Q. Our insurer rejected our mold claim, even though we have additional coverage for mold, as well as for, "Sudden and accidental tearing apart, cracking, burning or bulging of a steam or hot water heating system, an air conditioning or automatic fire protective sprinkler system, or an appliance for heating water". The a/c repair man as well as the claims adjuster and the engineer who investigated the claim (both hired by our insurer) attributed, in writing, the cause of our mold to tearing of the attic duct work tape. The insurer claimed they would not cover our Section C loss from mold because, "the claimed loss and damage and the mold was the result of humidity and condensation. There was no physical damage; therefore the mold is not a result of a covered cause of loss." Can you please explain why they are rejecting our claim? 

The following is an insurance claim question we answered for a policyholder through the United Policyholders Ask an Expert Forum.

Q. I live in St Thomas. My house suffered substantial damage from Irma and Maria. It is a two level house with a 3rd level apartment. The upper level is missing the roof and the bottom level apartment is pulling away from the main structure. I am currently living on the 2nd level. When I bought the house in January I had planned on returning the house to the previous layout of 3 separate distinct living spaces to help with the mortgage and homeowners insurance payments. The 2nd level had already been zoned as a separate living area but was added to the main house by the previous owners. I removed the spiral staircase between the 1st and 2nd level and had contractors scheduled to come back to repair the opening. Earlier this year my parents decided they were going to move here. My father has Alzheimer disease and responds well to me. I was going to help my Mom care for him. My parents sold their house in Colorado, bought plane tickets and hired movers. They were to arrive on island October 1st. We decided ahead of time they would be paying rent and we would have a written agreement drawn up. As a result of the storm I was forced to move to the 2nd level. Had the house survived intact this would not have been a safe place for them. I would have still rented out the 2nd level to someone else. My insurance agent said I could not claim a loss of use for the vacant apartments because I had no lease already in place for them. Is this correct?

If you are in the market for a new roof because of Hurricane Irma, you may want to consider a metal roof.  From my observation as a public adjuster handling a wide variety of insurance claims, metal roofs are becoming more popular all over the country. I’d like to share this article about hurricane resistant metal sheeting roofs. I have seen these roofs hold up very well, if installed as detailed in this article. In the case of St. Maarten which had sustained winds of 183 mph with gusts over 200 mph, the metal roof stayed on,  where other types such as asphalt shingles and/or clay/cement tiles for the most part blew off in part or total. 

The effects of Hurricane Irma’s wind and rain damage are still apparent throughout Florida and the Caribbean. Roofing crews and blue tarps are ubiquitous wherever you travel. While the blue roofs are obvious, what may not be so obvious are damages that may have resulted to electrical and mechanical systems in your home or building from the effects of Hurricane Irma's wind and water. Too many policyholders are blindly following a contractors or even their insurance company’s desire to “fix up” the damage and move on to the next claim, putting themselves in danger. 

Many of the calls we get from policyholders lately, regarding their Hurricane Irma insurance claim goes a little like this:  “Roof damage caused bedroom flood, water running down the wall, water came in the front door, sheet rock and crown molding are ruined, now mold growing causing health concern.” Most homeowners will have a limit on their mold coverage in their policy.  But remember there would be no mold but for water and water loss is not limited. I am making this statement despite the fact that we have seen some insurance companies actually try to limit water loss coverage.

Policyholders may be surprised to find that their flood claim for foundation damage is denied because the NFIP says the damage is caused by earth movement or settlement; even though the earth movement was caused by flood waters! Before I discuss this, let me remind the reader that each loss is fact specific to each property. You may have two homes or commercial buildings in close proximity to each other and the loss conditions from the same insured event may vary to the point where they impact the claim.

Policyholders who experienced any type of water intrusion from Hurricane Irma may experience mold infiltration. When claims are delayed and repairs put on hold, it can become a real problem because mold can grow unseen for months and create a serious health hazard. Many of those who contact our firm report mold issues. To get more insight about mold: Read our Frequently Asked Questions about Mold Claims.

Property owners who were impacted by Hurricane Irma and filed a property insurance claim are starting to receive settlement offers from their insurance company.  Some are shocked at the settlement offers they receive. Sometimes our firm will be retained by a homeowner only to receive a call several weeks later to say the insurance company adjuster had called them with a verbal settlement offer they might be able to live with. Even though it’s outside of our contract cancellation date and work may have begun on the loss, we typically wish them well and thank them for their consideration in selecting our firm to assist them. That got me thinking about all the property insurance claim offers we’ve gotten over the many years assisting clients.  

A lot of properties that experienced Hurricane Irma losses will have Law & Ordinance issues. Law & Ordinance kicks in when the Florida building code requirements impact what will be required in order to obtain a CO (Certificate of Occupancy) in order to reoccupy the damaged structure. It is a separate coverage in your policy that you must elect and covers some of the cost of required code upgrades. If your property (be it commercial or residential) suffers a loss where the cost of repairs is greater than 50% of the pre-loss value of the real property, your repairs must incorporate current building code upgrades. 

If the inquiries coming into our offices are any guide, policyholders are receiving settlement offers for their insurance claims and many are not happy and in some cases shocked at the offer they are receiving. Most often we are told the offer does not remotely cover the cost of repairs based on estimates local contractors are providing.