Sewage Backup. Insurance Questionable.
June 16, 2014 6:04 AM   Subscribe

We had a sewage backup - we live in a townhouse, on a slab. (Two neighbors got hit, too.) My homeowners insurance covers rain, flooding, and roof problems, but not sewage. However, the cause of the backup was not our toilets - a branch dislodged on our shared roof and sent down a swimming pool full of water, which overwhelmed the sewer. Insurance is... confusing, demoralizing.

When I called my insurance, they were very clear that my coverage does not include sewer-related issues. And, technically, this is one. However, the sewer is not the underlying cause. There was a branch on our roof that was blocking drainage, and someone went up there to move it so our roof did not leak. It's clear now that the massive volume of water collecting up there would have definitely caused a roof leak, and we're glad that guy is okay, but the end result is that our entire first floor is now stripped down to the concrete on the ground and lathe on the walls. It was pretty bad.

We are going to be able to get the structural stuff (flooring, drywall, paint) and the actual cleaning/disinfecting (ServPro)* covered by the HOA's insurance, but it does not cover the other stuff - rugs and items we could not clean with bleach and have to throw away, loss of use (we are staying with a very good friend), lost income from taking days off to clean, food that spoiled in our fridge, things we had to acquire to live elsewhere on short notice, transportation.

My insurance agent was very firm about us not being covered for sewer issues. He said we were welcome to attempt to make a claim for the loss of use, but it would probably be less than $500 over our deductible and would cause our rate to go up a lot, plus it's not even guaranteed to be approved, and if it's not, our rate would still go up.

So other than our insurance agent showing an extreme lack of compassion - yes, we'll be shopping around once this debacle is over - we're not really sure what to do now. Make a claim? Don't bother making a claim? We just moved into this house, our first home, less than a month ago. To say this is demoralizing is an understatement. We unpacked our last box the night before this happened. Our emotions are absolutely clouding our judgement.

*Fortunately the HOA was very quick on the cleanup. Within 24 hours, all of the floors that touched black water plus a perimeter of three feet were removed down to the concrete slab, and all molding and drywall that touched black water plus about four inches above were removed down to the posts. They've cleaned meticulously. There is nothing in our home right now that is in any way sewage-y.
posted by juniperesque to Home & Garden (10 answers total) 2 users marked this as a favorite
Can you look over your copy of the insurance policy to see what you can get covered?

I understand that you got sewage in your house but technically I wouldn't consider this a sewer problem. Your sewer line did not get damaged and backup into your home. It was the excessive water that overwhelmed the drainage system

This could presumably have happened without the incident with the branch. If it had been your neighbor 3 doors down who caused the excessive water to go into the sewer system and flood all your homes would it be a different scenario? What if it was just raining a lot that day/week?

Do you understand what I'm saying? The fact that the material that came into your home came out of the sewer pipe doesn't make it a problem caused by sewage.

I guess it really depends on the extent of the damage and the costs. If it will really only cost less than the $500 over your deductible then maybe it's not worth pursuing it. If it will cost considerably more, how much more? And will it be worth the surcharges you will have to pay on your insurance premiums?

The agent has every incentive to discourage you from filing a claim so he/she is not necessarily looking out for you.
posted by eatcake at 6:16 AM on June 16, 2014

Usually when making car insurance claims of a certain ilk, I heartily recommend getting a lawyer. A lot of insurance companies routinely deny covered things unless/until a lawyer is involved. I think this situation requires some legal guidance.

You could at least call around and get some advice. Sadly, the best insurance settlements usually happen with intervention from (or simple guidance of) a legal professional who specializes in insurance claims.

Call around and see what your options are.
posted by jbenben at 6:27 AM on June 16, 2014 [1 favorite]

This is not a sewer backup claim; the sewer backup occurred as a result of a branch falling (storm damage?) in the wrong place. It is therefore (I think) a storm damage claim.

Seconding the suggestion that you at least talk to an attorney to see what your options are. Definitely shop around for a new homeowner's insurance policy provider once this is all settled.

I've never made a claim on homeowner's or renter's insurance, so I'm afraid I can't truly recommend any of the companies I've had for such insurance; all I can say is they're good at taking my money and sending me lots of words on paper in exchange for that money.

