- Thread starter
- #11
Claimed Denied Have a Question
- Thread starter Deer01
- Start date
- 11,997
Nope, it just blocks the valves from closing completely.
If it happened the way you say then it probably should be covered, but I haven't seen the tube in question.
Carriers don't usually deny claims for no reason.
I'm just curious here:
1) What is your deductible
2) How long have you had State Farm
3) What was the estimated amount of repairs that had to be done?
I was writing an ASI policy for a client who was in FL (moved to NC) and he had a sudden, overnight break in his AC line and he had about 25k worth of repairs done to his floors. ASI called BS on that based on the description and we had to get an adjuster report to get the approval for writing the policy. They said that usually costs a few grand unless it was sitting longer than overnight or a variety of other circumstances.
If the damages are above and beyond what is normal for something like this then the insurance company has a few more questions or might deny. If you go to a doctor and have to pay 75 cash for a physical and then one day you have to pay 200, aren't you going to ask what is up and either decline paying, fight it, or reduce the fee somehow by questioning the work being done? This could be a similar idea, though we don't have all the facts.
A lot of companies don't like negligence and have most have clauses in there for it. Hence the "sudden and accidental" part. Obviously this is where the fun part comes in. But if the claim amount is substantially higher than what was expected, well, that could be part of why they think it wasn't sudden and accidental. Or it WAS but you are leaving out details that make then wonder if it was fraud.
MAN, I wish I could have an adjuster license here in NC on top of being an agent. I'd love to go investigate some of these things because it sounds like a big puzzle. Though I could imagine the paperwork being a bear...
1) What is your deductible
2) How long have you had State Farm
3) What was the estimated amount of repairs that had to be done?
I was writing an ASI policy for a client who was in FL (moved to NC) and he had a sudden, overnight break in his AC line and he had about 25k worth of repairs done to his floors. ASI called BS on that based on the description and we had to get an adjuster report to get the approval for writing the policy. They said that usually costs a few grand unless it was sitting longer than overnight or a variety of other circumstances.
If the damages are above and beyond what is normal for something like this then the insurance company has a few more questions or might deny. If you go to a doctor and have to pay 75 cash for a physical and then one day you have to pay 200, aren't you going to ask what is up and either decline paying, fight it, or reduce the fee somehow by questioning the work being done? This could be a similar idea, though we don't have all the facts.
A lot of companies don't like negligence and have most have clauses in there for it. Hence the "sudden and accidental" part. Obviously this is where the fun part comes in. But if the claim amount is substantially higher than what was expected, well, that could be part of why they think it wasn't sudden and accidental. Or it WAS but you are leaving out details that make then wonder if it was fraud.
MAN, I wish I could have an adjuster license here in NC on top of being an agent. I'd love to go investigate some of these things because it sounds like a big puzzle. Though I could imagine the paperwork being a bear...
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- 11,997
I think being an adjuster could be a blast.
I think the *theory* of being an adjuster is awesome, similar to how people think of being Doctor House for medical professionals. I think that in the core of adjusting there is a lot of fun but the politics, business, screw ups and expectations of clients and agents, and similar things of adjusting would ruin it for me. Agents are seen as the good guy while adjusters are often viewed as the bad guy. It's like "fun dad" and "strict mom" for the clients. Allstate has an adjusting center near me that also does subrogation and they have to have security guards and things over there for the safety of some adjusters.
- 11,997
You're only making it sound better! Security guards? Awesome!
- Thread starter
- #17
1. $500 deductible
2. Been with State Farm for 24 years (car, house and life insurance policy)
3. I do not know the estimated amount of repairs. We did not give the adjuster any quotes for repairs. We were waiting for his assessment. On a side note, he was very professional and reassuring. He even made notes of damages we did not notice.
No, we have laminate flooring, tile in kitchen and carpets in the bedrooms. Our house is well maintained and we live in a middle class neighborhood...we live humbly. For instance, our kitchen cabinets will cost $2500.
If there is one thing that I am puzzled about is shut off valve in the garage. Why did we have water damage even though it was completely off? My husband even took video yesterday to show the claim's adjuster.
Thank you again for your expertise and advice.
2. Been with State Farm for 24 years (car, house and life insurance policy)
3. I do not know the estimated amount of repairs. We did not give the adjuster any quotes for repairs. We were waiting for his assessment. On a side note, he was very professional and reassuring. He even made notes of damages we did not notice.
No, we have laminate flooring, tile in kitchen and carpets in the bedrooms. Our house is well maintained and we live in a middle class neighborhood...we live humbly. For instance, our kitchen cabinets will cost $2500.
If there is one thing that I am puzzled about is shut off valve in the garage. Why did we have water damage even though it was completely off? My husband even took video yesterday to show the claim's adjuster.
Thank you again for your expertise and advice.
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- 11,997
I found this out the hard way.
I own a house that is over 100 years old and I completely renovated it. When I pulled out the plumbing I turned off the water line, hacked off the pipe, and went to put in the new stop pipe. Unfortunately it was a non-standard size and the "shark bite" connector that was supposed to attached to everything didn't take, so it was just drizzling relentlessly. I ended up *very temporarily* running some pipe (with duct table joints) from the drizzling main pipe to the drain in the basement while I went to get the supplies to fix it. Something about paying for water to put directly into the drain made it very difficult to forget about sediment build up in valves.
- Thread starter
- #20
GOOD NEWS...Our claim was approved.
My husband and I called our agent to find out why the claim was denied and she said that she was surprised. Then, she said that she would have to look on the computer to find out why. While looking on the computer, she saw that the insurance company issued a check. While we were talking to our agent, the claim representative called us to let us know that our claim was approved. We proceeded to ask why they sent out a denial letter. The claim representative said that they did not deny the claim, but rather deny the replacement of the line. Huh?? This totally does not make sense.
How do you read this? Give me your insights. I wish that the wording was more lucid.
Here is the letter that was sent to us:
Based upon the results of our site inspection on July __, ____ it was determined the damage to your water supply line was caused by wearm tear and deterioration.
Damage resulting from this cause(s) of loss is not covered by your policy.
One more thing, the best job in the world is....TEACHER. I am very lucky and fortunate.
My husband and I called our agent to find out why the claim was denied and she said that she was surprised. Then, she said that she would have to look on the computer to find out why. While looking on the computer, she saw that the insurance company issued a check. While we were talking to our agent, the claim representative called us to let us know that our claim was approved. We proceeded to ask why they sent out a denial letter. The claim representative said that they did not deny the claim, but rather deny the replacement of the line. Huh?? This totally does not make sense.
How do you read this? Give me your insights. I wish that the wording was more lucid.
Here is the letter that was sent to us:
Based upon the results of our site inspection on July __, ____ it was determined the damage to your water supply line was caused by wearm tear and deterioration.
Damage resulting from this cause(s) of loss is not covered by your policy.
One more thing, the best job in the world is....TEACHER. I am very lucky and fortunate.
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