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Last Post 11/24/2009 9:54 PM by  BobH
IICRC S500
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StormSupport
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08/16/2008 6:51 PM

I have tried to stay out of this topic but I finally have to speak up.  I've heard everyone's opinions regarding mold and I'm here to tell you that there are people who are sensitive to mold and that sensitivity can and does cause real health problems for some. 

Some years back I unknowingly moved into a duplex in VA that had been flooded during Isabel.  They were in the process of remodeling the kitchen and I was in and out of there for a week to 10 days moving small things in with no problems whatsoever.  Finally when I took possession of the place I dug in and started cleaning, only to wake up the next day with my entire face swollen and my eyes nearly swollen shut.  I went to the local emergency room, and by that time I had developed a cough and sore throat.  The doctor diagnosed my problem as a severe allergic reaction and gave me steroids and kept me overnight, to make sure my throat didn't close up completely.  Needless to say I was miserable.  I actually had blisters under my eyes filled with fluid.  It took about a week or so for all the swelling to subside, and at that point I had no idea what the problem was.   

Some days later the crew came to complete the kitchen remodel, and when they pulled the bottom cabinets out all the walls behind the cabinets were black....shall I tell you with what or can you guess? 

A later follow up with an Allergist and lots of testing found me to be highly allergic to several types of molds.  And now I am very careful when I think I'm around molds to wash my hands and face several times, use a breathing mask if necessary, and I alway have an emergency supply of benedryl handy just like someone who's allergic to bees.  Granted, had I not had my hands all over the everything cleaning, and probably wiping my face during that time I may not have been affected, but apparently the contact was enough for me to have a severe reaction.  The mold beind the cabinets may not have affected me had it stayed contained.  I don't know, but I do know I ended up in the hospital and the cause was mold. 

So, whether or not you think the issue with mold is real or imagined, I'm here to tell you that there is a very real threat to some people, just as other sensitivities or allergies effect others in different ways.   End up in the hospital due to mold and you'll think differently about it. 

Do the right thing, ALWAYS
~Meg~
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Hogan53
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08/16/2008 11:11 PM

 

        Meg,your experience is not uncommon. Something that the folks here don't get is that no two immune systems are the same.

  What does not affect Bob or myself might make you very ill..........ask any allergist,not an adjuster,and you will get the true story

 on mold and its affects on people. It is said that 98% of mold is non toxic.......it is the 2% that you need to be concerned about.

   Of the 2%, a small percentage of folks get quite ill,others get symptons of sore throat,fatigue,headaches,etc. The MAJORITY

  have no symptons whatsoever.   Attorneys have turned this into an issue,not contractors. Having said that,when my ass is on

 the line,I will do whatever needed to remediate,especially when I have an IH over my shoulder waiting for me to fail a

  clearance test.

 

 

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BobH
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08/16/2008 11:21 PM

Mike, what part of the USA are you working, and are you seeing Insurance claims that include payment for mold remediation as part of the claim (allowed scope of repair).

Posted By Mike Hogan ...Having said that,when my ass is on the line,I will do whatever needed to remediate,especially when I have an IH over my shoulder waiting for me to fail a clearance test.

When you say "IH" my understanding is that this is an abbreviation for a Certified "Industrial Hygienist" is that correct?

Bob H
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08/16/2008 11:51 PM
Posted By Bob Harvey on 08/15/2008 11:48 PM

  But I quit arguing against carriers in how they want to respond to alleged mold issues, it is their interpretation of the policy and their ball game.

 I agree with you on this Bob

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ekraft
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08/16/2008 11:59 PM
Posted By Bob Harvey on 08/16/2008 4:10 PM

and if you move to California and adjust day-claims here you will find yourself being asked to write estimates for mold remediation including setting up containment, etc. I am not creating the propaganda, or defending those who say mold is toxic. I am adjusting the claims.

 

The same thing goes on here in Idaho.  When I did day claims in CA in the early 90's, mold didn't really seem to be as big of an issue as it is now.  I think it comes back to the insured's perception.  I recently adjusted a minor water loss that resulted from an improperly installed washing machine cold water supply line.  Water damage was minor.  Seeped underneath wall into adjacent family room in basement.  Carpet and pad affected that were laid over concrete so the water had no where to go.  It was properly mitigated and dried and minor repairs to the drywall were completed.  I did not visibly see any mold and neither did the contractor.

