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Do you understand that your participation to read or respond is voluntary?

Just because you do not want to particpate does not mean that I don't.

I have benefited from the exchanges.

I like to see all the arguments that can be thrown out against the payment of the claim so that I can address them and research them.

I try to answer every legitimate response. I ingored the ones with inflammatory language like the one that simply said "it smells".

 

Talkin' to this guy is like talkin' to a stump.

He's not gonna go away because we don't agree with his stance on this.

Where's the "Red Hand" when we need it?

Happy Trails

Two thoughts.

First, the basic tenet of insurance adjusting, the very first thing to be done on every claim, is to check coverage. As we do not have access to the declaration sheet any discussion regarding coverage is moot.

Second, some advice for the insured. A unvented sump pump should drain somewhere other than a sewer. If a sump pump drains into a sewer it should have a P-trap and and a vent.

The reason for a P-trap and vent has to do with sewer gas. Sewer gas (methane) is explosive and can backup into the basement, where it can ignite and explode.

I will send you a link to the insurance policy, endorsement, and declination letter. You can post all or any portion of it you wish. I have sent the link to others that have replied as well. Anyone who wants a link can e-mail me at jim@wangerin.com . Since the file is encrypted and secure, I need to have an e-mail address to grant access. You are welcome to share your e-amil address and the password that is generated for access if you want so that others can access the policy, endorsement, and declination letter.

There is no sump pump.

I assume the basement floor drain has a P-trap.

A vent was added after the overflow of the drain.

The house is a 100 years old. There is an antique washing machine in the basement. I am sure the drain was used to drain water from the washing machine although not by the insured. The basement floor drain worked well until it became completely overcome with water. There was never a smell of sewer gas.

 

A correction to my prior reply. I was not able to find an e-mail address for you so Ididn't send the welcome e-mail to access the files for policy, endorsement, and declination letter on share file.

However, I am willing to share the access to the information for anyone that wishes tohave access. The HO3 policy, endorsement, and decliantion letter are 37 pages. I would be surprised that such lengthy documents are posted here.

You can access the policy, endorsement, and denial letter by opening the insurance file by doing the following:
Go to https://wangerin.sharefile.com
enter user Id: forums@catadjuster.org
enter password: 0CAM10P5

It is possible to disagree without being disagreeable.

Flood is defined in policy endorsement which can be viewed (along with policty and decliantion letter) by going to

https://wangerin.sharefile.com

e-mail address to enter: forums@catadjuster.org

password: 0CAM10P5

"Flood" means a general and temporary condition of partial or complete inundation of normally dry land areas from ...

"Flood" does not mean standing water not caused by "flood", on the residence premise, that does not leak or seep through walls, windows, and/or external openings of windows of the dwelling and/or other structures.

The flood insurance carrier and appeal to FEMA both determined there was no flood.

Since they determined there was no flood, a claim was filed against the endorsement in homeowner's policy that covers overflow from system designed to remove water from foundation area.

The 18 inches of standing water in the basement was a reult of overflow from drain designed to carry water away from foundation.

The concrete basement and foundation walls do not have any cracks in them. The water did not come through the walls but from water underneath the foundation.

The basement had a root cellar that allowed the water under the foundation to flow into the basement and out the drain. The drain became overwhelmed with water and overflowed.

When I represent taxapayers, I think it is wise to settle the case at the lowest level possible.
I would think that the same would be true for independent adjusters.
My understanding is that insurance companies will not settle with attorneys and force the case to go to trial. They feel that this discourages more lawsuits even if they lose. i think it has been an effective strategy.
However, in this case the insured is not represented by an attorney.
I don't think it is wise for insurance companies to not attempt to settle claims at the lowest level possible.
One would want to get an honest opinion from an expert. An opinion that is biased towards the insurance company asking for the opinion may actually be a disservice.
Here is a claim that could be settled for a couple thousand dollars.
If it goes to court, treble damages and attorney fees and costs could be awarded against the insurance company. The damages could easily be detemined to be the policy maximum of $5,000. Treble damages could be determined to be $15,000. Depositions would need to be taken of at least 25 people that I can think of. There could be a court award for attorney fees and costs of $60,000 or more.Fees for the insurance company attorney could be another $60,000 or more.
If the flood isssue is raised, it could literally become a federal case with actual damges equal to $70,000.
The homeowners insurance carrier and flood insurance carrier could get together and each chip in a few bucks to settle this case.

No, Sir, they can't "get together and each chip in a few bucks to settle this case".

First, there must be coverage under the policy. You say you have a letter declining to pay the claim due to no coverage.

If this is the case, there is no need to go any further.

No coverage, no claim. Really pretty simple.

Happy Trails

Thanks for all of your responses.

