TRY ME!
Denied Homeowners Insurance Claim
Summary
Homeowners insurance claims in Ohio may exclude damage caused by fungus. However, if the damage results in a sudden collapse due to hidden decay, it might be covered under the collapse clause. Review your policys specific terms and consult with your insurance provider. If denied, consider legal action for breach of contract and bad faith denial.Full Conversation
homeowners insurance denied claim
What was the reason given by your insurance company for denying your claim?
damage by fungus is not covered
What state are you located in, John? Different states have different regulations regarding homeowners insurance coverage.
ohio
What type of damage did the fungus cause to your property?
In Ohio, homeowners insurance policies may exclude certain types of damage, including those caused by fungus.
In Ohio, homeowners insurance policies may exclude certain types of damage, including those caused by fungus.
hidden decay to trusses causing ceiling to collapse
What was the extent of the damage and have you had a professional assessment done? In Ohio, insurance policies may exclude fungus damage, but exceptions can occur.
not complete
What is the estimated cost of the damage and did the professional provide a written report of the assessment?
don't know
Could you please get a professional assessment and a written report of the damage? This could be helpful in your case.
Can you read an insurance policy and create filing
Sure, I can help you understand your insurance policy. Could you please provide me with the specific sections you're having trouble with?
SECTIONI- ADDITIONAL COVERAGES
The deductible will not apply to Section I - Additional Coverages, except where specified in the Additional
Coverage.
What specific aspect of Section I - Additional Coverages are you having trouble understanding or need clarification on?
Please remove that section and let me re-enter
Of course, please go ahead and re-enter the section you need help with.
SECTIONI- ADDITIONAL COVERAGES
The deductible will not apply to Section I - Additional Coverages, except where specified in the Additional Coverage.
*. Collapse. We will pay for sudden and accidental direct physical loss to covered property involving the entire collapse of a building or any part of a building caused only by one or more of the following:
A. perils described in SECTION I - BROAD NAMED PERILS;
B. hidden decay of the structure;
C. hidden insect or hidden vermin damage;
D. weight of contents, equipment, animals or people;
E. weight of ice, snow, sleet or rain which collects on a roof;
F. use of defective material or methods in construction, remodeling or renovation if the collapse occurs during the course of the construction, remodeling or renovation;
G. water or water-borne material which backs up through sewers or drains; or
H. water or water-borne material which enters and overflows or is discharged from within a sump pump, sump pump well or other type system designed to remove subsurface water which is drained from the foundation area.
Loss to an awning, fence, patio, pavement, swimming pool, underground pipe, flue, drain, cesspool, septic tank, septic field, foundation, retaining wall, bulkhead, pier, wharf or dock is not included under items B., C., D., E., and F. unless the loss is a direct result of the collapse of a building.
Collapse means an abrupt falling down or caving in of a building or any part of a building. Collapse does not include settling, cracking, sagging, bowing, bending, leaning, shrinking, bulging or expansion. A building or any part of a building that is in danger of falling down or caving in is not considered to be in a state of collapse.
This coverage does not increase the limit of liability applying to the damaged covered property.
The policy deductible does apply to this coverage.
Can I upload my insurance policy and ask questions about it?
Start over
Can you read an insurance policy and create filing
What specific sections or terms in your insurance policy are you having trouble with or need clarification on?
Collapse means an abrupt falling down or caving in of a building or any part of a building. Collapse does not include settling, cracking, sagging, bowing, bending, leaning, shrinking, bulging or expansion. A building or any part of a building that is in danger of falling down or caving in is not considered to be in a state of collapse.
What is your specific question or concern regarding the "collapse" clause in your insurance policy?
If the ceiling has collapsed, does this also cover the trusses that have failed
What caused the trusses to fail? Was it due to any of the reasons listed under the "collapse" clause in your policy?
Yes, hidden decay
Based on the policy clause you provided, if the trusses failed due to hidden decay, it should be covered under the "collapse" clause. Please confirm with your insurance provider.
Does a collapsed ceiling mean the building is in a state of collapse?
Based on the policy definition, a collapsed ceiling doesn't necessarily mean the entire building is in a state of collapse. It depends on the extent and cause of the damage.
If the ceiling collapsed, is the rafters above also in a state of collapse?
The state of the rafters would depend on the extent of the damage. Have they been directly affected by the ceiling collapse?
