The majority of mold insurance claims typically arise in one of two circumstances:
(1) mold comes to the property owner’s attention along with the discovery of ongoing moisture buildup, water leakage or water intrusion that has gone on for some time below the property owner’s radar; or (2) after a sudden, accidental flood or leak from a plumbing system or appliance, there is a delay in or failure to adequately dry out water damaged building products, fixtures, furnishings, finishes or belongings. The certified technicians at Five Boro Mold Specialist have been trained to detect any water damage and/or intrusion affiliated with the property.
If you are making a claim to your own insurer for damage to your property, you are making a "first party" property claim. If you are asking your insurer to investigate or defend a claim against you–for example, your tenants are suing you for mold contamination–you are making a "third-party" liability claim to your insurer. Five Boro Mold Specialist provides all of our clients with a detailed report that will assist with any type of insurance claim. The following are some helpful pointers for each type of claim...
Homeowner, commercial property owner and renter property policies differ in kind
and in scope from insurer to insurer. Whether mold contamination is covered
under your policy will depend on the specific policy language and the cause or
causes of the mold contamination. Read your policy carefully. Some property
policies are "specified peril" policies, which may cover mold contamination if you
can prove that it is caused by one the listed "perils" or causes. Some property
policies are "all risk" policies, which may cover mold contamination, unless the
insurer can prove that the cause(s) or the mold contamination itself is excluded in
the policy. Five Boro Mold Specialist provides the most comprehensive
investigation of the property to verify the exact cause of water damage to
further assist in your claim.
Most property policies have a long laundry list of exclusions for damage caused by mold, dry or wet rot, corrosion, pollution, wear and tear, deterioration, faulty workmanship and materials, construction defect, and the like. To make matters more complicated, some policies have limited "exceptions" to the exclusions– kind of like a double negative–that may provide some very limited coverage for mold contamination. In several states, like California and Texas–in response to insurers threatening to boycott coverage for water damage, as well as mold contamination coverage–insurance regulators are developing rules to permit insurers to provide minimum mold contamination coverage, e.g., $5,000 property limits, unless the policyholder buys more expensive coverage separately. Check your policy after it has been renewed to see if mold coverage limitations have been inserted.
When, however, mold contamination develops as a secondary or "ensuing" problem from water damage that is covered, your insurance company may cover the additional cost to remediate the mold contamination. With the inspection that Five Boro Mold Specialist offers we will be able to determine if the damage is covered under the client’s insurance policy. All findings are detailed in the customary report provided, specifically formatted for insurance submission. More often than not, the real fight with your insurance company is over identifying the most important cause or causes of the mold contamination–are they covered or excluded? The jury is still out in most states as to whether mold is a "pollutant" within the meaning of most pollution exclusions.
As a general rule, most insurers attempt to exclude coverage for mold contamination associated with long-term leakage, moisture or water intrusion from a construction defect, wear and tear, deferred maintenance or poor repairs. Most insurers will acknowledge coverage for mold contamination associated with accidental discharge of a closed plumbing system–as long as you take reasonable steps to protect and repair the property after you discover the damage. Accordingly, never speculate or guess about the cause(s) of the mold contamination or suggest to or agree with your insurance company that the mold must have been around for a long time or that there must be some hidden leak somewhere. Wait until all the investigation is completed before you acknowledge or agree as to the cause(s) of the loss with your insurance company. Five Boro Mold Specialist will provide you with all the proper information to determine the source and/or cause of the water damage.
Once you determine that you have a covered loss, be sure to go down the list of all the coverages in your declarations page, including additional living expense (if you have to move out during repairs), and make sure that you explore all the benefits you are entitled to.
In most liability policies, your insurer agrees to defend you if you’re sued, and to reimburse ("indemnify") you if get hit with a judgment. Somewhere in between, there is a duty to settle claims against you. The duty to defend you is much broader than the duty to indemnify you: typically the insurer must defend you if the person suing you alleges facts that merely potentially seek damages within the coverage of your policy. You only have to show that the claim might be covered; the insurer has to show conclusively that the claim cannot under any circumstances be covered. Accordingly, immediately tender the defense of any lawsuit against you to your insurer by sending a copy of the complaint and summons and asking for a defense. Don’t wait. Tender early and often. You may not be able to recover attorneys’ fees you have to pay before you tender your defense to your insurer. If your insurance company refuses to defend you, consult a policyholder attorney to analyze your policy and the claims against you. Mold analysis and reports submitted by Five Boro Mold Specialist are widely acknowledged and accepted by insurance companies for reimbursement for water and/or mold related damages based on individual coverage.
6. UNDERSTAND YOUR RIGHTS. LEARN YOUR STATE’S LAWS THAT
REGULATE HOW INSURANCE CLAIMS ARE SUPPOSED TO BE HANDLED.
Every state has statutes and regulations that set minimum standards for handling insurance claims. You usually can find these laws through your state department of insurance or insurance regulator website. You can also call your state’s department of insurance or insurance regulator for information.
