This is the most common question that we get at Lightning Restoration. The truth of the matter is that we wish that we had the Magic 8-Ball that would give us that answer every time, but we don’t. There are a lot of factors that come into play when a carrier is deciding whether to cover your property damage claim.
What Factors into My Property Damage Claim?
What is stated in your policy?
This is the most important factor: what coverage did you purchase with your policy? Insurance policies are more difficult to read than stereo instructions. If you don’t fully understand your coverages, call your Insurance Agent and request a review. Know what you are buying and don’t try to save a few bucks by limiting essential coverages, like water damage.
What is the source of the damage?
You may have $10k in mold coverage, but if that policy doesn’t cover the source of the mold, then it won’t cover the mold. An example would be ground water intrusion from pooling water on the side of the house. Standard Homeowners Policies do not cover ground water at all, and Flood Policies will not cover ground water intrusion unless there is storm flooding. This is defined as when two or more adjacent properties are flooded. If it is flood water, mold remediation may still not be covered since flood policies typically only pay for the water remediation & repair.
Did you mitigate the damages?
Every insurance policy requires the policy holder to mitigate the damages. In essence, this means that you have to act to stop the damages from getting worse. The policy also requires that the loss be “sudden & accidental”. We have found property owners who were aware of water damage to the home for months but failed to act. Now there is a mold problem and there is an urgency to remediate and file a claim. However, since they failed to mitigate the water damages, the carrier can deny the claim. There is an unwritten 14-day rule that is quite common in the state of Florida. This refers to the situation where the carrier feels like the loss has been going on for more than 2 weeks. It is not “sudden and accidental” and they will deny the claim.
Failure to maintain the property
If the property owner is not taking care of general maintenance, the carrier can deny the claim for that very reason. This is commonly seen in roof leaks, where the roof is past its lifespan.
Construction or Manufacturer Defects
An insurance carrier can deny a claim if the manufacturer of a structural material, appliance or fixture fails from defect. This is also the case with a contractor that performs work that causes damages. However, in most cases, we find that the carrier will go ahead and pay the claim and later subrogate back to that manufacturer or contractor. Our recommendation is to always attempt to file a claim directly with a manufacturer or contractor before contacting your own insurance carrier. This will save you from having a claim that will cost you a deductible and possibly increased rates upon renewal.
- Most appliance and fixture manufacturers have their own claims department. Research the manufacturer’s claims department online to get the contact info.
- To avoid an ugly confrontation, always request a Certificate of Insurance (COI) from your contractor up front. You can also request to be added as an Additional Insured to the policy. When going this route, get that COI before any work begins. Getting the COI when they want to get the job is easy. Getting insurance information out of a contractor when damages are in dispute is always a difficult task that often gets very contentious.
Your Claim Could be Denied for Multiple Reasons
These are a handful of reasons why a carrier could deny your property damage claim. However, the truth is that each carrier, and each adjuster for that matter, is different and may interpret the policy differently. By state law, if a claim is denied that you feel should be covered, you do have other recourse. With each denial, the carrier is required to supply you with the information about how to file for mediation. The state requires that the carrier pay for the mediation. It is quite common for carriers to overturn denials in mediation if the policy holder can show a reasonable explanation of expected coverage.
Lightning Restoration are experts in working with every insurance carrier in the state. Do not hesitate to contact our office when you have Water, Mold or Fire damage. We will walk you through the process and get the insurance carrier everything that they need to accurately assess the claim. If a carrier has denied your claim, we offer discounted services and financing for our clients paying without insurance assistance.
