LD1
Epic Contributor
I am battling a claim being denied by my insurance right now and am frustrated to say the least.
This is not at my place, rather at a 3-unit apartment I own.
Back in December I had a tenant call be because of an unusually high electric bill and it was discovered that the T&P valve on the water heater failed and was leaking (I would estimate ~1gpm) into the crawlspace.
The T&P was supposed to be plumbed over a 4" drain, and it was....however given the splash/steam effect around this drain, the 3 little screws pulled loose from the subfloor. So this 1gpm of hot steamy water was basically just dumping straight into the concreted 42" high crawlspace.
After seeing everything completely saturated, all joists and subfloor, I called the insurance agent. They started a claim and gave me a number to a mitigation company they work with. They were out the next day to start the drying process.
The next day the adjuster also called. Asked questions. I explained what happened and by my estimation....it has been leaking for at least 2-3 weeks....but not more than 4 or so due prior utility bill being normal.
It actually took the mitigation company 19-days to completely dry everything due to the steam saturating everything.
At one point about half way through, the adjuster was even on site and in the crawl space with me and said yes it does appear that it falls under the sudden and catastrophic coverage. The mitigation company was in constant contact with the insurance adjuster, and being advised/approve/authorized to continue mitigation. And the contact I had with the adjuster was basically just "stay the course" we have to get it dry and determine if there is any more damage that will need repaired.
About 3/4 through the process I got passed off to another adjuster. My first contact with him was the first time I had an uneasy feeling that this might not be covered. They "wanted to get an engineer in there to determine the extend of the damage and the cause to see if it is a covered loss before they write a check for the mitigation bill"
This whole time I have been under the impression this was a covered loss. But basically all I did was give the insurance company a blank check to dry the structure on my dime.
Well, the engineer confirmed my initial statement, that the water was leaking for 2-3 weeks. And now they are citing the dreaded seepage clause that is excluded
"Continuous or repeated seepage or leakage of water or steam from within a plumbing, heating, air conditioning or automatic fire protection sprinkler system or from within a domestic appliance which occurs over a period of weeks, months or years"
I have plead my case to the adjuster and the manager and they are still denying the claim. The agent has even tried on my behalf and is in complete agreement with me that this is total BS.
Basically, If I had discovered this leek on day 13.....everything would be covered and no questions asked. But since I didnt discover it until day 15, or 17, or 18 (irrelevant).....ZERO Coverage at all.
What has me hopeful is reading some case law, specifically in florida from Hicks v AIIC that gave partial judgment in favor of insured. Citing something to the effect that the insurance company is indeed responsible for any/all damage that occurred within the first 13 days. And that the burden of proof was on the insurance company to determine what if any further damage occurred beyond those initial 13 days.
Given that the 19-day mitigation bill is a little in excess of $19k....this is pretty significant and IMO, worth consulting legal advise.
So what are some thoughts, and does anyone know a good attorney in Ohio that handles property insurance stuff like this?
This is not at my place, rather at a 3-unit apartment I own.
Back in December I had a tenant call be because of an unusually high electric bill and it was discovered that the T&P valve on the water heater failed and was leaking (I would estimate ~1gpm) into the crawlspace.
The T&P was supposed to be plumbed over a 4" drain, and it was....however given the splash/steam effect around this drain, the 3 little screws pulled loose from the subfloor. So this 1gpm of hot steamy water was basically just dumping straight into the concreted 42" high crawlspace.
After seeing everything completely saturated, all joists and subfloor, I called the insurance agent. They started a claim and gave me a number to a mitigation company they work with. They were out the next day to start the drying process.
The next day the adjuster also called. Asked questions. I explained what happened and by my estimation....it has been leaking for at least 2-3 weeks....but not more than 4 or so due prior utility bill being normal.
It actually took the mitigation company 19-days to completely dry everything due to the steam saturating everything.
At one point about half way through, the adjuster was even on site and in the crawl space with me and said yes it does appear that it falls under the sudden and catastrophic coverage. The mitigation company was in constant contact with the insurance adjuster, and being advised/approve/authorized to continue mitigation. And the contact I had with the adjuster was basically just "stay the course" we have to get it dry and determine if there is any more damage that will need repaired.
About 3/4 through the process I got passed off to another adjuster. My first contact with him was the first time I had an uneasy feeling that this might not be covered. They "wanted to get an engineer in there to determine the extend of the damage and the cause to see if it is a covered loss before they write a check for the mitigation bill"
This whole time I have been under the impression this was a covered loss. But basically all I did was give the insurance company a blank check to dry the structure on my dime.
Well, the engineer confirmed my initial statement, that the water was leaking for 2-3 weeks. And now they are citing the dreaded seepage clause that is excluded
"Continuous or repeated seepage or leakage of water or steam from within a plumbing, heating, air conditioning or automatic fire protection sprinkler system or from within a domestic appliance which occurs over a period of weeks, months or years"
I have plead my case to the adjuster and the manager and they are still denying the claim. The agent has even tried on my behalf and is in complete agreement with me that this is total BS.
Basically, If I had discovered this leek on day 13.....everything would be covered and no questions asked. But since I didnt discover it until day 15, or 17, or 18 (irrelevant).....ZERO Coverage at all.
What has me hopeful is reading some case law, specifically in florida from Hicks v AIIC that gave partial judgment in favor of insured. Citing something to the effect that the insurance company is indeed responsible for any/all damage that occurred within the first 13 days. And that the burden of proof was on the insurance company to determine what if any further damage occurred beyond those initial 13 days.
Given that the 19-day mitigation bill is a little in excess of $19k....this is pretty significant and IMO, worth consulting legal advise.
So what are some thoughts, and does anyone know a good attorney in Ohio that handles property insurance stuff like this?
