{"id":896237,"date":"2019-08-01T11:13:29","date_gmt":"2019-08-01T17:13:29","guid":{"rendered":"https:\/\/www.myconstructionexpert.com\/blog\/?p=896237"},"modified":"2019-08-01T11:13:37","modified_gmt":"2019-08-01T17:13:37","slug":"property-insurance-claim-denied-undefined-terms","status":"publish","type":"post","link":"https:\/\/www.myconstructionexpert.com\/blog\/property-insurance-claim-denied-undefined-terms\/","title":{"rendered":"When Can My Property Insurance Claim Be Denied Due to War or Other Undefined Terms?"},"content":{"rendered":"\n

Derek Chalken | Property Insurance Coverage Law Blog<\/a> | July 23, 2019<\/p>\n\n\n\n

I often receive calls from policyholders asking how an insurance company can deny their claim based on an exclusion that isn\u2019t defined in the policy. One of these terms is \u201csurface water,\u201d a common exclusion found in most policies. Recently, I had a client whose home\u2019s gutter system malfunctioned during a rainstorm. Rather than channeling water to run from his roof, through the gutter system and out to the street, water was redirected at the side of the home. The water filled up a planter built in to the side of the house and eventually made its way into the home, damaging his flooring.<\/p>\n\n\n\n

His insurer denied the claim based on the \u201csurface water\u201d exclusion, claiming the water became \u201csurface water\u201d when it pooled in the planter. In that case, I used one of my favorite resources, Couch on Insurance<\/em>, to define \u201csurface water\u201d and to explain to the carrier that they were wrongly defining the term. We were forced to file a lawsuit and the trial court agreed the term was ambiguous, and better yet, agreed with our definition of the term, ruling that surface water is water diffused over the surface of land, following no defined course or channel, and which naturally drains. In that case, as the water did not follow a defined course\u2014that is through the gutter and into the planter\u2014it was not surface water. The carrier\u2019s \u201ceveryday\u201d definition of surface water (\u201cwater on the surface of the ground\u201d) was unpersuasive in the insurance context.<\/p>\n\n\n\n

Recently, an appellate court in California was faced with making a similar decision in determining whether undefined policy exclusions for \u201cwar\u201d should exclude coverage in a commercial claim. In California, an insurance policy is a contract subject to ordinary contract interpretation rules holding that the \u201cmutual intention\u201d of the parties.1<\/sup> When it comes to undefined terms, like \u2018war\u201d or \u201cwarlike actions by a military\u201d, the terms are to be interpreted in their ordinary and popular sense, unless used by the parties in a technical sense or a special meaning is given to them by usage, in which case the latter must be followed.<\/strong><\/em>2 3<\/sup> Even then, the policy exclusions need to be strictly construed against the insurer and exceptions to those exclusions are broadly construed in favor of the insured, under the doctrine of Contra Proferentem<\/em>.4<\/sup><\/p>\n\n\n\n

Last week, the United States Court of Appeals for the Ninth Circuit issued its opinion in\u00a0Universal Cable Productions, LLC, et al. v. Atlantic Specialty Insurance Company<\/em>, Case No. 17-56672 (Central District of California Case No. 2:16 cv-04435 PA). The appellate panel reversed portions of the lower court\u2019s summary judgment ruling in favor of Atlantic Specialty Insurance Company (\u201cAtlantic\u201d), in the lawsuit brought by its insured Universal Cable Productions (\u201cUniversal\u201d).5<\/sup><\/p>\n\n\n\n

As part of its insurance claim, Universal claimed damages for expenses it incurred when it moved production of the television series Dig (starring Anne Heche) from Israel amid the conflict between Israel and Hamas in June 2014, just after the show\u2019s pilot was filmed in Jerusalem. At that time, the United States State Department issued warnings about worsening conditions in and around Israel due to the conflict. Universal claimed it incurred costs for a breach of contract and bad faith in the amount of at least $6.9 million when Atlantic denied their claim.<\/p>\n\n\n\n

The policy held by Universal covered losses caused by terrorism, unless the loss was not otherwise excluded, and in this case, the relevant provisions were exclusion by:<\/p>\n\n\n\n

  1. War, including undeclared or civil war, or,<\/li>
  2. Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign, or other authority using military personnel or other agents;\u2026<\/li><\/ol>\n\n\n\n

