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FEMA Flood Insurance Appeal Decision #D15

BUILDING COVERAGE: $250,000PERS. PROPERTY COVERAGE: $20,000DATE OF LOSS: June 2023DATE OF DENIAL: July 2023APPEAL SUBMISSION DATE: July 2023APPEAL ELIGIBILITY DATE: July 2023INSURER’S DENIAL: The insurer denied coverage for asbestos testing.POLICYHOLDER’S APPEAL: The policyholders appeal the denial of coverage for asbestos testing. [1]Result: Concur with denialBASIS FOR DECISION UNDER THE STANDARD FLOOD INSURANCE POLICY (SFIP):[2]The SFIP does not pay for the testing or monitoring of pollutants unless required by law or ordinance. (See SFIP (V)(F)). When the SFIP extends coverage, it includes the cost to test and monitor only if testing is required by law or ordinance.[3]On appeal, the policyholders stated the mitigation company performed an asbestos test prior to starting the tear out and drying process. However, the policyholders did not present any evidence to show a local or state law or ordinance required testing for asbestos prior to tear out.In case of the loss or request for payment, the SFIP require the policyholders to provide a signed sworn-to proof of loss with documentation that supports the loss and dollar amount requested. (See SFIP (VII)(G)(3)-(5)).Without written documentation from the policyholders’ county that states asbestos testing is required, FEMA finds no basis to overturn the denial or request the insurer re-evaluate the claim.After submission of the appeal, the insurer issued an additional payment of $5,641.08 for asbestos removal, abatement, drywall repair and paint in stairwell, and water heater repair.[1] 44 C.F.R. § 62.20. All appeal-related documents are on file with FEMA [hereinafter “Appeal File”].[2] *See*44 C.F.R. § 61.13 (2021); Dwelling Form available at 44 C.F.R. pt. 61 App. A(1).[3] *See* National Flood Insurance Program Claims Manual, Section 2: Claims Processes and Guidance, 39 Pollutants, pgs. 267-268 (Oct. 1, 2021).
  
      
            Related Resources
Appealing Your Flood Insurance Claim (fema.gov)
NFIP Claims Manual, October 2021 (fema.gov)
Flood Smart Glossary
Flood Smart | How to Appeal a Flood Insurance Claim Payment





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