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Miami Insurance Claims Lawyer > Blog > Property Damage Insurance > What if an Insured Repair Can’t be Done Because of a Non-Insured Condition?

What if an Insured Repair Can’t be Done Because of a Non-Insured Condition?

Legal17

A property insurance policy is not a maintenance contract. It is not designed to refurbish things that get old, or to fix rot, erosion, or wear and tear, which is why these items are specifically excluded from almost every type of policy. However, there is a problem that occurs that can be very frustrating for homeowners and insurance companies alike: What happens when damage that is insured, cannot be fixed properly because the underlying structures are too damaged because of rot?

A simpler way of putting this is what happens when part of property that is insured, cannot be repaired without fixing or replacing parts of property that are not insured because they are damaged due to rot or wear and tear?

Policy Exclusions

Many insurance companies will admit coverage for the insurable damage, but will then say that they cannot complete repairs, or cannot make full repairs, unless you as the homeowner agree to pay for the part of the repairs that have to do with the excluded, non-insured rot or wear and tear. The insurance company does not want to pay for simple maintenance issues, or for the homeowner’s failure to maintain or to timely replace his or her roof.

Internal Policies

However, many insurance companies have their own internal policies, and because of this, a lot of what the insurance company will do has to do with what insurance company you are making a claim with. Some insurance companies acknowledge that as long as the damage is covered under the policy, that the repairs necessarily include replacement of the parts of the structure that are old, or rotted, even if those parts would normally be excluded.

In some cases, in order for the full claim to be covered, the rot or wear and tear must be so bad that the insured part of the property cannot be properly repaired without repairing the rotted parts of the structure.

However, just reading your policy, you would be under the impression that the insurance company does not have to make repairs to damage if making those repairs necessarily means replacing old, worn out parts of your property. The exceptions above would only be revealed in the course of a lawsuit, where company policy manuals can be obtained. The insurance company would have a hard time denying its obligation to pay for the repairs if it has an internal policy that requires that it do so, even if that policy conflicts with the terms of an insurance contract.

Ambiguity is Resolved for the Homeowner

Remember also that the homeowner is not the party that drafted the insurance contract. That means that if it is unclear, vague or ambiguous whether non-insured rot must be replaced in order to make otherwise insured repairs, the Court will assume that the homeowner is entitled to having the structure repaired.

Problems can arise in your homeowner’s insurance claim that you did not anticipate. Contact the Miami property damage insurance attorneys at Velasquez & Associates P.A. today with any questions you may have.

Resource:

investopedia.com/terms/w/wear-and-tear-exclusion.asp

https://www.jvelasquezlaw.com/squirrel-causes-damage-to-a-home-would-you-be-covered/

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