On Sunday, May 31, I called and submitted a repair claim for my pool's booster pump. After calling several times during the week to get a status update, I was informed that it was assigned to a local pool company (name witheld) located in the Northern Alabama area. On 08 June, the repair technician visited my residence, inspected the defective component and informed me that it needed to be replaced. Additionally, I was informed that they (the contracted pool company) would need prior authorization from Nationwide Home Warranty before the pump could be replaced.
I patiently waited from Jun 08 to Jun 18, and never heard back from either the repair company, or Nationwide Home Warranty regarding the disposition my pool pump claim. On Jun 18 @ 1335hrs CST, during my initial call back to Nationwide Home Warranty I was informed that the claim had been denied. I then asked for what reason, and the Nationwide Home Warranty representative informed me that the part was not covered. I then asked her to read to me the applicable section of the contract.
Applicable Contract Section:
"6.4.3. Pool/Spa Equipment. This agreement applies to the following list of pool/spa components: (i) all components of the pumping system...
I asked for clarification on why that section of the contract was being ignored and why it was determined that the BOOSTER PUMP was not considered part of all components of the pumping system.
I informed the representative, Shirley Cooper, that I would review the contract in my possession and follow-up. After driving home and retrieving my copy of the warranty contract, I reviewed the section quoted to me over the phone and made multiple phone calls to the Nationwide Home Warranty Office at 1-888-500-2110.
After more than 10 return phone calls, multiple disconnects, and 2 hours of waiting; I was finally able to speak with a representative who then transferred me to Shirley Cooper (Whom I had previously discussed the claim denial with). During this conversation, I attempted and succeeded at eliciting vague statements/'details' from Ms. Cooper, regarding my claim. Ms. Cooper informed me that the repair company's (name witheld) technician called the previous week to request authorization. The technician reported to Nationwide Home Warranty that the pool's BOOSTER PUMP needed to be replaced.
[BECAUSE SWEEPER MOTORS ARE EXPLICITLY NOT COVERED] Ms. Cooper then made it clear to me that the Nationwide Representative speaking with the pool technician asked a follow up question seeking "clarification" from the pool repairman; can this be called a sweeper motor? To which the pool repairman said, sometimes. I then attempted to refute the comment using various sources, photos and information regarding its implementation and usage.
Ms. Cooper placed me on hold and claims to have called another non-related pool repair company and seek clarification. After waiting patiently, she returned to the line and informed me that the company said it could be called a sweeper motor. I asked that the pool company she spoke with be identified and she refused. She said it was separate pool repair place and that she made no mention of Nationwide Home Warranty, nor did she disclose details of the (my) claim.
Subsequent to the alleged phone call by Ms. Cooper, I attempted to convince Ms. Cooper to change the denial decision because it was wrong and constituted a breach of contract. She informed me that there was nothing she could do because the initial technician had submitted a request for repair/replacement authorization for the BOOSTER PUMP and it was denied because the representative was able to lead the repair technician's response into that of a non-official and improper product description. My response was to the effect: You are relying on a pool technician to make the final determination as to whether or not a product is covered under this warranty. This is being done by matching his/her description of a product to the applicable section of the coverage warranty? Do you know how ridiculous this is? Informal product descriptions can change from region to region and such variance could never be accounted for in a legal binding contract, laws are based on facts and certainty.
Furthermore, I asked Ms. Cooper to transfer me to a higher level, so that I could speak with someone above her. She refused and said she was the supervisor. I asked to speak with a manager. She said managers were below her. I asked who she reports to and she could not answer. I asked, Who signs your pay check? And she said she does not know. I told her that as a CIO, I have supervisors, managers, and staff that report to me. I am at a higher level than that of a supervisor, but I still report to someone. She said that she is the shift supervisor and that there is no one else to escalate the issue to. She said I could call back at another time and speak with another shift supervisor. I then asked, Who hired you? How did you get this job? She said she applied online. I asked again, Who hired you? Who interviewed you? That person's job role is typically considered to be "your boss." She then passively mentioned an appeal process, saying that it takes 2-3 business days.