 

A couple of weeks later, the claimant was complaining of a "smell" and they felt slightly ill.  The insurance company hired another company to come in and test.....Test showed "mold" present. 

To make a long story short, turned out mold resulted from a previous water problem not related to this loss and the carrier was advised of this in my report.

 

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BobH
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08/17/2008 12:17 AM
Posted By Eric Kraft 
...The same thing goes on here in Idaho.

Gotcha.  Like your example on the last page, Insured with $5,000 mold limit.

Posted By Eric Kraft
 ...A couple of weeks later, the claimant was complaining of a "smell" and they felt slightly ill.

Are these folks your Insured, or is this a 3rd party claimant? I have done a lot of those Claimant vs. appliance store claims. Sort of a different relationship, liability.

Bob H
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Hogan53
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08/17/2008 10:00 AM

Bob.......I am in upstate NY,Dutchess County...........rarely mold coverage here.I get called in by companies experiencing

 "Sick Building Syndrome".......landlords,who are having issues with tenant complaints.......homeowners with sick children...realtors with listings that won't sell........

       We ALWAYS require third party clearance,no exceptions. To do otherwise would be a conflict of interest. By the time we get to

    many of the jobs,there is already a report/protocol by a third party.  The reason we do our own testing prior to remediation is that

  in too many cases the party who did the testing either did not test properly,or read the reports to their advantage,scaring folks into

 costly remediation. Case in point.............2 weeks ago customer called with "high counts of dangerous mold",tested by a remediation

 company.        The report showed high numbers for Cladosporium and Ascospores.........2 very common genera found everywhere

 in nature. We live with them everyday. The ripoff company did not do any baseline testing.......how do you know if counts are high if

 you don't have anything to compare them to?   Lots of trees,plantings,flowers,etc. all contribute to these counts.Some folks live in

 the city,others in the country................we did the testing and found that the indoor levels were less than half of the outdoor base

  samples.  No remediation needed.   btw,lawyers who specialize in environmental claims have never been busier. I belong to

 our local Chamber and was told by more than a few lawyers to "protect your ass" when it comes to mold.

 Like it or not,this is real,it is out there in the public eye and many tenants see a big payday when it comes to collecting on a

 mold claim.

 

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BobH
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08/17/2008 10:22 AM

Thanks for the info.

Posted By Mike Hogan 
......rarely mold coverage here.I get called in by companies experiencing "Sick Building Syndrome".......landlords,who are having issues with tenant complaints....

These are good examples of what Ray was saying, not an insurable loss. When a building doesn't ventilate properly, or has long-term moisture issues, that is rarely-never covered in California. But you get a standard homeowner claim where the toilet overflow was UPSTAIRS and the adjuster overlooked water in the wall below, or part of the wall that was covered by a cabinet, or a tub surround in the downstairs bath where "everything looked OK" that is where coverage kicks in where I live.

I go on the other side of that downstairs shower wall, usually a closet, and see if that wall needs to be opened up or have air injected.  We learn by our mistakes, and our supplements.

Posted By Ray Hall on 08/16/2008 
...But , I do have a question. If the base mold is 2 1/4 inch is removed and 5/8 holes are drilled in the drywall that hit the sole plate how does the air get in and the water get out.

A 2x4 is really 1 1/2 x 3 1/2. So the bottom plate of the wall framing is 1 1/2" tall. If the moisture in that wall is really minimal, a hole saw can cut a hole in the drywall that ventilates the wall and is still covered up by the 2 1/4 base. Keep in mind that the carpet tack strip and carpet go down as the first layer, and the base is usually another 1/2" above that so the carpet gets "tucked under" the base around the perimeter of the room. In reality, the top of that base is going to be about 3" above the slab and there is plenty of room to ventilate if holes are drilled above the base plate - the holes should not "hit" the framing.  If it's a big hole saw, most of the hole should be above the plate.  If that drywall is soaked and I am concerned about any significant volume of water in that wall cavity, or there is insualtion holding that water, I have them cut the drywall out - especially if it is going to need paint anyway.

I looked at a water damage claim today where the base was 6" tall - the point is that we need to dry out the water or the house will smell like an old Hotel, or one of Mike's old New York apartments.  There is a reason they smell that way.  Someone can spill a glass of water, no big deal.  Water running in your house while you are at work all day is another matter.