If fungus caused the decay is it covered
What does your policy say about damage caused by fungus or similar issues? Some policies may exclude this, while others might cover it under certain conditions.
Fungus is not covered
What caused the fungus growth that led to the decay? This information could be important in determining if there's a possibility for coverage under a different clause.
moisture and heat
Does your policy have any clauses related to damage caused by moisture or heat?
no
no it does not
Does your policy have a clause about "sudden and accidental direct physical loss"?
does additional coverages overide general exlusions
Does your policy have a specific clause stating that additional coverages override general exclusions?
no
What is the exact wording of the general exclusions in your policy?
SECTION I - LOSSES WE DO NOT COVER
*. We do not insure under any Section I coverage for any loss which would not have happened in the absence
of one or more of the following excluded events. We do not insure for any such loss regardless of:
(a) the cause of the excluded event;
(b) other causes of the loss; or
(c) whether such causes acted at the same time or in any other sequence with the excluded event to
produce or contribute to the loss.
These exclusions apply whether or not the excluded event results in widespread damage or affects a
substantial area. The excluded events are listed below.
A. Intentional Loss, meaning any loss arising out of any intentional or criminal act committed:
*. by you or at your direction; and
*. with the intent to cause a loss.
This exclusion applies regardless of whether you are actually charged with or convicted of a crime.
In the event of such loss, no one defined as you or your is entitled to coverage, even people defined as
you or your who did not commit or conspire to commit the act causing the loss.
B. Pollution, meaning loss or damage to property which results directly or indirectly from:
*. discharge, dispersal, release or escape of pollutants or contaminants, including damage caused by
chemicals in the soil and loss resulting from the release of toxic materials or other pollutants or
contaminants, no matter how caused;
*. discharge, dispersal, release or escape of fuel oil and other petroleum products; or
*. smog; smoke from agricultural smudging or industrial operations.
However, we pay for direct loss that ensues after pollution. We pay for such ensuing loss only if caused
by fire, smoke that is not from agricultural smudging or industrial operations, explosion, glass breakage,
or water damage not specifically excluded in this policy. If a covered water loss follows, we will pay the
cost of tearing out and replacing any part of the building necessary to repair the plumbing or appliance,
but we do not cover loss to the plumbing or appliance from which the water escaped.
C. Lead Exposure, meaning loss or damage to the residence premises or any property owned, rented or
controlled by you (including private structures and private approaches), which result directly or indirectly
from the presence of lead. We do not pay for any costs or expenses incurred or loss arising out of:
*. the abatement, neutralization, cleanup, removal, repair, refurbishing or treatment of:
a. lead;
b. property containing lead;
c. soil, or earth containing lead;
d. water, pipes or plumbing containing lead;
e. paint, putty, dust or plaster containing lead; or
f. any other product or substance containing lead; or
*. any government directive, law, regulation, request, requirement or mandate to remove, clean up, test,
monitor, abate, contain, neutralize or treat:
a. lead;
b. property containing lead;
c. soil, or earth containing lead;
d. water, pipes or plumbing containing lead;
e. paint, putty, dust or plaster containing lead; or
f. any other product or substance containing lead.
D. Water damage, meaning any loss caused by, resulting from, contributed to or aggravated by:
*. flood, surface water, waves, tidal water or overflow of any body of water, or spray from any of these,
whether or not driven by wind;
*. water or water-borne material which backs up through sewers or drains, or which overflows or is
discharged from a sump pump, sump pump well or other system designed to remove subsurface
water which is drained from the foundation area; or
*. water or water-borne material below the surface of the ground, including water which exerts pressure
on, or flows, seeps or leaks through any part of a building, sidewalk, foundation, driveway, swimming
pool or other structure or water which causes earth movement.
This exclusion applies whether or not the water damage is caused by or results from human or animal
forces or any act of nature.
However, we pay for direct loss that ensues after water damage if caused by fire, theft or explosion and
then we pay for only the ensuing loss.
Water damage to property described in Coverage C away from a premises or location owned,
rented, occupied or controlled by you is covered.
Water damage to property described in Coverage C on a premises or location owned, rented, occupied or
controlled by you is excluded even if weather conditions contribute in any way to produce the loss.
