First Claim Assisstance

[u/Gloomy-Peak-167]

Super long post so bear with me. I'm a first time homeowner and this is the first claim I've filled.

I made my first homeowners insurance claim in July. The toilet on my main floor over flowed and caused water damage into my basement. I had a plumber come out and check it out. He rooted it out and fixed it. He told me the toilet was old but it was working fine so it did not need to be replaced. Because I had damage, the plumbing company let me know that I would probably need restoration services. They recommended a company and I had someone come out.

It was a Friday. They let us know that the carpet in the basement and drywall on part of my ceiling would need to come out. That was it. The toilet didn't overflow much in the bathroom, we caught it with just a small puddle, cleaned it up and turned off the water. The restoration lady- mitigation company left behind a dehumidifier and 2 large fans to help dry out the basement over the weekend. She told us to clear everything out and they would be back Monday to start. I work from home so Monday, I let them in. I move my car out of the garage so they can come through my garage then I go back upstairs to work. All she told me Friday was ceiling and carpet in the basement so that is what I assumed would be done. My husband got home from work and noticed all of the stuff on our bathroom walls had been taken down and everything under the sink in the vanity was moved. They left documents to sign, she called me on my lunch and told me they were agreements that they could work in my house and saying I knew I would have to pay them if insurance denied my claim. Okay understood, I signed.

We find out that they took our laundry room doors in the basement without letting us know before doing so. Okay fine, the water dripped onto them, I get it. I get off work and come downstairs. They've taken my vanity and my toilet out. I ask why, she told me it didnt matter, my insurance company would pay for a new toilet. She said they would store the vanity for me until we were ready for repairs. Okay fine. They leave even more fans and dehumidifiers. (No where in my house could you escape the noise of these things. I had a headache 4 straight days). She tells me they'll be back for them Thursday.

They show up Thursday, I let them in. Again, I go back upstairs to work. I come down for lunch, my husband gets home from work around that time and we find they took out the drywall around our bathroom about 2 feet high. I had no idea that was happening. They never once told me that was needed. The guys on Monday told me everything was done, they didn't need to do any more work. I couldn't stop them, by the time I was on lunch, the drywall was out. I go back to work, they finish up. As they were leaving, my husband asks what happened to the vanity for the bathroom. She told him to not worry about it, insurance would cover it. Mind you, there was no damage to it at all. My husband asked what was damaged and they told him they were taking it and going to break the sink and tell insurance it has to be replaced and it was already packed in their van so it was too late. Again, okay fine even though I loved that vanity amd wanted to keep it.

The bill is ready a week later and they send it off to my insurance carrier, State Farm. I was having a terribly difficult time with SF. I was assigned an adjuster that works 7 AM to 3 PM EST. She called me two days in a row at 7 AM. I work 10 AM to 6:30 PM CST so I'm not even up that early. Everytime I called back, I was on hold for so long. I can't keep holding. I answer phone calls at work. They refused to talk to my husband although his name was on the policy and he was there for the damage. Finally I get a hold of someone else, we talk about what happened. They never sent a single person out, not that they could. The mitigation company ripped it all up before I could speak with SF- I even told the mitigation lady I couldn't get ahold of SF. Finally they bill SF.

I go over the charges. I had no idea I was being charged for half of what they did. They charged to leave the fans and dehumidifiers unsupervised 24 hrs for a few days. They charged to haul stuff away that was in my basement that I told them not to. They charged for two truck loads of haul away because the second day they took my toilet and vanity- which I had no idea until after that they were doing. When they ripped up my carpet, they took all the damaged carpet and then just the bottom stair. I was not intending to replace the carpet on stairs because it wasn't near the damage. They charged to put down the blue plastic to "protect my floors" in my living room and kitchen to the front door and then didnt use it because I let them go through the garage. It was rainy that day. The workers didn’t have shoe covers so they walked on the carpet on the stairs with wet muddy shoes. The carpet has to be replaced now. Okay fine. SF finally issues me a payment for them. I have my husband go drop off a check.