Posted By Mike Hogan 
......I belong to our local Chamber and was told by more than a few lawyers to "protect your ass" when it comes to mold. Like it or not,this is real,it is out there in the public eye and many tenants see a big payday when it comes to collecting on a mold claim.

I hear ya. And the way most people protect their "Ass-ets" is with insurance. The vast majority of homeowner claims I handle would allow for mold remediation following a covered loss, and many of them are starting to have limitations on dollar amounts but there are still some without limiting endorsements.

Bob H
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BobH
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08/17/2008 1:53 PM
Posted By Rocke Baker on 08/16/2008 
After reading this "debate" , PLEASE A CORK IN THIS SUBJECT!!! Let's move on to other subjects.

Before you edited your post, you said you agree with Ray, and I respect that. Maybe neither of you are getting this type of assignment, where the Insurance company (not the contractor) is asking you to write a scope of repair for specific mold remediation to compare to a sub-limit. I have done a lot of earthquake claims in California, maybe you don't get those in Michigan. Doesn't make me a better adjuster.

If you and Ray don't think adjusters are receiving these type of assignments, you just haven't received one personally. Don't shut others out from learning about it.

Posted By Rocke Baker ...The carrier will make the determination anyway unless you are the staff adjuster handling the loss to it's finality.

I love it when out of state adjusters think they are an expert in my area. As an Independent Adjuster, I am the "Eyes and Ears" for the claims examiner who writes the checks. There are about 250 carriers admitted to write homeowner insurance in California. Maybe 10 of those carriers are large enough to have a staff adjuster assigned to my territory, the others will use an IA if they can't handle it over the phone (or rely on what a contractor is telling them).

I am in the trenches, working these claims to conclusion. If you don't want my insight, change the channel.

Bob H
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08/17/2008 5:17 PM
Posted By Bob Harvey on 08/17/2008 12:17 AM

Are these folks your Insured, or is this a 3rd party claimant? I have done a lot of those Claimant vs. appliance store claims. Sort of a different relationship, liability.



One loss involved an insured, the other, a claimant.  Don't envy you in CA Bob.....That's why I came back to Idaho.

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Ray Hall
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08/17/2008 7:24 PM

This is a hypo but it will happen to Bob and many others who leave the scope of damage up to a water remediation contractor.

The house is insured for 300,000 under a DP 3. It has a 1% deductible. It is has some households goods in all rooms. The house was purchased from one brothers estate by another brother who lives in the city two hundred miles away. Two sisters still live in the town with the purchased house and have been removing items form the house several times a week.

Sister A goes buy the house late in the evening and discovers a broken pipe has put clear water in 3 bedrooms, den, living room and dining room with carpet and pad over a pine subfloor and the house is on pier and beams. She turns the water off and calls her brother and tells him of the seen damage. He thanks her and says do nothing as he will bring down a two friends this week and do some work on the house as he wants to rent it out ASAP. Next morning sister B goes to the house and see's the mess and knows the house is insured with the same agency as hers.

She reports what she saw to the agent and he recommends that the local water remediation franchise who she knows from high school and she agrees. The water contractors do thier thing remove all the carpet and pad, place fans, dehum and remove the 1x8 knotty pine base boards and send a bill to the agency and gets an agents draft for the total 2,850.00.

On Friday at 6:00 PM three males arrive with a floor sander and enough Bruce Laminate Floor to cover the carpeted area. The insured is outraged at the bill and contends he and his buds could have done the same thing in 15 man hours @ 24,00 per hour or $360.00 , six 20 inch fans at Walmart @ $13.00 each or $78.00 and mop the two bath rooms and kitchen. He is so upset he states if the bill is paid and a water claim goes on his CLUE report he will sue the agent and carrier for 10% of the market value. He also feels the alum foil between the furniture feet and the pine subfloor is out landish. Explain to this irate man you were only looking out for his health concerns, when he had none. I think insureds who can not abandon thier property have the same right to disagree with the waters suckers protocal for clear water spills

Now as far as slum lords liability claims  I work several mold claims per year and the claimants and attorneys drop the case when I read the mold exclusion for BI/PD. AND its coming ever policy will have an abosolute mold consequence exclusion. The London policys and most of the E &S have them now. It will suprise some mold adjusters, but when liability or first party health issues are excluded, the health concerns just fade away. But just keep the drums beating, mold has made me a good living for the last nine years.

