Our FAQ
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How Do I Know if My Loss Will Be Covered by My Insurance Company?
Every loss is different, and the final decision is always up to your insurance company and typically decided by your adjuster. Clear Coast Restoration has been dealing with insurance companies and water damage for many years. Your project manager will almost always be able to tell you if your particular loss will be covered, or if it would be best to wait on their decision. Please keep in mind that it is your home, and you are ultimately responsible for mitigating it in a timely manner. You can be denied coverage for waiting too long and having secondary damage occur as a result. This damage can include wood rot, mold, or unsanitary living conditions. Claims that are covered are occurrences that happen one time and have not gone on over a period of time such as days, weeks, months, or years. Major signs of long-term damage are mold and wood rot. But even in these situations, Clear Coast Restoration can usually help.
I bet you didn’t know that even an accident is a covered claim! Have you ever started the bathtub filling up for your child and forgotten about it? Maybe you caught it just in the nick of time? Well, had you not caught it just at its spilling point, and it were to have flooded your home, even if your bathtub is upstairs, this would be 100% a covered claim! Thank goodness for our insurance!
Examples of Covered Claims:
Here are some other examples of claims that should be covered-
- Backed up drain due to a soft stoppage, causing an overflow into the structure
- Pipe breaks and bursts
- Toilet overflows due to mechanical malfunction
- Filling up a utility sink and accidentally forgetting about it
- Water heater tank bursts
- Broken faucets, angle stops, and shower valves
- Slab Leaks are covered by all insurance companies except one – ask our team for more information
Examples of Claims that May Not Be Covered:
- Rainwater damage
- Groundwater damage
- Roof Leaks
- Leaks with signs of long-term damage
- Leakage and or seepage
- Losses that have sat for a long period of time without beginning the mitigation process for ANY reason
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How Much Am I Going to Have to Pay?
If you are like most of us here in California, funds are always a factor. Here are the only costs that you should be responsible for:
- The repair of the plumbing that failed (if any), usually due to your plumber
- Your deductible (explained below)
- Any changes or upgrades that you choose to make
- Any additional work outside the damage that you may want us to complete for you
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How Does the Deductible Work, and Do I Have to Pay that Up Front?
This will not be due upfront to Clear Coast Restoration. We will first mitigate and dry your entire loss before you will need to pay your deductible, by this time your claim is already approved, and we have begun to move forward with the reconstruction estimate. Your construction coordinator will come up with a job timeline for you as well as a payment schedule. Once this is agreed upon with you and your construction coordinator, your deductible will be due.
Your insurance will usually remove your deductible from the check that they issue you for the repairs (different from your check for the mitigation which is explained below). For example, if your repairs are $10,000 and your deductible is $1,000, then your insurance will send you a $9,000 check for your repairs.
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How Does My Insurance Company Issue Payment?
Your insurance company usually pays Clear Coast Restoration in 2 parts, sometimes 3 depending on the work being done-
- Mitigation AKA emergency services (EMS)
- Re-construction AKA repairs
- Pack out/pack back AKA contents (only issued if Clear Coast Restoration is having to move, and or store, and bring back contents to reset. Includes the cleaning and drying of personal contents if needed. Insurance usually does not cover any contents if it is a rental and the contents belong to a tenant.
- Sometimes, your mortgage company is named on your checks, if this is the case, your construction coordinator and estimator will walk you through those steps, this process varies per mortgage company. Clear Coast Restoration may ask for your help in this situation and would urge you to sign a 3rd party authorization for Clear Coast Restoration so that we may be able to deal with your mortgage company directly to speed this process up. This does not happen very often.
Payment(s) issued by your insurance company may be made out in one of three ways-
- Checks may be endorsed directly to the insured and sent to you. In some cases, even directly deposited into your account.
- Another option your insurance company may choose is to write the check as a 2-party check which could be made out to you and Clear Coast Restoration and require both signatures. Those will be sent directly to you or directly to Clear Coast Restoration and both parties need to be made aware immediately upon receiving those funds.
- Lastly, payments may be endorsed to Clear Coast Restoration and sent directly to us.
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How Long is This Going to Take?
This depends on a lot of different factors, and every loss is different. We break our restoration process into two stages, each of which have their own average timeframes and completion requirements.
