JT04
Contributor

SUBJECT:  Appeal -- USAA Denial of Homeowners Claim –

TO:  Ms. Suzanne Gilboux

FROM:  Joe & Linda Milam  USAA 113-52-45

                4732 W. Dengar Ave

                Midland, TX [removed sensitive data]

                432-559-6111

 

We wish to appeal denial of coverage for our garage ceiling storm damage.  The damage was adjacent to the exterior wall on the side of the house that was damaged due to the wind and hail storm, 23 April 2019. 

There is apparently an error in the USAA claim notes stating possible previous repair and existing water staining around a drain.

 

There is no drain in that area of our garage.  The storm damage was above our gas water heater and immediately adjacent to the damaged exterior wall.  All water lines are well below the ceiling and no water lines exist in the ceiling.  We have a concrete slab foundation with water lines in the foundation.

Also, our Contractor, DK Construction, determined that the ceiling damage was storm related – likely from wind and water from the damaged roof as well as the hail and wind damage to the exterior wall of our home.  The contractor determined the exterior wall damage likely allowed wind and rain water ingress to cause the ceiling sheetrock to fracture. 

 

The Contractor submitted an estimate addition in advance to USAA as they were required to do by USAA.  The Contractor has done many storm damage repairs for USAA and is well aware of USAA procedures.  AND, since it was their sense that the ceiling damage was clearly a result of storm damage, they did not anticipate their estimate addition would be denied. 

 

Important to note:  NO ONE from USAA informed Linda or me that the estimate addition would be denied – Also, no one from DK Construction was informed that their estimate addition would be denied.  They were on site for 2.5 days repairing the damage, and during that time, the ceiling sheetrock was replaced. 

Again, NO ONE from USAA informed us their estimate addition was going to be denied. 

 

It is of further note, that the adjuster supervisor, who inspected his adjuster’s submission the week after the filed adjustment, also indicated that the ceiling damage was most likely storm related. 

 

We had NO idea that the storm damage estimate addition would be denied, and no one was informed as such, so the damage was repaired. 

That is the basis of my appeal for reconsideration of the coverage denial. 

 

1 REPLY

Thank you for your message. I'm sorry you didn't have a satisfactory claim experience. I understand you have concerns about the handling of your claim, so I am asking a subject matter expert to investigate your situation further, and to follow-up with you. Please expect contact within 3-4 business days.