When Does Citizens Cover Water Damage Under an HO3 Policy?
Hello everyone,
I have an HO3 policy with Citizens in Florida, and I’m trying to clarify when they cover water damage. Unfortunately, representatives, my insurance agent, and the adjuster have all been unclear. I have water damage underneath my flooring, but neither the field adjuster nor the water mitigation company or leak detection specialist has pinpointed the source of the leak. Citizens wants to send out an inspector, who I assume will look out for their interests.
I’m preparing for the possibility that they might deny my claim, which could mean I need to bring in independent specialists to investigate further. I have vinyl flooring installed over hardwood, and I discovered a soft spot, prompting me to remove part of the vinyl and revealing rotten wood underneath. I haven’t noticed any water on the floor itself.
From my understanding, Citizens excludes coverage for gradual leaks and seepage. However, they do have a clause that addresses hidden water damage that is unknown and concealed beneath floors, behind walls, or in ceilings. I’m curious how this works in practice since there’s no obvious active leak, which might indicate the issue is situational, hidden, or due to an accidental spill. I find the policy’s fine print somewhat contradictory and difficult to interpret. I’ve included some pages from my insurance declaration regarding water damage in the link below:
Here are some scenarios I’m wondering about regarding coverage:
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Does Citizens cover moisture buildup under flooring caused by a failed vapor or moisture barrier?
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What about an AC leak inside the walls from a pipe failure or faulty installation that occurs over time?
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Could sporadic leaks from a poorly installed air handler be covered?
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What about a cracked condensate line or a leaking sewer pipe under the slab?
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If water was spilled in the past and ended up beneath the floor, would that be covered?
Has anyone had success getting a claim approved by Citizens for similar situations, or have they been denied as a maintenance issue? If your claim was approved, what kind of evidence did you provide?
I’m trying to be well-prepared in case they challenge my claim. It has already been over a month without being able to start renovations because the adjuster wants things left as they are for now. They’ve even instructed me to keep the damaged flooring (which has mold) bagged indoors. The adjuster claimed that mold didn’t seem to be a significant problem based on the photos, despite the water mitigation company’s assessment that it’s over 10 square feet. They advised us to find temporary housing since we have a small child, but the adjuster didn’t approve this.
Any guidance or advice would be greatly appreciated. Thank you!
I’m sorry to hear about the challenges you’re facing with your water damage claim. Understanding the specifics of your HO3 policy with Citizens can be frustrating, especially when it comes to grey areas like hidden water damage. From what you’ve described and the general guidelines for HO3 policies, here’s a breakdown of how coverage typically works in situations like yours:
Concealed Water Damage: Your understanding is correct that HO3 policies often cover hidden water damage if it’s caused by a sudden and accidental event, as opposed to gradual leaks or seepage. The key point is whether the source of the leak was indeed concealed and unknown at the time. If a specific cause of water damage can’t be identified, it may be challenging for the insurer to determine how to classify the claim.
Moisture Buildup: Moisture buildup from a failed vapor barrier typically falls into the category of maintenance issues, which insurance doesn’t cover. However, if you can prove that it stemmed from a specific sudden event, you could potentially have a case.
AC Leaks: An AC leak due to a pipe failure may be more likely to be covered, especially if it can be proven that the leak was sudden and caused water damage. Documentation of the leak’s origin will be important.
Sporadic or Cracked Lines: Similarly, if you can establish that a sporadic leak or a cracked pipe caused the damage and that it was sudden and unforeseen, you might have a valid claim.
Past Water Spills: Water from a past spill, unless it was within a very recent timeframe and could be tied to a specific incident, is usually seen as a maintenance issue and may not be covered.
To prepare for potential denial:
Collect Evidence: Document all communications with your insurance company and specialists. Get photographs of the damage, details of what the water mitigation company reported, and any documentation you have regarding the conditions of the leak.
Independent Assessments: If possible, having an independent adjuster or expert review the situation can be beneficial. They may provide a different perspective or identify an issue that could bolster your claim.
Formulate a Narrative: Prepare a clear and concise explanation of why you believe the damage is covered. Include dates, incidents, and any relevant documentation.
It’s important to stay persistent and engage legal help if necessary, especially if you feel that your claim is unjustly denied. The fact that it has been over a month and you’re facing health concerns with mold is certainly a serious issue that may require further escalation with your insurer. Best of luck, and I hope you get the assistance you need to resolve this matter!