State Farm Rejected Mold Claim

State Farm Rejected Mold Claim

Claim Doctor Q&A: State Far Denies Mold Claim

Often I get questions about denied claims. Too often it is too late for me to provide any meaningful assistance.  The moral of this Q&A is: Don’t delay in getting professional help.  The longer you wait, the worse your chances of a fair settlement.

 

Q: Jim R.

I’m a mold remediation contractor who is trying to help a homeowner.

They had some storm damage to the house and did not realize the damage until months later. The incident date was May 22nd 2014 and they applied for coverage 11 months later after realizing the situation.

Neighbors had roofs replaced with other repairs but these clients are struggling with State Farm to get the repairs completed.

In addition, they have a condition 2 mold situation that is concealed by carpeting and sheetrock. An air test was completed with structures still in place an did not come up elevated. The problem is that the species count of penicillium/aspergillus is 3 times higher in the affected area vs. an unaffected area.

If mold removal was to take place, without following S520 protocol, the spore count would skyrocket and mold spores would spread throughout.

This is a sensitive situation as one of the homeowners was involved in a very serious auto accident and is mostly bedridden in the affected area. Medications have reduced immunity and an increase in mold sensitivity is a major concern.

So far, State Farm has rejected any mold claim and I’m not completely sure about costs covered, if any, for the roof.

A: Andy McCabe

Hi Jim,

Thanks for reaching out.

Coverage issues are always tough, and State Farm is notorious for denying coverage for mold.

I would recommend putting together a package of anticipated costs, including the roof repairs, and have the homeowner submit it as part of a Proof Of Loss.

This is getting fairly old and it is likely less than $100k, so getting a PA to take the case isn’t very likely. That doesn’t mean you shouldn’t reach out to a local Public Adjuster to ask some questions.

I can help with developing repair scopes, but beyond that I’m afraid I don’t have any magic bullets.

Good luck,

Andy

The Insurance Claim Process for Homeowners

The Insurance Claim Process for Homeowners

What Does an Insurance Claim Feel Like?

This post is an excerpt from an email I received from a client.  The city they live in experienced a sewer system failure and flooded their finished basement with sewer and storm water.

denyeverythingState Farm denied coverage

Their own insurance company refused to even open a claim for them.  This is, unfortunately, standard procedure for most insurance companies.  If they see a way to avoid you filing a claim, they will take it.  Ordinarily, I recommend insisting that a claim is filed.  That way you have a representative in the process against the city or other party who is to be held liable.

I’ve seen many, many cases where the homeowner’s carrier accepts the claim, pays for repairs, and then subrogates against the City’s insurance carrier.  Under subrogation, the homeowner’s insurance company (first party) usually recovers 100% of the claim.  It is a very common practice, but you’ve got to be insistent with your own insurance company.

oopsServiceMaster drops the ball

As is unfortunately often the case, ServiceMaster completely dropped the ball.  Drying was incomplete, demolition was overly invasive, and contents were ruined by lack of attention to detail (items were packed up wet and then never dried).  I see this most often with “program vendors” who are overworked and ill-equipped to handle large CAT related events.  I’ll write another post on the pitfalls of hiring emergency service contractors later.  The bottom line is that the large, franchised vendors work for insurance companies, not homeowners.

Then they called Claims Delegates

I’ve been in business for almost five years now.  I try very hard to spread the word about the services I provide.  Unfortunately, most folks don’t know to even look for help with their insurance claims until they are well into the weeds.  The best time to hire a claims expert is BEFORE you file a claim.

More often it’s not until things start to go very wrong that people turn to the internet for help.  And then they find Claims Delegates.  We got involved and things started moving in the right direction.  The following is part of a survey response I received from my client.

Feelings Before Hiring Claims Delegates

BEFORE: I felt like every move might be the wrong move.  Made me paralyzed to make decisions, but had to regardless so very anxious.  Without any knowledge base I was just hoping for a favorable outcome on the incorrect assumption that the insurance company was going to make things right “for” me since this was not my fault but happened to us.  I assumed the service we have always been paying for from the insurance company was to fix the situation.

AFTER:  I felt like I had someone in my corner who would shoot straight with me about the available moves that could be made, some of which I did not know were even available if requested.  You are neutral and knowledgable, which made me feel empowered instead of ignorant.

What information does Claims Delegates provide that you found most helpful?

  1. A walk through of what to expect from the insurance claim process.
  2. An outline of what a “Loss List” looks like and includes.
  3. Document every thing for reference if needed later.  Every conversation, date, and visit with everyone involved with the claim.
  4. Don’t trust the mitigation company to take care of everything on their own.  I would have supervised and had them take more care of my belongings if I knew they would be as reckless as they were.  They eased my fears by just saying “add it to the claim”.  I did not understand at that time I would never receive full replacement cost but a depreciated value for the items they were telling me to just “add to the claim”.

Which specific items or information were you the most grateful to recieve?

  1. That I could ask for the air quality test and that you had someone to recommend that would be on the homeowners side and not in the insurance companies pocket.
  2. Terminology to use and someone to interpret the adjusters terminology that made me feel less susceptible to being railroaded.

Where do you feel the insurance claim process is stacked against the homeowner?

That the insurance company is the one to decide fault.  
That everyone involved in the claim is more knowledgeable about the process than the one needing the repairs.  Makes me feel vulnerable to being taken advantage of.
Why Isn't This Covered

Are you ready to talk to the Insurance Experts?

We’re here for YOU.