Why Did My Insurance Deny My Mold Claim? | Reliant PA - PUBLIC ADJUSTER BOCA RATON

Why Did My Insurance Company Deny My Mold Claim?

3/29/2022

Dealing with a public insurance adjuster is different than dealing with an independent adjuster in South Florida. An independent adjuster, is a third party who works for the insurance company. A public adjuster will make sure to review your insurance coverage and assist you with reporting your claim properly. Oftentimes, we receive calls about property damage and the property owner uses the wrong terminology while explaining their damage. This can be detrimental to your claim if you do not report your loss or explain the damage correctly, and your claim could be denied.

The same cannot be said with an independent adjuster. The difference is that an independent adjuster works for and represents the insurance company, not you. We are sometimes referred to as independent adjusters, however our true title is public insurance adjuster.

Therefore, if you have any issues with property damage and mold, you should seek help and assistance from an independent public adjuster to handle your claim. If your claim gets denied, you could be throwing thousands of dollars out the window. What do you need to know about mold claims, and why do some claims get denied?

Why Was Your Mold Claim Denied?

When Does an Insurance Company Cover Mold Damage?

Mold remediation is covered if it results from a covered peril in your insurance policy. For example, if your pipe breaks and causes water damage to your property that results in the presence of mold growth, then yes, you can file an insurance claim. Additionally, your insurance policy should also cover the ensuing damage and repairs to your property, as long as it is not excluded in the policy.

If your insurance policy includes accidental water damage, it should also cover mold damage providing it is not excluded in your policy. As long as you can prove that the mold growth was a result of the water damage, you will avoid getting a claim denial.

Some examples of covered perils are a leaking hot water heater that resulted in mold growth in your walls and a malfunctioning washing machine that caused moisture to penetrate your floors and possibly produce mold.

However, it is essential to mention that not all policies are the same. So, before you invest your time and effort filing an insurance claim, make sure you have thoroughly read and understand your policy. Insurance policies are confusing at best because they provide coverage, then remove or exclude the coverage in a different portion of the policy, then can replace the coverage with different language and coverage. An independent adjuster will review your policy and explain the coverage so you should get help to make sure you are covered for your loss.

What Are the Reasons Why Insurance Claims Get Denied?

Not all insurance policies include mold coverage. So, the first thing you should do is review your policy and see if it is included. Then, you should seek assistance and guidance from an independent adjuster.

Usually, insurance companies deny claims if there is sufficient evidence proving that the mold infestation resulted from poor maintenance, long term damage or neglect. An example is if you have a plumbing problem and you wait too long to get it fixed and the leak continues for a period of time.

Do You Need to Talk to an Expert Independent Adjuster in South Florida?

Dealing with water and mold damage is stressful, but what is more stressful is receiving a claim denial. Hiring an independent adjuster will relieve you of much stress and they will assist you every step of the way.

At Reliant Insurance Adjusters, we have your best interest at heart. We strive to give you nothing but the best service by offering our knowledge and experience so that you can get the highest possible claim settlement. Give us a call to learn more about what we do.

2 Comments

Dave Hinson link

5/24/2023 11:10:20 pm

Thank you for sharing the link discussing insurance claim denials for mold damage. Dealing with insurance claim denials can be frustrating, especially when it comes to mold-related claims. Here are some additional insights on the potential reasons why an insurance company may deny a mold claim:

Policy Exclusions: Insurance policies often have specific exclusions for mold damage or limitations on coverage. These exclusions may be based on the cause of the mold, such as gradual leaks or maintenance issues, or they may limit coverage for mold remediation or related expenses. It's important to carefully review your insurance policy to understand the specific coverage and exclusions related to mold damage.

Lack of Documentation: Insurance companies typically require thorough documentation to support a mold claim. This includes evidence of the cause of the mold, the extent of the damage, and the steps taken to mitigate and remediate the mold. If the documentation is incomplete or insufficient, the insurance company may deny the claim. It's important to document the damage with photographs, written descriptions, and professional assessments to strengthen your claim.

Failure to Report in a Timely Manner: Insurance policies usually have specific requirements for reporting claims within a certain timeframe. If you fail to report the mold damage promptly, the insurance company may use this as a reason to deny the claim. It's crucial to notify your insurance company as soon as you discover the mold damage to ensure compliance with the reporting requirements.

Maintenance and Negligence Issues: Insurance policies generally expect homeowners to take reasonable steps to prevent mold growth through proper maintenance and timely repairs. If the insurance company determines that the mold damage resulted from neglect or failure to address maintenance issues, they may deny the claim. Regular maintenance, prompt repairs of leaks, and addressing moisture issues proactively can help prevent mold growth and strengthen your claim.

Insufficient Coverage: Some insurance policies may have limited coverage for mold-related damages or separate mold-specific coverage options. If your policy doesn't include adequate coverage for mold damage, the insurance company may deny the claim based on the policy terms. Review your policy to ensure you have appropriate coverage for mold-related incidents.

Disputes over Cause and Origin: Insurance companies may deny a mold claim if they dispute the cause or origin of the mold growth. They may argue that the mold was pre-existing, caused by factors not covered by the policy, or resulted from excluded events like floods. Providing clear evidence and expert assessments can help support your claim and address any disputes over the cause and origin of the mold.

If your mold claim has been denied, it's advisable to review your policy, gather additional documentation or expert opinions, and consider seeking legal advice to understand your options. An attorney specializing in insurance claims can provide guidance and help navigate the claim dispute process.

Remember, every insurance claim is unique, and the reasons for denial can vary. It's important to carefully review your policy, gather supporting documentation, and seek professional advice to understand your rights and options when dealing with a denied mold claim.

Jacoby Johnson link

5/30/2023 12:09:05 am

I recently visited your website and read the blog post titled "Why Did My Insurance Company Deny My Mold Claim" on the Reliant Public Adjusters blog. I wanted to take a moment to express my appreciation for the informative content you provided on the topic of mold claims and insurance denials. Your article effectively sheds light on the reasons why insurance companies may deny mold claims and offers valuable insights for policyholders facing such situations.

I found it valuable that you addressed the common reasons for mold claim denials, such as policy exclusions, lack of coverage, and failure to meet specific conditions or requirements. By outlining these factors, you help policyholders understand the complexities and potential challenges associated with mold claims and insurance coverage.

Your explanation of the importance of understanding policy language, limitations, and exclusions is commendable. Policyholders often encounter difficulties when they are unaware of the specific terms and conditions outlined in their insurance policies. By highlighting the need for a thorough review of policy documents and seeking clarification from insurance professionals, you empower readers to make more informed decisions and potentially avoid claim denials.

I appreciate that you mentioned the importance of documenting mold issues, including evidence of the cause, extent of damage, and remediation efforts. By emphasizing the significance of proper documentation, you provide readers with valuable guidance on how to strengthen their mold claims and potentially improve their chances of a successful outcome.

One suggestion I have is to offer some additional advice on what steps policyholders can take when faced with a mold claim denial. It would be helpful to provide information on the appeals process, the role of public adjusters in advocating for policyholders, and any legal remedies or options that may be available to them. This additional guidance would further assist readers in navigating the complexities of the claims process.

Overall, your blog post on mold claim denials provides valuable insights and practical guidance for policyholders who may be facing challenges with their insurance companies. By addressing the reasons for denials, the importance of policy understanding, and the significance of documentation, you contribute to raising awareness and helping readers navigate the insurance claims process more effectively. Thank you for sharing your expertise and providing a resource for those seeking information on this topic.

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Why Did My Insurance Company Deny My Mold Claim?

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