Title: Questions About Vague Insurance Language and Claim Denial for Water Damage
I’m dealing with my first homeowners insurance claim and have some concerns about how certain terms are being used, specifically regarding a recent water damage incident.
A pipe broke underneath my house, causing significant water overflow through the walls and washing machine pipes. This incident was sudden and unintentional, and while the water damage is covered, the plumbing repairs are not. Although I know my policy doesn’t cover damages to the pipes themselves or any associated trenching, I’ve learned from the plumbers that in some situations, the tunneling process can be covered. This is critical because the tunneling costs amounted to $20,000 out of pocket for me.
I have a slab foundation with a sleeper system, which my adjuster noted is unusual for my area. Because of the lack of access points inside the house, the plumbing company had to dig under the house to reach the broken pipe. The terms “tunneling,” “trenching,” and “backfill” were all separately itemized on my plumbing invoice. However, my adjuster denied coverage for tunneling last night, incorrectly citing “a clogged pipe” and stating that trenching and backfilling wouldn’t be covered. I’m trying to argue for coverage of the tunneling expense specifically.
Here is the response from my adjuster regarding the denial and the relevant policy language:
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.”
Policy 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 refers to a gradual, continuous, or repeated leakage of water, steam, or fuel over a period of fourteen days or more, leading to damage to the structure, whether hidden or visible:
(1) From a plumbing, heating, air conditioning, or automatic fire protection system or from within a domestic appliance; or
(2) From within or around any plumbing fixtures, including, but not limited to, shower stalls, shower pans, bathtubs, sinks, and 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, but only if the water or steam causes actual damage to a building on the “residence premises.” There is no coverage for any testing of the foundation or plumbing within the foundation, nor for the tear-out, repair, or replacement of the foundation or foundation slab.
d. We do not cover loss caused by or resulting from water or sewage from outside the “residence premises” plumbing system that enters through sewers or drains or water that overflows from within a sump pump, sump pump well, or any other system designed to remove subsurface water drained from the foundation area.
I find the language in this policy quite vague. Nowhere does it specify exclusions for “access” to broken pipes,
It sounds like you’re facing a challenging situation with your homeowners insurance claim, and you’re correct to explore the wording of your policy and how it was applied in your case. It’s important to thoroughly understand the terms, especially when it comes to a significant financial implication.
From what you’ve shared, it seems that the core of your argument revolves around the distinction between “tunneling” and “trenching or backfilling.” Your adjuster’s response appears to conflate these terms, which could undermine their position. If tunneling was necessary due to the lack of access to the broken pipe, and if it’s understood by industry professionals to be a separate operation from trenching or backfilling, it would seem reasonable to advocate for coverage of those costs.
A few strategies you might consider when discussing this with your adjuster:
Clarify Terminology: Present clear definitions of tunneling, trenching, and backfilling, possibly drawing on your plumbers’ invoices or their professional explanation. Emphasize that tunneling was specifically required to access the broken pipe.
Policy Interpretation: Point out the absence of vague language regarding access to broken pipes in your policy. Highlight that while certain exclusions apply to the plumbing system itself, the policy does not explicitly exclude costs incurred to attain access to fix an issue caused by a covered peril.
Focus on the Damage: If tunneling was directly related to the covered loss of water damage due to the broken pipe, this connection could strengthen your case. Document all related damage and ensure it clearly ties back to the need for tunneling.
Request a Reconsideration: Officially request your adjuster to reconsider their decision, providing them with the additional context and documentation. It may be beneficial to ask for a more senior claims adjuster to review your claim if your initial adjuster remains unyielding.
Seek Professional Advice: Consider consulting with a public adjuster or an attorney who specializes in insurance claims. They can provide valuable insights into your specific policy language and help navigate the appeals process effectively.
Maintaining a clear line of communication and expressing your concerns about how the terminology was interpreted could lead to a more favorable outcome. Best of luck with your claim!