What to do if insurance denies your water damage claim

What to do if insurance denies your water damage claim

The last thing you want to do is panic if your insurance company denies your flood or water damage claim.  Flood Metrix will not complete a water damage restoration project with the intent to bill insurance if the source of your water damage or flood is not typically covered by insurance.

No representative of Flood Metrix can state the fact of what your water damage insurance provider will or will not cover.  Flood Metrix will perform an initial assessment and document all water damage discovered during the process.  This information will be used to help your insurance company determine coverage.

Insurance companies are not always able to determine coverage over the phone.  Water damage adjustors rely heavily on documentation provided by the water damage mitigation company, the plumbers report and your insurance coverage.  Over 85% of the water damage claims handled by Water Damage, Mold & Flood Metrix LLC in 2021 were complete or in the drying phase before an insurance adjustor ever came on site.

We are trained for emergency response to Commercial & Residential Water Damage

The emergency part of flood & water damage restoration is executed with an “emergency response attitude” to stop/mitigate water damage.  You and your insurance company want this immediate response, but the insurance adjustor also needs documented information.  Flood Metrix aims to have an initial project report completed within 24-36 hours of responding to a flood damage or water removal project.

The Reason your Flood/Water Damage Claim Was Denied May Shock You.

Not all water damage claims are covered by insurance due to policy design or exclusions.  You may think there wouldn’t be any other reason your water damage claim could be denied, but you would be mistaken.

Insurance is meant to cover “sudden or accidental” damages not “long term/lack of maintenance” damages.  This is where the overwhelming majority coverage mistakes are made because making the determination of sudden vs maintenance issue is not always easy.

Review your homeowners’ policy for the appeals procedure

If you water damage claim is denied, then review your policy to better understand the appeals process.  Many homeowners do not realize that many claims are covered after they have completed the water damage claim appeals process.  The process can be long and stressful but well worth the reward.

Act within the allotted appeals time frame and be diligent.  It is a good idea to start by sending an email to your insurance company notifying them of your intention to formally appeal the denial of your water damage claim.

Contact your Insurance Agent, they sold you the policy

The insurance agent who sold you your policy has a vested interest in keeping your policy open.  They can be a valuable resource in helping you to navigate your water damage claim appeals process.

Credentials Check

Your adjustor may be inexperienced and lack knowledge of advanced restoration industry details. Or they may be very experienced, but still not be an IICRC Certified flood or water damage expert.

Check the credentials of your insurance adjustor, they may not be IICRC certified, which means their opinion is not an “expert opinion on water damage restoration”.  Your water damage service provider/company should have more IICRC certifications than your insurance adjustor.

Hire an IICRC Certified Water Damage Company

Always hire a water damage restoration company with IICRC certified technicians.  If a portion or all of your water damage claim gets denied due to how your adjustor interprets information about the flood, the IICRC credentials of your water damage restoration contractor can easily help get your claim paid.

Why is this important?

Whoever has more water damage IICRC certifications also has the most authoritative opinion on water damage restoration.  Flood Metrix has IICRC Certified Master water damage restoration professionals on staff.

Reports & Documentation

All lines items submitted for payment should be supported by an organized presentation of photos, videos reports and projects notes.  A claim or portion thereof can easily be denied due to non-submittal of supporting documentation.

“Water Bills Don’t Lie”

Another key factor in proving your claim is by submitting copies of your water bills.  This will show the sudden spike of water loss at the time of your flood.

Organize and submit evidence to rebut reason for denial.  Be sure to inform your water damage service provider, they can provide IICRC citations to support your claim.

Highlight IICRC S500 & S520 Water Damage/Mold Remediation Standards

Your insurance company is obligated to pay flood and water damage restoration costs in accordance with IICRC standards.

Insurance Ombudsman

You may have waived your right to sue your insurance company and may only have arbitration as your course of action.  Most insurance companies have an “ombudsman” responsible for handling escalated appeals.  It is their job to resolves such matters.

Contact A Public Adjuster, they don’t get paid until you do.

Public adjusters can also help apply pressure to your insurance company to pay your claim if it should be covered.  Public adjusters work for you and not for the insurance company.  You may find the services they provide invaluable to helping get a difficult water damage claim settled.

Scott A. White is Commissioner of the Virginia Bureau of Insurance with the SCC//State Corporation Commission.

Contact Commissioner Whites office if you are not satisfied the results of your appeal.  Visit https://www.scc.virginia.gov/

“Because the Power to Change the Matter is in the Metrix”

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