(Credit: IanRedding/Shutterstock.com)
Plaintiff counsel is fighting to prove an exception to policy exclusions after a major insurer denied a Georgia couple's claim.
And insurance attorneys unaffiliated with the case say it just might work.
As spotted on Law.com Radar, Paul and Ashley Skinner of Carroll County sued State Farm Fire & Casualty Co. for breach of contract after the insurance company denied coverage for $75,000 worth of damage attributed to a refrigerator waterline leak.
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The couple's attorney, J. Mac C. Pilgrim of the Pilgrim Law Group in Villa Rica, said the homeowners learned of the initial water damage during an unrelated pest-control inspection, in which the professional found water in a crawl space. A plumber's follow-up inspection linked the leak to the refrigerator's ice-maker waterline.
J. Mac C. Pilgrim, owner and founder of The Pilgrim Law Group in Villa Rica, Georgia. (Courtesy photo)
"[The Skinners] replaced the waterline with the help of a plumber," Pilgrim said. "They put a fan down there [and dried] the water out … [They checked] it a couple of days later, … there's no problem."
Pilgrim said his clients believed they had remedied the issue, and only learned otherwise when they discovered additional water damage while taking up flooring during a kitchen renovation months later.
"I think they did what a reasonable homeowner would do, which is call a plumber and fix the problem," Pilgrim said.
But when the homeowners filed a claim with State Farm, the complaint alleged the insurer refused to compensate the damages, citing them as pre-existing.
The couple had not consulted a water mitigation specialist upon learning of the initial refrigerator waterline leak, and State Farm determined the secondary damage was excluded from coverage under the policy.
"[State Farm] has repeatedly denied the claim on the basis that water leakage and mold caused the damage to the [Skinners' residence], which are exclusions to coverage in the policy," the complaint drafted by Pilgrim read. "However, the [Skinners] would not have known about the damage, other than the initial water leakage and water line, which were repaired and replaced, but for the remodeling work on the kitchen, because the damage was hidden from view by the tile, cabinetry, and/or any other structural and/or design elements in the kitchen area that covered the damage. Therefore, exceptions to the exclusions apply."
Pilgrim said he planned to fight for that exception.
Burden of Proof
Imran Malik, founding member of Malik Law, Maitland, Florida. (Courtesy photo)
However, Florida-based insurance attorney Imran Malik said the success of the litigation hinged on a burden of proof being satisfied.
"Water damage claims are extremely common, and most policies cover them, unless there's an exclusion that's applicable," he said. "These are all things that would be proven through discovery, and ultimately shown to a jury and proven to a jury at trial."
Malik, who is unaffiliated with the case, said it presented a common challenge faced by insurance attorneys.
"In instances where you're dealing with an exception to the exclusion, a burden would shift back to the plaintiffs to prove that the exception to the exclusion applies," said Malik of Malik Law near Orlando, Florida. "So in order for these claims to be valid, they can certainly proceed, as long as you're capable of meeting your burdens of proof."
Pilgrim agreed. He said he faced an uphill battle proving the timeframe surrounding the water damage but intended to fight to prevent the case from being tossed on summary judgment. Instead, he hoped to try the case before a jury that would relate to his clients.
"If we can get to a jury, I can imagine a homeowner looking at this and saying, 'Whoa, how am I supposed to know that?'" Pilgrim said. "'I'm supposed to climb underneath the crawlspace of my house to see if there's a leak, and if there is a leak and I do [the] responsible thing and call the plumber and get it fixed, that's not enough?'"

