In December of 2016, I wrote about Sebo v. American Home Assurance Company,1 where the Florida Supreme Court reversed the appellate court’s adoption of the “Proximate Efficient Cause” doctrine and found that instead, the lower court should have applied the “Concurrent Causation Doctrine,” as laid out in Wallach v. Rosenberg,2 in a situation where both the excluded cause of faulty construction, combined with the covered causes of rain and wind resulted in a total loss to Sebo’s property.
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Florida’s Second District Court of Appeal recently reversed final judgment against a homeowner and remanded for a retrial after a jury was instructed that the insured had to prove the damages to his home were caused by a sinkhole. The case, Mejia v. Citizens Property Insurance Corporation,1 stemmed from an insurance claim brought by a homeowner under an all-risks policy issued by Citizens for a sinkhole loss. The homeowner filed suit for breach of contract after Citizens concluded the damages to the insured’s property was not caused by sinkhole activity and denied coverage.


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We have often discussed the importance of the type of insurance policy involved and the difference it makes from a coverage perspective. For example, the burden of proof is different between a named-peril policy and an all-risk policy. Knowing the difference is important, and knowing what your rights are under the policy you have purchased from your insurance carrier is imperative. So, if you have an all-risk policy, and you have an accidental loss that occurs during the policy period, do you have the burden as the policyholder to prove the exact cause of the loss?

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I was recently contacted regarding an insurance carrier that was requiring an insured property owner to disprove a policy exclusion before providing coverage. Litigation concerning policy exclusions is not uncommon. Courts in New Jersey have routinely held the burden of establishing a cause of action is on the plaintiff. The same is true in first party insurance litigation. In such instances, the plaintiff policyholder must establish they have suffered a loss that fits within the basic policy terms. The questions remains, however, who bears the burden with regards to any exclusions in the policy.


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In litigation, parties’ burdens of proof are extremely important. Litigators must understand the burdens of proof applicable to the case they are involved in. Think of the difference between having to prove that a loss is covered pursuant to specific policy terms and having to prove only that a loss that was fortuitous and it affected the insured property. The first situation may be appropriate under a named-peril policy. The second is a policyholder’s burden of proof under an all-risk policy. A recent New York case involved the second situation and an all-risk policy.1


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Most of my blog posts are about hurricanes, roof leaks and fires This week I write about a theft claim submitted under a property insurance policy. American Pepper was a business insured under a policy with Federal Insurance Company. When property was stolen from American Pepper, notice of the loss was given to Federal. After its investigation, Federal sent a letter denying the claim under the concealment and misrepresentation provisions in the policy. 


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On January 4, 2011, I discussed the case of Nat’l Fire Ins. Co. of Pittsburgh, PA v. Valero Energy Corp., 777 S.W.2d 501 (Tex.App.—Corpus Christi 1989, writ denied). Nat’l Fire taught us that an otherwise excluded peril could be covered under an insurance policy if the policyholder could demonstrate that the excluded peril itself was caused by a covered peril. However, even if the policyholder can demonstrate that an excluded peril was caused by a covered peril, the policyholder still has work to do: s/he must also show the extent of the damage attributable to the covered peril. But what does that mean? The Texas First District Court of Appeals dealt with this very issue in Travelers Personal Sec. Ins. Co. v. McClelland, 189 S.W.3d 846 (Tex.App.—Houston [1st Dist.] 2006, no pet.).


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An “all-risk” insurance policy provides coverage for all fortuitous losses, less enumerated exclusions. Imperial Ins. Co. v. Ellington, 498 S.W. 2d 368, 371 (Tex. App.- San Antonio 1973, writ denied). Generally under an all-risk policy, the insured need only prove a fortuitous event resulted in a loss. Id. at 375. If the all-risk policy excludes coverage, the insurer must prove that the loss is excluded. Texas Ins. Code § 554.002.

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