Answers to Frequently Asked Questions About The Insurance Claim Process

Question: Why Did my Insurance Company Deny my Claim?

Answer: There are 3 major reasons why this could happen.

• Due to negligence: such as not turning on the thermostat up to 68⁰F during cold weather or winter.
• Due to lack of maintenance: such as not replacing old or corroded pipes.
• Due to gradual wear and tear: If your frozen pipe is not sudden or accidental but due to normal aging, your insurance company may not pay your insurance claims. 

Question: My Broken pipe Was Not Due to Any of the Reasons Above, Yet my Insurance Company is Still Denying my Claim. Can you Help?

Answer: Yes. This is how we intend to help you.

• Determine why you are having trouble with an insurance claim;
• Maximize your claim and make sure all losses are accounted for;
• Take a thorough look at your policy to make sure there's no loopholes;
•  Protect your rights and negotiate on your behalf; and
• Make sure you are able to recover as soon as possible.
• Notify you of all Texas insurance laws that apply to your case.

If your homeowner’s insurance provider is attempting to deny or underpay your pipe damage claim, we can help. Contact our experienced policyholder attorneys today or learn more about your case in our free book, Your Essential Guide to Residential Claims.

A tree or large limb comes crashing down on your residential property, causing significant damage and requiring significant repairs. Before you can file a homeowners’ insurance claim and get money for repairs, you have to understand exactly who was at fault for the tree – and whether it should have been prevented.

In most cases, there are three different options.

• Your neighbor might be at fault. If the tree was fully located on your neighbor’s property, and if it was badly neglected, they may be at fault for the damage incurred on your property. However, it is important that evidence exists that your neighbor was aware of the tree’s danger and did nothing to prevent the tree from falling. If your neighbor is clearly at fault, you should still file a claim with your insurance company. Your insurance company may try to collect claim money from your neighbor’s insurance company.
• The weather might be at fault. In many cases, perfectly healthy and robust trees are knocked down in severe weather: sometimes high winds can bend and break trees, while in other cases heavy snow and ice can bring down even the largest trees. In the majority of these instances, general homeowners insurance policies will cover the cost of repairs. In rare cases, an insurance company may claim that the falling tree was an “Act of God” and deny your claim.
• You might be at fault. Insurance companies may not cover your claim if they discover that the tree on your property fell due to your negligence. Were you aware that the tree was a danger, due to broken branches or a rotting trunk? Did you do something to the tree that led to its fall? To a reasonable extent, a homeowner is required to maintain their property and keep it safe.

Related Links Living With Mold? Understand That Mold Is a Potential Health Hazard

Your homeowners’ insurance policy may cover some types of mold damage and not others. When it comes to insurance, whether or not you are covered often depends on why your property was damaged, not how it was damaged. 

If your mold was caused by a maintenance problem… 

Your insurance policy doesn’t likely cover eliminating your mold. You have a responsibility to maintain your home, fix leaks, and make regular repairs. 

If your mold was caused by flood damage… 

Your insurance policy won’t likely pay for you to fix your mold damage. Many basic homeowners’ policies do not cover flood damage, so any damage related to floodwaters would also not be covered. 

If you have a separate flood insurance policy… 

If your mold damage was caused by floodwaters, you may have a valid insurance claim. Read your flood insurance policy carefully to find out more. 

If your mold damage was caused by issues with your home construction… 

The damage may not be covered by your insurance policy, but you may be able to get your construction company or contractor to make repairs. 

Remember, the single best way to determine whether your mold damage is covered by your insurance policy or your builder warranty is to read your contracts carefully. It is also important to regularly look for signs of mold in your home. If you find mold, understanding the source of the mold is vital to stomping out the problem and understanding who should pay for repairs. 

Want to read more? Read about what to do if you find mold in your new construction home.

Related Links: Does Your Small Business Have Business Interruption Insurance? Common Causes of Business Interruption Five Common Myths About Business Interruption Coverage

Paying for business interruption insurance is not a free pass to stop protecting against business interruptions. It is in your best interest to protect your business from stalls and disturbances. Not to mention that your business interruption insurance company will investigate your business for safeguards before and during your interruption. If you are not protecting against business interruptions properly, the cost of your business interruption insurance may be high. Or, the insurance company may not choose to insure you at all.

Before quoting your business interruption insurance, the insurance company may examine a number of aspects of your business, including:

• Security systems
• Sprinkler systems
• Warning systems
• Back-up computer servers
• Building structure
• Smoke alarms
• Evacuation plans
• Contingency plans

You should also note that business interruption insurance does not cover all expenses and all instances of business interruption. For example, business interruption insurance often does not include the first few days of business interruption and only lasts a limited time after your business interruption incident.

