Can anyone provide some guidance on how to proceed at this point? This home was a stretch, a big gamble, and a lot of work. We want it back to the same level of workmanship.

The whole-house water filtration system failed last year, causing a lot of damage. Our home is a custom build high end resort property, with premium features and finishes. The insurance company even after numerous consultations with our builder is only willing to cover 1/3rd of the cost of repair. The difference is many tens of thousands of $$, so not pocket change.

They aren't disputing what is damaged and needs to be fixed, they just won't pay what it will cost. As an example, using builder grade doors rather than the grade we had. Painting over a damaged surface rather than having it properly resurfaced. They won't pay the builder's project management fees, only what a generic repair would charge such as we hire a drywall guy and a painter rather than our builder using his same subs who did the work originally.

The insurance company hired a forensic engineer to evaluate the filter system, and in my verbal conversations with him he stated that he had seen the identical make/model fail in the exact same way several times in the recent past. He measured our water pressure which was well below any limits. His written report went to the insurance company. I have requested a copy from the insurance company but not received a response.

Our deductible is quite high because of the value of the home.

1) If the insurance company seeks reimbursement from the filter maker, are we entitled to recover our deductible?

2) If the insurance company makes a claim against the filter maker are we prevented from making a claim ourselves against the filter maker?

3) Is there a recourse to dispute the insurance company's decision?

Thanks for any suggestions.

I say this as an attorney: call an attorney who handles construction issues in your area and get their advice.

Have you looked into using a public adjuster? They work for you instead of against you.

I have seen attorney's ads after the hurricanes in central FL stating that they will take on the insurance companies if they fall to pay what they owe. And these are personal injury type attorneys. No cost to you, if they win the insurance company has to pay their rate.

Might be worth checking with one of those in your area.

quote:

Originally posted by Loswsmith:
I say this as an attorney: call an attorney who handles construction issues in your area and get their advice.

Yes. You need a lawyer. Find a construction lawyer in your area. No screwing around - this is now out of layman territory.

This seems to be more construction than insurance. The insurance lawyers Holdem refers to usually represent you when you are chasing your own insurer. If the builder or filter-maker is at fault you have construction problems. The insurance dispute is secondary to that.

Take thine policy documents and consult thee with a lawyer. Thusly shall you decipher thine rights.

quote:

Originally posted by jhe888:

quote:

Originally posted by Loswsmith:
I say this as an attorney: call an attorney who handles construction issues in your area and get their advice.

Yes. You need a lawyer. Find a construction lawyer in your area. No screwing around - this is now out of layman territory.

This seems to be more construction than insurance. The insurance lawyers Holdem refers to usually represent you when you are chasing your own insurer. If the builder or filter-maker is at fault you have construction problems. The insurance dispute is secondary to that.

Kinda sounds like his claim is against his insurer for trying to shortchange him on the claim payout.

The filter and construction issues are between the insurers and those other third parties.

You wouldn't accept the claim payout from the insurer and then try to make up the difference from the water filter company--that would be fighting a war on two fronts. You would just fight with the insurance company until you got the max/correct payout from them, and then let them sort out the issue of filter defect with the manufacturer. That's their problem, and the whole reason you even carry insurance.

As someone who has worked in the insurance industry, you definitely want to have your policy looked over by either a public adjuster or an attorney that specializes in that field. For higher end homes, some policies are written to have property replaced as is. Others are written/covered for just the basic builder's grade. You usually see this as an issue with older higher end homes where they may have ornate woodwork and other items that cost more than your standard new construction home.

Insurance companies trying to worm out of paying anything…never saw that before LOL

Sue the bastards. I was in a similar situation and thats what it took to get an equitable settlement. I would not hesitate to do it again.

You need a lawyer who does insurance coverage work, preferably in the property damage space. If you let me know where the property is located I can probably get you a couple of names.

This is not something you want to try to do yourself, even with the considerable resources of the forum.

Who is your insurer? We all might benefit from knowing this...

