Pest Control: A Method to Prevent Insurance Claims from Being Denied
What you consider to be a “sudden, catastrophic” leak may be considered a “systemic” leak by your insurance carrier, and your claim may be DENIED.
Welcome to the field of forensic water assessment. Forensic assessment compiles the study of building materials as they relate to water absorption in differing environments, mycology of mold and other fungi and entomology. Yes, entomology as in, “if we find cockroaches it may mean you have had a moisture problem for some time or they would not be here.” I’m not kidding. Think CSI meets the forensic insurance adjuster /building consultant /pest control operator /mold assessor.
According to a presenter at a recent conference I attended, over 300 such claims were analyzed for a large Florida insurance carrier to determine the duration of a water loss. The presenter has developed an inspection protocol to determine:
The presenter accounts for moisture requirements necessary for fungal growth to occur, the diversity of the fungal growth (the type or species of the fungi), the nature of the water source and the conditions of the surrounding building materials to determine the duration of the water loss.
This data is compiled into a scientific looking report citing case studies, internal consultant test data (think theory) and a hypothesis supporting that, “yes, you did have a sudden catastrophic pipe burst; but, there was a small pinhole in the pipe for many months prior that really caused the fungal damage, and by the way, that is why you have cockroaches in your home! There was a water source for them. Our recommendation is the carrier pay $85.00 to place a coupler on the pipe, but everything else – the mold, the drywall restoration, the flooring replacement, the new cabinets and the painting – are your responsibility. This makes pest control as important as changing your AC filter and cleaning out your gutters; it shows maintenance of the home on a regular basis.
Insurance carriers are using available technology to mitigate claims. The insurance carrier today has an arsenal of data they may draw upon to dispute or even deny claims.
- High value roof claims are subject to historical aerial photographs available from satellite imagery. In fact, a complete take-off/measurement can be done with a few clicks on the internet for a modest fee.
- Wall cladding claims may be denied simply because your sprinklers are too close to the walls. Yes, they can most likely obtain multiple photos showing your sprinklers hard at work.
- The water heater claim may be denied because your plumber/contractor did not pull a proper building permit.
- Windows leaked – were they permitted and inspected when you had them installed?
- HVAC condensate drain backed up and caused damage? Do you have proof of annual service inspections? If the AC contractor recommended a repair, did you do it?
- Do you have a current pest control service provider? There are at least some who are attempting to prove your cockroaches are indicative of long term water leakage.
- When you purchased the home, did the Seller disclose any information regarding repairs needed or previous damage? Some, including this author, believe Seller Disclosures are finding their way into big data through title/escrow paperwork. This data is then sold to the carriers.
- When you purchased the home, did you hire a home inspector? Who was provided a copy of the report? If the inspector noted repairs or concerns, did you act on them? If the carrier requests a copy of the report, are you bound to provide it? I’m not a lawyer, but I think the answer is yes. What about other insurance specific reports like the Uniform Wind Mitigation report or the 4 Point Report – did you submit those to underwriting?
Before you submit your claim, you should stop and think about the loss and how it may be perceived by your carrier. When did you first notice damage? If you failed to act at the first sign of damage, why did you delay taking action? Quite frankly, the carrier is justified in many cases in protecting against losses which were actually the result of poor maintenance by the homeowner. Your policy requires you to maintain the home to support your right to make a claim for damages. You can’t ignore the maintenance and expect the carrier to suffer the consequences of neglect.
