Claim Results
What Happened
The homeowner discovered significant water damage behind a bathroom wall after noticing discoloration on the adjacent bedroom wall. A plumber identified a burst copper supply line inside the wall cavity. The water had saturated drywall, insulation, subfloor, and baseboards in two rooms, and early mold growth was visible behind the damaged drywall.
The homeowner filed a claim with their insurance carrier. The carrier's adjuster inspected the property, then issued a full denial. The denial letter cited the policy's “gradual or repeated seepage or leakage” exclusion, claiming the pipe had been leaking slowly over time and was therefore a maintenance issue, not a covered sudden and accidental event.
What Care Claims Did
The homeowner contacted Care Claims after receiving the denial. Our licensed adjusters conducted a full interior and wall-cavity inspection within 24 hours of engagement.
The critical first step was establishing the cause of loss. We retained a licensed plumber to perform a formal cause-of-loss analysis. The plumber's report documented that the copper supply line had failed at a fitting joint due to material fatigue — a sudden failure, not gradual seepage. The plumber noted fresh, clean fracture edges at the failure point, consistent with an acute rupture, not long-term corrosion or slow dripping.
Our team then documented the full extent of resulting damage that the carrier had never assessed because they denied at the cause-of-loss stage. This included saturated drywall in two rooms, compromised insulation, warped subfloor and baseboards, and active mold growth behind walls that required professional remediation. The carrier's adjuster had not opened any walls during their inspection and had no documentation of the actual damage extent.
We submitted a comprehensive appeal package that included the licensed plumber's cause-of-loss report, detailed photo documentation through our Eden platform, moisture readings from all affected areas, a professional mold assessment, and a full Xactimate estimate covering water damage mitigation, drywall and insulation replacement, mold remediation, and finish restoration.
When the carrier maintained their denial after reviewing the appeal, we invoked the appraisal clause. The independent umpire reviewed all documentation and ruled in favor of coverage, settling the claim at $43,200.
Timeline
Day 1 — Engagement & Inspection
Homeowner signed Letter of Representation. Care Claims performed interior inspection, opened wall cavities, and began documenting all water damage and mold growth through Eden platform.
Days 3-8 — Cause-of-Loss Analysis
Licensed plumber inspected failed pipe, documented acute rupture origin. Moisture readings taken across all affected areas. Professional mold assessment completed.
Day 12 — Appeal Submitted
Comprehensive appeal package submitted with plumber's report, mold assessment, full damage documentation, and Xactimate estimate.
Day 30 — Appeal Denied & Appraisal Invoked
Carrier maintained denial. Care Claims invoked appraisal clause per policy terms.
Day 62 — Settlement Reached
Independent umpire ruled in favor of coverage. Final settlement: $43,200.