7. YOU MUST COOPERATE WITHIN REASON WITH YOUR INSURANCE COMPANY’S INVESTIGATION AND HANDLING OF YOUR CLAIM, BUT DO NOT GIVE A RECORDED STATEMENT, A SWORN STATEMENT OR A SWORN "PROOF OF LOSS" FORM UNTIL YOU ARE SURE YOU UNDERSTAND YOUR RIGHTS, YOUR INSURANCE COVERAGE AND THE FULL EXTENT OF YOUR CLAIM.
You have a contractual obligation under your insurance policy to cooperate with your insurer in its investigation and handling of your claim. You do not have an obligation to allow yourself to be abused. In most states you and your insurance company have a reciprocal obligation to act in good faith and deal fairly with each other to investigate and process your claim. This means that each of you should avoid taking any unreasonable position or doing or saying anything that would unreasonably frustrate each other’s rights under the policy. The insurer should never make an unreasonable request to you. You should never refuse a reasonable request from your insurer for information related to your claim.
Your insurer may require you to give one or more recorded statements. Use your own tape recorder to tape your statement and the insurer’s questions. More often than not, insurers and their attorneys delay or refuse to give you a copy of your recorded statement. Do not give a recorded statement until you are sure you understand your rights, your insurance coverages, and the full extent of your claim. Five Boro Mold Specialist will assist in recommendations for this process upon completion of a full inspection, to insure the statement corresponds with the information provided in your Mold Inspection Report.
Your insurer may ask you to make available various documents related to your claim, including banking statements, investment reports, receipts and other personal financial documents. You are not required to produce your tax returns, but you are required to produce any other documentation reasonably related to your insurer’s investigation of your claim. Your insurer can require you to produce these kinds of documents as long as they are reasonably related to its investigation. Do not provide these documents to your insurer until you are sure you understand your rights, your insurance coverage and the full extent of your claim.
Most policies require that you submit a "sworn proof of loss" form to your insurer within a certain amount of time after being provided the form. In most states you are contractually obligated to submit the sworn proof of loss within the time limit, or at least to substantially comply with the requirement, unless you get an agreement from your insurer for more time or an agreement to dispense with the sworn proof of loss. Do not submit the sworn proof of loss to your insurer until you are sure you understand your rights, your insurance coverages, and the full extent of your claim. It is not unusual for an aggressive insurer to use mistakes in the sworn proof of loss to reduce or reject coverage for a claim.
Aggressive insurers may keep asking you for more and more information, anticipating that at some point, you will draw a line in the sand. If, however, you refuse to comply with reasonable requests for a recorded statement, an EUO, a sworn proof of loss, or documents reasonably related to your insurer’s investigation, you may be giving your insurer a valid excuse to deny your claim, based solely your purported breach of the duty to cooperate. If you believe that any requests are unreasonable, ask you insurer to explain the reason for the requests in writing. Err on the side of caution. If in doubt, consult with a policyholder attorney, a public adjuster or your state department of insurance, before you say "no way" to a request that may–in retrospect–turn out to have been a reasonable one.
8. NEVER SIGN A RELEASE, WAIVER, INDEMNITY OR "HOLD HARMLESS" AGREEMENT WITHOUT PROPER LEGAL ADVICE.
You should never have to sign a release to settle an undisputed claim. If your insurer, adjuster, consultant or contractor asks you to sign a release, waiver, indemnity or hold harmless agreement, ask them to explain why in writing. These kinds of agreements can be used to deprive you of rights and benefits forever. These kinds of agreements can obligate you to pay thousands of dollars for issues that come up down the road that you never anticipated. Consult a policyholder attorney as to your rights before signing any such agreement.
9. GET A SECOND OPINION. DON’T ACCEPT A LOWBALL OFFER.
Be wary of "lowball" estimates from insurance friendly contractors. Get a second and even a third written estimate to repair and replace damaged property from reputable, independent professionals that you would hire to do the actual work. You are entitled to have your damaged property replaced with "like kind and quality." Insist on it. When you can’t match the remaining undamaged tile, wallpaper, carpeting, or other portions of undamaged property, you are entitled to have the entire "line of sight" replaced to match. Insist on it. Five Boro Mold Specialist provides a comprehensive detailed Mold Inspection Report, specifically outlining any and all damages relating to your claim as well as their severity.
Make sure that you understand how your insurance policy pays out on covered claims. Some losses are paid on "actual cash value," which in many states can mean either the "fair market value" or the cost to replace the property, less depreciation for age, wear and tear. Some losses are paid out on a replacement cost value. Your policy may permit your insurer to pay you actual cash value, and withhold the additional cost to replace property until you actually go out and replace it. In recent years, some insurers have attempted to also withhold an amount for contractor "profit and overhead." Don’t let them. Policyholder attorneys and some insurance regulators have successfully prevented insurers from withholding these amounts.
