Conflicting clauses in insurance contract. Help?

[griffin8r]

What is the name of your state (only U.S. law)? Virginia.

So we got nailed (along with half the state) in this last big storm with massive groundwater flooding. Seals broke loose in certain places on the foundation walls and the French drain system overflowed the sump (sump pump never stopped running, but just couldn't keep up).

Long story short, I have about $4,000 in personal property, and $2,000 worth of interior walls destroyed.

First thing I do (after getting the interior wall replacement estimate, which was approved and paid by the insurance company) is have a couple of foundation experts come in and assess the situation, because there is a clause in the insurance policy that states that (slight paraphrase, can't remember exact wording) "Insured must take all necessary action to protect property from covered loss once a covered loss has occurred, insurance company will pay reasonable costs associated with such actions."

Every one of them said that the French drain system was failing, and these problems would continue to occur unless it was replaced by a more effective system (three estimates were collected, all ranged around $10K)

The adjuster comes back to me and says that they won't pay for the foundation repairs because the exclusion in the water damage rider states "[the insurance company] will not pay for damage to the sump pump or related drainage systems caused by mechanical breakdown"

Now, obviously there is a conflict here between the two clauses. If I put the walls back in down there (which they've already paid for), how can I protect those walls (property) from another flood if they won't pay for the necessary repairs to the drainage system?

And furthermore, the sump pump never stopped functioning, it was just overwhelmed. I fail to see how this is a mechanical breakdown?

I greatly appreciate any clarity you can offer me here.

 

[JustAPal00]

What is the name of your state (only U.S. law)? Virginia.

So we got nailed (along with half the state) in this last big storm with massive groundwater flooding. Seals broke loose in certain places on the foundation walls and the French drain system overflowed the sump (sump pump never stopped running, but just couldn't keep up).

Long story short, I have about $4,000 in personal property (my home office is set up in the basement - it's a small house), and $2,000 worth of interior walls destroyed.

First thing I do (after getting the interior wall replacement estimate, which was approved and paid by the insurance company) is have a couple of foundation experts come in and assess the situation, because there is a clause in the insurance policy that states that (slight paraphrase, can't remember exact wording) "Insured must take all necessary action to protect property from covered loss once a covered loss has occurred, insurance company will pay reasonable costs associated with such actions."

Every one of them said that the French drain system was failing, and these problems would continue to occur unless it was replaced by a more effective system (three estimates were collected, all ranged around $10K)

The adjuster comes back to me and says that they won't pay for the foundation repairs because the exclusion in the water damage rider states "[the insurance company] will not pay for damage to the sump pump or related drainage systems caused by mechanical breakdown"

Now, obviously there is a conflict here between the two clauses. If I put the walls back in down there (which they've already paid for), how can I protect those walls (property) from another flood if they won't pay for the necessary repairs to the drainage system?

And furthermore, the sump pump never stopped functioning, it was just overwhelmed. I fail to see how this is a mechanical breakdown?

I greatly appreciate any clarity you can offer me here.

It wasn't a big enough pump! It is your responsibility to have a big enough pump. If a system in the home is failing, it is your responsibility to fix it. Lack of maintanance can result in claims being denied.

 

[griffin8r]

It wasn't a big enough pump! It is your responsibility to have a big enough pump. If a system in the home is failing, it is your responsibility to fix it. Lack of maintanance can result in claims being denied.

They didn't deny the claim. They already cut me (and I cashed) a check for the interior wall replacements.

 

[Zigner]

They didn't deny the claim. They already cut me (and I cashed) a check for the interior wall replacements.

Yes, but now you KNOW the problem. YOU need to fix it. It's not an insurance issue.

 

[griffin8r]

Yes, but now you KNOW the problem. YOU need to fix it. It's not an insurance issue.

Contract states that they will pay for it, that's the point of contention.

 

[Zigner]

Contract states that they will pay for it, that's the point of contention.

I understand your point. However, the type of repair you are proposing is specifically excluded.

 

[ecmst12]

When clauses appear to be in conflict, the more specific one will rule. The repair you want is specifically excluded. But you still must pay for it, or the next time this happens, your insurance can deny for failure to keep property in good repair. Welcome to home ownership.

 

[JustAPal00]

I don't see a conflict.

"Insured must take all necessary action to protect property from covered loss once a covered loss has occurred, insurance company will pay reasonable costs associated with such actions."

Is refering to not allowing the OP's property to continue to get damaged after the flood. In other words, the OP must do what he can to minimize the damage and the insurance company will reimburse him as long as his efforts are reasonable.

"[the insurance company] will not pay for damage to the sump pump or related drainage systems caused by mechanical breakdown"

This says they won't replace your drainage system if it is damaged due to a mechanical breakdown. They have nothing to do with each other.

OP, your asking your insurance company to replace your french drain so that there are no future claims. That's a maintanance issue, like a new roof or paint, you are responsible for all maintanance to your home. I'm surprised they paid the claim at all. Sounds like a flood to me, it was ground water wasn't it?

 

[griffin8r]

OP, your asking your insurance company to replace your french drain so that there are no future claims. That's a maintanance issue, like a new roof or paint, you are responsible for all maintanance to your home. I'm surprised they paid the claim at all. Sounds like a flood to me, it was ground water wasn't it?

It was ground water that leaked in through the foundation drainage system, which is explicitly covered under the add-on rider we bought.

Understand, this is the first time I've ever filed a claim on my homeowner's policy. I'm not trying to argue, I'm just expressing what seems logical to me, and am most grateful for your corrections.

As to the maintenance issue, if my roof leaks after a storm because some of the shingles blew off, the insurance company will pay for the roof to be re-shingled (I know many, many folks who have had such claims approved).

What I'm saying here is that something has failed in the system, because not only did we flood during that last storm, but in the three times it has rained since that storm, we have water coming in (not as severely) in places it shouldn't be, which is something that never happened before. It seems to me that a previously working system no longer works, which is why it would seem reasonable to ask the insurance company to pay for its repair so that it will work. Again, if I'm off base, I'm happy to be corrected if someone is willing to be patient and explain the logical flaws here.

 

[JustAPal00]

It was ground water that leaked in through the foundation drainage system, which is explicitly covered under the add-on rider we bought.

Understand, this is the first time I've ever filed a claim on my homeowner's policy. I'm not trying to argue, I'm just expressing what seems logical to me, and am most grateful for your corrections.

As to the maintenance issue, if my roof leaks after a storm because some of the shingles blew off, the insurance company will pay for the roof to be re-shingled (I know many, many folks who have had such claims approved).

What I'm saying here is that something has failed in the system, because not only did we flood during that last storm, but in the three times it has rained since that storm, we have water coming in (not as severely) in places it shouldn't be, which is something that never happened before. It seems to me that a previously working system no longer works, which is why it would seem reasonable to ask the insurance company to pay for its repair so that it will work. Again, if I'm off base, I'm happy to be corrected if someone is willing to be patient and explain the logical flaws here.

I'm sorry, I missed the part where you mentioned the rider. If a rider was purchased to cover ground water flooding, then yes of course it would be covered.

As far as the french drain and sump pump. They will not pay to improve your system. If durring a storm a block wall were to collapse onto your pump damaging it, then it would be covered. Just like the wind blowing off shingles providing your roof was in good shape prior to the storm. However a roof like a sump pump has a lifespan. Eventually they wear out. At that point it is up to the homeowner to replace it. You have not described any damage to your system, just that it no longer works like it used too. Insurance only pays for damage.