A Policyholder's Guide to Water Damage Claims
By: Greg Melancon, Advanced Vac & Extract (405) 691-8800
Water damage is one of the most common and stressful experiences for homeowners and business owners alike. Whether it’s from a burst pipe, natural disaster, or a malfunctioning appliance, the aftermath can be devastating. Unfortunately, navigating the insurance claims process adds another layer of complexity that many are unprepared for.
This comprehensive guide is designed to empower you with knowledge, strategies, and actionable advice so you can take control of your water damage claim and secure the compensation you deserve.
Section 1: Understanding Your Rights
1.1 The Right to a Fair Settlement
- Insurance companies are bound by the terms of your policy and state laws to settle claims fairly.
- A fair settlement means covering the cost of restoring your property to its pre-loss condition.
1.2 The Right to Choose Your Own Contractor
- Insurance companies may recommend or push for their "preferred vendor," but you are not required to use them.
- Choosing your own contractor ensures that the work meets your standards and is done without cost-cutting measures that may compromise quality.
1.3 The Right to Request Your Full Policy
- You are entitled to a copy of your insurance policy. Reviewing your policy is crucial to understanding what is covered, excluded, and limited. Request your "Declarations Page" and specific endorsements related to water damage.
1.4 The Right to Challenge a Denied or Underpaid Claim
- Request a detailed explanation of the denial or underpayment.
- Submit an appeal with supporting documentation.
- Hire a public adjuster or an attorney to represent your interests.
1.5 The Right to Timely Communication
- Insurance companies are required to acknowledge claims and respond to inquiries within specific time frames (varies by state). Failure to do so may constitute bad faith.
Section 2: Maximize Your Claim
2.1 Document Everything
- Take high-quality photos and videos of the damage from multiple angles immediately after the incident.
- Include close-ups and wide shots of affected areas, including damaged personal belongings.
- Keep all receipts and invoices for emergency repairs, temporary housing, meals, and other expenses.
2.2 Take Immediate Mitigation Steps
- Shut off the water source.
- Dry affected areas with fans or dehumidifiers.
- Use tarps to cover exposed areas.
- Retain a professional restoration company to prevent mold growth.
2.3 Hire a Certified Water Damage Restoration Company
Certified professionals provide detailed reports, including moisture mapping, loss assessments, and repair estimates. These documents are crucial for substantiating your claim.
2.4 Request an Independent Adjuster
The insurance company’s adjuster works for them, not you. Hiring an independent or public adjuster ensures you have someone advocating for your best interests.
2.5 Know What’s Covered
- Common covered events: Sudden and accidental pipe bursts; appliance overflows; roof leaks caused by covered perils (e.g., wind, hail).
- Common exclusions: Gradual leaks; poor maintenance; flooding (unless you have flood insurance).
Section 3: Who You Have a Right to Hire
3.1 Why Independent Contractors Matter
Preferred vendors may be incentivized to keep costs low for the insurer, which can lead to corner-cutting. Independent contractors are accountable to you.
- Accountability to You: They work for you, not the insurer.
- Better Quality Repairs: More likely to use premium materials and ensure proper drying/remediation.
- Transparency: Provide detailed, itemized estimates.
- Advocacy: Help document damage and negotiate with adjusters.
3.2 Specialists You May Need
- Water Damage Restoration Company: Extraction, structural drying, mold prevention.
- Plumber: Identifies and fixes the water source.
- Mold Remediation Expert: Handles microbial growth safely.
- Public Adjuster: Works for you to maximize payout.
- Attorney: For bad-faith denials/underpayments.
3.3 Questions to Ask Your Contractor
- Do you adhere to IICRC S500 drying standards?
- How much experience do you have with similar claims?
- Do you have reviews, testimonials, references?
- Are you experienced dealing with insurance documentation?
- Can you provide a detailed scope and estimate?
- Are you insured and licensed?
- Do you guarantee your work?
Red Flags: Pushy tactics, unrealistically low estimates, lack of documentation, reluctance to communicate with adjusters.
Section 4: Common Misconceptions
4.1 “I Can’t Start Repairs Until the Claim is Settled.”
Reality: Immediate mitigation is your responsibility. Take emergency measures and document everything.
4.2 “I Have to Use My Insurance Company’s Contractor.”
Reality: You have the right to hire any qualified contractor.
4.3 “Adjusters Work for Me.”
Reality: Adjusters work for the insurer. Consider a public adjuster and get independent opinions.
Section 5: Scrupulous Adjusters and Their Dirty Tricks
- Lowball Offers: Counter with multiple estimates and documentation.
- Delaying Tactics: Keep a written log; escalate if delays persist.
- Partial Denials: Request written explanations; reference policy language.
- Misrepresentation of Policy Language: Ask for full policy; consult pros if needed.
Section 6: Communication & Getting Your Contractor Paid
6.1 Be Proactive
- Respond quickly; document everything.
6.2 Involve Your Contractor
- Let your contractor present scope directly to the adjuster.
- Submit itemized estimates and evidence.
6.3 Escalate If Necessary
- Request a supervisor review.
- File a complaint with your state’s Department of Insurance.
- Hire an attorney for bad faith.
6.4 Request an Advance
Advance payments help with immediate needs (ALE, emergency repairs). Provide documentation and clear amounts.
Section 7: What to Do
- Stop the Source of Damage: Shut off main water supply; limit exposure.
- Document Everything: Photos/videos of all affected areas and items.
- File Your Claim Promptly: Provide description, photos, receipts.
- Hire a Restoration Company: Extraction, dry-down, moisture mapping.
- Get a Professional Inspection: Mold can begin in 24–48 hours.
Section 8: What NOT to Do
- Don’t delay reporting the claim.
- Don’t skip mitigation.
- Don’t complete permanent repairs before inspection.
- Don’t sign a release prematurely.
- Don’t discard damaged items without documentation.
- Don’t assume everything is covered.
Section 9: Other Common and Uncommon Issues
9.1 Common Issues
- Mold coverage limitations.
- Policy exclusions (flood, gradual leaks, maintenance).
- Disputes over repair scope.
- Lowball estimates.
9.2 Uncommon Issues
- Hidden damage inside walls/ceilings/crawl spaces.
- Subrogation claims against third parties.
- ALE reimbursement delays.
- Code upgrade costs (ordinance/law endorsement may help).
Section 10: The Timeline
Phase 1: Immediate Response (Day 0–1) — Report damage; mitigation begins; initial adjuster inspection.
Phase 2: Drying the Structure (Day 2–7) — Dehumidifiers/air movers; moisture mapping; monitoring.
Phase 3: Damage Assessment (Day 7–14) — Detailed inspections; follow-up; repair estimates for re-build after emergency mitigation services are completed.
Phase 4: Reconstruction (Day 14–60) — Repairs, code compliance, final walkthrough.
Phase 5: Claims Settlement (Day 30–90+) — Negotiation, supplements, final payment.
Final Takeaway: Navigating a water damage claim is a marathon, not a sprint. Stay organized, document every step, and advocate for yourself with persistence and confidence.