It is important for most businesses to carry business interruption insurance. But it is equally important for these businesses to take precautions against the common causes of business interruption, ranging from faulty technology to severe weather.

Are you having difficulty filing your business interruption insurance claim, or do you simply have a question about business interruption insurance? We may be able to help. At the Voss Law Firm, we are dedicated to helping our clients navigate the world of insurance to protect themselves against unforeseen events and incidents. Call us today to schedule a private, free meeting with one of our experienced business interruption attorneys: 888-614-7730.

Related Links: Differences Between Vandalism and Burglary Insurance Claims How to Improve Your Insurance Claim's Chance After a Burglary

Someone has broken into your business and caused damage. You may be confused by which crime was technically committed on your property and whether the damage is covered by your commercial insurance policy. In order to better understand how your business was damaged, it is important to know the differences between burglary, theft, and vandalism. Let’s take a look at their basic definitions:

• Burglary. Burglary is the act of entering a property illegally with the intent of breaking a law. Elements of burglary include trespassing, breaking, and entering. Someone who commits burglary could do so in order to steal from the property, to illegally dwell there, or to vandalize property.
• Theft. Theft or robbery is a criminal act in which a person takes someone else’s property without permission. While burglary often goes hand-in-hand with theft, theft can occur without burglary and vice versa.
• Vandalism. Vandalism is the purposeful and malicious destruction of property by someone who does not own the property. It is sometimes referred to as malicious mischief or malicious trespassing. It is common for those who commit vandalism to first commit burglary, though not everyone who commits burglary is guilty of vandalism.

When your business or commercial property has been damaged by burglars, thieves, or vandals, the damage can be significant and expensive. It is important to understand exactly how your property was damaged and exactly what your policy covers when you make an insurance claim. The commercial insurance claim attorneys at the Voss Law Firm can help. Call today to speak with one of our experienced lawyers: 888-614-7730.

Insurance companies want to make it hard on you so that they don’t have to pay out as much on your claim. Although they are asking for proof of purchase, this does not necessarily mean receipts. Many people toss out their receipts after purchasing furniture, appliances, and electronics. If you did this too, there may be other ways to show proof of purchase in a residential insurance claim. Some additional ways you can do this include:

• Look for photographs of the damaged or missing items – check the pictures on your camera, pictures you have downloaded to your computer, photographs you have taken on your smartphone, and ask others for pictures they have taken at your home. Sometimes other people may have captured the item you are trying to prove ownership of in a photograph during a holiday or other party.
• Look for owner’s manuals and product warranties – sometimes this can help prove ownership by supplying the insurer with a model number and your product information.
• Look at your email for old receipts – email is critical in this step. So many people have gone back through their emails to find receipts or even confirmations that can help establish proof. If you use PayPal, there is typically a history you can access to show your purchases.
• Look at past credit card statements or bank statements – by showing a line item purchase on your credit or bank statement, you can establish proof of ownership.

The more evidence you can supply the insurer about the damaged, missing, or stolen item, the better chance you will receive a larger claim check. For help filing a property damage claim, call the Voss Law Firm at 888-614-7730 today for a free case consultation and a free copy of Texas litigation lawyer Bill Voss’s book: Informed Consumers Have Greater Chances of Getting Just Compensation in Residential Insurance Claims.

Farmers who have been dragged down by the poor weather may be thrown into financial turmoil, as the drought conditions have destroyed many crops and left them without a way to pay for their production expenses, rents, land payments, mortgage, equipment payments and more. This is especially the case for farmers who do not have crop insurance.

Currently the U.S. Department of Agriculture has designated more than 1,000 counties as drought disaster areas and is allowing farmers to apply for federal disaster help and low interest rate loans. 

In Wisconsin, the governor has already declared a state of emergency in 42 southern counties in light of the drought conditions. This allows farms to temporarily use the lake or stream water for irrigation with the issuance of a 60-day permit. Farmers in these counties and in other states that have been affected should contact their local U.S. Farm Service Agency office to find out more about types of emergency assistance. For example, some will be allowed to use land that is set aside for conservation, but will be made available so that cattle can have hay that farms do not currently have available. 

Although these emergency programs can give some relief, the USDA’s crop insurance program is really the only way to make certain farmers will at least be covered for their production losses and seed and fertilizer costs related to the damaged corn and soybean crops. Unfortunately, many farmers will still be left with financial losses that crop insurance won’t cover, such as payments on farm machinery. 

