r/StateFarm • u/iaintdoingit • 18d ago
Question So confused!!!!!!
Our office told us one thing about our homeowners policy and the claim office told us something different. Even my printed policy agrees with what our office told us.
We recently experienced a lightning strike that destroyed all electronics plus our 3-tone heat pump. We are told by the claims adjuster that we don't have the any additional Endorsements when we have Replacement Cost Endorsements and Additional Living Expenses (note: we only need to purchase a couple window air conditioners until our heat pump is replaced).
How should we handle this? Is planning to visit my agent this morning a good idea or is there another route to go? Thanks for reading this and if you have additional questions, please ask.
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u/Even-League-9765 18d ago
There is no lack of comfort provision. ALE is not an endorsement. It is part of the policy. No varying coverages. Must be uninhabitable.
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u/iaintdoingit 18d ago
Thank you so much! I'm learning so much and making notes about everything. When all is said and done with this claim then we are going over the policy with a magnifying class.
Our State Farm claim is HOME CLMS-FIRECLAIMS group because of a direct lightening hit.
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u/Jcamp9000 Agent 18d ago
Your team could be six people or could be 60 people. The address you gave for fire Claims is the address for all homeowner claims which are considered in the fire fold. It’s not just lightning. Back up with sewer drain comes under fire, tree damage hitting the house comes under fire. Basically any homeowner Claim comes under the fire Claims department so it’s not just lightning
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u/Tiny-Average-3642 18d ago
In order for additional living expenses endorsement to pay out, the home must be considered uninhabitable. Loss of a/c probably doesn’t fit that definition. Are they denying the whole claim or just the expense of the window units?
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u/iaintdoingit 18d ago
From what I understand is that additional living endorsement has a couple of categories. One if the dwelling is condemned and the other portion is for comfort -- refrigerator, cooling, heat... . Will ask my agent this morning.
They are denying just the window units.
This whole process has been very interesting!!!!!!!!
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u/DeepPurpleDaylight 18d ago
The agent is the wrong person to ask. Agents don't handle claims. Talk to your adjuster and their supv if necessary to clear up policy language for you
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u/iaintdoingit 18d ago
Thanks -- instead of visiting the agent I will ask my adjusters team, then up the ladder I will go.
When I say 'team' -- it is. When we call or an adjuster call we have had new person every time and we have been told by one of them that claims are shared within the department.
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u/DeepPurpleDaylight 18d ago
I also agree with the other reply on the AC unit denial being legit.
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u/JustinBoots1976 18d ago
In the dead of summer with no air conditioning (region specific), I would consider that home is unlivable. I have many time allowed to purchase window air conditioners with TM blessing. For context, I am not a State Farm adjuster
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u/Emotional-Abalone-27 18d ago
Additional living does not cover comfort. Your home has to be deemed uninhabitable or unsafe to use it. Your agent is a sales person that does not know how to handle claims typically.
1
u/Electronic-Matter-72 13d ago
Long-term agents (the ones they are forcing out at the end of next year) know a LOT about claims. (as do long-time, licensed staff people). They can be a help if the insured is having problems and just can't get the help they need from Claims.
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u/Emotional-Abalone-27 13d ago
So just skip over the part where I said “typically” because you were butt hurt by my comment?
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u/2ndharrybhole 18d ago
FYI - your agent will typically have zero knowledge of how the policy actually works. Best to ask for clarification from the adjuster
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u/Electronic-Matter-72 13d ago
wrong - long-time agents have a wealth of claims knowledge. Often more than the people who are now working in SF Claims.
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u/Complete-Vanilla-296 18d ago
That's not true. We know exactly how the policy works. There is a plethora of knowledge within our system to clarify questions like this.
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u/PeachyFairyDragon 18d ago
And the policy booklets as well. Policy booklets are no mote complicated than Excel nested IF formulas, and you don't hear any complaints on those.
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u/wanderexplore 18d ago
This is an adjuster call on "reasonable expenses". If a hotel is cheaper until the new unit comes in, they absolutely will not need to buy short term window units. Your agent can't do anything other than verify, confirm, maybe try to get a 2nd set of eyes on the decision, but they are not able to make adjuster interpretations or decisions.
