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  1. #1
    Join Date
    May 2017
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    Default How Can I Get Paid for a Claim Under a Home Warranty Policy, Which Was Denied

    My question involves insurance law for the state of: PA
    I purchased a home warranty policy which covered my home heat pump. The coverage was delayed for 30 days after signing. 7 days after the coverage took effect, my heat pump failed. The insurance company denied the claim, saying the condition was preexisting, and not covered. They based this on a statement by an contractor they hired who reported that the system wasn't used for a long time. He based this solely on the fact that the system had no refrigerant. I had been using the system up until the day I observed the failure to maintain temperature, and the compressor banging loudly. The contractor didn't even attempt to operate the system during his visit. I had another HVAC company look at the system who confirmed that the compressor had failed. The insurance company's terms said that mechanical failure was covered for the compressor. Do I stand a chance of recovering payment from the insurer?

  2. #2
    Join Date
    Nov 2013
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    6,890

    Default Re: How Can I Get Paid for a Claim Under a Home Warranty Policy, Which Was Denied

    What does your contract say about preexisting defects? Is there any duty for the insurer to inspect that which is covered? If after the signing the coverage doesn't take effect for 30 days, one would think that anything after that would be covered.

  3. #3
    Join Date
    May 2017
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    4

    Default Re: How Can I Get Paid for a Claim Under a Home Warranty Policy, Which Was Denied

    My contract says that preexisting conditions are not covered, but nothing about how to prove if a condition was preexisting. The contract provides for the inspection of failures by the insurer's contractor, but doesn't say exactly what the contractor should do. The contractor did such a superficial inspection, that he couldn't ever determine the reason for the loss of refrigerant. His only valid conclusion was that when he inspected, the lack of refrigerant was sufficient to render the system inoperative. I also thought that the 30 day wait was for the purpose of assuring operability of insured systems, but apparently now the insurance company is claiming preexistence despite the 30 days. I have no direct proof of operability, other than my own experience, and electric bills consistent with the proper operation of the heat pump.

  4. #4
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    Nov 2013
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    Default Re: How Can I Get Paid for a Claim Under a Home Warranty Policy, Which Was Denied

    Considering what the temperatures have been in the north east this spring I would think that your heat pump would have been heating your house. To say that this is a preexisting condition (after 30 days) sounds bogus but the contractors do work for the insurance company. They get paid for their inspection regardless. But to save the insurance company the cost of repairing the pump or replacing it, priceless.

    If it were me, I would cancel that policy ASAP and demand a refund and find another home warranty company.

  5. #5
    Join Date
    May 2017
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    4

    Default Re: How Can I Get Paid for a Claim Under a Home Warranty Policy, Which Was Denied

    Yes, I have cancelled. But do I stand a chance of trying to get the company to pay for the heat pump system, as provided by the policy? Or would it be to difficult to achieve, even if possible?

  6. #6
    Join Date
    Nov 2013
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    6,890

    Default Re: How Can I Get Paid for a Claim Under a Home Warranty Policy, Which Was Denied

    To be blunt, if the heat pump was bad when you took out the policy in hopes that you could get an insurance company to replace it, then shame on you. You got caught. You should just wake away and pay to have it repaired.

    If you want to peruse this and spend your money and time to try to force coverage, well that is your choice.

  7. #7
    Join Date
    May 2017
    Posts
    4

    Default Re: How Can I Get Paid for a Claim Under a Home Warranty Policy, Which Was Denied

    Thanks for your help. I have paid to get the heat pump replaced because I need the system for heat, and it was working up to 7 days after the 30 day wait. I didn't approach the insurance company for a policy, they solicited me. Can you accept this for the moment, and comment on the possibility of recovery?

  8. #8
    Join Date
    Mar 2013
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    17,938

    Default Re: How Can I Get Paid for a Claim Under a Home Warranty Policy, Which Was Denied

    I don't think anybody will be able to predict whether you will win or lose.

    But small claims court is cheap and informal and you don't have much to lose by giving it a shot.

  9. #9
    Join Date
    Sep 2005
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    98,846

    Default Re: How Can I Get Paid for a Claim Under a Home Warranty Policy, Which Was Denied

    Quote Quoting dieseldawg
    View Post
    Thanks for your help. I have paid to get the heat pump replaced because I need the system for heat, and it was working up to 7 days after the 30 day wait. I didn't approach the insurance company for a policy, they solicited me. Can you accept this for the moment, and comment on the possibility of recovery?
    You need to start by reviewing the policy and following the appeals process you agreed to in that contract. If you do not prevail in that appeals process, you need to also consider that your contract may limit your right to go straight to court, such as by requiring mediation or arbitration. If there is such a clause in your contract there may be a way around it under your state's consumer law, but that's an "if" to address after you have determined if such a clause exists in the contract.

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