Insurance Adjuster Asking for Copy of Estimates for Claim Filed & Paid10 Yrs Ago

[Gonzozap]

I recently filed a claim due to water in my basement. Found it was coming from a cracked pipe. The adjuster asked me if I had any prior claims for water damage. I told him yes and it was 10 years ago with a different company. The cause of the water damage the 1st time was freezing pipes. This time, it's due to a cracked pipe - no freezing. And the water damage this time is at the rear of the basement. 10 years ago, all the damage occurred in the front of the basement. No overlap at all.

The adjuster is asking me for copies of estimates for the 10 year old claim. He says he needs to check for overlapping claims to avoid a 2nd payout. Huh?? How could claims be overlapping when they are 10 years apart and paid by different companies? It's amazing what lengths the insurance company will go through to try to deny a claim. This sounds flat out ridiculous. Even if the claims were exactly the same, where in an insurance policy does it say the company will not pay for a claim if they (or any other company) previously paid a claim for the same or similar incident? So, my pipes can freeze only once while I am in that property? Or my roof can be damaged just once? Or I can have only one fire in the kitchen? Or for that matter, can someone rear end me from the back just once? And any time after the 1st is on me. Suppose my prior claim was 25 years ago. Would he want to go back that far?

Insurers can find out about claims over the previous 5 years from a CLUE report. My understanding is that's what they get. Period.

I'm asking to see if anyone has ever heard of this madness. And do I have any obligation as an insured to provide this info? By the way, he has already contacted my old company - Allstate, to try to get the info. They told him no & that he would have to get it from me.

Would appreciate any thoughts on the best way to handle this too. Don't want to royally piss off the adjuster. Not smart.

Thx.

 

[tranquility]

I recently filed a claim due to water in my basement. Found it was coming from a cracked pipe. The adjuster asked me if I had any prior claims for water damage. I told him yes and it was 10 years ago with a different company. The cause of the water damage the 1st time was freezing pipes. This time, it's due to a cracked pipe - no freezing. And the water damage this time is at the rear of the basement. 10 years ago, all the damage occurred in the front of the basement. No overlap at all.

The adjuster is asking me for copies of estimates for the 10 year old claim. He says he needs to check for overlapping claims to avoid a 2nd payout. Huh?? How could claims be overlapping when they are 10 years apart and paid by different companies? It's amazing what lengths the insurance company will go through to try to deny a claim. This sounds flat out ridiculous. Even if the claims were exactly the same, where in an insurance policy does it say the company will not pay for a claim if they (or any other company) previously paid a claim for the same or similar incident? So, my pipes can freeze only once while I am in that property? Or my roof can be damaged just once? Or I can have only one fire in the kitchen? Or for that matter, can someone rear end me from the back just once? And any time after the 1st is on me. Suppose my prior claim was 25 years ago. Would he want to go back that far?

Insurers can find out about claims over the previous 5 years from a CLUE report. My understanding is that's what they get. Period.

I'm asking to see if anyone has ever heard of this madness. And do I have any obligation as an insured to provide this info? By the way, he has already contacted my old company - Allstate, to try to get the info. They told him no & that he would have to get it from me.

Would appreciate any thoughts on the best way to handle this too. Don't want to royally piss off the adjuster. Not smart.

Thx.

Don't worry about pissing off the adjuster. That is irrelevant other than the ease of collecting. But, if they DO fight the claim, they will get what they are asking for. (Unless it is already in their possession.)

I don't know home insurance claims, but have some (dated) second hand knowledge of auto claims. Heck the firetruck yes, the insurance company wants to limit the amount they pay out. Facts, legal tricks, intimidation and anything they can think of is free game. They will demand strict compliance with your contractual agreement or will not pay.

That being said, they're not stupid. They know that lawsuits cost money. Fact issues and contractual issues may save them. All they really care about is if they can be accused of bad faith.

Here? Not so much. Asking for more information, even from long ago, is not bad faith. If they deny because you do not supply it, maybe. This is going to be your or your attorney's call. Especially with water damage, problems seem to last. A little water a long time ago may make a big difference today. There is nothing unreasonable to ask about it and what was done to mitigate. Why do you not want to disclose? Is it because you feel it irrelevant or because you don't have it?

 

[Gonzozap]

Thanks for responding tranquility. No, I do not have the info but Allstate is sending it to me.

I didn't want to provide it just on GP. However, after I posted the thread, I was able to reach out to an old colleague who works for a casualty insurance company. He said they probably want the info for subrogation purposes. If they somehow find that the prior plumber did a piss poor job and the current break in the pipe is due to his negligence, they can attempt to get some of their claim money back from the plumbing company. That could have been a possibility except for the fact that the Statute of Limitations (SOL) has passed.

I am very familiar with subrogation. If the adjuster had just told me this was what he was looking for, I would have understood. But I suppose he felt we laypeople are too dumb to know anything about subrogation. Insurance policies even tell insureds they must cooperate with subrogation claims. In the best of cases, the subrogation, if successful, could entitle the insured to a refund of their deductible. So, the insured would want to cooperate.

