Caleb Meriwether explains the 5-step process for all-risk home insurance claims

Caleb Meriwether, Haven Insurance Partners, visits with Dan Reaves, host of ‘The Dan Reaves Show,’ each Wednesday at 3:30 p.m., to discuss all things insurance.

The Big Picture Rule

Your home is covered for all causes of physical damage unless the policy specifically excludes the cause of loss.

This is different from “named perils” coverage, where the policy must list the cause of loss for coverage to apply.

Step 1: Was There Physical Damage?

Insurance requires direct physical loss or damage to covered property.

Covered examples include:

Fire damage
Storm damage
Water damage to walls or floors

Not covered examples include:

Pure financial loss
Preventive repairs
Loss of value without physical damage

Step 2: Is the Damaged Property Covered?

Typically covered:

Your home (dwelling)
Permanently attached components such as the roof, walls, flooring, and cabinets

Typically not covered:

Land
Certain outdoor property unless specifically endorsed

Step 3: Is the Cause of Loss Excluded?

Because coverage is all-risk, exclusions determine most claim outcomes.

Common Exclusions to Know

Wear and Tear or Maintenance
Includes aging materials, gradual deterioration, rust, rot, or corrosion.
Insurance does not cover routine maintenance or expected aging.

Faulty Workmanship or Defective Materials
Includes poor construction, improper installation, or defective products.
The defective work itself is not covered, but resulting damage may be.

Water-Related Exclusions
Commonly excluded:

Flood or rising water (requires a separate flood policy)
Groundwater seepage
Sewer or drain backup unless endorsed

Typically covered:

Sudden and accidental pipe bursts
Accidental appliance leaks

Earth Movement
Includes earthquake, landslide, and in some cases sinkholes.
Coverage requires a specific endorsement.

Mold, Fungus, or Rot
Usually limited and often capped.
Typically only covered if caused by a covered loss.

Intentional Acts
Damage caused intentionally by an insured is excluded.

Ordinance or Law
Increased costs to meet current building codes are excluded unless coverage is added.

Step 4: Are There Exceptions or Endorsements?

Some exclusions contain exceptions.

Example:
Wear and tear is excluded, but if it results in a sudden pipe burst, the resulting water damage may be covered.

Endorsements can also add coverage back for items such as flood, sewer backup, or ordinance and law.

Step 5: How Replacement Cost Works

If a loss is covered:

The insurer initially pays Actual Cash Value
Depreciation is paid after repairs are completed
If repairs are not completed, settlement remains Actual Cash Value only

Key Takeaways

All-risk does not mean everything is covered
Most claim denials involve maintenance issues, long-term water problems, or flood and earth movement
Coverage depends on the cause of loss, not just the damage
Replacement cost requires actual repairs

Questions about a specific situation?
Coverage often depends on small details. Contact your agent before making repairs or assumptions.