Types of Claims

Homeowners or Dwelling insurance is intended to protect your financial interests if your home or rental property is damaged or destroyed by a covered peril. A peril—or cause of loss—is something that causes or may cause injury, loss, or destruction, such as a hail, wind, fire, tornado, or hurricane. 

Homeowners insurance typically covers the dwelling (the house) including attached structures, and your personal property, for damage from a covered peril, up to the limits specified in your policy. Importantly, not all perils are covered by insurance policies. For example, damage caused by “wear and tear” or a “construction defect” are typically not covered.

If the available evidence shows that some of the damage might be from a covered peril, and some may be from a non-covered peril—it is fairly common, albeit incorrect, that the insurance adjuster will interpret the evidence to conclude that none of the damage is covered under the policy.

When most homeowners envision the “type” of claim they may have, they are typically referring to a claim for damage caused by a covered peril. According to the Insurance Information Institute, the most common covered perils include wind, hail, water damage, fire, lightning, and theft.

Windstorm damage can be due to a named storm (i.e. Tropical Storm or Hurricane), or simply from a high wind event. The forces of high winds can cause damage to windows, in the form of compromised seals, allowing water to seep in during a rain event. Wind can also cause trees to fall and damage fencing, awnings, roofs or exterior components like HVAC systems.

Wind damage is frequently identified in roofing systems in the form of broken and cracked tiles, or bent, creased or missing shingles. Roof systems are especially susceptible to wind forces, as a result of the Bernoulli Effect. While the most dramatic claims are seen during the aftermath of major hurricanes or tornados, not all covered windstorm damage is so dramatic. 

If your roofing system has sustained any damage due to the effect of high winds, even if there are no leaks produced, and no tiles or shingles are missing, the damage is nonetheless likely covered under the terms of the policy and should be repaired in accordance with the applicable local Building Code.

Both Florida and Texas regularly experience significant hail storms.

Substantial hail of one inch or more can cause broken windows, dented vents or gutters, dents and breaks in shingles, or cracks to roof tiles. All of this damage--while sometimes difficult to ascertain--is considered sudden and accidental, and is covered under most insurance policies. Even minor hail damage can decrease the effectiveness and life expectancy of roofing systems. If you have witnessed a substantial hail event in your area, I would suggest that you speak with a licensed roofing contractor to determine if your roofing system has sustained damage which would necessitate repairs or replacement.

Just because you do not immediately see a leak in your roof, does not mean that you have not sustained the type of damage that will lead to leaking in the near future. Turning a blind eye, and “hoping” your roof was not damaged, does not help you. If you wait to investigate and determine whether you sustained damage from a storm event, you risk waiving coverage under the policy. I regularly speak with potential clients who “waited” because they didn’t want to be the “type” that files an insurance claim. Then, when they do realize they have hail damage that needs to be reported, the insurance company holds the delay in investigating against the homeowner and argues that the “delay” caused the insurance company to be prejudiced, and therefore there should be no coverage.

If you suspect a storm was in your area, and may have caused damage to your property, please call Your Insurance Claim Lawyer, at 407-542-9999, to discuss your options.

Not all water damage in your home is caused by a leaking roof. Water damage can happen suddenly and accidentally from broken or frozen pipes, leaking water heaters, A/C leaks, and even broken fish tanks. When these events happen, the water must be quickly dried up and removed, before mildew or mold can start. If you sustain damage from water, call your insurance company immediately to file a claim. Most insurance companies will help you identify a contractor to handle the “dry-out” work. If the damage is extensive enough, you may need a second contractor to help you with the “rebuild” portion of the claim.

Frequently, these contractors will (and must) act so quickly, they do not yet have approval or agreement from the insurance adjuster to pay for the damage. DO NOT rely on the contractor to get “approval” from the insurance adjuster for the work that needs to be done. I recommend that you insist on an email from the adjuster agreeing to pay for the damage sustained. If an adjuster is hesitant to put the agreement in an email, you should respond in writing and ask them why.

