Denied Insurance Claims Advice and Examination Under Oath Info

788 Responses to “Denied Insurance Claims Advice and Examination Under Oath”

October 13th, 2008 at 9:50 am #Suzanne

we had a hotwater heater burst on vacation damaged our wood flooring,was denied, and we are pursuing the claim further but we just received interregotorie questions that need answering is this legal to ask for 15yrs of questions also list all receipt’s and contractors name address
that did work on the house when we have only had the policy with them for 2yrs.
October 16th, 2008 at 5:42 pm #admin

Hello Suzanne,

Wow, thats a lot of stuff. When you use the word “interrogatories” that implies your claim is in litigation. Has a lawsuit been filed? Whether or not a lawsuit was filed, the 2 key legal words to focus on are “Reasonable” and “Relevant.” Most insurance policies themselves in “Your Duties After Loss” say you (the policy holder) will provide the necessary information “that we (the insurer) ‘reasonably’ require.” The law is the same in most states. If it’s in litigation, you or your attorney have to file an objection to each question or request for information on the grounds that it is unreasonable, irrelevant, over broad, vexatious, annoying and whatever fancy legal words attorneys like to use. If its not in litigation, just state your objection and reasons in a reply letter. Give them only what you think is reasonable and relevant. If the adjuster, claim manager, attorney persist in an unreasonable, invalid or illegal denial, fax a letter to the CEO of the insurer. Now the insurer will be facing punitive damages if your claim was unreasonably denied.

As to the water damage from the hot water heater, I assume the insurer is saying the damage occurred over a long period of time resulting in rotted wood. If the floor is not rotted, but just delaminated or swollen, that does not constitute “a long period of time”. Adjusters also often call black or stained wood “rot”. If you can’t push a butter knife through the wood, its not rotted. A reasonable insurer should cover the claim.

Don’t forget to make a rating on your adjuster and insurer in the Consumer Ratings section of this website when the time is right.
December 14th, 2008 at 9:47 pm #Paula

I have a question about a claim. Can my homeowner’s insurance company deny my claim for a break-in if we did not put our alarm on when we left out, we were only gone for a couple of hoursMy company is ny central mutual.
December 14th, 2008 at 10:45 pm #admin

Hello Paula,

I have never seen such an exclusion in a homeowners policy. But there is always a first time. I have never seen a NY Central Mutual policy. Look in your policy under exclusions, conditions and provisions, etc. Also look at the endorsements to see if there is an exclusion.

If you don’t want to put the question to your local adjuster, you could place a telephone call to a NY Central Mutual claim office in another city in New York. Ask to speak to a property adjuster. You don’t have to give your real name or policy number if you fear being charged with a loss.

If you would like me to review your policy for free, either mail, fax or email me a copy of the booklet and endorsements. I could use a copy of that policy anyway for the “Free Policy Copy” section of this website. (Your declaration sheet would not be posted). Just let me know and I will send you an email with my contact info.
December 26th, 2008 at 8:32 am #Karen

We have a house that’s been on the market for over a year. We stop in about once a week to check on it, since our new house is in the same area. A few days ago we found that the heat was off (Minnesota -10 degrees F), and in contacting the gas company learned that the last LP tank fill had been July. They filled it again, the furnace started up on its own, and when we went over to check on it later it was obvious there was pipe damage and water damage over 3 levels on one side of the house. It seems there was miscommunication with the gas company; they have on record that we requested that service stop after July. State Farm claims dept is saying it is denied because we didn’t take proper precautions. Do we have any chance? We are already paying 2 mortgages!
December 26th, 2008 at 2:59 pm #Karen

Update to our situation: The claims agent set up a conference call with the gas co., and asked them what evidence they had. They said they have a record in their computer that we called to update our billing address and then a note saying “July fill only”. The agent asked if they sent any notification in writing regarding the understanding about a change in the standing contract, and they said no. The claims agent took the conversation as sufficient evidence for them to deny the claim. He then said we might want to take the gas company to court. Does State Farm ever not find a reason to deny a homeowner’s claim?
December 27th, 2008 at 2:13 am #admin

Hello Karen,

Take a good look at your own policy wording under Section 1-Loses Not Insured (If you want to fax, mail or email us a copy of your policy for review, send an email to info@insuranceclaimhelp.org). Most home and rental policies say damage resulting from a broken pipe due to freezing is not covered if the house was “vacant, unoccupied or being constructed.”

If you have a “special form” policy, the burden of proof is on the insurer to disprove your claim.

My opinion is this:

1. Unless the gas company has something in writing signed by you, or a tape recording requesting no more gas, a note on the gas company computer could have been a clerical error.
2. There was no motive to shut off the heat. No reasonable person would shut off the heat.
3. The definition of “vacant” is open to interpretation and the entire clause is ambiguous, when compared to the exclusion for vandalism, further on down the list of excluded losses. Note it says that “a dwelling being constructed” is not considered “vacant”. That clause also gives 30 days as a definition of the time period of “vacancy.” You could argue that “under construction” implies new construction, not remodeling or maintenance, and if you did any remodeling or maintenance on the house, no matter how small, once every 30 days, then the house would not be vacant.

It would also look better if you had a good reason for not shutting off the water to the house. (I myself am so paranoid about broken water pipes, for any reason, that I will shut off the water valve to my house even if I am gone for the night. I leave the lawn sprinklers on with a separate valve.)

This is a tough claim to fight, even for professionals, and usually requires threat of litigation and multiple letters, sometimes up to the CEO for the insurer. You will be lucky if you get it covered.

And yes, suing the gas company is a possibility, if it can be shown that they were negligent. Also take a look at your contract with the gas company. And also talk to a lawyer who knows Minnesota law regarding negligence, etc.
December 27th, 2008 at 9:03 pm #Karen

Thank you for your helpful comments. What a great service this website provides.

Our policy states that loss resulting from freezing pipes is excluded from coverage if the house is vacant, etc, unless the homeowner takes reasonable care to:
a)maintain heat in the house, or
b)shut off the water to the house and drain the system.

We didn’t have the water shut off because we’ve had trouble with the line to the septic tank freezing, requiring a service call that costs about $100. The first time we had this trouble we still lived there, but were on a week’s vacation in January. The condensation from the furnace drains out to the septic, and if there is no water usage in the house the flow is too slow and it freezes. So to prevent this we stop over in the winter every 4-5 days and flush a toilet. Maybe in the future we’ll have to shut off the water and just take a few gallon jugs over to pour down the drain to the septic.

Regardless, given the “or” statement in the policy we were not required to shut off the water. It seems to me we did take reasonable care to maintain heat in the house–I don’t understand why the claims agent can deny our claim when all conditions were met. The fact that the gas company did not take reasonable care does not seem relevant.

I guess we need to get a lawyer to find out if we have a better chance suing the insurance company or the gas company.
January 1st, 2009 at 4:55 pm #admin

Hello Karen,

If your policy says “reasonable care” then that’s what you hang your hat on. Most policies don’t say that. Fax a letter to the adjusters supervisor with your story. If he denies your claim, then the next letter should be faxed to the CEO of the insurer. Don’t waste time climbing the chain of command. If the home office denies your claim, then go to small claims court if its under the limit or close. If its over the small claims court dollar amount, then see if a lawyer thinks its worth his time to handle on contingency. Of course any lawyer will work for an hourly fee. If a lawyer can shake them up with a couple of threat letters, it may be worth it.

Talk to a plumber and see what they do in your area. Maybe pour antifreeze in the drain once, but don’t flush? Or blow the water out of the drains with a leaf blower (or compressed air). The septic lines won’t be damaged from freezing water if there is no water in them. And I did not know that a partly full drain line would freeze enough to break a drain pipe. I can see if a p-trap would freeze, or a water line full of water???
January 5th, 2009 at 1:12 am #admin

Karen,

For some in depth easy to understand help, take a look at the Table of Contents for the UClaim report entitled “DENIED HOME AND BUSINESS PROPERTY INSURANCE CLAIMS ADVICE AND HELP DELUXE VERSION (W/APPENDIX) at UClaim.com . Scroll to the Miscellaneous report section.

It would be appreciated if you could take a few moments to give a quick rating on your insurer and/or adjuster and/or other insurer’s vendors on the Consumer Ratings/Rate Your Adjuster page of this website. You don’t have to show your real or full name if you don’t want to.
January 9th, 2009 at 10:14 am #Jane Pytel Insurance Expert

Just taking a moment to review some of the problems encountered by visitors to your site. Claim denial and claim delay are two of the most serious and common problems encountered by consumers. I know because I was in insurance investigator for 12 years.
Since my departure from insurance, I have taken a very proactive approach to assisting people who suffer from insurance company tactics.

I’ll be checking with this site, insuranceclaimhelp.org on a regular basis. Nice job.
January 9th, 2009 at 3:31 pm #admin

Hello Jane,

Thank you for your nice comments and spread the word.
January 23rd, 2009 at 9:18 pm #Maricela

My auto was stolen in Mexico, within 25 miles of the border. Farmers Insurance has denied my claim.
My policy reads : MEXICO COVERAGE – LIMITED ]
Read This Warning Carefully ]
Auto accidents in Mexico are subject to the laws of Mexico only-NOT the laws of the United States of America. Unlike the United States, the Republic of Mexico considers an auto accident a CRIMINAL OFFENSE as well as a civil matter. In some cases, the coverage under this policy may NOT be recognized by Mexican authorities and the Company may not be allowed to implement this coverage at all in Mexico. You should consider purchasing auto coverage from a licensed Mexican Insurance Company before driving into Mexico. This coverage does not apply to trips into Mexico that exceed 25 miles from the boundary of the United States of America.
The coverages for your covered auto provided by this policy are extended to accidents occurring in Mexico within 25 miles of the United States border. This extension only applies for infrequent trips into Mexico that do not exceed ten days at any one time.
Additional Exclusions
We do not provide any coverage:
1. if your covered auto is not principally garaged and used in the United States; and
2. to any covered person who does not live in the United States.

The claims office obtained a copy of my crossings using the license plate reader from the port of entry. My auto had crossed 15 times in the past 30 days. Farmers has determined that I am a frequent crosser. Why are they allowed to deny a claim if the definition of infrequent is not defined in the policy?
?
January 24th, 2009 at 3:01 am #admin

Maricela,

If the policy does not define “infrequent”, then they cannot deny your claim. Insurance policies are “contracts of adhesion”. This means you can’t line stuff out or change stuff when you buy the policy. It’s a “take it or leave it” deal. Therefore the law says that any ambiguities or unclear language in the policy must be ruled in favor of the party who did not draft the policy contract, (that’s you).

Fax a letter to the adjusters supervisor. If he denies it, then fax a letter to Farmers CEO at their home office. If he denies it, then sue them either in small claims court yourself or in Superior Court (if you can find a lawyer to take it).

You can compare your Farmers Mexican policy to a sample Mexican Auto policy download at UClaim.com . You can also get much more detailed information on how to pursue a denied claim with the report entitled “DENIED AUTO AND MARINE PROPERTY INSURANCE CLAIMS ADVICE AND HELP Subtitle: STANDARD VERSION (W/O APPENDIX)” for $29.95 also at UClaim.com .
February 20th, 2009 at 6:41 pm #Kyle Larson

My question revolves around exclusions. I manage a large roofing company and we handle aprox. 1000 roofs damaged by hail each year. An issue that is coming up alot lately is if the insurance company owes the insured for roof decking when the old decking no longer functional due to age delamanation etc…. I know that all policies exclude losses wet or dry rot, bulging cracking of roofs walls etc… and defects, weakness in materials used in construction… However my argument is two pronged. 1. Since it is not possible to install the new roof over the old decking. The insurance company cannot fullfill thier contract of restoring the insured to thier pre event postion without paying for the cost to redeck the roof. My understnading of replacement cost is to pay for “equivalent construction for similar use” If we were to install the new roof over the old decking it would not adhere to code or manufature’s requirements. Thus the insured has lost because prior to the hail they had a roof covering that met code and manufactuer’s requirements. 2. Most of these policies have an endorsement for code upgrades which states that if an undamaged portion of the structure is required by code to be replaced the inurance company would then pay that cost to repair or replace. We have had building departments visit the job sites and put it in writing that it must be replaced and we still get denials based on the exclusions. By definition a roof assembly includes the decking and therefore if needed would be a part of the damaged loss as you can’t complete the roof covering without replacing it as well. The response I get most often is “what caused the decking to need to be replaced” and I say it is the hail that destroyed the roof. Insurance companies of course don’t agree. What are your thoughts.
February 21st, 2009 at 3:36 pm #admin

Kyle,

You are absolutely right in all you say. And guess what, even without a code endorsement on the policy, they still owe for the decking if the shingles can’t be removed and replaced without further damaging the decking. You can’t get the new nails exactly back into the old nail holes, right? So right there you have more holes, more weakness in the decking.

Yes, these insurers are still denying, even with the code endorsement. They do it either out of ignorance or intentionally, knowing you can’t afford to sue and no lawyer will take it because punitive damages on property cases are now restricted to 3 times the hard damage part (a “Bushenomics” supreme court legacy we will be stuck with for years).

How to deal with it? I just had a fire loss in Bakersfield, the building department said the non fire damaged crumbling foundation had to be replaced or the house could not be rebuilt. State Farm’s adjuster denied the foundation replacement, even though there was a code endorsement with clear language. His manager told me they had not paid on any code edorsement claim since 1991. I faxed a well written letter to Ed Rust, CEO for State Farm asking if State Farm had collected premiums for this endorsement since 1991 in Kern County, or California or the USA for that matter. In a couple days I got a letter from the local manager saying they would now cover this claim. I also got a letter from the head of State Farm Claims in California THANKING ME for bringing this to their attention. Now this is what I do like about State Farm. State Farm may be rotten, but it’s not “rotten to the core”. A lot of companies are rotten to the core.

Tell your clients to make ratings at the Consumer Ratings page on this website. This is what its for. I don’t believe the government can stop corporate abuse. Its got to be us, unselfish people. When you buy something on Ebay, do you check out the Sellers rating first? It’s got to be the same here if we want to get control of the bad boys.
April 2nd, 2009 at 7:11 pm #Evangela

Hello,
I recently let my friend borrow my car to pick up her kids from school and to pick up a friend from the hospital. While on her way to the hospital, she was rear ended by a driver that caused her to spin into another car. My car was a 2005 Saturn Ion 2 Four Door Sedan and fortunately Saturn makes quality cars because the trunk just folded up and her 7 yr old son was unhurt. My car is completely totalled now. The guy who hit my car (I didn’t have insurance at the time of the accident) had insurance through Preferred Auto Insurance so I called in the claim myself once I got the police report. He was deemed at fault on the report for following too closely. On Monday, 3-16-09, No one had called in a claim and the adjuster had no idea about the accident which had happened 3-13-09. My friend was taken to the Emergency Room with neck and back pain due to the impact of the hit snapping the driver’s seat back. I received a phone call from Preferred Auto Insurance saying that this was a non covered loss and that the details couldn’t be discussed due to their privacy policy. A letter was sent in the mail without anymore detail than what I was told on the phone. I proceeded to contact two lawyers so far who are telling me they can’t take the case but no one will tell me why. The Kelly Blue Book Value of my car is $7915 and my friend is now in physical therapy and I need to know what to do because this man has insurance and neither I nor my friend contributed to this accident in any way. Also now the person whom my friend hit is suing my friend when she would not have hit her if it were not for this guy rear ending her. My car and his vehicle sustained the most damage in this six car pile up.

Please Help!!!!!
April 3rd, 2009 at 11:19 pm #admin

Evangela,

It may be that Preferred Auto is denying the claim because your state does not allow victims to sue if they have no insurance themselves, regardless of who was at fault. It’s a way that some states penalize drivers without insurance. This may also be why the two lawyers would not take your case.

You may also be a risk of being sued by your friend who you loaned the car to.

Please let us know what state you are in, and if this is indeed the reason so that others may learn from your very unfortunate experience.
April 3rd, 2009 at 11:42 pm #Evangela

I live in the state of Tennessee and I’ve been in an accident in which someone hit me and I didn’t have Insurance then either and they paid for all the repairs through their Insurance. I was laid off Recently and that’s why I haven’t had Insurance.
April 4th, 2009 at 12:12 am #admin

Evangela,

Check to make sure the law has not changed. Laws get changed all the time and often the public never hears about it.

If indeed you can legally file suit and the situation is as you said, then there has to be dozens of lawyers who would love your case. Feel free to email a copy of the insurer’s denial letter to info@insuranceclaimhelp.org if you want better advice.
April 13th, 2009 at 4:30 am #Debra

Hello,
We had a flexible spending account in 2007 which we used to pay for approved medical expenses. We provided the fsa company with receipts which they say they did not recieve. They did not notify us about this denial until August 2008, at which time they asked for receipts again, which we provided again. In March 2009, they demanded money, claiming that they never recieved our receipts. We sent them proof (a dated fax receipt) that we did indeed send the receipts to them when requested.

The fsa company is not denying the viability of the medical claims. They are denying recieving the receipts.

After several conversations with the company’s service reps, who agree that we provided the company with everything they asked for, their “review board” still denies our appeal and is asking for money. I spent much of last week on the phone with this company and am at a loss as to how to proceed. What now?
April 13th, 2009 at 12:50 pm #admin

Oh Deb, you can have some real fun with this one 🙂

I normally suggest faxing documents to insurers (as you have already done) in order to get the “transaction report” as proof of delivery. And you can still use this in court if you have to. But in your case, I think I would scan the receipts and save as PDF’s, attach them to an email sent to whoever you are talking to at the insurer and Cc the email to several other addresses and get the insurance rep on the phone and ask him to open the email and attachment while you are on the phone. If you don’t have a scanner, have Office Depot or a friend do it.

And the fun part, Cc the email to your state department of insurance, 60 minutes and whoever you want to add.

And do this too, fax a copy of the receipts to the CEO’s office for the insurer.
April 16th, 2009 at 3:58 pm #patrick

ok here is my situation

i was out of town for ester break, friday through sunday night and when i took off i guess my garage didn’t close, the sensor must have triggered it back up.

now i work out of my garage which i am not really suppose to do but its the only space i have left to work in. i buy computers from apple and upgrade them and i had over $30k in units on the shelf in there that are now gone!

when i got home it was very late and i just drove 8 hours and the last thing i wanted to deal with was the cops there so i waited till the next day to deal with it. i live right by the manager and wanted to go into the police station to do the report because i didn’t want them making a major scene at my apartment. i didn’t want the appt. manager coming over and seeing whats going on and see that i have been working in my garage which i could get evicted for!

also i didn’t want my neighbors coming over or asking whats going on because then everyone will know what i do and keep in there. that would put me at risk even more with everyone knowing whats in there.

i got all the documents needed, the receipts, and went to the police station and waited to do the report and when the officer came out, a young rookie, he stated that i should have called them out when it happened and there is nothing he can do. i told him it was late and it didn’t just happen since i was out of town the whole weekend. i also explained my situation with the fact i am not suppose to be working in there and didn’t want to get in trouble with my complex manager who lives right by me!

his response to that was, well whats more important you place or your things? i said BOTH ! i dont want to get evicted and i also want to be covered for my things so yea

i said he can come out to investigate it as long as he can keep it quiet so i don’t get in trouble with the manager and draw attention to my garage. he said that is not possible and would talk to the manager and knock on my neighbors doors and make a scene.

now without a report and them not caring i have to deal with my insurance company who wants a report to file my claim. i might be screwed now since i can’t provide a report….

can the police do that and say no to making a report for me?

can my insurance company deny my claim if i CAN’T get a report for them because the police department wont make one?

if i try to get a report and can’t because the police wont do it then i think the insurance company should still cover me because its out of my hands and not my fault they won’t take the report…

any ideas or thoughts on the subject or help for me here
April 18th, 2009 at 1:22 am #admin

Hello Patrick,

Well, your story sounds “reasonable” to me. And that is a very important word in insurance law and in your insurance policy.

1. No, the insurer can’t deny your claim based on your story. But they may try like crazy to delay their “decision” for a couple of years until you just give up. Maybe they will deny it for “failure to cooperate.”

2. Nothing in most policies says you have to make a police report. Your policy says you have a “duty to cooperate”, “within reason”.

3. If the police refuse to make a report, then try to get that in writing, and sent that to your insurer. In fact, you should make your request for the report in writing and fax it. Any failure on their part to respond can in itself be an admission.

4. The insurer may make a false issue of this since they know you want to keep a low profile.

5. But consider this before you spend a lot of time pursuing a claim, unless you have a “business” policy, or an endorsement on your renters or homeowners policy to cover, or increase a small limit on “business property”, your renters or homeowners policy may not cover business property.

If you decide to pursue the claim, consider the eBooks “DENIED HOME AND BUSINESS INSURANCE CLAIM ADVICE AND HELP” and “INSURANCE CLAIM PRACTICES LAWS WITH UCLAIM COMMENTARY, ADVICE AND HELP” on the product page at UClaim.com .
April 21st, 2009 at 11:58 am #patrick

they tried to give me the lower business coverage which is only 2500 leaving me screwed on the 40k plus worth of lost equipment!

i told them that its not technically a business since i haven’t sold anything yet, don’t have a business name or license or web site. the lady who was not even in California said it doesn’t matter and told me that since i mentioned a business that there is nothing i can do about it.

i told her that we haven’t even done the recorded interview and that i will not state its a business because its not one yet and may never be one. i told her that its all mine and that i was thinking of selling some of the units or all of them but they are mine. same as buying a lot of furniture and turning around and selling it all for newer pieces.

she also said that i can’t get anything or continue with my claim unless i get a police report. so i am up sh#t creek here and very very upset!

so i have no idea what to do now and feel very taken advantage of by this insurance company being esurance

they wont even return my 266 dollars i paid 5 months ago for a year up front of coverage. i demanded it back since i am not getting the coverage i am paying for and they refuse to do it. they said i would get 160 back and thats all…

i really want to sue them but i don’t want to deal with it really but its a lot of money i am loosing that they aren’t covering!!!

can anyone help me out here?
April 21st, 2009 at 3:32 pm #admin

Hello Patrick,

1. I still don’t think they can insist on a police report.

2. If their claim denial is valid, then I don’t think they owe you a full refund.

2. Read the definition of “Business Property” in the definitions section of your policy. If it does not exactly fit your situation, then they can’t deny the claim. If there is no definition, then look up the legal definition in Blacks Law Dictionary. Short of a clear definition, I think a judge could consider what the property was “intended” for. On the other hand, if the property was never offered for sale and you filed no business papers, then maybe technically it was not a business.

3. If the policy definition is not clear, then the benefit of unclarity goes to your favor.

4. If you want us to review your policy for no charge, scan it or have Office Depot scan it and email it to info@insuranceclaimhelp.org .
April 29th, 2009 at 10:48 pm #annmarie

We had parked our brand new Lexus in a commuter rail parking lot from 930AM to 905PM. When we returned the rear side of the car had been hit. We took it the next day to the body shop that the Lexus dealership uses and the insurance adjuster viewed the car I believe a day later. There was over $4000 of damage, being a new Lexus it is expensive to repair. The insurance company is trying to deny the claim, saying that the car was moving when hit. The car was in perfect shape when we parked it in the morning and damaged when we returned. Can you give me any help in what to do next.
May 1st, 2009 at 10:54 am #admin

Hello Annmarie,

I don’t know what difference it would make if your car was moving or not. Most auto policies cover collision damage to the car whether it was moving or parked. And if you have comprehensive coverage, most insurers require collision coverage as well. I would also think that you have uninsured motorist coverage with a Lexus?

Ask the adjuster to put the denial in writing and to quote the policy language that says collision to a moving vehicle is not covered. If they have more reasons for the denial, then it should state why.

If you don’t have your policy form copy, you can get a sample at UClaim.com.
May 6th, 2009 at 11:18 am #Zedition

We have a standard homeowners policy with a company that has an exclusion for “collapse”. A while back, we noticed damage to our well, and immediately contacted the insurance company with a claim. They denied it outright without sending out an inspector, and because the well was within 5 feet of our home (and a safety risk), we filled the well in. After contacting the State Department of Insurance, we learned that common practice is for a company to send out an adjuster/inspector before denying a claim – in our case it is possible that the well did not collapse – nobody really knows what happens because the only damage was the subsidence of a few cubic feet of soil and very dirty water in the pipes.

Now it sounds like they want to deny it based on several other factors, primarily that it “probably was a collapse”, “flooding”, and inferior construction because the well was brick-lined, not cased in modern concrete tiles. The brick-lining was state of the art before WWII when the well was probably built, and I just can’t see that “inferior construction” applies just because technology got better over the next 75 years.

My argument is that the company did not exercise due-care in investigating the claim, and that they should have either sent out an inspector before denying, or recommended that we have the well professionally inspected before we began to fill it in. What kind of responsibility to exercise due-care in the investigation of a claim does a company have?
May 7th, 2009 at 1:26 pm #admin

Hello Zedition,

Lots to consider here. Was the denial in writing? Was there a tape recorded statement? Is the well a “structure” below the casing or bricked in part? Or is that lower part just a hole in the dirt or clay or rock below the casing? Is this a wide well that you drop a bucket down?

The insurer has a duty to do what is “reasonable” in deciding how much investigating to do. And that depends on what information you gave the adjuster on the phone to describe your well and what questions you were asked. Well construction may vary considerably. At first I assumed you had a submersible type well with a steel pipe casing at the top. But when you said “brick lined”, then I started to wonder if it was a well like you drop a bucket down.

A collapsed well is a very unusual insurance claim, and in my 30 years living in a farming area, I have never has such a claim.

Most adjusters know nothing about how wells are constructed in different parts of the country. And if they do have knowledge, it is probably about how wells are built in their own area.

Even though you filled the well in, it may be possible to “exhume” enough of it to determine the cause and origin by an engineer.

As to denial for “inferior construction”, that sounds like an over zealous wishful thinking adjuster. Most policies exclude “negligent construction”. That’s not the same as “inferior construction”. If “inferior construction” was not covered, then there would be no coverage for old homes, right?
Read your policy wording and check it against the denial letter wording.

I think you could also say the well was an “appurtenant structure”, if part of the denial is that the well is not a structure or that the well is a hole in the land and land is not covered.

You can learn the basics of dealing with denied claims in the eBook entitled “DENIED HOME AND BUSINESS INSURANCE CLAIM ADVICE AND HELP – STANDARD VERSION (W/O APPENDIX)” at UClaim.com .
May 7th, 2009 at 2:03 pm #Zedition

The well is a ground-water well, very common in older rural homes in the Midwest. My research on this tells me that today’s common drilled wells (diameter 12” or less) didn’t become common until the late 1940’s, and hand-dug tiled wells like mine were still being put in up to the early 1970’s. Concrete ring-cased wells become common to line the wide, dug wells like mine once truck-mounted dolleys and cranes were available.

The well was larger than 36 inches wide, and I bet you could drop a bucket down it. But mine had a submersible “push-pump” resting on the bottom – similar to a sump pump in a home, but designed for this kind of wide but shallow well.

I personally did not tape record the claim denial, but when I bypassed the claim adjuster and spoke with the claim manager, I heard the tell-tale pauses and clicking of a recorded conversation. I’ve documented that I was informed of the denial on day 1 to the company and the State Insurance Commissioner as well. What I do have is that the letter notifying me that they intend to investigate the claim is dated almost a week after I first contacted the company.

The entire well casing from top to bottom was “clay tile”, similar to field tillage tiles, but squared off and made for use in a well. The top 6 inches was a poured concrete cap. I believe the bottom of the well was sand, because it tapped into a subterranean mineral water spring. Putting concrete over this would stop the spring water flow.

It would be difficult to exhume the well, as it was within a few feet of my home’s foundation. One of the key problems right now is that what caused the well to malfunction is “unknowable”. It’s kind of like having your house bulldozed before the claim adjuster arrives to evaluate the fire damage. Maybe it was a total loss, maybe a partial loss, maybe the fire was not accidental, now that the house is gone – it’s impossible to be certain what happened.

Thanks for the link, I’ll check out the eBook!
May 7th, 2009 at 3:36 pm #admin

Zedition,

If it was “legal” (admissible in court) tape recording, they would have to have asked your permission.

1. What would it cost to replace the well:

A. exactly as it was built?

B. With current replacement to code?

2. What was the current “market value” of the well?

3. What was the demo cost?

Feel free to post the exact denial wording from the letter here if you like, or email a copy of the denial letter to info@insuranceclaimhelp.org for our review. Black out any id info. if you like.
May 7th, 2009 at 3:41 pm #admin

Zedition,

One more thing. Check out the wording on collapse exclusions in your policy. Some policies don’t clearly exclude “eminent collapse” (a sagging, leaning, slumping, cracked, etc. structure).
May 28th, 2009 at 7:44 am #Denise Lattin

My insurance company denied my claim by saying my loss is due to long term leakage at the water heater which is not true. I hired a plumber and the hot water heater is not leaking it is the pipe and valve that started to leak. At the first sign of water on my floor I contacted the insurance company they sent out an adjuster who just took pictures and didnot even check so see where the leak was. The hot water heater is in the wall in the bedroom so how am I to know something is wrong until I see water on the floor?
May 29th, 2009 at 2:48 am #admin

Hello Denise,

Unfortunately it does not matter if the damage was hidden from view. And it does not matter if the water leaks from a pipe, valve, or the heater itself. They are all “appliances”. But all is not lost.

Adjusters often mistake a black wood floor or buckled floor for “long term” damage. The key is whether you can push your finger or a dull butter knife through the “damaged” floor. If you can’t push your finger through the “rotted” wood, then it is not “long term” damage. A plywood floor can buckle over night and can turn black in a couple days. That’s sudden and accidental, not long term.
May 29th, 2009 at 10:25 pm #david

i was t boned by a taxi driver who ran a stop sign; there insurance in nationwide in ny. they wont pay claims as person was using car as a taxi and only had personal insurance on it, isnt there a way to get some payment for my car. i cant work as i use it for work
May 30th, 2009 at 10:56 pm #admin

Hello David,

Most personal auto policies exclude liability coverage if the vehicle was used as a taxi. Did the “taxi” have any passengers during the accident? If not, there may be coverage if the taxi driver argues the accident occurred during personal use of the vehicle.

And of course, you are still free to sue the driver and taxi owner, regardless of whether his insurance covers him or not. That could motivate the taxi driver to pressure his insurer to cover your claim.
June 10th, 2009 at 8:53 am #Tracey

My question is regarding health insurance, I have a claim that was denied stating that a procedure was “investigational”. My doctor did not inform me that the procedure was investigation and would not be covered by my insurance, if he had, I would not have had the procedure done. Shouldn’t the doctor assume the risk on any “investigational” procedures, or at least have the procedure pre-approved by the insurance company?
June 12th, 2009 at 12:09 am #admin

Hello Tracey,

In my opinion, common sense and decency would say that the doctor should have pre approved the procedure with your insurer, even if you did not ask them to pre approve it. They should know better because they do this every day. While you probably had no choice but to sign a paper that says you will be responsible for the doctors bill if the insurance company denies the claim, I say that a patient should have a “reasonable expectation” that the service provider will pre approve whatever their service is. “Reasonable expectation” is a legal concept that can be used to override an unreasonable or deceptively written contract.

Considering the unfriendly nature of explanations of medical procedures, coverages and billings, policy holders should not have to jump through a thousand time consuming hoops that no reasonable person can understand anyway, and therefore should get the benefit of the doubt if litigation ensues.

We all know that most medical providers grossly over bill for their services and “suck us in”, giving us as little information as possible when we are at our most vulnerable, when we have a health problem. When they engage in negligence and deception for the purpose of sticking you with the bill, they should be fined and have their license to practice revoked. Period! But the system is broken when our legislators are getting “contributions” and free game tickets from the medical lobbyists.

Want a little satisfaction? Go to http://www.RateMDs.com and rip your doctor up so everyone can see who not to go to. Medical providers hate this website, but it gives consumers power that failed government and the media lack.
June 19th, 2009 at 5:42 am #Mary

My laundry room floor caved in. Farmers sent an agent who said it was due to a leak from the A/C unit which was in the room. I received a check for partial repairs, but when the A/C was removed we discovered the floor was a 3 1/2 inch slab of concrete on a pier foundation in the laundry room (house is 65 years old) As my agent asked me to do I sent him a copy of the new proposal as the cost increased for the repairs due to the concrete and the size of the area to be fixed. No word…call…no word..call… agent on vacaton for 2 weeks. Meanwhile we have no A/C and in south Louisiana it is in the 90’s, the room is half way torn down, and the floor is tilting more each day. I called Farmers who sent another agent and he was a total jerk with an attitude. Told me if they had seen it I wouldn’t have gotten anything due to decay, and that I was lucky to have gotten what I did. In my policy under the collaspe cause it mentions hidden decay, water damage, weight of object. Now they say there was a change in the policy that I should have recieved due to some H114 endorsement which will not cover repairs for any decay no matter what the cause, and are refusing to cover the additional 5000.00 to fix it. What recourse do I have? It seems to me that since collaspe is a covered loss, that maybe the cost to repair the A/C that cause the damage would not be covered, but the damage to the floor should be. Should I file a complaint with the insurance commissioners office, or is the insurance company right?
June 19th, 2009 at 11:09 am #KC

I had a house fire almost four months ago. I met with state farm a week after the five and answered a lot of questions. I then received a letter from a law firm asking me to provide a great deal of information such as bank statements and tax records to them on the insurance companies behalf. I had to meet with them in person and under oath answer more questions. My lawyer told me to provide everything that was asked for. I know that this is normal in a case with a suspicious fire. However I do not understand why they never verified any where I was yet have questioned me about it several times. I know from the insurance investigator that me and my exhusband are suspects he told me that himself yet is this a normal tactic. I do not know what to expect next. Are they trying to find a loop whole in the contract and why so long. The house is now in foreclosure yet they still have not made a decision one way or another. I could use any advice that lets me know what they are doing or is going to happen?
June 20th, 2009 at 2:13 am #admin

Hello Mary,

When you said the AC was leaking, I thought you were going to say the claim was denied. But you said they covered it. The policy covers “sudden and accidental” not long term damage over time. And policies cover collapse, but there are more limitations and endorsements being attached to that kind of claim every day. The policy and endorsements that apply are the ones in effect on the date of loss, not after the DOL.

Without arguing over that issue, your best argument is that Farmers waived their right to deny any supplemental claim since they already decided to cover the claim and issued payment and told you to proceed with repairs. You relied on their actions and instructions. In insurance law this is called “estoppel”. An insurer can’t take back what it already paid, even if in error. And an insurer can “change its mind” after it already said it would take a course of action. I assume you have documents to prove that the insurer initially covered your claim, for example a check, cover letter, adjusters estimate, etc.

Yes, make a commissioner complaint
June 20th, 2009 at 2:34 am #admin

Hello KC,

Go to the UClaim.com Products page under Miscellaneous and consider the eBooks entitled “DENIED HOME AND BUSINESS INSURANCE CLAIM ADVICE AND HELP” and “EXAMINATION UNDER OATH (EUO) INSURANCE CLAIM ADVICE AND HELP”. If things get dirty, you may also consider the eBook “INSURANCE CLAIM PRACTICES LAWS WITH UCLAIM COMMENTARY, ADVICE AND HELP”.

Note, most attorneys know nothing about the differences between an EUO and a deposition. Most will handle your EUO as if it were a deposition. But even so, an attorney with you during EUO is far better than none at all. And the insurer can recall you for more EUO’s. So don’t assume its all over with.

If after all this “stuff” they put you through they put in writing that they will cover your claim, then you will need the eBook “HOMEOWNERS INSURANCE CLAIM ADVICE AND HELP – ALL ASPECTS (deluxe)”.

If they deny your claim, you need to have an attorney and or good public adjuster take a look at your claim. In fact it’s a good idea to get them working for you now. The UClaim eBooks will also show you what your PA and or attorney should be doing. You can also get advice on hiring a PA on the Free Stuff page at UClaim.com.

Good luck.
June 23rd, 2009 at 11:51 am #G Willmann

Hello,

Any help/advice appreciated.
I rented a truck from Penske with the cargo insurance. In the truck was my motorcycle which was attached to the cargo “ribs” in the truck via very secure ties. (Drove from VA to RI). When I opened the back the “ribs” were broken and the bike was down with a very dented gas tank. After going through Penske I was eventually sent to Zurich (Empire Fire and Marine) who told me this wasn’t covered for 2 reasons:
1) Section A. Coverage – “We will pay for all direct and accidental loss or damage if caused by cyclone, ….upset or overturn of “truck””. I told them the truck was upset and resulted in the damage, they say NO.
2) Section E: Exclusions – We will not pay for damage sustained by 4-wheel, licensed vehicles to include motor vehicles, motorcycles…
– My issue here is that the contract says “Damage done by”, in my case it was damage done to…my motorcycle. They told me I didn’t know legal definition of “to” and “by”. My response was “If a crime is done BY domeone they are a criminal, if it is done TO someone they are a victim”. Am I wrong? Any advice is appreciated as I feel I am getting the once over. Thanks in advance.
June 25th, 2009 at 10:25 am #james b

We had a house fire Christmas eve 2008 and luckily we we at church.
The fire started in the basement and was contained there except for all of the smoke damage throughout the entire house. I will spare you with some of the details and get rigt to the point. Our insurance company has paid us for
the dryer ( the fire source) washer, and water heater . The heater is what I have been denied on. Our heater stopped working when the water heater did
and they paid for that and the heater is next to the dryer.

Is it worth pursuing?
June 26th, 2009 at 1:08 am #admin

Hello G,

1. Find out the definition of “upset”. If it is not defined in the “Definitions” part of the policy, then look in a Websters Dictionary, and look in a Blacks Law Dictionary (at your local county free law library, usually at the court house). Look for the legal definition before the common man definition, because that will carry more weight with a small claims court judge. If you want to see how court cases define “upset” either get the law librarian to help you search, or go to Findlaw.com “professional section” and search for case law in your state first. If none, check other states. To learn how to research the law for insurance claims consider the UClaim.com product entitled “INSURANCE CLAIM PRACTICES LAWS WITH UCLAIM COMMENTARY, ADVICE AND HELP Subtitle: Save HOURS of Research Time”. View the table of contents.

2. Your thinking about “damage to” and “damage by” is logical and reasonable. Theirs is what I call “brainwash brainlock” or intentional stonewalling (gambling you won’t sue them). In either case you will get nowhere with the individual who denied the claim. Advance to the supervisor, if no luck advance straight to the CEO. If no luck, then small claims court. You can learn the techniques in detail in the “standard” versions of UClaim home and auto eBooks.

(And we can thank George Bush and his supreme court for effectively getting rid of punitive damages against insurance companies.)
June 26th, 2009 at 1:33 am #admin

Hello James,

1. Most policies are “All risk” on structure, stating “we cover all perils except …”. This means the insurer has the burden to disprove your claim. So let “them” hire the engineer to find out why your heater failed. And they are supposed to give you a copy of the report. And the heater is part of the structure, not “contents”, like the washer and dryer.

2. Get a written statement from an HVAC person that the heater could have been damaged from the heat and or smoke.

3. If the insurer still denies it, go to small claims court for around $25.00 and no attorneys allowed in.
July 7th, 2009 at 1:51 pm #Archana

Hello

any help is appreciated.

2 weeks back my retaining wall (which retains my pool) collapsed. On the day of and the previous day there was severe rain and hail. The Insurance company(Nationwide – which is NOT on my side!) sent in a structural Enggineer to check it out and ultimately today I received a letter of denial. The reason being, no earth movement, faulty construction, etc is covered. The retaining wall has taken down a whole chunk of the fence, concrete patio, landscaping, irrigation system and landed on my basket ball court. The engineers report also mentions that it is not clear whether there was a leak in the irrigation system that might have caused it.(in which case, I think, the insurance should cover the peril). Since they are not sure of the reason, shouldn’t I reply back with the above said points and ask them to reconsider. Please let me know what you think. Thanks for your time.
July 8th, 2009 at 3:53 am #admin

Hello Archana,

Yes of course reply, and put it in writing. You have to build your own file so if you have to sue, you have good evidence, not just your word against theirs.

Get your own expert to state the cause in writing. Start with a plumber, or pool tech and if you can afford it, get your own engineer. Sadly, many experts will conclude whatever you want them to and make the facts fit their conclusion.

Your policy probably says “we cover everything except …” on structure items. That means the burden of proof is on the insurer. So if their engineer can’t rule out a plumbing leak, then the insurer has to pay you. Consider one or more of the products (currently on sale) at UClaim.com to teach you how handle this situation.

Is your insurer really Nationwide or “Allied in disguise”. Nationwide is normally generous. They bought Allied, a low quality insurer, for their claims infrastructure (see Recommended Insurers link on this website).
July 8th, 2009 at 4:50 am #Archana

Thanks. I I have sent a letter to the insurance. We’ll wait and see what they have to say about the claim. will keep you posted. Thank you.
August 1st, 2009 at 7:00 am #Honest Guy

My roommate called me while I was in school and told me he just got home and noticed the apt was broken into.I left school came home and called the cops and filed a claim.Allstate took 5 months to investigate my claim,including giving me a EUO with their big Attorney ,Looking at my bank statements for the last two years,incomtax records for the last two years,cell phone records,Renters history of 5 years,credit reports,loan history,school grades and attendance,and everything inbetween.After five months of finding nothing to discredit me….they still deny my claim stating….1.On the police report the officer said”The porch balcony door had pry marks on the outside but appaired to be in random places” and “the door jam was broken outward apairing as if it was kicked outward.”…2.My policy canceled in January and was reinstated less than 48 hours before the burgulary..3.Most of the items that were stolen from apt were bought with cash from local sellers on craigslist.org and I have no receipts so they say I didnt prove I owned the items(even though I have a video tape inventory of my entire apt specificly incase something like this was to happen)When the police was at my apt taking the report they couldnt conclude as to how the perps got into myapt….they say it could have been my roommate,maintnance,or anyone else but they couldnt conclude who or how.But Allstate concludes from reading the report.Allstate never came out tomy apt to see the door or anything.Early in the investigation,Allstate asked for my roommates phone number and they called him and asked him whatever…then coming to the end of the investigation they when I keep asking for a status on the claim,they start telling me that they need to talk to my roommate again and they been trying for over a month and he never answers the phone or reply back.Its very clear that Allstate simply doesnt want to pay.I plan on sueing them for handling my claim in bad faith.
August 7th, 2009 at 12:06 am #admin

Hello Honest Guy,

Well you are right, its suing time.

FYI, on a contents loss, the burden of proof is on the policy holder, whereas on a structure loss, usually the burden is on the insurer to disprove your claim. But Allstate has gone too far, IMO.

A court may have to decide whether your videotape is reasonable proof of ownership. I think it is. You could also get affidavits, written statements from people saying they saw the property in your home. If Allstate still denies your claim, it’s that much more angry it will make a court.
September 3rd, 2009 at 6:55 am #Trish

I have a rental property in Pittsburgh where the tenants destroyed my home. From allowing their dogs to urinate and crap all over the floor, kitchen cabinets ripped off, carpeting torn off, superglue to put on walls, holes in doors, ect. And my insurance company denied my claim based on normal wear and tear, deterioration and maintenance. Maybe for a zoo but this is my home. What should and can I do?
September 5th, 2009 at 4:36 pm #admin

Hello Trish,
You have to approach this as a vandalism. Make a police report, even if only by phone. You will have to argue each and every item claimed with the adjuster, preferably on site. Be prepared to give in on some items. For more details on how to handle this kind of claim, consider the eBooks at UClaim.com Homeowners Loss Deluxe and possibly Denied Claims. Look at the tables of contents for each product.
September 14th, 2009 at 2:41 pm #Darek

Hi. I’m a Restoration contractor in NY and I have a question as to how a denied claim affects “mitigation”.
We performed the mitigation on a water damaged home for a customer that has Insurance. The cause was determined to be a frozen/ruptured pipe in the bathroom sink. (water supply line)
Anyway, the claim has been denied due to lack of due diligence on the insureds part for not insuring his LP tank was full. (He was staying at his relatives due to being temporarily disabled from a previous car accident)
Now I believe that on most policies it is required for the insureds to “mitigate” their damages. If they do not, than the claim is likely to be denied. If they do, but the claim is then denied after mitigation has been performed by a contractor, wouldn’t the “mitigation” portion of the claim still be covered being that the insureds did what their policy (and an insurance rep)directed them to do?
I mean, if the insured did not mitigate, and the claim was valid and not deniable, then once the insurance company discovered all the additional damage from the insureds failure to mitigate, than I’m sure the insurance company would be very quick to now deny the claim. So, am I crazy to think that Mitigation would still be covered on claims that are later denied?
I can see the build back/restoration/repairs being denied, but the mitigation?
What say you?
Please allow me to thank you ahead of time…
Thank You……….
Darek
September 14th, 2009 at 3:29 pm #admin

Hello Darek,

Well first of all, to simplify communication, you should not refer to restoration services or mold remediation as “mitigation”, because that word has different meanings. In insurance policies, the word mitigation means the insured must do what they can to reduce their damages or chance of damage, for example, cover a roof if it has a hole in it and it’s about to rain. So if the homeowner in your case had a good reason (that a court judge would agree with also) for not keeping the heat on, or the propane tank full, then his claim cannot be denied. While insurance policies say “mitigation”, they are overridden by the law, which says “mitigation, within reason”. But it sounds to me like your client (and his relatives) just forgot, unless he was in a coma or mentally incapacitated from the accident.

I see no difference in “build back” and “mold remediation” (if that’s what you mean by mediation) when it comes to denying a claim for mitigation. Consider the UClaim.com eBook on denied homeowner claims if you need to play hardball with the insurer.
September 14th, 2009 at 4:02 pm #Darek

Thank you. Insurance companies have specifically divided “restoration” from “mitigation” and we are directed to refer to our services as either “restoration” or “mitigation” when either calling the claims center/dept to update the adjusters on the status of the job or to ask the adjuster questions,or even when submitting our emergency service estimates.
On most of our jobs in Florida, when we performed the “initial emergency services” ie: water extraction, contents manipulation, initial structural drying, etc, we were for lack of a better term, “protected” on performing those services even if the claim was later denied. It is those services that we refer to as “performing the emergency mitigation”. ie:stopping the damage from getting worse when it is above and beyond what most homeowners could perform themselves.
I guess the key here is when you stated “While insurance policies say “mitigation”, they are overridden by the law, which says “mitigation, within reason”. That, I think, answers my question..
Thanks again…
September 18th, 2009 at 2:58 pm #Ken

Greetings Admin,

The air handler in my house was somehow tilted the wrong way and ended up leaking out in my attic and down my walls rather than down the condensate line. I have no idea how long it was going on for, but I first noticed damaged when the carpet in my hallway was completely soaked. I called a contractor to come look at the damage. He saw the water damage in my walls and immediately recommended I open a claim with my insurance company. I called the same day and opened a claim. The adjuster wasn’t able to make it to my house until 8 days after I opened my claim. I tried to escalate the issue with my claims handler, stating that due to the closed-in environment and extreme amount of moisture, the water damage and mold would exacerbate. They were only able to send the adjuster a day sooner so it took a week for him to arrive.

By the time the adjuster arrived, my walls were covered in mold (it was a lot worse than at the time I opened the claim) and it had spread to the vanity cabinet in my bathroom. The adjuster concluded that due to the mold damage, the water must have been a constant seepage and must have occurred over a period of weeks, months or years. His verbiage was direct verbatim from the policy under “Losses we do not cover.”

I have filed a complaint with my state’s department of insurance and am in the process of appealing to my insurance company. The department of insurance has reviewed all documentation of my claim was not able to assist me.

I had an air quality expert inspect my house and state that there is no possible way to determine the genesis of the event and confirmed my suspicions that the issue was exacerbated due to the adjuster’s unwillingness to change his schedule and arrive sooner.

I am getting a written letter from the contractor and air quality expert that should help contravene the insurance company’s results, however, from conversations over the phone, I have a strong suspicion that it will still not be covered.

My question to you is, will this be worth pursuing in court as a bad faith claim? My arguments would be that the insurance company took no action (via hiring professionals) to prove that the damage has occurred over a period of weeks, months or years. The policy is also a contract of adhesion and the ambiguity of the policy should be refuted in court. The damage to my home is only about $5,000, so would it be worth the money to get a lawyer? I’ve gotten a quote from a lawyer already and he stated that $5,000 is usually the minimum for court fees, lawyer fees, etc.

I appreciate any assistance you can provide. Thanks.

-Ken
September 19th, 2009 at 5:46 pm #admin

Hello Ken,

You may want to condense this question. Way too many details for most contributors to take the time to read. You may also want to post it in our Discussion Forum and change a few words to avoid Google penalties to this website. And take a look at the “Denied Claim” eBook at UClaim.com.
September 22nd, 2009 at 7:24 am #Ken

Which words do I change to avoid google penalties?
September 22nd, 2009 at 5:25 pm #admin

Ken,

Thanks for asking. It does not matter. Make one word or grammar change for every 10-20 words. It could be a spelling change (like a misspelling), adding a comma or parenthesis, capitalizing a letter, changing a “the” to an “a”, etc.
September 22nd, 2009 at 5:49 pm #Ken

I’m confused… I have a little bit of experience with search engine optimization. Would the penalties be coming from the use of repetition?
September 22nd, 2009 at 5:55 pm #admin

Ken,

Not worth hiring a lawyer. Go to small claims court if suing. And no lawyer is going to take such a small case, even if it has bad faith. Punitive damages in property claims in recent years are now limited 3 to 10 times special damages, in all states. So those days are over, thanks to the George Bush supreme court legacy. Big business can do whatever the hell it pleases.

If you policy does not cover mold up to a stated amount, usually 5 or 10 thousand, then your only option is to sue the insurer for negligence, ie. their delay caused more damage. The eBook at UClaim.com on denied homeowner claims will coach you on how to build a liability claim against your own insurer on denied water damage claims.
September 22nd, 2009 at 5:59 pm #admin

Ken, you wrote:

“I’m confused… I have a little bit of experience …”

Answer:

Yes, absolutely.
September 23rd, 2009 at 10:22 am #Abisoye

I have farmers renters insurance. My apt had a fire accident some days ago and the insurance company is saying they cancelled my policy in Aug 10. I didnt know this change because i didnt think i had any problem with them as i had sent out a check for my premium for additional 6months way back in May. They are sying they didnt get the check hence the cancellation. What should i do in this situation because i have property damage.
Thanks
September 23rd, 2009 at 9:11 pm #admin

Hello Abisoye,

Well the easiest first step is to see if the check cleared. Look at your bank statements. If it cleared, then there is your proof.

If it did not clear, then there are other ways to show how the insurer screwed up. You can get details on how to pursue this kind of denial in the eBook at UClaim.com entitled “DENIED AUTO AND MARINE INSURANCE CLAIM ADVICE AND HELP”. Check out the table of contents. The eBooks are 50% off and have a money back guarantee.
October 7th, 2009 at 4:45 pm #Carl

I was in an auto accident in Florida. I went to the hospital and am now in physical therapy. The other car caused the accident and was cited for it. Their insurance carrier has now send me a letter that they will be denying all claims for this accident because their insured has not assisted in the investigation (which they say is required by their policy). What can I do? Is this allowed?
October 7th, 2009 at 10:12 pm #admin

Hello Carl,

Well then you will have to pursue your damages directly from the other driver, and sue him if necessary. And if he looses in court, then his insurer may not reimburse him. Its his loss. If you have insurance, then you should make your claim with them and let them chase the other driver. I’m not sure if your uninsured/under-insured coverage would kick in on this. Maybe someone else here knows.
October 25th, 2009 at 6:13 pm #lori damato

Can anyone help me…. I have h/o with additional collapse coverage. I have had the policy 8 years the house was built in 1977 and the family room adition in1984… I purchased in 1997 and the h/o company has been out 2 times in the 8 years to inspect and it was fine… My family room collapsed with 24 teenagers and sits in a state of collapse since 2/20/2009.. My claim was denied due to faulty construction… The company agrees it is a collapse and I am covered for weight, decay, insect…. I did not own the home when it was built and the building code says it only needed to be fastened??? I have had to get an attorney and now they have increased my policy by $1631.00
I have put complaints in and called my senators office…. I am wondering if a new insurance company would insure nme while this is going on?? and How can a insurnace company deny a collapse claim…when you have collapse coverage.
The homeowners expectation is they are covered… It is time the insurance companied are made to disclose and review entire policies to consumers before just handing a policy and taking a check….It is a total injustice and something needs to be done…… Can anyone help me….
October 27th, 2009 at 4:59 pm #admin

Lori,

IMO, the insurer wrongly denied the claim. Collapse like yours is covered, and the insurer can try to subrogate (collect back) from the builder for negligent construction. And your claim is for “collapse”, not negligent construction, so the claim can’t be denied for “faulty construction”, unless there is a specific clause in the policy saying collapse is excluded if faulty construction contributed to the loss.

Your claim was “sudden and accidental” which is what insurance is intended for. The intent of the collapse exclusion is to exclude coverage for dilapidated and rotting structures. If you have an attorney working on a contingency, he should be on top of it and perhaps should have filed a complaint in court? Ask the attorney for copies of EVERYTHING he has done, letters, pleadings etc. and show it to another attorney if you think your attorney has been doing nothing. And pay attention to the statute of limitations to file suit. Don’t let your attorney blow that.
November 7th, 2009 at 5:46 am #Tony

I am actually writing for my 78 year old mother who recently had a renter’s claim denied. The living arrangements there sound like something out of a bad soap opera, but need to be explained. My mother lives with my sister (her daughter) and her 3 kids as well as my sister’s ex-husband (yes, ex-) and his new wife and 6 year old son. My mother has her own renter’s policy. My sister has her own and the ex-husband’s family has their own (3 separate policies, 2 different companies). Told you it was weird. Anyway, my mother started her policy in January 2009 and it was in good standing in July when a fire destroyed the house they were renting while they were all away over the July 4 weekend. Although arson is suspected (and, IMO, probable), there is no evidence any of the residents are still considered suspects or had any involvement (residents are frequently the initial suspects). The apparent reason for the denial (she hasn’t received a written explanation yet) is inconsistencies in her “testimony” as to the location of various objects within the house. She claimed an item was in one room when it was apparently in another, for example. My questions: can an insurance company deny a claim based on an elderly client’s faulty memory? Can they deny based on lack of knowledge regarding an item’s value? How about lack of knowledge on the insurance company’s part. When told there were at least 2,000 DVDs in the house, one interrogator claimed “there aren’t 2,000 DVD titles available” (despite the fact that Netflix claims over 100,000 titles are available on their site). As an outside party, I realize my information on the case may be incomplete, but I have tried to give you what I have been told. Is there any info you can give me (or more you need) that I can pass along to her/them. P.S. the other 2 claims, which are both with the same company (but a different one from my mother’s) are still open.
November 7th, 2009 at 7:48 pm #Andy

About six months ago, my wife and her side of her family were on vacation in Florida. Her mom pulled out of a parking space after a White SUV passed and the coast was clear.

While she was pulling out, the White SUV stopped and reversed direction, hitting my wife’s car, which was only about two to three feet out of the parking space (we have the pictures to prove it).

There were multiple witnesses and the police report indicated that the driver of the White SUV was at fault. No citations were given since it was on private property.

A claims agent was working with us on the claim and we did get an estimate done at the shop of USAA’s choice, for around $650. USAA’s claims person indicated that the other driver was at fault at some point during the multiple conversations we had.

Since then, the claim was transferred to another claims agent who says the file did not show any history or claim that the other driver was at fault. They then indicated that they were working with the other driver’s insurance company and would contact us soon.

USAA claims that the liability is 50% our fault and 50% the other driver’s fault since my mother-in-law was supposed to wait until there was ‘reasonable’ safety to exit the parking space. It is quite reasonable to believe that the driver of the white SUV would not throw it in to reverse and go in the wrong direction in the wrong lane without looking, which is exactly what happened – as evidenced by the testimony of the passengers of the white SUV.

Since when is it ok for an insurance company to contradict a police report that states the other driver is at fault?

We have pushed this for months now and are at our last resort, and are considering arbitration. However, USAA says that they only offer 0%, 50% or 100% liability. In other words, if the arbitrators say that it is 51% our fault, then it rounds to 100% our fault and then our rates hike and it stays on our records for a few years. With the 50%/50% option, that would not happen.

However, if we take the 50%/50% option, we must pay our entire deductible and wait for USAA to obtain the other driver’s half of his deductible prior to us then getting a refund of half our deductible. Is this common insurance practice?

Is it even legal for them to contradict a police report?
November 10th, 2009 at 1:42 pm #admin

Tony,

Way too complex for a couple of paragraphs of answers. You either need a lawyer (if you can find one or afford one) or get two of the publications at UClaim.com: Homeowners Loss Deluxe (it covers renter claims) and Denied Home and Business Claims. If the insurer is going to do an EUO (Examination Under Oath) then you need the eBook on that as well. The insurer will slaughter your mom in a EUO, so don’t go through it without a lawyer or the UClaim eBook on that.

Any visitors to this website are welcome to counsel Tony on this, either here or in the Discussion Forum, if Tony wants to post without delays.
November 10th, 2009 at 1:54 pm #admin

Andy,
I don’t know the liability laws in Florida, but that is possibly correct, on the 51% part. Call one to those big yellow page ad accident attorneys in Florida or the Florida DOI.

If it was me, I would just go into small claims court with my evidence and tell your insurer to drop the claim so you don’t risk the premium increase.
November 12th, 2009 at 9:17 am #Andy

I guess my main question is about the deductible. Is it normal to pay an entire deductible to the insurer, then wait on them to obtain the funds from the other insurer before giving half of it back to us?
November 12th, 2009 at 10:17 am #Sherella

My Automobile insurance company denied my claim, stating that the fire was intentionally set. What should I do?
November 12th, 2009 at 8:01 pm #admin

Andy, yes, that’s normal. And it can take months to get it back from the other drivers insurer or years or never to get it from a driver without insurance. That right of “subrogation” to your insurer is in your policy contract. Now if you can find a way to “encourage” the other driver or his insurer to pay up sooner, then go for it.

So take some kids with drippy ice cream cones into their plush claim office and let em run wild while they “find an adjuster” or manager to find your file and discuss it with you. You may not have to wait very long 🙂

Or sit outside their claim office, or their best agents office on the “public” sidewalk with a sign saying you got screwed by xyz insurance company 🙂 Oh, and you may as well put a hat out there for donations while you are at it :)))

These “Guerrilla tactics” are one kind of minimal effort “last resort” strategy, short of litigation, you will find in the eBooks at UClaim.com.
November 12th, 2009 at 8:13 pm #admin

Sherella,

Unless they have evidence it was YOU who set the fire, they can’t deny the claim. All they can do is drag out the investigation in hopes that you will just fade away. Short of hiring a lawyer and or public adjuster, get the eBook from UClaim.com on denied auto claims. And if they demand an EUO (examination under oath) both you and your attorney should get the eBook on that subject. You can view the tables of contents online free. The eBooks are on sale with a money back guarantee.
December 7th, 2009 at 10:28 am #Jon Casey

I have a question. Does the insuarance company request for a deposition means that they are preparing to deny my claim? I had a breakin/fire while I way away on my honymoon (I was out of the country actually). Although I had an alarm Im not sure if it was set or not. I have made a claim before for theft (unfortunately I dont live in the best area). Just wondering what’s the run around with the insurance co. They interviewed almost everyone I have ever come into contact with. Any suggestions?
December 10th, 2009 at 1:30 am #admin

Hello Jon,

What they usually request is an EUO (Examination Under Oath), which the policy gives them the right to do. “Depositions” are done in litigation. There is a huge difference. An EUO should be non adversarial. A deposition is adversarial (all out war). However some “low quality” insurers instruct their attorneys to handle their EUO’s the same as depositions anyway. If you (and your attorney, if you hire one for this EUO) want to be fully prepared for an EUO, you can get an eBook on EUO’s at UClaim.com in the Miscellaneous product section. And if you hire a good attorney to represent you in your EUO, he will keep a 2 hour EUO from turning into a 16 hour EUO.

And yes, the purpose of an EUO is to either deny your claim or cut it down. Most insurers look for ways to deny coverage, not ways to cover claims.
January 12th, 2010 at 10:33 am #Al

Situation – Husband/Wife separate, divorce proceedings start. Children remain with wife in the jointly owned home. Weeks later a house fire causes extensive damage. Wife was the only one home at the time of the fire. Months later the PA State Fire Marshall rules the fire “undetermined cause”. Insurance co. denied the claim stating fire was intentionally set by wife. Wife sues the insurance company. Husband tied into the suit because name remains on mortgage/deed. Divorce can not be finalized until the suit is settled.

Questions- If the insurance co. proves in court fire was intentionally set by the wife can charges of both arson and insurance fraud be brought against her?

Approximately how long until suit goes to trial?

If the insurance co. loses the suit and pays the claim are the home owners responsible to hire contractors to repair the home and how are they paid (check directly to contractors or owners)?

The house uninhabitable for over a year. Contents were saturated with water and now house has mold issues. If the insurance company pays the claim would they be responsible for the additional mold damage because it took so long to settle?

Children live with different families. Are those families entitled to any compensation from the insurance company for temporary living expenses?
January 13th, 2010 at 5:30 am #Craig

I purchased a wood boiler for outside use that comes enclosed in an attractive shed like fasade. The mental roof was badly bent and rippled in shipment along with multiple dents and damage around the perimeter of the boiler. I made a claim for damages against the shipping company that delivered the wood boiler. I received a letter from there claims department that the claim was denied. They said that containers must be such as to afford reasonable and proper protection of its contents, these goods wood require crating or boxing. These are large units, like a small automobile, weighing 2000 lbs plus and all vendors ship hundreds of these uncrated as standard procedure each month without damage. When my unit was delivered the driver tried twice to open the rear overhead door only to bang against the boiler. A fork lift had to push the unit back enough in order to allow the door to be opened. The boiler was not secured or tied down and had wedged itself into the right corner of the truck against the door. The driver assured me that the boiler was insured and all I had to do is make a claim. Do you have any advice on how to answer this denial.
January 19th, 2010 at 4:29 pm #admin

Please you Visitors who monitor this website via RSS feeds or other methods. Due to the burden of increasing visitors with questions, your help is needed. Questions will be posted, however Admin responses may now be delayed, or even not given at all. Your involvement in the Discussion Forum page of this website is also requested. Thank you.
February 4th, 2010 at 11:23 am #francine cain

my lawyer says that the definition of ‘flood’ is ambiguous and that a policy is a contract of adhesion… what does this mean?????
February 4th, 2010 at 11:28 pm #admin

Look up “Contract of adhesion” in the insurance claim glossary link at the top of this page.

Your lawyer should have no shortage of business for flood claims. Ask him why its ambiguous and post here please 🙂
February 9th, 2010 at 10:54 am #Seetums

My brother died in a single-vehicle accident. He was the only person involved. There were no witnesses but, the accident report says he was driving too fast and failed to make a curve. He had a suspended license and was driving my mom’s car without her knowledge. Mom’s insurance company denied the accidental death benefit because he “did not have a valid drivers license and was therfore using a motor vehicle without a good faith belief of the legal right to do so.” Is there anything she can do?
February 9th, 2010 at 7:56 pm #admin

Seetums,
I don’t know. Anyone else want to comment?

1. What does the policy say? I doubt that the policy requires a driver’s license.

2. He may have been driving “without her knowledge”, but that does not necessarily mean “without her permission”.

3. Most auto policies don’t have a “death benefit”, just Medical Payments coverage for the living. So if its and endorsement, then read that.

Sorry about your brother.
February 11th, 2010 at 2:15 am #Tracy

In January of 2009 we had a leak around a vent in our roof. While the roofer was fixing the leak he stated that we might want to call our Homeowner’s insurance(Selective) because he noticed major hail damage.

Selective sent out what they call their “expert”(took one month for him to come out) who stated that it was not hail damage but just normal wear and tear/sun damaged shingles and that we just needed to replace the roof.

We saved our money all year and started getting quotes a few weeks ago. The two different roofing companies that came out documented(with pictures) severe hail damage.

Once again we called our insurance agent to tell him what the two roofers had documented. He stated that most roofers in this tough economy are just looking for work(money). We were going to replace roof anyway we never even spoke to roofers about insurance company, so I don’t believe this statement. The agent stated that the only other thing to do would be to go to arbitration, but it would be with his same”expert” and our roofers were not experts in the field….so we should just go ahead and replace the roof on our own. He also stated that he would be sending highlighted policy notes on arbitration for us to read before we made a final decision.

Just wondering: we don’t really have money to hire a lawyer to fight claim.
Isn’t arbitration suppose to include an independent 3rd party and not just the insurance company? We just really don’t know what to expect and what our rights are?
February 15th, 2010 at 9:30 pm #noman

I installed a water supply line (plastic) about 3 months ago. I never do the plastic but in this case I didn’t have a hose long enough to fit. Anyways I came home and water was all over the floor. I want to file a claim, will the insurance company comply with this claim?
February 17th, 2010 at 12:31 am #admin

Yes because your claim was sudden and accidental.
March 3rd, 2010 at 8:01 am #Timo

I had a ski accident and injured my knee. Before going to the emergency room I called my health insurance, told them what happened (explicitly stating I had a ski accident) and asked for pre-approval. The woman said I can go to the hospital. But now the insurance denies my claim saying that ski accidents are excluded. I checked the fine print and it’s correct.
However, I must be able to rely on the information I received by phone. They cannot expect me to double-check the fine print after having an accident. The problem is that I cannot proof that I told them that I had a ski accident, because I have nothing in writing. What can I do?
March 3rd, 2010 at 10:45 pm #Mr. Smith

9 months ago my home caught fire. The insurance company has yet to settle and I am being treated as prime suspect. Ive submitted any and all financial records they requested as well as completed and EUO. Recently an investigator showed up at the home that the insurance company is covering for displacement unannounced. I was away on business and the guest I had staying there didn’t answer his questions correctly. He didn’t identify himself. She informed me that he also went into the mail box. My question is can they deny my claim based on the fact that she told them i didn’t live there? (she thought it was someone sent from my ex-wife) Aside from my lease I cant prove otherwise.
March 3rd, 2010 at 11:42 pm #admin

Timo,

Unless you can get the woman who told you to go to the hospital to admit that’s what she said, then I think your only argument would be a legal principal called “Reasonable Expectation”. Basically, a person should be able to reasonably expect that certain things will be covered without having to read every word in a policy. And the more buried or small print the exclusion is, the less reasonable it becomes. You may need an attorney to help you research the law in your state and to write a threat letter, or more.
March 4th, 2010 at 12:13 am #admin

Mr. Smith,

I have a hunch there are a ton of more details that go with your story, more than can be dealt with here. If you don’t hire a good public adjuster and or attorney, your next best bet is to at least get some eBooks from UClaim.com on Homeowner claims, Denied claims and EUO.

Is there a policy provision requiring that you live in the house? If they are saying you lied or misled them on the application to insure the house and are trying to void the policy on that, then it has to be a lie that is “material”, relevant to the loss. For example, if you lied about smoking cigars, but the fire was started with gasoline, then the denial won’t stand, in most states, IMO.
March 4th, 2010 at 10:18 am #Mr. Smith

Sorry I wasn’t too clear. The home that the fire took place at is not so much in question right now although I’m sure its being investigated. The special investigator showed up at the temporary housing that Allstate is paying for while they decide to settle. problem is, when they came I wasn’t there and the person who answered the door told them I didn’t stay there. She didn’t know who was asking and as I mentioned she thought it was someone from my ex and wasn’t giving up any info. My question is can they deny my claim based on the fact that she told them i didn’t live there? somehow try to prove misrepresentation. The only prove I have to show I was living there is the lease.
March 4th, 2010 at 6:24 pm #admin

Mr. Smith,

Allstate owes for at least one temporary residence, the cost of which they owe to reimburse your incurred expense. It doesn’t matter if you stay there or not. And even if they used their own house placement service and are paying them direct, the policy says they owe ALE expenses incurred. You don’t owe them any explanation at this point. And if they later try to deny your claim by calling this misrepresentation, then give them the same reasonable explanation you gave here.
March 4th, 2010 at 7:28 pm #Mr. Smith

Thanks for the responce! One last question, maybe two. Does it matter if the temporary house I chose was rented from a person I know? Allstate didn’t supply the home. Reason I’m asking is they are trying tooth and nail to find a reason to deny. Can they go through my mail? Secondly what eclaim book will specifically help me in my situation. Unfortunately I don’t have a lot of confidence in my lawyer.
March 4th, 2010 at 8:16 pm #admin

Mr. Smith,

You can rent from anyone you choose. And FYI, although Allstate may tell you that the words “incurred expense” in the policy means you have to present a canceled check or credit card receipt, that’s just their procedure, not necessarily the law or policy wording, meaning or intent. Once you present a copy of a bill stating “amount due”, then it’s “incurred”, even if you can’t make the payment until later.

As to going through your mail, I’m sure that’s a crime, unless they have a warrant. You should check with your postmaster and local police. And if you want to give Allstate a reason to drop their delayed investigation, make a complaint with your local police and/or FBI on this mail thing.

As to the UClaim.com eBook, start with the Homeowners Loss Deluxe, just to make sure you are covering all the basics properly. You and your attorney could have greatly benefited from the eBook on EUO, before it was taken. If the claim is denied, then get the eBook on denied claims, and if it was denied based on something in the EUO, then get that eBook also. Considering the dollars at stake, the cost is nothing (and they have money back and “information” guarantees). Keep us posted.

And Mr. Smith, you should line up another insurer while you are currently insured, because you will probably get a “non-renewal” notice from Allstate just 10 or 15 days before your policy renewal date.
March 6th, 2010 at 8:24 pm #Miquel

If a total loss is denied (house fire) after euo will the mortgage company be paid off? This company states that while they can’t prove this person set the fire, there is some evidence that they did, or had a hand in the fire. Will the insurer subrogate after paying the mortgage, or will the mortg co not be paid, and they sue the insured?
March 7th, 2010 at 6:52 pm #admin

Miquel,

1. Yes, if the claim is denied for the insured, the mortgagee still has to be paid up to the amount of their loan.

2. Doesn’t matter what the insurer has, if they can’t get you arrested by the cops, then they have to pay your claim.

3. You need a good public adjuster and or attorney. If you can’t get those, get the eBook at UClaim.com on denied home claims.
May 12th, 2010 at 9:44 pm #Cheryl

I own a multifamily home with rental units. I was away when a fire started and the insurance co won’t pay stating I did not live there because there were rental units and has denied the claim. The attorney on the case seems reluctant to go forward with the case. What is my recourse?
May 13th, 2010 at 1:41 am #admin

Cheryl,
Can you clarify the part about you living there?
May 13th, 2010 at 5:27 pm #Lita B.

Recently,was a victim of 3 break-ins back to back. Have State Farm for insurance. They have came out took recorded statement about items that were taken. Some didn’t have reciepts for because 1 item was purchased from friend. But item is expensive to replace if have to buy from store. Can insurance company deny claim if you don’t want to involve others in it? But still have box that it came out of. And can insurance company ask for credit report? What do this have to do with stolen items. And are they obligated to pay for items that are rented? Thank-you in Advance!!
May 18th, 2010 at 10:25 am #admin

Lita,

You have a duty to cooperate “reasonably” within the policy and the law. You have to give the names of your friends you bought the stuff from for example, but your friends don’t have to “cooperate” or talk to them if they don’t want to. Let the insurance company get the credit report. It shows your possible motive for a phoney claim if you are in great debt. They don’t owe for rented stuff.
May 25th, 2010 at 5:52 pm #Cheryl

My garage is a 2 1/2 on a slab, built 1977. Problem is that the garage is leaning almost 6″. No neglect, no cracks in floor, no water damage. I am afraid to use the garage. Will homeowners cover the repair??
May 26th, 2010 at 1:34 pm #Angela B.

Our home was partially damaged by a fire in the Laundry room, it was determined the Clothes Dryer was the cause, simple enough. However, State Farm has denied reimbursement for the Dryer based on this being the cause of the fire? I wasn’t able to find anything in my policy stating this and when I contacted claims dept I was advised “that is our policy”. Would this be listed on my policy? I live in PA, is there anything I can do to get this reimbursed?
May 28th, 2010 at 12:05 am #admin

Cheryl,

Most HO policies don’t cover “settlement”.
May 28th, 2010 at 12:18 am #admin

Angela,

Most policies cover “resulting” damages, not the cause of the loss.
May 30th, 2010 at 7:05 am #Jason

Angela,
See answers in “Homeowner Insurance”. Because of the long-standing policy of the insurance companies, probably the best approach is to accept that the responsible clothes dryer part is the cause of loss, not the entire clothes driver, and see if the insurance company will modify their position on that premise.
June 1st, 2010 at 7:36 am #Jorge

We got water damages in our laminated floors due to a water pipe breakage, damaged floors are in the dinning and living room but these are connected to a small office and my kids rooms, there are no transitions between rooms so the floor looks like one piece; insurance company says they will only pay for the dinning and living room and since we are not able to find the same floor we will not be able to match what we currently have and basically obligated to put transitions and install a different type and look of floor; our house will look really ugly and of course the value of our home will take a substantial drop.
The insurance agent said I can call the insurance commissioner and they will give me the same answer.
Is this actually true? Do I have to take a lost of value in my home and make it look basically like a collage? I would not buy a house like that.
Should I seek for legal help?
Thanks in advance for your help.
June 1st, 2010 at 1:18 pm #Jorge

Forgot to say I’m in GA
June 2nd, 2010 at 10:50 pm #admin

Jorge,

You are entitled to what you had before, matching floor covering, even if there was a doorway. Unfortunately you may have to sue your insurer since most insurers will not give in on this. California used to have a “line of sight” law that forced insurers to go past the doorways. But that law got repealed thanks to our current insurer friendly insurance commissioner Steve Poizner.
June 9th, 2010 at 7:34 am #Bobby

Here is my situation.
Im sure this is probably one of the more common questions, but i have not been able to find any answers.

I Have renters insurance on my home through Liberty Mutual, the same company we have our auto insurance through. 5 weeks ago ( may 6,2010) we were gone from around 6pm till midnight. We came home to find we have been broken into!

There were about $13,000 worth of items and electronics taken. The police came out, did a report. Everything they have asked for, we have provided , i.e. pictures, invoices, receipts etc. After the 3rd week, Our claims rep continuously gave us contridictory statements like . the first day i reported the claim a police report was being requested, after three weeks, he told me they still have to do that, order a police report. After he kept giving me conflicting statements and not returning my calls/emails. I requested my claim be re-assigned to another agent.

It was re-assigned to another claims agent. He called, informed me the claim has been turned over to there SIU ( Special Investigation Unit) and that an investigator was assigned to the claim and would be in contact with me to follow up. Any questions i had would need to be addressed to him!

2 weeks ago, the special investigator came to our home and completed a recorded interview. Very shrewed , elderly man. made it a point to state he was a retired detective with the police force for 20 years. The home belongs to me and my boyfriend, also on the policy. we are “two gay males”. The reason i state this is because you could tell the whole time the investigator was there, he was uncomfortable.

The investigator went through the items on the list that were taken. However, there were many items he didnt even ask about that were on the list. We could tell that he was anxious to get out of our presence.

He requested i send him some information that i had present with me at the time of the interview. i offered to give them to him at that moment to speed the process up. He declined and informed me i could email them.

That same evening, i emailed him copies as he requested. With every email i sent, i was very cordial, always starting out with a greeting and something to the effect, “hope you are having a great day, it was nice talking with you earlier”, etc etc..all the greetings and salutations! haha

I had asked him in the email, if he had an idea of how long the claim may take to finish, if he had an idea or estimate he could share, that would be great. I informed him in the email my boyfriend is a type 1 diabetic and had an expensive legg massager he used to help his circulation in his legs. It was stolen and we are anxious to replace alot of items as soon as feasible.