Just a further note on the sewer gas thought, methane gas/sewer gas is odorless and colorless. That is why there's a federal regulation that mandates the addition of the rotten egg smell that we associate with commercial natural gas. If I remember correctly, in a prior post you mentioned that there is a water heater in the basement.

My suggestion is that you determine where the drain leads, if the water in the basement is drained into a city sewer or septic tank then a P-trap and a vent is badly needed. Hiring a licensed plumber is advised. my suggestion is that the drain needs to be rodded out and a P-trap and vent installed.

My expectation is that the Insurance Commissioner will give the claim a cursory examination and request documents from your carrier. Should the Insurance Commissioner agree with the carrier it is unlikely that a court will overturn the decision.

Dear OkcLarryD,

I am asking for a second opinion.

It is kind of like if you asked for a second opinion from a doctor.

The patient would hope for a another diagnosis not just simply a statement that it is simple because you already have a diagnosis from another doctor.

Sorry about the confusion. I need to be more clear in my communications.

 

Jim, In your own words from your first post you wrote this:

There was seepage from foundation resulting in 18 inches of water standing in basement for 21 days.

_____________________________

I understand that you are very passionate concerning this claim as it directly affects your child (monetarily), however you can't change the senario when it suits your needs.
___________________________________

In reading the denial letter that the insurance company sent you the only fault that I find is that they were to broad in quoting exclusions from the policy. IMHO they should have only included information from the policy which was directly pertinent to this loss.
This overload of information would be confusing to most insured's.

As I posted earlier, sometimes an enorsement can overide an exclusion in the main policy form. Mr. Wangerin's endorsement appears to do that, but not for seepage. His endorsement also doesnot appear to cover the scenario he described, if you read it carefully.

The endorsement mentions "backup" and "water which enters into and overflows from within a sump pump".

Let's analyze both "backup" and "water which enters into and overflows from within a sump pump":

A backup is typically water or sewage from someone else's property. If your home is on the base of a hill and some fish guts, sewage, and grease from the sea food restaurant up the hill comes flowing the wrong way out of your toilet THAT's a backup.

If your teenager takes a 1 hour shower on the second floor and the water can't get down the sewer line due to roots etc. blocking the line, and the water fills up the downstairs toilet and overflows, that's not a backup. That's your own waste water that couldn't escape down the drain and OVERFLOWED into your first floor bathroom. It didn't "backup" from some where else and go in reverse direction up your sewer line- it simply never went down your sewer line in the first place. Such a loss would usually be covered even if there is a "backup" exclusion. Even if the homeowner calls the toilet overflow a "backup" or their plumber calls it a "backup" it is not a "backup" and should usually be covered on an "all-risk" policy. (but not covered on most named peril policies).

Now I want to look at "water which enters into and overflows from within a sump pump". My common sense tells me that the insurance company may have intended to offer an endorsement that covers damage from water that is not promptly pumped away by a failed sump pump. My common sense tells me that it makes sense for the insurance company to deny damage from a long term ongoing natural circumstance, such a water seeping from a foundation. And they do. My common sense also tells me that if a homeowner installs a sump pump to take care of this problem; purchases a sump pump endorsement; and the sump fails, resulting in water damage, maybe this should be covered.

However we can't rely on "common sense" of what sounds fair or how we would have designed the policy, or what we think it should say.

We have to llok at the actual wording "water which enters into and overflows from within a sump pump".

It doesn't say "damage from water that is not transported away due to sudden failure of a sump pump"

It doesn't say "damage from water that is not transported away by the sump pump fast enough due to a poor design or partially clogged line."

It talks about water that eneters within the sump that comes back out of the sump pump, not water that hasn't yet gone into the sump.

It looks like a strict reading of the endorsement means that water comes the wrong direction back into the basement because of a failure of the sump pump might be covered, but water that NEVER LEAVES THE BASEMENT IN THE FIRST PLACE is not covered.

Kind of a harsh interpretation for Mr. Wangerin but that's how the endorsement is written.

What's interesting is that the insurance company mentioned that the sump was working, based on their investigation.

Perhaps they beleive the sump was pumping water away, but just not fast enough. And they don't think water flowed the wrong way back into the basement. If the sump was working, but was struggling due to age or overheating or maybe undersized, that is not a "Failure" of the pump in my opinion. But it doesn't matter if the pumping action "failed" or stopped. The critical issue is did the water come out of the sump pump (within)?. Maybe the sump pump has a little check valve that allows the water to go down the line and not backwards, and that check valve failed, and the water came the wrong way, then maybe the endorsement would kick in. My garden hose is connected to an anti-siphon valve which serves this function, to prevent water sitting in the garden hose from getting sucked back into the house pipes. The anti siphon vallve on a dishwasher does the same function. It keeps dirty water in the dishwasher from coming out the kithchen sink faucet.