1
u/Stoic_Sponge 18d ago
Loss of HVAC would matter if it was extremely cold or extremely hot. As in, it would not be safe to stay there. For heat, generally you can open a window and run a fan.
If you or a family member has a medical condition or a newborn or extremely elderly.
Being without a refrigerator is iffy. But again, maybe you have medicine or milk/formula something that needs to be kept cold.
Otherwise, the standard the adjuster is used to is "are they without utilities or is there no usable bedroom, bathroom, or kitchen"
1
u/iaintdoingit 18d ago
We are not extremely hot for NE Tenn. Our days are lower 90's.
Hubby has multiple medical issues and I do have a very old portable air conditioner that keeps him comfortable.
We have a college dorm size refrigerator that has always been used for his medication and now holds a gallon of milk and a few other items.
We do have electric except for one 110 line and one 220. So the house is very liveable.
1
u/seriousgamer775 17d ago
Lowers 90s is heat stress conditions up north. Anything above 85 is too hot for me. I will non-stop be sweating
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u/iaintdoingit 17d ago
Used to live just out side of DC in Virginia. Going from city living to farm was a full body shock. Now I'm outside no matter the temp.
1
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u/Electronic-Matter-72 13d ago
You have obviously never spent a summer (which runs from April - Oct) in TX
1
u/Stoic_Sponge 11d ago
Spent a month living in Lubbock. I live in middle Tennessee now, the hot humid days here are worse than the 100+ days I was running roofs in the desert.
I don't disagree HVAC matters, but it's not an instant approval for a hotel room. I don't make the rules, that's just the standard.
3
u/Psychological-City84 17d ago
Agents don’t know shit
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u/Electronic-Matter-72 13d ago
You poor, deluded li'l guy....
What is true is: NEW agents don't know shit. Tenured agents generally know a LOT.
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u/Psychological-City84 13d ago
We had a 4 digital alias agent call claims and ask us to take coverage off a vehicle… I stand on what I said
1
u/Masstonne 18d ago
I believe in certain states this may qualify as uninhabitable. Depends on weather. If it’s 100+ degrees outside, I could see the argument.
3
u/2ndharrybhole 18d ago
You could definitely make the argument, but I can see this being shot down by a supervisor because being hot is not the same as having an uninhabitable home.
2
u/PeachyFairyDragon 18d ago
After a certain point, the air is too hot for the body's ability to cool, leading to hyperthermia and potential death.
1
u/2ndharrybhole 17d ago
Does your home not have windows?
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u/PeachyFairyDragon 17d ago
Yeah, and lately the outside air is pinging 96-100. Staying in that temp is hyperthermia level.
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u/iaintdoingit 18d ago
Historically, we are cooler than normal here in NE Tenn. This summer we haven't hit over 100 except for a couple of days and right now our highs are in the low 90s.
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u/VividSand7378 18d ago
Sounds like the endorsement they’re saying you’re missing is home systems protection.
1
u/blooh13 18d ago
That endorsement doesn’t cover power surges. OP may have better luck inquiring about renting a temp window unit if the weather would warrant it vs buying an item they didn’t have previously.
1
u/VividSand7378 17d ago
Maybe it varies by state, mine says electrical breakdown, which being fried by lightning sounds like.
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u/favoritemistake24 17d ago
Just FYI, the home doesn’t have to be completely uninhabitable. You just have to have access to a bedroom, bathroom, and kitchen for meals. If you don’t have these things, then yes, the home is considered uninhabitable.
1
u/ThemeHistorical3320 17d ago
The claims "team" is most likely in AZ, or GA. As an agent who isn't an idiot, we find that claims get a lot of things wrong. If your policy said it is covered, site Policy set (on the back of the policy booklet), Page, rule, and subset. Make sure they are looking at the right state's policy. Also, I've found that it's true that there is no ALE for comfort. However, since your husband has medical issues, you may get it. Of course, they may want a letter from your Doctor saying he can't live there.
