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Ocean Point Claims:policy exclusions denial
Denial Playbook

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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