At that time, I started asking questions about the appeal process. How does it work? Who reviews the case/claim? How will I be aware of the status/outcome? What is the appeal process? What information is taken into consideration? Can I submit refuting documentation and evidence that supports my side of the claim? Ms. Cooper said I could submit anything regarding the claim and it would be reviewed by an independent team that does not speak directly with customers. They review the claim notes (records). She informed me that I could fax my documentation to 214-453-0024. I thanked her for her time and apologized for any undue stress, but made it clear that I am appealing the decision and will submit documentation that officially defines and indicates that the part needing repair/replacement is a BOOSTER PUMP.
The following is a summary of the information:
1. The claim was submitted via phone: 31 MAY
2. Assigned to Pool Company: 04 JUN
3. Technician Inspected the defective pump: 08 JUN
4. Technician/Pool Company requested authorization: 08 or 09 JUN
5. Claim was Initially Denied: 08 or 09 JUN upon speaking with pool technician
6. I was never notified of the denial. No phone call, no email, no fax, no letter in the mailNOTHING
7. I patiently waited for the repair/replacement authorization and scheduling of the pool repairman
8. I called Nationwide Home Warranty on JUN 18 seeking the claim status
9. This is the first time I was aware of the claim denial.
10. I am filing an appeal based on several facts and contractual requirements:
a. The contract clearly states that all components of the pumping system are covered. Contract Dated 06/05, section 6.4.3 Pool/Spa Equipment. This agreement applies to the following list of spa/pool components: (i) all components of the pumping system;
b. The product requiring repair/replacement was misidentified by the pool technician when it was referred to as a sweep motor. Sweep Motor is an informal and unofficial term that was inappropriately used to describe the pool pumping system's BOOSTER PUMP.
C. Documentation from the BOOSTER PUMP's manufacturer that states clearly and concisely that the product in question is legally referred to as: POLARIS BOOSTER PUMP Part#PB4-60
d. The part needing repair/replacement is legally referred to as: POLARIS BOOSTER PUMP in the following instances:
i. The manufacturer's legal description
ii. The intellectual property rights/patent (s) held
iii. The manufacturer's technical documentation
iv. Throughout the manufacturer's installation/repair manual
v. Within the manufacturer's warranty titled: POLARIS BOOSTER PUMP LIMITED WARRANTY
e. The manufacturer's Technical Support Representative provided documentation that establishes the fact that the product is officially and legally referred to as and titled: POLARIS BOOSTER PUMP
11. I have enclosed/attached these documents and submitted them along with this appeal letter.
12. This appeal is being submitted via:
a. Fax: 214-453-0024
b. Email: [email protected]
c. Certified Mail using the United States Postal Service
Finally, please note that I am thoroughly familiar with the contract and have thoroughly researched my obligations. All of the necessary documentation is being or has been submitted.By reading and researching published articles on the internet, I notice that you often times request maintenance logs/records. Therefore, I am proactively submitting to you the following notice from the manufacturer that is attached/enclosed:
There is no maintenance schedule for this product. The only time the unit requires maintenance is if the unit is leaking water or inoperable (which it is at this time).
I also submitted multiple photos of the BOOSTER PUMP including: the pump installation label and diagram, along with the attached manufacturer's serial number and identification tag that clearly identifies the product as a "PB4 BOOSTER PUMP."
PLEASE NOTE: I am currently seaking council to represent me in a potential lawsuit regarding this matter. I have additional details that support the claims and all necessary documentation to support my side of the story. NATIONWIDE HOMEWARRANTY refuses to release case notes or provide any documentation to me.
There is also a separate matter regarding NATIONWIDE HOME WARRANTY's Billing that has come to light and I am currently working with a firm in NYC, NY to look into a potential class action suit. If they choose not to accept the case, I will release the details here on usacomplaints.com.
Once the current Nationwide customers are aware of the flaw, they will definitely want to seek some type of recourse against this business.
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