Mitigation is the 1st phase of the job. Also called emergency services or EMS for short, this stage is mainly composed of the drying process. The drying process consists of many facets which may include content manipulation, testing for lead and asbestos, removal of unsalvageable building materials that may include drywall, flooring, cabinetry, etc., building containment, documentation, photos, and equipment set up, take down, and monitoring. Once the equipment is set up, a technician will be on-site every day to take readings of the moisture in various materials as well as documenting the temperature, and humidity inside and out of the containment as well as inside and outside of the structure. A basic timeline is as follows, again, every loss is different, and this schedule may vary-
- Testing process begins
- If testing is negative, (Which means no lead or asbestos is present) an average job should take approximately 7 to 10 days to be dry and complete with the Emergency Services.
- If materials test positive for lead or asbestos, an average job should take 10-15 days to complete the Emergency Services portion of the loss.
Repairs are the 2nd phase of the job and is sometimes referred to as reconstruction. This step is a little more time consuming depending on the loss size and the materials being used. Your construction coordinator will walk you through this and will create both a payment and work schedule. For more construction details regarding the rebuild process and to get to know your coordinator(s) better, see the CCC Process pamphlet in the folder that our team provides.
Reconstruction moves rather quickly once an agreed scope is determined between our estimating team and your insurance company’s adjuster. Things that may make this process take longer are as follows-
- Your adjuster or insurance company’s lack of communication – Unfortunately, we have found this to be the most common reason for a job to take an extended amount of time. Clear Coast Restoration will attempt to be in constant communication with your insurance adjusting firm. If we are unsuccessful after several attempts to get a response, we may ask for your help in reaching out to them. We have found this to be a determining factor in getting timely responses on other losses. Any kind of waiting period is almost never Clear Coast Restoration’s neglect. This is not to say that we do not make mistakes, which we sometimes do, and we do our best to fix them immediately if we do.
- Waiting on an insured to pick out materials - You will have plenty of decisions to make. You may choose to upgrade your flooring, or your countertops, or any other number of building materials. If so, this is the best time to do it. With that, we have many samples to choose from. This can be a difficult decision and may require you to take some time to be sure what you are having us install something you love, after all, our home is our largest asset, its where we spend most of our time, its where we entertain guests, so by all means, take as much time as you need. We want to get it right the first time, and we want you to love it!
- Negotiations – You can read in more detail about this in the pamphlet titled estimating found in your white Clear Coast Restoration folder. This is where we turn in the estimate to your insurance firm and have to justify everything that we put in it. Your adjuster may not agree with some line items in the estimate. This can cause some back and forth in negotiations in order to justify the amounts we are billing. We do not over bill, but we do fight for you so that you are not taken advantage of. We will look out for you 100% of the time during this journey together.
- Do we have to wait for negotiations? – You do not have to wait for the negotiations to be completed. You would only need to sign the payment schedule. Keep in mind that if negotiations are not complete, then no funds have been sent. We would be more than happy to move forward during negotiations if you choose to, but you would be responsible for paying the cost per the payment schedule before receiving the funds from your adjusting firm. Another great option is financing, especially if you are in a hurry to move forward. Please ask your construction coordinator about this option and they would be more than happy to explain it and send you the necessary paperwork to move forward. We do carry our own financing and it is a simple process!
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How Do You Come Up with the Cost for Each Loss?We use an estimating software called Xactimate. This program is most widely used with insurance company’s and restoration companies alike. We use this program because it helps us to speak the same language with your insurance company and it keeps everyone honest. We do not make up any prices. We simply enter the measurements of materials removed/installed and it tells us how much we bill for those things. All the pricing is set to include equipment we use to dry, materials removed and installed, and everything in between. Our goal is to make things as if they never happened. In most cases, your home will look better than it did before this unfortunate incident occurred.
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Why is the Amount Written on My Contract Under Estimated Cost So High?
You may have noticed on your contract an amount that seems high. It may say $10,000 or $20,000 just as an example, yet you are thinking that there is no way there is that much damage. The fact is, you are probably right. We create this amount hoping that it is higher than what the job will actually cost, and here is why.
In the state of California, by law, we have to provide you with an estimate. This is very difficult in this type of work as we have no idea what we may find in walls, under cabinets, or under flooring. Furthermore, we cannot determine if it will take us only 2 days to dry your home or if it will take 6 days. This is a big factor in the cost. We understand this and so does your insurance adjustment firm. This is why that amount is put in place, if we were to try and estimate it closer and go over that amount even by a penny, then we would have to do a bunch more paperwork to include change work orders. Please notice, that next to that amount we estimated it also says, “or amount agreed upon with your insurance company”. What this means is, we are only going to bill you for the amount we agree upon with your insurance company. We document the entire drying process from start to finish and once complete, our estimate for the drying is then sent to the adjuster for review, where they will then ask for our supporting documents.