I have worked in Northern California on windstorm and flood losses three time and I never heard the word mold.I did explain all wet material would be removed; except structutal timbers. I found the carriers in California were abreast of all the fads, has this changed.

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BobH
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08/17/2008 9:38 PM

Posted By Ray Hall
This is a hypo but it will happen to Bob and many others who leave the scope of damage up to a water remediation contractor.

What makes you think I leave the scope of damage to a water remediation contractor??

I am a very "hands on" type of adjuster, and will work with the Insured, or their relatives, or contractor of their choice. I am usually on site for hours measuring, scoping, and making sure the place gets dried out properly. It is a cooperative effort, toward the common goal of preservation of property. If it's a smaller loss, I make sure they don't go overboard.

1. The Insured has a duty to mitigate damage once a loss has occurred.

2. If they want to do it themselves - or their associates, that is great.

3. As Dave pointed out, the contract with an Emergency Service vendor is with the owner of the property. If I tell the Insured they need to mitigate damage, and they are unwilling to give the "OK" to a professional, and they aren't doing themselves, then they are not upholding their end of the policy. I almost never see that happen.

4. Your total amount of damage on this scenario would exceed the deductible, and emergency services is part of the claim. I would be much more concerned about the failure to mitigate damage than anything else.

Posted By Ray Hall 
AND its coming ever policy will have an abosolute mold consequence exclusion.

If they want the coverage, they will pay for an endorsement.

Bob H
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okclarryd
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08/17/2008 10:14 PM

Once again....................this is why I like ol' Bob.

Good answers.

Larry D Hardin
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BobH
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08/17/2008 10:56 PM

Thanks Larry, appreciate it. I am all for saving the Insurance company some $$, and when it happens like that scenario it's great. At the end of the day, $3,000 is going to come off the top of the claim. If the relatives can do the emergency work for a fraction of the cost, then the rest of that $3,000 deductible is going to come out of the "put back". If they do the "put back" themselves at a rate lower than a professional would charge, then the check they get in their mailbox will be even smaller, and that's OK with me.  Most people do the math, and call a contractor.

Posted By Ray Hall 
...He is so upset he states if the bill is paid and a water claim goes on his CLUE report he will sue the agent and carrier for 10% of the market value.

His upset would be with the person that called in the claim. Once a claim is reported, the agent has a duty to report it to the Carrier. The carrier has a duty to accept or reject the claim.  Someone already "drew blood" before the water damage claim hits my desk.

I have had a number of claims over the years where the Insured decides to retract the claim because they realize it wasn't a big deal and may be near, or just over their deductible.  If I see the 6 wet rooms you described, they better make their decision quickly.

Posted By Ray Hall 
...I have worked in Northern California on windstorm and flood losses three time and I never heard the word mold.

As you know the NFIP is rather specific and consistent in their position on mold, and that has no relevance to this thread. If your work on windstorms in CA was prior to about 2000 it would have no relevance to this thread. We were still throwing black drywall in the dumpster then.

Bob H
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rickhans
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08/20/2008 2:41 AM

Bob & Ray,

I have followed this thread and finally decided to make a few comments, although as you know they never end up being very short. I am not taking sides because I understand where you are both coming from, but I have a few experiences, one recent that might shed some new light on this topic, at least in Texas.

1.As most who read this site already know, I got into adjusting in '83 in Galveston after Alecia, but had already been operating my construction company doing remodels and some fire restorations.  My latest reconstruction job was a single family house that burned in March and I completed it in June, just before going to Missouri to adjust tornado and hail claims.

2. Over the last few weeks, I adjusted a large multi residential fire claim that ran over $600k.  This is relavant as I will explain.

Like Ray, over the years I never talked about the mold that was on the drywall after a flood, tornado, or fire. As the contractor, we just tore out the drywall and put it in the dumpster.  In Galveston, even though mold was not a dirty word back then, GAB taugt me to write the claims as water damage, not mold, even when 100% of the drywall in the house had mold after sitting with flood soaked carpet after the hurricane. That philosophy continued through Florida and through this year until I was informed that under certain conditions, that is not correct. in Texas any more.