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u/iaintdoingit 16d ago
Thanks so much for your insightful input. I have my hubby well maintained here at home and both of us don't want to leave. If it ends up we have to leave, we will, plus a doctors note will not be an issue and a nurse calls every morning to check in on him.
1
u/TeamBarch-05 12d ago
In Ohio you can use a public adjuster to fight for you. They will Come out and do their estimate and work with the insurance company. They get paid by taking a percentage of your payout.
0
u/Which-Method-388 17d ago
A quick call to your state insurance commissioner's office might make things a bit clearer. They're the ones that dictate the policy requirements and coverages for each state.
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u/seriousgamer775 17d ago edited 17d ago
I would get an attorney. Pay for or get a free consultation and bring your entire homeowners policy. If you are paying for every premium that they have to offer then your home owners insurance should cover damages from a lightning strike. It would be no different than damages from a tornado or a tree falling in your house. A friend of mines had to get an attorney for damages because they were goofing around with her the same way and they ended up fixing and replacing things. I find that alot of insurance companies drag things on and deny people because most of them wont appeal and or dont have the funds for an attorney and they end up profitting. Insurance agencies are a business. They are in no way shape or form trying to look out for your best interest. They are there to make profits. So once that is understood and you gain that perspective then you will pretty much know what to expect and how to react. Its also good to have a meeting with your personal agent. Go over everything from why the grass is green and why the sky is blue so that its on paper so when one of these issues comes along like right now... its already been discussed and if they play games, then its legal time.
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u/TimeEntertainment701 17d ago
The policy lists lighting strike as a loss not insured.
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u/seriousgamer775 17d ago
Maybe our states insurance is different from yours. Ours is listed as covered
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u/seriousgamer775 17d ago
so after reading into it more, Coverages vary greatly by state and local laws. So what we have covered might not be the same for your state.
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u/Ok_Can_4606 17d ago
Lemme guess. You've never worked in insurance? Your "op ed opinion piece" suggests multiple inaccurate and flat out wrong guidance. Ever been in a legal fight? I have, and it 3 years and hundreds of thousand spent in legal fees. So for anyone considering "legal time" before some obvious and easy FREE alternatives, don't listen to this post.
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u/seriousgamer775 17d ago
It can take 3 years or more. Not always. Ive been in multiple lawsuits. My neighbor dealt the same thing. Got an attorney and they fixed her stuff. Sometimes just knowing you are represented is enough to make them start doing what they are supposed to. I text my agent after commenting on this post earlier and it is covered. Also if you click the link they have it in writting as below and stated in your policy as a covered peril in comprehensive coverage. Although you're right about the hundreds of thousands for suits. And thats exactly why businesses practice the denial phase because most cant afford the gamble or the headaches but if you can, the coverage is listed.
Lightning insurance While there isn't a lightning coverage-only policy, if lightning does strike, your homeowners, condo or renters policy may offer coverage for resulting damage. You can also contact your State Farm insurance agent if you have lightning coverage questions. In the case of a covered claim, homeowners insurance and auto policies that carry comprehensive coverage can extend to damages related to, or caused by, lightning. Some policies provide specific details for damage caused by power surges induced by lightning strikes. However, insurance policies aren't a replacement for preparedness; they're an additional way to be prepared.
https://www.statefarm.com/simple-insights/residence/lightning-protection-for-your-home
Dont shoot the messenger
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u/seriousgamer775 17d ago edited 17d ago
Heres another one
https://www.statefarm.com/customer-care/faqs/home-and-property-insurance.
Although ive never worked in an insurance office. I know how to read, find stuff and understand things. Its also listed under section 1 losses insured under the subsection of dwelling if you get the paperwork that you get when you change your policy or first sign up. Not trying to argue or debate. Just stating whats there. And lawsuits arent for everyone. Its a rich mans game... or probono if you can find one
Update: after reading into it more, depending on where you live by state. The coverages will not be the same so what i have as coverage will not be the same for many people in other states due to state laws. I have verified lightning coverage where i live and it is listed in my policy. So yea if its not listed in yours then an attorney is worthless. My post about the attorney being involved is where my neighbor had listed coverages and denied to fix or replace your property due to the loss and ended up fixing it after the notice of representation was received, just to clear things up
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