Disclaimer

I want to say for the record that I know there are good insurance companies with good hardworking people working for them that are trying their best to be fair, helpful and honest. I have personnel had a bad experience with my insurance company which has probably given me a mistrusting view of them so please keep that in mind.

Insurance Companies

Never forget what insurance companies are and what they are in business to do. They are not your GOOD NEIGHBOR (I have never had a neighbor charge or pay me money) or the GOOD HANDS PEOPLE (what does this mean anyway). Don't get me wrong, we need them but lets tell it like it is, they are financial institutions that like any business are trying to make money. The way they make money is by collecting premiums from the masses and paying claims to relatively few. The better they are at limiting claims the more money they make. To limit claims they try to be as efficient as possible. Unfortunately sometimes efficiency can be taken too far at your expense. For example, your insurance adjuster gets evaluated on how efficiency he or she settles a claim. The way they measure this by judging his or her performance based on the anticipated costs of a claim. Lets say you have a shower pan leak and it is the insurance companies experience that these claims costs around $2,500 to repair. Now if the adjuster settles it for $2,300, "That a Boy." If he or she settles it for $3,000, "What the hell happen?" (I know I am probably pissing off some insurance advocate out there, for those people I say - get over it). Now, throw in the fact that the insurance companies did not anticipate big claims to be paid for mold testing and removal, "Oh No, we didn't plan on this, we are making less money." I think you get my point. These guys are not your friend they are only doing what they have been contracted to do so please don't for a minute think that they are looking out for your best interest. Only you can look after your best interest.

What is covered?

Insurance Companies cover "Sudden and Accidental Occurrences." For example, a water pipe breaks in your house while you are at work and when you come home the house is flooded (Covered). You have a slow water leak that you knew about but did nothing to fix and over time it caused a problem (Not Covered). So what does this mean with mold? Well if you have significant mold growth and you have widespread contamination, just by the nature of how mold grows and spreads you are probably talking about something that has been a long standing problem or some type of construction defect. Do you feel a -Not Covered- heading your way? Ok so here is the drill, you have widespread contamination your insurance company says "hey we better test this mold and investigate how this got started, aren't we good guys." They are doing this for their benefit, not yours. They are investigating whether or not they can deny your claim, not what are the potential health effects. I'll will go even further I bet at the same time they said lets test your mold they also sent you a certified letter saying that they are investigating the claim and they "Reserve their Rights" under your insurance contract. Lies, what this means is they reserve the right to decline your claim in the future even if they started to pay you for some items like "additional living expenses." The right answer here is as soon as you have mold pay someone who knows what they are doing, to safely remove it without contaminating the rest of your house in the process. Testing for mold is incidental to fixing the water leak and stopping the mold from growing. You test mold to determine what health effects there might be and how to reduce your risk of those effects, not to fix the mold problem.

So what should I do?

First go out and buy a small tape recorder and an attachment that allows you to record your telephone conversations with the insurance company. Some states require you notify the other party that you are taping they call (if so tell them) a lot of states like Texas does not. This will give you tremendous peace of mind and will avoid them back tracking in the future. THIS IS A MUST. Next your answer it always that the water leak was from a sudden discharge that you had no way of knowing that there was a problem and as soon as you did you contacted the insurance company and took precautions to insure no further damage occurred. Let's say it is looking like a construction defect. Then your answer is well "I don't believe it was a defect, I believe it was the "Driving Rain" or it just broke. Don't let them off the hook. Look at it this way, you went to the store and you bought some furniture. You ask them to deliver it and they didn't. You would be pissed off and you would do anything you could to make them live up to their obligation. Well you bought the furniture with your premiums now it is time for them to deliver.

Other helpful hints

Mold Testing Companies - Remember how I said that the insurance company would investigate by sending companies to investigate for their benefit. Mold testing companies are no different. First of all, the majority of these guys business is paid from insurance claims. This means most of there revenue and profit also comes from insurance companies. So when it comes down to making you happy or making their biggest customer happy well human nature tells me they answer is screw you. (I know there are some very honest mold testing companies and they can be your biggest allies) This all starts with them wanting to be contracted directly from the insurance companies. Which by the way is the insurance company's right to hire their own testing company (The testing fees do not come out of your policy limits). This is my advice; when the topic of testing comes up you say that you would like to hire the testing company directly and would they please reimburse you. This makes the testing company have a contractual obligation to look after your best interest not the insurance companies. Let's take that one more step. The testing is flawed and you get some serious illness that from a mold that they should have caught. Guess what you can't sue the testing company if the insurance company contacted them you can only sue the insurance company. Good luck on suing the insurance companies. These guys go to court all the time and have a pack of attorneys on staff to screw your world over. If they say they won't let you hire the mold testing company directly (what does that tell you) then I would say you don't mind if I hire my own testing company in addition to your guy and will you reimburse me for that? The answer will probably be no then immediately say will you at least pay ½. The answer will still probably be no but you have them on tape being jerks which will help you down the road (See Bad Faith).

Contractors - Just like mold-testing companies should be hired by you so should contractors. I always hate how contractors say give me your adjuster's name and I will work directly with them. Maybe that is ok for some repairs but mold remediation and repair, I don't think so. I want to be in-charge. Sure it is more of a hassle but you want to make sure they are looking after your best interest. If a contractor says who is your insurance company, tell them that you will be handling the insurance company and they don't need to contact them. A lot of companies won't work for you when you say this but then again you probably know why.

Items that toxic mold victims have found helpful.

Bad Faith?

In order for you to have a lawsuit against an insurance company you are going to have to prove Bad Faith. This is a legal term, which basically means they intended to screw you or they were grossly negligent. My advice on this is you constantly need to ask yourself when you talk to these guys "what would a jury think." You need to keeping asking them questions that make you look reasonable and them look unreasonable. Even if you know the answers, like no we won't pay for extra testing, ASK ANYWAY. I would also say don't be optimistic that you will be successful with a lawsuit against an insurance company. These guys are professional litigators who know all the tricks, rules, laws etc and have a pack of attorneys to drive you in the poor house and wait you out forever. Yes I know people get settlements from insurance companies all the time but if your case is not strong enough for an attorney to take it on a contingency, then you probably don't have a case. I believe you should build a case assuming you are going to court but keep in mind this is just the backstop.