He replied to the email stating this, and ONLY this in the email:
“As i told you, i cannot give you an exact date”!!

Every since then, i have been emailing him, called the assigned claims adjuster for an update. The claims adjuster informed me very rudely that he would not give me any information and that he told me if i had any questions, i needed to contact the investigator.

I have emailed the investigator again, ive sent a complaint and request for an update to the claims adjusters supervisor, ive even emailed the home office to Liberty Mutual Insurance SIMPLY asking them, if they know a rough timeframe. We are still just as in the dark as we were in the begining of the first conversation when we filed the claim.

It is now 5 weeks. Ive never had this happen, i have no clue how long it takes. Some people may think 5 weeks so far is hardly enough time, others i have spoken with have told me this is too long to wait.

They have all the information i have provided them with. I have told them in all emails, “if you require further information, please let me know now as to not delay the claim in the future with telling me there was something i forgot etc”..

We had a Flat screen tv taken, blue ray dvd player, bose entertainment center, expensive projector, high end digital camera and alot more. 5 weeks without them, is a long time.

Yet again, every person i have emailed for an update or status report cannot give me one. Since the begining, we havent spoken to anyone kind, no sympathy or empathy, rather, we get talked to like we are the criminals vs the victims. we feel as though we are being victimized twice, once by the burglars and 2nd, by liberty mutual.

The investigator asked for our income records, wanted us to sign a paper giving him the right to do a background check. we submitted that information and encouraged him to do so. We have never EVER been in trouble, no criminal record, nothing of the sort. It just seems to us, this should be a smooth claim but im not sure.

any information you can provide is GREATLY appreciated.
regards
June 9th, 2010 at 4:30 pm #admin

Bobby,

Start with the eBook Homeowners Loss Deluxe at UClaim.com. If it goes to EUO, then get that eBook as well. Your claim is too small for a public adjuster or attorney. The insurer has some red flag on you. And its not the gay thing, IMO.
June 9th, 2010 at 5:00 pm #Bobby

Yes, ive actually spoke to an attorney today who is jumping on this. Last week, i filed a complaint with the NC insurance commission. Today, I received a response from Liberty Mutual In reference to the complaint and it was SO full of lies.
1. In the response, the “senior” investigator stated that i first told them the items were stolen during my move from SC to NC which was a big lie. Today i even sent a copy of my last 2 years rental leases showing where ive lived. 2. The insurance investigator replied that several items i had listed stolen in fact did NOT belong to me. yet, ive showed verification they were mine. After i received that notice today is when i contacted an attorney and stated i should also request a transcript of the recorded conversation to which i have..
June 21st, 2010 at 12:41 pm #Clark

My house was robbed, police came and investigated etc… said to record all items stolen as I realize them missing. My insurance adjuster said no item will be reimbursed without proof of ownership ie…pictures or receipts. Is is legal?th
June 21st, 2010 at 3:22 pm #admin

Ok ICH visitors, who wants to help Clark with this?

(Clark, if you don’t have an answer in a week, please repost)
July 14th, 2010 at 10:07 am #Public Adjuster

Clark,

In this situation you are required to provide documentation. You need to document and substantiate your loss. There are many ways you can do this. First, create a detailed list of all items that you recognize as being stolen. This can be a lengthy task. I suggest going room by room – area by area. Keep it orderly both for your benefit and the adjusters benefit. You will need to provide approximate dates of purchase (m/y), place of purchase (best buy, sears, gift, etc.), and approx. cost of purchase.

You now need to substantiate that these items actually existed. This can be done a number of ways. First – receipts. If you have receipts, credit card statements, debit card transaction (bank statement) then great. If not … 2nd – warranty manuals. Warranty or instruction/ownership manuals can prove ownership of electronics and some household items. For other items – photographs. Go through old photos that you may have.. birthdays, Christmas, events at your home etc. Often the items taken are verified in the photographs! I recently verified a diamond bracelet and an expensive gown for a client through a photograph that was taken when they dedicated their baby at church.

The more proof of ownership you can provide the better. Being well documented and detailed also makes the insurance adjusters job easier. If you cannot prove the item existed, then depending on the item, it may be that the insurance company denies coverage for that item. However, as the admin advises over and over.. the carrier must act in a reasonable manner. Meaning – if you claim your flat screen tv was stolen and the adjuster can see a wall mounting brace that was torn off the wall… with cables laying on the ground.. they need to pay for that item regardless if you have a receipt or not. But if you claim your Iphone was stolen but can’t even produce a phone bill… well…. hopefully you get the point.
July 14th, 2010 at 5:10 pm #Tony

To: Public Adjuster
I am just curious how a person is expected to produce evidence of the existance of an item in the case of a fire? My mother’s house burned down last year and she was never allowed back into the place, even to retrieve items that were NOT damaged. Any receipts, photos, etc. were either destroyed by the fire or inaccessable. Any evidence was IN the house and was therefore destroyed (even if it wasn’t physically damaged by the fire). How was she was expected to provide this information (which she, of course, couldn’t)? Needless to say, HE wasn’t going to verify any evidence he may have found in the house. That’s contrary to his job.
July 16th, 2010 at 11:33 am #Ms. K

DATING BACK TO HURRICANE KATRINA I CALLED MY INSURANCE CO. THEY CAME OUT AND I DONT RECALL ADJUSTER LOOKING AT THE ROOF. I CALLED INSURANE AROUND SEPT OF 2009 B/C MY CEILING IS STARTING TO GET BROWN. I CALLED THEM AGAIN THIS YEAR BECAUSE IT IS NOW MOLD. AN ADJUSTER COMES OUT AND LOOK AT THE ROOF FROM THE GROUND AND STATES I HAVE HAIL DAMAGE. SHE GIVES ME 2 NUMBERS TO CALL FOR ESTIMATES B/C SHE SAYS THAT HER INSURANCE COMPANY USE THESE PEOPLE ALL THE TIME AND THEY HAVE THE BEST ESTIMATES. WITHIN A MATTER OF DAYS SHE THE ADJUSTER CUT A CHECK OF MY PERMISSION TO THE PERSON SHE REFERRED ME TO , BUT I ASK HER IF I COULD GET A FEW MORE ESTIMATES. AFTER I SENT HER AN ADDITIONAL ESTIMATE SHE TELL ME THAT SHE MADE A MISTAKE AND I AM NOT COVERED. SHE SAID MY CHECK IS NO GOOD AND THEY ARE NOT COVERING MY DAMAGES. MY CHILDREN HAVE BEEN TO THE DOCTOR ON VARIOUS OCCASIONS FOR RESPIRATIRY INFECTIONS AND THEY HAVE TO TAKE BREATHING TREATMENT WHEN THE INFECTIONS REOCCUR. PLEASE HELP.
July 16th, 2010 at 11:35 am #Ms. K

MS LAST POSTING I MEANT TO SAY THAT THE ADJUSTER MADE THE CHECK TO ME AND MY MORTGAGEEE FOR THE REPLACEMENT OF A NEW ROOF. AND SHE NOW SAYS THE CHECK IS NO GOOD.
July 18th, 2010 at 6:40 pm #Public Adjuster

Tony,

It sounds like it was a devastating fire. In this situation I would assume policy limits were reached. What an adjuster should be looking for in this situation is a list that makes sense. Your mother would need to recollect room by room what was in the house and provide a comprehensive list. If something sticks out like a sore thumb to you… it’s probably going to stick out like a sore thumb to the adjuster.

Your question was one of verification. General items will more than likely not be questioned. Food, the run of the mill clothing, televisions, dvds, players, general electronics, refrigerator, books, and so forth. Questions come in when a policyholder has a list of 200 items from Sears or Target etc., and then all of the sudden they have a painting by Picasso. While it may be true – they’re gonna want to verify that item.

Verification of items while difficult is not impossible. While irritating, it’s not as hard as one might think. Most stores like Best Buy, furniture stores, Sears, keep records of what you purchase and you can go back to them and get a print out. You can also go back over debit purchases, credit card statements, etc. Generally the items that you purchase with cash are not the items that the insurance company is going to want to question.

The adjuster does have to assist in the process. The adjuster may need to hire a demo or salvage company to assist you with verifying items. The adjuster is required to act in an advisory capacity to help you obtain the benefits you are entitled to. But generally in devestating fires like this.. insureds hire a public adjuster to assist them. You should consider doing so. I recently came to this site but it also appears the owner of this site has ebooks to assist in the process which are inexpensive. This is a big loss – get help. There are many more issues besides verifying personal property that might just be beyond your understanding.

Finally, before its too late for your house.. and this goes for everyone – take a half an hour on a Saturday and video your entire house. Take the dvd and copy it and have a friend and a family member hold it for you. Make sure to note items that are unique in your home. This is your best preparedness technique to prove your loss for fire and theft if one of those does occur.
July 18th, 2010 at 6:56 pm #Public Adjuster

Ms. K,

You definitely have some issues on your claim. Most homeowners policies carry a 1 year statute for you to be able to file suit against your insurance company. Generally the insurance company also considers this the limit in which you can make a claim against them – although that is not entirely true. Unless your claim for Katrina was improperly closed or there is some other mitigating factor, the adjuster is correct – the claim is done. However, the adjuster said you had hail damage. Okay – when? What is the date of loss for the hail damage? Was she saying it was hail during Katrina?

Does your policy exclude hail? I can’t imagine it does. So, you need to find out why it is not covered or why the check was issued in error. I seriously doubt it was retracted because you went out and got other estimates. Homeowners get estimates all the time. This is why adjusters are called adjusters…. because they “adjust” the differences.

Finally, during the time that you were getting estimates, and prior to the adjuster advising you that they were withdrawing the payment, did you do anything such as sign a contract with a contractor, begin work to your home, purchase materials or anything of the sort? If so, it may well be that you can hold the insurance company responsible for “detrimental reliance” in where they acknowledged coverage and caused you to rely on them to your own detriment.
July 19th, 2010 at 9:32 am #Tony

Public Adjuster,

Thank you for your response. As stated, this is not my policy or case, so my information is second hand. More info can be obtained by reading item #71 in this forum. That was posted in November and more info has come to light since then. For example, ALL claims have been denied based on inconsistencies in EUO testimony (such as locations of items) and, according to at least one of the insurance companies, “irrefutable proof” (their words) that at least one of the occupants had something to do with the fire. Keep in mind it has been over a year since the fire and NONE of the occupants has so much as been questioned by police or fire investigators beyond the initial interrogations. If the insurance company’s investigator uncovers “irrefutable evidence” (that, apparently, the police and fire departments missed), are they not required to turn this evidence over to the police? Obviously it is not that irrefutable.

I admit this is a very complex case and I do not have all the specifics. However, I believe I have sufficient information to draw the following conclusions:
1. Their house burned down.
2. The authorities (police and fire departments) have investigated it.
3. Although I believe the cause has officially been ruled arson, the authorities have thus far uncovered no evidence the residents were involved, otherwise someone would be in jail.
4. Considering modern forensics, the residents, neither individually nor collectively, are intelligent enough to “beat the system”. Therefore the fact that no one has been arrested definitively clears them in my mind.
5. The insurance company has not, apparently, released their “irrefutable proof” to the authorities, otherwise someone would be in jail or it is not that irrefutable.
6. It is a well known FACT that the last thing an insurance company wants to do is pay out a claim, no matter how legitimate. This appears to be one of those situations. The claim amounts exceed what the companies were expecting (especially from renters), therefore they have elected to completely deny the claims as opposed to paying an “adjusted” amount.

BTW, it is my understanding that the fire department’s report is still open.
July 20th, 2010 at 4:56 pm #Christine

My husband and I moved from NV to TX in Jan 2009 and needed to put all our belongings in storage. We have a renters insurance policy and made sure that it covered our stored items. The roof leaked and all our furniture was damaged. When reporting the claim they tried to tell us nothing was covered without even looking at anything. They finally said that if the damage was caused by water getting/ leaking into the building everything would be covered. They sent someone out to look and take pictures and he told us that everything would be covered. I took tons of pictures and submitted them to him with a letter. He processed the claim and submitted it over three weeks ago. Now USAA is saying the claim has been denied because there is no wind damage to the building. Also the storage facility told us that they just put a new roof on about 9 months ago. I don’t understand how they can say it is covered and then now say it is denied and for different reasons. What do I do now?
July 21st, 2010 at 3:06 pm #Public Adjuster

Christine,

If you have a copy of your renters policy – read it over. If not, get a copy and read it. Many policies require that a “storm created” opening occur first prior to extending coverage for the ensuing rain water damage to the contents. More than likely the policy is what is known as a “named peril” policy for the contents. This means that the item originally causing the damage has to be listed under the “Perils Covered” section of the policy. I surmise that carrier is correct in denying the coverage (assuming it was rain water damage) even if the adjuster/inspector originally stated it was covered. This happens quite a bit believe it or not. Adjusters are often dealing with many different policies and could have believed you had a certain policy.. or simply could be untrained or not knowledgeable of that particular policy and on and on… it’s disappointing but it happens.

If all the facts are as you stated and are correct then I would see what the storage facility is going to do about it. You may have a claim against their roofer for liability.
August 8th, 2010 at 11:43 pm #Joann

Our business experienced a fire. Shortly thereafter we had a flood. The insurance co. had instructed us to store our contents in POD’s as the township
condemned the building and we had to get all contents out. we submitted a claim, we were denied and then we made an appeal that was also denied. The clauses we are going to our agent with are: consequential loss to stock and/or preservation of property. is there any advice you can offer without seeing our policy? Thank you!
August 9th, 2010 at 12:26 pm #Public Adjuster

Joann,

That’s very disheartening and I feel for you.

Others may have better insight to this than I do but I will extend my thoughts. Consequential loss is probably not going to hold. I can give you the general idea of the term by example;

You suffer wind damage to your roof and it is raining. You or someone goes on your roof to put a tarp on the roof and in the process damage tiles that were not otherwise damaged by stepping on the tiles. Or more on point… you have a fire to your building, the firemen come in and use water to put the fire out.. and the water flows to an area that was previously not damaged by fire – but now has water damage. That is the idea behind consequential damages.

In your situation your contents actually suffered a separate and distinct occurrence/loss which is generally not covered under the policy. I am assuming by flood you mean rain water that rose to a level that impinged the POD and not a pipe burst or rain water that came in through the top of the POD.

I’m not quite sure of the “preservation of property” but possibly you mean protecting the property from further damage or “mitigating”. I really don’t know how that would apply in this situation since no damage occurred preserving the property but rather by way of a separate occurrence.

It is tough without seeing your policy as some business policies allow coverage for property while stored on the grounds of the property.

You may also consider discussing this matter with the storage company and read your agreement with them. Thinking very liberally… did they store it in the correct spot? Was it high enough off the ground to keep out normal surface water? What waterproofing methods or guarantees are provided? These PODs are designed to be outdoors so wouldn’t any reasonable person believe that they are going to be able to stand up to the elements?

Just food for thought.
September 9th, 2010 at 8:05 pm #Cintos

Hi i need heló my auto was stolen and tottaly damaged am told after 9 months i had full coverage with allstate and they aré fenying my vclaim in full i need heló
September 11th, 2010 at 6:40 pm #Don

My wife has severe osteoporosis, over the past five years she has broken her right wrist, T-6 vertebrae, left hip, left arm and L-3 vertebrae. Treatment for the compression fractures of the vertebrae’s was a verteplasty and this latest one a vertebroplasty.
The hospital received pre-approval for a Cat Scan and MRI for the vertebroplasty, even though it was touch and go for awhile as to weather they’d approve it, they did, and an approval was faxed to the doctor and they proceeded to treat my wife.
Now some 4 months later the insurance company has sent a letter stating the claim is being denied. In their letter they say their Medical Reviewer ( an “MD”) has determined the requested service were “inappropriate and were not in accordance with generally accepted standards of medical practice and clinically inappropriate in terms of type, frequency, extent, site and duration and were not considered effective for the patient’s illness, injury or disease, The scientific literature fails to confirm that this services improves health outcomes. This decision is based on The Health Plan’s Medical Policy Medical Necessity and Investigational and Not Medically Necessary Reviews of Service in the Absence of a Company Applicable Medical Policy or Clinical Utilization Management (UM) Guideline.
What can we do? Where should we go from here to fight this decision they have made?
September 16th, 2010 at 2:34 pm #matt

Hi,My dishwasher stopped working suddenly. I had homeowner insurance from Fidelity. They send Sear’s technician to fix the dishwasher; the technician made a mistake while fixing the dishwasher, which caused water leak and kitchen floor (laminate floor) was damaged. The technician accepted that it was his fault and asked us to take up with Sears.

I had file the claim with Sears liability department…handled by third part Sedgwick CMS. They dragged the case for long time (6 months) and then denied the claim, without any reasoning. I called them multiple times and left voice message but they never called me back. Just they send letter denying the claim.
Now, what should i do ?
September 16th, 2010 at 3:31 pm #Public Adjuster

Matt,

Wow… this brings back memories (not good ones)… I had a case involving the EXACT same situation and the same parties.

Based on past experience, file the claim with your homeowners insurance – Fidelity. They have a first party contractual obligation with you and have to follow certain criteria and standards. Let them deal with any issues related to subrogation and third party liability. Sedgwick knows they do not have a contractual obligation to you and they don’t have to respond to your telephone calls, letters or anything. They will… but not with much care or concern. Getting Sears involved is of no avail. They will simply refer you over to Sedgwick.

If you are dealing with a lady.. who I am only going to give the initials “DS” … I find it odd that a lady that apparently works in claims and customer service belongs to a group on FB that names itself the “I Don’t Give a F&#$” group….. nice huh? Kind of says a lot to me.

We ended up settling the claim we had with Sears which was from a dishwasher which the tech put a hole in the bottom somehow and it leaked… but we settled through litigation and not with ANY help from Sedgwick or Sears. They dragged it out for nearly two years and virtually did nothing.
October 13th, 2010 at 1:48 pm #Angry insured

Recently noticed some damage to roof vents on my house and called a roofer who was recommended to me by a friend to check it out. He thought the damage was from hail. I filed a claim with Country Ins. and they have since sent out an adjustor (who admitted he didn’t know anything about hail), tried to deny that there was hail in the last year at my house (which I proved that there was), sent out an engineering firm who said the damage was not hail but “man made to look like hail” and now have had an “insurance investigator” contact me. The investigator said that I can’t get the claim paid under a hail claim but that if I filed it under a vandalism claim that they would pay it. I would also have to fill out a police report and apparently give some sort of recorded statement to them (Country Ins.) What should I do? Are they trying to set me up to blame me at a later date to get their money back? Please help!!!
October 13th, 2010 at 4:00 pm #Public Adjuster

Angry Insured,

Ok – I am going to go off of the premise that 1. You had no involvement to the damage to your roof vents 2. You put in a claim with the earnest belief that you had damage due to hail. We need to work off of these premises and set every other scenario aside.

The insurance company has a duty and obligation to “properly” investigate a claim and act in an “advisory capacity” to the insured as to the coverages that are available to them. If you believed at the time that you filed a claim that the damage to your roof was due to hail, and when asked by the carrier what caused the damage – you stated “hail” because they of course need a cause of loss… you provided information that was available to you at that time.

Now, you have new information. You were told by the engineer that the damage was man-made. You were also told by the insurance company that had you filed the claim for “vandalism” it would have been covered – but you need to file a police report etc.

The error on the part of the insurance company is their thinking that this is a “new” claim. This is not a new claim but rather one that needs to be re-keyed and given a different cause of loss. Then sure, file the police report if they request you do so and explain to the police the reason you are filing the report and provide them a copy of the engineers report.

Do I think you are right that the damage was caused by hail. Probably. I don’t know all of the facts – but if they want to state that it’s vandalism.. fine… let them. The fact is that it is a covered loss. If during their investigation they uncovered new factual information – AWESOME! They did their job.

Are engineers ever wrong? All the time! Plenty of engineers are deeeeeeep into the insurance companies pocket and get fed a ton of info before they even set foot on the property so they are already pre-disposed to the claim rather than having a truly objective opinion. But in this case, they are not denying your claim – so… I would just say… “great.. thanks for the new and accurate info…. pay me”!

As for the recorded statement – I could go on and on about what to do and what not to do. Bottom line – you have nothing to hide. Recorded statements are fairly standard. They are probably not a requirement of the policy but I always advise my clients to cooperate and answer their questions honestly. I doubt they are trying to set you up. Possibly rattle your cage a little.. but big deal.

A few do’s and don’ts.

1. Record the conversation yourself and make them aware of it. So many people make the mistake of not recording it and then later get called in for EUO’s (examination under oath) and forget what they said and have conflicts.

2. You are not under oath – but expected to be truthful and accurate.

3. Don’t elaborate when not necessry. Ex. Mr. Jones.. how long have you lived in the home. “Well.. I moved in in 1989 just after my last house was destroyed by a fire set by my neighbor because he hated me and my dog had to be put in a kennel.. and my grandmother didn’t love me… ” yikes! The question was… how long have you lived in the home… “Since 1989” is the answer… that’s it.

Now.. they will ask you ?’s like.. explain when you first discovered the damage. So, explain it.. but that’s it.

4. If asked compound ?’s – recognize them.. and answer them individually. For ex; Mr. Jones.. since you purchased the property have you ever gone on the roof or made any repairs to the roof, gutters, vents, or any other repairs to the home. These types of questions get tricky. Many people are tired and may just answer NO to this. But later when questioned again and it’s reworded to individual questions like “Did you ever clean your gutters” and you say “Yes”.. well it appears theres a conflict. Or, did you ever have a plumber come out .. and you say “Yes”.. but previously you answered “No” to repairs to the home because you thought they were talking about just the roof.

I know my post is long winded but in a nutshell don’t worry – just answer their questions and get your claim paid. If they ask you to file another claim I would question that since then you would have 2 claims in one year on your record and make it more difficult to get renewed – or your rates raised. But other than that it just sounds like the typical red tape b.s. of an insurance company.

Don’t forget to record the conversation or “statement” as they call it yourself. Very important!
October 20th, 2010 at 7:52 am #Jim Lynch

My wife had a series of back issues throughout 2009. All claims submitted to Aetna were covered each time. The company I had worked for for 15 years was being sold (after nbankruptcy filing). We were still in business and operating. I was offered a package to leave which I took as I had another offer. I paid all of my cobra premiums. Somehow one of the premiums did not make it to Aetna one month and the insurance was shut off but reinstated once the error was discovered (August 2009 timeframe). Here is the problem. The doctors office had submitted one round of claims in the window where my insurance was technically non-existant. When I received word from them I said to re-submit because my coverage was in effect. The company was soldin parts and ceased to exist late September 2009. The doctors office submitted the claim again but it was denied now because they said the company was no longer in business. I have gone back and forth and Aetna does say that I was covered for the dates of service and does agree that they had paid for my wifes care for many months in 2009 from the same provider. They claim that my comppany was “self funded” and since there was no money left they cannot pay. Its over $1,600. I pais ALL the premiums. Any advice?
October 27th, 2010 at 4:57 am #Insurance Company Property Adjuster

To: Public Adjuster

I work in Eastern Pennsylvania. I have rarely in my 25-years in claims, if ever, encountered a PA either as knowledgeable as you are, and have never found one as willing to share the accurate analysis of a claim situation as you do. I have just stumbled upon this site.

While I am not thrilled with the tone on the Uclaim site and it’s tilt towards PAs, the insurance industry shares more than a little responsibility for not providing even adequate alternative information or websites to assist consumers, leaving the field wide open to what (at least in my area of operations) wind up being the predatory practices of public adjusters.

While I doubt I can single-handedly change the public’s perception of insurance companies and their adjusters, I hope to be able to contribute some insights and advice.
October 27th, 2010 at 9:49 am #Public Adjuster

Property Adjuster,

Thank you for your kind words. That was very nice of you.

I’m sure we can agree that the Insurance Company Adjuster and the Public Adjuster should always have the same common goal and that is to make certain the insured is promptly and fairly indemnified for a covered loss. I previously worked for several insurance companies and I have the same mentality now that I had then… “advocate for the policyholder”.

Clearly the Public Adjusting field is wide open because there simply is no shortage of policyholders that are disgruntled with their insurance company. If more people knew what a public adjuster was, I would imagine that more people would hire them. And that will always continue until more insurance companies put their policyholder first, properly train their staff and field adjusters, quit overloading their adjusters, and properly pay claims. And properly pay their staff! Not all insurance companies – but most.

And I agree with you – the public adjusting field can be predatory in nature. My firm flat out does not engage in certain tactics such as listening to fire scanners and then showing up at someones door to solicit ourselves. Many companies do, but we are straight referral – period! We often donate our services and have waived our fees on numerous claims by senior citizens, low income, or special circumstance claims. But I get the fact that some insurance companies would group us into a certain category simply because some public adjusters do some bad things.

I for one think your point of view as an inside property adjuster would be a fresh perspective and an educating one. While I try to remain objective I do realize that is not always the case and that there is much to learn.
October 27th, 2010 at 3:36 pm #admin

Property Adjuster,

We welcome and encourage your continuing objective comments. Help us create a groundswell to reward good insurers and good public adjusters, and not give our dollars to the bad ones.
November 8th, 2010 at 6:01 am #Sharon Taylor

We have been in business in California for over 45 years. Three years ago we changed our business insurance package (including Workers Comp) to Farmers. After our yearly audit, our agent advised us that we owed Farmers 20K for changes in employee codes that they had discovered for all three years. We advised him that we did not agree with the findings and he told us he would work on the matter personally with underwriting and Farmers as a whole and that we should just continue to make our premium payments as usual. We did. In June we received a letter from Farmers of intent to cancel our policy. We contacted our agent who advised us not to worry, that he was working on the matter, to continue to make premium payments. In August, two of our employees received minor injuries and were seen by a physician. My employees later received letters from the doctor stating these were not covered losses. We contacted our agent who advised we still had coverage and he would handle that as well. Since then we received confirmation that Farmers had cancelled our policy effective July without notification, leaving us uninsured for several months which is a clear violation of the law in CA. We have since obtained a new policy but I want to know if I there is any legal action I can take against the agent and Farmers. Please advise.
November 8th, 2010 at 4:07 pm #Joan Heidenreiter

I recently moved from AZ to CA and took out additional insurance to cover certain expensive and new items.The movers damaged almost everything and now the insurance company denied the claim.I have papers at the point of origin that was forced to sign or he was going to leave everything in the driveway in front yard.Then upon the destination my papers never show a signature and he would not let me get ahold of the papers to fill out the damages. It shows they packed the majority of the items in a dispute letter to my credit card company.Now the insurance company says the opposite when there is proof that they packed these items and on my slips it show that I did not pack them but they are insisting that they have slips that show that I packed them.Like the heavy HD TV which there is now way I could even lift it and to pack it in the box I had originally from when purchased.They are again denying the claim even though the moving company sent a letter stating clearly that they packed all the items.
WHAT DO I DO????WHAT ARE MY OPTIONS TO GET THEM TO PAY MY CLAIM???
November 26th, 2010 at 5:52 pm #Chris

Our vehicle was struck by someone who ran a red light. When the police office questioned the 83 year old driver what color the light was, he said he didnt remember. This is all down on the police report, it clearly states the other driver was at fault. The other insurance will only pay 50% and forcing me to file through my insurance company. My insurance company does not cover car rental fees or bodily injury. What can I do?
December 7th, 2010 at 7:11 am #Brittany

My fiance is currently deployed. He has a house in Tennessee with tenants, and the house is covered by a home warranty in case of any material issues or concerns. This past year the A/C quit working, and the home warranty company sent a contractor out to repair the system. The repairs were not completed properly – improper installation, missing parts and issues related to an undersized duct system (the A/C unit that they put in was too large for the current ductwork, and larger than the previous unit in the house). The warranty company no longer does any work with this contractor; however, the problems related to workmanship were not identified until recently, when the heating system went out, and the warranty company sent a new contractor who reported these issues. The warranty company has denied claim and states they are not responsible for the repairs because of the missing parts, undersized ductwork and installation issues (two out of the three caused by the previous contractor that the warranty company had hired to perform the services!).
My question is – is the home warranty company culpable for the problems/issues related to the A/C system repairs, which subsequently resulted in the heating system issues currently experienced? In my opinion the first breakdown resulted in the second, and therefore makes them responsible. Do we have recourse? Please advise.
December 7th, 2010 at 2:20 pm #Connie

This is complicated but I would like to know if I have a case. My car is totalled after hitting a large pot hole in Oct. of this year. I call the insurance company and they tell me I only have liability. I argue the fact that I didn’t want just liablity and it’s an error and the rep. agrees and writes and email to explain his error for the cliams dept. etc, Then I find out that not only did he make an error about libility vs, full coverage, but I didn’t have insurance for the prior two weeks. I was never sent notice, but in the meantime I’m corresponding with my rep. which tells me don’t worry about payment make it as agreed. All along I have no idea that I was not covered, never received notice etc,. Again my rep. writes an email indicating that I was not notified. Well after two months I find out that they denied my claim. Mind you in the meantime, my totalled car was towed from my apt. for which I notified them of the fact that it would be due to the tags beging expired as of November. Here’s the real kicker, I’ve been with State Farm for over 30 years and this is how they treat one after all those years. Any adivce. Here is what I plan to do. I am a paralegal and work with the courts and have over the past 25 years, I would like to know if there is a procedure other than the court system that I must go through before filing a legal complaint? Thank you.
January 5th, 2011 at 11:07 am #Elaine

We recently purchased a new home that has a swimming pool, within a month of the closing a blizzard caused the swimming pool cover to cave in, causing damage to the pool liner. Damages total near $6,000. I called the claim in to the insurance company who deny the claim because of an exclusion in the policy that states it does not cover damage caused by the weight of ice or snow. Can I fight this? This is really just not fair!
January 5th, 2011 at 11:56 am #Public Adjuster

Elaine,

If you have yet to receive a denial letter then ask for one from the adjuster. Also request a certified copy of the policy if you were not provided one. Often the insurance company will only send you what is known as the “Declarations Page” which explains how much coverage you have but this isn’t the actual policy.

Once you have both of these in hand – compare the wording utilized by the adjuster to the policy and see if they match. The adjuster is required to inform you in writing of the specific policy language that they are relying on when denying a claim.

Not all claims are covered. What you state is not fair might not seem fair to you but if it is excluded, and the exclusion is in the policy, then the insurance company has every right to contractually deny the claim.

But even with this you may still have outs. So, here is what you should do in my opinion;

1. Get the denial letter
2. Get a copy of the policy if you don’t already have one (call your agent)
3. Cross compare the wording and see if it matches.
4. If it doesn’t match – reach out to a public adjuster for help. Maybe even do that anyhow. Many PA firms will give you some quick advice free of charge especially for smaller claims. At least we do. We are here to serve the community and depending on your situation some firms like ours take cases free of charge depending on the situation.

Lastly, lets say everything points to the direction that the insurance company has properly denied the claim. Did you receive a copy of the policy when you paid your premium? The insurance company is required to provide you with a copy of the policy at the time (or shortly thereafter) when you originated your policy. If they never did this, and you are certain they never provided you a copy, then you may have a case which would need legal help. An insurance company can hardly deny a claim when they have never even explained what the exclusions are by providing you a policy. But that is a last ditch effort and only with the certainty you did not receive the policy.

I hope this helps and you are able to get the claim covered. I’m a little puzzled at the reason for the denial because weight of ice or snow is generally covered even under the “collapse” provision of the policy. But possibly they have a specific exclusion for pools. So, write back – I’d like to read the wording in the policy.

Take care
January 5th, 2011 at 12:02 pm #Public Adjuster

Elaine,

I wanted to add to my last post because I was kind of thinking out loud when I was writing the last post. The collapse provision of the policy would only apply to a “dwelling” and very unlikely would it apply to a pool. Under the collapse provision generally collapse is covered if a dwelling collapses under the weight of ice or snow. But, it is possible depending on the wording in the policy that there is a long shot there may be coverage. Not sure. It would be nice to see your policy and go from there.
January 6th, 2011 at 1:14 pm #Juhi

Last month due to heavy rains in my area…our living room ceiling leaked…so there is a roof leak. The insurance company(AAA) denied the claim because they say the roof tiles were laid too close by the builder 16 years back, making a narrow valley space and debris getting in there because of that over time. They said they don’t cover building defects.

My builder says they met the code at that time, they warrant the roof for 15 years, and my house is 16…so they won’t help either.

Do I have a recourse against either one of the two? We are talking about $15, 000 worth of damage…in repairs.
Anyone has any advise about what I should do?Thanks
January 6th, 2011 at 3:06 pm #Public Adjuster

Juhi,

Some insurance companies cover the interior damage that rain water causes despite how the water was able to intrude into the home. Unfortunately, AAA is not one of those companies. Here in CA Mercury, Allstate (Deluxe Policy), and State Farm will cover the interior damage from rain water but will not cover a worn out roof, or improperly installed roof, or a roof not up to code etc. However, companies like Farmers, AAA (Interinsurance Exchange of So. CA), and all other carriers I can think of reject rain water damage to the interior unless there is first a storm created opening to the structure that allowed the rain to come in.

There is an opening in your roof which has allowed water to penetrate to the interior. Who made the determination that the rain water penetrated due to the roof tiles being installed too closely thus allowing debris to build up.. causing rain water to come in? Was it the adjuster or was it a roofing expert? It seems if the roof tiles served their purpose for 15 years… then why not 15 more? What made the 16th year the year the channel failed? If AAA did not get a roofing expert out there.. then get one. Make sure this is the actual cause of the water intrusion.

If you are able (otherwise have someone look at it) – go into the attic and see exactly where the water is penetrating in. Also look at THE ENTIRE ROOF and see if there are any displaced tiles. If you’re in Southern California (are you?) we had high winds along with rains. While wind driven rain may not be covered if there is an opening in the roof – your claim will be covered. I have dealt with many claims where even the insurance companies so called expert roofer was wrong and the claim was eventually overturned. It’s just a lot of investigation and work. But, remember where these companies get their money! I know several roofers/contractors/flooring experts that no longer even perform construction. They don’t have to… they make their money by providing so called “expert reports” – making well into several hundred thousand dollars a year and more just giving reports… a majority of which help the insurance company deny claims. So, no… don’t roll over just yet.
January 15th, 2011 at 3:41 pm #Renata

Would my house insurance company denial my claim because I was renting a illegal basment?My house was on fired, the fire started on the first floor. but I am worry because i rented a illegal basment would that affect my claim?
January 16th, 2011 at 7:07 pm #Paul

My apartment was broken into over the weekend while having a day out. There is no sign of forced entry. Both of my 50inch tv’s were smashed, wholes were in the walls, video games, ipod, silverware and my small safe was taken.

A few thousand dollars and all of my important documents were taken such as social cards, birth certificates, and receipts for large ticket items. There is probably no way for me to get records from the stores due to the fact that I pay cash for everything and always decline to giving information when asked.

After reading here I’m concerned about not having receipts or any other way to prove the purchase of these products, the two 50inch tv’s are still in my possession but smashed to hell. My receipts are in the safe that was taken, so do you guys think that this is going to cause me problems, and if so what kind of problems.

This is my first time that I’ve had renters insurance and I only got it because the complex requires it, but I’m glade they did.
January 16th, 2011 at 8:20 pm #Public Adjuster

Paul,

You will probably be okay for the most part. You’re most likely going to be over the policy limit for the cash which I believe will have a limit of $250.00 to $500.00. The televisions are a non-issue because that should be covered under vandalism. The silverware is probably also going to have a low limit like around $500.00. The documents that were stolen will only be replaced for the value of replacing them.. like ordering a new birth certificate, passport, etc.

Adjusters are for the most part reasonable people and if it makes sense then they will push it through. If something sticks out like a sore thumb, then they are going to ask some questions and try to get supporting documents. Like, let’s say you have average items.. and then all the sudden you claim a $50,000.00 rug. Well, you may very well have owned the rug, but it raises an eyebrow so you could suspect they will question that. Games, silverware, an iPod, etc. are all things that one would normally suspect would be in a home. So those items shouldn’t really be questioned – but if you have proof – then all the better. Try looking through old photos to verify some items. Also, if you have an iPod then you probably either have songs on your computer downloaded from iTunes, or can verify your iTunes account through your bank statement.

The holes in the walls in the apartment would be covered by the building owner I would imagine. But try to look through recent photos and see if you can verify some of the items to help the adjuster properly document their claim file. It will also help expedite the processing of your claim.
January 25th, 2011 at 5:26 pm #beba

I did an auto claim I had told them that somethings that were on the car that was Prior Damage was all the same claim. but when we did the ESTIMATE we listed as Unrelated Prior Damage and estimate is only for the new claim. Can they denie it do to that.
January 26th, 2011 at 11:59 am #Janet

My son just received a letter denying his insurance claim for total loss of his home and contents, including car parked in the garage. They paid off the existing mortage, but are denying to pay anything on the household contents. The home was insured for the replacement amount and had content coverage also. What or where do we do at this point. He lost everything.
January 26th, 2011 at 8:53 pm #Public Adjuster

Janet,

It’s very difficult to provide any guidance to your son without you providing the complete picture to what is going on. We need to know more information. Why is the insurance company denying further coverage? I can understand certain circumstances that an insurance company would pay off the mortage and not pay anything else – but I would only be guessing why. The insurance company not only has an obligation to the insured, but also to the mortgage company. So, if the claim was denied due to fraud… then the carrier would still owe the mortgage company and pay off the loan but deny covergage for everything else. So, to best help you, please fill in the pieces of the puzzle. Give me some facts surrounding what happened and why the insurance company is taking this position.

🙂
January 29th, 2011 at 9:31 am #c koos

Five months ago I was in a very bad car accident which resulted in a totalled SUV. When I was recovering from my injuries (broken back and right and left shattered arms) my husband who asked for divorce 2 weeks prior had been dealing w/ Allstate on the final settlement for my truck. He then opened a new bank account in his name only and directed Allstate to direct deposit the check (my name was on check and policy) into HIS bank account. To date, I still haven’t gotten any of the $27,000. Do I have any recourse w/ Allstate for not verifying I was also on the bank account or something?

2nd question: the day of accident, I was going to a local consignement store to sell a lot of my belongings b/c I needed to hire a lawyer. During the accident my truck rolled 2 or 3 times and the contents were either damaged, not recovered from scene or stolen by tow driver/salvage yard. I filed claim for these items, amounting to $10,000 under my Homeowners policy. After being given the run around for 2 months, the claim was re-assigned to a man who is very harsh and gave me the feeling from the beginning, that I was lying even though I have pics and receipts for every item on list. I finally called hm yesterday to check thje status and he said I would be rcv’ing a call from Allstate’s lawyers on Monday. Why and what should I anticipate happening?
Thank you for any help.
January 29th, 2011 at 1:47 pm #Public Adjuster

C Koos,

In my opinion regarding the check you are going to need an attorney to sort this out. It’s definitely not in my realm of being a public adjuster. If you have a divorce attorney ask him/her what to do.

As far as the contents in your vehicle… it sounds like the guy on the phone is probably part of Allstate’s SIU (special investigation unit). It’s quite possible they think you are lying or you are overinflating the items on your list or amount of items. If you are not.. which I assume you aren’t, just stand your ground. Give them the proof they request and the information they request. No more – no less. Write down to document all of your responses. You may need to refresh your memory later when asked again.

If the adjuster stated that you would be hearing from Allstate’s attorneys… what he really means is 1 attorney. They aren’t going to have multiple attorneys call you. If they do it’s highly inappropriate. Just remember, it doesn’t matter who asks the questions… just give your honest response – cooperate with their investigation – and provide CLAIM RELATED responses to what they ask.. NO MORE – NO LESS! Don’t be evasive – just answer them.. you have nothing to hide.

Now – you asked why? More than likely they are going to request your EUO (examination under oath) if they are assigning an attorney to your case. Otherwise there is no point since having an attorney ask questions would be no more than making the attorney a glorified adjuster. So, expect that you will receive a formal request to sit for your EUO which is a requirement of the policy conditions upon request. Once again, nothing to be concerned with. However, I ALWAYS recommend that my clients attend the EUO with an attorney of their own. This is very prudent as your attorney can object to certain questioning, guide you with how to answer questions, help you avoid answering compound questions or questions that are intended to solicit a different response to a prior question already asked.

But don’t worry. Just go through the process and you should be just fine. Dozens and dozens of my clients have sat for EUO’s and it has only helped their case – not hurt it.
February 11th, 2011 at 12:34 pm #Michelle

My 13 year old nephew was shot and killed at his friends house while staying over. The police have closed the case as accidental, the coroner has ruled it an accident yet the homeowners insurance is denying the claim due to information gleaned from blogs and facebook. Apparently there are suspicions that it may not be an accident by bloggers? What legal right would they have to deny the claim based on that when the authorities have ruled it an accident? What should my sister and brother-in-law do now? Any advice would be greatly appreciated.
February 11th, 2011 at 2:37 pm #Public Adjuster

Michelle,

My heart pours out to you and your family to hear of this tragedy. Since I am one of the guys that generally offers advice here I at least wanted to answer you and extend my condolences.

My opinion is they really need to get an attorney involved that is knowledgeable with insurance and personal injury/wrongful death. As a public adjuster I’m only permitted to deal with and knowledgeable about “property damage”.

I wish I could be of more assistance. And once again, I’m sorry to hear of your tragic loss. I hope your family heals quickly from this.
February 14th, 2011 at 1:19 pm #David Allen

I had a water pipe over the kitchen burst at my vacation house, which brought down the ceiling in the kitchen and flooded 3 other rooms. I called the insurance company and they immediately sent out a restoration company, which started work that day on a temporary approval from the insurance company. They did a full cleanup, pulled all the wet carpet and pad out, removed all the baseboards, and cut a lot of wet sheetrock out (about 3 feet up from the floor). No furniture or anything else was damaged, just the ceiling, sheetrock and carpet.

Today the adjuster called and said that because I didn’t have the heater on at the vacation house while I wasn’t there, they were denying the claim. That seemed like an excessive request in Texas. So I asked about all the work the restoration team had done already. She said that they would pay for the work done so far without a deductible. So I asked about all the stuff they pulled out that they said was required under the insurance codes, even though it looked fine to me and just needed to dry out. They are going to send an adjuster on-site to see how much has been removed and might be willing to pay to replace what the restoration guys removed. I have a feeling the restoration guys were going a little overboard to make it into a bigger job.

How much can I expect them to replace? What limits would apply? What are my negotiating options?
February 16th, 2011 at 11:37 am #donna

i had short term disability insurance with aflac. my hours were reduced at work to 20 hours, and i was told by the aflac rep that if i did not work over 22 hours, i did not qualify for the coverage, so i canceled the policy. at that time i had aflac for 4 years and was pregnant, and anticipating a c-section birth. the only reaosn i woudl have ever canceld the policy, is because of the info i recevied from the rep. when i went out on maternity leave, i decided to not return to my old firm, but took a new f/t position at a new firm. witin 6 months of starting the new job, i solicited aflac for the firm, and began a new policy. during the course of that registration, i was told by my new rep that the info the old rep gave me was not correct, and that once you have aflac, you can keep it as long as you can self fund it, regardless of your hours worked. i filed a claim for reinstatement and was denied multiple times, so i filed suit. i am looking for interrogatory and request for produciton of document samples i can send aflac for my scenario. do you have any pretinent examples you could send me?
March 12th, 2011 at 5:26 pm #Pat

Center Point Energy shut off my gas service (2/15 in Minnesota) when I was out of town without notifying me prior to or after the disconnection. As a result water pipes broke causing extensive damage. Center Point Energy claims that a (one) mailing was sent on 1/20 informing me of the shut off and phone calls were attempted to my old disconnected phone number to contact me prior to shutoff. My mail is being forwarded to a different adress and I didn’t receive anything from them about any shut off but coincidently received a bill from them on the same day they say the notification was sent which had no mention of any shut off. Other bill sent after that also did not have any mention of a shut off. There were two letters in plain envelopes left at my house which I found when I returned there after 3-4 weeks dated 2/9 and 2/15. The latter of the two stating that the gas was shut off that day and I should pay $302 plus reconnection fees to get it reconnected. No more contact about the shut off was attempted by any means after the shut off up until when I called them after arriving home 3 weeks later. When I called the billing department they told me that everything was current and my service is on. Later someone else came on the line and said they locked it out for non-payment. The whole time normal bills arrived without any mention of a shut off.
My insurance company talked with the gas co who said they sent the one mailing and is denying my claim because heat was not maintained because I didn’t pay my bill ($302). The actual wording was that I did not maintain reasonable care in keeping the heat on. I already got a bill from the damage mitigation crew the insurance company sent out which I don’t know what I’ll do with. I also called my bank about this to see if they could help, as my house is in the process of a short sale and they said I would be responsible for the repairs and needed to find some way to pay for them. I am unemployed, losing my house and am up against a large bank, insurance company and the gas company. I feel that the gas co acted reclessly and violated the MN cold weather rule around notifications. The insurance company was very quick to deny based on the gas company shuting off for late payment and then directed the damage mitigation company to collect from me. I’m not sure if the bank can make me pay to fix this ($30-$40K) either as it will more than likely be foreclosed on now. Thanks in advance for any help or advice on this matter.
Pat
March 26th, 2011 at 10:33 am #Kim

My husband and I were in an accident on Dec 30th 2008 in Tampa Fl. We had insurance through Geico, 10,000 PIP and 10,000 Property Damage (the min allowed in Fla), WE were on the highway and the guy in front of us slammed on his breaks to avoid hitting the stopped cars ahead of him, we went to swerve into the emergency lane and he swerved to hit our front end. Becuase our front hit his back, it was deemed our “fault”. There were no injuries and only minimal damage to his van. Two years later we get a letter in the mail stating we are being sued for damages in excess of 8,000 (but not 9,000 so still well under our coverage) and that our insurance had denied it. We had to sell our truck about a week after the accident to pay for ticket costs so canceled our insurance. We called the day it happened and made a claim and we have proof that we had insurance the day it happened. Can our Ins. deny the claim? and Can they even sue us two years later for a long forgotten accident? and How much would they really be able to do as my husband is the sole worker (who as of today isn’t working, but is looking for a job), and we have a medically needy daughter and another baby on the way?
April 2nd, 2011 at 1:59 pm #Regina

approximately how many individuals pursue appeals on a denied insurance claim?
April 5th, 2011 at 10:41 am #heather

two years ago we had a leak in our roof. the adjuster who came claimed the damage was under our deductable of $2,500. this winter we had a section collapse. when this adjuster came this time, he is all but condemning my building. The have flatly denied my claim, and are dropping my policy out right. My position is had the initial adjuster done their job properly, I would have never been in this position. Furthermore, the insurance company continued to cover me (or rather, take my payments…), w/o any further inspections. I am a small, semi-seasonal, woman-owned business who is struggling to survive in New York. Winter is my slow time of year, which means having to pay for the neccessary repairs myself now with almost nothing in my accounts, keeps me from purchasing inventory to sell, and could potentially bankrupt me. I am desperate. Please tell me small business has a voice and maybe some rights??
April 5th, 2011 at 11:07 am #Public Adjuster

Heather,

I’m trying to read through the lines here a little bit – I have to make the assumption that you are referring to a commercial property that you conduct business in.

Do you own the building or lease?

If you are paying for the repairs yourself I have to assume you own the building so I will go with that first unless you indicate otherwise.

Set aside the other claim 2 years ago for the time being. If the building/roof has collapsed – and by that I mean truly collapsed (not just leaking) then there should be a collapse provision contained in your policy providing coverage for collapse from the weight of things like water, snow, ice, people, etc. Probably also even covers collapse from hidden decay. However, your inventory may not be covered depending on the reason behind the collapse – or even due to collapse at all. Generally contents/inventory coverage is provided on a “named peril” basis. These being fire, wind, theft, etc.

You need to refer back to your policy once again assuming you have an insurance policy that covers the physical structure. And I’m assuming you do since you are upset about the denial for the structure and making the repairs out of pocket.

The adjuster is required to give to you the reasoning behind the denial and how it applies to the policy. You need to compare the reason for the denial with the poilcy if you have received the denial letter. If not, demand a denial letter in writing so that you can refer to their basis for denying the claim.

If the insurance company is claiming that you failed to make repairs to the structure from 2 years ago which has led to this collapse, then they need to prove that the collapse was causally connected to the prior occurrence and even then.. that is really a stretch for them.

I realize you are going to need more help. Please feel free to ask additional questions and I will be glad to extend my opinion as well as I am sure others here might be also.

Take care
April 19th, 2011 at 1:22 pm #Marie

I have a catastrophic claim in with State Farm for an Ice Storm that blew through the Philadelphia area the beginning of February. I called my agent that miserable day as the ice damns formed on my roof and 40′ tall pine trees boughs broke and landed on my house and garage. The agents secretary said she would get the claim started. At no time was I advised what to do or who to call but rather was told to have a nice day.

Nearly two weeks after my initial call I still had not heard from State Farm or my agent – so I called my agent – who advised to have a local remediation company come out and remediate until the adjuster scheduled an appointment. During this two weeks my fiance and I had gone up on the icey roof to remove the ice damns and tree boughs so I saw no reason to have a remediation company come out to “take all necessary steps to prevent further damage”. To me it seemed like a racquet and I didn’t want any extra bills.

The adjuster showed up 3 weeks after the storm and said she doesn’t go on roofs and that a Second Story Adjuster would have to come out to figure out what was going on and if there was an additional claim. She could only adjust on ground level and interior claims.

The roof adjuster came out the beginning of March and declared I needed a complete new roof (30 squares) and all new gutters 170′. Terrific I thought!

Here’s where the nightmare begins –
– At the request of my agent I did have his remediation company come out during the time between the ground and roof inspections. They observed where I had dried out the wet attic insulation, melted the ice on the roof, gutters and downspouts, dried out the walls inside my home where the ice damn water came in and finally said I had done a great job remediating the situation.
– A week later we had a terrible rain storm which caused my basement to flood. I emailed my agent immediately. He said I do not have flood insurance so its not covered. So I gutted the finished basement to figure out where the 3″ of water was coming from – I had to remove walls, carpet and drop ceiling – all stripped out. I couldn’t find the source so I called in a structural engineer to figure out where the water was coming from since the basement had never been wet before. He determined the flooding was due the gutters that were compromised and were not capable of managing the mass amounts of rain in their current state. He suggested tarping the exterior of the house where the gutter/downspouts are and observing. If I didn’t have anymore flooding then the problem is the gutter, if I continued to flood then I would need a french drain. Over the last 6 weeks we have had torential rains and guess what – no water in the basement.

– I’ve brought this to State Farms attention – they are denying the addition to my Cat Claim based on the following: That I should have taken additional steps to protect the property, That I do not have flood insurance, and that my policy excludes ground water penetration.

This seems outrageous to me – I believe I’ve gone above and beyond what any home owner should do…

Here’s the arguements on the balance of the claim that they have agreed to pay:
– They will replace gutters but not the downspouts. (They are managled from the ice)
– They are covering the roof but will not put on new sheathing – The roof currently has two layers so it will be a total tear off. I don’t want sheathing with all of these nail wholes. It’s 3/8″ Plywood and its still to code in my township
– They agreed to paint (1) coat of paint on the walls where the water came in – I want the sheetrock removed and the insulation replaced as I’m sure it is compromised and I want two coats of paint.
– They agreed to replace the attic insulation and bring the insulation up to R38 (local building code) but are refusing to pay for the baffles which is required to install r-38.

I am frustrated beyond belief and my agent is of no help what so ever.
April 20th, 2011 at 5:52 am #Pat

This whole insurance thing is nothing but a false sense of hope. Why buy insuance? When we want to get our claims settled they come up with some excuse not to pay? What do we do then? Call a lawyer and give away 1/3 or our claims. Complain to the insurance comission? I did and never heard back from them. What is the little guy to do when up against their arsenal of lawyers. Seems one sided against the consumer.
Pat
April 21st, 2011 at 9:07 am #taliah

actually it is true about the csi people paying health insurance and it is alot of money
April 25th, 2011 at 6:25 pm #PhilipDC78

My wife and I purchased our home 1.5 years ago, and one of the main selling points was that it had a 1.5 year old roof (3 year old roof now). Well the roof is leaking in multiple locations. My insurance company (Florida Peninsula) denied coverage of the claim because of “faulty workmanship” in the installation of the roof. I think most people would agree with this off the top of their heads, however the roof was installed by a licensed roofing contractor in Florida, a permit was pulled (city of Gainesville), and the roof was inspected and passed. The insurance company did not provide any other other backup to the “faulty workmanship” claim (no pictures, specific code violations, etc). I already talked with the roofing contractor, but apparently the warranty does not transfer to new owner (very shady contractor), so I basically have no recourse. Do you think I have a leg to stand on to appeal the insurance denial? What should I put into my appeal letter?
April 28th, 2011 at 3:11 pm #Melanie

I own a mobile home that is insured with Foremost and just discovered water “spots” along on entire side of my home. The adjuster told me that no type of water damage from rain, sleet, or snow is covered.
I had my home re-roofed last year, the home is a 1976 that has a metal flat roof, the roofer used a roll down type of material that I am now told is the WORST thing to put over a metal roof. The roofer has been back here 3 times because I noticed areas where it was lifting. He always claims it’s not his fault and he’s not responsible.
Foremost claims they won’t cover this either, there are mold spores on a section already and my daughter has respiratory problems. The mold is coming off with bleach, but I really feel the ceiling needs replaced to eliminate future issues with mold.
I’m at the end of my rope trying to get answers and hope you might have the best advise. thank you
May 3rd, 2011 at 4:10 pm #JK

My husband had surgery for sleep apnea and all but 2 of the procedures were covered and deemed to be “experimental” by the insurance company. The doctor’s office said they had everything sorted out with the insurance company prior to the surgery. We were surprised when we received a bill for 2 of the 4 procedures that were done during the surgery. We have appealed the claim and have evidence that the very same procedure codes have been paid by Medicare and don’t seem to be getting anywhere. Do we have a leg to stand on with this claim?
May 9th, 2011 at 12:26 pm #Ally

I have an inground pool which is winterized and covered for the winter. I travel and came in one day to find the liner had been cut. I called my insurance company and filed a claim for vandalism and called the police. The officer filed an event report as he stated he could not prove it was vandalism nor could he prove it wasn’t altho we had a clue who may have done this we couldn’t prove it either. With this being said our insurance did pay for the liner minus depreciation and deductable; however; when the old liner was removed the water that had gotten behind the liner damaged the bottom which is made up of vermiculite. I called my insurance again and he informed me they paid this on a benifit of a doubt. I told him we knew it was vandalism. but without the bottom being repaired the liner was useless. My question, do they have to pay the addition claim, And do I need to sit down with them on exactly what my policiy does and does not cover as This is the first time in the 40 years I’ve
had homeowners insurance that I have ever filed a claim and I am finding this a nightmare. They also did not cover the water nor lost chemicals. They just sent me my policy and I’m scared they will find ways not to cover the home as it is stated in the policy.
May 13th, 2011 at 2:41 pm #Chris

Hi,
I have Liberty Mutual auto insurance on my 2002 Chevy Avalanche. The vehicle has an addendum for business use, and is used solely for business use. While on a job, my vehicle was backed into. I was not in the vehicle at the time, nor did I see who hit me. I noticed when I got home that the tailgate was busted in, and also noticed on the ride home that there was a loud whirring noise coming from the rear. After filing the claim, I had my vehicle repaired at a local Chevy dealership. I live in Virginia, and the claim was determined to be covered under the uninsured motorists’ claim. The dealership fixed the damage to the tailgate and bumper, but did not do any diagnostics on the vehicle to assess the mechanical damage to the rear end. Upon calling Liberty Mutual back, I finally got in touch with a supervisor that allowed a further diagnostic to be performed on the rear axle. The dealership has determined that there is damage to the rear axle of my truck, but out of what I assume is lack of interest in a legal battle with my insurance company, they said that they are unable to determine whether or not the damage was caused by someone backing into my vehicle. However, as I have explained to both my insurance company and the dealership, it was not making this noise before the accident, and now it is. Liberty Mutual is denying my claim for the mechanical damage, saying that it was not caused by the accident. What can I do, as this is obviously caused by the accident. It wasn’t happening before, it is now. Is there any type of measure I can take to right their wrongs? Also, are there any reliable insurance companies that won’t let you down? I signed with Liberty Mutual because I thought they seemed like a reputable company. I could understand if I was at fault in any way, shape, or form, I would take full responsibility. However, I feel very let down that a company I pay (quite a bit, mind you), would treat their client as such, when from what I understand, the “uninsured motorist” policy that this claim falls under is also given leniency financially from the state of Virginia. Any help is much appreciated.
Thanks,
-Chris-
May 23rd, 2011 at 5:06 am #L hassan

my insurance company withdrew contents cover ten years ago due to non disclosure of information. My Bank was covering me for building cover, however, I have recently had notification that this will cease from May. Will I be able to find cover from another insurer? I am very worried as My bank keep writing to me
May 29th, 2011 at 3:01 pm #tjones

I live in Texas and a huge hail storm dented my car really bad. I think about 9 years ago or so I filed a hail damage claim with State Farm and they paid it. I called them again for an appointment and asked about the procedure. In course of the conversation I heard “normally we cut a check but some cirmcumstances may prevent this.” What circumstances might prevent them cutting me a settlement check?
June 5th, 2011 at 10:58 pm #kay

I have a renters claim in to my Insurance Co. I had a break in a few weeks ago while out of town and quite a few items was taken. My girlfriend that live next door founded my door window broken out and door ajar. I came home the next day, and did call for a Officer to come out for a report. I asked for fingerprint Officer to come out and she did, noon was found. I called my Insurance and made my report. I got a call a day or so later from a Claims Rep. and she came out a few days to take my report. A few days later and was told a Investgater will call me, and she did and came out. I gave her the same report and i showed her around and she took picturs.She asked for a list of friends and #’s and my mother. I was called a few days later an told i would have a new Claims Rep. I was called a week later and told i will have to take a EUO. I know i have not been able to prove owenership some of the idems becouse the was take when took every thing out my jewelry box, but i have been able to give proof for most. idems. I do not have the best of credit becouse of illness but my claim is a true
I need some feedback
kay
June 7th, 2011 at 10:02 am #kay

i am still waiting
June 7th, 2011 at 2:51 pm #admin

Kay,

You should have a lawyer with you when you get your EUO (Examination Under oath) taken with a court reporter. A good lawyer will keep a 2 hour examination from becoming a two day examination, among other things. Most lawyers will confuse deposition with EUO, and don’t know the finer points of an EUO or the differences. BOTH you and your lawyer should get one of the eBooks on EUO at UClaim.com on the products page in the Denied/misc section. If you go it alone you would be crazy not to get one of those eBooks. The eBooks have a money back guarantee. Regardless of how you proceed, let us all know what your EUO experience was like. There is no way to fully advise you in a couple of paragraphs.
June 9th, 2011 at 1:39 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.
June 24th, 2011 at 7:49 am #TAY

I HAD A BREAK IN BACK IN MARCH. MY INSURANCE COMPANY HAS DECIDED TO DENY COVERAGE ON A JEWELRY ITEM THAT BELONGED TO MY HUSBAND BECAUSE AT THE TIME OF THE BREAK IN HE WAS MY FIANCE AND HIS NAME WASN’T ON THE POLICY. HOWEVER, THIS IS THE ISSUE THAT I HAVE…THEY COVERED A WII CONSOLE THAT BELONGED TO HIM, BUT WOULDN’T COVER THE JEWELRY ITEMS. I ALSO HAD SEPERATE COVERAGE ON THE ITEMS, BUT THEY ELECTED TO CREDIT ME THE PREMIUMS PAID ON THE ITEMS.

DO YOU THINK THAT I CAN SUE THEM? THEY ALLOWED ME TO PLACE PERSONAL PROPERTY INSURANCE ON HIS ITEMS, BUT NOW THAT THE ITEMS WERE STOLEN THEY SAY IT ISN’T COVERED AND THEY WILL GIVE ME A CREDIT FOR THE THE PREMIUMS ALREADY PAID.
June 28th, 2011 at 3:56 pm #Bud

We had an extreme freeze in the Southwest this year (Feb 2011), coldest in recorded history. Temps dropped to below freezing for a few days. In the SW, we are not required to “winterize” our boats due to the mild conditions. My boat is stored inside an insulated storage room with a concrete floor and for the last 3 years. We only have 15 hrs on the boat as it is still brand new. I filed a claim, it was a freak nature storm or an “act of God” that caused the damage and we were denied. What can I do?
July 7th, 2011 at 8:23 pm #Whitney

We were recently evacuated from our home (a mandatory evacuation) due to a wildfire. Our friends told us to save all receipts for gas, food, and lodging because our Farmer’s homeowner’s insurance would cover it. Our deductible on our homeowner’s insurance is $1000. Since we were extremely frugal, our expenses were less than that. However, some of our friends said the deductible doesn’t apply to the displacement costs, and that we should be reimbursed for all of it. I can’t find any information anywhere on whether deductibles apply to mandatory evacuation displacement costs. Do they?
July 12th, 2011 at 9:30 am #Grant

My parents had to have the roof over their porch replaced because the wood was rotting and carpenter ants had eaten away at the wood. The insurance company denied the claim because the roof did not collapse. Do you know of a way to get this covered? By the way, this is a really helpful site! Thanks!
July 18th, 2011 at 9:13 am #Lee Tam

Home insured with Auto Owners Insurance Company for couple years. Previously insuranced with All State. Water leaks on pipeline due to rustic nail. The claim was denied due to the nail in the pipe was something that happened about 5 years ago (Home was build 5 years ago), Auto Owners want us to pursuing alternative claims with your previous insurance carrier. I thought since it happen now, the current insurance should cover the claim. What is the possibility for Auto Owners to pay for the claim and should I contact previous insurance company.
July 20th, 2011 at 3:06 pm #Trish Johnson

I was involved in a rear end collision and suffered a moderate whip lash injury. I received treatment and 2 MRI’s. The bill came to about $10,000. I had not health insurance at the time and I only had collision and liability on my vehicle. There was no question of liability in this case.

The at fault party’s insurance company immediately repaired my vehicle. After about 4 months I hired an attorney to represent me and do the paperwork for a fair settlment. The insurance company denied my claim stating I did not make an in peson statement and questioned my injury. I took it to 2 more attorneys who did not want to get involved with the case. It was a clear cut pi case and now I am stuck with this bill.

I even tried to contact the adjuster myself to see if I could work something out since I no longer have an attorney, but no surprise she did not return my call.

Can an insurance company just flat out tell me to “shove it”? What can I do about this if anything.

Please help.
July 21st, 2011 at 10:03 am #Marilyn

Hi, My boyfriend’s insurance company is telling him that he has a clause in his homeowners policy that does not cover a loss due to him not having his units rented within a 30 day period of the break-in.
He just came into possession of the property in January and work was being done on the property.
There was an break-in where the criminals busted out holes in walls to get into an occupied unit. The property is in CA.
Have you heard of such a clause? Any guidance would be appreciated.
July 22nd, 2011 at 5:32 am #Laurie

hope you can help. almost a year ago my rental apartment was flooded with over 2 feet of sewage. The fault was due to the municipality not maintaining the sewer system and the condo corporation not maintaining the plumbing. They are not denying this and their engineers have admitted fault. The city is “self insured” and we had to sue them to get compensation. Flood insurance does not exist where we are. They have no defense, but are calling an “expert” witness who says our claim amounts of the items lossed are not valid. How do I counteract an “expert” on values? Amounts listed were not unreasonable by any means, just close to what it would cost me to replace them. Several items were antiques.
I would appreciate any advice you might have.
July 22nd, 2011 at 11:42 am #Julia

We just bought our house couple months ago & my house got burglarized couple weeks ago and I have submitted a claim from my insurance. It got denied because they said that no one has stayed in the property in last 30 days when the burglar was happened. Could you please give me any guidiance on how to get my compensation? Thanks!
July 25th, 2011 at 2:35 pm #Kim

My daughter has been covered by my health insurance plan since 2002. She was dropped from her father’s plan in 2008. In September of 2010 she dislocated her shoulder and required surgery. My insurance (Anthem) paid all her medical costs, minus co pays and deductibles. In January 2011 she was added back onto her father’s plan (with the Obama Law). Now my insurance (Anthem) has recalled all payments made on her behalf for her surgery. They are stating that she was covered by another insurance company (which she was not). I have a letter from her father’s policy (Central States) giving the exact dates as to when she was dropped and when she was added back on. I forwarded this letter to my insurance company and today I received a letter from an attorney stating that they are representing (Anthem) and trying to determine if her accident was caused by another party. They are trying to determine if they can go after someone else for the money. She was playing softball and dislocated her shoulder. It was not anyone’s fault, just an accident, and I have sent in paperwork explaining this before.

Now my daughter is receiving thousands of dollars worth of bills and being threatened with collections. What are our rights and how do we get this resolved? I get the feeling that Anthem does not want to pay these claims, yet she was covered and I do pay for a portion on my health insurance. This is really frustrating. Any thoughts or suggestions would be appreciated.
August 3rd, 2011 at 3:35 pm #Jason

Kim,
What you have to do is communicate with anthem and make sure they clearly understand it is a sport injury with no at-fault person causing the injury and there was no other insurance for your daughter. They paid once and rescinded those payments. They don’t want to make another mistake on this and that is likely why they are being so cautious about paying again. Just keep following up with them.
August 3rd, 2011 at 3:40 pm #Jason

Julia,
From what you’ve indicated, you’ve purchased a home and moved into it. You’ve left your other home you moved from and are in the process of selling it or renting it, I presume. When certain properties are vacant for periods of time, the insurance is taken away. It’s much easier for a burglary to take place in a vacant house than it is a house that is inhabited. In this case, if your house was vacant for over 30 days, the insurance for certain events was removed and you became self-insured. So, the only person that you can seek insurance payments from is yourself if you are really looking for compensation.
August 3rd, 2011 at 3:46 pm #Jason

Laurie,
An antique is not always valuable. They are always old but that doesn’t mean they are always valuable. How did you obtain the values for the items that were damaged? Are the items damaged beyond repair? The modern day approach to many things that are old is to replace those items with new items that are available to replace it with. For example, an old couch can be replaced with a new couch. It is much more difficult to replace that old couch with another old couch because there is more of a market for new couches than old couches. Ok, now let’s put the age of the couch at 50 years. That doesn’t make the couch an antique – it merely makes it a 50 year old couch with little to no value. In the case of this municipality, and by most common law, they owe you ACV (actual cash value). Let’s go to this couch I just mentioned. If you have a 50 year old couch, it’s useful life is all but consumed and it’s ACV is at or near $0.
August 5th, 2011 at 7:30 pm #ramiro

I switch insurance companies about 18 months ago. An agent was sent to look over the property and stated in writing that a few shingels needing replacing before insuring the property. The shingles were replaced and pictures were sent to the insurance company, which in turn stated they were satisfied and issued coverage.

In June 2011 we had some hail in my area and several contractors stated that the roof had substain some hail damage.

I put in a claim and an agent was sent to look at the damage. He acknowledged that there was hail damage but stated that the hail damage was prior to our policy and denied my claim.

Are they correct in dening the claim after they accepted to cover the roof as well without condition?

Can I go ahead an replace the roof while I depute the decission.

It is my understanding that old shingles are more easily damager thay newer one due to deteriation. Deteriation will also make damage age faster than on new ones.
August 5th, 2011 at 7:39 pm #Jason

Ramiro,
Who says the insurance company covered the roof without condition? That is not something an insurance company will do.

Your claim is denied because you have hail damage that occurred prior to 18 months ago. Your insurance company won’t pay for damage that happened before its watch.

It’s your property and you can replace the roof anytime you want. If you are gonna dispute this, you might want to wait until you have a resolution.
August 6th, 2011 at 8:39 am #Lana

A civil law suit was filed against me giving me 21 days to answer. Contacted my homeowners insurance immediately, provided all the documentation and informed them of a dead line. Did not hear from insurance until two weeks later. Insurance rep left voice message on Friday at 5:30pm stating that they will not cover this claim and that letter explaining why is in the mail, additionally same insurance rep stated she will not be in her office on Monday and thus the reason she called, so I can find an attorney. This leaves me only 4 days to find an attorney and file an answer or judgment can be entered against me. There was no communication from insurance company during two weeks letting me know they will not cover me. What are my legal rights and what obligation insurance company has because they left me defenseless with not enough time to retain the attorney
August 6th, 2011 at 8:48 am #Jason

Lana,
Not everything is covered by insurance. If they aren’t going to provide coverage in this claim against you, then it is your responsibility to provide your own defense.

You had 14 days to contact an attorney and do your homework regarding this law suit against you while waiting to hear from your insurance company. if you needed a answer within that 2 weeks, you should have been calling the insurance company daily. Since you have 4 days remaining to retain an attorney, this will have to be enough time for you to do that.
August 6th, 2011 at 11:39 am #Lana

Jason

Thank you for your prompt response. Just to clarify I did contact insurance several times and was assured that my claim is under revew. I was not told it’s not going to be covered, I was told to wait untill they make a decision.
I understand not everything is coverd but do have an issue with insurance company waiting untill 4 days before the answer must be filed. This is not a question of coverage but insurance co Responsibility to provide a timely response so I would be given an opportunity to regroup.

Thanks again for your response
August 8th, 2011 at 2:13 pm #Dennis

I had some water damage in my kitchen from a leaking faucet. We were out of town for a week and when we returned we discovered the leak so I replaced the facuet since the leak was no able to be fixed so replacement was the only option. A few days later noticed discoloration on the trim and wood floor curling. So checked under the cabinet and noticed the counter top was rotted away and cabinet completly water logged so basicly the countertop and cabinet and part of the hardwood floor is ruined. So I made a claim on my insurance and was told it would be about a 2 weeks before some one could come out so I took some steps to help by drying it out and also treating the wood floor with some killz paint to help with any mold, also had a fan on the area from the time I discovered it till today. Had a adjuster come out today said my claim would be denied cause he said this is maintence not damage. Also said it was leaking for a long time since the wood on the flooring from the basement was black. Do I have any rights for a appeal or am I on my own for this one?

Thank you
August 8th, 2011 at 6:38 pm #Jason

Dennis,
Generally a claims adjuster can determine if a water leak has been on-going for quite some time. However, there can be times when a leak will occur and then it takes a couple of weeks for an adjuster to examine the damage. The damage can appear to be something that has been happening for a long time – and perhaps much longer than 2 1/2 weeks. Generally wood will turn black over a long period of time but there are exceptions to that.

You can ask your insurance company to have another adjuster examine the damage for their assessment and see if the other adjuster has a different perspective of the damage, when it occurred, and if it should be covered.

Another approach, or one that you can do in addition to having another adjuster re-examine the damage, is that you could have a contractor come in and have the contractor provide you with a written statement of when the loss occurred and what happened and you can share this with the insurance company.

Generally, there is no appeal with claims but the insurance company needs to do a full investigation before they deny your claim. If you believe they didn’t provide a full investigation and they interpreted the damage incorrectly, you may want to talk to the claims manager and express your points about the loss and how the adjuster interpreted it incorrectly. This may have to fall under the category of “the squeaky wheel gets the grease”. Best of luck.
August 9th, 2011 at 2:00 pm #Grant

My parents had to have the roof over their porch replaced because the wood was rotting and carpenter ants had eaten away at the wood. The insurance company denied the claim because the roof did not collapse. Do you know of a way to get this covered? By the way, this is a really helpful site! Thanks!
August 9th, 2011 at 4:15 pm #Jason

Grant,
It is very likely the denial for the roof is not because it didn’t collapse. It is that they have an exclusion for the condition of the roof, dry and wet rot, and carpenter ant damage. Sometime the expenses of owning a home falls under the general category of maintenance. It is very likely there is not a way this will be covered.
August 15th, 2011 at 9:05 am #Jim S

My 6 year old son found a knife in the garage, most likely out of my tool box and he and my 4 year old daughter got into my wife’s’ car. While in the car he proceeded to cut up old paper and some left over french fries they found under or beside the seat. The problem is that he laid the items he was cutting on the leather seats and then cut. He managed to leave cuts in the back seat, the arm rest and the drivers seat that I have found so far. Each cut i approx 4 – 8 inches long. My question is this: Will my auto insurance cover this damage? I carry comp and collision on this vehicle. I have not contacted the insurance company yet as I just found the damage this weekend and also was able to get the story out of my children.
August 15th, 2011 at 8:32 pm #Jason

Jim S,
If you mistakenly put water in your engine thinking it’s the area for the anti-freeze and the engine locks up, that is covered by insurance.

You situation is similar in that your son intended to cut the items he was cutting, not the leather upholstery – so it should be covered.
August 16th, 2011 at 11:50 am #Jeff

The pipe that connects our sewage line from the inside of the house to the city’s line (ie, the pipe that runs from the garage to the city) broke and flooded our house…State Farm will not cover this, claiming the pipe is OUTSIDE our physical house even though the pipe and the sidewalk are owned by me. Does this make any sense at all??? He even said anything that were to happen in my back yard would NOT be covered.
August 16th, 2011 at 5:04 pm #Jason

Jeff,
That pipe you described seems to be attached to your house in some fashion to remove the wastes from the home. That is part of your plumbing system. If that causes damage to your home, that should be covered whether it’s inside or outside. You need to get the claims manager involved with your claim as soon as you can.
August 17th, 2011 at 10:14 pm #Jeff

That’s what I think as well, Jason…I’ve already had 2 claim agents review and both gave me the same B.S…I’m going to escalate
August 17th, 2011 at 11:52 pm #Tony

This is just a note to anyone visiting this site, a little bit of FYI. I think it is important for people to know that an insurance company (any insurance company) is a business like any other business. And, like any other business, the purpose of that business is to make money, and as much as possible. Period. Do you know of any company that doesn’t fit this description, especially any big company? Because of this, the insurance company business model is simple: collect premiums (usually over-priced ones) and find any way to deny claims. They can’t MAKE money if they’re paying out claims, regardless of how legitimate. Even when they DO pay out, they don’t WANT to. They may give you a check “with a smile”, but you can rest assured that they are by no means pleased about doing so.

Virtually EVERY scenario on this board is testimony to the above facts. Even though the claim may be 100% legitimate (as MANY of these stories seem to be), the above authors still have horror stories to tell.

Just a little tid bit to keep in mind whenever you find yourself considering making an insurance claim.
August 18th, 2011 at 6:43 am #Jason

Tony,
It is correct that insurance companies are in business to make money. The insurance industry has been doing great financially, even in the recession/depression we are in. Their net income since 2003 has been increasing at a steady and solid rate.

Contrary to what you’ve indicated, insurance companies can and will make money even if they are paying out claims. That is what they collect the premiums for. They collect these premiums to pay the operating expense of running a business, the actual losses that are incurred, and a profit. These insurance companies pay for claims based on the insurance policy which is a contract.

You have to understand that there are exclusions in the policy and not every single claim is a covered loss. There are occasions when covered claims are not paid, and there are occasions when non-covered claims are paid. Sometimes there are mistakes in the system.

We don’t know all the specifics of the above posts and we provide information based on the questions posed. I’ve reviewed many of the claims above and it is impossible to know all the specifics. Insurance companies don’t just deny claims for no reason. Claims are denied for exclusions. If there are no exclusions, the claims are paid. The majority of claims that should be paid are paid as they should be paid.