On this large fire claim, a demolition/water restoration contractor (not a general contractor) stated that on one room, perhaps others, they would have to do mold remediation because any mold now requires it under a new law. A 2nd demo contractor said that it was not needed in this case, that it depended on the amount of mold, but I researched it anyway.  Much to my surprise, the State of Texas passed a law and updated it in 2007 (I was told) that is very specific that if more than X square feet of mold has formed on contiguous surfaces of drywall (I don't have my notes to tell you what X is), then mold remediation is required, meaning the white space suits and a sealed off room, and the drwall broken up and bagged, or by other similar methods depending on the situation.  I was told that Texas  means business on this, that they have already taken a roofing contractor to court and won for doing a ceiling replacement themselves after water damage caused mold, and they did not use any prescribed remediation methods.  They tore it off and put it in the dumpster.  This would mean that the words "mold remediation" would have to be in the claim, although mold is still not the peril.

I have not read any of my HO policies specifically to see how this type of remediation is covered, if it is at all but intend to as soon as I get the time.  However, It has been my understanding that NO mold remediation is covered on any Texas HO policy.

3. As to the "restoration contractors", water suckers as you call them, I had a bad experience with a franchisee of the largest one in the U.S.  involving the burn out in Oklahoma that I rebuilt.  The insurance company did not have anyone to call in that part of Oklahoma so I recommended the one I new about just across the border because I had used that brand name in the past as a contractor and knew of their supposed good reputation, and have seen adjusters here and on other forums recommend them.  I made the arrangements for them to take care of the UPP carry out and cleanup, including laundry and drycleaning of clothes and turned it over to my customer who got it approved by their insurance co.  By the time the job was finished, the customer was so unhappy because of numerous problems involving lost items that were never returned, even though it was on the inventory list and she had photos; they would not deliver their inventory list until about the time we were ready for a move in; they refused to talk to me because I was "not their customer" even though my customer told them to deal with me; they would not provide accounting in a timely fashion, turned the clothes over to a cleaners and refused to deal with the customer, making them deal directly with the cleaners; and refused to deliver any of their belongings until they were paid in full, not allowing any inspection of the items supposedly restored until they were paid and the items were delivered; and so on and so on. 

Obviously, I will never use that brand name again, and will be reluctant to call in any of that type as an adjuster or contractor due to this experience, at least without a detailed bid and a published price list, and a mile long list of references.

4.In response the comment that neither adjusters nor carriers let out a contract, only the homeowner does, I assume that references general contractors.  I think the intent of the earlier statement referenced carriers contracting with water mitigation contractors since insurance companies can do a direct contract for emergency mitigation, whereas they are prohibited by law from contracting with a renovation contractor to do a re-build.  As a side issue, I have often wondered how that line of business started calling themselves "Restoration Contractors" when they don't restore, they mitigate. You will never see one hanging drywall, only tearing it out. That is not restoration.  I made the mistake of naming my Oklahoma business using the word "Restoration" because that is what I do, but find myself having to explain to the insurance agents and adjusters that my company is a full fledged "rebuild" general contractor because some  seem to think that I am one of the other types, a "water sucker" as you refer to them. 

5. As to mold affecting health, I am another one that has a problem with mold, due primarily to allergies.  I too wear a respirator when the mold is very strong, and also wear it in burn outs and at other times as needed.  If I don't, I am subject to some severe allergy problems that can result in bronchitis.  I have several double carbon filtered respirators in various locations so I will always have one on hand if I need it.

 

 

 

 

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BobH
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08/20/2008 11:14 AM

Thanks Rick. The Texas mold info can be found here: http://www.dshs.state.tx.us/mold/rules.shtm They seem to get excited when the area is over 25 Sf

Posted By Rick Hansen:   As to the "restoration contractors", water suckers as you call them, I had a bad experience with a franchisee of the largest one in the U.S.

Yep. I think all of us have been there. My story involves a water heater that was in the garage, on an elevated stand covered in drywall that also served as a platform for the HVAC. The water heater leaked as they often do, and the "restoration contractor" worker forgot to cut open the new drywall before installing the cold-air intake vent... so the HVAC was blocked.  (the same company that did the "dry out" did the "put back").

