Broken Sewerline And American Family Ins

bill02

I have a HO who has a broken 2" sewer line under the concrete slab of their basement. Other insurance companies in the past have paid for all the removal and re-install of anything in the way of the repair (they have not paid for the pipe replacement itself).
American Family Insurance claims this repair is just maintenence and refuses to pay for any damages.
any one here ever get Amer. Family to cough up any dough?
This is an expensive repair in that the line runs under a tiled shower, tiled floor and a vanity.
thanks!

SLSTech

I don't see how it would be covered, but have them read the policy, if I am wrong & it is covered have them try the adjusters supervisor.

If they still refuse & it is covered or not specifically excluded, they will need it in writing why they are declining the claim and it will need to be brought to your states insurance board

__________________
Alabama Full Service Remodeling, Renovation, and Preservation by SLS Construction
Certified Energy Efficiency Audits, Ratings, Modeling, Verifications, & Consulting
Residential, Commercial, & Industrial Infrared Thermography Scans

cleveman

sounds wacky to me. Do they cover a clogged toilet also? I've got to get out more often.

K2

"Sudden and Severe" is what i've been told in the past but i've seen ins co's pay for all kinds of maintenence issues. I think if you push the limits into the gray areas, you get the jacked up rates. I think ins co's have a rating on everyone that's like a credit score.

bwalley

Why should homeowners insurance be expected to pay for maintenance and repair?

The HO should have bought a home repair warrantry policy for repairs and maintenance.

This is the problem with the United Sates, everyone wants someone else to be responsible for their problems.

The HO needs to pay for the repairs to his house.

BCConstruction

We added a extra to our policy that covers any problems with plumbing that includes flooding also. If you didnt take out extra coverage then you prob wont be covered. We have to have seperate coverage for our sofa and flooring as they only have low limits for things like that.

__________________

bwalley

Flood damage caused by sewer backups is one thing, expecting the insurance company to pay for repairs due to maintenance issues is another thing.

adamk

Why you are expected to pay for maintenance & repair ??

Insuranceclaims

With the limited information provided, I (restorer/adjuster background) will make these comments:

IMPORTANT: Did any water/waste access the interior of the home? You are dealing with a Category 3, Black Water Loss. Health issues come into play for both the insured, you and your employees.

If water/waste has accessed the house, timing is very important.

Yet, before any work begins, determination of coverage is a must. I can help with this.

There are certain procedures that must be taken for any materials that have come in contact with water/waste from this line.

If the demo is not handled properly, you could be open to liability issues to the insured and any pets in the house. You don't want to contaminate others areas of the home.

1) Clarification of the policy coverage and any endorsements would have to be clarified; especially, involving sewer lines and backups.

When was the date of loss? Did an adjuster visit the site and where you present?

I handled some claims for this carrier years ago in Ohio on hail and sewer backup claims. Sewer backups, at that time, were a separate endorsement.

2) Here are two key items needed:

a) A letter from the carrier denying the claim and why. When a claim is denied, they usually refer to the part of the policy that denies coverage.

b) A full copy of the HO policy and an outline of any paid endorsements. If they do not have this, they should call their agent and immediately get a copy.

I would also have them ask their agent if they have coverage for sewer backups due to a broken line. He should be able to give an immediate answer.

3) If there is coverage, the HO will have to pay to repair the pipe, but the carrier will pay to repair any damage caused by the leaking sewer line.

In addition, and, depending on the policy, there should be coverage to access and close the structure to repair the pipe. Consideration should also be given to re-route the damaged line.

4) Photographs and documentation is very important. Before any demo takes place, a complete scope of the area should be written to determine cost to remove/replace. This can be explained in detail later.


Can you call to discuss (Mark, 210-823-3864) or e-mail me any photos? I am currently traveling in Florida.

bwalley

The OP said it was a pipe that was broken under the slab and he wants the insurance company to pay to fix the broken pipe and all of the demo and restoration of stuff that is covering it, he didn't bring up any issues of sewage back up.

Insuranceclaims

My previous posting was written in its specific order to:

1) Bring awareness to any potentional existing water (Black Water, Category 3) that may have entered the home and to bring awareness to specific safety guidelines that must be followed when demolition begins....covered or not; example: containment of the room (sealed masking), air scrubbers, protective equipment (PPE) for the workers, heavy duty contractor bags, plastic floor runners and anti-microbial spray are just a few items that may be required for this job.

I, then, focused to answer the initial posting by bill02.

Insurance losses are covered based on the type of peril (risk) that can cause loss or damage to the property, unless specifically excluded in the policy. There are "named" perils and "all risks" perils.

Insurance companies pay on covered claims that are "sudden and accidental." Broken plumbing lines are considered a maintenance issue....this is a responsibility that is part of being a homeowner. The insured is responsible to pay to replace/repair the plumbing line. Yet, depending on the policy and any additionally paid endorsements, the damage caused by the broken line and any damage to access the line and repairs to close, plus any resulting damage may be covered.

Sewer lines and sewer backups are not treated like indoor plumbing lines.

Insurance policies do not pay for "long-term" damage. This may include constant or repeated seepage or leakage of water or the presence or condensation of humidity, moisture or vapor, unless such.....and the resulting damage....is unknown to all "insured" and is hidden within the walls or or ceilings or beneath the floors or above the ceilings of a structure.

They do not pay for "Wear and tear, marring, deteriation."

There are separate endorsements for "Fungi", Wet or Dry Rot, or Bacteria Coverage. This only applies if the damage is a result of a named peril.

At this point, I do not know if any demolition has been done yet. Documentation (text and photos) is very important before, doing, and after repairs are made.


Bill02:

1) There are too many variables involved on how to resolve this issue on this site. If you will call (Mark, 210-823-3864) or e-mail your contact information, I can expedite how to proceed and resolve.

To benefit others, I can, then, summarize all activities, and post, at a later date, so that others can benefit from this information.

2) Again, the denial letter, the policy and any paid endorsements need to be "in hand" and reviewed before any work is done. By who? See below.

3) After discussion, I would recommend that you talk to two different vendors: a) an experienced insurance restoration contractor, and b) a public adjuster.

Before contacting these two vendors, I would make sure that you have a contract or written commitment from the insured that you will be the primary contractor on this project........covered loss or not.

a) If you are not experienced in dealing with Category 3, Black Water losses, you might want to consider a restoration contractor as a sub to properly demo and deal with any seepage and provide proper removal of materials and cleaning to prevent contamination to the loss site and other parts of the house during removal. Unfortunately, this will not be cheap. Again, coverage needs to be determined before any work begins.

b) While I am not a big fan of public adjusters, you may want to help the insured contact a public adjuster to review and determine policy coverage. There are + and - to having a public adjuster. They are qualified to interpret policy coverage and deal with the carrier. They do not charge for the initial visit, nor any other services, unless they recover any insurance funds. Keep in mind, they will have the insured sign a contract before providing any advice. Their contract may require a fee of 10-30% of the gross loss for their fee. So, in total, there could be as many as 4 estimates for this project: 1) yours for demo/repair, excluding the pipe, 2) the restorer, if used, 3) the public adjuster, and, an estimate from the carrier/adjuster if the claim continues.

Insurance estimates are prepared in computerized, line item, unit pricing (sf, lf, ea, sq, etc) format.

This particular loss is a gray area. By not being on site myself, I can only make general recommendations on how to proceed and protect all parties involved.

When dealing with insurance losses, all avenues must be considered to protect the interests of the insured.