The alternative to having insurance is to self-insure, or not have insurance at all. Many people will not go this route.
August 18th, 2011 at 12:47 pm #Steven Powell

What can i do if my insurance company denied my renter’s insurance claim/
August 20th, 2011 at 12:30 am #Tony

Jason,
The insurance industry has been doing great financially, even in the recession/depression we are in. Their net income since 2003 has been increasing at a steady and solid rate

Precisely. And why is this? How have they accomplished this? By collecting premiums and trying any way possible to deny claims, regardless of how legitimate the claim may be. Virtually every adult in this country is required by law to have at least one type of insurance, with many having several. Yet comparatively few ever need to make a claim. The result? Individuals pay THOUSANDS AND THOUSANDS of dollars for their coverage over the life of their policies, while getting little if anything in return (besides a major headache).

…insurance companies can and will make money even if they are paying out claims.

Pretty much the same answer as above. Take in as much as possible while paying out as little as possible equals, well…, you’ve already answered that one.

There are occasions when covered claims are not paid

Which is what most people are complaining about in this forum. This is an example of what I said earlier, the insurance industry’s desire NOT to pay claims regardless of how legitimate they are.

and there are occasions when non-covered claims are paid

But only through some kind of fraud. There is NO WAY an insurance company would pay for a non-covered loss unless they were duped into believing the loss WAS covered. An example would be someone lying about possessing an item that they later claim was stolen. Or even removing an item themselves and claiming it was stolen.

Sometimes there are mistakes in the system.

And virtually always these “mistakes” benefit the insurance company, screwing over the poor policy holder who just wants what he’s been paying for.

We don’t know all the specifics of the above posts

Granted, we don’t. But the poster does. At least, they know their side of the story.

Insurance companies don’t just deny claims for no reason

No, they don’t. They’ll give a reason, regardless of how much BS it contains.

Claims are denied for exclusions

Whether they exist or not. The insurance companies know that most people have never read their policies and probably couldn’t understand them if they did. They’re written in “legalese”, and generally, only a lawyer can understand them. The majority of claimants can’t afford to hire a lawyer, which the industry also knows. So the vast majority of unjustifiably denied claims are never adequately contested, so the insurance company wins. And these cases far outnumber the ones that ARE successfully contested (where the company loses). This results in a win-win scenario for the industry. The money they “lose” in successfully contested cases is dwarfed by the money they “save” in those that aren’t contested.

The alternative to having insurance is to self-insure, or not have insurance at all. Many people will not go this route.

Maybe that’s because it’s illegal. Try driving a car without proof of insurance. If it’s financed, the lien holder requires full coverage, or they won’t finance it (they’ll even go so far as to repossess it if they learn you don’t have adequate insurance). If it’s paid off, the state still requires liability coverage. Even Bill Gates is required to have insurance, even though he could pay more than the insurance company would. Thus the reason “many people will not go this route”.

The point of all this is clear. Insurance companies are businesses whose purpose is, like any other business, to make as much money as it can. This is done by having an income which exceeds your expenses. The greater the difference between the two, the more your profit. The key to achieving this is maximizing income while minimizing expenses. Business 101. For the insurance industry, which deals with an intangible product, the best way to accomplish this is by charging high premiums while minimizing the amount paid to claims. Pay what you have to, yes. But ONLY what you HAVE to, and no more.
August 20th, 2011 at 6:04 am #Jason

Steven,
That depends for what reason your claim was denied. If you didn’t make the required renewal payment for coverage, there isn’t much you can do. There has to be an in-force policy for coverage to apply.

If the claim was denied for any other reason, perhaps you could submit a letter to the adjuster or the claims manager why you believe that denial should not apply to your claim.
August 20th, 2011 at 10:57 am #Paula

We had some rough summer storms that resulted in damage to our French Doors in our walkout basement and subsequently the laminate floors. We originally thought the doors were just hung incorrectly and needed shimmed, but after 3 different contractors came to look at them, all agreed the entire door unit needs replaced. When removing the trim around the door, we found black mold and evidence of rotting wood in the door frame. There was a gap between the home’s foundation and the door unit itself, which is where the water was coming in. Basically, we were told the doors were installed incorrectly 8 years ago when the home was built. When we bought the home 2 years ago, we had a full home inspection and no issues were evident at that time. Ironically, at the time of the damage we actually had 2 active insurance policies on our home – only because AAA failed to cancel our policy and refund our money even though we notified them we had switched carriers.
Our new insurer: Midwest Family Mutual sent an adjuster to the home that agreed with our contractors that this was NOT a seepage issue (which would not be covered) but improperly installed doors. They said the policy would not cover the doors, but would cover the damage to the floors that ensued. When we contacted AAA (our original carrier that was supposed to be cancelled) they asked us to submit photos and the estimates for repairs … and instead of sending a claims adjuster, they called to tell us the photos showed an existing problem (wood rot) that would not be covered by our policy. Thus, our claim was denied. Is this something we should just accept? The amount we got from Midwest Family Mutual will not even cover the full cost of installation of the new floor, let alone materials for flooring, doors, and door install. Are we just S.O.L. or can we appeal with either company? We have already pulled up the damaged floor, as suggested by both claims adjusters, due to the existence of mold. This is a finished basement/living area that is basically unusable because of the current condition. Please Help!!!!
August 20th, 2011 at 11:56 am #Jason

Paula,
If you have the floors covered and you are aware that improperly installed doors, the doors themselves, and wood rot is not covered, what would you want either insurance company to do? There should be enough of a payment to remove and replace the damaged portion of the floors. If there are new doors needed, then that is a homeowner expense including the labor cost to remove and replace the doors.

If you cancelled you policy with AAA, you should be following up with that company to make sure they have your cancellation date correct and you should be requesting a refund of your premium instead of making another claim for the same damages that are being covered by Midwest Family Mutual.
August 25th, 2011 at 3:12 pm #Sharon

I just moved to a neighborhood about 4 1/2 months ago around May, when I first moved into the house it was broken into about a week later. We didnt have renters insurance then so the cop that took our report to us to get some because it was cheap, apparently we must have snuck up on the burgalars because we seen someone fleeing from the scene. So we got renters the next day from State Farm, our house was broken into again on August 3, cops came out took a report and we were told by the cops that the previous tentants had been burgalized twice within the same month. I filed a claim with the insurance company and I submited all of the information that they asked for. The adjuster said that she had every thing and she sent it to pricing, I get a call on yesterday from a lady from the State Farm Special Investergative unit and she said she wanted to come out to my house b/c there was indicators on my claim. Found out today that the indicators are from two of the invoices that I gave her she said that the company logo’s were the indicators b/c two of the company’s didnt have logo. What type of crap is that, are they tying to find ways to deny my claim or what, the interview she and had today was recorded and she wanted my SSN, High school I went to, employment info, if I had a boyfriend, where was my last place of residency and etc. Why is this, does anyone have a clue as to what’s going on, she wanted to pull my credit report, arrest history even though I dont have one, driving history and hse wanted to know if I had a car
August 25th, 2011 at 3:12 pm #Sharon

just moved to a neighborhood about 4 1/2 months ago around May, when I first moved into the house it was broken into about a week later. We didnt have renters insurance then so the cop that took our report to us to get some because it was cheap, apparently we must have snuck up on the burgalars because we seen someone fleeing from the scene. So we got renters the next day from State Farm, our house was broken into again on August 3, cops came out took a report and we were told by the cops that the previous tentants had been burgalized twice within the same month. I filed a claim with the insurance company and I submited all of the information that they asked for. The adjuster said that she had every thing and she sent it to pricing, I get a call on yesterday from a lady from the State Farm Special Investergative unit and she said she wanted to come out to my house b/c there was indicators on my claim. Found out today that the indicators are from two of the invoices that I gave her she said that the company logo’s were the indicators b/c two of the company’s didnt have logo. What type of crap is that, are they tying to find ways to deny my claim or what, the interview she and had today was recorded and she wanted my SSN, High school I went to, employment info, if I had a boyfriend, where was my last place of residency and etc. Why is this, does anyone have a clue as to what’s going on, she wanted to pull my credit report, arrest history even though I dont have one, driving history and hse wanted to know if I had a car
August 25th, 2011 at 7:14 pm #Jason

Sharon,
The insurance company is doing a complete investigation to determine if the claim if valid. Just by what you indicated, there are some concerns. One is you obtaining insurance and shortly filing a claim.
August 26th, 2011 at 8:34 am #Sharon

Jason,

Thanks for your prompt response. I spoke with the SIU on last night and she stated that she was having issues verfiying one of the reciepts that a family member provided to me about a item he had purchased and given to my step dad, I explained to her that receipt was given to me and if thats such a problem we can remove that item, its not even mines. Even the cop that came out was like there were 7 burgalieries in the neighborhood that night and they have an idea of who did it which means nothing to the SIU, does that mean an automatic denial of my claim? So how long will this take? She makes sure she keeps mentioning the fact that she has forwarded this to NCIB. I just cant believe this is happening to me,I provided her my bank statement yesterday to show her that I made 13,000 in a little less than 3 months which is like 2,000 more than my claim but she didnt seem to care. Then she tells me she will be out of the office all next week so I cant reach her. I heard you say a complete investigation, what does that entail? I was very open and honest with her, we are also planning to move out of this neighborhood.
August 26th, 2011 at 7:15 pm #Jason

Sharon,
It seems you are trying to be flexible that you ok’d the item to be removed from the claim. However, the removal of an item is not a good measure. You should provide further support why that item is claimed so it can remove any doubt about the item and why you are claiming it.

You indicated the item you claimed and they have questioned and is not even yours. I believe you can claim stolen items if the person who had the item stolen lives with you but it’s not appropriate to claim items of another person. That other person should be making a claim with their insurance company.

It may be the dollar amount claimed that is suspect – I don’t know. No, it doesn’t mean an automatic denial of your claim. To be blunt, if there is fraud by an insured in any part of their claim, the entire claim can be denied. I don’t know exactly what they are doing with their investigation. The SIU unit remains tight-lipped about the entire process until it’s complete.

I believe all thefts and fires are reported to the NCIB and/or another index that keeps track of all those incidents, These indexes include people that have claims of that nature and other detailed information.

A complete investigation is just what is going on with your claim. It can include anything and everything from your finances, health, friends, neighbors, family, criminal history, past claims, police reports, business activities, employment, etc. There is no limit to what this investigation includes. Those are the main areas that are researched. If you are honest with your entire claim, that is an important step.

Personally, I would not want to be part of an investigation but if there are reasons why it is happening, it is a process that is allowed by your policy. I am not aware of possible reasons other than the repeated burglaries you had and the claimed dollar amount, but that is only my speculation.

Also, if you are claiming $11,000 in loss, that is a large claim for a burglary. That likely means there were a lot of things stolen and with that quantity of things stolen it would take a considerable amount of time carry out this crime. For the most part, burglary incidents are specific to items taken and of short duration so the person or persons that did this must have spent a lot of time in your home. Burglaries are generally a get it and get out type of incident.

You ask how long will this take. It should be relatively quick if the SIU is able to obtain all the information they want to review in a timely manner. I wish I could be more specific but I am removed from the entire process and I only know the things you have provided in your posts.
August 28th, 2011 at 8:33 am #Mickey

Hi,

I recently had a liability claim denied by my neighbor’s insurance company. My neighbor is renting out her condo unit and for months the air conditioning unit was leaking. Her unit’s floors were horrendously damaged and my bedroom grew quite a bit of black mold. The tenant did absolutely nothing about the leak and didn’t even tell the landlord until I went over and asked about a leak. The owner’s insurance company denied the liability claim, saying the owner did not show negligence in this matter. I’m planning on filing an appeal, but am unsure of how to go about this. Am I entitled to the full insurance report, findings, and evidence so I can dispute the denial more accurately? I’ve asked for everything but have not gotten a positive response yet. My initial thought for the appeal is to claim that our homeowners manual recommends getting the a/c unit serviced twice a year. The leak came from a clogged drip pan, which is checked during each service. If the a/c was serviced properly, my unit would not have been damaged, and the lack of mainenance constitutes negligence. I emailed this statement to the adjuster for this case and he says that according to the lease contract, maintenance falls on the tenants, and not the unit owners. I’ve asked for a blank copy of the lease contact to double check, but have not gotten it yet. Is it worth filing this appeal and wasting another month+ (I’ve moved out of my bedroom because of the mold and have been staying in my living room for the last 5 weeks). Do you think I would get further by filing a claim against the tenant’s renters insurance?

I talked with the unit owner and she passed along some thoughts from her insurance company. They said that my insurance company should pay for the repairs first and then go after them. They also said that my condo association should help out with this matter. I’ve talked to my insurance company and they said the policy states clearly that damage caused by slow leakage over time is not covered. I don’t dispute this at all. I’ve also checked with my condo association and the management company and they all say that unless the mold and damage were affected a common element, it is not the association’s responsibility.

I’m also wondering how my neighbor’s claim was approved. The damage was clearly caused over a long period of time.

Thanks in advance for any advice/feedback.
-Mickey
August 28th, 2011 at 9:50 am #Jason

Mickey,
Lack of maintenance does not constitute negligence. Sure, it is recommended to service the air conditioner periodically but not doing so does not amount to negligence. It could be categorized as forgetting or bad planning but certainly not negligence.

If you want this damage repaired, get it repaired. There is not going to be any insurance company assisting you with the damage and neither is the condo association.

As far as the full report, it is not your insurance company so they don’t have an obligation to provide you anything. Regardless, you will have a difficult time trying to prove negligence whether you have it or not.

Perhaps if the owner admitted that they knew there was a leak and they avoided it because they had other things to do instead, then that would be negligence on their part but you won’t have them admit something like that. It would be best to understand that insurance is not going to be involved and you just have to repair this as a property owner and it will be out of pocket for you.
August 28th, 2011 at 9:58 am #Mickey

Thanks for the quick reply Jason. It looks like I’ll have to try to settle this matter with them…hopefully outside of court.
August 28th, 2011 at 8:01 pm #Todd

My insurance company is denying a homeowners claim. About 10 years ago we had a similar case but fought it for 4 months and they paid. At this point in our lives (kids, work, etc) we don’t have time to fight it. Aren’t there third-party arbitrators or professionals who can fight the insurance companies for us – who can better “speak their language” and help us win this case? We live in Colorado.
August 29th, 2011 at 6:38 pm #Jason

Todd,
You may be talking about a public adjuster. They can work for you and they take a cut of the settlement. It may be similar to the fee an attorney charges to take on a case but I’m not certain of the percentage.
September 2nd, 2011 at 12:18 pm #JS

Noticed about 1/4 cup of water next to a wall in my toilet room. The water was not underneath or near the toilet so I knew it wasn’t from the toilet. The wall’s baseboards look as if they’re peeling away from the wall and cracking some, Behind that wall is my Tub with no panel installed ever and next to my tub is the Shower. All with tile surround to both.
Farmers agent came out and took some photos – said 99% sure it’s the shower pan but I’m not covered b/c it’s not sudden/accidental.
As a homeowner I’m supposed to maintain my shower pan. So that tells me as a homeowner I’m to Rip away all the tile 10-15 years later to replace a pan that I have no idea is leaking or not which means I have to replace all the tile around my shower and my tub, just to see if that’s what’s causing the apparent leak/damage.
By the way, this water is not always there, and filling up a shower, bathtub (hardly used), etc – nothing that I can see directly affecting it. They determined it as Seepage from wear/tear on pan?
September 2nd, 2011 at 1:47 pm #Jason

JS,
What is needed is a panel to access your tub supply and drain lines. That should be a simple matter of removing the panel and then maintaining whatever may be loose or leaking. This is a relatively easy fix but the home builder did not build your home to code. Sometimes being a homeowner is not always the easiest task in the world. When you open up the wall, you can make an access panel when you put the wall together so any future fixes are easier.
September 10th, 2011 at 7:31 am #Sharon

Hi Jason,

The SIU lady has flat out lied to me, the item that was in question was my step fathers, a gift from my uncle the business went out of commision like the end of lst year oe something but she is continuing to tell me she needs to verify that reciept. I told her go to the better bbb and look up the business. I got a sworn statement from the manager from the walmart across the street stating that the business was there. Now its something else, the other receipt that we ahve is from the flea market, she wanted a number for the lady we bought a item from, we drove out there to the flea market and got a direct number for the girl I gave it to her. Four days later I get a certified mail asking for additional proof of that item since she was unable to reach the lady, drove back out there yesterday and the lady said she spoke with the SIU lady like monday and she asked what she sold, and for her address so that she could mail her out something to veifry proof of purchse from a customer. The SIU lady flat lied to me stating she couldnt reach her, now she is asking for my call details from my celluar phone, my banking deposit, I mean whats really going on, Even my attorney was said that her wanting my mobile call history has nothing to do with this claim and he found it odd. I call her like two days ago to confront her with the information and she hasnt call me back, usually she calls me back withing the hour, whats her deal? This is getting crazy now
September 10th, 2011 at 5:23 pm #Tony

Sharon,
Your story is just another example of how the insurance companies will go out of their way (and how FAR out of their way they’ll go) to deny a claim. As I’ve already said above, each dollar they DO pay out on a claim is one LESS dollar in their pockets.

When you go to a retail store (like Wal-Mart), you immediately receive what you purchase in exchange for your money. With the insurance industry, you pay your premiums (often for YEARS) without receiving ANYTHING in return other than the “promise” that you will be covered in the event you ever make a claim, only to find that when they do make a claim, they are not covered after all. And some peolpe NEVER make claims, despite having paid their premiums for years.

The industry KNOWS that MOST people do not keep the intricately detailed records of EVERYTHING they buy and own that they require to prove ownership. That is one way they “get away” with so readily denying claims.
September 10th, 2011 at 7:38 pm #Jason

Tony,
You are comparing tangible items to non-tangible items. Of course you get something from walmart but that’s not what you should be focused on. If you own a $250,000 home and you don’t have it insured and a tornado takes it out by leveling it, don’t you wish you had paid your premium? Even if you have been paying for 20 years? Ok, let’s say your premium is $500/year. Sure you pay them $10,000 over those 20 years but that is kind of worth it, don’t you think? In this example, they also would pay for your personal property – often around $130,000 or more for a home of that value. Also, the insurance company will provide you a place to live while your home is being rebuilt. If the rent is $1000 and it takes 10 months to rebuild the house, that is $10,000 alone to provide you housing. I agree the insurance companies have a lot of money but they pay a lot of money out too.

Now can you tell us what you would do if you were in this situation and you didn’t have insurance? It would be rather costly to live in another house and have to pay rent and a mortgage (on your leveled house). Would it take you longer than 10 months to rebuild? It’s very likely it would take you years and years to rebuild if that was even an option. Remember, you are paying $1000 in rent, the $1300 for your leveled home. There really isn’t any money left to rebuild a home.
September 18th, 2011 at 7:41 pm #Natasha

i had a fire in march. i started out with serv pro. fired them right before memorial day weekend. my adjuster said she had a company on their preferred list that could help me clear up this problem. well the contractor sent by the adjuster performed work with out license and without proper permits. also not getting business license to work in the town i live in, then they let a painter spray kills all over everything inside my electrical panel. nec code violation of 110.12.B (national electrical code) so now my panel, breakers and all wiring have to be replaced and there is moisture and mold under my house because they didnt clean the hvac unit properly. so you have to have licensed plumber, electrician and hvac people when this kind of work is performed. this contractor didnt use this. the insurance company is wrong, and the contractor is wrong. what are my legal rights for recourse against both insurance company and contractor? thanks
September 18th, 2011 at 10:22 pm #Jason

Natasha,
You have no recourse against the insurance company. They had no direct relationship with the actions that you indicate are occurring to your home. You may have some opportunity to go after the contractors but it’s very unlikely. Now, the real concern is that you have to get qualified contractors in your house to do the work. You are the one responsible for that. There is nobody other than you that can authorize these unqualified people to work in your house. So, the best advice is to get qualified people in your home or else you can accept the blame for things that go wrong with these people.

Also, the relationship that you think is there between an improperly cleaned hvac unit and mold is very unlikely the reason for mold. If you think about it a little bit, you would understand that mold growth occurs because of moisture and at minimum a slight food source for the mold to grow upon, not because of an uncleaned filter.

Also, what that code says is that the “Electrical equipment shall be installed in a neat and workmanlike manner.” It was already installed and kilz spayed on the electrical does not constitute a violation because the kilz sprayer guy is not installing any electrical items. Please don’t get caught up in this. You don’t have to replace any panels, breakers, or wires and I’m sure you have no intention of doing that. Why? Because that would not make any sense just because they have a little paint on these items.
September 21st, 2011 at 3:36 pm #Tyson

I had a leak from my upstairs toilet that went into the ceiling of my downstairs bathroom. I noticed it gushing right when it happened as it was going into the fan and down to the floor. It took me about two weeks to diagnose where it was coming from. The plumber and the leak detection/restoration company came and saw that when I flushed the toilet about a 1/2 a gallon of water burst threw the ceiling. My plumber noticed that the toilet was no longer fully secured so diagnosed that the wax ring may have been torn due to movement. After removing the toilet, it seemed to be exactly what he had said. I called Allstate who sent out an adjuster this morning. He spent all of 5 minutes looking at the bathroom. The ceiling was covered in plastic so she was due to the restoration company drying the effected wood. He said that he was unable to see anything. He then determined that because of the wax ring leaking it was something that must have happened over time, which is not covered my insurance. He did not bother to look at the plumbers report nor talk to the leak detection company for what they had determined. I told him that it did not happen over time because I noticed the leak right when it happened because of the amount of water that was pouring thru. He said claim denied and if I wanted to appeal, then I would have to take it up with his boss. What recourse do I have?
September 21st, 2011 at 8:38 pm #Jason

Tyson,
Water that escapes from a plumbing fixture is covered by your policy. If it was occurring for a very long time and a little bit each and every time, then it may not be covered but what you mentioned, it happened and you didn’t realize what was going on immediately but regardless, the leak was coming from a plumbing fixture and the insurance should cover that type of claim. Take it up with his boss (who I would assume is a claim manager) and state the facts to him about how the loss occurred and attempt to persuade him that the water leak is something covered under the policy.

You can review your policy under the water damage aspect of your policy so you can see how it applies to your specific situation so you have more knowledge and information when you talk to the claim manager. Good luck with your efforts.
September 24th, 2011 at 5:34 pm #Thomas

My garage suffered a tremendous amount of damage as a result of Tropical Storm Irene. It was torn from its foundation and slammed into a neighbor’s building almost 500 feet away. I do not have flood insurance, but submitted a claim for wind damage as the wind speed was documented at 62 miles per hour on this particular day. My claim was denied simply stating that the adjuster did not find evidence of wind damage- only flood damage. Do I have any recourse? What are the steps needed to prove wind damage?
September 25th, 2011 at 9:19 pm #Nancy

I bought my house about 6 years ago. I didn’t notice at the time, but a room that was added as an addition has foundation problems and is moving. It’s on a slab foundation, and the floor slants, the windows no longer open, and the walls are cracking. The exterior siding and roof are also buckling. The whole room needs to be replaced. Is there any way I can take this to my homeowner’s insurance? There were no building permits filed, so I don’t know who did the addition. I had a contractor come and for $15K can install helical piers into the bedrock, but this will destroy the windows and floor, celing, door.
September 26th, 2011 at 8:00 pm #Jason

Thomas,
Wind speeds of 62 will not move your garage 1/2 inch, let along 500 feet. However, water will. If you want to attempt to prove wind damage despite obvious evidence that water moved your house, you will be taking on an impossible task and you will never succeed.

As far as recourse. No, none at all.
September 26th, 2011 at 8:08 pm #Jason

Nancy,
So you know that there is foundation problems and is moving. Great, now if you take that knowledge and review your homeowner policy, it will indicate the policy doesn’t cover for earth movement and similar conditions that are affecting this room addition.

Also, an insurance contract covers incidents that are sudden and accidental. Since this issue with the room has been happening for at least 6 years, that does not meet the requirement of sudden.

The policy doesn’t cover the deficiencies and workmanship of others, like the person or company that built the addition.

In light of these things, and likely many more from your policy, do you think it would be reasonable to make a claim for this?
September 29th, 2011 at 9:25 am #Sharon

So Tony and Jason,

Can anyone explain to me why the special investigator would lie, she is now just blatenly lying to me and being dishonest. I finally faxed her in my bank statements from may until august which showed her I made over $17,000 which is far less than the claim and I dont have to fabricate anything. She said still cant verify three of my recipts but she asked for my statement to substantiate that I could of made the ourchase and she has that, she said the lady that own the company refused to verify the info over the phone so she sent her certified mail and she hasnt gotten a response from the company. So I called the lady today and she said that the adjuster only wanted her address to mail a letter and that she asked the adjuster to just give her the reciept number or customer name as she is very seldom home to get the mail and she faxed the letter and would show me the fax confimation and the letter. My second reciept she claims she cant verify, I actually attend church with the lady and I asked her sunday b/c the Special investigator claims she cant get in touch with her when she works from home and owns her busines righ tout of a storage shed in teh bakof her home – she says she hasnt recieved a call from the claim investiagtor as well so I asked her to just let me have them get in touch with her and she was silent and then agreed, Then the final reciept which is on my banck statement from AT&T she want call reocrds and AT&T store manager signed a letter stating that my account is now a go phone account and there is not any call detail because its what they call a throw away phone that I didnt even have to register I just by minutes and put them on the phone. So can anybody tell me whats really going on?
September 29th, 2011 at 1:23 pm #barbara

Hi,
I left a garden hose on and it seeped into my basement.
Luckily only the carpet and drywall was ruined, $3,500 worth
we estimated.
My claim was refused. I have never had a claim and have been insured 40 years.
My policy says the first claim is no deductable to pay and also is forgiven. I live in Ont. Canada
September 29th, 2011 at 6:13 pm #Jason

Sharon,
No, I can’t tell you why any one would lie. Everybody has their own reasons. We can answer questions about insurance but we can’t tell you about things in which we aren’t involved. I believe I already told you what I believe is going on and your posts pretty much contain the same information you provided before.
September 29th, 2011 at 6:15 pm #Jason

Barbara,
Do you have a question?
September 29th, 2011 at 8:40 pm #Terry

I had a surgery in 2007. I had to move the surgery to an earlier date than originally expected because I was informed by my employer that my position was being sold to another company and that at the end of the month, I would be working for the new company. With the notification that I would receive paychecks from another company soon, I was also informed that my current medical insurance (Anthem) would remain valid until the end of the month. I rescheduled and re-pre-certified to have the surgery before the end of the month. The surgery happened, Anthem paid their part, the hospital and surgeon wrote off their amounts, and I paid mine.

Nearly two years pass and the hospital contacts me, saying that I owed them the money that Anthem paid and the amount that they had written off because Anthem took their payment back. After finding as many relevant documents as were remaining after two years, I contact Anthem- several different times, and get a range of explanations from “the transactions were in error and we will fix” to “you were not covered at the time of service.” The last explanation is now the one they seem to be sticking with, although I “am not entitled to specific documentation” that could help me to figure out the truth- I was only a member of the health plan, not the administrator.

If dealing with the hospital was not bad enough, NOW I find, through a collections notice, that Anthem waited 2 ½ years to reverse payment to the surgeon. Of course the surgeon now wants the value of what Anthem took back AND the amount they wrote off originally.

I find it hard to accept that my eligibility conveniently lapsed, especially since my pay stubs showed that my contribution for health insurance was taken out of every one of my checks, till the very last one. I find it harder to accept that an almost 2 year and more than 2 ½ year window is needed to discover payment discrepancies, especially since my state has a 2 year “take back” limitation, written into law. The hardest thing to accept, though, is the reaction of the hospital and the surgeon. Anthem took $1,900 or so back (2 ½ years after originally paying that amount). Because they took that amount though, the surgeon claims that I now owe nearly $7,300. The numbers for the hospital are much larger but the value of their write off is roughly proportional- WOW.

All in all, it seems as if I am getting a pretty raw deal. How is it that a person can do all the things required: get coverage that gets financed directly from my pay check, pre-certify, take appropriate action to adjust to known changes, pre-certify again, pay my responsible amount, and verify that insurance has paid their responsible amount, and that person still have to go through all of this- now almost 4 years after the surgery even happened? Something seems unfair here; thoughts?
September 30th, 2011 at 11:16 pm #Jason

Terry,
I don’t have any thoughts on the matter.
October 5th, 2011 at 4:51 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.
October 10th, 2011 at 5:58 am #LT

Our basement was flooded because the county storm drain behind our house was blocked up and water backed-up. Our ins. company initially approved the claim, but now denies it, saying that the drainage back-up was not covered because the drain was not within the 4 walls of our house. Is that usual for most sewer/drain back-up policies? The denial letter calls the water a flood, but the adjuster said it was a sewer/drain back-up. Can we file an appeal? Thank you for your help.
October 10th, 2011 at 8:47 pm #Jason

LT,
Generally water at or below ground level is not covered by insurance policies. It seems that the initial approval was an error and was corrected when they denied our claim. Of course you can appeal their decision. Just have them re-evaluate your claim if you have information that would bring them to a different conclusion. However, the information you provided would not be sufficient to have them re-evaluate your claim.
October 11th, 2011 at 7:18 pm #Shannon

Hi, Back in June of 2011 we had someone drive threw our yard and arround to other side of our garage and break the door down and stole several items and broke door then left and while driving out shoot our airconditoner and a window. We ended up filing a claim under our homeowners insurance because 2 weeks after this happened we had a 4th of july party with about 15 people and our toliet over flowed and was coming out of top of tank. At that point my husband and i realized that the area that was drove over was our septic area.The insurance company we have was right on it have gotten payment for some items that was taken, along with enough money to have septic tank pumped 2 times. Was told to get estimates on the septic and was given the advise because of the drive over the system would prob have to be replaced because health department isnt going to let you repair to many parts on current system. so i sent those in. then county was out doing some road and dig work same day as septic guy was showing us where new system would be put and the county had informed us that they flushed our dig lines and that they needed to be replaced before they would let us tie into them so i contacted insurance compnay the claims person say yes do it and sumit receipts so we paid 1000.00 for that then our claim was turned over to another person and all hell has happened since.. he had a engineer come out and then engineer wanted the ground opened up so took another month to set that all up well they came out opened a large hole in ground and dicovered corner of tank was crushed those guys took off out of here like it was no ones business the one guy who was incharge said health dept needs notified and coned off area said to stay off of it and left me a bill with a note to give in engineer when he arrived. engineer showed up hour later did what he needed to do read the note previous guy left and was on his merry way. The next day i got a phone call from insurance company stated based off this engineers finding this isnt covered under our policy and would not be covered. i said well what happens now he said we will send someone out to cover hole and fix grass and i said one problem cant do that because health department invaluved now for 3rd time and they wont let you do that. My question is to you can they do this? It seems to me they took responceabliity when they opened the ground for one. 2 they sent me down to health department 5 months ago to find out if repairs can be made on this and if not what system would be allowed. then when second guy came on as new rep he send me back down to get a copy of one paper he claims he didnt have. I have had my toliet back up on me 2 times inbeganing and have had it pump every month since June. I just dont understand why its taken 5 month to come to this and they open the ground and now gracefully backing away. Please help
October 12th, 2011 at 8:40 am #Jason

Shannon,
Yes, they can do this. Although someone drove their vehicle across your lawn, that would provide coverage if you had vehicle damage to your septic system. Apparently after an engineer was able to confirm the vehicle had nothing to do with the septic, the claim appears to be denied.

Septic systems don’t last forever and they have to be maintained over time. That is one of the responsibilities of being a home owner.
October 13th, 2011 at 8:11 am #Ororo

Hello, on Oct 5 2011 my house was broken into. I’m having a hard time finding receipts, photos, old credit card statements on items I purchased throughout my military career. I’m retired from the military and traveled extensively around the world during my military career, I’ve purchased items such as, various gold pieces, diamond rings and earring, diamond watches/watches and silver I can’t find anything to show proof of ownership or any type of purchase receipt. Unforunately, one receipt I’ve found is faded out with a company name lightly showing up on it from 1991. Furthermore, according to the local county deputy and detectives (detectives had to be called in due to the value of the items stolen), they valued my items that were stolen to be around 8 to 15 thousand dollars. Rising the break in, to grand theft.

One of my questions is — What can I do to prove these items are mine and I purchased them?

Furthermore, contacting the companies I purchased these items from is tuning out to be harder than I thought due to the fact, I was stationed at various overseas bases i.e. Korea, Egypt, Kuwait, Israel, Qatar, and Iraq from 1987 til I retired in 2008 the companies have either gone out business, are under another name, or was destroy during military war/conflict or military operation. I’m totally at lost of what to do and if there is anything I can do.

My other questions is — Do I just take the lost and move on without completing the claim? Most of the items I can’t replace any way and are ONLY valuable to me due to the fact I purchase these items throughout my tour of duty and military career.

Any help, suggestions would be greatly appreciate.
October 13th, 2011 at 8:40 am #Jason

Ororo,
It’s bad enough that you were the victim of this crime. You should not have hurdles involving the insurance company.

I hope they don’t require more than a list of personal property that was stolen and perhaps an affidavit relating to that. Nobody keeps receipts for the items that you have mentioned and the insurance company should not require receipts. They should take your word on the items that were stolen.

Present your claim the best way that you can. There are sub-limits on some aspects of personal property like cash, jewelry, and guns to name a few. So, just complete everything as accurately as you can and hope that you have a reasonable claims adjuster that will work with the limitations that are reasonable for your situation.

Your items should be described as accurately as possible. Also, sometimes items can be found in the background of photographs for some documentation of ownership and possession. Again, I hope your adjuster will not hold you to an impossible standard of proof for these items.
October 28th, 2011 at 4:22 pm #Alexandria

Hello,

I recently had a sudden water damage caused by a cold water supply line that completely flooded my entire home minus one side of the home where theref is just a room and a bathroom. As soon as this happened I called my mortgage company and I did not have flood insurance but this is not technically a flood and my normal homeowners insurance should cover the damage. So then I called are homeowners insurance company Universal Property and Causulty let then know the situation, the man I spoke with told me it was covered no problem, gave me a claim number and told me to call to have the water extracted which I had done already, he said great, all was well…so I thought. Then a day later my husband receives a call from an adjuster saying that it was not covered because it was not a roof leak or a natural rain disaster. I then called the insurance company told them what the adjuster just told my husband, the woman I spoke with told me to disregard that message because their computers were down in addition they always sent an adjuster to the home and do not give denials like that over the phone. They would have someone call me within the week to set up a day to view our home and assets the damages. Two days later I had still not received a call so I called then was referred to the same adjuster that had called my husband. I called him left him a message and then recived a call from the adjuster who rudely spoke to me about the denial in addition to saying ” I thought I told your husband this already” and said that our coverage doesn’t cover that type of damage only holes in roofs natural disasters and the like. I asked for an explanation of my benefits and policy. Researching what normal homeowner policy’s are in Florida this should covered. Is this something that is an additional insurance purchase I have to make or should this be covered.
October 28th, 2011 at 5:19 pm #Jason

Alexandria,
The way you described the damage, this should be covered under a basic homeowner’s policy and should not require any additional coverage added besides what you already have as the base policy coverage. We understand the damage to be from one of your home’s cold water pipes that leaked or burst that caused this damage, and this cold water pipe is not exterior to your home.

Avoid this adjuster and speak the claims manager. Ask to have this claim handled by another some other adjuster different than the guy that says it is not covered.
November 2nd, 2011 at 2:49 am #ravi

We baught this home 5 years ago in Ohio area. House got flooded recently and we made a claim. While the claim is being processed, we also foundout that the retaining wall is slipping and not supporting a couple of structures (Deck and Sun Room). The Contractors are asking $60,000 for this. Shouldn’t the insurance cover this? We had full coverage against flood etc. What other details do you need to get me an answer? My Current insurer is saying this is gradually evolved problem but that is not true. The Retaining Wall failed only after the flood in Dec 2010. Please help with your valuable suggetions or links.
November 2nd, 2011 at 7:11 am #Jason

Ravi,
Insurance doesn’t cover everything that goes wrong with a home. There are exclusions and limitations in every homeowner policy. The effects of ground movement and damage to retaining walls are commonly excluded items.

Actually without seeing the retaining wall, what the insurance adjuster indicated is happening to the retaining wall is what happens to retaining walls over time. Sure, it might be accelerated with the flood waters but there is also a “catch-all” in the policy that if covered damage occurs at the same time as uncovered damage, then all of the damage is uncovered.

But again, I still don’t see the covered element of your claim concerning ground movement or retaining walls. Your homeowner policy likely has the water exclusion that indicates they do not provide coverage for water at or below ground level. Did you happen to read your policy to review your coverage and limitations? That may be helpful to you.
November 5th, 2011 at 7:12 am #tane

My home was broken into a month ago, October 3. I had recently gotten a 60 in flat screen TV in August therefore I thought it would be a good idea to get renters insurance since I now live in a high crime city. I got my insurance September 1 well a month later I was broken in to. The insurance company has denied my claim on the basis of inconsistent documentation. When I called to make the claim the first thing the adjustor said was that I had just gotten my policy and that an investigators would come to see me. I provided reciepts and pictures of items. I had taken pictures of all of my items and put them on my computer with the intentions of sending them to my insurance broker. Unfortunately my computer was stolen before I could do this. I did have some pictures of these items saved on my phone which I provided to the insurance company in addition to receipts that I had recovered. When the adjuster called me on Friday at 3:30 she stated that my claim had been denied due to inconsistent documentation and refused to elaborate. I questioned my administrative remedies and she refused to tell me what I could do to.appeal or challenge her decision. Only after continued questioning did she give me the name of her supervisor. I don’t know what to do now? Do they have to provide additional detail because I don’t understand what is inconsistent?
November 5th, 2011 at 3:55 pm #Byesheba

Hello,

I feel my policy warrants an appeal but not sure. During hurricane Irene my basement flooded from the lights going out and the subpump stopped working. My insurance company told me that I did’nt have water back up insurance. The issue came from the lights going out however. The subpump is fine and is not broken or anything. They said I have insurance that would cover things like if the toilet was to overflow. Something just is not adding up. I was reading various articles about this issue and wanted to get your opinion. Thanks in advance!
November 5th, 2011 at 8:26 pm #Jason

Tane,
Your insurance company needs to explain their denial to you. If they are unable to do it by telephone, have them send you a letter explaining why your claim is denied.
November 5th, 2011 at 8:30 pm #Jason

Byesheba,
Generally water at or below ground level that entered your home and causes damage is specifically excluded in your policy. Perhaps if you have a sewer backup and sump pump overflow endorsement, you may have had coverage for this loss.

Losing your electricity did not cause damage. What caused damage was water that entered your home.
November 9th, 2011 at 12:45 pm #Allen

One of my sisters was hit almost head-on by an individual that blacked out while making a right turn at a controlled intersection. Her car was totaled and she suffered minor neck injuries that caused her to miss a couple days of work. State Farm has taken care of reimbursing her for the loss of her car but is telling her that she is on her own to recover the dedcutible and lost wages from Founders Ins. This company has been very hostile towards her when she calls and has even been snubbing State Farm when they call asking for information.

I talked to the Illinois State General Attorney’s Insurance Division recently. They said all insurance companies will deny liabilty due to a medical condition but he said State Farm should reimburse her lost wages. Should she turn-in the paperwork showing her lost wages to State Farm? Can she get State Farm to give back her deductible or is she out of luck there?

The individual said all the claims will go to arbitration and once Founders Ins does not show up, which he said they won’t, then State Farm should just pool those claims with other unsatisfied claims against Founders Ins. Only when the claims reach a profitablity threshold to recover will State Farm sue to recover those claims.
November 9th, 2011 at 1:43 pm #Jason

Allen,
Any time spent trying to get reimbursed through State Farm for a coverage she does not have will just add up to the time she has lost and is not being reimbursed for. The deductible she agreed to pay when she took out the insurance is what she pays for damage to her car. Where do you come up with the idea that State Farm would reimburse the deductible?

Barring something not known, this will never go to arbitration. Don’t believe everything you hear from people that don’t know what they’re talking about.
November 16th, 2011 at 10:19 am #Nickolas

Hello Dears,

So far I get in accident an few weeks ago, I was driving straight to get into route 130, I took an street (Speed limit 30 than I gets 40) It was dark night aroud 7-8 pm, what happed next some truck was getting out so fast from his driveway (backing up” rear”), i did use my brakes but so far i hit him in tire, he has no damages but I need to fix my bamper and etc..( $1400 to spend to fix it), than he get out from his car and start saying that my fall, but i did not have alot time to stop my car, because he cut me off. So in police report i get that: car#1 hit car#2, and thats it.

I did contact his insurence but they dinied my claim, they just making up some points, so they will not pay money to me.

Please Help me what to do?
November 16th, 2011 at 10:32 am #Jason

Nickolas,
If you are driving on a roadway and a truck is backing out of the driveway with their white backup lights on, you really have to notice what is in front of you and stop to avoid hitting the truck, or go around it. What you want to do is avoid hitting things with you car. To hit something blatantly in front of you is not safe driving. Although it may have been rude of this driver to back out of his driveway in front of you, it is negligent to hit things with your car.

If you have physical damage coverage, make a claim with your insurance company for the damage. If you don’t have physical damage coverage, then you will have to pay out of your pocket to get you car fixed.
November 16th, 2011 at 10:48 am #Nickolas

Well it was an black nissan truck, and it was an blank spot, trees, and he was fast. He was rude and trying ti injure my self but police come on time.

As well I was driving and that happen before an second or two. When I was next to driveway.

Thank You

His car has no damages.
November 16th, 2011 at 11:37 am #Jason

Nickolas,
If it was dark outside, the color of the vehicle is not a factor. So, if he is backing up fast, rather than slow, that should have alerted your attention to the unsafe conditions in front of you. Not only are the white backup lights alerting you to him backing, but he also has red taillights that are in front of you.

Again, if you have physical damage coverage with your policy, all you have to do is submit a claim with your insurance company.

You may want to ask his insurance company to re-evaluate their position. Based on what you presented, there is fault with both drivers, and likely a little bit more can be attributed to the backing driver because he entered your lane unsafely. Send an e-mail to** complete.insurancehelp@gmail.com that includes the name of the other insurance company and in what state this loss occurred.
November 22nd, 2011 at 10:24 pm #John

Currently have 2 claims with USAA involving theft. Parts of my automobile and personal Property inside my car that where taken. They paid half the claim and now are disputing the remainder of the claim. My questions are
1 Should I involve The Dept of Insurance to help assist me in this matter ? And if so will my insurance Co look at us in a negative matter from here on out ?
November 22nd, 2011 at 11:06 pm #Jason

John,
This sounds like a homeowner claim involving the contents that were in the car, and an automobile claim for items that were taken off your car.

The department of insurance will do little, if anything to help you resolve any issues with your insurance company. They merely get in the middle and make sure the insurance company responds to you. They have very little influence over insurance companies.

I don’t know what to suggest with the information you provided.
November 23rd, 2011 at 3:28 pm #Tasha Houston

Me and my husband this is the second fire loss we have had with insurance company they sent a special investigator to come and retrieve phone records,bank statements,utility bills, mortgage payment history so the special investigator tells my husband that my phone records are in question because I received a call from the person who let me know that our house was on fire 11 minutes after I left the residence and the call is in question but like I told the investigator the phone records may show that someone called me 11 minutes after I left home but I did not talk to anyone. I explained to him that I did not find out my home was on fire until I got to my fathers house which is about a 45 minute to and hour drive from where I live and that is the only thing they are basing the decision on is the phone records but no decision has be made he advised my husband we may have to give a statement under oath what does this mean
November 23rd, 2011 at 3:56 pm #Jason

Tasha,
They are not just basing their decisions on a phone record. The insurance company is basing this investigation on a number of things. First, they believe this fire was not accidental, but intentionally set. And, they have reason to believe that although fires are rather difficult to start, not one, but two occurred that involve you and your husband and they believe you or he set the fire or had something to do with it being set.

A statement of oath is a serious tool available to the insurance company similar to a deposition but not quite as formal. In many cases, an examination under oath (you referred to it as a statement under oath) is a way to pin down things that happened or didn’t happen, and eliminate or include other things concerning the events before, during, and after the fire. It can be short and simple or rather extensive and time consuming. It is best to plan on this being extensive and time consuming.

This is a serious matter and perhaps you should consult an attorney if you have not done so yet.
November 24th, 2011 at 7:52 pm #Casi-lee

Please help!!!! My husband and I came home from a trip to find that our hot water heater had overflowed all over the carpet. My husband was able to free a clog in the drain of the bowl under the water heater and the water subsided. We figured the water in the bowl was normal, thought nothing else of it. We took the carpet out, opened windows and put on fans. There was a 1000 deductible on our policy, so we decided we would pay for new carpet. A month later my husband noticed mold under the linoleum in a bathroom near the h.w. heater. we decided we better call the ins co. At the time my husband said he wasnt sure what date it happened but said a couple weeks ago. Since then we have come to believe it was probably two weeks earlier than that & told them so when we were contacted by the internal adjuster grp. (the letters they have sent since still have the wrong date). After finding the mold my husband had a good look around and under the house, and found lots of mold on the wood in our crawl space. It is all over the wood under the room that was flooded. Also elsewhere where we have linoleum. My husband also found that our hot water heater was dumping lots of water (we figure many gallons) under our house, through the drain, and that it is faulty. When the external adjuster came to our house he said the crawl space-mold is not covered but he did say all work in our house was covered and exactly what would be covered. he said he would call with numbers in 3 days. after he left he called and said that the ins co would want to sue the hot water heater co. and that they would be sending a forensics co to get our tank and to take mold samples, and this was “good” for us. we said they could have the tank but were hoping to get a setlement first so we could buy another, he said that would probably work. AFter this call, he didnt call on monday, so we called him and he said he would call with a building supply est the next day. Again he didnt call. A few days later we received a reservation of rights letter”and it basically stated this was because we didnt call them right away about the incident and didnt take action to keep the house safe from further harm. The forensic co. came to our house a week later, they tested and found the tank faulty. He said test resutls on mold will be back in a week. What should we do now? Thanks so much for your help. This website is informative and seems to be great help for many people. God bless, Casi
November 24th, 2011 at 8:32 pm #Jason

Casi,
The reservation of rights is a good idea to send to you. In simple terms it simply states that the insurance company has no idea what, if any, part of your claim is covered and they are going to investigate and gather information to make a coverage determination. It is simply a formal notice that says they don’t want you to assume your damage is covered because they are their investigating it.

We don’t have any advice that we can provide with the information you provided. Everything seems to be happening as it should.
November 25th, 2011 at 8:35 am #Casi-lee

Thanks Jason! i feel much better knowing this is common. Thanks for your time! All the best, Casi-lee
Ps please disregard a second poting of my question in the home owners insurance area.
November 26th, 2011 at 2:33 pm #Barbra

Is there any way to fight an insurance claim denial if the policy states something isn’t covered? I put in a claim because my front porch was leaking and has caused mold in My house. The whole porch has to be rebuilt ane will cost $20.000. We’ve been with this company for over 40 years and have only filed 2 claims. I would like to petition them to reconsider our claim. They say because the water damage was caused by rain & snow and not a broken pipe, that it’s not covered. Do you think I have a chance at fighting this? What is the best way to fight this?
November 26th, 2011 at 2:49 pm #Jason

Barbra,
If there was some storm related event that caused a branch (for example) to damage your roof and that caused water and melting snow to enter your home, then that is one way it might be covered.

You’re indicating a rather expensive repair and that sounds like it might be water leakage occurring over a long period of time causing wet rot, mold, and other damaging conditions to develop.

Sometimes maintenance is required on a house and this may just be that. Insurance covers sudden damage to a home (unless excluded). From what you mentioned in your post, there was nothing sudden about the damage to your house.

You can ask the insurance company to reconsider if there was some event like a tree branch that caused damage to your roof that led to this mold damage but if there is nothing new you can introduce the insurance company, you should just save your time.
November 28th, 2011 at 7:07 pm #Sonja

I have a similar problem. But my water damage was caused by a leaking pipe. The contract states that if the leaking is longer than 14 days it will not be covered. However the leak was behind the wall and not discovered until we noticed mold behind the toilet. We filed a claim but were told it was leaking longer than 14 days and therefor not covered. Now how could we have known that we had a leaking pipe??? when the pipe is behind the wall??? This is not right, what can I do???
Thank you
November 28th, 2011 at 7:08 pm #Sonja

Please let me know by email if there is a answer. Thank you
November 29th, 2011 at 12:01 am #Jason

Sonja,
We need more information to be able to address your questions. Please indicate when you found the leak, how you found it. Why it wasn’t found sooner? Was the mold found only after removing part of your house like the drywall. Please respond to these questions to complete.insurancehelp@gmail.com

Also, please explain where the insurance company has come up with the 14 day limitation. Provide the name of the insurance company and in which state this damage occurred.

We will post the response on this site but without any identifying information about you.
November 29th, 2011 at 7:49 am #Natalya

Hello,

Our upstairs neighbour flooded our kitchen twice in one year. First time he claimed that the pipes and the dishwasher were fixed, and his insurance company paid our claim. We had our ceiling repaired. Second time, 7 months later, the damage occurred in a slightly different place in the kitchen. The neighbour claimed that this time he replaced the broken dishwasher, but refuses to cooperate any further. I filed a third party claim with his insurance company, but the adjuster is telling me that they will not pay the claim, as the damage was not the result of the neighbour’s negligence. This I don’t understand entirely, given that the problem was his dishwasher and pipes, which he claimed he fixed the first time.
I also filed a claim with my insurance company, which told me that my deductible is very high and most likely, after i pay it, the money my insurance company will pay will not be sufficient for repairs. Plus, a far as I understand, it is not benificial for me to file a claim against my insurance company, as my premium might go up.

Please advise. Thank you!
November 29th, 2011 at 8:25 am #Anthony Merchant

Hello,

I have purchased a few months ago an antique car at an auction estimated at $89000. The day I purchased the car I called my insurance company and put an insurance on the car. During the quote, the agent has estimated my car for $70000 and has mentioned they will send me some paperwork so that I can complete an appraisal and send pictures of the car to them. Unfortunately a few weeks after the car was purchased, it has been vandalized. I have open a claim with my insurance company and sent an adjuster to look at the vehicle. They came back as a total lost. A few days later, they insurance company called me and left me a voicemail telling me they are about to stop my coverage because I have not yet provided them with the appraisal and the pictures of the car. I should mention that the insurance company at the time of the incident has not sent the paper work that they told me about over the phone. Since then, the insurance company has conducted an investigation, an Examination Under Oath and order an appraisal themselves. Their appraiser has estimated my car at 7500 which is 10% of the value they have insured the vehicle. Please advise on how to handle this frustrating situation as I have paid a lot of money on the insurance of this car and it appears that the insurance company is trying not to honored their own policy. Should I get ready to file a Law Suit Against them?

Please advise. Thank you!!
November 29th, 2011 at 8:47 pm #Jason

Natalya,
For the first time this happened, his insurance should not have paid for your damage unless your neighbor upstairs was negligent to cause your damage.

As for your damage now, you would have just the right amount of money to make the repairs if you take your deductible and add that to the amount your insurance company provides. Your deductible is what pays the first part of any claim.

If your premiums go up, that is just the risk you take. Since you insurance company is already aware of this, you essentially already did file a claim.
November 29th, 2011 at 9:04 pm #Jason

Anthony,
It seems that you purchased a $7500 car for $89,000. Not all investments turn out good.

The insurance company is honoring what it is supposed to do. They will insure a vehicle for it’s value. The vehicle’s value – before the vandalism was $7500, not $89,000 or even $70,000. Just because someone pays an incredible amount over its value does not change the cars value.

We don’t have all the information concerning this EUO and if we knew more, we could tell you more. However, I believe you have kept the details limited because the more we know, the more it looks better for the insurance company.

It is very unlikely that you should consider suit against the insurance company.

(What would be telling is where the vehicle was when it was vandalized and what type of vandalism was done to the car.)
November 30th, 2011 at 11:33 am #sue

I have 2 cars insured. I let my son borrow the 2nd car and it was stolen. The insurance company wants me to give them the police report, access to phone records, approval to do a credit check, access to my bank accounts, power of attorney to the title, etc. This car was bought 2nd hand for a few thousand and I have the title. The records department of the police say they cannot release anything when a case is ongoing and that the insurance company should know that. I feel it is an invasion of privacy for them to ask for access to my phone and financial information, do I need to give them access to all of this?
November 30th, 2011 at 1:37 pm #Kate

Jason,
I hope you can help and advise how to proceed. The problem is a condo was purchased 3 months ago with a home inspection. After living in it for a few weeks my Mother stayed one night and she said she smelt mold. I had a mold test done and mold was found from air samples. They advised the floors be taken up. Carpet and sub-floor treat with different things. A cost of $9,000.00 just for mold removal. I did some digging and found out that 2 years ago there was a leak in the kitchen that flooded the unit and unit below. Police and fire department were called and they shut off the water.
I called my insurance company and they will not cover it because it was caused from previous owners. The field adjuster that was there said the home inspector should have noticed the floor in dining room and living room because it is very wavy, goes up and down and a line in carpet where there is a difference of height in sub-floor. He said it was from a floor that had been wet. I don’t know to get this resolved. Should my insurance company cover it under my mold coverage? Under coverage there is M10 Mold -10/50k. It is fidelity ins. HO-6 in NJ.
Thank you in advance for any help you can give.
December 1st, 2011 at 12:30 pm #Steve

I hope you can provide some advice. 6 years ago I purchased a house and sat down with an agent to go over coverage. I told him the area I will be living in is notorious for sump pump issues and back-ups. I wanted to make sure I am covered if anything happens. He provided me with a policy had a $1000 ded. and $10,000 coverage. I recently moved into a newly constructed house only 1 mile from the first house. I told the agent I wanted the same coverage I had on the old house in the new house (this was 1 year ago). Subsequently, our basement flooded the other night and I called the agent. It took him 40 hours to get back to me to tell me I wasn’t covered. Meanwhile the carpet cleaning bill is going up by the minute and the carpet might not be in good enough condition to save. He claims I never told him to place the extra coverage on the new house that this is my fault. Basically, it is his word versus my word…any advice? I have been in contact with their adjusters, but I don’t think they are going to believe me over the agent.
December 1st, 2011 at 1:02 pm #Jason

Steve,
Likely your claim will be denied by your insurance policy. Once that happens, you will need to make a against your agent – or at the same time as your claim is being processed. Hopefully, they will provide you with information how to do this. If they don’t, then you may have to seek legal assistance.

Did you review your coverage when you received your policy coverage and forms a year ago? If the coverage wasn’t the same, that would have been the time to correct it.
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December 2nd, 2011 at 9:43 am #Tony

Nickolas:
Ignore Jason. His series of posts to everyone, not just you, clearly indicate he is pro-insurance company therefore anti-consumer.

Let me tell you what the LAW says in my state. I am sure yours has something virtually identical:

§ 4133. Vehicle entering roadway.

The driver of a vehicle about to enter or cross a roadway from any place other than another roadway shall yield the right-of-way to all vehicles approaching on the roadway to be entered or crossed.

You said you were on the road and the truck was entering from a driveway. A driveway is the very definition of “other than another roadway”. This law describes your scenario perfectly.

Yes, Jason is right about one thing: You are responsible to avoid an accident if you can, even if the other person is clearly at fault. However, his posts are trying to put the primary responsibility on you where it does not belong. You had the right-of-way as much as you would have had if this had occurred at an intersection with a traffic light and yours was green (i.e. he ran a red light). You, as the vehicle with the right-of-way, cannot be stopping every time you see another car. Even though he had is reverse lights on, you have to assume he is going to yield the right-of-way to you (as required by law) just as you do when approaching an intersection with a green light. If you have the green, the cross road has the red. You have to assume the cars approaching the red are going to stop, even though they may still be in motion. Otherwise you’d be stopping (or at least slowing) for a green light, something the drivers behind you are not anticipating, thereby creating an even greater hazard.

Nickolas, I don’t know what state this occurred in. I gave you a direct quote from my state’s law. As, I said, your state probably has something very similar and it should vindicate you, at least partially
December 3rd, 2011 at 6:14 am #Jason

Tony,
It may be difficult for you to recognize the difference between pro-insurance company information and anti-consumer information that one provides, and for that I will forgive you.

The information I provide is direct and to the point. It is factual and will save people time, money, and frustration with their claim.

Now to take one side of the story concerning the forward moving car hitting the backing car and making a fault determination is at least one story short of having enough information.

You made the statements, “Let me tell you what the LAW says in my state. I am sure yours has something virtually identical:” . . . . For one thing, I won’t assume someone lives in my state and apply the laws for my state to their situation. The primary reason for that is because there 50 states and the odds of that other person living in a state other than my state are incredibly high.

Also, I won’t assume laws are similar in every state about every circumstance. “Virtually”, “somewhat”, or “almost” identical serve no purpose when talking about a state law that you know nothing about.
December 3rd, 2011 at 9:33 am #Tony

Jason,
I have read numerous “rules of the road” laws for my state and compared them to those of various other states, usually my neighboring states (the ones I am more likely to drive in). When it comes to the “generic” laws like this one, in EVERY case of those I have compared I have found little significant differences. Often they are written verbatim. Other times they vary by one or two words. Even those that aren’t so similarly worded, the concept is still the same. In this case, I’m confident I’ll have difficulty finding one that doesn’t require the vehicle entering a roadway from a driveway to yield to the traffic already on the road. I’ve only checked maybe a dozen states so far, I’ll let you know when I’ve checked the rest.

The information you provide is NOT factual if it is not accurate. In Nickolas’ case, you are strongly implying that he bears primary responsibility for avoiding the accident while simultaneously relieving the other party of any responsibility. You make claims regarding Nickolas seeing the truck’s reverse lights on or even seeing it moving and blaming him for not yielding to the truck. You NEVER advised him that, depending on his state, he may have legally had the right-of-way. And we know this to be true because there are states that have this law. If so much as ONE state has this law (which we know to be the case), then he may be covered by it.

Just because I have not checked the laws of every state does not mean the probability of Nickolas’ state having a “virtually identical” law as mine are low. I’m 100% confident that all 50 states make it illegal to run red lights and stop signs, although I’ve never verified this. Believing otherwise only demonstrates one’s ignorance of reality.
December 3rd, 2011 at 10:06 am #Jason

Tony,
Now that you have read those rules of the road pamphlets, you should read the law in your state and those that you travel in.

Now, when you indicate when I said Nicolas shouldn’t hit cars on the roadway or in his path, that is not the same as me saying that relieves the other party from any responsibility. If you read carefully, you will see that I did not indicate that.

Every vehicle in every state is required to have backup lights and since it was at night, these would have been illuminated. So would the other back up lights of the car.

Here are a couple of other things Nikolas has violated.

INATTENTIVE No person while driving a motor vehicle shall be so engaged or occupied as to interfere with the safe driving of such vehicle.

SPEEDING Reasonable and prudent limit – No person shall drive a vehicle at a speed greater than is reasonable and prudent under the conditions and having regard for the actual and potential hazards then existing. The speed of a vehicle shall be so controlled as may be necessary to avoid colliding with any object, person, vehicle or other conveyance on or entering the highway in compliance with legal requirements and using due care.

I don’t have the other person’s perspective so I would even speculate about what he may have done wrong.
December 3rd, 2011 at 11:43 am #Tony

Jason,
Now that you have read those rules of the road pamphlets
Sorry, I haven’t read a single pamphlet, I’ve read the statutes.

you should read the law in your state and those that you travel in.
Didn’t I say I’ve already done that?

since it was at night, these would have been illuminated
Are you implying that they would NOT have been illuminated during the day? And, since it was at night, it is more than likely that Nickolas’ HEADLIGHTS would have been on, too. Regardless, the fact that the truck is in reverse gear (thus activating the reverse lights) is irrelevant. He STILL has the responsibility to yield to the traffic on the road in EVERY state I’ve checked so far (still working on checking the rest).

INATTENTIVE No person while driving a motor vehicle shall be so engaged or occupied as to interfere with the safe driving of such vehicle.
Doesn’t this apply to the truck driver as well? I’ve read nothing in Nickolas’ posts that confirms he was inattentive. However, since the other driver apparently illegally entered a roadway without yielding, there is some evidence that HE was inattentive.

Here are a couple of other things Nikolas has violated…SPEEDING
Where did you get this from? The closest thing he has said regarding speed is “Speed limit 30 than I gets 40”. Due to his broken English, I’m not sure how to interpret this. It could mean he was doing 40 in a 30 zone. It could also mean a 30 MPH zone that increases to 40 MPH (with no indication of his speed). He WAS approaching RT 130 which sounds like a road with a higher speed limit.

No, I am not saying Nickolas or any other driver has the “right” to just run into another vehicle, even if that vehicle is clearly operating illegally. My point is that you’re improperly putting the majority of the responsibility onus on Nickolas, which from what has been posted by him is incorrect. Even if Nickolas was driving illegally (lets say, speeding), the other driver also has the same responsibilities to avoid a collision. But he has the added responsibility of YIELDING to Nickolas since he is entering from a driveway.

I am not going to stop or slow down approaching a GREEN light, just because I see traffic on the cross street (with the red light) also approaching (i.e. still in motion) the intersection. I have to assume that they are going to obey the law and stop. Likewise, I have to assume that a person backing out of a driveway is also going to obey the law and yield to me. Yes, I am going to be vigilant in case they don’t stop and make every effort to avoid a collision. Perhaps my vigilance is how I’ve avoided getting into any accidents all these years. But that still doesn’t alter the fact I’m not the only person who has those same responsibilities. Everyone does. That includes not only Nickolas but the other driver as well.
December 3rd, 2011 at 12:35 pm #Jason

Tony,
I’m not talking about the other person. That would not be fair because we didn’t receive anything concerning that other person. We’ve only received information about his driving from a 3rd party.

Yes, if you read the violation, the proof that Nikolas provided in his post was that he struck the other vehicle. That violates this part of driving too fast for conditions: “The speed of a vehicle shall be so controlled as may be necessary to avoid colliding with any object, person, vehicle or …”

And regarding Inattentive, I’m sure you agree with it. Now you want to indicate the other driver is at fault for this too but we don’t have that information so neither once of us can say anything about that.

Headlights don’t drown out taillights or back lights if that is what you are trying to imply. You sure have some issues with this other driver. Accidents happen all the time.
December 3rd, 2011 at 1:22 pm #Tony

BTW, if Nickolas is referring to US Rt 130, that is in New Jersey.

New jersey law states:

39:4-66. Emerging from alley, driveway, garage, or private road or driveway
39:4-66. a. The operator of a vehicle emerging from an alley, driveway, garage, or private road or driveway, shall stop the vehicle immediately prior to driving upon the sidewalk, and shall proceed to enter the sidewalk only after yielding the right of way to a pedestrian on the sidewalk, if the pedestrian is so close as to constitute an immediate hazard.

b. In addition to any duty imposed under subsection a. of this section, the operator of a vehicle emerging from an alley, driveway, garage, or private road or driveway, shall stop the vehicle immediately prior to entering or crossing a highway, and shall proceed to enter or cross the highway only after yielding the right of way to the traffic on the highway, if the traffic is so close as to constitute an immediate hazard

That violates this part of driving too fast for conditions: “The speed of a vehicle shall be so controlled as may be necessary to avoid colliding with any object, person, vehicle or …”
The only way to comply with this regulation as you are describing it is to not drive at all. There is absolutely NO evidence that he was driving too fast for conditions. I have no idea if he was going the speed limit (30MPH), faster than that or slower. Irrelevant. What we DO know from Nickolas’ statement is the HE (Nickolas) was on the road and the truck was entering from a driveway. Based on this info alone the indications are that Nickolas had the right-of-way and the other driver is required BY LAW to yield to him.

but we don’t have that information
We have the info that Nickolas provided and, in lieu of any contradictory information, we have to assume a certain amount of reasonable accuracy. My determination is based on the assumption that Nickolas’ statements contain some degree of accuracy. IF Nickolas was already on the road, and IF the truck was entering that road from a driveway, then the driver of the truck bears primary responsibility in yielding the right-of -way. Nickolas’ responsibility is to try to avoid a collision if possible. Even if Nickolas WAS inattentive in not seeing the truck backing out, that DOES NOT relieve the truck driver for ALSO being inattentive AND failure to yield.

Headlights don’t drown out taillights or back lights if that is what you are trying to imply
Are you serious? No I’m not trying to imply that Nickolas’ headlights might have “drowned out” the taillights. That thought had never even occurred to me and the fact that it did to you demonstrates your mentality. My point was that, if Nickolas was supposed to see the reverse lights and tail lights, why couldn’t the other driver see Nickolas’ headlights? Our eyes see light, that is what they do. You’re contending that Nickolas should have seen the lights of the truck. I’m simply saying that the truck driver has eyes too. The BOTH should have seen each other. Are you suggesting the truck’s tail and reverse lights “drowned out” Nicholas’ headlights? It still comes down to who has the right-of-way, and who has to yield.

Accidents happen all the time.
And they shouldn’t. The overwhelmingly vast majority are because SOMEONE wasn’t paying attention to their surroundings, or WAS paying attention and didn’t care. In this case BOTH parties share some responsibility. But, based on the info I have and the law, I tilt the burden of responsibility more on the truck driver than Nickolas. The tone of your stance is that it is the other way around.
December 3rd, 2011 at 1:33 pm #Tony

BTW, Jason:
Since this was at night, that means the truck driver SHOULD have seen the reflection of Nickolas’ headlights, even if he couldn’t actually see Nickolas’ car. I know I frequently see a headlight reflection long before I see the actual car. Therefore I often know another car is coming long before I actually see the car. But that’s me.
Nickolas made a statement about a “blind spot” regarding trees. It is possible, because of this, neither driver actually saw the other until it was too late. Again, irrelevant. The person entering from the driveway needs to exercise MORE care and vigilance than the person already on the road. I’m sorry if you have a problem with the law, but that’s the way it is.
December 3rd, 2011 at 1:59 pm #Jason

Tony,
No, you say, “The only way to comply with this regulation as you are describing it is to not drive at all” in reference to driving too fast.

I disagree, the way to comply with that rules is to follow the statute: No person shall drive a vehicle at a speed greater than is reasonable and prudent under the conditions and having regard for the actual and potential hazards then existing. The speed of a vehicle shall be so controlled as may be necessary to avoid colliding with an . . . – And since we are aware Nickolas was in an accident with this truck, and by doing that, he was driving too fast. The mere impact with another vehicle confirms that so his speedometer speed is not needed.

We know Nickolas was inattentive. We don’t know if the other driver was. We can’t use your rational that because one driver is inattentive, it automatically makes other driver inattentive. You may be correct but assuming and filling in the pieces isn’t the right thing to do.

You brought up the headlights, not me. Please note that you again are assuming that this other driver should have ….. we are not talking about the other driver. We are talking about Nickolas. Nickolas had taillights and backup lights available for him to see.

Accidents happen all the time. You can tilt your burden responsibility anyway you want. I don’t have a tone and I don’t have a stance. I merely answered a post. Once again, your assumptions have you inferring that I made my stance know about this accident. I’m certain I haven’t.
December 3rd, 2011 at 6:14 pm #Tony

Jason,
No, you say, “The only way to comply with this regulation as you are describing it is to not drive at all” in reference to driving too fast.
Who was driving too fast? You weren’t there and neither was I. The only reference to speed by the one person who WAS there was this: “some truck was getting out so fast from his driveway”. According to the person who was there, the truck was “going fast”. There is absolutely no indication whatsoever as to Nickolas’ speed. According to him he was in a 30MPH zone, but he doesn’t say how fast he was going. The mere fact that he was unable to stop for a car ILLEGALLY pulling out in front of him is not proof that he was going too fast. Are you suggesting that a car going 30MPH in a 30MPH zone is going too fast? There is no evidence of any special hazards which would require slowing below 30 (i.e children or other pedestrians, weather, etc.) OTHER than the ILLEGALLY operated vehicle he hit.

And since we are aware Nickolas was in an accident with this truck, and by doing that, he was driving too fast.
And this same logic doesn’t apply to the other driver why? Simply because it was Nickolas’ car that hit the truck and not vice versa? Using this logic, if someone runs a red light (you’ve got the green) and YOU hit HIM, YOU are at fault, not him. It’s purely a matter of timing? Are you suggesting that had Nickolas been 1 second faster (or the truck 1 second slower) and the TRUCK hit Nickolas, you’d be singing a different tune?

The mere impact with another vehicle confirms that so his speedometer speed is not needed
You have a lousy sense of logic. It’s clear you’re not a Vulcan.

We know Nickolas was inattentive
No, we don’t. We know he MAY have been. We cannot confirm this based on the presented testimony alone.

We don’t know if the other driver was
At the very least we know he entered the roadway without due regard for traffic on it. that can be construed as inattentive.

We can’t use your rational that because one driver is inattentive, it automatically makes other driver inattentive
Agreed. Because the truck driver was inattentive, we can’t assume Nickolas was. Glad we agree on something.

Nickolas had taillights and backup lights available for him to see.
Maybe, depending upon any obstructions. Again, the only info I have to work with was provided by the person who was there. And he indicated that there WERE obstructions, at least a tree. MAYBE Nickolas didn’t see the truck until he was already in the street (at least partially). Keep in mind the physics involved here. The vehicle backing up has to also STOP, change gears and accelerate to complete the maneuver. If he can’t do all that without traffic on the street having to take evasive action, then he is wrong (legally).

Again, I am sorry if you have a problem with the law. Your evaluation of the incident concluding that Nickolas was inattentive based on the information provided by him is flawed, especially when not taking into consideration the responsibilities of the other driver regarding HIS attentiveness.

We cannot make any definitive assessments of Nickolas’ attentiveness based solely on the information provided. He may have been inattentive, he may not. We also cannot determine what factor Nickolas’ speed played in the incident. It is a 30MPH zone, and he has a legal right to go 30MPH barring any special and unusual circumstances and hazards. There is no evidence there were any, so I will assume there were not any. We do not know at what point the truck first became visible to traffic on the road. Was it still in the driveway or was it already entering the street? We don’t know what role visual obstructions may have played. Nickolas mentioned a tree, so there is evidence there may have been some obstruction. What about other obstacles such as cars parked on the road, etc.?

We do not have sufficient information to make a definitive determination as to fault.You’re making the assumption that Nickolas should have seen the truck’s tail and reverse lights, and therefore should have stopped and yielded to the truck. You claim (at least you imply) that the only reason Nickolas would NOT have been able to stop in time is because he was inattentive and/or “going too fast for conditions”. This assumption is incorrect. You fail to place any responsibility on the other driver based solely on the fact that he has not testified in this matter. This is also flawed because we know, based on what testimony we have, that he backed out of a driveway without due regard for the traffic on it. We know Nickolas hit the truck, which means the truck came from SOMEWHERE. Did it just suddenly appear there from nowhere? I’ll assume it DID back out of a driveway and into Nickolas’ path. Unless you can PROVE Nickolas was negligent (which nothing here indicates, despite your convoluted sense of logic), the primary responsibility for yielding falls to the truck driver. HE’S the one with the implied yield sign, not Nickolas. Again, sorry if the law offends you.
December 4th, 2011 at 7:35 am #Jason

Tony,
No, I’m not suggesting he’s speeding – What we have here is his inability to stop to avoid hitting another vehicle (this confirms he is speeding). This had nothing to do with me. At least you confirm that the hazard he should not have been driving to fast around is the truck he struck.

PARA#2. Since we are talking about Nickolas only, I am going to ignore this paragraph.

“The mere impact with another…” Vulcan seems to be out of context and I am unable to determine what you are referencing.

“We know Nickolas was inattentive…” Nickolas was inattentive because he surpassed the requirements of the law to be considered inattentive.

“We don’t know if the other driver was…” Again, we are not discussing the other driver because we don’t have his input.

“We can’t use your rational that be…” Nickolas’s inattentive driving is established on his violations of the law that confirm he was inattentive. Again, we are not discussing the other driver.

“Nickolas had taillights and backup…” If you ever see a tree growing out of a highly traveled roadway, please take a photo of it because that would be interesting. Short of that, there are no trees, phantom objects, or other mysterious things that could be an obstacle. To think there would be on any segment of a highly traveled roadway is very short-sighted.

PARA#8 – We are not talking about any possible inattention of the other driver, just that of Nickolas. Nickolas’s inattentive actions have nothing to do with my evaluation. His inattentiveness is based entirely on what he did to meet the threshold of being inattentive based on the law created by the legislatures who wrote the laws.

PARA#9 – The mere contact of Nickolas’s car to the truck is the complete and entire source to prove, without a doubt, that Nickolas was not only inattentive, but that he was also driving too fast. Because striking a vehicle with your car confirms those presumptions and actually makes them facts. (You can fish for obstructions all you want but the reason why Nickolas’s car struck the truck was not because of any obstruction propelling the car into the truck, it was because of Nickolas propelling his car into the truck.)

PARA#10 – I don’t assume to say that Nickolas should have seen the tail lights or back up lights. That is irrelevant. Because whether he did or not, he failed to avoid colliding with an object in his vehicle’s path. That is the important part of the things we are talking about. Also, anything that you are discussing about the truck is hearsay. It is Nickolas telling us that and is not supported by the other driver. Why is that? Because we didn’t hear from the other driver and we cannot use that hindrance against him. You can if you want to be careless, but I will not out of respect to him. Again, you continue to assume many of your points.

It appears you want to argue about some minor things and I am here to provide helpful answers to questions for others who need insurance help. I’m going to allow you to respond one more time, but I am going to end this back-and-forth dialog so it doesn’t continue.

Getting back to topic – you are welcome to provide answers to any of the questions you see on here in which you think you can benefit others.
December 4th, 2011 at 10:48 am #Tony

his inability to stop to avoid hitting another vehicle (this confirms he is speeding)
How does this confirm he was speeding? Are you saying it is physically impossible to hit another vehicle unless you are speeding? “Speeding” is defined as exceeding the posted speed limit (in this case 30MPH). Is it impossible to hit another vehicle if you’re going 25 in a 30 zone (thus not speeding)? Oh, that’s right, you don’t mean “speeding”, you mean too fast for conditions, regardless of actual physical speed. Thus, 5MPH in a 30 zone would be speeding to you (and you alone). He’s in a 30MPH zone. According to the state, he is allowed to do 30 in that area under normal conditions. This includes vehicles entering the roadway from private driveways. If there are houses on this street (which there obviously ARE), the speed limit has been established based, in part, on this. Thus, the possibility of a vehicle entering this street from a driveway IS a normal condition. The mere fact that the two vehicles collided proves ONLY that one party or the other violated some rule. It does NOT, in and of itself, prove WHO, as you believe. You have 100% failed to take into consideration ANY responsibility on behalf of the other party, simply because HE has not testified here, thus exonerating him of ANY liability. This perspective is flawed.

Since we are talking about Nickolas only
No, we are talking about Nickolas’ situation which INCLUDES the other driver. The actions of the other driver(s) involved in such an incident MUST be considered in order to determine the extent of any given driver’s involvement and responsibility. Again, if the truck had run a red light or stop sign, would you still exonerate them of any responsibility?

Vulcan seems to be out of context and I am unable to determine what you are referencing.
Vulcans are a race known for their highly refined sense of logic. Since your sense of logic is 100% opposite of theirs, it is clear you are not one of them.

Nickolas was inattentive because he surpassed the requirements of the law to be considered inattentive
In your world only. Again, there is absolutely NO evidence Nickolas was legally negligent in any way based solely on the info provided. Are you suggesting it is 100% impossible for a fully attentive person to get into an accident? There is NO WAY for another driver to do something unexpected and unanticipated? Again, I get back to a car running a red light or stop sign. It’s not possible for a fully attentive driver to collide with such a car? It’s IMPOSSIBLE?

Again, we are not discussing the other driver because we don’t have his input.
There are two parties involved. How does one discuss an incident with mentioning both? Can you discuss a ball game without mentioning both teams?

