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When a loss falls within the scope of policy exclusions as a legal issue, the complaint cannot survive



  Collapsed House

The policyholder is responsible for showing that a loss that is affected falls within the scope of the insurance policy. In other words, the existence of coverage is a significant part of the policyholder's claim. If the insurance company gives rise to an exclusion, the first burden on the insurer is to show that all claims within the complaint are entirely exclusive. Many homeowners and other property policies have exceptions for losses caused by water and for wear. Second Circuit recently upheld these exceptions in a dispute over water damage to a home and confirmed the dismissal of the complaint.

Mazzarella vs. Amica Mutual Ins. Co. No. 1

8-1269 cv (2d on May 16, 2019) (Summary Order), household owners sued their insurer for breach of contract, crimes against implied associations of good faith and fair trade and statutory violations according to Connecticut law to deny their claims direct physical loss to his home caused by water and oxygen filtration, including damage to concrete basement walls and other parts of the home. The district court dismissed the complaint because it had not submitted an application for the exemption that could be granted. Second circuit confirmed.

In confirmation, the court argued that the loss described in the complaint falls within the scope of the political exclusion as a matter of law. The accusations of damage caused by water and oxygen filtration and rainwater which resides unequivocally reside within the scope of the exclusion of loss caused by water, including surface water, overflow, storm flow, backwater, water under the ground, water leaking through a building and others similar problems. In addition, the court claimed that the exclusions for wear, deterioration, latent deficiencies, sedimentation, bulging and expansion would also carry the loss.

The Court also confirmed the dismissal of the remaining documents, as the allegations raised a mere coverage dispute or negligent investigation, which did not propose a dishonest purpose and because the refusal of coverage was not wrong. The statutory allegations of unfair settlements were also rejected because the claim was denied correctly given that the loss fell within the framework of political exclusion. In addition, the Court found that there was insufficient reason for the insurer to engage in statutory assault differing from the waiver of cover.


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