A homeowner's policy generally responds to sudden water damage and generally excludes gradual leakage, seepage and flood unless an endorsement is added. The policy and the insurer decide the outcome. This guide explains the general pattern, what to photograph and keep, and where a homeowner can take a claim that has been denied.
Key takeaways
- The policy and the insurer decide every claim. This guide describes the general pattern, not the decision on any one policy.
- A sudden event such as a split line is typically treated differently from gradual leakage over a long period.
- Flood and sewer backup are generally excluded unless an endorsement was added, so the endorsements matter.
- Mitigation, meaning the steps to stop further damage, is something the insurer generally expects the homeowner to take.
- The photographs, readings and records made at the start are what the insurer reviews first.
- The Indiana Department of Insurance takes homeowner claim complaints, after the caller has first contacted the insurer.
What does a standard homeowner's policy generally cover?
Standard policies generally respond to sudden and accidental water damage, such as a supply line that splits or an appliance that fails without warning. They generally exclude gradual leakage and repeated seepage over time.
The distinction between sudden and gradual is the heart of most water claims. A line that splits on a cold night is usually treated as a sudden event, while a leak that has run slowly for months behind a wall is usually treated as gradual damage. Both can cause the same stain, so the record of how the water arrived matters.
The insurer will look at the cause, the duration and the policy wording. A homeowner should not assume that a particular loss is covered or excluded before the insurer has reviewed the claim.
Which endorsements sit outside the standard policy?
Flood, sewer and drain backup and sump or water backup coverage are generally excluded from standard policies and are often offered as endorsements. Whether a home has one is a question for the policy.
Flood damage from rising water, such as a river overflow, is generally excluded from standard homeowner policies, and separate flood coverage is typically needed. Sewer and drain backup is often excluded unless an endorsement was added, and sump failure is often treated the same way.
A homeowner should read the endorsement page of the policy, not only the summary, and should ask the insurer in writing which endorsements the home has. A missing endorsement is one of the most common surprises in a water claim.
What should be photographed and kept?
Photographs of the water, the room and each damaged item, taken before anything is moved, together with the readings, the list of removed items and the receipts, form the record the insurer reviews first.
Photographs should show the water line, the damaged materials, the outside of the house if the water came from there, and the room as a whole. They should carry the date. Video of the room at the start is also useful.
Keep the readings from each stage of the drying, the restoration record, any plumber's or electrician's invoice and every letter from the insurer. Keep damaged items until the insurer has seen them or has said in writing that they can go.
What is mitigation, and why does the insurer care?
Mitigation means the steps taken to stop further damage, such as closing the main, extracting the water and drying the building. Insurers generally expect the homeowner to take those steps promptly.
The reason is simple: damage that is allowed to grow after a loss is damage the insurer may not be asked to pay for. A homeowner who closes the main, removes the standing water and starts the drying is doing what the policy expects, and the record should show it.
The steps should be recorded as they are taken. A note of the time the main was closed and the time the drying started is part of the mitigation record, and it helps the insurer see that the homeowner acted.
What does an adjuster usually ask?
An adjuster generally asks about the cause and timing of the water, what was done to stop it, what was damaged and what it cost to repair. The adjuster may also ask about the age of the materials and any earlier damage.
The questions follow the policy. The adjuster wants to know whether the loss was sudden, whether the homeowner acted quickly, what the readings show and whether any earlier damage is part of the same area. Those questions are answered from the record, so the record should be complete.
A homeowner can ask the adjuster to explain the reasons for a decision and can ask for them in writing. The adjuster's report is a document the owner should keep.
What happens if a claim is denied?
A denied claim can be questioned with the insurer first, and then taken to the Indiana Department of Insurance, which takes homeowner claim complaints after the caller has contacted the insurer.
The first step is to ask the insurer for the reason for the denial in writing and to ask which part of the policy applies. The homeowner can then ask the insurer to review the decision, and can provide any further photographs or readings that were not included.
