Not all insurance claims require expert intervention. But when a dispute arises, it can be invaluable to identify and retain an expert, not only for the final solution but to keep a claim open and alive. For example, in Vargas v. State Farm General Insurance Company 1 the Central District of California issued an order rejecting State Farm's claim for summary judgment, based on the well-motivated and well-motivated statements views of the plaintiff's expert, Sandra Watts.
This case concerned the infamous "continuous or repeated leakage or leakage of water" 2 insurance exclusion, together with an insurance exclusion for losses caused by "wear and tear", damage, scratches, deterioration, inherent load, latent defect and mechanical breakdown. "Plaintiff left his home for a trip and returned to find water damage throughout the house; a water heater and connection hose appeared to be the culprit. State Farm initially denied covering only the source of the water but told the plaintiff, Ms. Vargas, that the subsequent water damage was covered.Vargas insisted that State Farm send a just
After spending only 30 to 60 minutes, the adjuster left the property without talking to Vargas. . He denied the allegation the same day, stating that the predominant cause of the loss was wear, tear, damage, scratches, deterioration, inherent screw, latent defect or mechanical failure of the supply line, resulting in repeated leakage and leakage of water or steam. State Farm claims that its denial was correct because damages from these risks are excluded under the policy. The plaintiffs claimed that there was a real dispute as to how the water supply was damaged and whether the water damage was caused by repeated leakage or leakage of water, or alternatively claimed that they suffered a sudden and unintentional loss.
To address the issue of coverage in the light of the summary judgment The district court quickly turned to the experts and highlighted in particular their experience of the decision. State Farm's expert stated:
[T] the extent of [the mitigation contractor’s] alleged dehydration, water removal and extensive remediation of muckout / flood loss is only compatible with a water loss that was a continuous or repeated leak …
According to Ms Watts, when [the State Farm Adjuster] inspected the residence, he failed to (1) interview Ms. Vargas regarding Ms. facts about the loss, (2) attempt to contact the plumber who repaired the supply line, (3) contact [the mitigation contractor] to confirm or discuss the cause of the loss, (4) identify any specific indicator of repeated leakage or leakage, or (5) implement any other investigation to determine or confirm the cause of the loss.
According to Ms. Watts, "[i] it is well established that repeated leaks and leaks are generally identified by indicators of a continuing problem – such as deterioration of building components, or wet or dry rot – none of which have been noted or observed in the insured's home. . "
The basis for the court's analysis in assessing a summary motion is made crystal clear in an order that the insured. industry, and I'm incredibly lucky to have learned a lot from her right away. Sandra is a claims consultant and expert at Resolved SF. Sandra has over 30 years of experience in the industry, and has previously worked as a claims specialist, agent, team manager for claims, owner and manager of a restaurant
A well-balanced and experienced expert should be considered for all insurance claims where a dispute arises.
1 Vargas v. State Farm General Ins. Co. No. CV 20-09935 PA (CD Cal. July 19, 2021).
2 For more blogs on this topic, check out: The “Continuous or Repeated Seepage or Leakage Of Water” Exclusion and Absence of a specific definition, leakage generally refers to low volume or gradual event .