Miami Plumbing Leak Egregious Denial from Insurance Company - Overturned in Litigation
Miami, Florida - VIP Adjusting usually doesn't handle many claims in Miami. Our headquarters are in Fort Pierce in St Lucie County, and we normally handle claims throughout the Treasure Coast and Space Coast, from Jupiter, to Stuart, to Vero Beach, and Indialantica, but a client referral came to us in Miami.
This client, M.V., came home from work to find water spraying from the wall in his garage where his washing machine hookup connected to the wall. What happened next will probably make your head spin.
Even our public adjusters were surprised with the conduct of this insurance company!
The Loss - Pressurized plumbing leak to washing machine
The homeowner/insured came home from work and entered through his garage. He immediately saw water on the floor and spraying from the wall at about chest height since the washing machine was on a raised step.
Thinking quickly, the insured snapped a quick video and turned off the water supply to the house at the main valve to the home.
The damages to the garage and kitchen
Obviously there was water spraying in the garage. The pressure from the spray had burst a hole through the drywall and was spraying out onto the concrete floor. Aside from the drywall damage in the garage, and what would be required to open the wall and repair the pipe, the damages in the garage were minimal, but, a lot of water also ended up inside the wall, which was shared with the home's kitchen.Inside, there was visible damage to half of the kitchen's cabinets, and in one space between the cabinets, you could see extensive staining and discoloration to the drywall behind the cabinets. Adjacent to the cabinets, tile baseboards had fallen off and broken.Despite the relatively minimal visible water in the garage, this home clearly had much more extensive damage and required significant repairs.
A plumber initially opened the garage wall, and repaired the supply line to the washing machine, leaving it open for inspection by the insurance company. What remained outstanding was removing and replacing all the kitchen cabinetry, drywall in the kitchen, replacement of the tile backsplash, and replacement of the continuous tile flooring that could not be matched throughout the home.
The Insurance Claim and Outcome
For such a small leak, there were some pretty substantial repairs to restore the home to pre-loss condition. Maybe that's what made the insurance company do what they did next.
Despite the fact the insured had a video of the active leak from the burst pipe (that wasn't leaking when he left for work), the insurance company conducted its "investigation" and DENIED the insured's claim, declaring that the homeowners' leak was the result of "constant or repeated seepage or leakage which occurs over a period of time."
This language in the insurance policy is meant to exclude coverage for leaks that have been ongoing and known to the insured for a long period, essentially reinforcing the duty to protect the property from further damages. An insured who can't be bothered to address a leak for months shouldn't be entitled to insurance coverage because the damages have likely worsened because of the insured's actions.
A leak that occurred the same day and was actively observed and documented, however, is not that. To adopt this insurance company's view, this insurance policy would cover all plumbing leaks except when the insurance company didn't feel like paying for it. Technically, the first drop of water is a new leak and the second drop is "repeated leakage." This is just an illogical conclusion.
The real outcome
Unfortunately the insured had to file a lawsuit to obtain a fair recovery and obtain the benefits he was entitled to under the insurance policy. Luckily, it happened in short order. The time from the date of loss to the final settlement in litigation was just about 6 months, which is pretty reasonable for Florida insurance claims.
At the end of the day, a settlement was negotiated that let the insured replace their kitchen and backsplash, but instead of replacing the full tile floor because of the broken baseboard, the insured agreed to replace the baseboard with wooden baseboards.
Had this homeowner not connected with a public adjuster, he may well have never pursued the insurance company after they issued the coverage denial, and that's exactly what most insurance companies hope for.
St Lucie Plumbing Leak - Broken Tiles - Successful Appraisal
St. Lucie County, Florida - A single family homeowner (R.Y.) in Port St. Lucie had a burst supply line inside the slab of his home. Water was coming out of the slab in multiple locations causing significant damage.
The homeowner contacted the public adjusters at VIP Adjusting to assist him with the insurance claim process and to make sure he was fairly paid for his homeowners insurance claim.
The Loss - Supply Line Plumbing Leak - Burst Copper Pipe
A copper supply pipe inside the slab of this home burst and resulted in water damage in the insured's garage. The homeowner immediately contacted a plumber who turned off the water supply and located the break between the home's main and the kitchen, as well as a leak between the plumbing manifold and the master bathroom. The plumber noted water coming from the slab in multiple locations. In order to restore the use of the home's plumbing, the plumber performed a plumbing re-route, which is typically covered by most homeowners insurance policies.
