Insurance Claims for Water Damage

Statistically, insurance claims for water damage have increased to approximately half of all insurance claims filed in the United States over the years. Some geographic areas or states may have higher percentages of water damage claims than others, depending on many factors. For example, there are usually more frozen pipe burst claims in colder climates; cast iron pipe sudden and accidental pipe leaks or a pipe burst in areas, especially with older homes where contractors more commonly used cast iron when building these homes. Cast iron pipes were used by builders up until the 1980s and were used for many decades until contractors switched to PVC piping. It is common for cast iron pipes to fail due to corrosion from the pipe for years of what flows through your sewer or drain lines. There are so many types of water damage claims. Each policy and state case law determines if they have coverage, are excluded, or have case precedent that allows a licensed member of the state bar to argue the case law in that particular state. That is why having a local Public Adjuster resides in your state that is trained extensively and continuously to stay current with the constantly changing insurance claim industry. There so many types of water damage claims that could be covered by your insurance policy such as toilet overflows, tub overflows, shower pan failures, was seal leaks, drain line breaks, sudden and accidental pipe leak, pipe breaks, plumbing issues, slab pipe leaks, slab pipe bursts, supply line breaks, valve leaks, faucet malfunctions, HVAC leaks, Air Handler freezes, garbage dispenser seal break or malfunction, Air handler clogs, Sewer Blockage, Sump pump failure, main line burst on your property, How water heater water damage, hot and cold supply line leaks, pin hole pipe leaks, drain issues, washer drain line breaks or detachments, Bursting water pipes, Frozen pipes, Spicket pipe break, copper pipe leaks, copper pipe pin hole leaks, cast iron pipe damage, Freezer ice water supply line, Refrigerator water dispenser supply line, Dishwasher back up, dishwasher supply line pipe burst, and we have even had pipes burst from the pressure built up from a lighting strike that burst two copper pipes as the lighting heated the water and caused the copper pipes in the concrete slab to cause a slab pipe burst that flooded out half a 3,500 square foot home.

Public Adjuster for Water Damage Claims

We will advise all insured the best time to call a Public Adjuster is before you call in a water damage claim. However, we can step in at any stage of the process to represent you to reach a fair settlement for your claim bringing you back to pre-loss condition. Even if you receive a denial or a partial denial, we will provide you a no-cost claim evaluation to see if there is a way we can overturn their initial decision. You may also get a denial letter that reads, “Our investigation also revealed that the damages to the cabinets are a result of exposure to water, condensation or humidity for a period of time greater than 14 days.”

In this case, in Florida, it would be wise to have a Public Adjuster who understands the partial summary judgment that ruled in the Appellate Court in favor of Hicks in the lawsuit Hicks v American Integrity Insurance Company. 

Remember that as the insured or insured, your policies have duties and responsibilities that you have to comply with to make sure the insurance company cannot use that as a defense for not paying you fairly or at all. You have a duty to make an emergency repair to prevent the home from suffering further damage. If you have a water loss and are not sure where it is coming from or know, it would be wise to have the water shut off at the street. Either call your utility company or in most cases, it’s an emergency, so you will need to call a plumber out to stop the flooding to prevent further damage. Please, do not hire just any dry-out company. Many contractors out there are steered by the insurance company, who intentionally does not document the loss properly so they can get paid quickly. Still, they do not do the right thing to support documenting the claim. Thermal imaging photographs should be taken, moisture maps put up, and the proper equipment following IICRC/S500 standards. You want to hire In most cases if the house has been wet for over 24 hours, a WRT Credentialed/Florida Licensed Mold Assessor, or in a different state, you need someone that is an expert in the mold but also water damage. Each state licensing requirements are different. You also want to hire a Licensed Mold Remediator with a WRT Training Certificate. The most important part of the claim is how you answer the questions they ask you on a recorded line when you call in the claim and how you document it from the moment the loss occurred. This is why we suggest you hire a Public Adjuster as fast as possible, and then they can help you navigate these dangerous waters. Many unethical contractors get you to sign documents while you are under duress. They start dropping off equipment and tearing up your home with either a direction to pay contract or work authorization contract, both leave you liable for the contractors to hit you with a mechanics lien on your home if well we should probably say when the insurance company does not pay them at all or in full. The remainder of what is owed goes to a collection agent, and in 30 days, a mechanics lien gets put on your property.

DO NOT EVER THOUGH OUT THE PIPE, VALVE, OR PART THAT WAS REPAIRED AS THAT PROVES THE CAUSE OF LOSS. NEVER ALLOW ANYONE TO REMOVE ANYTHING FROM THE PROPERTY. EVEN IF THEY TAKE UP CARPET PUT IT IN A BAG IN THE GARAGE UNTIL THE YOUR PUBLIC ADJUSTER AND INSURANCE COMPANY FIELD INSPECTOR CAN GET TO THE PROPERTY.