E. Earth Movement, meaning any loss caused by, resulting from, contributed to or aggravated by events
that include, but are not limited to:
*. earthquake and earthquake aftershocks;
*. volcanic eruption and volcanic effusion;
*. sinkhole;
*. subsidence;
*. mudslide including landslide, mudflow, debris flow, avalanche or sediment;
*. erosion or excavation collapse;
*. the sinking, rising, shifting, expanding, bulging, cracking, settling or contracting of the earth, soil or
land; and
*. volcanic explosion and lava flow, except as granted under SECTION I - ADDITIONAL COVERAGES
for Volcanic Action.
This exclusion applies whether or not the earth movement is combined with water or caused by or results
from human or animal forces or any act of nature.
However, we pay for direct loss that ensues after earth movement if caused by fire, explosion other than
explosion of a volcano, theft, or breakage of glass or safety glazing material and then we pay for only the
ensuing loss.
F. Ordinance or Law, meaning enforcement of any ordinance or law regulating the construction, repair,
demolition or zoning of buildings, unless specifically provided under this policy.
G. Power Failure, meaning the failure of power or other utility service if the failure takes place off the
residence premises, except as granted under SECTION I - ADDITIONAL COVERAGES for Emergency
Living Expense. If a loss we pay for ensues on the residence premises, we pay for only the ensuing
loss.
H. Neglect by you to use all reasonable means to save and preserve property at and after the time of a
loss, or when property is endangered by a peril insured against.
I. Nuclear Action, meaning nuclear reaction, discharge, radiation or radioactive contamination, all whether
controlled or uncontrolled or however caused, or any consequence of any of these. Loss caused by
nuclear action is not considered a loss caused by fire, explosion or smoke.
However, we pay for direct loss that ensues after nuclear action if caused by fire and then we pay for
only the ensuing loss.
J. Governmental Action, including war, undeclared war, civil war, rebellion, insurrection, revolution, warlike
act by a military force or military personnel, destruction or seizure or use for a military purpose, and
including any consequence of any of these. Governmental Action also includes loss arising out of risks of
contraband or illegal transportation or trade and loss due to order of any civil authority except:
*. conditions we insure under Prohibited Use of SECTION I - ADDITIONAL COVERAGES for Loss of
Use; or
*. acts of destruction during a fire to prevent it from spreading as long as the fire was not caused by any
peril excluded by this policy.
*. We do not insure under Coverage A and Coverage B for any loss consisting of one or more of the items
below. However, we pay for any ensuing loss unless the ensuing loss is itself excluded by any other
provision in this policy. Further, we do not insure for loss described in Exclusion *. above and Exclusions *.
and *. below regardless of whether one or more of the following: (a) directly or indirectly cause, contribute to
or aggravate the loss; or (b) occur before, at the same time, or after the loss or any other cause of the loss.
The items are:
A. conduct, act, failure to act, or decision of any person, group, organization or governmental body whether
intentional, wrongful, negligent or without fault;
B. defective, inadequate, faulty or unsound:
*. planning, zoning, development, surveying, siting;
*. design, specifications, workmanship, repair, construction, renovation, remodeling, grading,
compaction;
*. materials used in repair, construction, renovation or remodeling; or
*. maintenance;
of any property whether on or off the residence premises. Property includes land, structures or
improvements of any kind; and
C. weather conditions.
However, this exclusion only applies if weather conditions contribute in any way with an excluded event or
cause of loss to produce the loss.
*. We do not cover loss or damage to the property described in Coverage A, Coverage B and Coverage C
which results directly or indirectly from any of the following:
A. wear and tear, marring, scratching, aging, deterioration, corrosion, rust, mechanical breakdown, latent
defect, inherent vice, or any quality in property that causes it to damage or destroy itself;
B. fungus and mold. There is no coverage for loss which, in whole or part, arises out of, is aggravated by,
contributed to by acts or omissions of persons, or results from fungus and mold. This exclusion applies
regardless of whether fungus and mold arises from any other cause of loss, including but not limited to a
loss involving water, water damage or discharge, which may be otherwise covered by this policy, except
as granted under SECTION I - ADDITIONAL COVERAGES for Fungus and Mold Remediation;
C. settling, cracking, shrinking, bulging, or expansion of bulkheads, pavements, patios, foundations,
footings, supports, walls, floors, roofs, or ceilings;
D. animals owned or kept by you or any person regularly residing on the premises;
E. birds, vermin, rodents or insects;
F. theft in or from the residence premises while under construction, or of materials and supplies for use in
the construction, until the residence premises is completed and occupied;
G. freezing of a plumbing, heating, air conditioning, or automatic fire protective sprinkler system, or of a
domestic appliance, or by discharge, leakage or overflow from within the system or appliance caused by
freezing. This exclusion does not apply if you have used reasonable care to maintain heat in the building
or if you shut off the water supply and drained the plumbing and appliance of water. However, if the
building is protected by an automatic fire protective sprinkler system, you must use reasonable care to
continue the water supply and maintain heat in the building for coverage to apply.