The name of the game in water damage claims is to get as much documentation in writing as possible. It never ceases to amaze me how quickly the insurance company and the contractor will “forget” everything that was discussed regarding the damage and what part will be paid for by the insurance company. The lesson: Handle Everything in Writing (by email).

If you find yourself in a water damage claim, in which the insurance adjuster and the contractor are not documenting what will be covered or not covered, in writing, please give me a call to discuss your options.

Fire and smoke claims are rarely denied, except in cases of suspected negligence or arson.

If an insurer claims that they suspect fire or smoke damage was caused by arson, and they are seeking to deny coverage, the insurance company has the burden to prove arson. Proving arson, that waives coverage, is very difficult. If an insurer is denying coverage on the basis of a suspicion of negligence or arson, please call me to discuss your obligations to cooperate with the investigation, so that we can best protect your interest in coverage for the loss. There is never a fee or cost for a consultation of this type.

While the obvious result of lightning is fire, lightning can also cause considerable damage to electronic systems, and can cause force of impact damage to roofs (i.e. holes left behind). Damage due to fire or force of impact is relatively easy to identify and assess. Damage to electronic systems or equipment is far more difficult to assess. If you suspect a lightning strike caused damage to a piece of equipment in your home (i.e. ‘it worked fine before the storm, but not after’), you must be careful to document the cause of loss. The equipment should be assessed by a licensed professional, with the appropriate level of knowledge or experience to identify the damage caused by lightning.

MOST IMPORTANTLY, if you repair or replace the damaged item, DO NOT allow the technician to take away or throw away any components that were replaced or repaired. Any damaged components should be wrapped in protective plastic and kept in a safe place, until the insurance company’s adjuster has ample opportunity to review and investigate the parts. Even if they say you are free to get rid of the parts, DON’T DO IT, until you have been fully paid for all damage.

When in doubt on this issue, please call me at 407-542-9999, there is never a fee to call me, for any reason.

When a homeowner sustains a loss due to theft or vandalism, they may feel violated or personally harmed. This can cause a homeowner to act rashly, without thinking through statements they are making, or fail to consider how the insurance adjuster may only be asking questions that will help the insurance company find a reason to deny a claim. If you experience a loss related to theft or vandalism, first call law enforcement to report the loss, then call Your Insurance Claim Lawyer at 407-542-9999, to discuss your obligations in reporting the loss to the insurance company and how to best protect your interests in a fair investigation and adjustment of the claim. As always, there is never a charge of fee for the call. Let’s discuss to put you in the best position to make the insurance company keep their promise to cover the loss.

When it comes to tree damage, clients typically envision a tree being blown over by the wind and landing on your roof. Of course that is damage that would be covered under your policy, but trees can cause other damage that is not so obvious. Tree roots can interfere with plumbing systems. A tree that has moved during a storm event may have caused damage under the ground to the foundation of a structure if the root system was near the foundation, or if the movement of surrounding soil cause the foundation to heave or settle from the movement of the tree. Depending on the wording of your policy, all of these types of damage may be covered losses.

The more common problem I see related to trees, is when a neighbor’s tree falls across a property line and causes damage to your property. Because the tree in question was on the neighbor’s land, clients frequently assume the neighbor’s insurance should cover the damages (this feels correct, but it is not). Accordingly, many clients will not file a claim with their own insurance company. Legally, this is the wrong approach. While you may be concerned about rising premiums for filing a claim, filing the claim with your insurance company is the only way to ensure that you get paid the full amount owed for the damage to your property.

If you find yourself in this circumstance, please call me to discuss. Be sure to protect your rights to get fully paid for the claim before you go down the path that feels correct but which may be legally wrong. 

You can reach me at 407-542-9999. As always, there is never a fee, charge or obligation to call me. Please don’t wait.