Hail injury is a subject of debate on the Rocky Mountain Affiliation of Public Insurance coverage Adjusters (RMAPIA) Fall Seminar. Mike Poli offered a speech, Traps For the Unwary, and highlighted an Arizona insurance coverage determination,1 which has a superb dialogue about how put on and tear, insufficient upkeep, and concurrent trigger exclusions function within the context of a hail loss.
The court docket said this concerning the put on and tear exclusion:
Put on and Tear.
The related part of the coverage states:
[I.]B. Exclusions
…
2. We won’t pay for loss or injury attributable to or ensuing from any of the next:
…
l. Different Forms of Loss (1) Put on and tear;
…
But when an excluded reason behind loss that’s listed in Paragraphs (1) by (7) above ends in a ‘specified reason behind loss’ or constructing glass breakage, we pays for the loss or injury attributable to that ‘specified reason behind loss’ or constructing glass breakage.
The coverage clearly and unambiguously excludes protection the place put on and tear is the only trigger of harm. The final sentence quoted above clearly states, nonetheless, that the exclusion of protection in Part I.B.2.1 doesn’t apply— in different phrases, the coverage gives protection—the place an ‘excluded reason behind loss’ ends in a ‘specified reason behind loss.’ The phrase ‘specified reason behind loss’ is outlined in Part I.H.11 to incorporate ‘hail.’ Subsequently, changing ‘excluded reason behind loss’ with ‘put on and tear,’ and ‘specified reason behind loss’ with ‘loss from hail,’ the clause reads: ‘if [wear and tear] ends in [loss from hail], we pays for the loss or injury attributable to that [hail].’ Thus, when put on and tear contribute to break by a hailstorm, the coverage gives protection for the hail injury. Additional, the coverage covers any ensuing injury from the hail, equivalent to water penetrating the roof on account of the hail.
Relating to the exclusion for insufficient upkeep, the court docket famous the next:
Insufficient upkeep.
The related part of the coverage states:
[I.]B. Exceptions …
3. We won’t pay for loss or injury attributable to or ensuing from any of the next Paragraphs a by c. However [i]f an excluded reason behind loss that’s listed in Paragraphs a by c ends in a Coated Explanation for Loss, we pays for the loss or injury attributable to that Coated Explanation for Loss.
…
c. Negligent Work
Defective, insufficient or faulty … Upkeep;
For functions of this difficulty, the ‘excluded reason behind loss’ might be said as ‘insufficient upkeep.’ The ‘Coated Explanation for Loss’ might be said as ‘hail’ or ‘loss from hail’ as a result of hail presents a ‘threat of bodily loss’ and isn’t excluded by the coverage. Utilizing these substitutes, the important thing provision reads: ‘if [inadequate maintenance] ends in [loss from hail], we pays for the loss or injury attributable to [the hail].’ This produces the identical consequence as the damage and tear exclusion mentioned above. Thus, when insufficient upkeep permits hail injury to happen, the coverage gives protection for the hail injury.
The court docket then made this quite simple conclusion when confronted with hail injury:
The coverage gives protection from injury by hail whether or not the injury is the only or partial reason behind the loss. The coverage doesn’t present protection the place hail just isn’t accountable for the loss.
Insurance coverage firms and their consultants usually overuse the damage and tear exclusion as a purpose for denial, as famous in Why is the Service so Fast to Argue the Put on and Tear Exclusion? I strongly encourage these with questionable denials on account of put on and tear to learn the Insurance coverage Journal article by Invoice Wilson, Put on and Tear Exclusions Worn and Torn.
Thought For The Day
Nothing is everlasting on this depraved world — not even our troubles.
—Charlie Chaplin
1 Monterra Apts. Ltd. V. Sequoia Ins. Co., No CV11-1236 (D. Ariz. Mar. 12, 2012).
