 My insurance policy, and probably yours as well, has special policy limits and deductibles for certain coverages. In particular, up to $5,000 for coverage when sewage backs up into your home through the waste lines and originates from the sewer system in the street off your property. This can certainly result in a nasty, smelly mess inside your home and possibly a great deal of damage that is not covered because of this policy limit.
Also, within this coverage there is a special deductible that gets applied which can be anywhere from $500 - $1,000. The coverage in your policy is usually worded like this: For an additional premium, we insure, up to $5k, for direct physical loss not caused by the negligence of any “insured” to property covered under Section I caused by: a. Water which backs up from off the “residence premises” through sewers or drains; or (b) Water which overflows from a sump event it such overflow results from the mechanical breakdown of the sump pump etc. Sometimes clients get confused with this language when they have a broken waste line or drain line which results in the kind of damage to your home caused by the overflow of contaminated water. It is important to know that the above policy language does not refer to damage caused from broken waste lines under your home nor the resulting damage it causes. This damage, unless specifically excluded from your policy or capped by a $10k water damage cap, would be covered and not limited by the $5k back up policy limit and deductible. For any questions regarding your policy and coverage please contact us here.
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We want to wish you all well during this very difficult time and hope you are all staying safe. We take safety precautions very seriously and make it a part of our normal course of business, not just for the Covid-19 virus or Flu season. This is a daily practice for us, both at home and during business.
As Emergency Orders are being issued in every county restricting business from operating, we are still open and running because it has been deemed that Public Adjusters are an essential business that may remain open as we provide services that are necessary to maintaining the safety, sanitation and essential operation of residences and other structures. As Public Adjusters, we routinely enter homes and businesses and are exposed to elements that can affect ones health such as mold, smoke and soot, damp moist conditions from a plumbing leak, sewage issues and even illness. We wash our hands regularly, keep disinfecting wipes and hand sanitizer on us at all times, wear masks and gloves when needed and also change clothes when needed. There are also times when we need to don our very fashionable hazmat suits. There have been many times when we arrived at a meeting to find out someone was sick. Oftentimes, people don't think to tell you because it may be minor to them, but it can be harmful to someone else or their family member. You really never know. It’s important during any time, and more so during this difficult time we are all faced with, to be mindful and think of others. Wash your hands regularly, sneeze into your arm, cough into your shirt and if you are not feeling well, honestly is the best policy to keep everyone healthy and safe. We are all in this together and we are here to help in any way that we can and our business is still open and running. If you have any questions about your insurance policy coverage for your business during mandatory shutdowns or still need assistance with an insurance claim, please contact us here or call us 561-288-6434.  We received a call about a leak in a bathroom and the homeowner asked if she should stop using the shower? We explained that it’s her responsibility under her insurance policy to prevent further damage to her property and she should stop using the shower immediately. Her reply stunned us for a minute when she said that her plumber told her to “go ahead keep using it, the damage is already done”.
An insurance policy is a contract with your insurance company and there are specific conditions that must be complied with or you risk the possibility of getting denied on your claim. Here are a few examples of those conditions:
Try to imagine the look on an insurance adjuster’s face if you told them what the plumber advised you to do. Lack of knowledge is no excuse for not understanding and knowing your responsibilities under your insurance policy. When we met with the homeowner, she said that the plumber did not know where the leak was coming from. After our careful and thorough inspection, we determined the cause was not covered under her policy and all she needed was a new tub and advised her against filing a claim. We previously discussed claims like this in a prior blog Not All Property Damage Is An Insurance Claim.  Mold. That ugly, smelly stuff growing on your walls and furniture. You see it and call your insurance company to report a mold claim. After all, you have coverage in your policy for mold/fungi so you should be covered right?