PLEASE DO NOT REPIPE WITHOUT SPEAKING TO A PUBLIC ADJUSTER. INSURANCE COMPANIES DO NO PAY FOR UPGRADING YOUR PLUMBING, AND THEY DO NOT PAY FOR THE PIPE THAT BROKE. ONLY THE ENSUING DAMAGES RESULTING FROM THE SUDDEN AND ACCIDENTAL WATER LOSS. If you want to repipe down the road, fine, but you have a duty to allow your insurance agency to inspect the cause of loss. Remember that the assessment and repair are reimbursable under almost all policy language if you have a covered loss. The pipe repair cost is not covered, so for example, if you have a slab pipe leak and you need to break through the flooring and the concrete foundation to access the leak and make the repair, then in most cases, this is your obligation. Free Advice, “Make sure you get two invoices from the plumber or make sure they itemize the work they did and separate the access and repair to the assessment from the actual pipe repair so you can be reimbursed for what normally is the most expensive part of the repair when it comes to a pipe slab leak. This applies to all loss assessments and a plumber or leak detection company you need to hire. The assessment is your duty to locate the loss and stop the loss immediately to prevent further damage to your home. Then you are required to hire licensed and qualified mitigation and remediation company that will do as little damage as possible until the insurance carrier approves, so you are not left with a gutted house and a mitigation company that moved forward with the demolition of your home before the field inspector was able to inspect and photograph the loss. And most importantly, coverage has not been granted, so there is no guarantee you will be reimbursed for the money to rebuild the home. If you’re in Florida, AOB Contracts can be specific in scope to just an assessment or just emergency services protecting your money. Never sign a full Assignment of Benefits that do not limit the scope of what they are there to do. The goal when the mitigation and remediation are complete that you get a PRV or post-remediation verification clearance that proves you did your job and that if you ever need to sell your house, you can be fully honest and transparent that you had a water loss. You hired experts and have a Florida Licenses Mold Assessors Post Remediation Verification Certificate.

We have had years of success reaching successful outcomes against Chubb Insurance, AIG Insurance, USAA Insurance, Nationwide Insurance, Universal Property & Casualty Insurance, Pure Insurance, Cincinnati Insurance, Lloyds of London, Bankers Trust Insurance, State Farm, Farmers Insurance, Liberty Mutual Insurance, Hartford Insurance, Citizens Insurances. Specifically, we have been winning substantial claim settlements against the Top 25 Insurance Companies in Florida for many years.

Am I Covered For Water Damage Claims?

Let us first discuss where you look at your insurance policy to see if you have coverage for water damage claims. A homeowner’s HO3 insurance policy is the most common type of insurance policy sold. When you get your policy, it is common for your agent to only go over “Your policy declarations” to provide you with a broad overview of your insurance policy. They will not provide you with the specific language crucial to know when filing an insurance claim. A full policy will include the language those of us that are not familiar with insurance policies would call the “fine print.” As is typical in the State of Florida, you may find that a policy has a $10,000 water cap on coverage for water damage claims. For example, Citizens Insurance was established in 2002 as what we call in the industry the last line of insurance for people having trouble getting insurance. It is a not-for-profit insurance company in Florida enacted by the state legislature by passing Chapter 627.351(6). They were the first to get State Of Florida approval to put a $10,000 water cap put in their policies, or you could waive your rights to the 10k water cap on water damaged claims if you were to us their Managed Repair Contractor Network Program. This went into effect in Florida policies starting February 1st, 2018, and it did not take long for other insurance companies to start adding this to their insurance policies. And it is usually hidden in the endorsements, and it’s widespread for insurance agents not to advise the people they sell these policies to that they have this limit in coverage. Most of the carriers implemented the $10,000 water cap on insurance claims for water damage. Still, they left out the option of the managed care program that Citizens provided to at least attempt to put a large loss back to livable conditions. 

What is included on this broad 5-6-page document called “Your Policy Declarations’ or more commonly known to us in the industry as your declarations page? Here’s a list of what this document will include:

1. Your Insurance Company
2. Insurance Agent Name and Contact Information
3. Insurance Agency ID
4. Agent License #
5. Policy Type
6. Policy Number
7. Policy Effective Date
8. Policy Expiration Date
9. Amended Date
10. Date Printed
11. Premium Information (This may separate, for example, the cost of Hurricane Premium and Non-Hurricane Premium and Policy Fees)
12. List All Named Insureds (This will include the name, address, email address, and phone number)
13. Coverage Information (This will go over the different Property Coverages and Liability Coverages afforded to you in your policy.)

