday I called my adjuster follow-up the development of the case and asked for a copy. He said the paper was already passed to the examiner and advice to get the copy from them. Called them up. The paper is there but she refuse to give me an estimate. She said, when we send you the check the copy of the adjuster report is there??

    My question again is?
    What happens if the damage settlement is not enough the repair or replace all the damage area?
    When is the right time to settle this issue.
    Can I refuse the sign the check??
    Please advice thank you very much…

  970. December 5th, 2011 at 12:52 pm #Carol

    My daughters house has multiple problems, 2 bathrooms have black mold and leakage from pipes, the walls have to be torn into and replaced, the mold taken out and the pipes replaced. the insurance adjuster did this as 2 claims. which took 2 500.00 deductibles, I thought this wasn’t right. But, when I contacted my adjuster he said yes it is 2 different incidents. the claims were written on the same day.. I explained to him that I had a roof leak and had a bedroom fixed and the roof replaced, that was only on 1 claim, but he went into if you have a car wreck 1 day that is a claim and if you have a car wreck the next day that is a claim. Yes, I understood that…. but this is different. Can someone explain this to me?

  971. December 5th, 2011 at 2:18 pm #Jason

    Carol,
    I’m sorry this guy brought cars into his explanation because cars have nothing to do with your daughters homeowner claims.

    It depends what the source of water is for each claim. If 2 separate areas of your daughters home were damaged from water from a broken pipe, then that would be one claim.

    If there were the same 2 different areas of damage in your daughters home from the broken pipe and there was another area of the home that was damaged from water that leaked from a hole in the roof because of a tree branch that fell and made the hole, then this would be 2 claims and 2 deductibles.

  972. December 6th, 2011 at 8:16 pm #shirvell

    Is there a legal rate/cap that a public adjuster can charge to help with a claim in the state of pennyslvania…Is 20% the going rate for this service?

  973. December 6th, 2011 at 9:35 pm #Adam

    We had a couple severe hail storms roll through northern Illinois over the summer that did some moderate damage to the windows of our home. A property claim company came out and inspected the windows — determining nearly all showed evidence of spattering and/dents. Further, about 8 windows had broken seals. Our insurance provider, Liberty Mutual, sent an adjuster who had no idea about windows who cut us a small check covering a power outage during the storm time (for spoiled food in the fridge) and to cover skylight flashing kits for the 5 damaged skylights (two of which leaked and one had broken seals).

    She then proceeded to say one of their contractors would need to come out as she didn’t think replacement of the windows was warranted. A few weeks later their contractor came out and met with our property claim rep and looked at all windows. He agreed that the majority of the windows had evidence of hail/wind damage and should be replaced. The Liberty Mutual rep said things were approved and were in process of being finalized. A couple months of back and forth went by when the insurance rep said their contractor hadn’t filed some necessary paperwork.

    The property claim rep kept on top of Liberty Mutual rep who rarely returned calls. Finally, the Liberty Mutual contractor stopped by (unannounced) to look again at the windows. He didn’t actually inspect anything but suggested his company could do the work and since he was authorized to approve the windows we would get more approved. It seemed shady to say the least. We told them we already had a contractor we’ve used before and would be using for the work.

    Next day we get a call from the Liberty Mutual adjuster saying 16 windows were approved & the 5 skylights for replacement. This was a shock as the original word form their contractor was 45 windows and the 5 skylights.

    Yesterday we had our own contractor come out and take a look and he agreed with the original assessment of the property claim company and the insurance’s contractor in that 45 windows and the 5 skylights were damaged and needed replacement. He submitted a bid directly to and spoke with the insurance adjuster today.

    I haven’t heard a final answer but what should I do if Liberty Mutual tries to only approve the 16 windows. It seems very suspicious as three contractors (including Liberty Mutual’s) all say 45 windows and the skylights should be replaced. It seems that only after Liberty Mutual’s contractor was told by me he wasn’t doing the work (which I assume is a direct conflict of interest) that he changed his “assessment” and told Liberty Mutual only 16 windows warranted replacement.

    Your experience, wisdom and advise are greatly appreciated.

