Water damage insurance claims in Ohio: the general pattern and the file

The general pattern of a water claim

The insurer looks at the cause, the policy and the evidence of the damage.

A water damage claim is usually decided in three steps. First the insurer decides the cause of the water, such as a burst line, a backed-up drain, a storm or a river. Then it reads the policy to see which causes are covered and which are excluded. Last it looks at the evidence of the damage and the work done to dry it.

This guide describes that general pattern only. It does not say what any particular policy covers, because the policy is the document that decides it, and this site has no access to a homeowner's policy.

Why river water is often a separate question

Many standard policies exclude flood water from a river, and flood cover is often separate.

Water from the Little Miami or any other river is commonly treated as flood water. Many standard homeowners policies exclude flood water, and flood cover is often a separate policy. A homeowner in Loveland should ask the insurer in writing which terms apply to a river loss, and should not assume that a standard policy covers it.

A river loss is also often harder to explain, because the water line and the silt tell one story and the policy tells another. A dated photograph of the water line helps the file stay clear.

What the file should hold

The file holds the scope, the photographs, the readings, the receipts and the insurer's letters.

A complete file is the homeowner's best tool. It shows what was wet, when it was measured, how it was dried and what was paid. It is also the file a second contractor will read, so a clear file saves time for everyone.

The file is kept in one dated place, on paper or on a phone. Dates matter more than detail. A photograph with a time shows the water line in a way that a later description cannot.

Explaining the cause of the loss

Give the cause as the crew found it, and say what you saw before anything was moved.

The cause of the loss is the first thing an insurer asks. Give it as the crew found it and as you saw it. If a supply line split, say where and when it was found. If a sump stopped, say whether the pump was running and whether the float was stuck.

Do not guess at a cause you did not see. A plain account of what you saw, with the photographs, is stronger than a guess that later proves wrong.

• Where the water came from, as found
• When the water was first seen
• Whether the source was still running when found
• Whether any repair was done before the crew arrived
• Whether the water was clean supply water or river or storm water

Asking the insurer for its position in writing

Ask for the position in writing, with the policy section it relies on.

A position given by phone can be hard to check later. Ask the insurer to put its position in writing, and to name the part of the policy it relies on. If you disagree, say so in writing and give the reasons.

The Ohio Department of Insurance, Consumer Services, asks the insurer for an explanation when a complaint is filed. A written position makes that process easier for you and for the department.

Complaints about an insurer in Ohio

Complaints go to the Ohio Department of Insurance, Consumer Services, which can be filed online or on paper.

The Ohio Department of Insurance, Consumer Services, takes complaints about insurers. The department says a homeowner can file online or by paper, and that it asks the insurer for an explanation. Its 2019 homeowners and renters complaint report counted 880 complaints, and the common categories were denials, delays and low settlement offers.

Telephone numbers from secondary guides are not printed on this site. Use the department's own site, at insurance.ohio.gov, to find the current contact details.

• Denials of a claim without a clear reason
• Delays in deciding or paying the claim
• Settlement offers that the homeowner believes are too low
• Requests for information that the homeowner cannot find
• Disagreement about the scope or the cause of the loss

Where a contractor's paperwork fits

A contractor's scope and readings support the claim but do not decide it.

A contractor's scope and readings are evidence for the claim. They show the work that was needed and the drying that was done. They do not decide the claim, and a contractor cannot promise a payment.

A homeowner should not sign a document that transfers the claim or the payment to the contractor without reading it, and should ask for the terms in writing first.

A short checklist before you call the insurer

Gather the file, write the timeline and ask the questions in writing.

Before the first call to the insurer, gather the file and write a short timeline of the loss. The timeline should give the time the water was seen, the time the crew arrived and the main steps since.

• Find the policy and the declarations page
• Write a timeline of the loss with the times
• Gather the scope, photographs and readings
• List the questions to ask in writing
• Note the claim number and the adjuster's name

Working with an adjuster

An adjuster reviews the loss for the insurer, and the homeowner can ask for the review in writing.

An adjuster is the person the insurer sends to review a loss. The adjuster may visit the house, read the scope and the readings and talk to the crew. The adjuster works for the insurer, and the homeowner can ask for the adjuster's findings in writing.

A homeowner can ask to be present at the visit and can take notes. A visit that is recorded with the date and the names is easier to check later.

• Ask for the adjuster's name and contact details
• Ask to be present at any visit
• Take notes with the date and the names
• Ask for findings in writing
• Keep copies of anything the adjuster sends

Deadlines, proof and the words the policy uses

Policies use defined words, and the file should match them.

Policies define words such as flood, sudden and accidental, and the defined meaning can decide the claim. A homeowner should read those definitions in the policy, not in a summary. The file should use the same words as the policy where it describes the cause.

This guide does not give deadlines or statute periods, because those are set by the policy and by the law, and they vary. Ask the insurer in writing for every deadline that applies to your claim, and keep the answer in the file.

• Read the defined words in the policy
• Use the policy's words to describe the cause
• Ask the insurer in writing for each deadline
• Keep the deadline answer in the file
• Note the date each deadline was given

When a claim is denied or reduced

Ask for the reason in writing, check it against the policy, and put the disagreement in writing.

If a claim is denied or reduced, ask the insurer for the reason in writing. Check the reason against the policy and the file. If the reason does not match the evidence, put the disagreement in writing with the evidence attached.

The Ohio Department of Insurance, Consumer Services, takes complaints about denials, delays and offers that a homeowner believes are too low. The department asks the insurer for an explanation, so a clear written position on both sides helps.

• Ask for the reason in writing
• Check the reason against the policy
• Attach the evidence to the disagreement
• Send the disagreement in writing
• File a complaint if the disagreement is not resolved