We were recently hired by a very nice couple in Boca Raton that had some water damage to their property and their claim was denied.   I know from working on both sides of the claim process that many times there is a good reason for denying the claim, however, in this case it didn’t sound right and I wanted to take a look for myself.  From what I was told the Air Conditioning system had leaked damaging the walls, ceiling and some baseboards.  I proceeded to read and reread the policy and was stuck on the part where they state the covered perils, one statingInsurance Claim Denied? Our Public Adjusters may be able to help. the following:

“Accidental discharge or overflow of water or steam from within a plumbing, heating, air conditioning or automatic fire protective sprinkler system or from within a household appliance”

It seemed pretty clear to me that this claim should in fact be paid and I took on the challenge to get the insured what they deserved.  It turned out that their reason for the denial was stating that the water damage was caused by condensation on the outside of the system and therefore it was not ‘within’ the system.  The only question I repeatedly asked was “what other water is in a A/C system other than condensation?”

Results:

Insured was paid within 30 days of our Florida Public Adjusters fighting the case.  I have seen the insurance companies reach far for a reason not to pay but in my opinion this one was a bit further than most.  I am thrilled that we were able to help and the insured finally got what they deserved.

If you have had an insurance claim denied for condensation or any other reason, do not take their word for it.  Insurance policies are complex documents that will exclude coverages and then add coverages back.  Sometimes these policies are even tricky for us to review.  The good news is that any ambiguity in the policy is seen in favor of the policyholder.

We are happy to offer a complimentary claim review and consultation where we will give you our opinion as to if we feel the denial is correct or not.  If we feel that your claim was improperly denied, or delayed, we will explain all of the options available so that you can make the right decision for you and your family or business.

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