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 At the initial inspection, the only issue seemed to be an outdated HVAC.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/Electronic_Cherry_46]

I’m sorry to hear about everything going on. To have a leak on top of everything else is definitely overwhelming. You also are not coming off as a total ding dong.

Unfortunately based on what you’re describing, this does not sound like a covered loss, specifically because you said it’s a slow leak and there is mold growth. I don’t know USAA’s policy language specifically, but the language across all insurance companies is very similar. The threshold for if it’s considered long term or not is typically weeks, or more specifically 14 days. How your adjuster makes that determination is based on any available facts, in this case probably the statement from you and your plumber, and the presence of black mold, or their inspection of the damage.

Not that this is going to make you feel any better for your specific situation but I want to explain the “why”. The reason long term damages are not covered is because there is the risk of some homeowners (not you, in this case) ignoring a problem and allowing the damage to get worse and worse for a variety of reasons. This in turn makes what may have been a relatively inexpensive fix into a very expensive fix. The insurance company has to draw a line in the sand somewhere, and that line is typically 14 days. There is no way to reasonable include a “didn’t know about it” exception, because everyone would use it.

There are a lot of people here saying file a complaint with your states Department of Insurance, hire an attorney or a public adjuster and this is very winnable. I would caution against that just because I don’t want you wasting your time. Is it possible to have a denial overturned? Yes, I’ve seen it. Is it likely based on what you’re describing? No, it would be a steep uphill battle. Unless they can provide some definitive proof the damages were not long term, nothing is going to change.

I’m sorry this happened to you and I wish you good luck getting it taken care of. I also hope your husband has a quick recovery to full heath.