Should Court or Arbitrator Decide What Caused Loss? It Depends on How Insurer Treated Insured's Claim.
This story is reprinted with permission from FC&S Legal, the industry's only comprehensive digital resource designed for insurance coverage law professionals.…
August 01, 2018 at 06:03 PM
2 minute read
This story is reprinted with permission from FC&S Legal, the industry's only comprehensive digital resource designed for insurance coverage law professionals. Visit the website to subscribe. The Case
THERE IS COVERAGE UNDER THE POLICY FOR THIS LOSS AS A WHOLE; HOWEVER, THE SCOPE OF DAMAGES COVERED BY YOUR POLICY INCLUDES ONLY THE INTERIOR DAMAGES BUT DOES NOT INCLUDE YOUR ROOF.
We have completed our investigation of your claim, and based upon what we were provided and what you reported, and additionally, based upon our claim investigation, there is generally coverage for your loss as a whole. However, and more specifically, our investigation revealed that the roof leak you reported stemmed from age-related wear and tear and deterioration; general mechanical breakdown or latent defect; and/or faulty, inadequate or defective maintenance of the roofing system - none of which are covered causes of loss. Therefore, in our opinion, the scope of covered damages would not include your roofing system because those damages were caused by uncovered or excluded causes, but would provide coverage for resulting ensuing damages to the interior of your home. Therefore, we believe our obligation is to repair only those damages to the interior of the home. If you are not in agreement with that assessment, the question of whether the scope of repairs should include the roof, can be resolved in appraisal.
The Appellate Court's Decision People's Trust Ins. Co. v. Tracey, No. 4D17-3945 (Fla. Ct.App. July 25, 2018) FC&S Legal Comment People's Trust See, e.g., Pernas v. Scottsdale Ins. Co. Sunshine State Ins. Co. v. Corridori Steven A. Meyerowitz Esq FC&S Legal Insurance Coverage Law Report FC&S Legal FC&S Legal
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