Arguing with insurance company

J

JeffM

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May 25, 2004
24
Catalina 36 Lake Perry KS
Last year was not the greatest, and for us, it was especially bad as far as sailing. We are on an inland lake, and during a period of about 30 days when we were not using the boat, the shaft log decided to start leaking, and the bilge pump quit. The result was a flooded boat during very hot weather. Flooded in this case means water was about 8" over the floorboards of our Catalina 36. The cleanup has been done and we are nearly back to normal.

The problem is my insurance company is claiming that the water damage to the sole and lower cabinetry is NOT covered. They claim it's excluded as "gradual deterioration". All the damage was to the finish and there's no rot or permanent damage. I'm having it refinished, and it looks like new. The cost is going to be $2000-3000.

Calling damage to the finish that happened within a 30 day period "gradual deterioration" seems to be a big stretch. These exclusion are typically about dry and wet rot and corrosion. Has anyone had experience with a damage claim like this?

Thanks
Jeff
 
Charles Erwin

Charles Erwin

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Jan 30, 2012
1,123
Nor'Sea 27 "Kiwanda" Portland/ Anacortes
Jeff

Based on what you have presented so far here - no one will be able to give you very reliable advice. This starts with reading the insurance contract - the policy. But prepare yourself for the probability that you will not comprehend a word of it. You should consider consulting a professional arguer. Not necessarily hiring one but for a small amount you could at least talk to someone who knows something about the rules - the law - concerning coverage, exclusions and the like.

Charles
 
D

dlochner

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Jan 11, 2014
11,423
Sabre 362 113 Fair Haven, NY
This could be a tough one to argue. Check the clauses of your insurance policy that cover maintenance related items.

If I was the insurance company I would argue that the cause of the damage was poor maintenance which caused the leak. The company may claim that its not a covered item for that reason.

Also check to see if you have coverage for "Consequential Damage" that might cover some of the loss, but not all.

Good Luck.
 
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jssailem

jssailem

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Oct 22, 2014
21,104
CAL 35 Cruiser #21 moored EVERETT WA
Arguing with an insurance company...
I think there were lyrics to a song that yielded advice on this subject...

You don't tug on Superman's cape​
You don't spit into the wind​
You don't pull the mask off that old Lone Ranger​
And you don't mess around with SLIM... (Special Licensed Insurance Manager - The Adjuster)​
 
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MikeHoncho

MikeHoncho

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Dec 28, 2015
1,850
Laser, Hunter H30 Cherubini Tacoma
See if you can get a lawyer to take the case. If one does and they settle, you will be paying 2/3’s less than you are right now.
 
nightowle

nightowle

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Aug 28, 2006
564
Bavaria 35E seattle
I don't think an attorney would take a case for $2-3k. They may at least write a letter to your carrier taking umbrage with their denial, but that could cost upwards of $1k just for a retainer. You might look for a Public Adjuster to give advice. Again, your claim amount is so little for an adjuster to be directly involved but for a small fee, he/she might give you some good pointers to revisit your claim for an additional amount.
 
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Maine Sail

Maine Sail

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Feb 6, 1998
11,672
Canadian Sailcraft 36T Casco Bay, ME
Most insurers would have denied any and all coverage as they do not cover issues related to a lack of maintenance. I suspect Trying to push this one you may wind up losing all coverage..
 
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M

MitchM

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Jan 20, 2005
1,021
Nauticat 321 pilothouse 32 Erie PA
was shaft log leak due to lack of maintenance ? was bilge pump failure due to lack of maintenance ? as i see the facts , shaft log unexpectedly starts leaking. may be due to lack of maintenance. but you anticipated that by having a working bilge pump in place. bilge pump v aliantly tries to keep up but quits : that's NOT due to 'lack of maintenance' as bilge pumps don't typically need 'maintenance (except maybe, keep bilge clean and not have junk clogging its little worthless filter.) so your consequential damage to wood work is due to the unpredictable event of the bilge pump quitting , not due to the initial shaft log failure. i'd notify insurance company that you are suing them for all out of pocket costs to repair woodwork and for a refund of the entire policy amount , based on their breach of their contract of insurance to cover yr repair damages. we can file a 'small claims ' lawsuit in small claims court for $70 here in PA, without a lawyer. and the ins co then has to hire a lawyer at $400 an hour...
 
MikeHoncho

MikeHoncho

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Dec 28, 2015
1,850
Laser, Hunter H30 Cherubini Tacoma
nightowle said:
I don't think an attorney would take a case for $2-3k. They may at least write a letter to your carrier taking umbrage with their denial, but that could cost upwards of $1k just for a retainer. You might look for a Public Adjuster to give advice. Again, your claim amount is so little for an adjuster to be directly involved but for a small fee, he/she might give you some good pointers to revisit your claim for an additional amount.
Click to expand
They would delegate it to a legal aid and still get the 1/3rd.
 
