Coverage denial for water damage for “repeated leakage” Christopher Brelje asked 11 months ago
Coverage denial for water damage for “repeated leakage”

Insurer denied our water damage claim based upon a policy exclusion for “continuous or repeated seepage or leakage…over a period of time and [which] results in deterioration, rust, mold, or wet or dry rot.” The undiscovered/undiscoverable cause was a bad upstairs toilet wax ring. The water leak caused saturation, but no obvious deterioration. Also, no rust, mold, or wet or dry rot.

Questions: (1) is “over a period of time” impermissibly vague language? (could be 2 seconds or 2 years) (2) If there was no deterioration or other of the named conditions, is there coverage because the exclusion used the conjunctive “and,” thereby requiring at least one of these conditions to be present? (3) Insurer’s adjuster authorized demolition work to gain access for the plumber to determine the cause. Insurer subsequently denied the claim. Is Insurer responsible to pay the demo company’s invoice?

1 Answers
Jade Bentz Jade Bentz Expert answered 10 months ago
0 Vote Up Vote Down

Hi Christopher, This exclusionary language is becoming more and more prevalent in coverage decisions for water damage losses. It used to only exist in commercial polices but has not found its way in to many homeowner’s policies. Based upon the information you shared:

(1) Correct it is vague, and if the policy does not define a phrase or a word than it goes to a standard definition from Merriam Webster or similar or a reasonable person’s understanding. I’ve seen policies include language that allude that a period of time is weeks, days, months, years, or sometimes defined as in excess of 14 days.

(2) I would agree with you if the language reads “and,” and only one of the conditions are met then I would agree there is an argument the exclusion does not apply. There is certainly a difference between saturation and the physical deterioration or rotting of wood.

(3) Not necessarily unfortunately, unless they committed to you that they were paying for it regardless, or they arranged for them to come out and provide the access. They would argue that you have an obligation to both present your claim and allow them to investigate, as well as protect the property from further damage regardless of coverage.

For both (1) & (2) in the event of an ambiguity, it should go in your favor. Based on what you have described it does sound like you should continue to pursue this. Many times with denials, it’s necessary to involve an attorney to review the coverage position, case law in the state, and determine if you have an argument for coverage. Short of that you can present the facts in an outline and request management review, including photos showing the criteria in the exclusion language are not met (“and” argument). The policy is THE document/contract they must base any decisions upon.

Hope this helps, and best of luck in your recovery.