Western Mutual Insurance Group

Revdex.com:
I have reviewed the response 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.
First of all these people never talked to Mr. [redacted].They talked to Mrs. [redacted].From the beginning of trying to open up a claim,we were given the run around. We were reporting water damage from an "accidental toilet overflow ".When the adjuster came to our house he spoke to my wife in a very unprofessional  manner.He did take any of our concerns  seriously, instead the adjuster along with residence mutual tried to pass the blame to the builder of the house. We were told that there would be someone calling us to take a statement because the adjuster was so much of a hurry to not do his Job right and take a statement himself.We were also told that we would get copy of the report, to witch this day we have not received.
Again builder and age of this house is one thing but the accidental part should be covered. Also we have been with this company for over five years thinking we were covered,never opened a claim. Now residence mutual will not renew our premium. That's  the insurance company saying " well since there is a reasonable   cause for a claim we just won't acknowledge the claim and not renew it either". Residence should refund most of our premium for the years we have been with them since they won't honor our claim. One minute they are covering us the next it's blame the builder and you are on your own. This is as close as you can get to insurance fraud as you can get.
Regards,
[redacted]

Revdex.com:
I have reviewed the response 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.First of all these people never talked to Mr. [redacted].They talked to Mrs. [redacted].From the beginning of trying to open up a claim,we were given the run around. We were reporting water damage from an "accidental toilet overflow ".When the adjuster came to our house he spoke to my wife in a very unprofessional  manner.He did take any of our concerns  seriously, instead the adjuster along with residence mutual tried to pass the blame to the builder of the house. We were told that there would be someone calling us to take a statement because the adjuster was so much of a hurry to not do his Job right and take a statement himself.We were also told that we would get copy of the report, to witch this day we have not received.Again builder and age of this house is one thing but the accidental part should be covered. Also we have been with this company for over five years thinking we were covered,never opened a claim. Now residence mutual will not renew our premium. That's  the insurance company saying " well since there is a reasonable   cause for a claim we just won't acknowledge the claim and not renew it either". Residence should refund most of our premium for the years we have been with them since they won't honor our claim. One minute they are covering us the next it's blame the builder and you are on your own. This is as close as you can get to insurance fraud as you can get.
Regards,
[redacted]

Revdex.com:
I have reviewed the response 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.
Please see the report of a structural engineer that I hired. The insurance would have enlist the inspection of a structural engineer to ascertain the cause of the cracks which this report indicated rather than what the insurance general contractor is claiming. They refused to do this to avoid the cost.
The insurance need to reimburse me for the cost of this inspection ,  fix the cracks and go after the builder. They inspected the home prior to insuring it and have insured this home since I bought it. How can they now turn around and abandon me in time of my need.
Not only are they denying the claim, they are lying about it. There are no homes in my area that have similar cracks as indicated in their letter of denial. If they can give me such address, I will be glad to go there and see for myself.  They claim it is due to wear and tear, please review the pictures yourself, how can a crack from the roof be due to wear and tear? or from the ground expansive soil? That does not make sense to me, there should be  floor buckling inside the home if this is from the foundation as claimed by the insurance or soil expansion.  
It is ironic that only the soil in my home is expanding in the neighborhood if their claim is correct. I wonder why?
 
Regards,
[redacted]

Revdex.com:
I have reviewed the response 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.
Please see the report of a structural engineer that I hired. The insurance would have enlist the inspection of a structural engineer to ascertain the cause of the cracks which this report indicated rather than what the insurance general contractor is claiming. They refused to do this to avoid the cost.The insurance need to reimburse me for the cost of this inspection ,  fix the cracks and go after the builder. They inspected the home prior to insuring it and have insured this home since I bought it. How can they now turn around and abandon me in time of my need.Not only are they denying the claim, they are lying about it. There are no homes in my area that have similar cracks as indicated in their letter of denial. If they can give me such address, I will be glad to go there and see for myself.  They claim it is due to wear and tear, please review the pictures yourself, how can a crack from the roof be due to wear and tear? or from the ground expansive soil? That does not make sense to me, there should be  floor buckling inside the home if this is from the foundation as claimed by the insurance or soil expansion.  It is ironic that only the soil in my home is expanding in the neighborhood if their claim is correct. I wonder why? 
Regards,
[redacted]

