House Insurance claim denied

[stament]

We have been with the same insurer for 4 years and just tried to make a claim that was denied.

 

There appears to be water leakage from the upstairs bathroom as we can see the impact in the ceiling below. We stopped using the bathroom and called the insurance company. They denied the claim as they said they are only responsible for fixing the ceiling part of the quote not the pulling up of the tiles and fixing the leak and any other remedial works required (since we cannot see the exact root cause) and I suspect it will involve the replacement of some bathroom floor tiles at the very least.

 

Furthermore as the ceiling part of the quote falls below their minimum 10,000 baht threshold they won't be covering that either!

 

Never experienced anything like this in England. If it's a lean they fix the whole thing not just the ceiling. What on earth is their logic? Do they honestly expect us to believe by fixing the ceiling it will cure the problem?

 

Anyone else had any similar issues?

 

Secondly, is there an Insurance Government Authority we can complain to as I feel they aren't meeting their obligations and are simply playing the percentage Gabe of fobbing us off.

 

Needless to say I won't be renewing with said insurance company ...

 

Any thoughts/advice greatly appreciated.

 

 

Edited May 31, 2019 by stament

[beau thai]

House Insurance Claim denied? Dog bites man. 

 

I sympathize but denying claim seems to be the start point for most insurers.  I had the exact same issue at my place in spain with the Insurer owned by my bank and recommended by the manager of course. Who was a friend until he washed his hands rather than helping with my claim settlement denial.  We also had to dig up the floor under the tiles to find the problem.

 

The water leaks followed severe storms with massive flooding all around the area- on the coast. The insurer initially denied all claims as caused by Act of God. Seriously!  ( Try watching the Billy Connolly film-The Man who Sued God-similar circumstance and light relief!)

 

I kept at it, letters to the press, letters to the ombudsman etc and eventually they settled.  Same thing happened 2 years later and they denied the claim and this time they were immovable.

 

Google will give you details for Thai Ombudsman and Consumer Complaints office. I would hit both and copy in the insurer, as they will not enjoy being referred and may settle.

 

Best of luck.  My own perspective now though that if it is about the principle rather than the money, I try to let it go and get on with my life before the irritation gets worse....

[petermik]

Insurance companies the world over do not like paying out....any loophole they will try and wriggle through...

[stament]

7 minutes ago, petermik said:

Insurance companies the world over do not like paying out....any loophole they will try and wriggle through...

I don't mind loopholes but they aren't considering the water problem just 

fixing the ceiling as their responsibility. They are denying the cause and saying they only consider the damage that is visible as if skimming and painting the ceiling will fix the water leakage and prevent further damage.

 

 

Edited May 31, 2019 by stament

[potless]

You would need to go through the policy with a fine tooth comb. It may depend on the initial cause of the leak. If it was shown to be a lack of maintenance, a claim may be denied. If switching to another company, be sure to see if the coverage is actually better than that you have now. Good luck anyway.

[stament]

2 minutes ago, potless said:

You would need to go through the policy with a fine tooth comb. It may depend on the initial cause of the leak. If it was shown to be a lack of maintenance, a claim may be denied. If switching to another company, be sure to see if the coverage is actually better than that you have now. Good luck anyway.

Nothing to do with maintenance. All sealed been fine ever since we moved here 4 years ago. This is an internal leak not due to rain or storm or any other damage.

 

I certainly will be looking at this when changing insurance company, cheers

Edited May 31, 2019 by stament

[utalkin2me]

Welcome to insurance. Part of your fees went to the people who they hired to find ways to deny the most claims as possible. You are paying them to f you. Enjoy. 

[potless]

There are videos about the removal  and replacement of floor tiles on you tube that may help you limit the damage. depends on how they were laid in the first place. Worth a look anyway. 

[Thaidream]

2 hours ago, stament said:

We have been with the same insurer for 4 years and just tried to make a claim that was denied.

 

There appears to be water leakage from the upstairs bathroom as we can see the impact in the ceiling below. We stopped using the bathroom and called the insurance company. They denied the claim as they said they are only responsible for fixing the ceiling part of the quote not the pulling up of the tiles and fixing the leak and any other remedial works required (since we cannot see the exact root cause) and I suspect it will involve the replacement of some bathroom floor tiles at the very least.

 

Furthermore as the ceiling part of the quote falls below their minimum 10,000 baht threshold they won't be covering that either!

 

Never experienced anything like this in England. If it's a lean they fix the whole thing not just the ceiling. What on earth is their logic? Do they honestly expect us to believe by fixing the ceiling it will cure the problem?

 

Anyone else had any similar issues?