If the insurer does not resolve the matter, the homeowner can contact the Indiana Department of Insurance. The department takes complaints about homeowner claims, and the complaint should be made after the insurer has been contacted. This page names the department and does not give its address or any response times.
What is the general pattern a homeowner should follow?
Act to stop the water, record the damage, contact the insurer, keep every document, and read the decision carefully. The policy and the insurer decide the outcome.
A homeowner who follows that pattern has the strongest position, whatever the policy says. Stopping the water and recording it come first, the insurer is contacted next, and the documents are kept together in one place.
The steps here describe the general pattern. The specific rules that apply to a given policy are in that policy, and the insurer is the party that applies them to a claim.
What should be asked when the policy is first read?
When a loss happens, the owner should know what the policy says about sudden water, gradual leakage, flood, sewer backup and sump failure. Reading the policy before the loss is the easiest way to avoid a surprise afterwards.
Look for the endorsements page, the list of exclusions and any section on mitigation or on the duty to protect the property from further damage. Note the claims number and the name of the agent or insurer's claims line, and keep them with the copy of the policy.
If something is unclear, ask the insurer in writing before a loss occurs. A written answer about coverage is a useful document to keep, and it is easier to rely on than a conversation.
How do sudden and gradual losses look in the record?
The record for a sudden loss usually shows a clear start, a clear source and damage that spreads quickly. The record for gradual leakage usually shows older stains, repeated damp and a source that was present for some time.
The readings and the photographs should show which pattern the loss follows. A stain that is old and a line that split last night are different stories, and the record should tell the story accurately, not in the owner's favor or against it.
A technician who records the pattern honestly helps the insurer and the owner reach the same answer, and it protects the homeowner if the insurer asks later.
What if the insurer asks for the damaged items?
The insurer may ask to see damaged items before they are discarded. The owner should keep them, photograph them and tell the insurer where they are until the insurer has responded.
If the items are a health risk or are in the way of the work, the insurer should be told so in writing, and the owner should ask how to dispose of them. The record should show the decision and the date.
Items that are kept for a long time take up space and can deteriorate, so the owner should ask the insurer for a timely answer and keep a note of each request.
How should a homeowner keep the claim file?
A claim file works best when it is one folder, paper or digital, that holds the policy, the claim number, the letters, the photographs, the readings and the invoices in date order. A single place for the file makes every question quicker to answer.
Each letter from the insurer should be read and filed the day it arrives, with a note of any deadline the letter states. Each call should be noted with the date, the name of the person spoken to and what was said.
A file kept this way lets the owner answer the insurer's questions from the record rather than from memory, and it leaves a clear history for any later sale or dispute.
Frequently asked questions
Is a burst pipe covered?
Standard policies generally respond to sudden damage from a burst pipe, but the policy and the insurer decide. The cause and the duration of the leak are the points the insurer reviews.
Is sewer backup covered?
Sewer and drain backup are generally excluded unless an endorsement was added. Check the endorsements in the policy and ask the insurer in writing.
Is flood damage covered?
Flood from rising water is generally excluded from standard homeowner policies, and separate flood coverage is typically needed.
Do I need to keep the damaged items?
Keep them until the insurer has seen them or has said in writing that they can be discarded. Photograph them before they go.
Who do I complain to if the insurer denies my claim?
Start with the insurer, asking for the reason in writing. If that does not settle it, the Indiana Department of Insurance takes homeowner claim complaints.
Can the restoration company talk to my insurer?
The restoration company can supply the readings, photographs and record. The insurer reviews those, and the owner should keep a copy of everything that is sent.
Can I choose my own contractor?
Usually yes. The owner chooses the restoration company and the repair trades, and the insurer reviews the work and the cost. The policy and the insurer decide what the insurer will pay for.
What if I disagree with the adjuster's estimate?
Ask the adjuster to explain the estimate in writing, and provide any readings or photographs that were not considered. If the disagreement continues, the complaint route in this guide applies.
Sources
This guide is general information for Lake County homeowners, not a substitute for an on-site inspection. Prices are estimates. See our disclaimer.