For this provision, a plumbing system or domestic appliance does not include a roof drain, gutter,
downspout, or similar fixtures or equipment;
H. freezing, thawing or pressure or weight of water, snow or ice, whether driven by wind or not, to a
swimming pool including filtration, heating and circulation systems, fence, driveway, roadway, walkway,
pavement, patio, foundation, footing, retaining wall, bulkhead, pier, wharf or dock; or
I. pressure from or presence of tree, shrub or plant roots.
We do pay for any direct loss that follows items A. through H. to property described in Coverages A, B and C
not otherwise excluded or excepted in this policy and then we pay for only the ensuing loss. If a covered
water loss follows, we will pay the cost of tearing out and replacing any part of the building necessary to
repair the plumbing or appliance, but we do not cover loss to the plumbing or appliance from which the water
escaped.
*. We do not pay for loss or damage to the property described in Coverage A and Coverage B:
A. caused by vandalism or malicious mischief or breakage of glass and safety glazing materials, and any
loss caused by any act committed in the course of the vandalism or malicious mischief including any
ensuing loss or fire, if the residence was vacant for more than * consecutive days immediately prior to
the loss. A residence premises being constructed is not considered vacant;
B. caused by seepage, meaning continuous or repeated seepage or leakage of water or steam or the
presence or condensation of humidity, moisture or vapor, over a period of weeks, months or years, from
within:
*. a heating system;
*. an air conditioning system;
*. an automatic fire protective sprinkler system;
*. a domestic appliance; or
*. a plumbing system, including from, within or around any shower stall, shower bath, tub installation, or
other plumbing fixture, including their walls, ceilings or floors.
However, we pay for ensuing damages to building property that results from such seepage if the leakage
of water is not able to be observed and is hidden within the walls or ceilings or above the ceilings or
beneath the floors but not below the slab or foundation floor of a structure.
For this provision, a plumbing system or domestic appliance does not include a roof drain, gutter,
downspout, or similar fixtures or equipment.
We pay for any direct loss that follows after seepage to property described in Coverages A and B not
otherwise excluded or excepted in this policy and then we pay for only the ensuing loss. If a covered
water loss follows, we will pay the cost of tearing out and replacing any part of the building necessary to
repair the plumbing or appliance, but we do not cover loss to the plumbing or appliance from which the
water escaped; or
C. involving collapse, except as granted under SECTION I - ADDITIONAL COVERAGES for Collapse.
However, we do pay for any ensuing loss to property described in Coverages A and B not excluded or
excepted in this policy.
*. We do not pay for loss or damage to the property described in Coverage C caused by:
A. breakage of:
*. eyeglasses, glassware, statuary, marble; or
*. bric-a-brac, porcelains and similar fragile articles other than jewelry, watches, bronzes, cameras and
photographic lenses.
There is coverage for breakage of the property resulting from:
*. fire, lightning, windstorm or hail;
*. smoke, other than smoke from agricultural smudging or industrial operations;
*. explosion, riot, civil commotion;
*. aircraft, vehicles or vandalism and malicious mischief;
*. collapse of a building or any part of a building;
*. water not otherwise excluded;
*. theft or attempted theft; or
*. sudden and accidental tearing apart, cracking, burning, or bulging of:
a. a steam or hot water heating system;
b. an air conditioning or automatic fire protective sprinkler system; or
c. an appliance for heating water;
B. dampness of atmosphere or extremes of temperature unless the direct cause of loss is rain, snow, sleet
or hail;
C. refinishing, renovating or repairing property other than watches, jewelry and furs;
D. collision other than collision with a land vehicle, sinking, swamping or stranding of watercraft, including
their trailers, furnishings, equipment and outboard motors or engines;
E. destruction, confiscation or seizure by order of any government or public authority;
F. acts or decisions, including the failure to act or decide, of any person, group, organization or government
body. However, any ensuing loss to property described in Coverage C not excluded or excepted in this
policy is covered; or
G. an error in computer programming or instructions to the computer.
can
Can you answer questions about my entire insurance policy?
