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: Sat Aug 07, 2010 05:02 am Post Subject:
Here’s the problem as I see it and most likely what touched a nerve with TCope, most people in an agent’s office and it has been my experience many agents know just enough about a policy to be dangerous. It seems that losses like these are treated by agent’s office as denials because of the:
Seepage, meaning continuous or repeated seepage or leakage over a period of weeks, months or years of water, steam or fuel. a.)from plumbing, heating, air conditioning or afps…….
They tell their client there is no coverage. At face value it seems okay to them to tell their client that, but without actually visibly seeing the resulting damage and conducting an investigation, how would the agent’s office know that the loss was not sudden an accidental or something else that may trigger coverage. That’s why those insurance companies hire them there adjusters to look at a loss and investigate what happened. Sometimes it is easy and sometimes it is not. In most circumstances, it is not right for an agent’s office to deny any claim over the phone.
Posted: Sat Aug 07, 2010 04:17 pm Post Subject:
Although an agent definitely is not the final say on what is covered or not,
Agents aren't even the "first word" in what's covered or not. It's all governed by the lawyerly words in the contract. Period. We simply explain the basics of the contract, and the clients are supposed to read it all for themselves and ask a lawyer for assistance if they don't understand something.
As an agent, I am supposed to be knowledgeable in what the contract covers and does not cover, in general terms. A very few of us actually have some background in law, and actually know how to read and understand a contract (which gets us into little spats here on the forums when those who don't fully appreciate lawyerly words try to make them say something other than what they do).
The same goes for claims dept personnel. The lowest level employees have, for the most part, only a passing knowledge of what policies cover or don't, and they often make mistakes in favor of the company when it comes to denying claims. InsuranceDude is correct in stating that one should always recontact the insurance company and get a detailed, specific reason for the denial which can be compared to the language of the contract.
In her most recent post, Ingrid states:
The pipe wasn't broken; it appears that one of the connectors was not put on properly so the water was leaking from that.
While this is not the insurance company's problem, the resulting water damage almost certainly is, as tcope has said. There will be an expense to open the wall, make the repairs -- including the possibility of having to replace wall framing and subflooring -- and the expense of replacing damaged floor coverings, cabinets, etc, some of which would be covered and some of which would not.
I can't speak for states outside California, but in California, the laws governing construction require the original licensed contractor to bear liability for their workmanship for a minimum of 10 years. If the construction is not older than that, even if a homeowner's policy would not cover the loss, the original contractor would be liable for their negligence. Problems will arise if the contractor is no longer in business, but if they can be located, they can still be sued.
Add your comment