Exclusions to Frame-it/Capax/Hartford BOP

BUDDY

SPFG, Supreme Picture Framing God
Founding Member
Joined
Nov 23, 1997
Posts
11,913
Location
Mandeville, LA USA
Business
retired
I have illuded to the EXCLUSION language contained in the Hartford BOP offered by both CAPAX and Meadowbrook insurance agencies. I would like to now show anyone what exactly these exclusions are in the event anyone doesn't have a policy to read or if you were as foolish as I to assume you had any coverage .

Please note that these exclusions void any and ALL coverage in the event any ot the exclsions occur. This includes but is not limited to "INTERUPTION OF BUSINESS" Unless you are prevented by "Local Civil authorities " from returning to your shop and then the maximum is 30 days coverage.

Suffice it to say if there is water involved in your claim you in all probability will not be covered by these policies ,and you must have a seperate FLOOD INSURANCE POLICY to be covered.

The actual wording of the policy exclusion reads:
We will not pay for the loss or damages caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss.

Water Exclusion(G)

1.)Flood waters ,surface water, waves, tides, tidal waves, overflow of any body of water, or their spray, or whether driven by wind or not.

2.) Mud Slides or mud flows

3.)water that backs up from sewer or drain or

4.) Water under the ground surface pressing on, or flowing or seeping through

a.) Foundations, walls, floors, or paved surfaces
b.)basements, whether paved or not
c.)doors, windows or other openings.

Please note that it is not only in the case of a castitrophic Flood like Katrina that you will be excluded ,but even if the swere system backs up .

I know I sound like sour grapes but I am posting this in the interst of preventing anyone else from being as foolish as I was. This policy will not cover any loss involveing water as far as I can see.
BUDDY
 
Yeah, I'm in the same boat (sorry). All kinds of water damage from a perimeter drain that failed, and the insurance company is washing their hands of the whole thing. Of course, they built those tall shiny buildings by taking in premiums and not paying out for people's losses. F'ers, the lot of 'em.

Fortunately for us our damages are much more limited. A few thousand out of pocket and we'll be more or less whole.
 
I am so glad that you are bringing this to our attention. We have Hartford and years ago they denied a home claim due to water leakage through a door frame from a monsoon rain.

If the studio got flooded.....oooooph!

It is certainly time for me to make some calls - perhaps all of us should.
 
Sorry to hear about that Buddy.
Insurance coverage is very tricky and slippery yet a necessary evil of doing business. I believe it to be one of the worst forms of usery as it preys upon peoples worst scenario fears, paranoias, and leads you to belive that having it will allay those fears.
When your worst case scenario comes true (flood, hurricane or any "act of God")the wording in your policy is never in your favor.
 
Water damage is not covered under any circumstance? Just curious...if my shop were to catch fire and the fire dept. used water to try and put it out, would that also be considered water damage?
 
janet thanks for pointing out what MAY be an overstatement by me,( If it involves water you probaly won't be covered).
However in many cases in the Katrina area and in one I personally was involved in ( My Home) the general opininion is that any damage below the visible water line was attributed to FLOOD and only the damage above that mark to Home owners policies. This is despite the fact that the wind damage could and did occur BEFORE the water but the FLOOD covered up all eveidence of prior destruction and it was generally denined by most insureres. ( except I had proof that my home was openned before the water arrived ( a dead cat I didn't own) under furiture)and despite historical evidence that the flooding occured a day or two after the hurricane passed.
I say this because in your scenario it is entirely possible that the insurer could claim the the real cause of the loss was the Firemans WATER and if he hadn't soaked everthing it wouldn't have been damaged ( barring of course char marks LOL) But ithink reading the EXCLUSIONS can show some real loop holes.

We were denied Interuption of Business since it was a flood. Only to find out that it didn't matter that our business was indeed interupted .The PRIL was a flood( water) which excluded everything. But the worst insult was when the adjuster told us personally that even if it were enforceable it would only be good for the evacuation period of TWO days. We were prohibited from returning to the area by authorities for 3-4 weeks. But in his on the spot opinion it didn't matter.

However after fileing a written complaint with the Louisiana Insurance comisssioner we received a written notice( accompanying the Exclsions) that stated that hartford was LOOKING into an endorsement that aloowed payment of LOR if prevent by local civil authorities but only for aperiod of 30 consecutive days. Why didn't they realize that Local authorities control all entrance and exit to a disaster area( before I filed a complaint) and why didn't they LOOK for endorsements that could afford some payment .They should have realized my Hard copies were destroyed in a flood that engolffed the ENTIRE COMMUNITY.

