We have a claim situation where there was hurricane damage, but the premises also flooded. The insured claims the damage is from the hurricane, but the insurer says it was from flooding. How is this dispute resolved?
Puerto Rico Subscriber
In such cases, you need to look at the damage and the facts of the loss. Did wind from a hurricane damage the roof and let water into the building? That is not flood damage and would be covered under the commercial property policy. However, if the hurricane caused water to rise up around the the building, enter it, and damage the floor, walls and business personal property, that is probably flood damage.
You want to look at the wording of the exclusion itself – the insurer has to prove the exclusion.
The standard CP 10 30 Special Causes of Loss water exclusion is as follows:
(1) Flood, surface water, waves, including tidal wave and tsunami, tides, tidal water, overflow of any body of water, or spray from any of these, all whether or not driven by wind (including storm surge);
(2) Mudslide or mudflow
(3) Water that backs up or overflows or is otherwise discharged from a sewer, drain, sump, sump pump or related equipment;
(4) Water under the ground surface pressing on, or flowing or seeping through:
(a) Foundations, walls, floors or paved surfaces;
(b) Basements, whether paved or not; or
(c) Doors, windows or other openings; or
(5) Waterborne material carried or otherwise moved by any of the water referred to in Paragraph (1), (3) or (4), or material carried or otherwise moved by mudslide or mudflow.
It's entirely possible that you have damage both from a hurricane and from a flood; you would need to determine what caused what damage. Timing is important – did strong winds and rain come through an area first, so the roof was damaged and rain entered the building for several hours before floodwaters surrounded and damaged the property, or did floodwaters arrive first, and did wind and rain occur later? The weather service may be able to give you information as to what happened and when, if needed.
If you have further questions please let us know. Without more detail, we can only address this in general terms.
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