  974. December 7th, 2011 at 5:20 am #Deb

    HI again, it’s been a few days but I was the last Deb to post the question about water damage. The water is coming in through the roof and siding. I just found out from an inspector that the insurance company sent out that it was due to poor design and workmanship by the builder who did the addition.
    If the insurance company denies the claim, what would be my next steps? lawyer? or just contact the builder to see if his insurance will cover it.

  975. December 7th, 2011 at 6:31 am #Jason

    Deb,
    Perhaps the water that is coming in through the roof and siding is covered. The insurance company won’t fix the poor design and workmanship by the builder. You policy, if it’s like most homeowner policies has a concurrent causation clause it in it. This clause simply states that if a covered cause of damage occurs with an uncovered cause of loss, then the entire loss will not be covered. We don’t know enough about the details of your claim from the information you provided in you posts to provide more information to you.

    The contractor’s insurance may cover the resulting damage because of the contractor’s inability to do this job correctly but it won’t have anything to do with making the job right which sounds like doing the entire effort over from the beginning.

    I don’t know about you but if this is the result of that particular contractor, I would have lost all trust and faith in his abilities to do anything correctly.

    Why would you contact a lawyer?

  976. December 7th, 2011 at 8:20 am #Deb

    Thanks Jason! I may have been jumping the gun with considering a lawyer, it’s just that I’m worried that the contractor won’t want to bear the burden of the damages that ensued from his poor workmanship. The water that has been coming in from the flashing and siding is pretty extensive and is in the front and back of the house encompassing 4 rooms.
    I definitely have lost faith in the contractor but I also don’t want to have to pay out of pocket for the roof flashing work. Would the contractor’s insurance cover someone else to do the repair?
    Do I have another option to have the contractor do the repairs and then insist that it’s inspected by a third party at the contractors expense?

    Thanks again, this site has been very valuable!

  977. December 7th, 2011 at 8:40 am #Jason

    Deb,
    I have lost faith in this contractor too. If he can’t do it correctly the first time, there the odds of him messing up again are pretty high.

    It’s likely that you didn’t do a lot of background work when you got this contractor because of his poor workmanship and with these kind of people – it’s almost guaranteed they don’t have insurance. You get what you pay for and you probably got a cheap job but the results are right in line with what you paid.

    If this is covered by your insurance, your insurance may go after this contractor to collect for the repairs made necessary because of him. Again, I am assuming everything to be accurate that you have posted.

    Yeah, if the contractor has insurance, that insurance would allow you to hire whoever you wanted but it’s very important to make sure you get qualified people to do any type of work on your home.

    You can make any arrangement you want concerning a reinspect by someone else but why? If the contractor is qualified, why go through that extra work? Just get a qualified contractor that can do things without causing more damage. If he does the work correctly, it won’t need to be inspected. I personally believe a job should be done only once.

  978. December 7th, 2011 at 12:49 pm #Deb

    Thanks Jason!

    The contractor is local but has been in business for over 35 years and he is insured. So he’s not completely a fly by night operation. I will be sure to request another contractor regardless.

  979. December 7th, 2011 at 5:03 pm #Kat

    Hi,
    I have the following situation and would appreciate your advice:
    Late September 2011 my tenants noticed 2 gaps in the corners of their kitchen wall. It appeared that the tape in the corners came off and revealed gaps of abot 3.5 inch wide- the wall has separated from the joists. I had several contractors look at the damage and say that it happened because of the snow load we had last winter (I live in Massachusetts). Roof may have more than 1 layer of shingles (I do not know how many)- so the additional weight of the snow started to push the wall out. Once the portion of the wall completely separated from the joists and the nails came all the way out- these large gaps in the corners became visible. Company’s claim adjuster had an egineer look at it. Engineer came out and asked if I tried to fix the problem- according to him the wall separated long ago and somebody tried to fix it. Commerce told me over the phone today that based on engineer’s report, the wall separated many years ago, before I purchased the house, and the issue was concealed, therefore, they are denying my claim.
    Now, I was able to find pictures of the kitchen from 2 years ago that don’t show these large gaps- the wall looks fine. My tenants provided me with a few more most recent pictures of the same wall -one taken this spring may show a slight sign of a problem- the wall probably shifted somewhat and revealed an unpainted portion (1 mm) of the board that runs across the kitchen all. My tenant has also signed an affidafit affirming there were no gaps and she became aware of the loss this fall. I have hired an independent architect/engineer to inspect the walls and provide me with a report of his findings.

