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From the Editor
"Ask an Expert" Briefs
Roof ice dams are a common phenomenon in the north and can result in significant damage when water thaws, is blocked by an ice dam, and flows back under shingles or eaves and into buildings. In this article, we'll explore the insurance implications of ice dams. Just as important, we'll look at some loss control measures your insureds can take to prevent or minimize damage caused by ice dams.
Are ‘Mudslides’ Covered by HO or Flood Policies?
We are all aware of the human tragedy involved in the landslide which buried homes in Darrington, Washington in March 2014. From the perspective of our industry, the first question is whether a “landslide” is covered by most homeowner policies. And, since this may have been more of a “mudslide” than a landslide, is it possible that coverage could be found under an NFIP flood policy? If the answer to both questions is “No,” then is this exposure insurable?
HO Dock Damage…Water or Wind?
A boat dock was damaged by boats blown in a windstorm. The adjuster has denied the claim, citing the “water damage” exclusion reference to water damage “whether or not driven by wind.” Does this exclusion apply in this non-ISO homeowners policy?
Is Damage Caused by a Dropped Object Excluded as “Marring”?
Case law can be a great tool in resolving coverage and claims disputes. Find a precedent-setting court case to support your position and you’ve probably won the debate. However, not all court decisions are correct. This article illustrates that point when a court, we believe, erroneously considers damage caused by a dropped object to constitute “marring” which is excluded by the policy.
Thermal damage to Vinyl Siding…Covered by an HO Policy?
A homeowner has his vinyl siding painted a darker color. Direct or reflected sunlight then causes the siding to warp. Does his HO policy cover this damage? If liable, does a neighbor’s HO policy cover a liability claim that the damage was due to reflected light from the neighbor’s windows? To answer the question of whether the painter’s CGL policy might respond, check out this VU article.
Wear and Tear and the HO Policy
An insured’s party guest wore spiked high heels that left major dents in his home’s hardwood floors. The adjuster has denied the damage, citing the “marring” and “wear and tear” exclusion and suggests the insured file a claim against the guest’s policy. Does the ISO HO-3 homeowners form cover this type of loss?
Property Coverage for Damage Caused by Windblown Lake Ice
A home is located on a lake that is covered in ice during the winter. In the spring, when the ice breaks up, a strong wind “pushes” ice across the lake and the backyard and into the dwelling. Is this damage covered by an HO policy? If it’s a commercial building, is it covered? What about an NFIP policy?
Coverage for Fuel Oil Spills
A furnace was supplied by two fuel oil tanks in the basement. The tanks had just been filled when one or more of the legs on the tanks failed under the weight of the fuel oil, which in turn broke the pipe connecting the two tanks, spilling fuel oil into the finished area of the basement. The sump pump in the basement subsequently pumped some fuel oil into a creek/ditch that traverses the property, requiring an EPA clean-up. The insurer has denied all property damage and clean-up costs. Is there any coverage for this under the HO or umbrella policies?
Does the HO 'Neglect' Exclusion Apply to Roof Snow Accumulation?
What if snow that accumulates on a roof over time results in collapse? Could the carrier deny the claim, citing the 'Neglect' exclusion in the HO policy due to the insured's failure to have the snow removed? Below is an 'Ask an Expert' question and the responses of our faculty members. As always, if you have anything to add, send an email to Bill.Wilson@iiaba.net.
Earth Movement or Falling Object?
A boulder dislodged from a hillside and ended up inside a home at the bottom. Is this excluded as earth movement or would it be covered as a falling object or any other non-excluded peril under the HO-3?
HO Coverage for Glass Scratched by Contractors
The insured owns an expensive home with numerous high end windows. He hired a window washer with 25+ years experience to clean and wash the windows. While removing plaster and varnish from the windows, he scratched most of them. The insured subsequently learned that the window washer is uninsured. Does the insured have any coverage under his homeowners policy?
I See Dead People...Are They Covered?
While it's an unpleasant topic to consider, sometimes people pass away in their homes and their bodies are undiscovered for weeks. Decomposition can lead to decay and loss of body fluids. Similarly, the clean-up costs for firearms-related suicides can cost thousands of dollars. Are these clean-up and removal expenses covered by homeowners policies or is coverage removed via the pollution exclusion?
Is Animal Feces a "Pollutant"?
Two denied claims were brought to our attention recently. In the first, raccoons had scratched through siding and were nesting in the attic of an Indiana home. The HO insurer paid for the structural damage, but refused to pay for damage caused by raccoon feces and bat guano, citing the pollution exclusion. The second claim was virtually identical except that the offender was a family of opposums in the attic of an Alabama home. Does the ISO HO-3 cover animal feces or not?
