Insurance filter: Can a medical condition make a house inhabitable?
January 3, 2015 1:51 PM Subscribe
I had a sink overflow and flood a finished basement. After a really long fight, insurance begrudgingly agreed to replace all of the affected carpeting. I have asthma, and now that the remodeling has begun, the dust and/or mold kicked up caused triggered my asthma. I think the insurance should provide money for me to stay in a hotel. They said they only do that if the house is unfit to live in. I say that as I have a medical condition, making it unfit to live in for me.
You are not an insurance adjustor/my insurance adjustor, lawyer/not my lawyer. I have adult-onset coughing variant asthma, dx'd in 2011. Up until the water damage happened, it was only ever triggered by exposure to rabbits. Then the water damage happened, and the company that came out to clean it up did a terrible job. This caused another asthma attack, along with the worst migraine I'd ever felt in my life. I went to after hours urgent care because I thought I was dying. (I'm not trying to be dramatic, just give some context. Normally I suck up migraines if my abortive mediation doesn't work but this felt like something different, and I was so so cold even with several blankets. I thought something serious wrong. It wasn't, just a migraine solved within 20 minutes by an antiemetic and injection of migraine abortive.)
That ended in me staying in a hotel for a few days, and having to using advair diskus to help the inflammation stop. I don't normally need to take it- my allergist prescribed it to take when I know I'm going to be around rabbits (say I wanted to go to stay with a friend that has a rabbit, or I want to go to the state fair.) Once everything was dried out, my lungs did calm down after a week or so.
Fast forward to now. The remediation work began last week. Shortly after, the asthma came back. I tried barring myself in a bedroom, covering all the vents, letting it air out with a fan for a couple hours, then heating with a space heater. Unfortunately, even with those precautions, my symptoms kept getting worse, and I was relying on the rescue inhaler more and more frequently.
I've checked into a hotel (restarted the advair as well), and I expect the insurance to pay for it. However, insurance say they only pay for it when the home is unfit to live in. I argue that it's unfit to live in for someone with a serious medical condition. The remediation company brought in a air scrubber gratis (insurance said they wouldn't pay for it) but I don't know how well it will work, especially with ongoing work. And unfortunately the only way to test it is basically exposing myself to the air again.
I also just learned they won't be covering the other hotel stay for the same reason. I'm broker than broke ATM, so bearing the cost of both stays is a significant financial difficulty. I think that I should be entitled to be reimbursed based on being unfit to live for someone with a medical condition. I haven't needed the diskus inhaler since the last time this happened. My doctor is more than willing to write up something with my dx and restrictions, and I have medical records that document the asthma diagnosis in 2011 (and the migraines!).
I can actually be in the house if I wear a painting respirator like this. I did this for significant stretches of time on Thursday and Friday morning before checking into the hotel and it helped, but it's not really practical (I really considered trying to sleep with it on though, my lungs felt so much better using it).
They still have carpeting to tear out in one more room. So even if the scrubber is working, more dust and debris is expected next week. I suspect the insurance company is dragging their feet on this because they think I'm just trying to get more out of them (I'm really not! I would much rather be at home; I chose the cheapest of the two close hotels which are fairly cheap to begin with). And the remediation company said that we can have the scrubber for the weekend, but they need to get it back Monday or we have to pay for it. The carpeting in the other room is supposed to come out Wednesday or Thursday.
I strongly suspect that I legally am in the right, but haven't been able to find a lot to suggest one way or another. The closest I found was this explanation which talks about asthma in terms of needing air conditioning. But I don't know how accurate the piece is. The problem is the dollar amount is small enough that I suspect hiring a lawyer would eat up and money that I should be receiving, but to me is a big expense.
I could use some clarification if anyone knows how the standard of being unfit to live in might apply to medical conditions and special needs related to it. And any suggestions on how to convince the insurance company to see it that way. My understanding is that the clause that covers Loss Of Use/Additional Living Expenses is dependent on the individual's needs. What little I could find is that I should be covered for any expenses that wouldn't normally occur, and normally I wouldn't be in a hotel right now.