There are many causes for mold growth, especially living in South Florida where the climate is warm for most of the year. You come home from your 10 day vacation to find mold growing in your home and it is everywhere, including your furniture and clothing. You have no idea how this happened and call your insurance company to file a claim. The adjuster comes out to inspect the damage and boom, the insurance company denies your claim stating there is no covered cause of loss. You pay your insurance premiums so how can this be? Your policy says you are covered for mold, so what gives? What you do not realize is that you are only covered for mold when the mold is caused by a peril/loss that is covered under your insurance policy. What caused the mold? Is it humidity? Is it a plumbing leak that caused water damage to your home and then mold started growing? Did you have storm damage to your home where water entered and damaged the interior of your home and belongings which resulted in mold growth? There could be many reasons why this happened and the burden of proof is always on you to prove your damage and what caused the damage. Humidity, in and of itself, is not a covered loss. Water damage is often a covered loss, as well as any resulting mold growth, as long as it has not been going on for a period of time and the cause of the water has been remedied to protect your property from further damage. Your insurance policy covers damage that is sudden and accidental. However, some insurance companies exclude water damage all together resulting in no mold coverage. We get many calls regarding mold damage that ask “should I file a claim?” You first have to know what is causing the mold and if that cause is covered under your policy. Contract us here and we can help you understand what is and is not covered in your policy with our comprehensive insurance policy review.
isDocumenting the contents of your home and business is very important to do before you have an insurance claim. What are contents? Contents, also described as “personal property” in your insurance policy, or "business personal property" in a commercial policy, is everything that belongs to you that is not attached to the building. For example, if you turned your home or building upside down, everything that would fall out are the contents.
As previously written in our recent blog “Preserving Evidence of Damage Property”, the burden of proof is on you to prove the damage to your property. In this example, we are referring to your personal belongings and business personal property. Let’s say you have a fire or flood that also results in destruction or damage to the contents. Showing the condition of the contents and properly documenting them prior to the damage occurring is key to getting covered for these items. In cases where a fire loss has occurred, the contents may not be recognizable and the burden of proof is on you to prove what you had before the loss, as well as the condition and age of the item. It is never too late to properly document the condition of your property. We specialize in Pre-Loss Property Inspections and can relieve you of this tedious task.  As your insurance rates increase and you may be thinking about shopping for new homeowner’s insurance, I cannot tell you how important it is to shop coverage and not price!
While meeting with a client who had a fire at their home and reviewing their insurance policy, they were sadly underinsured and their policy did not cover the cost of the damages to their home. I was shocked to learn that their personal property coverage was higher than their building coverage! They said “we didn’t think we would ever have an insurance claim. This is the same insurance we have had since we owned the property and it has never changed in all these years”. It is your agent’s responsibility to advise you to insure your home with enough coverage to keep up with the current property values and inflation costs. Sometimes this doesn’t happen, but it is also your responsibility as a homeowner to do the same and make sure you are properly insured. While reviewing policies for our clients, we are always asked if there is a “cheaper” insurance company and should they change their coverage to reduce their rates. This is probably the worst thing you can do because that one day you have an insurance claim, your insurance company will not be there for you with enough money to cover your claim. I am sure you do not want this to happen nor do you want to have to come out of pocket for most of the repairs. It is also important to make sure you do not have policy limits or exclusions on water damage coverage and that you stay away from any managed repair or right to repair insurance companies just to save money and reduce your premiums. For more information or an extensive policy review, please contact us https://www.reliantpa.com/  Recently when my mother received a ridiculous rate increase from her homeowner insurance company, I began researching a new policy for her. Having the knowledge about policies and coverage that I do, I was very specific with her insurance agent on what insurance companies and the types of policies to stay clear from.