But They didn't single out me or my business,a friend had Hartford as a home owners policy and was told that after flooding to 6-7 feet they could return to live in their home as soon as the "BLUE ROOF" was placed on their home.

This clearly indicates they have NO CLUE of the destruction found inside these premisses ,and i seriously wonder if they really care.

But You made good point, as did many of the Katrina victoms. If i sound bitter please excuse me ,it is just that I am very annoyed by haveing to PROOVE that my claim is truthfull and valid ,and not always being told of little known endorsements in a loss policy. So be very carefull and ASSUME Nothing is understood.
BUDDY
 
Buddy, I meant that as a REAL question. Wasn't trying to nit-pick what you had stated. It seems a fire extinguished by water could be a catch-22. I'm home w/out my Hartford policy but you can bet I'll look into it when I get to the shop. I called Hartford about a year ago because someone was going through town starting a bunch of fires. They assured me I had coverage for a scenario caused by a pyromaniac.
 
I think it is about time somebody schlepped an insurance company into court.

Now especially with Katrina, courts might act more favorably and scrutinize more closely those catch-22 and misleading policies. If no one says anything, nothing will happen.

First thing to do Buddy, is to file a complaint with the insurance commission in your state and the Better Business Bureau and see what happens.

Bad publicity and the squeaky wheel will get results.

I am surprised no bad a$$ed lawyer has filed a class action suit against such misleading policies.

On the other hand, if Big Business was being duped by same insurance companies, you can only imagine how fast the Congress and the politicos would react...
 
Paul,

It may be tragic, but it is hard to call the exclusions quoted by Buddy "misleading". What we should be demanding is the availability of coverage for those events. You could then make your own choice as to whether the risk/cost ratio is worth it to you. Insurance companies are only going to pay for risks that are specifically covered - and paid for. The ground water issue is sadly one of construction techniques over the years rather an "event" which might be worth underwriting by insurance companies.

The question of liability in New Orleans appears to be focusing on faulty construction of levees and whether there is an entity with sufficiently deep pockets and legal vulnerability to justify class action.

The question that needs to be faced is who is financially responsible for the inevitable damage sustained by structures built in a flood plain or coastal setting. There is no easy answer.

Pat
kaffeetrinker_2.gif
 
Yeah, right, Pat, who are you going to sue?

NO, who has been asking for better levies for over 40 years?

Army Core,who had their funds pulled 4 years ago?

LA who wouldn't structure it into their budget?

Bush, who did give a rip about the little people living 30' below the water line?

I stand/sit in amazement as I watch news clips about people already rebuilding 20' below water line.....
I find it to be as stupid as removing the sheet rock, washing it all down with clorox and replaceing the sheetrock and calling it good....

For 20 Billion we can crush everything, pump in 20' of sand and dirt, pack it, lay all new pipe and electical for a 21st century city, and cover over with 10' more feet and take this opertunity to build a city that is highly energy efficient, eco-sensitive, and 10' above water line.

but they won't concider doing it this time or the next two times.

Even though the CNN poll of 145,000 people across America said resoundingly (98%) don't send the money to rebuild a disaster waiting to happen again.
 
Several years ago, our next door neighbor (our stores are all in major, regional super malls)had a pipe burst on Dec 23rd. By the time we were notified, there was standing water through out the store. Any art or material that was touching the floor wicked up water quickly. Now, understand that the last two days of the holiday season are mounmental for us, not to mention th emany, many workorders that are more easily store at our store than under the tree

The store was closed all of the Dec 23rd and was still a problem on Dec 24th.

In another store, we had a fire system sprinkler burst and spray a 20ft diameter of water for quite awhile until it got turned off at the central plant. It sprayed walls, clients, art and inventory and was dark, brackish water that was so foul

We had Capax/Hartford in both cases

Bottom line:

I received checks within two weeks that covered everything lost and for those sales lost during the interruption (and Dec 23rd/Dec 24th was a chunk). It was painless and frankly, I had no idea what really was covered. Like most If I ever read even 5% of the policy that would probably be a stretch

The only thing they refused to cover was I had a pair of Eel Cowboy boots that the water just flat ruined. However, the adjustor "suggested" that perhaps if I included another framed print or two, that it would probably be approved

Buddy-I am sorry for the headache that you must be going through and if I lived in your neck of th ebayou, I'm not sure my policy would be much different than yours. But, I suspect that most of us overlook "little" contingencies in the hopes of saving a few dollars in premiums.