Our relationship with the insurance company is strained due to fighting over what amount is covered, over the numerous times they said "the check was in the mail" and it never arrived and some miscommunication over various things we thought would be covered but weren't.
You are not an insurance adjustor/my insurance adjustor, lawyer/not my lawyer. I have adult-onset coughing variant asthma, dx'd in 2011. Up until the water damage happened, it was only ever triggered by exposure to rabbits. Then the water damage happened, and the company that came out to clean it up did a terrible job. This caused another asthma attack, along with the worst migraine I'd ever felt in my life. I went to after hours urgent care because I thought I was dying. (I'm not trying to be dramatic, just give some context. Normally I suck up migraines if my abortive mediation doesn't work but this felt like something different, and I was so so cold even with several blankets. I thought something serious wrong. It wasn't, just a migraine solved within 20 minutes by an antiemetic and injection of migraine abortive.)
That ended in me staying in a hotel for a few days, and having to using advair diskus to help the inflammation stop. I don't normally need to take it- my allergist prescribed it to take when I know I'm going to be around rabbits (say I wanted to go to stay with a friend that has a rabbit, or I want to go to the state fair.) Once everything was dried out, my lungs did calm down after a week or so.
Fast forward to now. The remediation work began last week. Shortly after, the asthma came back. I tried barring myself in a bedroom, covering all the vents, letting it air out with a fan for a couple hours, then heating with a space heater. Unfortunately, even with those precautions, my symptoms kept getting worse, and I was relying on the rescue inhaler more and more frequently.
I've checked into a hotel (restarted the advair as well), and I expect the insurance to pay for it. However, insurance say they only pay for it when the home is unfit to live in. I argue that it's unfit to live in for someone with a serious medical condition. The remediation company brought in a air scrubber gratis (insurance said they wouldn't pay for it) but I don't know how well it will work, especially with ongoing work. And unfortunately the only way to test it is basically exposing myself to the air again.
I also just learned they won't be covering the other hotel stay for the same reason. I'm broker than broke ATM, so bearing the cost of both stays is a significant financial difficulty. I think that I should be entitled to be reimbursed based on being unfit to live for someone with a medical condition. I haven't needed the diskus inhaler since the last time this happened. My doctor is more than willing to write up something with my dx and restrictions, and I have medical records that document the asthma diagnosis in 2011 (and the migraines!).
I can actually be in the house if I wear a painting respirator like this. I did this for significant stretches of time on Thursday and Friday morning before checking into the hotel and it helped, but it's not really practical (I really considered trying to sleep with it on though, my lungs felt so much better using it).
They still have carpeting to tear out in one more room. So even if the scrubber is working, more dust and debris is expected next week. I suspect the insurance company is dragging their feet on this because they think I'm just trying to get more out of them (I'm really not! I would much rather be at home; I chose the cheapest of the two close hotels which are fairly cheap to begin with). And the remediation company said that we can have the scrubber for the weekend, but they need to get it back Monday or we have to pay for it. The carpeting in the other room is supposed to come out Wednesday or Thursday.
I strongly suspect that I legally am in the right, but haven't been able to find a lot to suggest one way or another. The closest I found was this explanation which talks about asthma in terms of needing air conditioning. But I don't know how accurate the piece is. The problem is the dollar amount is small enough that I suspect hiring a lawyer would eat up and money that I should be receiving, but to me is a big expense.
I could use some clarification if anyone knows how the standard of being unfit to live in might apply to medical conditions and special needs related to it. And any suggestions on how to convince the insurance company to see it that way. My understanding is that the clause that covers Loss Of Use/Additional Living Expenses is dependent on the individual's needs. What little I could find is that I should be covered for any expenses that wouldn't normally occur, and normally I wouldn't be in a hotel right now.
