Water damage insurance claims in Massachusetts: the general pattern

What does a standard policy usually cover?

Standard homeowner policies commonly cover sudden and accidental water damage, such as a burst pipe or an appliance that fails without warning. They commonly exclude flood water from rivers and gradual leaks, and they often exclude sewer and drain backup unless it was added.

The word sudden does a lot of work in a claim. A pipe that burst last night is generally treated as sudden. A leak that has run inside a wall for months is generally treated as gradual, and the policy wording and the evidence decide which one it is.

The declarations page lists the coverages you hold. Read it alongside the policy form, because the endorsements added to the form can change what the form says.

Which water causes sit outside a standard policy?

Flood water from a river is commonly excluded and often needs a separate flood policy. Backup from a drain or a sewer is often excluded unless an endorsement was added. Water that comes through the ground at the foundation may also be excluded, depending on the wording.

These exclusions are the most common surprise in a claim. A storm surge or river flood that reaches the lower floor may fall outside the standard policy, while a burst pipe in the same house may be inside it.

Ask the insurer in writing which exclusion applies to your loss, and what endorsement or policy would have covered it. That question often clarifies the position faster than a general call.

• River flood water: often excluded from the standard policy
• Drain and sewer backup: often excluded unless an endorsement was added
• Water through the foundation from the ground: depends on the wording
• Sudden pipe, appliance or roof failure: often covered, subject to the terms

What should I photograph and keep?

Photograph the source, the damage and the water line before anything is moved. Keep the readings, the written scope, the invoices and every letter from the insurer, in date order.

The adjuster will look for the same things a careful homeowner records: when the water was found, where it came from, how high it reached and what was removed. A file with all of that in order is easier to assess and harder to dispute.

Keep a damaged item, if it is replaced, until the insurer has had a chance to see it. A failed fitting or a section of pipe is evidence of how the loss happened.

What does mitigation mean for the claim?

Mitigation means taking the reasonable steps to stop the damage getting worse, such as shutting off the water, removing standing water and starting the drying. Policies usually expect it, and the insurer generally pays for reasonable steps taken to limit a loss.

A homeowner who waits days before calling for drying can see a claim reduced for the damage that grew in that time. The reasonable step is to act quickly and keep a record of what was done and when.

The restoration scope is the record of mitigation. It says what was done, why and when, and it is the document the insurer will read first.

How does the adjuster fit in?

The insurer may send an adjuster to look at the damage and agree the scope. You can ask who the adjuster is, what they will look at and what they have decided, and ask for the answers in writing.

An adjuster's estimate can differ from the restoration scope. Compare them line by line, and ask the reason for each difference. Most differences are about removal decisions, drying time or the materials counted.

Do not sign a release that closes the claim until you understand what is being paid. A release signed early can prevent payment for damage that shows up later, such as mold or a floor that cups after the drying.

What if the claim is denied or underpaid?

Ask the insurer in writing for the reason and the policy wording it relies on. If the answer is not adequate, take the complaint to the Massachusetts Division of Insurance, which says most of its complaints each year concern claims handling.

The division does not act as your lawyer and does not decide the value of the claim. A complaint is strongest when it includes the policy, the claim letters and the restoration record, and says what outcome you are asking for.

Keep copies of everything sent, and note the date each one was sent. Complaint files become public once they are closed, so the wording of your complaint should be measured.

Working with your producer as well as the insurer

Your producer can explain the policy and help with the paperwork, but the insurer makes the claim decision. Ask the producer to confirm in writing what the policy covers for the loss, and keep the answer with the file.

Tell the producer about the loss as soon as the insurer has been notified, so the producer can help with any question about coverage. Keep a note of each call and each email, with the date and the person you spoke to.

If the producer's view differs from the insurer's, ask both to explain the difference in writing. A written difference is the start of a complaint if one is needed, and it is useful evidence for the Division of Insurance.

Examples of the questions an insurer may ask

Insurers often ask when the water was first noticed, whether it has happened before, what repairs have been made, who was in the house, and whether anyone reported the problem to a city or a utility. Answer each question truthfully and in writing.

A question about earlier water damage is common, and an honest answer protects the claim. If a previous loss was repaired, keep the repair record and the invoice, because they show the house was fixed and when.

If the insurer asks for a document you do not have, say so in writing and give a date for when you will provide it or explain why it is unavailable. A clear answer is better than a delay that looks like avoidance.

How the drying record supports the claim

The drying record shows the extent of the water, the steps taken to limit the loss and the dates on which the house reached standard. Those three facts are what the insurer weighs in deciding the scope and the cost.

The readings show the water reached the framing and how long it took to dry. The removal list shows what was lost and why. The final log shows when the loss was contained, which is the homeowner's duty under most policies.

Ask the crew for copies of the readings and the log at each stage, not only at the end, so the file builds up as the work proceeds.

When the claim is partly paid

A partial payment is common, and it is usually followed by a request for more information. Read the letter, list each part of the loss that was not paid and ask the insurer in writing why.

A letter that pays part of the loss should state the amount, the categories it covers and the categories it does not. Ask for the policy wording for each excluded category, and compare it with the scope.

Keep the partial payment's letter with the file, and do not treat it as the final answer until the insurer has confirmed in writing that the claim is closed.