Interesting Claim Denial: Condensation

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 but in this case 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 statingBoca Raton Claim denied for condensation.  As Florida Public Adjusters we helped to get the claim paid 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 began 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.

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What our clients say…

  • Laura M. AvatarLaura M.

    Greg and Eric made a terrible situation with my insurance company tolerable. They were able to get a fair loss layout so I can restore my home after slab leaks. Thank you both for all of your help. You guys are great - 10/02/2019 

    Summerlin V. AvatarSummerlin V.

    I have done a few claims with insurance companies over the years. It's never easy and the insurance company goes in with the upper hand because they do that all day every day. Well we had a claim started and we were made an offer by the insurance company which I thought was a little bit low. I started by doing an internet search for an attorney but they wanted way too high of a % or they just weren't interested. Along the way I came across Claim Concepts and researched a little more about public adjusters. The insurance company sends an adjuster to represent their best interests and so I figured I would give them a shot at representing my best interests like the insurance company had. Since I had already been offered an amount and the insurance company had already cut a check with final payment on it, it would give me a very good idea of whether or not hiring a public adjuster was beneficial or not. In conclusion, Claim Concepts took over the claim and kept me very much in the loop with emails telling me exactly what was going on and where we were in the process. They were very nice and had it ended there and Claim Concepts were not able to get me any more money I would have been satisfied because I knew they had tried every angle to try and get us the money we were owed. Claim Concepts was able to get more than 6 times the amount the insurance company had sent a check for. So, now I am a believer. Not just in a public adjusters, but Claim Concepts public adjusters. I will never deal directly with an insurance company again. Thank you so much Claim Concepts. - 4/18/2021 

    Nancy F. AvatarNancy F.

    Due to a water pipe leak in between my first and second floor bathrooms, I sustained quite a bit of damage. All I knew to do was to contact my insurance company. They sent out a claims adjuster who looked at the obvious damage and created a claim that just fell short of my deductible. When looking for a company to repair the damage, it was becoming apparent that the damage could be more significant than originally quoted by the claims adjuster. That is when it was brought to my attention that there was someone out there who could support those findings and have my best interest in mind. That's when I found Claims Concepts. I had no idea that this type of business even existed. Insurance companies can be a bit intimidating, especially if you're not in the construction business. I called Claims Concepts and worked with Greg, who substantiated the information that there was more damage than the adjuster quoted. He took over from that point on and worked on my behalf with my insurance company, to make sure that all damages were properly covered. - 10/23/2017 

  • Willie G. AvatarWillie G.

    Great experience working with Greg at Claim Concepts. Insurance company originally paid me $1400 and after getting Claim Concepts involved we recovered an additional $21,500! My only regret is not hiring them sooner as once they got involved I was relieved of all the stress of dealing with the insurance company and clearly they knew exactly what to do. I highly recommend them to anyone with a claim. - 10/02/2017 

    Lloyd C. AvatarLloyd C.

    5 stars - 10/02/2019 

    Vitasta M. AvatarVitasta M.

    Claim concepts helped us file a claim that I insurance company had denied. they came up with a very detailed estimate and were helpful throughout the process - 11/23/2018 

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