Water Damage Claim

Dealing with an insurance company when addressing the issue of a water damage claim can be an easy process if the channels of communications are open.

First of all, never try to find an answer by yourself; insurance rules are set by companies under state guidelines, meaning that there are politicians and lawyers involved. And as everyone should know, it spells for no clear cut answer. Ever.

Call your agent, if you have one, or your customer service department. Most likely you will be asked to put in a claim with the claims department. At that point, you will find out if the loss is actually covered.

Often flood damage is considered water damage, while water is involved, flood damage is treated completely independently from all other claims. The flood insurance program is underwritten by the federal government, meaning that they are the insurance carrier. Insurance companies manage the policies on behalf of the government, and there is no cheaper flood coverage from one company versus another. The government sets the rates, not the individual insurers.

Flood insurance is expensive in flood zones. You can purchase flood insurance if you are not in a flood zone, and it will be very affordable. You can even buy flood insurance for an apartment or a home you are renting, and that will cover your personal property alone rather than the structure.

All other water damage claims are under the insurer’s responsibility, under home, condo or renters policies. Another distinction to be made is when dealing with sewage backup or sump pumps failure, there is a specific coverage called water backup coverage and not all insurers offer it but most of them sell it as an additional endorsement that you most likely will have to ask for.

A leaky pipe over period of time causing damage is not covered, but the damage to the structure (ceiling, wall or floor) is in most cases covered, a pipe that bursts suddenly is covered. The insurer will also cover the cost to access the pipe (if floors need to be dug into etc).

If water leaks through the roof, the damage caused by the water is covered; if the roof leaked because of age the roof, it is not covered; if the roof was damaged by wind or debris damaging it; then it would also be covered. Insurance companies want to see that the insured has made every possible effort to avoid the damage; for instance if during a storm a branch falls, and breaks a window, the insurance company expects the insured to at least attempt to cover the broken window in an effort to stop rain from entering the house and cause further damage. If a tree or large tree branch falls on a roof there should be an effort to remove the debris and assess the damage. That may be achieved by simply calling your insurance company, and explaining what happened as soon as you notice the potential damage.

The insurance company will investigate all claims, and you will be given forms to fill out. In some cases inspectors will come to your house to assess the damage, and phone statements will be taken. Whatever the procedure, the most important thing is to communicate with your claims representative, give them your home number your cell number your work number and email address (no one will try to contact you and sell you anything). Their job is to close a claim in a timely manner and in a way that everyone is happy. Remember the goal for home insurance is to make you whole, not better not worse, an insurance company’s job is to bring you back to the point where you were at the time right before the loss occurred. No one should gain from a loss, and unfortunately many individuals try to take advantage when putting in a claim and this has caused insurance companies to be tougher in their investigations.

Here is a final story to illustrate the situation. A few years back an insured’s window broke due to a tree branch falling during a storm. He then decided to go into his basement and move a bunch of old furniture upstairs in his living room near the broken window, and took his new furniture downstairs safe from the elements. He then proceeded to leave the house, book a hotel a few towns over and spent the night. The next day he puts in a claim telling the insurance company that he had gone to a relative’s house, had a few drinks and decided to get a hotel room because of his drinking as well as the weather. The claims adjuster saw the red flag right away but then, when on-site he noticed furniture marks on the carpet but no furniture on it, of course the claim was denied after they were able to get a confession from the insured. Unfortunately, out there there are more intelligent people who will successfully defraud the insurance companies… and you and I will pay for it with your premiums.