Mold Coverage and Insurance Policies

"Not covered, what do you mean?" Sarah whispered to her self, but wanted to scream.  Instead, she just stared at the adjuster like a deer in the headlights.  "I'm sorry," the adjuster murmured, "but your policy doesn't cover mold remediation."

Returning from three weeks of unimaginable fun in the Bahamas, Sarah and her husband Jack discovered that the washing machine water line had broken, spraying water all over the laundry room.  

There was mold growing on the laundry room walls as well as on the ceiling and walls in the bathroom below.  There must be thousands of dollars of work to be done and if isn't covered by their insurance, she had no idea how they would pay for it now.  

What is insurance for, if not for this?  Why isn't this covered?  

She felt cheated, . . . abandoned, . . . violated.

Mold coverage in insurance policies varies greatly from company to company and you must check with your insurance company to see what coverage you have purchased. 

What follows is a general synopsis of how I have seen different insurance companies in the United States deal with mold coverage.  As coverages change from policy to policy as well as from year to year, I will not identify specific companies and their policies, just general guidelines.  You must check your own policy to determine the coverages you actually have.

Example: Homeowner, Rental and Commercial policies, even issued by the same company, usually have differing coverages for damages, repairs and remediation.

General Mold Exclusion  
Every insurance policy has a General Mold Exclusion.  Wording for this exclusion usually follows this vein:

"Fungi", Wet or Dry Rot Or Bacteria meaning the presence, growth, proliferation, spread of any activity or "fungi", wet or dry rot, or bacteria is not covered under this policy.

There is a reason for this exclusion and its wording.  Insurance policies are designed to cover the costs of repairs to your property in the event of a sudden, unforeseen or accidental event.  Damage caused intentionally, by neglect, or abuse, is not covered under most insurance policies.  Insurance covers accidents, not maintenance.

To make this distinction, policies do not pay for any repairs, unless it is a direct result of a sudden or single, event or occurrence, which causes loss or damage.

Therefore, damage that results from failure to properly maintain your home or long term damage that could or should have been fixed, such as a slow leak, but wasn't, are not covered. This would also include fungal, mold or bacterial growth that was a result of the environment; especially in very warm, moist, humid climates, where mold and bacteria proliferate without a water leak occurring.

Example: Mold grows along the baseboards behind the bed or dresser, or in the corners of the room at the ceiling because of condensation resulting from high humidity levels, caused either by the climate or a bathroom shower. Neither clean-up nor repairs would be covered.

While this is a general policy, there may be situations where mold remediation might be covered.

Complete Exclusion
A few companies have a complete exclusion on any mold remediation, regardless of the source.  There are no instances where they will cover any mold remediation. Many policies with exclusions, will cover the costs of the covered repairs, such as drywall, paint and carpet; but they will not pay for any labor or equipment needed to clean or remediation the mold.

Some policies will also not cover the water loss itself, if mold has grown as a result.  Their reasoning - If your home had been properly maintained, the leak would have been discovered and corrected before mold had time to grow.

Example:  You take your family on vacation for 2 weeks.  A water line breaks as you drive down the street, flooding your home the entire time you are gone.  There is significant mold growth in the wet areas of the building.  With this type of coverage, neither the mold, nor the water loss damages would be covered.  You would have to pay for all of the repairs yourself.


Mold Riders
Many insurance companies, after announcing an exclusion on fungal, mold or bacterial remediation, will add back to the policy, a rider covering remediation and clean-up under limited conditions.  These conditions can include:

1. Mold growth that occurs as a result of a covered loss.
2. Existing mold growth that has to be removed/cleaned before damage from a covered loss can occur.

Example: With this policy, if you went on the same trip, as in the previous example, all the repairs, including the mold remediation, would be covered.

If your policy has the rider covering remediation from a covered loss, it still will not cover mold growth resulting from an uncovered loss, such as ground water or culinary water that enters through the foundation from the outside.

Limits of Coverage
Providing you have coverage for mold remediation resulting from a covered loss, the limits of this coverage vary greatly.  Your company could pay any one of the following:

1. From $1000 up to $100,000 toward the remediation of the mold only.  The repairs to the structure would be covered by the water loss portion of the policy up to the value of the policy.   The average cost allowance for the mold remediation by insurance companies is between $5,000 - $10,000 per occurrence.
2. From $1,000 up to $10,000 for the total cost of repairs.  This would include the cost of the mold remediation as well as all of the drywall, paint, carpeting, etc. 

Statistically the national average for the cost of a typical mold remediation, as well as my personal experience, is about $2,000 - $3,000 for the remediation and about the same or less for the repairs. Some jobs are more, some are less, but most people will never encounter a remediation situation of $50,000 - $100,000 where their entire home needs to be demolished. Most often, there is mold growing along the baseboard in a bedroom, or growing behind a kitchen cabinet or bathroom vanity.

It should be evident, that coverage for mold, fungal or bacterial remediation varies drastically from company to company.  It is imperative for home owners to carefully research what their policies cover and what risks they may still be exposed to.  Paying $5 less per month for a policy that does not have mold coverage is no bargain if you later have to pay $1500 to $5,000 for repairs that resulted in mold growth.  But then, maybe you always win at blackjack, too.

It is also important for agents to carefully read and discuss with company adjusters, what the policies they sell actually offer their customers.  There are few things worse that overselling your product to a customer and then watching the resulting anguish and heartache as they try to deal with the situation; while your credibility erodes and your client defects.

Mold coverage in insurance policies varies greatly from company to company and you must check with your insurance company to see what coverage you have purchased.