Navigating the Minefield of Modern Insurance Claims
At Watermark Restoration Solutions, Inc., we’ve seen firsthand how confusing the insurance claims process can be for homeowners, business owners, and even insurance professionals. From misapplied policy exclusions to misunderstood coverage limits, navigating a property damage claim can quickly become overwhelming.
As restoration professionals working directly in the field, we often encounter common claim issues that leave property owners frustrated and unsure of their options. That’s why we believe strongly in consumer advocacy — helping clients understand their coverage and ensuring claims are handled fairly and accurately.
Below are several situations we see frequently and how knowledgeable restoration professionals can help clarify them.
Misuse of Anti-Concurrent Causation (ACC) Language
One of the most misunderstood areas of property insurance claims involves Anti-Concurrent Causation (ACC) clauses. These clauses allow insurers to deny a claim if both a covered and an excluded cause contributed to the loss.
Because this language can be complex, it is sometimes applied incorrectly.
Example Scenario:
A homeowner experienced a refrigerator water line leak. Believing the issue was minor, they cleaned up the visible water themselves. Months later, buckling floors prompted an insurance claim. The claim was initially denied under “seepage” or “long-term damage” exclusions combined with ACC language.
After a proper review of the situation, it was determined that the primary cause of the damage was the sudden discharge of water, which may qualify as a covered loss under many policies. Once the situation was properly explained and documented, the claim was reconsidered.
Mold Coverage: Understanding the Limits
Mold coverage is another area that often causes confusion for policyholders. Many insurance policies include a fungi or mold sublimit, commonly around $5,000.
However, this limit does not always apply to the entire loss.
In many cases, mold develops as a result of a covered water damage event. Under certain policy provisions — such as ensuing loss provisions — remediation costs beyond the mold sublimit may be considered if the mold resulted from a covered water loss.
Understanding how policy language applies to specific situations is critical when evaluating these types of claims.
Section I vs. Section II Coverage Confusion
Another issue we occasionally see is confusion between Section I (Property Coverage) and Section II (Liability Coverage) within an insurance policy.
For example, asbestos testing related to damaged building materials may sometimes be denied under liability exclusions. However, if the claim involves first-party property damage, it typically falls under Section I coverage instead.
Applying exclusions from the wrong section of the policy can create unnecessary claim disputes and confusion for property owners.
Knowing When Appraisal May Be an Option
Disagreements over the cause or extent of property damage — such as hail damage — can sometimes be treated as coverage disputes by insurers.
However, under Michigan law (MCL 500.2833(1)(m)), disagreements about the amount of loss may qualify for the appraisal process. In certain cases, determining whether damage was caused by a specific event may fall within the scope of appraisal rather than outright denial.
Understanding these distinctions can help property owners explore options for resolving claim disputes.
Educating Insurance Agents Through Lunch & Learn Sessions
One way we support the local insurance community is by hosting Lunch & Learn sessions with insurance agencies throughout Southeast Michigan.
These sessions provide agents with practical insight into how property damage claims unfold in real-world scenarios. Topics often include:
Common claim misunderstandings
Policy interpretation examples
Michigan laws affecting property claims
Best practices for helping clients navigate damage situations
Our goal is to provide agents with useful knowledge that helps them better serve their clients while improving claim outcomes.
If your agency would be interested in hosting a Lunch & Learn session, our team would be happy to coordinate one.
Why This Matters
Most homeowners are not expected to understand the complex language found in insurance policies. When property damage occurs, they rely on professionals to guide them through the process.
At Watermark Restoration Solutions, our role goes beyond mitigation and restoration. We aim to help property owners understand their situation, document their damage properly, and move forward with clarity during a difficult time.
Need Help Navigating a Property Damage Claim?
If you or your client are dealing with water damage, fire damage, mold contamination, or another property loss, our team is here to help.
📍 Watermark Restoration Solutions, Inc.
Brighton, Michigan
📞 248-278-6166
🌐 www.wrspros.com
Emergency services available 24/7/365.
Because at WRS, we don’t just restore property — we restore peace of mind.
