Our insured has a water backup or sump pump overflow endorsement on his homeowners policy, which states the insurer covers direct physical loss caused by "water or sewage, which backs up from outside the residence premises plumbing system through sewers or drains." A heavy rainstorm occurred, and water entered the residence through the drain in the basement floor.

Because the insured has a radon remediation system installed in the drain, the engineer sent by the insurer reported that the water must "have come into the drain system via the perforated pipe and the drain could not handle the flow. Thus the water backed up onto the basement floor." The insurer then denied the claim, citing the exclusion for water below the surface of the ground, and then adding that the surface water below the ground entered into the perforated radon remediation system.

We think this is a covered loss and would like your thoughts.

New York Subscriber

The insured has paid an additional premium for backup of sewer and drain coverage, and it appears his claim is being denied based on a misreading of the endorsement language.

It does not really matter if the water entered the drain pipe because the pipe was perforated; the water came from outside the residence premises plumbing system and then forced its way up through the residence premises system by way of the basement drain. That is all that is necessary to trigger coverage. The drain's inability to handle the flow (as per the engineer's report) is meaningless—if this were the case then the insurer could deny any loss, for which the insured has paid an additional premium, based on the drain's inability to handle the flow. That is, after all, what essentially constitutes a water backup through a drain.

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