How Fidelity National Home Warranty Tried To Cut Costs by Denying My Legitimate Claim

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This is a document of my experience with Fidelity National Home Warranty and the argument they made in order to deny a completely legitimate claim I made to have them repair something covered in their contract.  I feel their argument is absurd because it hinges on a definition of "inaccessible" that no normal human being could agree with, unless you were an insurance company trying to cut costs by denying your customers legitimate claims.  I feel cheated, disgusted, and mostly want to write this down so others could be better informed when looking for a home warranty insurance company.  Read the facts about their dealings with me and form your own opinion.

FINAL STATUS: After almost 6 months of dealing with these people, they finally decided to repair my spa.  

 

The Claim

I have a spa with two jets that move up and down, in addition to the normal type of spa jets.  One of the jets no longer moves up and down, so I hoped to have it repaired under the home warranty I got when I purchased my house.  I'm not sure when I called them, but they sent a technician out on January 29, 2004.

 

The Contract Language

Regarding the swimming pool and/or spa equipment coverage, the following is the language in their contract.

Covered Items: all above ground and accessible parts and components of the filtration, pumping, and heating system (including the pool sweep pump motor, blower motor pump, motor and timer).
Not Covered: Solar-related equipment - underground water, gas, and electrical lines - skimmers - jet pump - chlorinator/ozinator - ornamental fountains - structural and/or cosmetic defects - damage due to lack of general maintenance or improper chemical balance - cost of access to make repairs or replacements - inaccessible portion of the spa jets [emphasis is mine] - motorized valves - electronic/computerized controls and/or control panels - pool sweeps and related cleaning equipment.

 

Why I Think It Should Be Covered

Listing "Inaccessible portion of the spa jets" as not covered implies that accessible portions of the spa jets are covered.  These movable spa jets have an access panel over them with a slot for the water to shoot out from.  The access panel is held in place by two regular screws.  That's 2.  Regular.  Screws.  Seems accessible to me, I am not particularly handy but I am capable of removing two screws in about 30 seconds with a tool known to some as a "screwdriver", a quite useful and easy to use device.

 

Their Excuse for Denying My Claim

I'm going to paraphrase the discussion on the phone with a supervisor at Fidelity National Home Warranty regarding the letter of denial I received for this simple claim.  This is not their exact wording as I did not record the phone call, which I now wish I had, surely I could have sold this to some comedian for a decent chunk of change.

Them: Sorry, sir, the contract says that inaccessible portions of the spa jets are not covered.  Therefore we denied the claim.
Me: But it's easily accessible, there is an access panel with two screws on it.  That seems pretty accessible to me.
Them: Nope, it's not accessible because the panel is covering the part that is damaged.  Therefore it's inaccessible and not covered.
Me: This is absurd, anyone can remove this panel, it has TWO screws in it.  One of the specifically covered items in my house, the heater, has an access panel in front of it with at least two screws in it.  Does that mean you won't cover it if it breaks?
Them: No, because it's covered.
Me: (flabbergasted at this circular logic and blatant twisting of the word inaccessible to cheat me) OK, how about this, I'll remove the access panel myself and then your technician can just show up, reach into now open and accessible hole in the spa and remove the broken part and replace it.  I'll even put the access panel back on myself.
Them: No, it's still inaccessible.
Me: How can it possibly be inaccessible if I've removed the panel myself?
Them: Because it just is.

 

The California Department of Insurance

I called the California Department of Insurance to report this disgusting abuse.  They were nice, and although stating that they had to remain neutral regarding any issues, that they thought I had a reasonable claim.  They sent me paperwork to file a complaint.  I filled it out and sent it back to them.

A couple weeks later , I got a letter from them stating that they were going to contact Fidelity National Home Warranty and try to resolve this for me.  A couple weeks after that, I got a letter (dated March 26, 2004)  from Fidelity National Home Warranty (cc'd to the Dept of Insurance) stating that they had reviewed the claim and were maintaining the denial status because jet is inaccessible, the exact portion is this "The technician indicated your jets had failed but that an access panel would have to be removed in order to repair the jets" and then says they are denying because "inaccessible portions of the spa jets are not covered".  No mention of the fact that the access panel in question is removable by taking out two screws and how this meets any reasonable definition of "inaccessible", nor that I had offered to remove the offending panel, nor that a blind one-armed monkey could remove this panel and access the jet inside let alone a spa repairman who almost certainly possesses a regular screwdriver.