Can you answer questions about my insurance policy
is fungus covered?
start over
quit
end
exit
Is fungus covered by my policy?
What type of insurance policy do you have? Coverage for fungus damage can vary depending on the specific terms of your policy.
What is the case law for hidden decay
Could you please specify the jurisdiction or state you're inquiring about? Laws regarding hidden decay can vary by location.
ohio
What is the specific situation or incident involving hidden decay that you're dealing with?
In Ohio, insurance policies may cover hidden decay if it's sudden and accidental.
In Ohio, insurance policies may cover hidden decay if it's sudden and accidental.
Ceiling collapsed, broken trusses, rafters dropped a few inches
What was the cause of the ceiling collapse and the damage to the trusses and rafters?
decay due to fungus from moisture in the attic
What steps have you taken so far to address this issue with your insurance company?
Is wood rot in my attic considered hidden decay?
Yes, wood rot in the attic can be considered hidden decay. However, it depends on your insurance policy's specific terms. Have you checked your policy for any exclusions or limitations regarding hidden decay?
It doesn't define hidden decay, but it does talk about hidden water damage
What does your policy specifically say about hidden water damage?
However, we pay for ensuing damages to building property that results from such seepage if the leakage
of water is not able to be observed and is hidden within the walls or ceilings or above the ceilings or
beneath the floors but not below the slab or foundation floor of a structure.
Does your policy mention anything about damage caused by hidden decay or rot, specifically in the attic?
no, but there is a section about collapse.
What does your policy state about damage caused by a collapse?
Collapse. We will pay for sudden and accidental direct physical loss to covered property involving the entire
collapse of a building or any part of a building caused only by one or more of the following:
A. perils described in SECTION I - BROAD NAMED PERILS;
B. hidden decay of the structure;
Does your policy define what constitutes a "collapse"?
Collapse means an abrupt falling down or caving in of a building or any part of a building. Collapse does not
include settling, cracking, sagging, bowing, bending, leaning, shrinking, bulging or expansion. A building or
any part of a building that is in danger of falling down or caving in is not considered to be in a state of
collapse.
Has the wood rot in your attic caused any part of your building to abruptly fall down or cave in?
The ceiling is caving in and insulation has fallen to the rooms below.
What is the extent of the damage caused by the ceiling collapse?
Just the ceiling itself
Did the collapse occur suddenly and accidentally, or was it a gradual process?
Sudden
What was the cause of the wood rot in your attic?
Fungus
What steps have you taken since discovering the fungus and the resulting damage?
None
What is your location? This will help me provide you with the most accurate information regarding your legal rights and options.
Ohio
What is the extent of the damage caused by the collapse?
*
What is the estimated cost of repair for the damage caused by the collapse?
*
What steps have you taken to report this to your insurance company?
I opened a claim. They cover the ceiling but not the trusses.
What was the insurance company's reason for not covering the trusses?
Long-term decay, wear/tear and rot are excluded
losses under the policy.
What does your policy specifically state about exclusions for long-term decay, wear/tear, and rot?
We do not cover loss or damage to the property described in Coverage A, Coverage B and Coverage
C which results directly or indirectly from any of the following:
A. wear and tear, marring, scratching, aging, deterioration, corrosion, rust, mechanical breakdown,
latent defect, inherent vice, or any quality in property that causes it to damage or destroy itself;
Does your policy mention anything about coverage for damage resulting from fungus?
fungus and mold. There is no coverage for loss which, in whole or part, arises out of, is
aggravated by, contributed to by acts or omissions of persons, or results from fungus and mold.
This exclusion applies regardless of whether fungus and mold arises from any other cause of
loss, including but not limited to a loss involving water, water damage or discharge, which may
be otherwise covered by this policy, except as granted under SECTION I – ADDITIONAL
COVERAGES for Fungus and Mold Remediation;
What does SECTION I – ADDITIONAL COVERAGES for Fungus and Mold Remediation in your policy state?
Fungus and Mold Remediation. We will pay up to a limit of $* for remediation treatment and
remediation testing as necessary to complete the repair or replacement of the damaged property. This
coverage applies when property covered under Coverages A, B or C is damaged by a covered water loss.
