Insurance claim denied: So who do you call?

Insurance claim denied: So who do you call?


by BILL McGINTY / NewsChannel 36 Staff

Bio | Email | Follow: @billwcnc

Posted on September 17, 2012 at 3:33 PM

Updated Wednesday, Oct 30 at 11:18 AM

CHARLOTTE, N.C. – Marjohn Elyaderani’s back kitchen wall and part of the floor is rotted from water damage.

“I mean you can just stick your hand in there and peel out the wood, because it’s rotted and molded” said Marjohn, who bought the home new just 10 years ago.

Fixing it is a big and noisy job.

“Yeah, it’s a little aggravating.  They’re taking the house apart, upstairs and downstairs, so it’s not just this area,” he said.

Marjohn said she’s had water damage repaired in that same area once before. Luckily, Marjohn’s home warranty is still in effect this time around, or so she thought.

Pulte built the townhome and her Pulte warranty provider told her “water intrusion protection is only good for the first two years,” and because she fixed water damage in the area before with a non-Pulte approved repairman, the home warranty claim was denied.
At that point, Marjohn did what most of us would do—she made a claim to her homeowners’ insurance and surely they would cover it—right?

“I just expected a little support for either the insurance company or Pulte.  I mean I didn’t do anything,” said a frustrated Marjohn.
Marjohn’s insurance company, Cincinnati Insurance, sent out an engineer to inspect, and he wrote that the trim and the doors were “improperly installed,” so Cincinnati Insurance also denied the claim, saying the problem of seeping water went on for “weeks, months” or years and for that reason, was excluded.
“It’s frustrating, and it’s going to be expensive,” Marjohn said.

The NewChannel 36 I-Team contacted North Carolina Insurance Commissioner Wayne Goodwin, asking him, what are your options when everybody denies the claim?

“Sometimes, a lot of times, a person will hit a brick wall, and when that happens, you have to know your rights. First, it’s important to know that you have the right to appeal their denial, so absolutely do that,” Goodwin said.  “Secondly, read your policy carefully so that you know exactly what’s covered before you make any claim. If you still run into a brick wall, then contact my office and we’ll get to the bottom of the problem.”
Based on advice from the Insurance Commissioner, Marjohn appealed her claim denial and she says Cincinnati Insurance is taking a second look at her case. 

Cincinnati Insurance told NewsChannel 36 that it’s up to the policy holder to know what’s in your policy and that the company “covers all claims covered by the policy.”

In this case, we’ve learned it’s sometimes more important to know what’s not covered in your policy.  If you have questions, ask your provider—doing so when you make a claim is too late.