Nickolas’s inattentive driving is established on his violations of the law that confirm he was inattentive. Again, we are not discussing the other driver.
This has already been covered. Nickolas’ “inattentive” driving has NOT been established (except in your world) and, as an involved party, the other driver’s actions ARE open to discussion.

If you ever see a tree growing out of a highly traveled roadway
If ANY statement you have made so far demonstrates your warped mentality, this one certainly does. NO ONE (certainly not me) ever suggested the tree was in the STREET!!!!! But they do COMMONLY grow on SIDEWALKS! Want pictures? I’m sure I can find plenty on the net. I don’t even have to leave the house. And where are driveways to houses usually located? Oh, yeah! Beyond the sidewalk! So, guess where the tree would be? BETWEEN the street and the driveway.

there are no trees, phantom objects, or other mysterious things that could be an obstacle.
Interesting choice of words: “could”. Nothing? No parked cars (it is apparently a residential area) “could” be between the road and the driveway? No trees? NOTHING “could” be an obstruction? And, if there couldn’t possibly be any obstructions between the two cars, why couldn’t the other driver see the car he has the legal responsibility to yield to, regardless of any infractions that driver may have been committing? Are you suggesting it is OK for someone to enter a roadway from a driveway without yielding as long as the other driver is violating the law? Again, you’ve completely exonerated him of any responsibility to avoid an accident simply because he hasn’t been heard from so he doesn’t exist.

To think there would be on any segment of a highly traveled roadway is very short-sighted.
On which planet (let alone country)? such things exist ALL OVER THE PLACE! Want pictures?

We are not talking about any possible inattention of the other driver, just that of Nickolas
Again, his actions are as relevant as any other, regardless of whether he has been head from or not. To ignore such actions is pure irresponsibility.

based on the law created by the legislatures who wrote the laws.
Is this not the same legislature that wrote the law regarding entering a roadway from a driveway?

The mere contact of Nickolas’s car…
Again, flawed logic. It takes 109′ for a car traveling 30MPH, under pristine conditions, to stop. This calculation includes the reaction time of the driver, calculated at 1.5 seconds, which is not considered inattentive but average. It is also the same calculation the courts use. Thus, even an average person driving the legal speed limit in a 30MPH zone would still take over 36 yards (over a third the length of a football field) to stop once the driver sees the hazard. 30MPH = 44 fps. Thus, with a reaction time of 1.5 seconds (before the car starts to decelerate), the car will travel 66′ in this time. The actual stopping distance (once brakes are applied) is, therefore, another 43′. Thus, if a car pulls out of a driveway with another car less than 109′ away, it will be impossible for that car to stop in time to avoid a collision. These are averages, of course. Specific times and distances can only be determined with a forensic investigation.

I don’t assume to say that Nickolas should have seen the tail lights or back up lights. That is irrelevant
Uh, yes you did: “…with their white backup lights on” and “Not only are the white backup lights alerting you to him backing, but he also has red taillights that are in front of you” and “Every vehicle in every state is required to have backup lights and since it was at night, these would have been illuminated”. If the lights are not important, why keep mentioning them? Why mention them at all? Obviously they ARE relevant. At least to you.

The truth of the matter is, regardless of any additional input from the other driver, it is clear that two vehicles collided, which means at least one of those drivers involved violated some law. You contend that, because only one person involved as provided any information regarding the incident, and because it was HIS vehicle that struck the other (as opposed to vice versa), HE is therefore at fault 100%. This is a completely flawed assumption. And that is all it is, an assumption. Legally speaking, from the info provided, regardless of source, it would appear it is the TRUCK driver who bears primary responsibility for this incident, as he definitively failed to yield. Any determination as to Nickolas’ attentiveness is pure speculation.
December 4th, 2011 at 11:38 am #Tony

Nickolas (and everyone else for that matter):
You come here to this site seeking defense help. You already know you’re getting shafted by and insurance company, you don’t want to hear how badly. The best advice I can give; do not seek defense help from a representative of the “prosecution”. It is clear from his posts that Jason is, at the very least, an advocate of the insurance industry, if not a direct employee. He is not interested in helping you resolve your dilemma and you are, therefore, unlikely to find anything you’d consider useful in what he says.
Also, do not seek help from your insurance agent. He IS an employee of the insurance company. As much as he/she may act, like your best friend and that they are on your side, they not only ARE not, they CANNOT be. To do so would be in direct contradiction to their employer. If the insurance company makes a determination with which you are displeased, do not expect your agent to fight for you (i.e. against the people who pay his salary).
Remember, as I have said before, insurance companies, like any other business, are in business to make money, and the more the better. The best way to do this is to take in more than they pay out. They “take in” via the premiums you pay and “pay out” via claims. The less they pay in claims, the more their profit. Therefore, they will use any means possible to deny a claim.
Unlike most other business you deal with, insurance companies do not deal in tangible goods. When you pay them your money, you have nothing tangible to show for it. You have only the perception that, should you suffer a loss, they will pay you accordingly. Again, this pay out is contrary to what is in the best interest of the company’s bottom line. Thus, they will try harder to find a reason to deny the claim than they will to find a reason to pay it.
Jason is right about one thing: the insurance policy is a contract. But these contracts were written by high priced lawyers. They are very specific on what is covered and what isn’t. That is why they are so “wordy”. If a policy does not specifically state a certain condition is covered, then they probably won’t pay a claim concerning it. There are few, if any loopholes in these contracts. Remember, you are not the first person to sign one of these things. Any possible loophole has most likely bee found and closed long ago. Your only hope is if you can clearly find an ambiguity, but this will be difficult. A contract is legally defined as a “meeting of the minds”. If you can find something in the contract that applies to your incident that is either clearly or most likely ambiguous to most people, you may have a case. Keep in mind that, in the eyes of the law, any ambiguity in a contact will almost always go against the author of the contact. That means that if the insurance company wrote it, they are the author, not you.
In short, this forum is a good resource for seeking help, as long as someone with YOUR interests in mind replies. Jason is good at giving you the insurance industry’s position. But you already have that. Do not rely on his information to ASSIST you. It will not help you.
December 4th, 2011 at 2:06 pm #admin

Thanks so much to Tony and Jason for giving their time to this website. It’s a huge education for our visitors to see this kind of discussion between professionals. And it’s really nice, for a change, to see a discussion that does not go into four letter name calling 🙂

I would like to hear both your (and anyone else) opinions on whether insurers should be federally regulated (instead of the current regulations with 50 states with 50 different sets of statutes and 50 sets case law).

“The United States Department of the Treasury’s Federal Insurance Office (“FIO”) announced today, October 17, 2011, that it is seeking public comment to assist in the creation of its report to Congress on how to modernize and improve the nation’s insurance regulatory system. This report, which is expected to be completed in early 2012, is required under the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010.” Read more here http://www.cftnews.com/index.php?cmd=article&id=7446
December 12th, 2011 at 7:52 am #ken

Hi,
My home caught on fire. It is over 100 yrs old is part log cabin and the other part added on about 50-75 yrs it burned just about everything and left a crater in the middle of the house. When the adjuster called he asked if the roof was still in tact which it is. The fire started in the basement and took out most of the floor joists and ceiliings through out the house and the fire was in most of the walls.
Will they make me fix the house or will they total it? I have extended replacement value insurance with allstate. I’ve also read horror stories regarding allstate claims with fire protection the past few days.

I really don’t want them to just put on a band-aid for fear something down the road wasn’t fixed correctly. After reading I’m horrified my family will get screwed.

They are sending out someone today to investigate the fire then the adjuster will be here tomorrow.

Thanks for any help.
December 12th, 2011 at 8:18 am #Jason

Ken,
When we read about the horror stories about any claim situation, we can rest assured that those stories are about just a few people that had a bad experience with their insurance company. However, Allstate is the exception. That is not just some otherwise good claim handling that went bad, instead it’s about the entire core of how Allstate handles small, medium, and large claims. Maybe you claim will be the exception to their claim handling practices and might actually turn out ok. We don’t know.

Another thing we don’t know is how they are going to approach what your house needs. That can only be determined by a physical inspection and evaluation of the damage.
December 12th, 2011 at 1:17 pm #ken

Jason the FSI stated he had thought it looked like the Christmas tree caused the fire. I forgot I put the tree up that morning, it was the kind that was in 3 pieces with lights and motor built in. The lights in the top didn’t work and we were out that day to get lights to put on the top since they didn’t work. I know I turned it off before I left.

Will they find me at fault? It was a tree that was given to my wife last year when they took it down.
December 12th, 2011 at 2:46 pm #Jason

Ken,
It shouldn’t matter if they find you at fault or not. Accidents happen. What is important is if they find the fire was intentionally set. It shouldn’t matter if you turned it off or not before you left.
December 12th, 2011 at 6:31 pm #kate

i need help…
I boughtmyhouse 2 yrs ago nevr had any water/electrical problems i live in ct where last week we got about 4 inches of rain over night thurs morning my basement was dry i have a sump pump that was running i left for work came home about 8 hrs later to find about5-6 inchesof water in my finished basement drywall,floors,furniture,computer etc all ruined then i noticed some of my lights didnt work my sump pump was not working outlets didnt work i cleaned all the water up calle my ins they told me to call service master to have them come and dry out all the rooms down there they came hooked everything up i still have fans down there but my ins is saying they dont cover floods i tried to explain something happened with he electrical system and thats why my sump pump didnt do its job they told me to call the electrician and get it in writting i did he cant sayfor sure untill he an get into the attic and cieling but he thinks some of the electrical wires were overloaded and they melted causing a power failure to parts of my house my home owner is saying it was my responsibility to make sure my electrical was working… how its covered in walls and cieling?? can i fight them? or do anything abot this i have a big mess
December 12th, 2011 at 6:55 pm #Jason

Kate,
Generally, water that enters at or below ground level is excluded. Also, it really doesn’t matter how the water came it at or below ground level for coverage to be there or not – almost never is it covered. Sometimes a homeowner can buy a water back up and sump pump overflow coverage and that is a way to have limited coverage of this kind. With your situation, we don’t know enough about your coverage.
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December 19th, 2011 at 1:05 pm #kristina

Hello,

I recently filed a liability claim on my landlords policy. I fell down the stairs and broke my big toe because my landlord has a slippery plastic runner on them. I’ve asked her in the past to remove it but she never did. Farmer’s called and left a message stating they have denied my claim because they do not think their insured was liable and will be sending me a letter. The only information I gave them was a recorded statement. No medical records, bills, or pictures so I’m assuming they are basing this on that and information given from my landlord. What recourse do I have now?

Thank in advance!
December 19th, 2011 at 4:40 pm #Jason

Kristina,
In order for the landlord to be liable, they must fail to do something that is reasonably expected, or to do something that caused your injury. We can rule out one of these things right away. The landlord didn’t do anything to cause your injury.

That leaves us with “they failed to do something so you would not be injured”. Runners are used all the time on steps and in various parts of houses. We don’t know exactly how your injury occurred but because of the denial, the insurance company doesn’t believe that what your landlord didn’t do was the principal reason why you were injured.

There isn’t always recourse. You presented a claim and it was denied. That was the recourse you had and it has ended with a denial.
December 20th, 2011 at 3:51 am #Bill Jameson

I just spent the last 45min reading through post’s on this website and actually see 1 or 2 input’s that actually apply to my circumstance.

This past weekend myself along with my wife decided to paint our laundry room and put up new trim and shelves, during our prep of the room , my wife noticed ( by the exit door/doggie door ) the the floor was soft.

I pulled back the flooring ( sheet vinyl) approx. 1 ft and found that the sub-floor to be rotted in about a 2′ radius , the rest of the area had black mold but still solid, upon further investigation the damage went up the exterior wall about 6 ” so from the sub floor to 6″ up the framing of the wall was rotten as well, proceeded to investigate outside the house ( had to remove decking ) removed siding and found that the exterior wall/sheeting was rotten as well , the sill plate seems to be solid but is covered in black mold as well.

Insurance adjuster ( State Farm) comes out 3 days later looks over the damage takes a few pictures and measurements , also providing recommendations on how to properly repair the damage, and also determined that the dog door was the culprit for the damage , the the addition was done 6yrs ago the door was not flashed/installed properly causing the weather to weep down behind the siding and enter through the bottom of the door.

The adjuster turns to me and asks when filed your claim did anyone go over what is and is not covered I said no they told me too uncover the areas that I could and get a fan on it to get it dried up and too take pictures and keep everything I had taken apart , which I did. So the adjuster opens up his handbook ( dated 2004 ) and opens to a page ( latin if you ask me) and the paragraph he points too states pretty much they will cover it unless appendix A-f/g? are applied he goes too appendix C and it states in like 5 words Denied if Mold/Mildew/Rott are present

I understand ( do not agree) about the Sudden/Accidental BS but I am looking at 4 to 5 grand worth of damage and possible structural damage

What do we pay insurance for ? Is there any recourse ?

Thanks
Bill
December 20th, 2011 at 6:13 am #Jason

Bill,
Thanks for reviewing this site to see if your question was answered already. Also, we appreciate you submitting a well-written explanation of your situation with your questions.

There are only a few policy’s that insure homes in the insurance industry. Even though there are a few different ones, the insurance forms and wording are so close in wording and format that it’s difficult to tell them apart. And even though State Farm has their own proprietary insurance policy, it is like all the rest of them that insure homes across the country.

Even though the handbook of his was dated 2004, it may have been published the same year your policy was published. These policies don’t change much over time.

To indicate what your insurance policy covers would be extremely long and complicated and we won’t go into those details. The policy is written to exclude things that happen to homes on a regular basis that are related to human error and improper planning. The doggy door and it’s related damage seem to fit under this category.

Another common exclusion is water seepage or entry into a home at or below ground level. This event happens to homes a lot and insurance companies don’t want to cover that so they excluded it. Sure, there is some limited coverage that can be purchased back under the Water Backup and Sump Pump Overflow and that is a coverage endorsement, in our opinion, most home owners should have.

Regarding your situation, there is no recourse.
December 20th, 2011 at 9:29 am #Sonja

HI Bill

I just had a very similar event happen to me. I have a rental property and my tenants called me that there was some mold on the wall. I went to look and indeed some mold on the wall behind the toilet. However when we looked further there also was some mold in the wall in the cabinet. I called in a claim, they told me to take out a small part of wall so we could see what was going on. Major mold behind the wall, some rotten studs etc. Turned out the shower pipe had leaked and clearly for some time. We just did not know it. Claim was denied because it was older than 14 days. Now how could we have known???
It did cost me over $5000 to get fixed. Indeed what do you have insurance for if not for unexpected things.
What if a doctor would say sorry but your cancer is older than 14 days so you are not covered, it is absurd. Anyway I was not getting anywhere with the insurance company and if anyone knows if there is a way to change this rule, not even for this, but for future problems like this for others also. Let me know.
December 21st, 2011 at 5:53 pm #Kathryn Tompkins

Ok, so I started my dishwasher last night and then walked into the livingroom. I started to hear water downstairs in our finished bonus room (drywall ceiling). I walked downstairs and there was water pouring out of my ceiling fan and cracks between the celing and walls. The adjuster came and told us that they would cover the damage that was done to the room and ceiling but not the pipe itself that had burst. They are telling us that it is basically negligence on our part, maintanence issues. My husband and I are confused on this because if we can not see a leak how are we suppose to prevent it? Do you have any words of advice for us? We are already sitting on hard times just like everybody else and we depended on this company to be there when we needed it the most. Everyone pays their dues to insurance hoping this and then they are let down. Thank you so much for your time and we look forward to hearing from you!
December 21st, 2011 at 6:57 pm #Byron

Sometime in the last two years, we had ice build up in the shingles and developed a leak in the roof. I saw water on the floor one time, but thought it was due to an open window. Recently we became aware of significant wall and floor damage. We only noticed it because we bumped the wall in it broke through. State Farm has denied any coverage because there is now mold and rot. They agree that water damage caused the rot, but thier policy specifically excludes rot. If I ask them if they would have covered the damage if I had caught it earlier, they say they can’t deal in hypotheticals and repeat that they won’t fix anything with mold. We have to replace wall and bricks because the OSB covering is ruined. So far we are talking over 6,000 dollars to repair it. Its kind of a catch 22 and seems to revolve around when I noticed the damage. Any suggestions as to how I can approach them.
December 22nd, 2011 at 8:31 am #Jason

Byron,
The sooner you notice the damage, the sooner you can address the repairs. This type of loss is not something insurance companies provide coverage for. This is something that comes with being the owner of a home.

Are you asking for suggestions on how to approach the insurance company? If you are, just avoid them. Any time you spend communicating with them will be time you should be addressing the repairs to your home. Your damage is denied and there is nothing that will change that.
December 30th, 2011 at 1:31 pm #liza

I have had USAA for all of my insurance needs for 10+ yrs. Recently my home was vandalized after my live in boyfriend and I got into an arguement we are both covered under the insurance policy. My claim is being denied for intentional loss. Police reports were made, pics and video sent all hoops jumped through. He denies doing the damage, I have never had a claim in the past, what do I do?
December 30th, 2011 at 5:17 pm #Jason

Liza,
If your boyfriend is not an insured, and he did the damage, then your policy should pay for the damage above your deductible. If you did any or all of the damage, than it would not be covered.

For your sake, I hope the damage isn’t significant. The insurance company doesn’t take denials lightly so once they make that determination, it’s pretty much final.

What should you do? If he hasn’t moved out yet, he needs to do that and you need to get on with live without him messing up yours.
December 30th, 2011 at 9:07 pm #robert

Hi,

My family experienced a fire before Christmas, the Fire Investigator said he believed it was caused by the christmas tree. The Allstate adjuster came out to assess the damage and explained that it was “repairable” even though the house was pretty much gutted with most of the floor joists gone but the structure itself was still standing.

We have had a couple contractors come out to give estimates and all agree they can’t figure out why they would consider it repairable but also stated that if it was to be “repaired the repairs would cost more than it would be to to have a total loss because everything would have to come down to the studs and even most would have to be replaced due to water damage that was in the walls.

I called the adjuster today who told me he hasn’t worked on our claim since he was out to the house doing his assessment. (This was the second week in Dec) then he went on vacation the week before christmas. And now with the New Year they won’t be back in their offices until Jan 3rd.

Then I received a letter today saying the claim was still under investigation and would have it resolved within 90 days. Is this normal procedure? We want to get things started to get back in our home wither it is rebuilding or repaired.

Also what kind of depreciation is involved in replacement value on contents?

thanks for your help
December 31st, 2011 at 7:18 am #Jason

Robert,
We don’t know the specifics of your claim. We don’t know the detail of the fire investigator’s report. Sure, the insurance company can take the required amount of time to investigate a fire (or any claim for that matter). So, this is normal procedure. They should spend more time on your claim than they are but that is probably because they are short-staffed, and we won’t get into that in this post.

You will need to have a contractor or contractors. Whether the insurance adjuster calls it repaired or rebuilt, the same procedures have to be done no matter what. You shouldn’t get caught up in what it’s called.

Contents are valued based on their consumed life based on their condition and age. There is nothing specific we can provide about valuation except that if this is a covered claim and you have replacement cost coverage, you will be paid the ACV portion of the contents damaged and when the specific items are replaced, you many collect the difference between the ACV and the actual replacement cost.
December 31st, 2011 at 9:05 am #robert

Thanks for the reply Jason.

We were worried that maybe they were trying to find a way not to pay. I understand with the holiday’s it may be delayed.
We are living with relatives and the sooner we can get back into our own home the better we all will feel. We’ve been living out of hotels and now with the in-laws.

The insurance has been real good about helping us with a place to stay and calling to make sure we were doing ok.
January 2nd, 2012 at 9:41 am #Tony

Robert,
We were worried that maybe they were trying to find a way not to pay

They are, it is what they do best.

The insurance has been real good about helping us with a place to stay and calling to make sure we were doing ok.

So was my sister’s insurance company after their fire…at first. Eventually she got denied because, according to the letter my sister received from them, they had “undeniable proof” that she or someone in the family had something to do with starting the fire. Keep in mind that the law requires the insurance company to turn over to the police and fire marshal any such proof. The fire was 2 1/2 years ago and NO ONE living in the house has ever been questioned by the authorities (beyond the initial interrogation), let alone charged with anything. Obviously the “proof” is not really “undeniable”, or else one or more of them would be sitting in jail right now.

The facts: insurance companies put more effort into trying to find a way to deny a claim than they do verifying the validity of same. Insurance companies are publicly traded commodities. As such, their primary concern is their bottom line, not the interests or well being of their clients. Insurance is mandatory. As such, they don’t have to worry about their clientele, the worst they can do is switch companies, not drop insurance altogether. All any one company has to do to attract customers is provide a better “gift wrap” than the others, while the contents remains the same. Being mandatory, required-by-law “services”, insurance companies should be not-for-profit organizations. Maybe then their focus would switch a little more towards real customer service than their own pockets.

In short, Robert, don’t count your chickens before they hatch. You may well get exactly what you should, it does happen occasionally. But don’t let their smiling faces and handshakes fool you, insurance companies don’t give a damn about YOU. And don’t be fooled by your agent, either. Remember, he is an EMPLOYEE of the insurance company, where do you think his interests lie?
January 2nd, 2012 at 10:11 am #Jason

Tony,
It appears it has worked out at is should have for your sister then. When someone intentionally burns their property, it is called arson. Arson is one of those things that insurance doesn’t provide coverage for. In all cases, loss by arson is excluded.

Just because there are no criminal charges doesn’t mean the information was not shared with law enforcement. You have to understand that a district attorney will decide on criminal charges based on their perceived success rate going forward. They may have made a business decision not to pursue anything. That just isn’t our area to be concerned about.

So, it kind of makes sense that you would be upset that the damage to your sister’s property was not paid by the insurance company. Your anger is misguided. Instead of the insurance company not paying because there was obvious arson, you should be angry with your sister for mindlessly burning her property. If you cannot find it in your heart to be angry at her for burning her property, perhaps you should be angry that she did this carelessly and was caught red-handed at arson and insurance fraud.
January 2nd, 2012 at 2:18 pm #Tony

Jason,
There was obvious arson, just not by them. They were targeted by another individual. They were victims, not criminals.

If the evidence was as “undeniable” as the insurance company claims, it is clear the police and/or fire marshal would have investigated it. THEY DID NOT. They were NEVER questioned AT ALL by either department beyond the initial routine questioning immediately following the fire.

District Attorneys do not make the decisions whether or not to investigate a crime, only whether or not to prosecute suspects after an investigation. There never was an investigation, therefore the DA never got involved. Your statement regarding the DA is moot. The only logical conclusion is the insurance company never had the evidence they claimed to have had. I cannot see the police reveiving such “undeniable proof” of a crime and not at least questioning the suspects.

You’re making a quantum leap in assuming that the insurance company is right based on no evidence at all, other than the insurance company says so. Again, the insurance company, as a publicly traded corporation, has an agenda, a commitment to it’s stockholders, to improve it’s bottom line. This can best be achieved by denying as many claims as possible, regardless of the truth and regardless of equity. Every word you write, more strongly than ever, reinforces the fact that you yourself, for whatever reason, have an agenda clearly supporting the insurance industry, not the consumer.

Here is something for you to gnaw on: if the IC was as right as they claim, why did they not, at least, demand what money they had advanced to my sister back? If this was such a clear case of fraud in their minds, why was there never a mention of being reimbursed the thousands of dollars they were advanced for motel rooms and food, etc.? Not pursuing the issue legally may be a business decision, but not even mentioning it? Even in the denial letter? Even in the letter that claimed “undeniable proof”? Sorry, not logical.
January 2nd, 2012 at 3:13 pm #Jason

Tony,
I dispense information to people on this forum. You seem to dispense hate. You are an instigator that has an agenda because someone you are related to got caught trying to collect insurance funds from their insurance company for a reason related to fraud. I don’t know exactly what it was but the reasons to burn their property and claim that someone else did it a lot of the times involves finance trouble and that is what I would speculate was the case with your sister.

You seem quick to jump on the bandwagon that they are victims of someone staging a fire who then blamed it on your sister when you have done no investigation of your own and you are relying on the information your sister provided to you – including the inflammatory letter your sister let your read from her insurance company.

The police, fire marshal, and criminal authorities do not make their investigation attempts or procedures available to the public so for you to conclude they didn’t investigate is a weak attempt to determine something without allowing us the means to determine the validity of what you say.

It is clear you have no understanding of the law and criminal investigations because you believe that all investigations have to be concluded before a prosecutor becomes involved.

You are the one making a leap believing the insurance company is not correct. Denials require a lot more basis and foundation than actually paying for a claim. That is because their denial has to stand the review of a judge and/or jury to make sure it stands.

So, please update us on how your sister’s lawsuit is going. I would bank on it that since she started the fire and tried to collect insurance proceeds, she did not file a lawsuit so she doesn’t draw attention to herself from the prosecutors.

You can have your opinions about what position I hold on this forum but that will remain just that – your opinion. I will let you know that I provide reliable information to consumers based on experience and common sense. (I can assure you I don’t have your perspective that just because your sister got caught pursuing insurance fraud that the entire insurance industry is corrupt.)

To question the legitimacy of an advance insurance payment provided in good faith while the claim is being investigated should not have to be paid back. Your sister should consider that the insurance company trusted her initially, as they should until they learned that she could no longer be trusted when they investigated the fire she played a role in starting.
January 2nd, 2012 at 3:42 pm #admin

Tony and Jason,

If I may put in my 2 cents worth :), and without having read all your posts on this. IMO, the insurer may be doing like many do now, denying the claim based on what they think the outcome of a CIVIL lawsuit would be, which is based on a PREPONDERANCE of the evidence and a majority of jurors voting guilty, a different standard than the DA looks at, which would be eidence BEYOND A REASONABLE DOUBT and all 12 jurors voting guilty. And remember, that evidence can also be circumstantial as well as testimony (which can be, and is, fabricated. For the right price, some “witnesses” can be bought). So the DA may not pursue prosecution, but an insurer can still GAMBLE that they would win if the insured prevailed in a civil lawsuit.

Now here is the problem for consumers and plaintiffs lawyers. Ever since the George Bush supreme court ruling in Campbell vs. State Farm (around 2003?) that punitive damages would be limited to between 3 to 10 times (the exact multiplier is subject to different interpretations in different states) the actual damages, there has been little to no incentive for most plaintiff’s lawyers to sue insurers. (It’s the same laissez faire economics mentality that led to the current great recession, as well as anti trust laws and unions in the early 1900’s. The Mission Statement on the home page of this website talks more about this. You think banks and Wall Street controls big money? It’s a drop in the bucket compared to the insurance industry).

So if the most you can get is $300,000 to $1,000,000 in punitive damages on a $100,000 fire damage claim, and the costs (not attorney fees) are $300,000 – 500,000, thats too big a gamble for most policy holders and plaintiffs lawyers. And if its a small claim, $10,000.00 for example, the costs can be just as much.

About Costs: I had a San Francisco attorney run up $300,000 in costs alone (not his fees) in a 3 week trial against one of the big three insurers over a lousy $7,000 dispute. This was before Campbell vs State Farm. The attorney was hoping for an 8 million punitive damage verdict (which was 1% of that company’s net earnings that year). The jury awarded 1 million. But the insurer appealed. The case was tried again a year later, adding another $200,000 in costs, and this time … the jury came back with a ZERO dollar punitive damage award. (This particuar jury, in a very poor and conservative community, was polled and felt it was preferable to allow the insurer to continue the bad faith practice, to making one of their neighbors a millionaire!). Going to court is never a sure thing, no matter how good you think your case is.

So you see, insurers are money ahead to deny the claims, even with little or no evidence, and see if a lawsuit is filed, and settle if necessaary. The problem is, nobody is suing insurers these days. And the states Departments of Insurance are only slapping insurers hands (a lousy $5,000 in California) on wrongful denials, if they even get involved at all.

Until Campbell vs State Farm gets turned over, this may not change in our generation (Maybe the Occupy Wall Streeter generation will do this?) This is why the Rate Your Adjuster, etc. page was created on this website. To enable consumers to hit the bad insurers in the wallet, something that can no longer be done with punitive damages. But look at that page, and you will see little or no activity there. Why? Because our ME GENERATION is too timid and selfish to help each other. Sorry for the rant, you can see this is my hot button. 🙂

How about a Federal set of insurance claim regulations versus the current 50 sets of states regulations and the resulting 50 sets of states case laws and duplicated litigation? Do you think that would benefit insurers or consumers more? “States Rights, less government” you say? Well, in this case, “States Rights” benefit big corporations over consumers, IMO.

Incidentally, there is current legislation being considered for a Federal Insurance Office. Comments are being taken by insurer’s lobbyists. The public is in the dark. Any guess as to how this will end?
January 2nd, 2012 at 4:05 pm #admin

Jason and Tony,

Ok, I think I got ahead of myself and I’m guilty of not reading all the posts first :). I just saw that Robert’s fire was “shortly before Christmas”. So its way to early to jump to any conclusions about how this insurer will handle this claim. Sorry, my bad!
January 2nd, 2012 at 5:18 pm #Jason

Admin,
I am very familiar with the Campbell v. State Farm suit. As far as I’m concerned, it’s not just campbell v. state farm, it’s campbell v. the insurance/banking, bigmoney, business, etc. Where campbell is the “consumer”. The consumer had a fairly large verdict in the initial ruling but then the award was reduced, and then reduced again. This is just what happens. The consumer stands no chance when it is up against giants. These aren’t just giant, they are incredibly massive giants.

The deck is completely stacked against insureds. If any insurance company makes up it’s mind about a certain thing, there is nothing that can be done about it. I am pro-consumer for the most-part but I am clearly against jumping to conclusions and assumptions without all the facts, so I will speak up when that occurs.

The rate your adjuster does not hit an insurance company in the pocketbook because the pocketbook of the insurance company is industry wide. So when you change the premium from going to insurance company A, to insurance company B, there is no delineation. In a sense, you are still paying the insurance industry, you are just changing the name of the individual insurance company receiving the check. There is so much cross-contamination in the insurance industry that it doesn’t matter. All insurance is related, and it gets even more related with re-insurance and further re-insurance. In short, it’s one big pot we all contribute to and the only winner is the entire insurance industry.

To make this point, let’s say you have a bad experience with a Jenn-Air kitchen appliance so the next time you make a conscious effort to not buy a Jenn-Air so instead you by a Maytag. Well guess what, you just advanced the company of Jenn-Air with your new purchase of Maytag because they are all under the single umbrella or Whirlpool. (including kitchenaid, Amana, and others) So when we try to keep the money out of the offender’s pockets, it is impossible.

We are in a consumer-lose world. Whether there is a Federal Insurance Office or 50 individual ones, there main purpose of that organization is to make sure the industry survives. It may change how it’s made up but it will do little to nothing to help the consumer. It will likely even help erode the standing of consumers in the industry more than it helps.

You are correct. This is a ME, ME, ME generation and I see nothing that can change that.
January 3rd, 2012 at 7:22 am #Tony

Jason,
You seem to dispense hate
I attempt to relate the truth regarding the operation of the insurance industry, nothing more. Many, if not most, people cannot see beyond the facade the insurance industry presents. I can. I’m simply trying to educate a rather naive “David” on the realities of dealing with “Goliath”. And, to be fair, it is not just the insurance industry, it is ALL big business. This forum simply deals with insurance, so that is my focus here.

You, on the other hand, represent Goliath. But the people who come here don’t need or want to hear that point-of-view, they already have it. They come here because they have had what they perceive to be a perfectly valid claim denied. The want “defense” advice, not that of the prosecution.

You are an instigator that has an agenda because someone you are related to got caught trying to collect insurance funds from their insurance company for a reason related to fraud.
My knowledge of the way the industry works and disdain for it predate that event by decades. This incident merely reinforces my position.

As for your opinion that they “got caught” attempting insurance fraud, on what evidence are you basing this decision? You know absolutely nothing about this case beyond what little info I have provided. I know far, far, far more about it than you do, and my opinion is based on that knowledge. Please do not comment on issues you know nothing about.

I am clearly against jumping to conclusions and assumptions without all the facts
Yeah, right. Yet you’ve done it here. You’ve convicted my sister without any facts at all, basing your decision solely on the statement from their insurance company that they were somehow involved. Or is it because of your hatred of me? Oh, I’m sorry, I forgot. I’m the one who dispenses hatred (which implies that you don’t). There are a lot more facts in this case that you have completely ignored, which is a common theme throughout your posts.

You seem quick to jump on the bandwagon that they are victims of someone staging a fire who then blamed it on your sister
I never said that. I never said, or even implied, that the arsonist blamed the fire on my sister. The insurance company did that. On the other hand, you “seem quick to jump on the bandwagon” that they are guilty based on…I’m not sure what.

you have done no investigation of your own and you are relying on the information your sister provided to you
I’ve done more investigation than you have. What exactly are you basing your determination on again?

The police, fire marshal, and criminal authorities do not make their investigation attempts or procedures available to the public
But they do contact suspects in criminal investigations. And since neither she, nor anyone in the household, has ever been interrogated by any legal authority (only the insurance company), by that alone I can conclude that they are not under investigation, especially after 2 1/2 years.

It is clear you have no understanding of the law
Apparently more than you do. I also reference your knowledge of the law regarding Nickolas. You were quick to convict him, too, when all the evidence provided supported his position.

their denial has to stand the review of a judge and/or jury to make sure it stands.
But only if it makes it to trial, which very few cases do, and the industry know that. Also, the industry has legal and political clout and resources the average Joe does not. The industry knows this as well. Therefore, the industry does not fear going to trial as these cases are few and far between, and their chances of winning are all but assured in most cases. Even if the industry does lose a case, the judgement is infinitesimal compared to what it has saved on those claims that were denied and did not go to trial. On the extremely rare occasion when a really big judgement is awarded against the industry, that amount is still not enough to seriously damage or worry them.

So, please update us on how your sister’s lawsuit is going. I would bank on it that since she started the fire and tried to collect insurance proceeds, she did not file a lawsuit so she doesn’t draw attention to herself from the prosecutors.
Actually she has already spoken to a lawyer (not sure if she has retained him yet) who is simply waiting for the state fire marshal to close the case. He, too, apparently suspects her but has no substantial evidence against her (certainly not the “undeniable proof” the insurance company claims), so he is waiting for the 3 year statute of limitations to expire before officially closing the case. Until that happens, the lawyer cannot proceed. However he has apparently discussed with her damages, including for libel and/or slander, that could reach into the millions. Why libel/slander? They have been denied insurance because the insurance company has labeled them arsonists, even though they have never been so much as suspects in an arson investigation, let alone accused or, more importantly, convicted. In this country people are innocent until proven guilty (except by the insurance industry where it is the other way around, of course). Since they have never been officially suspected, even the word “alleged” doesn’t apply.

As for the rest of your post, you are again convicting a person without a trial, nor any facts. You are against her based solely on your hatred of me. I’ll leave it at that.

One more thing. You said In all cases, loss by arson is excluded.
In all cases? Then riddle me this, batman. How is it the house was rebuilt via insurance money? If arson fired are never covered, and this was arson, how is it the insurance company DID pay to rebuild it?
January 3rd, 2012 at 9:22 am #Jason

Tony,
Ok, great – we agree that large business is very powerful. You didn’t provide any education about how to deal with the goliath. Why don’t you take the time to do that right now.

And to clarify, I didn’t convict your sister, her actions did that.

With Nickolas, I present the information like it is. If you want to interpret that as “conviction”, I can’t control your thought processes.

Thanks for the update on your sister’s non-existent lawsuit. Just as I figured, nothing is happening as she waits for the cloud of guilt to pass. The odd things is that the statute of limitations for the criminal aspect of her situation equals or exceeds the civil statute of limitations and that is how it should be.

Clearly you are confused because I’m not batman; he is a fictional character. Also, I don’t get involved in questions that don’t have enough information surrounding them. If you want to provide sufficient information about the question you posed, then I might address it. But what I can say is that if the insurance company paid to rebuild the arson destroyed house, there shouldn’t be any concern. And if your sister has been labeled as an arsonist, then all she has to do is prove that she is not. Otherwise if it’s true, then it’s not slander or libel.
January 3rd, 2012 at 10:14 am #admin

Jason,

Wow, you appear, under the surface, more skeptical about the insurance industry and our Capitalist system than me :).

Thanks for your reply to my recent comments. I agree with most of your comments. But not sure about “the industry as a whole”. While “bad boy” companies like Allstate might be able to be cleaned up by consumers switching to companies like Chubb and Nationwide (just as Bank of America recently abandoned their plans to charge $5/month to debit card users AFTER customers started switching banks), i Am not so sure that Allstate and Nationwide are tied together anymore than United Airlines and Southwest Airlines. And while Lloyds of London may reinsure both Allstate and Nationwide, I think that is just for money lost in claims dollars, not loss of premium dollars?

But lets look at something we all agree on: the existing system has a lot of problems for consumers. Do you think it can reformed to be more fair to consumers? And if so, HOW?
January 3rd, 2012 at 6:24 pm #Tony

Jason,

You didn’t provide any education about how to deal with the goliath.

Sorry, didn’t know that was the purpose of this discussion.

I didn’t convict your sister, her actions did that

In what way? You know nothing of the case other than what has been presented here. And the only “evidence” alleging her guilt presented here is the statement and denial by the insurance company, an agency with a clear cut interest against approving claims. You’re not delusional enough to believe they are incapable of lying, are you? If they say it it must be true? Get real.

With Nickolas, I present the information like it is

On numerous occasions you tried to place 100% of the blame on him simply because he hit the other vehicle. Not once did you even consider any potential wrong by the other driver. You convictred Nickolas without all the facts, just as you’ve convicted my sister without all the facts. So much for I am clearly against jumping to conclusions and assumptions without all the facts“. You do it constantly.

Just as I figured, nothing is happening as she waits for the cloud of guilt to pass

I’m guessing you read only what you want to read. The lawyer can’t do anything yet. It’s not that they don’t want to, they can’t. What is so difficult to understand about that?

Also, I don’t get involved in questions that don’t have enough information surrounding them

You do it all the time, why is this time any different?

If you want to provide sufficient information about the question you posed, then I might address it

YOU (not I) made the statement that In all cases, loss by arson is excluded (key word: all). Apparently that statement is in error, as this was an arson fire but the unit was still covered.

And if your sister has been labeled as an arsonist, then all she has to do is prove that she is not

As previously stated, in this country (btw, I’m talking about the United States. Don’t know what country you’re talking about), people are innocent until proven guilty. Therefore, as someone not even a suspect, let alone convicted, she already has proven her innocence, legally. Even a person who has been arrested and charged with a crime is, legally speaking, an “alleged” criminal. To refer to such a person prior to conviction as a murderer, thief, rapist, arsonist, whatever without the precursive adjective “alleged” is libelous or slanderous such statements cause that person a loss. This is the reason my sister’s lawyer is so confident regarding the lible/slander portion of their case. She did suffer a loss based on the insurance company’s inappropriate statement(s).
January 3rd, 2012 at 8:27 pm #Jason

Tony,
You indicated in your post that you provide information about how to fight goliath, yet you didn’t do that. You just make statements that the insurance company is out there to cheat their customers. That provides no information that you said you provide to fight goliath with. You should review things before you press the submit button.

Nickolas has an obligation not to be hitting things with his car. That’s why he has brakes and his focus should be to the front of the car so he can avoid things in his way. Just because these things are in his way does not give him the right to hit them.

The lawyer can do whatever he wants but if your sister is waiting for the DA to officially close his file, she is having her attorney hold off. This attorney doesn’t care. He is getting paid for his hourly fee whether he wins anything or not. I can guarantee he is not providing his services on a contingency basis. You see, he gets paid regardless of whether she wins or loses. He wins regardless of the outcome. He’s confident of this libel/slander because it guarantees that she will be paying him no matter what and it is the proverbial carrot he dangles in front of her so she continues to pay.

Yes, all arson is excluded. Sometimes arson gets paid but it’s all excluded. If you want to prove that it’s not, please find a policy that does not exclude arson. You won’t because you cannot.

Here’s an example: If your sister burned down a unit of her apartment or condo complex, the insurance would provide the owner and the innocent landlord/owner with insurance funds to rebuild. Your sister would have no insurance funds for her personal property she set ablaze. Since she is an arsonist, she should rightfully be called an arsonist, just as you are correctly called the brother of an arsonist.

Now you are saying the “insurance company’s inappropriate statement(s)”. Based on your careless suggestions, you should instead be saying, ” “insurance company’s alleged inappropriate statement(s)”. As far as I’m concerned, the statements by the insurance company are accurate and appropriate.
January 3rd, 2012 at 8:39 pm #admin

Jason, Tony and all,

Here is another thought on my recent comments about “the system” and the Campbell vs State Farm case. Should judges and jurys only be given the option to chose between 1. punishing a proven mis-behaven insurer or 2. overly enriching a consumer and lawyer with a punitive damage award?

Why not create new Federal legislation, (like the Rico Act) to let a judge and jury carve up any punitive damage awards between the plaintiffs, their lawyer, AND A CHARITY of a judge and jury’s choosing?

I once saw such a “give the punitive damages to charity” clause put in the prayer of a complaint, but the judge ordered it stricken from the complaint. I don’t think he could have done that had there been an explicit statute allowing it. I don’t think case law can override legislated statutory law. But I’m no lawyer 🙂 You lawyers please jump in here with your comments.

The executive branch of government, that is, the States Departments of Insurance, are obviously not cutting the mustard with unfair claims handling regulations. Their punishments are window dressing and some of their boastful press releases border on propaganda when they leave out all the underlying facts. IMO, not one DOI has the nerve to suspend any of the big three big insurers license to sell insurance (not even for a day!). And the fines are a joke. In California, when Roxanne Gillespi, a Democrat, was insurance commissioner, I heard that the DOI trash canned 13,000 consumer complaints without looking at even one. Comments???
January 4th, 2012 at 7:03 am #Jason

Admin,
People are confused about the purpose of why DOI agencies exist. Their sole purpose is to promote the longevity of the insurance industry and the continued and healthy business of each and every insurance company in their state.

To make this clear, their goal is not to mediate, settle, and make fair thousands of consumer complaints – it is instead to make sure the insurance companies are not participating in bad business that would cause one or more of the companies to fail and go out of business. This is simply a big-brother peek at the heartbeat of the insurance industry at the source. For people to be misled that the DOI’s primary goal is to deal with consumer complaints is completely wrong.

If you want to see the sister company related to the DOI, it is the department of banking or the department of Financial Institutions. The primary goal and function of this organization is to make sure of the continuity of banks and credit unions. These organizations are able to continue to monitor the industry closely by inviting consumer complaints and giving the ruse that they help consumers with these issues.

FDIC and NCUA are the redundant organizations doing the exact same overlapping functions of DFI because it is so important that financial institutions don’t fail. But when banks and credit unions do fail, they orchestrate the takeover into a healthy and stable one without any notice or alarm.

Don’t worry if you don’t understand what I’ve just written because it is clear that far less than than 1% of the population would understand it. Even when people do comprehend it and understand the entire process, they are helpless to do anything about it.

As an example, if the government bailout would have been for insurance companies instead of GM, citigroup, and BOA, there would have been no discussion in congress. It would just have been done even if the cost of the bailout was 10-fold in cost. Everybody with political power understands that banks are important to the stability of the world but insurance companies own the banks, many parts of government, and are even more of a foundation to the global economy than banks.
January 4th, 2012 at 7:14 am #Tony

Jason,

You indicated in your post that you provide information about how to fight goliath

I’ve never said that. Would you like to quote an example of where I said “how” to fight goliath?

Nickolas has an obligation not to be hitting things with his car.

You’re making it sound like he’s going around doing it on purpose, like he’s playing bumper cars. I saw nothing in his posts that even hinted at that. You said it yourself, accidents happen. You also said, several times (and I can provide quotes if you want), that the mere fact that he hit the other car proves his guilt. Nothing could be further from the truth, and you’d be hard pressed to find any legal entity (lawyer, judge, etc.) who would agree with that logic. BTW, on that note, you never did provide an answer regarding a car running a red light and being hit by someone who had a green light. Or is that too difficult a question? Using your logic, the car with the green is wrong, and the car running the red is blameless.

if your sister is waiting for the DA to officially close his file

You CLEARLYread only what you want to read and this statement proves it. I never said she was waiting for theDA to close the case, I said fire marshal. You want me to quote you that one too? The attorney has to wait for the official report from the state fire marshal before they can proceed. Perhaps “can” is the wrong word there. At the very least, he wants to see the report first before proceeding. Please learn to read people’s comments before responding to them and stop inserting your own words.

Yes, all arson is excluded. Sometimes arson gets paid but it’s all excluded.

Incorrect. For proof see your next paragraph. You, yourself, admitted that the innocent parties can “get paid” (i.e. are covered) in the event of an arson fire. Thus, by your own admission, not ALL arson is excluded. You are contradicting yourself.

she is an arsonist

You clearly know less about the law than you do this case (which is very little). That single statement there, if it were to cause her a “loss”, would make you a libeler. Your belief that something is true does not make it so, legally. I believe Casey Anthony is a murderer, but she cannot officially be labeled that since she was never legally proven to be so. In the eyes of the law, she is NOT a murderer. That is why the news media, prior to her verdict being read, had to use terms like “accused” or “alleged” murderer when referencing her. Now that she has been found not guilty, if she applies for a job, for example, and gets rejected because the prospective employer says she is a murderer, she can sue that employer for slander/libel. And if she can prove it, she’d most likely win. And there is a BIG difference between Casey Anthony and my sister, besides the notoriety. Anthony was suspected, arrested, accused, charged and tried. My sister has never so much as been a suspect. She has never even Even if the fire marshal believes that she was involved, that belief is not enough. There is no substantial evidence to support that belief. But, because he apparently DOES hold such an opinion (which he’s entitled to), that is why he is withholding the release of his report until he is legally required to do so (3 years from the date of the event).

BTW, you mentioned in another post that financial problems may have been her motivation to set the fire. Apparently that was investigated and they found no such problems. The owner of the house is a different matter from what I understand. He apparently was having financial difficulties.

Also, I was in error for indicating that the official reason for being denied was their suspected involvement in the fire. That was simply a statement made to her by the adjuster or agent. The official reason is more complex, but involves such things as discrepancies in the EUO’s of the residents. For example, physical placement within the house of certain items. There were discrepancies between the different EUO’s as to where in the house a certain item was located at the time of the fire. An irrelevant point for two reasons: first, objects often get moved without the knowledge of everyone else and second, there was also a burglary. The burglar(s) (also the actual arsonist(s)) may have stolen the items (s) or even moved some from one location in a room to another (such as for access to something else). Insignificant points to most people.

Based on your careless suggestions

I’m not the one making careless suggestions or statements. You are the one that has difficulty reading and understand plain simple English, as I’ve explained above, and have extreme difficulty comprehending the concept of logic. You repeatedly make wild, unsubstantiated claims, inserting your own wording into another person’s statements and try to pass that wording off as theirs. Your sense of logic leaves MUCH to be desired (no one ever suggested there was a tree growing in the road – except you), leaving one little choice but to question your true mental capacity. As such, it provides another reason to question the usefulness of any information you provide here. I’ve already stated the info you do provide is of little use to the posters and readers as it is.
January 4th, 2012 at 8:19 am #Tony

admin,

As I’ve suggested already, one place to start in correcting the insurance industry is to make insurance companies non-profit organizations, that way less emphasis is placed on the bottom line. Any service that is mandatory, required by law, should not be for profit.

Another reform would be to make what the customer pays into their policies accessible to them for reimbursement for losses (and only that purpose). For example, under the present method a person might have insurance on their car for 10 years with the same company and never make a claim. During that time they have paid in thousands of dollars and gotten nothing in return. Now, suddenly, a rock is kicked up by another vehicle, shattering their windshield. Nobody at fault here, purely accidental. It is going to cost $400 to replace the windshield, but the insured has a $500 deductible. Therefore, it makes no sense to even report this incident since they are going to pay 100% out of pocket anyway. And if they did report it, it is not like the $400 would reduce the $500, leaving only a $100 deductible. If the same thing happened a week later, they would STILL have a $500 deductible.

Now, if that person had “banked” what they had paid to the insurance company, they might have $10,000 available to them (assuming $1,000/year premium). Thus they take $400 out of that $10,000 leaving them still a balance of $9,600. Now, when the windshield gets broken a week later, they draw from that. Where the insurance company would fit in is they would act as the “bank”. The insured would make a claim and the company would issue the funds, from their account, to them. This would also help reduce insurance fraud, as the person would be defrauding themselves.

Now, this “personal fund” would not necessarily cover big losses such as as totaled $25,000 car when you’ve only got $5,000 in the bank. That is where the insurance company comes in. If you simply took your monthly premium payment and put it in a regular bank instead, that accumulated amount is all you’d have access to (plus any interest if placed in such an account). The advantage to using an insurance company is that they would have their own “account”, much as they do now, from which larger claims would be paid. A person’s “deductible” would be whatever they had in their account. Also, this amount would be transferable from one company to another so if a person wanted to switch providers, they wouldn’t lose what they had paid to the old company.

Of course, you say, what is to keep a person from getting a policy and then, with little or nothing in their account, destroying their car (or any other property) just so the insurance company can buy them a new one? Simple. A payback system. Whatever you get from the company beyond what is in your account you have to pay back, at least partially. The amount you have to pay back would depend on several factors such as how long you’ve gone without making a claim and how much you got on any previous claims you did make. For example, if a person goes 10 years without making a claim, they probably wouldn’t have to pay much if anything back (they are a good risk). On the other hand, a person who makes frequent claims might have to pay it all back (high risk).

There are many specifics, details and proposed ideas as to how, exactly, this system would work that I am not going to cover right now. Suffice it to say, this system seem a far sight better than what we have now. I welcome any comments, questions and ideas regarding this system.
January 4th, 2012 at 11:34 am #Jason

Tony,
Here is your quote. It is your 4th sentence of post #332 that begins with, “I’m simply trying to educate…”

Whether or not I make it sound like he’s hitting into cars on purpose or not, he might as well be.

That sure is odd that an attorney would subject themselves to be held hostage by a report that isn’t being released. This goes back to the billable hours he gets paid no matter what.

When arson is excluded, that means it’s contractually not covered. I can explain this over and over to you but there is nothing I can do to make you understand it.

Ok, so what is your sister going to win if she can prove the items related to libel/slander? She might win a 20% coupon for a replacement toner cartridge for her printer. Sometimes when you win, you really lose. There is no way she is going to win so much that she is going to recover all her time, attorney fees, and agony over this entire issue.

It seems like I don’t have any clue about your sister’s claim but you sure changed changed your tone when I clarified the entire situation like I was the adjuster handling the claim from the start to it’s present state.

The tree issue: Unless a tree is growing in the roadway, it cannot be a factor in not seeing a car that a person is going to hit. You have to understand that for an excuse of a tree blocking a driver’s view of the car they are going to hit, that it would have to be at a point between either of the two cars. I can guarantee there was no tree obstructing Nick’s vision. Nick didn’t raise any issues about trees – you did.
January 4th, 2012 at 12:10 pm #Jason

Tony,
I cannot agree with your ideas about how to correct the insurance industry. Your ideas are akin to making the insurance companies administrators that get paid to shuffle our money around. I would rather shuffle my money around myself and not pay anyone to do that for me.

Not all insurance is legally mandatory. Sure, liability coverage is mandatory in all 50 states if you drive an automobile but physical damage insurance isn’t. Even home owners insurance isn’t mandatory. It is because people borrow to much money to buy too big of homes and they need a mortgage company who requires insurance. Having a mortgage holder is the only thing that makes home owner insurance necessary. And homeowner insurance isn’t legally mandatory because of the mortgage holder; it is contractually required.

Your way to change insurance is already out there. It’s called self-insurance. You see, all you have to do is put money aside for when you have a loss. If you don’t have any losses or very few, then your money will continue to grow. When you have a loss, then you will have to use that accumulated money (and maybe even borrow some to make up the difference) but this is called self-insurance and is actually an even older style of protecting ones property and assets than what we currently use today. This method was the only way people could protect their assets until the current and modern way of insurance began where we transfer our risk to a 3rd party that we are all accustomed to.

Your example of the rock chip in a windshield is, in most cases, an avoidable loss. Studies have been conducted that support that rock chips are primarily caused by following a lead vehicle too closely. You would have to understand physics, and the laws of cause and affect. There will no longer be any damaging energy, or height in a rock if one maintains a safe driving distance behind the car in front that could throw up a rock. So to say that it’s not the fault of anyone; it actually is. It’s the fault of the driver following too closely – (with certain exceptions)
January 4th, 2012 at 1:31 pm #NJ:Jane

I am divorced and living in the marital home with our three children. Ex has to pay for everything until the house sells. Hurricane Irene blew through here and we had water in the basement. I filed a claim with homeowners insurance and a check was issued. This is when I found out that I am NOT on the homeowners policy. The ex refused to sign the check and canceled the claim. I am on the deed. Do I have any right to the money?
The kids and I have been sick from mold. I bought bleach to clean up as best I can.
January 4th, 2012 at 1:36 pm #Tony

Jason,

Here is your quote. It is your 4th sentence of post #332 that begins with, “I’m simply trying to educate…”

Once again, this time in context (i.e. the complete sentence): “I’m simply trying to educate a rather naive “David” on the realities of dealing with “Goliath”.

Your original query was “You indicated in your post that you provide information about how to fight goliath,

Note the key word “how”. My response to you was “”I’ve never said that. Would you like to quote an example of where I said “how” to fight goliath?”

Please notice again I emphasized the word “how”. A I said previously, I never said “how”, I said “on the realities”. One reality being that no one associated with the insurance industry is your friend, no matter how much they insist they are. Another reality is that no in the industry is going to fight for you, no matter how much they say they are.

Actually, in a manner of speaking, I am providing information on how to deal with them. By understanding and accepting these facts, the consumer can be better prepared to deal with them. By going into a situation armed with this knowledge and being skeptical of everything the industry representative says (just as they go into it being skeptical of everything you say), an individual knows a little od “how” to deal with them.

Whether or not I make it sound like he’s hitting into cars on purpose or not, he might as well be.

That is a rather odd attitude. There is no possibility whatsoever that the other person may have made a mistake?

That sure is odd that an attorney would subject themselves to be held hostage by a report that isn’t being released

What do you mean “held hostage”? Eventually the report will be released, it has to be by law. He is simply waiting until it is. He’s waiting to have full information. Your attitude suggests you would not. Again, so much for you wanting all the facts before opening your mouth.

This goes back to the billable hours he gets paid no matter what.

He gets paid according to the hours he works on the case. Since he is NOT working on it right now, guess what he’s getting paid? At this time he simply has knowledge of it. There are no billable hours yet, and won’t be until after the report is released.

When arson is excluded, that means it’s contractually not covered

You have no explaination for this. Your statement was ALL arsons are excluded. That is 100% wrong. Arson is excluded only if the insured is involved. You even provided an example of how a person can be covered for an arson fire, and you STILL can’t comprehend it.

Ok, so what is your sister going to win if she can prove the items related to libel/slander?

I’m not clairvoyant. That would be up to the judge or jury to decide. Legally it would be based on what such slander/libel cost her. Also, why are you asking? To even ask such a question implies the possibility that she can win. Are you conceeding this possibility?

…but you sure changed changed your tone when I clarified the entire situation like I was the adjuster handling the claim from the start to it’s present state.

I must have missed that, to what are you referring? I don’t recall “changing my tone” one iota, other than to clarify a piece of information I remembered incorrectly.

Unless a tree is growing in the roadway, it cannot be a factor in not seeing a car that a person is going to hit

Oh really? It cannot? Nicholas’ car was on the street, the truck was in a driveway. Driveways are located OFF the street, between the street and the house. Trees are frequently planted just off the street, between the street and the house, usually between the street and the sidewalk (if there is one). Ergo anysuch tree would be between the car on the street and the one in the driveway. Trees are opaque, therefore such a tree could block one’s view of the driveway from the street. Would you like pictures? I am sure I can find a couple thousand online without really trying. I can’t beleive I have to explain this like I’m talking to a two year old.

I can guarantee there was no tree obstructing Nick’s vision

Oh, you were there? I didn’t know that.

Nick didn’t raise any issues about trees

Actually Nick did: “…and it was an blank spot, trees…. I don’t know, that last word looks like “trees” to me.
January 4th, 2012 at 2:31 pm #Jason

NJ: Jane,
The situation you raise is very difficult to address. You may have to consult with an attorney about any options, if any, that you may have.
January 4th, 2012 at 2:53 pm #Jason

Tony,
I keep things simple for people like you that have a difficult time understanding. That is why I have talked about Nickolas only and what he did or didn’t do regarding the accident. I didn’t dilute the matter by bringing in information that won’t benefit the reader (such as the other driver). If you would stay on topic, I would not have to keep guiding you back.

Nickolas had the word “trees” in his post. He didn’t say they were impeding his vision or if he was shopping for one to plant in his back yard. You are the one indicating trees were obstructing his view. I can factually tell you trees had nothing to do with him hitting the other vehicle. Yes, Nick’s post has the word trees in it. He raised no issues about trees – you did.

You are getting confused by words. Arson has a specific definition. The damage that was paid to the owner of the property that your sister set ablaze was because of vandalism. Vandalism is defined as: Willful or malicious destruction or defacement of public or private property. Vandalism is the peril that the insurance paid the property owner for what your sister did.

Your sister’s act of arson, defined as: The willful or malicious burning of property (as a building) especially with criminal or fraudulent intent is excluded and nothing was paid for this. I am sorry but I cannot keep explaining things like this to you . Like I said, I can explain and explain but I cannot make you understand.
January 7th, 2012 at 11:39 pm #Dale Haglund

DENIED…moved out of our farmington house to a larger one with acreage…about 60 miles away…son did not follow due to social issues..he had full use of the home and maintained both inside and out..up untill renters whse had leased the house out…the home was recleaned after most of our personal property was removed and the garage cleaned out and the floor scrubbed (did alot of auto repairs up untill the home was leased out).this was done on saturday .the home ,an up scale executive home was vandilized a day or two prior to the new tenants move in on monday…the last of our personal property was removed shortly after the move in….the adjuster took timeout of her busy schedule (she let me know that she was doing me a favor) to look at the damage three days later…in a casual conversation she asked me how long ive been out of the house…i told her it was just less than a year…in a phone conversation she asked the same question the answer was the same…she stated ” if no one has lived in the home for a year..than your policy is void…i told her that if she asked the question differently she would have known that my son/sons had use of the home …that her question was always when did i move out…not if the house was still being used…i provided more facts ,evidence and proof that the home was not Vacant as she puts it…now in a letter they say i lied i changed my story i told them that i did not change my story it was merely added to when the claims rep asked me a different question…i have friends relitives,neighbors,real estate agent.the local police report (they showed up at the house and had my son call me the officer asked if charlie and girl friend had permission to stay at the house)…i provided the elec./water bill….still the insurance co.investigation dept rejected the claim saying it was vacant for more than 60 consectutive days…i have copies of my sons visa statements of consistant local purchases….the claims rep told me that i need to take a deposition under oath and to have my legal counsil with me….the claims rep supervisor stated the same i told him to listen to the recorded conversations that the rep took of our casual conversation..he deined there exsistence…i just talked to the claims rep,she said they do exsist..that they were made for her personal file….in a letter i requested the claim file,copies of all recordings made without my knowledge and internal corrispondance/memos along with all opinions and case analysis to add my investigation on how they came to such a conclusion…the supervisor called and declined to provide me with any such documentation,transcripts,investigators name or contact number…he then reminded me that they wanted a statement under oath….why..all there doing is posturing in my opinion…they have rejected and made no contact with anyone that had direct knowledge…how did they come to such a conclusion…..travelers ins stock tanked..too many east coast claims
January 7th, 2012 at 11:54 pm #Jason

Dale,
Property that is vacant is more prone to certain damage and those causes of loss are contractually removed from being covered. If your son had use of the house and it was otherwise not lived in, it is vacant.

With a statement under oath from you, they want to establish that coverage does not exist based on the circumstances. When you indicate posturing, what they are doing is supporting that there is no coverage and your statement to them will likely confirm that so they can be confident their decision is the correct one.
January 8th, 2012 at 11:36 pm #Tony

Dale,

The fortunate thing for you is that, apparently, the only reason you were denied is the issue of whether or not the house was occupied at the time of the event. It is fortuitous because “vacant” is often an ambiguous term that the insurance companies don’t usually define in their policies. From a legal standpoint, ambiguities in contracts (like your policy) almost always always automatically go against the party who wrote the contract (in this case, the insurance company).

Whether or not a house is vacant or not can easily be open to interpretation. For example, if you were renovating the house, and it was uninhabitable because of those renovations, it might not necessarily be considered “vacant”.

In your case you say your son “had full use of the home and maintained both inside and out”, however you do not say if he was actually living there. Did he sleep there, even on occasion? Did he maintain personal property such as clothes and toiletries there? If so, then the property was not vacant.

However, we must also examine the issue of the time frame you mentioned. It would seem your provider considers a house “vacant” only if the property is not occupied for a period of 60 consecutive days or more. Thus if your son stayed there even one day a month, that would invalidate their 60 day criteria. A lot of this depends on how much your son used the house and how often.

As for Jason’s comments on your situation, my best advice to you is to do as I advise everyone: ignore him, he clearly has no sense of reality (just read our correspondences above, you’ll see what I mean), and is clearly not on your side. You’ll notice in his response to you he gave no information you’d find useful, such as the ambiguity of the word vacant or the importance of the 60 consecutive days. You can also tell by his last statements that he believes the insurance company was justified in denying your claim. This is his normal posture. He, like the insurance companies, enters into each situation with the automatic assumption that the client is wrong, and proceeds to build a case supporting this position from there, often completely ignoring facts, logic and the laws of physics.

As for the statement under oath (EUO), it is nothing more than a way to trick you into making legally binding statements (because they are under oath) they can use to further their case against you. One example is like you alluded to above, the terminology they use. They might ask you how long ago you moved out, not how long has it been since anyone has lived there?. Your response to the first question would be “1 year” whereas your response to the second would be more like “I moved out a year ago, but my son still stays there occasionally”. The second variation requires a followup question whereas the first does not. In order to prove their 60 day criteria, the followup might be something like “how often does your son stay there?” Any response by you that indicates he stays there at least once every 60 days is not what they want to hear, and strengthens your case, which is why they carefully choose how they ask their questions. They will also try to confuse you and intimidate you. Best advice: do not attend an EUO without a lawyer.
January 9th, 2012 at 11:59 am #Jason

Tony,
Vacant is not an ambiguous term. Vacant means “not lived in”. Just because that might be a term or concept you find confusing doesn’t mean it’s an ambiguous term. Either the house is lived in or it’s not. If the term is not defined in the policy, the common-world definition is used and it’s pretty clear that it means not lived in.

If you want to circumvent the definition by staying there 1 night a month, it is still not lived in. If you did that, then it is slept in 1 night a month but not lived in. These are fairly simple concepts.

You say if the son had toiletries or clothing there that it is not vacant. That is not correct because the presence of clothing and toiletries in a home does not make the house “lived in”. It simply means clothing and toiletries are there.

If you read Dale’s post, he is clarifying this property was being leased to tenants and just before the tenants moved in, it was vandalized.

“had use of” and “lived in” are 2 distinct and different things. One means “not vacant” and the other is unknown.

Dale even wrote in his post about the police who arrived at the home (apparently there checking on something) and Dale confirmed that Charlie (his son?) and his son’s girlfriend had permission to stay at the house. Permission to stay at the house is not the same as living there.

There is nothing in Dale’s post that would lead me to believe that the house was “lived in” in order for policy coverage to be in force.
January 9th, 2012 at 12:25 pm #Kim

I purchased a roof 12 years ago with a 25 year warranty. The manufacturer pays during the first 5 years for material and labor, but thereafter, only for pro-rated materials. Long story short, the IKO shingles are defective and I understand that there is a class action lawsuit against the company.

In my own case, I just ascertained that my shingles are crumbling, curling and allowing water beneath the substructure. A roof leak has damaged a bedroom ceiling. When I contacted IKO about the warranty, they only offered $300 for a $6000 roof, so I turned it down. I then called my insurance company about the leak, but they said to go after the manufacturer. I also had a roof leak in 2006, but when the insurance adjustor looked at my roof, he couldn’t find the source of the leak. Insurance refused to pay to add shingles to the valleys as requested by a contractor at that time. They only paid to repaint the foyer ceiling. The 2006 ceiling is in a different area of the house than the present bedroom ceiling.

I know insurance usually won’t pay for faulty materials, but what if they inspected the roof several years ago on a claim and found nothing unusual. Should the insurance company pay to repair the roof and ceiling this time? Would a replacement roof be covered in this situation? Thanks.
January 9th, 2012 at 1:04 pm #Jason

Kim,
The insurance would pay for damage to the roof if there was an event like hail or wind that damaged the roof. From what you posted, nothing happened to your roof so the insurance would not pay anything.

Again, since nothing happened to your roof that insurance would cover, they won’t pay to repair anything because nothing was damaged that insurance pays for.

If you knew about the poor roof condition since 2006, you really need to do something about it. Maintenance of the home is something that homeowner’s have to do and insurance isn’t for maintenance.
January 9th, 2012 at 2:08 pm #admin

Jason and Tony,

Regarding the Vacancy discussion. I seem to recall that the FC&S Bulletins cite case law in some states that support any work being done on a structure, such as remodeling, to be considered as being occupied, and therefore being an exception to the vacancy exclusion?
January 9th, 2012 at 2:19 pm #Jason

Admin,
Thanks for the input. Dale did not even bring that up – Tony did. We have no reason to believe the home was being remodeled or renovated.
January 9th, 2012 at 3:17 pm #Kim

Jason,

Just a point of clarification. The roof was in excellent condition in 2006. My contractor and adjustor both said so. They were only discussing adding shingles as a precaution since no leak was found. Moreover, I have my roof checked every year. This was the first year any deterioration was noticed.
January 10th, 2012 at 9:04 am #Tony

Admin,
I used the renovation scenario as an example of a situation where a house that is not physically being lived in would not be considered “vacant” by the homeowner, but the insurance company might. Another example might be a person who works as a contractor away from home (very common in my line of work), or even a deployed military person. Neither are actually physically living in the house, but it is still their primary residence. As long as the house is maintained, especially externally (grass cut, snow shoveled (if applicable), mail collected, etc.), most homeowners would not consider their house to be “vacant” under these conditions. However the insurance company might, and therein lies the potential ambiguity. Is a house not physically being lived in on a regular basis automatically considered “vacant”?

When it comes to Dale’s situation, he states his son “had full use of the home”, implying he could live there if he wanted to, even sporadically. He did not expound, however, on how frequently his son did stay there. However, we do have the “60 consecutive day” clause Dale mentioned. Such a 30 or 60 day clause is standard in insurance policies and, in Dale’s case, it is apparently the latter. Thus, a house that is “lived in” or “occupied” (depending on the terminology in Dale’s policy) at any point during that 60 days does meet the criteria for that clause to be invoked.

The next step would be to define whatever terminology is used in Dale’s policy (“lived in”, “occupied”, “unoccupied”, etc.). To what extent and for how long does a person or persons need to “occupy” a property for the insurance company to consider it “occupied”. Is there a set number of days or hours? Do I have to make my meals there, or can I eat out every night? Is it purely a matter of sleeping there? What if I go there just to sleep, does that qualify? If so, is there a set number of hours I must sleep in order for it to qualify?

Consider the following scenario, which could easily apply in Dale’s case: If a person is in college, and the school is far enough away from home as to make a daily commute impractical, he might stay closer to the school during the week (in a dorm, for example). On the weekends he comes home to maintain the place. During this time he also sleeps and does everything else a person “living in” a house would normally do. But it is only for two days a week. Is the house occupied? I am sure that person would consider it to be so.

This vacancy clause was established to protect the insurance company during periods when the property is truly vacant (when no one is actually living there, even for a short time) because, as Jason said, the chances of vandalism are increased if a property is vacant. However, vandalism occurs to clearly occupied properties as well. So having a property that is occupied is not a guarantee against vandalism, its merely a “deterrent”

Dale has demonstrated that his house falls in between the two extremes. It was clearly not the stereotypical “vacant” property the insurance clause was meant to protect against, but neither is it the standard “lived in every day” residence. Clearly Dale does not see the property as vacant. He even refers to it as the “home”, not “house” (and there is a distinct difference between the two – a house is a building where people can live, a home is a building where people do live). The question is whether or not Dale’s property falls into the category of “unoccupied” as that clause was intended, and I do not believe it does so, based on the information Dale has provided. This is merely the insurance company doing what they do best, finding a reason, any reason, to deny a claim.

I also find it interesting when this occurred. A “vacant” property is more susceptible to vandalism due to it’s decreased level of activity. And, although Dale’s house had been “vacant” (according to the insurance company)for a year , this event occurred at a period of heightened activity at the house, while they were moving their remaining belongings out and cleaning the house in preparation for the new tenants (or shortly thereafter). So much for the concept that inactivity is the catalyst for vandalism.
January 10th, 2012 at 9:43 am #admin

Tony,
First, many thanks to you and Jason for donating your time here!

I am sure there is case law going both ways here. The issue for Dale is convincing his adjuster. He could start with a Blacks Law Dictionary definition, which may give many definitions of one term and sometimes case law cites. If that fails and no lawyer or public adjuster will take his case on contingency, his best chance IMO would be to just argue his case in small claims court, unless he wants to represent himself in a higher court (99% of people will lose just on errors in civil procedure).
January 10th, 2012 at 3:17 pm #Tim

Hello, we filed a claim on our pool electronics that were damaged during a lightning storm. In this same storm, our cable box outside was damaged. This was fixed by the cable company. My next door neighbor also lost both his a/c units in the same lightning strike. Unfortunately, there is no visible damage on or around the pool equipment from the power surge. We have sent in letters to our adjuster from the cable company and letters from our neighbor’s repair stating those components were damaged due to lightning. Because there is no visual damage to the pool electronics, we are getting the run around from the adjuster and looks like our claim may be denied. I know the power surge damaged our equipment because it was working before the storm and was completely dead after. Delicate electronics can be damaged from power surge without showing burn marks or fried components. How do we prove this to our adjuster?

Thanks for any help.

Tim
January 10th, 2012 at 4:36 pm #Jason

Admin,
It is nearly impossible to find an attorney that will take a claim on a contingency basis unless it is a bodily injury claim.

The reason for that is because the attorney’s don’t have a vested interest in a case when they are being paid on an hourly basis. They will be paid whether they win or lose. If they were paid on a contingency basis, more people would be winning.

There are 2 reasons attorney’s would not take on a case such as this for Dale on a contingency basis. The first is that it’s clear that coverage for the dwelling was not because it was vacant and there wouldn’t be a recovery, and the second is because the dollar amount is minimal. It is the like throwing good money away trying to pursue bad money.
January 10th, 2012 at 5:28 pm #Jason

Tim,
It is likely you have an all perils policy meaning that it’s covered unless it’s excluded.

You don’t need to prove it was damaged by lightning. The burden of proving something is on the insurance company to prove that it wasn’t damaged by lightning.

It is common practice that the insurance company will provide you and/or your electrical contractor with lightning affidavits that you sign indicating the item or items in question were damaged as the result of lightning.

Just like it’s difficult to prove lightning damage without any physical signs of damage, it’s also difficult to prove that lightning didn’t cause the damage. The connection between your cable box and the damage you neighbor suffered due to the same lightning should be convincing enough for the adjuster and the insurance company to decide in your favor.
January 10th, 2012 at 5:46 pm #admin

Jason,

Thanks for your comments! 🙂
January 10th, 2012 at 6:49 pm #Jason

Tony,
Dale did not demonstrate his house falls in between the 2 extremes you raised. His house had nobody living in it and that is considered vacant. The other extreme is a house that is not vacant. The vacant status of this home is not between these 2 ranges; it is entirely on one end.

You indicate, “This is merely the insurance company doing what they do best, finding a reason, any reason, to deny a claim.”

The insurance company isn’t doing anything to find a reason to deny a claim. This vacancy clause is in the insurance contract and it was before Dale vacated the home 1 year ago. The risk of having his home vacant for over 60 days is the loss of coverage for some perils. The insurance company did not have to find this – it was blatant and part of the insuring agreement. The insurance company doesn’t want to be exposed to vandalism claims because vacant homes attract vandalism.

Vacancy is the catalyst for vandalism and this situation supports that, and that is why we find that exclusion in the homeowner policies.
January 10th, 2012 at 7:50 pm #admin

Hey Jason and Tony,

Here is more food for thought regarding Vacancy. Most DP and BOP policies vacancy clause give 30 days. Most CP policies give 60 days and 31% occupied for an owner, or “enough business personal property to conduct business” for a tenant.

What this tells me is that the mere existence of this kind of language indicates that it was put there as a result of adverse litigation judgments against one or more insurers, and probably in more than one occasion.

And the fact we do not see this more clearly defined in most homeowner policies may be because it is not being litigated, or, these cases, few though they may be, are getting settled with confidentiality agreements?

But as you say Jason, it is not likely this insured will get a lawyer on contingency on a small claim. But he may have a shot in small claims court, depending on the judge?
January 11th, 2012 at 1:30 pm #Carter

Hey I have renters insurance with state farm and our house gotten broken into a month ago my local agent told me everything would be a breeze and it has not. I filled the police report immediately and have gotten it ammended as items have been found missing but I did Jo home inventory when welevstarted the policy because my agent told me jot to worry about it. I also have receipts for nothing and pay for things with cash so the best I can do is scounge up owners manuals for things but I don’t really keep up with those and wont be able to find them all. Today my adjusted said he refused to move on with my claim without proof of ownership… is that legal?
thanks
Carter
January 11th, 2012 at 4:42 pm #Jason

Carter,
What items were taken? Was there forced entry? What it the approximate replacement value of the items stolen?

Most people don’t have receipts for things they bought just last week. So, to hold you to that requirement is unthinkable. Technically, they can require you to produce receipts for what you claim. It depends on the wording of what you need to provide to substantiate your claim.
January 11th, 2012 at 5:39 pm #Sam Pollock

My wife and I have been “full-time” RVers since 2003. Our current coach is a 2004 40′ Mandalay. During part of 2010 and most of 2011, we came off the road and placed our motorcoach in storage at a friend’s residence in Central Florida, while we were in Kentucky helping a family member.

We returned to our full-time RVing lifestyle in late October 2011. We discovered interior water damages for rainstorms that had occured during our time in KY. I filed a comprehensive claim with my long-time carrier, GMAC. They denied the claim, stating the manufactuer most likely improperly installed the automatic patio awning which falls within “wear and tear” and therefore they would not cover the claim. I firmly believe their actions were in “Bad Faith”.

What options do I have to battle this insurance giant???? Loyal customer for long period, paying very expensive premiums — FOR WHAT????

Thank you for your time, expertise and consideration regarding this matter.
January 11th, 2012 at 7:42 pm #Jason

Sam,
The denial reason is rather weak if it says “most likely improperly installed…”

It’s not in bad faith because bad faith requires a lot more than denying a claim.

Wear and tear is likely the correct denial reason. Was there any event that cause the water to penetrate into the RV? It there wasn’t and it was a seam that opened or something along that lines, it seems to be wear and tear.