Revdex.com:
I have reviewed the second response made by the business in reference to complaint ID [redacted], and have determined that this response is still evasive and would not resolve my complaint.  See the details below.
I appreciate the company’s second response, but it is still evasive and resolves nothing. The insurer is now saying that its refusal to renew coverage is based on a break in trust and communication, but this is not consistent with the reason stated in the Notice of Non-Renewal (“Notice”).  The initial reason given by the company is that THE TOTAL AMOUNT PAID ON MY CLAIM DOES NOT MEET THE UNDERWRITING STANDARDS FOR CONTINUING COVERAGE.  The company has not shown, and apparently cannot show, that its refusal to renew coverage is based on:   (1) objective standards, (2) substantial relationship to risk of loss, and (3) consistency of application among insured consumers in the particular group being non-renewed.  The company’s allusion to the existence of a break and trust and communication as an underwriting standard, without more, is specious logic and sheds more light on the insurer’s own displayed frailties than on the insured . . . . It’s another way of the insurer saying to the insured, if we do something wrong or break any of the terms of our contract, you must support us in the wrongdoing or else we will not continue coverage.  This type of stance is a precarious one for any insurer to take.  It goes against the insurer’s fiduciary duties owed to the insured and is a BAD BUSINESS PRACTICE (legally and morally indefensible).  I want to review the specific underwriting standards that supposedly justify the company’s decision to refuse renewal of coverage.  As for the insurer’s allegation that a copy of my current policy was mailed to me on 5/15/17, I should have received it by now, but have not.  Perhaps the mail was sent to the wrong address, in which case I want to know the exact forwarding address that was used.   Regards,
[redacted] ("**") [redacted]

A few months ago, after heavy rainfall, I noticed there were water coming down the wall between the patio and my house. I got on my roof and noticed the tar around the vent was getting old so I repaired it. Then I contacted my Residence Mutual Insurance and asked them to send someone out to make sure there are no additional problems or damage that my be caused by the heavy rain. They immediately sent someone out to inspect my roof and the walls and said that there are no damage done and the repair that I had done fixed the water leak. Then last week, Residence Mutual without any notice sent someone out to my house while I was a work. My wife was home, but she did not open the door because she did not expect anyone to come over. The gentlemen that rand the door bell had regular clothes on, so of course my wife did not open the door. She peeked out from the window and said the man was there for about two minutes then left. He left a noticed on our door [redacted] which stated that he inspected the outside of our house. How can someone spent 2 minutes to perform an inspection. Today, I received a letter from the company stating that my roof is showing signs of wear and because of that, they are charging me a 40% surcharge. They also claimed the right side of my house is filled with debris and clutter, which is another false statement. Without formally speaking with me, they are charging me a 40% surcharge. To me, this is robbery.