Our relationship with the insurance company is strained due to fighting over what amount is covered, over the numerous times they said "the check was in the mail" and it never arrived and some miscommunication over various things we thought would be covered but weren't.
My doctor has told me that Advair is not for temporary use, such as when you're exposed to rabbits, or such as in the present situation. You must use it every day to maintain its level of effectiveness. If you don't use it consistently, it's no more effective than simple albuterol.
posted by JimN2TAW at 2:48 PM on January 3, 2015 [1 favorite]
posted by JimN2TAW at 2:48 PM on January 3, 2015 [1 favorite]
Do you have any friends or relatives you can stay with instead of staying in a hotel? That might be easier than fighting with am insurance company.
posted by rabbitrabbit at 2:49 PM on January 3, 2015
posted by rabbitrabbit at 2:49 PM on January 3, 2015
Contact your state's insurance commissioner/department of insurance. It should be free to talk to them.
You might also consider contacting a public adjuster. I don't know if public adjusters exist in all states, but for extensive work on a house, I have seen stats that suggest they have a decent track record of getting more out of the insurance company than homeowners who self advocate. They do take a percentage cut of the claim, but they typically work on commission, which means they don't get paid unless you get paid.
The insurance company has an inherent conflict of interest here. It both wants to keep you as a paying customer and also wants to minimize what they pay out on each claim. That tension creates a lot of friction. A public adjuster has no such conflict of interest because they get paid only if you get paid. In some states, the only people who can intercede on your behalf with the insurance company are 1) you 2) a lawyer 3) your insurance broker or 4) a public adjuster.
What you are legally entitled to depends in part on what state you live in. And it's really rather obscure info. (I worked in insurance for a few years.) You need people who are familiar with your state's laws, who are on your side.
posted by Michele in California at 2:49 PM on January 3, 2015
You might also consider contacting a public adjuster. I don't know if public adjusters exist in all states, but for extensive work on a house, I have seen stats that suggest they have a decent track record of getting more out of the insurance company than homeowners who self advocate. They do take a percentage cut of the claim, but they typically work on commission, which means they don't get paid unless you get paid.
The insurance company has an inherent conflict of interest here. It both wants to keep you as a paying customer and also wants to minimize what they pay out on each claim. That tension creates a lot of friction. A public adjuster has no such conflict of interest because they get paid only if you get paid. In some states, the only people who can intercede on your behalf with the insurance company are 1) you 2) a lawyer 3) your insurance broker or 4) a public adjuster.
What you are legally entitled to depends in part on what state you live in. And it's really rather obscure info. (I worked in insurance for a few years.) You need people who are familiar with your state's laws, who are on your side.
posted by Michele in California at 2:49 PM on January 3, 2015
Mold calls for hazmat style cleaning team for your safety and for the safety of the people doing the removal. If you just have a bunch of dudes doing it then it is being done wrong and they are spreading mold spores throughout your house and the problem will persist and intensify over time as the mold spores germinate.
Watch some Holmes on Homes episodes on Netflix to see what proper mold remidiation involves.
(I too have mold allergies and when my parent's house flooded due to a burst water heater it was not properly cleaned. Tens years later I would still have asthmatic attacks if I even wore a piece of clothing that had been in the basement for an hour. My parents had to keep my xmas presents in my mom's sewing room rather than with everyone else's presents).
posted by srboisvert at 3:07 PM on January 3, 2015 [1 favorite]
Watch some Holmes on Homes episodes on Netflix to see what proper mold remidiation involves.
(I too have mold allergies and when my parent's house flooded due to a burst water heater it was not properly cleaned. Tens years later I would still have asthmatic attacks if I even wore a piece of clothing that had been in the basement for an hour. My parents had to keep my xmas presents in my mom's sewing room rather than with everyone else's presents).
posted by srboisvert at 3:07 PM on January 3, 2015 [1 favorite]
Oh and talk to a lawyer. I know you think it will eat up the 'small amount' but the amount won't be small, a lawyer will get you a larger amount and the lawyer will actually make the insurance company do proper remediation.