You may want to consider shopping around for a carrier that would cover this type of loss. You might even pay less in premiums.
January 17th, 2012 at 1:04 am #Texas hosting

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January 18th, 2012 at 2:11 am #Robert

I posted a comment #321

Hi,

My family experienced a fire before Christmas Dec 9th, the Fire Investigator said it was caused by the Christmas tree (the fake tree with lights built in them) and has called mea couple times for more information regarding the tree. We lost the home (even though he said it was repairable, and each and every contractor has stated that it can’t be repaired) and all of the contents.
I have called the ALLSTATE adjuster (after not hearing from him for almost a month) again Monday only to have him say he still hasn’t finished working on our claim and will call me when he gets it done. I did receive a letter stating they would have it resolved within 90 days.
Am I being impatient? We just want to get work started.
January 18th, 2012 at 7:22 am #Anthony

Yesterday I got into an accident involving me hitting a guardrail in my local town. I called my insurance company to file a claim but was denied because my insurance was cancelled due to non-payment.
On Nov 10, 2011 I had called my insurance company because I have not yet to receive an insurance card for the next six months for my automobile. The agent I spoke to stated my policy was good and they mailed out my card stating my insurance was valid till May 5, 2012. So at this time I was led to believe my insurance was paid for and valid.
After my accident I spoke with an agent who stated since no payment was received my policy was cancelled. I did not receive a phone call or any piece of mail stating this fact. Also for the fact my vehicle is fully insured I would believe they have an obligation to notify my financial company of any type of cancellation with my policy. I contacted my financial company and they stated they have not received any phone calls from my insurance company.
I even went as far as to say to them ok well since it was probably a misunderstanding I will make the insurance payment in full in which they still denied me.
What are my steps to rectify this situation? I believe I have a case due to the fact I have hard copy proof saying my insurance is valid to May 2012.
Thank you for hearing my plea.
January 18th, 2012 at 9:30 am #Jason

Robert,
This is taking way too long. You should know what is going to happen after a few days, not a few weeks. Please ignore the banter between Tony and me – we have some philosophical differences about some things.

If you want, please send me the 4 exterior corner photos of your burned home to the e-mail address at the top of this page. Also, please indicate in what state you live. Our address is located at the top of the page in orange letters and starts with, “complete…”

Total losses to houses are fairly obvious and that is what we would like to examine. You many need someone to get involved on your behalf such as a public adjuster to speed up the repair. If you live in a valued policy state, and your house is a total loss, that will need to be handled differently.

Time is of the essence because you have 180 days to repair your house and if they have consumed 1 entire month, that leave you with 5 months left to do the rebuilt. If you don’t rebuilt within the time allowed by your policy, you policy turns into an ACV policy and that could mean that your claim funds will be substantially reduced.
January 18th, 2012 at 10:42 am #Jason

Anthony,
You are sent a renewal notice with insurance cards so the ins. company doesn’t have to mail you those cars in a separate mailing after you submit your premium. Yes, you may have documentation that you have insurance but that documentation is dependent on something and that would be payment of your premium. If you look at the time from when you called them, it was roughly 6 months ago. They may have received a check that made it look like your insurance was going to be good for 6 months but perhaps that checked bounced and there was no coverage for that 6 month period that you called about.

The insurance company doesn’t call your lien holder company to inform them that you don’t have insurance because insurance is in business to sell insurance and pay claims. They have nothing to do with notification efforts.

If you have a document saying your insurance is good until may 5th, that would be dependent on your insurance receiving a payment for that time period, or a check for that time period that had sufficient payments.

The remedies you have at your option are to pay for the guard rail and the repairs to your car out of your pocket.
January 18th, 2012 at 11:03 am #Robert

Jason

Thanks for the reply, I’ll send you the photo’s,

we live in Ohio and we also have the extended replacement policy.

Thanks
Robert
January 20th, 2012 at 7:44 am #Belkacem

Hi!

Last month I had a car accident. I was traveling straight in the left lane,traveling north when the other vehicle in the right lane came into my lane hitting the passenger side of my vehicle. After the accident the driver of the vehicle involved said to me he did not see me coming.Her fault was very obvious. Still her insurance company denied my claim saying: We do not feel our insured can be held legally liable or negligent for you damages as result of this incident. At the time of the accident I called the police,but they did not want to come, because there was no body injury,and they asked me to pick up a report sheet from their station.
note that I have a partial coverage whit my insurance company, not a full coverage,so I’m claiming from the other party to pay for my car damage. Also they appraised my car and estimate the cost to be $2761.69.
What should I do in this case?

Thank you for your help.
January 20th, 2012 at 6:52 pm #Jason

Belkacem,
There is really nothing you can do except pay for your damage to you vehicle.
January 23rd, 2012 at 12:40 pm #t. wells

Thanks in advance for your advice. We own a 2 story office building. On Christmas Eve, we discovered that a toilet valve had broken, creating a massive water leak that left us with about $39,000 dollars in damage on both floors combined. The top floor was vacant at the time. My husband used the bottom floor for his business meetings a couple times a week. Went there to make business calls and conduct business a few hours a week. We were hoping to lease out the bottom floor – that obviously would be more profitable – but in the meantime, he used it, albeit minimally. Most of his work is done in clients homes. The utility bills don’t help because they are so minimal as well. The insurance company is trying to deny our claim saying the entire building was vacant. I realize they will probably not pay loss of income, but if they completely deny the claim, it will be devasting to say the least. How can I persuade them that it wasn’t completely vacant?

Thanks,
T. Wells
January 24th, 2012 at 4:17 pm #Puja

I have a major issue right now with Enterprise Rent-a-Car, and I didn’t know who else to go to.

Back in October, someone backed into my car and I had to file a claim. My insurance company sent me to Service King Collision Repair, and I had a rental from Enterprise while my car was being worked on (total of 3 days with a rental). A few days after I returned the car to Enterprise, they called me and told me the muffler was missing (I don’t even know what a muffler is!).

They said they would file a damage claim, but then apparently it was denied. I dropped the car off to Service King like I was told to, and whatever the issue was had to have been between Service King and Enterprise, and now I am stuck with a $2,200 claim for something I had nothing to do with…nor do I think a muffler on an old grand marques would be anywhere near the claim amount they want me to pay.

I am not sure what to do — do you think you can help me get this claim settled? Or know anyone that could possibly help me?

I really don’t have this kind of money right now, nor do I think this is at all fair.

Please advise and let me know you think. I’d really appreciate anything feedback or help I can get on this.

Thank you so much!
January 24th, 2012 at 5:41 pm #Jason

Puja,
From what we understand, you are alleged to have knocked off a muffler from a grand marquis. Whether you did or didn’t, we don’t know. Since we don’t know, it is the rental car’s obligation to prove that you did what they claim. That would require then taking you to court to have a judge or jury determine if you did what they allege or if you didn’t do what they allege.

I have no suggestion for you other than to ignore them and the entire situation. If they to take you to court for a muffler that costs $205 to replace (you would only own acv which is the cost less deprecation, then you might owe even less but the burden is on them to prove what they allege you did to their vehicle. My guess is they won’t do anything.
January 28th, 2012 at 10:42 am #Dan

I recetly file a comprehensive claim with Geico for vandalism damage to my Harley Davidson. It was sprayed with a dry chem fire extinguisher, then a water hose was left to run on it for an hour in 10 degree weather. When I found it I figured the best way to melt all the ice was to run the engine for a while. Geico covered the shorted switches and a shorted starter but, apparently, I caused some damage to the engine by running the bike too long. I didn’t know this would happen. Geico is refusing to cover the internal engine damage stating that was my fault not the vandals. My position was it was a cause and effect issue. Anything I did, which certainly was not intended to cause further damage, was directly caused by the initial act of vandalism. But so far they won’t budge and the Harley mechanic is telling me “I wouldn’t plan any long trips on it”. Great, now I have an $18,000 bike I can’t trust to take my wife and I out of town. Is there anything I can do? The bike is still at the shop.
January 29th, 2012 at 2:02 am #Jason

Dan, you did nothing to vandalize your bike. Vandalism is covered cause of loss and if you did things to correct the vandalism you did nothing wrong. You did what any reasonable person would do any your insurance company needs to realize that the damage was not done by you but by people that damaged your bike. Although you did everything you did to protect your bike, it didn’t work. Your insurance owes you for a repaired bike.
January 30th, 2012 at 4:26 pm #Dan

Thank you for the response. I just got off the phone with the adjusters supervisor. On one hand he freely admits that it never would have occured to him either that warming up the motorcycle for an extended period of time would cause internal engine damage. But then he also states that per the clause in geico’s policy I am required to “protect” the bike from further damage, therefore, the damage is my own doing and a seperate act and not covered. My position is that those clauses were put in place to protect against intentional damage to fraudulently “total” a covered vehicle. My position has been that in this case only a trained mechanic knows you shouldn’t warm a Harley up that long and there was no intent to damage the bike further, therefore, the act of warming up the bike was the act of a reasonably pruent lay person in response to finding his bike covered in two inches of ice. The olny intent was to thaw the bike so I could go home after work. I guess I’m goin to have to hire an attorney for this one because right now I have a, $18,000 paper weight.
January 31st, 2012 at 8:03 pm #Jason

Dan,
You actions were done an intended to protect your probe from additional damage. If they want to hand their had on that condition, I feel terribly sorry for them.
February 2nd, 2012 at 10:01 am #hope

Recently my renters informed me that they noticed stains on the kitchen floor in the apartment building. The first plumber concluded that ice maker water pipe was disconnected and water leaked on the floor behind refrigerator and seeped into floor and leaked into garage below. There were never any water ON the floor. My insurance paid for another plumber who said the same thing adding that it was long term damage. They denied my claim. Adjustor and his plumber inspected the place about a month after the first sign of damage. I repaired everything (mold, walls, floor). I found on this site (response #35) that the key thing about long term damage was pushing a finger or a dull butter knife through the damaged floor.
Can I appeal ?
Can my renters file claim on their insurance ?
Does filing a claim (without being reimbursed) affect the premium ?
Thanks.
February 2nd, 2012 at 10:18 am #patricia

we are military. could not sell our home forced to rent. tenant forgot to unhook hose and our landlord insurance says we have no water coverage? only fire perils only policy. This is the first we have heard of this? We thought we had homeowner’s with tenant occupancy, apparently, that doesn’t exist. The tenants have USAA renter’s insurance and I am trying to file a claim, since the tenant didn’t unhook the hose, which causes the pipe to break. I have about 8k with of damage? Is it worth getting an attorney? Can I hold the tenants responsible? How can I find a hole in the landlord policy to get them to accept the claim? spontaneous accident?I thought the word “insurance” meant to insure help when an accident happens. The agent who wrote the policy is playing dumb and acting like I knew it was a overpriced sub-standard policy. Hubbie is deployed could use some advice????
February 2nd, 2012 at 8:20 pm #Jason

Patricia,
Use my address in orange at the top of the page to provide detailed advice about your claim.. Prove the name of the policy,and exclusions. What fire what-so-ever in your vehicle that may have occurred? More questions to follow later. Thanks, Jason
February 5th, 2012 at 9:19 am #John

Hello:
In 2008 we moved up in boat size from one that was 24 ft to one that is 35 ft. For years we had a boat policy w/ Markel American and had no issues or claims. When we purchased the larger boat I called my agent and asked him to “add” the larger boat to my policy much like you would add a second car to your auto policy. The smaller boat was for sale but that hadn’t happened yet. He called me a few days later and said he had to insure the boat on a separate “yacht” policy because any boat over 34 ft is defined as a yacht. Markel’s “boat” and “yacht” policies are virtually the same with only one exception. The yacht policy calls for a defined “lay-up” period. Usually during winter months like Oct 1 to Apr 1. I was not aware of this difference and was not informed of it. That day in my agent’s office I signed a 4 page application for yacht insurance fully filled out on Markel’s letterhead and included a check as payment of premium. The box that indicates the lay-up period clearly says “NONE”. I have a copy of this. On Oct 5, 2011 while bringing the boat to its winter storage site we had a grounding and resulted in $14,000. worth of damage. We reported the accident that day and 2 days later Markel denied coverage stating that our declaration page indicates an Oct 1 lay-up and we were not supposed to be on the water. What the declaration page says and what I signed are two different documents. Markel or my agent cannot provide us with any documentation to prove that they notified me of a change in my policy terms and conditions. To make matters worse I stopped in to one of my agents offices and asked the secretary to get me a copy of my initial application. She did and in the box indicating lay-up the word “none” was crossed out and the word “Oct” was penned in. No specific day in Oct. We are now in litigation. Markel has counter sued us in federal court seeking dismissal (since they claim this falls under admiralty law hence federal jurisdiction). I paid for the boat repairs out of my pocket. I, as well as my attorney, think this falls under basic contractual law where an agreement was made and it was breached. What are your thoughts?
February 5th, 2012 at 9:27 am #John

Oh I forgot to say: Since our “yacht” was tied up for repairs for 3 weeks I still had to get it to its storage site by then it was almost November. I called Markel to change my lay-up to Nov 1 and they said “OK thank you”. No premium charge for this. Don’t you think that If I knew this I would have made that phone call on Oct 1?
February 5th, 2012 at 5:46 pm #Jason

John,
All this drama and you’re paying your attorney obviously by the hour and he’s convincing you it’s not an admiralty case when it clearly is a federal case. To figure that out takes almost no research to determine it is. There are some people in this world that should not be trusted without first being verified and your attorney fits that requirement.

That would be like your attorney telling you that a bankruptcy case is not a federal jurisdictional case without you questioning him about that. You need to do a little thinking before believing everything people tell you. The existing court will eventually assert that they have no jurisdiction in their court and you will need to start all over. If you need to start all over again, why don’t you make that move right now in federal court?

Find out if your odds of winning or if you will just be throwing away more money that your efforts won’t be worth it.
February 6th, 2012 at 3:40 pm #John

Jason: Thank you for your reply. My attorney is my best friend. As a matter of fact he owes me more money than I owe him. If he doesn’t produce I’m not paying. Now that that is clear …our (his) point is that an insurance carrier (or agency) has to notify its policyholder of a change in terms or conditions. They can’t just arbitrarily change things and not send out a notification. Correct? Whether it’s a boat, car, airplane or bicycle the contract terms and law still apply. Markel’s suit in federal court is purely for the purpose of dismissal. There is not a lot of drama. I just want what what agreed to. If I signed and payed for a contract (agreement) does the insurance carrier have the right to change the terms with out telling me? and again …….your thoughts thank you
February 6th, 2012 at 5:40 pm #Terra

Hi there, I recently notice a little bubble on my floor in my kitchen next to my refrigerator. My husband pull the refrigerate out and noticed that the wall and floor were wet. The wall had got so wet you could push it in with you hand with easy. We call and filed a claim with our insurance company and they declined our claim because they are stating that the problem had been there for a while and it is not covered under our policy unless it was an accidental incident i.e. letting the bath tub water run over the top. How in the world am I supposed to known that something is happening BEHIND the walls and under the floor! I don’t pull my refrigerator out every evening to check and make sure everything is okay! Help please I need to know what action and step I can take to get them to cover my water damage. Why do I pay them if they aren’t good for anything! Please help!
February 6th, 2012 at 5:57 pm #Jason

John,
Thank you for your well written reply. Of course an insurance company can’t just change things unless all parties agree upon existing contract that allows that, or the other party by some element of action or inaction accepts that change the way its presented or done. Sure contracts apply and laws guide those contracts but they, just like many things fall through the cracks. If things fall through the cracks and it happens incorrectly anyway will it all of a suddenly become right or correct?

Actually, since this is an admiralty subject it belongs in federal jurisdiction. It will be dismissed from any other one it falls into.

Now you ask if you paid for a contract, is the insurance company allowed to change the terms without telling you? Again, it’s likely how the contract is set up and if it’s like current insurance contracts, no, they don’t have that right. However, they do it all the time and you are an example of attempting not to let them get away with it when there are hundreds and thousands that don’t make the effort your are taking.

So, in summary because you stand up and hundreds and thousands don’t, the insurance company’s are allowed to change the terms of their contracts. (and you are the one contrary to what actually happens on a constant basis.)
February 6th, 2012 at 8:58 pm #Jason

Terra,
Technically, your damage is covered. I don’t know why they are telling you that. If water escapes from a plumbing line or appliance, the claim is covered. This is where you need get a manager involved or someone knows a little bit about the insurance policy. They are relying on it not being sudden and that is why it appears they won’t provide coverage but that is just my guess.
February 7th, 2012 at 1:08 am #Tonya

I live in Florida.. I was in an car accident and I was not the driverbut I file an claim and was granted compension. Than I was in an shopping plaza and got hit by a car and was granted compension. I was drivin my truck and had no insurance and a girl came out of an shoppin plaza and hit my truck and was granted compension. Dmv had sent me an paper to get insurance r my driver license would be suspended so now my license are suspended now and I’m went out to try and get insurance now don’t no insurance copmany want me because of the 3 claims that I was not at fault of. Please help I need insurance and also my driver license.
February 7th, 2012 at 9:17 pm #Jason

Tonya,
You can use this as a learning example and learn what to do to keep your license and things to avoid at all costs.
February 8th, 2012 at 12:17 pm #Tonya

Jason that wasnt my question. Thank you but no thank you for your input. Not a great answer to my question.
February 8th, 2012 at 1:57 pm #Phuong

Hi, I was recently in a car accident. The other driver merged into my lane and hit the back driver door with his front passenger bumper. There were no witnesses and the police did not want to come out for an inspection. Allstate his agency denied the claim saying he provided a different story and as such they aren’t liable for my damages. Allstate made no attempt to investigate the matter other then to call me and call the other driver. They didnt even send someone to look at my car. I want to take my claim to small claims court. I realize it is going to be a he said verses she said kind of thing. But I was wondering what you opinion on this is? I was also reading online and I feel like my claim was not investigated in a just and fair manner. Will that hold up in court?
February 8th, 2012 at 7:39 pm #Jason

Phuong,

A driver’s most common blind spot is at the left rear of their car. The right front (such as the view of the other driver) had a better clear than you did. That is going to be a huge burden for your to overcome. All claims happen differently and this one will likely not conclude in a favorable light for you. Just move one with your life and forget about this situation ever happened.
February 8th, 2012 at 7:52 pm #Jason

Tonya,
Sorry, I didn’t know what your question was because you didn’t present one. Perhaps if it’s difficult to keep your license in Florida, you might want to move a state that let’s you have your insurance and your licence too. Could you move to another state that isn’t concerned whether you have you have either accidents or insurance?
February 8th, 2012 at 11:21 pm #Tonya

I live in Florida. I was in the back seat of a car that got into an accident and I file a claim against the insurance and was compension. The next, accident occur 5 to 6 months later and I file another claim. The third,accident occur that which I was drivin and some girl pull out of and shopping plaza and hut my truck and the state trooper came out and stated she was in the wrong and I file my third claim. Now Dmv sent me and paper stated I need to get some insurance or my license will be suspended. That which I didnt cause neither of the accidents I just file 3 claims that which cause me no insurance company want me. I need help on this is there any good people that can give me advice on this.
February 9th, 2012 at 6:32 am #Jason

Tonya,
Call your State’s department of motor vehicles.
February 9th, 2012 at 8:53 am #Frances Thompson

I am writing on my mother n law behalf..She was up north visting her daughter and returned on Oct22,2011 in Titusville Sunday we setting outside and noticed a puddle of water coming from the outside back dr..Just pouring out I got up and tryed to see where it was coming from and could not figure, we went inside and pulled the sofa over and the laminate flooring had buckle up..I took it upon myself to call the public adjuster which came the next day..He called a company florida desaster recovery and they came out and removed the whole intire kitcen all flooring sin,all cabinets, counrt tops and just about everythin they could get there hands on..Made a fake wall fan fans..The public adjuster called stste farm and they came out and said this was not a sudden release so we are not going to cover this..It has been since Oct 24th 2011 sice we have had a kitchen..I pay rent here and keep getting sick from the Mold my Dr. said..We have to wash disches in the sink,outside or bathtub.My mother in law is 87 yrs old and this house is not liveable..This is totally not liveable only thing that really works is the bath room..There are five people in this house and I Have had a quaddruple bypass,5 back surgery,& a diabetic and I pay rent to stay sick..Allstate has been out here a couple of times and said this was a slow leak so it is not covered…I am trying to help her get some help to get her kitchen back, I do not have another place to move until I can save and that is impossible if I need to keep paying rent..Can not cook right for my diabetic because it just not working out..Can you help us????
February 9th, 2012 at 4:54 pm #Jason

Frances Thompson,
How about if you move to a place that you can pay rent that doesn’t have mold? That seems to be the most obvious solution. If the bathroom is the only thing that works at the place, the rent shouldn’t be very much.

I have questions about why you, as tenants, are involved with dealing with the property home insurance? Can your landlord provide assistance or are one of you the landlord in this situation? I ask because I can’t figure it out.

Also, you said the water just “rushing out”. Those terms kind of support the water was a sudden release
February 12th, 2012 at 7:35 pm #Susan Schneider

On 12/18/11 a nut that connects the toilet supply line to my approx. 7 year old toilet cracked and caused significant damage to my condo unit and my neighbors on either side and for five floors below.while I was away for less than 24 hours. I contacted Universal Property and Casualty. Two weeks prior the building manager and maintenance man inspected all units for leaks and no problems were found in my unit. The DriRite company removed all flooring and baseboards and dried my unit. I hired a contractor who removed my kitchen cabinets and stored all of my belongings in his warehouse. He arranged for me to move into a furnished apartment. My home is uninhabitable. The insurance company sent me a check on 1/27/12 for $5,000 for my rent for two months. Nothing else has been accomplished to repair my home so that I can return. The contractor and insurer agreed to a price for repair on 2/2/12 and the insurer sent me a Release of All Claims form for me to sign and notarize before they will release a check so that repairs can begin. I sent them a letter advising them that I could not sign that release because it had errors and misstatements. In my opinion, it would have released all of my claims for costs of personal property damage, ongoing living expenses, legal advice(if needed), etc. I only want to return home to something like I left it, nothing more. I need assistance with the 92 items of personal property that were damaged. They insist that I need to provide documentation for each item regarding when and where I obtained it, its cost, and an online search of how much it would cost to replace it. I have no idea of how to find some of the items, such as shoes and purses. I fear that when I replace some things, they will argue that they are not identical, but some items are no longer made and I will not be able to match them. How can I speed this process so that I can get back into my home? Every few days or whenever I inquire the insurer has new excuses of why reports, investigations, etc. etc. have not been completed. The contractor and I have complied with every request, but they continue to request more even though I ask if they have all that they need and they say they do but then they find something else to delay the claim further. The latest request is for someone to pick up the supply valve for inspection. I’m a bit concerned that they could lose this hard evidence of the cause of this disaster but I will gladly give it to them but am considering asking the guy who picks it up to sign a receipt. How long are they allowed to continue to investigate? I cannot fathom how they might think that I contributed in anyway to this horrible event. It absolutely ruined my Christmas plans. The building manager and lots of neighbors witnessed the event and I have done everything humanly possible to comply with all requests. What possible outcome of their investigation could possibly support a denial of this claim? Can you please advise me of how to speed the recovery of my claim? The estimated cost of reconstruction is approx. $35,000, personal property of approx. $16,000 and living expenses are ongoing but rent is $2,500/month. My policy includes enough coverage for all of this and replacement value. I do not understand why the insurance company is willing to continue to cause me to remain in an apartment while they try to decide what to do. If they would simply rule on this, money could be saved in living expenses and the case could end and I could go back home and get my life back This is not a huge claim and I do not have resources to continue to fight them. Do I have to give up part of the money I need to repair things to hire a professional to assist with this claim? How long might this conceivably take? They will not give me any idea. Can you help me????
February 12th, 2012 at 8:27 pm #Jason

Susan,
Get the errors and misstatements corrected so that is not delaying your end of the claim. Also, don’t give them any opportunities to delay or make excuses. If they do, come up with solutions so it doesn’t affect you.

The don’t want the supply valve to deny. They want that part to see if someone else should be paying for this damage. How long will take to conclude? Not as long you think because if contractors begin and start, it takes a certain amount of time and no longer. If it takes 4 months, for example, to get this all done and you delay the claim on your end and you need to stay in a furnished place for 6 total months, they could limit your stay to the 4 months. You have to choose your battles wisely and if you don’t get the 92 items corrected quickly, you may have to pay for 2 months of additional housing. Find a way to work with the insurance company instead of letting them delay, and you allowing those delays.
February 13th, 2012 at 7:03 am #Susan Schneider

Do I HAVE to sign a Release of All Claims form BEFORE the insurance company will give me a check to cover the build back portion of the claim? I do not think I am ready to release the claims for the personal property, additional living expenses, etc. yet. I will not know the amount of additional living expenses until I can get back into my home. I only refused to sign the Release of All Claims form now because I cannot give up those rights yet. Can’t the insurance company just pay for the reconstruction of the dwelling only portion now so that I can get back home and then I can submit the bills for the living expenses and when those expenses are paid, I could sign the final release of all claims? It just seems premature to sign that legal form now before I can accomplish that. Why should that delay anything? I could sign a release of claims for the build back portion only pending any unseen or undiscovered damage that could turn up during the reconstruction. Is that reasonable?
I am working as hard as I can to do the extensive research the insurance company is requiring for the personal property, but can’t that part be separated from the reconstruction part? Do you view that as me trying to delay anything? That is the last thing I want to do, but I also don’t want to be left with the living expenses, etc. if I sign a release for it before they pay it. Please advise. Thank you so very much!
February 13th, 2012 at 7:29 am #Jason

Susan,
Why don’t you scan that document and send it to the e-mail address in orange at the top of this page that starts as “complete…”

The document they may be presenting to you maybe a proof of loss and that, in the insurance industry, works very much like a receipt.

Look at it this way. You paid this insurance company premiums before they were able to deliver you a policy. This is kind of like the time in-between the payment of premium and the time you actually received the policy. You had to trust that you were going to get what you paid for.

Just like you don’t know what the exact amount of the additional living expenses will be, neither does the insurance company. Contractually they will pay your reasonable, additional living expenses so you already have that part covered in an agreement with the insurance company. To require the exact numbers in the document they are asking you to sign at this point doesn’t sound like a release.
February 13th, 2012 at 8:06 am #Susan Schneider

I sent information to you at the email address. Did you receive it?
February 13th, 2012 at 9:53 am #Jason

Susan,
Yes, we did receive the information you sent. The document clearly is a release and not a proof of loss form, receipt, or anything other than a release.

You appear to be taking the right approach to all of this and it’s unfortunate that the insurance company has put you in this situation to give away all your rights before they will issue any further payments. The document they sent clearly relieves them of all their obligations after they pay the amount indicated in the document. We will review it, and your other document, completely before we respond again.
February 13th, 2012 at 10:57 am #Jason

Susan,
It appears this is the insurance company’s protocol to settle claims. It is not the correct way to do it and you are knowledgeable enough to know it’s not the right way to do it either.

Mr. Felix Diaz, the claims supervisor needs to become involved in what is going on concerning your claim if he is not already there. This is likely the most direct person for you to communicate with about your claim and the standstill that it’s at right now.

Your suggestion that the company separate the personal property/additional living expenses from the reconstruction is reasonable. We don’t know if they will do that. No, we don’t view you as delaying anything. The claim manager has to become personally involved with your claim so it’s not delayed any further because requiring you to sign the release is what’s delaying your entire claim from proceeding.
i
The party responsible for the delay portion oft really won’t matter if you need to actually hire an attorney to intervene on your behalf. It appears you already used a free attorney to assist you to this point. We don’t know what to suggest other than getting the claim manager involved. Hopefully he will be able to get things in order for you.
February 16th, 2012 at 11:09 pm #Ruben A.

Hello,
We are having a problem with the city. Our lateral sewer pipe collaped. We called out two plumbers to find out what’s happening. Both plumbers told us where the pipe is collapsed. Unfortunately, where the pipe is collaped is where the actual road is failing. The road is collapsing as well. Even though both our plumbers are saying its the road fault that our pipe is collapsed. The city is claiming that it is not the street. So as I type this to you I have a huge puddle of sewage in my front yard. We can’t wash our clothes at home. We wash dishes outside to prevent sending water down the drain. We try and use the restroom a few blocks away at our local jack in a box. We take one minute showers. We can’t be outside with our 3 year old niece because of the sewage and how bad it smells. It’s a health hazard and all our neighbors are complaining. We also tried and file a claim with our insurance but got denied aswell. The owner of the house is a senior citizen and is on a fixed income and the city trying to make her pay for a project that’s going to cost at least 25 thousand! If you have any information that can help us in any way that will be greatly appreciated. Thanks for your time in reading this.
February 18th, 2012 at 7:15 am #Susan Schneider

Thank you ever so much for your quick reply. It is very much appreciated. Felix will not respond to my letters or telephone calls nor will anyone else with the insurance company. I have heard nothing from them since 2/2/12 when they sent the Release of All Claims form for me to sign. I have been out of my home for two months now and nothing has been done to repair it. I am extremely concerned because the ALE will soon reach its limits as will my sanity.

Which of the following options would you advise: 1)insist on arbitration with me and the insurance company, 2)hire an attorney, 3)try to file a civil remedy notice myself or is there anything else I might consider? I have no idea how long it might take for me to get them to go to arbitration even though it is outlined in my policy and I need a quick resolution. The attorneys I have consulted so far indicate they would work for 33%. I do not know how I could recover financially from this disaster by allowing an attorney to take that much as I really need more than 67% of the meager amount the insurance company is likely to ultimately give me to restore my home and reimburse me the cost of replacing my things plus the living expenses the insurance company is forcing me to pay so far. I have no legal knowledge and do not want to do anything that might compromise my situation.

I truly feel that I am being held hostage by keeping me out of my own home, which I own free and clear, and separating me from my belongings that are stored in the contractor’s warehouse. At the rate things are moving, I am extremely concerned that I will soon lose everything. I cannot afford to continue the current situation much longer. You are the only one who has offered me any advice that I feel I can trust. I am a single working old woman facing retirement and I cannot tell you how helpless and violated I feel. Whenever I do finally recover from this situation, I am promising myself that I will fight with fervor to help others and to impact legislation that makes it illegal for insurance companies to treat people this way. I surely am grateful for your efforts.
February 18th, 2012 at 10:13 am #patricia

hi. we are a military family, my husband is currently deployed. I live in Washington State with my 4 kids. We have two rental houses in kansas. One week after my husband deployed my tenant called informing me the fully finished basement carpet and floor was wet. To make a long story short, the tenant did not unhook a hose, the pipe froze and the next time he went to use the hose, the water poured into the basement causing $4250 to clean up and now I have no flooring in 2/3 of basement. My claim was denied. My agent never informed me that I had a fire only, perils only policy. The tenants have USAA renter’s insurance. I tried to file a claim, tenants were negligent. USAA denied me as well. The tenant claims the house has “pipe problems” and his statement claimed there was no hose hooked up? I have $1575 security deposit. I can not risk them moving out on me. I emailed the previous tenant and she NEVER had any problems with pipes. The house was built in 2005. Where do I go from here? I sent a letter to the agent who wrote the sub-standard policy and requested reimbursement for damages, wanting him to file with his errors and omissions…..I also filed a complaint with the Dept of Insurance in Topeka. They came back and said the agent did nothing wrong. It was my responsibility to read the policy. I tried. I really did and it was so confusing and complicated with inclusions, exclusions, etc…..I also spoke with an attorney in Kansas and he says I have one year under the statutes of limitations to go back and file a suit with tenants or USAA. Basically, it’s me saying the tenant didn’t unhook a hose from a previous, unknown freeze and the tenant disagreeing and stating “bad Pipes” My lease states: Tenant responsible for negligence or misuse. Landlord responsible for repairs???Any suggestions? Should I even repair the flooring or wait until there lease it done in December 2012? Is it worth even pursuing or is this just one of those learning lessons in life. I did change my current landlord policies and now have coverage for water/frozen pipe accidents….I thought, you have insurances for accidents….I feel the AmFam Agent who wrote this policy under some crazy co-op did me a huge DIS-service. He did not help to manage my policy, isn’t that the agent’s job, not just selling the policy to manage it and give his professional opinion. HE DID NOT do that……any suggestions, most appreciated….
February 20th, 2012 at 12:50 pm #Paul

Jason — you appear to be someone who has a lot of good information in this area, and I believe I know the answer to this, but would like to double-check anyway. My understanding is that an insurance company can deny a claim by concluding arson was the cause even if no criminal charges are ever filed or they were filed and the defendant was acquitted. This is because the insurer can pursue a civil arson investigation that is separate from and can conclude differently than a criminal arson investigation. Basically like OJ getting off of criminal murder charges but still being held liable for wrongful death determined through a civil trial. Am I basically correct here?

Also — Tony — regarding the excludability (sp??) of ALL arson, I think you need to consider the perspective Jason was using. He was not indicating that if an arson was determined to have occurred that nobody can be indemnified. It is from the perspective of the claimant. If an individual is filing a claim to be indemnified and it is determined that he/she committed arson or conspired to then there is no way that person is going to be indemnified. The claimant will be excluded, 100% of the time, from collecting if such a determination is made. That is what Jason is referring to. It is like auto insurance and DUI. If I am guilty of DUI and I am involved in an accident where another is involved (or anothers property — like I drive into their home), then I am 100% excluded from receiving any claim benefit. However — the third party involved is not and in fact will generally receive compensation from my insurance company for my actions (and then in turn I may be sued by the insurance company to indenmify them and make them whole regarding what they had to pay the third party). Regardless, from my perspective, the DUI is 100% excluded. Jason — that is what I believe your were communicating — correct me if I am wrong.

Looking forward to a validation on my first question. Thanks.
February 20th, 2012 at 10:10 pm #Lauren C.

Two weeks ago I was in a car accident while leaving class. There was a truck in the right lane and I was in the left. They attempted to make a U-turn *FROM THE RIGHT LANE* across to the opposite side of the road. The driver’s front tire ran almost over the top of my hood. A police officer showed up, the other driver admitted fault in front of the officer, my boyfriend and my mom when they arrived. The officer said we did not need a police report as long as we just took care of it through the insurance company and she admitted fault to them. I immediately called my insurance… I do not have collision so they said I had to go through the other driver’s insurance (Allstate). That same day only 3 hours later I got an estimate of the damage. Not only was the estimate ridiculously low, the guy didn’t even open the hood! It all felt very wrong. So it took Allstate a week and a half just to contact their client. They continued to screw me around. Today I called my insurance company (Progressive), and they said that they contacted Allstate, and they admitted fault. LESS THAN FOUR HOURS LATER Allstate calls and says they denied my claim! They said the story their driver gave did not match mine! ARE YOU F$@*&#&@ KIDDING ME!? They said that their driver stated she WAS in the right lane, but she merged into the left lane. WELL THAT STILL DOESN’T EXPLAIN HOW THE ACCIDENT HAPPENED! That doesn’t back up how the damage happened to my vehicle in the area it did! If I go back to the officer and get his statement will that help? There was also a traffic camera pointing towards the spot where the accident occurred. I don’t know where to get the footage from or if there is footage. Or if they even keep the footage for two weeks. What can I do? There is over $2,300 worth of damage to my car! I was less than a week from selling it when the idiot hit me! Please help!
February 21st, 2012 at 3:26 am #Addy Pyle

Hi, I got a job in the mines over in WA. The arrangement was fly in fly out which ultimately meant I flew from Brisbane to porthedland for three weeks to work then flew home for 1 week at home. The company provided me with a house to live in whilst staying there. Whilst at work, the house was broken into and manybof my personal possession were stolen. The company I work for do not have home and contents insurance, are they responsible in any way for replacing my items?
Appreciate and thoughts or advice.
Cheers Ady
February 21st, 2012 at 7:37 pm #admin

Addy,

Which house was broken into? If it was the one at the workplace, I would say no liability unless there was some negligence by your employer, for example security guard fell asleep, security system not working. And I would say no responsibility for replacing stuff unless it was in their contract with you. You should have asked them ahead of time if you needed your own insurance, IMO. But check with a lawyer in your area. Also, your own insurance on your home in your hometown may have coverage for property away from the premises.
February 21st, 2012 at 10:57 pm #Alex

We where out of power for 7 days and the fridge leaked all over the laminate floors. I let the insurance company send there pick of floor guys to look at it. Within hours our floor was torn up and the floor guy said we needed new ones. I had to wait for a week and a half for the estimate to come in. It was $6400. I told them I would do all the work for $4100 and they told me no. If I do it they will give me $3200. They said that the floor guys they sent out are professionals and they pay more hourly. I am a journeyman carpenter And I know more than the guy that came out here. I put my floors in originally. I make $35 per hour scale but they want to give me $12 a hour. Is there anything I can do? The materials are $2804.27 my labor was $1315 split so I have helper. Why wouldn’t they want to cash me out? They want receipts for the materials so I can’t get cheaper and make up for labor. Do they have to pay if it’s reasonable? How should I word it? They are more than willing to pay the guy that wouldn’t return my calls and took for ever on the estimate almost $4000 in labor. Please help!
February 22nd, 2012 at 8:35 am #Alex

After thinking all night, they have to bring my house back to the state BEFORE the loss right? Do I have to do the floors the same as what they where? What if I want tile in the kitchen so this doesn’t have a chance of happening again. Can’t they just make a check for the cost of replacement and I can do what I want? I mean at first they offered $6300 and I said I only need $4100 to bring it back to the way it was. Then for some reason it went to $3200 and I had to provide receipts. My wife is all over the place with wanting to do different as well. Still just want to know options I have and what I need to say. Thanks for any help.
February 23rd, 2012 at 9:03 am #Patrice H.

Hi, my home was broken into but my alarm was no longer being monitored. Can my insurance company deny any part of claim because of this? I still had a system and it went off when the crooks came but didnt send a signal because it was not being monitored.

Also,

Since the breakin I have contracted with an alarm company. The crooks ripped out motion detectors and the keypads and I’ve had that replaced/repaired through the new company. Will my insurance reimburse this out of pocket expense even though I got into contract after the break in?
February 23rd, 2012 at 2:32 pm #Bebe G.

I live in a private community and was on my way to work across the street in the shopping center. There are three laness exiting the community–one on the right that is for right turns only, one on the left for left turns only and a middle one for right turns or straight ahead into the shopping center. The morning in question, I was in the middle lane and the cars in front of me turned right. As I entered the intersection, at the left of the entrance was an unmanned digging machine and at the right on the curb were several workers engaged in conversation and between the workers and machine was an unmarked open area which I proceeded to enter. There were no cones, markers, baracades, nothing at all to indicate that there was an open trench which the front wheels of my car immediately fell into. The workers saw my car just as it was falling and one of them (who I assume was the foreman) came over to see if I was o.k. and said they would get my car out. It was too heavy to lift out so they hooked the machine to the back and pulled it out by the back. I never exited the car as I was pretty shaken and was afraid to drive it but the man said that there seemed to be nothing wrong with it and one of them was already motioning for me to enter the shopping center as he was holding up traffic. To my surprise and happiness my car drove and seemed to be o.k. When I got to my office all that I saw was a teensy little tear at the bottom of my bumper but it didn’t seem to amount to much. I thought the work was being done by our City so the next day I wrote a letter explaining everything to them as I just wanted the letter on file in case of problems down the road. I received a letter back from the City saying they had forwarded my letter to the Edison Company as one of the subs was doing the work. Later I saw the tear in the bumper was spreading so I called the Edison Company and they gave me the name of the contractor and they turned it over to their Insurance Company. When the man called me, he asked me if there was other damage underneath the car and I said not that I knew of but I had never had it checked. He said the contractor wanted to have it talken care of and asked me to take it in for an estimate so I took it to a Hyuandi dealer who I had purchased it from. They put in up on a rack and the estimate came back at over $2,000! They said there was a lot of damage underneat that could cause future problems and the damage should be fixed. I sent the estimate to the insurance adjustor. A little over two weeks later I received a letter from him denying the claim. There were 3 reasons–(1) that their records showed that a barricade was in front of the trench which is completely untrue and can be proven (2) that I drove into the trench–which I did because I had no idea that a trench was there and (3) that a an open trench constituted blah blah–something that I did not even understand what he was trying to say and what did it have to do with my claim! The letter stated that I had 30 days to respond (which I immediately did). What recourse do I have if they continue to turn down the claim as I cannot afford to have my car fixed myself and have to get back and forth to work?
February 29th, 2012 at 6:12 am #John Tamburello

On May 23, 2011 a tree crush and destroyed our house. We did not know at the time but the contrator we hired was a crook. He conned us out of using our money till we were dead broke and took all the insurance money that was paid out…we had to use our last dime to be able to move back in. We felt when Allstate paid the balsance of what they owed us we would be OK…In the meantime…the contractor has suesed us for the very money he already stole and then some…and Allstate is denying our claim due to fraud….We are dead broke and every attorney we call only cares about money…hard to find one to do it on contingency. What can we do…we cooperated with Allstate and told them of the contractors fraud and the CAT claims person said nothing they can do…the restoration company put a hot tub on the damaged property list….and said it was damaged…we did not know anything…Allstate called and asked if i could get an estimate..i called the company i bought it from and has serviced it…they are saying its fraud and denying our entire claim totally destroying our lives….please help us…please How can they get away with this?
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March 2nd, 2012 at 4:43 pm #Stressed out

Hello,

I was in an accident 2 months ago. I hit ice and my van slid into on oncoming vehicle. Neither of us were injured in the accident. I called my insurance immediately to process the claim. Due to the age and wear of my vehicle my van was a write-off. All was processing smoothly and about 9 days after the accident i was advised of the amount they would be giving me for the writeoff. I did not agree to the amount over the phone as i advised the rep i wanted to discuss with my husband first as i do not like to make final decisions without his ok. Life caught up with us which prevented me from calling insurance back right away and 4 days later i receive a call from them stating they are now in the process of investigating my claim. The reason being because the name on the ownership (my father) did not match the name on our insurance(myself & husband). However my father sold me this vehicle 7 years ago. We did not switch the ownership as we did not think this to be an issue since it was just my dad selling me his van. So insurance advised that my father had to get a notarized letter stating he did in fact sell me the vehicle, there were no liens or loans outstanding on it and he had no interest in the vehicle. After all of this the under-writer still came back and denied the claim as they said there is “no isurable interest” due to the fact that i was not the registered owner of the vehicle. What i find odd is that they are not cancelling my policy they are just going to back-date and remove the van from the policy all together going back to the date we originally registered the insurance with them. They also advised that they would be reimbursing me for all of the premiums i paid on the van over the last 3 years i have had insurance with them. This all does not sound too bad except for the fact that if the man in the other car ever decides to file a claim for injury i would be personally liable. I cannot live with that thought looming over me for the next 3 years. Can this be fought? I just cant understand that if i am the insured and the one who was in the accident and with all of the docs we sent to prove this vehicle is in fact mine, how can the insurance company do this???
March 4th, 2012 at 2:50 am #admin

I don’t know what happened to Jason. I sent an email to him a long time ago, but no response. This website would do better if some of you would step up and start answering questions. I know you are out there and listening because there are many of you who subscribe to RSS Feeds for this website.

For those of you who want automatic notices of new comments on this website, just click on the “comments (rss)” link at the bottom right corner of the page.
March 4th, 2012 at 5:18 am #Susan Schneider

Jason was great and quick to reply to my question in mid February. I would have no knowledge of how to help anyone else as I’m still struggling to muddle through my own issues. This is a good site with helpful info for those in the midst of these horrible situations. I hope those with knowledge will continue to offer advice.
March 4th, 2012 at 8:36 am #Polly Carras

I was in an automobile no fault accident. A woman with her daughter cut right in front of me which the speed limit of 45mph. I slammed right into her passenger side of vehicle where her daughter was sitting. I saw smoke or dust and feared for my life if my powder blue Ford convertible T-bird was going to blow up. I forced myself to get out of the car forgetting to press the electric button so the seat can go back. That is the only way for me to get out of the car. I’m only 5 ft 1″ and the stealing wheel is always 7-8″ away from my breast. This woman had a falsified Insurance card, that I found out from a letter Allstate Insurance sent me mega months later. I have uninsured
Motorist and Liability a 30/60 thousand policy. I have been fighting for my life going on 6 1/2 years and had hired a attorney due to my injurys. I’m in the Hospitals and ER’s, wrong 15,000.00 rehabilitation place that said They can rehab my back, well they lied, it was a junkie place. I have a Buldging LT-5 Disc on the left lower part of back and now it’s tearing at the root of the Nerve which it’s starting to climb up my spine a painful burning sensation. The accident messed with my equalibrium to be off which causes randomly and more than normal my head will start to spin and then I fall and fall and fall. Several times on my scull, on my face on the concrete causing me to black out, my 3 little dogs were licking my face, that’s how I came to and wiping my face only to see blood on my right hand and began to panic. I have a scar on my nose and forehead. Every time I fall makes the Disc hurt more which I’m in 24-7 pain. The institute of research Nuerology I went to diagnosed me to be inbalanced, I lean to the right in Laymens term I’m crooked. This place took NO insurance, I went there twice and obtained shots in the low part of back which was 3,000.00 per visit. The shots never worked. They did tell me that Allstate should pay them and for other injurys caused from the accident. I have blacked my right eye when I was trying to go to the bathroom, lost my balance and fell on a iron magazine rack. Paramedics came and took me to hospital to rule out a stroke. My cheekbones were popped out and the eye I could not open. I’ve fallen own my stairs 6 times, the third I tried crawling to a phone but couldn’t. I almost drowned 3x my shower is a step down approx 6″ I take a shower on a chair, got that woodsy feeling and fell blacking out. I began choking and sucking in water. One of my body part was covering the drain. I forced myself to get my nose and mouth above the water which I did and was screaming hoping my daughter was home. She finally heard me and helped me up and slid out of her arms and fell again on the stone floor. Dirt water was coming up in the shower, the bathtub the sinks and toilet which flooded the whole bathroom and water leaked to downstairs family room and ruined the drywall which we had to pay for. Allstate is a fraudulent Insurance Company, I know this due to googling “Allstate denying claims and was floored with Thousands of victims just like me. They are known for the Dirty “D”s. DELAY, DEFEND and DENY. Alot of there employees wrote How Allstate trains them to Cheat, lie and lowball there Policy holders. It’s all political, unfair and wrong to unfaithfully Deny my Policy. My Attorney never returns my call. I desperately need help. I’ve called The State Insurance, Consumer affairs, The BBB,
Law Enforcement, even the FBI, All’s I get is a DEAD END. I’m going in circles and Pray everyday that this nightmare will get JUSTICE. Lost my job, I had 10 sessions to complete my Private Investigate License and was going to take a year of Criminal Law. Well my main goal in life has been stripped from me. No one will hire me at any job because I can barely walk and also broke my hand and fingers on another inbalanced fall hanging clothes in closet, got the spinning feeling and fell. They say Allstate will protect you and your in “Good Hands” Well that’s not true I broke my left hand and had surgery. My hand is a year recovery and will be deformed for the rest of my life. There is so much more as I’m so depressed. I was a Recital Dancer since the age of 12 I want the Stage Back. Allstate took my own Medicare and Blueshield as secondary away from me. Medicare put Allstate as Primary yet Allstate has not given me a penny, as a matter of fact they bounced the reimbursement check of the 389.00 for the rental car while my car is being repaired causing me to bounce 3 checks at 38.00 a check and they won’t reimburse me. I beg for help I was gifted with balance and was able to single water ski at age 6, Snow Ski, Dirt bike ride, Horseback riding even bare back, I was a cheerleader for 4 years, Mascot my senior year, a gymnast, Bike riding, Loved to Go bowling, swimming, canoeing, jumping off the cliffs into the Lake, Name the sport I did it without fear. And now I fear going to the bathroom from my Hospital bed I have slept on for two years. I can’t even sleep with my husband and fear I’m going to lose him. WE lost our home, I can’t drive. Why won’t they rehabilitate me? This is inhumane, what happens if I die on the next fall, they would probably be more than happy. Please help me get justice so I can live a normal life and become a PI which I have this goal since a child. I wanted to make a difference in someone’s life of helping Child Abuse, Elder Abuse, abducted people especially Children, and Rape. I will hang on to this goal forever because I wanted it soooo bad. Thank you for the time to read this, there is so much more that has happend to me and family. This has got to stop, enough is enough.

Polly Carras 661-312-6484 or 661-288-1703
March 4th, 2012 at 2:50 pm #Rebecca McKee

My issue is regarding, ‘Notice Of Nonrenewal Insurance’ from my homeowners insurance company. ‘The reason for non renewal is the lack of proper care and maintenance to the dwelling as evidenced by severe moss accumulation on the dwelling roof. In addition, you have had two claims in the past five years: 1/20/12 water damage; 3/18/10 medical payments for slip and fall.”

I do have a bit of moss accumulation, but it did not cause the water damage to my roof. ‘Ice dams’ were the source of damage after a foot of snowfall created by mother nature.

I do have an open claim pending medical payments to a visitor who fell on my property.

How can this insurance state non facts? How can they cancel my coverage when there is an open claim?

Thank-you,
Rebecca
March 9th, 2012 at 6:10 am #Constantine

Dear All,

To make the story short, structured and easy to get complains points:
1. I have PREPAID car reservation made thru Dollar Web to rent a car in Cancun Mexico.
Complain: DollarMexico charge me twice: in the final invoice PREPAID amount wasn’t deducted.

2. We arrived 11pm, so nobody was picked us, so after some half of hour waiting we agreed with our some other rental company to bring us to Dollar Mexico office.

3. We spent over 3h (until 2:30am) DURING 24-25th of December (they spoil us Christmas Eve, a key reason for our visit to Mexico!!!).
a) manager on duty was not experienced and cannot believe that service is prepaid inadvance. Presented voucher doesn’t help…
b) when I asked him for possibility to speak with his manager, he called some person who “suggest me to take a car, not sign a contract because of prepaid amount wasn’t minused from the total sum in the contract and drive to relax in hotel”. I spoke with the man, but next day manager of the local branch was a lady and she said that I spoke with fake manager!!!
c) when I asked to call a taxi, he refused
d) when I asked him or his collegue bring me to hotel (20min in Cancun Hotel zone) for additional fee, he refused
e) at the end he bring us back to airport when we have get a shuttle to hotel for $60 USD!!!
Rent car on arrival was a reason to avoid this fee!!!
f) same manager of duty, without my permission “froze” about $3000 as a insurance fee. That amount was call back next day, but my bank gave me a possibility to use it again only after the week, so I have difficulties on my other vacation expenses.
e) when the manager bring us to airport, he start to call us dirty words for local taxi drivers, that was ugly because we are famous brand CUSTOMERS.
At the end we reach the hotel after 3am, without a PREPAID car rental service for additional $60 USD fee with spoiled Christmas Eve.

4. The transfer fee next day from hotel back to Dollar Mexico office cost me additional $20 USD

5. Next day service was fast and professional, but…..
a) I have prepayment for a “full size” car (Dodge Stratus or Similar, like it’s in Booking Confirmation letter) and new manager on duty tryed to give me “Standard”, which is lowest than “full” category.
b) Finally he gave me Nissan. Later in contract I notice that it’s VW Jetta, Standard Class. So how is possible to give me Nissan and made a contract for Jetta???!
How is possible to gave me a lowest rental service when it was PREPAID for highest?

6. On the perfect highway from Chitzen Itza back to Cancun cars rear tyre has exploded. Car became out of control and jumped out of the road. Car has two turnovers and striked into tree cuting 2 more before.
a) Car was totally jummed, BUT NO AIRBAG has been activated!!!
b) We drive around 100km/h (speed limit was 120km/h)
c) We notice later that the whole 3 tyres which left was from the different vendors!!!
(I have a picture proof)

7. Nobody was deadly injured.
a) Only scratches and hits.
b) Next day, after X-ray in Cancun Hospital, doctor diagnoside a heavy spine stretching in neck area for me and not heavy of other passenger. We have a documents from Cancun Hospital and photocopy of X-rays. I still have an inconvenients in neck area. (I have a pictures and documents from the hospital).
c) 3 car passengers still feel inconvenients and fear to drive after an incedent.

8. When I checked my credit card statement:
a) I surprisely found, that Dollar Mexico Charge me twice (not deduct prepaid amount from the final invoice).
b) they charge me extra 9879peso (about $600USD) for “crane and transportation fee”.
b1) I have bought a full insurance: LDW+SDW+ERA which should cover that kind of expenses!!!
b2) There is other person handwriting on the bill, I DIDN’T AUTHORIZE ANY ADDITIONAL PAYMENT FOR CRANE!!! So I think it’s criminal element already!!!
b3) The day of invoice “with my signature” is 5th of January, but my last visit in Dollar Mexico office was on 4th of January

RESUME:
CAN SOMEBODY ADVISE ME:
– Did crane and towing service included in LDW+SDW+PLI+ERA type of insurance products?
– How I can proof that I didn’t sign for the “crane”?
– How can I get money back which was paid for the car rental service in a case that there was no service?

Wish everybody to have a nice weekend!
March 10th, 2012 at 12:37 pm #Andreous

I purchased a mattress topper at a department store. The chemical smell of the topper seeped through to my pillows and onto my mattress. This smell went through sheets and covers. I took off the topper but the odor remained causing me to be ill. I turned over the mattress and the smell remained but I could now smell the odor on my box spring also.
The department store was courteous replacing my pillows and submitting the claim to the manufacture of the topper.
I tried opening windows and even putting the mattress and box spring outside to air out. Upon returning it inside the odor was so great it permeated the bedroom and hallway.
I threw the set away not wanting to store it outside for a long period of time due to being unsightly and attract rodents to nest.
The insurance company called and the adjuster asked a series of questions and assured me the claim would be resolved and he did not see a problem with reimbursement. It took over a month until I finally called and stated I was upset that it was taking so long. The adjuster stated he had to just ask the manufacture questions to conduct his investigation and would settle the claim soon. He even stated he submitted $2600 due to depriciation but then agreed to $2800. Though the bed was totaled well over $3000.
I received a denial letter via email the next day saying that since I threw the bed away prior to them inspecting it the claim was denied. The adjuster never told me that from day one and said my claim was approved.
My questions are; Should I write back stating I want them to reconsider or I will seek legal counsel and / or file a bad faith complaint against them? I would think for such a small amount they would just settle or do I just file the bad faith without warning them? Would they reconsider or would that just cause them to deny again? Since I threw the mattress out prior do they have a legitimate right to deny? Since they took so long to deny could I file bad faith anyway for punitive damages for failure to give me an answer in a reasonable timely manner?
I did everything they asked even getting an estimate and faxing same to them. Not once did they say since the bed was tossed before they saw it did he indicate it would not be approved.
Thank you for any input
March 10th, 2012 at 8:31 pm #Kari

@Rebecca- it doesn’t matter If your claim is open or not nor will it affect the payout of that claim- look for another company.
March 19th, 2012 at 11:08 pm #Michelle

I had a break in at my apt over a month ago I have provided the insurance company with most receipts some pictures and my rep said my claim should be able to move forward. Over a week later I get a phone call from an investigator asking if he could record a statement at first I didn’t think anything of it until he started asking crazy personal questions and I told him that’s none of his business then he asked me for permission to get my phone records I said absolutely not but answered all other questions although they were really personal and uncomfortable. Then at the end if the conversation he asks me if I want to proceed with the claim and I said absolutely are you serious I did nothing wrong. Then he says it’s a lot wrong with this case and I said I’m going to get a lawyer and hung up. I can’t believe I was being interrogated should I get a lawyer
April 24th, 2012 at 10:40 am #Kathy

Four weeks ago, our rented home was broken into. Not only were items stolen, but there was quite a bit of damage done to both my property as well as the home itself. The owner filed his claim for the actual home damage (USAA) and we filed our own claim with our Auto-Owners Insurance for our stolen/damaged property.

Our insurance took a sworn statement from my husband the day after the events and we provided the police report as well. There was a point of entry and prints were taken. Unfortunately, the prints didn’t match anyone in the system and it seems that we are at a standstill. Now our insurance has denied our claim. They gave no reason, but said we could meet with their lawyers to submit our sworn testimony. What possible reasons could they have for denying our claim? To add to that, the owner’s insurance has put a hold on his claim. What could be going on? I do know the owner’s claim is for quite a bit of money because all 3700+ square feet of carpeting needs replaced and several walls repainted, but things had been moving along quite smoothly up until last week.

We gave us much detail as possible when we listed all our items and included pictures and receipts where we could. There’s nothing over the top. How do we need to be prepared when meeting with the lawyers? It doesn’t help that I’m seven months pregnant and just want to have my home back in order before our newest arrival comes. Argh!!!
April 24th, 2012 at 7:57 pm #Jason

Kathy,
Something is likely very suspicious with your or the owner’s claim – or both claims. Burglary or vandalism (or both) are carried out in certain ways by perpetrators committing the crimes. Sometimes owners damage their own property in order to perpetrate fraud to collect insurance money. Although we don’t know the manner in which the carpet was damaged, causing damage to 3700 sq. ft. doesn’t make sense and makes us wonder why all of it was damaged, if not done purposely and with planning.

We don’t have enough information to determine why your claim might be denied. They are probably requesting testimony under oath from you and it’s likely your claim is not formally denied as this time.

Perhaps you may want to consult with an attorney before you proceed because examinations under oath are kind of serious.
April 24th, 2012 at 8:07 pm #Kathy

Thanks, Jason. We heard from the owner today and his insurance is proceeding (the perps had squirted acrylic paint randomly throughout the house so thatbis one less thing to worry about. I also received more instruction from the lawyer representing our insurance and they want us to submit W2s, tax returns, the divorce papers from our first marriages, etc. I’ve never dealt with an insuranc claim before. Is this typical?
April 24th, 2012 at 9:10 pm #John Tamburello

Kathy..read #419 above by me….in my case Allstste made me think I was meeting with their attorney to help go after the contractor who stole our insurance money…so we met with him and had no idea we were being set up.they interrogated me and them my wife as if we were criminals…a tree destroyed our house….yet their attorney, under oath kept pushing and pushing asking in 30 differents ways about stuf we had no idea about….when we then had the claim claim denied by Allstate…the lawyer we hired said once the do that…they are committed not to paying the claim..they will invent something…if they have to…in our case…even though we are sueing the contractor and Allstste now…they think we were in collusion with the fraud artist contractor…and still they will not pay us the rest of the money which is about $100,000 between contents and dwelling …SO PLEASE LEARN FROM OUR MISTAKE…..IF YOU DON’T MEET WITH THEIR ATTORNEY AND AGREE TO BE DEPOSED UNDER OATH..THEY POINT OUT YOU WILL BE DENIED. IF YOU DO MEET WITH THEM TO BE DEPOSED UNDER OATH..THEY WILL CREATE A REASON TO DENY. ONCE THEY DO THAT THEY ARE COMMITTED TO DENYING YOUR CLAIM…SO YOU MUST DO IT…BUT DO NOT GO WITHOUT A LAWYER AND DO NOT ANSWER ONE QUESTION UNTIL HE OR SHE GIVES YOUNTHE GO AHEAD.
April 25th, 2012 at 6:44 am #Jason

John,
Not all situations are the same so to infer that your situation applies to Kathy’s claim is far fetched. We don’t know the details of your claim and/or your involvement with the contractor so we cannot speculate about that.
April 25th, 2012 at 7:08 am #Jason

Kathy,
If I was handling this claim, I would be concerned about acrylic paint being randomly applied to 3200 square feet of the entire property’s carpet. First, the detail of knowing the paint is acrylic raises concern about how that is known. Why do you say that is that one less thing to worry about? What the insurance company is doing is investigating the claim circumstances.

This has no bearing on your claim and it is my personal perception of some things I would want to determine about this incident. You indicate perps, as in more than one. How do you conclude there was more than 1 person acting? You know the type of paint used to vandalize. How do you know that kind of detail? A new born child’s environment would be best if the child is crawling on carpeting that is new rather than old. Carpeting for 3200 sf. will cost up to $10,000 to replace using a low to moderate replacement price. Carpeting doesn’t increase rent income and instead is strictly a rental investment cost. Had you or your husband requested the owner to replace the carpeting prior to this? What is your husband and your personal relationship with the owner? Again, these are just some of the things I would want to know if I was handling this claim. I don’t want to know these answers on this forum so do not attempt to answer them.

It may be good to consult with an attorney like John suggested.
May 18th, 2012 at 6:54 am #Teresa

My ex-husband had an at-fault accident in my car. My policy paid them for their property damage and the insurance company has made an offer on the personal injuries, which they declined. He is now being sued in district court and service was made thru publication as he cannot be found. If they get a defaut judgment against him for the personal injuries, can that come against me?
May 24th, 2012 at 2:39 pm #joi

I really need help. a couple months ago i came home to find that my place had been broken into. I did everything i thought i was supposed to. i called the police, notified the landlord and called my insurance company. I even went so far as to not touch anything in hopes that the police would be able to retrieve finger prints, footprints, Anything!. today i got a call from the adjuster stating that they have denied my claim based on not enough physical evidence to forcible entry? I’m feeling violated all over again and i don’t know what to do. any help would be greatly appreciated.. thanks
May 24th, 2012 at 4:13 pm #Jason

Joi,
We don’t have enough information to provide any suggestions. The insurance company has the luxury of investigating your claim and we don’t and it appears they have more information than you provided. Many times the items taken, how entry was gained, any roommates, people being dated, other guests in the house, etc can paint a picture that we don’t know anything about. The police report may even provide detail in it about why they are denying. You may want to obtain a detailed explanation why your claim is being denied.
May 29th, 2012 at 3:51 pm #Jennifer

We filed a home owners claim with Metlife when a tornado touched down 2.5 miles from our home about 2 years ago, and it was PROMPTLY denied! They said the previous home owner had a claim for the same thing in 2008 and she did not fix the roof. We had 6 different companys tell us there was over 60% of the roof damaged. Metlife came in and hired an engineering company to then say the vertical racking method was used to install the roof and it was improperly installed. After talking to the Ohio board of insurance, and being defeated, we paid to have our roof sealed and just put a bucket under the leaks when they occur.
NOW……..we are having our house painted, the painters came to prep and found significant damage to the back of the house which they say was caused by ice dams. I have pictures of HUGE ice dams hanging off the back of our house, but we honestly never crawled up there to see if there was damage. We did make an additional claim when we had water running inside the walls, but the adjuster said it was from the roof and DENIED. After she kicked my dog. The adjuster I talked to on the phone when I placed the 2nd claim said if it was HIDDEN damage, it would be covered, if it was just rot in general, it would not be covered. It took me almost a week to get an adjuster out and when he did come, it took me 5 days to get back in touch with him. When I did get ahold of him, he told me the claim was denied and to get an attorney if we wanted to pursue it further. Our contractors are in shock as they said this is a CLEAR ice damming issue, with great pictures to back it up.
Should this type of claim be covered, I have great documented pictures. How do we the home owner, whose policy have all but double in 3 years, fight Metlife with their engineering firms and BS.
The back of my house on the 2nd floor is literally wide open with a sheet of Tyvek over it. My drywall is open to the sun and wind and bugs.
Any advice would be greatly appreciated.
Thank you.
May 29th, 2012 at 6:49 pm #Jason

Jennifer,
Ok, so you are aware that the roof damage is denied.

If you have documented photos of large ice dams on your house, the water accumulation in those dams is not hidden – in fact, you have photos of the dams and dams cause water to enter through the roof.

Regarding your house, get is sealed up and don’t rely on the insurance company to assist. Then get a different insurance company.
May 31st, 2012 at 1:42 pm #Mayra

Hello i have a question … I had 2 people burglarize my home while i was in it and they took quit a bit of stuff from it….the insurance that im with has send a private investigator to do a preliminary investigation…. I don’t have receipts only pictures of some of the items and they did take a very expensive pair of heel my mother bought me for my b-day at a cost of $1,000… she is out of the country since one of my aunts has stage 4 cancer and isn’t able to provide much…. My question is that if my claim gets denied would the company charge me with fraud or just deny my claim… I honestly at this point don’t even care about the items what i want is this claim to be over because i witnessed the burglarers jumping out of my window and i went into shock so i cant sleep or be at peace and just want this to be over with…
thank you
May 31st, 2012 at 4:10 pm #Jason

Mayra,
If you were in the house, it appears you startled the people doing their work. So, their plan was disrupted, yet they still ended up taking quite a bit of stuff?

These thieves stole some heels? I don’t know if that’s even realistic to steal heels. Did they also take large items like electronics, furniture, and clothing?

The insurance company doesn’t charge you with fraud; the city, county, or state attorney would charge you with fraud.
June 1st, 2012 at 5:16 am #Mayra

I was in the living room drinking with my friend and they were in the bedroom they jumped in through a window I didn’t hear anything I live on a partment complex i figures the noise came from the outside so once i realized that there was someone in my bedroom I tried opening the door and they had barakated the door with some luggageI had in there and I push the door hard and ended up seeing 2 people crawling out of my window… Then i realized all the stuff they had took which oviously wasnt electronics because they only went as far as the bedroom… And yes i understand that the court system is the one who charges you with fraud but my questions is hiw does this wholr entire process goes from here do i just get my claim denied or apprived do they take further action if its denied??? Or not unless you pursue the case once its denied that they could take u to court???
June 1st, 2012 at 5:53 am #Mayra

And in addition to the heels they took clothing, purses and jewelry… they might have been there for a hour or so and this was the guest bedroom where i normally put my stuff at because of the closet space… I saw the burglars crawling out of my window it was a boy and a girl and i also did a police report and gave the police a description of them….this past month and half there has been so many break inns in this apartment complex and around this area and this is suppose to be the good side of town… like i said since i don’t have any receipts or records of my purchases just some pictures and letters forms friends i just wanna know what the next step would be…. i have never gone through this so i don’t know what are the following steps for a situation like this
June 1st, 2012 at 7:38 am #Jason

Mayra,
This is odd. Jewelry doesn’t take up a lot of space and you had your jewelry in the guest bedroom rather than the bedroom where you get ready for the day?

We can’t imagine thieves taking clothing unless the thieves know you and what kind of clothing you have. Used clothing isn’t on the top of the list for items to steal.

Another odd thing is that this boy and girl knew to gain access to the guest bedroom rather than your main bedroom to take these items.

Somethings may stand out to the insurance company such as the value of the heels when most heels cost less than $100. High priced heels are in the range of $200-$300, and christian louboutin or Charlotte Olympia heels would be over $1000 in price. If you have expensive heels, there will be receipts available, even if you got the heels as a gift.

Generally a fraud or fraud charges will be initiated after the claim is fully investigated. If you are concerned about criminal charges, you should be talking to a lawyer, not us.
June 1st, 2012 at 5:53 pm #Mayra

lol yea the funny thing is that most people don’t have all of there stuff in the same place…. and yea obviously these thieves like i said didn’t get passed the bedroom at all or else im sure they would have took other things…. what i think is some one probably followed me and my friend home from being out and did this or its people who have been watching my husband and i for a while…… and like i said i don’t know who these people are and the reason for me to ask about fraud is because as i clearly stated in the other paragraph i don’t know this process and i looked up the process online and found out where people would say that companies tend to deny claims for the simple reason of not having receipts and i don’t keep receipts…. im not worried about fraud i just wanted to know the process about claims and what happens next since i haven’t been informed of anything or how long it takes after a private investigator comes to your house .. Sometimes people get on sites like this just to get questions answered from “experts” like you but end up getting not much

but thanks for your time and the help you provided me with…
June 15th, 2012 at 11:24 am #Clarke

Hello,

Can anyone help me….Last month my little boy caught the cable to the Projector and DVD Player on his leg and knocked them both to the ground….I tried them immediately and the Porjector did not go on and the DVD player skipped the movies when I wired it to the tv.

DVD was 3 months old and the projector a couple of years old….2nd hand but expensive.

After Insurance Collected the Items they are now saying both items suffered Component Failure “Not Consistent with an Impact Fall” Both myslef and my wife take this as an insult as they are almost calling us liars.

I have since asked for A/Copy of the Report B/ Asked for full explanation and have contacted a third party appliance tester and they say that it is pretty impossible to tell one way or another if no signs of impact on the machine. As the Component has failed then that is what they claim to get out of paying out.

I am thinking of the FOS and or Legal Action?

Any suggestions on what and where to go next?

Thanks in Advance for any help.
June 15th, 2012 at 11:41 am #Jason

If they determined the result of failure is not impact damage, then that will be difficult to overcome.
June 15th, 2012 at 12:03 pm #Clarke

Thanks Jason,

But as you can imagine myself, Wife and Daughter watched them Fall after watching them nightly for long enough before the fall then they don’t work after the fall….Sounds pretty straightforward to me.

The Impact Damage is difficult to prove unless there are signs of impact on the casing or the centre, also usually the core components on these appliances are apparently fairly well rooted towards the centre of the unit again for protection….but this is irrelevant as we know the impact damaged them to the point of Component Failure (Optical Block Failure or Needing Replaced). I know that this may well be the case but the fact is the lamp more than likely went with Mirror Plates Etc…It was an older Sony Model..

I dont think they are interested and will try and get out if they can possibly manage to.

Thanks Anyway
June 15th, 2012 at 7:27 pm #Jason

Clarke,
It sounds straight forward to me too. Perhaps you can talk to the claims adjuster and offer to provide an affidavit or affidavits from your wife, you, and your child that the items worked prior to when the items fell and then after the items fell, they didn’t work. The affidavits can be as simple as your statement of events concerning the damage that you then sign in front of a notary pubic.

What it amounts to is a long dragged out effort legally if you sue them. They will have a lawyer that will try to win at all costs and they have the money to pay for the attorney and their experts.

Try to work with them about this. Also, if you are inclined, ask for the items back so you can have your expert inspect them to determine failure so you have another opinion.

List the name of the insurance company so we all know what company is doing this to you. Thanks.
July 18th, 2012 at 6:35 pm #Tasha Houston

I have a question What happens if a suit is being filed against and insurance company for wrongfully denying a claim and punitive damages are being sought and the home goes into foreclosure before the suit is settled will the punitive damages be paid and not the claim to repair the home just curious
July 18th, 2012 at 8:02 pm #Jason

Tasha,
Do not ever, ever count on winning a wrongful denial. And more importantly, don’t even think about winning a punitive damage award because those are more rare than an unopened can of coca cola with a live rabbit living in it.
July 19th, 2012 at 4:21 pm #Moderator1

Tasha,

Regarding punitive damages and litigation, for a more detailed explanation, see Jason’s and Admin’s comments on this page on January 2, 2012 regarding the Supreme court case Campbell vs State Farm, which essentially eliminated punitive damages as a deterrent to unfair claims handling by certain bad boy insurers.
July 19th, 2012 at 8:08 pm #Moderator1

Tasha,

One more thing. Greatest respect to Jason, and we all have our own opinions, but I myself think you can win a wrongful denial … IF … you can get a judge who cannot be “influenced” outside of the courtroom. Most of the news on corrupt judges is buried, if it makes it at all to the media.
July 19th, 2012 at 9:23 pm #Jason

moderator1,
Judges are influence by everything around them including what they ate that morning for breakfast. They are influenced by keeping the big players happy and not causing a disturbance with people with power. Insurance companies have power – a lot of it. You don’t want to mess with power because that power influences the judges. If you do want to try to mess with it, prepare for a losing outcome.
July 19th, 2012 at 9:30 pm #Moderator1

Jason,

Well said. I could not agree more.
July 20th, 2012 at 3:13 pm #Toni

GEICO denied claim – reasons; vehicle was not operable during the time it was stolen (vehicle was not driven to and from your sister’s residence about 40minutes from my home) and that auto damage adjuster’s inspection determined that there was no oil in the vehicle and it had dried underneath, indicating the vehicle had not been driven prior to the reported loss.

Additional notes: My car was recovered about 20-25 minutes from my sisters house on fire (GEICO stated they were not investigating that part, but only investigating if my car was operable prior to it being stolen). I was on medical leave one month prior to vehicle being stolen. I provided documents (work in DC and they have ParkMobile – parking invoices from ParkMobile from Oct. 2011 – March 23, 2012 – tag#) and medical slips (March 30th – June 2012). so of course my car was not barely moved during that time (foot broken). Vehicle was paid off 3 years prior to calim
July 20th, 2012 at 4:55 pm #Jason

Toni,
Is there something you have questions about or are you just sharing your experience?
July 20th, 2012 at 11:29 pm #toni

Sorry. My question(s): can I appeal and to who? Does this sound like I need to get legal reprsentation? Is this insurance denial valid
July 21st, 2012 at 7:42 am #Jason

Toni,
We don’t know much about your situation. A denial is valid but it can be challenged. Sure you would need a lawyer for this.
July 30th, 2012 at 10:01 am #Angela

I recently had a fire out on my back deck at my current residence that is a rental.
The current claim after over a month is being denied because apparently my address was “not updated”. According to their records my previous address is still on file. (I have not lived at that address for 7 months) I am certain that I did update my address as it is required to have renter insurance on the current lease I am on and of course have beenmaing my payments.
Progressive is now stating they are pulling phone records to see if I did update my address, but will not give a time frame on when they will close the investigation. It has now been over 2 weeks since they have started this phone record investigation and the current home owner is threatening to sue me for the damages because they do not want to put the damages through their own insurance because they do not want to have their rates go up.
Please help! How do I make Progressive hurry this process? They are refusing to update us on the process and are also refusing to give us a time frame.

Angela
July 30th, 2012 at 11:06 am #Jason

Angela,
Let progressive do what they have to do. Who cares if the landlord has to file under his insurance? That is what he has insurance for.
July 30th, 2012 at 2:23 pm #Jim

My work van got broke into at my home and all of my personal tools were stolen, as well as some company tools and items. Work told me i had to file a homeowners claim for my tools but it was denied cause they said i use the tools to make money, is there any way to fight this or would it be a waste of my time and money.
July 30th, 2012 at 8:06 pm #Jason

Jim,
Work tools and equipment would require a separate coverage – similar to contractor’s equipment coverage. There are a number of different names for this kind of coverage.

Your homeowner insurance is designed to provide coverage for personal property and is usually insured any where in the world. Please note the catch all word – “personal” and not business property.

You have to determine if you want to fight it but it’s not something we would recommend.
August 1st, 2012 at 6:21 pm #Annette

STATE FARM INSURANCE CLAIM DENIED

We have had a policy with State Farm to insure our boat for up to $13k for 14 years. No prior claims and all premiums paid as asked. The policy has traveled with us as we relocated for our careers across three different insurance agents.

My current agent of 4 years, has never taken the time to meet me or even talk to me on the phone. I recall his assistant calling me to validate policies when we transferred to our current community four years ago.

Recently, we advised the agent that we had an unfortunate accident with the boat with $4k to $6k in property damage. (no one was hurt). Upon the first phone call to the assistant, I was told, “No problem, you are insured for up to $13k. Simply take the boat to the marine shop and get us the repair estimate.”

We did just that. The claims adjuster and the agent later notified us that the claim was denied.

Apparently the policy notes coverage for a 115 hp motor, and we have a 150 hp motor. Thus, their conclusion was they would not cover the motor at all. (the most expensive part of the repairs, of course)

We always simply made sure the dollor coverage was sufficient and upon transferring policies to the latest agent, I know we confirmed that the dollar coverage was sufficient (coverage was $13k and the boat value is $8-10k). So apparently, three agents and 14 years later no one caught the 115 vs 150 typo or mis-communication. You can imagine how easy it would be to confuse a phone conversation for 115 vs 150, right?

The agent also indicated that neither our homeowners policy for personal property nor our umbrella policy would cover the claim either.

We asked for a face to face meeting with the agent, and were denied any scheduled meeting time.