Revdex.com:
I have reviewed the response 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:
I have been so frustrated with the fact that Western Mutual(WM) discounting days that we stayed out of our house to get their "preferred" contracting company ([redacted]) to restore ALL issues (not partial) caused during the water damage back to normal. As they have been notified in my previous communications, [redacted] has NOT completed their task since Western Mutual keep them busy with new claims. Western Mutual is solely responsible for not getting our house back on time and you still counting 44 days!!!
We are asking WM to fully reimburse us for as minimum of 45 days+ since they rushed us back to the house that was uninhabitable. They have intentionally kept us out of our house up to 44 nights to avoid reimbursing for the mortgage payments and I can easily prove that in the court of law. I have taken several pictures showing major unresolved issues. As an example, they left live wires that were previously connected to the doorbell uncapped behind the wall and patch and paint! And several more issues up to this date. They still have not sent an electrician to fix the electrical disconnection to the doorbell.
By the way, WM claimed that we were satisfied with the condition of the house upon our arrival is completely baseless! [redacted]’s crews were working up until 7:30 pm on 1/29/16. I was told just last week by [redacted] (employee of [redacted]) that he advised Pat that the place is still so filthy dusty, but Pat insisted that they need to leave the job site ASAP!!! WM surely covered up by hand to hand with Baily [redacted] to show that the house was ready less than 45 days. They were supposed to mop and polish the floor (based on Signal Restoration Services) in which they failed to do prior to their departure. Furthermore, we never had a meaningful opportunity to fully inspect our property before crew left the premises! So, the Completion and Satisfaction Notice that was forced to us to sign is NULL since the job site remains incomplete as of today 3/29/16.
In regards to food and additional cost of living while our home was uninhabitable, all receipts have been submitted for the second time to WM on Feb. 21, 2016. Every purchased item besides food is legitimate item and it was necessary for us to be able to continue living while we lived at the hotel. If you ever looked at item # 129, page 19 of Signal Restoration Services report calls for removal and reset of refrigerator. This was done and power remained disconnected for the entire day! Additionally I have taken picture of our refrigerator showing power was unplugged and the freezer in the garage was completely blocked by items that were moved from inside to the garage area while their contractors worked on the job site. There was absolutely no way for us to rescue food! Per WM letter dated February 24, 2016, clearly Pat Taylor expressed a false statement with the refrigerator was not unplugged! PICTURES DON’T LIE BUT PAT TAYLOR WHICH WAS BARLEY AT THE JOB SITE DID!
WM is welcome to inspect the property at ANYTIME. They have my phone number, e-mail and the property address. They claimed that we weren’t available to inspect the property. The reason for that particular meeting was for the personal property rather than property inspection in which we decided to let it go to have no additional headache! WM never ever bothered to return my calls and avoid talking to me directly ever since we moved back. As a matter of fact, ever since this person advised Revdex.com someone will contact me – nothing has happened. One lie after another to keep their records clear with the Revdex.com.
Again, the accident was too huge and unexpected to comprehend for us while our home was submerged with water. WM doesn't practice a meaningful opportunity with their policy holders (like us) fully to read and understand their micro footprints with terms and conditions before even we have a chance to hire our own contractor nor discover additional issues that where lingering by their “Preferred” contractor!!! Additionally, their Yelp reviews say it all! As a result of that, we can settle the issue in one of these two ways:
1) To sue WM and/or [redacted] for all the money due to us which is not limited to the additional cost of living, unpaid mortgage payments, time and tremendous stress they left behind with my family, attorney and court fees, report your unfair practice for hiring a "Preferred" [redacted] company that cut the corners and try to work a deal with them under the table to earn their business. I wonder, how many of the last 10 claims were handled by [redacted]?
Additionally, report WM practice to Dept. of Insurance, report [redacted] to Dept. of Contractors, leave negative reviews all over websites and continue with our ongoing complaint with Revdex.com. This is for the principal reasons and if had had tried to speak and understand victim like us, we wouldn't take it to this level.
2) Try to open the communication lines and listen to our demands by fully reimbursing us for the above damages.
As a piece of advice to WM, save money by communicating with us. It will cost them substantially more time and money in the court!
THE CHOICE IS theirs!
Regards,
Mehdi Moghaddam

We are sorry that our customer is disappointed that her claim for cracks in the walls of one of her properties was denied.  We asked a licensed general contractor to inspect the property to assist us and our customer in determining the cause of the cracks.  The...

contractor believes that the cracks were caused by expansive soils in the area.  We note that the contractor did not enter other homes in the area; he advised that he noted significant cracks in the street outside the home consistent with his conclusion that the cracks in the home were caused by expansive soils.  Unfortunately, the policy does not cover losses involving settling, cracking; shrinking, bulging, or expansion of pavements, patios, foundations, walls, floors, roofs, or ceilings.  As a result, the claim was properly denied.  As our customer was upset that her claim was denied, we engaged the services of a leak detection company to perform a non-destructive leak detection to investigate the possibility that there may be some water leak that could have caused cracks in different areas of the home, even though the insured had not reported any water leaks.  The leak detection technician tested the plumbing and found no active leaks. Based on the inspections by both a licensed general contractor and a leak detection company, we remain unable to find coverage for our customer’s loss.  We have sent another copy of the original inspection, and will also be sending a copy of the leak detection report to the customer for her review.

