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MIAMILAW1127, Lawyer
Category: Legal
Satisfied Customers: 755
Experience:  Founding Partner at Moises Law, P.A.
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I am embroiled in a pretty lawsuit currently that has many

Customer Question

I am embroiled in a pretty nasty lawsuit currently that has many different parties involved and has a variety of different issues, everything from lies found on the seller disclosure/disclaimer form, an estate that the 2 rightful heirs won't put into probate (including filing of a fraudulent will of no estate), breech of contract, neglugence and unethical behavior on the part of the real estate agent, and failure of a contractor to provide warranty information and complete work satisfactorily they were already paid's like a soap opera! I am paying on a monthly basis a team of three lawyers, but it is still taking forever to get any kind of monetary relief and now I'm told it can take up to 2 years to even get my day in court. But, my question this evening actually regards ***** ***** from my homeowners insurance to cover any part of the subsequent latent damages and defects that are plaguing my home. I purchased the home in December of last year, and due to a well-documented mold and moisture issue that was not disclosed prior to the sale, despite a home inspection ( it came out well after the fact that the home inspector was actually a good friend of the real estate agent who committed the unethical acts and fraud), and issues with the home's foundation and electrical system, which has already caused a fire and caused my home to start splitting in 2 and severe cracking of the foundation, due largely in part to the fact that the extension on the home and was completed by a non licensed contractor who did not obtain the appropriate permits or inspections and who is currently in jail for the crime and the prior owner was taken to court about, none of which was expressed to us on any of the disclosure or disclaimer documents prior to purchase of the home. After the problems begin to surface about a month after purchasing the home, and approximately 6 months after the purchase of the home and the items on the agreed upon addendum from the contract of sale still had not been fixed by the contractor that was obtained by the real estate agent, we had to get the lawyers. The home has been inspected by approximately 4 teams of Engineers, master electricians, and plumbers, all who have noted several issues with the plumbing, the entire electrical system, and the structure of the home. I put in a claim to my homeowners insurance, because to rectify all of the issues with the home is going to cost me upwards to $200,000. Neither the widow of the homeowner or the next of kin has stepped up to be executor of the estate, so even our attempts at request for mediation have been met with no responses. The real estate agent has become uncommunicative and disavows any responsibility for the issues or non disclosure. The first time my claim was flatly denied by my homeowners insurance. I fought the decision, and requested that the decision be appealed, which it was, and my homeowners insurance sent out another team of independent experts to evaluate the home. We just received the report, and along with several discrepancies and out not errors in the descriptions of the home described in the report, the independent structural engineer stated that despite identifying several major issues with moisture damage in the home, the source of the water damage is unable to be determined without destructive examination. There are also issues in the report with discrepancies in terms of what was observed, and it is apparent that the inspector rushed to get the report done and was not thorough in his review and revision of the information contained in the report. The report also is contrary to the information found by the first set of insurance adjusters, and the group of experts that I had assess the home on my own dime. So my question is this, without having to spend even more money that I don't have and more time that I don't have to fight the homeowners insurance, what can I do to get yet another appeal and resolution of these issues? The homeowners insurance also threatened that since I disclosed all of these major issues in my home, if I do not rectify the issues within a short time frame, they will discontinue my homeowners insurance. Due to all this damage, we have been unable to unpack because of the mold and moisture issues in the closets, we have been living out of boxes for almost a year, we have been baraged with several nasty pest swarms due to the widening cracks in the foundation, my young daughter, who is disabled, has been treated for lung & skin infections over 9 times since we have lived in the home, all of which the doctor states potentially are related to be toxic mold situation, and I have no more money to pay for the lawyers. Also, I have no way to raise the $200,000 to fix the home, which is currently starting to sink and dip into the ground and we are having fires due to the electrical issues and we found out that the electrical system in the home is not grounded. I was hoping my insurance would help pay. HELP
Submitted: 1 year ago.
Category: Legal
Expert:  MIAMILAW1127 replied 1 year ago.

Hello. My name is***** and I am going to assist you with your question.

I am assuming that you obviously filed a claim with your homeowner's insurance company, correct?

Customer: replied 1 year ago.
That was the was the whole point of my question.
Expert:  MIAMILAW1127 replied 1 year ago.

I understand. I just want to be clear.

Was the claim outright denied or did they pay any portion of the claim? If the claim was denied, did the insurance company state a reason why (e.g. wear and tear, settling of the foundation, etc.)?

Customer: replied 1 year ago.
It was denied by the original adjusters, but I requested a reevaluation of the claims prior to the formal denial. What I was told was that it was based on the fact that a fair amount of it was pre existing, or could not be traced back to a singular source, like a specific rainstorm or fire or tornado or some other act of nature.
Expert:  MIAMILAW1127 replied 1 year ago.

