Case Report of JPark Public Adjusters (PA Jae Park)
Sort: Residential insurance claim, wind & water damage claim
Type of policy I Homeowner
City I Pomona, CA
Description of loss I Two story house located in gated community sustained wind damage to their tile room causing intrusion of rainwater into interior of their home.
Insurance Adjustment Summary I
- Insurance company initially denied the claim; $0.00.
- Case was re-open for re-examination of the causation of the loss, and coverage was extended for resulting damage. Agreed claim settlement in amount of $48,127.25 with insurance company; before applying deductible & depreciation.
4th Case Report of PA Jae Park. Home owner claim ( wind & intrusion of rain water) denied based on insurance company’s retained independent roofing contractor’s report. Loss location near Pomona, California.
4th Case Report of PA Jae Park
A doctor couple (whom I’ll refer to as Mr. P) in their thirties, who immigrated from South Asia, lived in a two-story single-family home in Pomona, L.A. County. On January 1, 2012 they discovered that a bedroom on the second floor was wet. The water had come down through the tile roof of the house and infiltrated the closet and wood floor. Immediately after the flood, they filed a claim with the insurance company. After the roof contractor assigned by the insurance company visited and inspected the site, Mr. P was notified that he couldn’t receive compensation due to the following reasons:
1. The flooded home seemed to have the structural wear and tear in progress due to faulty workmanship from the construction of the new home.
2. On the day Mr. P discovered the flooding, the source of flooring were result of intrusion of the rain water occurred due to rain storm.
3. Because Mr. P’s home insurance only covered the damage caused by external influences (DP-3 policy), the insurance company couldn’t compensate the damage caused by faulty construction, and wear and tear of the roof.
Mr. P, who received the notice as mentioned above, was greatly surprised at the unexpected attitude of the insurance company, and eventually he became angry. Upon his discovery of the flooding, Mr. P thought the insurance company would surely compensate, since he had home insurance. Even after he received the denial notice, he thought there might be a mistake within the insurance company. (Mr. P could not understand the reason for claim rejection.) He contacted the claim adjuster of the insurance company several times and strongly requested another review of his case. He even pleaded in regard to his pitiful situation. The situation of the couple was that, due to the flood, the room for the baby, which was due to be born in a month, was gone.
However, the insurance company completely ignored the continued requests of Mr. P. Eventually, Mr. P thought the insurance company was planning to remove him from its list of clients by rejecting the payment of claim, and he became enraged.
After this, until June when this PA got involved in this case, the couple was forced to live uncomfortably with a newborn son. As soon as this PA was commissioned to this case, the PA found the following problems through a site visit and related inspection:
1. It appeared that the flood started when one of the tiles in the roof came off due to external influence (wind), allowing water to flow down.
2. According to the denial notice of the compensation payment by the insurance company, it said the flood occurred due to rain on January 1. However, based on the weather data this PA checked, there was no rain in the area that day, but on December 13 of the previous year there was heavy rain and strong wind. It seemed that one of roof tiles came off that day.
3. The insurance company indicated that the faulty workmanship of the new construction was the cause. However, how was it possible for Mr. P to live in a poorly constructed house without the construction inspection and occupancy permit from the city’s building inspector?
4. This last point was the most important thing this PA checked. The staff claim adjuster from the insurance company , who was in charge of this case, never visited the site but determined the denial of compensation according to the report of a roofer he had sent.
According to the indications of this PA as mentioned above, the manager of the compensation unit, who reviewed the claim adjustment process handled by the responsible staff claim adjuster, responded to this PA immediately. The insurance company, which had consistently maintained a high-handed attitude, was aware of the seriousness of the situation and finally changed its attitude. This was the moment at which the powerful adjustment authority granted to the PA by the state for insurance policy holders was brought to light. Following an adjustment process of approximately two months, Mr. P couple received the compensation of $45,000 and the case was concluded.
Eventually, they received the compensation, but it wouldn’t be possible to fully describe all that they went through. I really hope our readers will not suffer from the tremendous hardship because of similar case such as this.
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