Homeowners insurance is intended to cover sudden and
accidental losses, not loss that develops over time due to faulty construction,
wear and tear, long term water seepage, or losses caused by domestic animals.  When Mr. [redacted] reported the claim to us, he
indicated that he had had...

problems with the home since it was built, which was
in 2000.  While we advised Mr. [redacted]
that there may be coverage issues based on his initial description of his loss,
we did send out an Independent Adjuster and a Contractor to evaluate the losses
at the home.  They reported the following
to us:
 
1) Several kitchen ceramic tiles along the back
splash have fallen off the mortar. The cause of this loss is from long term
water damage due to repeated seepage of water leaking through a window above
this area and/or repeated seepage of water getting leaking through hairline
cracks in the grout eventually causing the tiles to lose their bond with the
mortar. This damage has been ongoing for several years.
2) The windows seal gaskets and frames that are
facing the south are deteriorating due to faulty construction of the windows
and/or improper installation. Rainwater has leaked through several of these
windows and caused long term damage to the drywall and sills of the interior.
These damages have occurred over many years.
3) There is a previous drywall patch on the ceiling
of the family room from an old plumbing leak that has been repaired.
4) At the time of our inspection, all of the carpet
and pad downstairs, some of the stairway and the entire upstairs hallway had
been removed by the insured. We observed a large amount of fungus was growing
at the baseboard areas in these rooms. The insured admitted that their two dogs
had been repeatedly urinating on the carpet for several years. There was still
a very strong urine smell at the time of our inspection. We found urine stains
on the remaining carpet in several rooms and on the exposed upstairs hallway
sub-floor.
5) The upstairs hall bathroom is very soft around the
toilet and near the tub/shower, which is an indication of wet rot and dry rot.
The vinyl flooring is also discolored. The cause of this is due to long term
repeated seepage of water around the toilet wax ring and also from repeated
over spray from the tub/shower around the shower curtain. The water has
repeatedly seeped down to the ceiling of the garage causing long term damage to
the drywall. Our inspection found a previous attempt to patch this area of
damage in the garage.
6) The fence exhibits evidence of long term wear and tear
along with evidence of several previous repairs.
 
Thus, the primary cause of the damage is due to repeated
and continuous exposure to moisture over time, improper installation, wear,
tear, deterioration and wet/dry rot to the dwelling as a direct result of poor
maintenance, neglect and damage from domestic pets.   This type of damage is not both sudden and
accidental, and is not covered under the homeowners policy; as a result, the
claim was properly denied.  While there
were actually multiple separate losses claimed, we opened only one claim file as
a courtesy to Mr. [redacted].
 
Later, the policy was nonrenewed due to the evidence of
wet and/or dry rot and the long term, unmitigated water damage.  We were concerned that the lack of
maintenance could eventually result in a covered loss.
 
We are very sorry that Mr. [redacted] was unhappy with our
denial of his claim and the nonrenewal of his property.  We are a preferred insurer and we employ
strict underwriting guidelines.  Mr.
[redacted]’s policy will expire on 12/9/2015, but if he obtains coverage elsewhere
prior to that date, we will be happy to refund any unearned premium.
 
CC 11/13/2015

We are very sorry that our customer is upset by the denial of her claim.  However, her allegation that we have manipulated the results of the investigation to deny the claim is untrue.  Three separate companies inspected her rental property and all independently determined that the damage...

was caused by constant or repeated seepage from within a plumbing system.   All opined that the leak in the shower valve that caused the damage has been occurring for at least 3 months, every time the shower was used. When we spoke to the customer to discuss the findings after the inspections, she advised us that one of her relatives rents the home and she admitted that she had not observed the condition of the bathroom for some time. We informed her that based on our review of the photos and the reports that there was no coverage for this loss. We attempted to explain the reasons for the denial of the claim to her, however she ended the call. Despite the fact that coverage did not exist for this loss, we paid Water, Smoke & Mold Restoration $908.39 for the emergency services they performed. Again, we are sorry that we could not find coverage for this loss despite three separate inspections.  However, we must apply the policy language fairly and there is no coverage for constant or repeated seepage or leakage of water or steam over a period of time from within a plumbing system.

Revdex.com:
Thank you for helping me get a response from Western Mutual Insurance.  You helped me get a response, which is something I could not get on our own.  Western Mutual Insurance is a horrible insurance company and I will make it my mission to publicly warn other consumers to beware of this organization, their communications, and their lack of payment for legitimate claims. Thank you again for your assistance. 
Regards,
[redacted]