Claimed Denied Have a Question

[Deer01]

My husband and I went away for vacation and came back to a house filled with water even though my husband turned off the water to the house and to the toilets. When we came home, water was coming out of the water line hooked up to the refrigerator (it split).

Today, we received a letter stated that it was determined the damage to your water supply line was caused by wear, tear, and deterioration. Therefore, we do not insure because of wear, tear, marring, scratching, deterioration, inherent vice, latent defect or mechanical breakdown. But according to our policy, losses insured is the following: sudden and accidental discharge or overflow of water or steam from within a plumbing, heating, a/c or automatic fire protective sprinkler system, or from with a household appliance.

I do not understand. Could someone please explain the thinking behind the insurance company? Any information will be helpful.

 

[Josh]

A few questions, mostly out of curiosity:

How long were you gone on vacation that you would have turned off the water to the house?
Do you normally cut the water to the house when you leave? Although it's probably a good idea, I've never heard of anyone doing it.
If the water was cut to the house, how much water could have made it out of the fridge? I'm sure there is some pressure built in, but it wouldn't have had a steady flow.

Now for a much more relevant question:
-How old was the ridge in question?
-Was it obviously in disrepair?

If you have an old refrigerator and the tube is supposed to last (for the sake of discussion) let's say 10 years, but you've had it there for 20 without replacing it, that's a reasonable basis for them to say it was normal wear on tear, because parts don't last forever. That might not have been the case here, but perhaps.

Usually when folks come on here with a claim question they aren't always presenting all the facts. I'm not saying that's the case here, but is there anything you're leaving out? You're telling us that the water to the house was turned off, but you came home to a house full of water? Surely you can appreciate why I find that curious.

On a positive note, that denial letter isn't necessarily the end of your claim. You can usually appeal the decision and have other avenues to get information, not the least of which is to call the carrier (which at this time of day/night and week is probably going to result in an answering machine) and ask for more of an explanation. As a last resort you likely have an option in your policy to arbitrate and/or litigate to get the claim paid. If they're really not paying on something they should (which doesn't happen as often as people generally think) then you could be explaining the situation to a judge/arbitrator and they may rule in your favor. Binding arbitration is usually a fairly simple process and generally does not require a lawyer.

I'm sorry for your loss, but hopefully this helps.

 

[Biggdogg]

What state are you in and if you don't mind, what company? Those two issues can narrow things down considerably.

 

[Deer01]

We went away for 9 days to visit family up north. To make our house save, my husband turns off the water to the house and the toilets. When we came home, our garage had a huge puddle of water and water seeping from the kitchen door all the way out the garage door. Immediately, we opened the kitchen door and heard the water flowing out of the ice-maker line. Our house was built in 99 and we moved in at the end of 2003. We had no indication of wear and tear or issues with our refrigerator. The refrigerator is 13 years old.

My husband went around the house to check the damage and I went to get towels to clean up the mess in the kitchen. Behind our stove, the water wicked up the wall 4 feet. Our bottom cabinets, swelled in the kitchen. Also, our bathroom cabinet swelled too. Our laminate flooring were soaked and began to buckle. Also, all our bedrooms were covered with at least 30% - 40% water. Immediately, we called our Florida State Farm Insurance Agent told my husband to take up the laminate flooring. All the baseboards in the kitchen and living area had to be removed due to water.

We had a Florida Recovery Team come out to the house to clean up the water damage.

It is good news to hear that my husband and I can appeal the decision. Would it be wise for us to hire an attorney?

 

[Newby]

For what it's worth, I always turn my water off if leaving for 2-days or more.

 

[b61mack]

I would call a plumber or small appliance repairman. and get an expert opinion. One that is on your side. Also find the right shut off. On some houses it is confusing. The only reason i could see for a denial, is if you told them it has been leaking for a long time. The reason i say a small company. You want someone who will go to court with you if need be.

 

[djs]

Florida has different rules than I'm used to so I can't give a lot of insight into this, but, hey, that never stopped me before

Chances are, the insurance company thinks this has been leaking for a while and just ignored till the problem became severe. In this case, they can deny the claim since it is simply routine wear.

Your case is that not only was this not leaking prior, you went the extra step and shut off the water to the house to make sure you didn't have this problem, but it happened anyway. Of course, this means your shutoff valve leaks (and many do).

I would appeal the decision. You probably don't need an attorney unless they drag feet on the appeal or deny the appeal. The next step beyond that is arbitration, which is where the attorney would come in to play at.

On your appeal, make sure you use terms like 'reasonable care' and 'sudden and unexpected', etc. Basically, make it fit their definition of a covered claim (without stretching the truth). Also, don't get to wordy. Be very succinct, extra words do nothing but give reason for the denial.

Don't use the word 'backup', as in the water was backedup in the garage. This gets read as a sewer/drain backup problem which is an entirely different discussion.

Dan

 

[b61mack]

I also turn off the water if i go away for long periods of time. But i must note if it is in the winter time, and you have a hot water heating system, (mostly found in the northeast, and northwest). Unless you are going to winterize the system. Leave the water on.

 

[Deer01]

Wow, you all made great suggestions. I greatly appreciated. I will definitely hire a plumber to find out why the shutoff valve did not work. I even asked my neighbor to check his valve and the same thing...the water continued to flow.

Another good point brought up was insurance company thinks this has been leaking for a while. There is no evidence of this and no way did we have issues with our refrigerator. If so, we would have replaced it immediately. Also, the insurance adjuster who came out took the refrigerator piece connected to the ice maker. What should I do?

Lastly, I love the words "reasonable care," "sudden" and "unexpected." You nailed it! Thank you all for your helpful advice.

Should I call the claims adjuster requesting more of an explanation? Or should I call a plumber first? This a first for my husband and me. We have never made a household insurance claim.

 

[Josh]

Call the adjuster first.

100:1 the reason why the valve didn't shutoff is that there was some sediment built up in your lines (either always or almost always happens) and so it probably wouldn't shut all the way.