Many policyholders are frustrated when their homeowner’s insurer refuses to process their property damage claim in a timely manner, but they, nonetheless, attempt to pursue a fair resolution without the benefit of an experienced Florida insurance claims attorney. This decision can have extremely unsatisfactory results because insurance carriers have a team of adjusters, experts, insurance defense attorneys, and virtually limitless financial resources to protect their bottom line. When an individual policyholder takes on a large insurance carrier without legal representation, the complexity in understanding applicable law and the languages of policies can make it difficult to prevail without a proven Miami homeowner’s insurance lawyer.
A recent decision out of the Court of Appeals of Iowa, Salem United Methodist Church of Cedar Rapids v. Church Mutual Insurance Company, provides an example of such complexity when considering the interplay of case law and policy provisions. The insured church facility was damaged when the Cedar River overflowed its banks and inundated the City of Grand Rapids. The sewer drains system for the church backed up because of the flooding. The trial court ruled in favor of the insured’s claim, but the appellate court found the trial judge committed reversible age, so the decision was reversed.
On appeal, the court indicated that the controlling principle is that the intent of the parties must control the court’s interpretation unless the policy language is ambiguous. The court indicated that a policy is ambiguous when there are two reasonable interpretations when the policy is read as a whole. When the relevant terms are ambiguous, the insurance policy must be construed in terms most favorable to the policyholder.
The appellate court considered the following provisions and concluded that they were not ambiguous with respect to coverage involving damaged caused by concurrent perils:
We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss.
- Flood, surface water, waves, tides, tidal waves, overflow of any body of water, or their spray, all whether driven by wind or not;
ADDITIONAL COVERAGE—BACK UP THROUGH SEWERS AND DRAINS
Subject to all other terms and conditions of this policy, we will pay for direct physical loss or damage to Covered Property caused by back up of water or sewage through sewers or drains only if caused by an event away from the described buildings and when the damage is not caused by flood, surface water, waves, tides, tidal waves, overflow of any body of water, or their spray, all whether driven by wind or not, and which did not enter the building through foundations, walls, floors, windows, cracks, roofs or through other opening of the building.”
The court interpreted this policy language as unambiguously excluding coverage for concurrent causes where either of the causes is excluded. Although the policy provided coverage for sewer backups, it denied coverage for flooding, so the court ruled the claim had to be denied because the policy clearly denied coverage for any claim involving both a covered and uncovered claim.
This case provides an example of complex legal issues and the challenge of policy interpretation which makes it important to seek legal advice when your insurer refuses to pay your claim. If your insurance company refuses to pay for losses covered by your insurance policy, you might have a legal claim for financial compensation. My law firm represents policyholders in claims disputes in Miami and throughout Florida. The Law Firm of J.P. Gonzalez-Sirgo, P.A. offers free consultations and case evaluations. No Recovery, No Lawyer Fees. Call 305-461-1095or Toll Free 1-866-71-CLAIM.