    My questions are:
    1. Do I need to get legal involved at this point or do you think I have a chance of fighting on my own by submitting my appeal with all the pictures, tenant’s affidavit, and architect’s report (if my architect agrees with builders)
    2. Commerce refuses to provide me with a copy of adjuster’s and engineer’s reports. They cannon provide me with evidence that would say it was a known issue. The tape that came off in the corners is not wide enough to cover the gaps, so it is obvious the gaps appeared recently. Do I have a legal right to copies of their reports?
    3. Per contractors temporary fix may not bring any results and does not guarantee against further damage, if we had significant snowfall. So it has to be a permanent fix- costly and I need to come up with my own funds. Do I need to wait for Commerce to review my appeal and agree on coverage before I hire a contractor? Time is not on my side. They’ve been dragging my claim for 2 months before denying it and now we are getting very close to the snow season..

    Any other advice, suggestions, opinions will be much appreciated.
    Thanks,
    Kat

  980. December 7th, 2011 at 7:14 pm #Jason

    Kat,
    Do your appeal with the old pictures, your tenant’s affidavit, and your architectures report, whether he agrees with the contractors or not. Also, present all the facts of your position that you can to convince them your claim should be paid.

    I would have to inspect and evaluate the property before I knew what the remedy would be. There are a couple of principles here that the insurance company is ignoring. That would be that your policy covers damage from the weight of ice, snow, etc.

    For example, if a car gets smashed and the front fenders, hood, and bumper are repaired from that accident and the car is then purchased by you, your insurance company cannot and will not say they are not going to repair your car because it was damaged (and repairs) before. What the insurance company is basically saying is they are not fixing your damage because it happened one other time and was repaired.

    The car repair (or the house repair) may not have been the best or most appropriate repair but you purchased this house without the damage you are claiming at this moment.

    During your coverage duration with the policy with Commerce, you experienced damage from a covered peril. What is supposed to happen is an estimate to repair the damage, and payment for something that is sudden, accidental, and needs to be repaired, and your claim should be settled, not denied for something that was repaired with the best techniques and methods as was determined at that time.

    Another example is a leak from a pipe in the ceiling. The ceiling is opening up, the pipe is repaired, and the ceiling drywall is replaced, taped, mudded, and textured. Then the ceiling is painted. Does the insurance company consider this a concealment or a repair? To say the previous attention to this home is concealment is an irresponsible position on their part.

    The insurance is making leaps and bounds by saying what was done is a concealment rather than a repair. Their position is unfounded. This is a very weak denial if everything you present is accurate.

    No, they will indicate that report is something they commissioned and paid for. You can argue their position with the fact the subject of their report is your property they order and paid with your money. Yes, your premiums paid the the engineers expenses and fees for this report.

    Your premiums mixed with the premiums of thousands of other insured’s paid for that report. Your premiums pay their salary; your premiums pay for the office equipment they use; Your premiums pay for every single aspect of what goes on in your insurance company’s office. So, if they really want to be that way, ask them to send you the report you paid for.

    I say you have a right to those reports but a judge many not agree with that because judges seem to be on the insurance company’s side no matter what the issue. It’s not a level playing field.

    If you would like to provide more specific details about this claim, photos, your architects report, etc. you may send to complete.insurancehelp@gmail.com

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  981. December 8th, 2011 at 6:08 am #Kat

    Jason,
    I appreciate your input! You provided some good arguments I haven’t considered. The architect should be inspecting the property today, once I have his report, will forward everything I have to your e-mai. Thanks again.
    Kat

  982. December 8th, 2011 at 6:58 am #Jason

    Kat,
    It’s a giant (insurance company) against you. They have unlimited resources made up of your premiums to do whatever they want.

