Many times you may wonder how you are covered for a loss if you don’t discover damages for many months after an incident occurs. Noting that normal wear and tear are not covered, here is an example of a covered loss due to an incident, but realized many months after occurrence.
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A few months ago, following a downpour, an insured noticed some wet patches on the ceiling and high up on the walls. When he called in a roofer, the roofer said that the roof had been damaged in a severe hailstorm that occurred about a year previously.
We turned the claim in to the insurer, who denied the loss, saying that too much time had elapsed between the hailstorm and the resulting water damage.
Is this denial correct?
Indiana Subscriber
There is no requirement in the HO 00 03 that the cause of loss and the resulting effect follow each other within minutes, days, or even months. It is difficult to recognize that a covered cause of loss has occurred unless the physical signs of that cause manifest themselves. So, until the insured noticed the wet patches, he had no idea there was a possible covered loss.
The HO 00 03 excludes losses caused by wear and tear, marring, and deterioration. That is because these are things that will happen over time, and so are uninsurable. However, the policy adds that “any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered.” In other words, had the roof simply worn out, the ensuing loss—water damage to the interior—would be covered because it is not excluded. But in this instance, the roof did not wear out. An event specific as to time and place—the verifiable hailstorm—caused the damage to the roof.
Therefore, both the loss to the roof and the water damage to the ceiling and walls are covered.
Information supplied from Summit Business Systems.
AJR Public Adjusters 