Insurance companies and their repeatedly very well paid for consultants understand that expert consultants can drive the value of a claim. Nobody in the insurance industry is going to say insurance company experts are bought and paid for, but anybody in this business for long knows what is really going on. It forces everybody to be skeptical because many insurers, not all, want their adjusters and attorneys to find ways to minimize payment by hiring ever so clever outcome-oriented vendors to only provide a narrative for less payment.
I suggest that readers of this article read and study my recent blog post, Exact Proofs of Loss and Flood Claims: Procedure Drowns Reality. One of the main contentions was the replacement of tile following a flood. A basic truth that engineers, builders, and anyone who owns property understands instinctively is that property is not static. Buildings age. Materials fatigue. Adhesives cure, shrink, and slowly lose tolerance. Membranes dry out. Concrete moves. None of this is damage in the insurance sense. It is simply the condition of existence. Yet, national flood insurance claims are often evaluated as though structures should behave like laboratory specimens, frozen in time until the moment water arrives.
This disconnect becomes most visible in disputes over materials like tile, flooring systems, mechanical components, and assemblies that FEMA and insurers routinely label as “flood-damage-resistant.” That label has taken on a life of its own in NFIP claims, frequently being used as a substitute for causation analysis rather than the starting point for it.
The moment of coverage in a property insurance claim is not the moment water touches a surface. It is the moment floodwater acts upon real property as it exists at that time, whether aged, imperfect, exposed, and carrying the history of years of use. Floodwater does not arrive in a vacuum. It arrives in systems that already have tolerances, margins of safety, and latent vulnerabilities. The question is not whether those vulnerabilities existed beforehand. The question is whether floodwater converted a serviceable condition into a loss.
That distinction is often blurred or intentionally ignored by insurance industry experts and consultants in flood claims, relying on categorical assumptions. We see this most clearly in tile disputes.
Industry standards do generally recognize ceramic tile as water resistant. Thin-set mortar is cement-based. Grout is inorganic. From those truths, claims decisions often leap to an unwarranted conclusion that floodwater cannot cause tile failure. That conclusion only holds if one assumes clean water, brief exposure, intact membranes, perfect installation, and complete post-loss drying. Those assumptions rarely survive contact with a hurricane. Why don’t these experts say this in their reports unless they are biased reports?
Floodwater is not neutral. It carries salts, organic matter, sewage, petroleum residues, fine sediments, and biological contaminants. These materials alter the chemistry of what they touch. Chlorides migrate. Organic matter feeds microbial growth. Fine sediments lodge beneath finishes. Prolonged saturation changes how assemblies behave, even when the individual components are theoretically “durable.” When floodwater enters through grout joints, microcracks, perimeter gaps, or control joints, and it almost always does, it reaches layers that were never designed to be submerged in contaminated water.
Again, why don’t insurance industry vendors and experts write about this and include it in their reports if they are truly independent?
In that moment of loss, floodwater may not instantly cause tiles to pop loose, but it can materially degrade the bond interface, saturate crack isolation membranes, trap contamination beneath impermeable surfaces, and make proper sanitation and drying impossible without removal. That is not hypothetical. It is what remediation professionals confront every day in real losses.
To repeat the important point, why don’t insurance industry vendors and experts fully write about this alternative and place this into their reports if they are truly independent and not biased to help insurance companies pay less?
Flood claim denials and other property insurance denials frequently reframe this reality as “exacerbation of a pre-existing condition.” That phrase has become a powerful rhetorical tool. It suggests that if anything about the assembly was imperfect before the loss, the property loss becomes legally irrelevant. This framing collapses causation into a false either-or choice: either the property was perfect, and peril damaged it, or it was imperfect, and the insured peril did nothing. Real-world failures do not work that way.
Every material system has a failure threshold. Aging, wear, and minor defects reduce the margin between normal performance and failure. In flood claims, as an example, floodwater is the force that pushes systems past that threshold. When that happens, the flood has caused damage, even if it did not create the original vulnerability. Traditional property insurance law recognizes this. Insurers take property as they find it, not as it was when it left the factory or passed its final inspection.
The NFIP context often resists this principle because of its regulatory and fiscal structure. Courts analyzing national flood losses repeatedly emphasize protection of the public treasury, and FEMA’s claims framework reflects a preference for bright-line rules over nuanced causation analysis. That preference may be administratively efficient, but it comes at the cost of accuracy. It encourages reliance on generalized industry statements rather than loss-specific evaluations. It also incentivizes the use of engineers whose opinions fit neatly within pre-approved denial categories.
This is where both policyholders and insurers should be cautious. When coverage decisions rest on broad assertions that something “cannot” happen, rather than on a careful examination of how it did happen in a specific loss, alarm bells should ring. Buildings are complex systems. Damage is often progressive. Floodwater, like other perils, interacts with materials, assemblies, and conditions in ways that cannot be reduced to a single handbook citation.
There is also a hygiene and habitability component that is routinely under-appreciated with the specific material at issue. For example, even if a tile remains bonded, floodwater trapped beneath it can pose a health risk that cannot be resolved through surface cleaning. Environmental professionals often recommend removal not because of visible failure, but because contamination cannot be reliably eliminated in place. Treating that recommendation as irrelevant because the tile did not immediately debond is an example of technical formalism overriding practical reality.
The same analytical flaw appears in discussions of metal components, mechanical systems, and assemblies like stovepipes. Corrosion, fatigue, and age are part of the normal course of existence. Floodwater that accelerates corrosion, destabilizes supports, or introduces contaminants that shorten service life is not merely revealing deterioration. Instead, it is acting upon it to produce loss. To deny coverage on the ground that the component was not new is to deny how damage actually occurs.
What is most concerning is not that FEMA or insurers rely on industry standards. Those standards matter. What is concerning is the failure to fully engage with the complexity of how those standards apply or fail to apply under catastrophic loss conditions. Standards are context-dependent. They assume conditions that perils routinely destroy.
Policyholders should be skeptical of coverage determinations that sound simple in situations that are anything but that. Insurers’ claims management should be equally wary of overconfidence in generalized conclusions that may not withstand scrutiny outside the narrow confines of what engineers may fail to say. Insurance company engineers, adjusters, and lawyers alike should resist the temptation to flatten complex losses into convenient narratives to suit their desire to prove they can reduce claims severity as a metric to gain future business.
Insurance losses are often about how force, time, and pre-existing conditions interact to transform usable property into damaged property. Anyone who claims that these interactions can be resolved with a single sentence about industry standards is not explaining the loss. They are avoiding it. Policyholders and their advocates need to understand and study how to challenge these on a routine basis in the modern claims adjustment process.
Insurance claims complexity is not an inconvenience. It is the reality. Ignoring that reality does not make claims handling more accurate. It only makes it easier to deny and calls for more professionalism to challenge.
I would suggest that readers of this blog also consider studying The Outcome Oriented Claims Culture Is Pervasive and Killing Any Good Will Towards the Insurance Industry.
Thought For The Day
“It is difficult to get a man to understand something, when his salary depends upon his not understanding it.”
Upton Sinclair