When he was providing me a quote from a company I was not familiar with, he stated there were not many options. I was really taken aback by his comment as my mother only had one claim in the 15 years she has owned the home. Upon further research, it turns out the company he provided the quote from is a surplus lines carrier and not an admitted carrier. What does this mean to you? If you are insured by a surplus line carrier, they do not have the protection of the Florida Insurance Guaranty Act if they were to go insolvent. Also, their policy rates and forms are not approved by any Florida regulatory agency. So, if you have have an insurance claim and you have any issues or complaints with them, you are at the mercy of the insurance company with no back up or help from the State. When I pushed further for him to find coverage with an admitted carrier, not only did he come up with a quote from a known admitted carrier, but it was a better quote for less money! At that moment, it became very clear that my mother’s insurance agent was not looking out for what was best for her, but instead his own pocket. There are many insurance agents that protect their client’s interests, but as I stated in my blog last week (The Never Ending Erosion of Coverage – Do You Know What You Are Covered For?) it is important to know what you are and are not insured for in your homeowners or business policy. This is another great example of why it is important to know who insures your property.  When purchasing insurance coverage for your home or business, you expect to be covered when you have an insurance claim. When you least expect it, then comes along that one day you need to file a claim and you are blindsided by your insurance company when they say you are not covered. I cannot tell you how many times we have heard “I didn’t know I wasn’t covered” and “Why didn’t my agent tell me”.
I refer to this as the never-ending erosion of coverage by the insurance industry. Our insurance agents should be explaining coverage to us, or should I say, the lack thereof. Many agents go the extra mile, as they should, and explain coverages to their clients. However, some do not and then beg the questions above. An All Risk policy is supposed to be exactly that and cover us for our insurance losses, but they no longer do. The insurance companies are either placing limits on coverage or excluding coverage all together for example …
It is so important to understand and know what you are covered for and what you are not. We offer policy reviews and suggestions for coverage based on our years of experience. Remember, we are also homeowners and business owners. If you have any questions or concerns about your policy, please contact us.  New clients often ask what they can do to help their claim get paid. The answer we give is a simple one. Make sure your property is clean and neat when the insurance company adjuster comes to inspect the damages with us. By that, we don’t mean remove or cleanup the evidence of the damage, but rather make sure the rooms are uncluttered so the adjusters can move about and inspect without any difficulty. Clean floors and bathrooms so that the property has the look of one that is well kept and maintained.
So why is this important? It comes down to this. If an insurance company adjuster comes to a property that is unclean and poorly maintained, it is more likely they will view the damages they are being shown as being the result of lack of maintenance or neglect by the owners. Insurance covers damage that is sudden and accidental. They do not cover damage that is ongoing over a period of time. If the damages are viewed in a setting that is neat, clean and organized, it is much more likely that an adjuster will see those damages as being new and not consistent with the way the rest of the property looks. It’s just human nature. So, if it’s been a while since your property was treated to a good spring (or winter) cleaning, it may be time to bring out the vacuum and mop. It could help the settlement of your claim down the road.  Most days we receive calls for help with insurance claims. That is what we do and we do it well. Our clients expect us to work miracles and we often do. But, we cannot produce coverage where coverage does not exist.
We recently inspected a home with water damage to the ceilings, walls and floors which were continuous throughout their home. There were also some damaged personal belongings in two adjacent rooms. The homeowners said that during a few days of heavy rains, their roof began leaking and the ceiling in one of the rooms had fallen down. They called their insurance company to file a claim and a company representative told them they were not covered for a roof leak and asked them if they still wanted to file the claim. Unsure of what to do, they decided to hold off and contacted us for assistance. We reviewed their policy and this tricky language was as clear as day to us, “Windstorm or Hail. This peril does not include loss to the property contained in a building caused by rain, snow, sleet, sand or dust unless the direct force of wind or hail damages the building causing an opening in a roof or wall and the rain, snow, sleet sand or dust enters through this opening”. However, in this particular policy, the language was not referring to the actual building damage caused by a roof leak, but was listed under the Personal Property section and referred to the damages to their personal belongings which were not covered due to this excluded language. Luckily for this family, they are covered for the building damage. However, many insurance policies today do not cover water intrusion from a roof leak and use the same language above to exclude building damage from their policies. Thought for the day … It is important to know what is in your insurance policy and what is not. We have extensive knowledge of insurance policies and offer comprehensive insurance policy reviews which is invaluable if you have ever had an insurance claim and found yourself with no coverage. |
AuthorKaren Schiffmiller Archives
February 2020
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