On March 4th, Wheeler, DiUlio & Barnabei hosted a lunch & learn webinar, Policy Exclusions and Anti-Concurrent Causation. Partner Anthony DiUlio discussed how to get around the most common and complex exclusions as well as answered viewer’s questions live.
The webinar also specifically addressed:
- How to interpret the exclusions in a way that grants coverage
- How to navigate the balance of anti-concurrent causation and the ensuing loss
- How to respond to the denial letter by using their own exclusion language against them
Here’s a recap of some of the questions discussed:
What are Anti-Concurrent Causation Language and Ensuing Loss Language?
Anti-Concurrent Causation means if your cause of loss is combined with any other cause of loss that is not covered, the loss itself is not covered. Ensuing Loss is if you have an excluded cause of loss, and then as result, a covered cause of loss happens, that covered cause of loss IS covered. When these are used together, it can be very confusing since they are contradictory. In the webinar, we showed some policy examples to further explain this.
What has the court said about this?
In Pennsylvania and New Jersey, recent court cases ruled that an ambiguity in a policy should be interpreted in a way that is in favor of the insured and against the insurer. In New Jersey, court rulings say that the ensuing loss language is the enforceable language in the policy.
Some of the Questions Submitted About Policy Exclusions and Anti-Concurrent Causation
If there is mold after a water claim, can the insurance company deny the entire claim?
The short answer is no. This is a great example of the conflict between anti-concurrent causation and ensuing loss. The cause of the damage that you will be claiming is water unless there is mold coverage. Keep everything mold-related out of the claim. This is very important because as long as your claim is water, there is no exclusion for it.
Obviously, you need to read the policy language to determine how/what exclusions apply. What can you do if the insurance carrier refuses to or delays the delivery of the certified policy copy to you as the public adjuster?
This happens all of the time. Insurance companies do this because they know if you have the policy, the insured has the upper-hand. There is a certain amount of times you can request it, but we recommend doing it once. If they don’t provide it, get a higher power involved, not a lawyer, but the insurance department of your state.
For example, Pennsylvania law states that a reply needs to made within 10 working days by the carrier and if by day 11 there is nothing, contact the insurance department. This is the fastest way to force their hand. Most likely, they will send the policy themselves.
If the carrier declines to provide the policy, is that considered bad faith? If that alone is not enough to litigate, is it a step toward that?
As with any specific review of an issue, the answer is often it depends. Generally, Bad faith is typically an ongoing issue. Not providing the policy may not be enough, on its own, for a bad faith claim. It is a step in that direction though. As stated earlier, contact the insurance department for your state.
Join us for our next lunch and learn webinar on Friday, April 9th at noon, Estoppel and POLS: How to use the carrier’s promises and requirements against them. Click here to register.
Have any questions about policy exclusions? Click here to contact us.