I hope that perhaps some of the millions donated into so many funds might find their way into pockets of individual business people to get back to work.

You know Billions will be distributed to so many that have absolutely no interest in going back to work.

What's wrong with that picture
 
Baer,

I'm in no way talking about that political bashing. I'm talking about a very specific failure in the cement wall levees, where due to negligence in design or implementation, failed because the pilings were not driven in deep enough. Ergo: Cause for action.

Bob, that's correct water damage, per se, is not excluded - just the listed hazards. Therefore events such as burst pipes or sprinkler system failures are covered losses.

Pat :D
 
I don't mean to minimize the unfortunate nature of what's happened to Buddy and others. Nor do I want to put myself in the position of trying to defend every insurance company in the world.

But, nearly every day, I speak with someone who is threatening to sue my company, or me personally, because they are unhappy with the way a claim was processed. If the claim was processed improperly, part of my job is to get it fixed. In the vast majority of cases it was processed exactly according to the plan benefits.

Maybe the plan sucks but it's the plan either you or, in the case of the groups I work with, the employer, signed up for. Want better benefits? Buy a better plan.

Health insurance, and presumably property insurance, is moving toward more cost sharing.

If it makes you feel any better, I have a $4500 annual deductible on my health insurance before it will pay a dime. And I work for the company.
 
Sometimes it does pay to consult an attorney to make sure. I had a car accident, I won't go into it, but the insurance company was going to leave me high and dry until an attorney read the policy and wrote to them threatening to sue, he said he had a very good case and the insurance company caved immediately.

It took two attorneys before we found one who knew what he was doing.

There also might be a class action suit against whoever built the levee system.

Insurance companies would like to never pay out. I had workman’s comp and my business insurance with one company. I had an employee injured, a robbery and a truck pulled an electrical wire down into my roof, which when it rained caused a leak all in one weeks time. The insurance company paid, but then cancelled me. I had been with them for more than ten years, never missed a payment or had a claim.
 
Originally posted by nona powers:
The insurance company paid, but then canceled me. I had been with them for more than ten years, never missed a payment or had a claim.
That what really drives me up the wall!

Why are we paying premiums for?? So that insurance companies cancel the moment we file a claim?? This is truly amazing. And again should be challenged in court: Case being: Based on what is the policy canceled?? I thought we pay for coverage, not for having coverage interrupted the moment we use the coverage!!!!

I am not litigious by any means, but this cries out for major a court battle.
 
I hear ya Nona. And Ron, just because you work for an insurance company doesn't convince me there on the side of the client. You may be, but the company isn't. Every insurance company is out to make money or they wouldn't be in business. If there are any loopholes, they will find them. Nothing wrong with that I suppose, but there is nothing wrong with the other side getting a lawyer to help with the fine print so to speak when they don't want to pay up because of some loophole. I've been burned before by insurance companies and I have found they are not your best buds in any case. How could they be and make money? I suggest everyone read their policy more than once and if they can't understand it, go to someone who can. It's better than the alturnative for sure.

Rock
 
Before I start any divisive fueds. I clearly said I missed the exclusion clauses. And i don't think any of the exclusions listed were for falling water only riseing water .But riseing for almost ANY reason. I posted that because Rebecca said she had an evacuation plan for floods. However some of these conditions can occur with no warnning and in very isolated places. I also wasn't jokeing or just complaining about the fact that some Home owners policies are trying to say the secondary Flooding conditions take precidence and void all other coverage since it is all but impossible to prove which was the chicken and which was the egg.This may be very similar to water damage resulting from a firemans hose. But then as Bob stated sometimes they pay claims with no questions. This is mostly when you are the only claimant, but woe to you if there are hundreds of thousands and some of the adjuster were turning burgers the day before( an actual case) they need all the warm bodies they can get qualified or otherwise.they may just tell you that all you are entitled to is 2 days interuption of business when they know full well that no one ( I nor they) could gain entrance to the entire Parish for at least 4 weeks.Then when threatend with a Insurance comissioners complaint they just happened to remeebr a endorsement that allows for Civil Authority Barring of the area.

