Under Florida law, when an insurance policy is silent on the matter, the standard in determining whether a loss resulting from multiple causes will be covered is determined by application of the concurrent clause doctrine. That doctrine provides that an insured will be covered, notwithstanding the fact that multiple independent causes, some covered and some not, combine to produce a single loss that would not otherwise have occurred absent the joinder of the multiple causes. For the purposes of this rule, independent causes are those whose occurrences are unrelated to one another, such as when a home is damaged by wood rot and windstorm damage. On the other hand, dependent causes are those that are related to each other, or in other words, when the occurrence of one peril sets in motion another peril, for example an earthquake destroying a gas main that ignites a fire.
The concurrent clause rule is generally regarded as providing the insured with added protection because the insured will be able to recover under this doctrine even if some of her loss is attributable to a non-covered peril. However, Florida also recognizes the rule that an insured and an insurer are free to contract around the concurrent clause rule by expressly incorporating an anti-concurrent cause provision in their homeowner’s insurance contract. A typical anti-concurrent cause provision will say something like this: no coverage will be afforded when a loss is caused directly or indirectly by a non-covered peril. The effect of such a provision is to deny coverage to an insured in instances when the concurrent cause doctrine would otherwise have allowed the insured to recover.
By way of example, assume that your homeowner’s insurance policy provides coverage for water and windstorm damage but specifically excludes coverage for wear and tear. After a severe storm your roof is badly damaged and you file a claim with your insurer. Your insurer sends out its adjuster and after inspection the adjuster determines that your roof damage is the result of several causes. First, the adjuster determines that the structural integrity of your roof has been weakened over time as a result of normal wear and tear. Second, the adjuster determines that the strong windstorms and rain from the recent storm further weakened your roof until it collapsed, and that your loss would not have occurred absent the joinder of these multiple causes. Scenarios like this occur every day. You paid your premiums and you understandably believed that you would be covered. After all, that was the point of purchasing homeowner’s insurance. However, if your insurance policy contains an anti-concurrent clause provision, your insurance company is likely to deny your claim on the grounds that your loss is the result concurrent causes, some of which are covered some are not. Your insurance company will claim that the anti-concurrent clause provision in your policy relieves them of the duty to pay your claim. Unfortunately, these provisions are typically upheld as valid and often result in claim denials.
On the other hand, if your insurance contract does not contain an anti-concurrent clause provision an insured facing the scenario above will likely be able to recover for her loss. It should come as no surprise that anti-concurrent cause provisions are standard form in Florida homeowner’s insurance contracts. However, insurance contracts, like all other contracts, require careful examination. Just because there is anti-concurrent cause language associated with some excluded perils in your policy does not necessarily mean that the anti-concurrent cause language will apply to all excluded causes. An oft stated maxim relating to insurance contract interpretation is that ambiguous terms are resolved in favor of providing coverage. Thus, these types of clauses have to be carefully drafted to effectively relieve an insurer of its duty to pay in these cases, and a failure to do so often results in recovery by the insured. In our example above, assume that the insurance contract contained anti-concurrent cause language after a different excluded peril, such as vandalism. However, the contract did not contain such language after the wear and tear exclusion. In this case, a strong argument can be made that the anti-concurrent language is ambiguous as to whether it applies to the wear and tear exclusion, and a court would likely find that the insured is entitled to recover under these facts. In fact, this has been the holding in many Florida cases, with the reasoning being that the contract should be interpreted against the insurer and in favor of the insured, thus allowing the insured to recover.
Moreover, these provisions often come into play when determining whether recovery may be had under other provisions of the contract. For instance, the applicability of ensuing loss provisions in the face of anti-concurrent clause provisions is often a point of contention in insurance litigation. While an ensuing loss provision typically allows an insured to recover for the portion of a covered loss that occurs as a result of a non-covered loss, the existence of an anti-concurrent cause provision may nonetheless have the effect of negating an insured’s right to recover. In our example above, the non-covered wear and tear to the roof may have allowed water, a covered peril, to leak into your living room damaging the contents of your home. Typically, an ensuing loss provision would allow you to recover for the damage caused by the covered peril (i.e. water damage to your furniture) although it would not allow you to recover for the damage associated with the non-covered peril (a leaky roof). However, the existence of the anti-concurrent cause provision may prevent you from recovering for either of the damages. Insurance litigation in this area is highly sophisticated and it usually requires an experienced attorney to review your policy and the applicable rules of your jurisdiction to evaluate the strength of your case.
You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].