We are pretty frustrated. Does anyone have suggestions for our next steps?
A
August 7th, 2012 at 2:35 pm #Sparkle

Test. Could not submit?.
August 23rd, 2012 at 11:04 am #Jon askew

Need help. While on vacation we had a main water line burst. Our house is on a concrete slab. The breakage was under the slab. They had to tear out carpet and dig through foundation to get to break and fix. Allstate has denied my claim because they state that they do not cover anything below the concrete. This is not considered a part of the dwelling. I have filed a report with dept of ins in Indiana and they received the same information from them. I have spoken to another adjuster from state farm and he states that this should be covered because of damage that was done to get to break. The cost of fixing the break, the pipe itself, isn’t covered. Please help me to figure out how to reword a rebuttals letter back to dept of insurance. If there are court cases that prove that your main water line in your foundation is part of dwelling that would be great. Any advice would be much appreciated.
August 23rd, 2012 at 1:03 pm #Jason

John,
When you submit a claim, the insurance company needs to conduct an investigation to determine if the damage to the pipe is covered. In order to determine if the pipe rupture was caused by a covered cause of loss, they have to dig down to examine the pipe. They also need to restore the part of your home that they disturbed to examine the pipe. Most times, pipes that break under a slab are not caused by a covered cause of loss.

The necessary tear-out and fixing of the tear out should be part of the investigative cost even if the pipe break is not covered.

However, court ruling similar to this seem to indicate that the demolition of the floor and reconstruction of the floor to gain access are not covered:

http://www.paed.uscourts.gov/documents/opinions/07D0562P.pdf

You may be able to find case law that is different from this and you may want to find that case law in your state. An attorney would be the best to find this information for you because they have access to search engines that can look for key words to that end.
August 23rd, 2012 at 4:52 pm #elaine

HI-
We recenlty had a water leak under the bathroom sink. When I reported the claim to my insurance company, I explained to the agent that this wood could no longer be obtained (we tried previously). The insurance agent, advised that the entire wood floor wougld be replaced as long as it was a continous floor without any breaks or door thresholds.

The wood goes down the hall way, into the foyer and into my entire family room. At the end of the hall is a door (between the hall and the entrance), it seperates the bedroom area from the entrance. The adjuster came out and advised that the insurance company will only replace the wood in the hall, because the door at the end of the hall is considered a “break” in the flooring like a threshold. He stated that they will replace the wood and a threshold would be added where the door is located. I don’t want a threshold at the end of my hallway. Do I have any recourse?
August 23rd, 2012 at 5:09 pm #elaine -cont'd

sorry-one other thing that I don’t like about the adjuster’s purposal: by replacing the wood only in the hallway, I will have a different type of wood, color and pattern in the hallway than in the other parts of the house. Again, do I have any recourse?

thank you for your time
August 23rd, 2012 at 5:33 pm #Jason

Elaine,
I’m surprised the adjuster is not considering a break of the flooring at the bathroom door. Wood naturally is not a matching product because each piece of wood is different from the next. There technically is no such thing as matching wood. The insurance company covers direct damage and does things that a reasonable homeowner would do with their repairs had their not been any insurance.

If there wasn’t insurance, would you be ripping out all the undamaged wood in the family room if you had to pay for it?

It’s likely if you complained enough about having mis-matching wood in your house, they would cave and provide all of it for you.

I’m not a big proponent of complaining but it probably will get all of your floor replaced if that is actually what you insist upon.
August 25th, 2012 at 7:42 am #James Seaborn

While my adult son was in the hospital for two months I accepted help from two strangers who wiped out my sons collections and storgages totaling somehere between $140,000-$160,000. out of pocket. I have only been able to find an estimated $25,000 to $27,000 worth of receipts so far. I went through 11 hours at an EUO and they are coming back next month to take my son’s statement. But I am wondering if I am just wasting my son’s money paying an attorney $175.00 an hour if he is just going to denied anyway and cannot afford to fight this in court. He has already sold off so much to pay just $2,000 to date and this is not looking promising despite an overwhelming (about six thick of paperwork) amount of evidence regarding his propery and claim. He is now living in SSID and cannot continue to afford to pay for something that is not going to be productive anyway if what I am reading here is true. Any advice? I am so angry as I have M.S. and I was home bedridden when all of his things were being wiped out. Is there anything I can do to help him? I am on SSI and do not have funds to help him.

Would it be better to invest in ads on search engines to shame this insurance compant than throw money at a claim that is just goint to be denied? I don’t want them to get away with this as my son lost over $300,000 in current value and his insuance only covers $125,000 with a $5,000 deductable for personal property.

One of the men is in prison. But he plead to a lesser charge. I could use any help I can get as I feel so bad my son lost his retirement collection on my watch.

(Links and email addresses are not posted in comments – moderator)
August 25th, 2012 at 11:47 am #Jason

James,
We don’t know what you are talking about.
August 30th, 2012 at 8:21 am #Louis

I had someone tell me that they know of a person who sustained property damage from a fire in a single family dwelling,their insurance company denied claim,citing a non working smoke alarm system.I could see this as a escape clause for personal injury,but property?

Remember folks that you certify you have a working smoke alarm system to enjoy some sort of discount,for them to stick it to you for a 9 volt battery.Boy is it getting ugly out there!

To your knowledge is this common practice? I know denying claims is!
August 30th, 2012 at 8:33 am #Jason

Louis,
You heard this from a person who heard it from another person. That is at least two bouts of hearsay that this information traveled through. We don’t address hearsay on this forum.

Unsupported statements such as, “I know denying claims is (common practice)!” seems to be either a personal perception you have or is based upon more hearsay.
October 7th, 2012 at 12:51 pm #Stephen

My father had paid into life insurance for many years and just recently passed away and his life insurance company is denying his life insurance because they said that he did not declare he was diagnosed with COPD 2 years before he getting the the policy. Even though he did say he was a long time smoker. They have sent back all his payments and denying payment of the benefits he thought he was paying for. Is there anything that can be done. Knowing my father, had a smokers cough for 30 years but never went to the doctors until later in life, so knowing him he thought it was nothing, which is why he did not report it to the insurance company. What should we do?
October 7th, 2012 at 1:44 pm #Jason

Stephen,
Untruthfulness on a life insurance contract allows the insurance company to void the contract. There is nothing you can do.
October 19th, 2012 at 3:31 pm #kim

On December 24, 2011 (christmas eve) after leaving work I was involved in a head on collision by a hit and run drunk driver, the police made a report on the scene and a tow truck removed my car from the premises to a impound yard.

Due to the holiday season and lots of places were closed I decided to use the insurance company’s preferred shop a Cadillac dealership (one of many mistakes), I have a 2003 mercedes benz with 64,000 miles and is (was) excellent condition. Three(3) days later the shop had my car towed to them for the repairs.

My car was kept for 26 days, and when released back to me I noticed my things wrong, noise coming from the front end, headlights not working properly, car felt as though it was shifting improperly on acceleration, it slipped twice, I returned it back the shop within 30 mins, and was told to return it back Monday, this was a Friday. I returned my car back and was given a rental car by the preferred shop. My car was kept for 3 weeks I was told the didn’t find anything wrong with the transmission, or my other concerns. Even though I knew better, I had taken my car to MB for a paid for by me inspection, the insurance had sent the adjuster to MB, and was told the transmission symptoms that I described could “not be duplicated” meaning it didnt show up on the computer. The adjuster told me that nothing was wrong with my transmission and to take the car back to their preferred shop because other body work issues were discovered. The shop says that my “air flow mass sensor” was the culpit not the transmission. I asked for written denial and explanation, and never received one not in 3, 5, 15 or even 45 days not even to this day I haven’t The shop manager and the adjuster told me if another shop touches my car I void the warranty work, I felt sick to my stomach having to be forced with this shop, my car has been in the shop for supplemental work for some part of every month since the accident almost a year ago! In July of this year my head light goes out yet again, only the 5th time, but this time I’m pulled over by the police, I explained my problems, the officer tapped the head lamp and it did come on, and gave me a warning, he also gave me a bit of good advice and that I DID NOT HAVE USE THE PREFERRED SHOP, and to call the insurance adjuster back letting them know to come back out and insist on using the shop of my choice, if repairs are authorized.

The adjuster had come back out and this time I insisted on a new adjuster, a new one was sent and my car was finally authorized for the noise diagnosised by MB in March when the org. adjuster had come out, I was told I had to give permission to have the transmission torn down for inspection, and guess what? It’s the transmission, my mechanic says it is completely shot, and the damage is extensive and indictive to either “drag racing” or improper towing”, I’m a 50 year old woman with not as much as 1 traffic ticket in over 25 years, my car does not have any modified engine work, nor has it ever, I never in my life dragged raced! Now the adjuster is saying the transmission is shot due to poor maintance! There were no leaks, on any of my transmission lines just the inside componets, MB requrie trans fluid on 100,000 miles, I have 64,000 miles. The adjuster also told me “good luck in determining which tow truck driver towed it wrong and that I have to sue them! Any advice would be helpful, my car is disassembled at the shop and the cost of repair is $3,800 and I have no idea how I’m going to pay for it after coming from battling breast cancer 2 years ago.

Please assist with any suggestions
October 19th, 2012 at 3:39 pm #kim

I forgot to add after the denial yesterday for the transmission, I called the insurance company about the trans being damaged by the towing and was given a 2nd claim number for this.
October 19th, 2012 at 5:38 pm #Jason

Kim,
The cop gave you some good advice. Taking a mercedes to a cadillac shop is the biggest mistake any mercede’s owner should know about.

With the towing and your transmission, that is a completely different and separate occurrence from the accident. A different claim number seems appropriate.

We have no suggestions for you. The issues seem to all be related to an unqualified repairer working on your car.
October 19th, 2012 at 6:16 pm #kim

Thanks Jason,
May I kindly ask you another question if you don’t mind? Who’s liable the towing company whichever one that may be out of the two? or the insurance company? I did call a attorney who told me it’s “foreseeable damage” and not my responsibility to figure which tow company improperly towed my vehicle.
October 19th, 2012 at 6:55 pm #Jason

Kim,
A towing company is not liable for the damage to your transmission. The person that found the damage to the transmission said could be due to drag racing or being towed improperly. That sounds like a wide difference of the type of damage he is apparently describing. For any towing company to be liable, it would have to be proven that the towing company did the damage. Proving something as vague as that is nearly impossible.

You might want to have that attorney explain foreseeable damage to you in lay man’s terms so you can clearly see that he is blowing smoke by using a careless term like that. Look up the legal definition so you know what we’re talking about.
November 10th, 2012 at 2:08 am #Frustrated

There was a fire 2 doors down from me at 2am on Monday the 15th of October. There is only one hall. All 10 apartments are connected by that hall. 5 apartments on each side. All apartments are split level with living room and kitchen downstairs and bedroom and bathroom upstairs. The upstairs is like a loft and has a rail 2 feet from the outside wall. So you can stand and look down into the living room. The hall was full of smoke by the time fire department came. There was also smoke in my apartment by the time I got out of there. The door to my place was jammed open for a while, can only guess it was from the fire department double checking. It eventually got closed again. None of the doors to the hall are sealed so everything gets in anyways. A meth lab was found in the area of the fire. We had been let in after the fire was out and the smoke was fanned out of the hall. A few hours later we were all evacuated again because of the lab. No one was told what was going on other than that “bad stuff” had been found when the search warrant was executed. No one was deconed and we were allowed to take stuff out. I had a new rash, felt like my skin was on fire and felt like I was breathing fire. Drug task force guy said to get checked out but not why. Hours later the local papers web site posted “meth lab incident”. When I went to dr we did not know for sure it was meth. We knew it was drugs and I suspected meth but not the lab. Biohazard suits where every gap is taped shut should have given that one away. I should have known from all the emergency response training I have had and from the medical training I have had but my head was really messed up and my memory sucked that day. Dr said she could smell “it” on me, after indicating that she suspected it was meth. She washed her hands right away after looking at the rash. She told me to basically decon. Shower, don’t touch the clothes, don’t wear any clothes that I brought out of the building. Drink lots of water to detox my body. She gave me script for some cream to use on the rash and for any other that I found.
Went shopping, my mom got me some clothes and I went to my uncles to shower. Stripping what I could off before going in because I didn’t want the animals in the house coming into contact with whatever was on me from the fire.
Went to insurance agent. She gave me an advance and said that was the beginning of my claim. I bought what I needed since I was told not to use what I brought out. Building was locked up for 4 days. Testing was done the day after the fire, tues 10/16. The police had taken out at least 10 bags of stuff. It was all sitting in a pile in front of the building where a cop was posted.
Test results were back on Friday 10/19. No one could show me the actual results for my place. I was told they were negative for meth. .002 is what came up. There were 5 test spots marked in the hall. The health dept sign was moved to the ply wood covering layers of thick plastic and the door to the apt that burnt. We were told that all test areas would be marked. I went through my place looking. The hall stunk like chemicals when my mom and I walked into it. It had not been aired out at all. We drove by everyday to check and make sure the windows to my place were not busted in as two strips windows start at ground level and go to the roof and the apartments are located in the area of down town. With all the drug activity in the area, it was actually surprising that none of the windows were broken.
So the hall smelled of chemicals. My apartment did as well. I could also smell burnt plastic and the smoke upstairs. Downstairs just smelt like chemicals. The air burnt my skin and it was hard to breath in there. I found no test marks at all. It was getting harder to breath so I got out of there.
Called the manager but he had no idea why the test marks were not up. Was told health dept had the results. Went there the following Monday to get them, only to find that she had not seen them and that she was going by what the contractor had said. He also said he was not in the building with out a suit on, he was. We were over there at the local salvation army store while he was there and watched him go in and out with out a suit on. Even asked if he didn’t have to wear one and he shrugged it off.
Talked to insurance guy on 15, who talked me into staying at a hotel instead of couch surfing. Figured they would put me at a cheap place in town. Was told my stuff would get cleaned or replaced. Went with the hotel thing. Talked with the various insurance people through out those 4 days as no one could get in building with out a biohazard suit on. On the 19th I did talk to the actual adjuster, whose not even in this state. He told me to stay where they put me, 8 miles out of town and a 20 minute drive away (30 if I was going to my apt), until they got in there and looked around and he said he had extended me til the next week. Ummm ok. So the guy going in to look don’t get back to me until late on Monday 10/21. We meet at my apt 10/22. I don’t go in because of how bad I reacted to it the last time. The farthest I went was to pick up my mail. I went around to the front door and went in and got it and got right out. Rash was back in just that little bit of contact and my breathing was worse again. The hall still stunk of chemical. The guy came out and said he couldn’t smell anything in the apartment and the test came back negative for meth, only meth was tested for none of the chemicals taken out, and that they would prob pay for hotel and that would be it. All he would talk about was the meth. Not the smoke. A neighbor stopped and talked and said he wasn’t “sick” but the dude is a bit slow. He described the black stuff he washed off his wall after he got back in. He thought that was the test markings. The insurance guy said that he would call me and meet me the next day 10/23 because they were suppose to fax him the test results. He knew I was not available til afternoon and said he would call in the afternoon. After the insurence guy left, the neighbor said he was tired but said that it was from work. He did not look good and was more forgetful than normal. He also said to keep fighting to get the building cleaned, as nothing in the building outside the apt that burnt was going to get cleaning. At that point the glass was still on the floor in the main hall.
The insurence guy did not call on 10/23 at all. I went to my dr that day because I still couldn’t breath. I was given a note by the dr saying, “I suggest that you stay out of your apartment complex at this stage as you appear to be allergic to the smells you are exposed to.” Ummm again ok. Not thrilling but whatever. I was given an inhaler and told to return if it got worse. I called the adjuster right away asking what I could do and started looking for an apartment because I knew that they were not going to clean it at all and all the floors, including the hall are carpet, except kitchens and bathrooms. I left a message for the adjuster upon getting his voice mail. He never called me back that day.
10/24 The guy who was suppose to meet me called early in the morning. Said that he mailed the test results to me at the apartment and that he faxed a copy to my agent and I could pick them up there. That evening the adjuster called. He said that the guy in town said that he could smell nothing in my apartment or the hall and that there was no damage. I asked how it was suppose to get my stuff cleaned up, he said they were paying hotel and nothing more and hung up on me. Then the collection department for them called wanting my $500 deductible. I played phone tag with them the rest of the day. Packed my stuff and went back to town.
Went to the store, got a bandana and went to apt to check it out. Actually took time to look around this time. Took pictures of the test spots, and also of the claimed test spots that I could. There were ones that were claimed to have been done in the hall that were not marked. Only one test came back positive and that was the apt right next to me. All the test spots were low, on rough and/or porous surfaces. None actually matched the suggested test standards. I look around my place. There was a powdery substance on everything, some was oily and dark, while others were a very fine powder I had not seen before. My white comfortor was yellowed as were the walls. The upstairs smelt like burnt plastic and smoke to me despite the fact that the window had been opened up there since before the fire started. There was a very acidic odor downstairs. My nose was on fire even though it was covered under layers of the bandana. My eyes also burnt and it felt like I was breathing fire every time I inhaled. So I left before I could take very many pictures. The stuff covering my things was not the normal dust. I did get some pictures of that. I was just finishing up cleaning my apt when the fire started. So everything had been wiped down/dusted before the fire.
I found another apartment and did the paper work for that. I had taken my computer out. Every time I turned it on and used it my hands turned bright read and burned, as did my eyes and face. The computer is a lap top and has been running super hot since the fire even with a new duel cooling fan under it. Currently I am borrowing a computer as I don’t want mine to burn up.
My mom went to my building for a meeting with health dept and property manager. She never went in my apt and was in the hall for 10-15 minutes. That night she had to go to ER where they found a spot on her lung. Did a CT and ruled out cancer and blood clots and everything else. Gave her a lot of meds. The diagnosis was broncho spasms from chemical exposure. I had gone with her. I should have been going though myself because I still couldn’t breath. I held her jacket and ended up with a burning hot rash from it. Turns out that she had worn it in there. Also was told that the place still smelled of chemical. Her jacket didn’t and I had no idea that she even wore that in there. Just felt something burning my arm and there was a rash. Anyways, so my breathing had not improved. I had been spending a lot of time on my hot computer with that fan blowing up through it; went to dr. told to stay out of building again. Was put on steroids for a week. Felt better for a while but then went off the steroids and couldn’t breath again. Did not go back to dr because I always feel like an idiot going in when I don’t think there is a lot that can be done. I was doing everything they would tell me to do. Staying out of building. Avoiding contact with items from it, other than the computer. I had cleaned the outside of it many times hoping that would help. On the borrowed laptop my hands are not reacting and I am not burning up from it. Breathing is even way better.
The insurence collection dept did not call for a whole week. I had returned their call but had heard nothing. They called on 11/2 to tell me that I owed the whole hotel bill plus my deductible. Called 11/3 with similar message. They called called 11/5 to tell me that I owed over $1200 and that they were sending a bill and if it was not paid within two weeks they would send it to collections. Talked to them, only to find out that it was sent to the apt. and that I had until 11/19 to pay it. That was not even a full two weeks away, counting mailing and actually receiving it.
Got a new apt. Had to file court papers to get out of 60 day notice requirement and penalty. It was settled outside of court, the day before the court date because the owners did not want to go to court and told the management company to fix it. Told my agent I was moving and what was happening. I am paying a couple people to pack it up and move it to storage until I figure out what to do with it. I can’t use it, don’t really have the money to clean it and really don’t know what to do any more. I haven’t got anything more from insurance or heard any more from them since talking to my agent. At this point I am still couch surfing and going to be moving in with my bag of clothes that I picked up that did not come out of there, a chair from a thrift store, a few blankets and some new food. Have driven by my old apt a few times. No one is really ever home like they use to be. All the windows have a yellow tinge to them. The curtains are all yellow too. The burnt apt is still sealed and boarded up. There was a break in the basement over the last week. The only way in or out is by using a key or someone leaving the one and only entrance/exit open just a bit. The washer and dryer were both broke and badly beaten. They never did get the coins out, which in a good month generates maybe $15. All the locks had been cut off the storage units down there as well. Including mine. I can’t tell with out being able to go through everything, if anything is missing because I had just reorganized at the end of Sept. Its like a never ending parade of bad things lately.
Dropped drs note at agents office. She said she would fax it to the adjuster. There was nothing in her system saying that it was closed and that they were not paying. I had asked for a written denial and an appeal form. She did not give me either. Told her the dude had hung up on me. That I had to pay people to go in and pack my stuff up and that I had to pay to put it in storage until it got cleaned. I seriously can’t believe the dude couldn’t smell anything at all. Even the building inspector went in and smelled for me. He said there was a definite chemical odor in the hall. I have been in contact with the state health dept cause the women at the county who is handling it, couldn’t answer any question I had. She had more concern that the dude was in with out the suit on, than the actual testing methods used/test location/ surface texture. They had been cooking for 4 months. We had all smelled it and all complained to management who told us to call him. Never once did he say to call the police. State is looking into it. My issue was that it said to exclude a portion that it had to “be free of chemical stains or odors.” Plus the one test was positive and most test areas were not marked. Leaving the test areas marked would not have caused any more harm than leaving the 5 that were still marked up.
Insurance, the very last I talked to the adjuster before he hung up. Told me test was clean and health dept cleared it. So it was safe and clean. Because the word meth is in there and corners were cut, no one wants to touch it. There are 8 other units of people in there still, no one but one seems to ever be there much any more. Local health dept had no idea as to what other chemicals were involved or what was taken out. She started trying to find out after I emailed her telling her that meth wasn’t the only issue there. According to her though, nothing needs cleaning because its all clean because those few spots, except the one, were all .002. I read that and emailed meth labs 101. Seriously. I am still sick from being in there. But getting loads better. Still running into the issue of burning skin but not half as much as I was using my lap top. Breathing is loads better. I would love to find out which chemical or chemicals it is that I am reacting to though. They never tested pluming or air quality in there. I and one other person were the only ones with insurance. Different companies though. Don’t know what hers is doing. The rest had no choice but to go back in because the help for a place to stay ran out when they opened it. No one wants to help them because their place is clean and safe even though the RN putting them there has no idea what went through. After all, the fire was contained to one unit, and even though the paper even said the smoke was in the main hall, it is perfectly safe. And because she says that the insurence is behind her. I am beyond frestrated. In another state a meth lab went boom and the authorities issued a warning that anyone in the area at that time should wash their clothes and shoes before even going in their house so that they would not contaminate it. Here, we throw everyone back into the building and call it clean and safe. It was only a meth lab found in the area of the fire which also burnt carpet, part of a couch, the plastic curtains, the bed on the second level, the screen out of the window upstairs and down and it burnt who knows what else or other chemicals. Plus whatever was there from previous drug activity over the last 4 months that made a few of us sick but in a different even less enjoyable way. How the insurance can claim no damage is beyond me. The dude they sent wasn’t even in there very long. I am frustrated and out of ideas on what to do any more even. I don’t have a copy of my insurance cause its in the fire proof safe in the apartment that I can’t go into. In the future it will be in a location outside the apartment, as will an inventory of everything I own. Lesson learned. At least I can put rubber gloves on and go through the stuff after it is out. Would love to take my clothes that smell of smoke and my leather jacket that stinks into the insurance office and see if they can “smell” it. Would love to move my 10 inch futon mattress that I had got on sale two months earlier in there for them for a while. Stupid things back up to full price and out of my price range. Just like the vacuum and ac that I got as early bday presents. Neither are below $150 in value. And all less than 4 months old. Doubt they would make an exchange on it at this point. Even more frustrating is the fact that the couple that rented the place, have yet to be caught. They went to ER for smoke inhalation, went to the cable company and said their cable box burnt up and were seen at the local Walmart. Yet the police have yet to locate them. ERRRRR….. Seriously.
November 10th, 2012 at 3:11 am #Frustrated

That was suppose to be .02 not .002. I have full replacement up to like $25000 plus some riders or something for the electronics. The insurance is state farm. The claim was never meth. It was the smoke cause everything is covered in its stinky ick and I can’t touch it. Service master don’t even want to go in the building and only gave a ball park estimate of $5,000 -$7000 for my things alone. There is a thing for the state on what can be kept and what has to go. Mattresses are suppose to be tested and then still need to be approved (when there is not a fire). Still not sure how the dude smelled nothing and saw nothing. Funny how fast their collection dept starts calling even though, their denial of it is not in their computer. My agent was clueless and was like, well I told you would have to give back your deposit. And it was like wait a minute. It is not over. I signed nothing. I am losing a ton of money here because state farm wasn’t there. They are just like the idiots that caused the issue in the first place. They are all nice and helpful at first and then try to burn down the stupid building and cost you even more money. Is there any reason to even bother putting renters insurance on my stuff? Cause now its already damaged and not going in my new place. Leaving the stink in climate controlled glory for an extra amount a month until its cleaned or thrown. Not like they are leaving me any choice.
November 10th, 2012 at 5:10 am #Susan Schneider

Can you tell me how I might find out if ALE includes costs incurred for pet boarding/pet care while I’m out of my home and if extra travel expenses (gas for the car) are covered for the additional miles I have to travel to return to my home from the place where I have to reside until repairs are completed in order to check my mail and check on progress in my home, etc.? Thank you!
November 10th, 2012 at 6:39 am #Jason

Frustrated,
Although your claim was never meth, it was checked out and was actually meth/chemicals. And meth and/or chemicals does not appear to be a covered cause of loss. It’s entirely up to you if you want to carry renters insurance.
November 10th, 2012 at 6:41 am #Jason

Susan,
Yes, contact your insurance adjuster and ask the specific questions about ALE that you have.
November 10th, 2012 at 6:53 am #Susan Schneider

Thank you for your answer, Jason. I submitted ALE expenses for several months and was reimbursed for all including the cat boarding and additional travel (gas) expenses. Suddenly, the insurance company says those are not covered expenses although they have already paid for several months of them. How can I determine if I am correct in continuing to make the claim for these expenses or if they are correct in saying they are not covered. If they are not covered expenses, I would question why they paid for them without question for all these months? Now that the expenses are nearing the ALE portion of the policy limits due to delays by the insurance company to pay the contractor to begin the repairs, they suddenly suggest that parts of previously paid ALE expenses are not covered. I have been begging and urging them for months to pay for the repairs so that I can again live in my home. I do not like living away from my home and have warned them that continued delays would cause the ALE to exceed the limits but they continue to delay. I do not understand why the insurance company is willing to pay ALE that would not be necessary if they would simply pay for the repairs. Now, I’m left with expenses I am incurring and they are indicating they are not covered. What is your advice in how to proceed now?
November 10th, 2012 at 7:01 am #Susan Schneider

Thank you for your reply, Jason. The insurance company has paid in full for living expenses including cat boarding/care and travel/gas for several months with no question or indication that these were not covered expenses. Now that the ALE is nearing the policy limit for that portion of the claim due to insurance company delays in paying the contractor for the repairs so that I can move back home, they suddenly declare that these particular expenses are not covered. I have been urging and begging them to simply repair my home so I can live there again. I do not want to live elsewhere. I do not understand the delays and why the insurance company has delayed for so long and paid living expense that would not be necessary if I could simply get my home repaired and move back. I just need to know the definition of ALE and how to determine if these expenses are covered or not. They have just now finally paid in full for the repairs to begin but it will take a little time to have the repairs done and my living expenses will continue and exceed the ALE portion of the policy limits. That seems to be the reason they are suddenly discounting this portion of the ALE for pet care and travel. What is your advice for this situation?
November 10th, 2012 at 7:21 am #Jason

Susan,
Additional living expense means any necessary increase in living expense incurred by you so that your household can maintain its normal standard of living.

The coverage for boarding or pet care is not extra because you are in a different place where you temporarily reside. Your pet(s) will incur boarding/pet care whether you live at location A or location B and is not an extra expense.

You can have your mail forwarded to you at your temporary location so the mileage to retrieve it is not something that will be paid. Expenses for progress checks on your home does not seem like it fits under ALE.

Find out what expenses are covered and not covered as ALE through your adjuster. Bring up any concerns about coverage you have to your agent and read and understand your insurance policy – especially parts of it that apply to your specific current claim.
November 10th, 2012 at 8:10 am #Susan Schneider

Thank you so much for your explanation of ALE. I understand; however, under my normal living expenses I would care for my own cat. I cannot do this in an apartment where I’m being forced to live temporarily as no pets are allowed so I must have someone else care for my cat during this time. This is not my preference by far as I miss my pet terribly and certainly would not pay anyone else to take care of her if I could do it myself at a much lower cost. In fact, I have not even tried to claim the full cost of the care being charged to me, but only a portion that I attribute to the money in excess of what I would normally incur.

In addition, the apartment where I’m forced to live is far away from from my work and church and my normal activities. I would not usually have to pay additional costs in gasoline to go to these places and it seems that should fall under ALE. It is a great inconvenience to me to be so far away from my normal activities, not to mention an increased cost for it. If these costs do not fall under ALE, why would the insurance company have reimbursed these expenses in full for all these months so far?

I have not forwarded my mail because each month, I have been hoping it would surely be the last month I would have to live away from my home. I thought this would be a short term inconvenience, not something that would last for all these months. These seem to me to be increases in my cost of living that I would never incur if I lived in my home, which is certainly my preference and my goal and I am terribly frustrated by the time it is taking the insurance company to pay to even begin the repairs.

Once again, I just cannot understand why the insurance company would pay these particular costs under ALE for a number of months and then suddenly suggest they are not covered when the costs are approaching the policy limit simply due to their delays. Could you kindly address this?
November 10th, 2012 at 9:05 am #Jason

Susan,
It is very likely you are not being forced to live at that apartment. You are the one renting it and the insurance company is paying for it. If that apartment doesn’t allow cats, you should have sought one that did. If you secured an apartment that accepted cats, then there would be no expense to care for your cat.

You can change your forwarding mail by stopping at any post office and re-directing your mail to your temporary location. This can be done immediately to forward and when not needed anymore, to stop the forwarding request.

Each claim is different and it is difficult to comment about specific details without knowing much, much more information, which will be too involved on this forum.

Why did they pay for non-covered items? That was likely paid in error and their actions to stop paying for it is a correction based on coverage upon their review. However, that review may not be accurate and that is difficult to determine with the information you provided.

Discuss your concerns with your adjuster and provide your adjuster with justification why you believe it should be covered. If that should not provide you with acceptable results, contact your agent about your concerns and ask your agent to become involved if you are able to explain to him/her your reasoning that some items should be reimbursed.

Again, read and understand your policy so you can effectively communicate your concerns to support your position of why certain items should be reimbursed. Please note that prior payment of some of these expenses is not justification that it should be reimbursed if they were paid in error. ALE is not a black and white coverage and the insurance company may be basing coverage on their prior handling of claims with other people. You basically have to convince your adjuster that reimbursement you are requesting falls under the parameters for ALE reimbursement.
November 11th, 2012 at 6:34 am #Frustrated

They made it about meth. Meth test in my apt was clean. It has smoke damage which is visible. Smoke from carpet, couch, plastic curtains, bed, and who knows what else are the issue. At least for me. My computer that was in there is over heating and never did before. My tv I don’t even want to try when it gets out cause with my luck the 52 inches would go boom. Now I’m just wishing the whole damn thing woulda burnt. Woulda been a lot easier. My insurence was suppose to return my stuff to the condition it was before the fire that I had nothing to do with. Before the fire I could touch my stuff with out reacting to what ever is on it now. They failed to do that. And only made things worse by turning around and billing me $1200+. When I have to pay for it to get packed out of there and pay for storage cause I can’t bring it to my new place til it is back in the condition it was prior to the fire. Seriously tempted to go drop my clothes that stink of smoke from the smoke and see if the can still deny it. The “chemicals” only made it into my place because of smoke from a hostile fire. The fire was not suppose to be there and it was by no means controlled. Thus the other pollutant clause, if there even is one, us null and void. I was told by the dude that “couldn’t smell anything” that if they, the owners, had not challenged the meth my stuff woulda been fully covered, and either cleaned or replaced. There’s still damage from the smoke which they are totally ignoring.
November 11th, 2012 at 7:37 am #Jason

Frustrated,
They made it about meth because it is about meth. It’s not about fire or smoke. You apparently have chemical residue on your stuff and you want the insurance company to clean off chemicals when that isn’t something covered by insurance.

If you are so convinced that your stuff is covered because of smoke residue on your property, get a public adjuster to assist you in getting your property covered.

You know what’s odd? It’s that you say the meth test was clean. And then several sentences later you say that chemicals made it into your place. You can’t have it both ways. Also, don’t blame meth on your laptop over-heating because if you thought about it, that makes absolutely no sense. Also, you should not be frozen into inaction that your tv will destroy itself when you turn it on because of anything related to this. laptops don’t get hot, and tv’s don’t blow up, because of meth or due to any other drug.
November 11th, 2012 at 7:20 pm #Frustrated

Are you really that stupid? All smoke from a fire is made up of chemicals. That’s why smoke often kills before a fire does. Smoke from a house fire can contain: Carbon monoxide – All organic materials
Hydrogen cyanide – Polyurethane, wool, silk, paper
Acrolein (aldehydes) – Wood, acrylics, cotton, rubber
Nitrogen Dioxide – Cellulose, wood
Ammonia – Nylon, wood, silk, polyurethane
Hydrogen chloride – Polyvinyl chloride (PVC pipes), upholstery
Hydrogen fluoride – Teflon
Hydrogen bromide – Fire retardants
Sulfur dioxide – Rubber
Isocyanates – Polyurethane, wool, silk, paper
Acrylonitrites – Polyurethane, wool, silk, paper
Hydrogen sulfide – Wool, silk, rubber
Benzene – Petroleum-based plastics
Styrene – Polystyrene
Phsogene – Polyvinyl chloride (PVC)
My apt contained low levels of meth, meaning that whatever is in there is from the smoke. I call it chemicals from the smoke cause that is all ash, soot and residue from the smoke is made up of. Between a couch, bed, carpet, plastic curtains, and whatever household chemicals burned, the composition of the chemical makeup of the smoke that came through and the residue that if left behind is a variation of chemicals that mixed while the fire was burning.
As far as electronics, carbon, a main component if smoke, is a conductor. Partials from the fire go every where in the smoke. Into even tiny little holes. They cause electronics to short out or malfunction. As far as a laptop over heating, smoke could have easily gone through it cause it was on and open during the fire and was exposed to the smoke. At the very least it needs cleaning. There is a reason that you’re not suppose to use electronics after a fire. A little research on your part may have made you sound like nothing more than another insurence jackass that works for State Farm. And maybe if you hadn’t slept through your high school science class you may actually understand what smoke is made up of. Idiot. And yes, my policy covers smoke. Being meth test is negative, the issue is the smoke residue left on and in my stuff after the fire. I know that meth don’t smell like burnt plastic, 100% sure plastic burned in there, cause all those stupid plastic curtains the apt manager furnished all apts in building with all burnt in that apt. Hmm but yet you are saying that even though everything upstairs in my apt smells like burnt plastic and smoke its not covered cause the smoke gas chemicals in it and by your brain dead thinking smoke contains zero chemicals if a meth test were clean. Lol. Look it up and maybe put some thought into it next time. You are an idiot.
November 11th, 2012 at 7:30 pm #Jason

Frustrated,
If you want results find a public adjuster to present your claim for you. If you can’t figure that out, there is no other advice that can be given to you.

If you would be part of your local community, you would not have a meth factory in your building for 4 months. We all hold you responsible for what goes on in your building and if this is the result, you let it happen because you let people that lived in your immediate vicinity do this to your entire building.

Like I’ve said before, if you can’t present your claim to the level needed for coverage, hire a public adjuster to assist you. You have absolutely nothing to lose.

Although if you present your claim like you did in here, I am not surprised you were denied. Your denial was likely based on state farm claim representative being irritated with you. Step back and figure out how to better present your claim because the way you have done it has failed.

It is very common for people with bad attitudes get perfectly legitimate claims denied and people’s attitude goes a long way toward the outcome of things.
November 11th, 2012 at 7:47 pm #Jason

Also,
Fire and/or smoke is not needed to transfer the chemicals produce in a meth lab which include, but are not limited, to the following chemicals: methanol, ether, benzene, methylene chloride, trichloroethane, toluene, muriatic acid, sodium hydroxide, table salt, ammonia, anhydrous ammonia, red phosphorous, iodine, and reactive metals.

None of these things are covered by an insurance policy.
November 25th, 2012 at 8:56 pm #Ammend

What is the process for making ammendments to an EUO? How many days do I have to ammend? Any information would be helpful. Thank you very much.
November 26th, 2012 at 6:49 am #Jason

Amend,
There are no amendments to facts and truths that you provided in an EUO. If you change what you said in an EUO, then all the information you provided originally in the entire EUO will be questioned as not being truthful.

If you don’t have an attorney, now is the time to get one.
December 1st, 2012 at 7:13 am #Kelly

This past year I had to switch insurance to try and save some money after my roommate moved out. So I had to switch to a new insurance company in February for my home and auto. In August there was a bad storm with straight line winds that damaged my roof, along with fence and shed. My house is approximately 18 years old and I’ve lived there 8 years. When I had a roofing company come out, they discovered hail damage on my roof as well as the wind damage. So I filed a claim. Well first I was denied and they said it was just repairable and didn’t cover my deductible, but my roofing company sent them over an estimate stating that my roof is not repairable. So they sent another adjuster out for a re-inspection. This time they agreed to some repairs however they said it was still repairable. My roofer again tried talking to them and they sent out an engineer. This time around they decided they would pay for a few more “repairs” but would not replace my roof. They are paying to replace 14 squares when my roof is only 22 squares! Is there anything I can do to get them to total the roof? I have spoke with two other roofing companies who have stated my roof is not repairable it has to be replaced. I’m so disappointed in how insurance companies take your money but never do anything when you actually need it.
December 1st, 2012 at 3:07 pm #Jason

Kelly,
There are 2 adjusters that indicate your roof is repairable. Additionally, there is now an engineer that indicates your roof is repairable.

At this point, the insurance concedes that the damage affects 14 squares and will pay for the removal and replacement of those shingles. They won’t total your roof. If you wanted to total your entire roof besides the 14 squares, you can do that but it would be at your expense for the 8 squares not considered by the insurance.
December 6th, 2012 at 10:46 am #Susan Schneider

My insurance company has finally agreed to pay the last of the claim for the water damage to my condo that happened almost a year ago. In order to receive the final payment they are asking me to sign a release that includes the cancellation of my policy within 30 days. Because my loss was significant (through no fault of mine as stated by the insurance company that I was not negligent and could not have prevented or foreseen the incident), I cannot find another company to provide me coverage. Why can they cancel me for no reason other than asking me to agree to cancellation in order to get the final payment? What advice do you have for me to obtain coverage now? I have never had any claim in my entire 60 years of life and hope to never have such an experience again. Can the insurance company just not renew my policy when it is due for renewal in June if I do not sign this release now? This just seems so unfair and is adding insult to injury.
Another question: If one of my neighbors sues me after the policy cancels, would the insurance company still be responsible to defend me as my current coverage provides? I do not think any neighbors will do this since they have all settled with their own insurance companies, but I think the slim possibility exists and do not know who would be responsible if such a horrible thing were to occur now before the statue of limitations expires for them. What advice do you have for this? Thank you so much!
December 6th, 2012 at 11:32 am #Jason

Susan,
Your insurance company cannot require you to cancel your policy as a condition to receive your final payment for your claim. The only way that can happen is if you allow it to happen. Simply hold your ground that you don’t want to cancel and if they don’t want your business any longer that they will have to non-renew.

It is difficult to believe that you cannot find another company to insure you and that will be dismissed as an over-exaggeration. There are hundreds and hundreds of insurance companies out there that will insure you and your property.

If your neighbors went through their insurance companies, they have given up the option to sue you directly. Let’s just say there is on someone out there that will sue you. All you would need to do is submit that legal paperwork to your insurance company (even if you are no longer insured with them) and they will substitute in your place and defend the law suit or else settle it.

Regarding suit – you would have to be negligent for anybody to successfully sue you over the water damage, and that very likely is not the case unless you did it intentionally, which is also likely not the case.
December 6th, 2012 at 11:41 am #Susan Schneider

Thanks for this advice. It is most helpful and encouraging. I think the chances of a lawsuit are extremely remote, but with my luck I am glad to know that the insurance company would still handle it if need be. That is a huge relief! I will hold my ground not to cancel and then deal with it in June if they fail to renew. Meanwhile, I will continue the search for someone to cover me should I need it in June. I suppose I should try more than the two agents I’ve approached so far. What do you think are the chances they will non-renew?
December 6th, 2012 at 11:50 am #Jason

Susan,
If they are trying to tie the cancellation of your coverage to your final claim payment, the likelihood that you will be non-renewed is certain.
January 7th, 2013 at 10:29 am #Joe A

My grandfather owns a home in which he stays one or two nights a month. On December 13th or 14th he left the home, and either didn’t latch the door tightly or left it open. On December 31st he went back to the home to find several inches of standing water and a couple of freeze breaks. He is elderly, undergoing cancer treatment, and obviously in poor health. Somehow he forgot to pay the insurance and the policy cancelled effective December 29th. He reported the claim immediately. Farmers is obviously denying the claim based on a lapse in coverage, although they have sent an adjuster and requested that a POL and Sworn Statement be sent to them. Is there anything we can do? Should we fill out the POL and Sworn Statement even though it is unlikely they will pay for the damage? The home is small, and the loss is under $30,000. He has been with Farmers for 20+ years with no claims and no late payments. Does asking for a break ever help in these cases, or am I wasting my time? Any advice is appreciated. Thank you.
January 7th, 2013 at 8:54 pm #Jason

Joe,
It seems if he discovered the damage on dec 31st, and your grandfather doesn’t know when the damage occurred, the insurance may rely on the ineffective insurance that started on dec 29th.

There is also another aspect of the policy that requires the property to be heated when it is not occupied. That is not something that can be determined with the information you posted.

The most you can do is submit as much information as you can about the claim and provide the POL and Sworn Statement of Loss as soon as possible and see if a premium payment can be made to make the insurance continous (which will even back-date coverage if that option is available to you.

However, for unknown elements of a claim, the insurance company uses the forms you mentioned to obtain those unknown details which you need to provide to the best of your knowledge.

If you provide those statements and can substantiate the loss occurred within the policy coverage, the insurance company would have to prove that coverage was not available because the damage occurred outside of that time period. The statements give a basis for coverage, if there is coverage; and after submitting those forms, the burden then falls on the insurance company to determine and establish that it did not.

An unknown date of loss is a very grey area and there is no telling what the insurance company will do in this particular case. You may want to get the agent to help you in this effort.

Since this is a recent cancellation, there may be a grace period of time (that can range from 5 days to 30 days) that the premium can be paid to make the coverage continuous, but that is not known for sure with this insurance company. This is a question for the agent and the insurance company and they should help you with that if there is a grace period.
January 17th, 2013 at 4:06 pm #Tammy

Hello,

I’m hoping you can help me. I bought my home in October 2009 and with the house took over a lease for a hot water heater. In March 2011 the city sewer main had a problem and my basement filled with sewage. Insurance did cover most of the loss and it took many months for the work to be done and final payment received in June of 2012. The problem is at the time of the flood the professional restoration and cleaning company and HVAC personnel paid by the insurance company were not able to inspect the water heater because it was a rental. I called the vendor/supplier repeatedly but they would not come. The HVAC person hired by insurance company told me it is probably ok and not to worry about it. I had a problem with my water heater this month and my vendor sold all or part of the business to another company. That company came to service my water heater which was the therma coupler. I asked him to look at the burner. The tank was completely rusted. I told him about the flood and he told me they will replace it without charge, but when I called for a service date for installation they said they will be charging 2,000 plus continuing the contract. I told them about the problem with the inspection and they said yes this is their policy not to come to inspect the equipment and it is up to me to hire a third party and I would have to collect from insurance. My real question is will the insurance company reopen my case or will I have to hold the bag based on my vendor’s negligence? Thanks for any advice you might offer.
January 17th, 2013 at 4:49 pm #Jason

Tammy,
You can call your insurance company and see if they will re-open your claim so they can investigate the water heater condition and determine if anything else should be paid.

The biggest concern I have is why you would want to pay $2000 and continue paying rent on a water heater when you should be able to easily replace the water furnace for under $2000 and own it and not have to make any further payments
January 25th, 2013 at 12:18 am #Mendel

HI

We have a summer home that was broken into and cleaned out, and a few weeks later they came again and stole the copper pipe, after filing 2 claims, the insurance asked for a list of items taken, we wrote up a list on my computer and submitted it, they said it had to be rewritten on their form with a pen and not on a computer print out, after rewriting and sending it in on their form, they requested all receipt or manuals, after explaining that some of the stuff has been in the family for years and submitting, pictures of some of the items, they requested approval to talk to our mortgage co, in a nut shall after 8 months of back and forth they declined both claims, the pipe claim as we replaced them before they inspected them, even though an arrest was made and we supplied a bill for the repairs, as for the stolen items they said that we didn’t submit the information within 60 days, even though they were still requesting stuff 7 months after the break in, and that we hid stuff from them, the policy is null and void.
February 3rd, 2013 at 12:11 pm #todd moneette

i had a house fire a few months ago and filed my claim, the claim was denied by the insurance company, they indicated that i lied about the distance from the fire hydrant and fire department–the agent from the company was at my house and wrote up the paperwork, he never asked a question regarding the fire department or fire hydrant and since i live in the country you can clearly see that i have no fire hydrant by my home, the policy states i am 5 miles from the fire department, when actually there is one that is 1 mile from my home and it also states 1000 ft from fire hydrant–i think the agent knowingly listed the wrong fire department (the one 5 miles from me has a better rating then the one down the road. what are my options on this
February 3rd, 2013 at 12:24 pm #Jason

Todd,
You should talk to an attorney about your situation to find any legal remedies you have available to you.
February 6th, 2013 at 8:48 pm #David

About 7 weeks ago or, I had covered homeowners loss. Recently, I contacted my adjustor and asked about status of my claim. My adjuster replied that they are about to forward documentation and other information to an attorney in order to take examination under oath. I work overseas and in about 3 weeks I’m going back overseas out of country. My question is, if I will be out of country for about 1 year or so, how the insurance company is going to take an examination under oath? Thanks!
February 7th, 2013 at 7:48 am #Jason

David,
If they get a EUO done before you leave, that is a way they can obtain that statement. Perhaps you should let them know of your time constraints.
February 15th, 2013 at 3:57 am #star

i was hit on 12-29-13 i was visbaly shaken very badly the guy pull out of a parking lot stating he felt he had ample time to pull out into the flow of on coming traffic i aditted to being distracted for a moment adjusting my heat the police come and cite him for failure to yield his insurance co. denies my claim any ideas on what i should do any thing would be gratefully appreiceated thanks star
February 15th, 2013 at 4:08 am #Phil

How about using proper punctuation, proper sentence structure, and complete sentences so that we can actually figure out what the *H*E*L*L* you are trying to say.
February 15th, 2013 at 4:48 am #Jason

star,
Phil has a good point because information is best relayed when the writer makes their message clear so the receiver of the message can interpret it properly. Good grammar and punctuation make communication effective and an attempt at good writing is appreciated more than sloppy writing.

In your situation, you are being denied coverage from the insurance company of the guy that you hit as he exited a parking lot onto the roadway. It is difficult to determine if the other guy was making a right hand turn or a left hand turn and don’t know if you struck him in the rear or the what area of his car, but for this situation, that doesn’t matter.

You can submit a claim to your insurance company, if you have collision insurance on your car.
February 19th, 2013 at 8:24 pm #Frustrated

This is for Jason. My items have now been tested for meth and there was none on it. 3 different items that had been located in 3 different locations in my unit were tested for meth, industrial toxins, meth bi-products and soot by a qualified tester, and an accredited lab. All were negative for meth, meth bi-products and industrial toxins. All tested positive for soot. Only took 2 months to get it reopened, a month to get it looked at and a month to get all the test results back. The claim was not presented how it was earlier. Earlier, you just pissed me off to no end with your ignorance. It was presented as smoke damage and ultimately, as it turns out, I was 100% right. The damage was from the smoke. As far as the meth being my fault they did that in my building, I did everything I legally could to get them out before it happened, we all did. And in case you did not notice, I am a pain in the ass when something pisses me off. I never backed down to management about the drugs. Management was so kind to send around a memo after 3 months of me and everyone not involved in the drugs complaining to them about the drugs. The memo they sent told all of us that they had many complaints from many tenets on the smells that “may be related to illegal drug activity.” It also said the police were aware of the situation and that if illegal drug activity was found, the occupant(s) would be evicted. They were evicted after their lab went boom a month after the memo came out. The memo didn’t do jack and neither did they, as the complaints about the drugs never stopped. Police didn’t step in but had them under surveillance. Not a lot of help really. So please, do tell me again, how that was my fault? Short of breaking down their door and physically throwing them out, there wasn’t jack that anyone could do beyond what they were doing. The cops were hoping to bust another big ring and we all ended up being collateral damage to it. And every apartment tenet moved out except for 2 units out of the remaining 9 (10 units total but not counting meth heads). One of the 2 that stayed was also involved in the drugs and management and the police are aware of that situation as well, none of us hesitated when talking to the cops about the drugs going through, and the other apartment dweller that stayed is a husband and wife who are vulnerable adults. No meth on my stuff but soot on everything. It was even tested to prove that the soot was from a fire, and not caused by industrial sources. No surprise, it smelled like smoke and the black on everything certainly looked like it was from smoke. Now its proven to be from the smoke and not the meth. Looks like a duck, quacks like a duck it really was a duck and not the elephant everyone got side tracked with. Only 4 months in hell. Maybe now I can get my life back.
February 21st, 2013 at 4:16 pm #Julie

Hi
We have a property in Arizona, that we have been renting out consistantly. The last tenants broke their lease and moved out on the 1st, the day their rent was due. When we saw the property, there was extensive property damage that the renter’s had caused in only 3months of living there. Including holes punched through walls and doors. And the most extensive damage of what looks like a car was driven through the garage wall breaking the 2x4s and pipes of the bathroom on the other side of the wall. We cleaned up 100s of beer bottles and cigarette butts, indicating they had had a big party before notifying us they were moving out.
Insurance has just denied our claim says the damage was a result of “hard living” and not vandalisim. We have a criminal police report siting criminal distruction of property.
Why is insurance denying this?? What is the point of having renter’s insurance, if they won’t cover this?? What can we do?
We can’t pay the morgatge because the property is unlivable in the condition it is in, and we can not get new renters in there, even though we have recieved many parties interested in moving in immediatly. And we do not have the finances to fix up the property properly.
Please help!
February 21st, 2013 at 8:40 pm #Jason

Julie,
The insurance company’s stance of no coverage due to the tenants damage, including the vehicle damage, would not be covered by the policy.

The Perils Insured Against in your policy likely read much like this if you have a standard DP-002 policy:
Perils Insured Against
6. Vehicles.
This peril does not include loss:
a. caused by a vehicle owned or operated by you or a resident of the Described Location; or… (end of policy quote)

(The only way that vehicle coverage would apply is if someone other than the resident caused the vehicle damage but that would require you to prove the vehicle damage was done by someone other than a resident of the dwelling. This is an entirely uphill battle because it is very unlikely for a non-tenant to be using the parking stall inside the garage.)

So, this means that coverage from vehicle damage is not covered and the wear and tear exclusion (no matter how minor or major that wear and tear is) in the policy would apply to the rest of the damage.

Regardless of insurance coverage, the repairs need to be made so you can continue the rental income so you can pay the mortgage.

For the “hard living”, you should be able to withhold the entire security deposit and pursue damage beyond that by suing the tenants for the damage that exceeded their security deposit.

The insurance won’t cover this loss and in order to avoid further loss of rent, it would be best to move forward knowing none of the damage is covered by insurance.
February 21st, 2013 at 11:06 pm #Julie

Thank you Jason

A few more concerns
Shouldn’t the policy cover the structural damage? And also how can the insurance say it wasnt vandalism if the police have found enough to charge criminal destruction of property, which is a class 4 felony in Arizona.
Also we recently spoke to the tenant in an effort to settle this matter out of the courts. He said his brother in law, who was not on the lease, was the one responsible for the damages and who drove the car through the garage wall.
Would this information help us when dealing with the insurance?
Also could a personal claim adjuster be beneficial in this situation?
February 22nd, 2013 at 8:09 am #Jason

Julie,
The contractual relationship with the tenants is what prohibits the insurance coverage for the wear and tear the tenants did. They paid money to use the property and they didn’t keep up their end of the bargain by the excessive damage they did. Insurance doesn’t get in between contractual issues.

Yes, if you can get the insurance company to settle the damage caused by the vehicle if the driver and owner of the car did not live there. Be prepared to obtain an affidavit from your tenant to provide to the insurance company. You will have to convince them who caused the vehicle damage.
February 22nd, 2013 at 8:12 am #Jason

Julie,
Regarding a personal claim adjuster, I don’t know what you mean by that.
February 25th, 2013 at 11:55 am #dawn ripp

Dear Jason,

In 3/2010 my washing machine flooded my basement. I filed a homeowner claim and Liberty Mutual suggested a water mitigation company. That company left most of my belongings in my basement and pumped out most of the water. They then spent the next several days trying to dry my basement until a record Nor’easter was supposed to hit and they packed up and left. Soaked belongings still in the basement. In the interim, an adjuster came to my house. Both the adjuster and water mitigation company both took pictures of my basement and the way it was left. That was the last i heard of that first adjuster. In may 2010, another adjuster from the company’s subrogation department contacted me and I proceeded to communicate with him over next 2 years. In July of 2012 I was told to submit my proof of loss sheets or they would close the case. I did. Then was told that the original adjuster had to handle the loss part of my claim. When I contacted him, in August of 2012, he told me that he closed the claim due to inactivity and my claim was denied. I told him that I never heard from him nor received anything from him and assumed that he handed off my claim to another adjuster. I appealed his decision. And his supervisor denied my claim.

What can I do? I can prove damages based on the pictures THEY took. I can prove that I did what I was supposed to do as far as my obligations. I can prove that I maintained connection with Liberty Mutual. I can prove that i protected my belongings as best I could. I can’t afford to hire an attorney. Help me please. I didn’t receive anything from this adjuster. He says that he sent and called, but he didn’t. I can prove that I did everything the second adjuster asked of me. I Even went so far as sending the defective part as well as the two repair invoices. Which allowed the second adjuster to receive an offer from whirlpool to reimburse 65% of my deductible.
February 25th, 2013 at 1:03 pm #Jason

dawn,
The information you post is rather vague. It seems roughly 3 years ago you had a water damage claim and preliminary drying was done. Then your claim went idle for nearly 3 years.

You indicate Whirlpool offered to reimburse 65% of your deductible. What that indicates is that your insurance company was also offered 65% of the funds they paid out for your claim.

Your insurance company engaged in subrogation efforts to reclaim money that was due to the negligence of the whirlpool item. Subrogation is something that concludes when a claim has been finalized. The information you provided leads to the conclusion that your claim has been settled.

You mention the insurance company is denying the remainder of your claim. What do they cite as the reason(s) for that? It doesn’t seem that “inactivity” would be the reason for denial.

If you want to provide more detailed information, you may send information to the e-mail address in orange lettering at the top of this page.
March 4th, 2013 at 5:11 pm #Rita

I had liability insurance on my car when it got struck by a police vehicle and so I had to file a claim on my own.
They denied it and I sued. Now they countersued me. If I lose in court, do I pay out of pocket or will Allstate fight for me? And pay if they have to?
March 4th, 2013 at 5:32 pm #Jason

Rita,
Yes, by all means bring the notice of the counter-claim to your insurance company immediately because they will defend that part of the claim against you. If you (and your insurance company) lose, your insurance company will pay.

Please not that your insurance will have assist you with your damage claim against the police department.
March 4th, 2013 at 5:41 pm #John Tamburello

Rita…you were not clear as to who you sued. The police ? Or your own insurance..Allstate….

We had Allstate for homeowners….our house got destroyed in a storm…the contractor stole insurance money…committed fraud and All Snake denied our claim. Because of what he did. So..we are sueing both now…but if you have Allstate ….your in big trouble…check out http://Www.allstateinsurancesucks.com . A local news channel profiled my case on their consumer segment ..and they called All Snake the worst of the worst…

Two things I want to close with…some insurance company troll named Jason might answer this…he always sides with the insurance company ….he’s definatly an insurance company plant..”.so don’t be discouraged if he try’s to get you to give it up…keep fighting these scum bags…

And finally…don’t forget..”YOUR IN GOOD HANDS WITH ALL SNAKE…UNTIL YOU HAVE A CLAIM!”
March 4th, 2013 at 5:45 pm #John Tamburello

Wow…Jason gave good advice for a change….about time…

Good news for Rita….problem is she has All Snake
March 4th, 2013 at 5:45 pm #Rita

Jason,
Phew!
I was so worried.
Thank you for help and your speedy response (-:
March 4th, 2013 at 5:47 pm #Rita

John,
You’re hilarious lol.
I have nationwide now and full coverage (;
March 4th, 2013 at 6:02 pm #John Tamburello

Good for you Rita ….I did some research since I am in the insurance industry…not the casualty end though…what’s important is not price when choosing a company …it’s their claim paying satisfaction ratio…Allstste s by far the worst…but several companies including nationwide are not that far behind…Allstate had the balls to send me a renewal…I called them nd said …oh sure..let me send you more money for you to not protect me…..I told hem to shove their renewal…then I sued them…and switched to a company called AMICA…..extremely high claims satisfaction…I expected to pay more then all snake but if they actually paid their claims it would be worth it…but the good news is they were half the price of All Snake…and almost half of ate farm and nationwide ….you can do it over the phone or on line…www.AMICA.com. Give them a shot…good luck to you with your endeavor.
March 4th, 2013 at 7:14 pm #Jason

Rita and John,
Please realize that the information provided through Jason is accurate and realistic at every turn. Sometimes the answers are not what someone wants to hear, but in every case, the answers are honest, direct, and most importantly – truthful.

Most every single policy, with only a few exceptions are the exact same policy. Sure, some policies might be drafted by ISO, AAIS, or a few others, but most policies are written with almost the exact same language, wording, and coverage.

So, without regard to minimal differences, all policies are written equally. Since almost every single policy is the same, the differences that consumers have to look at is the company’s rating, financial strength, and claim payment satisfaction, but the most important real-life component is based on premium price (with most things being equal) because we as consumers don’t have unlimited resources to pay a high premium for the protection we get from an insurance policy.

Information provided most recently to 3 separate people writing to the e-mail of Jason has been about state insurance commissioners and what they do, and do not do, for people who are insureds that have complaints.

Because that information is received from, and sent to individual e-mails, that information is not available on this forum. The following information concerns insurance commissioners in each and every state:

Insurance commissioners in each state exist only to ensure that the insurance industry remains solvent. Insurance commissioners field insurance complaints not to help individual insureds, but instead, they are there to monitor whether or not there is a trending concern for the insurance companies that may be detrimental to a specific insurance company or the insurance industry as a whole.

What this means is that insurance commissioners will not side with (and help) an insured unless not doing so will cause immediate and irreparable harm to the insurance industry as a whole (or the targeted insurance company). When insurance commissioners field complaints, they will almost never help the insured with their problem or complaint. Most people don’t understand this. People may think the insurance commissioners are there to help individual insureds but this cannot be further from the truth.

I provide factual information based on the information provided. I cannot change the industry; I can only advise people with what is realistic in a straight-forward and honest way. Although it appears that the answers I provide don’t provide a “rosy” picture all the time, at least people know that what I provide as far as responses is realistic, truthful, and in the interest of what is realistic and what is not.

Directly to John: Feedback on here is appreciated from everybody and if you have feedback, your input is welcomed to guide and advise people that have concerns. Thank you for your involvement.
March 5th, 2013 at 8:08 am #Rita

Thank you for your help gentlemen. I spoke to my Allstate representative this morning and she does in fact confirm that they will be taking care of the situation.
Best regards, Rita
March 5th, 2013 at 9:17 am #John Tamburello

You are welcome Rita and I’m very pleased Allstste is saying they will defend….had you filed the claim with yiur company, Allstate, they would have fixed your car minus your deductible ..then they would have subrogated and gone after the police depts. ins pretty much leaving you out of it except for some statements ….then once they collected they reimburse you your deductible…..it might have been two or three years down the road but never the less you would have gotten what we pay for when we buy any form of insurance …PEACE OF MIND. You had much better luck with all snake then most do….good for you…and shame on the police dept for putting you through this….I’d sue the city of that dept. for sure…big time….

Also…that allstatesucks.com does exist..it was featured in my story on tv here in cleveland, Ohio ….they really are the worst company to have if what you want is protection and piece of mind…..I’d give that AMICA a call if I were you.

Finally, it was news to me that there are multiple Jason’s that answer most of the postings on thus site…..I liked this Jason…he or she should be the only one because I have found it very disturbing at times to read what he or she says to people who are hurting due to a loss and the company deals in bad faith. They need to get rid of the other Jason’s and just utilize the one that replied to you and me.

Again, congrats and I pray you get justice….
March 5th, 2013 at 10:25 am #Jason

Bad Faith explained:
As an example, Texas is jurisdiction that recognizes the tort of bad faith. In order for an insured to establish the tort of bad faith in Texas, proof must include: (1) the absence of a reasonable basis for denying or delaying payment of benefits under the policy, and (2) that the carrier knew or should have known that there was no reasonable basis for denying the claim or delaying payment of the claim. However, as long as the insurer has a reasonable basis to deny or delay payment of the claim, even if that basis is eventually determined by the fact-finder to be erroneous, the insurer is not liable for the tort of bad faith. [Lyons v. The Miller Ins. Co. of Texas, 866 S.W. 2d 597 (Tex. 1993)].

The bad faith allegation requires meeting the above 2 very high threshold requirements. These 2 requirements are very, very difficult to prove and the information provided in this forum takes into account when people loosely use the term “bad faith”.

Many states have very similar requirements to prove the above 2 points to establish bad faith. Absent intentional and provable elements required, it is nearly impossible to prove bad faith for nearly every single claim – no matter how poorly the claims were handled by the insurance company.

Information provided on here reinforces realistic and honest answers about the circumstances provided. If there are any responses that have been provided that have misled people about the reality of the situation presented, then those responses should be disputed.

The most recent claim that comes to mind is the one involving “Frustrated”. Information was provided to Frustrated to contact a public adjuster for assistance if Frustrated could not present her claim to the threshold needed for coverage under her policy.

Regarding Frustrated, there is also a moral component of her claim because there was known information that meth was being produced in her building in which Frustrated did little to nothing to prevent that illegal activity from continuing. Meth labs are not only illegal, they are very dangerous to people, including people in near proximity, property, and structures.

By allowing a meth lab to continue constitutes implied permission for that operation to exist that involves risk to property and safety. To acquiesce regarding a known meth lab continuing in a building in which someone lives takes away parts of the elements of fortuitous and accidental from any resulting incident due to the meth lab operations.
March 29th, 2013 at 5:18 am #Citizens denied my claim

On Feb. 24, 2013 my neighbor informed me that the skirting on my mobile home was wet. After doing a little detective work and notifying Citizens that there was a leak under my refrigerator, a claim was filed. There was no visible leak inside the home. Citizens informed me with a letter that I had to prevent any further damage which I did. I paid a contractor to move the refrigerator and at that time a very minute hole was found in the copper tubing that ran the water to the refrigerator. The tubing was removed so there was no water going to the refrigerator, but damage was found as the water was seeping under the floor of my kitchen cabinets, up the wall of the cabinet immediately next to the tight fitting refrigerator. The floor under the refrigerator was opened up per Citizen’s instructions to take pictures. Pictures were taken and submitted to Citizens. A claims adjuster came out about a week later. I was told by my rep that it would be a fast track claim. Then several days later I was told a field adjuster was coming out to look and after looking I was told my claim would be denied as the water leaking was longer than 14 days! If I knew the water was leaking I would have done something sooner, but it was not noticeable inside my home and believe me I would have noticed a wet floor if I saw one! I got a call from the field adjuster stating my claim was denied on Friday, March 22, but have not gotten a letter stating that. My rep said after I told him how frustrated I was that I would have to go to arbitration. Since I haven’t received a letter denying claim I have no information about arbitration. I asked when I would get the letter, but have no answer as yet, March 29. My kitchen sits in disaray and I have paid for the work Citizens demanded I have done. This is such an injustice as my insurance is $1,600/year!! Please help me resolve this.
March 29th, 2013 at 8:51 am #Jason

Citizens,
It seems you already know the next step in this process is arbitration. Hopefully you will be successful in that phase of your claim. It seems the “14 days” part of the policy language is the thing the insurance company is focusing on for the lack of coverage. You will have to create doubt about the leak existing for over 14 days in the arbitration process.

Also, if you are paying $1600/year in premiums, you should do some shopping and find a more competitive rate for your mobile home coverage.
April 15th, 2013 at 6:49 am #Sally

I had a plumbing leak behind my kitchen cabinet. When we pulled out the cabinet, we discovered mold and extensive damage to the cabinet and drywall. I called a plumber and it was determined I needed to have the entire house re-plumbed. I paid for the re-plumb and filed a claim with my insurance company for the drywall and cabinet damage. After much back and forth, the insurance company agreed to pay for the drywall repairs and to replace the kitchen cabinets. My house is 35 years old and we could not find cabinets to match and the kitchen is VERY small, so it was not too expensive to replace the cabinets.

I paid for the cabinets to be replaced and have not received reimbursement from the insurance company. I did however, receive a notice in the mail today that they are cancelling my policy because my house needed to be re-plumbed and I was now considered a substantial risk.

Can they do that? Do you think I’ll ever get reimbursed?
April 15th, 2013 at 9:11 am #Jason

Sally,
An insurance policy is a contract entered into by 2 consenting parties. Just like you can cancel your policy at any time, they can do they same thing, but with a minimum number of day’s notice.

If the claims adjuster told you they will pay for the drywall and cabinets, then that is what we expect to happen.

This is a great time for you because now you can search for a better insurance company. At the top of this page, there is a link to the BEST AND WORST INSURANCE COMPANIES. When you are on that page, there are links to insurance companies ranked by their customers. Do additional research on your own to make sure you choose the right company to do business with.
April 30th, 2013 at 8:00 am #Mark Cook

An external structural wall has collapsed and my insurers are not accepting responsibility. Will the Contents and Public Liability sections of the policy still be in force as I am concerned that the wall may fall further and I may have a Public Liability claim against me from my neighbours?
April 30th, 2013 at 9:37 am #Jason

Mark,
If there is a dangerous condition on your property and you don’t take action to make it so the dangerous condition no longer exists, you could be found liable for any damage or injury that results. Unexpected damage or injury is covered by your policy. Expected damage or injury is not covered as dictated by the following policy language:

i. “bodily injury” or “property damage” that is:
1) expected by, directed by, or intended by an “insured”;

This exclusion applies even if the “bodily injury” or “property damage”:
1) that occurs is different than what was expected, directed, or intended; or
2) is suffered by persons, entities, or property not expected, directed, or intended.

So, if you have a dangerous situation on your property, it is best to remedy it so no property or injury arises from it as soon as you can.
May 30th, 2013 at 8:38 am #Tiffany

We filed an insurance claim because some of the shingles came off the roof when a huge wind storm hit us at the end of April. We filed a claim earlier this month and was denied because whoever put the roof on didn’t do it properly. They didn’t put the nails in the strip or enough nails to cover the roof pitch. (ie 6 nails in a shingle over a 7/12 roof pitch). We were upset of course but planned to replace the roof in 6 months after saving a good bit of money. There is a clause in the insurance that states that they can’t replace anything that was not done properly. We received a letter in the mail that told us that we needed to replace the roof within 30-60 days or they couldn’t continue coverage. 2 days after the adjuster came out, a roofing contractor that we hired to see about the blown shingles came out and replaced the shingles that had flown off to prevent any damage to the roofing deck. Today, 3 weeks later, we get a phone call telling us that we have to replace the roof within 2 weeks or they will discontinue coverage by June 14. If they didn’t inspect it when we applied for coverage through this insurance company to know that the roof wasn’t put on correctly, shouldn’t they have denied coverage to us then?? The house is only 8 years old with a 30 year architectural roof as I was told this by the adjuster. We can’t go back on the contractor since we bought the house as a foreclosure and it was built by Jim Walter Homes. Our realtor told us that there wasn’t a need for a inspector since the home was new. Can they just cancel us without waiting for us to get money saved to replace the roof?? I mean I am not made of money. If I were, I would have bought the house outright and not had any insurance on it because I could just buy another house!
May 30th, 2013 at 5:26 pm #Jason

Tiffany,
Common shingles, regardless of a roof’s pitch, don’t require 6 nails per shingle – only 4.

Your insurance policy does contain language that it doesn’t cover improper workmanship. It does cover for wind damage. The shingles remained attached to the house for 8 years. Had it not been for the wind causing damage, the shingles would have remained on your roof well beyond 8 years as they had remain attached for their current duration.

I personally believe the wind damage should be covered by insurance in your case. Replacing all the shingles may not be needed to address your damage, and a repair may have been all that is needed. If they allowed for a repair, they would not be paying for the improper installation – only the shingles that were damaged by wind.

Your insurance company likely has a policy that they can continue your coverage but exclude your roof as a covered part of your home, until it is replaced. Conditions or excluded parts of your home are a common practice by many insurance companies. You would need to talk to your agent to arrange for this.

This may be a good time to get a different insurance company if they won’t work with you on this matter. At the top of this page, there is a link to the best and worst rated insurance companies so know what other customers are saying about their insurance company claim experiences.
June 1st, 2013 at 12:39 pm #Charlene "Charlie" von Schlesien

Good day Mr. Cercone,
My Boulder county, Colorado farm home had a fire on 1/13/13, and I am being requested to participate in an EUO.
I have made a recorded statement within a week of the fire which was concluded by the Fire marshall as accidental electrical, yet ASI Llyods claims gasoline in the house.
The question I have is does that EUO require a physical presence…long story, or can I request a video conference?
Thank you
Charlie
June 1st, 2013 at 1:39 pm #Jason

Charlie,
You can certainly request a video conference but it is unlikely that your request will be honored.

I am somewhat familiar with the fire to your Niwot home. In most cases, it is good to have an attorney for anybody subject to an EUO. For your EUO, an attorney is, without doubt, required. There is an informative write-up about examinations under oath at http://www.scottandfenderson (dot) com/index.php/client-services/examination-under-oath

copy the above link in your address bar and remove the (dot) and insert an actual “.”
June 1st, 2013 at 5:50 pm #Susan Schneider

I would like to know if an insurance company can cancel coverage after finally paying a claim. I will be unable to get coverage from anyone other than Citizens at this point because no other company will accept me after a claim. This seems unfair since this was completely and accident and not my fault in the least.
June 1st, 2013 at 5:53 pm #Susan Schneider

After finally settling a claim, the only claim of any sort I have ever had in my 60 years of life, my homeowner’s insurance company has notified me they will not renew my coverage. Is this allowed? I cannot get coverage from anyone else at this point other than Citizens because of this claim. It was a complete accident and proven not to be my fault at all. This seems unfair. Is this allowed?
June 1st, 2013 at 5:55 pm #Jason

Susan,
An insurance policy is a contract between the insured and the insurance company. Either one can end the contractual relationship within the guidelines allowed in the contract.

There are hundreds of companies that are available for coverage. If Citizens will take you, then many others will too.
June 5th, 2013 at 11:27 am #LeAnn

Question – can pipes that burst be linked to a Sandy Claim. We live in NJ and finally had the water turned on to our home in May, but when we did, we discovered that the pipes must have frozen due to the fact that we lost all power/heat/utilities during Superstorm Sandy. We did winterize the plumbing by draining the water tank, and blowing out the lines. The pipes were insulated the best they could be, but apparently we couldn’t do anything to prevent this from happening. Our insurance company says its a different claim then Sandy. Is it?
June 5th, 2013 at 11:43 am #Jason

LeAnn,
You had a claim from Sandy. You drained and blew out the lines right after the storm. The usage of those pipes in May, having not been functioning since the storm, are all related to sandy, in my opinion. If you had the water off and no water usage since sandy and your winterizing of those pipes and appliances, it could only be related to last year’s storm.

You should insist the insurance company prove that it’s 2 separate events despite your claim that it is all related to the storm. They won’t be able to prove it so they should not be able to consider it a separate claim. This is one where you are going to have to demand that it remains under the sandy storm claim damage.
June 13th, 2013 at 4:55 pm #Eric

Help,

My daughters mother had a fire 3 1/2weeks ago. Her father bought her the house from Hud in 2009. The agreement was that she would pay him back monthly but because she can barely meet ends meat he just wanted her to pay the taxes which she owes for 2011 and keep the insurance paid. She kept the insurance paid and is currently trying to get the taxes paid up. unfortunately she cant get a payment arrangement until its in a foreclosure status 2014. Which she says she can not let happen. Put it to you like this even with my help she is still struggling but manages to just stay afloat. A fire started at her house in the basement ceiling somewhere. She is not sure what may really happen but the cause and origin people with the insurance company have mentioned electrical. They were there for all of 6 hours tagged a air conditioner as evidence a said they were going to have someone with a little more expertise come out. When he came he said he was mapping out the electrical whatever that means. She also said they said something about a hot wire. I don’t understand what they are talking about to even explain it to her. All of her adjusters came out and her cousin who owns a agency now referred her to contact a contractor he knew. She hired him to get the house back together. He also met the adjuster over at the house when he came. They removed everything from the property but left some things. They also bagged some of the clothes in the basement and gave her a list of the items in the bag. They gave her 2500 and found her a room for her and her kids. Now the are trying to find her housing. She got a cal from someone saying they were a special investigator They asked her questions about the taxes, She is clinically diagnosed kleptomaniac and they asked about all the retail fraud she has. who she met her contractor how much she receives in food stamps , where she works and if the put her in housing. What is this about? Then they mailed her a sworn statement of loss. That she has no ideal how to fill out and had to call and go get her fire Report. ? The fire report says undetermined everywhere and says still under investigation but they haven’t been back out there. Please tell me what that means. They also sent her a release form that she going to sign stating that she gives them permission to check her bank, credit,invoices,hospital records,insurance records,traffic reports criminal arrest by any law enforcement agency convictions and payment records related thereto. What is going on I’ve told her to call and ask but she just keeps saying that they are probably doing what they do when someone has a fire. I think she is being naive and they think she did something. How thats possible it was electrical but I see from some comments and blogs they don’t want to pay.
I think because of the history of retail fraud they are not going to pay the contractor or deny her. She has never done anything but that and she really has a mentally condition that she gets medicine and therapy for. I hope they don’t think she’s this demon. I just don’t want her to worry so I don’t mention that. Can you please explain all thats going on so that I can guide her. I think she thinks she is in good hands but the blogs say something different. She doesn’t even ask any questions or call them. Please Help. Her insurance company was voted #1 worse insurance company. She has been with them since 09. Please advise Please Advise me . What does that police report undetermined mean. Thank You
June 13th, 2013 at 6:14 pm #Jason

Eric,
What you are describing is the investigation process of determining the motive for your daughter’s mother to start this fire for insurance proceeds.

The insurance company can ask for a lot of information from the insured to either conclude she had something to do with the fire or that she has nothing to do with it.

It is impossible to tell you or her what is going on because we received some information from you. That is not enough information to determine all that is related to what the insurance company is doing.

Undetermined in a fire report simply means they don’t know what, or who, caused the fire.
June 13th, 2013 at 6:44 pm #Eric

Jason

What insurance proceeds would they be talking about. Money for the things they considered damaged. They would only have to pay the contractor to fix the property back. What would she gain from that is this investigation normal. Is there something we may should be doing. i think she cares more about that then anything. Should I just relax, and let them do there investigation do they do this with every fire. When do she know she needs a lawyer. thanks for responding Jason your greatly appreciated. also ? can a air conditioner really cause a electrical fire. and shouldnt they be looking to make sure if electrical how to make sure it doesnt happen again.
June 13th, 2013 at 6:51 pm #Eric

Again Jason Thank You

Just lost at what to do or how to do it. Neither her or myself have ever been through this and I hate to see her so depressed. I worry her criminal background of retail fraud will lead them to not fix her house. If there is anything else you can tell me that may help I really appreciate it. You guys are great for taken time to help people.
July 9th, 2013 at 7:09 pm #Jason

Eric,
Somehow I did not see your latest posts until just now. I can’t provide answers to all your questions because I don’t know enough information to do that. You ask when should she get an attorney. That depends on the situation – that determination needs to be made by each person. For example, it is a good idea to get an attorney prior to any EUO.

