Claim Type 2: Reimbursement Application

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  • BEFORE YOU COMPLETE THIS APPLICATION:

    Did you purchase this home on or after February 1, 2019?

    If the answer is "no," please proceed to the application.

    If the answer is "yes," PLEASE CONTINUE TO READ and be aware of CFSIC's guidelines on this subject.

    1. If "yes"…you MUST HAVE in your possession EITHER a visual examination report assigning a CFSIC Severity Class code of 3, 2, or 1 to the foundation OR a foundation core testing report (not both…it's just EITHER).
    2. If "yes"…the date of either report MUST BE a date prior to the date on which you purchased the home.
    3. If "yes"…for an inspection report, it doesn't make any difference if the Severity Class assigned is 3, 2, or 1.
    4. If "yes"…for a foundation core test report, it doesn't make any difference whether the results are positive OR negative for the existence of pyrrhotite…and if positive, it makes no difference as to the amount of pyrrhotite.

    If you purchased your home on or after February 1, 2019 and you have not observed these rules, your claim will be rejected.

  • Claimant Notice:
    

    ** You are applying as a Pending claimant. Because of that specific designation,
your application will be registered and confirmed, but your claim details may not be
reviewed by an adjuster for some time to come, based on the backlog of earlier applications
and the way in which the CFSIC program is funded.
We will not lose your application. **
    
* If you start this application and need more time, there is a "Save and Continue Later" button
at the very end of the application to save your work and return to the application later.
  • (40 character max)
  • Select date MM slash DD slash YYYY
    (To learn about why the date of purchase is important to your eligibility, please go to Appendix 1 to this application, which is found at the very end of the application after the signature and date lines.)
    (PLEASE NOTE: If the owner of an eligible residential building is a contractor who participates or plans to participate in the CFSIC program as a contractor providing foundation replacement services to the public, that contractor will be ineligible to apply for either a Type 1 or Type 2 claim with respect to any eligible residential building unless such contractor seeks acceptable bids for Type 1 foundation replacement claims from contractors not owned or controlled directly or indirectly, in whole or in part, by the contractor-owner of the eligible residential building. With respect to a Type 2 claim involving a contractor-owner, the contractor-owner will have to represent and warrant that the work performed to replace a foundation for an eligible residential building was not performed by that contractor-owner or by a contractor owned or controlled directly or indirectly, in whole or in part, by the contractor-owner of the residential building. If you check “yes” to Question 9, you are representing and warranting that this is the case with respect to either type of claim.)
  • PLEASE NOTE: Type 2 claimants may make a claim for the reimbursement of a partial foundation replacement on a one-time basis, with the understanding that the claim payment made for a partial foundation replacement will be considered as part of a single claim involving the residential building and will be deducted from any final claim payment made, the total of which will at all times be subject to CFSIC’s cap on a total eligible claim.

  • PLEASE NOTE: Before answering question #14 and #15 below, please note that CFSIC will not consider as eligible for reimbursement any of the following costs or expenses which may have been incurred as a result of the partial or full replacement of any foundation:

    • Replacement of drywall and/or finishing wall features, including re-framing;
    • Removal/replacement of porches or decks;
    • Removal/replacement of gutters;
    • Removal/replacement of landscaping features such as driveways, walkways, paths, shrubs, lawns, trees, gardens, or other plantings or garden structures;
    • Any work done to outbuildings, sheds, or barns;
    • Swimming pools, whether in-ground or above-ground, or any ponds or water features;
    • Moving or relocation expense;
    • Temporary housing expense;
    • Meals, transportation, mileage, and incidentals;
    • Loss of wages or income or revenue associated with any work or any business, whether such business is home-based or not;
    • Any liability incurred by the homeowner or any other person on a direct, indirect, or consequential basis.
  • [PLEASE NOTE: If your foundation was replaced on or after January 10, 2019, you cannot submit a Type 2 claim for foundation reimbursement unless that work was performed by a CRCOG-approved contractor.]

    [ALSO NOTE: The amount in the answer to #15 above must correspond exactly to the amount shown in the contractor’s contract amendment or separate letter and on contractor’s letterhead (in either case, inclusive of the contractor worksheet) to be attached to your application.]
  • (PLEASE NOTE: Some commercial insurers provide direct financial assistance to their current or prior homeowner insureds who are in turn also CFSIC-approved claimants whose claims have been first fully adjusted and paid by CFSIC. For a complete list of those insurers, go to www.crumblingfoundations.org)
    - OR -


  • The person signing this application represents and warrants that all information in this application is truthful and accurate.

    In order for an application to be considered for reimbursement, it must be complete, with no questions left unanswered. It must be signed and dated.

    In addition to the completed application, you must attach or include the following:

    (a) Evidence of current ownership of the building in question, such as a local tax bill.

    (b) If a core test or other type of approved laboratory analysis was done, a copy of the final laboratory report, OR

    (c) If a visual inspection was done, a copy of the final written report;

    (d) If you have made a claim to a current or prior homeowner’s insurer and the claim has been denied or is pending, evidence by way of a letter of denial, or evidence by way of a letter indicating that the claim has not been denied and is therefore under active consideration. (The term “current homeowner’s insurer” means the homeowner’s policy in force as of the date the claimant signs his or her CFSIC application; the term “prior homeowner’s insurer” means the homeowner’s policy that was in force at the time a claim was filed with a prior homeowner’s insurer.) Type 2 claimants will not have their claims be made active unless they can produce a claim denial or acceptance, with respect to the foundation in question, from a current or prior insurer.

