Stuck in insurance claim hell

[TangoJuliet]

Last month my condo was damaged in the hurricane. A tree was uprooted and took my AC unit (compressor) with it. I don't want to get into too many details but the unit was on its side for a couple days until the managment company removed the tree and placed the unit back to where it was.

I filed a claim with my insurance company (allstate) and it was denied which they reference Article 7 in the by-laws.

So I contacted the HOA's property manager and he sent this message to their attorney

Question: Tree fell during windstorm and crushed Condominium Home Owner’s air conditioner. Who is responsible for replacement of air conditioner?

Under Article III, Section 6 of the Condominium’s By-Laws, “All maintenance, repairs and replacements to the Homes including windows… and repairs to the heating/air conditioning system, pipes, wires and conduits located within or without the same Home… shall be made by the respective Home Owners at their expense.” Therefore it appears that the Home Owner is responsible for the repair/replacement of his air conditioner.

The Home Owner submitted his claim to his insurance company, which denied coverage citing to the Condominium’s By-Laws, Article VII, Section 1, Insurance to be Carried by the Board. Section 1 pertains to fire insurance with extended coverage, water damage, vandalism and malicious mischief endorsements, insuring all the Condominium’s buildings “together with all heating, air-conditioning and other service machinery, contained therein…” Although “air conditioning” is mentioned, it is only in relation to damage caused by fire, water, vandalism and malicious mischief, none of which caused the damage to the air conditioner.

Section 1 concludes with: “Home Owners shall not be prohibited from carrying other insurance for their own benefit provided that such policies contain waivers of subrogation and further provided that the liability of the carriers issuing insurance procured by the Board of Managers shall not be affected or diminished by reason of any such additional insurance carried by any Home Owner.”

Therefore, since the tree falling had nothing to do with fire, water damage, vandalism and/or malicious mischief, the Condominium’s insurance obligations are not triggered by such an event.

So my insurance company is saying the HOA is responsible and the HOA is saying my insurance company is responsible meanwhile nothing is getting fixed.

Last week I came across this article in newsweek

http://www.prweb.com/releases/2012/11/prweb10150413.htm

I was given a free consultation by the firm and they are willing to take on the case. There is no fee if no judgement is awarded but they will take 40% if there is.

40% is a pretty big price to pay but it may be my only choice if nobody is going to work with me on it. I thought about taking them both to small claims court but don't know exactly how that would work.

Cliffs:

HVAC unit destroyed in Hurricane
Personal insurance and property managment co insurance will not take claim
Hire Attorney?
Take both to small claims court?
Help!

 

[dr150]

If they deny you, take them to court. Also look for class actions claims that may have been filed.

Many have taken insurance companies to court and won based on going to court individually or part of class action suits during recent hurricane storms.

I feel for you. It sucks. But don't lay down to these insurance companies.

Apparently Allstate is one of the worst offenders in paying out hurricane claims and have lost MANY cases.

In the future, use an insurance company that won't play games and are stand up guys when it comes to claims.....

....Use USAA or Amica. You can't go wrong with either.

 

[SphinxnihpS]

In condos your responsibility ends at the interior paint, meaning everything outside the imaginary planes that define the interior of the box you live in are the association's responsibility.

 

[Gooberlx2]

....Use USAA or Amica. You can't go wrong with either.

This. A couple years ago one of my manager's house burned down in the Boulder fires. Everyone in the community who had State Farm had to retain a lawyer as a group to get their claims settled, because it was such a mess and they were all being put through a wringer. Meanwhile everyone who had USAA basically claimed (to the effect of) "My house burned down and all my shit is gone.", and USAA replied with (to the effect of) "Here's a bunch money to make you whole! Glad you're okay".

 

[TangoJuliet]

In condos your responsibility ends at the interior paint, meaning everything outside the imaginary planes that define the interior of the box you live in are the association's responsibility.

The AC unit is outside.

 

[sactoking]

The condo attorney is correct. Article VII Section I only covers loss to heating, air conditioning and other service machinery when the loss is covered by fire, water, vandalism or mischief. The wording is pretty clear.

No need to hire an attorney, New York has a very consumer-friendly Department of Financial Services (Insurance Department). Rather than throw away 40% of a property damage claim on an attorney (meaning you wouldn't have enough to pay for a new unit) lodge a complaint with the DFS. They should agree with the condo attorney's reading and, assuming they do, will contact Allstate and tell them to pay the claim. If Allstate refuses then DFS can do a targeted market conduct exam which could easily cost 100x the claim cost.