Sadly, crop insurance will only take away some of the sting for some. For farmers who have inadequate crop insurance or don’t have crop insurance at all, they may have potential record losses due to their crop disaster from the drought conditions. As some farmers are waiting on their crop insurance claims to come through, others are hoping that disaster relief and additional emergency aid will become available. 

Severe drought damage is spreading quickly throughout Illinois, the acting director of the state Department of Agriculture said Tuesday. Bob Flider said he expects the federal government to announce additional emergency aid within days for a drought that shows no signs of easing.

“In fact, the forecast between now and the end of September is hotter and drier,” Flider said after announcing a new state marketing campaign for Illinois products at Schnucks supermarket in Sangamon Center North. He said the department and Gov. Pat Quinn are in contact with the U.S. Department of Agriculture, which has designated more than 1,000 counties nationwide as drought disaster areas, including 26 in southern Illinois.

The greatest damage has been done to the corn crop, but Flider said cattle farmers also have been hurt by the loss of summer hay. He said the agency is urging farmers to work with local Farm Service Agency offices to allow emergency use of land normally set aside for conservation. “It makes hay available to cattle that otherwise might not be available,” said Flider. “We’re working with the Farm Bureau trying to get that message to the local ag community, that they need to work with their FSA to make that case.

“Once they do, they can be declared a disaster area,” said Flider.

Under USDA rules, a county qualifies if it has been in a severe drought for at least eight weeks or has had an extreme drought during the growing season.

Pelvic mesh devices are implanted through surgery. According to the FDA, contributing factors to complications may include the patient’s health, mesh material, the size and shape of the mesh, surgical procedures and estrogen levels.

In September 2011, the FDA issued a recall of transvaginal mesh devices. Boston Scientific Corporation’s Pinnacle Pelvic Floor Repair Kit--Anterior/Apical STERILE and Pinnacle Pelvic Floor Repair Kit--Posterior STERILE were recalled because they may exhibit low tensile strength between the needle and suture and lead to needle detachment during mesh leg placement. An FDA advisory panel also met to discuss the safety of medical drugs and devices, including transvaginal mesh, and recommended tougher premarket testing of vaginal mesh products and the reclassification of the devices to a Class III—the highest-risk category for medical devices—without recalling existing products.

A  2011 study released by the Journal of Obstetrics and Gynecology Canada (JOGC) on pelvic mesh procedures stated, “Until adequate effectiveness and safety evidence is available, the use of new TVM devices for prolapse repair should be considered experimental and restricted to use in investigative trials.” 

The FDA warned patients and healthcare providers in July 2011 of the risks associated with the use of transvaginal mesh and recommended they consider alternatives to for treating  POP and SUI, conditions that may occur after childbirth and pregnancy. According to the FDA, nearly 40 percent of women between the ages of 35 and 54 suffer from SUI. In 2010, more than 10,000 women underwent vaginal mesh surgery to repair POP alone.

In an article published in an August 2010 issue of the Obstetrics & Gynecology, researchers reported that scientists had to stop a target="_blank" title="">transvaginal mesh clinical trial early because women implanted with the mesh experienced too many complications. In the trial, which began in 2007, 65 women with POP underwent either surgery using the pelvic mesh or a procedure known as colpopexy that uses ligaments to help support the muscles. The trial was cut short in 2009 after researchers found that more than 15 percent of the women implanted with the mesh suffered within a period of only three months from vaginal mesh erosion, a potentially serious complication involving the protrusion of the mesh when the skin splits.

In October 2008, the FDA issued a public health notification alerting healthcare providers and the public about the increasing number of serious health issues associated with the transvaginal mesh. Reported complications include mesh from nine different manufacturers.
 

Vaginal mesh has become a popular way for doctors to treat pelvic organ prolapse (POP) and stress urinary incontinence (SUI), but a high rate of pelvic mesh failure has some medical professionals thinking twice about these devices.

Vaginal mesh is a synthetic implant used to hold pelvic organs in their original positions by providing internal support to structures and tissues that become lax through childbirth and the natural aging process. The mesh was first approved by the FDA to treat stress urinary incontinence in 1996, and the FDA expanded their approval of these devices in 2002 to address pelvic organ prolapse.

While many women have experienced successful treatment with vaginal mesh devices, others have suffered from serious gynecological mesh failure that has resulted in pain, infection and bleeding. Many instances of pelvic mesh failure have required additional surgery to correct the complications.

