case, the insured’s building (both exterior
and interior) and business personal property sustained loss from “ice damming.”
The company adjuster is trying to deny all
coverage for external damages based on
the exclusion for damage from the “weight
of ice and snow.” What’s your opinion?
• Our second insured is a medical office.
These doctors rent the entire building but
occupy only the first floor of a three story
building. During the winter, our insureds
turned the heat off in the unoccupied
portion of the building. As a result, the
pipes in the unoccupied portion froze
and burst, causing considerable damage.
The insurer is denying all coverage
based on the requirement that the insured
must “do [his] best to maintain heat in the
building.” We believe that because the in-
sured maintained heat in the occupied
portion, the loss should be covered.
In the first situation, there should be
coverage. The current edition of the spe-
cial perils form does not exclude damage
caused by snow, rain, ice, or sleet except for
personal property that is out in the open.
There is, however, a clause in the form’s
Limitations section that excludes coverage
for damage to a building’s interior that re-
sults from rain, snow, sleet, or ice. There are
two exceptions to this limitation:
There is coverage if the building is first
damaged by a covered cause of loss and that
damage permits the rain, snow, sleet, or ice
to enter the building, and there also is cov-
erage if the loss or damage is “caused by or
results from thawing of snow, sleet, or ice
on the building or structure.”
In the case presented, both the building
and personal property were damaged, and
the damage was caused not by rain, snow,
sleet, or ice but, rather, by the thawing of
ice that had built up under the eaves. This
cause of loss is covered by the special causes
of loss form and should be paid.
In the second case, the insurance company
is correct. The standard commercial property program excludes coverage for damage
caused by freezing of plumbing, heating, air
conditioning, or other such equipment
unless heat is maintained in the building. In this
situation the policyholder controlled the entire building even though part of it was not
occupied. Since the policyholder turned off
the heat in that part of the building, there is
no coverage for the damage.
These last two questions point out some
of the insurance issues that the Missouri
family will face. They also point out, once
again, the importance of carefully reading
the policy and not relying on adjusting rules
that were learned when an earlier form was
in popular use.
Diana B. Reitz, CPCU, is editorial director
for the professional publishing division
of The National Underwriter Company,
which includes FC&S Online. She may be
reached at firstname.lastname@example.org.
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