 

[JulesMaximus]

This. A couple years ago one of my manager's house burned down in the Boulder fires. Everyone in the community who had State Farm had to retain a lawyer as a group to get their claims settled, because it was such a mess and they were all being put through a wringer. Meanwhile everyone who had USAA basically claimed (to the effect of) "My house burned down and all my shit is gone.", and USAA replied with (to the effect of) "Here's a bunch money to make you whole! Glad you're okay".

USAA is the bomb. I'd never insure with any other company. Sadly, they seem to be the only decent one.

 

[RossMAN]

The condo attorney is correct. Article VII Section I only covers loss to heating, air conditioning and other service machinery when the loss is covered by fire, water, vandalism or mischief. The wording is pretty clear.

No need to hire an attorney, New York has a very consumer-friendly Department of Financial Services (Insurance Department). Rather than throw away 40% of a property damage claim on an attorney (meaning you wouldn't have enough to pay for a new unit) lodge a complaint with the DFS. They should agree with the condo attorney's reading and, assuming they do, will contact Allstate and tell them to pay the claim. If Allstate refuses then DFS can do a targeted market conduct exam which could easily cost 100x the claim cost.

Thanks for the info, you seem to know your stuff

http://www.dfs.ny.gov/

 

[tailes151]

Saw this thread while at work but forgot about it until now.

Before you bother going to an attorney, call both of the adjuster's and again clarify (since I'm sure you have already done so) that the both of them appear to just be pointing fingers at each other.

Tell them that since they can't seem to decide who is responsible, you're willing to let your state's DOI figure everything out. Drop the words "bad faith."

See which folds first.

This certainly worked when I worked as an auto adjuster, I assume it's probably near the same for property adjusters.

 

[TangoJuliet]

The condo attorney is correct. Article VII Section I only covers loss to heating, air conditioning and other service machinery when the loss is covered by fire, water, vandalism or mischief. The wording is pretty clear.

No need to hire an attorney, New York has a very consumer-friendly Department of Financial Services (Insurance Department). Rather than throw away 40% of a property damage claim on an attorney (meaning you wouldn't have enough to pay for a new unit) lodge a complaint with the DFS. They should agree with the condo attorney's reading and, assuming they do, will contact Allstate and tell them to pay the claim. If Allstate refuses then DFS can do a targeted market conduct exam which could easily cost 100x the claim cost.

Thanks for the info, you seem to know your stuff

http://www.dfs.ny.gov/

Saw this thread while at work but forgot about it until now.

Before you bother going to an attorney, call both of the adjuster's and again clarify (since I'm sure you have already done so) that the both of them appear to just be pointing fingers at each other.

Tell them that since they can't seem to decide who is responsible, you're willing to let your state's DOI figure everything out. Drop the words "bad faith."

See which folds first.

This certainly worked when I worked as an auto adjuster, I assume it's probably near the same for property adjusters.

Thanks guys! I filed a complaint this morning with DFS. I sent an email to both allstate and the property manager that a complaint was filed against them. Hopefully, somebody will take responsibility and fix my property. I mean, thats what I am paying insurance for!

 

[Jimzz]

If that does not go anywhere then get a estimate and sue both in small claims. Let the court decide, but make sure to sue both at the same time or they will point the finger at each and then get off.

 

[TangoJuliet]

That was pretty quick. The DFS called me today and just wanted to go over some of the info I submitted. They said they are opening an inquiry today.

 

[jagec]

Now aren't you glad you didn't end up just lining the pockets of some scum-sucking ambulance chaser?

 

[ThePresence]

This. A couple years ago one of my manager's house burned down in the Boulder fires. Everyone in the community who had State Farm had to retain a lawyer as a group to get their claims settled, because it was such a mess and they were all being put through a wringer. Meanwhile everyone who had USAA basically claimed (to the effect of) "My house burned down and all my shit is gone.", and USAA replied with (to the effect of) "Here's a bunch money to make you whole! Glad you're okay".

I just had storm damage and State Farm paid up in full without the slightest issue. I was shocked how smooth it was.

 

[SphinxnihpS]

The AC unit is outside.

Yeah I understand that. I'm saying that your condo association is screwing you.

 

[Uppsala9496]

Do you have a copy of the associations insurance policy?

Wind damage is usually included under a fire policy. I'm curious what company is providing the coverage.

 

[TangoJuliet]

Do you have a copy of the associations insurance policy?

