Damage to Roof—Subsequent Interior Damage Covered?

Our insured has an HO 00 03 10 00. A few months ago, following a downpour, he noticed some wet patches on the ceiling and high up on the walls. When he called in a roofer, the roofer said that the roof had been damaged in a severe hailstorm that occurred about a year previously.

We turned the claim in to the insurer, who denied the loss, saying that too much time had elapsed between the hailstorm and the resulting water damage.

Is this denial correct?

Indiana Subscriber

There is no requirement in the HO 00 03 that the cause of loss and the resulting effect follow each other within minutes, days, or even months. It is difficult to recognize that a covered cause of loss has occurred unless the physical signs of that cause manifest themselves. So, until the insured noticed the wet patches, he had no idea there was a possible covered loss.

The HO 00 03 excludes losses caused by wear and tear, marring, and deterioration. That is because these are things that will happen over time, and so are uninsurable. However, the policy adds that “any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered.” In other words, had the roof simply worn out, the ensuing loss—water damage to the interior—would be covered because it is not excluded. But in this instance, the roof did not wear out. An event specific as to time and place—the verifiable hailstorm—caused the damage to the roof.

Therefore, both the loss to the roof and the water damage to the ceiling and walls are covered.

 

 

This premium content is locked for FC&S Coverage Interpretation Subscribers

Enjoy unlimited access to the trusted solution for successful interpretation and analyses of complex insurance policies.

  • Quality content from industry experts with over 60 years insurance experience, combined
  • Customizable alerts of changes in relevant policies and trends
  • Search and navigate Q&As to find answers to your specific questions
  • Filter by article, discussion, analysis and more to find the exact information you’re looking for
  • Continually updated to bring you the latest reports, trending topics, and coverage analysis