Your Insurance Claim Has Been Denied. Now What?

Game Room Water Damage | Professional Loss Adjusters

This article features a case study of a claim handled by a member of the Professional Loss Adjusters’ team. Together, our adjusters have more than 225 years of experience handling insurance claims. Our team is here to help you. Call us.

Oftentimes, home and business owners seek our assistance after their claim has been denied by their insurance company. Owners are then faced with some tough questions: How will my damage be repaired? How will I be able to recover from my loss? What do I do? Here’s an instance in which a homeowner’s claim was denied and they contacted Professional Loss Adjusters for assistance.

A homeowner called us asking for help with a water damage claim that his insurance company had denied. There had been extensive flooding to the client’s indoor basketball court, gym, theater room, hallway and game room. The insurance company’s denial was based on the assessment of an outside engineering expert hired by the insurance company to find the source of the water break. Being unable to find the source, the engineer assumed that the water came from the ground. Since groundwater is excluded under this, and virtually every other homeowners’ policy, the insurance company denied the claim. 

Gym Water Damage | Professional Loss Adjusters

However, two things stood out for us: the homeowner said the water was warm—not cold—and the ground was dry, so there was really no indication that the source was groundwater.

We asked for a new engineer to be assigned by the insurance company’s adjuster. They agreed. While waiting for the engineer to arrive for the appointment, Mike Garofalo, our Public Adjuster on the case, decided to do some investigating on his own. Mike’s background is in water mitigation, so he has extensive training in seeking out sources of water. He followed the water stain patterns, eventually tracing the cause back to an overflowing condensate pump. When the engineer arrived, Mike showed him the problem. The engineer agreed the pump was the source of the flooding. The denial was reversed, and the client received a settlement of $180,000. 

When you have a claim, call us first. Together we can advise you how to proceed to ensure you have the best chance of fully recovering from your loss.

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Leonard Theran, SPPA

Len earned a Bachelor of Science degree in Mechanical Engineering from the Massachusetts Institute of Technology and an MBA from Stanford University. He has more than 35 years of adjusting experience and also earned the SPPA designation. Because he has also been involved in the management of several high-tech companies, Len has a unique perspective when adjusting industrial losses. He is a past-President of the Massachusetts Association of Public Insurance Adjusters (MAPIA) and is on the Board of Directors of the National Association of Public Insurance Adjusters (NAPIA) and CAI-New Hampshire. He has also qualified as an Expert Witness and has been a featured speaker before several organizations including the Risk and Insurance Management Society, the Institute of Real Estate Management and Lorman Education Services.

Len is licensed in Massachusetts, Connecticut, Maine, New Hampshire, New Jersey, Rhode Island, Vermont, Georgia, North Carolina, South Carolina, Texas, West Virginia, Virginia, Oklahoma, Florida, and the U.S. Virgin Islands.