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D

dlochner

.
Jan 11, 2014
11,423
Sabre 362 113 Fair Haven, NY
MitchM said:
was shaft log leak due to lack of maintenance ? was bilge pump failure due to lack of maintenance ? as i see the facts , shaft log unexpectedly starts leaking. may be due to lack of maintenance. but you anticipated that by having a working bilge pump in place. bilge pump v aliantly tries to keep up but quits : that's NOT due to 'lack of maintenance' as bilge pumps don't typically need 'maintenance (except maybe, keep bilge clean and not have junk clogging its little worthless filter.) so your consequential damage to wood work is due to the unpredictable event of the bilge pump quitting , not due to the initial shaft log failure. i'd notify insurance company that you are suing them for all out of pocket costs to repair woodwork and for a refund of the entire policy amount , based on their breach of their contract of insurance to cover yr repair damages. we can file a 'small claims ' lawsuit in small claims court for $70 here in PA, without a lawyer. and the ins co then has to hire a lawyer at $400 an hour...
Click to expand
If the OP went this route, he would have to demonstrate that the shaft log was properly maintained and offer an explanation of why it just suddenly started leaking. A maintenance log entry about shaft log inspection and maintenance, a current receipt for new packing material, etc. Even then the insurance company will question his qualifications to do the maintenance.
 
thinwater

thinwater

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Mar 26, 2011
3,414
Corsair F-24 MK I Deale, MD
You need to have "consequential damage" coverage. Otherwise, the insurance need only cover the actual damamge (accident), which in this case was lack of maintenance and not covered. Consequential damage coverage includes the other stuff that got damaged.

Read the the fine print, since this depends on the contract.
 
M

MitchM

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Jan 20, 2005
1,021
Nauticat 321 pilothouse 32 Erie PA
too bad we dont know why the OP's shaft seal was leaking. (NB- there have been reported instances of PSS shaft seals leaking , far before the recommended maintenance intervals . PBO of UK just did an a article where a well maintained PSS started to leak after boat was docking w rudder hard over which created excess pressure that messed up the seal. fortunately the owner was s till aboard and caught the leak before his boat was 'consequentially' damaged, (unlike OP. ) on my boat i had the old style flax packing and kept my log of when it was greased and adjusted. (along with every other maintenance thing done on the boat...)
 
MikeHoncho

MikeHoncho

.
Dec 28, 2015
1,850
Laser, Hunter H30 Cherubini Tacoma
MitchM said:
too bad we dont know why the OP's shaft seal was leaking. (NB- there have been reported instances of PSS shaft seals leaking , far before the recommended maintenance intervals . PBO of UK just did an a article where a well maintained PSS started to leak after boat was docking w rudder hard over which created excess pressure that messed up the seal. fortunately the owner was s till aboard and caught the leak before his boat was 'consequentially' damaged, (unlike OP. ) on my boat i had the old style flax packing and kept my log of when it was greased and adjusted. (along with every other maintenance thing done on the boat...)
Click to expand
How did the rudder cause pressure on the shaft?
 
Sailfanatic

Sailfanatic

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Jul 19, 2013
384
Pearson 31-2 Boston
I'd say the folks suggesting sueing the insurance company over this issue have never actually sued anyone, as it is silly advice. Lawyers start at $200/hr..

As painful as it may be, I think the insurance company holds all the cards here, and PO should move on.
 
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MikeHoncho

MikeHoncho

.
Dec 28, 2015
1,850
Laser, Hunter H30 Cherubini Tacoma
Sailfanatic said:
I'd say the folks suggesting sueing the insurance company over this issue have never actually sued anyone, as it is silly advice.
Click to expand
Since you are being absolute, I’ll be absolute.....you are flat ass wrong. They will review the case and decide if they want to take it on. If they do then you sign a contract that stipulates the payment. If they take it, more than likely it will be a 1/3rd plus costs of the winnings. If they don’t normally you can hire a firm at a hourly rate.
Now the question is will a firm take it? Don’t go to a firm without knowing your insurance policy. If it can be interpreted that you are in the right they might listen. Being that it is associated to a insurance company gives you some attention with firms. It’s not like they will be going to trial. This is a letter head, correspondence situation that a paralegal will be dealing with. So not very silly at all.....and I bet the actual costs of the damage is a lot more if you figure in professional repairs and not DIY/handyman levels.
I’m not going to get into my experiences with tort law but again I’ll say you’re wrong on that also.
 
D

dlochner

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Jan 11, 2014
11,423
Sabre 362 113 Fair Haven, NY
Given the size of the claim, $2-3K, most experienced attorneys would be hesitant to invest much time. However, many attorneys will at least review the claim and the policy and provide some guidance.
 
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tfox2069

tfox2069

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Apr 8, 2011
768
Hunter 40 Deale, MD
thinwater said:
You need to have "consequential damage" coverage. Otherwise, the insurance need only cover the actual damamge (accident), which in this case was lack of maintenance and not covered. Consequential damage coverage includes the other stuff that got damaged.

Read the the fine print, since this depends on the contract.
Click to expand
This is an interesting point I've seen discussed elsewhere on the site as well. In one case someone's mast fell, and the insurance company agreed to replace mast components but not the damage to the rest of the boat the mast damaged on the way down.

Someone else recently posted about a major insurance company not covering boats for freeze damage unless the owner could show a receipt from a marine service business that completed the winterization. DIY winterization voids freeze coverage.

You really, REALLY need to read the policy. Ideally BEFORE needing to make a claim (or agreeing to pay for the coverage).
 
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