If you have a mortgage, you are required to have homeowner’s insurance. What does it cover? Primarily, if your house is damaged by fire or something that comes from the sky (rain, hail), it will pay for certain damages (but not all). Other covered claims include water damage from burst pipes. However, there are many, many damages to your house that it will not cover.
The most significant exception is flood damage or “water from below”. Another exception is water damage from old, corroded, or leaking pipes, where the condition has persisted for a long time. Another biggy is foundation damage due to shifting ground (subsidence, drought). Among dozens of exceptions is no coverage for mold or termite infestation (both common in Houston). A typical homeowner’s policy is 40 pages, ¾ of which are exceptions or limitations. Your mortgage company is also listed as a covered party. That means when the insurance company (also called the “carrier”) does send you a check for a claim, both your name and the mortgage company will be listed on the check, and you will have to negotiate with the mortgage company to release the funds to make the repairs. Often, the insurance company imposes conditions to ensure the money goes to the contractor to make the repairs, not to you.
In the Good Old Days (before Smart Phones, 2006), when you obtained a policy, the carrier would send you a paper copy of the policy, or would send you an email with an attachment—no more. Today, the vast majority of carriers require you to download their app on your phone and use their Portal to obtain information. There might be texts, emails, or occasional letters, giving you summaries of the coverage, requests for information on making a claim, or what the carrier will pay on a claim. Still, it is almost impossible to obtain a copy of the policy, with all the exceptions and limitations in a form you can read or store in your own records (paper, electronic file).
The actual policy language is essential if you want to know what your policy covers, does not cover, and what your obligations are in making a claim. What is most important is that you need the policy language to challenge the carrier’s denial of a claim, or be unhappy with what they are offering.
Try asking your insurance agent or carrier for a copy of “The Policy” when you sign up for insurance coverage or make a claim. YOU WILL NOT GET IT. All you will get is a summary, but no exceptions. If you ask, you will be told the information is on “The Portal.” Good luck trying to click through the tabs to find what you need. You will have to be an IT specialist to see it. The other trick is that you will be told to scan a code with your phone. Try reading a 40-page document on your phone.
Texas insurance law provides many protections for the person who pays for insurance protection. The general rule is that all perils are covered unless there is a specific exclusion. That is the reason 30 of the 40 pages are exclusions and limitations. More importantly, you are only bound by these exclusions if you are informed about them. In the old days, you were actually given a copy of the entire policy, and it was up to you to read it. Today, you are not given the policy. Typically, the only thing you are given is a summary of the coverage, NOT THE EXCLUSIONS, and therefore, I would argue the exclusions do not bind you.
If the insurance company has denied your claim for any insurance, homeowner’s or business or you are not paid the amount you feel you are entitled to, contact the Law Office of Elliott Klein, PLLC at 281-961-2380.