Dec. 17, 2022, 8:50 a.m. by MICHELE
Michele Benzing
Service Request 312384584
On 12/5/22 at 1AM EST, we discovered an active leak in our bathroom, fresh/clean water was draining into the floor/downstairs ceiling (finished basement) and raw sewage was backing up into the tub. We had to turn the main water off to stop the leak and make small holes in the ceiling to relieve the pressure/drain the water. I initiated a claim with our home warranty at that time. By morning, we'd heard nothing and I made another call at 8:55 AM, on hold waiting for a rep for 20 minutes and was told they were searching for a contractor in their system. I called again at 12:25, on hold for 24 minutes and was told the issue had been assigned to Jefferson Plumbing. I then called Jefferson Plumbing and was told that they accepted the assignment but could not be out until late Thursday (4 days later) to diagnose the issue (not repair it). I called the First American back at 12:52 on hold for 33 minutes, then telling them that this was an emergency situation, and the rep I spoke with did agree and escalated the claim to "Emergency After Hours" and this would expand the search area for a contractor. I called back at 4:28 PM, on hold for 6 minutes, was disconnected, called back, on hold for 14 minutes and was told they were still searching for a contractor. I called back at 7:31PM, was on hold for 34 minutes, was disconnected, called back at 8:06PM, on hold for 4 minutes when a rep called me back on another line. Was finally told we could hire a contractor, they would cover at $125 service fee or the repair up to $265. Anything above that would require add'l authorization. I was specifically told the plumber would have to call the customer service line (the one I was always on hold) to get the approval. We live in a rural area, you would have to agree there was no plumber that was going to come out at 9PM make a full repair for $265 and/or stay on hold for a rep in excess of 15-20 minutes. We did make contact with a licensed plumber Chris Vogt on Tuesday and he was going to come out after his normal work day (5PM) Tuesday night. At this point, we've been 17+ hours without water, had to haul water from a neighbors in 5 gallon buckets just to be able to use the bathroom and we bought water at the grocery store. I received an email from First American at that time giving me the parameters of the "Outside Reimbursement". It did give an alternate number for the plumber to call but it was only available from 7AM to 5PM, not the 24/7. The plumber did identify the issue which was 2 fold. The drain assembly in the ceiling did not have the proper support so the drain was "sagging" in the ceiling and became clogged resulting in sewage backing up into the bathtub. The toilet had a crack and the fresh water line had a leak, that was the fresh water that drained into the downstairs ceiling. The plumber returned on Wednesday, completed the repair and we had our water service restored. I emailed the completed Outside Reimbursement Form with supporting documentation to First American on Thursday 12/8. I received an email and call 12/13/22 that the claim is being denied and they will not be performing any further correction (our entire ceiling is open in our finished basement). Their reasoning is that they don't cover issued of "improper installation". The coverage on the service request says nothing of "no coverage for improper installation." They also stated that the plumber did not call the number provided on the Outside Authorization approval the one that NOBODY IS AVAILABLE AFTER 5PM. We paid the plumber a total of $540 which is UNHEARD of reasonable for the work they did. In addition, I paid at $85 service fee to First American. I don't know what the cost is going to be to repair/secure the openings in the ceiling
In short, the claim was denied due to:
⦁ “improper installation, which is not a covered cause of failure under this policy.” The contract reads one thing and the service request coverage details (which is what I went by) says nothing of it. I told Rhianna, manager when I spoke to her on 12/13 about the discrepancies during the whole situation in regards to the direction I was given on how to proceed. Rhianna “apologized for any miscommunication but everything regarding your coverage is in writing in your contract”. There is NOTHING in the coverage for this claim that states “improper installation” is not covered, if it is written somewhere else, hence my accusation of discrepancies. This information is under the “VIEW COVERAGE DETAILS”
The second reasoning for denying coverage is
⦁ work performed without authorization from First American Home Warranty will not be reimbursed. The issue with our plumbing was finally designated as “Emergency After Hours”. Our repairs were made after normal business hours and the number that the plumber was supposed to call was only in service from 7AM-5PM as outlined on the actual Outside Reimbursement Authorization Form…..
⦁ If the diagnosis and repair exceeds this limit, the work requires further approval, which can be obtained by completing the outside reimbursement form and return it to outsideapproval@firstam.com or call 833.307.0891 with the report details during the hours of Monday – Friday 7:00 am PT – 5:00 pm PT.
After numerous calls, FAHW did reconsider and is now paying for the toilet and 1/2 the labor however I'm left with 4 large holes in the ceiling of my finished basement and still out of pocket $387.94
Click here to see the complaint and comments
