A water backup in your bathroom, mold on the basement walls, damage from a fire – what can you do? 

CHAMBERSBURG- Mrs. Smith was looking forward to spending an afternoon baking cookies with her grandkids, but when she walked into her upstairs bathroom, the weekend plans all shifted. 

There was black, brackish water all over her bathroom floor and even in her bathtub. Her carpeting squished. She could hear it dripping down into the basement below.   

She dreaded walking into her bathroom off the bedroom, but she did and found the exact same thing. 

This was all supposed to have been fixed the first time it happened. 

She wants to cry, but she knows she has to figure this out. What can she do? 

This is where Rainbow Restoration came in.  

Brian Bitner, owner of Rainbow Restoration in Waynesboro, said, “I told her I’m going to go ahead and send it into the office, the office will give you a call and we’ll get something scheduled here to come on out and help you out.”

To begin with, the folks at Rainbow Restoration will do a vetting process to see if they can help. 

Bitner said, “So they’re vetting her out and just kind of hey, Mrs. Smith, what happened? Can you explain what happened when? As she was walking through the process she said, well, this is actually the second time it’s happened in the past month. So okay, can you tell me a little more about what happened the first time? Yeah, the backup happened the first time and it’s pretty much the same spots in the house. She said, it happened and I had a company come out. They looked at it and they did what they needed to do, one of our competitors, and I said okay, and we always ask for the insurance information.”

It’s sometimes a good idea to have Rainbow Restoration come out and look before you even contact the insurance company – but the decision is yours. 

Bitner explained, “Because anymore a lot of companies are going to percentage base deductible. It’s all based on your house value. So you get into some, especially in today’s world of prices of homes, the houses are $300,000, $400,000, $500,000 and some of these deductibles are 1.5%, 2%. So if you’re 2% of $500,000, that’s $10,000 deductible, that’s definitely above our average water job. So there’s no reason for you to call the insurance carrier, if we get there, it’s like this is a small job. We’ll do it, but it’s going to be well below your deductible. So there’s no reason to go ahead and call the carrier ahead of time and then that goes against your loss history, which let’s be real, it affects your premium and then your premium goes up, and there’s a chance that they might drop you for this, that or whatever.”

Most of the time, the insurance company will be engaged. 

Bitner said, “Depending on the carrier, there are some things that they just typically always exclude. So that’s where, again, when we get there, and we can get to the root of the real problem, it’s like okay, Mrs. Smith, I have never, ever seen this covered by an insurance carrier. So if you’re going to call, this is how you will want to approach this conversation. So it’s not just hey, I had this happen. I mean, it still may affect you, but it depends on who the carrier is.” 

With Mrs. Smith’s issue, since this is the second time this has happened and someone else fixed it first, would Rainbow Restoration be able to fix whatever wasn’t really fixed the first time? 

Bitner said, “That can get into a little bit of a gray area. That’s something that we’re going to have to deal with the carrier. So essentially, whenever we call we call Mrs. Smith, and kind of going through the whole process, who’s your insurance carrier? Oh, well, this isn’t going to be a covered loss. Okay, tell us why not? Well, the same thing happened and I called my carrier and they said, it’s not a covered loss. Okay. Well, I’ll tell you what, let us come out. Don’t call them yet. Let us go out, take a look at it. Because you would be surprised how much of the time something is not covered to begin with and it’s all because of verbiage. It’s in your mind as the customer, you said what you thought was the right thing. But that’s not the legal terms that need to be said to get the loss covered.”

Mrs. Smith called it a sewer backup. 

Bitner explained, “Generally, the term sewer backup refers to something that happens outside your foundation walls, something like from the septic system or something from the sewer main from the municipality, that something in their system had backed up and went into your house. So generally to have that coverage, it’s an extra rider. It’s not very expensive, but it’s an extra rider you need to have. Most people, whether they’re not aware of it or don’t want to pay the extra money for it, don’t have that coverage. So when she called her agent, and her agent, right, wrong or indifferent, just took her verbiage for it and said, you don’t have backup coverage. So then it’s over.” 

This all comes down to making the right decision as a homeowner – who to call for both restoration and insurance coverage. 

Bitner said, “She said the wrong words, which then in the mind of the carrier is automatic, boom, denial, this is easy, right? There’s a solution right there. No backup coverage. Boom, you’re done. His job is not to get extra information. You said backup. Boom. Not covered. Now of course they’re still going to say if you want, we have a list of what’s called preferred vendors in the area. There are certain requirements, generally, you’ve got to be in business for anywhere from one to three years at least and you have to have the right business insurance requirements. So, enough coverage for this and that, and this, and then the biggest thing is, you have to adhere to all of their, we’ll say, made up guidelines.”

A preferred vendor is taken literally – a preferred vendor of the insurance company. Rainbow Restoration is not a preferred vendor of any company. 