If Mr. Wangerin can show that his pump stopped operating or failed in such a way as to allow water to flow the wrong way back into his basement he may have a compensable claim. If he can show that the pump worked intermittently, pumping water for a few minutes, stopping, allowing water to reverse into the basement, then starting up again, he might also have a compensable claim.

If he just proves somehow that the pump stopped at all, the company might give him the benefit of the doubt and pay him.

It seems like the endorsement only covers certain specific sump pump scenarios, not all sump pump problems.

My understanding from all that has been written here is he does not have a sump pump at all only a drain.

His denial letter mentions his sump pump working. You have to go to the website he posted.

The polciy language is "water which enters into and overflows from within a sump pump, sump pump well or other type system designed to remove subsurface water which is drained from the foundation area."

There is no sump pump.

The system is a partial basement with items sitting on pallets to keep them from getting wet while the water is drained from the foundation area.

HORIZON III REAL ESTATE v. HARTFORD FIRE INSURANCE COMPANY No. 00-CV-2420 JMR/RLE. United States District Court, D. Minnesota. February 11, 2002. is a case that indicates that the water does nothave to reverse direcction to be an overflow under a similar endorsement.

Here is an exceprt from Horizon v Hartford:
In relevant part, the applicable policy provisions state as follows:

A. COVERAGE
* * * * * *
3. Covered Causes of Loss
RISKS OF DIRECT PHYSICAL LOSS unless the loss is:
a. Excluded in Section B., EXCLUSIONS; or
b. Limited in Paragraph A.4, Limitations; that follow.
4. Limitations
a. We will not pay for loss of or damage to:
* * * * * *
(3) The interior of any building or structure caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless:
(a) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters[.]
B. EXCLUSIONS
2. We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss.
* * * * * *
g. Water
* * * * * *
(3) Water that backs up from a sewer or drain[.]
Exhibit A attached to Affidavit of Mark S. Brown.

Additionally, Horizon's policy secured "Stretch Coverage" for "back up of sewer or drain water damage." The Stretch Coverage provided as follows:

(9) Back up of Sewer or Drain Water Damage
We will pay for loss or damage to covered property caused by water that backs up from a sewer or drain. However, this Additional Coverage does not provide coverage for loss or damage due to water emanating from a sump pump well or similar device designed to prevent overflow, seepage or leakage of subsurface water.
The most we will pay for direct physical damage is $25,000 at each described 1006*1006 premises which is listed in the Declaration.
Id.

Given this language, Hartford contends that the damage to the Howard Terrace, regardless of the course that the water followed before it flowed onto the basement floor, was covered by virtue of the "Stretch Coverage" for "Back up of Sewer or Drain Water," which it has already paid to Horizon. Beyond that "Stretch Coverage," Hartford maintains that the policy language does not cover the loss Horizon sustained, because of the plain, and unambiguous language, of Limitation A.4.a(3).

Couple of things:
1) Do you have the same policy form and form date as the Hartford policy in the quoted case?
2) If you have all the answers, why are you asking us for our opinion. Should you not be seeking the opinion of legal counsel in the applicable jurisdiction?

Just my .02

Leland states, "If he just proves somehow that the pump stopped at all, the company might give him the benefit of the doubt and pay him."
There is something that court cases call reasonable expectations of the insured.
In this claim, there was no sump pump but the basement floor drain provided that function.
The basement floor drain was not vented and when it became overwhelmed the water overflowed above the pallets designed to keep the hot water tank and other items out of water. This resulte din loss of for example thehot water tank.
To demonstrate the failure of an unvented drain: submerse a straw in a glass of water, put your finger over the top of the straw, and remove it from the glass. The water will not flow out of the straw until you allow air to enter into the top of the straw.
jlombardo states: "1) Do you have the same policy form and form date as the Hartford policy in the quoted case?
2) If you have all the answers, why are you asking us for our opinion. Should you not be seeking the opinion of legal counsel in the applicable jurisdiction? "
The policy and endorsement are similar to the hartford policy but not the same. I have previously listed a link to the actual policy in this claim. For one thing, this claim is limited to $5,000.
I don't even have allthe questions let alone the answers.
I am particiipating to gain an understanding. Just because someone is an attorney does not mean that would make them an expert on this particular matter. The attorney would need to gain an understanding in a manner similar to the way that i am doing. That would include seeking an expert opinion, which I have indicated that I am willing to pay for.
If unable to get the insurance company to reverse their denial, this small case (limited to $5,000) will go to small claims court. Attorneys are not allowed in small claims court in Montana.