The question about the poorly engineered levees has been documented by a team of national Scientist and there is proof that the Corp of engeineers knew this back in 1980 before the cap was completed. Infact the engineering firm ( Pittman I think?)asked for an explanation for why the sheeet pileing could sway by as much as 1.6 inches with no stress and they where refused to be allowed to view the statistics. So I think that lays the blame squarely at the feet of the Corp in 1980.

I have heard some wish to file a class action but still others who wish to have Criminal charges filed since they realize full well that there is very little chance of any real cash settlements and the real need is to FIX ALL the levees to withstand a cat 5or at least 4.

Baer is partially correct there are a lot of culprits but this didn't start with the current administration it started 25 years ago and all the pundits just ignored it. Now fingers are pointing in all directions.But my insurance problems at the shop are due to my own IGNORANCE and i am just trying to make others not make the same mistake and read that other 95% that Bob and I missed.
BUDDY
 
I posted it once and I'll post it again: whoever thought an insurance company ws there to help someone is NUTS. They're there to make money for the shareholders.

You must PROVE the flood actually caused the damage. Silly isn't it?
 
Mike I don't mean to keep this going,but some clarification is necessarey.

Your comment:"You must PROVE the flood actually caused the damage."

Is actually a bit backwards in the cases I was suggesting. If you don't have FLOOD coverage ( as is the case for many ) but you do have HOME OWNERS .You must prove that the damage incurred was caused by wind or wind driven rain ,before any "RISEING WATER" ( better known as flood) destroyed anything or covered up the damage that already existed,in order for the Home owner's insurance to agree to pay.

In the case of Katrina this is entirely probable since the Cat .5 Hurricane occured and reaked havoc and the flood didn't occur until a day or two later but all anyone sees after 4 weeks of forced evacuation is water damage and the HO insurers claim all damage is flood related below the water mark ,despite things being blown apart and around ,things that are even too heavy to float.

Is that clearer? If not there is a awfull lot of MUD ( about 6 ins. to a foot) inside my home that can confuse the issue even more ,Includeing the Skelital remains of a cat that I didn't own that is pinned and burrried in that same mud under a JELLY CABINET full of cook books in my kitchen that with my best effort i can't even right or move.

By the way today I spoke to Hartford's main office and they still denined I had any compensation due for loss of revenue .This is despite the fact that the duplicat policy they sent had an endorsement for Governmental Forced Evacuations up to 30 days and the adjuster sent me a letter saying the same.

After I asked why they didn't know the policy as well as an indipendent adjuster and that I was going to have a local Authority FAX them a notice saying the evacuation was that long and the conditions still prohibited doing business,
Mr. FONG of Hartford had My adjuster call and say they would indeed pay the claim but only for 30 days.

Wonder why the Main Office of Hartford Insurance didn't tell me that I had that endorsement before?
Or why the adjuster knew their endorsements better than their home office and why they needed him to agree to pay me?You'd think they'd point out little known endorsements I had paid for so I could be happy with my coverage .Wouldn't you?
BUDDY
 
If all holds true Buddy, you won't be wondering for long. You'll get your money and then they'll cancel your insurance. Hold off till then so that you can REALLY formulate an opinion of them.

I am soooo happy you are getting some form of compensation following the 'forced evacuation'. Every little bit helps.
 
Buddy, I am so sorry to hear about what you are going through. Seems so unfair. I hope that things turn around with the insurance company.

I think that you have already investigated this (from reading your posts) but is it possible to prove when the roof was torn off and how much rain came down before the flooding started? If you had 9 inches of rain in a 5 hour period prior to the flooding, that would create quite a bit of damage to the property within your home, regardless of the damage done later on by the flooding. Ditto with the winds. I think that I understand that the timing of the flooding in the different areas is pretty well documented.

Perhaps there is a "friendly" insurance agent who could look up previous claims history for leaking roofs or roofs torn off to give you an idea of the claims due to water "falling down" rather than "rising" and wind damage. This might be the basis for a claim based on damage that could be "realistically expected" due to the loss of the roof during an intense storm. This could be combined with your items that are too heavy to float, but were moved around due to the winds to help substantiate that there was xxxx amount of damage due to water and wind prior to the flooding.

I understand that the insurance company is suggesting that it is not possible to determine just what damage is due to the rain because the flooding wiped out that evidence, but perhaps it is possible to fudge the definition by utilizing the claims history of rain and wind caused damage during storms that were similar, but without flooding.