The homeowner started to freeze (January) and walked into the garage to see if the heater needed to have the pilot light lit or something. Luckily she wasn't smoking as she walked into the garage, because the same worker didn't tighten the gas connection to the furnace. She had a puppy in the garage, and luckily he survived the gas.

Regardless of these experiences, a house that is seriously in need of dryout will require professional help.  We become more careful after getting burned.  It just causes me to be more pro-active and follow up, rather than assuming it is going OK.

Bob H
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Ray Hall
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08/20/2008 11:36 AM

This topic will just not die. In the example I gave the owner of the house thanked sister A for bringing this to his attention. (he intended to rough sand the floor and install the Bruce the next weekend, AND he was in the floor business) sister B took matters in her hands and called the agent, the agent knew he had draft authority of 5,000 and called the water suckers and you know what happened.

If the water suckers bill is paid for $3,000 a clue report will be made on that ADDRESS and all real estate tranactions for the next 5-10 years will have a black cloud. This will cloud the market value of the property, which all any investor is looking at. The named insured did not hire the water suckers and 95% of the "sucker" claims are  not authorized by the owners but the insurors agents)adjusters).

The real problem was the fee bill rates do not break out slab on grade sub floors and pier & beam sub floors. And with t&g pine floor the darn thing will dry it self in 36 hours with a little ventalation.

I HAVE NEVER HAD AN INSURED THAT WAS PLEASED, with the cost of pac out and return and cleaning with all the household contents. Never in 40 years. Its wasted money by the insurance carrier. The carrier must have the adjusters write a caption on the increased cost and why it was attempted to stop this farce. Ninty percent said they wished they had a chance to absorbe or reduce their deductible by doing the work themselves or making their own arraignments. Why dont policholders raise holy hell about these blood suckers who were CALLED by the insurance company. Or who chased the fire trucks

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09/01/2008 9:00 PM

What makes you think I leave the scope of damage to a water remediation contractor??

I am a very "hands on" type of adjuster, and will work with the Insured, or their relatives, or contractor of their choice. I am usually on site for hours measuring, scoping, and making sure the place gets dried out properly. It is a cooperative effort, toward the common goal of preservation of property. If it's a smaller loss, I make sure they don't go overboard.

1. The Insured has a duty to mitigate damage once a loss has occurred.

2. If they want to do it themselves - or their associates, that is great.

3. As Dave pointed out, the contract with an Emergency Service vendor is with the owner of the property. If I tell the Insured they need to mitigate damage, and they are unwilling to give the "OK" to a professional, and they aren't doing themselves, then they are not upholding their end of the policy. I almost never see that happen.

4. Your total amount of damage on this scenario would exceed the deductible, and emergency services is part of the claim. I would be much more concerned about the failure to mitigate damage than anything else.

 

Bob,

I'm new here, but have been following the heated debate on the mold coverage issue. I am a staff field adjuster for a major carrier in California. I love the above points and I agree totally.

The attitude my current employer has with regards to handling mold is, first...determine if it is related to the covered loss and if so, remediate, and get it cleared, up to the limits. If the resulting damages are not covered...the mold will not be covered.

A lot of the time, we have direct physical loss to the structure (ex. Plumbing loss) that would be covered and mold develops during the time the loss occurred and the claim was filed. We would go to the proximate cause of loss…the sudden burst from a plumbing system…that resulted in sudden and accidental damages (no long term rot or deterioration) and afford coverage for the loss and if mold develops, would cover the remediation up to the limit (5K in our policy).

I could fight this and bring in an expert to test the mold and id the species and then extrapolate the life cycle of the species and cross reference the date of loss and then argue that it is pre-existing…turns out not to be very cost effective and ends up in court and then it really is not cost effective.   

Per the IICRC, mold can develop within 48-72 hours with the correct environmental conditions present (moisture, temperature, and food source) and losses with mold, but free of other long term damages will be covered. Attorneys here (California) have argued that a long term leak is (per most HO-3’s) a “continuous and/or repeat leakage and/or seepage,” that has been occurring for “weeks, months, or years...” Considering that mold growth can occur in 2 to 3 days, declining because of the presence of mold only is setting you and your carrier up for a bad faith suit.