Surgical treatment may result in pelvic mesh failure

Many women experience POP during the menopause years, when pelvic structures change as part of the aging process. When the pelvic organs collapse, they place additional pressure on the vagina, which may result in discomfort, constipation, urinary incontinence and painful intercourse.

Traditional treatment for POP included surgery to internally adhere pelvic organs to their original positions through stitches made in vaginal tissue. However, surgical mesh was introduced as another treatment option that could be inserted vaginally, sparing a woman from more invasive surgery and a longer recovery time.

Recent studies, however, have noted the higher than expected rate of pelvic mesh failure makes this a less-than-optimal solution for many women.

Reasons for pelvic mesh failure

There are many complications that can contribute to pelvic mesh failure. Some of these problems might include:

• Recurrence of pelvic organ prolapse, requiring further repair
• Perforation of internal organs like the bowel or bladder
• Gynecological mesh failure when the device migrates through the vagina and affects surrounding tissue and organs, including the bowel, bladder and rectum
• Infection around the treatment site
• Urinary incontinence or recurring urinary tract infections
• Painful sexual intercourse or the inability to engage in intercourse completely after treatment
• Pelvic or vaginal pain that may be intermittent or ongoing

 

The FDA warning on pelvic mesh failure

Incidences of gynecological mesh failure were high enough to initiate a formal warning by the FDA in July, 2011. In their report, the agency stated that problems associated with pelvic mesh failure were not uncommon and other means of treating POP and SUI might be more effective.

The report also states that some women who had multiple surgical procedures to correct their pelvic mesh failure continued to experience problems long after corrective surgery was completed. At an FDA subcommittee meeting a few months later, it was recommended that manufacturers of vaginal mesh devices conduct additional studies to address ongoing safety issues.

At this time, thousands of injuries associated with pelvic mesh failure have been reported to the FDA, and hundreds of lawsuits alleging gynecological mesh failure have been filed against the manufacturers of these devices.

One of the most common of the many vaginal mesh complications is vaginal mesh erosion. According to one large analysis of nearly 12,000 women, about 10 percent reported vaginal mesh erosion within a year after surgery.

In addition, an FDA Safety Communication issued July 13, 2011, noted that a review of published scientific literature from 1996-2011 showed vaginal mesh erosion through the vagina was the “most common and consistently reported mesh-related complication” from transvaginal pelvic organ prolapse (POP) surgeries using mesh.

 

What is vaginal mesh erosion?

Vaginal mesh erosion, sometimes referred to as vaginal mesh exposure, extrusion, or protrusion, occurs when the mesh fails to remain in place and instead works its way through the vaginal wall, eroding skin and tissues. The mesh may then become visible around the vaginal area.

Women who experience vaginal mesh erosion often suffer pain, bleeding, and painful sexual intercourse, sometimes leading to an inability to engage in sexual intercourse at all. Men may also experience irritation and pain to the penis during sexual intercourse with a woman who suffers vaginal mesh erosion.

Women who have experienced these vaginal mesh complications may require additional surgical repairs to attempt to remove the mesh, but the FDA has noted that sometimes even multiple surgeries may not resolve serious transvaginal mesh complications such as vaginal mesh erosion.

 

Women seeking relief for POP may experience vaginal mesh complications

POP occurs when the muscles and tissues that hold the pelvic organs in place become weakened or stretched due to childbirth, surgeries, menopause, or other causes. As a result, the internal organs—including the bladder, uterus, rectum, and bowel—may bulge (prolapse) into the vagina or even past the vaginal opening.

Some women can cope with POP through lifestyle changes, but others suffer more serious symptoms. These may include pain and pressure, painful sexual intercourse, disruption of normal urinary and defecatory functions, and stress urinary incontinence (SUI)—a condition in which normal activities such as coughing, sneezing, laughing, or exercise causes leakage of urine.

Women with more serious symptoms of POP may opt for surgical repair. Traditional methods do not employ the use of mesh, but newer methods adopted mesh to provide additional and supposedly superior support the pelvic organs. Unfortunately, surgery with mesh has been found to increase risk of transvaginal mesh complications.

 

FDA’s recommedation to reduce risk of vaginal mesh erosion

The FDA has recommended that patients considering surgical repair with mesh be aware of potential vaginal mesh complications like vaginal mesh erosion, and discuss with their doctors other repair alternatives. Patients should also be sure their doctors are well trained in surgical mesh implantation with the product they intend to use.