I once tried to make a loss of use claim on my apartment. A fire sprinkler pipe had burst in my neighbors' apartment, the landlord shut off the water to all the apartments on our floor for 2 days to make the repairs to the plumbing. I tried to file a claim for the hotel room my wife and I got as a result. The insurance company said it would definitely be covered, but since the amount I was claiming was less than my $500 deductible it wasn't worth it to file the claim, since I wouldn't get any money and my premium would go up.
posted by tckma at 6:39 AM on June 16, 2014 [1 favorite]

It is a water (sewer) backup claim because the pertinent issue is that the water entered the house from the sewage line.
The policies can be different from state to state, but based on what I'm used to there would be no loss of use coverage because loss of use is provided when there is a covered loss. Since water backup is not covered, there is no loss of use.
Other questions come to mind: Is water backup available at an extra charge as an optional coverage? If it is, did the agent bring it to your attention when you purchased the policy? If not, it constitutes an error on the agent's part and you could make a professional liability claim against the agent. It's kind of yucky, so I leave it to you to determine if that is a path you wish to venture down.
posted by elf27 at 7:07 AM on June 16, 2014

My advice is that you need a lawyer to read your policy and go to bat for you if necessary.
posted by DarlingBri at 7:32 AM on June 16, 2014

"but it does not cover the other stuff - loss of use (we are staying with a very good friend), lost income from taking days off to clean, food that spoiled in our fridge, things we had to acquire to live elsewhere on short notice, transportation."

You need to have a rider in your insurance policy to cover things like lost income or loss of use, spoiled food, things you had to acquire to live elsewhere. If you don't have that rider (and I'm sorry but I cannot remember the insurance term for it), you're out of luck with getting these ancillary incidentals recovered. I know. I went through a major fire loss and took copious notes on my loss and considered them vital to valuation. My attorneys just tossed that entire part of the claim away.

Do you have a "contents" clause in your insurance policy that covers loss of contents in sewage/flooding situations? Read your policy very carefully. If you do, then you should push your agent on this by pointing out the clause. Policies are very boring and technical. But believe me, with patience you can wade through them and pick them apart to where you can begin to understand what is covered and what is not. We found a provision in our policy that entitled us to $90,000 that our agent had completely overlooked. If, after analyzing the policy, you still feel your coverage entitles you to loss of contents, and your agent denies it, consider going to an attorney just to get his/her opinion on whether you even have a legitimate claim. The first thing an attorney will ask for is your policy. Beyond evaluating an insurance policy, however, going to an attorney would be, imo, dependent on the value of the loss. You have to weigh the costs vs benefits. If the claim is dubious, you don't want to pay an attorney to fight a losing battle. Most attorneys worth their salt won't work on anything without a serious retainer (unless there is reasonable expectation you will receive a considerable settlement from the insurance company). Further, deciding to go with an attorney will lead to yet another time-sucking ordeal in your life. So just make sure your losses are considerable enough to merit one.

One last thing. If you don't like your agent, call the agent's supervisor and ask for a different agent. That's what I did. Not that the next agent got better results, but at least she moved things honestly along.

When you get a new insurance company after the dust settles, consider State Farm. Honestly, I can't say enough kind things about this company.
posted by zagyzebra at 7:43 AM on June 16, 2014 [1 favorite]

Sorry to threadsit, but to be clear: the HOA's insurance is covering the damages to the structure like the flooring and the walls. They don't have a rider that covers the individual items in the owners' units, etc. That is what individual homeowners insurance is for. My own homeowners insurance does cover those things, but possibly not in the case of this sewage thing.
posted by juniperesque at 7:55 AM on June 16, 2014

I work with an attorney whose practice area is exactly this sort of thing. Reading your policy is a good place to start, but it's not realistic to expect a layperson to understand it or know where the policy directly contradicts the relevant case law. Make a claim and contact an attorney who knows this area of law very well.

So sorry that this happened to you ... sewer issues are a nightmare. :(
posted by stowaway at 9:15 AM on June 16, 2014

Attorney and possibly hire a public insurance adjuster of your own.
posted by jerseygirl at 9:45 AM on June 16, 2014

Call a plumber. This is not a a sewer issue, it never was. It is a storm drain issue. Advise your insurer that you had an plumber look at it and he said it was a storm drain attached to the house that caused the problem. Never ever mention sewer again.
posted by Gungho at 11:34 AM on June 16, 2014

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