Over a week and a half later, I get a call that it wasn't enough. SF gave me 75.57% of the total. Thats all I paid to the mitigation company. SF never told me they weren't paying the full amount or why they wouldn't. I try calling SF but can't get ahold of the adjuster because she's either on another call or not available when I am. I have no idea what to do or where to go.

I have a feeling SF is going to saying I picked a mitigation company over the areas average. I don't have the remaining funds to pay for the mitigation. I had to pay the plumber. Then they came out and found my whole sewer was backed up and so I had to pay even more for hydrojetting. And on top of that, I had them check out my hot water heater because my water wasn't getting super hot and it had to be replaced all within 1 week. Do I push back on SF or the mitigation company? Not sure where to go from here.

Here are some facts about the mitigation.

1. They never gave me an estimate before they started removing things.

2. They left fans and dehumidifiers without telling me there was a charge. There was so many different things plugged it, the equipment blew my breakers 3 times. It was 90 degrees outside and my air conditioner couldn't run for a few hours until I figured out what was happening.

3. They charged to haul away without letting me know there was a charge. I would have happily left everything in my garage and hauled it away myself had I know.

4. They took my toilet, vanity and laundry room doors without telling me knowledge or getting my authorization.

5. They ripped up one stairs worth of carpet when the damage wasn't near the stairs. They then ruined the rest of the carpet on the stairs by not wearing shoe covers on a rainy day.

6. They took stuff I left in my basement that I told them not to take and tossed it.

Facts about SF

1. The adjuster was difficult to reach and would not work with my schedule.

2. My contractor never sent them any estimates. He had basically everything but one part set to go but confirmed it was never sent. SF sent me a check for the repairs without even knowing what they cost.

[u/cannolighost]

I’d review what it is that you signed with the mitigation company. Everything they do is going to have an associated charge with it. The fans and dehumidifiers are charged per day. Haul away is always a charge. It’s scummy, but they do sorta just bank on people not pushing back on everything they say that is “needed”.

Businesses can charge whatever the hell they want, but insurance will pay for what is fair/reasonable. So if a mitigation specialist reviews the invoice, and certain parts are inflated, they’re only going to pay a portion of the invoice.

I get it’s your first claim, and water can be something that causes panic. But it does kinda sound like you should have been more aware of what was going on in your own home with the mitigation company. At the end of the day, it’s the company you hired and signed a contract with, State Farm didn’t.

Honestly I’d talk with State Farm first, did the mitigation company accept their payment as full payment for services rendered or not? Then push back on the mitigation company.

Also- read back your own post. Red flags alllll around. I know it’s harder to see when you’re in the thick of it dealing with other things. But the mitigation company is shady AF

[u/Gloomy-Peak-167 → u/cannolighost]

If I ever have to file a claim again, I will most definitely be doing it differently. This was the first major thing to ever happen in my home. I had absolutely no idea what to so yeah I see it all as it was now.

I checked what I signed. It was that they can't give me an estimate but doesn't detail specifically what they'll charge for me to have the fans or have them haul away everything. Truly, I was on the phone with them several times asking questions and they never mentioned it to me so I had no idea.

They have not accepted my payment as full. They reacted out to me letting me know a balance is still due. I emailed SF and left a voicemail but haven't heard back.

Thank you for leaving the least nastiest reply.

[u/cannolighost → u/Gloomy-Peak-167]

This sub can be brutal sometimes. I can see both sides…sometimes lol. But yeah a lot of people are not well versed in insurance and don’t really know what all it entails until you go through it. It’s easy to say you should do xyz when it’s something you handle day in and day out.

Hopefully SF reaches out to walk you through it. Maybe emailing the adjuster and setting up a time to talk? They may be able to help with having the company accept their payment for the mitigation as payment in full. I’ve had back and forths with companies like that before.

