Any home claim handler or experiences?

[Trying2bFrugal]

Nov 2021 we got a house, moved out in Dec 2022 and rented from Jan 2023. This house basement/utility room is at or above ground level, duplex, walkout basement. SE MI.

Got the landlord insurance from State farm as AAA dont write them.

The sewage backed up last week, 5 different plumping companies came, 3 companies ran camera and said same location, same issue.
Pipe was ruptured under concrete 7 ft down, inside the house, just 2 feet away from foundation. And all 5 plumbing companies said a ruptured pipe should be covered by insurance in its regular policy not requiring a sewage rider as it is happening inside the house, not a blockage due to maintenance issue .

State farm claim handler said I dont have sewage rider on policy and not covered. They dont cover anything on plumbing not for opening up the concrete or restore. Plumbing company need the stairs to be removed as the pipe rupture happened under the 3 ft crawl space under stairs.

Claim handler said State farm policy say about it will pay to open up/restore to find the root cause of the issue, in this case since we know the issue, they wont process claim (wtf, if camera said means nothing until they got down to see and fix the pipe). And when I asked him about the verbiage on Tead down, he said he would cover it but as exception. It appeared very common sense, but when the claims team make non-sense whom should i ask? Is there someone else I could ask? The general contractor who came in today (insurance company sent), said the instruction he got was to repair necessary for water damage and he said he is confused why they put in that verbiage instead of clear instruction. In his opinion, insurance companies usually pays for all the work as it is a pipe rupture and not sewage backup due to other issues and if it is inside the house it is always covered. He said I have to talk to the agent who wrote policy and handler is not my friend.

I can be handy but removing and fixing stairs on a 45 yo house isn't something i would do and at the moment i am going through a lot of other personal/emotional stress (even before this issue) where I had to take break on work. They havent solved and this came in.

Tenant is not living in the house now and he didnt took the tenant insurance as requested on lease, also the lease expired on last month, he is on month on month. Tenant moved to his relative house last 10 days. There are lot of his stuff on the basement and atleast 25% of it has some kind of water damage. He doesnt seem to listen to remove them. Also I am not sure if I would get the rent from him or it would come from the insurance company. Insurance policy does state that they would cover the rent if the place becomes inhabitable. 

The water damage-removal of drywall, carpet (6k), stuff then plumbing (5k), tearing and restoring of stairs, carpet (still havent gotten an estimate) and 3 weeks from now, makes me think what I should be doing with insurance scene. There is a 3200 deductible on my part in insurance. Which could cost me about 10k overall.

Anyone have gone through similar or any Mustachian handler here who could help me point on right direction?

[reeshau]

This sounds like my experience with State Farm in 2022.  I had two major claims with them in 30myears of doing business, and it wasn't just fine, it was smooth--a reason to stay.  This last one, also a pipe rupture, but from the AC drain, was a nightmare.  I have heard rumors its because State Farm is forced to sell home insurance, if they want auto business in Texas.  But that would not explain issues in Michigan.

My advice if you foresee trouble dealing with the insurance company is to hire and independent adjuster.  They will work for a percentage of the claim--so they are motivated to make a claim for the complete costs.  This percentage is paid by you, out of your proceeds.  But they also help the insurance agency by completing all the paperwork.  They also know how to play the game, so won't get caught by misstatements or contradictions by various people.  They are quite common to use after a hurricane, because the sheer amount of work would swamp the insurance company staff.  But you can hire them for any case.

Saving money is good.  In this case, you first save your time and your emotional health by not having this dumped on your life.  You might even get money ahead, as your adjuster catches shortcuts taken with your claim.

[Trying2bFrugal]

This sounds like my experience with State Farm in 2022.  I had two major claims with them in 30myears of doing business, and it wasn't just fine, it was smooth--a reason to stay.  This last one, also a pipe rupture, but from the AC drain, was a nightmare.  I have heard rumors its because State Farm is forced to sell home insurance, if they want auto business in Texas.  But that would not explain issues in Michigan.

My advice if you foresee trouble dealing with the insurance company is to hire and independent adjuster.  They will work for a percentage of the claim--so they are motivated to make a claim for the complete costs.  This percentage is paid by you, out of your proceeds.  But they also help the insurance agency by completing all the paperwork.  They also know how to play the game, so won't get caught by misstatements or contradictions by various people.  They are quite common to use after a hurricane, because the sheer amount of work would swamp the insurance company staff.  But you can hire them for any case.

Saving money is good.  In this case, you first save your time and your emotional health by not having this dumped on your life.  You might even get money ahead, as your adjuster catches shortcuts taken with your claim.

Thanks! I never knew about independent claim adjusters. How do I check the agents in an area?

