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Ocean Point Claims:policy exclusions denial

Policy Exclusions Denial

Carriers invoke exclusions routinely to deny, but exclusion language is narrow and specific. Careful parsing of the policy and the facts often defeats exclusion-based denials.

Common exclusions cited

  • Gradual seepage / long-term leak
  • Wear and tear / maintenance
  • Pre-existing damage
  • Flood (excluded under most HO-3)
  • Earth movement
  • Neglect
  • Intentional acts

How exclusions are interpreted

Florida rules:

  • Narrowly construed
  • Ambiguity resolved for insured
  • Proximate cause analysis
  • Specific language controls

Ocean Point Claims:improper repairs denial

Challenging an exclusion

Precise language analysis

  • What does the exclusion actually say?
  • What facts does the carrier cite?
  • Do the facts actually fit the exclusion?

Carve-outs within exclusions

  • Most exclusions have carve-outs
  • "We do not cover X, except when..."
  • Read the full provision

Proximate cause

  • Multiple causes; which is primary?
  • Efficient proximate cause in Florida
  • Concurrent causation considerations

Ensuing loss

  • Damage resulting from excluded cause
  • Ensuing damage typically covered
  • Florida ensuing-loss doctrine

Related

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FL DFS #W829547
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