But given they can't bring a subrogation claim, it still makes me think they are looking for some way to deny the claim based solely on a prior claim. I just can't conjure up how that could be possible.

It's always possible that the adjuster has forgotten about the SOL for subrogation for property damage.

 

[justalayman]

Unless the adjuster has been to the property, while the damage not being from the prior claim is easily determinable by you, they are setting in an office miles away and do not have the benefit of having paid the original claim so that they would have records of the incident nor the ability to run down the stairs and see it is not associated with the first claim.



with that said; this is due to a cracked pipe. How do pipes crack? They crack when they freeze. You said there has been no freezing since the incident 10 years ago. Not much else will make them crack so, they are likely thinking this damage is in fact from a crack that occurred previously and due to that, they will try to escape payment since your pipes were already damaged when you purchased the current policy. They are not going to cover pre-existing issues. You might say; if it cracked 10 years ago it would have already been known and leaking. Well, maybe and if you had had freezing problems since then, it may be more easily accepted but you said no freezing problems so what caused the cracked pipe? Depending on a lot of things some damage may not be discovered immediately. A crack typically will be but, with me not being a plumber, I cannot say it was not damaged previously and not leaked for some reason until now.

 

[Gonzozap]

Unless the adjuster has been to the property, while the damage not being from the prior claim is easily determinable by you, they are setting in an office miles away and do not have the benefit of having paid the original claim so that they would have records of the incident nor the ability to run down the stairs and see it is not associated with the first claim.



with that said; this is due to a cracked pipe. How do pipes crack? They crack when they freeze. You said there has been no freezing since the incident 10 years ago. Not much else will make them crack so, they are likely thinking this damage is in fact from a crack that occurred previously and due to that, they will try to escape payment since your pipes were already damaged when you purchased the current policy. They are not going to cover pre-existing issues. You might say; if it cracked 10 years ago it would have already been known and leaking. Well, maybe and if you had had freezing problems since then, it may be more easily accepted but you said no freezing problems so what caused the cracked pipe? Depending on a lot of things some damage may not be discovered immediately. A crack typically will be but, with me not being a plumber, I cannot say it was not damaged previously and not leaked for some reason until now.

Adjuster has seen the damage. Your synopsis involves a lot of "ifs" and suppositions. The plumber who repaired it said the crack was unusual and did not appear to be from freezing. I would think they will have a tough time proving in court that this incident is definitely related or continuing from one 10 years ago, especially since that pipe did not freeze and crack before and no water entered the home from that area. Water entered the home 15 feet away from that wall and involved a completely different pipe. Proving beyond any doubt that my pipes (or that pipe) have been damaged for a full 10 years with no signs of such until now will not be an easy task. The basement is finished and much time is spent there.

Time will tell. Thx for chiming in. .

Speaking to an attorney tomorrow and might retain a public adjuster.

 

[justalayman]

Adjuster has seen the damage. Your synopsis involves a lot of "ifs" and suppositions. The plumber who repaired it said the crack was unusual and did not appear to be from freezing. I would think they will have a tough time proving in court that this incident is definitely related or continuing from one 10 years ago, especially since that pipe did not freeze and crack before and no water entered the home from that area. Water entered the home 15 feet away from that wall and involved a completely different pipe. Proving beyond any doubt that my pipes (or that pipe) have been damaged for a full 10 years with no signs of such until now will not be an easy task. The basement is finished and much time is spent there.

Time will tell. Thx for chiming in. .

Speaking to an attorney tomorrow and might retain a public adjuster.

of course it involves if's and supposition. Obviously I cannot exclude them as I have nothing to base anything on, factually speaking. I was simply attempting to give you a possible scenario the adjuster might see as a possibility and use to reject the claim.



I am curious though; what is unusual about the crack? Cracks from freezing are generally easily discernible. A pipe will almost always show bulging and the crack (unless near a fitting) will be longitudinal. If it is near a fitting, a lot can change but the bulging will generally be there. The metal does not shrink after the pressure of the ice is removed and it is the bulging beyond the capacity of the pipe to expand that causes the crack so it is not generally difficult to differentiate the crack as to it being from freezing or some other issue such as simple a bad piece of pipe or from some external source of damage.

 

[Gonzozap]

of course it involves if's and supposition. Obviously I cannot exclude them as I have nothing to base anything on, factually speaking. I was simply attempting to give you a possible scenario the adjuster might see as a possibility and use to reject the claim.



I am curious though; what is unusual about the crack? Cracks from freezing are generally easily discernible. A pipe will almost always show bulging and the crack (unless near a fitting) will be longitudinal. If it is near a fitting, a lot can change but the bulging will generally be there. The metal does not shrink after the pressure of the ice is removed and it is the bulging beyond the capacity of the pipe to expand that causes the crack so it is not generally difficult to differentiate the crack as to it being from freezing or some other issue such as simple a bad piece of pipe or from some external source of damage.

Oh I know you were speculating. I appreciate it. Gives me something more to think about.

I do not know why the plumber said it was unusual. Perhaps because he did not see what you described. Thx for that question. I will reach out to him to ask why he came to that conclusion. The ServPro guys said the same thing (i.e., not from freezing) & they have surely seen a lot of these claims.