Possibly. Many policies exclude or limit coverage for interior water damage unless there is evidence of a wind-created opening in the roof, outside wall, door or window where rain entered the home or business. I often see carriers deny coverage in a manner similar to the below scenario:
On such and such a date, a loss was reported to Insurance Company for water damage from roof leak causing damage to your home. The insured property was inspected by Mr. Adjuster who documented the claimed loss and determined there was no damage to the roof due to a weather condition. Because there was no storm damage to the roof then there would be no coverage for the interior damage to the ceiling in the master bedroom and living room.
The carrier then cites to the applicable water damage or wind-driven rain exclusion amongst other common policy exclusions to deny coverage. Policyholders should be aware of the following policy language:
We do not insure for loss caused by rain, snow, sleet, sand or dust to the interior of a building unless a covered peril first damages the building causing an opening in a roof or outside wall, door or window and the rain, snow, sleet, sand or dust enters through this opening.
An insured may need a second or third opinion when faced with a denial letter citing this popular limitation. A denied claim is always stressful, but a knowledgeable property insurance professional will know the right experts to call to properly review the claim.
In Ortega v. Citizens Property Insurance Corporation,1 the Third District Court of Appeal (“Third DCA”) recently reversed a trial court’s order granting summary judgment in favor of Citizens on similar issues. The material issue was whether a covered peril caused an opening in the roof of the insured’s home, which allowed rain water to enter and damage the home’s interior. The Third DCA held that disputed issues of material fact remained sufficient to preclude an entry of summary judgment in favor of the insurer.
Ms. Ortega made a claim on her homeowner’s insurance policy issued by Citizens after she discovered interior water damage to her home. The policy excluded coverage for direct loss to her home “caused by . . . rain . . . to the interior of a building unless a covered peril first damages the building causing an opening in a roof . . . and the rain . . . enters through this opening.”
Many readers can make an educated guess on what happened next. Citizens inspected Ms. Ortega’s home and denied the claim, stating her roof leak did not occur because of a covered peril that created an opening in the roof. Instead, Citizens cited some of my favorite policy exclusions to date: wear and tear, defect, improper maintenance, and/or improper roof repairs.
Ms. Ortega retained counsel and filed suit. Citizens moved for summary judgment arguing that “there is not one iota of evidence to establish that a covered peril created an opening that first caused damage to the subject roof which resulted in water damage to the interior of the home.” The trial court granted summary judgment in Citizens’ favor, and the Third DCA reversed on appeal.
In its analysis, the Third DCA noted that Ms. Ortega supported her initial response to Citizens’ summary judgment motion with an affidavit from a licensed general contractor and engineer, who attested in his affidavit that:
- He observed classic windstorm damages to the roofing system at the Property, specifically . . . evidence of uplift damage from increased wind forces;
- The damage he observed on the ceilings, walls and baseboards of the property were consistent with a sudden and accidental leak;
- In his professional opinion, the property suffered an accidental direct physical loss to the roofing system from heavy wind and rain which allowed water to enter the Property and cause the interior ceilings to collapse and caused ensuing damage to the interior property; and
- The damage occurred at the Property on or about the date of loss reported by the Insured.
As a result, the Third DCA held:
Contrary to Citizens’ suggestion, as set forth herein, Ortega introduced an “iota of evidence” sufficient to preclude entry of summary judgment on the material issue of whether a covered peril created an opening to the roof of Ortega’s home which then permitted rain water to enter and damage the interior of the home.
As my colleague, Erin Dunnavant, stated in a recent blog, “It is very important to make sure that you have retained the appropriate professionals to evaluate the insurance company’s findings and render reports and affidavits, especially in the face of a summary judgment motion.”
This is a good lesson for policyholders to remember.
1 Ortega v. Citizens Prop. Ins. Corp., No. 3D17-2028, 2018 WL 5623786 (Fla. 3d DCA Oct. 31, 2018).