MEDIATION with Insurance Company?

Question

Tim Herman · Answer

@Agustin Conti Why do you think you have a case? Most failures of cast iron pipe will be considered capex. Maybe some of the damages from the leaking pipe might be covered.

Mark F. · Answer

You are doing yourself a serious disservice by taking this to mediation. Even if you get some money from them through mediation , even though this is not a claim and only wear and tear, there's a high likelihood your rates will either jump up dramatically or they will drop you. Insurance companies do not like claims, especially bogus ones, and they share all of this info with each other. And you're in Florida, I have buddies in the insurance world down there and it is literally the worst time to be making claims for stupid crap.

Drop the claim.

Look at the bigger picture.

Jason Bott · Answer

@Agustin Conti insurance policies need to be triggered by a covered Peril.  Fire, Wind, Freeze, Collapse are a few of the common Perils listed on policies.

Did something happen that caused damage to the pipes?  If not, you don't have a case.  Policies do not replace items that have failed due to old age or normal wear and tear.

Agustin Conti · Answer

Hi, Sure. We did have a case. I consulted with a very seasoned and knowledgeable adjuster who looked at my situation. But it would have taken almost a year to fight this and I would not be able to fix this in the meantime as the tenants would need to use the house. So it was a cornered situation. The expense was 29k, and it was solved in less than a week. Tenants will renew the lease and the house will continue to operate with good cash flow. Done.

Carlos Ptriawan · Answer

I do, but not in FL. In CA, we hire public adjuster at the end.

Tim Herman · Answer

@Agustin Conti Capex is capital expenditures. It is parts of a property that wears out. Roof, floors, pipes, hvac, appliances, hot water heater, driveways, etc. All of these items have a limited lifespan. That is why you get to depreciate the property and why reserves are necessary to replace the parts that wear out.

Jason Bott · Answer

@Agustin Conti unfortunately both of these items fall under normal wear and tear and would not be covered.

If you have a claim that falls in the grey area, you want to start with your agent first.  They should be able to pull the section of the policy showing where coverage is found and cite where the Exclusions are limited and do not apply to your specific claim.

The insurance carrier isn't going to go to mediation until they have concluded their is coverage in the policy.  The mediation is really a negotiation of the $ amount, not if there is coverage.

Hopefully your agent can find some solution for you.

Carlos Ptriawan · Answer

you could, explain your case to the public adjuster that's friendly, then she/he will give you advice for free, if it makes sense for them to jump, or not. In this case my bet is no.

Agustin Conti · Answer

thanks guys, I am looking for input from  people with experience with the mediation process with home insurance companies that may help me prepare for it or even decide if its worth a shot, not if I have a case or not. I have 2 issues in the pipes:

one section with damaged floor (gone, rusted) that did not create the clog in the toilet that caused this turmoil, as water flows through the damaged pipe no problem. That is not covered (and the reason why the claim was denied)

AND root intrusion very visible in another section of the pipe that caused the backlog on one toilet. Root intrusion is covered under the policy. They should pay to access the pipe, they don't cover the pipe themselves. That is the most expensive part of the project. They denied the claim based solely on the the first issue and conveniently ignored the second one which is the one that provoked the clogged toilet. I know I have a case.

Thanks,

Chris Seveney · Answer

@Agustin Conti

What is your claim?

Replacing pipes would not be covered but damage from the pipe potentially could be

If

Mediation is free then go for it

MEDIATION with Insurance Company?

Most Popular Reply