Homeowners Insurance Claim: Have We Exhausted All Options?
We’ve lived in our house for 2.5 years with no plumbing issues, but recently, unexpected problems arose. It turns out our main drain line is cracked and collapsed due to gravel, and since we live on a slab, there’s no basement or crawl space to access.
After submitting a claim to our homeowners insurance, we were met with a denial. The adjuster based this decision on a single photo of a section of the pipe buried in gravel, labeling it as wear and tear. They didn’t visit our home, consult with the plumber, or provide any updates on claim progress. We were even told that the plumber had agreed with the adjuster’s findings—a claim that is untrue.
We escalated the situation to the adjuster’s supervisor, who was willing to review everything again, communicate with us, and consult the plumber. The initial wear and tear claim was debunked based on the location of the crack (along the top rather than the bottom). Unfortunately, we received a second denial citing that this was “not a sudden or accidental incident” and labeling it as a long-term issue. My view is that our plumbing functioned normally from 2022 until late 2024, only to present a sudden failure that required extensive repairs.
While we understand the insurance might be hesitant to cover the damaged pipe itself, we believe they should cover the costs associated with accessing the pipe and restoring our home. Additionally, we expect reimbursement for living expenses incurred due to being displaced for a few nights. The plumber we hired has extensive experience with these repairs and is baffled by the insurance company’s refusal to pay anything.
We have lodged complaints with our state’s Department of Insurance and the Better Business Bureau. Unfortunately, both responses did not address our concerns with the adjuster’s handling of our claim; they merely reiterated the insurance company’s version of events, even including inaccuracies.
We are consulting a lawyer to determine if pursuing legal action is viable. Is there anything else we should consider beyond what we’ve already done? If the lawyer advises against it, are we just out of options?
Are we wrong to expect our insurance to cover at least part of these costs? I’m open to the possibility that we might not be entitled to coverage, but I also don’t want to give up if the insurance company is not handling our claim properly.
It sounds like you’re going through an incredibly frustrating situation, and it’s understandable to feel disheartened by the insurance process. Here are a few suggestions and considerations that might help you navigate this:
Documentation: Ensure you have all documentation organized, including photos, written statements from your plumber, and any correspondence with the insurance company. This will be crucial if you decide to pursue legal action or further discussions with your insurer.
Consult Your Policy: Review your homeowners’ insurance policy carefully. Specifically, look for language regarding what constitutes a “sudden” versus “gradual” issue. Sometimes, policies have specific definitions that can influence how claims are handled.
Seek a Second Opinion: If possible, consider getting a second opinion from another plumbing professional. Their assessment may provide additional support for your claim, especially if they can explain why this situation arose suddenly and is not simply wear and tear.
Ask for a Re-evaluation: If you haven’t already, request a formal re-evaluation by a different adjuster or ask for a third-party adjuster who would look at your case without bias.
File a Complaint with the State Insurance Department: It seems you’ve already done this, but sometimes it can take a while for an investigation to unfold. Keep any follow-up records or communications from them as you might need them later.
Consider Mediation: Sometimes, insurers are more willing to settle disputes through mediation rather than litigation. This could save time and costs while still providing you with a resolution.
Legal Consultation: It’s wise to speak with a lawyer well-versed in insurance claims. They can offer guidance on whether you have a case worth pursuing. Even if it ends up not being worth pursuing in court, a lawyer might help you negotiate with the insurance company or protect your interests more effectively.
Public Pressure: Sometimes sharing your story on social media platforms or consumer advocacy forums can create pressure for the insurance company to reconsider. Make sure to share facts and avoid inflammatory language, as this can be counterproductive.
Keeping Records: If you are forced to incur additional living expenses, continue to keep all receipts and document everything as it may help substantiate your claim for those expenses.
It’s reasonable to expect coverage for the disruption and costs relating to getting back to normal after an unexpected plumbing issue. Ultimately, don’t lose hope in pursuing your rights. Seeking professional guidance and maintaining thorough records will be essential as you navigate this issue.