Furthermore, this coverage applies only if all reasonable means were used to save and preserve the property
from further damage at and after the time of the covered water loss. This limit includes:
a. the cost to tear out and replace any part of the covered property necessary to gain access to any
organisms listed under remediation treatment; and
b. if the need for remediation treatment or remediation testing makes the residence premises
uninhabitable, the reasonable increase in living expenses and your loss of rental income. Payment will
be for the shortest time required to perform the remediation treatment or remediation testin
Did you take all reasonable steps to save and preserve the property from further damage after the water loss was discovered?
yes
What was the insurance company's response when you reported the ceiling collapse and the fungus issue?
The ceiling was covered but the trusses were not
What was the reason given by the insurance company for not covering the trusses?
Fungus
Did the insurance company provide a detailed explanation as to why the damage caused by the fungus was not covered under your policy?
Why is my ceiling not covered under the collapse clause of my policy?
What does your policy specifically state about the collapse clause? Policies can vary greatly, so it's important to understand the specific language in your own policy.
Can I start over?
Of course, you can start over. What's the specific legal issue you're facing now?
My insurance company is covering a collapsed ceiling, but they are applying a deductible clause that should not apply if it is covered under the collapse clause.
What does your insurance policy specifically state about the collapse clause and the deductible clause?
Collapse. We will pay for sudden and accidental direct physical loss to covered property involving the entire
collapse of a building or any part of a building caused only by one or more of the following:
A. perils described in SECTION I - BROAD NAMED PERILS;
B. hidden decay of the structure;
What caused the collapse of your ceiling? Was it due to any of the perils described in Section I or hidden decay of the structure?
Hidden decay of the trusses
What evidence do you have to prove the hidden decay of the trusses?
A forensic inspection
What were the findings of the forensic inspection?
The ceiling collapsed due to decay of the trusses caused by long term moisture in the attic
What was the insurance company's reason for applying the deductible clause despite the collapse being due to hidden decay?
They did not say the it was covered under collapse. They said it was covered under COMPREHENSIVE PERILS
What does your policy state about the coverage under "Comprehensive Perils"?
We will pay for sudden and accidental direct physical loss or damage to the property described in Coverages A, B
and C, except as excluded in SECTION I - LOSSES WE DO NOT COVER.
What does SECTION I - LOSSES WE DO NOT COVER in your policy state?
SECTION I - LOSSES WE DO NOT COVER
*. We do not insure under any Section I coverage for any loss which would not have happened in the absence
of one or more of the following excluded events. We do not insure for any such loss regardless of:
(a) the cause of the excluded event;
(b) other causes of the loss; or
(c) whether such causes acted at the same time or in any other sequence with the excluded event to
produce or contribute to the loss.
These exclusions apply whether or not the excluded event results in widespread damage or affects a
substantial area. The excluded events are listed below.
D. Water damage, meaning any loss caused by, resulting from, contributed to or aggravated by:
*. flood, surface water, waves, tidal water or overflow of any body of water, or spray from any of these,
whether or not driven by wind;
*. water or water-borne material which backs up through sewers or drains, or which overflows or is
discharged from a sump pump, sump pump well or other system designed to remove subsurface
water which is drained from the foundation area; or
*. water or water-borne material below the surface of the ground, including water which exerts pressure
on, or flows, seeps or leaks through any part of a building, sidewalk, foundation, driveway, swimming
pool or other structure or water which causes earth movement.
This exclusion applies whether or not the water damage is caused by or results from human or animal
forces or any act of nature.
However, we pay for direct loss that ensues after water damage if caused by fire, theft or explosion and
then we pay for only the ensuing loss.
Water damage to property described in Coverage C away from a premises or location owned,
rented, occupied or controlled by you is covered.
Water damage to property described in Coverage C on a premises or location owned, rented, occupied or
controlled by you is excluded even if weather conditions contribute in any way to produce the loss.
*. We do not insure under Coverage A and Coverage B for any loss consisting of one or more of the items
below. However, we pay for any ensuing loss unless the ensuing loss is itself excluded by any other
provision in this policy. Further, we do not insure for loss described in Exclusion *. above and Exclusions *.
and *. below regardless of whether one or more of the following: (a) directly or indirectly cause, contribute to
or aggravate the loss; or (b) occur before, at the same time, or after the loss or any other cause of the loss.
