Augusta Mutual Insurance Company

Review: We were on vacation when storm came through and damaged our property. We were not going to initially report the damage because house damage figured we could fix, Internet dish covered b Internet provider and pool fence we figured we would fix in time. We noticed our pool had been hit and leaking water an reported to [redacted] at [redacted] and he contacted Augusta Mutual. To this day they never came out to look at any damages and we have has numerous companies come out and paid some of them out of our pocket to come out. One company could not definitely say lightning and there installer that did not even look at pool or come out for that purpose tells ins company pool is rusting and he even to us he didn't know and rust . Since then we have provided Internet letter, 3 other pool company letters 2 state storm /lightning damage plus house estimate. It is now November 2013 and we resubmitted all this information again 10/24/13 and they refuse to get back to anyone of call the recent pool company. They paid for fence. Last letter from them states denied claim again due to their investigation etc but provided nothing to us and they also cancelled us and we had to find other coverage, claim was still open and could not drain when still having pool looked at by pool companies when they cancelled us not to mention we never received any letters before the letter stating they were Cancelling us to drain the pool. They have not been nice to us or [redacted]'s and have not honored our numerous requests to come out and have not done good job processing this claim. We have proofed this was storm damage and we think they just don't want to pay.Desired Settlement: They need to be informed about all this and it's not right so doesn't happen to others. Give claim proper attention and Pay our claim damages got house and pool and do not take deductible again since same claim.

Business

Response:

We acknowledge receipt, on December 2,2013 your November i9,2013 letter of inquiry

regarding the above.

Augusta Mutual did not send an independent adjuster to the insured premises but requested the

insured contact one of the local pool companies, of their choice, to inspect and advise an estimate

for repair of the pool and advise a cause of the loss. Our reasoning for this was most independent

adjusters are not familiar with pools and typically do not adjust losses on pools. As for our

reasoning on the cause or not the cause of the loss is based on information received from the

several pool companies the insured used to inspect their pool.

We have addressed the insureds inquiries on the following dates through written correspondence

on the following dates;

o Letter dated September 6,2013 addressed to Ms. [redacted]

o Letter dated October 4,2013 addressed to Ms. [redacted]

o Email dated November 22,2013 addressed to Ms. [redacted]

The basis for our action was based on policy wording in the homeowners policy form Form 3 Ed

2.l,pages 12,13 and 14 under exclusions 2.b.1)b)c) and 2.b.2.

Storm damage is not a covered cause of loss wind, hail and lightning as examples are covered

causes of loss. It was reasonable, in our opinion to assume wind caused damage to the pool

railing and therefore we made payment for this damage. The damage to the aluminum pool was

described as corrosion which was noted above is not covered. As lightning damage leaves

physical evidence with a very physical mark or damage and this physical marking or damage

was not present in this case. Due to the lack of physical evidence we denied this portion of the

insureds claims as noted to the insured in the above referenced pieces of correspondence.

If you have any other questions please let me know. The attached information is for the exclusive

use of the person addressed and is not to be reproduced in whole or part.

Sincerely,

David B Johnson, CIC, CRM

Executive Vice President

Consumer

Response:

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Augusta Mutual has been requested numerous times to come out to the property and refused to do so stating waste of time to them and the claim. Nothing was submitted to us in writing regarding our pool. We have requested numerous times for the research they have done and they have sent nothing proving anything from their end. We have submitted which we believe you have copies of all letters from pool companies etc . They paid for fence and house but refuse to pay for pool that was damaged same time. Not to mention by all proof submitted we have proven damage was not rust, corrosion, age, construction or anything we did to our pool and also have proven something else caused damage to our property including our pool with 2 pool companies stated in writing and verbally to Augusta Mutual. Augusta Mutual is refusing to pay because they do not want to and based on facts and Uncle D's and Blue Ridge Pool and Spa the damage based on their 25 plus years of experience and findings it was storm and lightning damage. Also stated not everything is not hit the same way or shows same kind of damage but that does not mean it didn't happen and just because no one can state 100% because they did not see it happen and because it did not happen the way they want it they are refusing to pay pool claim based on one pool company's opinion that even they stated were not sure. We have proven this claim should be paid for the pool under our coverage because this pool was damaged by elements of storm.

Regards,