Revising My Homeowners Insurance Claim Denial
I’m currently navigating my first homeowners insurance claim and have encountered some confusing language that may be impacting my case, particularly regarding a recent water damage incident caused by a broken pipe.
To summarize my situation: I had a pipe burst beneath my house, resulting in significant water damage that flowed through the walls and washing machine. While the water damage itself is covered by my policy, the plumbing repairs are not being addressed. I understand that my policy excludes coverage for the pipes themselves and related trenching, but the plumbers I hired indicated that the tunneling necessary to access the broken pipe might be covered, as it represents a significant expense—around $20,000 that I’ve had to pay out of pocket.
I live in a home with a slab foundation and a sleeper system (which my adjuster mentioned is unusual for the area and might provide some benefit concerning the flooring). Unfortunately, we had no internal access points, leading the plumbing team to tunnel beneath the house to reach the pipes. The terms “tunneling,” “trenching,” and “backfill” were distinctly used in the plumbers’ invoice. However, my adjuster recently denied my claim for the tunneling costs, mistakenly referring to it as “a clogged pipe” and stating that trenching and backfilling are not covered. This was incorrect, and I am attempting to get the tunneling expenses approved.
I want to share the adjuster’s comments and the specific policy language they relied on for the denial. Am I misinterpreting this, or does it seem vague? My policy doesn’t specifically mention excluding access to broken pipes; it only addresses the pipes themselves and any resulting water damage or losses.
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 revised as follows: 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 conditions:
a. We do not cover losses caused directly or indirectly by seepage—which is defined as a gradual, continuous, or repeated leakage of water over a period of fourteen days or more, resulting in damage to the structure, whether hidden or not.
b. We do not cover any loss or damage to foundations or foundation slabs resulting from seepage or discharge of water or steam.
c. We do not cover losses to the system or appliance from which water or steam escaped. We will cover the costs 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, as long as actual damage has occurred to the building.
d. We do not cover any losses caused by water or sewage from outside the residence plumbing system entering through sewers or drains or water overflowing from a sump pump or similar system.
I hope to clarify these points with my adjuster and make a compelling case for covering the tunneling costs. Any insights or suggestions would be greatly appreciated!
It sounds like you’re in a frustrating situation, and it’s understandable to want to challenge your adjuster’s decision, especially when it involves such significant expenses. Here are some points to consider as you prepare to discuss your claim further:
Clarification of Terminology: It’s crucial to clearly differentiate between tunneling, trenching, and backfilling. If the policy does not explicitly exclude tunneling related to access for repairs, you can argue this point. Tunneling was necessary for accessing and repairing the broken pipe, which is distinct from trenching and backfilling, which your adjuster referenced incorrectly.
Vague Language: If the policy language is open to interpretation, use that to your advantage. Since access to the broken pipes isn’t mentioned as an exclusion, you may have a strong argument that the tunneling should be covered as part of the necessary repairs. Highlight the fact that this was not a result of negligence or wear-and-tear but rather a sudden occurrence that required immediate action.
Documentation from Plumbers: The invoices and documentation from your plumbing company could be critical. Make sure they detail the reason for tunneling, emphasizing that it was necessary to access the broken pipe. Their professional opinion may carry weight in your discussions with the adjuster.
Appeal the Decision: Consider formally appealing the adjuster’s decision. Write a clear, concise letter that outlines your understanding of the policy language, the specifics of the work done, and why you believe tunneling should be covered. Include all supporting documentation.
Speak to a Supervisor or Another Adjuster: If you feel comfortable, ask to speak with a supervisor or another adjuster who might have a different perspective on your claim. Sometimes a fresh set of eyes can lead to better results.
Legal Guidance: If you continue to have difficulties, you might want to consult with a legal professional who specializes in insurance claims. They can provide insight into the language of the policy and help you formulate a stronger argument or take further action if necessary.
Keep Records: Make sure to keep records of all your communications with the insurance company. Documentation of every conversation and correspondence can be helpful if you need to escalate the issue.
Overall, it seems you have legitimate grounds for arguing your case. Being well-prepared with documentation and a clear understanding of the policy language will strengthen your position. Good luck!