Why Was My Water Damage Claim Denied?

Most people assume the damage to their homes caused by water from storms, leaks, burst pipes, or sewer backup will be covered by their homeowners’ insurance policies. They are then very upset and disappointed when their water damage claim gets denied.

At Malik Law, we generally suggest that you become familiar with your insurance policy, but we totally understand how anyone can get confused by the difficult language and ambiguities in their insurance documents. Given this situation, we thought it would be worthwhile to clarify the reasons why many water damage claims get denied.  After all, knowledge is power, and we want to help you be prepared to navigate the claims process and obtain fair payment for damage that should be covered.
 

Flood Damage Is Not Covered by Standard Homeowners Policies

Standard insurance policies exclude water damage caused by flooding, including flood water caused by storms, overflowing bodies of water, runoff of surface water, mudflow waves, tidal water, and spray from flooded areas or bodies of water, even when caused by the wind. Water that flows over the ground into the building or seeps through foundation walls is not covered by regular policies;

To be covered for flood damage, property owners must have a separate flood insurance policy.  People who live in high-risk areas in Florida typically have to have flood insurance, but many other Florida homeowners also opt for flood coverage because of the damage floods from hurricanes have done to homes in areas considered moderate and low risk.
 

Gradual Water Damage Is Typically Not Covered

Homeowner insurance policies generally cover water damage caused by a sudden, accidental occurrence, such as a burst pipe inside the home, a broken appliance, or overflow of water or steam from a part of the plumbing, heating, air conditioning, or fire protection sprinkler system.  Usually, however, coverage does not extend to the appliance itself or damage caused by water that enters your home through sewers, drains, or sump pump.

Coverage may also not extend to damage that your insurance company believes happened over more than 14 days.  For example, damage due to slow seepage from a leak in your roof would probably not be covered because you are supposed to fix issues such as leaky roofs in a timely manner.  A more ambiguous situation occurs when an appliance or pipe leaks but you don’t discover the leak until damage is noticeable.  If your insurance company thinks the water damage occurred over more than 14 days, they could deny your claim.

Common causes of gradual water damage include faucets, plumbing, or pipes leaking, causing damage to floors, ceilings and walls or parts of your roof deteriorating over time, allowing water to enter and damage the ceiling and walls.  Good, timely maintenance of your home, appliances, and systems can help you avoid these types of situations, but even a careful homeowner can be surprised by water damage that goes undetected, either because it was hidden or because you were away from the home for a while.
 

Damage from Sewer Backups and Sump Pumps Is Usually Excluded

Water that backs up into your home from sewers or drains can be very unpleasant, unhealthy and damaging. However, the damage is not included in most homeowners’ policies. Since sewer or drain backup can result in thousands of dollars in damage, many homeowners add special coverage to their policies.

You may also be surprised to find that damage from water that overflows from a sump pump or any system designed to remove subsurface water from a building’s foundation area is not covered, nor is damage from water below the surface of the ground.
 

Handling a Water Damage Claim

By maintaining your home, its systems, and appliances, you can help to avoid water damage to your property. However, even the most careful homeowner can be caught off guard by sudden or hidden leaks and breaks and storms.  When this happens and you file a water damage claim, it’s a good idea to make sure it is as complete as possible, with pictures of the damage, receipts for damaged property, and maintenance records, if possible.

If your claim is denied, you should ask for an explanation. Since several different insurance company people can work on your claim, it’s important to understand who made the decision to deny payment and the basis upon which that decision was made.  If you are not satisfied with this explanation, you can always ask for a second opinion.  If you believe you should have been covered for the damage and your insurance company is standing firmly behind their denial, it is a good idea to start working with a water damage claim attorney.

As United Policyholders, a non-profit organization designed to help consumers of insurance, puts it, “An insurance claim is a business negotiation, pure and simple. So although you paid good money for coverage and good claim service, you may have to fight for it. And you may need professional help in that fight. In an ideal world no one would need to hire a lawyer to get an insurance claim paid on time and in full, but in this world, many do.”

Source

United Policyholders.  Hiring an Attorney for an Insurance Claim.  https://www.uphelp.org/pubs/hiring-attorney-insurance-claim