    (e) If you have made a claim to a current or prior homeowner's insurer and the claim has been paid, in whole or in part, evidence by way of a letter indicating the amount of the settlement made or the settlement to be made.

    (f) Evidence that the building or structure in question was originally constructed during calendar year 1983 or subsequent.

    (g) A Certificate of Completion signed by the building inspector of the town in which the residential building is located, which was provided at the time the foundation replacement was completed.

    (h) Evidence in writing, obtained from the contractor who replaced your foundation, confirming the replacement work done to the foundation in question, itemizing all costs and expenses associated with the work done as that work relates to the replacement cost parameters specifically shown in these guidelines, and indicating how much of the work may have been covered by insurance and how much was covered by out-of-pocket private payment. This would be required even when the claimant litigated the claim with the insurer in question.

    (To the extent your application is accepted for participation in the CFSIC program and you are not the owner of the residential building in question by virtue of your response to question #8, you will be provided with a Power of Attorney form and instructions for its completion. The Power of Attorney must be completed and received by CFSIC prior to any further consideration of your claim.)

    [PLEASE NOTE: Reimbursement will only be made to the current owner (or with respect to a Legacy Claimant, the former owner) of the residential building in question who, in addition, was also responsible for the payment of the replaced foundation, whether such payment was made in whole or in part.] 

    Please be aware that applications not accompanied by each and every required piece of evidence noted above are permitted, 
but with the understanding that for a claim to be deemed as “active” and therefore potentially eligible for funding, 
all points of evidence required must eventually be submitted.
    By signing this application, or authorizing a representative to sign on their behalf, the claimant agrees, to the extent the application is approved for reimbursement, to become a “Participant,” among any other claimants, in the indemnification and reimbursement program facilitated by CFSIC’s unincorporated protected cell. Claimants shall not, by virtue of their participation in the CFSIC indemnification and reimbursement program, have any ownership interest or voting rights in CFSIC or its protected cell. The claimant acknowledges that funds available to pay the CFSIC claims shall be limited to assets contributed to the protected cell by the State of Connecticut and other available funding sources, if any, for the purpose of funding such claims, excluding those claims involving collaborating insurers, if any. All Participants approved for reimbursement under this application acknowledge and agree that all claim payments made by CFSIC will be remitted directly to the owner of the residential building. Participants further agree that they acknowledge and understand that CFSIC will have no responsibility in any way, directly, indirectly, or vicariously, for the quality of a chosen contractor's workmanship. All Participants will be required to enter into a Participant Agreement upon acceptance to their claim prior to any claim payment being made.

  • “In Connecticut, a person is guilty of insurance fraud when, with the intent to injure, defraud, or deceive any insurance company, he knowingly presents false, incomplete, or misleading information in support of an insurance application, claim, or other benefit. The offense includes conspiracy. Insurance fraud is a class D felony, which subjects a person to a fine up to $5,000, up to five years imprisonment, or both (C.G.S. § 53a-215).”



  • APPENDIX 1

    The Board of Directors of CFSIC has determined that the eligibility of claimants with respect to both Type 1 and Type 2 claims is affected by the date on which the affected residential building was purchased. With respect to such eligibility:

    • For any residential building purchased on or after February 1, 2019, if the buyer of such residential building is aware that the building or any addition(s) to the building, inclusive of any garage, was constructed in 1983 or subsequent, such buyer will only be eligible to apply to CFSIC as a Type 1 or Type 2 claimant if the buyer or seller of the building has tested for pyrrhotite, or has conducted a visual exam for evidence of pyrrhotite conducted by a Connecticut-licensed professional engineer or CFSIC-certified home inspector, prior to the date of sale;

    This Appendix is a material part of the application. A claimant signing this application acknowledges his or her understanding of the terms and conditions of this Appendix, and agrees to be bound by those terms and conditions.

  • Next Steps


    There are two “Next-Step” options, based on your progress in completing the above application. 

    Option #1: You have completed all the questions on the application.

You are now ready to sign, date and submit the application before uploading your attachments.
In the boxes below, please sign your name (with your mouse), then type your name, and add today’s date.
Then, click the CAPTCHA checkbox to confirm you are human (and not a robot). At that point, click the
“Submit” button, a new page will appear showing you how to upload all your attachments.

    Option #2: You require more time to complete the application.

If you need more time to complete your application, go directly to the “Save and Continue Later”
button below.  This option will save your answers and provide a clickable link for you to return to,
within 30-days, to complete your application.


    The person signing this application acknowledges that this is an application to become a Pending claimant of CFSIC as that term is defined by CFSIC’s Underwriting and Claims Management Guidelines; and the applicant acknowledges that as a Pending claimant the claim may never be eligible for payment.

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    (to re-attempt signature, click the circle symbol above to clear and re-sign)
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