by ingridhenden » Fri Aug 06, 2010 04:33 pm
My mom just discovered a leak in the pipes behind the wall in her bathroom. The floor in the adjoining room is damaged (located under a bed), as is the floor under her bathtub. She was told by her insurance agent that this was not covered because it is considered 'maintenance'. Do they really expect her to periodically rip open walls/floors to check for leaks?
Posted: Fri Aug 06, 2010 06:00 pm Post Subject:
No they don't expect her to do that. But, a broken pipe is a maintenance issue and therefore would not be covered. What was the reason the pipe broke?
Posted: Fri Aug 06, 2010 06:09 pm Post Subject:
It really depends on the type of policy she has. Some policies limit water damage coverage to "Sudden and Accidental Discharge of Water." An example of this would be a water heater bursting or a washing machine overflowing and suddenly flooding the home with water. These policies do not cover slow leaks that cause damage over an extended period of time.
There are, however, other policies that do include coverage for slow leaks and would generally pay for the type of damage you have described. It just varies from company to company and policy to policy.
Unfortunately, it sounds like you have the type of policy that limits water damage to sudden and accidental discharge of water.
Posted: Fri Aug 06, 2010 06:24 pm Post Subject:
She was told by her insurance agent that this was not covered because it is considered 'maintenance'.
Here was your first mistake. Your possible second was that it was not a licensed agent who gave out that info, rather just someone in that office.In my experience agents don't know anything about a claim being covered or not. I, as an adjuster, would never try to sell someone a policy either.
While the damage to the pipe won't be covered (wear and tear... not "maintenance") the resulting water damage is usually covered (for fun, call the "agent" back and have them point out in the policy where it states the water damage is not covered. You can also ask the "agent" for a written denial. They won't be able to do either).
If you want to file a claim... call your insurance company and do so. Don't call the agents office.
Posted: Fri Aug 06, 2010 06:45 pm Post Subject:
I would have to disagree with you tcope. As an agent, it is a big part of my job to understand policies and the coverage that goes with them. Although an agent definitely is not the final say on what is covered or not, hopefully most of us do have some idea of what is covered or not. With many years of industry experience, I would like to think I at least have some idea of what is covered in a homeowners insurance policy.
Also keep in mind, while you are making blanket statements, that there is more than one coverage form available and more than one state in the U.S., so this may not be as simple as you are implying.
Also, there are many occasions where it is in the best interst of the client to contact the agent before filing a claim. Some things are clearly not covered or will be below the deductible. If the insured contacts the claim department to ask a question, they will be assigned a claim number and will then have a claim show up on their claim history report whether or not anything is paid out. Even zero paid claims can, at times, cause a premium change when applying for new coverage with certain companies.
Posted: Fri Aug 06, 2010 07:08 pm Post Subject:
As an agent, it is a big part of my job to understand policies and the coverage that goes with them.
Two things with that statement... you are applying my statement just to you. I'm speaking about agents in general. Yes, that includes you but not as an individual. You also state that you need to understand coverage. I agree... but an agent has no business adjusting a claim. How would you feel if an adjuster started quoting crazy premiums to your clients? Agents don't extend coverage or den claims and adjusters don't sell policies.But the fact is, a _lot_ of coverage info that comes from an agents office is incorrect. I also don't think a lot of this info actually comes from the agent... I find it usually comes from someone in the agents office.
Also keep in mind, while you are making blanket statements, that there is more than one coverage form available and more than one state in the U.S., so this may not be as simple as you are implying
While that is always true... trust me.. the resulting water damage is almost always going to be covered as those police forms are only modified, this is pretty standard coverage.Also, there are many occasions where it is in the best interst of the client to contact the agent before filing a claim.
I guess... but the agents office should also be acting correctly. They should _not_ be adjusting a claim (unless they are licenses and allowed to do so) and they _should_ know what they are talking about. I've had plenty of agents call me and ask if I thought something was covered. These are long time commercial agents who sell million dollar policies every day.What I'm posting is in response to the the OP's post. Based on the crap info the OP got from his agents office, I'm recommending that the OP not call his agent and rather call his insurance company.
But what you state is certainly true/correct.
Posted: Fri Aug 06, 2010 07:23 pm Post Subject:
I completely agree that agents can not and should be attempting to adjust claims and I did indicate that in my post. Not to mention the fact that you must be a licensed adjuster to settle a claim.
I'm am just saying that in my experience, most P & C agents are quite professional and knowlegeable about coverage and policies and can play an important role in the process. But, it is critical that the agent know when to back out of the claim discussion and forward to the experts. That would be you, tcope... :)
I wont debate whether this is covered or not. As alway, I would refer this person to their insurance company to make the final determination.
Just keep in mind, us agents are not all bad. Most are pretty good and as long as we all (adjusters included) keep the clients best interests in mind, we will be fine.
Posted: Fri Aug 06, 2010 09:03 pm Post Subject:
What you mention I don't have a problem with... what I do have a problem with is 1) idiots in the agents office, who are not agents, who just "think" something should not be covered so they says it's not... and 2) Agents who fall under #1 and/or who tell people something is not covered as they don't want it to go against their loss ratio. Some agents _will_ do this! It just pisses me off.
The other part of this that kills me is the process that adjusters need to go through when they deny a claim. I've never worked for a company that allows a denial to be sent without upteen people reviewing the claim and the denial. This is vs what an agent goes through when telling someone something is not covered.
Again, no offense meant, InsuranceDude. I _know_ you know what you are talking about. I'm also not trying to bad mouth agents... so I should probably have chosen my words a bit better.
Posted: Fri Aug 06, 2010 09:28 pm Post Subject:
Thanks for your quick response, everyone.
The pipe wasn't broken; it appears that one of the connectors was not put on properly so the water was leaking from that.
My mom called her agent first, but she also did call the claims office to file a claim and was told it wasn't covered and was denied the claim over the phone. Since she has been paying for this insurance since she bought the home and this is her first claim, she is not impressed that they dismissed it so quickly without even looking at it.
At this point, the pipe is the least of her worries - it's replacing the bathroom, bedroom floor, the wall between the two and any possible damage to the outside wall they both share.
Posted: Fri Aug 06, 2010 09:41 pm Post Subject:
A denial needs to be in writing... I'm willing to bet that any states won't allow an insurance company to refuse that a written denial be issued.
What was the reason they gave for not covering the resulting water damage?
I'd highly recommend that she call back and ask for a response in writing.
Posted: Fri Aug 06, 2010 09:46 pm Post Subject:
Ingrid,
I would contact the company again and make them give you a more specific reason for declining the claim, instead of: "it's just not covered." Ask why its not covered, have them show it to you in the policy and ask for this in writing.
I have see claim rep's reject claims that should have been covered before. I have literally had to show them in the policy where it was covered and go to a supervisor to get it handled properly.
It sounds like you are going to have a lot of damage and you want to be certain that the policy does not provide coverage before you give up. No harm in double checking.
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