Homeowners’ Claim: Have We Exhausted Every Option?
My wife and I have lived in our home for 2.5 years without any plumbing issues, but suddenly we faced unexpected plumbing problems. Upon investigation, we discovered that our main drain line was cracked and collapsed, surrounded by gravel (we have a slab foundation with no basement or crawl space).
We filed a claim with our homeowners’ insurance only to have it denied. The adjuster based the denial on one photo of a section of pipe buried beneath gravel, stating it was a case of wear and tear. Unfortunately, they never visited our home, didn’t consult our plumber, and failed to provide updates on the claim’s status. We were incorrectly told that the plumber agreed with the adjuster’s assessment, which was untrue.
We escalated the issue to the adjuster’s supervisor, who was willing to review everything and connect with both my wife and me, as well as consult our plumber. The wear and tear denial was debunked based on the location of the crack (on the top of the pipe rather than on the underside where water flows). Despite this, we received a second denial stating it was ‘not a sudden or accidental incident,’ framing it as a long-term issue. My perspective is that the real sudden incident occurred between 2022 and the end of 2024 when our plumbing functioned without problems—only to unexpectedly require extensive repairs.
While we can appreciate the insurance company’s reluctance to cover the pipe replacement, we believe they should cover the costs associated with excavating to access the pipe and restoring our home afterward. Additionally, we seek compensation for temporary living expenses incurred while our home was uninhabitable for a few days. Our plumber, who has extensive experience with this type of work, is also baffled by the insurance denial.
We’ve filed complaints with our state’s Department of Insurance and the Better Business Bureau. However, both responses failed to address our experiences with the adjuster, which I believe would have changed the outcome had proper diligence been observed during the initial claim process. Instead, the responses reflected the insurance company’s narrative and included inaccuracies regarding events that did not occur.
We’re now consulting with a lawyer to assess the viability of legal action. Is there anything we’ve overlooked in our efforts? If the lawyer deems it unworthy of pursuit, are we then left with no options?
Are we in the wrong for believing insurance should cover some portion of these costs? I understand if we have to accept this situation, but I also don’t want to give up if we are being unfairly treated by our insurance provider.
It sounds like you’re going through a really frustrating situation with your homeowners insurance. You’ve clearly put in a lot of effort to advocate for your claim, and it’s understandable to feel upset about the denial, especially with the complications that arose. Here are some steps you might consider taking next:
Consult with Your Plumber: Since your plumber has experience with these types of issues, ask them to provide a written statement or report detailing their findings about the pipe and why it experienced a sudden failure. They may also have insights into why the insurance company’s assessment is inaccurate.
Gather Documentation: Make sure you have all the documentation related to your claim organized. This includes photos, invoices from the plumber, and any correspondence with the insurance company. This could be useful if you decide to pursue legal action or further escalate the claim.
Request a Reconsideration: If you haven’t already, formally request a reconsideration of your claim based on the new information you have. Provide additional evidence and ask for a thorough review of your situation.
Insurance Ombudsman: It sounds like you’ve reached out to the DOI and BBB, but you might also check if there is an insurance ombudsman in your state. They can provide additional guidance and help mediate disputes between policyholders and insurance companies.
Legal Consultation: Since you mentioned consulting with a lawyer, make sure to choose someone with experience in insurance claims. They can provide direction on whether your case has merit and what steps to take next. Ask the lawyer about Alternative Dispute Resolution (ADR) options, which might allow for a resolution without going to court.
Review Policy Coverage: Double-check your insurance policy to understand the specifics of what is covered. Sometimes policies have specific language regarding sudden and accidental damages, and that clarity can help in your discussions with the insurance.
Stay Persistent: If the legal route doesn’t seem worthwhile, it’s important to remember that persistence can pay off. Many policyholders find success after continually following up and advocating for themselves, especially if they present solid evidence to support their case.
Ultimately, it’s not unreasonable to think you should receive coverage for some of the costs incurred during this incident, especially given that it was an unexpected plumbing failure. Just be sure to document everything and remain organized in your approach moving forward. Good luck!