Case Study

Property Owner Denied Coverage for Loss

  • Client sustained a water loss because of a water line break underneath the foundation. 
  • Seven units and a hallway were affected because of water intrusion into the building. 
  • Insurer denied coverage for the loss in its entirety.
  • Symphony React provided the client with Claims Services to rebut the denial.
  • The insurer reversed their coverage denial.
  • The client will be compensated for the damages.

The Challenge

The client, an owner of an apartment complex, suffered a loss related to a waterline underneath the building that burst. This resulted in water seeping through the foundation — causing damage to the hallway and several apartment units.

A claim submitted to the insurer was promptly denied, with the insurer citing that water damage was excluded in the policy. Considering the coverage denial, the client was faced with the pressure to get remediation done and the rebuild started. Additionally, several residents in the affected units required relocation following the loss.

The Solution

Symphony REACT consulted the client about the claim denial. Soon after the consultation, a rebuttal was submitted to the insurer followed by a conference call with an adjuster. After the conference call, the insurer agreed to re-assess coverage.

The Outcome

The adjuster advised that the insurer would be reversing their coverage position, and that it would be afforded the loss. While it was correct that there was a water exclusion in the policy, the definition of “water damage” meant the exclusion did not apply to this loss.

Symphony REACT was able to successfully argue coverage in favor of the client and reverse the denied claim.