Wind and wind-driven rain, which can also be characterized as hurricane claims depending on severity, can be challenging claims to present under certain circumstances. Typical property damages for such claims include roof failure, windows leaks, and other building components that have potential to be damaged in high winds and heavy rain. Additional living expense and contents often also become components of the claim.
Often the wind damage is not immediately discernable, until a subsequent heavy rain. Indeed, it is not unusual that wind claims that initially appear manageable, for one reason or another, end up turning into a bigger, complicated claim, because of a later water intrusion. And the spread of water damage is often unpredictable. Indeed, in Los Angeles, where rain occurs infrequently and generally only during certain times of year, it would not be surprising that there would be a delay in discovering wind damage between the time it occurred, and when it became noticeable during heavy rains.
Delayed reporting of an insurance claim can, under limited circumstances, create a basis for an insurer to deny a claim. But California law requires an insurer to show “substantial prejudice” from late notice, so it is rare that late reporting of wind and rain damage is alone is an adequate basis to deny claim. Nevertheless, these claims often create coverage issues relating to the interplay between the coverage provisions with policy exclusions.
As with many property losses, whether coverage exists often depends on the efficient proximate cause of the loss. This means the loss is covered if the moving or prime cause is a covered event, even if an excluded cause played a role in the loss. Although some insurance companies attempt to write around this provision, and give themselves wider latitude to deny claims, such an effort is invalid under California law, as efficient proximate cause is the controlling legal standard.
Typical exclusions involve water damage from flood or surface water, which insurers contend apply. But wind is usually covered, so wind driven rain should also be covered. Where rain is driven by the wind so is it hitting the structure at angle, and there is evidence this is the reason for the water intrusion, the argument of coverage is strong.
As with other property claims, even if coverage issues are agreed to or set aside, there are often disagreements over the proper repairs and their cost, Insurance companies often want to do minimal repairs, at a low cost, and have experts who support the position. Insureds typical want to do more comprehensive repairs, with sufficient monies to do it correctly. Even where coverage is not an obstacle, the inability to agree to the scope and cost to repair wind and rain damage frequently can prevent informal resolution.
Where an insured is no longer able to live at the property, it is important that the insured keep records about additional living expenses, including rents, utilities, parking – anything the insured didn't have to pay when living before the loss. Although there is usually a 12 month limit to ALE, arguments can be made that inadequate payments or scope or repair delayed move in and ALE should continue beyond six months.
Insureds who have suffered a wind and rain loss, and are having issues obtaining adequate insurance coverage, can contact us for a consultation.