Fires can be caused by a number of sources. There are many things in a home that will start a fire but unless the combustible items are part of or around the fire, the fire cannot grow and the fire will extinquish itself. Many items in a home require a persistent exposure to flame or extreme heat before it can spread and grow. Drywall is not something that will burn easily. Another example is that paper in a trash can will burn easily but that leads to a more important question of how that paper started to burn in the first place.

Insurance is a based on repairing or replacing damaged items – it doesn’t focus on prevention. The homeowner should be focusing on prevention as a diligent and aware property owner.

Investigations generally occur for all fire losses. Some are brief and some are very intense. Each investigation is based on the circumstances of each fire and the details surrounding each insured and the people closest to them.

An insurance company can investigate almost anything about a person making a claim. Criminal history does play a part but it should not be the single reason for denial of an insurance claim. A conviction of a prior arson event would be more serious than a retail fraud conviction. In turn, a retail fraud conviction would be more serious than a DUI conviction. Past activity of an individual is a character concern.
July 11th, 2013 at 6:46 pm #Nesh

Please help…

My boyfriend and I rented a car for memorial weekend and we were suppose to be out of town for the weekend but the hotels were all booked. So we stayed one night and we went to a parade in San Francisco. To make a long story short the car got broken into and all of our things got stolen and they broke the window. So we hve been having so many issues with this claim. My agent sold us so many dreams it is unreal. Now they are trying to deny our claim because I am no longer working I was laid off and my boyfriend took leave from his job because his father is sick with cancer. However I have unemployement in addition to pulling out 17, 000 on my 401k and I took an additional 13000 from my seperate retirement just to have extra cushion. I receive 1600 a month from unemployment whih covers all of my bills. And as for my boyfriend he receives 1000-1500 a month for taking care of his father. He also does side jobs for his friends company from time to time. But now they are saying that we are having finacial troubles, which is not true and since I have bad credit they are trying to say that is an issue as well. But I was a victim of identity theif 3 times amd I have proof to show for it. And my boyfriend filed bankrupcy over 8 years ago before we we’re together and they are saying that is an issue as well. What can we do? Please help because I am so frustrated and I have given receipts and bank statments and I don’t know what else we can do.
July 11th, 2013 at 6:52 pm #Nesh

Our car insurance would not cover anything not even the broken window. So my renters is suppose to cover it but it doesnt look like it. Our policy is in california
July 11th, 2013 at 7:10 pm #Jason

Nesh,
Car insurance, or car rental insurance, would address the damage to broken window or any other damage to the car due to the break-in.

Personal property stolen from the car would be what is covered under a property policy, and in your case it appears to be a renter’s policy.

The issues you are having with your insurance are more in depth than what can be addressed within this forum. If you believe your claim is being handled unjustly, your best avenue to get some help is with an attorney.
July 11th, 2013 at 7:18 pm #Nesh

Thanks for the fast response Jason. The car insurance did not cover the window and the renters insurance for our property is making a big issue about me not working even with all the financial documents. I am suppose to meet with another investigator 4th one. But I am confused as to why my credit report has anything to do with it especially since all of my identity theif or what’s left is over 7 years old. My agent said she didn’t even have a police report before they processed her claim and she has a low 500 credit score and they did not even question her not ince on her claim. I Just want to better understand what I is the next step for them and myself as well.
July 11th, 2013 at 8:15 pm #Jason

Nesh,
The car coverage would have been from your own personal automobile policy, or if you purchased the damage insurance when you rented the car. If you don’t have insurance protection for the rental, any damage that occurs to it while in your possession would be out of your pocket. You said your car insurance didn’t cover the window damage. Perhaps that damage was below your deductible. I don’t know any other reason for why it would not be covered. You did not say the car window damage was denied so I don’t know if it was.

If you were planning to stay 3 days over the weekend, but you didn’t have a hotel reserved and you only stayed one night and had a day excursion at the S.F. parade, you could not have had much personal property in the car. I don’t know anything about your claim but if any of the property you claimed stolen from your car was anything more than a gps unit, luggage, clothing for a couple of days, some cd’s, some books, and toiletries, then that would require a closer look. The amount stolen from any car rented that had overnight bags in the car at the time can be what is expected. Many times the amount stolen does not even amount to the deductible carried on an insurance policy.

I can’t imagine there being a claim for cell phones, a wallet, a purse, sunglasses, etc being claimed because those are items that are generally carried upon a person instead of left in a car.

Again, I don’t know what you claimed or the value of the items claimed, whether or not you did a police report, or how you presented your claim. I don’t know any of the information the insurance company is using to deny your claim.

Credit, financial difficulties, criminal history, debt, prior claims, and a whole bunch of other factors can be taken into account but if they are denying your claim, there needs to be more than just one of those factors involved.

It seems there are no further steps for the insurance company because it is assumed your claim is denied. As suggested before, if you believe your claim is being handled unjustly, speak to an attorney.

I just re-read your initial post. If the break-in to the car happened while you were in the hotel, your would have had your luggage, toiletries, and nearly everything in the hotel room. To break into a car that doesn’t have anything visible to steal does not make any sense.

If the break-in occurred during the parade, that is highly unusual because car break-ins generally happen during the darkness of night. Also, items such as light luggage for a 1 day’s stay would be in the trunk area and out of sight. Perhaps your claim includes property that is unusual or improbable of being in the car for the short trip you made. Again, I don’t know.
July 15th, 2013 at 8:58 am #Jeremy

Please help:
We live in Kentucky. We bought our house (a bi-level) 6 years ago. Just recently, we decided to repaint the finished basement. DUring the process we found the drywall to be badly damaged. I began to remove the drywall to replace it, and as I did, found that there had been a very substantial and long term water leak from the exterior deck. Our home inspector missed the fact that there was a missing piece of weather flashing and the deck had been improperly built causing the leak. Our first claims adjuster (who told us this was not her normal area of experience) came out and we had a contactor there as well. He showed her what was wrong, expalned what happened, how it needed to be repaired, cost estimate, etc. She agreed we could not have known about the issue (which had been covered up by previous home owners). Within a few days, we were told our claim was approved for all costs’expenses minus the cost of the weather flashing. We began having a plethora of contactors come and inspect and prepare quotes. One of them was recommended by the insurance company. He came, and we liked him very much. He called a few days later and I told him that my wife and I were close to picking a contactor and that he was one of the firms we were strongly considering. He said he would send us a work authorization to sign so he could put us on his schedule and get started and in a few weeks he would give us his bid/quote. We never told him he was getting the job. My wife and I discussed he request for a work authorization with out giving us a quote as to what he was going to do or how much it was going to cost and quiockly changed our minds on his company. He called the following week to say he hadn’t recieved the work autorization, and I told him that we were not going with his company. He was angry and got of the phone very abruptly. The next week, my wife called the insurance company to see if they had reviewed all of the bids/quotes to which they replied that they were too vague. They also brought up their recommended contractor that we declined. I told them we decided that we did not want to use his services. To which the adjuster said our claim was being suspended and a property evaluator had to come do an inspection. They sent a structural engineer who said all of the same things the contactors said. Now today, we get a letter saying our claim is denied because the damage is from “wet rot” and it has been going on for a long time and they don’t cover isses that have been ongoing. We have contacted several lawyers to review our policy and claim, but I was wondering, can they just up and deny our claim after they approved it? How can this not be covered? The damage is of no fault of our own and was even missed by our home inspector prior to purchase of the home.
July 18th, 2013 at 3:09 pm #Jason

Jeremy,
When I read your post, I was reluctant to believe the damage to your home was covered. It is not intended to be a covered cause of loss.

The insurance can correct their decision from coverage to denial or denial to coverage at anytime, especially if new information is obtained.

This doesn’t go back to the inspector, it goes back to the contractor that did not place the flashing where it belonged when the deck was installed. The insurance company covers for sudden and accidental damage. The element of your claim does not meet the sudden part that’s needed.
July 24th, 2013 at 3:07 am #Sandy

I own one-half of a duplex. The owner of the other half moved, and now has tenants. The tenants’ washer overflowed, and has damaged my side. This is the second time it has happened. The first time didn’t cause that much damage, and I tried to repair myself. This time, though, the washer overflowed for hours, and I had to get a restoration company. The realtor for the other owner, and the other owner’s insurance called me with a claim number, which I gave to the restoration company.

The owner of the other side wants her insurance to pay for the damage to her side, and mine, but now her insurance company says that the renter has to pay for damages to both sides. (It is the tenant’s washing machine.). It will most likely be a problem for the renters to pay. The tenants do not have renter’s insurance, though it’s part of their lease to do so.

When purchasing the unit, the other owner and I had Declarations of Covenants made part of the deed. For example, it says that “Every owner must promptly perform all maintenance and repair work within own unit and on the premises…and every owner shall be expressly responsible for any damages and liabilities suffered by other owners resulting from or caused by said owner’s failure to maintain or repair as herein provided…” There are also provisions about the common wall (The water came under the common wall.), and about each owner having extended insurance on the respective part’s property.

The other owner is going to call the insurance company, and insist that they pay for both sides.

If they deny this, are the tenants solely liable, or is the other owner possibly liable due to the clauses in the deed?

If the tenants are solely liable, how do I contact them for damages – do I mail them a letter directly, or do I do it through their landlord (the other owner that I have a contract with)?

Is it possible that the other owner’s insurance will pay the initial clean-up from the water damage, or would that be part of their denial? (I had given the claim number to the restoration company who sent the EMS bill to the insurance company.)

Is it possible that the other owner’s insurance will also not pay damages for her side, and that the tenant is solely responsible?
July 24th, 2013 at 8:10 am #Jason

Sandy,
Firstly, no one is liable unless they are legally negligent for the damage. Nothing in your post indicates anyone is negligent or liable for the damage to your unit. Water can originate from a washing machine by accident, and without negligence involved.

So to your question about “tenants solely liable…?”. No, that has not been established. You are responsible as an owner for the damage to your unit. Your covenants confirm that obvious reality.

Don’t contact the tenants in anyway because an assumption of their negligence and requiring them to pay for your side’s damage is not the right thing to do.

The only insurance information you should be providing to the restoration company is your insurance company information. If there is negligence involved or overlapping coverage/damage, your insurance company will sort it out.

To address your last question – Who cares about the other person’s insurance and problems – certainly you shouldn’t? Concentrate on your unit’s damage.
July 24th, 2013 at 10:40 am #Sandy

The insurance company has decided that the tenant was negligent, and that is the reason that they are not paying. This is the second time that it has happened, just a few months apart. I don’t know if the other side filed a claim, then, but I didn’t. (I made the repairs/paid for them.). This time it was beyond the scope of what I could do.

Throughout the years, according to the covenants of the deed, any time that there was damage done by one side to the other, the other side paid. This was mostly out of pocket. Once, about 20 years ago, when a refrigerator on the other side was being moved, the water hose came lose, and flooded my side. The other owner’s insurance paid for damages to my side then. (The same insurance, as now.)

The insurance company contacted me with the claim number to give.
The work has been done.

The insurance company is the one that told me to contact the tenant for payment. They also said that the other owner may be liable due to the covenants in the deed, but that would not involve her insurance.

IF the tenant is liable, as the insurance company has stated, do I contact the tenant directly, or should I go through their landlord (the other owner)?

The reason that I asked about her insurance not paying for the damages to her side…I have that same insurance for my auto, and another property. Could they really not pay for her, if they have decided that her tenant was negligent?

Thank you most kindly.
July 24th, 2013 at 3:20 pm #Jason

Sandy,
What you are posting is hearsay that the insurance is not paying the property damage because of another person’s negligence. That is not how insurance works.

Insurance pays for covered damage regardless of negligence. Then the insurance company goes after the negligent and liable party or parties.

Comparison of current damage to damage that occurred 20 years ago is not something anybody should rely upon.

I don’t know why you would be in communication with the other person’s insurance company. Submit a claim with the insurance company that insures your side for property damage. Let your insurance figure out the details and deal with either the owner or the tenants. I still fail to see the basis for why the tenant is liable. Just because someone suggests the tenants are liable, doesn’t mean they legally are. Negligence and liability is a legally established position.
July 24th, 2013 at 4:51 pm #Adam

I was involved in an auto accident while driving down to see my family, it happened on 07/13/2013. I have a non-owners policy, but my policy has an exception that states it will cover liability on any vehicle that I become owner of for 15 days after I become the owner and if I did not own any other vehicle. My father gifted me the car on 07/09/2013. I have the bill of sale, statement of facts and filed a release of liability/transfer of ownership online on 07/19/2013. I still have not transferred the registration into my name because I have just been to busy. Now my insurance is declining the claim and not covering the cost of the damage to the other persons vehicle because they are saying that the car was registered in my name back in January 8, 2013. That is not the case. I did check with the dmv and they confirmed I am not the registered owner my father is. They did say that they had a release of liability on file from back in January of 2013. My dad had offered me the vehicle back in January, but I told him I did not want it because I didn’t need it so I did not keep the car or take ownership of it. He even registered the vehicle himself in his hometowns dmv office at the end of April when the registration expired. I am trying to contact the supervisor to appeal the claim or have it reopened, but do you think this is something they should cover? I have also contacted my broker who sold me the policy, but they have not called me back. I’m just a little upset in general because I don’t submit many claims, only one in the past and that was with another insurance company. I also talked to my broker back when my policy was renewing at the end of March to see how much more it would be to add the vehicle to my insurance, but decided not to because I still did not want or need the car and was planning on travelling for most of the year.
July 24th, 2013 at 5:50 pm #Jason

Adam,
Possession is 90% ownership. Regardless if the car is registered in your name, your possession and use of the car seems to dictate that you are the “owner” of the car.

Named non-owner policies are supposed to be for people that do not own a car and who only drive vehicles owned by other and never one owned by themselves. Many people use the named non-owner policy to skirt the system in order to have lower insurance premiums, while driving cars not technically “owned” by them.

If they denied your claim because they have concluded you are the legitimate and practical owner of the car (in its usage), then that decision will not change.

Policies generally have language of providing up to a couple weeks worth or coverage for a newly acquired vehicle. What you need to understand is that language doesn’t apply to the car you own, your policy, or you. You have a named non-owner policy. If you own a car and have an accident with that owned car, your non-owner policy will not cover it. The non-owner policy applies to all vehicles you do not own and excludes all vehicles you do own.
July 27th, 2013 at 5:34 am #Jason m

My question is I had a flood in my area and my flood insurance is covering the cost of a new furnace and hot water heater. My hot water heater still works fine. My question is will I have to get a new one if they have me money for one. Also will my mortgage company make me show the proof I replaced it.
July 27th, 2013 at 7:15 am #Jason

Jason m,
Nobody can force you to spend any money, except the new obamacare law which forces you to buy health insurance, or face stiff IRS levied fines.

All mortgage companies have their own guidelines when it relates to insurance damage so you will have to contact your mortgage company and ask them any questions you may have.
July 31st, 2013 at 11:32 am #Just Bill

Great site! Here’s a question for you:

Due to a flooded basement after Hurricane Sandy, we had to replace the carpet and other things. Being very fearful of future water damage, we decided to replace an older water softener in the laundry room… it was completely functional but due to the age we felt it was better safe than sorry.

I ordered the softener from Home Depot Online and hired a local plumber to install it. I didn’t personally inspect the unit and left it in the box until he came to install it and I was at work at the time of installation… my wife was home. Apparently the unit had a minor crack to the plastic shell that was cosmetic only, and also the resin tank was slightly out of alignment and he just muscled it back into place. This also had no effect on the functionality of the unit and I did not learn about it until the flooding.

So we have our brand new carpet and brand new water softener and one weekend we discover our basement is covered in water again. We check the washer for leaks, the water heater, sump pump… everything is fine. Turns out the brand new water softener is the culprit… it’s missing a clip and during the recharge cycle that occurs at regular intervals, it sprays water throughout the basement like a fire hydrant. We have the plumber return and he explains that this internal clip is not touched or part of the installation and is pre-installed as part of the unit and as a defective unit we should deal with Home Depot where we got the unit.

Home Depot refers us to the manufacturer (GE) who puts us in touch with the insurance claim department.

The insuracne claim department denied our claim because the plumber’s letter they had us get for them outlining what he found mentioned the physical damage prior to installation, and that they cannot confirm the damage was caused by a faulty appliance.

Now what?
July 31st, 2013 at 9:22 pm #Jason

Just Bill,
Submit a claim to your home insurance carrier. That should have been your first step. If the damage is the result of a failed product, your insurance would take care of the subrogation effort to collect money from the manufacturer.
August 6th, 2013 at 7:41 am #Kaitlyn

Wow, amazing site! I just got my General Lines P&C license so I will be checking back here often to learn from the vast knowledge on this page.

On to my question…

My husband was insured by USAA (Navy veteran) for automotive coverage when he experienced a loss on October 2, 2011. He had lapsed in his payments to USAA (before we were married and me making sure everything paid on time, silly man) in September and called on October 2nd to reinstate his policy and pay his premium. While on the phone with the USAA agent on the 2nd, he asked if his truck would be covered if he were to drive it that day and she assured him that it would be (I remember this specifically as I told him that if it would not be covered we would be taking my car that was fully ensured on a separate policy).

Fast forward about 12 hours, he had driven one of the trucks covered on the newly reinstated policy (full coverage) to a local game arcade, parked (locked, and set the alarm on the truck) and spent around 3 hours inside. At 11:00 pm he left the arcade to find that his truck had been stolen while he was inside. He immediately called the police, they sent out an officer to whom he gave a full description of the truck and contents, and received a case number to reference. He also spoke to the parking lot security attendant and the manager of the establishment. While still in the parking lot with the police officer, he called USAA and explained the situation to an agent who checked his coverage and assured him the the loss would be covered and he would be “taken care of”. He was relieved.

Three days later, on October 5th, he received another call from USAA stating that they would not be covering the loss as the policy wasn’t in effect at the time of the loss. He explained to him that he was assured twice, once before the loss and once after, that his truck was indeed covered, however the adjuster said that these statements did not matter and that USAA would not be paying a dime.

What I’m wondering is if its worth it to try and get an attorney at this point to resurrect the case and if so, what would be the best way of handling this? In Texas, claimants have 2 years plus one day to file a suit against an insurer so time really isn’t on our side here…
August 6th, 2013 at 7:58 am #Jason

Kaitlyn,
You have to consider the cost of an attorney to pursue this. You have to account for the total claim amount. You have to assess your chances of success. The decision is entirely up to you what you do. The best way to handle it is to decide if this is something you want to do, and if it is, then find an attorney and get the ball rolling.
August 6th, 2013 at 8:10 am #Kaitlyn

Jason,

Thank you for your quick response.

The acv of the truck at the time of loss was $20,000 so I would like to pursue if possible. However, attorneys are expensive so I’m wondering if you knew of others who were successful in similar situations to his? I suppose I’m just wondering if you think we have a case as our inexperience prohibits us from fully assessing our “chances of success”.
August 6th, 2013 at 8:27 am #Jason

Kaitlyn,
Each case is different. I don’t know enough about your case to provide you with information concerning your success or failure in obtaining a judgment. An attorney would be able to gauge that better than me. It all revolves around when the coverage was in force, and when the loss occurred. Verbal confirmations of coverage are not the same as a written confirmation of coverage. If you have paperwork that indicates you had coverage on the date of loss, that would be good. However, if you have paperwork that indicates coverage started after the loss, then that will be more challenging.
August 18th, 2013 at 2:34 am #Adria

Can you advise if it is typical to deny a claim for theft (from a vehicle) of property that is used by the insured (me) but actually owned by someone else (my significant other) he is not a named insured. The property (electronics) were stolen from my vehicle. The adjustor has indicated that the insurer will only pay for the items “owned” by me.
August 18th, 2013 at 6:50 am #Jason

Adria,
So you were using some electronics owned by another person, and these electronics were in your car and stolen. The issue is did you, an insured, suffer a loss by theft? No, you didn’t – your friend did. Your friend should file a claim with his homeowner insurance because the policy says property owned by an insured is covered nearly anywhere in the world.

So, yes it’s appropriate to deny claims for which the insured has no ownership interest in it.
August 30th, 2013 at 7:48 pm #Sandy

I own one-half of a duplex. The owner of the other half is a tenant.

About a month ago, the tenant’s washing machine overflowed for hours doing damage to both sides.

The owner of the other side’s insurance did not pay for the damages to my side.

Today, I got a phone call from a collection agency. They said that the owner of the other side’s insurance company had turned me in to them to pay for the damages to the other owner’s side. The damage was done by a washing machine on the other owner’s property.

Surely this is a mistake, or do insurance companies really ask a neighbor (in this case, the victim) to pay for damages that they did to their property?

Don’t know if I can say the insurance’s name, but it is the largest insurance company in the country.

Just to be clear, I did not do any damage to their side, or mine. No damage originated on my side. Their side, and my side, were damaged by the washing machine on their side.
August 30th, 2013 at 8:04 pm #Jason

Sandy,
Just to reiterate, you own your side of the duplex and someone owns the other side. It’s unclear but I assume the owner of the other side doesn’t live there but a renter does. The washing machine overflowed and there was damage to each side of the property.

You had the repairs done on your side and the owner had the repairs done on their side which were apparently paid by insurance. Now the owner’s insurance company is asking you to pay for the damage.

It doesn’t seem like you would be responsible for their damage. I don’t even see how a renter would be responsible for the damage unless they knew the water was overflowing from the washing machine and did nothing to stop it.

Explain the scenario to state farm in the most accurate way you can and ask them to remove your personal information from the collection company’s records so you are no longer contacted for collections purposes.
August 30th, 2013 at 8:33 pm #Sandy

Thank you so much for responding.

Yes, the owner of the other side has a renter. It was the renter’s washing machine that overflowed.

Had been in contact with State Farm from shortly after the incident, and they had all of the details. The owner of the other side had turned it in to State Farm, assuming that they would pay for my side (and hers), and State Farm called me with a claim number. State Farm ultimately denied paying for my side as they said that it was the renter’s fault. They did pay for hers.

At first, I thought that maybe they had gotten things mixed up, but the collection agency had the renter’s name, the owner of the other side’s name, and mine, (and my cell phone number which I had given to the adjustor at State Farm), and the price that they quoted me was not the price that I paid for the damages, and the collection agency said that it definitely was for me to pay for the damage to the other side.

Will call State Farm, and will do as you said about the personal information, etc. (Thank you so much for that advice.) Should I call the adjustor that I had spoken with before, or someone else? Any idea if it will show up on a credit report? I’m not planning on buying anything. Just don’t like the idea of something like that being on a credit report.
August 30th, 2013 at 9:00 pm #Jason

Sandy,
Speak to the same person if you can. If you don’t remember who it is, just make sure that you get your point across with the person you speak with. You can speak with a claim manager, or the claim manager’s manager if your information is not removed from the collection agencies records. Although I don’t have much faith in state insurance comissioners, write a complaint to them if this continues. If the s.f has to specifically address this with an answer to the dept. of insurance, they will research the entire claim thoroughly to figure out that focusing on you for repayment is the wrong course of action.

I try to keep the topic related entirely to insurance but in regard to being reported to the credit bureau agencies, perhaps – but it would be on your report in error if it was added. Just go through the dispute process to get it stricken from your report.
August 30th, 2013 at 9:08 pm #Sandy

I appreciate the information very much. Very, very helpful.

Will follow your suggestions.

Should I file with the BBB?
August 30th, 2013 at 9:23 pm #Jason

Sandy,
No, you have spent way too much time dealing with something that you should not have to be dealing with. Just do the bare minimum to get them to stop focusing on you and get this behind you.
August 30th, 2013 at 9:47 pm #Sandy

Sounds good.

Thanks again.
September 6th, 2013 at 3:28 pm #Jennifer

My question is about my Heating and Cooling installation. I purchased my unit and had it installed in 2011. In August 2012 I went under my house to retrieve some decorations….well there was water every where. I called the company and they said that the drain line was clogged and they fixed it by moving the line about an inch lower. This September (2013) I went under my home again and the same thing happened. Only this time there was mold on all of the flooring including the main supports. I contacted them and was told that the initial report did state there was some mold the first time!!!! I was not told this before. A tech was sent out and said that it was fixed. He was also on the phone with his boss and said that a “T” fixture was installed wrong. I went and looked after he was gone and he done exactly what the last tech done…drilled a little lower. He stated on the report that the pipe was running uphill and clogged. He also stuffed a SOCK in the previous hole and filled it with clear silicon….with no mention doing anything about the mold. So my question is..can I sue this company and make them pay to fix the damage??? By the way I have a 10 year warranty with the company and the house was just built in 2011, the same time the unit was installed.
September 6th, 2013 at 4:11 pm #Jason

Jennifer,
Your issue isn’t about insurance – it seems to be about the incompetence of the HVAC people.

You would have to be sucessful in your suit in order to collect money from them. You have to determine what you should do. You might want to get some people in there that know what they’re doing before there is more mold and it gets worse.

I don’t know if your mold or damage is covered but you may want to consider submitting a claim with your insurance company. If your insurance covers it and the damage is the result of somone else, the insurance company can sue if they deem that the best course of action. I don’t know if your mold and damage is covered by your policy.
October 27th, 2013 at 4:37 pm #Brad

My AAA Michigan has denied my claim of wind damage. I have owned the property for 3 years and when I bought it it had a old barn with a hip style roof on it 1890’s. I never had plans to put any money into it.

One day there were 40mph straight winds that blew it over. I checked my policy to see if the old barn was covered not thinking it was due to is age and condition and come to find out it was covered, so I made a claim thinking I paid the insurance for it maybe I could get some money to clean up the mess. After the adjustor and structural engineer came out I received a letter the claim was denied due to structural rot on the beams. The report included pictures of the rot. I could have told them that.

So I sent a letter arguing my case that the rot was there when I bought the property and AAA should have been aware of it, that the doors were off it so they could have seen inside when they first observed the property. I asked them why did I pay on it for three years if we knew about the rot.

Another denial letter came stating they were not aware of the rot when they first insured the property that the inspector looks around the property but does not go in and that it was my responsibility to maintain the structure. Then they cancelled the insurance on my shed which was in decent shape (Uncalled For).

Not sure what to do, should I give up because of my failure to maintain the barn or is it worth my time to pursue further. If so what are my options and what else should or could I do.
Thanks
Unsure
October 27th, 2013 at 4:58 pm #Jason

Brad,
In your third sentence you say, “I never had plans to put any money into it.” That about sums it up. Why would you expect someone else (your insurance company) to put money into something that is falling down on its own?

The barn withstood all winds and gusts for 120 years. It probably seems like wind caused it’s failure because at the time the barn failed, the wind happened to be blowing – just like it does every single day.

The insurance company shored up its position with an engineer’s stamp of approval supporting denial. I don’t believe your time and effort would result in anything positive for you.
October 30th, 2013 at 1:48 pm #Stacy

Please advise me as to what I should do in regards to a delivery company that does not want to be liable for a water damage that occurred during a washing machine installation. They are denying the claim that was filed at the time of the incident which was in June 2013. Something happened when one of the installation guys was connecting the washing machine which caused water to spill out everywhere. This lasted about 5-10 minutes until I was able to contact my husband to tell the other guy where the main water system was outside and how to shut it off. (As an installation crew, I would have imagined they would have knowledge of this.) Sheetrock had to be replaced in my kitchen and garage at my own expense one which they do not want to reimburse. And the carpet still needs to be dried and treated for possible mold build up. The company was called at the time of the incident to inform them of the damages and get a claim started. But to this date, we are still fighting, going from company to company, person to person to get this claim taken care of. Is there any legal action I can undergo? If so, what legal area would specialize in this manner? Thank you.
October 30th, 2013 at 2:05 pm #Jason

Stacy,
Stop wasting your time and immediately cease trying to get anything out of delivery company.

Then immediately file a claim of water damage with your homeowner insurance company. After your insurance company pays for the damage in a prompt manner, they will attempt to collect the damage from the delivery company. They will even attempt to get your deductible back so they can send it to you.

As far as a legal area – you don’t need a legal area, you just need to use your insurance company because you have coverage for this exact thing.
November 2nd, 2013 at 5:48 am #Jessica

Hi we had a hot water heater burst 2 days before thanksgiving last yr We caught the problem immediately and our insurance sent out a first response mitigation company to dry out our house take out insulation the crawlspace, take out carpet backing. After the house was “dry” a restoration company performed repairs over the mitigation company work. They put in new carpet pads, linoleum floor and insulation in the crawl. work was completed by christmas eve that yr. fast forward to September this yr we keep smelling mold but cant find any source until it shows itself in a small patch on the living room ceiling. We think it must be a roof leak. We call our insurance they send an inspector who determines the roof is in great shape (less than 3 yrs old). says we dont have a claim because there is no cause for mold. Since we assume we are coming out of pocket for this we begin to buy damp rids to dry out our extremely humid house. We hire a property inspector who determines the roof is fine but the crawlspace is in terrible condition. Turns out the repairs made by the restoration company were shotty. Insulation was installed upside down,displace in many areas, vapor barrier was the incorrect one needed and crawlspace was full of water just sitting inside of the barrier. Restoration company comes out to look at the damages and says it appears we had large amounts of condensation from the air ducts underneath because it wasn’t wrapped or encapsulated inside the vapor barrier which is something they were suppose to do with their repairs. They have currently filed a liability claim with their insurance company and have not performed corrective actions on the house. Since we saw that spot of mold on the ceiling i began investigating throughout the house and found mold hidden in all the sheet rock walls directly affected by the initial claim of water damage and even toxic mold on an adjoining wall inside a bathroom. We spent thousands of dollars discovering that both the mitigation company and the restoration company cut corners and due to their shotty work have cause mold in our house but nobody wants to except responsibility. I’m 8 1/2 months pregnant and thought the repair work would have been completed a month ago but nobody has acted. Insurance adjuster never answers the phone or emails i send. They called me yesterday saying they hired an environmental specialist to check the origin of mold and moisture damage to our house so we are waiting for him to call us to come to the house. Additionally Insurance says they are going to pay for the repairs upfront and back charge it to the responsible contractors. They offered us use of our ALE benefits 2 days ago but then denied us a hotel that met our normal standard of living without a cause. So we have just been living in mold and high humidity for months. We cant run the heat this winter until they make repairs in the crawlspace and the house is extremely uncomfortable. I’ve documented everything I can but am not sure what to do at this point as the baby will be here by the 25th. What other actions should I be doing to get some results. I filed a complaint with the insurance commissioner and BBB. I feel like everyone is covering their own asses and leaving us high and dry. Thanks, Jessica
November 2nd, 2013 at 8:00 am #Jason

Jessica,
Stay on top of the situation. Make sure the contractors do a correct job this time. It’s your home and you have a vested interest in making sure the repairs are done correctly. Although many people don’t have the experience or knowledge to confirm the contractors did the work correctly, it still remains the homeowner’s responsibility to do that.

Make sure it happens this time – even if you have to hire someone capable of confirming it’s repaired correctly.

Technically your insurance company would excuse itself from the entire situation and place full blame on the contractors where the blame rightfully belongs for the contractor’s failure to do their work correctly.

It seems you have a second chance with the insurance company paying for additional work. Just make sure ALL is repaired and corrected before you consider it done. Stay involved and informed about what is being done, why, and if more should be done while the contractors are still there.

ALE is a judgment call. The insurance company will allow it if they deem it’s necessary. It’s your job to convince them it’s necessary. If you cannot run your heat, record the house temperatures during day and night each day and use those results as a basis for the need for ALE. If you have to involve a claim manager, do that.
November 2nd, 2013 at 12:23 pm #Jessica

Thank you so much for the advice. It is so helpful when it seems everyone is out to get you and nobody has your back. I will definitely stay on top of the situation and hopefully a contractor will be out here to start on the house before the baby arrives.
Thanks again,
Jessica
November 7th, 2013 at 10:39 am #Jessica

Hi Jason,
Can you please explain to me the limits of ALE. What is considered reasonable living expenses and comparable to normal standard of living when it comes to staying in a hotel. Currently most Hotels are booked up for Thanksgiving so nothing cheap is available for us. We would have to stay in an expensive Hotel and obviously our insurance doesnt want to pay for that. Additionally we are going to have a new born infant with us so is it reasonable to want accommodations that are a higher standard? Our insurance has a 3 month limit not a monetary cap.. We requested a 2 bedroom with a king bed cable a kitchen and internet access. We need the king bed because my husband is 7 Feet tall and cant fit on a queen. We have a premium king bed at home, cable and internet and my daughter has her own room. We requested the same accommodations but currently only really expensive Hotels have these because of the Holidays.
November 10th, 2013 at 2:00 pm #Jason

Jessica,
ALE is supposed to be the increase in your living expenses that allow you to sustain the same lifestyle you currently have.

It’s not narrowly defined and it can be different for all types of families. It’s not something that needs pre-authorization for your expenses to be valid and reimbursable. Spend your money to sustain your lifestyle as close as you can and submit the expenses for reimbursemement.

Some families get 2 or more hotel rooms to maintain their current lifestyles. Your insurance company would need a good reason not to pay for the housing expense you incur, no matter its expense. ALE doesn’t require the use of budget hotels.
January 17th, 2014 at 1:01 pm #Jessica

Hi I originally wrote you in November regarding my mold/water claim. Since then the Insurance has put us in a hotel but its been about 3 months now ans our ALE benefits are about depleted and the insurance has yet to make an attempt to settle our claim. Originally they were going to fi the house but once the estimates came in at 30k+ they stopped taking action and gave us the run around. So much time has passed now that the entire house has molded out/ and became contaminated with some sort of mold mites. They did a pack out our my home(most of the contents minus clothes) but never fixed the house. At this point its a total loss but they haven’t given us any offers and I’m assuming we will be having to find other living arrangements since ALE is used up. We have a ACV policy unfortunately however their lack of action has severely delayed this claim. What else can I do at this point to get a fair settlement.
January 17th, 2014 at 6:49 pm #Jason

Jessica,
The information provided before was to make sure the house got dried out and repaired properly. It doesn’t appear that occurred. That is the owner’s responsibility and the owner has the most to lose because of that.

I was surprised your insurance was stepping in after the terrible work of the initial contractor for your house, but that was good news for you.

I’m not a fortune teller but I don’t see this ending well for you. I don’t know all that transpired in the last few months but somehow your home got worse and worse. In fact so bad that you describe it as a total loss. I can’t grasp how a failed water heater with water damage turned into a total loss unless there was gross negligence involved. I suspect this negligence can be traced back to you.

Even the best home insurance policies have mold coverage limits with about $10,000 worth of coverage. Insurance companies have tried very hard to stay away from mold exposures and by covering mold, but with a coverage limit saves the insurance company a lot of money.

You mention the insurance company’s “lack of action has severely delayed this claim.” I cannot fathom anything they would do or not do that would prevent a homeowner from protecting their property from further damage – in your case a total loss.

It seems that since you want to get a fair settlement, that you’ve essentially walked away from your home and are relying on the insurance company to make it all better. I’m at a loss of words unless I have more information. My current impression is that you allowed (or failed to prevent) continuing damage and because of that, the insurance will exit the entire situation and you will be left with a big problem.
January 18th, 2014 at 3:29 pm #Jessica

Hi Jason, yes this situation isnt look good for me but i’ve done exactly what the insurance has told me to do. There are considering this a water loss not a mold loss. I do have mold coverage on my policy either way. I spent 7,000 of my own money trying to fix and find the source and problem which was determined faulty repairs/water retained in the ac system from when it drained out through the floor vents from the leak. The repairmen never checked the air ducts for drainage. The repairmen have acknowledge they did not properly complete the job. my insurance hired a private engineer to determine who was at fault. His own report puts the blame on the repair work. The home is getting worse because it is just sitting there. The humidity level in the house is extremely high and we have to keep the heat running so the pipes dont burst. We bought a dehumidifier that runs 24hrs a day over there but its not helping. The insurance kept telling us they were going to start repair work on my house and then months went by and they never did. Everyday we call and get no answers. They transferred our claim to the high claims department a month ago. We met with a new adjuster who said he was going to do whatever it took to get us back right but everytime we call him no answer. We really did do everything possible that was within our means to fix our home because initially the insurance denied our claim so we thought we were going to have to pay for this out of our own pocket. I sold my car for money to fix the house and investigation after investigation pointed to the contractors hired by our insurance. whats even stranger is that our claim files doesnt even show the initial company who dries out the house getting paid. We have no document on this company at all that our insurance hired. I requested the dry out companies work estimates, payout, contract etc and our adjuster blatantly ignores my requests. I dont know what else to do
January 18th, 2014 at 8:59 pm #Jason

Jessica,
I can assure you the insurance company didn’t hire anybody to do any work to your home. If any contractors did any work to your house, they were hired by you – and most definitely not by the insurance company. The only person that can hire someone to do work for their home is the owner. The insurance company doesn’t hire anybody – they merely pay the bills for covered damage.

If you are requesting a contract from the insurance company concerning the first company, I’m confident there is no contract because your insurance company does not enter into contracts with companies to do repair work – only owners of the property have the capacity to enter into contracts for work on their home.

There is water damage and there is mold damage. The under-addressed water damage led to mold damage. Your claim is comprised of both. Mold coverage limits are standard on homeowner policies and this is to limit the insurance company’s exposure when a water loss gets out of hand for whatever reason. Since you have an ACV policy, you might not even have any mold coverage. I don’t know this for sure but that is my guess. ACV policies are generally bare-bone policies.

I still don’t see this ending well for you and I am unable to provide any guidance or suggestions for you.
January 22nd, 2014 at 8:28 pm #Sarah

Interesting one for you- we purchased a condo 18 months ago and replaced many plaster walls with drywall, the trim and crown, and windows through out the unit. We decided on, signed for and paid for windows to be ordered, toward the beginning of the remodeling process. The contractor (Contractor A) we hired did replaced walls and trim, painted, etc. In spring, after several delays, we were informed that the windows (which were custom, wood casement windows, as building is old) had arrived, and we scheduled the installation. The windows arrived and were installed in one day, we left for work before even seeing them outside their boxes and without inspection/signing for anything. Long story short the windows installed were not the ones we ordered and Contractor A refused to fix his error. We filed a small claims suit and he eventually settled out of court. We were awarded the money we’d paid for the correct, custom windows months ago, money to pay Contractor B to install them, and not charged for removal of the incorrect windows. In that settlement, we agreed to forfeit any warrantees on any other work that Contractor A had done in our home and waive his liability in any past/future issues. So he’s out of the picture. Now, the current issue:

One weekend in November it became obvious that a large amount of water was leaking in our wall. We weren’t sure if this was a roof or pipe issue. Our floorboards were damaged and the neighbor below us suffered damage to his wall as well.

It was an emergency so the condo building manager asked to cut a hole in our wall to examine and hopefully stop the cause of the leak. We agreed if the condo association agreed to cover costs of returning that wall to it’s original condition. They did and the source of the leak was found to be a baseboard nail driven into the (common) hot water pipe by… our lovely Contractor A. The nail had rusted over time and suddenly had started spraying a lot of water.

In January we hired Contractor C whose estimate and scope of work the condo association had approved, to repair the hole in our wall. They paid for this. We paid for replacement and refinishing of the damaged wood floor in our unit.

The neighbor below us, super nice, we’re on good terms, had Contractor C do an estimate of the damage to his unit. He called it minor damage, however the estimate is like $5000 and apparently WE are to cover the cost, in addition to our own unit’s damages.

We have some options that we’ve thought of, but the most obvious is to go after Contractor A who was insured, and is at fault…. but we legally can’t.

1. Approach the condo association to pay for the damage. The pipe is under “Common Elements” and according to our condo bylaws, we’re not liable to fix those unless they’re damaged due to our negligence.

2. Attempt to file a claim on our homeowners insurance, though it’s not likely going to be covered because it was caused by a contractor… whose insurance would normally cover this sort of thing.

3. Talk to the owner of the unit below us, to have HIM file a claim on his homeowners insurance.

4. Try to talk to the condo association, and the other owner amicably: this situation is unique and the circumstances just ironic. Maybe they’d be willing to split the costs of the repair– each of us paying a third, just to avoid involving insurance companies at all.

Any advice on which option is best? Which is a bad idea, or what’s most likely to avoid US having to shoulder the cost of the entire repair, ourselves? Contractor C is pretty much having a hayday, his estimate includes a line saying there might be additional work, billed at $65/man hour and replacement costs of cabinets and countertop (which our neighbor never even mentioned being damaged– he is only concerned about the wall).

I was exhausted after our first issue with Contractor A… I don’t know where to start!

Thanks in advance.
January 22nd, 2014 at 8:47 pm #Jason

Sarah,
Don’t be concerned about or commit to anybody elses damage except your unit’s damage. The condo can take care of their damage through insurance or paying it themselves.

Same for your lower neighbor. He can submit the damage to his insurance company for his unit or he can pay it himself. Or he can do nothing – that is his choice. You don’t have to pay him a dime.

Submit this damage to your insurance company. If you think it won’t be covered, you are misunderstanding your insurance coverage. Just make a claim and don’t pay anything out of your pocket. Don’t commit to pay for the condo association’s damage or your neighbor’s damage.

You are making this situation way too complicated and it really isn’t. Each owner pays for their own insurance – and each insurance, in turn, pays the owner for their unit’s damage. If the insurance companies have any overlapping damage or liability, they will figure it out amongst themselves and you don’t have to be worried about it.

Also, if they want to go back to the first contractor, anybody can. Just because you released him, it didn’t release him from liability to anybody else.
January 30th, 2014 at 2:29 pm #Ann

Hi. Useful website. My question is this:

My 100 year old 4 story house in California had a large and devastating fire about a year ago. The fire burned off the top story of the house, half the 3rd floor and water caused severe damage to the rest. The house is now empty and gutted, awaiting reconstruction.

My policy with State Farm covers replacement cost and has a sizeable code endorsement. The city requires a new foundation in order to rebuild. The insurance company appears to be saying that unless the foundation was actually damaged in the fire they don’t have to pay for replacing it.

Since I can’t rebuild my home without replacing the foundation, this seems wrong to me. Can they really do this?

Thanks so much,
Ann
January 30th, 2014 at 2:54 pm #Jason

Ann,
Your policy doesn’t pay for undamaged components. In fact, foundations are generally excluded unless damaged by just a handful of causes.

Your insurance company should be finding as much coverage for you as they can. If you have to remove and replace your entire foundation because of code updates, the “code enforcement” allowance of your policy should be used for that. Generally a policy will have “code” coverage up to 10% of your home’s coverage. If you have the home insured for 250,000, then what should be available to meet code will be $25,000. This does not increase the policy coverage of your home but it does allocate that up to 10% of your coverage may be used for code compliance. Communicate with your adjuster if that has been taken into consideration for your claim. Based on the new basement requirement, your home is a total loss.

You have a complicated situation and you may need to consult with an attorney to receive all the benefits of your policy. Although there is a poicy allowance to bring your home up to code, it may not be enough to remove and replace the entire foundation. Some of that expense might be your own.

Another suggestion is to find a qualified public adjuster to assist you. I don’t favor public adjusters but a PA may be able to assist you. Write again if you have other questions. (If you have questions about PA’s, perhaps we can have Moderator1 provide some insight because Mod1 favors PA’s more than I do.)
February 5th, 2014 at 11:17 pm #Jessica

If a claim was handled and closed but damages were found months later and the claim was reopened does this change the 1 year time of occurrence to sue? Our 1 yr mark has passed because of frequent delays from the insurance however they still have us in a hotel and have just made a settlement offer that isnt sufficient. Im wondering if I can still sue
February 6th, 2014 at 7:29 am #Jason

Jessica,
The occurrence date for a claim is the day the damage happened (or first discovered). That date, and reference point, doesn’t change.

I don’t know if your 1 year is the time frame in which you can sue. Each state sets it’s own statute of limitation about suing and you would have to check that. The wording in a typical homeowner policy is stated as such:

8. Suit Against Us — No suit may be brought against “us” unless all of the “terms” that apply to the Property Coverages have been complied with and the suit is brought within two years after the loss.

If a law of the state where the “described location” is located makes this time period invalid, the suit must be brought within the time period allowed by the law.

Statute of limitations of your state can be found by searching the internet using the terms, “statute of limitations in all 50 states”. For more information, you may need to do additional research or talk to an attorney.
March 6th, 2014 at 6:32 am #Franchesca

My friend purchased renters insurance about 2 years ago. At the time her lease was for six months. She moved but failed to update her address. Her premiums are deducted from her checking account each month as they have been for the last two years. Her apartment burned to the ground this past Tuesday night. Thankfully she was not home when this happened. When she contacted her insurance company she was told that because she didnt update her address her claim would be denied. Is that accurate? She is a renter and as such her belongings and personal property are what should be covered. Not the dwelling. They never made contact with her regarding updating or renewing her policy or anything.
March 6th, 2014 at 9:04 am #Jason

Franchesca,
Providing information from a friend is not as accurate as your friend posting the information directly. Regardless, I will base my response upon the information you provided.

The policy definition of “insured location” is below:

4. “Insured location” means:
a. The “residence premises”;
b. The part of other premises, other structures
and grounds used by you as a residence and:
(1) Which is shown in the Declarations; or
(2) Which is acquired by you during the policy
period for your use as a residence;
c. Any premises used by you in connection with a
premises in 4.a. and 4.b. above;…

Because of the above wording, the policy understands that people move on occasion and insurance still applies.

As further indication that coverage should apply to your friend’s personal property, the following language is also found in a typical renters insurance policy:

COVERAGE C – Personal Property
We cover personal property owned or used by an
“insured” while it is anywhere in the world…

Based on fire damage to her property, and if she had renters coverage, her personal property should be covered.

Your friend should also have “loss of use” coverage from her renters policy.
March 26th, 2014 at 11:32 am #Jay Winter

My insurance broker didnt update my address when I moved. Insurance denied my claim saying I didnt have coverage at the new address. What’s my options?
March 26th, 2014 at 11:45 am #Jason

Jay,
The information you posted is too vague to provide any type of meaningful response. Is it home, personal property, or what us damaged as part of your claim? Homeowner or Renter insurance?

Also clarify, did your agent fail to change your address when you notified him, or did you fail to notify him when you moved?
April 28th, 2014 at 7:16 am #Dave

Our vacation home had a septic system backup through the floor drain and caused considerable damge in our finished basement. Upon investigation it appears the septic tank failed/ collapse as it is an old metal tank. Our insurance company claims that there is a $5000 limit on damge and repair to our structure caused by sewage problems. I only find this exclusion in the contract for “public sewage systems”…..not private.

Anyu advice?
April 28th, 2014 at 4:26 pm #Jason

Dave,
The vacation home is not covered the same way your primary home is covered. Do you know the form number? It would be something like HO-04 07 10. This form number can be found on any page of your policy and is either in the header or the footer.

There is a coverage endorsement called Water Back-up and Sewer Overflow which is where the limited coverage may be coming from. In base policies, the water and sewer damage is generally excluded and this endorsement gives back otherwise excluded coverage.
May 25th, 2014 at 3:08 am #Bobbie Washington

I had a homeowner’s policy with Allstate in Texas. This policy was converted to a Landlord package policy when my grandmother passed away. I learned of the Landlord policy when I went into the office to file a claim on the homeowner’s policy. At that time, I never discussed any particulars about the Landlord policy because I wasn’t sure whether I was going to remain with Allstate or switch to another insurance agency, since they had denied my theft claim under the homeowner’s policy. Allstate is contending that they presented a questionnaire to me, and I refused the Vandalism and Burglary endorsement. I have emails detailing my request to have my homeowner’s policy converted to a landlord policy. What is my next step. I have written letters to the Allstate home office and the Texas Dept. of Insurance Consumer Protection. Thanks.
May 25th, 2014 at 6:51 am #Jason

Bobbie,
If the policy you have doesn’t cover theft/burglary, then there is nothing you can do. The landlord policy you mention provides protection for the dwelling you own but in which you don’t live. It doesn’t provide any type of coverage for personal property. If you want to be covered for those type of losses, get a policy that provides that kind of protection.

The best advice I could give you is to find a company other than your current company because there are hundreds of companies that are rated better. Look at the Best and Worst Insurance Companies link at the top of this page.

One other thing worth mentioning is if you have a different homeowner policy in your name covering a home in which you do live, that policy provides protection for personal property you own which may be located any place in the world. Since the dwelling where the theft occured was formerly your late grandmother’s place, I don’t know of your ownership interest relating to the personal property.
June 3rd, 2014 at 8:52 pm #Jay

We have a home that we owe free and clear. We are attempting to get Homeowners insurance in NY State. We are being told by progressive they are denying us coverage because the age of our home is over 100 years old. Built in 1839 to be exact. Is this legal? I read on another site that it is illegal to deny coverage based SOLEY on the age or low value of a home. Our house has been completely renovated with all new electrical, insulation, roof, heating system and so on. Frustrated in NY.
June 3rd, 2014 at 9:16 pm #Jason

Jay,
Insurance is a contract between 2 parties. One party is the insurance company and the other party is the insured. There is no agreement and no contract until both parties agree to the terms of the agreement. If progressive doesn’t agree to the terms of the agreement, there is no contract. Insurance companies can refuse to insure any property they want. Just like any insured can refuse to do business with any company it wants to avoid. Contracts need to be entered into on a mutual basis. If progressive doesn’t want to enter into an insurance contract with you, that is perfectly legal. Find an insurance company that wants your business for a fully renovated home. Look at the link at the top of this page called Best and Worst Insurance Rated Insurance Companies to find an insurance company for your needs.
June 7th, 2014 at 10:09 am #Jim

We had a house fire over 3 months ago. We live in the state of Georgia. Within hours of the fire, they started asking us if we did it. The reasons being, from what we have discerned are because we were home at the time of the fire, our house was up for sale at the time of the fire, we had things in storage (of course because we were hoping to get it sold and move quickly), and because we had been doing the repairs to the home ourselves. Apparently, from what we were told by the insurance investigator, the cause of the fire was a mystery. They can not pin point how it started. We provided everything they asked for – financial records, phone records, etc. and the investigator called us and told us that she was satisfied that we did not set the fire and was recommending a settlement. A few days after that she called and said management wanted a statement under oath. They raked us over the coals for everything under the sun and are requesting even more documentation. What should we do? We really need to get this settled Our children are traumatized.
Thank you for any advice!
Agitated in Georgia
June 7th, 2014 at 2:16 pm #Jason

Jim,
A statement under oath is kind of serious. You and your spouse will be questioned about an endless array of things. Even things about which you have already provided a statement and documentation. Each examination will be only you or your spouse, both individually.

It’s always good to consult with an attorney before one of these things so you are prepared. Although you can consult with an attorney prior to the examination, your attorney is not allowed to assist you once the examination starts.

I believe the truth – provided contantly is the best way to address and investigation of your claim. It seems that you have a number of markers that has caused your insurance company to cover their bases before making a settlement. The things that stand out are that you were at home, your property was being stored, your home is for sale, and there is an undetermined fire that caused the damage.
June 14th, 2014 at 1:04 pm #Jordan

My car insurance is denying a claim because i moved and did not inform them. Is this legal?
June 14th, 2014 at 1:56 pm #Jason

Jordan,
I don’t think they are denying your claim because you moved and didn’t notify them. What is the exact wording of the denial letter you received?
June 24th, 2014 at 8:59 am #Eric

Insurancecalimhelp Administrator, What’s the Insurances Companies Monetary Claim Responsibility when They, ( Insurance Co. Admits Fault ) of my pumping BAD GAS of the Gas Station that they represent ? Summing this up I’ve had much Out Of Pocket Expense through this ordeal and they are offering approximately 3/4 maybe a little more of reimbursement.
As a result I have to Sign a Release Form over the Internet to receive the partial funds and put closure to this matter.
Please Advice Me regarding my expectations / rights as a Customer Unknowingly Simply Pumping Gas that happened to be Bad ? Thank You.
June 24th, 2014 at 9:00 am #Eric

Insurancecalimhelp Administrator, What’s the Insurances Companies Monetary Claim Responsibility when They, ( Insurance Co. Admits Fault ) of my pumping BAD GAS of the Gas Station that they represent ? Summing this up I’ve had much Out Of Pocket Expense through this ordeal and they are offering approximately 3/4 maybe a little more of reimbursement.
As a result I have to Sign a Release Form over the Internet to receive the partial funds and put closure to this matter.
Please Advice Me regarding my expectations / rights as a Customer Unknowingly Simply Pumping Gas that happened to be Bad ? Thank You for your advice.
June 24th, 2014 at 9:08 am #Eric

Insurancecalimhelp Administrator, What’s the Insurances Companies Monetary Claim Responsibility when They, ( Insurance Co. Admits Fault ) of my pumping BAD GAS of the Gas Station that they represent ? Summing this up I’ve had much Out Of Pocket Expense through this ordeal and they are offering approximately 3/4 maybe a little more of reimbursement.
As a result I have to Sign a Release Form over the Internet to receive the partial funds and put closure to this matter.
Please Advice Me regarding my expectations / rights as a Customer Unknowingly Simply Pumping Gas that happened to be Bad ? Thank You for your assistance.
June 24th, 2014 at 2:43 pm #Jason

Eric,
Your situation is specific to a legal liability issue where an insurance company is stepping in to bail out their insured.

Without looking at all your information, the insurance would pay you for only the ACV of your damage. That is all they legally owe you.

If you don’t want to settle with what they are offering, you would have to sue the gas station. Their insurance company would defend the gas station against your suit. The insurance would likely again offer you an amount to settle.

In order to sue, you would likely need an attorney since the insurance company will have attorneys representing the gas station. If you look at your options, accepting their offer is probably going to be the best option for you.
June 24th, 2014 at 9:57 pm #Eric

Thank You very much Jason, Although your advice is self explanatory for maybe a Home Owner and Such, would you please in layman Terms tell me exactly what is my Actual Cash Value of this claim ? I’ve supplied the claims agent the following; #1 Bill for Repair ( Insurance seems to have that $ figure included )
#2 Towing Expenses ( ? )
#3 Rental of a somewhat comparable vehicle for the time element of repair of my own vehicle. ( Most if not all is accepted in their offer pertaining to the rental )

#4 My Gas for Necessary Traveling as I would have had the incident never happen.

I think #4 are the funds I am lacking. Again since this has never happened to me I have no idea what to supply them in actual receipts, Etc. Thank You. Eric
June 26th, 2014 at 1:28 pm #Jared

Hi: I had damage from a storm/hurricane. The insurer initially denied the claim and then covered part after I threatened to sue. They argue that that portion not covered is from damage due to “earth movement” and “flooding”. The dispute is windstorm v. earth movement/flooding. Before the storm/hurricane my property was not damaged and did not have this damage. Their expert was not able to determine whether damage was from one source or another conclusively, i.e., if it’s flooding not covered but if it’s windstorm that caused water then it’s covered. You probably know better than I do the distinctions that are being relied upon. But what kinds of questions should I ask them in a deposition? And what traps should I be vary of in depositions of me? If you have a sample deposition questions to ask insurer in these cases, I’d appreciate it. Thank you.
June 28th, 2014 at 4:04 pm #Jason

Jared,
I have no idea of what your plans are. You do not lead a deposition – your attorney does. So this will avoid any need for you to come up with any questions.
June 28th, 2014 at 9:44 pm #Nolan

I was on warning light of running out of gas, I stopped at a remote area and put only $ 10.00 of what I found out to be BAD GAS after Pumping. By Law what are their ( Bad Gas Stations and Their Insurance ) damages ? I’ve had to TOW then Arrange for Repair Then get a Rental Vehicle Then Claim Agent didn’t show till 10 Days After had to wait for a part to to properly repair ( 1 day more ) Resulting to 13 day total of Gassing The Rental and Awaiting for my Damaged Vehicle I might add had to Pre Pay with personal credit card in order to retrieve my personal car.
July 18th, 2014 at 12:53 pm #Shital Patel

My canopy collapsed 4 and 1/2 months ago at my business. Had to remove pumps for new canopy and construction. After new canopy, pumps got put back in the Island and had all kind of issues. I was 100% operational before collapse, now I ended with non functional pumps and other equipment connected to pumps. I called petroleum company and they fixed all the problems and I am 100% operational. My problem right now is, I have around $11k worth invoice that need to be paid to company who fixed all the problems with pumps and the adjuster is “what it has to do with collapse, and what caused pumps not to work’ and kind of like stucked there. He is still looking for the cause after 4 and 1/2 months of business shutdown for construction. Please advise. Thank you..
July 18th, 2014 at 2:21 pm #Katie

I filed a claim with Progressive regarding our boat.
They denied the claim stating that it was not related to a sudden, direct and accidnetal loss.

While opperating our boat our engine cut out and would not start.
Had to get towed to the marina and brought our boat in for repair.
The Marina Service department detrmined that the Upper and Lower Units needed to be replaced.

Progressive inspected the damange and documented with pictures.
We provided evidence that the boat was serviced on a yearly basis and stored indoors every year. Progressive verified these facts.

Progressive denied the claim and stated that the damage was caused by low oil in the upper drive.
I called back to appeal the finding and they indicated that they could go back out and research further.
They went back out and tore down the drive and found additional damage, they found that the seals on the prop shaft failed which caused the oil to leak out and ultimately caused the damage to the upper and lower unit.

Progressive still denied the claim stating that it was considered normal wear and tear that caused mechanical failure and is therfore not covered.

We called around to Volvo Marine dealers and servicers and they indicated that “Prop Shaft Seals do not fail, they last around 20 year” and that “something in the environment caused the seals to fail”.

We presented this information to progressive and they stated that they will not cover it and our only course of action at this point is to file a complaint with the MN Department of Insurance.

What should we do, we have done everything to ensure that our boat is serviced and we are responsible for $10,000 worth of damage.

How can we appeal, should we get a lawyer?
Any advice would help.

Thanks
July 21st, 2014 at 12:05 pm #Jason

Shital Patel,
I agree entirely with your adjuster. The inoperable status of the pumps is not related to your damaged canopy. The 2 events are entirely independent of each other.
July 21st, 2014 at 12:13 pm #Jason

Katie,
Your claim is not covered. In fact, the damage was caused by excluded items which are outlined in your policy. There is no hope in appealing a decision that has already been accurately determined.

Don’t waste your time writing to the Insurance Dept. of MN. You would be better off writing a 4 page letter to them and then throwing it in the garbage. They can’t change the terms of the policy and force the insurance company to pay for contractually excluded events.

Why would you want to hire a lawyer? He can’t change the terms and conditions, including exclusions, in your policy. You encountered some maintenance costs and maintenance is not covered by insurance. No attorney can change that.
July 26th, 2014 at 10:37 pm #Chauna

Hi Jason,
I am trying to get some advice on our insurance claim through Progressive. My husband’s car was stolen July 5th. His car was parked out front of our house for a few weeks with the keys hidden in the console because my husband was going to be having it towed to a Subaru garage because it had a cracked seal. We had finally saved the money to get the car fixed and we planned on having the car towed the following Monday.
However, July 5th my husband is woken by the police stating that his car had been stolen, and the engine had been blown. The officer stated that there was a report of the car going past a local gas station “red lining” earlier in the night.
I immediately, after speaking with the police, called Progressive and reported our claim. After two weeks of hearing absolutely nothing from our adjuster I got onto my Progressive account online and saw that the car has be totaled.
Today I received a certified letter from my adjuster stating that Progressive is reviewing the case to see if they will be liable to cover our claim because of the cracked seal.
Now, my car was running prior to being stolen. What, if any, advice would you might have for us. I can’t imagine having to pay for a new engine or vehicle that we can’t even drive, nor can we afford it.
I would appreciate any advice.
July 27th, 2014 at 9:22 am #Jason

Chauna,
If you presented your claim to progressive in the same way you presented it on this site, progressive is very likely trying to verify whether the car was stolen or not. It sounds fishy that the keys were in the car waiting for a tow in the next few days. Key questions are: How long have you had comprehensive coverage on the car? What is your comprehensive deductible? What is the year, model, and mileage of the car? Why didn’t you have it towed earlier? How much was the seal estimate repair? Was the same subaru gargage that is was going to be towed to also intitially diagnose the cracked seal or was it a different shop? How long had the keys been in the car? Who put the keys in the car? Why tow a vehicle that can be driven? When was the cracked seal confirmed? Why would a thief focus on “redlining” a car’s engine with the apparent attempt to destroy the engine and only the engine?

Other questions are why was only your husband woken by the police – don’t you and he live together? What was your husband doing the night of the 4th when this car was “stolen”? Your husband put the keys in the console, he was going to have it towed to a repair facility, he is the car owner, he parked the car. So far, your husband is fully in control of all things to do with this car, but you are the one who makes the claim to the insurance. Why didn’t he make the claim since he did everything else?

I think this claim is going exactly as it should with the information you provided about the claim. I have doubts it was stolen and I think that is also progressive’s position. They have to verify the engine was not destroyed by its owner before they will consider honoring the claim.
July 27th, 2014 at 10:04 am #Chauna

Jason,
To answer some of your questions: the night of the fourth my husband, myself, and our three kids went to the fireworks in town. When we got home my husband fell asleep on the couch (where he usually sleeps) and I put our kids to bed after I ran to Walmart. I, after putting our kids to bed, fell asleep in the chair. I woke up about midnight, got up cleaned a bit. I went outside at about 1:30 a.m. threw out our trash and locked my car and took the keys out of it. I then went to bed. The next thing I know I was being woke up by my husband, who was just woke by the police.
The keys had been hidden in the console since we initially found out what was wrong with the car from a local garage. We intended to have it towed earlier, and Progressive does have record of this, because we have tow coverage. I had cancelled the initial tow because we talked to a mechanic friend who said it was going to cost us a lot of money because they were going to have to remove the engine to fix the seal. We had just paid our local garage $130 for diagnosis, and we were going to have to pay $150 for what insurance wouldn’t cover for the tow. They cover hitch and 15 miles, and the Subaru dealer is 50 miles away. Plus the cost for Subaru to diagnose the car and fix. So we waited to save money.
The local police did have video of the thief and an eye witness as well. The perpetrator also left a bookbag and a t shirt in the car. He ran into the woods once the engine blew because a car was coming up on him and the car. That person is who called the police, what we think from the time line, around 15 minutes after it was stolen and call to police came in. We know it was stolen after 2:25 am because my brother had his car at my house. He picked up his car at that time, and the car was still out front. The police were called about his car at 2:50 am.
I am the one who deals with all of our bills, calling places ect. Because my husband doesn’t do any of that. He thinks it’s easier for me to do that stuff. The car was fingerprinted. The keys were in the console to be towed because my husband works nights (had fourth off) and I work days. So we left keys hidden in console so that when we had it towed they could just take it without my husband having to get up.
Hope this info gives you more insight.

Again, thanks for the helps,
Chauna
Sent from my iPad
July 27th, 2014 at 10:08 am #Chauna

Also, car is a Subaru Legacy with 61,000 miles on it. Bought it November 2013, the Subaru dealer where car was going to be fixed is 50 miles away, I didn’t want to take the chance, with oil leaking, for the car to be driven and break down on the way. The dealer that diagnosed the cracked seal is in our town, but a Cheverolet dealer so they couldn’t fix the car. That garage is also where he bought the car.
July 27th, 2014 at 11:09 am #Jason

Chauna,
Let me clarify that the insurance company has to determine whether the car’s engine was damaged at the hand, or at the direction, of the insured.

The late night activity of your brother arriving at 2:25 pm, and the car being taken shortly after that, your husband being at home on this day when he is normally gone during the evening at work needs to be looked into.

All of this lines up that the engine may have been destroyed at or by the direction of the insured. There is both motive and opportunity. There is also financial benefit if the car is stolen and the engine is damaged. Who gains the most if the car is stolen?

If the insurance covers the engine replacement, then you wouldn’t have to pay for the engine removal, seal repair, and engine re-installation. You would only have to pay a comprehensive deductible. What would have been ideal is if the engine was damaged within 15 miles of the subaru garage. Your insurance has to check this out.

If it was indeed stolen and nobody who owns or insures the vehicle was involved in the theft or engine damage, then the insurance company would have to determine how much damage there is. It would be the difference between the cost of replacing a used working engine and what it would cost to pull and reinstall the engine after replacing the failed seal.
July 27th, 2014 at 2:26 pm #Chauna

Oh, and one other thing: the make seen driving the car, redlining it was white, and my husband it half black half Hispanic. Also the guy who stole it must have been about my height, 5’2″ because he had the seat moved all the way up, and my husband is 5’8″.
July 28th, 2014 at 12:18 pm #Julie

Our Homeowners Association has a bunch of pipes that feed stormwater into a pond….From the pond the water flows thru one sole concrete pipe into the County storm drainage system….We were having issues where the water wasn’t flowing out of the pond properly and water was backing up into the neighborhood roadway….The Association paid to have a video robot look inside this concrete pipe….Inside were found numerous roots and bits of concrete broken off because of the root intrusion….Our hired engineer has informed the Association that the roots must be removed and the pipe needs to be lined to keep the structural integrity of the pipe together long term….

2 Questions:
1) Would this repair (cleaning out the roots and lining of the pipe) be covered by insurance?….
2) If so, where would one look in the policy for language that would cover this type of thing?….
July 28th, 2014 at 8:39 pm #Jason

Julie,
The repair seems to be general maintenance that needs to occur when events of this nature present themselves. You ask if this will be covered by insurance.

The answer to that is yes and no. Any expenses incurred by a homeowner association is passed onto its owners. You and a whole bunch of others are owners so you should expect to be one of the people paying for this assessment.

Your unit policy covering you specifically may have a coverage that pays for an assessment, up to a certain amount, such as $1000. Anything above that amount would be your responsbility.

If you are looking for coverage, look under condo assessments.
September 13th, 2014 at 9:47 pm #Danielle

Hello,
I have a question, we have home owners with Usaa. Last year someone broke into our house we are guessing through the garage. Anyway we were covered for the incident. The thieves took quite a bit of our stuff including jewelry. Our claim totaled about 17,000. No one ever asked questions and well this year we had another incident. I talked to the rep and asked them to advise me if I should file the claim or not. They advised me to do so. So I did well they investigated that claim sending someone from SIU out to our house to harass us and force is to give recorded statements as well as go through our house. Well now they are saying they want to investigate our claim from a year ago as well. I just find that odd. They are starting to get on my nerves. Is this typical ? I mean we have had usaa for 6 years I don’t know why they are treating us like this now. Should I get a lawyer ? I really can’t afford one. What’s your opinion?
September 14th, 2014 at 6:06 am #Jason

Danielle,
You have a very good insurance company. Nothing they are doing is out of the ordinary. I would be surprised if they weren’t involving SIU. Two robberies in a shorter period of time is a very uncommon situation.

You should, at minimum, talk to a lawyer about your situation and do what you think is right.
October 2nd, 2014 at 2:27 pm #Jim

My tractor was stolen from my girlfriend’s backyard last week, now my insurance company “safeco” tells me yes the tractor is covered under my personal property but they won’t cover it because it wasn’t on my property.
I live at my girlfriend’s house every other week because of my custody for my kids.
What can I do?
Thanks
October 2nd, 2014 at 6:38 pm #Jason

Jim,
If you have a homeowner policy and safeco says your tractor is covered as personal property, then you need to point out to your adjuster (or his/her manager) that your property is covered because of the common and simple language of your policy. Most insurance policies have the following language (or very similar) in the policy:

Covered Property
We cover personal property owned or used by an “insured” while it is anywhere in the world.

**** I believe your girlfriend’s backyard would be considered to be “anywhere in the world”.

Pertaining to your claim, it doesn’t matter what your living arrangements are.
October 9th, 2014 at 4:46 pm #BradyGirlForLife

Hi~
I live in Massachusetts and (unfortunately) I have Travelers Insurance. Have it for 20 years and never used it once~ Until May when my home was broken into~ We had only moved in 1 year prior! They put my through the Spanish Inquisition and then sent a fraud investigator~ Mostly because I didn’t have many receipts or owners manual~ I did have some, however due to the move we had cleaned house! After all was said and done~ we were found not responsible ( No kidding). ANyway that was back in May~ recently we were cleaning our shed and discovered some items missing. I informed the police and submitted claim to the insurance company! They asked for proof of ownership~ First, I have no photos as they where all stolen in the robbery~ I contacted one of the stores and they gave me a receipt for two of the items~ The insurance company has put the “Fraud ” investigator on the case~ He said the store is denying giving me the receipt and they are going to deny the claim! Help…….fist question isn’t this still considered part of my original claim which I was already found “innocent” of and paid for replacement? If yes, how can they deny? Secondly, do you have to have proof of ownership to be paid? I am so sick of them and I am leaving ASAP~ My policy states that I should provide as much proof as possible but it does not say they wont pay if you don’t~ nor does it say they will accuse you of robbing yourself and put off paying and make you run around like a chicken with your head cut off~ As for the receipt~ the store is denying it and I don’t want to get the employee in trouble for doing me a favor? Hope you can help??
October 11th, 2014 at 5:50 am #Jason

Brady,
It is still a single claim. Fraud has to be elimiated at all stages of a claim and your claim is not concluded with your recent submission of missing items. Possession is generally considered ownership. If you can provide proof of possession, that should be enough.
October 11th, 2014 at 10:33 am #Bradygirlforlife

I guess I understand that, however proof of ownership isn’t always easy! I don’t save reciepts and don’t have pictures as they where on all devices stolen! So that’s where it’s tricky, also the policy doesn’t state they won’t pay if you can’t provide proof! Also, I have read that any ambiguity in the policy falls in favor of the insured? So, do I have a chance? If claim is denied do I just let it go? Its so frustrating and disheartening when you pay for insurance for 20years and when you need it they put you through the ringer! We are the victim’s yet are made to feel like we have done something wrong! The entire system is backwards and after our experience I have deep disdain for the insurance industry, yet it’s a necessary evil!
October 11th, 2014 at 8:18 pm #Jason

Brady,
Ambiguity is something a court will decide – unless the insurance company concludes the issue is ambiguous on their own. The policy is not ambiguous on the requirement for an insured to cooperate in the investigation of their claim. Of course this requirement is very broad and rather vague but it is not ambiguous. It is written this way so it is not considered ambiguous.

I don’t know the details of your claim and insurance is not a contract based on odds or chance for coverage or denial so I cannot answer if you have a chance. It’s your choice to do something further after a claim is denied or paid and I won’t advise what that action should be.
December 15th, 2014 at 7:26 pm #brian

I recently had a home break in, and have a policy limit of 2000 on firearms. The guns that were stolen are estimated at 3500. Now is there anyway of fighting the limit or am I stuck with 2000?
December 16th, 2014 at 4:28 pm #Felicia

Hello

My entire house flooded in 2008 from a pipe and Servpro came out to dry out the floors. Now my house is on the market. An inspection was done on my home and now I’m being told there’s mold underneath the house. Could this be a result of the previous claim and is it to late to revisit?
December 16th, 2014 at 8:36 pm #Jason

brian,
No, you can’t fight the limit. The limit is what you and the insurance company agreed upon. Some insurance companies view your loss as $3500 with $2000 worth of coverage – which means your loss is $1500 beyond your coverage and they may offset your deductible by up to $1500. In your case, if your deductible is $1000, they will absorb $1000 of your deductible because your loss was more than your coverage, which would result in just $500 not being covered. This application of coverage doesn’t apply to all insurance companies.
December 17th, 2014 at 3:19 am #Jason

Felicia,
Yes, it could be related to the previous claim. No, too much time has passed for the insurance company to become involved again.
December 17th, 2014 at 3:39 am #Felicia

Thanks for the feedback. I kind of figured as much, but wanted to be certain before trying to take care of this. It’s just sad when you trust that a situation was taken care of and then you find out something different.
January 13th, 2015 at 9:46 am #lou

Hello,
Question my car was broken into on blackfriday, and my my presents were stolen along with my jacket while I was eating dinner.the majority of my reciepts were in my coat. When I filled out the statement of loss I put the price I paid explaing that some of the pricing was extremly low compared to replacement due to black friday.liberty mutual now wants euo schedule in march . obviously since I haven’t been paid and dont care now since Christmas has passed and I replaced the itiems .can I cancel the claim? Not having the majority of the receipts since I paid in cash. They also are requesting my bank statements, and the recipet from the restaurant. Who keeps restaurant reciepts? Do I have the right to close the claim? Since I cant offord the time off work or pay a lawyer to represent me
January 13th, 2015 at 5:31 pm #Jason

Iou,
Yes, you can cancel your claim. Your claim will then be denied because of your lack of cooperation, which is required of you based on the language found in your policy.
January 13th, 2015 at 7:26 pm #lou

Will there be any repercussions for doing this, being dropped? I dont have the money for a lawyer and to take a say off for a 4 thousand dollar claim
January 14th, 2015 at 11:52 am #Deborah

We filed a claim with Citizens/Hanover Insurance after a pipe froze in our house in Michigan. We stayed at our house in Florida while the Michigan house was being reconstructed. I submitted to the insurance company what a comparable place to rent in Florida would cost for the number of days our Michigan home was unlivable. They denied that part of our “Loss of Use” coverage because we did not incur any additional expense—we already had the home in Florida in which to live.

I explained to them that our home in Florida was not free to us, and that we had invested a lot of money to purchase it, pay taxes and insurance on it, etc.

Bottom line, if we had been the average person without a second home, they would have put us up in a hotel and bought three meals a day for my husband and me. Isn’t this discrimination against people who succeed and get ahead in life? Couldn’t we argue that we did pay additional living expenses for the Florida home–we just prepaid them prior to the claim.

Also, we were in Florida when the damage occurred. We had to fly to Michigan, rent a car, eat at restaurants, etc., to meet with the contractor and go to tile places and lumber yards and cabinet companies, etc., to pick out all the new items. The insurance company’s position is that although it might have been uncomfortable or awkward doing those things over the phone, they did not ask us to come back to Michigan. Wouldn’t any reasonable person go back to their damaged home to pick out all the things needed to renovate 2/3 of the home? If so, wouldn’t the expenses incurred in so doing be related to the “Loss of Use” of the flooded home in Michigan?

We have $66,000 “Loss of Use” coverage, and they are only willing to pay for the dog sitter we hired for the 16-day trip to Michigan and food costs over and above what we normally spend. I submitted over $15,000, including the comparable rental fees of what we should be able to rent, air fare, car, food, gas, etc.

I hope to hear from you. Any advice you could give us would be greatly appreciated.

Sincerely,

Deborah
January 14th, 2015 at 4:48 pm #Jason

lou,
Of course the insurance is looking at you more closely and if you refuse to submit to the EUO, they will believe their suspicions are are accurate. They will likely drop you because they won’t want to do business with someone they don’t trust. An insurance policy is a voluntary agreement between 2 willing parties. If you withdraw your claim, they likely won’t be willing to continue the agreement you had before.
January 14th, 2015 at 4:58 pm #Jason

Deborah,
I don’t have any advice. I agree with the assessment of the adjuster. I say that because I’m confident the insurance company has much more information about your claim and situation than I have.
January 21st, 2015 at 4:57 am #TJ

I moved Oct. 2014. I hired day laborers from the store around the corner to help me move. After finally unpacking about a month later due to heath issues I noticed that my safe was missing. It had documents, jewelry (some proof of jewelry purchased), and my passport. I filed a police report and I gave a recorded statement to the best of my ability. Should I give another recorded statement? Also, How do I show proof of items other than pictures and boxes when some of the items were bought 2nd hand?
January 21st, 2015 at 4:57 pm #Jason

TJ,
It is entirely up to you if you want to provide another recorded statement. If you don’t, your claim will be denied for lack of cooperation with the investigation of your claim.

