Insurance Company Gets Away With Fraud Again
The same adjuster has treated three of my customers with similar circumstances the same within the last year, and it hasn’t been to the customer’s advantage. One customer had a very high deductible and not very much damage so he didn’t challenge the insurance company. Another customers’ policy was very recent and some of the damage happened before the policy was in force. The other customer I thought was going to hold the insurance company accountable.
Each of these customers had homeowners insurance policies with the same insurance company, and their policies actually had coverage for mold. Each of these customers had water damage in their home from what should have been a covered water damage event. Mold was also discovered on some of the wet materials in each home. Each had insurance for water damage and mold, but this adjuster denied all three claims using the following rational: The adjuster said “because there is mold present the current leak started much earlier, went undetected and allowed mold to grow.” Policies have language that says if there is long term seepage that is undiscovered, the damage is not covered.
Let me tell you more about the case in question. The homeowners came home one day and found their entire basement flooded. The water was from a leaky pipe in a wall. There was also some evidence (mold) that suggested that the leak may have started as a very small leak some time before. If this leak had been going on for awhile, it would have been very small because the homeowners never noticed any dampness or puddles on the floor in the area. We also found mold in the bottom of some other walls that were not near the leak. This mold could not have been from the current leak, the dampness could not have reached those walls undetected. So this suggests that some of the mold or maybe all of it was not related to the recent leak. And even if the leak started smaller earlier, there was clearly “an event” that took place, a sudden event that flooded their entire basement. This “event” should have been a “covered event” for insurance purposes. It was clearly an event and not long term seepage. This is where the adjuster really tried to stretch things. He said “because it is from the ‘same source’ as the alleged seepage the damage is not covered”. So to summarize: Even though there is little or no evidence that there was any long term seepage, the water damage from the pipe leak which should have been a covered event is not going to be covered because there is mold present, which they also should have coverage for.
I have been looking forward to going to small claims court in support of this customer as they sued their insurance company. We have coached this customer on what they needed to do. Only they can sue their insurance company, we cannot do it for them. We can coach them, advise them, show up and testify, and be an expert witness, but we cannot sue their insurance company for them. We have been waiting for a few months for this customer to get the paperwork filed with the court. They have procrastinated and just haven’t gotten it done. Just recently they took out a lone and paid our bill in full. I hope they still follow through and hold their insurance company accountable, but I fear that they may not which would allow this adjuster and his insurance company to get away with fraud once again.
We have seen nearly identical circumstances many times and the damage has always been covered by insurance. The damage adjusting process is not consistent, and is sometimes not fair or ethical. The best way to protect yourself is to hire a restoration company that is loyal to you and able and willing to be an advocate on your behalf.