Exclusion

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Most homeowners are surprised to learn that almost all homeowners’ policies include exclusions for damage caused by sewage water originating outside their home. For example, if your city or county’s sewer main line backs up because of tree roots or debris and the sewage water backs up into your home, the resulting damage will not be covered, or if it is, may be subject to significant limits—often covering only $5,000 or $10,000 of damage. Given the scope of cleaning required in these events, this amount will likely not cover even the costs to clean up the sewage. What’s more, some policies even exclude backups on the homeowner’s own lateral lines. Insurers may offer policy endorsements for coverage at an additional cost, but as many homeowners shop based on price alone, they may not realize they lack the coverage until it is too late.…
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In a recent case,1 a federal appeals court addressed the issue of whether fire damage to a vacant dwelling from an arsonist was considered distinct from vandalism, so as to not implicate an exclusion within a homeowners insurance policy. In that case, Wells Fargo Bank owned an insurance policy on an abandoned house that an arsonist set ablaze. The insured sued its insurer after the insurer refused to indemnify the insured for the loss, relying on a policy provision exclusion for damage caused by “vandalism or malicious mischief” after the property had been vacant for more than thirty consecutive days.…
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Chip Merlin & Guy Cohen

Public adjuster Guy Cohen and I discussed various issues of property insurance and adjustment at a recent lunch. He raised a very serious topic of coverage gaps being created in the small print of property insurance policies which Florida insurance regulators are allowing to be sold. He thinks that these coverage gaps are the most serious issues facing insurance consumers. He is not alone.…
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Chomp, Chomp!

Insurance Policies are designed to cover sudden and accidental loss and damage. Mary Wischusen, 77, believed that she had a suffered a sudden and accidental act of nature and that coverage would be afforded when a gator came crashing into her kitchen. This 11-foot alligator was not her domestic pet or a planned guest, but her insurance company has denied the claim.…
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I often receive calls from policyholders asking how an insurance company can deny their claim based on an exclusion that isn’t defined in the policy. One of these terms is “surface water,” a common exclusion found in most policies. Recently, I had a client whose home’s gutter system malfunctioned during a rainstorm. Rather than channeling water to run from his roof, through the gutter system and out to the street, water was redirected at the side of the home. The water filled up a planter built in to the side of the house and eventually made its way into the home, damaging his flooring.…
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Chip Merlin posted about the Wear and Tear Exclusion just last month in Wear and Tear Exclusions Versus Depreciation For Resulting Damage To Worn and Torn Older Parts of a Structure. Explaining about wear and tear, Chip gave this example:

The judge made up his own example of ten old bolts giving way and then the rest of what the bolts failed to hold up, crashed and broke the rest of the old structure. The worn-out bolts may not be covered, but if you have the right ensuing loss provisions after the “wear and tear” clause, the rest of the loss is covered—even if the rest is old.

The older parts of the structure are the ensuing loss. They did not suffer a loss because they were worn out and broke. They suffered a loss because other parts of the structure broke from “wear and tear.” Those ensuing parts of the loss are depreciated on an actual cash value basis. If replaced, they are then valued at Replacement Cost.

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Victor Jacobellis and Chip Merlin

Victor Jacobellis left his job in San Francisco representing insurance companies to join Merlin Law Group and help policyholders obtain insurance coverage benefits. He asked me to speak with him about exceptions to exclusions of coverage which are often overlooked and lead to wrongful denials of coverage. The photo above shows yours truly speaking with Victor Jacobellis in Napa, California at the National Association of Public Insurance Adjusters Annual Conference on this important insurance topic.…
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Lately, much of the United States have seen wild swings of severe weather. From the mid 70’s on Saturday to 47 degrees and an inch of rain on Monday, severe weather can wreak havoc on your home. With torrential rains and flash flood in most parts of the Northeast recently, many find themselves asking: my house has suffered water damage, am I covered?…
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In a recent court opinion,1 the New Jersey Appellate Division interpreted a homeowner’s insurance policy’s water damage exclusion and determined whether damage from a broken municipal water main under a public street was covered under the policy. In that case, a homeowner brought an action against his insurer for breach of contract after the insurer disclaimed coverage on the basis that damage to his real and personal property resulting from a broken water main was excluded under the policy as flood, surface and ground water intrusion.…
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