The incoming stories from real victims continue to amaze me. Today, I received this from Mark (I've withheld his last name) who has been a professional adjuster himself. I'm including my responses to him:
At 11:41 AM -0600 12/3/03, Mark (Last Name Withheld) wrote thusly:
MARK: Rob,
I've handled property insurance claims, including homeowner's losses for over 20 years, both as an independent and staff adjuster. While I was an independent, I handled some homeowner's claims for State Farm. As a staff adjuster, I worked for Fireman's Fund, the Hartford, CIGNA and ACE USA. And in that time, I've handled many claims for leaking and broken shower pans.
ROB: Hi Mark:
I'm interested! Always can use some good information.
MARK: As an experienced adjuster, I can tell you that what the claim representative may have been looking for is evidence of a sudden and accidental break in the shower pan as opposed to wear and tear or deterioration over a period of time. Most homeowner's policies would pay for one loss and probably exclude the other. Even so, many policies have language, for example, that will pay for repairing a broken pipe within a wall even if the break occurred from corrosion over time. Yours appears to have such language. In my experience, however, shower pans, depending on their construction and installation, are a major maintenance problem and, as a result, are a major leak hazard.
ROB: Here's the first issue: By all accounts (from leak detector people and plumbers) this was a sudden break, although neither speculated as to the cause of the break. As I write in the blog, even the State Farm agent said that "if a 500 pound man was in your shower and the shower pan broke, that would be covered."
At that point, I told him that indeed, I NOW remember a 500 pound man jumping up and down in my shower! NOW will you fix it? Obviously, he said no. But the point remains: State Farm would cover it if it were a sudden break. They simply choose not to view it that way, because they haven't investigated it thoroughly.
MARK: Your story did not have sufficient details to assess whether or not State Farm made a fair decision based on your insurance contract but their bedside manner certainly seems to have left much to be desired. As I'm sure you know, no homeowner's insurance policy is meant to be a maintenance policy on your home although many people today, especially in tough economic time, try to use them that way.
ROB: Absolutely. And I'm not a hand out kind of guy. I repair my own sprinklers, seed my own lawns, etc. I can't even remember when I last filed any claims.
MARK: Regardless, I was taught early on in my career that my job was to find a way to pay a claim - not find a way to decline it. As such, I've always given the insured the benefit of the doubt unless the evidence against the claim is undeniable and the policy language against coverage is unavoidable. The companies that I've worked for have more or less embraced that philosophy. And I've found most of the claim reps I've worked with to be even-handed and fair-minded people. After all, they're homeowners themselves and carry the same homeowner's insurance. Hopefully, although this doesn't sound like the case with you, they treat other claimants as they themselves would wish to be treated.
ROB: I was hoping so. But I was disappointed.
MARK: Never-the-less, I continue to hear and read personal horror stories from neighbors, friends and in the media about how claims are mishandled often times from lack of experience or from a contentious attitude or mean spirit on the part of the insurer. As an example, a friend of mine had his roofing claim denied after a hail storm damaged many houses in our area including mine. Even though houses to all sides of his had major hail damage, the adjuster (not State Farm) told him that the trees shielded his roof from the hail. I inspected his roof myself, and although it was heavily deteriorated and, as such, it was difficult to discern hail damage in the asphalt shingles, the metal chimney flashings and caps had a multitude of pock marks. When I asked my friend about whether or not the adjuster had seen that damage, he said the adjuster explained away the damage by blaming it on falling acorns!
ROB: Well, there you have it: there's this attitude on the part of some adjusters that seems to be saying, "the burden of proof to get coverage is on the homeowner." Hardly the stuff of the "good neighbor" commercials we watch on TV. My sense is that since State Farm is going to have to pay out heavily for the California fires, they're putting normal, legitimate homeowners on the back burners, so to speak. Hoping we'll go away.
MARK: I told my friend that he had paid for a replacement cost policy and that even though the insurer may not wish to replace his deteriorated roofing, if it was damaged by hail, they had a legal obligation to do so. I told my friend the adjuster would sound pretty pathetic using his acorn explanation before a judge and/or jury. Instead of filing a complaint with the state department of insurance or filing suit in small claims court, my friend unfortunately chose to replace the roofing himself at his own expense because he didn't believe he could successfully fight the insurer. The worst part of it was, his insurer, after declining his storm damage claim, sent him notice that he had 30 days to replace his deteriorated roofing or else they would cancel his policy! At least they didn't cancel his policy for making a claim like some other insurers have done.
Mark (Last Name Withheld)
ROB: Amazing. Thank you for your story, Mark. I'm publishing it (without names, of course) on the blog site for others to read. This is good stuff from a real professional.