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denied claim

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Nashi

Junior Member
What is the name of your state? Indiana

Sorry this post is so long, but I wanted to give as much info as I could.


The other day my husband came home and noticed a large chunk of plaster had fallen in our garage. A friend who is a contractor determined, after tearing out some of the garage ceiling, that our upstairs shower had been leaking into the floorboards long enough to seriously rot the floorboards; serious enough to cause the plaster to fall and to cause the floor in our bathroom and an adjacent one to literally drop about an inch or so cracking ceramic tile and causing some damage to the wall between the bathrooms - cracks between the drywall and the floor and to a lesser extent the ceiling. The shower is customized ceramic tile that was there when we purchased the house and it will likely have to be torn out. There may be other problem depending on the extent of the damage we find once we get into tearing the floor out.

When we figured out what the problem was, we immediately called the insurance company. At first they acted as if everything would be taken care of, no problem, but today when my husband spoke to them, they'd changed their tune. They denied our claim because we "should have repaired the problem before it got to this point."
NOTE: the water damage itself was not an issue

Based on the condition of the floorboards, the leak had existed for a long time. But it was not a big leak because we had never seen water or noticeable moisture anywhere. The only thing I ever noticed was a mildewy smell in the bathroom, but we are talking about a bathroom here.

How could we reasonably be expected to fix what we couldn't see? In this case, does it seem like the ins. comp's reason for denying our claim is rational and/or valid?? I mean we'd have to tear out the floors and walls regularly to find something like this... :confused:

Is the insurance company just being unreasonable? Should we keep calling and arguing with them until they fianally approve our claim (I was told to do this one time with our med insurance company over some prescription meds and it didn't take long for them to approve coverage)?

I don't want to have to get our attorney involved if it is at all avoidable. Can you offer some advice on what would be the best way to approach our insurance company, to get this mess settled amicably and quickly?

Our friend the contracter told us that he could probably fix it for about $3200.00 if we help and barring any unforeseen difficulties. I think we should present the ins. comp. with a couple of other estimates because I am sure they would be considerably higher and I want to show the ins. comp. that we are not asking for an outrageous sum of money.

FYI, We have been with this particular insurance company for almost 20 years and we have never filed a claim before even though we could have on at least a couple of occasions.

Thanks for any advice you can offer.
 
Last edited:


moburkes

Senior Member
WHO at the insurance company told your husband this?
Wait until you receive a denial letter in the mail, then post back with the exact policy provision that they cited.
 

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