Many policyholders are hesitant to talk to a homeowner insurance claims attorney even when struggling to get an insurance company to pay the cost of repairs or replacement under a policy.  This hesitancy is normal if you are someone who has little or no experience working with attorneys.  However, an insurance policy is in essence a complex contract between an insured and an insurance company.  The insurance company has a team of lawyers and adjusters who handle a multitude of claims annually.  This means that the average homeowner is at a distinct disadvantage when attempting to prevail in what is really a contract dispute with the insurance company.  The idiom that states: “A person who represents himself has a fool for a client” is rarely as true as in this context.

A recent New York appellate court decision provides a clear example of why you need an experienced insurance claims attorney on your side.  In Pichel v. Dryden Mutual Insurance Company, the court found that damage to the property caused by water that overflowed from the plumbing system was covered by the policy where the language of the policy was ambiguous.  This decision, which is consistent with decisions in other states construing similar language, represents the first New York appellate court decision recognizing coverage for this type of loss.

The insured suffered significant damage to two separate apartment complexes after waste water entered the ground floor of the buildings through toilets, drains and tubs.  The insurance company denied the claim citing the policy’s water damage exclusion.  The language of the exclusion provided:

“Water which backs up through sewers or drains.”

The policy contained another exclusion that contained language that appeared to exclude coverage as well as language that suggested the loss should be covered.  The language of this exclusion that suggested non-coverage provided:

“For loss caused by repeated or continuous discharge, or leakage of liquids or steam from within the plumbing system.” 

However, this exclusion also provided language indicating coverage for the following:

“Loss caused by the accidental leakage, overflow or discharge of liquids or steam from a plumbing system.”

The trial judge found that the exclusions seemed to contain conflicting language when read together, so he construed the language to harmonize the provisions.  The judge concluded that such losses are covered if the plumbing backup originates in pipes that are not located on the subject property.  In other words, the judge concluded that the provisions did not conflict if they were read to exclude coverage when the clogged pipe that initiated the damage was not part of the insured’s plumbing system.

The appellate court accepted the reasoning of the trial judge and affirmed the decision that the loss was covered.  This is an example of how having an experienced insurance coverage attorney review and analyze your policy can help you prevail in a dispute with your insurance company.  Homeowner policies are long, complex and difficult to understand.  They also are often riddled with conflicting language, which your attorney might be able to use to persuade your insurer to pay your claim.  If the insurance company continues to refuse to cooperate, your attorney might even be able to file a lawsuit for breach of contract or insurance bad faith.

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].

J.P. Gonzalez-Sirgo
J.P. Gonzalez-Sirgo, P.A.
Post A Comment