Am I covered? Sure I’m covered! I’m not covered, am I? These are the three questions many people ask or state when their property is damaged. Three little short questions that may have a big impact on our lives. Three short questions whose answers are often not short or easy to answer.
Before we can answer these questions we must first know whether the loss was sudden and accidental, covered or excluded by the policy. These questions may seem simple but as you will see are often times not.
Let’s look at the homeowner’s loss to Kelley’s home. Kelley’s mother lived in the family home until she passed at the ripe age of 78, When Kelley moved in he discovered the basement was very wet and the boxes of stored items soaking wet and moldy. Kelley hired a professional contractor to remove the debris and determine the source of the smelly debris. It didn’t take long for the contractor’s plumber to find the rusted and deteriorated cast iron drain lines.
Kelley found the homeowner’s insurance policy and started to read it. It wasn’t long before he reached the beginning of the section he had trouble understanding. Even after graduating from both high school and two years of college he could not understand if he might be covered or not.
One thing he did know was he needed help. He asked around and was directed to our offices, an experienced public adjuster. When Kelley and I reviewed his policy we found it was a good one; form number HO-3 which is as close to an all-risk policy one could buy.
The loss was certainly sudden and accidental and within the perimeter of the home. We continued on with the reading of his HO-3 policy which the rather short section dealing with types of losses covered and again he was reassured his loss would be covered. I told him there was a saying that said, “if it’s not excluded, it’s included.” Well, it was time to read over the section labeled Exclusions.
This section was by far the longest part of the entire policy! And there it was, water backup damages. After reading this section several times it was clear this section was not; clear that is. On the one hand it appeared this type of peril (cause of damage) was covered for the property insured (within the property perimeter) except (exclusion) for losses caused by certain kinds of water backup (definition confusing). Was Kelley’s loss covered or not? Even after inspecting the damages, making repairs to prevent additional damage and reading the policy, Kelley still could not determine if his loss would be covered by the policy in force at the time of loss.
Upon further investigating it was discovered the cast iron pipes from the roof which connected the drain lines of the second floor hall bathroom and first floor kitchen with the main drain in the basement which then connected to the main sewer line under his sidewalk and the street. There were several areas of piping that showed heavy deterioration, apparently from long term wear. These causes are clearly excluded by the policy.
Kelley’s claim is not covered due to the repeated wear and tear of his drain pipes.