If you have a disagreement with your insurer over the amount of your claim, you may be required by your insurer to submit the dispute to "appraisal." Appraisal is a form of binding arbitration to settle disagreements over the amount of your claim. It typically does not decide disagreements about what is covered, what is not covered, what caused the loss or poor claims handling problems, unless you and your insurer agree to submit those additional disputes to the appraisal. While appraisal was initially designed to be an inexpensive, informal resolution of insurance disputes, insurers have turned it into one of the most expensive, overlawyered, and dragged out sideshows in insurance claim resolution. If you cannot resolve a dispute with your insurer over the amount of your claim, or your insurer demands appraisal, you should consult with a policyholder attorney.
10. THOROUGHLY INVESTIGATE THE QUALIFICATIONS, LICENSE, AND REFERENCES OF YOUR INSURANCE COMPANY’S "APPROVED" CONTRACTOR BEFORE AGREEING TO HIRE THEM TO DO THE REPAIRS.
You do not have to use consultants or contractors recommended or "approved" by your insurer to perform repairs. "Approved" contractors are typically contractors who have agreed to discount their labor and costs, and follow insurer guidelines, in exchange for a volume of business from the insurance company. If your insurer promises to "guarantee" the approved contractor’s work, the "guarantee" is generally limited to replacing any defective materials or correcting faulty workmanship. Your insurer is not insuring against any contractor delays, negligence or liability. Accordingly, do not use the "approved" contractor unless it is a contractor that you would independently hire to do the work after a thorough screening.
Be sure to check that each contractor’s license is valid, and for any complaints against the license. Be sure that the contractor is bonded and insured. All our technicians at Five Boro Mold Specialist are certified, insured and bonded and always guarantee to work in your best interest.
11. GET PROFESSIONAL HELP IF YOU NEED IT.
If you reach an impasse with your insurer, be sure to document the dispute fully in writing. Explain why your position is reasonable, and your insurance company’s position is not reasonable. If your dispute does not necessarily require legal advice, you may be able to resolve the dispute by calling your state’s department of insurance or insurance regulator, or by hiring a public adjuster. If your dispute requires legal advice, contact a lawyer who is experienced and specialized in representing policyholders.
12. MAKE SURE YOU KNOW ALL THE DEADLINES THAT MAY CUT OFF YOUR RIGHT TO FILE A LAWSUIT.
All states have statutes of limitation that will cut off your right to bring a lawsuit against your insurance company if you don’t file a lawsuit in time. The statutes of limitation differ from state to state. Most property insurance policies have a shorter contractual limitation period that will cut off your right to bring a lawsuit against your insurance company if you don’t file a lawsuit in time. These periods are typically one year or two years after a loss occurs or after you first discover a loss. Sometimes the "clock" stops running during the time your claim is pending, and starts again once your insurer denies your claim. In most states your insurance company is required to tell you in writing that your claim is denied, and that the limitations clock is running. Make sure you understand all possible deadlines. Consult with a policyholder attorney sooner, rather than later. You will make it harder for a policyholder attorney to give you the representation you deserve, if you show up on her doorstep the day before the clock stops ticking.
13. REPORT ALL UNFAIR CLAIM HANDLING TO YOUR DEPARTMENT OF INSURANCE OR INSURANCE REGULATOR.
Most state insurance regulators track policyholder complaints about their insurers and compile the results. The results may be available through your state insurance regulator’s web site. In some states you can file a formal complaint online. Insurance regulators also regularly compile "market conduct" reports on unfair claim practices. If you don’t file a complaint, you can’t make a difference.
1. Be pro-active in the claim process.
2. You’re not on a level playing field when you’re dealing with an insurance claim.
3. Think of your insurance claim as a business negotiation—you’re dealing with a for-profit company.
4. Give your insurance company a chance to do the right thing, but don’t mistake a friendly representative for a friend.
5. Document and support your claim with proof, details and estimates. Five Boro Mold Specialist’s Mold Inspection Report will provide thorough and complete analysis of damages incurred.
6. Present clear requests in writing that explain what you need, when you need it, and why you’re entitled to it.
7. Don’t pad or exaggerate your claim.
8. Don’t sign legal documents without consulting with a qualified attorney.
9. Try to resolve problems informally but complain in writing, go up the chain of command and/or use government agency help when necessary.
10. Get specialized professional help when you need it; start by calling our office staff at 718-677-6653 to become more informed of the process.
The staff and technicians at Five Boro Mold Specialist are here to assist our clients with a precise and thorough inspection. Because our inspection reports are so thorough they are recognized and accepted by insurance companies and court systems. Our technicians use state of the art infrared cameras throughout the property to find any and all sources of moisture intrusion. Every step of our inspections, including all damages caused, are documented and provided for our clients in a detailed color report. All of our technicians are highly professional and prepared to deal with any mold and/or water related situation. Our company is certified, insured and bonded. If you have any questions about our services you can visit our website at www.fiveboromoldspecialist.com or contact our office at (718) 677-6653.