Evidence of Loss
My claim with Lemonade Insurance was my second rodeo, so I had an inkling of what I would need to provide to help them process the claim. This is 1 more claim experience than most would have when filing their own claim.
You be the Judge
Let’s play a game where you are the judge. You have two duties: 1) protect shareholder profits by ensuring your company stays in business by not paying more in claims than you collect in premiums, and 2) an obligation of “fair dealing” to your policyholders.
Given the amount of personal information in the information package provided to Lemonade, redacting is a big job and may not provide sufficient privacy protection. I’ll summarize instead.
- Timeline of events
- April 10 – Telegram conversation between Angel & Travis discussing Angel’s general malaise and 2021 mold exposure anemia as a possible cause. Angel also discusses her past experience with Burning Mouth Syndrome, which can be related to low iron. [Mold can reduce your body’s iron count dangerously
- May 7 – Copy of iMessage from Angel to daughter Grace apologizing for feeling bad lately and being inattentive
- May 11 – Travis reports reflux [mold in your GI tract can cause issues, or it can be a sign of eating too much spicy food or too late at night]
- May 14 – Angel nearly faints in public and goes home early. Mentions cardiac testing the next day to find the problem
- May 14 – Travis exchanges texts about Angel with a family member, a Nurse Practitioner, seeking advice
- May 18 – Angel’s birthday, feeling unwell, she cancels all plans
- May 19 – Telegram conversation between Angel & Travis postponing more plans. Travis states “I wonder if we’re being exposed to mold somehow again? My hair is falling out like crazy.” Angel: “My face has red spots all over it for the second time. My heart hasn’t stopped feeling like it’s on overdrive since Tuesday. I feel weak and out of breath on the slightest exertion.”
- May 20 – Mercy starts to feel unwell: headache, nausea, fatigue.
- May 22 – Travis notices increased fatigue and allergy-like symptoms. Calls a home inspector
- May 29 – Home inspector investigates, finds mold growth hidden in AC ducts
- May 31 – Lab testing confirms low levels of Aspergillus airborne(If this resonates with you and causes unknown, start looking around for mold at home and work. Look how long it took us to connect the dots on our second trip.)
- Copy of environmental report from a lab showing growth and low levels of Penicillium / Aspergillus in the air. The general comment: “A mold growth “feed-back loop” was found to have been established by the apparent mold growth in the home. The HVAC air handler filter was saturated with condensation and covered in growth, as well as signs of extensive growth were found at multiple registers throughout the home, particularly at the guest bathroom, laundry room, and left front guest bedroom. The ductwork was noted as aged, evident by visible internal ribbing at multiple legs of the ductwork itself. The air handler platform was saturated at all four sides, with signs of visible growth, particularly at the makeshift 2X4 supports.”
- Doctor visit summary. DX toxic mold exposure, prescribed steroid for inflammation, antifungal, and albuterol for breathing. Referred for CT imaging, pulmonology follow-up, and infectious disease follow-up. Lab work showing mold antibodies. Copies of old DX of CIRS & MCAS for the family, highlighting extreme sensitivity.
- Photos and videos of Travis & Angel continued skin reactions through June after contact with items from the home, as well as this instruction letter to the family.
- A box set aside labeled “Biohazard – Mold Samples” that contained items in the house known to not have been washed or dry-cleaned recently that would likely test positive for spores. I don’t know of any mycotoxin testing for clothing – that’s exclusive to urine and blood.
Your first opportunity to deny the claim is to state that “humidity” caused the mold growth (condensation on the air handler), and since that’s not one of the policy’s listed covered perils (fire, flood, etc), the claim is denied.
Deny?
Allow?
Second Chance
Lemonade dispatched a local service company to take all of our items. We believed this was for inventory valuation purposes because the service provider was not interested in the Mold Samples box. Three weeks later, we learned that the service provider did not see any evidence of mold growth on the items they removed from storage and their test of “an item” did not reveal the presence of spores.
You communicate to the policy holder that your testing of an item revealed nothing, and since you didn’t see any evidence, either. You share that the “onus is on you [the policyholder]” to convince us there’s mold. The policyholder responds with directions to test the items in the box or specific name branded items in the closet which were not likely to recently been dry-cleaned. You decline to do the testing, and you decline to share the results of the testing that you did do.
Your second opportunity to deny the claim because mold was not visible to the naked eye and the item you tested did not show mold.
Deny?
Allow?
Policyholder Next Step
Here’s my final, almost certainly futile attempt to change the Denial:
Adding Maria from XXX,
The items are useless to us because we react so strongly to the mold mycotoxins that can’t be washed out. I shared plenty of photos and videos in the claim, along with medical DX, to demonstrate the problem.
I would like to send an environmental tester to the XXX facility to test the items I suggested you test but you declined: 2 or 3 samples from hanging items in the closet that wouldn’t have been washed or dry-cleaned in the days leading up to the discovery.
Once you observe those test items being sent to the lab, everything can be discarded. This will save me the expense of storage, coordinating an environmental tester & court-certified courier for the samples, and taking video of the truck arrival and test sampling to avoid chain-of-custody disputes later.
If any of the samples above test positive for mold spores,
Deny?
Allow?
How we feel about this
I predict, without a jury trial, this claim is not going to be paid, no matter how the test above turns out.
And we haven’t even gotten to the part yet where we discuss the actual value of the items and the difference between “cash value” (find a second-hand market where you can purchase clothes that reflect the depreciated value of what you owned) and “replacement value.”
Only time will tell.