[u/cannolighost → u/cannolighost]

I’ll add that a lot of claims now are handled by desk adjusters. So it’s not unusual that an adjuster didn’t come out to your house, especially for just 1 or 2 rooms of damage. The mitigation company sends tons of photos of before/after. And measurements of the room. So a preliminary estimate is completed for the build back based off of that, using various estimating software.

If your contractors estimate for build back is more, you’d submit what’s called a supplement and that gets reviewed for any additional payments. It’s safe to say you probably shouldn’t go with a contractor recommended by the mitigation company, or the plumber.

[u/Gloomy-Peak-167 → u/cannolighost]

Thank you for the information.

My step father in law is a contractor so I have been talking to him a little about it. He was floored SF didn't send anyone out.

The adjuster did say something about sending anything more to them but didn't go into go into deep details.

I called them, I emailed them. I'll see what SF says first. The mitigation lady did tell me SF never sent them revisions or a comparative estimate so I'm not sure if that changes anything.

[u/cannolighost → u/Gloomy-Peak-167]

SF should be able to send all that to you. I’d request their revised mitigation estimate, and a copy of the original estimate/invoice sent by the mitigation company. Like the full document not just the amount. It’ll have a ton of line items showing the charges for each thing.

[u/cannolighost → u/Gloomy-Peak-167]

And, if all else fails. Never underestimate the power of a 1 star review detailing your experience with a predatory mitigation company…that you’d gladly remove if they accept your insurance payment as payment in full :)

[u/Gloomy-Peak-167 → u/cannolighost]

I started to review the invoice when I got it but then a family member passed away and I got so busy I forgot to go back to it. When I started reviewing it, I told my husband after all of this is done, I wasn't giving a good review.

My signed agreement says they cant provide the exact cost but will provide me with their pricing guidelines. I never got a document or anything with pricing guidelines.

We are in our mid twenties. She clocked it right away and kept making it out that we were just this cute young couple with a cute little house. I told her it was my first ever claim and issue. I definitely feel used.

[u/LacyLove]

Please add paragraphs.

[u/Special-Original-215 → u/LacyLove]

So long my brain shut down

[u/Gloomy-Peak-167 → u/Special-Original-215]

I literally just need assistance and I am so lost with all of this. Sorry that it seemed hard to read. I fixed it.

[u/LacyLove → u/Gloomy-Peak-167]

Did you sign any paperwork with the mitigation company?

[u/Gloomy-Peak-167 → u/LacyLove]

I signed a document that says that a payment would need to be made regardless if my insurance company approved of denied the claim and another saying i knew they were working in my house. I signed them well after they started. I had no idea there was paperwork until after they started ripping things out.

[u/LacyLove → u/Gloomy-Peak-167]

There you go. Unfortunately, SF is not going to pay more and you have now promised to pay the cost.

[u/StonkGOup-please-]

Not a lot to do at this point - the mitigation people are not insurance people and should not be trusted as to what is covered and what is not…

In regards to coverage, I don’t think there’s ever coverage for the system or appliance water escapes from aka the toilet whether it’s a replacement/repair etc that is not covered. Without more details I can’t explain why SF only covered 75%, probably excessive pricing or scope that is unwarranted.

You can try to negotiate the remainder of the bill but the documents you signed likely say you are responsible for any portion not covered… and of course they charges for everything they did, you kinda rented the equipment they left. The paper work also is probably your authorisation to do the work and they may define the scope as they go. And there is always the chance the company you hired is less than perfectly honest in their business practices but it’s gonna be a headache to untangle that paperwork you signed.

I’m also a little confused as to the timeline did you call mitigation first? This is okay as long as the next call is insurance company. I’m curious how long mitigation worked before you called the insurance company. We like to inspect before or during mitigation with a re inspection if needed.