    These terms were drafted by Universal, which is part of the reason why Contra Proferentem (holding that terms be construed against the party drafting them) did not apply to this case.6<\/sup><\/p>\n\n\n\n

    Prior to the June 2014 incidents, Universal\u2019s insurance broker and Atlantic discussed potential issues that may arise on the production of the show Dig as a result of filming in Israel. After these discussions, Atlantic confirmed it would not be changing the policy\u2019s terms or adding exclusions, or even charge any additional premium. Even though the parties had these discussions, Atlantic rejected the claim on the two exclusions for losses related to \u201cwar\u201d and \u201cwarlike actions by a military force.\u201d Originally, the lower court held that the war exclusions should be understood in their ordinary and plain sense, instead of applying the special meaning of the terms in the insurance context of which Atlantic had notice. However, the Ninth Circuit reversed these rulings holding that both of the war exclusions describe only conflicts between two or more sovereign or \u201cquasi-sovereign\u201d movements. However, the court reasoned that Hamas was neither a sovereign or quasi-sovereign movement, and thus the exclusion should not have applied.7 8<\/sup><\/p>\n\n\n\n

    In making its ruling, the appellate court noted that Universal presented compelling information from another leading insurance reference, Appleman on Insurance<\/em>, which defines \u201cwar\u201d as a course of hostility between states or state-like entities.9<\/sup><\/p>\n\n\n\n

    Like with \u201csurface water,\u201d the court went through the process of defining \u201cwar\u201d by using the most applicable treatises and case law in reaching its conclusion.<\/p>\n\n\n\n

    Should your claim be denied due to a policy term you believe to be ambiguous or undefined, contact a Merlin Law attorney for a consultation.
    ______________________________
    1<\/sup>\u00a0Waller v. Truck Ins. Exchange, Inc.<\/em>\u00a0(1995) 11 Cal.4th 1, 18.
    2<\/sup>\u00a0Id.<\/em>; California Civil Code \u00a7 1644.
    3<\/sup>\u00a0First, a policy provision needs to be found to be ambiguous \u2013 that is, when the provision is capable of two or more constructions, both of which are reasonable.\u00a0Bay Cities Paving Grading, Inc. v. Lawyers\u2019 Mutual Insurance Co.<\/em>\u00a0(1993) 5 Cal. 4th 854, 867.
    4<\/sup>\u00a0E.M.M.I Inc. v. Zurich Am. Ins. Co.<\/em>\u00a0(2004) 32 Cal.4th 465, 471.
    5<\/sup>\u00a0Following\u00a0Nat\u2019l Am. Ins. Co. of Cal. v. Certain Underwriters at Lloyd\u2019s London<\/em>\u00a0(1996) 93 F.3d 529, 537.
    6<\/sup>\u00a0Even though the provisions were proposed by Universal, they were common form language used in many insurance policies.
    7<\/sup>\u00a0A third exclusion based on losses due to \u201cinsurrection, rebellion or revolution\u201d was also relied upon by Atlantic but was not at issue in the appeal. The district court will need to rule on this exclusion on remand.
    8<\/sup>\u00a0The Ninth Circuit based its finding on facts that United States has never recognized Palestine or Gaza as sovereign territorial nations nor Hamas as a sovereign or quasi-sovereign (i.e.<\/em>, a\u00a0de jure<\/em>or\u00a0de facto<\/em>\u00a0government \u2013 a government having significant attributes of sovereignty).
    9<\/sup>\u00a0Universal Cable Productions, LLC, et al. v. Atlantic Specialty Insurance<\/em>\u00a0Company, Case No. 17-56672 (Central District of California Case No. 2:16 cv-04435 PA), page 21.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Derek Chalken | Property Insurance Coverage Law Blog | July 23, 2019 I often receive calls from policyholders asking how an insurance company can deny their claim based on an exclusion that isn\u2019t defined in the policy. One of these terms is \u201csurface water,\u201d a common exclusion found in most policies. Recently, I had a… Continue reading When Can My Property Insurance Claim Be Denied Due to War or Other Undefined Terms?<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[9914,10885],"tags":[9895,23,504],"class_list":["post-896237","post","type-post","status-publish","format-standard","hentry","category-insurance-coverage","category-property-insurance-claims","tag-advise-consult","tag-insurance-coverage","tag-property-insurance-claim","entry"],"jetpack_publicize_connections":[],"yoast_head":"\nWhen Can My Property Insurance Claim Be Denied Due to War or Other Undefined Terms? 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