Forums

Why would a clogged sewer line that needs to be replaced... be covered by insurance..... this is not the first time and you can bet on that. Tell me the company and I well expose them as give away artist. Now if this is a state that says a new sewer line is needed, but I don,t think any state will say that. Ever heard of maintance claims...... not covered.  I bet the house is 50-60 years old with clay tile sewer lines with black cast pipe under the foundation.

Which policy in the USA covers old work out clay tile or concrete sewer lines broken by tree roots.... None that I know off. Send in your report with this set of facts and someone that lknows coverage will write the deniel letter for you.

I don't see what you said the carrier said for you to cover? Was there damage from the backup inside the home? did the interior damage exceed the deductible?
There should not be any coverage to replace the sewer pipe. Like above that is a maintenance item and is the responsibility of the insured. You surely don't need a back hoe or auger for interior damage. this is not sudden and accidental. These type problems start out small and get worse over time.
I would have your supervisor do a serious check on coverage for this claim. Especially before you waste a bunch of time on it. if your superiors say it is covered tell them you want to put their name on it showing they said it was covered and to proceed then.

 Here again might be an example of never say never but it would be the first time I have seen the pipe it self covered.

He has likely got hold of a staff person that said simply "sewer backup is covered" without considering what the full facts were or what the claimed damages are. I would email the staff person with the full FOL and get in writing what they want you to cover. Unless this is some sort of 3rd part liability against a contractor or someone who damaged the sewer line, but the original post did identify the occupant as PH or policyholder. This certainly would not be covered under my HO policy.

JWG

Thats good advise non better than that

JWG:

You're right - I was going to deny it and called the Insurance Co's examiner who has this claim; she staed unequivocally that it is covered. Don't ask me how, but I wasn't going to argue. I even pointed the Exclusion out in the HO3 and she said that it applies to municipal water backups. Further, she said that she'd approve it.

Thus my problem - do you have any suggestions as to how to scope/estimate this damage?

Thank you,

Jim Teer

Ray:

You're right - I was going to deny it and called the Insurance Co's examiner who has this claim; she staed unequivocally that it is covered. Don't ask me how, but I wasn't going to argue. I even pointed the Exclusion out in the HO3 and she said that it applies to municipal water backups. Further, she said that she'd approve it.

Thus my problem - do you have any suggestions as to how to scope/estimate this damage?

Thank you,

Jim Teer

Ask this examiner how far she wants to go on this coverage. Have her put it in writing and then do just as she says.

It's their cow you milk it the way they want it milked.

Posted By Jim Teer on 14 Sep 2010 02:52 PM

JWG:

You're right - I was going to deny it and called the Insurance Co's examiner who has this claim; she staed unequivocally that it is covered. Don't ask me how, but I wasn't going to argue. I even pointed the Exclusion out in the HO3 and she said that it applies to municipal water backups. Further, she said that she'd approve it.

Thus my problem - do you have any suggestions as to how to scope/estimate this damage?

Thank you,

Jim Teer

Get the plumbers estimate, make sure no improvements are considered, write the estimate, in the narrative cite the exclusion and the examiners overide, get paid. This is an oversimplification, but cover your self, with emails, phone calls can be denied. Yes its happened before.

JWG

First pinpoint the location of the leak. American Leak Detection, or a similar company, has the equipment to do this. Some plumbers can do it.

I have seen it done, and it involves a transmitter on the end of the snake that goes through the drain line until it reaches the blockage. Then a handheld receiving device finds the location of the transmitter on the end of the snake, and that is where the blockage is located.

I think Xactimate has a unit cost to "camera a drain line". I think it is about $250 or so in Xactimate, but it costs about $350 minimum in my area.

The location procedure will determine if the blockage is in the yard under dirt, or if it is under a driveway or patio slab, or under a tree, etc, etc. Assuming it is in the yard, out in the open, the cost to repair will be whatever a plumber will charge to dig down by hand to reach the drain line, and then repair the drain line, and backfill the hole. If its not under a slab, I don't think any special equipment will be needed to make the repair.

Figure a two man plumbing crew will take all day (8 hours each man) to make the repair after the blockage is pinpointed, plus equipment, plus material. Whatever the plumber's labor rate is, plus truck charge, plus the material to make the repair will be a good starting point for an initial estimate.

After the blockage is located, you can bet the plumber won't have the proper pipe on his truck to make the repair, so he will have to go to the supply house to get it, which should be included in the 8 hours.

Once the blockage is located, a snake should be run down the rest of the drain line to make sure there isn't another blockage down line from the first blockage.

I have seen this procedure take two full days on a complicated drain system, so the above is just a starting suggestion.

Good Luck!

I am not disputing anything Medulus and Joe Black posted. These claims were called foundation claims. The start was a Corpus Christi Lawsuit in about 1992. These claims were for broken slabs that was caused by under slab,broken sewer drain lines. Most of these lines were 2 and 4 ihch cast iron pipe placed in Lake Charles clay soil (native to this area of Texas) and not in a trench filed with sand as back fill. The jury instructions was on the Contents coverage of the the ole standard Tx HOB. This soil is very moveable with weather conditions and large tree roots sucking mosture from beneath the foundation. A plumbing test would find the broken pipes under the dlab and an engineer could determine the low areas of the slab, and the house would be jacked up and piers would raise the low spots.  These losses ran from 15K to 20 K or more.

As I recall we did not concern our selves about the drain lines not underneath the foundation as it would not make the slab have any movement. Most of the movement was a plumbing leak under the foundation that (may ) have caused movement.

We also had upheavel of slab foundations, that was turned down, because some clay was brought in to raise the foundation about 1 to 2 foot above the flat rice patty the house was now build on. (It was a rice field 30 years before) This was a bad TX law that cost HOB writers millions.... but they just kept raising the HOB premiums each year to catch up. TX was also the shower pan capitol for 25 years, until sudden and accidental creeped back into the policy language.

I remember the year was between 1994 and 1995 when the HO-3 language was changed to eliminate "seepage claims". I was working branch assist in Atlanta both years. Lost a lot of good billers in 1995.

Today most PVC 4 and 2 ich drain lines are in a trench in a bed of sand, not clay backfill.

This is a claim that shows the world of adjusting losses what happens when a claim is reported. It is repored to a call center, then it is revewed by an adjuster wo makes a field assignment.

It,s unknown what the first report was, but it was probably something like this. When I flush my commode it drains very slow and some times spills over. The inside adjuster ask about the plumber.s opine and hears the outside clean out problem with dirt. This indicates an investigation is needed.

Now if this same insured had his auto insured and called in stating his call will start, but when he drives it 5 miles it stalls. Would you call for a field inspection-investigation or tell the owner to have a good mech. look at the car and call you back... In my opine this loss should have never been seen by an outside adjuster until the cause of the drain problems are known..... "we need not accept any property (dwelling) abandoned by the "insured".

In plain language from the insureds  standpoint "it,s not my problem, its yours" thats Abandonmant of property.