Mechanical Breakdown Exclusion
Most 'all risks' policies contain a mechanical breakdown exclusion. Often this exclusion, like many other 'all risks' exclusions, is misunderstood. This misunderstanding can sometimes result in the denial of a claim that would be covered by an inferior 'named perils' policy. This article explains why that should not happen.
Skunk Claim Denials: Something or Somebody Stinks
Given the number of questions our 'Ask an Expert' service receives about skunk claims, this is apparently a daily occurrence across America. The three most common bases for denying such claims are the pollution exclusion (no kidding) and the rodent or vermin exclusions. In this article, we'll explain why we believe none of these exclusions apply in most claims.
Soot...Is It Covered?
November is the time of year when homeowners and businesses crank up their heating equipment after months of disuse. Recently, our 'Ask an Expert' service received three questions regarding coverage, in both personal and commercial lines, for soot damage/clean-up caused by furnaces. In addition, we had a similar question about soot buildup from candles. In this article, we'll take a look at whether or not soot is covered by homeowners and commercial property policies.
Surface Water Revisited
An insured suffered severe water damage to the interior of the second floor of a dwelling. A heavy rain storm caused water to accumulate on a second floor deck which seeped into the interior of the structure. The homeowners insurer has denied coverage based on the exclusion for 'surface water.' The insured is arguing that 'surface water' refers to the accumulation of water on the ground, not 12 feet above it. Who's right?
Surface Water...What Is It?
One of the most common questions we get in our 'Ask an Expert' service goes something like this: 'Our insured suffered water damage to his basement when rain puddled and was blown in under or around the basement door.' While the HO policy generally covers rain, it excludes 'surface water,' a term not defined in the policy. In this article, we'll take a look at what constitutes covered or uncovered water damage from rain.
The "Rodent" Exclusion
In one of ACE Insura's adventures, damage was caused by a skunk. One of the exclusions cited by the adjuster applied to damage caused by rodents. You may have experienced similar claim denials with other critters such as squirrels. So, the question is, outside of mice and rats, what is a 'rodent'? You'll want to save this article for future reference in case a 'rat' is involved in a claim denial. :-)
The Concurrent Causation Exclusion
A number of years ago, ISO added 'concurrent causation' exclusionary wording to its personal and commercial lines property forms. This was done in response to several onerous court decisions that found coverage where none was intended. However, as sometimes is the case (e.g., with the pollution exclusion), this policy language itself can be interpreted onerously....
The HO Policy and Power Surges
Recently, I was contacted by an agent whose client was solicited by his power company to purchase insurance for power surge and lightning. As a commercial lines agent, he knew that power surges aren't covered by most standard commercial property policies, but he wasn't sure about homeowners policies. So, is this coverage needed or not?
The HO Policy and Underground Leaks
A contractor built a new inground pool for the insured. After the pool was installed, an underground leak was discovered in a water line between the house and pool after concrete walkways began to buckle. The adjuster denied coverage based on the earth movement and water damage exclusions. Is this correct?
The HO Policy War Exclusion
Recently we heard from an agent whose client has a son in Iraq. He wanted to know if his son's personal effects would be covered by his HO policy if damaged while there. As we all know, TRIA does not apply to personal lines, so how would the HO policy respond, if at all?
The Wear and Tear Exclusion Revisited
One of the most misunderstood policy provisions is the family of exclusions that deal with wear and tear, mechanical breakdown, etc. So far, we've published articles on mechanical breakdown under the HO and PAP policies and on wear and tear under a commercial property form. In this issue, we'll examine a collapse claim under the HO policy that was denied on the basis of wear and tear.
Tree Roots and Sewer Lines
Your insured discovers that the toilets, sinks and tubs won't drain. The plumber discovers a blockage in the main sewer line running from the house to the street caused by tree roots. Is any 'backup' damage covered by the HO policy? Is the cost to replace or re-run the sewer line covered?
What is "Fragile"?
A large, ornate wooden bowl was scheduled on the insured's HO policy. The bowl was accidentally broken and the insurer denied the claim citing the exclusion for 'breakage of art glass windows, glassware, statuary, marble, bric-a-brac, porcelains and SIMILAR FRAGILE ARTICLES.' Is a wooden bowl a 'fragile' article? This article will discuss this issue, including an extremely important legal principle that may apply to many claims.
What is a "Vermin"?
Mice, roaches, snakes, turtles, bats, pigeons, raccoons, skunks, carpet beetles, squirrels. What do these critters have in common? They have all been cited as 'vermin' in claim denials. In this article, we'll look at these varmints, examining a number of court cases, in an effort to determine what's a 'vermin.'
When "Deluxe" Really Isn't
A number of insurers have 'deluxe' homeowners packages that add all sorts of bells and whistles to the plain vanilla ISO program. Since these 'deluxe' packages typically cost more and provide generally broader coverages, they should be better for insureds, shouldn't they? Well, not necessarily. As is often the case...it depends.
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