Bitner said, “This preferred vendor has these made up guidelines, these made up rules that they have to follow. Some of the biggest rules are the pricing. The insurance carriers, they kind of try to set their prices based on historical data. With that, now, if I’m a preferred vendor, I have to adhere to these prices. So even if they’re only paying $41 an hour for this labor rate, that’s what I have to do the work for. With that, the restoration companies still make money at this, because they don’t have to advertise nearly as much.”

The insurance carrier provides the work to the preferred vendor. 

Bitner continued, “They get the work just flowing in from the insurance carriers. But at the same time, there’s things that they cannot do, because there is not enough time, they are not given enough time, meaning they’re not paid enough now, to be able to do some of these other things. Generally, a lot of those things are what we call onboarding and education to the homeowners. They’ll come in and essentially now because the preferred vendor has gotten their work from the insurance carrier, the insurance carrier is the one that is typically dictating the work that needs to be done, instead of the restoration professional, which should be the restoration contractor. The restoration contractor is the certified contractor. They’re the ones that are going to be held accountable if something doesn’t go right, or something goes wrong. So they’re the ones that are boots on the ground, are there every day, they’re interacting with the homeowners, with the building on a daily basis, they’re the ones that should be making the final call. Actually, if you even look in our standards of care, essentially our rulebook that the industry has, it even says in there specifically that these are guidelines, but everything should be decided by the restoration professional, because no two homes are the same and that’s the guy that has to make the final call. Where the difference is, is the preferred vendor is now essentially saying, well, I know this is going to be a fight to get this paid for, it’s the right thing to do, but that’s going to be a fight to get that paid for. So we’re just not going to do that. We’re just going to go with whatever the insurance carrier wants to do, because I don’t have people on staff to be able to fight this, I don’t want to worry about it. I don’t want to have to deal with it. And the homeowner is not going to be any of the wiser for it.”

Every insurance company has a list of preferred vendors. 

Bitner said, “Because again, it’s a way that they save money, but it seems like it comes and goes to be honest with you, because one of the large ones here, they seem to go in waves where whenever we’re talking to our customers, and we’ll say, hey, whenever you call, they may say, do you want us to get a preferred vendor out there? And they’re like, man, we called and they didn’t say anything about them, but the last three they did. So it really seems like it goes in waves.”

Can Rainbow Restoration be brought into the quote from the insurance company if the homeowner insists Rainbow Restoration be the one to help or can the insurance company insist a homeowner use their preferred vendor? 

Bitner said, “No. In Pennsylvania that is actually illegal. You will hear that, they will say, oh, if you don’t use our preferred vendor, then you’re going to have out-of-pocket costs. They may fight that, that you may have to pay extra money, but by the letter of the law, that is not correct. The insurance company has to reimburse you for incurred costs. Now, again, they may not like it. They may push back and say, this was our estimate or what it should be to do it. Well, it doesn’t matter. If you look, again, through the language of your policy, it doesn’t, it doesn’t say, we have a third party vendor that will write an estimate and whatever we feel is fair and right, this is what we’re going to pay. Your incurred costs are what needs to be paid.”

A public adjuster can really help. 

Bitner said, “They cost money. It’s usually not upfront. Usually they will take a percentage of the total claim. You can’t build that into the claim. Generally with the public adjuster, though, it’s like anything, there are garbage ones out there and then there are good ones. We seem to be working with a pretty decent one right now. The fire job’s not all done and over with yet, but the homeowner seems to be just elated. He’s like, I haven’t talked to the adjuster once after our initial site visit, like the public adjuster has been doing everything. Because it’s their job.” 

The public adjuster is supposed to go through the policy and figure out what’s owed and what’s not owed. 

Bitner said, “That’s one of the biggest things. Even with us as the restoration contractor, technically, by law, to be able to go back and look at the policy, to be able to give advice to the homeowner based on their specific policy, you’re supposed to have an adjuster’s license. We don’t have that. That’s a whole different ball game, whole different realm. A lot of what we do is more so look, this is in general, all the policies that I have that we’ve talked to from different public adjusters from different attorneys, this is something that they’ve never seen before. You’re probably going to hear the adjuster say this, but it’s never been in any policy known to anyone that we know in our area. There’s good public adjusters, and there’s ones that are just truly garbage. Right now we have one. We also have other consultants that are considered like expert witnesses in our area, ones that have legal rights in Pennsylvania. They’re not necessarily public adjusters, but they help homeowners and they also they also help us in certain claims.”

So what ended up happening with Mrs. Smith? 

Bitner said, “We told her look, we’ll get out there and we’ll take a look at it. So we met her on site and when we walked through, just walked through what happened, when you saw it, where you saw it, what you did, what you didn’t do and then since we know there was very recent previous damage, where was the last damage? Then as we’re walking through what did they do? What didn’t they do? Did they do anything that you thought was excessive? Did they do anything to that man, why didn’t they do this?”

In this situation, it came down to water. There are three categories of water. 

