Homeowner insurance usually treats pest damage differently from sudden damage, and termite and vermin damage are often excluded outright. Every policy decides its own terms, so this guide describes only the general pattern. Keep the report, the photographs and the invoice; ask the insurer what the policy covers in writing; and if a claim is denied and the explanation is not satisfactory, the New Mexico Office of Superintendent of Insurance takes complaints about home insurers.
Key takeaways
- Pest damage is often treated differently from sudden damage in a homeowner policy, and it is often excluded.
- Read the policy and ask the insurer in writing what it covers. This guide does not state the terms of any policy.
- Keep the pest report, dated photographs of the damage and any invoice for the work.
- Mitigation, meaning the steps taken to limit further damage, is generally expected by an insurer.
- If a claim is denied, ask for the reason in writing and check the policy wording.
- The New Mexico Office of Superintendent of Insurance takes complaints about home insurers’ handling of claims.
Why does pest damage often get different treatment?
Insurers commonly treat damage from slow, repeated or preventable causes differently from sudden damage. Termite and vermin damage are often named as exclusions, which means the policy does not pay for them. The policy decides, and the wording matters.
A homeowner policy is written to cover sudden and accidental loss, such as a fire, a storm or a burst pipe. Damage from a pest that works slowly over a long period, or from an animal that has been living in the building, is often treated as a maintenance matter and excluded. That is the general pattern and it is the single most useful thing a homeowner can know before a pest claim.
The general pattern is not a rule for any particular policy. Some policies cover some pest-related damage, and others exclude it in detail. Only the policy wording and the insurer’s answer in writing can say what applies to a given home, and this guide does not state any coverage limit or any deductible rule.
What is generally excluded, and what might not be?
Damage from termites and from vermin is often excluded. Damage from a sudden event that a pest did not cause, such as a storm that opened a wall, may be treated differently. The policy and the endorsements decide which applies.
An exclusion for termite or vermin damage usually covers the damage done by those pests themselves. A sudden event that happens to expose a pest problem, such as a fallen tree that opens a roof, is a different question, and it may be covered under the storm or the impact part of the policy. The insurer decides, and the policy wording is the reference.
Endorsements can change the picture. A policy may have an added cover for a particular kind of damage, or an added exclusion for another. Ask the insurer to list any endorsement on the policy that touches pests, moisture or water damage, and read each one.
What should a homeowner photograph and keep?
Keep dated photographs of the damage, the pest report, the list of sightings with their places and dates, the invoice for any work, and a note of any repair done. Keep them together, and send a copy to the insurer when asked.
A photograph is most useful when it is dated, shows the damage in context and includes a scale or a reference point. Take photographs before anything is cleaned or repaired, and keep the originals with their dates. A photograph of a damaged sill taken before the repair is worth more than any written description.
The pest report is the record of what was found and what was done. It should match the photographs and the sightings list. The invoice shows what work was paid for. Keep all of them with the house papers, and make a second copy in case the first is lost.
What is mitigation, and why does the insurer care?
Mitigation means the steps taken to stop further damage once it is found, such as sealing a gap, drying a wet area or removing the source of moisture. Insurers generally expect a homeowner to take reasonable steps, and they want to see that the damage has not been allowed to grow.
A homeowner who sees a wet sill and waits a year before acting may find that the insurer treats the later damage as a failure to mitigate. A homeowner who acts promptly, keeps a record of the steps and sends the record to the insurer is in a far better position. The pest report and the sealing list are part of that record.
Mitigation does not mean the homeowner must do the repair personally. It means the steps are taken by a person who can do them, and the record shows who did what and when.
What does the adjuster usually ask?
An adjuster usually asks when the damage was first noticed, how it developed, what was done about it, who did the work, and what the records show. The answers should be checked against the photographs and the report before they are given.
Expect questions about the timing. The adjuster will want to know whether the damage was sudden or gradual, and whether the homeowner noticed signs before the claim was made. Give honest answers, and check them against the dated records. A guess about a date is worse than a plain statement that the date is not known.
Expect questions about the work. The adjuster may ask who inspected the damage, what was recommended and whether the recommendation was followed. The pest report and the invoice are the answers to those questions, and they should be given in full.
What if the claim is denied?
Ask the insurer for the reason in writing, read the policy wording against it, and ask for the specific exclusion or condition that is relied on. If the explanation is not satisfactory, the New Mexico Office of Superintendent of Insurance takes complaints about home insurers’ handling of claims.