    Imagine this – If they took the expenses of the adjuster they paid, the engineer that they paid, their time and expenses they invested into denying your claim and instead used all that money to repair your property, the property would be repaired with the money they wasted, they would have upheld their part of the insurance contract, and life for everybody would continue.

    Instead, they should be embarrassed about what they are doing and the lame excuses they have decided to use.

    If there are any public adjusters out there and you are reading this, perhaps you would be willing to donate your knowledge, experience, and advice to Kat to help her on this. I believe this is an injustice.

    I don’t think you should have to spend a dime to get a lawyer involved but unfortunately, that might be what is required. At this point, when your architect has completed their report to you, the best route for you right now is to appeal their denial.

    Please advise what engineering firm Commerce used.

  983. December 8th, 2011 at 12:19 pm #Kat

    Jason,
    I have all the reasons to believe their denial is ungrounded, but I as a consumer I have very limited resources, which makes it more difficult to fight Commerce. There’s not much knowledge available out there, I am collecting bits and pieces of information from all the sources I can put my hands on.
    The architect/engineer came out today but left very promtly after I asked to sign an agreement detailing his services and payment. He wanted a full payment upfront which sounded sketchy to me. For some reason it appears to be difficult to find a structural engineering firm in the area that would provide services for residential- all work with commercial properties. I probably called a dozen companies. I am still calling around to see if I can find a reputable engineer willing to inspect the property.
    The name of the company that Commerce hired to inspect my home is Cianci Engineering out of West Hartford, CT.
    Kat

  984. December 8th, 2011 at 12:37 pm #Jason

    Kat,
    Think about it. Why do you need an engineer or architect of your own? You know what the wall condition was like before. You had the weight of snow damage it and that is apparent with it’s current condition. You don’t need anybody to tell you that.

    What Commerce did was got somebody with more perceived credibility to write a report that anybody could have done. Commerce is then basing their denial on that perceived credibility and making up an excuse that it was concealed to deny your claim. (repairs are always concealed so it doesn’t look like it was repaired or worked on) There is no exclusion in your policy for “concealing” anything as far as repairs are concerned. In fact, a contractor would not be doing the repair correctly if he left things undone and open so you could tell a repair had been completed.

    Insurance companies hire these kind of professionals all the time and these people know the insurance companies will pay after the work is done because insurance companies pay. Regular customers don’t use these engineers the same way so they don’t want to do work and not be paid. So in order to keep their clients (insurance companies) happy, they almost always come up with a report that is favorable to insurance companies.

    Is the abnormal? No, it’s normal because people want to to like their work product or results. When this engineer produces results the insurance company can use to deny with, then the insurance company like it, and this engineer likes it because he now has another satisfied customer that got what it wanted. In this case everybody wins and the customer (you) lose.

    Please send photos.

  985. December 8th, 2011 at 2:03 pm #Dodie

    I was robbed in August and the thieves took off with laptops video cameras as well as 35mm cameras. They also took off with my pride and joy CD collection which consisted of over 200 discs. My replacement cost was around $6000.00 with a $1000.00 deductible. Now I really didn’t expect to get $5000.00 back but my insurance company came back 2 months later and said most of what I lost were considered “limited” items and were not covered. What else exactly do thieves usually steal if not these items. The claim is for $615.00 and I am at a loss and do not know what to do.

  986. December 8th, 2011 at 2:49 pm #Enrique

    Last week I have a water leak in my kitchen. My insurance company gave a estimate and will be released next week. But according to the Agent it was named thru Us and the Mortgager (Bank). We plan to hire a good friend to fix the problem ( He is working in a legitimate contractor).And we know the fact that he is good. Compared to a contractor we can save a little bit and put the money to upgrade the material to be installed. (example: instead of laminate countertop will try to install a granite instead).

    Is there gonna be a problem with the bank.??

  987. December 8th, 2011 at 5:22 pm #Kat

    Jason,

    I have forwarded you the photos of the damage along with older pics of the wall.