 

Secondly, is there an Insurance Government Authority we can complain to as I feel they aren't meeting their obligations and are simply playing the percentage Gabe of fobbing us off.

 

Needless to say I won't be renewing with said insurance company ...

 

Any thoughts/advice greatly appreciated.

I worked  as an auto claims adjuster for 15 years in America but am also familiar with homeowner claims.

 

If your brakes on your car fail and you hit another car- your auto insurance will fix the other car but not your brakes.

 

If your home was flooded due to a maintenance issue such as a commode that overflows or a pipe that breaks- the insurance fixes the damage caused to other parts of the house but not the reason it happened- a broken pipe.   

 

All American insurance works this way and it sounds as if that is the way Thai insurance works- You may get some relief by going through the Insurance Commissioners office and filing a complaint.  It is also possible to go through the courts but it could be costly.  I would see if the Company  will negotiate.

 

Their reasoning is that the home owner/car owner is responsible for proper  maintenance of their premises or auto and they exclude things like you described.  I don't agree with it but somewhere in the policy description there is reasoning related to it.  

 

As i mentioned, they may negotiate if you can show the water damaged several tiles and panels , not just the ceiling panel. Undoubtedly, theree is hidden damage.

 

 

[stament]

1 minute ago, Thaidream said:

I worked  as an auto claims adjuster for 15 years in America but am also familiar with homeowner claims.

 

If your brakes on your car fail and you hit another car- your auto insurance will fix the other car but not your brakes.

 

If your home was flooded due to a maintenance issue such as a commode that overflows or a pipe that breaks- the insurance fixes the damage caused to other parts of the house but not the reason it happened- a broken pipe.   

 

All American insurance works this way and it sounds as if that is the way Thai insurance works- You may get some relief by going through the Insurance Commissioners office and filing a complaint.  It is also possible to go through the courts but it could be costly.  I would see if the Company  will negotiate.

 

Their reasoning is that the home owner/car owner is responsible for proper  maintenance of their premises or auto and they exclude things like you described.  I don't agree with it but somewhere in the policy description there is reasoning related to it.  

 

As i mentioned, they may negotiate if you can show the water damaged several tiles and panels , not just the ceiling panel. Undoubtedly, theree is hidden damage.

 

 

Makes sense apart from what maintenance is there to do in a sealed bathroom? No water visible or damage above the floor so can only assume leak is from a pipe which is under the tiles. Not sure what additional maintenance I could do besides pulling up the tiles and checking routinely.

 

Your rationale does seem to be what they are applying. I had this happen in England and they covered everything even water damage to other things. 

 

I will be contacting the ombudsmen though...

 

Appreciate the response

 

[mike787]

Hire the most powerfully connected insurance attorney and fight like mad.

[BritManToo]

22 minutes ago, stament said:

Makes sense apart from what maintenance is there to do in a sealed bathroom? No water visible or damage above the floor so can only assume leak is from a pipe which is under the tiles. Not sure what additional maintenance I could do besides pulling up the tiles and checking routinely.

They usually cut the ceiling below the bathroom and fix from below.

Easier to replace plasterboard than tiles, unless it's a poured solid concrete floor which is unlikely.

Edited May 31, 2019 by BritManToo

[Davo369]

19 minutes ago, BritManToo said:

They usually cut the ceiling below the bathroom and fix from below.

Easier to replace plasterboard than tiles, unless it's a poured solid concrete floor which is unlikely.

Absolutely, any pipes should have easy access. So you should be able to access from ceiling.

[stament]

3 hours ago, Davo369 said:

Absolutely, any pipes should have easy access. So you should be able to access from ceiling.

Ok didn't realise in that case might be cheaper than I thought

[stevenl]

So you have a leaky toilet and expect the insurance company to fix it.

 

Sounds like they're right to me, they'll cover the damage done by the leak (to your ceiling), and you'll have to fix it yourself.

[stament]

16 minutes ago, stevenl said:

So you have a leaky toilet and expect the insurance company to fix it.

 

Sounds like they're right to me, they'll cover the damage done by the leak (to your ceiling), and you'll have to fix it yourself.

Ok well insurance is different in England so I'm just surprised but if that's the way in the rest of the world fair enough

[leither69]

This is the preamble to health insurance, you didn't take care of your body so we ain't paying!!

