Expectation versus Reality: When Insurance Providers Fail You

Being in the industry of property development for several years has enabled us to encounter different cases from our clients. As part of our commitment to deliver after-sales assistance and other forms of services, we are exerting our efforts to make our clients feel that they can count on our support. This includes insurance claiming.

Depending on the case, our company is sometimes approached for several purposes like for investigation, to complete an assessment or to acquire some documentation.

Overall, we try our best to help our clients sort out their problems and issues with their property insurance provider. 

Case Scenario: Denied Claims

We have seen a client whose water damage insurance claim has been denied. Apparently, the original cause of the water damage is unknown and it all started with a minor leak on the kitchen pipe.

When the pipe burst, the homeowners were at work so they did not have an idea that water has already taken over their entire home. Upon arriving home, they were shocked and devastated to discover that the entire first floor of their house is soaked in water from the burst pipe and a lot of furniture has already been damaged.

The first thing that came into their mind is that their property is insured and everything can be fixed.

When they filed for insurance coverage for the damaged floor, boards, furniture and other appliances, they were denied any claims due to the element of neglect.

The investigation report states that there is already long-standing damage to their kitchen pipes as proven by severe mold infestation all over their kitchen counter which was caused by prior leaks.

The homeowners were aware of the minor leak but they never suspected that it is an indication of something that’s more serious.

Due to their busy schedule, they were unable to fix that small issue right away which, later on, escalated to a much bigger problem and resulted in a complete disaster. 

adjusters help
Adjusters team

Resolution of the Case

The head of the family decided to seek the services of a Miami Public Adjuster to reopen the case and negotiate for fair and reasonable insurance coverage. The Public Adjuster took care of all the documents and substantiated all the evidence.

Our office was approached for some supporting documents. One of our staff personnel was also asked about several questions that could help the case. 

After a few weeks, the homeowners were able to get insurance coverage with the assistance of their Public Adjuster and they received a fairly acceptable settlement.

They informed us right away because they needed to have their property repaired and restored the soonest time possible. Being the developers of the property, we communicated with them and made all the necessary arrangements.

We also reminded them about some restrictions when it comes to repairs and restorations in compliance with developer’s policies and guidelines.

Moral of the Story

While insurance companies can offer you peace of mind, things do not always turn out the way you expect them to. There are some matters and decisions that you will never fully understand because that it how insurance companies work. They have their own language and interpretation of certain situations, especially on insurance claims. 

An insurance policy does not always guarantee insurance coverage. It is far more complex than that because the incident has to go through a string of assessment, investigation, and evaluation.

On the brighter side, being aware of your rights as a policyholder can give you viable options such as hiring a Public Adjuster to represent you and negotiate on your behalf. 

On a final note; a tiny problem that is left untreated can escalate into something more serious and destructive. The best thing that you could do to protect your property is to pay attention to the minor details and to become mindful about the small issues.

Attending to the problem right away can spare you from a lot of stress and inconvenience. Remember, prevention is still a lot better than the cure as the old saying goes. So before any problem gets worse, take the necessary action. 

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