The items are:
A. conduct, act, failure to act, or decision of any person, group, organization or governmental body whether
intentional, wrongful, negligent or without fault;
B. defective, inadequate, faulty or unsound:
*. planning, zoning, development, surveying, siting;
*. design, specifications, workmanship, repair, construction, renovation, remodeling, grading,
compaction;
*. materials used in repair, construction, renovation or remodeling; or
*. maintenance;
of any property whether on or off the residence premises. Property includes land, structures or
improvements of any kind; and
C. weather conditions.
However, this exclusion only applies if weather conditions contribute in any way with an excluded event or
cause of loss to produce the loss.
*. We do not cover loss or damage to the property described in Coverage A, Coverage B and Coverage C
which results directly or indirectly from any of the following:
A. wear and tear, marring, scratching, aging, deterioration, corrosion, rust, mechanical breakdown, latent
defect, inherent vice, or any quality in property that causes it to damage or destroy itself;
B. fungus and mold. There is no coverage for loss which, in whole or part, arises out of, is aggravated by,
contributed to by acts or omissions of persons, or results from fungus and mold. This exclusion applies
regardless of whether fungus and mold arises from any other cause of loss, including but not limited to a
loss involving water, water damage or discharge, which may be otherwise covered by this policy, except
as granted under SECTION I - ADDITIONAL COVERAGES for Fungus and Mold Remediation;
C. settling, cracking, shrinking, bulging, or expansion of bulkheads, pavements, patios, foundations,
footings, supports, walls, floors, roofs, or ceilings;
We do pay for any direct loss that follows items A. through H. to property described in Coverages A, B and C
not otherwise excluded or excepted in this policy and then we pay for only the ensuing loss. If a covered
water loss follows, we will pay the cost of tearing out and replacing any part of the building necessary to
repair the plumbing or appliance, but we do not cover loss to the plumbing or appliance from which the water
escaped.
*. We do not pay for loss or damage to the property described in Coverage A and Coverage B:
A. caused by vandalism or malicious mischief or breakage of glass and safety glazing materials, and any
loss caused by any act committed in the course of the vandalism or malicious mischief including any
ensuing loss or fire, if the residence was vacant for more than * consecutive days immediately prior to
the loss. A residence premises being constructed is not considered vacant;
B. caused by seepage, meaning continuous or repeated seepage or leakage of water or steam or the
presence or condensation of humidity, moisture or vapor, over a period of weeks, months or years, from
within:
*. a heating system;
*. an air conditioning system;
*. an automatic fire protective sprinkler system;
*. a domestic appliance; or
*. a plumbing system, including from, within or around any shower stall, shower bath, tub installation, or
other plumbing fixture, including their walls, ceilings or floors.
However, we pay for ensuing damages to building property that results from such seepage if the leakage
of water is not able to be observed and is hidden within the walls or ceilings or above the ceilings or
beneath the floors but not below the slab or foundation floor of a structure.
For this provision, a plumbing system or domestic appliance does not include a roof drain, gutter,
downspout, or similar fixtures or equipment.
We pay for any direct loss that follows after seepage to property described in Coverages A and B not
otherwise excluded or excepted in this policy and then we pay for only the ensuing loss. If a covered
water loss follows, we will pay the cost of tearing out and replacing any part of the building necessary to
repair the plumbing or appliance, but we do not cover loss to the plumbing or appliance from which the
water escaped; or
C. involving collapse, except as granted under SECTION I - ADDITIONAL COVERAGES for Collapse.
However, we do pay for any ensuing loss to property described in Coverages A and B not excluded or
excepted in this policy.
What does your policy state about the deductible clause and how it applies to different types of coverage?
LOSS DEDUCTIBLE CLAUSE
We will pay only when a loss exceeds the deductible amount shown in the Declarations. We will pay only that
part of the loss over such stated deductible.
COVERAGE A - DWELLING
COVERAGE B - PRIVATE STRUCTURES '
COVERAGE C - PERSONAL PROPERTY
We will pay for sudden and accidental direct physical loss or damage to the property described in Coverages A, B
and C, except as excluded in SECTION I - LOSSES WE DO NOT COVER.
What is the deductible amount stated in your Declarations?
*
What is the amount of damage caused by the collapse of the ceiling?
*
$*
What was the insurance company's response when you argued that the collapse should be covered under the collapse clause, not the comprehensive perils clause?
I did not argue it with them. Should it be collapse?
What is the exact wording of the "Collapse" clause in your insurance policy?
