Adjuster Denying Claim without Seeing Property

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jul 5, 2013

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Insurance Question from Uniontown, OH

Asked on 07/05/2013

Adjuster Denying Claim without Seeing Property Furnace/air conditioner (heat pump) damaged due to power surge (have the charred circuit board, wiring, etc. plus confirmed by contractor). After initial settlement offer significantly below estimate, they now say incident not covered due to failure caused by normal wear & tear & life of unit. Adjuster nor any company rep has visited to see parts. Is their denial legal in Ohio? Carrier is Ohio Casualty w/ coverage from Mid-American Fire & Casualty. Thanks.

Answer given on January 02, 2014

Homeowner insurance policies cover for damage to appliances due to a sudden and accidental damage to the unit. This usually includes damage due to a power surge.The homeowner policy explains how settlements are made for such items. Usually they are covered on an actual cash value basis which is the replacement cost less depreciation. This would mean that if the item is very old, then the insurance coverage would be reduced by the age, plus the deductible. Some policies cover the item on a replacement cost basis. Check your policy to see how your company handles these losses.If you have evidence that the item was damaged due to the power surge (such as the circuit board) the adjuster should be willing to review his decision regarding the denial of coverage. Contact the adjuster again and ask for reconsideration. If he refuses, ask to speak to a supervisor to see if they will investigate. You should also talk to your agent, if you have one.

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