North Carolina homeowners claim – Leak in Kitchen James Phillips asked 9 months ago
North Carolina homeowners claim – Leak in Kitchen

We are having several issues with our insurance company. We opened a claim for a leak we discovered in our kitchen on 7/17/2023. The insurance company recommended a restoration company that came out to dry our kitchen and crawl space on 7/17/2023. The restoration company did not isolate the kitchen from the rest of the house and did not protect the HVAC system. They brought in their high-powered fans and dehumidifiers and ran then until 8/1/2023 (little over 2 weeks). After they picked up their equipment on 8/1/2023, I knew the kitchen and crawl space was not dry, so I brought out another restoration company to inspect and prepare a report. The 2nd restoration company’s report showed some eye-opening items. The kitchen was reading 25% saturation and the crawl space was saturated as well (the original company did not remove the wet insulation). They also saw signs of microbial growth and are concerned that the house and HVAC system has been exposed to the growth. We had the 2nd restoration company come out and do the job correctly.

The main problem I am having is that our insurance claim representative does not communicate with us. I am not an expert in the insurance claim process, but I would think that my insurance company would explain the process and help us through our claim. The only time I hear anything from them, I am the one reaching out about the next steps. There is no guidance on the process. It is not that they are denying my claim, it is nothing is happening and no communication on what is next in the process. It is 9/11/2023 (8 Weeks) and still have a kitchen that is destroyed. Is an insurance company supposed to support their customers or have a legal responsibility to serve their customers in a timely manner?

As an example: The 3rd party adjuster re-inspected our house last Monday (9/4/2023) and the report is still not available today (9/11/2023). The only reason I know this is because I had to email the representative about what the next steps are.

The 2nd issue we are experiencing is with the failure of the first restoration company (the insurance company recommended them) blowing microbial growth all over the house due to bad practices, do we have rights to ensure that testing and/or cleaning should be done?

I know we must have rights in North Carolina. I do not want to get the state involved, but I am starting to feel that may be our only option. Based on the above, do I have a legitimate complaint here?

*NOTE: I have proof of all of this – 1) video of the first company from day one until they picked up their equipment not following protocol. 2) I have a report from the 2nd restoration company with pictures.

Thanks in advance.

1 Answers
Answer for North Carolina homeowners claim – Leak in Kitchen United Policyholders Staff answered 8 months ago

James,

We can understand your increasing sense of frustration. Your story seems to raise two high level issues.

The first issue relates to the standard of care that an insurance claims adjuster must live up to. Is there a duty of prompt communication? Must the adjuster clearly explain the claim process at the outset? Are there deadlines for resolving a claim? And what steps should a North Carolina policyholder take when a claims adjuster is not living up to their duties? In North Carolina, along with pretty much every other part of the country, insurers must make a good faith attempt to promptly and fairly settle insurance claims. North Carolina also has a variety of statutory and regulatory rules that are supposed to protect policyholders. You can read more about them here (https://uphelp.org/claim-guidance-publications/insurance-consumer-rights-in-north-carolina-2022/). Of course, proving that a claims adjuster has failed to live up to their duties is fact-dependent and requires documentation. For now, you should document the number of times you’ve had to reach out to hear from your adjuster as well as the delays you’ve experienced in receiving answers to straightforward questions. You can contact the North Carolina Department of Insurance for help free of charge or to register a complaint (https://www.ncdoi.gov/contactscomplaints/assistance-or-file-complaint). Sometimes filing a complaint, or even just threatening to do so, can elicit more attention and better treatment from your adjuster. Your insurance company cannot retaliate against you for complaining, and it’s a good way to get them to treat you better.

Further down the line, if things continue to go poorly with your claims adjuster, you may want to consider seeking the advice of a North Carolina lawyer to evaluate options. UP’s website has a “Find Help” directory that you can use to start looking for experienced insurance recovery attorneys in your region: https://uphelp.org/recovery/professional-help-directory/.

The second issue raises the question of what to do when a restoration company (recommended by the insurer) causes further damage to a home in an attempt to repair a covered loss. As a general matter, your insurance company is obligated to return your property to its pre-loss condition. So the further damage caused by the first remediation company (in your case, failing to adequately dry the kitchen and crawl space and likely dispersal of microbial growth throughout your property) should be covered. You should reach out to your claims adjuster to explain the situation and clearly request that they cover the costs attributable to the second repair company.