Hidden Coverages Increase Insurance Payouts in Maine

Water Damage Flood Remediation | Professional Loss Adjusters

When was the last time you read your insurance policy? Terms like “stretch coverage,” “actual cash value,” “recoverable depreciation” or “Ordinance and Law” can mean very little to the average person, but can mean a lot in terms of sizable out-of-pocket expenses or money left on the table to an insured facing a building loss. The last thing anyone needs is the added pressure of becoming an expert on insurance terminology when faced with a loss.

Having a Public Adjuster on your side of the table who is as well-versed in the language of insurance policies as the insurance companies (and their adjusters) levels the playing field in any discussion. PLA’s Public Adjusters meticulously document each claim as they review each policy line-by-line to uncover hidden coverages to increase payouts for our clients.

To help underscore this point, we thought we would share a recent example of how our knowledge of industry terminology saved our client significant amounts of money, as well as helped get their business back up and running quickly. Professional Loss Adjusters’ Maine office received a call from a local nursing home for a water damage claim. 

When we arrived, there was significant water damage: approximately one third (7,000-square-feet) of the 23,000-square-foot facility was impacted. A “dry sprinkler system” had been installed above the ceiling and was thought to be safe in northern climates. The cause of the water damage was due to condensation building up within the sprinkler piping that could not be properly drained during annual inspections. A dip had formed in the piping where undetected water collected. This portion of the piping was located near an eave that sustained several days of subzero winds and temperatures.  No one knew that this fully functioning sprinkler system could not be thoroughly drained. As a result, the pipe froze, then thawed and burst, flooding eight rooms in a specialized wing within the nursing facility.

When our public adjuster reviewed the client’s insurance policy, he discovered they had “Ordinance and Law” coverage. “Ordinance and Law” Coverage (Part A) states that, if your building is partially damaged by a covered loss (in this case, water damage), and the local building inspector or fire marshal requires you to demolish the undamaged portion and reconstruct it to bring it up to a higher standard, that demolition and reconstruction would be covered under the policy.

Water Damage Flood Remediation | Professional Loss Adjusters

In this case, although the sprinkler system was not outdated, it was found to have several deficiencies.  Engineers representing both the insured and the insurance company agreed that the most cost effective plan was to replace the entire system rather than try to repair it.

Although the insured had to spend the money first in order to be reimbursed for this coverage, it alleviated the final burden of having to pay for this major system upgrade out of pocket. Our client did not realize that “Ordinance and Law” was part of their coverage until our adjuster told them. This allowed the insured to receive a fair settlement: triple the amount of the initial insurance company settlement, as well as a new sprinkler system for the entire facility.

We were beneficial in not only finding and convincing the insurance company to grant coverage for what the policyholder was entitled to, but as a liaison for mediation—working on behalf of the nursing home while negotiating with the insurance company. 

Hiring a Public Adjuster to represent you during a claim—whether you have a loss in your business or your home—can, and often does, result in the client being able to fully restore their property...quickly and effectively.

Do you have questions about an insurance claim or the claims process? In Maine or New Hampshire, contact Michael Creed at mcreed@pla-us.com or call 207.838.5912.


Michael Creed

Michael is a 1983 graduate of St. Anselm College and resides with his family in Medway, Massachusetts. After graduating from college, he served as an officer in the United States Marine Corps.

A Licensed Public Adjuster since 1990, he has adjusted numerous claims throughout New England, as well as hurricane claims in Florida and the Caribbean. He has served in various leadership positions within the Massachusetts Association of Public Insurance Adjusters (MAPIA) and is a member of the National Association of Public Insurance Adjusters (NAPIA). Outside of work, Michael enjoys spending time with his family and following all of Boston’s sports teams. He is an active member and a past-president of the Medway Lion’s Club, as well as a member of the Ancient & Honorable Artillery Company of Massachusetts.

Michael is licensed in Massachusetts, Connecticut, Maine, New Hampshire, Rhode Island, Vermont, North Carolina, South Carolina, Texas, and Florida.