Here is an insurance claim question that we answered as a contributing member of experts for United Policyholders who advocates for property owners.

Q. I had an upstairs pipe burst 1 month ago that caused damage to the upstairs bathroom (tile & drywall), carpet in upstairs (hallway & one bedroom), all of downstairs kitchen (walls, cabinets, ceiling, under-house insulation, HVAC ductwork). After quickly stopping the leak and vacuuming out the water, I set up my claim and started calling water damage restoration companies.  Of the dozen I called, only one could come out sooner than 5 days.  They began drying and demolishing within 2 days.  After my persistent calling, an adjuster finally got in touch with me 8 days later to setup an appointment.  This appointment was 24 days after initial damage!  Now I will talk about my dispute.  Two adjusters showed up.  The upstairs tile had expanded and contracted enough to bust loose.  The tile creaks badly and the adjusters bent down with me and clearly observed it moving.  However, they still were insistent on not replacing it.  I have continuous carpet (mended seamlessly at the thresholds) all over the upstairs including stairs.  They wanted to cut above the stairs and at thresholds, citing they only had to replace what was damaged.  Downstairs, they wouldn't even consider the tile, although I know that it was wet under those tiles for at least a week with plenty of time for mold spores to form.  Every piece of plywood under those tiles was wet and didn't get insulation removed for 4 days and never had a fan or dehumidifier put in the crawl space.

Where do I go from here? I thought I should first write the adjusters a letter in my defense.  I was an engineer for The Tile Council of North America which publishes industry-consensus guidelines for ceramic tile installation. I have plenty of expertise and sources to back my concerns. Or should I just get a public adjuster? Thank you!

A. First, a disclosure that I am a Public Adjuster. But thank you for your question, as I am certain there are a lot of other policyholders in the same situation as you.  As you may have heard, the insurance industry is flooded (no pun intended) with frozen pipe claims due to water leaks from burst pipes as a result of the recent freezes. One company has actually called their influx of losses a Cat (Catastrophic) loss as apparently this allows them to somehow benefit financially due to this declaration.  This "polar vortex" event may in fact be unprecedented due to the huge geographic area of the U.S. affected by this severe cold weather.

Regarding your situation, there is absolutely no excuse for your insurance company to show up 24 days after the loss. This is simply unacceptable. There is an army of insurance adjusters in America called independent adjusters who the insurance carriers hire in situations like this. Basically, they do the bulk of the field adjusting for the insurance carriers. Trouble is, the carriers don’t want to pay them as they are an expense beyond the actual salaried staff folks.  You did not say if the people sent out by your company were staff or independent adjusters.  But having two adjusters show up causes me some concern as it may be that one or both are inexperienced and covering for each other. Having said that, all of the issues you raise are common fights we see in water losses as the insurance industry looks to save money at the unknowing policyholders’ expense, either by denying, minimizing or offering to patch the repairs.

Given the circumstances, you definitely would benefit from engaging good experienced public adjuster that has your best interests in mind, knows the players and has dealt with all these issues. As always, check references and experience before hiring your own adjuster. Also be aware of market rates for public adjusters. You can call the insurance commissioner’s office to see if any fee caps have been established due to this big loss environment. Based on what you have described, you can expect to pay somewhere between 10% and 15% for a qualified public adjuster to handle your loss. While you have some knowledge and background, this claim will require a professional to get it turned around. Best of luck.

If you’re experiencing water damage from frozen pipes and have questions regarding any property insurance related issues, please call 800.321.4488 or contact us to submit a question to one of our public adjuster or insurance claim experts.