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, 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 stating
“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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Meet the Senior Public Adjusters at Claim Concepts
Our Commitment
Greg Roover, SPPA
Inspired by Personal Experience
Greg’s path to becoming a Public Adjuster was deeply personal. The Northridge Earthquake was a turning point, where his family’s experience with a public adjuster opened his eyes to the profound impact of this role. Greg embarked on a strategic career journey, motivated by a desire to help others as his family was helped. He honed his skills working for insurance companies as an independent insurance adjuster.
In 2006, Greg’s vision came to fruition with the founding of Claim Concepts. His insider knowledge, gained from years within the industry, and his passion for aiding others have been instrumental in the company’s success.
In 2025, Greg earned the Senior Professional Public Adjuster (SPPA) designation from The Institutes, the highest designation available to public adjusters. Awarded only to seasoned professionals who complete a rigorous course of study and examinations, the SPPA reflects Greg’s commitment to mastering every aspect of the claims process on behalf of the policyholders he serves.
Greg’s expertise is not just in his impressive resume but in the countless testimonials from those he has aided, reflecting his dedication to securing the rightful settlements for our clients.
Greg's Expertise Backed by Industry Accreditations
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Florida Public Adjuster -
Lic #P017831 -
Georgia Public Adjuster -
Lic #2790971 -
South Carolina Public Adjuster -
Lic #716585 -
Tennessee Public Adjuster -
Lic #716858 - SPPA - Senior Professional Public Adjuster Designation
- NFIP Certified Flood Adjuster
- Former Independent Adjuster working for the Insurance Companies
- Former ICC Certified Residential Building Inspector
- Former Licensed: Mold Inspector/ Home Inspector
- Member FAPIA - Florida Association of Public Adjusters
- Member GAPIA - Georgia Association of Public Adjusters
Morgan "Eric" Thomas
From Adjuster to Advocate
Eric’s journey in the insurance world began in 1989, marking the start of a career defined by expertise and dedication. Fresh out of college, he jumped into the role of an independent adjuster, swiftly advancing to a general adjuster position at a major firm. There, Eric specialized in complex homeowners and commercial property insurance claims, showcasing his skill in navigating intricate scenarios.
In 2001, his career took a pivotal turn towards the construction aspect of insurance. As the General Manager for a renowned Insurance Restoration Contractor, Eric oversaw everything from estimating to maintaining vital relationships with insurance companies. His profound understanding of insurance and construction led him to Claim Concepts, where he now thrives as a Public Adjuster. His unparalleled insight has been crucial in ensuring that our clients receive the settlements they genuinely deserve
Eric's Expertise Backed by Industry Accreditations
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Florida Public Adjuster -
Lic #A263869 -
Georgia Public Adjuster -
Lic #3233218 -
South Carolina Public Adjuster -
Lic #3607940 -
North Carolina Public Adjuster -
Lic #3607940 - Former Independent Adjuster working for Insurance Companies (Since 1989)
- Former Insurance Restoration Contractor (Working for the Insurance Companies)
- Member FAPIA - Florida Association of Public Adjusters
- AIC - Associates In Claims
- Vale Institute - Large Loss Estimating
THE PROCESS
Our Proven Process Built on Precision, Leverage, and the Art of Resolving Complex Claims
Over many years, our team of seasoned professional Public Adjuster have developed a proactive claim management process to ensure our clients receive the proper settlement for their losses. We understand that proving your claim can be a daunting and time-consuming task, and we are here to alleviate that burden for you. Our goal is to make this process as seamless and stress-free as possible for you while ensuring that you recover the full and proper settlement for your loss that you need and deserve.
Step 1 - THE DISCUSSION
Your Claim, Our Strategy – It all begins with a no-obligation, in-depth review of your claim. We know that by the time most clients reach us, they’ve already experienced confusion, frustration, or a settlement offer that simply didn’t feel right. We will review all claim documentation including estimates, letters, policy, photos, and any other relevant items. We will then work directly with you to map out the most effective path forward. Rest assured that we will only make an offer to work with you if we are confident that we will add value to your claim.
Step 2 - THE EVALUATION
Exhaustive Inspection & Document Review – Once we partner, our team immediately gets to work on your claim. We dive deep into your policy to ensure we fully understand how it applies to your specific loss, while carefully reviewing all existing estimates, photos and documentation. We then conduct an exhaustive, technology-driven inspection of the property using advanced field tools to document every aspect of your loss, ensuring nothing gets overlooked.
Step 3 - THE DEMAND
Estimate Preparation & Submission – We develop a comprehensive, line-item estimate utilizing industry-standard software, subjecting it to a rigorous three-tier review process covering field accuracy, technical precision, and compliance, to ensure nothing is missed. Once completed, we share it with you for your review, input and approval before submitting our entire claim package to the insurance company as The Demand.
Step 4 - THE NEGOTIATIONS
Expert Negotiation, Focused on Your Best Outcome – We stand strong on your behalf, skillfully negotiating for the resolution you need and deserve. When negotiations stall, we don’t back down, we guide you through your available dispute resolution options, to keep your claim moving toward the outcome you deserve.
Step 5 - THE RESOLUTION
Successful Resolution, Your Satisfaction is Key: The final step, this is what everything has been building toward. A fair resolution isn’t just our goal, it’s our standard. Our clients’ outcomes speak for themselves, and yours will too!
CLAIM QUESTIONS? WE HAVE ANSWERS
Peace of mind! We are here to represent you and your interest in the claim. Unfortunately, insurance companies often times deny claims that should be paid or do not pay enough money on a covered claim. This is not always the case and even when it is it may not be intentional. I know that most adjusters have the best of intentions but sometimes they may be inexperienced or simply trained to see things one way, the way the big insurance company wants it to be seen. As Public Adjusters our number one job is to get you the largest settlement available to you under your policy with the insurance company.
NO. Most states have laws stating that Public Adjusters are not allowed to represent the insurance companies. At Claim Concepts, we only represent the insuring public.
The public adjuster is employed by you, the insured. Their function is to represent your interests and ensure that you recover the proper settlement for all of your losses per the terms of your insurance policy. The insurance company’s adjuster works for the insurance company and is responsible to protect their interests throughout the claim.
Public Adjusters typically work on a contingency basis which equals a small percentage of any money recovered by the insurance company.
NO! This is NOT required under any policy that I have seen to date and I do not recommend it. In the event of a loss it is best to employ a Reputable Public Adjuster that knows what the policy will cover and what it takes to get your property back to its pre-loss condition. Many contractors will provide you with a competitive bid to make repairs but not necessarily get your property back to its pre-loss condition.
Yes! In most cases we can reopen your file with a supplemental claim. There are many factors involved. Give us a call and we will be happy to offer you a free claim consultation.
Not necessarily. It is not recommended to file a claim every time you spill a glass of water as you may become classified as a nuisance claim maker. Property insurance is typically rated based on your area which is why all homeowner rates increased in Florida after the hurricanes, whether you filed a claim or not. The risk is more related to the area where your property is located and in commercial situations the use of the property. However, it is known that there are databases where claim activity is logged and each insurance company may have their own stipulations based on claim activity of the individual or the property. Ultimately, you buy insurance to protect you in the time of a loss. If you are debating whether you should file a claim or not, please feel free to call and speak with one of our Public Adjusters about your particular situation, we are always happy to help.
Do not do anything before having a qualified Public Adjuster or Attorney take a look at your file. Depending on the way everything is written you may be agreeing to their offer by depositing the check. Please call our office and speak with one of our Public Adjusters about your particular situation, we are always happy to help in any way we can.