You will have to ask your adjuster how they want you to document your loss. It doesn’t matter if you purchased things new or used. You likely have a replacement policy for personal property.
January 22nd, 2015 at 3:52 pm #Susan

I had a pipe burst in my basement. The main was shut off and I got some spanish guy to help me with the water mitigation, but I did a lot of it myself. My deductible is high, so since the insurance company said I could use anyone I chose, I did it that way to keep costs low. The guy who helped works for another company and does this type work on the side and is very good. I thought I’d get a check for all the damage including what a water mitigation company would have charged. Now, I’m being told that Water Mitigation is separate from the loss and they pay the vendor directly… They said they need the Work Authorization, Record of Drying Conditions/Moisture Mappings/Drying Log, Final Estimate/Invoice, W-9, Photos. I just spoke with the guy and he said he can’t do that because he doesn’t have a company and if they pay him, his taxes will also increase etc and he thought I was going to pay him out of pocket. Can I demand that the insurance company pay me fair value for water mitigation instead of doing there way? Please let me know. Thanks
January 22nd, 2015 at 6:46 pm #Jason

Susan,
Just be up-front with your insurance adjuster and let him know that you had a friend who works at a mitigation company help you off the record and that you need to pay him for his service (and equipment use, if applicable).

If you want to charge for fair value of water mitigation, what would you charge? What you owe is for your friend’s help and that is what the insurance company should pay.
January 22nd, 2015 at 9:44 pm #Susan

Thanks for the advice. But my next question is won’t they attempt not paying for that at all if they find out he isn’t an actual water mitigation vendor company and don’t have all the documentation they require. Also, I was reading online and it seems some companies pay the owner if the owner does everything him/herself, so would it be better to say I did it myself or say I had a friend help me off the record in terms of how much I get for it from the company? Please let me know.
January 23rd, 2015 at 3:31 am #Jason

Susan,
See my last response.

Also, very few homeowners are qualified to do water mitigation and drying properly and that is why companies like that exist.
February 3rd, 2015 at 4:24 am #Dee

Just want to say first that this site looks like a great source and I appreciate the help in advance.

I moved about a year ago from one county to the other in California and didn’t update my address with my car insurance. I let my daughter borrow my car and she was in a car accident while driving it. I don’t believe its her fault.

She used to live at my old address after I moved out and was not on my policy but she moved out about a month before she got in the accident. I don’t see a problem with coverage there. My main question right now is whether or not the insurance company will try deny coverage because I didn’t update my address? I’m not trying to screw the insurance company over, I just didn’t didn’t update my address. I am forgetful.

I mention my daughter moving out because I am wondering if the insurance is going to say Hey that’s too close to the accident plus he didn’t update his address. Lets find any thing her to deny his claim! That’s what it seems like so far with all the questions they’ve been asking. They are asking why she was driving, where she was going and all and saying that they want that info for underwriting. Are they making up that underwriting part? Please let me know what you think, thanks in advance!
February 3rd, 2015 at 6:05 pm #Jason

Dee,
Underwriting is a legitimate part of the insurance company that needs to know the risks of each insured. Underwriting wants to know who is driving the car, or who has access to the car, on a regular basis. Either they charge the appropriate rates for that person or they don’t. A driver who may drive your car 1-3 times a year, if even that, doesn’t increase the risk of your car being in an accident significantly considering the other 360-some days in a year.

It’s not really a matter of when you update your address, it’s more about what actually existed as far as places of residence at the time of the accident. Claims can’t be denied because of failure to update an address in a reasonable amount of time.
February 3rd, 2015 at 7:43 pm #Dee

Thank you Jason,

well I just read that some insurance companies will deny coverage if the car was not kept at the owner’s residence. Is that what you were talking about when you said “it’s more about what actually existed as far as places of residence at the time of the accident.”?

I should be fine then since the car was mostly kept at my new residence at the time of the accident and even if I moved and didnt update my address, is where the car was kept what mostly matters?

Thanks for the info on the underwriter. I am just worried now about the “reasonable time” to update my address now. I keep reading about how insurance companies will do anything to deny claims. Why even have insurance right??

Sorry for all the questions. I have gone to an attorney already but they seem greedy. Thank you for all the help
February 3rd, 2015 at 8:02 pm #Jason

Dee,
It’s not if the car is not kept at the owner’s residence, it’s what is the actual use of the car? That’s what is important. That determines rates paid, and if there is coverage.

There may be delays in the notification of a residence change but it can be determined with certainty when residences have actually changed.

What do you mean you “should be fine since the car was mostly kept at my new residence at the time of the accident?”. No, that doesn’t mean you should be fine. What that means is that I need to know what “mostly” means. And also where the car was at when it was not at your new residence. This is important information, not only to me but to your insurance.

I don’t know what a “reasonable amount of time” is to update an address. I would do it the same day I changed my address but some people might think 5-7 days is reasonble to do that.

Why have insurance? That is to transfer the financial risk to another party more capable of handing that risk at any given time. Insurance is important, but it’s a give and take, not just one sided.

I don’t know why you would seek an attorney to assist you in this matter unless there is more to this incident than you posted.
February 4th, 2015 at 3:43 am #Dee

Hi Jason ok the use of the car was for myself. By “mostly” I meant that I normally had the car at my new place but sometimes would stay at my old place to visit my daughter or family. I would be there for a few days at a time and then go my new place. A few times I left the car there since I had an extra vehicle but that’s really it. Are they going to look at all of that and if they will, what can I expect more paperwork on someone showing up to interview me or something?

Should I expect to have to always keep a car on my policy with me at my current residence all days of the year or something? I hope there’s some freedom there but I dont know. How much all of this can be analyzed? If I have to, I won’t move a car around or I’ll ask them to cover me for 2 places if needed! If that’s possible, you think? Thanks again. I just want to get this squared away
February 4th, 2015 at 6:15 pm #Jason

Dee,
How many vehicles do you have? Who is the primary operator of each one?

What doesn’t make sense is how you visit your daughter while driving 2 cars there at the same time. I can only imagine you leave one there for your daughter to drive and the other one is for you. That is the logic your insurance company will have because it makes the most sense.

If the car usage doesn’t make sense, the insurance company will question it until they find out what is up. I just re-read your posts and don’t believe most of the stuff you’ve written. I’m sure your insurance company is in the same position.

You don’t need to be covered for 2 locations. Locations has nothing to do with auto insurance. What you should do is get all the regular drivers of the vehicles accurately reflected, including the primary home location of each vehicle.

One question that is of importance is whose vehicle does your daughter drive when she is not driving your car?
February 11th, 2015 at 11:04 pm #Dee

Hey Jason, I havent been on the internet with the new flooring Im putting in my house. Anyway, I am not sure why you dont believe what I am posting. I actually laughed at your comment. I dont have the typical scenario where I have a single car, I have 3. I have bought used cars through the years and some I dont want to give up like me 96 civic that gets great mpgs.

I dont go to the other house with two cars. My family, including brother in law goes back and forth between the two homes. They are not that far apart maybe 30 minutes. Sometimes I go and then head back in a different one of my cars or get a ride there or back with a family member. Why am I going to drive back when someone is headed that way alrady? Sometimes I leave a car at the first home, the one that used to be my main home for weeks at a time. But just because the car is there doesn’t mean anyone is using it. My daughter is young and I’m forcing her to save up for her own car. Thats how I was raised. If she uses one of my cars its because its a total need or emergency not things like groceries or the movies. She rides around with her friends, I dont even let her near the other 2 cars because those are no civics.

So, if the insurance company is confused about that I can clear things up for them. My worry is about if they will try to dig something up from my situation and my use to try to deny a claim. And yeah my situation is not typical so I dont know what they will try to do. I never remember them saying I cant freely use all my cars or use more than one car. I also dont remember insurance companies saying you cant leave your car parked somewhere for days or even a couple of weeks. Or will they look into that too?

But look I am not arguing with you. I just dont like how companies treat regular customers. All those commercials that say they will take care of you during an accident and then one happens and they sound like they interrogation experts. Thats my experience
February 12th, 2015 at 8:32 pm #Jason

Dee,
If you like the fuel mileage of your 96 Civic, why don’t you give up your other cars and drive the 96 Civic exclusively? Perhaps you can’t because your daughter is primarily using that car.

If you have a brother-in-law, and other family members who use your cars, what kind of cars are they using to get to this place where they can magically take your car and leave their car? The information you provided makes no sense.

So while you are forcing your daughter to save up to buy her own car, how is she getting to the grocery store and movies when she doesn’t have a car while your car is so conveniently left is in her driveway with the keys in her possession? Could she possibly be using the car that is avalable to her for emergency usage for more than emergency usage? Do friends seriously pick up other friends on a daily basis to go grocery shopping, pick up prescriptions, get cigarettes/beer, or a movie from redbox? Logic and reason would conclude your daughter has unlimited and free access to your car for whatever she wants it for. I am inclined to believe that her friends have their own lives and don’t cater to your daughter’s daily driving needs (especially when she has a readily available car for her immediate use.)

It doesn’t matter if you remember or not that the insurance company says you can use one or all of your cars. You can leave your car anywhere you want – they just don’t want any of your vehicles readily available to your young daughter without charging the appropriate rate to you for your daughter’s regular use of the car.

You may not remember that your insurance company said you can’t leave or park your car for days, weeks, or whatever, buy you have to realize a common question of each of your cars is, “where is the car usually garaged at night?” (or something very similar). If you indicate the car is usually garaged at your daughter’s place, they will rightfully require the appropriate premium for that. If you want to mislead them about where the cars are or who regulary uses them, it will eventually catch up to you.

You are a customer who is not forth-right with your car’s usage and insurance companies need to know how to charge for the exposure they have for the insurance coverage they provide. If a young woman is driving one of the 3 cars owned by a middle-aged woman, they should be accurately collecting an appropriate premium for that specific exposure.

I’ve changed my position – instead of not believing most of the things you’ve written, I instead don’t believe anything you’ve written.
February 13th, 2015 at 2:11 am #Dee

I didnt say other family members were using my cars. Maybe I didnt explain that good enough. When I go to the other home, not my home, I either take one of my cars or I get a ride there with a family member who has there own car. Obviously Im not going to get a ride there if one my cars isnt at that house already because then Id have to try to get a ride back. And if I am getting a ride back, again in one of their cars, thats when I can leave one of my cars there. Do you know a big benefit about leaving a car at that house? I can garage it! A nice clean roomy garage. I have 3 cars and no garage space at my current home.

My daughter does not use the car how you think she does. If she needs groceries she goes with her aunt, my sister. Yes I used to live with my sister and I finally moved out, thats the other home Im talking about. She doesnt have her friends pick her up and take her eveywhere but she certainly likes leaving the house to ride around with them whenever she can. Isnt that what teenagers do that dont have cars?

And yes yes I agree that if she was using the car or any of the cars often she should be covered but she is not. I dont know why its so strange to you of a family having a car that is off limits to a teenager. There is no way I will trust a teenager with regular use of my car. I guarantee you she will be much more responsible when its a hunk of metal she paid every penny for.

So that being said I will explain whatever I need to the insurance company. Thanks for your help.
February 14th, 2015 at 7:39 am #Jason

Dee,
So what I got out of your last post is that your two other cars remain at your sisters place where your sister and daughter have them available for regular use, while you lead yourself and your insurance company to believe they are using them only for emergency, or occasional permissive, use.

There is no way an insurance company will trust a teenager with regular use of your car – unless they are charging the appropriate rate for that car and its exposure. Your explanations fail the smell test. The actual or perceived exposure to others driving your cars is too great for the confused and unexplained risk associated with them. A reasonable insurance underwriter may pass on insuring more than one of your cars based on your explanations.
February 20th, 2015 at 9:07 am #Heather

hi there,
my boyfriend and i are insured thru state farm we lived thru a second fire having two in two years which is what my question is based on. i wont get into the devastation of it all- but my question is this: (i should first add that we did not receive a proof of loss to fill out on this second fire) we received partial payment for the item list we turned in which was incomplete as we were still working on our item list having troubles since our paperwork receipts etc. were burned up, when we turned it in they denied coverage saying 60 days is all the time we had to turn in item sheet. well this seems weird since the first fire it took us months to finally complete the list and they were helpful and accommodating and said we had two years. The second fire even more devastating having just replaced everything from the first, and more emotional than before now-we dont understand why they would deny the rest of our items saying 60 days when we had all the time of two years if we wanted the first fire. our lives have been turned upside down and sideways and feels like there has to be something we can do this doesnt seem right at all. is this a bad faith situation or are we damned and getting the short end of the stick real bad ANY HELP would be greatly appreciated.
February 20th, 2015 at 4:59 pm #Jason

Heather,
The wording of your policy referencing the 60 days is:

Send to us, within 60 days after our request, your signed, sworn proof of loss which sets forth, to the best of your knowledge and belief:…

From the information you provided, if you haven’t been provided a proof of loss, the 60 days has not yet started.

Be vigilant and know your insurance policy so you can get through this. Ask any further questions you may have.
March 4th, 2015 at 3:48 am #John

Hello there Jason, this has been troubling me.

I was in a car accident bot long ago. I am ok thankfully. I now have some papework. I have not updated my address with my car insurance for almost two years and they are asking me to sign forms that have my old address on them. These look like forms to cover me damaged vehicle. I want to sign to get everything processed but don’t know if they will deny coverage if I sign with the wrong address? How would they find out?

At the same time, if I tell them about the new address, I am worried that they will deny coverage because I didn’t update the address. I didn’t update because my wife and I didn’t plan on separating permanently but we did after we were back and forth of being together and not. She’s kept her car at my old place where I lived with her and I’ve mostly kept my car over here.

I have State Farm. Should I tell them about my new address or sign with my old one? appreciate the help.
March 4th, 2015 at 5:47 am #Jason

John,
I won’t tell you what to do because that is your choice. During those 2 years you could have corrected your address on any day of those 2 years with a telephone call to your agent. I don’t know enough about your situation, and I certainly don’t know what state farm will do.
March 25th, 2015 at 9:48 pm #Jerome

Hello Jason,

I like to thank you and the other advisers for such a great public service site.

In searching for the policy limit exclusions, after being denied full “APV” coverage for items stolen from my car which was based of my recorded statement of my desire to sell them for a profit, i found your site.

With the understanding there are policy limits “Products” for certain items within the household that are high value. However, if the items are damaged, and purchased with sales receipts, and provided i could perform the repairs to resell is this a “Reasonable” cause for exclusion because of my indication for economic gain (I could Sell it or Maybe not).

The agents made the point that since i indicated on a recorded statement with the Claims investigator they were not going to cover the items because of i purchased them for resell. Under what exclusion or insurance is purchased so as to not protect ones investment or vested interest in the item… Where do these people come from with this BS….?

They are tip-toeing with words and fictitious BS so as not to deny the claim excluding any civil action by my for coverage but offered $1,200 or $11k claimed.

My plan is to await your advice and generate letters which will be sent to the Governing Board, President (CEO), Claim Handlers Supervisor, Claim Handler and investigator whom put the whisper into the system.

Thank you in advance,
Jerome
April 2nd, 2015 at 5:41 pm #Maria Martin

Hello Jason,

I just stumbled across your site in complete desperation. Seven months ago I purchased a used Chevrolet diesel truck from a Ford dealership and also purchased the extended warranty that Ford offered. Long story short, 5 weeks later I’m told the Ford’s Extended Warranty has denied the claim. The reason they declined it is because moisture caused the fuel rails to delaminate. ????????? It just seems as an easy way to get out of paying for any claims involving the fuel system. Is this something that you have experience with and that you can give me direction on how to proceed. The bill is now over $7,000 due to all the labor involved in diagnosis.

Thank you in advance,
Mike
April 6th, 2015 at 10:11 am #Jason

Jerome,
I don’t know the exclusion(s) they are applying to your loss. I don’t have enough information to tell you. However, that should not matter because in the denial letter for the parts of your claim that are denied, they will inform you of which exclusion(s) apply.
April 23rd, 2015 at 4:44 pm #Rachel

I need help! A few weeks ago my family and I were rear ended sitting at a stoplight by a driver who was coming at us at full speed with no brakes applied. Thank goodness no one was hurt. All 4 children were fine. The car that hit us was a small car and actually hit the trailer hitch and went up underneath our Cadillac Escalade, sending us sliding 13 ft ahead and resulting in major damage to their car, but not a whole lot to be seen for ours besides a few dings and deep scratches. Our trunk hatch which is controlled by a motor would not latch so we did have to bungee it down to drive home. As we got home we heard a strange motor noise that Sounded like our air shock compressor , not normal to hear. However as the days went on it ran almost non stop, and we realized that our ride wasn’t as smooth as usual meaning their was obviously some mechanical damage. To make a long story short we took our vehicle to a dealership for a supplemental claim and the adjuster is now denying our claim saying that the airbags (shocks) are damaged from normal wear based on the fact that quote ” they don’t usually last more than 100000 miles”. And “there was no pint of impact that is visible to confirm that this was a result of the accident”. All I know is that our shocks (no matter what ware they had, worked, and now they don’t. Also our compressor is now burnt out from trying to pump air into a blown air bag! What can we do?
April 25th, 2015 at 6:57 am #Jason

Rachel,
Keep presenting your information to the adjuster that your concerns should be addressed by the insurance coverage instead of being denied. Speak to the adjuster’s manager. When your adjuster says “usually” in reference to the airbags, he is applying a generality to the airbags and his position doesn’t hold any water when it comes to the reason for denying your damage.
May 19th, 2015 at 3:34 pm #Mae

hello, we recently had a winter storm and branches were broken from my tree which I put in my back yard. I asked my roommate to mow my lawn because my grass was so long and when he was moving he had picked up some rocks and branches that I put back there and the grass was so long that he did not see that he was close to the blade and cut his fingers. Would he be covered by my personal liability insurance?
May 20th, 2015 at 6:27 pm #Jason

Mae,
Liability insurance is protection from negligent things you’ve done that has caused property damage or injury to others.

From what you’ve described, it appears your roommate was negligent for his own injuries. Your insurance would not be involved.
June 27th, 2015 at 8:18 am #Debbie

I just discovered a ice maker leak in my mountain cabin that buckled all the hardwood floors in the kitchen, dining room, pantry and part of the living room. My bedroom carpet was wet and some mold was present on the walls. The ice maker fill valve stuck open and filled the entire freezer with water. What didn’t freeze leaked out the front of the freezer. It happened within ten days of when I was last there. Farmers insurance was notified and immediately sent Servicemaster out to begin drying things out. Two days later the inspector came and denied the claim stating it was a long term leak (within 10 days?). He also told Servicemaster to remove all their equipment as they would not pay for it. I now am paying $6K for servicemaster to continue drying, removing the floor, mold treatment, pulling up carpet. Because I wasn’t there when it happened and therefore caused more damage to occur is the reason my claim is being denied. I thought damage no matter how or when it happened was covered. I am devastated by this loss both financially and emotionally. What is the point of having insurance. I have never made a claim in over 40 years. Any advice?
June 27th, 2015 at 10:02 am #Jason

Debbie,
Yes, the foremost and best advice I can give you is to find a reputable insurance company other than the current insurance company you have. Leave farmers and All State out of your options for an insurance company you pay to protect your property. These 2 insurance companies rank very high is claim customer dissatisfaction. I’ve repeated this message over and over yet people still wonder why their claim experiences end up like so many other claim experiences involving these 2 insurance companies.

The policy you have from farmers is one that insures for sudden and accidental losses which are not otherwise excluded. In your policy, you will find language very similar to the language below:

***SECTION I – EXCLUSIONS
A. We do not insure for loss caused directly or indirectly by any of the following.
3. Water Damage
Water Damage means:
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;
b. Water or water-borne material which backs up through sewers or drains or which overflows or is discharged from a sump, sump pump or related equipment; or
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. ***

The above language is one of several exclusions in your policy. The way you explained your loss, your loss is not excluded based on the above language. In fact, another part of your policy contains the following language.

***(5) Mold, fungus or wet rot. However, we do insure for loss caused by mold, fungus or wet rot that is hidden within the walls or ceilings or beneath the floors or above the ceilings of a structure if such loss results from the accidental discharge or overflow of water or steam from within:
(a) A plumbing, heating, air conditioning or automatic fire protective sprinkler system, or a household appliance, on the “residence premises”; ***

Sure, mold, fungus, or wet rot is excluded within your policy but the above language indicates it excluded in all events except when it “…is hidden in the walls or ceilings or beneath the floors…”, which seems to be the situation of your specific claim. The coverage for this loss doesn’t require the “sudden” aspect of typical and observable water damage.

Here is the wording of your policy in terms of what events are covered losses:

***SECTION I – PERILS INSURED AGAINST
A. Coverage A – Dwelling And Coverage B – Other Structures
1. We insure against risk of direct physical loss to property described in Coverages A and B. ***

Without the confirmation of the denial details contained in your denial letter, it appears your insurance company is relying on the information that your water loss has been on-going (in part) for a long period of time. It may have been a minimal leak over a longer period of time but the policy wording I’ve included above that begins, “Mold, fungus…” seems to address that in your favor because, I assume, you were not aware of it. (Any reasonable person who is aware of a small water leak will promptly correct it.)

No where in your policy does it require you to be at your home (cabin) to monitor when a claim may begin. You are not required to reduce further damage from a covered claim when you are unaware any damage had started, simply because you were not there when the damage began.

The implicit part of a covered loss is that it is sudden and accidental. A leak which occurred sometime within 10 days of you being at your cabin last is technically sudden. You have to realize that “sudden” is from your point of view, not the insurance company’s or his inspector’s point of view. You immediately addressed the damage when you became aware of it and you took reasonable measures to protect your property from additional loss.

In summary, how you explained your loss, it seems that it should be covered by your policy. You ask, “what is the point of having insurance?”. The answer is for damage you just experienced. Not having a claim for 40 years (or any period of time) has no bearing on coverage.

Knowledge is power so get it in writing why your claim is denied. Determine if their denial is appropriate based on the circumstances. If the denial is not accurate, explain to the adjuster why it is not accurate. If you need to explain it to the claim manager, do that. If they continue to rely on their denial, you may need to consult with an attorney to determine what, if anything, you should do next.
June 28th, 2015 at 8:37 am #Debbie

Thank you Jason for such a detailed and informative response. I will definitely fight this denial. Can you recommend an insurance company with a heart?
June 28th, 2015 at 8:58 am #Jason

Debbie,
Simply go to the top of this page and follow the link, BEST AND WORST INSURANCE COMPANIES, to do some research for your next insurance company.
June 29th, 2015 at 10:12 pm #Debbie

Jason… You did it! I copied off my question to you and your answer and faxed it to Farmer’s today and within hours I got 3 phone calls all telling me they had reconsidered my claim and would pay all but anything to do with mold. I protected your identity and website and did not include that in the fax. I am so happy. I was totally devastated at the prospects of funding all the demolition and repairs myself. Thank you, Thank you, Thank you!
July 28th, 2015 at 12:34 pm #Jon

About 3 month’s ago there was a fire at my vacant rental property, since then I’ve been hounded by an investigator from the insurance co blaming it on me. I had another claim about a year ago when the plumbing was stolen, with no payment on that claim.

I’m tired of dealing with the whole mess, and their disrespectful tactics investigating this claim. I sent them a letter to drop/retract the claim. The open claim, and it being the 2nd one is making it impossible for me to drop them and switch insurance companies.

How can I shut this down, I don’t want anything more to do with them or their arrogant investigator.
July 28th, 2015 at 1:09 pm #Jason

Jon,
They may close your claim, but that doesn’t mean they will stop their investigation.

You can drop your insurance immediately. Nothing indicates you cannot switch to another company while you have an open claim.

It seems you did what you needed to do to drop or cancel your claim. It is out of your control to stop their investigation.
July 29th, 2015 at 12:03 pm #Richard Riley

I backed out of a parking space in a small strip mall then I went forward as far as possible in the driveway waiting for a car on the street who was waiting for the signal to change to green to proceed. signal to turn green. I naturally had my foot on the brake then all of a sudden a van type truck backed into my quarter panel to an estimate of $3900.00. The party that hit me told me over and over again that he was sorry and if I was injured admitting his fault. He must have said this at least 10 times claiming it was all his fault. Now he tells his insurance company that I hit him backing up if this was so my back end would have been damaged and not the side panel. His insurance company is telling me they will only pay for 60% of the damages. I would appreciate any advise that you can give me. Thanks Richard
July 29th, 2015 at 7:50 pm #Jason

Richard,
Yep, the best advise is not to go through his insurance. Use the collision coverage through your own insurance coverage and you won’t have any he said/he said type drama. They will pay for 100% of your damage, less your deductible, and then the other insurance company will reimburse at least 60% of your deductible.

Stop relying on other people’s insurance when you have your own.
August 11th, 2015 at 2:28 pm #Kimber

We received an email recently- Friday after a burglary on June 6, 2015. After numerous calls and emails back and forth, now the company has requested we drive 120 miles to Atlanta, Ga and meet in their attorney’s office for an EUO deposition.

Are we required by law to drive that distance ?
Do we have to meet in an area that I consider “non-neutral”
They have requested we bring tax records for the last 3 years, bank statements, as well as information on our Chapter 13 bankruptcy plan.

Are we required by law to provide any of the above info in the State of Ga or am I right to think those requests are irrelevant/unreasonable and we can object to the request ?

Thank You
September 4th, 2015 at 9:54 pm #Brodie

Last year I noticed a couple of warped “stripes” in the vinyl siding along the side of my house. I thought at first that it was some time of hail damage. Days and eventually weeks went by and I noticed that the number of warped “stripes” were increasing, in a right to left pattern. At this point I thought it was some bizarre defect in the siding. A couple of weeks later, I looked at the side of the house in the late afternoon and saw a bright “x” on the side of my house, formed from the reflection of my neighbor’s west facing window. This was a high-efficiency window they had recently installed. Each day as the sun went down, the reflection “x” would travel up the side of my house in a slight arc. As the the days went from late winter to late spring, the angle of the sun shifted, causing the right to left pattern. I filed a claim with Allstate to have the siding replaced and it was denied within 24 hours because it was not “sudden”. I contend that it was a sudden loss because the first day that sun bounced of the window and melted my siding, there was loss. It just took me awhile to determine the cause of the melting, but the first “stripe” was the result of 1 day of sunlight. Is there a chance I can win an appeal in this? I’ve been told my neighbor’s Homeowner’s insurance won’t cover the damage because there was no negligence. Thank you.
September 5th, 2015 at 7:21 am #Jason

Brodie,
Absolutely your neighbor and their insurance won’t do anything because they are not negligent.

I can’t say it enough, so I will say it again. If anyone has allstate or farmers, get a different insurance company because both these companies rate very highly wit customer claim dissatisfaction. Now that it out of the way, we need to reviedw your home siding situation.

Allstate is correct about your claim and that the condition occurring with your siding is not sudden, and therefore not covered. Your policy requires the damage to be sudden and accidental. Accidental is the easy requirement. Sudden is not. There is nothing about the window and your siding that fits within sudden. You will have no success appealing or taking other action.
September 16th, 2015 at 12:57 pm #Brad

I am a PA and I have a client that was on vacation for 3 weeks and came home to find his condo flooded. It was caused by a hot water heater flex house that had a sudden and accidental failure. Safeco has a renter’s policy on the condo and did not have an adjuster inspect the loss. The adjuster initially extended coverage and then after receiving my Xactimate estimate and looked at photos, his manager denied coverage based on an exclusion for:”we do not cover loss caused by continuous or repeated seepage
or leakage of water or steam which occurs over a period of weeks, months or years.” The manager is adjusting the claim from his desk and denying coverage. The adjuster had already issued an Add’l Living Expenses check on the claim prior to denying coverage. Since a payment for ALE was made and conveyed by the insured, does that make appraisal an option? I informed the manager that it was sudden and accidental and he said it was leaking for weeks and is therefore excluded. Any ideas on how to refute the denial?
September 16th, 2015 at 7:20 pm #James

There is a city sewer project going on in my area. The contractor drove a
60,000 lb excavator on metal trax down my block and shook my house. Very shortly after I noticed a leak in my water main in front of my house, on my property. I emailed the company liaison of the issue. No response, I paid to have the water main replaced. I sent a claim to the contractor via a form which they provided me. A few weeks later I received a letter from their insurance company denying the claim. They said the water main was old and they contacted the contractor who did the install who confirmed it was corroded. Doesn’t their negligent operation of the equipment contribute to the damage?
September 16th, 2015 at 9:30 pm #Jason

Brad,
There first must be a covered cause of loss for the appraisal to be invoked. Coverage needs precede the discussion of how much covered damage there is. Since there is no covered damage, there is no need to determine how much it will cost to repair.

It may be possible that the water was not leaking for up to weeks before the damage was caused. If the damage was done within minutes or hours, it appears there may be coverage. Just because your client was gone for 3 weeks from the dwelling doesn’t mean the water leaked for 3 weeks. A detailed water bill, if such a thing exists, could shine a light on when the water started escaping from the pex pipe. If the water leak occurred within a day or 2 of his return to the dwelling, coverage should/might apply. The insurance company has to be certain of the information they rely upon to make a denial. If there is any question, the benefit of the doubt should go to the insured. If nobody from the insurance company inspected the loss, how can they determine the leak occurred for the duration of time they claim and rely upon?
September 16th, 2015 at 9:40 pm #Jason

James,
I fail to see how you arrive at negligent operation of an excavator. Excavators travel on dirt, snow, gravel roads, asphalt roads, and even contract roads to perform the work they are utilized for. The mere operation of a heavy piece of equipment is not negligence if some indirect damage happens. The corrosion of the pipe seems to be the reason for the pipe’s failure – the corrosion and the pipe’s failure may not be causal with the excavator operating in the proximity. The burden of proof that the excavator caused your pipe to fail, despite the pipe’s corrosion is on you. Proving that is nearly impossible.
October 1st, 2015 at 8:09 am #Tyrome

My question is does my children have to go through a EUO if they are under 18 of age or are still in high school?
October 1st, 2015 at 8:17 pm #Jason

Tyrome,
The cooperation clause of your policy indicates you will cooperate with the insurance company with the investigation of your claim.

You are responsible for your children and you don’t have to allow them to participate. However, that would be non-cooperation so it’s up to you.
October 2nd, 2015 at 3:56 pm #Tina

I filed a theft claim on my renters insurance. My car was broken into and a laptop and luggage was taken. Because my policy is new it has been referred to an investigator. I have cooperated providing 2 recorded statements and documentation for each loss. I have since been asked to submit tax returns, credit card statements, and cell phone records. And that is fine by me.

Now I am being asked to sign a release to provide past, current and future (2 years from the loss) for financial records, employer records, credit bureau, dmv, court, police, utility and telecommunication etc. I think the breaches “good faith” and is excessive. I would be willing to release specific information but I am not going to give them a blank check to my personal information particularly my employer. Is refusal to sign this release considered not cooperating and grounds for denial of my claim?
October 2nd, 2015 at 7:43 pm #Jason

Tina,
Yep.

By obtaining your insurance, you’ve already agreed to the parameters to which they are asking to review.
October 5th, 2015 at 7:22 am #Tina

My policy makes no mention of a release. It does state to cooperate by providing documents upon request, submit to a EUO, report to police and notify the insurer in a timely manner.

There is no mention of signing a release.
October 5th, 2015 at 6:01 pm #Jason

Tina,
A release is a formal acceptance of the settlement. You don’t have to sign a release because you can’t be forced to do anything.

The only result of not signing a release is that the claim won’t be settled. If you agree to the parameters of the settlement, the release should be of no consequence at all.
October 17th, 2015 at 5:18 pm #wey wong

How can my insurance company state that I am 100% at fault when my car went into an unmarked open trench (last month) that cannot be seen from at reasonable distance (100 feet) ? OSHA requires open trenches to have warning signs, so why weren’t warning signs posted by the city?

Another example of my insurance company’s co-opt: three years ago an SUV slammed on his brakes and his spare tire flew loose and was embedded under the front axle of my car raising my car’s front end 4″ above ground, compromised and reduced my braking power, and I rear ended his SUV. The same insurance company blamed me 100% for the accident. The insurance company claimed that I lost control of my car in both cases. Needless to say they raised my insurance rate!

The open trench caused my first accident and the spare tire of the SUV cause my second accident. What more can I do for justice?
October 17th, 2015 at 5:46 pm #Jason

wey,
You can’t just drive into trenches whether you can see them from near or afar. Since the city, osha, nor any road construction people controlled your vehicle, and only you did -100% fault is appropriate.

Who cares what osha requires? Were you working on the street for a company regulated by osha? If not, their requirements mean nothing to you. Don’t worry about osha. Instead avoid placing your car where it’s going to be damaged or cause damage.

The city is not responsible for where and how you move your car. If the city didn’t display adequate warning signs, that still doesn’t allow you to drive your car into a trench.

I don’t believe an SUV’s tire will fly loose when its brakes are applied so your explanation makes no sense. How do you know your car was raised up exactly 4 inches? No matter what, you have a duty not to rear-end other vehicles no matter the circumstances. If you have lessened braking ability, slow down or don’t drive a car at all.

Bottom line is that if you are causing damage to your property and/or property of others by your operation of a motor vehicle, you have considerably demonstrated that you have lost control of your vehicle. It’s rather simple.

If you don’t want the type of situations that you mentioned, you will need to drive safer or avoid driving altogether.
October 22nd, 2015 at 6:47 pm #Mack

I hit deer with my truck. Significant front end damage to vehicle, but the deer ran off into the woods. I immediately called PD and officer came and investigated accident and took pictures of damage including small amount of blood and hair.
I filed claim with insurance company the next morning via voice mail and online claims report.
Insurance adjuster took over 5 days to view vehicle, which by then had been delivered to repair shop for estimate. During this time period the vehicle was exposed to several rain showers. Adjuster found no “fur or blood” on vehicle.
Insurance company is denying my claim saying it is fraudulent and was attempt to try to cover up previous damage. (I did have a damaged headlamp replaced 2 days prior at my own expense). Insurance company did not request copy of police report. I sent in pictures to insurance company of the vehicle that were taken within 3 weeks prior to accident that showed no damage along with dealer service inspection records from days prior to accident that do not note any front end damage.
Insurance company is still denying the claim. What should my next step be, as the amount of damage (less than $6000) suggests attorney fees may out weigh the amount of damage.
October 22nd, 2015 at 6:58 pm #Mack

Hit a deer with new truck. Deer ran off but damaged front of vehicle. I called police and officer came to scene and took report and took photos of damage and small drop of blood.
Reported accident to insurance company next day. It took adjuster 5 days to view vehicle and during this time vehicle was exposed to several rain showers.
Adjuster claims that no evidence of deer strike apparent. Insurance company denied my claim stating fraud for trying to cover for previous damage. I did have the dealer replace a broken headlamp 2 days prior.
I submitted photos of vehicle taken 2-3 weeks prior to accident that show no damage to front end along with dealer service reports for inspections that do not note any front end damage. Insurance company has not requested copy of police report and is still denying claim. What should my next step be.
October 22nd, 2015 at 7:10 pm #Jason

Mack,
It seems your claim is denied. Your insurance company is not going to fix your vehicle.
November 3rd, 2015 at 10:33 am #Dorothy Carter

Hi,

I had damage to my roof and fence during Tropical Storm Sandy. My insurance company Interboro Insurance deducted money from the roof calling it hold back money. I was informed I would be able to get that money once my roof is repaired. I had to save up for the roof as they only paid me approx. $4000, and the roof was close to $8000.00. I recently submitted proof that the roof was repaired and asked for the additional $2500.00 hold back money, and was told my claim is now denied. I only had six (6) months from the time my claim was opened to make any and all repairs. Is this typical for claims, especially when NYS declared a State of Emergency, and there are homes that received more damage than mine, and people are still making repairs.
November 3rd, 2015 at 4:46 pm #wey wong

In 2013 the tire from an SUV flew loose and embedded itself under my front axle, thus compromising my braking power when the SUV slammed on his brakes to avoids hitting the car ahead of hm. So I rear-end
him and was charged with the accident.
In October 2015, my car went into an unmarked ditch that could not be seen and that had no warning.
CA AAA has charged me with these accidents and increased my insurance rates after my 50 years membership with them.
What can I do? Any help is appreciated!

Wey
November 4th, 2015 at 6:43 pm #Jason

Dorothy,
Yes, you have a time limitation in your policy for notifying if you will be making a claim for the hold-back. And then you also have a time limit when you can make that hold-back claim. I’m aware that some insurance companies extend that time frame but that has to be done before you are outside of the limits.

State of emergency is a government term. Government declarations have nothing to do with private insurance contracts.
November 4th, 2015 at 6:48 pm #Jason

Wey,
You can drive more carefully and more defensively. When following other cars, don’t follow as closely as you do so you have more time to react to situations as they may arise. Also, don’t drive your car into areas in which you cannot clearly see.

You may have a triple A membership which is called AAA, but CA AAA is an insurance company and you don’t have membership with an insurance company. What you have with an insurance company is a contract.
November 6th, 2015 at 1:00 pm #Sabi

Hello,

My vehicle was stolen from my friends apartment complex. I left it there as we went bar hopping. I wasn’t in any shape to drive so my wife picked me up and took me home. This was Saturday. I left the truck there sunday as we live far from town and had to be near his apartments first thing Monday morning to drop our son off.
when I arrived the truck was gone. my insurance company Safeco has been stringing me along with this SIU department for 4 weeks now. They have basically treated me, my wife and the friends I was with like criminals.
they have interviewed us all, requested bank statements for that weekend. earlier this week they said it should be wrapped up by this week they were just waiting on some information from a government agency. when I spoke to them today, they are now requesting my phone records. they said the vehicle was crossed over to mexico as we live by the boarder and it could not have been driven with out a key. my wife did lose her spare key to the truck some time ago and I still have mine.
Do I have to give them my phone records and if so should I block out any part of the number as I don’t want them calling random friends or business associates.

thank you
November 8th, 2015 at 12:37 pm #Jason

Sabi,
If you want your claim to continue, you need to cooperate in the investigation of your claim. If they are requesting your telephone records, you need to provide those records. No, you should not block out anything. They want all the telephone records, not just the parts you want them to see.
January 7th, 2016 at 10:36 am #Lizzy

My truck was stolen from outside my house. I believe I had a spare key inside because I can’t find my other set. I told Statefarm about this and now they have denied my claim. They are arguing that the loss was not “accidental” because there was a key inside the truck.
January 7th, 2016 at 10:38 am #lizzy

My truck was stolen from outside my sisters house, State Farm refuses to pay for it because I had a spare key inside my truck. My claim was denied because according to them it was not accidental theft.
January 7th, 2016 at 6:39 pm #Jason

lizzy,
The point of view of accidental when it comes to insurance is from the insured’s point of view. That would be your viewpoint. Was the theft of your car accidental (not wanted and not by chance)?

I don’t care if you leave your keys in it or their is a spare key in it. I know I don’t have all the information but did the person who stole your vehicle have occasional and permissive use of your vehicle?
January 7th, 2016 at 6:41 pm #Jason

lizzy,
Wait, I just read your additional post. From where was your car stolen? Your place or your sister’s place? Inconsistent information like that leads to more questions from your insurance company. At this point, I don’t have enough information about your situation and your claim because the information you have provided in conflicting.
January 8th, 2016 at 5:18 am #John riggs

Hi I had a 2014 rmz450 stolen from under my porch about a month ago after filling a police report and looking around the whole state for it i tried to see if my homeowners will cover it being that it was under closed roof and covered up (my parents bought it for me last year and still owe about 7000 on it and we really can’t afford to buy some theif a new bike) insurance said they won’t cover it because it’s not for farm use which I have used it for btw but after seeing the tricks that adjusters try to pull on policy holder I don’t know whether to believe them they closed the claim but if I can get some advice I would like to speak with them it was my mother that called them the first time and she’s easily talked right into believing whatever she’s told please email me or comment with any advice thanks for any help
January 8th, 2016 at 7:49 am #Brigitte Garrett

My parents had a long standing leak from an under sink water heater that they were unaware of. As soon as they became aware they contacted the insurance company. They are denying because of language:
“13. Accidental Discharge or Overflow of Water or Steam
b. This peril does not include loss:
4. Caused by constant seepage…over a period of 14 days.
(there is no verbiage regarding lack of knowledge of the leaK).
IDS Property Casualty Insurance Company – California coverage

What is your advice?
This was an unknown situation and I am sure that this happens all of the time within walls, or while someone is on a long-term vacation.
Have there been any cases supporting a situation there has been long term leakage which would be covered due to lack of visibility or knowledge?

Thank-you!
March 28th, 2016 at 5:08 pm #Tina

I have been fighting with American Family Insurance for three years after my home was destroyed by a natural disaster. American Family’s slogans are blatantly false. Why isn’t American Family ranked on your Best And Worst Insurance companies section on this website? I’ve had to hire 3 different attorneys to try and settle this matter but American Family still to this day refuses to pay the full value of the claim.

American Family has terrible customer service and the company has failed to make good on any of their promises that were expressly written in the contract and paid for by me when I bought the policy.

Thank you
March 31st, 2016 at 5:38 am #Rip C

If your pickup truck has a payload of 5,640 lbs and it’s determined that your payload at the time of the accident was in excess of that and is listed as a factor in the cause of the accident, can you be denied insurance coverage?
March 31st, 2016 at 8:39 am #Jason

Rip,
If you have insurance coverage at the time of the accident, coverage cannot be denied. What can be denied is your claim made under your insurance coverage. Exceeding a vehicle’s payload will not be hinder an otherwise legitimate accident claim.

For example, if excesses are used to deny claims, any person who is exceeding the speed limit and involved in an accident would face an arbitrary obstacle.
March 31st, 2016 at 10:06 am #Lisa

I own a rental property in another city. I hired a property management company to manage the house, tenets, etc. I have a contract with that company and paid for the highest level of “management.” The property has been vacant for a few months. I was just informed a pipe froze and burst causing significant damage. The management company never winterized the property. Since the house was vacant (and I wasn’t aware of vacancy insurance) my homeowner’s claim was denied. Do I have any legal recourse against the property manager?
Thank you very much
March 31st, 2016 at 10:24 am #Jason

Lisa,
You mention your insurance policy and the situation involving your claim. It was denied based on the limitations for either winterizing the plumbing system or maintaining heat in the property. Your claim was accurately denied. That is where the insurance topic ends.

Now you are asking for legal advice concerning a contract between you and the property management company. Asking a legal question on an insurance site is out of place, and usually I will ignore the question but I will provide some insight into your dilemma.

You are asking if the management company is negligent and liable for damage to the property you own. You mentioned you have a contract with the management company. You will find out in that contract if you are responsible for the water damage or if the management company is negligent for the water damage. Review the contract and determine if the property owner is responsible for maintaining the heat or winterizing the plumbing system, or if that responsibility was transferred to the management company.

Because you didn’t mention the content of the management contract, it’s very likely the ownership interest of protecting owned property was not transferred to the management company.
April 4th, 2016 at 3:09 pm #kayla

My car was stolen from my aunts driveway while we were out of town for two days. I filed police report immediately as well as notified my insurance company. The insurance adjuster called to get the facts, I am trying to figure out why the asked who my cell phone provider is and whose name is the bill under? What does that have to do with the stolen vehicle? I know they have to ensure not fraudulent claim.
April 4th, 2016 at 4:28 pm #Jason

kayla,
Your insurance company can ask nearly any question concerning your claim, finances, etc as they investigate your claim. You’ve already provided that leeway in your insurance policy wording with them.

I don’t know what your cell provider or who pays that bill has to do with yoru claim, but I’m not the one investigating your claim.

Perhaps they want to review your call/text history and knowing the account holder would enable them to go directly to the source. This is just my speculation.
May 7th, 2016 at 2:56 pm #Lisa

I had wind rain storm damage to my roof and as soon as I recognized I had roof leak. I called the insurance to make claim on March 27,2016.It took them 14 days to get out to review the damages.In mean time of waiting, I’ve had several storms with heavy wind & rain while waiting. Mold has wrapped around inside of my home. I was denied saying it was wear & tear.I appealed the case & Assurant Geico reopen the case. I got 3 different estimates for insurance.The insurance company called back wanting to meet up with one contractor of my choice & their adjuster.They waited over week to deny my claim again.In meantime several storms have passed with more damages to my roof while waiting on them since March 27,2016.Sad part is I have my motorcycles,cars,truck & home with Geico.I am paid in full until the end of this year with my homeowners.What has my premiums of over $1300.00 every year pay for on homeowners for a mobile home?
May 7th, 2016 at 3:04 pm #Lisa Mitchell

I had wind rain storm damage to my roof and as soon as I recognized I had roof leak. I called the insurance to make claim on March 27,2016.It took them 14 days to get out to review the damages.In mean time of waiting, I’ve had several storms with heavy wind & rain while waiting. Mold has wrapped around inside of my home. I was denied saying it was wear & tear and they could not tell if wind rain storm damage was the blame of roof to leak and the mold problem.I appealed the case & Assurant Geico reopen the case. I got 3 different estimates for insurance saying it was due to storms damages and what it would cost to repair.The insurance company called back wanting to meet up with one contractor of my choice & their adjuster.They waited over week to deny my claim again.In meantime several storms have passed with more damages to my roof while waiting on them since March 27,2016.Sad part is I have my motorcycles,cars,truck & home with Geico.I am paid in full until the end of this year with my homeowners.What has my premiums of over $1300.00 every year pay for on homeowners for a mobile home? This has to be insurance fraud for selling me insurance that is no good.
May 7th, 2016 at 6:22 pm #Jason

Lisa,
If you have a leak, get it repaired immediately. Don’t wait for insurance to look at it or you are not preventing further damage from occurring.

You may be paid in full until the end of the year but if you cancel your insurance, you can receive the unearned premium as a refund.

Rest assured, it is not fraud for a claim of an excluded event or condition to be denied.
June 26th, 2016 at 2:44 pm #John

I have a question regarding family third party (CQC) whole life insurance policies. My grandparents took out a whole life insurance policy right after I was born as a gift to my parents.
Well, somewhere along the line, the policy was transferred over to my parent’s name. It’s been bounced around between a few different insurance companies, and the current one has decided to transfer everything (including bills that don’t match the spreadsheets, and,”Company Credit Accounts,” (I.E. An Umbrella Policy) they’ve been taking out in my name over to me for some reason.
After losing the first bill, I was able to contact them and have one sent out after a few months of them lying and giving me the runaround game.
Well, when I was trying to have the policy number looked up, I decided to ask for a copy of an,”Enforcable Contract.” To which I was told,”Oh, it’s been bought out so much, we’re not sure if we have an e.c., but you can’t ask questions regarding your account, or the bills, without your father’s,”Authorization.”
I am no minor, and their state provisions say they cannot reguse access to recorded personal information from ANYBODY in their databases after verification of identity.
Anyway. Come to find out, they do not care about my father’s,”Authorization,” for my,”Identity Verification,” at all. They keep trying to strong arm me to have him sign “Transferrance Of Ownership,” forms, because, they,”Forgot,” they needed somebody’s signature on their stunt. I’m wondering if,”Law Abiding Insurance Companies,” are able to transfer policy ownership to the insured party once the insured is of adult age.
So far, they’ve told me bills can be sent to whoever they please (extortion), and they can block me out until my father agrees to give me access. (I am 31, so, Not a minor, and if they want to bill me, they can deal with me.)
Oh. And, they can supposedly act intelligent enough to take out seperate life insurance policies (why the billing amounts don’t match), auto policies, and ship out business documents and,”Transferrance Of Ownership,” forms….But if I ask for a dispute form, they act REALLY stupid. Everybody knows what a,”Dispute Form,” is. Forrest Gump knows what a dispute form is.
So, my question, could they have,”Legally,” swapped everything over to my (Insured Party’s) name because I’m over 21 without asking anybody?
June 27th, 2016 at 8:34 pm #Jason

John,
You are asking about the legality of something concerning an insurance company. I don’t address legal questions on this site. You many want to consult an attorney for your concerns.
August 4th, 2016 at 9:32 am #Jean Osborn

Man alive you appear to be the smartest person(s) on the planet when it comes to claims.
After a 2012 divorce, our second home that always had insurance became my only home with with all my possessions in it.
I travel for a living, and took an assignment that takes me travelling in California about half the time in 2013. Our agent retired and I did not get insurance for 1.5 years.
Then, I got a loan and insurance in 2014 and had utilities on. No one disclosed to me that I needed to spend the night any number of nights to get insurance, since we had it for years as a second home with insurance so I thought nothing of it. It is my “residence” but I spend very little time there, or anywhere for that matter, except hotel rooms during the week. I have never had a mailbox there, since they stole the pretty one.
I bought a California condo in 2013 for my job there to avoid rent.
We have fellow employees who just live in Missouri and don’t get a second smaller place in Cali, but I chose to have a condo instead of rent or more hotels. All my family is in Missouri, so I spend time in several places there.
Home broken into in 2014 and they took a few items since I am rarely there. Did not file a claim but just took precautions by turning off utilities so they wouldn’t get in and squat.
Now I was informed in 2016 that my 2 front windows were out. I went and saw total catastrophe! So so sad. Major vandalism, bird droppings caused by the house being wide open months without me knowing traveling, hundreds of thousands damaged.
So they are doing everything to make me look like it is all my fault for having to support my whole family as a single woman traveling and how I should have known that this certainly wasnot my “residence premises”.
Mind you this home has NEVER been vacant. It is my home, even if I am not there often.
Electric was turned off AFTER I got the policy in 2014 ONLY because I was broken into in 2014 to avoid them getting the large garage door open and stealing the classic car or possible squatting or water issues. You can’t harm my house with water if the electric is not on. since I am rarely there, I didn’t even need the electric on until I get off the road in 4 years. I do that often on my other California smaller home as well to avoid trouble while I am gone.
I keep saying, had someone told me I had to stay in this home a certain number of nights, I would never have paid them for years. We had years of insurance on it as a second home prior to the divorce and were NEVER there hardly and that was also not disclosed as any requirement of how many nights we had to be there.
I read up on it and it is estimated that only 1 in a 1000 agents is even aware of this “where you reside” issue, so how could I know if no one is disclosing it?
“Where you reside” is ambiguous at best. It is my main residence that houses all my heirlooms, but I don’t spend many nights there at all and won’t until I get off the road in 4 years. It is fully occupied and always has been with my heirlooms. It is my only home in the divorce and regardless of how many nights I am there. The California condo was $60k and this home is a million.
My beef is why would any reasonable woman pay premiums forever if her home was excluded from all covered because she travels and won’t be there for years? Shouldn’t this “time in home” requirement be disclosed up front?
Like the others say, I feel victimized twice here. No one in their right mind would pay premiums for a house not covered. No one told me up front I had to mow a certain number of times, spend a certain number of nights, keep utilities on when I travel far away, etc. I can have a residence premises as defined since NONE of those things are required. I had my jewels there even at the time of application in 2013. I never received any questions as to how many nights I was there or anything.
They haven’t denied me yet but this process will take a year I am sure. Grueling victimization a second time. I had no idea and read up on all the cases of “where you reside” when you have traveling and have more than one residence.
I did not stay there that often, especially being a single older women scared to spend the night in their main home that many nights a year, but this should have bee disclosed up front that I was required to or I was paying for nothing.
I believe they call that unfair and deceptive. A reasonable person would never pay premiums on one of her residences and get no benefit whatsoever out of it. A reasonable person should be disclosed what the requirements are on the home to get coverage. An agent is so quick to take premiums for years but not so quick to fairly disclose that this poor woman doesn’t have one bit of coverage for years if she travels for a living.
Any help here would be appreciated.
August 4th, 2016 at 5:57 pm #Jason

Jean,
After all you’ve said in your post, I have no reason to conclude that the home you referenced and insured is your residence.

When you are informed, rather than finding out by coming home to an alleged residence, that your 2 front windows are out (and had been out for months based on your input), this is not your residence premises. From all that you’ve indicated, this residence was vacant nearly all the time. You mentioned no renters, no relatives living there, and it seems your absence for prolonged periods of time was the norm.

As far as the claim insurance determination, I would support the decision of the insurance company after their thorough claim investigation.

There is no requirement to inform you of every single detail and/or requirement in an insurance policy. If you want to know the specifics, you should read and understand the policy and not rely on inferences or assumptions about your policy coverage and limitations.
September 11th, 2016 at 9:19 am #Mike F

Hello,

I recently moved into my house in Las Vegas. I closed on a HUD home on Thursday and went by the house and turned on the water at the street. The next day when I had movers coming in I found standing water in the in the entry way. I called the plumber and they determined it was a slab leak. I had an inspection done and no mention of it.

It caused 4k in damage and the insurance company denied my claim stating it was preexisting to my policy on the home. They state that the inspector mentioned leaks and I had him refund the inspection costs. My air conditioner also went out that day and when I asked about the leak and if he saw the meter spinning the inspector said he turned the water off to the house first so he didn’t see it spinning. Also the only leaks the inspector mentioned was a toilet that stayed on and a hose bib outside.

Can I take them to small claims court? I don’t believe they have sufficient evidence to say when the slab leak occurred.
September 11th, 2016 at 9:27 am #Jason

Mike,
You had the inspector refund your inspection cost based on him missing a preexisting incident in your home. He missed the slab leak during his inspection because the water was off. Everything you said supports the leak was there prior to your ownership interest and insurance policy starting.

Your insurance company doesn’t need to establish when the leak occurred, they just have to establish that it existed prior to you owning the property and the insurance coverage starting. They seem to have established that already.

You can take them to court but you have to prove the damage occurred after your policy started and that the damage is a covered cause of loss of your policy. Based on the information you provided, that will be nearly impossible to do. Besides nearly impossible to do, it will be costly and time consuming.
September 11th, 2016 at 9:59 am #Mike F

I had him refund the money because he didn’t check. How can they establish the leak was before I moved in if the inspector didn’t check? Doesn’t the insurance company have to prove it was preexisting? No one knows for sure when the leak occurred so how can either of us prove either way? Small claims court is inexpensive and no lawyers are allowed-
September 11th, 2016 at 10:01 am #Mike F

The water was on but the inspector turned it off because the toilet was constantly running.
September 11th, 2016 at 1:55 pm #Jason

Mike,
The burden is now on you to prove it occurred during your insurance coverage and that it wasn’t existing prior to you owning the place. Since you readily admit you can’t figure out when it occurred, how can you prove that it occurred after your insurance coverage started? That is the hurdle you face in court. Even small claims court requires legal proof. Attorneys aren’t required but, in nevada small claims, an attorney will represent the insurance company. I don’t know where you come up with the notion that attorneys aren’t allowed. Who do you think will defend your action against the insurance company other than an attorney?

Also, who will you be suing – the insurance company, the inspector, or both? Do you know how to subpoena witnesses? Will the inspector (defendant) be a reluctant witness if he’s sued? Do you know the insurance company for the inspector will introduce an attorney to defend the inspector? What evidence will you produce to the court that the loss occurred after you owned the property? Are you able to do the things required or will you need the costly assistance of an attorney? To file your affidavit and small claims action, you will pay the court $230.00. Did I mention the legal process is time consuming, and probably isn’t as simple as you think it is?
September 11th, 2016 at 4:02 pm #Mike F

I doubt they will even hire a lawyer for a 4k claim.

We will see-
September 11th, 2016 at 4:10 pm #Jason

Mike,
The insurance company has millions of dollars at its disposal. Who do you think will represent the insurance company other than an attorney?
September 11th, 2016 at 4:16 pm #Mike F

I don’t think they will even take it to court for 4k. Do you think it’s worth it for them? They do work by numbers and do you think it’s cost effective to send a lawyer for 4k or pay the claim?
September 11th, 2016 at 4:24 pm #Jason

Mike,
Your claim is denied. Insurance companies don’t pay denied claims. A lawyer will answer your affidavit and complaint and request a summary judgment of dismissal. It’s likely based on your lack of proof of anything, the judge will dismiss the case. If it cost the insurance company $10,000 to uphold your denial, they will pay the $10,000 not to pay $4000 for a denied claim.
September 11th, 2016 at 4:33 pm #Mike F

We will see-
September 13th, 2016 at 6:35 am #Carmelo Martinez

Hi! Am a disabled veteran and I live with my wife, we are separated. In Dec 23, 2014, I had an accident where I broke my neck and needed surgery, this was due to a recent hurricane that passed by but hit Orlando and damaged the house. The roof, and other appliances. The door was filling the attic with rain water and the garage ceiling came down. My wife reported to the insurance company, whom till today hasn’t done anything and on top of that sent her a letter stating they won’t fix or repair anything. I was trying to do something and walked in the garage, that’s when I felt and broke my neck because of the debris. Can I sue my wife’s insurance company for negligence, personal injury, and pain and suffering?
September 13th, 2016 at 6:55 pm #Jason

Carmelo,
Did you see the debris that you were walking on and slipped on? Why would you sue her insurance company? They apparently denied her claim. They have nothing to do with the condition of your wife’s house. Since you are married to her and apparently own the home too, you control the condition of the home. Since you are married and live with your wife, the house is your house too.

Let’s ask some simple questions. What negligence did the insurance company contribute to your injury? Since they don’t control your walking, movement, or ambulatory actions, they had nothing to do with your actions that led to your broken neck.

Did your insurance company cause your personal injury? No, your insurance company doesn’t dictate your actions and what you did on the day that you became injured.

Did your insurance company cause your pain and suffering? No, you walking in your garage caused your injury. Your voluntary actions caused your pain and suffering.

Can you sue your wife? No, you are married to her and that is equivalent to suing yourself, which you can’t do.

Can you sue yourself for your broken neck? No, that also is not allowed.

Bottom line is that it makes no sense to sue a company that has nothing to do with the situation and reason you broke your neck.
September 15th, 2016 at 1:30 pm #pamela sullivan

sue paul slayback for injury to my kids and home in anheim .ca 232 wilken way Anaheim.ca and abuse to my child by the neighbors -1985, invasion of our store target store by the dentist offices brother -fleming-for god sake-
September 15th, 2016 at 8:09 pm #Jason

pamela,
Did you have an insurance question?
September 16th, 2016 at 6:11 pm #Austin

I am in CO and recently my neighbors pvc pipe (between their copper line coming out of their house and their sprinkler manifold) broke causing a lot of water to pool between our 2 houses (the north side of my home) and somehow spread underground to my window well on the west side of my house spilling into my basement through the sides of my window.

As soon as I noticed the water I am mediately contacted my neighbors and after trying repeatedly to get a hold of my neighbors finally got back to me and said they were rushing home to turn their water off. Once he got home and turned his water off I had him go down to see the water still pouring into my basement. He then got his shopvac out to drain the 7 to 9 inches of standing water out of my window well . And after he got all that water out of the window well he then went over to the area between houses and shopvaced the water that was pooled there as well. This whole time he’s telling me we’ll pay for the damages, we’ll pay for the damages, I’m so sorry we’ll pay for the damages. I told him it’s probably best if we go through insurance and told him I would call my insurance and see what they had to say.

I contacted my insurance company who told me that because the problem originated on our neighbors property that it would have to be a claim run through their insurance. So I let them know they needed to file a claim with their insurance for my damaged property. They did so later that afternoon.

I received a call from their insurance adjuster the next afternoon stating that after an investigation they feel that their insured is not liable for any damages because they found it to be a complete accident; stating my neighbors were not digging or doing anything that caused the damage to the waterline so they’re saying it’s not negligent therefore it’s not covered. Their insurance company sent me an email today stating that the claim has been denied.

I contacted my insurance again and after they talked with an underwriter and higher up they told me that they cannot file a claim because the problem resulting in the water damage did not origante on my property.

I understand that this was an accident and that nobody caused it but at the same time my basement flooded as a result of their faulty/malfunctioning property and I don’t see how their insurance can deny the claim.

I know someone who was willing to read over my and my neighbors policy’s to see if either insurance company was liable. So I asked my neighbors if I could have a copy of their policy including any amendments and they got defensive and are not providing that to me.

Please help me to understand if I am stuck paying for all the damages incurred on my own or if I have grounds to get their insurance or even just my neighbors to pay for the damages.
Thank you so much for your time.
September 16th, 2016 at 6:37 pm #Jason

Austin,
I completely agree with your neighbor’s insurance company. There is nothing your neighbors did, or didn’t do, that cause the water concerns to your property. Since your neighbor is not negligent, because the water thing was an accident, your neighbor, and your neighbors insurance owe you nothing.

You will probably have your neighbor for a long time, so you might want to apologize for blaming him for an incident that was an accident. It’s not your fault, it’s not his fault.

You have some damage that isn’t covered by your neighbor or his insurance. I don’t know if coverage would apply from your policy, but that is what you should focus on, not having other people respond to accidental, non-fault damage that happened to your property.
October 5th, 2016 at 12:54 pm #Vic

Hi,

I have installed a spray attachment by the help of leasing office labor who was kind enough to do it for us(but illegally). We came back from a vacation after a month and found out that there is water leakage in our bathroom due to this spray attachment. Since the bathroom is on the upper floor, the water seeped into kitchen which is on the lower floor direct underneath it. There is mold, fungus and water dripping from the ceiling of the kitchen.

We reached in our home on Oct 3rd and found out all of this. We instantly reported this to the property manager. They inspected and found out that spray attachment is the issue and told us to talk to our Renters insurer. We called Statefarm and got our issue reported. Now, after 3 days, both the parties are saying they will not claim any responsibility for it and we have to pay it from our pocket.

What should we do? The estimated cost of remediation and reconstruction is around $8000 to $10,000.
October 13th, 2016 at 3:10 pm #Sur

Hello ,

I had a hail damage in my area when I talked to neighboring communities. So, I called roof guy to check it. They inspected the roof and said, there is hail damage to your roof (my roof is about 20 years old at the time of inspection), they said, we will file a claim with insurance company and they will cover the roof. But the insurance company denied it. Agent filed a case against home insurance company. Now we have deposition .. me and my wife will need to attend and tell all truth what happened. Please let me know what to expect in this deposition ? We want to make sure nothing happens to us personally … (just bec, we never had this kind of situations ..) Please advice what to discuss and what not to.. Thanks.
October 13th, 2016 at 6:39 pm #Jason

Sur,
In the deposition, tell the truth. If you need further advice beyond that, consult an attorney. Although you can consult with an attorney, your attorney won’t be allowed to be part of your deposition.
October 15th, 2016 at 7:59 am #Sur

I am going to tell the truth. But little scared to go to deposition as we did not experience going to court before in our life. I m thinking to drop the ball …what do you suggest please ?
October 15th, 2016 at 9:02 am #Jason

Sur,
I’ve already provided my suggestion in my previous post. If you have hail damage that occurred during your time of policy coverage, your claim should not be denied. I don’t have all the information which led to a need for a claim denial and an examination under oath (EUO). Beyond that, you have to determine what you will do.
October 19th, 2016 at 6:09 pm #Mike F

Jason,

You were completely wrong! They paid my claim after I filed a BB compliant and sent a certified letter asking them to pay my invoices. If I took your advice saying they would never pay my denied claim I would be out thousands of dollars!
October 19th, 2016 at 6:41 pm #Jason

Mike,
I don’t recall saying they would never pay your denied claim. If they paid because you complained a lot instead of due to a covered claim, that is entirely different and amounts to a business decision not to have to deal with you.
October 21st, 2016 at 6:40 am #Mike F

Jason,

You don’t have to recall it’s only a few posts up? Now you say it’s a business decision but before you said they will pay way more in lawyer fees than my claim costs?

“Mike,
Your claim is denied. Insurance companies don’t pay denied claims. A lawyer will answer your affidavit and complaint and request a summary judgment of dismissal. It’s likely based on your lack of proof of anything, the judge will dismiss the case. If it cost the insurance company $10,000 to uphold your denial, they will pay the $10,000 not to pay $4000 for a denied claim.”
October 21st, 2016 at 4:29 pm #Jason

Mike,
I don’t know why you aren’t able to understand what has happened. Your claim was denied. You made a complaint with the bbb and whatever other actions and complaints that prompted the insurance company to make a business decision to give you money so you would go away. Ironically, the amount of money was likely your insurance claim amount. It happens all the time. Not only that, your insurance company may non-renew your insurance coverage so they never have to interact with you again since insurance policies are contracts that require 2 willing parties.

The information you quoted is based upon you suing your insurance company. It remains accurate and I restate: If you sue your insurance company for a validly denied claim, a lawyer for the insurance company will request a summary judgment of dismissal. The judge will then dismiss the suit.

If you would have requested information about filing complaints with any organization that may apply about your denied claim, I would have discussed the business decision that you seem to have incited.
October 24th, 2016 at 10:40 am #Jean again

Mike, thank goodness I took your negativity and lack of understanding of my situation as a call to action to protect myself. I will teach others more by this paragraph I am sending than you taught them with your answer to me above: (Note: You are not the hopeful one that originally was on this blog I would suspect, or else a different company is subsidizing you for your slanted advice. I suspect you are paid by one insurance company and your job is to badmouth another insurance company, so please have the ‘nads to admit who pays you. No one pays us when we come to this site.) Let me preface to say I graduated the very tippy top of my MBA class so of course read everything under the sun on the “where you reside” issue when it hit home with me and I had never heard anything about home insurance’s dirty little secret. After all is said and done, my insuror paid me dearly, because I was sincere and in good faith bought insurance for years on my residence (you silly person – you and I will never forget now that I caught that you don’t even know how to define residence when a person has more than one now do you?!). I am an informed consumer yet still none of us receive any up front disclosures whatsoever of how many nights I had to stay there or how many neighbors I have to talk to out in the country to prove I stay there. Thank goodness I am smart and determined and understand how consumers do have rights if I am sincere and not dramatic and just want to get what I am paying for all these years. Keep this in mind in how you answer. If it is your opinion an insuror won’t pay, back it up with hard facts in the policy instead of just your negativity. Have a good day. I know I will.
October 24th, 2016 at 10:45 am #Jean again

I guess you name is Jason and not Mike. Sorry about that.
October 24th, 2016 at 10:48 am #Jean again

“you name” hahaha that is funny. You can tell I type 85 wpm.
October 24th, 2016 at 7:04 pm #Jason

Jean,
Your suspicions are incorrect. Otherwise, thanks for the feedback.
October 26th, 2016 at 6:47 am #Mike F

Jason,

I know you are moderating my comments now because you don’t want the truth out there but I know you can read this. It’s funny how others are saying the same thing. Your attitude and speaking in absolutes is what makes your responses so bad. When you say,”Insurance companies don’t pay denied claims” leaves you no room to say anything when they do. Maybe some humility and giving better advice would make you seem more credible. Don’t give advice if you can’t be respectful and knowledgeable.
October 26th, 2016 at 5:49 pm #Jason

Mike,
Thank you for your feedback.
December 6th, 2016 at 9:11 am #MsFaith

We own a rental (two story duplex). The duplex next door burnt down to the ground- apparently the fire started in the car parked in the carport. Everyone thankfully made it out okay, but our duplex was damaged due to that fire. We have visible damage, smoke damage and do not know what kind of damage we sustained that cannot be seen with the naked eye (pipes, insulation, electrical, etc).
The owner’s insurance company is denying liability stating that “no negligence was involved” in the fire being started. We can call our insurance of course, but do not think it is right that we should have to pay thousands in deductible + an increase in policy cost for a fire that started next door. Do we have any recourse with the neighbor’s insurance company?
December 6th, 2016 at 9:13 am #Faith Lingrell

We own a rental (two story duplex) in Austin, TX. The duplex next door burnt down to the ground- apparently the fire started in the car parked in the carport. Everyone thankfully made it out okay, but our duplex was damaged due to that fire. We have visible damage, smoke damage and do not know what kind of damage we sustained that cannot be seen with the naked eye (pipes, insulation, electrical, etc).
The owner’s insurance company is denying liability stating that “no negligence was involved” in the fire being started. We can call our insurance of course, but do not think it is right that we should have to pay thousands in deductible + an increase in policy cost for a fire that started next door. Do we have any recourse with the neighbor’s insurance company?
December 6th, 2016 at 6:07 pm #Jason

Faith,
If the owner’s insurance company is denying liability on behalf of their insured (because their insured did not cause the fire), then that is what it is.

If you have insurance for the fire damage to your property and you don’t want to use your insurance because you have a deductible, that is up to you. Where the fire started is meaningless. If you have fire damage, you might want to consider making a claim with your insurance company.
May 26th, 2017 at 12:08 pm #Russell

hi, i have renters ins with Triple A (AAA). i had a break in and property was stolen and some vandalism. my claim has been passed to 3 different people and now its under investigation. the adjuster came out and did a walk thru, took pictures of the property and receipts once we went over the inventory list. i made a recorded statement about what happen under oath as well. i come to find out my landlord was contacted, shes asking for bank statements now and im feeling like this is a invasion of my privacy.I did everything she asked me to do so far, and i feel this is unnecessary. Is this considered invasion of privacy and do i have to show my bank statements?
May 26th, 2017 at 4:15 pm #Jason

Russell,
If you want to continue with your claim, you need to provide the information they request. You’ve already given them permission for this information in the insurance policy wording.

If you don’t want to provide the information they request, they will take that uncooperation as an effort to not assist in your claim’s investigation and they will deny your claim for your refusal to cooperate. Refusing to assist in the investigation of your claim is a reason for denial based on the language contained in your policy.

It may be an invasion of your privacy but it’s an invasion you’ve already agreed to.
July 26th, 2017 at 7:51 am #Scott winter

I had my furniture stored in a self storage unit for a year ,as went to empty it I noticed the sofas where moldy all over and now I have been denied insurance as it’s not covered ! My girlfriend will not go no where near them as she has astma and is severely allergic to mold so basically I m 3000 out of pocket
July 29th, 2017 at 8:55 am #Jason

Scott,
Your assessment is correct. Since your claim has been denied, your insurance company has provided you with a detailed explanation as to why. I will expand upon that a little.

Your policy does provide some limited mold coverage (usually about $5000) but the mold has to be caused by a covered cause of loss, like a pipe breaking and spraying onto your property, or vandalism (such as someone spraying down your property with water). Neither of these events occurred otherwise you would have mentioned that.

Your property remaining in an uncontrolled environment in a storage unit for a year is not a cause of loss and the limited mold coverage will not apply.
August 20th, 2017 at 11:30 am #Jason P.

I woke up one more to find there was damage on one of my car doors. Upon taking a closer look, I noticed all my doors were unlocked and valuable property has been stolen. My claim is currently under investigation and the investigator informed me he would advise my adjuster he is categorizing this as a “suspicious claim” under grounds that the damage on the car does not seem like a possible way to gain entry but rather an unrelated impact. I never said to know exactly how the thieves gained entry but rather the order of events on how I discovered the theft was that I saw the damage and looked further. Do they have valid reason to deny my claim?

Note: I provided all valid receipts, descriptions, and accounts of stolen items to them.
August 20th, 2017 at 11:38 am #Jason

Jason,
They may separate the exterior damage from the theft claim but they will probably do that anyway. Your automobile physical damage coverage will address the automobile damage. Your homeowner policy will address any stolen personal property from the car. Your insurance company can label your claim anyway they want. I don’t know the details of your claim (s) so I can’t speculate where their investigation will lead.
October 11th, 2017 at 7:33 pm #Sireka

So I’m messaging for my aunt ! We are in Florida sustained a devastating hurricane. (Irma) My aunt sustained roof damage. It is leaking into the home so she took the steps to protect the property and tarp until adjuster comes. Which was the condition in the policy to receive help. I believe they refer to as protectin or mitigation? They stated they will not cover because it’s not hurricane damage they claim it is wnd loss mitigation and intend to have her pay, as well as $3200 in deductible. They are also referring to the hurricane force winds as Hurricane wind. This sounds crazy to me it seems like a sneaky way not to honor damages caused by acts of God. Please tell me your thoughts I’ve been searching all over to find some clear answer how they can get away with this. She is a faithful policy holder for well over 30 years and has never needed their assistance and now she does and they are angling their wordage in such a way to avoid fixing the problem.
October 11th, 2017 at 8:05 pm #Jason

Sireka,
I don’t know how the roof was damaged and I don’t know the exclusion to which they are basing their decision. Attach a copy of the denial letter and send it to the e-mail address at the top of this page that is in orange lettering.
October 13th, 2017 at 10:04 am #Sireka

OK thanks!
December 20th, 2017 at 12:26 am #Amy

We had a a really bad hail storm and it damaged our back colored stamped veneer concrete patio. It was starting to separate but the hail cracked the veneer. The first adjuster came out to the property and said it was hail damage but did not include it in the worksheet. I called him about it and he said he would put a note on the file for the AC and the concrete and not to worry that these would be covered. I found out recently that the note he put in was that we were to submit repair estimates for the AC and Concrete. he did not specify in the insurance notes that both AC and concrete were to be covered. it is now 6 months later and new adjuster talked to him and he is saying he never said the concrete was covered. but why put in the notes to get repair estimates if it wasn’t going to be covered anyway? doesn’t the note in our file show Allstate’s intent to cover the back patio initially even though it doesn’t specifically say ” we will cover the back patio”?

we have a new adjuster now (5 months later) and he is saying the back patio concrete is not hail damage. but everything was cleaned up when he came to the house so he did not see damage first hand. He asked for “before pictures” , which I found and reviewed in person with him and confirmed there was no damage in the before pictures. We have been in the house for 5 years and he asked what was the date of the pictures but I am unsure on this… so I thought we were good. but we are not…
.
I also provided Allstate with a DNR website that logs hail storm damage. I sent Allstate the website and a screen shot of a concrete dugout was destroyed on the same day from the same storm (we have close to 300K in hail damage repair to our home).
now Allstate wants to send an engineer out to see if the engineer can find hail damage that “was missed”. I have said “no” because all debris has been removed and there is no material failure testing completed on this material with 16 years of MN weathering so it is pointless to send an engineer out…

I don’t know what else to say or do with Allstate. Do you have any advise? Please help! The third adjuster denied the concrete repair saying “my manager wont let me add this on the worksheet.” I am speaking now to the manager but he wants to send an engineer..
April 16th, 2018 at 11:50 am #zachory bennett

We have a rental house and we have sold the house. the buyers wanted a mold test done due to some damage of the stucco and we had warranty repairs done. So we had air samples done and they came back bad. had another mold inspection done and the only place they found mold was inside the panel of the a/c unit. We started the process of getting the a/c unit cleaned and the house scrub down. finally I read the policy and they covered mold so we put a claim in. it got put in as water damage for some reason which is not what we claimed. the inspector went to the house to inspect but never went inside the house do to the fact it was getting cleaned and put in the report to evidence of mold. we sent them all the reports of the mold inspections saying there was mold. but since there was no water intrusion denied the claim as upkeep of a/c and cleanness of the house.
April 16th, 2018 at 11:54 am #zachory bennett

had claim put in for mold. we sold the house and the buyers wanted a mold test done. did air samples and came back bad. inspector only found mold in the a/c unit under a panel but said that couldn’t be the only reason for the high numbers but couldn’t find any mold any where else. we had the a/c cleaned and the house scrub down and did a negative air vent for a week. put a claim in for mold and they put it in as water intrusion. we never said water intrusion.. policy adjuster went to the house to inspect but told us she never went inside do to the cleaners being there and denied our claim do to no water intrusion and said it was caused by upkeep. do I have any hope.
April 16th, 2018 at 12:29 pm #Jason

Zach,
You said you sold your house. If you are no longer the owner, what concern is any mold to you?

If the sale as contingent upon something and you have a mold concern, the mold would need to be caused by an event that was covered. Mold can grow on it’s own under certain circumstances and mold in itself is not considered damage.

You have not mentioned a cause of loss that led to mold so the denial appears accurate.
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