A water broken condominium, a six-month insurance coverage wait

Final December, Nicky Enriquez started noticing beads of moisture on the ceiling and partitions of her condominium in Chelsea, which she suspected was by some means linked to the brand new ground not too long ago put in upstairs by a contractor.



Michael O’Shea and his wife Nicky Enriquez stand beneath ceiling damage that occurred after flooding, which happened earlier in the year.


© Erin Clark/Globe Workers
Michael O’Shea and his spouse Nicky Enriquez stand beneath ceiling harm that occurred after flooding, which occurred earlier within the yr.

Her upstairs neighbor dismissed her considerations, however a few months later, water got here pouring in so quick that she and her boyfriend had to make use of a dozen pots and pans to catch it.

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It was heartbreaking for Enriquez, 36, who works in increased training, who had bought her condominium in pristine situation in an getting old 16-unit constructing solely a few yr earlier. However at the very least she had insurance coverage to pay for repairs.

Six months later, nonetheless, she and her now-husband are nonetheless dwelling beneath an ugly tarp protecting the large chunk of the lounge ceiling that needed to be torn down. There’s water harm all through the condominium.

What’s inflicting the delay? Effectively, there are literally three insurance coverage corporations concerned, and perhaps a fourth but to be drawn into what has grow to be, for Enriquez, a disheartening wrangle.

An agent for Enriquez, responding to the fixed delays, advised her in Might that “these kinds of claims are at all times tough” as a result of so many insurers are concerned.

Let’s use this sad expertise to higher perceive the way it all works:

Q. Why didn’t Enriquez’s householders insurer merely pay for the repairs?

A. Vacationers, Enriquez’s insurer, did pay a number of 1000’s of {dollars}, however not the total value of repairs to her ceiling, partitions, and ground, which might be as excessive as $20,000. All customary insurance coverage insurance policies start with a declarations web page, which summarizes a half-dozen varieties of protection and the greenback quantities of protection. “Protection A” in the usual kind covers your “dwelling,” and could also be crucial. Vacationers paid $2,000 to Enriquez beneath Protection A, though her coverage gave her about $100,000 in protection.

Q. Why did Vacationers restrict its fee to $2,000?

A. If you personal a condominium, you’re truly coated beneath two insurance policies: your personal and the constructing’s, usually referred to as a “grasp” coverage. You and the opposite homeowners in your constructing pay for the grasp coverage via condominium affiliation charges. The grasp coverage is taken into account the first insurer of the constructing.

Q. If the grasp coverage covers the constructing, why did Vacationers pay $2,000?

A. Insurers of particular person models in condominium buildings usually pays as much as the deductible quantity on the grasp coverage. The 2 insurance policies are complementary, not overlapping. In Enriquez’s case, the deductible on the grasp coverage was $2,500. So Vacationers, because the secondary insurer, paid that quantity, minus its personal deductible of $500.

If you happen to personal a condominium, you must know the deductible quantity in your constructing’s grasp coverage and whether or not your private coverage will cowl as much as that quantity. Any hole between the 2 insurance policies leaves you uncovered. At $2,500, the deductible in Enriquez’s case is low. The development in recent times is for condominium associations to jack up grasp coverage deductibles to $10,000 or extra to save lots of on premiums.

Q. Did Enriquez’s Vacationers coverage pay for anything?

A. Sure. “Protection D” on the usual declarations web page is for “lack of use,” which allowed Enriquez to recuperate the price of a resort and a few meals when she and her associate needed to briefly transfer out. Had furnishings or different private property been broken, Enriquez may have made a declare with Vacationers beneath “Protection C, private property.”

Q. What occurred when Enriquez submitted her declare to the constructing’s grasp insurer?

A. Let’s step again a second and think about that almost all varieties of insurance coverage have two distinct parts. The primary covers you for harm to your property (Protection A, C, D, as talked about above, and B for “different constructions,” if any). It’s a contract between you and your insurer that claims you can be paid for damages, regardless of who’s at fault or if no one is at fault, with some exceptions.

The opposite part is for legal responsibility (Protection E for “private legal responsibility” and F for “medical funds”). It covers you when you’re at fault. Let’s say you neglect to keep up your condominium in good restore and a visitor takes a fall and suffers an harm. You might be personally liable to your visitor for damages together with medical payments. However your householders insurer covers you for these damages. (Auto insurance coverage is analogous in having distinct property and legal responsibility parts.)

Q. Why is legal responsibility protection related to Enriquez?

A. As a result of the constructing’s grasp insurer, Penn-America, handled her declare for property damages as a legal responsibility declare, as if Enriquez had been making a declare towards the condominium affiliation for by some means being at fault.

And it took Penn-America nearly six months to lastly situation a letter denying her declare. “We’ve accomplished our investigation … and discover our insured (the condominium affiliation) has no legal responsibility,” the letter mentioned.

Six months is manner too lengthy to attend for insurance coverage to repair your own home. I reviewed scores of e-mails between Enriquez and numerous insurers and brokers. For months, Penn-America targeted on attempting to achieve the upstairs neighbor, his insurer, and his contractor, repeatedly replying to Enriquez’s request for updates by saying it was nonetheless investigating.

When the denial lastly got here, it prompted Enriquez to return to Vacationers to see if it had any recommendation. That’s when Vacationers, after studying Penn-America’s letter, advised Enriquez it “appears to be a legal responsibility denial” however “ought to have been” a damages declare.

Q. Is it related to Enriquez what truly brought on the harm to her condominium?

A. No, not likely. However for Penn-America it’s related. It might have a superb declare towards the upstairs neighbor or his flooring contractor (or his contractor’s insurer), relying on what occurred. (A water pipe above Enriquez’s ceiling had small holes punctured in it.)

Q. The place do issues stand now?

A. Penn-America reopened Enriquez’s declare.

As of final week, the tarp was nonetheless hanging in her lounge.

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