STM317 PowerDork
3/20/23 12:34 p.m.

My parents have some structural issues under their kitchen due to a leak. The leak was located at the floor level of a drain pipe, and was the result of a nail puncturing the drain pipe upon construction of the home (in 1975). Not sure exactly when the leak began, but it was leaking anytime shower or sink water drained from the primary bathroom. It was only discovered after rotting out floor joists caused the kitchen floor to sag. The damage is such that the whole kitchen has to be torn out to replace joists/sill plate/subflooring.

Initially, they were verbally told by an adjuster that insurance would cover structural repairs as well as replacing the cabinets, counters, flooring, etc that had to be removed to perform the structural repairs. Now, after turning in some quotes for those items their insurance company is only agreeing to pay for the structural repairs, leaving my parents on the hook for replacement of everything above the subfloor. They've already cut the check for the structural repairs but have implied that any additional reimbursement would be unlikely.

I guess my question here is how normal would it be for insurance to "make them whole" in a situation like this? I know that water damage and leaks can be a tricky subject. I'd also imagine that it's probably policy specific, and I haven't read their policy but I was curious what the collective wisdom of this group might be. My parents aren't flush with cash, and have zero experience with this type of thing. They've asked me to look into it a bit. I'll try to go through their policy in the coming days, but do you all think it's worth pushing for more from the insurance company? Any wisdom for a proper tact to do that?

RX Reven'
RX Reven' GRM+ Memberand UltraDork
3/20/23 12:58 p.m.

I'm surprised they're even covering the structural understanding is that insurance typically only covers acute events not damage resulting from chronic issues.

Slippery GRM+ Memberand PowerDork
3/20/23 12:59 p.m.

As much as I do not like them, maybe you need to contact a public adjuster and see what they say.

matthewmcl Dork
3/20/23 2:09 p.m.

Had a short term leak at my house. Items damaged directly by the leak were covered. Items that were wear-and-tear worn and made worse by the leak were not covered. By that example, kitchen cabinets worth keeping are detached and reinstalled. Kitchen cabinets too old to come off without destroying are your loss.


STM317 PowerDork
3/21/23 8:22 a.m.

Appreciate the discussion thus far. I'll check around for public adjusters in their area.

Hoondavan HalfDork
3/21/23 4:20 p.m.

I'd recommend someone who knows how to read an insurance policy with a magnifying glass.  This might be a public adjuster, a really good contractor, or an attorney.  Not that you want to tell the insurance company you're ready to lawyer-up...but it might be worth consultation. A public adjuster might expect a % of the total claim regardless if their involvement results in a higher payout.  


Greg Voth
Greg Voth Dork
3/21/23 7:06 p.m.

Without the policy its all guess work.  There is usually language that excludes repeated or long term issues.  If coverage is afforded typically as stated above they would cover the direct damage from a short term or one time event.  It doesnt make much sense in my experience why they would cover the structural (long term damage) but not the other damages.  

To add to that if you are replacing the joists and subfloor you would likely be able to detach and reset the cabinets, countertops, sink, appliances etc (contruction and material dependent) whereas obviously the flooring would have to be replaced.  They arent going to be looking to provide an open check for a complete remodel.  

Before jumping to an attorney or public adjuster who take 10-40% of the settlement I would review the documents they sent.  There is usually an estimate provided and anything not covered explained in a denial or partial denial letter detailing the coverage limits or language in the policy that is the reason for the denial.  For example a lot of policies for older homes in Florida have $10k water damage limits related to leaks.  

If your parents give them permission to speak with you they should be able to discuss the claim with you as well. 

Feel free to PM me if you want to chat.  

Greg Voth
Greg Voth Dork
3/21/23 8:08 p.m.

I should add that I can certainly sympathize.  I am dealing with my own hurricane Ian claim and even being very familiar with the process its coming on six months of back and forth trying to dispute some of their objections.  Some of which are very clear and obvious, others involve more opinion on repair methods and providing code and manufacturer documentation to substantiate the loss. 

dean1484 GRM+ Memberand MegaDork
3/22/23 4:37 p.m.

They/you need to read the policy. This will determine exactly what is paid for by insurance and what is not.

From that you should easily be able to sort out what is covered. If you have questions you may want to call the state insurance regulatory office and see if they can help or if there are services provided by them to help interpret parts of the policy that you don't understand or are generally ambiguous.  Armed with there interpretation of the policy language in hand and if you think it supports additional coverage that the insurance company is not affording your parents I would then go back to the insurance company and present to them the state's interpretation of the policy. Making it clear that it is not your interpretation but that it is that of the states insurance regulatory agency.   

Or you may find that you are SOL and only the damaged structure is covered and all the old stuff is expected to be removed and re installed.  Or it is specifically excluded no matter what. The policy may not be written with the intent of making the policy holder whole. It could be written with specific inclusions and exclusions. Policy's written to meet the bare minimum required to obtain financing is probably not going to afford coverage that a home owner would consider making them whole.  

It all circles back to reading and understand what the policy actually covers. 

I will put it out there that I bet if you ask 100 random home owners if they have read there current homeowners policy I bet the percentage is very low.  

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