Duty to Notify Insurer of Water Damage under the PAP

November 30, 2009

The claim at issue has a date of loss of end of 2008. Although the insured is not sure when water started entering his vehicle, the investigation so far shows that water entered the vehicle and damaged the back seats and rug. This includes mold damage. The insured has known for a while and has tried to fix the damage and find out how the leak was happening. He never reported the damage to the insurer until nearly a year after the initial damage.
What coverage, if any, should be afforded?

Connecticut Subscriber

The main issue here seems to be whether the insured promptly notified the insurer. Based on what you describe, it sounds like he did not. However, the insurer will have to decide this for itself in accordance with state law as there is no judicial unanimity on the subject. Keep in mind also that even if there has been a duty to notify breached, some courts will allow an insurer to deny coverage for a claim only if the insurer has been prejudiced by the delay.

It sounds as if the insured wanted to fix the problem himself but could not, so he then filed a claim. Although there is no direct exclusion for this, the duties after a loss conditions in the PAP seem to have been breached. These include not only the failure to promptly notify, but also the requirement that the insurer be permitted to inspect and appraise the damage before its repair.

If the insurer has no problem with the lack of notification and the insured has other than collision coverage, the loss can be paid. We would advise, however, that if the insurer has yet to do so, it get an inspection of the car and a detailed explanation from the insured as to what he did to try and repair the car and why he waited so long to notify the insurer. Then, based on those findings, determine whether the claim should be paid.

 

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