not stand legal scrutiny.
Other companies took a different approach, opting to first exclude mold both as a peril
and a damage, and then providing limited coverage for mold, mold damages, and
mold-related claims if the mold resulted from another covered cause of loss. These
endorsements generally agreed to add back coverage for mold claims but also put
forth a separate policy sub-limit (such as $5,000) to cover claims related to mold, such
as physical damage to dwelling and contents, remediation, testing, and additional
living expense.
Depending on the specific wording of the endorsement, these revisions may have
some problems. Some endorsements provide mold limits for Coverages A, B, or C.
The key word in these endorsements, of course, is “or.” When written this way, the
endorsement does not clearly state that there is one single cumulative policy sub-limit
of $5,000 applicable to mold for all of the insured property combined.
Since the basic homeowner’s policy has separate limits of liability for each coverage
(A, B, C, and D), it is logical and reasonable for an insured to understand that the
insurer intended to provide a separate $5,000 sub-limit for each of the Coverages, A,
B, and C (and possibly D). This would be $5,000 for the dwelling, $5,000 for other
structures, and $5,000 for contents for a total of at least $15,000 (and possibly
another $5,000 or 12 months for ALE.). If the form is viewed as ambiguous, it likely
will be interpreted in favor of the insured.
When some mold endorsements talk about the $5,000 sub-limit for mold, they do so
in terms of remediation, which the endorsement defines as covering repairs,
investigation, and ALE. The insurance industry standard has been that the cost of
investigating the claim has not been part of the policy limit available to the insured for
A, B, C, or D, but has been part of the routine adjustment expense. When the insurer
agrees to provide $5,000 coverage for mold and then charges investigation costs
against that limit, the insurer is intentionally transferring part of its normal adjustment
expense to the policyholder and depriving the policyholder of the full limit or sub-limit
of coverage normally available to indemnify the insured for their physical loss.
Additionally, most property policies — when they place dollar limits on certain
categories of items or loss such as jewelry, cash, etc. — place the limitations together
in one place where the sub-limits can be easily discerned by the policyholder.
Placement of a sub-limit on mold damages in a section where one normally
encounters only exclusions of perils may serve to unduly confuse an insured and fail
to warn the insured properly of the limitation on mold damage.
Water Damage Claims
If the mold exclusions withstand legal scrutiny, the insurance industry is still left with
the problem of dealing with sudden water damage claims that are promptly reported.
Procedures must be implemented to deal with these claims in order meet industry
standards, minimize water damage, and prevent the growth of mold that might follow.
Water damage claims are among the most common property-damage claims made,
both in terms of number of claims made and dollars paid. Adjusters should be very
aware of the need to immediately remove water and start dry down of the property to
mitigate damage.
In the case of water damage claims, the industry standard is to make contact in 24
hours and inspection in 48 hours. It is imperative in a significant water damage claim
that inspection is made in 48 hours and that the insured be urged to obtain immediate
emergency water removal services to mitigate the damages. The insured also should
be advised as to whether or not such emergency services are covered under the
policy and whether the insurance company will be paying for such services or not.
The duty may be statutory, judicial, or simply an insurance industry standard, but the
general rule is that an insurance company has a duty to offer, provide, and assist the
insured in collecting the available policy benefits.
Most insureds are not aware of the areas where water may remain hidden and cause
further damage, but adjusters are. Most insureds are not aware of the dangers of the