The Damages to the home from the plumbing leak
While the homeowner initially only noticed water in the garage, during the leak detection process, the plumber noticed water escaping in multiple locations from the slab, often ending up inside the slab and escaping in other locations.
The use of a moisture meter during the inspection showed damage to drywall in several rooms, including multiple bathrooms and the kitchen, damage bathroom vanities, and damage to kitchen cabinets. In addition to the use of a moisture meter, there was also visible damage to exterior stucco where water was escaping, and multiple popped tiles and cracked tiles in the home that were not damaged prior to this plumbing leak.
The homeowner hired a water mitigation contractor to provide restoration services to the home, including removal of wet drywall, and the use of fans and blowers to dry wet materials in place, including the damaged cabinets and vanities, all to prevent mold growth. This type of water remediation was required under the homeowner’s insurance policy as part of his post-loss duty to protect the property from further damage.
The Insurance Claim and Outcome
VIP Adjusting's public adjusters reported the claim on the homeowners behalf and documented the damages while preparing an estimate on his behalf. Based on the public adjuster's presentation of damages to the insurance company, insurance initially paid $41,000 for the damages to the home, including repair to damaged drywall, replacement of tile flooring in the kitchen (but not all of the tile flooring), and a minimal repair for refacing of the cabinetry. The insurance company also paid for content manipulation, packout, and storage, including the difficult area in the garage.
VIP Adjusting's estimate prepared by our licensed public adjusters included replacement of the bathroom vanities, replacement of the damaged kitchen cabinetry, and replacement of the tile flooring throughout, including the visibly broken tiles that the insurance company did not believe were caused by the water damage.
Our public adjusters disagreed with the insurance company’s evaluation of the flooring, since the homeowner indicated it wasn't damaged prior to this leak, the cracks to the tile looked new, and not old or worn, and the damage was consistent with the dampening and drying, expansion and contraction of the slab and mortar underneath.
Resolving the claim through the appraisal process
Ultimately, as a result of the dispute for the proper payment of this claim, it ended up in appraisal. We wrote recently about the strengths and weaknesses of resolving insurance claims through the appraisal process.
For this claim, we selected an impartial third-party general contractor to act as the appraiser on behalf of the homeowner. Our appraiser and the insurance company's appraiser were able to come to agreement on the majority of the damages and reached a final appraisal award of over $85,000, more than double the initial claim payment. When all was said and done, our client was able to perform the significant renovations that restored him to his pre-loss condition.
If you've found yourself with water on the floor in your home, let VIP Adjusting's public adjuster's perform a free claim evaluation for you. Sometimes, when you think there's just a little bit of water on the floor of your garage, there can be a lot of hidden damage that can result in costly repairs. If this homeowner had waited until he started trying to make repairs to report his claim, he might have had his claim denied!
You might also be interested in:
More about damage caused by plumbing leaks
What’s covered by your insurance policy when you’ve had a plumbing leak
Port St Lucie - Bathroom Plumbing Leak - Multiple Supplements - Paid Full Estimate $23,000
A Port St Lucie homeowner (T.B.) made contact with VIP Adjusting about two weeks after having a leak inside the wall behind their bathroom shower. The water was turned off and the leak was repaired, but damage was caused by the water inside the wall, access was required to open the wall and repair the plumbing, and damage was caused in an adjacent bedroom to laminate flooring that runs continuously throughout the home.
The damages were presented to the insurance company and they made an initial evaluation of $8,900. VIP Adjusting finalized its estimate and provided it to the insurer, pointing out the deficiencies in the initial payment.
The insurance company conducted an additional investigation and issued a supplemental payment totaling 15,300. That payment was still insufficient.
After some additional negotiating, and a little legal help, the insurance company finally agreed to pay the full value of VIP Adjusting’s estimate, 23,000, including all of the bathroom damages and replacement for all the flooring.
Port St Lucie - Kitchen Plumbing Claim Denied - Final Settlement $13,000
In February of 2018, a Port St. Lucie homeowner (E.A) contacted VIP Adjusting after discovering water under his kitchen sink from a failed garbage disposal (or garburator if you’re Canadian) that caused damage to his builder grade kitchen cabinets. The garbage disposal was repaired and documented to be the source of the leak.
After inspecting, because of the dark color of the staining, the insurance company denied this homeowner’s claim, insisting that the damage was “long term” and therefore not covered by his insurance policy.
Unjust denials can cause the claim to take longer than expected, but after a few months of fighting, we were able to obtain the homeowners $13,000 to repair their cabinets.