It's raining, it's pouring, the drip drip is boring
August 29, 2012 7:33 AM   Subscribe

How do subsequent insurance claims work in conjunction with previous claims? Isaacy Details inside.

TLDR; had a what we thought was a roof leak, got a new roof, leak wasn't roof but we fixed the leak on one side. Now it's leaking on the other - if we report it to the insurance company are we going to have to pay back the $xx,xxx.xx to the insurance company?

1. Florida, Single Family Home, not in any special flood zone or special high rate hurricane (coastal) zone - built in the last decade
2. I am the homeowner (with the bank, whoever that is this month) and current in all ways
3. We've had a lot of hurricanes in the past decade, one that gave us superficial roof damage
4. We had Isaac this week but didn't get flooded out (though I have been putting off getting flood insurance and I will get it asap)

So, back during one of those years in the last decade when we had all those hurricanes, I lost some roof tile from my house from Hurricane [redacted]. Some guy came by, glued them back on (I know better now), paid cash. Looked to be superficial damage at the front of the house. No interior damage.

After the fix, things seemed hunky dory.

The next year, we had a bad rainy night and the ceiling started leaking in a totally different part of the house than the superficially replaced roof tiles. Argh. Put in a claim to insurance, they paid out a few thousand dollars to patch the roof where it seemed the water may have been coming in according to licensed roofers the insurance company paid. I believe the claim was paid as a part of Hurricane [redacted] from a year earlier.

A couple years later, it leaked more/again. I talked with a roofer (used by others of my acquaintance) who had his own lawyer who represented us to the insurance company to reopen the claim as "Hurricane [redacted]" damage / need a whole new roof (also, building codes changed in the interim, so our tiles would now be glued instead of nailed). They represented us on contingency type basis.

Our claim was reopened, adjudicated, and the insurance company paid for a new roof and interior repairs (I think - but we haven't got around to it). The roof was completely stripped and replaced (with newer technology), one bad plywood board was removed and replaced (not near the leak).

Paperwork was sent, inspections passed, checks were cleared, life went on.

Very shortly there after, it rained, and the ceiling leaked again. Through various types of trial and error, it was determined that the leak was from a crack in the wall that we sealed up. I spoke to other cookie cutter house owners in the neighborhood and the majority of them with our design have the exact same leaks in the exact same place. We all grumbled about design flaw and suing the builder but it never happened. Most everyone has moved away.

Now, a few years later, here blows in Isaac. We have a leak on the other side (symmetrically built house) and it's coming in from the ceiling.

Fixing it is a matter of getting someone nimble up on a ladder and squirting some sealant in a particular place on an exterior wall. The damage to the ceiling is not bad; a bit of spackle and Killz paint and it will look fine. Until we get a hair up our butt and fix up the interior properly with replacement sheet rock and a plasterer.

But? If we file a claim instead? Is the insurance company going to say "Hey, I remember you, we gave you a roof for a leak on the other symmetrical side of your house, no where near the bum plywood boards. So maybe it wasn't the roof? How about our $xx,xxx.xx back, then? Minus $xxx.xx it will take to get a guy in to fix the ceiling."

We have fans to dry out the ceiling (not pro grade but it's not that wet and dry to the touch a few hours later), no more rain expected any time soon.

If they make me pay it back, will they take payments? The cost is seriously my entire year's take home pay (not the only one bringing in money but we're crawling back from a multi year unemployment stint).

I'm not trying to intentionally defraud them, or unintentionally, but I'm very ambivalent about filing a claim or not. Advice?

Boils down to:

1. Claim - I know where the leak is, please pay money to a contractor to fix it. Here's a video of the leak during Isaac, see the light water marks up there.

2. Claim - there's a leak, here's the video we took during Isaac, see the light water marks up there. (Feels icky)

3. Fix it and forget it, save up to fix the interior properly (when we get the other side fixed, too).

The interior fix area is about nine square feet on each spot (leak is along a seam in an area with small pieces of sheetrock all interlocked together).

