In Florida, many insureds are still litigating over Hurricane Irma claims. One of the issues that insurance adjusters often fail to pay for is stucco damage to the structure caused by wind. Many policies, including Commercial, Businessowners, and even the Homeowners HO2 policy, include a version of the following exclusion:
Continue Reading Insurance Carriers Often Misapply Their Policies: The Exterior Paint Or Waterproofing Exclusion Does Not Apply To Stucco Surfaces

Exclusion provisions in a policy work to limit the range of coverage by restricting certain events or losses; often serving as a basis to deny a claim. Nevada case law has long held the burden is on the insured to prove a claim falls within the scope of coverage, and the insurer bears the burden to prove the applicability of an exclusion. However, for the first time the Supreme Court for the State of Nevada was faced with the question of who bears the burden to prove an exception to a policy’s exclusion provision, essentially restoring coverage.1
Continue Reading Nevada Insureds Bear Burden of Proving Exceptions to Exclusion Provisions

The Big I calls the “where you reside” language found in ISO standard language the “catastrophic homeowners policy exclusion.”1 On its website, it states:
Continue Reading “Residence Premises” and “Where You Reside” Insurance Coverage Gaps—The Killer Exclusion That Is Not Listed As An Exclusion: Part Two

A number of questions posed by coverage practitioners recently spiked about residency requirements found in the vast majority of standard homeowners forms. The spike and questions were the result of a particular Order denying a summary judgement.1 The case is still pending in Florida with trial set August 2, 2021. While that case is relatively new, the policy language which acts as a killer exclusion causing a hidden insurance coverage gap has been a topic of great controversy in the insurance industry for well over a decade. An article was published in an agents’ education journal twenty years ago about the “where you reside” wording found in homeowners insurance policies.
Continue Reading “Residence Premises” and “Where You Reside” Insurance Coverage Gaps—The Killer Exclusion That Is Not Listed As An Exclusion: Part One

In a recent case, Sullivan v. Nationwide Affinity Insurance Company,1 the 10th Circuit Court of Appeals upheld a trial court’s decision finding a policy’s earth movement exclusion barred coverage for damage caused by rockfalls. On Monday, the three-judge panel found the policy’s earth movement exclusion is not limited to damage caused by soil movement, but also included rocks, concluding a “rockfall” is a type of “landslide.”
Continue Reading Rockfall Damage Not a Landslide Victory

The loss of market exclusion excludes from coverage any lost profits due to the business’s market disappearing. The loss of market could be due to economic decline, competition, or shifts in demand attributable to a dramatic occurrence. The question, as usual, is whether that exclusion applies to the claims of lost profit by policyholders that follow a covered peril.
Continue Reading Understand Business Interruption—Do Not Let the Insurance Company Deny Your Income Claim on Bogus Loss of Market Exclusions

As the year goes on, state and federal trial courts will continue to tackle legal issues brought on by COVID-19. One recent decision comes from the Middle District of Florida, which recently granted an insurance carrier’s Motion to Dismiss a dental practice’s Complaint brought under the business income and civil authority provisions of the policy.
Continue Reading Trial Court Grants Motion to Dismiss Complaint Based on Virus Exclusion in Policy

Many of the homeowner policies we review exclude water damage resulting from, “continuous or repeated seepage or leakage of water or stream, or the presence of condensation of humidity, moisture or vapor which occurs over a period of weeks, months or years.” Courts have interpreted this clause to exclude water damage that occurs over 14 days. But what happens when you have a situation where there is significant water damage caused in the first thirteen days? Aren’t coverage clauses interpreted broadly so as to afford the greatest protection to the insured, while exclusion clauses interpreted narrowly?
Continue Reading The “Continuous or Repeated Seepage or Leakage of Water” Exclusion

The Certified Question: On July 2, 2020, a Ninth Circuit court of Appeals panel certified the following three-part question to the Nevada Supreme Court:

  1. Whether, under Nevada law, the burden of proving the applicability of an exception to an exclusion of coverage in an insurance policy falls on the insurer or the insured?
  2. Whichever party bears such a burden, may it rely on evidence extrinsic to the complaint to carry its burden, and if so, [3] is it limited to extrinsic evidence available at the time the insured tendered the defense of the lawsuit to the insurer?

The case out of which this certified question arises is Zurich American Insurance Co. v. Ironshore Specialty Insurance Company.1
Continue Reading Who Has the Burden to Prove an Exception to an Exclusion of Coverage in an Insurance Policy?