• Coverage A (Dwelling/Structure Coverage Limit)-Main House Typically
• Coverage B (Other Structures)-Examples would be a detached garage or a fence.
• Coverage C (Personal Property or sometimes referred to as contents)-Example non-fixtures in your homes such as a couch or television.
• Coverage D (Loss of Use or commonly known as Additional Living Expenses-ALE.) This provides for any cost you may incur after a loss that you would not have otherwise had to incur if you had not suffered a covered loss. For example: If your house was flooded from a pipe burst, sewer blockage, slab leak, plumbing issue, lightning strike, or fire and it made the house temporarily or permanently unlivable, this coverage limit would cover the additional cost of housing, the additional cost of food over and beyond what you would normally spend in your primary home that suffered the loss, additional utility costs, and just as it reads anything additional that you would spend while the home was unlivable. There are many instances where you may have a plumbing issue, pipe burst, drain line break that caused your kitchen to be unusable while the home is mitigated to prevent future damage, which is one of your duties after a loss. In this case, you could have the right to housing or a hotel, but you may want to stay in the home and eat out temporarily. This would cover your food expenses over and beyond what your typical food expenses would be.
• Ordinance or Law or Law and Ordinance Coverage is sometimes provided standard with a policy, and sometimes it is given to you as an option. It could be 10% of Coverage A, 25% of coverage A, or whatever they are willing to provide you and what you are willing to request and pay for. Remember, buying insurance may be a requirement that your mortgage company requires you to purchase, but this is still a contract between you, the homeowner, and the insurance company. This coverage would replace windows that were damaged but require more expensive windows to meet the building code energy saver requirements.

1. Coverage E (Personal Liability Coverage Limit) This, for example, would protect you if someone were to get hurt on your property and file a claim or lawsuit against you.) This is not cover an insured can use if they get hurt in their own home. Some people do not know this, but you cannot file a claim or sue yourself.
2. Coverage F (Medical Payments to Others
3. Deductibles are also listed in this section.

• All Other Perils Deductibles (This would include all perils except for special perils listed on your policy that may have a higher deductible such as hurricane deductibles will commonly have a 2% of your Coverage A limit as a deductible and sinkhole coverage which is usually optional, can have a 10% of your Coverage A limit as a deductible. (Remember every policy is different for many reasons: Geographic Area, State that your house resides in, If you are close to the water, making you more susceptible to hurricane damage in States like Florida, Louisiana, Alabama, Texas, Mississippi, South Carolina. Remember, these are private policies that you are purchasing; however, there is some oversite from usually the State Department of Insurance, and of course, the legislature may enact State Statutes. Public Adjusters exist to not only help you with your insurance claim but to help you review what you have available to you before you open a claim so you do not have a claim on your loss run report when if you had allowed your insurance agent to review your policy or a public adjuster review the policy before you opened the claim you might not have opened the insurance claim if you did not have the appropriate coverages when you purchased your insurance policy.

1. Additional Coverages or called Endorsements is listed. (For example, to name a few, this is where you will find out if you have Water Damage Coverage Excluded, Limited Fungi Coverage Included, Loss Assessment Coverage, Identity Theft Coverage, and there can be many more endorsements added or excluded from a policy.) THIS IS A IMPORTANT SECTION TO PAY ATTENTION TO WHEN PURCHASING YOUR POLICY OR UPON RENEWAL WHEN MOST PEOPLE PAY THE INSURANCE POLICY PREMIUM, AND THE INSURANCE COMPANY MAY HAVE to CHANGE THE ENDORSEMENTS.
2. Additional Coverage Limits will tell you when the endorsement says in the above section that it includes coverage of what our limit is on that endorsement. For example, if you have Limited Fungi Coverage, it may state that you have $10,000 per loss/$50,000 policy total. Meaning you can have 3 water damage insurance claims that require you to use the Fungi or Mold Coverage Limit. In this case, you would have $10,000 available to you for Limited Fungi Coverage for each claim. (If you notice, it says Limited Fungi Coverage! Therefore having a full copy of your policy is important to understand the full explanation of this coverage and the fine print. Especially an explanation of what the definition of “Limited” is and how it relates to the fungi coverage.
3. Premium Detail is required to breakdown how the insurance company calculated the total premium amount.
4. Property Information -This will include specific property information that is pertinent to both you and the insurer. It will typically list:

