You pay into an insurance policy for years, whether it’s disability life, or home insurance, to be on the safe side in case something happens. You trust that your insurer will come through for you if something does happen, but what if they don’t? What if you file a claim and your claim is denied?
You may have a valid claim and if so, you can seek legal help to get the insurance payout to which you are entitled.
In Buchanan v. Wawanesa Mutual Insurance Company, a homeowner purchased an “all-risk” home insurance policy. When it was discovered that water was leaking from an underground public water main and the ongoing buildup of water caused cracks in the foundation and the interior of the home, the homeowner filed a claim. The cost to repair the home was estimated to be between $175,000 and $250,000. The claim was denied.
At issue were two specific clauses in the homeowners’ insurance policy.
The clauses were apparently contradictory. One stated that the owner would be covered for any loss from the escape of water from a water main while the other seemed to suggest that the policy would not apply if the actual damage from the water loss caused issues with settling, bulging or cracking.
The B.C. Court of Appeal applies specific rules when interpreting insurance contracts. One such rule is the contra proferentum rule. This states that if a clause is ambiguous, it should be interpreted against the party that requested that clause to be included, usually the insurance company. Another is that contracts should be interpreted so that the parties’ original intentions are seen in the entire document.
In this case, the court ultimately held that a person who read this particular insurance policy would have reasonably assumed that they would be covered for any damage resulting from the escape of water from a public water main. The insurance company was therefore ordered to meet the claim they had denied initially and to pay for the homeowners’ repairs.
If you make a claim which is then denied by your home insurer, there may be something in your contract that appears to be contradictory or ambiguous, which may help you reverse their denial of coverage.
If you are unsure of the wording of your contract or feel that the policy as written suggests you ought to have been covered, we can help.
Partner, Dale McGregor, helped our client previously for a tragic 2008 motorcycle collision that ended her working life. In 2015 and 2016 she was then involved in two further collisions that left her even more disabled.
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