*. Collapse. We will pay for sudden and accidental direct physical loss to covered property involving the entire collapse of a building or any part of a building caused only by one or more of the following:
A. perils described in SECTION I - BROAD NAMED PERILS;
B. hidden decay of the structure;
Collapse means an abrupt falling down or caving in of a building or any part of a building. Collapse does not include settling, cracking, sagging, bowing, bending, leaning, shrinking, bulging or expansion. A building or any part of a building that is in danger of falling down or caving in is not considered to be in a state of collapse.
This coverage does not increase the limit of liability applying to the damaged covered property.
The policy deductible does apply to this coverage.
What state are you located in? Insurance laws can vary by state, and this information will help me provide the most accurate information.
Ohio
What was the insurance company's response when you presented them with the findings of the forensic inspection?
I did not present it to them
Can I start over
Of course, you can start over. What's the new legal issue you're facing?
Can I file a lawsuit without being a lawyer
Yes, you can file a lawsuit without being a lawyer. This is called "pro se" or "self-representation". However, it's important to understand the rules and procedures of the court.
How do I file a lawsuit in the state of ohio?
What is the nature of the lawsuit you wish to file? In Ohio, the process may vary depending on the type of case.
breach of contract and bad faith denial
What is the specific contract that was breached and how was it breached?
Homeowners insurance policy by claim denial
What evidence do you have to support your claim of breach of contract and bad faith denial?
Their settlement letter and their forensic engineering report
What does the settlement letter and the forensic engineering report indicate that supports your claim?
That the claim should have been covered under collapse due to hidden decay
What is the specific clause in your insurance policy that covers collapse due to hidden decay?
SECTIONI- ADDITIONAL COVERAGES
The deductible will not apply to Section I - Additional Coverages, except where specified in the Additional Coverage.
*. Collapse. We will pay for sudden and accidental direct physical loss to covered property involving the entire collapse of a building or any part of a building caused only by one or more of the following:
A. perils described in SECTION I - BROAD NAMED PERILS;
B. hidden decay of the structure;
C. hidden insect or hidden vermin damage;
D. weight of contents, equipment, animals or people;
E. weight of ice, snow, sleet or rain which collects on a roof;
F. use of defective material or methods in construction, remodeling or renovation if the collapse occurs during the course of the construction, remodeling or renovation;
G. water or water-borne material which backs up through sewers or drains; or
H. water or water-borne material which enters and overflows or is discharged from within a sump pump, sump pump well or other type system designed to remove subsurface water which is drained from the foundation area.
Loss to an awning, fence, patio, pavement, swimming pool, underground pipe, flue, drain, cesspool, septic tank, septic field, foundation, retaining wall, bulkhead, pier, wharf or dock is not included under items B., C., D., E., and F. unless the loss is a direct result of the collapse of a building.
Collapse means an abrupt falling down or caving in of a building or any part of a building. Collapse does not include settling, cracking, sagging, bowing, bending, leaning, shrinking, bulging or expansion. A building or any part of a building that is in danger of falling down or caving in is not considered to be in a state of collapse.
This coverage does not increase the limit of liability applying to the damaged covered property.
The policy deductible does apply to this coverage.
What was the reason given by the insurance company for denying your claim?
An engineer report attached details that the collapsed drywall ceiling was caused by long term decay of
trusses due to condensation in the attic space. While the collapsed ceiling is covered under the policy. The
policy provides for sudden and accidental physical loss. Long-term decay, wear/tear and rot are excluded
losses under the policy. Additional givebacks are available for fungus & mold remediation in the event
there is a covered water loss, which there was not.
Long-term decay, wear/tear and rot are excluded losses under the policy.
What is the timeline of the decay according to the engineer's report?
Yes, over years
What is the date of the engineer's report and when did you first notice the collapse?
Can you show me an example of a filing for a lawsuit
Sure, I can guide you on how to file a lawsuit. However, I don't have a specific example. Would you like to proceed with the general steps?
General steps please
To file a lawsuit in Ohio, you need to:
*. Draft a complaint outlining your claim.
*. File the complaint with the appropriate court.
*. Serve the complaint to the defendant.
*. Await the defendant's response.
For more details, contact Franklin County Clerk of Courts: (*) *-*.
*. Draft a complaint outlining your claim.
*. File the complaint with the appropriate court.
*. Serve the complaint to the defendant.
*. Await the defendant's response.
For more details, contact Franklin County Clerk of Courts: (*) *-*.
Start a new chat