Chip Merlin | Property Insurance Coverage Law Blog | June 14, 2019
Victor Jacobellis left his job in San Francisco representing insurance companies to join Merlin Law Group and help policyholders obtain insurance coverage benefits. He asked me to speak with him about exceptions to exclusions of coverage which are often overlooked and lead to wrongful denials of coverage. The photo above shows yours truly speaking with Victor Jacobellis in Napa, California at the National Association of Public Insurance Adjusters Annual Conference on this important insurance topic.
This blog has over 30 posts regarding ensuing loss provisions. Here are some of the highlights:
Whipped Cream, Honey and Covered Ensuing Loss Delights
Herb Albert and the Tijuana Brass produced an album, Whipped Cream and Other Delights, which has been on my mind lately. While a number of my less academic colleagues would simply be interested in the album cover and the music– –my insurance coverage nerd personality drove me to research insurance coverage cases involving whipped cream or honey.… Continue Reading
Wear and Tear Exclusions Versus Depreciation For Resulting Damage To Worn and Torn Older Parts of a Structure
Buy Bill Wilson’s book! This is the least I can say after quoting him about “resulting” or “ensuing” loss provisions following “wear and tear” exclusionary language. I am certain his book helped a judge understand how the coverage works. Here is what he says: Wear and Tear Exclusions Just about all that needed to be… Continue Reading
Recent New York Case Involving An Exception To An Exclusion
At times property insurance policies require a flow chart to navigate through in determining whether a particular loss is covered. If a policy exclusion applies, then the policyholder would not be entitled to coverage for a loss. However, some policies have exceptions to exclusions, which can bring a loss, or a portion of a loss,… Continue Reading
Snow is Causing Roofs to Fall — Is There Coverage After the Insurer’s Engineer Says the Roof was of Faulty Design?
Snow is falling all over the United States. So much that roofs are falling from the weight of snow and ice. Can you imagine the policyholder outrage if the insurance company’s engineer says the roof was designed wrong and coverage is denied on that basis? This was the scenario in Driscoll v. Providence Mut. Fire… Continue Reading
Defective Construction and Ensuing Loss Provisions
A public adjuster called with a common situation—a property loss occurred during repair and the insurance company had initially denied the claim, saying that the loss was from defective construction. The smart public adjuster thought the property damage caused in part by defective construction could lead to coverage under an ensuing loss provision. The policyholder… Continue Reading
Ensuing or Resulting Loss, and the Burden of Proving Causation Explained Simply
I am always looking for “an edge.” Just something to get a better chance of winning for my client–like all good litigators. This morning’s post, Chinese Drywall Losses Covered Under First Party Property Insurance Policy, mentioned how going to a NAPIA Conference can give a policyholder’s advocate that type of “edge.” Let me explain how… Continue Reading
I often call ensuing loss clauses the “Lazarus clauses” of property insurance policies. This is because insurers may claim that a loss is not covered citing an exclusion but fail to note the broad grants of coverage afforded by the ensuing loss provisions which are extraordinarily important to making the insurance product work as intended. Victor Jacobellis made the following slide for our presentation:
During our speech, I highlighted and stressed that all public adjusters should read Bill Wilson’s weekly blog posts about insurance coverage. In Claim Declination and Reservation of Rights Letters, Wilson noted:
My experience has been that claim denials that cite exclusions while ignoring exceptions to the exclusions, as in the last two examples, are very common. Often the exception is placed at the end of a series of exclusions, so one reason for the frequency of these types of improper denials could be simply overlooking them, not that this is a valid excuse.
The practical tips from the speech were as follows:
- Read the entire policy. This cannot be stressed enough.
- Do not accept coverage denials as being correct just because the insurance company cites lots of reasons for the denial.
- Do not overlook all the important exceptions to coverage found in the policy.
- Critically reevaluate each limitation for additional grants of coverage for in other parts of the policy. (Again, you have to read the entire policy to find them.)
- Use the research function of this blog, search FC&S, IRMI and other treatise material regarding the language the insurer is relying upon.
If all else fails, do not hesitate to call Victor Jacobellis or one of the other Merlin Law Group attorneys dedicated to helping policyholders denied or delayed insurance benefits.