Most policies that cover mold are limited, but in general the limit is used for testing, removal, and put back. I can apply both the mold and water coverage (below scenario) and split the costs under the two coverages. For example, if a kitchen cabinet is soaked and warped (beyond repair) due to a sudden loss from the hot water supply line and would need to be removed under emergency mitigation, but had developed some mold. I could remediate the mold and remove the cabinet under containment and apply the removal and subsequent clearance test under the mold limit and then put the repair for the cabinet under the water coverage…why? Because the cabinet would have been removed anyway during the emergency mitigation if the mold was not present. I would have been paying for it anyway…and in this State, a smart attorney would argue (has argued) in court that you applied the mold limit on the repair in an effort to short pay the claim/insured…bad faith? We all know our intent would not be bad faith, but as Bob has pointed out, strange things happen when you get a jury involved and yes…it makes handling claims here somewhat complex. A legal minefield to be honest.

As a former paralegal, I handle my claims as if every claim is ending up in court. Maybe it is different in other parts of the country handling day claims, but here…it’s all about limiting liability and managing your risk. Even if your policy is clear about what is excluded…case law may alter your claim handling.

When the insured files a claim on a water loss, I always offer to bring in emergency restoration contractor to dry down the home.

If the insured has not called in their own EMS contractor, it could be argued that the insured fulfilled their duty of mitigating the loss by filing a claim.  My offer is a referral, so it is still up to the insured to hire the vendor, but it is a vendor I can trust. Not the “rug suckers” that was mentioned earlier. I would like to be clear that in my opinion, a “rug sucker” would those emergency restoration guys that are out to bilk the insurance companies for unreasonable and unnecessary charges. There is a big difference in emergency service contractors and the good ones have a BIG place on my speed dial.

Along with my EMS vendors, the environmental contractors I use get calls from me on a daily basis to manage my risk in assessing asbestos abatements and mold remediations.

The point of managing the risk is really releasing an insurance carrier (whose business is insurance) of as much liability as possible in not properly drying down a home, properly abating asbestos or remediating mold. These contractors are supposed to be experts in their fields and as such, the money I spend is to make sure it gets done right.

When the insured hires their own vendors, I advise them up front that I only pay for “reasonable and necessary” costs/charges. I am an IICRC certified water damage restoration technician, so I can take the psychrometric readings, assess the equipment being set up, make sure the proper demo is being done, and the estimates being submitted are accurate. Even though I am a certified WRT, my business is being an adjuster. I am an expert in the interpretation and application of insurance coverage, not EMS, asbestos, or mold. So, I still send one of my vendors to do an assessment, write a comp bid, and photo doc the set up…in short, to manage my risk and liability (seems to be a repetitive theme).  

It may seem like a waste of claim dollars to some, but operating in California…trials are very expensive! I love preparing for a trial and putting together my docs for our attorney and during a status conference the opposing council sees the length I went to during the handling of the claim and it ends there. Trials are not won by the attorneys…they are won by the adjusters in field with the handling of their claims way before a lawsuit was even filed.

Sorry for the extremely long post…but I just wanted to make a point that yes, mold claims are covered (at least here) and as a result, it changes they way we handle our claims, despite what the policy may or my not cover.

Thanks for listening,

Sean

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Davidad1
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09/01/2008 9:41 PM

Sean
Very well stated 

Estimating is living on the edge between greed and fear
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GAADJUSTER
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09/01/2008 10:12 PM
I HAVE NEVER HAD AN INSURED THAT WAS PLEASED, with the cost of pac out and return and cleaning with all the household contents. Never in 40 years. Its wasted money by the insurance carrier. The carrier must have the adjusters write a caption on the increased cost and why it was attempted to stop this farce. Ninty percent said they wished they had a chance to absorbe or reduce their deductible by doing the work themselves or making their own arraignments. Why dont policholders raise holy hell about these blood suckers who were CALLED by the insurance company. Or who chased the fire trucks

I have heard that too, but of those 90% who said they would have done something, 90 % never would have. The bottom line is, water mitigation is important, you just have to keep an eye on who is doing it, I had a contractor who had never done it before( i surmise from talking to them), they wanted to charge me 60000 on water loss (granted it was bad, and I had an agreed scope with them from the start, they ending up tearing the whole house up which was not agreed to and ate it) I don't mind paying for good service when needed, but we need to keep pressure on them for overcharging or it screws all of us .
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