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5 Justifications for Homeowner Insurance Denial

Mon Aug 31st, 2020 on     Homeowners Insurance,    

Experienced Miami Insurance Litigation Lawyer  

As a general rule, homeowners purchase property insurance with a level of optimism — they tend to operate under the assumption that, in the event their property is seriously damaged, they will be covered by the purchased policy, and that submitting a claim (and receiving the necessary payout) will be fairly straightforward.

Unfortunately, homeowners often find that the truth is quite a bit messier than they might have originally thought.

Insurance companies will deny — or if necessary, undervalue — homeowner’s insurance claims where possible to do so, even if they do not have a particularly strong argument.  They count on the fact that many homeowners are too preoccupied with other issues (namely, fixing the property and the various demands of everyday life) to pursue the claim.

That’s where we come in.

If you would like to speak to an experienced Miami insurance litigation lawyer about your homeowners’ insurance claim, we encourage you to contact Ver Ploeg & Marino, P.A. as soon as possible to schedule a consultation.

Curious about what justifications insurers use to deny (or undervalue) legitimate homeowner’s insurance claims?  Consider the following.

Third-Party Misconduct Led to the Property Damage

Homeowners’ insurance policies do not generally cover third-party misconduct — instead, those third-parties must be held liable for property damage caused.  Your insurer will likely not be willing to pay out for damages caused by a third-party.

Homeowners’ insurance is primarily meant to cover property damage that was caused by a natural event or any other event that was not proximately caused by another’s misconduct (or even your own).

For example, if you paid a woodcutter to come onto your property and cut down a tree, and it falls on your home and causes serious damage, the insurer is not likely to pay for those tree-related losses, as the third-party was responsible for it.  By comparison, had the tree collapsed your home after a bad storm, the insurance policy may have covered it (depending on what the policy says about covered perils and natural disasters).

That simple change in how the event occurred could spell the difference between a payout and a denial.  This can be rather frustrating for homeowners who are not fully aware of how the conduct of others impacts their coverage — so it’s worth consulting a Miami insurance litigation lawyer for guidance on what exactly your insurance policy says about such conduct.

Property Damage Was Caused By Maintenance Issues

Every policy differs with respect to the specific definitions (and what the terms entail), but all homeowner’s insurance policies only pay out if the property damage at-issue was not caused by an “occurrence,” but was instead caused by some other issue, such as a maintenance-related issue.  Generally speaking, an occurrence is defined as a covered “event” that causes property damage, but it can also involve a long-term, sustained event — continuous exposure that causes property damage.

For example, a property owner would likely not be covered for damage that was caused because they failed to properly maintain the property — perhaps they failed to clear away snow on a flat roof, causing it to collapse after a long winter.  On the other hand, if the roof had collapsed suddenly and for no apparent reason, that would almost certainly be considered an “occurrence” justifying coverage.

Owner Failed to Mitigate Further Losses

Homeowners have a responsibility to mitigate their losses — in other words, they have to make efforts to minimize the losses that they’ve suffered (to the degree possible).

So, for example, if you discover a termite infestation in your house, then it behooves you to secure the assistance of pest control professionals.  Failing to do so could cause further damage to the structure of your home, leading to additional damage (that the insurer would not cover, as it could have been prevented had you called pest control earlier).  These circumstances would certainly be considered a “failure to mitigate.”

The Nature of the Loss is Misleading

If the insurer has any reason to suspect that the claimed loss is misleading in some way, or is not entirely truthful, then they may deny the claim on that basis.

For example, the insurer may believe that you are lying when submitting a claim for flooding damage — perhaps they believe that you attempted to fix a leaky pipe, which then burst, causing the flooding.  Under those presumed circumstances, the flooding damage may not be covered.  Given their suspicions, they will likely deny and then force you to submit additional proof or alternatively, go through their internal appeals process.

Coverage Does Not Extend to the Loss at Issue

Quite simply, there is a great deal of variation from policy-to-policy when it comes to homeowners’ insurance coverage.  More “premium” plans tend to include broader insurance coverage, with fewer exclusions and much less ambiguous language (with respect to covered perils).

For this reason, it’s important that you purchase a homeowners’ insurance policy that is actually appropriate for the sort of damage that you are attempting to protect yourself from.  If you live in coastal Florida and you would like hurricane coverage, then you may have to spend extra to ensure that hurricane-related losses are not excluded.  On the other hand, you may be fine with purchasing a plan that excludes coverage for earthquake-related losses.

Of course, the mere presence of an exclusion in the policy is not definitive.  Insurers often dress coverage in highly ambiguous language designed to entice homeowners to purchase the policy.  Fortunately, Florida courts interpret such language in favor of the homeowner, so if the language is truly ambiguous, it’s not necessarily unlikely that your interpretation will be accepted by the court. Contact our Miami insurance litigation lawyer today if you have questions about your specific situation.

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