Mold Damage and Insurance: What's Covered and What's Not

Mold can be a tricky issue when it comes to insurance claims. Many homeowners think any mold damage is covered but it’s not always that simple. After all, we’ve heard it thousands of times from clients saying, “I thought I was fully insured, why isn’t this covered?” 

Put simply, insurers should look at whether mold is the cause of loss (meaning it’s the primary reason for damage) or resultant damage (meaning it happened because of something else, like a delayed claim response). Here’s a simple guide to help you understand the difference—and how a public adjuster like ClearClaim can help you navigate this complex issue.

Mold as a Cause of Loss

If mold itself is the primary cause of damage in your home, insurance companies are often hesitant to cover it. For example, a most unfortunate turn of event is that you might have long-term mold growth due to high humidity or poor ventilation, many insurers consider this a “maintenance issue” or attribute it to a part of the policy that denies coverage for this damage. Since it could have been prevented by regular upkeep, they may argue that it’s not their responsibility to pay for repairs. In other words, mold claims, as a direct cause of loss is usually denied.

Mold as Resultant Damage

Now, here’s where things can get a bit more complicated. Sometimes, mold becomes an issue because of another problem covered by insurance, such as a broken pipe, roof leak, or water damage from a storm or damaged sewer line. If the insurer takes too long to handle the initial water damage claim, mold can start growing as a result of that delay. In these cases, mold isn’t the primary issue; it’s what happened because the insurer didn’t act quickly enough to fix the original problem.

In such situations, it’s possible to argue that mold should be covered under your insurance because it’s a consequence of an already covered loss that wasn’t handled in time.

Easy enough to understand, right? Not really. Unfortunately, insurers may try to sidestep responsibility when mold arises as a consequence of their own delay. By framing the mold as an “unrelated maintenance issue,” they sometimes attempt to deny valid claims, despite the fact that their delayed response allowed the mold to spread. This approach can be particularly frustrating for homeowners who did everything right, immediately reporting the original damage and trusting the insurer to act promptly. Instead, these homeowners are left with a growing, expensive problem that could have been avoided if the claim had been handled in a timely manner. 

This type of delay not only puts homeowners at risk of increased health hazards but also places them in a financially unfair situation, where they’re left responsible for damages that were preventable.

If this sounds like you, a public adjuster is the perfect teammate in these situations because they are experts in navigating the complexities of insurance claims and advocating for policyholders. When insurers attempt to deny mold claims by blaming homeowners, public adjusters step in to gather and present the evidence needed to prove that the mold damage was actually the result of the insurer’s delay. They meticulously document timelines, track the original damage, and link the spread of mold directly to the lag in the insurer’s response. Public adjusters also understand the specific language and technicalities of insurance policies, allowing them to challenge an insurer’s attempts to reframe or misinterpret terms in their favor.

Dealing with mold in a home insurance claim can be confusing and frustrating, especially if you’re not sure how to prove your case. Your public adjuster can make the process easier by advocating for you, making sure no detail is missed, and helping you receive the compensation you deserve. If you’re facing mold issues, whatever the cause, consider reaching out to a public adjuster who understands the ins and outs of these claims.