We understand how upsetting it can be for a client who has paid premiums for years with no claims, to turn one in and hear that it’s simply ‘not covered’ by their insurance. As an agent for 31 years, I can tell you that having to impart those words or explain them isn’t any more fun from this end than it is from the receiving end.
You purchase coverage to protect you from ‘sudden and accidental’ losses. Some of those are covered by policy language and some are excluded by policy language; and yes; there are times when we find ‘gray’ areas so to speak.
When talking about property insurance, common exclusions found in most policies are; faulty workmanship or defective materials, birds, vermin, rodents or insects; wear and tear, deterioration, rust or corrosion, flood, surface water, intentional acts of the insured, etc. *(Exclusions vary by company and your policy will have a section that addresses covered property and exclusions)
It is understandable when clients are facing a financial loss of their property that emotions can run high, and explanations of why coverage doesn’t apply, can be dismissed or argued. Even when a loss is clearly excluded by policy language, there will always be situations when clients just aren’t happy.
Some of the more common exclusions we see are wear and tear. A 10-year old camper that sits outside in the elements all year long has issues with leaking through the roof and along the sides. You assume your insurance on the camper will pay to have the roof and siding repaired or even replaced. All insurance however looks at ‘the cause of loss’. The cause of loss in this case isn’t wind or hail or weight of ice and snow, but rather a lack of protection and maintenance.
For example: in many of the vents, skylights and other elements pierce the roof of RVs, caulking is used to maintain a watertight seal. Over time, caulking dries, and as it dries, it shrinks and pulls away from the seams and edges. When left untreated, it will eventually crumble away and provide gaps in the unit where water and moisture can leak through causing mold and rotting wood issues. Storing the camper inside and reapplying caulking every few years can prevent the leaking from occurring.
When you purchase insurance, you are buying a ‘legal contract’ that needs to be referred to when a claim has been denied. I often tell clients that if they are owed coverage in their policy, I will do what I can to make sure they are made whole; which is what insurance agrees to do.
I have had claim denials over the years that I have stepped up to argue on behalf of our clients because I believed coverage was provided by the policy and that perhaps it was simply a communication issue with an adjuster, or just someone seeing something differently than I did. And yes, I’ve won a number of these scenarios for my clients, but I can’t put coverage into a policy that simply isn’t there.
There are always going to be clients who are angry and unwilling to listen when they have a claim denied. I’ve heard too many clients say negative things about great companies, and I’ve been doing this long enough to know that many times it simply isn’t a company issue. It’s a claim that was denied because it was specifically excluded, or coverage was available but not purchased.
We know that clients don’t sit around reading policies like some of us agents do (guilty); but it is important for them to be educated and understand what they are purchasing, and when a claim is denied to understand why to either purchase that coverage in the future if available, or to at least understand when coverage simply isn’t there.
As always, we are here to assist with your insurance needs, questions and inquiries.