November 2
complaint - regarding sewage back-up claim #5811690xx of august 30
policy #12pf-9402-xx-xx-phgs-il homeowners gold star special deluxe
From Paul
To: American Family Insurance
This is the first time we have ever put in a sewage back-up claim and this has not been a very good experience with American Family Insurance.in fact I just laughed at the parody, when I typed in Homeowners Gold Star Special Deluxe. There has not been anything gold or special in dealing with American Family Insurance. My proof of that is simple - the sewage back-up occurred over 60 days ago and my wife, my 4 year old, my two year old, and myself are still displaced out of our household. The construction company did not start the project yet because of items the original estimator overlooked and these allowances were not settled properly with American Family.
I am not trying to milk this thing for all it is worth; I am trying to protect my family, especially my children, from the harm of sewage bacteria, which your adjusters seem to not take very seriously.
When this first happened it looked like everything was going to move quickly and be over in 6 weeks. You can imagine our shock and dismay to now know we will not even be able to celebrate Christmas or the holiday season as we normally do. My daughter is sleeping on a mattress on the front room floor where we would normally set up a Christmas tree and have family gather round. When re-construction starts and the rest of the furniture is moved out, there will not be room for much of anything. With my mother's severe osteoporosis, I question if the cramped living arrangements are safe now. We did not move to an outside location right away only because we thought this nightmare would be over in 6 weeks.
My understanding of insurance coverage, especially Gold Star Special Deluxe, was to make sure this did not happen. When we added sewage back-up coverage onto the policy, our agent knew it was because we turned a big part of the basement into a 720 square foot finished apartment for my family to live in and to help take better care of my mother. We moved from Elk Grove Village into this basement apartment as we call it.
Will was the first estimator from American Family to come out and take a look at our place. He was cordial and took the time to answer my questions. When we finally received his numbers and allowances on the claim, overall I was pretty happy, but did find a few discrepancies. I thought they were small items that could be ironed out easily, but I'm finding out it was a huge mistake to even question the findings. Now some things he allowed are now being disallowed by a second adjuster named Curt Costello. Which teaches me there is no science to processing a claim, it must be all a matter of opinion - since 2 experienced adjusters are reporting different findings. So please allow me to express my opinions too within this letter.
In my first phone conversation with Curt on Oct. 23rd, he let me know he would be in control of my claim now and get things expedited. He let me know at that time, basements are uninhabitable. Once again you can imagine my surprise at learning this, since my family and I have been living in this basement for over three years. The first floor is my mother's personal dwelling space and she is the owner of this building. My name was put on the home title when I first ran into financial difficulties in 1989 and she lent me monies.
Curt also let me know the main item in question, a concrete patch, would most likely not be covered. This is a thin concrete patch that was used to level our floors in a small hallway and into the 2 bedrooms. The carpet normally covers it, so it is impossible to determine what the patch's condition was like before the sewage back-up. But the whole point (regardless if it was already cracked or not) is sewage worked it's way under the patch and loosened the patch up which caused cracks and took an extra week to dry out. I would like the patch removed and replaced simply because sewage was underneath it. There is no way to kill it or clean it sufficiently without removing it. There is no doubt the sewage temporarily trapped underneath it caused the patch to loosen and crack in areas.
During this initial phone conversation Curt also let me know that even the source of the water damage was at question, that it could have possibly seeped in somewhere. He would make that determination after seeing the place. I guess it made no sense to review the paperwork submitted by his coworkers prior to his happening on the scene.
My understanding was the insurance was supposed to cover replacement cost and also cover similar living arrangements if our living quarters became unlivable. Quite simply, 2 families and their belongings and furnishings can not safely occupy 1200 square feet of space, especially when a 4 year old, a 2 year old, and an elderly person are involved. This arrangement is causing a lot of stress not only for my family but also a huge burden to my mother who has been on her own for over 8 years. My son and daughter have now been sleeping on mattresses on the floor, my mother has lost over 60% of the space she is used to living in, and my wife has lost her kitchen and any way of keeping our household organized as we were used to.
I don't even want to think about what will happen if someone in my family gets sick from mold bacteria or if my children hurt themselves trying to climb around all the furniture for the next 3 months. All because Curt's opinion is we are not entitled to A.L.E. Even though Will and Elida were ready to allow it before I asked for some minor adjustments. Elida already sent us out to look at 3 different temporary places to stay.
Also, on Monday the 25th I let Curt know I'd be out of town but could meet with him and my construction company on Friday the 29th and that was OK. I did not want to slow the process down but my construction company felt I should be there. When I called to confirm that Thursday, Curt said he could not make it till Monday the 1st of November. That was impossible for me to be there that day. My wife tells me that while he was here he even started to question whether or not all the drywall needed to be replaced even though all the drywall was wetted by sewage. He also did not feel it was important for the paint to match after the project was completed as long as some paint was slapped up there. Originally, we tried to put together a nice home for ourselves (even though this is a basement which some would look down upon). We paid $29 per gallon for a better quality paint, we paid for lifetime Congoleum and a better grade of carpet and padding - I don't believe we'll get that replaced by American Family at the same quality.
We spent a lot of time cleaning, tearing up the old carpet, trying to make room for construction, trying to prevent mold growth from the moisture. Gutted a 40 year old workshop trying to make extra room, as we know this place will be like a dust storm when they zip out and replace all the bad drywall. I even hurt my back and pulled an arm muscle and was in pain for 2 weeks trying to do some of the work on our own. My children's birthdays just passed and this obviously put a damper on those events. We really just want to get our place fixed up the way it was and as quickly as possible.
Our garage is old, dirty, and damp and I do not think you would want us to take a chance by storing our Ethan Allen furniture out there. Yet furniture and boxes must still be moved out before construction can start.
In summary, I am contesting two things. First I'd like to be covered for A.L.E. During the construction process as it is a must for us to move out when the work starts. On top of the other reasons I listed above, I will not subject my asthmatic wife to the smells of the bacterial cleaning and paint fumes and dust. I will not have my 2 year old boy have his nap time destroyed by the noise that goes along with the construction. Second, I'd like the concrete patch R&R to be covered so we don't land up with a future lawsuit over my children getting sick from bacteria and mold caused by the sewage back-up and not covered by your estimators.
For your information, we are taking the necessary step to prevent this from happening again. We are spending the $5300 it takes for proper sewage back-up control to be installed. Wish we would have known about it sooner. I wonder if our future insurance company will give us a discount for making this effort.
Sincerely
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