The exterior fix area is at a place where one direction of cinderlblock meets another. Some sealant has taken care of the one side (either we didn't do it or didn't do it as well on the other) and I expect to do the same on the other side.

Have some interior building experience but nothing in cinderblock constructed houses. I don't expect to move in the next decade or so (market is teddible even if we aren't underwater).
posted by anonymous to Home & Garden (5 answers total)
I'm really curious as to how regular household maintenance repairs are being paid for by your insurance.

What you are describing is not Hurricane damage, it's just a house repair. You should pony up and pay for it out of pocket.
posted by Ruthless Bunny at 7:47 AM on August 29, 2012

It sounds like the cost to repair the leak is pretty low (squirting some sealant--so less than $100, yes? maybe more if you pay a contractor rather than DIY?), so I'm not sure why you would file a claim.

I don't know whether they'd flag that claim and make you pay back the cost of the roof, but even if they didn't and paid you a couple hundred bucks to fix the leak, I'd be very concerned about the new claim triggering the insurance company to raise your rates or drop you. Insurance companies that write homeowners policies generally report all claim into a database called CLUE, and filing too many claims (sometimes defined as "more than 2 in three years") or anything to do with water damage is definitely the sort of thing that can get your insurance company to drop you--and make it impossible to find any other carrier who is willing to sell you insurance. More information in this Bankrate article, where they specifically mention water damage from leaky walls as being the sort of claim that makes sense to take care of yourself rather than risk filing a claim.
posted by iminurmefi at 7:51 AM on August 29, 2012

To expand on what iminurmefi said, after Andrew, the condo building I lived in was dropped by Allstate. We hadn't even filed a claim, they just pulled out of Florida all together.

NO company was offering insurance to new customers. We ended up in the JUA, which is rather like having no insurance at all.

When I bought my new house in 2000, I was able to get Met Life to insure it ONLY because it was new construction AND I was an employee of the Death Star and it was one of our benefits.

Based upon what you've said, this is a relatively inexpensive fix, and again, not hurricane related.
posted by Ruthless Bunny at 7:58 AM on August 29, 2012

I'm not trying to intentionally defraud them, or unintentionally, but I'm very ambivalent about filing a claim or not. Advice?

First of all, you're asking for legal advice, which you're not going to get here.

Second, not only will your insurance company know your claims history forwards and backwards, but all insurance companies file their claims data with industry reporting services. My law firm routinely runs a claims search on every client we have and person suing them. You don't want to know the sort of stuff that shows up here.

Third, filing a claim is not the same thing as fraud unless you're dishonest about the cause of the loss. If you say "Look, I don't know whether this is covered or not, but here's what happened," the insurance company can make an informed decision and pay you or not according to their policy terms. But if you file a claim and lie or dissemble about the actual cause of the loss, that's fraud.

Fourth, what you're describing sounds like a design flaw and/or shoddy workmanship by the builder. That sort of thing tends not to be covered and generally doesn't count as an "occurrence" under most property insurance policies. Passing that sort of stuff off as hurricane damage is fraud, especially if you know the real cause of the damage.
posted by valkyryn at 8:01 AM on August 29, 2012 [3 favorites]

Mod note: From the OP:
Many thanks for the answers. This is my first experience as a home owner and hurricanes and with this whole house insurance thing. I had renter's insurance or did without.

Half the time when I post to Ask, I end up deleting it because laying it all out answers the question for me. This time, it looks like the answer was there (shut up and fix it out of pocket) but I seriously had no idea; still emotionally involved in the money freak out my house is leaky drama.

This is probably the first time I've really strung it all together. Without written notes, I wonder if the whole conversation about leaks everyone had in the same spot was back when we thought it was leaking at an exhaust air escape thing (damaged by the hurricane because of an uninformed guess at design flaw).

We also weren't totally clear on what "hurricane / tropical storm damage" is qualified/quantified as. Thought it was "damage that occurs during a hurricane / tropical storm and after (pre repair)". So now we know, thanks.

That makes this a design fail and/or wear and tear, we should just pay to patch it and move on.

Again, thanks for the helpful input.
posted by mathowie (staff) at 8:37 PM on August 29, 2012

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