Is My Insurance Company Trying to Cheat Me?
Let’s be honest, anyone who has had an insurance claim has had this or a similar thought run through their head. For many years insurance companies have done things to earn a bad rep. I’ve been in the insurance restoration industry for the last 10 years, and during this time I can honestly say that I have rarely met an adjuster or contractor that wanted to skimp on the settlement. The few times I’ve seen this is when the policyholder has been extremely difficult to work with. Yes, bad estimates happen, however, most of the time the feeling of being “shorted or cheated” comes from not understanding your policy and how it pays out.
The biggest misunderstanding is most often the issue of matching. Insurance policies are specifically written with terminology and phrases to avoid matching. Homeowner’s coverage is to replace the damaged items with like kind and quality. While as a homeowner and contractor I often don’t agree with this and I will fight it to the best of my abilities. To explain this policy the easiest is to give you situations where you will most likely run into this situation. Let’s say you have a flood where the carpet has to be removed in the hallway. The same carpet runs throughout the home. The living room opens and connects directly to the hallway with the same carpet and you have 3 bedrooms directly off of the hallway and an office with french doors off of the living room. The carpet in the hallway and living room will be replaced but the carpet in the bedrooms and office will most likely not be replaced as most insurance policies are written to stop at doorways.
The other situation is most often with kitchen cabinetry. If water damages your lower kitchen cabinets (or a fire, your uppers) most insurance companies will allow replacing the run of damaged cabinets (meaning all of the lowers or all of the uppers). If you have specialty/custom cabinets you will most likely be given a custom price to rebuild that run of cabinets to match what was there. Very rarely is matching kitchen cabinets likely these days, however, it is not impossible. Over the past 25 years, there are hundreds of cabinet styles and specialty finishes, from dozens of manufacturers. Unless you recently replaced the kitchen, it will take countless hours of research to find the cabinet manufacturer that made your cabinets (a good place to locate the manufacturer is on the inside of the door. Let’s say you’ve managed to find the manufacturer, companies usually discontinue a line every 4-7 years, or they make considerable changes to it. On top of the possible discontinued issue, it is very likely that the elements have changed the finish on your cabinetry. Perhaps your contractor has pointed the issues out to your adjuster, depending on the difficulty they may add extra money to allow to get a close match, perhaps a custom cabinet.
This is where you have several options:
1) You can take your budget and get quotes from cabinet places on a less expensive cabinet to replace all of your cabinetry. Remember that by using less expensive items elsewhere in the reconstruction you will have that money to allocate towards your new cabinetry budget.
2) You can certainly create a unique custom kitchen by finding an opposite finish cabinet to replace your lowers or uppers with. It is very common today to mix cabinetry finishes to give a unique custom look to fit your style. For example, let’s say your cabinets are a stain cherry cabinet in a shaker style. You could go with a complementing stained or painted finish cabinetry, perhaps in antique white or black.
3) If the mix/match isn’t your style consider a paint treatment. My best example of this is a fire I did in Durham, NC in 2007; my client had a small grease fire that scorched the finish on 3 of her upper cabinets above her stove. The insurance company allowed for replacement of these upper cabinets. She was not happy with that. (Now to be fair, this was an extremely smart professor at Duke University and as soon as the fire happened she started dreaming of her new kitchen.) When I broke the estimate down into our budget for the cabinets she was highly disappointed. She wanted her new kitchen. I replaced the 3 damaged parts of the cabinets with unfinished stock pieces that matched in style and repainted all of her dated oak cabinetry to a new beautiful modern black. We added new hardware, repainted the walls and I was able to get new countertops for her, by choosing a less expensive replacement floor. Within 2 weeks she had a brand new remodeled kitchen with nothing more than her deductible out of pocket.
4) You could order the cabinets to match your existing cabinetry and if they don’t match well enough you can go back to your insurance company and have them come back out to assist you with another option. PLEASE NOTE: if you’re set on getting a kitchen completely different than what you had and you opt to try and match your existing cabinets and fail, the insurance company is not going to pay to replace the newly replaced cabinets again. Do not go out and get cabinets that clearly will not be a match to your cabinets and then call the insurance company and say “I tried to match the cabinets but they don’t match.” This is fraud and you can be charged.
The best advice I can give anyone is to understand your policy. Look at your declarations page thoroughly. Understand your coverage. If there are any changes in your home update your insurance as necessary, to protect your home, yourself and your family.