A denial is not the end of the matter. The insurer should identify the part of the policy it relies on, and the homeowner can ask for a review or for the claim to be reconsidered with new evidence. Keep every letter and every email, and note the date and the person who spoke on the phone.
The Office of Superintendent of Insurance is the New Mexico regulator named for complaints about home insurers. Take the claim file, the policy and the correspondence to the complaint. This guide does not state any deadline, statute or penalty figure, and the office is the place to ask about the procedure.
Where does the pest firm fit in?
The pest firm can describe what was found and what was done, and it can supply the report and the photographs. It cannot decide the claim, and it does not speak for the insurer.
A pest firm that is asked by a homeowner for a report for an insurance claim should provide it, with the same care as any other report. The firm should not describe the cause of the damage in a way the evidence does not support, and it should not promise what the insurer will pay.
The homeowner should keep the firm’s report separate from the insurer’s decision. The report is the evidence; the decision is the insurer’s, and the policy wording and the regulator are the references for that decision.
What should a homeowner do in the first week after finding damage?
In the first week, photograph the damage in place, stop any further harm that is safe to stop, call the pest firm for the report, and notify the insurer if the damage is sudden or serious. Keep notes of each step with its date.
The first week matters because the photographs and the notes are the evidence the insurer will ask for. Photograph the damage before anything is cleaned or repaired, with a reference point in the frame. If it is safe, stop the source of further harm, such as a leak or an open gap, and record what was done.
Contact the insurer early if the damage is sudden or serious, so the claim can be opened. A homeowner who waits for the pest report to be complete before telling the insurer may find the timing is questioned later.
What should the homeowner not do?
Do not agree a settlement with a contractor that describes the cause in a way the evidence does not support, do not destroy the damaged material before the insurer has seen it, and do not sign a document from the insurer without reading it.
A contractor or a firm may describe the cause of the damage with confidence. The homeowner should not sign anything that repeats that cause as fact, unless the evidence supports it. A cause written into a document can be hard to change later.
Keep damaged material until the insurer has had a chance to see it, or until the adjuster has agreed in writing that it can be removed. Read every document from the insurer before signing, and ask for the policy wording to be sent if it is not already in hand.
How does a claim interact with a pest firm’s warranty or repair promise?
A pest firm’s repair promise is separate from the insurer’s decision. The firm may stand behind its own work, and the insurer decides what the policy pays. A homeowner should keep the two apart and should not assume one answers the other.
A firm that offers to fix its own sealing or treatment work is making a promise about that work, not about the damage. The insurer may still decide that the damage is outside the policy, and the firm’s promise does not change that decision.
Keep the firm’s written promise with the report, and keep the insurer’s written decision with the claim. The two documents answer different questions, and both are needed if a dispute arises later.
What does a complaint to the regulator usually need?
A complaint to the New Mexico Office of Superintendent of Insurance usually needs the policy number, the claim number, the dates of the damage and the correspondence, and a clear statement of what the homeowner disputes and why.
A clear complaint is easier to act on. Set out the facts in order, attach the policy and the letters, and say what outcome is sought. The regulator can say what its own procedure is, and this guide does not state a time limit or a fee for it.
Keep a copy of everything sent, and note the date and the reference number of each step. A complaint that is well kept is far easier to follow up than one that depends on memory.
Frequently asked questions
Will my policy pay for termite damage?
Termite damage is often excluded in homeowner policies. Read your policy and ask the insurer in writing. This guide does not say what your policy covers.
Should I call my insurer before I call the pest firm?
Call the insurer if the damage is serious or sudden, so that the claim can be started. Keep the damage as it is for the photographs, and call the pest firm to stop further harm and record the cause.
Does the pest firm guarantee its work for the insurer?
This site does not give a guarantee for any work, and it does not make one on a firm’s behalf. Ask the firm what it will stand behind, in writing.
Who regulates home insurance in New Mexico?
The New Mexico Office of Superintendent of Insurance takes complaints about home insurers’ claim handling. It is the complaint route named in the sourced material.
Sources
- New Mexico Office of Superintendent of Insurance, complaint process for home insurers
- New Mexico Office of Superintendent of Insurance, consumer guide (2022)
This guide is general information for Sandoval County homeowners, not a substitute for an on-site inspection. Prices are estimates. See our disclaimer.