How to get homeowners insurance company to pay for covered home repairs

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How to get homeowners insurance company to pay for covered home repairs

I recently filed a claim for mold and water damage which are covered claims within my home owners insurance policy. The Hartford They haven’t paid the adequate amount needed to do the repairs. We have been passed around from representative to representative and not one of them have been helpful during this difficult time. Temporary housing arrangements were granted in accordance with the loss of use of our dwelling due to the presence of black mold and water damage. The insurance company sent inspectors to my house to perform a limited inspection without going into the walls to accurately diagnosing the problem. The plumbers sent by the insurance company did air pressure testing of our plumbing system and stated there were no leaks and everything was in good condition except for a worn wax ring and new washers needed in the tub and sink area of the bathroom. Upon hiring a contractor to do and independent inspection and repairs he discovered the problems that existed were quite extensive. I have had my policy for over 40 years and have never used it. The last representative I spoke with stated they would not pay out our claim because the amount of coverage for mold remediation was absorbed with the temporary living arrangements. We hadn’t made any repairs at this point and were back at square one. We also made additional claims for expenses due to loss of use for example hotel expenses prior to the temporary living arrangement, personal damages, etc.None of these claims have been addressed. The contractor I hired went into the wall and discovered a pipe from the main line burst. It took us some time to have the repairs completed and we still have to remediate the black mold in the laundry room and kitchen. We need help. If you know an attorney that would review our case and be willing to take our case on contingency we would be so grateful. We have all had to go in different directions due to these hazardous living conditions and want nothing more but to return to live in our safe and healthy home. The home is currently unoccupied but the monthly mortgage still has to be paid.

Asked on August 7, 2018 under Insurance Law, California

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 years ago | Contributor

An insurance policy is a contract. Like any other contract, it can be enforced in court if necessary; you do so by bringing a "breach of contract" lawsuit against the insurer. To win the case, you need to prove that under the facts of the case, as applied to the plain terms of the policy (the insurer's obligation is to pay when and the amounts the policy's plain language states they must--no more and no less), they should have paid but did not. In this situation, that would mean showing that the policy covers mold remediation and water damage (which you show by presenting the policy in court, for the court to review); that you had a covered condition (for which you will need reports and--unless the case settles ahead of time, in-court testimony by contractor(s) who examined your home for you); and that you have not received the amount of payment due you (which you "show" by alleging it in court--stating you did not get the payment). The insurer can in turn attempt to show that this was not a covered condition (such as based on their own inspector's report) and/or that they paid you an amount equal to your policy limits (such as by showing evidence of checks sent you or costs paid for you and comparing those to the policy limits). If you win the case, the court will order payment. While an attorney would obviously be helpful, you are allowed to sue without an attorney, on your own or "pro se." If you intend to try suing on your own, you will need to download the court rules--nonlawyers still have to follow them--and should be able to get sample or template court documents online, either from your court's website or from one or another of legal services websites.


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