I have been involved in several commercial property claims where the insurer has agreed to pay the cost to remove and to replace roof shingles damaged by hail, but has refused to pay the cost to remove and to replace the decking, even though the condition of the decking is such that it no longer is in a suitable condition for application of the new shingles. The insurer’s reasons for refusing to pay for the costs of the decking removal and replacement are two-fold: (1) no coverage is afforded for the decking because it was not directly damaged by hail and (2) replacement of the decking is a code upgrade, and in my claims there was limited ordinance or law coverage. So, is the insurer right? Is replacing roof decking as part of replacing hail-damaged shingles a coverage or a scope issue? In my opinion, it is a scope of repair/replacement issue.
Continue Reading Replacing Roof Decking as Part of Replacing Roof Shingles: Coverage or Scope Issue?

In Florida, you can rely on three things with certainty—death, taxes, and high property insurance premiums. The reason for the latter is the subject of an intense debate that plays itself out in the halls of Tallahassee and on the editorial pages of our leading newspapers. I will not rehash the debate; our blog archives are full of articles on that subject. However, I want to highlight an article in the Sun-Sentinel I recently came across: Insurers widening lists of things they won’t cover.


Continue Reading More Money for Less Coverage

Floods do all sorts of damage. One aspect of damage often overlooked is when the flood removes property from one property owner’s land and deposits it on another’s land. Depending on where your property is located and the severity of the flood event, the debris on the policyholder’s property can be extensive and expensive to clean up. The question naturally becomes, is this a covered loss under the Standard Flood Insurance Policy?


Continue Reading Under Flood Policy, Land is Not Considered Insured Property

The words on the page of the insurance policy matter and are very important to both parties to the agreement. Since the insurance company drafts the policy, if there is any ambiguity in the terms it writes and selects, ambiguity and interpretation will be resolved in the policyholder’s favor and in favor of coverage. However, some Florida courts have allowed insurance carriers to present extrinsic evidence, such as internal operating guidelines, to clarify or explain ambiguous policy language.


Continue Reading Florida Supreme Court Says Ambiguities in Policy Language Are To Be Construed in Favor of the Policyholder and Coverage Without Considering Extrinsic Evidence

In North Carolina, when an insurance carrier alleges that a policy should be voided because of an application misrepresentation, the allegation is that an insured made a representation that is false and material, and the policy may be voided even if the statement was not fraudulent.1


Continue Reading Carolina Coverage: Can an Innocent Mistake Void your Insurance Policy in North Carolina

Insurance claims people handling first party property insurance claim appraisals in New York may be experiencing responses from insurance carriers informing them appraisal is inappropriate because there are coverage issues involved in the claim. Some are getting this response even where partial payment has been made on the claim. If that is your case, you may find some reassurance in a trial court opinion from New York on appraisal.


Continue Reading Appraisal May be Appropriate in New York, Even if There Are Coverage Issues

Two weeks ago, Southern California experienced unusually strong Santa Ana winds which brought gusts up to 140 mph in some places. Southern Californians, particularly in the Pasadena area, were forced to clean up debris left by the storm. A staggering 18,000 tons of debris was cleaned up in Pasadena, which is the city’s normal total for one year. Parts of Pasadena were left without power for seven days; approximately 419,000 customers effected by the outages at one time. The State estimates that the hurricane force winds caused at least $40 million in damage.


Continue Reading Southern California Braces for More Strong Winds; Damage to Structure Interiors May Not Be Covered

Recently I’ve been approached by several public adjusters regarding coverage limit and underinsured issues with their clients’ insurance policies after a loss. Specifically, I’ve been asked if an insured has any recourse when the insured’s policy falls short, leaving the insured effectively underinsured.


Continue Reading It is the Insured’s Responsibility to Maintain Adequate Coverage Limits