Insurable Perils vs. Maintenance Issues
When purchasing a homeowner policy, be aware there are some losses you can incur which are insurable events while there are others which are simply maintenance issues which are outside the scope of the policy and some issues which could be covered but are not due to the type of policy you purchase.
A Quick Overview
Perils covered in a policy can range from fire only to a policy described as a special form or deluxe form or all perils policy, or some other name which would connote anything which could cause physical damage to your home or personal belongings would be covered. It is common to all policies to enumerate perils, both the covered and excluded perils, so a quick review of your declaration page (page of policy showing limits of coverages) should help you understand what perils you are paying for. A better idea is to read the subsection in your policy which would be entitled “Perils insured against.”
In the same general area in your insurance policy you will also find a section called “Exclusions” which lists several perils which under “perils insured against” seem to provide coverage, yet because of exclusions some of those insured perils have limitations placed upon them.
Limitations On Insurable Perils
Here are a few examples:
- Under peril of collapse of building, collapse is defined as the abrupt falling down or caving in of all or part of a building resulting in the building being unfit for occupancy and its intended use. It also identifies how the building must have collapsed in order for coverage to be provided. Everything seems to be rather clear, but when you go to “exclusion” section you find an exclusion referring to earth movement which further limits the coverages.
- How about peril covering accidental discharge or overflow of water or steam from within a plumbing, heating, air conditioning, or automatic fire protection sprinkler system or household appliance. Clear enough, but when you read under exclusions you find there is an exclusion for water damage caused by flood, surface water, ice flow, waves, tidal water, storm surge, tsunami, seiche, overflow of a body of water…water or sewage that backs up or overflows from a sewage, septic, or drainage system….(City Squire, Farm Bureau Insurance p. 15 of 38).
- One more example, windstorm and hail coverage under perils insured against limits this coverage quite extensively, and then under exclusions expands the limitations under weather conditions–meaning any weather condition which results in landslides, mudflows, or earth sinking, rising, or shifting; flood, ice flow, waves, water or sewage backing up through sewer drains, or a septic system…(ibid)
Also, within the insurable perils there are limitations on how much the insurance company will participate in the event of loss, i.e. limitations on theft of guns, jewelry, electronic devices, removal of fallen trees, damage to landscaping, debris removal, damage caused by pollutants or mold to name a few.
Somewhere in your insurance policy you will find phrasing which introduces that the insurance company will not under any circumstance cover “. . . any loss where one or more of the following at any time directly or indirectly cause, contribute to, or aggravate the loss:
a. Any conduct, act, failure to act, or decision of any person, organization, or governmental entity, whether intentional, wrongful, negligent, or without fault. . .
b. Any faulty, inadequate, or defective construction, remodeling, renovation, repair, workmanship,or materials. . .
c. Any maintenance of all or part of any property whether on or off the insured location.(ibid)
A couple of examples will help here. Damage done by birds, vermin, insects, rodents, or domestic animals are generally considered maintenance issues; but in the event a building collapses due to damage caused by one of the above, it is covered.
In the wintertime snow and ice accumulating on the roof causing damage to roof, gutters, or stove pipes would normally be covered if you were not able to remove it on a timely basis. If you were aware of the build up and did nothing to clear the roof, an adjuster could very easily and justifiably deny the claim.
Bathroom floors over time have a tendency to rot away around the appliances due to water escaping from those appliances. If the damage was where you could not normally be aware of it, the adjuster would probably count the event as a one time event and pay for repairs; but if you were simply ignoring the ongoing damage, he again could justifiably deny the claim.
A roof finally just wearing out due to age and normal wear and tear should not be expected to be paid for by the insurance company.
It is not always clear as to what will or will not be covered under your homeowner policy; so if you feel you have a legitimate claim, talk to your agent and let him or her take a claim report from you pursuant to submitting the claim. I believe it is fair to say most agents will do all they can to make sure you get what is contractually your right to receive. Their interest in keeping you as a client rests upon their faith in you that you will submit an honest claim. They recognize that you have exercised your faith in them by your payment of your premiums and now is the time for them to show your faith in them was not in vain. Companies who treat their clients unfairly or fraudulently don’t stay in business very long, so find a company with longevity and a good public record of honesty and you can be pretty certain you will understand at the time of a loss whether it is an insurable peril or maintenance issue.