Navigating My Homeowners Insurance Claim: Seeking Clarity on Vague Language
TL;DR: The term “Access” to broken pipes isn’t addressed in policy exclusions. I’m looking to argue for coverage of “tunnelling” that was necessary for the repairs, as my adjuster incorrectly referenced “trenching” and “backfill” in denying that part of my claim.
I’m currently navigating my first homeowners insurance claim and have some questions regarding the specific language used in the context of my situation.
Recently, a pipe burst under my house, causing water to overflow through the washing machine’s walls and pipes. The incident was sudden and accidental, and while the damage from water is being covered, there’s no coverage for the plumbing itself. I know my policy doesn’t cover damage to pipes, trenching, etc., but the plumbers I consulted indicated that in some cases, tunnelling could be covered, which is the most expensive part of the repair—approximately $20,000 out of pocket.
The property has a slab foundation with a sleeper system, which my adjuster noted is unusual for my area and suggests we have extra protection for the flooring. Because we had no accessible points inside our home, the plumbing company needed to tunnel beneath the house to reach the pipe. Their invoice clearly separated “tunnelling,” “trenching,” and “backfill” as distinct services. However, I received a denial for the tunnelling part last night, with my adjuster inaccurately referring to it as “a clogged pipe” and stating, “we can’t cover trenching and backfill.” I’m specifically trying to get the tunnelling costs covered.
Included below is the adjuster’s response and the part of the insurance policy they cited for the denial. Does anyone else find the policy language vague? It seemingly fails to exclude “ACCESS” to broken pipes; it strictly addresses the pipes themselves and losses resulting from conditions outside the home. This ambiguity raises concerns that my adjuster misinterpreted the details of our claim.
Our Coverage Position:
“You are covered for the interior water damage caused by the drain clog. There is no coverage for any wear and tear to the plumbing or any plumbing within the foundation and therefore no trenching and backfilling is covered per the policy provisions.”
SPECIAL PROVISIONS
SECTION I – PERILS INSURED AGAINST
Coverage A – Dwelling And Coverage B – Other Structures
The Exception to A.2.c.(6) is deleted and replaced by the following: Unless otherwise excluded we cover damage to A – Dwelling and B – Other Structures from a sudden and accidental discharge or overflow of water or steam from within a plumbing or drain system, heating system, air conditioning system, or household appliance, subject to the following:
a. We do not cover loss caused directly or indirectly by or resulting from seepage, which is a gradual, continuous, or repeated seepage or leakage of water, steam, or fuel over a period of fourteen days or more, resulting in damage to the structure, whether hidden or not, from a plumbing, heating, air conditioning, or automatic fire protection system or from within a domestic appliance; or from within or around any plumbing fixtures, including, but not limited to, shower stalls, shower pans, shower baths, tub installations, sinks, or other fixtures, including ceilings, walls, or floors.
b. We do not cover any loss or damage to foundations or foundation slabs resulting from any seepage, leakage, or other discharge or overflow of water or steam.
c. We do not cover loss to the system or appliance from which the water or steam escaped. We will cover the cost of tearing out and replacing any part of the building necessary to repair or replace the heating system, air conditioning system, plumbing supply or drain system, or household appliance. However, such tear-out and replacement coverage only applies if the water or steam causes actual damage to a building on the “
It sounds like you’re navigating a complex and frustrating situation with your homeowner’s insurance claim, and it’s understandable to seek clarity about the language and decisions involved. Here are some steps to consider as you formulate your case regarding the tunneling costs:
Clarify Terminology: As you’ve grasped, there’s a significant distinction between “trenching,” “backfilling,” and “tunneling.” Since your adjuster erroneously referred to “clogged pipes” and denied the tunneling costs without addressing your specific situation, it could strengthen your argument to emphasize these distinctions. Tunneling, as you mentioned, was necessary to access the broken pipes, which is a separate issue from the plumbing’s condition itself.
Review the Policy Language: You’ve noted that the language regarding access is vague. Highlighting the lack of explicit exclusions for accessing broken pipes in your policy could work in your favor. If the policy doesn’t clearly state that tunneling is excluded, you might make a case that it should be covered as part of the necessary repairs due to water damage.
Gather Supporting Documentation: Collect any invoices, reports, or recommendations from your plumbing company that discuss the necessity of tunneling for repairs. If possible, obtain a written statement from them that supports the argument that tunneling is a common practice and a necessary step when access points are unavailable.
Request a Reassessment: With your documentation and clarifications ready, consider formally requesting a reassessment from your adjuster. Present your arguments clearly, including the definitions of terms and the reasoning as to why tunneling should be considered essential for the successful resolution of the damage.
Engage with a Supervisor or Appeal: If your adjuster remains unyielding, don’t hesitate to escalate the matter to a supervisor or consider submitting an appeal through the insurance company’s formal dispute resolution process. Detailing the errors made in the initial denial can further emphasize your position.
Consult a Legal Expert: If you feel stuck or your attempts at resolution are inadequate, you might want to consult with an attorney who specializes in insurance claims. They can provide guidance based on your specific situation and may help you navigate the complexities of your insurance policy.
Document Everything: Keep records of all communications with your insurance company, including dates, times, and names of anyone you speak to. This documentation can be invaluable if you need to escalate or pursue legal action.
While navigating this process can feel overwhelming, being methodical and informed about your situation can increase the chances of a favorable outcome. Good luck!