When something bad happens, most people’s first thought is whether insurance will cover and pay for it. Their next step is to pick up the phone, call and ask us. While we wish we could simply tell everyone that “it’s covered,” it is more complicated than that and we’d like to explain why.
In any potential home insurance claim, there are key facts that must be known to make a coverage determination – chief among them is the cause of loss. Determining the cause of a loss isn’t always easy. Many times, it isn’t known on the initial call and requires a contractor or adjuster to investigate and make the determination.
For example, let’s assume we receive a call from a homeowner who has noticed water staining on their bedroom ceiling. They don’t know, or disclose, anything more and want to know if there’s coverage. Unfortunately, we can’t say if it is covered because we don’t have enough information available. We don’t know the water’s source, what has caused the water to recently appear, and we haven’t seen the property or photos of the damage.
Insurance company adjusters are the experts, and their first responsibility is to identify whether coverage is applicable. This includes establishing the cause of loss and reviewing other pertinent details surrounding the claim such determining the time of loss. A formal acceptance or declination of coverage can only be issued once all necessary information has been gathered and reviewed.
In our above example with water damage to the ceiling, we’d recommend the insured contact a contractor of their choice to gather additional information and obtain an estimate for repairs*. Only once we have all vital information would we be able to make an educated recommendation.
*We have found that most minor repairs often cost less than we may think. Filing a small claim doesn’t make economic sense, so always seek a repair estimate before you file a claim.
Keep in mind that most home policies exclude the following causes of loss:
- Ordinance and Law
- Earth Movement
- Water Damage (Flood, Water Backup, Below-Surface Water)
- Power Failure
- Nuclear Hazard
- Intentional Loss
- Government Action
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