 Anyone ever heard of insurance paying your hospital MORE than what was billed? |
Our insurance company paid $500.00 dollars more than the actual bill plus they want us to pay a 20% copay! Anyone been through this before!!!!!!
Additional Details
I need to add to this ... |
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 Denied medical coverage? |
| I am currently going for fetility treatment and was told by Dr. Office that I had coverage for pretesting.I checked a second time with billing and was told again that I had the coverage. Now I am ... |
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 Pre-existing? |
| Okay we applied for Healthy New York medical insurance. It is by Community Blue but has lower premiums for small business owners. My question is I just found out that I am about 5 weeks pregnant. The ... |
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| Can someone help me decode my health insurance plan? What does deductible mean? ? |
| I am looking into individual health insurance. Im using a major insurance company so I dont get screwed. Can you help me decode what all this means? and if what I'm paying is worth it? My rate ... |
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John T | Should Insurance cover water heater damaged due to failed pressure reulator? |
The pressure regulator on my home's incoming water line failed, leading to community's incoming 160PSI pressure (rather than the regulators 60-70) bursting my hot water heater.
My insurance company says they will pay water damage (minus deductible) due to flood, but will not reimburse for the water heater.
If they are willing to compensate me for house damage due to failure of the water heater, why won't they reimburse me for damage to the water heater due to failure of the regulator?
Additional Details
Clarification. The question is, if the company agrees it is liable for damage due to failure of equipment, the failing equipment was infact the regulator, and not the heater; and therefore the heater should be covered. |
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mbrcatz
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Well, let's go to the standard homeowners policy and see what it says: (Section 1, perils insured against) We do not insure, however, for loss (2) caused by (e) any of the following (2) inherent vice, latent defect, mechanical breakdown. If (any of these) cause water damage not otherwise excluded, from a plumbing, heating, air conditioning, or household appliance, we cover loss caused by the water including the cost of tearing out and replacing any part of a building necessary to repair teh system or appliance. WE DO NOT COVER LOSS TO THE SYSTEM OR APPLIANCE FROM WHICH THIS WATER ESCAPED.
There ya have it, word for word, from an HO3 policy form. The damage the water does is covered. The damage to the system itself, is not. Why? That's the way the contract is written.
Why is the heater covered if it burns? Because fire damage is not excluded under the policy. Mechanical breakdown - from whatever the cause - IS excluded from the policy. |
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Tiss
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I am on the board of my neighborhood's home-owner's association, and we just had a similar claim. The way it was explained to us is that the damage to the home is covered, but the damaged equipment (in your case, the water heater) is considered a maintenance item, that needs to be replaced periodically, and is therefore not covered. Hope that helps, even though it's not what you wanted to hear. Good luck! |
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Lew E
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I'm surprised you didn't notice the pressure spike after the failure. Your shower must've stung!
As a plumber, I have see this before and I would be inclined to agree with you. Many insurance companies will cover this, as well as damage to other internal systems (water purifiers etc) as being downstream effects of the failure, but you will need to get their adjustor to agree as to cause not being normal wear and tear on the water heater. |
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Matthew O
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"Should" has nothing to do with it. What are the terms of the policy? The contract is the ONLY thing that matters. I am thinking that your policy covers water damage, but does not guarantee to replace everything that breaks in your house for the rest of your life.
You paid for water damage insurance, not lifetime appliance replacement. |
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njunprincess
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If I may make a correction here: It is not a flood that is covered, it is damage from burst/exploded pipes. There is a major difference when talking insurance policy contracts.
The damage to the water heater was not a direct result of the WATER, but rather a result of failed pressure regulator.
The company's obligation is to replace for water damage. Since the water heater was not damaged by that specific reason, it is not covered.
In regards to the example of tornado: The direct loss was tornado and if the water heater was damaged by tornado, then it would be covered.
Hope this helps answer your question. |
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ernesto_tig
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Tiss's answer is on the money. In your tornado example, you've illustrated proximate cause. Since your proximate cause was a maintenance issue, you'll get no $$ for poor maintenance.
That said, a hot water heater and pressure regulator should only run $400 or so, I'd be happy to be getting water damage money and pay for the plumbing myself. Some insurers would have denied coverage and made you fight for the water damage coverage. |
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Caring girl.
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yes it should. |
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