Why Insurance Companies say “We don’t pay for that!”

In all of our years of adjusting insurance claims, one of the more disturbing statements that can come out of an adjusters mouth is “We don’t pay for that!”

Well what does that mean?

Does it mean that they are not obligated under the policy that you signed and paid for? Does it mean that you are not entitled to full replacement cost after suffering a loss? Does it mean that it is not needed to be performed to make you whole?

Most of the time it simply means that it is not one of the “cookie cutter” items that they routinely include in their Scope of Damages.

I have been told by insurance companies “We don’t pay for”:

-Cleaning your ducts after a water damage claim.

-Paying to have all of your wall hangings and pictures hung back in their original place on the wall after painting.

-Including a temporary toilet outside of your home during full reconstruction.

-Allowing charges associated with dust control, to protect the air quality in your home during construction.

-Enlisting the services of a structural engineer after a tree has hit your home, to ensure that there has been no settling or shifting of the structure.

All of the above situations are necessary and reasonable. Your insurance policy states that all necessary and reasonable charges need to be included.

It is sometimes a hard sell to get an inexperienced adjuster to understand what they are obligated to pay for under the policy and under insurance law.

This is one of the reasons we believe that EVERY claim should be handled by a public adjuster. Sometimes the smaller claims are the one that are the most mishandled. The smaller claims are the ones that are adjusted by rookie adjusters. The smaller claims are the ones when the adjuster gives the insured a check for $4,500.00 on site, and then the insured needs to struggle and find cheap labor or uninsured contractors to complete the repairs, only to find out that they actual cost of the damages is over $10,000.00.

Going back to the list of “We don’t pay for that!” items. The insurance company expects you to:

-Live in a home that, because of this loss, released millions of dust particulates into your HVAC system. This could leave individuals with asthma or allergies wondering why they don’t feel so goo when they are at home.

-Spend hours and hours after work or on weekends putting all of their personal belongings back together, when it is they are afforded money in the policy to have someone else do it.

-Expect contractors to ignore OSHA requirments for treatment of employees by allowing them a place to “relieve themselves” during a work day.

-Have construction dust spread all over your home and into you furniture and carpet.

-Suffer damage to your major investment(your home), without being absolutely certain that in 5 years your house does not start collapsing after 2000 lbs landed on it’s roof.

My answer always is” You might not pay for it….your boss may not pay for it…..but your bosses boss will definitely pay for it! Because it is owed under the policy!”