Even just the hint of a lawyer changes the claims processing.
posted by srboisvert at 3:14 PM on January 3, 2015 [2 favorites]
Even just the hint of a lawyer changes the claims processing.
posted by srboisvert at 3:14 PM on January 3, 2015 [2 favorites]
If the house was unfit for anyone to stay in then, yes, the insurance should cover that, depending on your policy. As it is only unfit for you, you would have to get a lawyer to take your case to court. Do you use a hepa filter? You need to establish a clean room in your home. No carpet or curtains, clean walls, fresh sheets and bedding, with a hepa filter running full time. Sadly once asthma is triggered like yours was, it can take awhile for your body to fully recover, and, it might never fully be the same again. I'm surprised that you are fine in the hotel- I always get sick when I stay in one. All that damp carpet. If you go the route of the lawyer, sue the first company and the insurance company. You probably know this but, stress does make asthma worse so, you might be better off just crashing at a friend's house until everything has settled down a bit.
posted by myselfasme at 3:46 PM on January 3, 2015
posted by myselfasme at 3:46 PM on January 3, 2015
When this happened to me, I called the air quality control officer for my city. They wrote something up.
posted by Chaussette and the Pussy Cats at 4:08 PM on January 3, 2015 [2 favorites]
posted by Chaussette and the Pussy Cats at 4:08 PM on January 3, 2015 [2 favorites]
I don't know who told you to use advair as needed but all my medical professionals have been very clear about the this is a steroid inhaler and to work you must take it daily. It might take a few days up to a month but it can make a difference when taken regularly. I suggest you clarify with your pharmacist or doctor about proper use.
Get something from your doctor to submit to the insurance company and work with someone else (lawyer or adjuster) to handle the costs part.
posted by AlexiaSky at 4:38 PM on January 3, 2015 [1 favorite]
Get something from your doctor to submit to the insurance company and work with someone else (lawyer or adjuster) to handle the costs part.
posted by AlexiaSky at 4:38 PM on January 3, 2015 [1 favorite]
Have they installed new carpet yet? I have severe lung disease and I absolutely cannot be around new carpeting. I'm always kind of fighting to breathe, have been on the Advair discus for years now, as well as albuterol rescue inhaler and Spiriva - and on high-flow oxygen - but even with all those things, new carpet will close up my airway in only a few minutes. So my point is that if you're already having this much trouble you're probably going to have even more when they install new carpeting. If it were me, I'd have wood floors installed instead - or tile. And the place needs at least a week or two of windows open and airing out before you can live in it anyway.
But the problem is YOUR health. From the standpoint of the insurance company, all they need to do is get the place suitable and safe for SOMEONE to live in it. Is this your own home, or a rental?
I'd definitely get a lawyer to deal with the insurance company and I'd try to find someone I could stay with until the lawyer determines if the insurance company will pay for you to stay in a hotel until the work is done. Most important, though, is that you get written medical opinion from your doctor stating that you cannot be around mold or dust or old carpeting material, etc. The only thing you have to work for you is documentation by a physician - without that, you're not likely to get anywhere, unfortunately. It's one of those cases where selfish and dishonest people have ruined things for those who truly need help.
Good luck to you. Beware of new carpet.
posted by aryma at 5:45 PM on January 3, 2015
But the problem is YOUR health. From the standpoint of the insurance company, all they need to do is get the place suitable and safe for SOMEONE to live in it. Is this your own home, or a rental?
I'd definitely get a lawyer to deal with the insurance company and I'd try to find someone I could stay with until the lawyer determines if the insurance company will pay for you to stay in a hotel until the work is done. Most important, though, is that you get written medical opinion from your doctor stating that you cannot be around mold or dust or old carpeting material, etc. The only thing you have to work for you is documentation by a physician - without that, you're not likely to get anywhere, unfortunately. It's one of those cases where selfish and dishonest people have ruined things for those who truly need help.