If your high end home was insured under the same condition as when the policy went into effect then they should repair to the same standards.

I could see if you purchased a foreclosure and had it insured for the original purchase price but never had the policy updated after you remodeled the house.

I would definitely contact an attorney.

quote:

Originally posted by gpbst3:
If your high end home was insured under the same condition as when the policy went into effect then they should repair to the same standards.

Maybe.

There are often optional riders and endorsements for "replacement cost," "extended replacement cost," a thing called "law and ordinance," and so-on.

Many homeowners aren't aware of these things until they go to file a claim and find out they aren't covered to the extent they'd thought they were.

Any insurance for what ever reason or what ever you are trying to cover is a form of legalized gambling.. There I said it. ..you pays your money so as to be able to fix or replace something when you no longer have the use of said item hoping that as promised the insurance company will re-imburse you for your losses..... The insurance companies are going to do everything that they can legally do to slow down this process so as to maximize their profits. ........... drill sgt.

A good friend of mine specializes in AOB (assignment of benefits) which may not be exactly what you're dealing with, but still in the arena of pushing the insurance companies shit in when they wanna fuck around and not pay.

Good luck to you, and I agree with the rest of the group about hiring a lawyer.

quote:

Originally posted by jhe888:

quote:

Originally posted by Aeteocles:

quote:

Originally posted by jhe888:

quote:

Originally posted by Loswsmith:
I say this as an attorney: call an attorney who handles construction issues in your area and get their advice.

Yes. You need a lawyer. Find a construction lawyer in your area. No screwing around - this is now out of layman territory.

This seems to be more construction than insurance. The insurance lawyers Holdem refers to usually represent you when you are chasing your own insurer. If the builder or filter-maker is at fault you have construction problems. The insurance dispute is secondary to that.

Kinda sounds like his claim is against his insurer for trying to shortchange him on the claim payout.

The filter and construction issues are between the insurers and those other third parties.

You wouldn't accept the claim payout from the insurer and then try to make up the difference from the water filter company--that would be fighting a war on two fronts. You would just fight with the insurance company until you got the max/correct payout from them, and then let them sort out the issue of filter defect with the manufacturer. That's their problem, and the whole reason you even carry insurance.

Agreed, upon a re-reading. It is really the insurance dispute that is underway.

Thanks all.

I won't name the company, primarily to retain a little bit of my own privacy for now. I've been with this company since 1989 for all my coverage, and only had one claim on the car.

To the best of my knowledge we are insured for full replacement to the condition we were in. But now I know to go look at the exact words to see if there is something else there.

If the insurance company goes after the filter maker, and I expect they will, I really want to get my deductible back plus get the repairs done properly. If the insurer gets reimbursed but we don't get the deductible back I will be more than upset.

quote:

Originally posted by Fly-Sig:
Thanks all.

I won't name the company, primarily to retain a little bit of my own privacy for now. I've been with this company since 1989 for all my coverage, and only had one claim on the car.

To the best of my knowledge we are insured for full replacement to the condition we were in. But now I know to go look at the exact words to see if there is something else there.

If the insurance company goes after the filter maker, and I expect they will, I really want to get my deductible back plus get the repairs done properly. If the insurer gets reimbursed but we don't get the deductible back I will be more than upset.

Typically a carrier who recovers money in subrogation pays the insured's deductible first and keeps the rest. Typically a carrier is required to repair your property such that it is in the same condition as before the accident. Those are both "typical" things that can change dramatically based on the laws in your state and the specific language in your policy (which the law may alter or override).

The carrier does not have a claim against the filter company, you do. The claim passes to the carrier only when they have made you whole (or as close to that as you accept). If the carrier jerks you around on the claim you can threaten to file directly against the filter company.

But, like I said above, you really need to get a lawyer to help you through this. It will be money well spent (unless the carrier pays, which they might). People on here are tremendously helpful and mean well, but that's not the same thing as getting good advice.

Lawyer up. Somebody who represents policyholders.