[reeshau]

https://www.google.com/search?q=independent+claim+adjusters+michigan&oq=independent+claim+adjusters+michigan

They don't necessarily need to be local, although they should be familiar with claims in your state.  My Dad was in Ft. Myers for hurricane Ian.  His adjuster was in Louisiana.  Flew in for pictures and whatnot, and most things were handled remotely.

[sonofsven]

In the future, or for anyone else dealing with an insurance adjuster, I would make sure to have your builder or other construction professional in place  before meeting the adjuster, if possible. And definitely have them attend the meeting with the adjuster.
I just went through this with damage to my pole barn shop structure, which was crushed by a tree. Since I'm a builder I had spent a considerable amount of time thinking about how to repair the building prior to the meetup. I found the adjuster had unrealistic expectations regarding what needed to be done and how that would be accomplished.
For example, the pole building had three posts that were knocked out of plumb severely and three more that were slightly out: so the adjuster noted the need to remove and replace those posts. I pointed out the need to remove and replace all the roofing, roof sheathing, roof framing, roof trusses, metal siding, wall framing, and portions of the concrete slab. The adjuster was surprised. I asked him how he thought I should replace a wood post that was embedded roughly four feet in the ground in a six inch square hole through a four inch thick concrete slab with a roof truss still bolted to the top of it that still had all the roof framing and metal roof on it. Then he started to get it.
He was just looking at damage you could see, like those posts are crooked, get new posts, without much thought into everything that had to be removed to be able to replace the posts.

[GilesMM]

Have you read what your policy actually says?  It should clarify your coverage, unless it is incomprehensible.

[Trying2bFrugal]

https://www.google.com/search?q=independent+claim+adjusters+michigan&oq=independent+claim+adjusters+michigan

They don't necessarily need to be local, although they should be familiar with claims in your state.  My Dad was in Ft. Myers for hurricane Ian.  His adjuster was in Louisiana.  Flew in for pictures and whatnot, and most things were handled remotely.

Thanks! Should I call the insurance agent to find if they would allow independent adjustor when there is already an adjustor working on claim?
I will anyway give a call to one of the adjustor to find it out. I think I should have opened the claim and worked with the contractors to contact insurance handler, who would speak the terminology usually get the claim without issue.

[Trying2bFrugal]

Have you read what your policy actually says?  It should clarify your coverage, unless it is incomprehensible.

The Dwelling policy is vague and there are several one pager endorsements which is also vague. They sounded like if handler want to cover, not cover they can twist it. The contractor said it could have been simple from handler and he mentioned the handler is not doing a good job.

[Trying2bFrugal]

In the future, or for anyone else dealing with an insurance adjuster, I would make sure to have your builder or other construction professional in place  before meeting the adjuster, if possible. And definitely have them attend the meeting with the adjuster.
I just went through this with damage to my pole barn shop structure, which was crushed by a tree. Since I'm a builder I had spent a considerable amount of time thinking about how to repair the building prior to the meetup. I found the adjuster had unrealistic expectations regarding what needed to be done and how that would be accomplished.
For example, the pole building had three posts that were knocked out of plumb severely and three more that were slightly out: so the adjuster noted the need to remove and replace those posts. I pointed out the need to remove and replace all the roofing, roof sheathing, roof framing, roof trusses, metal siding, wall framing, and portions of the concrete slab. The adjuster was surprised. I asked him how he thought I should replace a wood post that was embedded roughly four feet in the ground in a six inch square hole through a four inch thick concrete slab with a roof truss still bolted to the top of it that still had all the roof framing and metal roof on it. Then he started to get it.
He was just looking at damage you could see, like those posts are crooked, get new posts, without much thought into everything that had to be removed to be able to replace the posts.

Thanks. Yes, I lacked the knowledge of getting the right company to talk to the insurance handler in first place. The policy clearly says they would pay for any tear and repair needed to fix the issue. But if i dont have rider, they wont pay for the actual fix, but all tear and repair. The handler says they would pay if tear is needed to find the issue, in my case since the camera says ruptured pipe they dont need to pay. When I asked him if it even make sense on how a plumbing company would dig 7 feet down the concrete when thats under staircase/crawl space which is 2 ft height. Then he said he would add verbiage to cover any repair needed. Still sent me one form stating tear and repair not covered and another stating waiting for water damage quote/fix and any repairs needed. Contractor said his instruction for his firm is rather confusing, and he would submit the quote for all required tear and repair for the work.
I would be paying 3000 on deductible and then plumbing company (4k). Out of 6 plumbing companies came, 5 who came to quote said it should be covered by insurance and rider is not required for ruptured pipe as it is not a neglect on maintenance. But still handler said the wording on policy is rather on grey area and he doesnt want to cover it. If I am not satisfied on the way it is getting handled, how would i approach it?

