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Bevo

What to do when an insurance company denies a claim?

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I had some drywall that was damp with some mold. An inspector came out and said it was probably coming from the roof. The inspector went up on the roof and took pictures. I called the adjuster today and he says that the damage was from age and not hail or storm. So, based on that info. the claim was denied and I had to pay thousands out of pocket and still have more to repair. Is there a way to dispute a rejected claim? How do you do that?

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Is the roof old and leaking causing interior damage?

or

Is the damage to the inside of the house caused by a roof leak due to hail stones?

What do the pictures reveal?  Can you post them?

If you're in Austin area @ROFL BOX can give you an opinion.  If Houston, PM me. 

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1 hour ago, deadshank said:

Is the roof old and leaking causing interior damage?

or

Is the damage to the inside of the house caused by a roof leak due to hail stones?

What do the pictures reveal?  Can you post them?

If you're in Austin area @ROFL BOX can give you an opinion.  If Houston, PM me. 

I don't know, but I just kind of assumed that interior water damage and mold remediation would be covered regardless of cause. Or another way to put it is that I purchase insurance to cover unforeseen problems like this.

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2 minutes ago, Bevo said:

I don't know, but I just kind of assumed that interior water damage and mold remediation would be covered regardless of cause. Or another way to put it is that I purchase insurance to cover unforeseen problems like this.

Have you read the covered perils section of your policy?  Not being a smart aleck.  Just asking.  

Many P&C policies specifically exclude mold claims.  

Read the policy. 

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Bevo, as mi compadre @deadshank asked... where are you located?

As to your addendum re: "isn't that what I pay insurance for?", that's like saying "I didn't change my oil & my auto insurance co. won't replace my engine."  Some things are homeowner maintenance.  Example:  Tree rubs the shingles through & through... leak ensues.  Whose responsibility is that?

Insurance is for accidental & unpreventable.

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9 hours ago, deadshank said:

Have you read the covered perils section of your policy?  Not being a smart aleck.  Just asking.  

Many P&C policies specifically exclude mold claims.  

Read the policy. 

It is Surly. I would be disappointed if there weren't some smartasses. I purchased the property, a small office bldg, about 8 years ago. I've been on the roof before but didn't notice any problems. Of course, I am not a roofer and wouldn't know what to look for unless there were obvious loose or missing shingles.

I don't think many people are more proactive in these sorts of incidences. I was doing some interior remodeling and asked the repair guy to replace some drywall that had a small crack. When he went to do that repair he noticed the problem and then I contacted the insurance company.

I personally am not even sure the problem was caused by a roof leak. Repairs were done to the bldg just before I purchased it. The repairs would have hid the problem. And I am not sure the problem came from the roof (I want to be vague here). Incorrect construction may even be more likely than the leak coming from the roof. Obviously, the inspector could have detected the problem but didn't and I would prefer not to go after the person I purchased the building from and probably couldn't anyway because of statute of limitations.

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30 minutes ago, Bevo said:

It is Surly. I would be disappointed if there weren't some smartasses. I purchased the property, a small office bldg, about 8 years ago. I've been on the roof before but didn't notice any problems. Of course, I am not a roofer and wouldn't know what to look for unless there were obvious loose or missing shingles.

I don't think many people are more proactive in these sorts of incidences. I was doing some interior remodeling and asked the repair guy to replace some drywall that had a small crack. When he went to do that repair he noticed the problem and then I contacted the insurance company.

I personally am not even sure the problem was caused by a roof leak. Repairs were done to the bldg just before I purchased it. The repairs would have hid the problem. And I am not sure the problem came from the roof (I want to be vague here). Incorrect construction may even be more likely than the leak coming from the roof. Obviously, the inspector could have detected the problem but didn't and I would prefer not to go after the person I purchased the building from and probably couldn't anyway because of statute of limitations.

If construction or other known defects were hidden and not easily discovered, the statute of limitations does not begin to run until you should have discovered, in the exercise of reasonable diligence.

But, you can either hire a lawyer or a building inspector to re-inspect the property and see what the cause is and whether it's a covered peril or not.  The lawyer will hire the building inspector, if you don't.  Some lawyers will try to make a case and so will the building inspector, some will just try to get the facts.  The lawyer or building inspector can advise as to whether you should have discovered earlier.

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In saying "building inspector" understand this is not the city building inspector.  You'd have to hire a professional engineer versed in building construction or maybe a competent (few and far between) home inspector, even though its commercial property. 

Or have a roofer look at the roof.   It may not be the roof.  It could be something else. Who knows? 

It sounds like you've done interior repair work but you've not mentioned what was the exact cause of the problem.  If it is an old roof at the end of its life and in need of replacement have you remedied that issue? Or are you leaving it and rolling the dice?

 

 

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9 minutes ago, deadshank said:

In saying "building inspector" understand this is not the city building inspector.  You'd have to hire a professional engineer versed in building construction or maybe a competent (few and far between) home inspector, even though its commercial property. 

Or have a roofer look at the roof.   It may not be the roof.  It could be something else. Who knows? 

It sounds like you've done interior repair work but you've not mentioned what was the exact cause of the problem.  If it is an old roof at the end of its life and in need of replacement have you remedied that issue? Or are you leaving it and rolling the dice?

 

 

Good point.  I meant to add that locating an appropriate building inspector may be somewhat difficult for a layperson.

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