by Mark Goldwich
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| Image courtesy of allposters.com |
The point is, as with many things in life, when it comes to
insurance claims, you need to watch your Ps and Qs (I couldn’t help throwing in
one more). Be mindful of what you say, and how it may affect you later. That
could be tricky, especially when you don’t know how what you say now can affect you later as it relates to
something as complex as insurance. So, stick to the rules above, and below.
My best advice for when you are talking to any insurance
representative (after recommending you consult a professional for
representation on your claim) is to say as little as possible, and to keep what
you say as factual as possible. Most people, once they get started talking,
have difficulty putting on the brakes. Most people are also uncomfortable with
“dead air”, or that “awkward silence.” They’ll start off telling you about the
pipe that burst, and before you know it, they’ll be rambling on about how their
“dog Petey, named after a favorite uncle, doesn’t like a certain neighbor,
who’s kid once stole a car and” … you know?
I tell people to just answer questions factually, in as few
words as possible, and only if they personally know something to be a fact. For
example, if their uncle told them the house was built in 1972, and he explains
he knows that for a fact because that was the year the Miami Dolphins went
undefeated…and they are asked how old the house is, and they don’t personally
know, the answer is “I don’t know.” Or they could say, “I don’t know, but my
uncle has said it was built in 1972.” But, “1972” is the wrong answer, even if
the uncle was right, and the home happened to be built in 1972.
There is absolutely nothing wrong with saying, “I don’t
know”, or “I don’t recall”, especially when that is the truth, but many people
feel saying that too many times gives the impression that they are being
evasive, or worse, that they are not smart (otherwise, they would know). To me, what’s not smart,
is giving an answer to a question when you don’t really know the answer. And to
an insurance company, giving an answer that turns out to be proven wrong – can
be considered evasive, or even “a material misrepresentation”.
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| Courtesy of experttextperts.com |
Another often confused term is “back-up”. Sounds innocent
enough, right? There are generally two reasons why water comes up out of a
drain, instead of going down a drain. Water is either backing up through the
city sewer line or a septic drain field (this is a true “back-up”), or there is
a clog in a drain pipe (this is technically a “fill-up”). In both of these
cases, the results appear to be exactly the same – water coming up out of a
toilet or drain. Why does this matter? Well, one is typically excluded from
coverage, and one is typically covered. The problem is, most people, even
insurance adjusters, aren’t familiar enough with these terms, and if the wrong
term is given, the claim is denied. Now, you can’t just say “fill-up” and
expect the claim will be paid, either. You have to be able to demonstrate it was
truly a “fill-up”, and you may have to be able to articulate the difference, to someone who is supposed to know the difference, but doesn’t, and
will not readily believe they have been “doing it wrong all these years” – You
can bet I have heard that response a
few times.
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| From newgeography.com |
And then there are words that just scream “not covered!” to
most adjusters. You see, most insurance policies have certain things that are
universally excluded from coverage. These are things like, “mold”, “rot”, “wear
and tear”, “defect”, and just plain “old.” So when an adjuster hears these
words coming from a policyholder, the little red light in their head
immediately goes off, and sometimes they don’t even bother to verify it for
themselves. After all, they were given the “facts” by you, the person who
should know best. Case closed.
Mold as a rule is often not covered. But water damage is usually covered. And in most cases,
guess what almost always precedes
mold? That’s right, water. So in cases where water has damaged property, and
then mold sets in, you might want to focus your attention on the water, not the
mold if you want to have a better chance of getting paid. Is this being
deceptive? An insurance company adjuster might suggest it is, but it absolutely
is not, it is being factually correct.
The same is true for rot. Rot is generally not covered. But
sometimes the rot that is seen (which may have occurred years ago from an old
leak), is simply found in the same area of a new leak. If you just show the adjuster the rot in that area, he or
she may assume the rot is related to the “new” leak, believing it is a
long-term, on-going leak. A small difference in understanding could change the
entire outcome of the claim. We have seen it happen more than once.
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This is just a sample of often confusing and misunderstood
terminology related to insurance claims. There are many more, and as we have seen,
policies are always evolving to minimize the potential misunderstandings or
ambiguities that tend to result in litigation. This is good for the consumer in
that lawsuits are reduced, which could (theoretically) keep premiums in check,
but on the other hand, it usually resolves the ambiguity in favor of those who
write the policies to begin with – the insurance companies.
I hope you have learned from this that when the chips are
down, it is best to know your insurance policy, know your terminology, and as
Kenny Rogers famously sings, “You gotta know when to hold ‘em.” By that I mean,
don’t spill your guts when talking to an insurance adjuster, because words
matter, and simple misstatements could mean the difference between a claim’s
life and its demise.
Mark Goldwich is president of Gold Star Adjusters, a group of public insurance adjusters dedicated to helping citizens get the maximum settlement for any insurance claim.