Bitner said, “Category one, which is clean drinking water; category two like sump pump water that probably has bacteria in it, but it’s most likely not going to kill you, but it needs to be cleaned to some degree. Then you have category three, which is black water, sewage water, that kind of stuff. So in Mrs. Smith’s case, it’s category three, black water, sewage water, anything past the trap, that backs up all your sewer lines, any of that that backs up and you get that much water, it’s black water. It contains viruses, pathogens, bacteria, all that stuff that’s probably going to kill you, if you ingest it. In our standards, essentially anything that gets contaminated with that sewage water, if it’s not structural, or if it is porous, then it has to come out because you can’t clean it well enough to be able for me to say hey, this is clean, there’s no bacteria left on this. So that means carpet, drywall, trim, most flooring like wood flooring, because you can’t clean both sides of the wood flooring when it’s down. So in general when there’s sewer water, you’re doing a whole lot of demolition to this. Now, it’s like anything, you have to take some of it into consideration. Is it the size of a cup or is there like a huge puddle here that we need to look at?”

In Mrs. Smith’s case, the black water had dripped down from the bathroom. 

Bitner said, “We’re looking at ductwork, the water dripped on top of the ductwork. My technician said was it the ductwork over here? And she’s like, yeah, right there. And he can see water spots on the ductwork itself, which typically means it wasn’t wiped off and cleaned, because it had dried on the ductwork. Then we’re looking at some boxes and she’s like, yeah, these boxes got wet before. They got wet, you can see the water lines on them. They just wiped them off and away they went. What about the carpet? I can see a kind of a ring? Yeah, there’s a ring here, they just dried the carpet. They said they cleaned it a little bit and sprayed it and away they went. So of course, our conversation with Mrs. Smith is look, here’s the deal. Whether this is an insurance claim or not, there are certain things that we don’t do. So you can tell me now, then that’s fine. We’ll walk away, nice to meet you. But this isn’t what we do. Whether insurance is going to pay for this or not, the carpet’s got to come out, the boxes get thrown away. At a minimum, the ductwork has to be cleaned on the outside and we can test it on the inside to see if the inside got wet. If the inside got wet, then we’ll have to replace the ductwork. But all of this stuff, it needs to be thrown away, because we can’t clean this well enough.”

Why wasn’t the whole thing analyzed to begin with to determine how it happened so it wouldn’t happen again? 

Bitner said, “That’s a big part of again, what we believe we provide, in addition to most preferred vendors, because again, a preferred vendor, they’re getting the bare minimum. It’s essentially like when you do health insurance, okay, if you go to an in network provider, this is what they’re paying. Generally, you are going to get better service with an out of network provider, because they’re able to charge the rates that they need to, to spend time with you to do the right things. It’s the same thing with us. So generally, when we get there, that’s some of the stuff that we’re doing. So she told us who the plumber was that came and got the clog out. I was on the horn with the plumber. Hey, what did you find? It was a blockage, okay. So it wasn’t a backup, it was a blockage. So now we’re in a different category, we need to call the insurance carrier to say, hey, this wasn’t a backup, this was a blockage. Where was the blockage? It was about 10 feet short of going out of the house. Boom. Trigger number two. It’s inside the house, it’s not the exterior of the house. So from our standpoint, most companies don’t do that. It’s just the blockage, the clog, the backup, that’s your problem Mrs. homeowner. Whereas we are here trying to help educate, help the homeowner as much as possible. Let’s get to the root of this problem. Where did it start? Why did it start? And is this going to happen again? Because if it is, you need to call a plumber in here now to get this fixed so it doesn’t happen again.”

Why did it happen again? 

Bitner said, “From my understanding, talking to the plumber, there’s something wrong with the pipe, the actual drain pipe itself, that it needs to be replaced and the plumber is supposedly supposed to be replacing it. They just haven’t gotten to it because of their backlog. It comes back to the homeowner to say, look, you have a decision to make. You don’t have to hire just this plumber, you can hire other plumbers, you can do whatever you want.”

What if the insurance company says the homeowner has to use a preferred plumber? 

Bitner said, “Still, as long as you have that in writing, there would be some legal thing you could go against, but in general, they can hold your feet to the fire but it doesn’t mean that’s going to stay there. Because again, legal in Pennsylvania, they cannot tell you who works on your house. We have other options to help you along the way. There’s certain things like the Pennsylvania Insurance Commission, that’s always the first step, to file a complaint with them. By law, they have to respond within 20 days. It does drag it out, but we have other consultants that do this for a living, fight the insurance carriers day in and day out for a living. They know the law, they know the legalese. They know all of this stuff. So depending on who your carrier is, there’s some carriers that as soon as we hear their name, that’s the first thing we’re telling the homeowner is look, you need to call one of these other consultants because this is going to be a fight again, unless you use their preferred vendor, but then again, you don’t know what you’re getting. If you’re okay with that, that’s fine.”
You can contact Rainbow Restoration, licensed in Pennsylvania and Maryland, by calling 717-788-3030 or clicking here.