Wind damage is usually included under a fire policy. I'm curious what company is providing the coverage.

I do not. The property manager will not give me that information. All that I have from the HOA is their by-laws.

 

[Gooberlx2]

I just had storm damage and State Farm paid up in full without the slightest issue. I was shocked how smooth it was.

To be fair, our rental house in Wyoming was damaged by hail, and State Farm replaced the roof without issue. OTOH, State Farm was such a PITA with an auto claim once that we bailed on them as soon as it was finally resolved.

I guess all I can say is, by my anecdotal observations, the frequency by which people have issues with USAA is low or even non-existent, compared to State Farm.

 

[Uppsala9496]

This response is for educational purposes only as well as to give you general information and a general understanding of potential coverage, not to provide specific legal or coverage advice.

Fire insurance is going to cover wind damage unless there is a specific exclusion. All homeowners (HO-1, HO-2, HO-3, HO-5) covers wind. Your HO-6 (condo owners) covers it as well.

They are being difficult in denying coverage. I am going to guess that they never submitted the claim to the respective insurance company. They had the association attorney look at the bylaws statement and say no, you are not covered instead of submitting a potential claim (which could raise their rates).

 

[weadjust]

Who is responsible for maintaining/replacing the HVAC unit in the event it is not working due to normal wear and tear. Condo Association or Condo Occupant? Just curious I am not familiar with condo ownership.

 

[TangoJuliet]

They are being difficult in denying coverage. I am going to guess that they never submitted the claim to the respective insurance company. They had the association attorney look at the bylaws statement and say no, you are not covered instead of submitting a potential claim (which could raise their rates).

You are quite possibly correct. Heres what happened and this might add some insight

Hurricane/Tropical Storm/Super Storm Sandy takes the tree out. I inspect the damage, taking photos and whatnot and file a claim immediately with allstate.

I get a call back within days and the rep goes over things. He tells me that they are ready to process the claim and all he needs are estimates. Maybe a week goes by that I have companies come by to give me estimates for repair.

I submit the estimates to allstate and get a call back from the same rep saying that a page must have gotten jammed in the fax machine because he didnt get the last page. I fax it to him again. I don't hear anything for a couple days.

Finally someone calls me from allstate and now its a new rep - a woman. She tells me that the first rep was removed from the claim and she is taking over. She tells me that they cannot process the claim without seeing the by-laws. I ask her why is that an issue now since the first rep did not need them and he was ready to process the claim.

Now let me tell you finding the by-laws was tough. I went through the paperwork when we bought the place and couldn't find it. I contacted a couple of neighbors and none of them had a copy. I finally got in touch with the property manager and he tells me that he has them on his computer and can send them over immediately - which he does. He ends the conversation saying sorry I can't be any more help because theres a new management company taking over. I was voted out. <click>

So I send over the by-laws to allstate and they deny the claim and the rest is above.
I mean, there was a ton of damage to the property so I can't see how no other claims were filed. Maybe everyone's personal insurance covered the damage?

 

[TangoJuliet]

Who is responsible for maintaining/replacing the HVAC unit in the event it is not working due to normal wear and tear. Condo Association or Condo Occupant? Just curious I am not familiar with condo ownership.

If you look above I quoted the HOA's by-laws. Article III, Section 6 seems to cover that.

I have asked my insurance company several times - since I am the one that maintains the unit then my insurance should be handling this claim. I have yet to get a straight answer from her.

 

[dr150]

Once you resolve your issues with Allstate, switch carrier asap.

USAA or Amica.

http://www.allstateinsurancesucks.com/

 

[TangoJuliet]

Once you resolve your issues with Allstate, switch carrier asap.

USAA or Amica.

http://www.allstateinsurancesucks.com/

I briefly looked into both today. Do you have to serve in the military to get USAA? I went through the quote process with Amica and at the end it said to call.

 

[Gooberlx2]

Do you have to serve in the military to get USAA?

You can be a child of someone who served and is a member.
link

1 Use of the term "member" or "membership" does not convey any eligibility rights for auto and property insurance products, or legal or ownership rights in USAA. Ownership rights are limited to eligible policyholders of United Services Automobile Association. The term "honorably served" applies to officers and enlisted personnel who served on active duty, in the Selected Reserve, or National Guard and have a discharge type of "Honorable." Eligibility may change based on factors such as marital status, rank, or military status. Contact us to update your records. Adult children of USAA members are eligible to purchase auto or property insurance if their eligible parent purchases USAA auto or property insurance.