Wish that I could come up with something for the IOB part.

Hope this is of some help or benefit to you.
 
Terry ;
Thanks for your efforts.However be very assured that every angle and some have been attempted. Also be very assured that not all people involved in the insurance industry are evil and underhanded.In fact One of my very own Brothers- in law is an agent. As are a couple of his sons. But even with that FAMILY connection and information even some of them are being given a hard sell treatment.

In reality the insurance industry is takeing an awfull hit and they are attempting to keeep their payments to a minimum ,which is all but impossible with out cutting a few corners.

One of my brothers was told that he is being denied ,since he had minimal FLOOD insurance and damage but becuse he didn't immediately repair the mamooth hole in his roof caused by a fallen tree, the resulting MOLD growth was his fault even though their was no real apprecable rain until Rita and by that time MOLD was growing on every surface immagenable and some you wouldn't even think of.

IMHO there has been no effort at all to assume that the Wind or wind driven rain damage harmed ANYTHING that any flood waters covered even if the flood occured DAYS afterwards.

I even was advised by that same brother-in-law to not allow one of my insureres to file a second claim when Rita came through inspite of my objections and questioning what good it would do. Especially since the first adjuster hadn't been there yet but the house was an obvious TOTAL loss from the first storm. You see they had told me that the adjusters would determine which storm did which damage when no one had seen the first. But the common TRICK is to file a second claim or "incident" which necessitates a second deduction. ( This was done in Fla. as many as 3-4 times on propeties that were a total loss from the first claim last year.)

The second unnecessary claim was only removed when I threatened to SUE for improper advise by some one who knew better and refused to heed my wishes.

Are you getting the concept of how RARE "friendly" insurance agents and adjusters are or how much they try to find information that might help your claim? Or even How much they claim to remember well documented News reports of the sequence of events in a given disaster?

As I just said the other day ,after being sent a duplicate hard copy of My Hartfor policy by the Office manager and reciveing a letter from the on sight adjuster confirming the endorsement clause that entiled me to 30 days of Loss of revenue caused by a Forced Evacuation by local authorities ( which occurs always in Hurricanes) the HQ person who took my call told me that because the PERIL was a flood all obligations to me ( the policy holder) were void. In fact I had to insist to speak to the Office mamager and even he differed to the Contract Adjuster . IMHO the HQ of an Agency should and would know more of what I was entiled to than any contracted aduster. But they steadfastly refused to complie until the adjuster called ,when it was spelled out in the policy and then they asked for a written note from a local Politician indicateing that the Forced evacuation did occur and it did exceed 30 days ,despite the fact that would only pay for 30 days even if the condition are still existing.

In a nut shell ,you may find some agent who can't do enough for you,but most are going to require docmentation of facts that are known world wide. The big problem is until they leave their office and come to the sight they don't have a clue of how horrible things can be and in most cases are.
BUDDY
 
Hope you don't mind a funny story, I had a lady run into the side of my van. She was looking at the traffic coming and going and missed me right in front of her, BAM. She actually claimed it was my fault. I asked the adjustor how I could possibly run the side of my van into the front of her car but the adjuster said she had to look. I won that one.
 
Originally posted by nona powers:
I had a lady run into the side of my van.
And you didn't get prosecuted for insurance fraud?
 
Ya, Nona! How did you get away with THAT!

My brother got t-boned by a car that ran it's red light - my brother was the third car to enter the intersection on a green light. The other guys insurance company wanted my brother to accept 40% of the responsibility for the accident because my brother was in the intersection. Go figure!

Buddy, I kind of figured that you had checked out every angle, but hope springs eternal. It makes me sad to hear about what you and other people are going through.

Isn't it time we put the grumble recovery fund back up on the top? I think that it is time to send another check. There but for the grace of god go I.
 
Terry your very generious proposal is exactly what I was frightened of. I sincerly worry that my numerious complaints about insurance trickery will seem like an effort to solicit support. Actually I am trying to return a favor not ask for one.

However I am sure there are many who can use help but please understand that is the furthest thing from my mind.
BUDDY
 
Buddy, I am not thinking only of you, but of others in our industry who are affected, too. I didn't interpret your posts as a plea for funds. I felt that you were posting to inform us, and to let us know how frustrating it can be wading through the process.

I think that we all are hoping for a good outcome for you and for everyone else who has been affected.
 
Back
Top