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The insured has a Special Causes of Loss form, CP 10 30 04 02, with a Manufacturers Property Extension Plus endorsement that includes $25,000 in coverage for backup of sewers or drains. 

During an extended period of heavy rain, about eight inches of water accumulated on the insured's flat roof. The roof membrane did not leak, but water spilled over the curb where the air conditioning unit sits, which in turn caused interior damage to the insured's offices. 

The building has two four-inch drain pipes for the purpose of removing water from the roof. The pipes drain to a nearby sewer/drainage ditch. When the insured was notified of the problem, he went up on the roof and there was minimal debris around the drain, but even when removed, the flow did not increase. Each pipe does have a cleanout at the bottom of the building (the pipes run down the sides of the building), and once the insured removed the caps on the cleanouts, essentially doubling the drainage capacity of the pipes, the water began to drain from the roof. 

The insurance carrier denied the claim for the interior damage, citing the limitation in the form stating the roof must first sustain damage, which it did not in the case. In addition the carrier does not acknowledge this as a backup claim. Our argument is that the limitation should not apply as that is not the intent of this limitation and that this is in fact a backup claim. 

Ohio Subscriber

The situation you describe is not a backup. It does not sound as if the water went down the drain then reversed direction and came back up. It appears to be a situation where the drainage system could not keep up with the capacity of rainfall until the caps were removed, by which time water had already pooled on the roof, not because it was backing up through the drain pipes but because it could not go down the pipes.

We agree that the limitation first requiring covered damage to the roof or walls to allow rain in applies. From what is described, there was no covered damage that allowed the rain in. There really is not a way to cover this type of damage as it could be considered a maintenance issue. As you stated, opening the caps allowed the roof to begin draining, suggesting that some human intervention was needed for the drainage system to accommodate the rate of rainfall, which could indicate a fault with the drainage system; this would not be a covered cause of loss.

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