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I have a mold claim with Safeco that they have denied. They…

Customer Question
I have a mold...

I have a mold claim with Safeco that they have denied. They say they don't have the adjuster's report in the file and don't know how to get it. I called the General Counsel's office and they said he retired and they are the corporate office not the legal department for claims but were not willing to provide me with the informations.

Lawyer's Assistant: What state are you in? It matters because laws vary by location.

The house is in Idaho. I live in Florida

Lawyer's Assistant: Has anything been filed or reported?

I have filed a claim and they have denied it and sent me a letter.

Lawyer's Assistant: Anything else you want the lawyer to know before I connect you?

Not sure what else he would like to know. I am a lawyer, but not an insurance lawyer. My policy has coverage for $10,000 of mold coverage, but every word out of their mouths has been that this is not covered, that is not covered, not this is covered.

Submitted: 7 months ago.Category: Legal
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Answered in 2 minutes by:
12/18/2017
Lawyer: Legal Eagle, Lawyer replied 7 months ago
Legal Eagle
Legal Eagle, Lawyer
Category: Legal
Satisfied Customers: 14,105
Experience: Licensed to practice before state and federal court
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Hello! I am a licensed attorney, admitted to practice in state and federal court. I have a nearly 100% satisfaction rating (click here for more info) so all that means is that you can count on me to help today. Because I want to provide you with the most accurate answer possible, do you mind if I take a moment to review your question?

Please keep in mind that our conversation does not include an attorney-client relationship and this is for general information purposes only.

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Customer reply replied 7 months ago
ok
Lawyer: Legal Eagle, Lawyer replied 7 months ago

So, generally, as you know, an insurer must act in good faith when it comes to approving or not approving legitimate claims. If they are saying they are denying the claim only on the basis that they lost the paperwork from the adjuster, then this appears to be a violation of the implied covenant (promise) of good faith and fair dealing. Under the Uniform Commercial Code Section 1-304, every contract comes with implied promises from both parties that they are going to be acting fairly toward one another. This is especially true for insurance companies. In this case, they could have easily sent out another adjuster or conducted deeper research to find out whether to approve or deny the claim on the recommendation of the adjuster as opposed to just not having an adjuster's report.

With that said, the failure of one party to act fairly toward other can result in a breach of contract, which is what appears to be your cause of action here. There’s a site that I’ve used in the past where you can find a good template for advising of a breach of contract. It's a bit easier (and cheaper) than going through litigation and I have seen it be effective in the past. If this doesn’t work, sadly, the only other option is to either go through an informal mediation or file a lawsuit in your local court. This website is also pretty cool because you can just purchase, download, and go. Click here to get started.

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Lawyer: Legal Eagle, Lawyer replied 7 months ago

If you would like a legal citation, you can review Barry v. Geico General Ins. Co. 938 So.2d 613 (Fla. 4" DCA 2006). Did you have any other questions for me today?

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Customer reply replied 7 months ago
No, they can't send me a copy of the adjuster's report because it is not in the file. They say that it is what they said in their letter of denial
Lawyer: Legal Eagle, Lawyer replied 7 months ago

Could you help me understand whether they'd be willing to send out another adjuster? If they don't send one out and if they can't provide you with a reason for the denial other than not having the adjuster's report, it may be a breach of contract . Does that make sense?

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