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.
Continue Reading When Can My Property Insurance Claim Be Denied Due to War or Other Undefined Terms?

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.


Continue Reading Why is the Carrier so Quick to Argue the Wear and Tear Exclusion?

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.
Continue Reading Property Insurer Wrongly Denies You Coverage? Victor Jacobellis and Chip Merlin Discuss How Exceptions to Exclusions Win Coverage

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?
Continue Reading My House Has Suffered Water Damage, Am I Covered?

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.
Continue Reading Broken Water Main Damage: Flood or Not Flood Under Homeowner’s Insurance Policy?

Feenix Parkside LLC owed a commercial building that incurred a partial collapse to their ceiling. When Feenix sought coverage for the collapse, the insurer—Berkley North Pacific—denied coverage for the loss. When Feenix reported the loss, they stated the collapse was due to decay, which was a gradual decline in strength and soundness.
Continue Reading Collapse Loss Ambiguity Determined With Dictionary Help

An Illinois Public Insurance Adjuster recently contacted me regarding an insurer’s denial of a smoke damage claim. The facts were as follows. While a condominium unit owner was using the fireplace in the unit (“unit 1”), smoke began to fill up in the condominium unit above (“unit 2”). The condominium association made a claim to its property insurer for the smoke damage to unit 2. Concluding that the fireplace flu in unit 1 was improperly installed, the insurer denied the association’s claim, asserting exclusions for damage caused by or resulting from (1) faulty workmanship (“the faulty workmanship exclusion”) and (2) the discharge or release of pollutants (“the pollution exclusion”).
Continue Reading Where There Is Smoke, There Is… A Denial

Buy Bill Wilson’s book! This is the least I can say after quoting him about “resulting” or “ensuing” loss provisions following “wear and tear” exclusionary language. I am certain his book helped a judge understand how the coverage works.
Continue Reading Wear and Tear Exclusions Versus Depreciation For Resulting Damage To Worn and Torn Older Parts of a Structure

“One size fits all” is a phrase used to describe pieces of clothing or accessories designed to fit all people. Over time, it has been used to refer to anything meant to apply in all circumstances.

Obviously, one size cannot fit all people. The same holds true when it comes to “freezing” exclusions in homeowner’s insurance policies. Not every freezing exclusion is the same. Compare the following two freezing exclusions.
Continue Reading Freezing Exclusions: One Size Does Not Fit All