Understanding your claim can be both easy and confusing. It’s easy if you listen, take notes and ask questions (to both your insurance company and your contractor). I’ve seen homeowner become completely befuddled by a claim when they try to make sense of it without knowing enough or by trying to break down the estimate line item by line item and add up the totals to “checkup” on the contractor or adjuster. Just remember that life becomes unsettled when it’s least convenient. There is never a good time to have to file an insurance claim. However, life is unpredictable and it will slap you in the face when you have all your balls in the air. I recommend to all of my clients to get a spiral notebook or notepad the moment they have to file a claim. Write everything down because if you’re like everyone else as soon as you think of a question for you adjuster you’ll forget their name and lose their contact information and/or your claim number. Keep track of everything. Start collecting pictures of things you like that will have to be replaced, it’s good to dream but don’t be unrealistic. Don’t assume that because something got wet it will be replaced. Carpet is one of the most argued for items. Most homeowners assume that because the carpet was wet for several hours before it was discovered it will be claimed as unsalvageable. In a general Class 1/Category 1 (Clean water) loss most carpet can and will be saved. Restoration companies are HIGHLY trained to dry these items. Carpet is replaced as a last resort. It may need to have the pad replaced and be restretched/rekicked and cleaned but in rare situations does it require replacement. Delamination is a reason for replacement. Delamination is when the primary and secondary backing of the carpet separate. One of my favorite arguments for carpet replacement was from one of my homeowners in Virginia who said that her carpet wasn’t wet before and therefore should be replaced. I had to laugh on the inside when she said this because while I am confident that the 83 gallons of water which we removed from her living room were not present prior to the loss; the water did not damage her carpet. She argued her point (I think she was a law student) for nearly an hour and a half. She did not win. She argued that water damages fabric and since it was not wet prior to her loss it should be replaced to prior condition. I agree that water does damage some fabrics but her carpet was not made of silk or wool. It was average nylon carpet, and after checking the tags of 8-10 pieces of clothing (looking for nylon) that she normally wears and washes, she dropped that argument. She rebutted that the carpet color changed/darkened where the carpet was wet. Yes, it was darker where the water was, because it was still wet! Two days later upon completion of drying the carpet, the homeowner confirmed that the carpet color returned to its original shade. Nonetheless, her next argument was that by getting wet, the carpet’s structure was now damaged. She couldn’t really explain what she meant, but I was confident I knew where she was trying to go. When I explained to her that during the manufacturing process carpet is routinely exposed to several “water baths” in order to manufacture it. When she learned that water is used in the manufacturing process she had no further arguments. Feel free to use any of her argument should you want to try and get your non-damaged carpet replaced. If you’re carpet gets wet with clean water and isn’t found to be delaminated, look for staining from furniture feet. Staining IS a valid reason to replace carpet.
Drywall and trim are the other most commonly damaged items in a home during a water loss. Drywall patches are 100% acceptable in restoration. The insurance company does not owe to replace all of the drywall in a room because there was a section that had to be removed. Understand that drywall can usually be dried without any relating issues. If a section has to be removed a patch fit to the squared-up removed section is acceptable. Once properly taped and mudded that patch will not be noticeable, if it is than your contractor needs to have another drywall crew redo the repair. Yes, drywall is hung in 4×8 or 4×12 sheets but that does not mean that you need an entire new sheet of drywall “because it wasn’t previously patched.” Any new drywall will be sealed and painted to match.
Insurance companies/adjusters are starting to release the reins on painting of a room. It varies company to company- adjuster to adjuster- and on the clients’ attitude. For years the standard has been to apply two coats of paint to the new drywall and 1 coat to the remaining section of wall (corner to corner). The corner to corner theory is that when painting a room you can/typically stop in the corner once you have an entire wall painted. You never want to stop mid wall because that will be noticeable. Also with corner to corner if the paint shade is slightly off it won’t be visible as it stops in the corner and light casting shadows will affect the paint shade as well. Having been met with so many contractor arguments over painting the remaining walls, during the last 2 years we have seen the corner to corner rule relax. Typically now, if I have a 12×12 room and I patch one of the walls, I will apply two coats of paint on top of two coats of primer to the new drywall. I can usually get the adjuster to approve repainting the remaining walls, to match. This does not mean that you get to change your 12×12 powder blue dining room to Victorian red. This means that you get a fresh coat of powder blue paint in your dining room. However, if you’re nice to your contractor you can update that powder blue to a similar tonal value color such as a grey blue. Cultivating and fostering a good relationship with your contractor can only benefit you.
One of the other biggest items homeowners don’t understand that don’t get covered are the source repair costs. Example: the ring between your toilet tank and bowl rots, causing your toilet to leak. The insurance coverage will be to repair the damage that the toilet caused. It however, will not cover the cost of fixing or replacing that toilet, or your cost to hire the plumber to come out and shut off the water and remove the toilet. In short, your insurance company is not trying to “stick it to you”. It is important to note that any form of water damage should be cleaned in a timely manner. Water damage can spread to mold damage, and your insurance company is not likely to pay for a mold inspection if they feel that you aided the progression of the mold by delaying in drying the area. If something doesn’t make sense. Ask about it. If you don’t understand the answer or are having difficulty with your adjuster ask for their supervisor. If something raises a flag in the supervisors head they can and often will either send out another adjuster/field reinspector or come out and investigate. Don’t be afraid to ask if you truly feel that you’re not being treated fairly. Your insurance agent can also help to explain your policy to you.
Regardless of what you feel you’re owed, just because you’ve been paying into you policy for x number of years doesn’t mean you get everything and anything you want. Indemnity is a basic insurance principle that states that you, as an insured should not be allowed to profit from an insurance loss. This principle is important and helps to protect both the insurance company and you.
Source by Daniel L Hoover