 

Current Status

July 9, 2004
The spa repair guy finally arrived with the necessary repair part around noon.  He spent all of a minute screwing it in, and then put the access panel back over the jet.  He apologized for all the time this had been going on, but said there was nothing he could have done about it, and left.

I'd sure like to know what changed their minds at the insurance company.  What was the motivation for finally living up to their contract, albeit 6 months late?  I doubt I'll ever know.  This is probably the last update to this page.  I hope you've found it informative and useful.

June 18, 2004
A few days ago, FNHW sent me a later saying that they had my "rebuttal letter to the Department of Insurance" and that I had "indicated that the jets are easily accessible and would be willing to remove the screws and paneling yourself".  They then said they'd send out a technician once "access had been made".  Not wanting to argue any further with these people regarding the whole point of my argument (which dear reader is certainly aware of by now), I simply sighed, grabbed my trusty screwdriver, removed the two screws, and took off the access panel.  A challenge worthy of your average 4-5 year old, accomplished so their technician can get access.  grrr

So I called them and told them I had removed the panel and to go ahead and send the screwdriver-less (I can only assume) technician out.

He came out on the 18th.  Nice guy, same one that came before in January.  He thought they didn't cover jets at all, but I explained to him the contract language in question here, and so he decided to call FNHW while he was at my house to get it resolved.  They left him on hold quite a bit, and he explained to them what the faulty part was, and the fact that it simply screws in and out of the spa wall behind this access panel.  And then he explained it again, ... and finally a third time.  Seems they have a hard time listening even to their own people, though that's just my supposition from listening to half the conversation.  They then decided they needed to speak to a supervisor/manager/whatever and that they'd call him back.  So he left and promised to call me when he found out the verdict.

Good to his word, he called back a little later (hour or less perhaps), and said that they had indeed decided to cover this.  I sure wish I could have been a fly on the wall to hear the discussion at Fidelity National Home Warranty when they were deciding whether or not to cover it.  I'm really curious about their motivations.  Did someone honestly read the contract language with an objective eye and say "hey, this is ridiculous, this is not an 'inaccessible portion of the spa jets', so we have to cover it.  Why'd we deny this in the first place?"  Or was it more like, "well hell, the Department of Insurance is involved, this guy's not gonna give us any peace, he has a legitimate claim no judge will deny if he sues us, and it'll cost us more to keep trying to use our ridiculous argument any longer than to just pay up."  In either case, I can only say "FINALLY!!!!!  5 months later!"

I guess I'll wait and see if they actually go through with it when the technician installs the part and drives away.  Then I guess I'll have to change the title of this page to "How Fidelity National Home Warranty Tried to Cut Costs by Denying My Legitimate Claim".  I guess the lesson so far is "If you want them to pay for the things they are supposed to, you may have to pursue your claim for a long time."

May 10, 2004
The California Department of Insurance has responded to the March 26 letter from Fidelity National Home Warranty with a letter to me.  It states:

Your inquiry is receiving our continued attention.  Proper review, however, has necessitated additional investigation and evaluation of the issues involved.
We regret this delay and will bring this matter to a conclusion as soon as possible.

So I guess I'll send them an email reiterating my position that an access panel with two screws by definition means that something is accessible.  At this point I'm just happy that they're still pursuing it and didn't just side with the insurance company.  I'm holding out hope that my tax dollars employ people in our government to actually help people and not let big insurance companies run roughshod over us.

April 12, 2004
I am currently (April 12, 2004) waiting for a letter from the Department of Insurance informing me of what they plan to do.  I hope they didn't just receive the letter from Fidelity National Home Warranty and close the case.  I'll wait some more for them to contact me, then give them a call.

I'll update this web page as this progresses.  Until then, form your own opinion about which insurance company you may want to avoid.  That reminds me, Fidelity National Home Warranty actually had the nerve to call me and inquire as to why I had not renewed my contract with them.  The salesman was of course very polite and friendly and promised to look into my claim, and I did my best to not take out my frustration on him while explaining the bizarre denial and why I would not give my money to a company that behaves that way.

 

Other People's Problems with Fidelity National Home Warranty

Here are some links to other people's troubles with this company.  I can't vouch for their validity, I just saw them on the web and am posting them here for your reference (in reverse chronological order):

http://ripoffreport.com/reports/ripoff89703.htm

http://www.ripoffreport.com/reports/ripoff21134.htm

http://www.complaints.com/complaintofthedayjune132000.11.htm

Bay Area Better Business Bureau from this site "Based on BBB complaint files, this company has an unsatisfactory record with the Bureau due to one or more unanswered and/or two or more otherwise unresolved complaints."

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