[BestB]

Yes, ombudsman office 

https://www.ombudsman.go.th/10/eng/index1.asp

 

or https://www.consumersinternational.org/members/members/office-of-the-consumer-protection-board-of-thailand/

[basinview]

Before cutting a hole in the ceiling, I would recommend that you put some dye down in the drain first to determine if the waste to the bathroom above is the actual cause, as I was a remedial builder before retirement I had noticed on more that one occasion where the leaks to the areas below were caused from

 

 - Where a paslode gun was used that shot a pin into the pipe and then rusted out ( this took about 5 years before anyone noticed any damage )

 

 - Leaks around the taps are very common and can then track across the beams

[inThailand]

Deny deny deny. It's a culture thing, thus not covered by insurance. 

[Harveyg]

OP.   If you dont mind, can you say how much you are paying for insurance?

[ujayujay]

Report these to the Ombudsman:

https://www.ombudsman.go.th/10/eng/index1.asp

[connda]

Personally I think that Thai insurance companies are not regulated very well.  Most insurance companies are happy to take your money but in return will look for ways not to pay out, but Thai insurance companies seem to have less government oversight of their predatory practices that international companies.  

Anyone insure their homes with an international insurance provider?  Maybe that's what the Op needs in the future.

[ICECOOL]

Google

 

Office of Consumer Protection Board

 

or

 

Thai Ombudsman

[connda]

22 hours ago, Thaidream said:

Undoubtedly, theree is hidden damage.

Not to mention the black mold that will grow in those dark recesses. Those areas need to be ripped out and replaced.

That's the bad news.  The good news is you live in Thailand.  The repairs will cost you about 5 times less (if not less) than in the US or UK or any other overpriced first world country.  Nor will you need to jump through upteen regulatory hoops including paying fees, licenses, easement costs, waste costs, CO2 fines or whatever BS the regulatory authorities seem to heap on homeowners.  You just find someone to fix it or fix it yourself.  In Thailand you can find a high-end contractor, a low-end contractor, uncle Somchai's toothless cousin who doesn't need a contract, or someone who knows someone who has done similar work that was deemed satisfactory.  I've had a lot of both maintenance and construction done on our property: some good, some excellent, some suckola.  Nothing has ever been done on a 'contract.'  We just don't rehire people who do crappy work.  The cost of the work is low enough that I can have it redone if necessary and still never come close to a fraction of what I'd pay in the US.
Example:  A friend of mine in New Mexico put in a new cement pad for and RV on this property.  He had to jump through a multitude of hoops: licenses, easements, inspections, inspection fees, authorizations and then contract the work out.  A freaking pad of cement cost him $9000 bucks.  <headshake>  I could have done the same on my property for the price o the sand, gravel, cement, and labor at ฿500 THB per day for each laborer and the construction would have taken 1 day.  <Another headshake>  My guess is that you could have the tiles, floor, and ceiling below ripped out and replaced for between 10,000 to 20,000 THB.  There comes a time you just flip the insurance companies off, shrug, and get on with business at hand.
This ain't the West.  And in a lot of ways that's a good thing.

[sawadee1947]

Wrong insurance company. Buy cheap and you'll get cheap, probably.

Go to Global Insurance, never got problems with claims.

[sawadee1947]

1 hour ago, connda said:

Personally I think that Thai insurance companies are not regulated very well.  Most insurance companies are happy to take your money but in return will look for ways not to pay out, but Thai insurance companies seem to have less government oversight of their predatory practices that international companies.  

Anyone insure their homes with an international insurance provider?  Maybe that's what the Op needs in the future.

Global Insurance Pattaya. Perfect service 

[connda]

On 5/31/2019 at 2:07 PM, stament said:

Nothing to do with maintenance. All sealed been fine ever since we moved here 4 years ago. This is an internal leak not due to rain or storm or any other damage.

 

I certainly will be looking at this when changing insurance company, cheers

If you bought a high-end home then I'd expect some warranty on the construction.  Me?  Lord, local workmanship, Thai at that.  If it breaks it was 'gum'...karma.  Labor costs are exceedingly inexpensive - you just fix the problem and move on. 

[connda]

22 hours ago, mike787 said:

Hire the most powerfully connected insurance attorney and fight like mad.

You could pay for the repairs 10 times over and there is no guarantee your 'powerfully connected insurance attorney' would do anything but take your Farang money while blowing smoke up your shiny behind.  

[khunPer]

On 5/31/2019 at 7:53 AM, stament said:

Any thoughts/advice greatly appreciated.

 

On 5/31/2019 at 7:53 AM, stament said:

Furthermore as the ceiling part of the quote falls below their minimum 10,000 baht threshold they won't be covering that either!

Not worth doing anything for relative small 10,000 baht – "relative", as 10k baht can a be lot of money for some, in some cases – any legal action might cost you a lot more than that, and without any gurantee that you gain anything from it, but a huge bill from the lawyer.

 

As often said in Land of Smiles: »Count your loss, and move on«...????