Water Damage Insurance Case Study:
How a Claim Denial Was Prevented

The Insurance Company’s Position: “No Opening, No Coverage”

After the claim was submitted, the insurance company assigned an adjuster to inspect the damage. The adjuster concluded that water was pooling on the roof, meaning it had not entered the building through an opening.

Under many property insurance policies, interior water damage is only covered if:

• There is a covered opening in the roof or walls, or
  
  
• The damage is caused by thawing snow or ice
  
  

Because the adjuster claimed there was no opening, the insurer issued a reservation of rights letter, signaling that denial was likely.

Public Adjuster Review Changes the Outcome

At this critical point, the policyholder contacted a public adjuster for help.

After reviewing the policy language, we identified an important coverage exception. The policy clearly stated that interior damage is covered when it results from thawing snow or ice, even without an opening.

Using verified weather reports, we documented that approximately 10 inches of snow had fallen just days before the loss. As temperatures rose, snowmelt accumulated and caused water intrusion—fully triggering coverage under the policy.

The Result: Denial Avoided and Coverage Preserved

Once the evidence was presented, the insurance adjuster agreed with the findings. The carrier reversed course and avoided denying the claim—protecting the policyholder from a potential $40,000 uncovered loss.

Without professional intervention, the insurance company would have proceeded with denial.

Facing a Water Damage Claim?

If your water damage claim is delayed, disputed, or at risk of denial, expert guidance can make the difference between payment and loss.