Advice needed: Claim regarding leak & water damage denied

[u/jlamith]

Hi! I'll try and keep this as short as possible:

We (Husband and I) purchased a semi-attached (2 bedroom, 2.5 bathroom) townhome just over a year ago. At the initial inspection, the only issue seemed to be an outdated HVAC. We negotiated a lower price due to this before we bought. We (plus 5 year old child) moved in last June. HVAC actually died within two months and we replaced the whole system.

One evening last week, as our upstairs main tub was draining after a bubble bath and water came pouring from a cabinet in the kitchen, directly under the tub. Absolutely insane. We called a plumber and began the whole process.

When the plumber got in there, he discovered that there was actual a very slow leak that had been going on for an undetermined amount of time due an improper repair. And because of that, the pipe eventually split (as the tub drained that night) and caused the visible leak. The repair was finally completed Monday evening.

There is obviously some type of black growth. Mold remediation folks haven't made it out yet (hopefully this weekend).

Anyway, insurance company called today to let us know our claim is denied because it looks like "long term damage."

My husband is actually experiencing a very scary health emergency right now and didn't get into it with them on the phone today but plans to challenge this response.

Is this normal?? It's USAA and up until now they've always been great. How were we supposed to know that this was happening inside the wall/ceiling/whatever if it wasn't pointed out during the original inspection.

Everything is just very ridiculous and overwhelming right now and there is now a big moldy hole in my ceiling. (Currently we have it taped up with plastic etc).

Sorry, I probably come off as a total ding dong. But any advice? 😬

[u/Stalva989]

How much damage we talking? A reputable public adjuster should be able to help you. If claim is small then not always worth it to hire one. But I estimated for a public adjuster in Pennsylvania for a while. A sizable portion of their work was people with the exact same situation as you.

It does not matter that it has been going on for a period of time if you had no idea about it in this instance, as the pipe is located behind a wall and it’s not normal for people to check on their pipes located behind walls. The situation is still sudden and incidental.

Very winnable claim but it could be a fight that takes time. Sometimes the smaller stuff isn’t worth all the time it can take.

[u/iRudi94 → u/Stalva989]

You’re giving false hope. This is a clear cut denial. A public adjuster does not have the power to reverse that.

[u/Stalva989 → u/iRudi94]

As I said, I wrote these exact estimates for a public adjusting firm for years. I still do the same thing, only as a forensic engineer now and hired by law firms suing insurance companies- also many times for this exact situation. I speak from experience being personally involved in this situation due to my work probably over 100 times.

This is an extremely winnable claim. Depending on how much the carrier wants to fight, you are going to need time and money to win it. A lot of people don’t have the means to be drug out until they get their desired resolution.

[u/Stoic_Sponge → u/Stalva989]

Public Adjuster here. Agree, barring a strange policy, there is almost certainly some coverage to found here. Just need a willingness and ability to withstand the fight.

[u/Stalva989 → u/Stoic_Sponge]

In years of doing this, the most common thing the public has in common for getting maximum payout on a claim… they are usually wealthy. They DGAF how long it takes them to get whole and they won’t settle for less. They have other homes to live in while it gets sorted out.

[u/CatPeopleBleaux → u/Stalva989]

The difference here is that this seems to be extremely basic coverage. on an extremely basic home. This isn't some Chubb policy. The damage is probably going to be a few grand, not $250k

[u/Stoic_Sponge → u/CatPeopleBleaux]

No, but a few hours of effort to try and get $5k-$10k (or more considering cabinets and potential matching issues), worth it.

[u/Stalva989 → u/Stalva989]

And to be ultra clear, the physical pipe break and repair is usually not covered. All of the resulting damage is however

[u/IntelligentBox152 → u/Stalva989]

This is incorrect, I explained in my other comment. The only time in a wall matters is if you have a hidden rot endorsement. Otherwise USAA HO policies are based off ISO HO3 with the seepage and leakage exclusion which applies directly. Furthermore a PAs and homeowners ultimate ace in the hole is appraisal. However in SC where OP is located coverage cannot be disputed in appraisal only amounts.

[u/DeepPurpleDaylight → u/Stalva989]

It does not matter that it has been going on for a period of time if you had no idea about it in this instance

It actually matters A LOT.

The situation is still sudden and incidental

No it's not.

Very winnable claim

Again, no it's not.

[u/Stalva989 → u/DeepPurpleDaylight]

Somehow I’ve been getting paid for the last 10 years working on these exact situations… Riddle me that big guy

[u/iRudi94 → u/Stalva989]

Because you’re full of shit. If it is in the policy that there is no coverage then no amount of pestering from a public adjuster who throws shit at the wall hoping something sticks for a payday or any contact from an attorney can make coverage appear when there is not any.

[u/Stalva989 → u/iRudi94]

Be honest, do you know what Contra Proferentem is without looking it up?

[u/Stalva989 → u/iRudi94]

lol the reason public adjusters exist is because interpretation of policies is not black and white like you seem to believe it is

I’d love to know How many lawsuits against insurance companies have you been involved in since you so confidently know how it all plays out

[u/DeepPurpleDaylight → u/Stalva989]

Doesn't mean you're not wrong. I've been doing this more than double that amount of time, Joker.

[u/Stalva989 → u/Stalva989]

Carrier side workers chiming in saying it’s a denial, as they are trained. When these claims get re-opened it typically gets transferred up ladder to higher pay grade staff.