Ok, so here is the explanation.

As to the sinking of the house. Most insurance policies do not cover sinking of the property due to the settling of the foundation or due to improper/negligent work done by a contractor. The online time that insurance policies cover the sinking of the property would be in the event of a sinkhole where there is what is referred to as catastrophic ground collapse causing structural damage to the property. If your property is sinking due to the addition/work by the unlicensed contractor, the insurance company will not accept liability for that claim. You would need to sue the previous homeowner, the contractor, the realtor, the company that did the inspections, etc. for their negligence in not finding the mistake or for not disclosing it to you when they had knowledge. If you believe that there is a sinkhole and the insurance company is wrong, then you need to sue them.

The same goes for the mold (as this would be excluded under the policy due to the fact that for mold to be present, the water damage that caused it would be considered repeated seepage and leakage and not sudden and accidental) and the fires (because this is the result of the electrician that did the electrical on the property for doing it negligently and the insurance company does not insure the work of third parties).

If you want to push the insurance company further, you can find an insurance litigation attorney (who typically will take the case on a contingency) to go over your policy and case and determine if it is in your best interest to sue the insurance company for a breach of contract (because they failed to indemnify you when they should have because the claim was covered).

If that is not an option, then your only remedy is to go after all of the parties that were involved in concealing that the property was faulty and selling it to you in the condition. Also, you would need to include all the parties that did the work that created the issue.

Expert:  MIAMILAW1127 replied 1 year ago.

Does that help to answer your question? Do you have any other questions for me?

Customer: replied 1 year ago.
That did not answer my question at all...what I asked was can my claim be denied due to the Insurance inspector listing the cause of several of the issues being of an undetermined source which cannot be determined unless destructive examination was done. Did you also not read the part where I already said that I was embroiled in a legal battle currently against all of the people involved, and that I did not have enough money to take on yet another lawsuit against the insurance company? Could you please answer the question that I asked before you take my $58? Not satisfied at all
Expert:  MIAMILAW1127 replied 1 year ago.

I haven't taken any money of yours yet. We are still involved in getting your questions answered.

Customer: replied 1 year ago.
please answer the accurate question as you just quoted back to me everything I stated in the summary of my question
Customer: replied 1 year ago.
I know I can sue everyone and I already am
Expert:  MIAMILAW1127 replied 1 year ago.

Yes, the insurance adjuster can deny the claim if they are unable to determine the exact cause of loss. If they need to do destructive testing to do so, then it needs to happen for them to determine the cause of loss. In other words, the insurance company will not pay out a claim without determining the cause of loss to be able to say that the claim is or is not covered.

Your attorney for the insurance claim should handle the case on a contingency fee which wouldn't cost you anything. You should look into using a public adjuster and/or attorney. Both work on contingency fees and help increase the probability that you will recover from the insurance company.

Expert:  MIAMILAW1127 replied 1 year ago.

Just be aware that insurance companies are in the habit of denying/underpaying claims and many times you will need an attorney to sue the insurance company to get coverage and/or a supplemental payment.

Customer: replied 1 year ago.
the insurance wont pay even if my 3 sets of experts stated the cause of the damage? Why are they only listening to their experts when there are obvious flaws in the report?
Customer: replied 1 year ago.
These are my expert witnesses from court...
Customer: replied 1 year ago.
I dont have 2 years to wait for another court case to be on the docket of civil court
Expert:  MIAMILAW1127 replied 1 year ago.

Because this is how insurance companies work.

You report the claim. They try to find reasons to avoid paying the claim. You use your own adjusters/lawyers/experts to counter theres. Most of the time, the insureds have to end up suing their insurance companies because they refuse to pay.

Expert:  MIAMILAW1127 replied 1 year ago.

Insurance companies tend to try to deny coverage rather than find coverage and indemnify the insureds.

I understand that the process is daunting, but the options are fight the insurance company and try to have them cover the loss, or pay for it out of pocket. You pay for insurance for a reason. You should at least try to have them cover it.

Customer: replied 1 year ago.
Gee...this is why people in this country...hard working people...are getting the shaft. So when my house blows up with me and my child in it, they would rather risk death and paying out for a whole house then helping me fix the damages now...none of this real estate deal is fair...
Expert:  MIAMILAW1127 replied 1 year ago.

The issue is that most of the time that someone files a claim and it gets denied, they don't continue to pursue it.

So let's say out of 10 claims, they deny 7. Of those 7 only 2 file lawsuits. Think about how much money they save by taking that approach? With the insurance companies, it all boils down to dollars and being profitable. It's very unfortunate.

Expert:  MIAMILAW1127 replied 1 year ago.

Have I now answered all of your questions?