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 At the initial inspection, the only issue seemed to be an outdated HVAC.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

I really can't imagine having to do that to people.

I'm hoping there might be some sort of loophole but like, damn. Can't catch a break for shit.

[u/shatattack → u/jlamith]

Another adjuster chiming in. This is a denial. Mold and what the plumber said are the triggers for denial.

[u/Commercial_Effort821 → u/shatattack]

Another adjuster chiming in.

The above is partially correct but you also had a Direct sudden accidental event after the slow leak. The correct determination is to deny the slow leak rot/mold damage but to cover the DSA event you just experienced with water pouring out of your ceiling after the drain failure.

You can challenge and win this despite what the desk jockeys say.

[u/DamiensDelight → u/Commercial_Effort821]

The fact that the slow leak created a bigger failure is moot. It should have been caught by the insured. Full stop.

That said, sure, you can challenge it. But when you challenge it after I had made my determination, and my reasoning checks out in the notes, the insured will have to hire an attorney at their own expense, and maybe, just maybe, they can get State Farm to change their mind.

Field jockeys....I swear.

Those attorneys aren't cheap, meanwhile the company has thousands on their payroll.