Insurance claim denied

Orange County, California
Insurance
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Insurance claim denied

Vipul Shah
Member since 2021 · 3 posts · 1 vote

I have a rental property in Orange county, California. We had a water leak and damaged the property. The plumber reported that "Burst copper pipe connecting to tub was the determined problem.  Tech found leak on 1/2 copper pipe that’s feeding the upstairs tub." However, Insurance denied my legitimate claims saying burst pipe is not covered.

 Is anyone here, had similar experience and got coverage by insurance. Any help and guidance is appreciated.

Any recommendation on hiring an attorney for this case? if so, any recommendation for attorney.

Thank you in advance.  

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John Mocker
Insurance Agent · Norwalk, CT · Member since 2016 · 2k+ posts · 1k+ votes
3y

Vipul,

The coverage, under most property policies, for this type of situation hinges on "Sudden & Accidental" vs. long term leak.  That is the first thing to determine.  Second thing to know is that the damage to the pipe itself is not covered.  The ensuing damage (soaked sheet rock, damaged paint, etc.) is what is covered.  Look up your policy and review the coverage.  Check the covered perils (Water damage specifically) and what exclusions are on the policy.  

Get a claim denial in writing.  If the reasons for the denial are incorrect, respond in writing.  You are building your case either for the State Insurance dept or court.

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  • Sam YinPro Member
    Los Angeles, CA · Member since 2021 · 583 posts · 738 votes
    3y

    @Carlos Ptriawan

    So very true. I am always very cordial and very nice to the adjuster.

    I make sure the scene is prepared for them so there is little left to be questioned.

    Since you discovered it, you should have already went to go check it out before making the claim. Thus, after reviewing your coverage thoroughly, you should be aware of what is questionable and what is indisputable. Therefore, prepare the scene and make it seamless for the adjuster. Or else, do not put in the claim and save the headache of possible nonrenewal in the next cycle.

    Remember, if/when you decide to sell, the next buyer might ask for a loss run report. It can make or break you deal. Just saying...

    1Reply
  • John MorganPro Member
    Rental Property Investor · Grand Prairie, TX · Member since 2018 · 2k+ posts · 2k+ votes
    3y
    Quote from @V.G Jason:
    Quote from @John Morgan:

    Avoid State Farm at all costs. I had a burst copper pipe with Germania and they went above and beyond. Total damage was 33k they gave me when it was all said and done.

    Avoid, but they went above & beyond?
    Yes, Germania was great and went above and beyond. And kept checking in with me to see if I needed anything else. And they even questioned me if I was claiming enough personal value on some things they thought I might have underestimated. Lol 
    1Reply
  • Jonathan R McLaughlin
    Rental Property Investor · Boston, Massachusetts (MA) · Member since 2016 · 2k+ posts · 2k+ votes
    3y

    @Vipul Shah the phrase “ensuing damage” will be your best friend in the mouth of a lawyer. Get one who can write a competent claim letter and request for an independent adjuster and I would be shocked if they didn’t move to a settlement amount quickly. It’s a numbers game for them and at this amount probably worth it to offer you something reasonable if their interpretation is not ironclad.

    Went through this with bad contractor work when insurance wouldn’t pay for water damage but paid for ensuing damage from the water. It amounted to pretty much the same thing and amount was similar. Reasonable cost.

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  • Jonathan R McLaughlin
    Rental Property Investor · Boston, Massachusetts (MA) · Member since 2016 · 2k+ posts · 2k+ votes
    3y

    @Randall Alan that’s fascinating. Our attorney advised the opposite with the caveat to take a lot of pictures. Different states though. One thing people forget is that lawyers can represent you in the mediation and that an action can often supersede despite all the language the companies put in.

    Feel like these guys are just check caching pawn shops with nicer suits

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  • V.G JasonPro Member
    Investor · Member since 2022 · 3k+ posts · 3k+ votes
    3y
    Quote from @John Morgan:
    Quote from @V.G Jason:
    Quote from @John Morgan:

    Avoid State Farm at all costs. I had a burst copper pipe with Germania and they went above and beyond. Total damage was 33k they gave me when it was all said and done.

    Avoid, but they went above & beyond?
    Yes, Germania was great and went above and beyond. And kept checking in with me to see if I needed anything else. And they even questioned me if I was claiming enough personal value on some things they thought I might have underestimated. Lol 
    Sorry misread. Thought you were still referring to State Farm when you said you went above and beyond. I'll have to check Germania out.

    Does anyone here use USAA?
    0Reply
  • Judy Parker
    Rental Property Investor · Closter, NJ · Member since 2015 · 884 posts · 722 votes
    3y

    Just curious...why did the copper pipe burst? You are in California, so I assume it didn't freeze? Once it burst, why didn't someone immediately shut off the water at the meter, to minimize damage? Had it been leaking for some time and nobody noticed? I had a similar situation - for many months water would occasionally leak through ceiling of first floor apartment. It took quite some time to pinpoint the leak. It was the copper pipe leading to upstairs tub - had a split in it. Each time the upstairs tenant used the tub, water leaked to downstairs unit.

    0Reply
  • Peter MckernanBusiness Member
    Residential Real Estate Agent · Irvine, CA · Member since 2013 · 2k+ posts · 1k+ votes
    3y
    Quote from @Vipul Shah:

    I have a rental property in Orange county, California. We had a water leak and damaged the property. The plumber reported that "Burst copper pipe connecting to tub was the determined problem.  Tech found leak on 1/2 copper pipe that’s feeding the upstairs tub." However, Insurance denied my legitimate claims saying burst pipe is not covered.

     Is anyone here, had similar experience and got coverage by insurance. Any help and guidance is appreciated.

    Any recommendation on hiring an attorney for this case? if so, any recommendation for attorney.

    Thank you in advance.  


     Sounds like they are avoiding the actual problem that they are responsible for as an insurance company. I would get an attorney.. If you need a couple OC attorneys let me know, that is the route I would take. 

    The McKernan Group4.954 Reviews
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  • Ryan KellyBusiness Member
    Real Estate Broker · Austin, TX · Member since 2018 · 1k+ posts · 1k+ votes
    3y

    @Wendy Man I’ve had good experiences with both Liberty Mutual and Travelers. We had an ice storm in Austin back in 2021 and suffered a burst copper pipe above the kitchen in one of our rentals, doing significant damage. They had a restoration crew out within 24 hours and covered all the damage ($6,000+). I personally avoid Allstate and State Farm as I’ve seen them deny claims at a much higher level.

    [email protected]512-674-5478
    Ryan Kelly Group - Keller Williams5110 Reviews
    WebsiteView Page
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  • Sean K.Pro Member
    Insurance Agent · 07930 · Member since 2019 · 39 posts · 12 votes
    3y

    I am seconding what another person posted before.  Your agent should have told you to make sure when you call to say it was "sudden and accidental" assuming it was.  I have never had a burst water pipe damage not covered.  As previously stated the pipe itself would not be covered but damage would be.

    The caveat to this is if you for some reason had what we call a DP1 policy form.  this is basically a "fire only" type policy and water would not be covered.  I generally try not to sell them unless requested.  You need to read the "exclusions".

    [email protected]908-955-7561
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