Good luck to you. Beware of new carpet.
posted by aryma at 5:45 PM on January 3, 2015
Response by poster: I am sorry for the confusion over the advair inhaler. I'm (more or less) taking it like you all describe. But, because up until now rabbits were my only trigger and I don't encounter them regularly but do have a friend with a rabbit, she felt I could take it with sufficient advanced notice to hedge off the worst effects when I knew I would be exposed. And since my first spell was REALLY BAD (I went from no rabbit allergy to extremely allergic and asthmatic in a short time, but didn't know what to do about the hacking cough that persisted for weeks), she said the advair inhaler would also help bring the coughing down post event by bringing the chronic inflammation down in a way that a rescue inhaler doesn't.
This doc is no slouch. She's one of the few that really tries to keep ahead of the rest of the curve. She's one of the few doctors I've seen that keeps really current with medical news and seminars. She diagnosed an unrelated condition that had been plaguing me for 25 years because she was more astute than the several allergists I've seen since grade school. And while my GP put me on just a rescue inhaler, it was her use of Advair that really seemed to bring my lungs back into alignment after the first episode. It wasn't immediate, but I was making no progress with the cough using albuterol and no longer being exposed to rabbits.
The hotel isn't the best air quality either, but is a ton better than at home right now. The best has been when I have been outside, but weather doesn't permit. The mask seems to work really well, but I can't be expected to wear that all the time. I don't have any family that is close. My of the friends I could ask either just recently. Well, except one, but she's quite a drive. And honestly she'd be the worst person to impose on - she would say yes even though she's completely stretched thin as is.
I am getting rid of (most) of the carpeting and replacing with LVT. The only exception is the stairways, and going with wood would be prohibitively expensive. But I figured vacuuming one flight of stairs is better than the terror show that is regular carpet cleaning.
posted by LANA! at 9:47 PM on January 3, 2015
This doc is no slouch. She's one of the few that really tries to keep ahead of the rest of the curve. She's one of the few doctors I've seen that keeps really current with medical news and seminars. She diagnosed an unrelated condition that had been plaguing me for 25 years because she was more astute than the several allergists I've seen since grade school. And while my GP put me on just a rescue inhaler, it was her use of Advair that really seemed to bring my lungs back into alignment after the first episode. It wasn't immediate, but I was making no progress with the cough using albuterol and no longer being exposed to rabbits.
The hotel isn't the best air quality either, but is a ton better than at home right now. The best has been when I have been outside, but weather doesn't permit. The mask seems to work really well, but I can't be expected to wear that all the time. I don't have any family that is close. My of the friends I could ask either just recently. Well, except one, but she's quite a drive. And honestly she'd be the worst person to impose on - she would say yes even though she's completely stretched thin as is.
I am getting rid of (most) of the carpeting and replacing with LVT. The only exception is the stairways, and going with wood would be prohibitively expensive. But I figured vacuuming one flight of stairs is better than the terror show that is regular carpet cleaning.
posted by LANA! at 9:47 PM on January 3, 2015
Response by poster: The answer to this was just to send an email to my claims rep explaining that I would be staying in the hotel for the duration of the remodeling work regardless if they were going to cover the expense. I explained why I needed to stay at a hotel and I explained that I felt it was something the company should cover under the Loss of Use clause because I have a serious medical condition. My intent was simply to make a document chain so if I did need to take legal action later, I had it well documented.
I think they must have sensed that's what was up, because I didn't have to argue, I just got a call the next day saying the whole stay would be covered.
posted by LANA! at 2:37 PM on January 14, 2015 [1 favorite]
I think they must have sensed that's what was up, because I didn't have to argue, I just got a call the next day saying the whole stay would be covered.
posted by LANA! at 2:37 PM on January 14, 2015 [1 favorite]
This thread is closed to new comments.
posted by saucysault at 2:35 PM on January 3, 2015 [4 favorites]