He did say, i can get another contractor to provide quote and they may send me the check and i can work. My friend said he could help me build the stair case with local contractor which could save some money towards the plumbing expense. I am just not sure how to play this, so I have asked the contractor insurance company have sent. But he wont tell me what quote is being sent, said only after insurance approves he will discuss on the things with me. Just felt like i have been thrown on dark.

[reeshau]

https://www.google.com/search?q=independent+claim+adjusters+michigan&oq=independent+claim+adjusters+michigan

They don't necessarily need to be local, although they should be familiar with claims in your state.  My Dad was in Ft. Myers for hurricane Ian.  His adjuster was in Louisiana.  Flew in for pictures and whatnot, and most things were handled remotely.

Thanks! Should I call the insurance agent to find if they would allow independent adjustor when there is already an adjustor working on claim?
I will anyway give a call to one of the adjustor to find it out. I think I should have opened the claim and worked with the contractors to contact insurance handler, who would speak the terminology usually get the claim without issue.

Don't call them!  They (the insurance adjuster) won't like it--it will mean more money for you!  Tell the independent adjuster where you are in the process, and let them judge how to begin.

[sonofsven]

In the future, or for anyone else dealing with an insurance adjuster, I would make sure to have your builder or other construction professional in place  before meeting the adjuster, if possible. And definitely have them attend the meeting with the adjuster.
I just went through this with damage to my pole barn shop structure, which was crushed by a tree. Since I'm a builder I had spent a considerable amount of time thinking about how to repair the building prior to the meetup. I found the adjuster had unrealistic expectations regarding what needed to be done and how that would be accomplished.
For example, the pole building had three posts that were knocked out of plumb severely and three more that were slightly out: so the adjuster noted the need to remove and replace those posts. I pointed out the need to remove and replace all the roofing, roof sheathing, roof framing, roof trusses, metal siding, wall framing, and portions of the concrete slab. The adjuster was surprised. I asked him how he thought I should replace a wood post that was embedded roughly four feet in the ground in a six inch square hole through a four inch thick concrete slab with a roof truss still bolted to the top of it that still had all the roof framing and metal roof on it. Then he started to get it.
He was just looking at damage you could see, like those posts are crooked, get new posts, without much thought into everything that had to be removed to be able to replace the posts.

Thanks. Yes, I lacked the knowledge of getting the right company to talk to the insurance handler in first place. The policy clearly says they would pay for any tear and repair needed to fix the issue. But if i dont have rider, they wont pay for the actual fix, but all tear and repair. The handler says they would pay if tear is needed to find the issue, in my case since the camera says ruptured pipe they dont need to pay. When I asked him if it even make sense on how a plumbing company would dig 7 feet down the concrete when thats under staircase/crawl space which is 2 ft height. Then he said he would add verbiage to cover any repair needed. Still sent me one form stating tear and repair not covered and another stating waiting for water damage quote/fix and any repairs needed. Contractor said his instruction for his firm is rather confusing, and he would submit the quote for all required tear and repair for the work.
I would be paying 3000 on deductible and then plumbing company (4k). Out of 6 plumbing companies came, 5 who came to quote said it should be covered by insurance and rider is not required for ruptured pipe as it is not a neglect on maintenance. But still handler said the wording on policy is rather on grey area and he doesnt want to cover it. If I am not satisfied on the way it is getting handled, how would i approach it?

He did say, i can get another contractor to provide quote and they may send me the check and i can work. My friend said he could help me build the stair case with local contractor which could save some money towards the plumbing expense. I am just not sure how to play this, so I have asked the contractor insurance company have sent. But he wont tell me what quote is being sent, said only after insurance approves he will discuss on the things with me. Just felt like i have been thrown on dark.

Can you decipher what your policy says about what is and isn't covered? The opinions of other plumbers don't count for much if they haven't read your policy.
Can you reach out to your state insurance board and see if they can offer you any help? In my state you can go online and fill out a complaint form. Be honest and describe your concerns and maybe something will grab their attention. I definitely don't know all the ins and outs of insurance work.
The insurance company is not your friend. Saying that the wording on the policy is "vague" so of course it favors the insurance company is a red flag.
You have had five different plumbers do a bid for the repairs? How do they compare to the insurance contractors bid?
Are they bidding on a repair as detailed by the insurance company or are they coming up with their own ideas to make the repair?
Can you abandon that section of pipe under the stairs in the crawlspace and pop it through the foundation somewhere else and then join back up with the main line? Trenching outside with a mini excavator is easy compared to removing a staircase.

[GilesMM]

Have you read what your policy actually says?  It should clarify your coverage, unless it is incomprehensible.

