3rd Case Report of California Certified PA (Public Insurance Adjuster) Jae Park
On March 2012, a homeowner of two-story single-family home in the Los Angeles County community of Rowland Heights found water dripping from the ceiling over the kitchen on the first floor. He suspected that one side of the ceiling in the kitchen had been slightly discolored for the past month.
Right after he found the water dripping, he went upstairs to the bathroom in the master bedroom, where he found that the wall where the shower was installed was wet, as he suspected it would be the source of the water intrusion. Intially, the homeowner thought it would be the problem of insufficient waterproofing plastic ring when the shower head and the cold and hot valves of the old shower were replaced, a month earlier.
The plumber, who came right after the discovery of the water leakage, told the homeowner that he needed to tear the wall to see the exact damage. However, the homeowner couldn’t allow that. It seemed that it would cost a lot of money. With great consideration, he discussed with the insurance agent, who was an old acquaintance, and the agent asked a close associate–a contractor–to check the site. The contractor also couldn’t inspect the site only with the naked eye, so the agent called this PA to check whether the homeowner could get compensation from the insurance company.
This PA inspected the site closely and identified the following points:
1) As the homeowner indicated, the back of the wall where the shower head and the cold and hot valves of shower were installed was wet.
2) This PA also noticed that the tiles on the door sill where the shower door was installed were cracked (the grout was cracked). So, during a shower there was the possibility that water from the shower door would seep into the cracks in the door sill tiles.
In that case, the water could leak onto the floor and leak out through the kitchen ceiling downstairs. In fact, this PA had several experiences like this case while working in the claims department of the insurance company. If this problem is the main cause of the water leakage, most insurance companies will deny the payment of compensation. That is because this type of water leakage isn’t strictly accidental. The problem has occurred gradually, due to the aging of the structure. The technical term of the insurance company is called leakage seepage (water leaks little by little).
3) Therefore, before filing the claim you should call a leak detector and get a detailed inspection. The leak detector is able to check the water leakage without damaging the site, thereby preserving the current state.
This PA reported the opinion to the homeowner as above, and a few days later the insurance agent contacted me. The agent told me that the homeowner said, “The cost of leak detection (about $400) is too much, so just file the claim with the insurance company without the leak-detection process. The water leakage is obvious. What else needs to be checked?” As a result, this PA received the related insurance contract from the insurance agent and reviewed it.
This PA specifically pointed out the related clauses where the payment of compensation might be denied.
I also reminded the agent about the similar case involving a house in Fontana, which the agent once consulted me about. Now the agent was aware of the situation correctly. Since that day, there was no further contact with this PA about the case, so I believe the homeowner handled the case well according to the agent’s advice.
If the homeowner receives a notice of payment rejection (denial of coverage letter) from the insurance company after filing a claim according to the homeowner’s will, with such notice the insurance company may ask the homeowner, who is the insurance policy holder, to repair the part of the problem at his or her expense within 90 days (change order letter). At this point, the homeowner has to secure proof, including repair expenses paid and photos before and after the repair. In some cases, the insurance company wants to check whether the homeowner fixed the problem. Such a case of payment rejection will be kept as a record for minimum three years by the related insurance companies and the Insurance Association Records Administration. If the site isn’t repaired but the homeowner switches to another insurance company and files a claim for the same issue, it may becomes an issue of insurance fraud based on mis-representation,or concelment and the person will be in a very awkward position. Please don’t forget that the insurance companies share adverse information with other insurance companies.
Through this case, I saw a true professional–a wise insurance agent,try his best to protect his customer.
Additional columns are available in English, Korean, Chinese, and Vietnamese at www.JPadjusters.com.
Jae Park, AIC
Public Insurance Adjuster, License # 2H67374
IICRC/Clean Trust- WRT, AMRT, FSRT
Member of CAPIA/ California Association of Public Insurance Adjuster
Jae Park & Associates, Inc.
3255 Wilshire Blvd Suite # 1414
Los Angeles, CA 90010
Business Cell # 213-572-7379
Fax# 877-277-9752
E-mail: [email protected]
Website: www.JPadjusters.com