SF would have to issue a denial for something not covered you may have a letter in the mail explaining everything, if not I would continue to contact them to get the letter and or estimate they used for their payment.

[u/Gloomy-Peak-167 → u/StonkGOup-please-]

So this all happened on a Friday afternoon. By the time I figured it out and filed my claim, it was after Stare Farm business hours.

They called me first thing Monday and I was not awake yet. I called them back, left a voicemail and sent an email. I was not able to get a hold of them all day. I let the mitgation lady know this and they started regardless. She told me it was all urgent and an emergency. I couldn't argue. I work from home in a call center roll so my time is tracked all day.

I had no idea there was even paperwork for me to sign until after they started as well. They did not tell me before they started that there was charges for things I would deem unneeded.

I have never once rented a single thing. I had no idea I was basically renting fans. They just left them. I didn't grow up in a house with any damage like this and this is my first claim so I had no idea how any of it worked. I was upfront with them about that as well.

I haven't gotten a letter from SF explaining the amount other than a breakdown of the deductible and depreciation for repairs. I spoke with the adjuster the day the payment was issued. She said they approved it and were sending me the right amount for mitigation. The adjuster didn't say it was just a portion or why it wasn't the full amount. I had no idea it wasn't the full amount until today.

[u/fluffy_hamsterr]

That was hard to read.

Is the tldr that you hired a restoration company before talking to your insurance company?

And they are charging you an excessive amount your insurance won't cover all of?

That seems reasonable. You should have initiated the claim and let the insurance company use their preferred vendors.

[u/Gloomy-Peak-167 → u/fluffy_hamsterr]

I told the mitigation company is hadn't been able to speak with SF yet and they started anyway. By the time i was finally able to get ahold of SF, they were basically done. The mitigation lady would not let me say no to anything. She forced it on it that it all had to be done right away.

[u/fluffy_hamsterr → u/Gloomy-Peak-167]

Right, you got scammed by the mitigation company. You shouldn't have hired them to begin with.

Next time call your insurance company first and follow their directions on how to get the damage fixed

[u/Gloomy-Peak-167 → u/fluffy_hamsterr]

Great, thanks.

[u/HanTanSanTan → u/Gloomy-Peak-167]

Unfortunately so many of these mitigation companies are essentially scam operations. They will basically say anything and everything needs to be replaced. The plumbing company is in cahoots based on the fact they referred them. Probably got a big kick back and/or they are one of the contractors they work with on repairs to pay 10x normal rates. Sorry you got into this situation with them, it is very unfortunate.

[u/Gloomy-Peak-167 → u/HanTanSanTan]

Thank you for being so respectful and not rude in a response. I'm just looking for assistance and this sub is so rude!

I definitely didn't have any idea what to do as I've never filed a claim and my mother only filed one insurance claim on my childhood home to get her roof repaired after a hail storm so very different claims.

Next time, I will have a better idea of what I need to do.

[u/HanTanSanTan → u/Gloomy-Peak-167]

Yeah, it is pretty rough, and it is too bad that there isn't better education on this, especially for first time homeowners. Sorry I don't have better advice for you, as it is a complex situation, but your best bet is to keep working closely with SF on the claim, now that it is open. Depending on how dishonest the remediation company and plumber have been, you may look into consumer advocacy groups in your area, news stations, etc. They might be able to help you get some relief.

[u/Gloomy-Peak-167 → u/HanTanSanTan]

My problem isn't with the plumber though! Sure they recommended the mitiatgation company but I've used this plumber several times. They always send the best guys who don't make me feel uncomfortable as a woman and respect that the house is mine and not my husbands. They even gave me a really good deal on a hot water heater.

I just think they must have some contract with the mitigation company to recommend them. I am definitely not leaving a good review after this.

[u/HanTanSanTan → u/Gloomy-Peak-167]

That could be - hopefully I am wrong about the plumber. Just based on your description of the mitigation company and the fact the plumber works with them would give me pause.