The Dwelling policy is vague and there are several one pager endorsements which is also vague. They sounded like if handler want to cover, not cover they can twist it. The contractor said it could have been simple from handler and he mentioned the handler is not doing a good job.

I have never seen a vague policy, they are normally highly specific and legally pretty tight. If the language is vague you can argue that coverage applies in your case and they will may not be able to legally defend against that.  You might have to talk to an attorney at some point.

[Trying2bFrugal]

In the future, or for anyone else dealing with an insurance adjuster, I would make sure to have your builder or other construction professional in place  before meeting the adjuster, if possible. And definitely have them attend the meeting with the adjuster.
I just went through this with damage to my pole barn shop structure, which was crushed by a tree. Since I'm a builder I had spent a considerable amount of time thinking about how to repair the building prior to the meetup. I found the adjuster had unrealistic expectations regarding what needed to be done and how that would be accomplished.
For example, the pole building had three posts that were knocked out of plumb severely and three more that were slightly out: so the adjuster noted the need to remove and replace those posts. I pointed out the need to remove and replace all the roofing, roof sheathing, roof framing, roof trusses, metal siding, wall framing, and portions of the concrete slab. The adjuster was surprised. I asked him how he thought I should replace a wood post that was embedded roughly four feet in the ground in a six inch square hole through a four inch thick concrete slab with a roof truss still bolted to the top of it that still had all the roof framing and metal roof on it. Then he started to get it.
He was just looking at damage you could see, like those posts are crooked, get new posts, without much thought into everything that had to be removed to be able to replace the posts.

Thanks. Yes, I lacked the knowledge of getting the right company to talk to the insurance handler in first place. The policy clearly says they would pay for any tear and repair needed to fix the issue. But if i dont have rider, they wont pay for the actual fix, but all tear and repair. The handler says they would pay if tear is needed to find the issue, in my case since the camera says ruptured pipe they dont need to pay. When I asked him if it even make sense on how a plumbing company would dig 7 feet down the concrete when thats under staircase/crawl space which is 2 ft height. Then he said he would add verbiage to cover any repair needed. Still sent me one form stating tear and repair not covered and another stating waiting for water damage quote/fix and any repairs needed. Contractor said his instruction for his firm is rather confusing, and he would submit the quote for all required tear and repair for the work.
I would be paying 3000 on deductible and then plumbing company (4k). Out of 6 plumbing companies came, 5 who came to quote said it should be covered by insurance and rider is not required for ruptured pipe as it is not a neglect on maintenance. But still handler said the wording on policy is rather on grey area and he doesnt want to cover it. If I am not satisfied on the way it is getting handled, how would i approach it?

He did say, i can get another contractor to provide quote and they may send me the check and i can work. My friend said he could help me build the stair case with local contractor which could save some money towards the plumbing expense. I am just not sure how to play this, so I have asked the contractor insurance company have sent. But he wont tell me what quote is being sent, said only after insurance approves he will discuss on the things with me. Just felt like i have been thrown on dark.

Can you decipher what your policy says about what is and isn't covered? The opinions of other plumbers don't count for much if they haven't read your policy.
Can you reach out to your state insurance board and see if they can offer you any help? In my state you can go online and fill out a complaint form. Be honest and describe your concerns and maybe something will grab their attention. I definitely don't know all the ins and outs of insurance work.
The insurance company is not your friend. Saying that the wording on the policy is "vague" so of course it favors the insurance company is a red flag.
You have had five different plumbers do a bid for the repairs? How do they compare to the insurance contractors bid?
Are they bidding on a repair as detailed by the insurance company or are they coming up with their own ideas to make the removing a staircase.

Yes, 7 plumbing companies. 4 gave quote. One gave quote 4k and said they need to do inside house as outside is not where pipe is broken and said wooden staircase build is simple than building porch back. I gone with this company for two reason. No upselling, came with crew instead of one person upselling and found things faster than others, was referred by one of those 7.

Insurance wont pay for breaking concrete, digging 7ft or changing plumbing. But they said they would pay for the water damage repairs, testing stair case and building back. They tore stairs yesterday and they just took it in blocks. They can put back same with minimal new stuff.
$3200 deductible+$4000 plumbing is my expense unless plumbing go higher.

Tear down, building it back to gain access on repairs is stated on  policy but sewer backup is also a separate rider which is not on policy. The handler is agreeing that I need to have access and remove stairs but say he wont think breaking floor need to be part of it as fixing the pipe is plumbing which I need to pay but getting access to it is insurance which he is not agreeing.
Once the contracting company give estimate, he said I would receive the check less deductible. In middle of the process, plumbing come in tomorrow to fix the pipe.