• Construction Type- Example Masonry 100% or Wood Framed
• Year Built (Why is this important for you and your public adjuster to know if you decide to hire someone to represent you? Some older homes built usually before 1977 may contain asbestos, cast iron pipes could be likely in older homes, and county or state building codes and permitting requirements will differ by county and state. It’s important that you and your trained public insurance adjuster, sometimes called a private adjuster, knows what to look for and also how to make sure he is providing you a detailed estimate of your loss to include the expenses you may be required to bring your house up to code and to determine if a permit is required and what will be required to get a COC or certification of completion that you have met the code requirements. Not knowing these important factors before settling a claim could potentially leave you with unknown financial exposure that was not considered when you decided to accept a settlement offer. Knowing these building codes if you hire a knowledgeable adjuster, could also get you paid to upgrade to code additional items that may have been overlooked if you hired an inexperienced public adjuster.
• Usage Type: Primary residence, Not Rented, is typically written here if you live in the home full time. You must notify your insurance agent and modify your insurance policy if you plan to rent the home, use a property management company to rent it short term, or if you try to make additional income through services like Airbnb, Tripping.com, VRBO, HomeToGo, Flipkey, HouseTrip, OneFineStay, Casamundo, Luxury Retreats, to name a few.
• Distance To The Coast- (Obviously, they have this listed to look at their exposure to flooding, Tropical Storms, Tropical Cyclones, and Hurricanes.)
• Territory
• Building Code Effectiveness Grade
• Opening Protection
• Exclude Wind/Hail Coverage
• This is just some of the standard property information they will list on your declarations page.

1. Credits and Surcharges- This section is where they can make you feel like you are saving money, and they will list these line items as credits. Remember, when a discount is provided, you usually had to give up coverage in the exchange. It may read that you have a Hurricane Deductible Credit, Senior or Retiree Credit, All Other Perils Deductible Credit, Protection Class Credit, Water Damage Exclusion Credit. We can promise you that you do not want a small premium credit in exchange for losing WATER DAMAGE COVERAGE, one of the most common types of losses that people suffer at their homes each year.
2. Policy Forms and Endorsements- THIS IS THE FINE PRINT THAT YOU NEED TO PAY SPECIAL ATTENTION TO THE LANGUAGE OF EACH ENDORSEMENT OR SOMETIMES REFERRED TO AS A INSURANCE POLICY RIDER. The term riders are typically used when referencing a life insurance or medical insurance policy – An endorsement can add, exclude, or delete with a special form and change your insurance coverage. It typically could be as simple as modifying how they define a term in the policy that could limit a previous coverage or exclude it altogether. Furthermore, this endorsement can increase, delete, or decrease standard limits of coverage and take precedent over the original agreement or policy. Homeowners may think reading the declaration page that they have coverage for something like water damage, but there is under Policy Forms & Endorsements in the back of the full policy. We are not licensed insurance agents; we would suggest you verify information regarding your policy coverages, exclusion, and endorsements with a State Licensed Insurance Agent. Warning, if your agent cannot explain your full policy in detail so that you can understand it, you may want to look for a new insurance agent. An insurance endorsement change can be made at any time during a policy period, but typically we have seen, based on our experience, that they make these changes at the time of renewal. Your insurance company may raise or lower your premiums and adjust payments. Once an endorsement is put in place, it will remain until either party cancels your policy or until your policy expires. They may renew this endorsement under the same conditions and terms as the rest of your insurance policy. An endorsement does have the ability to be written for a specified period, and upon expiration, then the endorsement would cease to exist. Here are some examples of Policy Forms & Endorsements:

• Additional Interests
• Coverages for Home Day Care Business
• Hurricane Loss Mitigation Notice of Premium Discounts
• Identity Theft or Identity Fraud Expenses Coverage
• Collapse Coverage
• Water Damage Exclusion Endorsement
• Personal Property Replacement Cost Loss Settlement
• Existing Damage Exclusion Endorsement
• Ordinance or Law Coverage
• Limited Fungi, Mold, Wet or Dry Rot or Bacteria Coverage Endorsement
• HO3 Deductible Notification Form. 
• Unusual or Excessive Liability Exposure
• This is just to name a few.

3. Additional Interest/Insureds/ Mortgagees-This section is to list all other vested parties to the property being insured. So, if Mr. Jones and Mrs. Jones are named on the policy, this section would include their Mortgage company, for example, US Navy Federal, their address, contact information, and loan number.

Experienced Public Adjusters is licensed to represent all home and business insurance claims for water damage. We are among the Top Rated and Top Reviewed Public Adjusting Firms in the United States. We are currently expanding into all 50 states. We have offices spread out throughout the Southeastern United States. 

When you hire a private claims adjuster from Experienced Public Adjusters, you are not hiring an individual; you are getting our entire team to support your claim. We are one company, one team, with a common goal to be of service, and through hard work, passion for what we do, our core values that are the foundation that provides us the moral compass to always do what is in the best interest of our client. We look forward to earning the trust of each and every one of our clients, and we fight to WIN! We will not let you down.