    Kat

  988. December 9th, 2011 at 6:00 am #Jason

    Dodie,
    If your claim is for $6000, that is about $30 per CD. What is the value of your computers, video cameras, and cameras? What is the value being allowed for each of those items. Is the $615 based on your ACV value or your replacement value? Do you have a replacement policy? Also, does the $615 include your deductible or not?

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  989. December 9th, 2011 at 6:08 am #Jason

    Enrique,
    There should be no problem with your bank. You bank simply wants to make sure the damage is repaired so they have the same value for the collateral they have securing your mortgage loan. Simply send the check to your bank and ask the bank how to obtain the funds and let them know what you want to do.

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  990. December 10th, 2011 at 10:46 am #Dodie

    The $615.00 is after $1000.00 deductible and I only claimed $10.00 each on CD collection. I had 4 cameras 1 video camera 2 laptops ( 1 of which was only a month old.) My adjuster told me to list everything right down to the orange juice and incense burner that was stolen. There were alot of things taken but I’m confused mostly at how the cd collection and cameras were considered limited items. I had to scan and email every cd jacket of the discs taken. Shouldn’t the adjuster know they wouldn’t cover these items ahead of time? So far they have shown me nothing of what was covered and what wasn’t. I had to call to find out what was happening with my claim they told me the adjuster had the check about two weeks prior to me calling. I heard from him about two weeks after that conversation and he was telling me I have to sign a “proof of loss” form before I can recieve my check. I have avoided his phone calls until I can figure out what to do. I have no copy of my policy so I feel I am up against a wall. The check they want to give me is a joke.

  991. December 10th, 2011 at 11:18 am #Jason

    Dodie,
    So the value of your claim is $1615. You really need to find out more about your claim. Generally, people have replacement coverage with their insurance and you will be paid ACV until you replace the stolen items. I don’t know anymore than you do about your claim but that is exactly what I would want to know. Do you know what “limited items” means? Well, if you don’t, you owe it to yourself to find out so you are not in the dark. What replacement means is that once your replace all the items you had stolen, you will be out $1000 and you will have everything replaced (and brand new).

    Why don’t you stop avoiding your adjusters phone calls and either answer his call or call him on your own so you can learn more about this process?

    The check they are offering is not a joke. What is a joke is that you don’t understand the claim process and you are doing nothing to learn about it. You are not going to learn what to do about your claim until you first can figure out what it’s about. In your case, learning a little bit can be the difference between having a good claim experience or a bad one.

    Yes, you will have to sign a proof of loss. That is a formal claim document outlining what was stolen and this is legal document that can be used in court. For example, that document can be used to support your loss if the insurance company finds the person that stole your property to ask the judge to order this guy to pay back what he stole from you to reimburse the insurance company for what they paid (and also to get your deductible back.)

    You will learn what is covered and what isn’t covered but you will not learn of that by avoiding the adjuster. Get involved in your claim so your can reduce or eliminate the frustration level you feel about the entire process. It’s not only you that’s frustrated by your avoidance, it is also your adjuster.

  992. December 12th, 2011 at 10:53 pm #Ted

    Ok so we lost our mobile home to a fire last saturday,, come to find out the coverage was for structure only!!! my question is, since the insurance company has sent out an adjuster and they do have the report from the F.D. and everything with it being a total loss and they are payin off the remaining mortgage do they have to give us the remaining amout of the isured amount? and can it be removed and or destroyed before they “release” the title.. The park it is currently at has told us it has to be removed by the 1st or the month however the insurance comp. is telling us it could take up to 30 days to finalize all the paperwork.. can i legally “dispose” of the unit without the title? or will i have to pay another months lot rent due to them not processing it quick enough??

  993. December 13th, 2011 at 11:54 am #Jason

    Ted,
    We don’t know how your policy is written so we don’t know how the settlement will take place.

    Those questions should be addressed to your adjuster and your mortgage holder.

  994. December 13th, 2011 at 2:31 pm #concerned

    if damaged areas are repaired using upgraded material and labor on a replacement cost claim will there be any problem with collecting the depreciation value holdback from the insurance co… do they care ….