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Homeowner's Insurance Policies Part 2: Definition or Exclusion?

As you read your homeowner's insurance policy one thing that you will inevitably encounter are terms referencing other terms, referencing definitions, referencing back to other terms (never mind all of the exclusions). It can be maddening. A logical next question is whether these definitions are there to exclude coverage, or simply to define coverage. While our previous discussion about exclusions should give you some peace of mind that anything not specifically excluded should be covered under Ohio law, courts are instructed to read policies in their entirety, and not to ignore one part of a policy to the benefit of another.1 Courts must "give meaning to every paragraph, clause, phrase and word."2

For example, many policies define the place being insured as the "residence premise." They then define the "residence premise" as "the place where you reside." This begs the question, if you have insurance on a property where you are not living, is it covered? Here are some tips to help you determine the answer.

First, look to the exclusions. Is there a specific exclusion for not living at the premises? If not, this makes it more likely that you are covered (i.e. "residence premises" is a definition, not an exclusion).

Second, if there are specific exclusions for not living at the premises, are they linked to unique situations? For example, do the exclusions say "we will not insure freezing pipes if you have not resided at your property for 30 days," or something to that effect? If so, and if your situation is not one of the situations specifically listed (i.e. you have a leaking pipe instead of a frozen pipe), then you have a strong argument for coverage. There would not be a reason to specifically link residency to freezing pipes if the default rule was that residency was not a requirement (once again, "residence premises" here is likely a definition, not an exclusion).

Third, more good news: if the policy is ambiguous as to whether a term is a definition as opposed to an exclusion, then you will likely get coverage. When a clause is ambiguous, Ohio courts are instructed to break the tie in favor of the insured.3

Last, and most importantly, call your insurance company or agent and document your questions related to coverage in writing when at all possible. Always remember to call your agent and inform him or her of changes in your circumstances so they do not have an excuse to deny a claim in the future.

If you have recently experienced a loss of property and were denied coverage, call us. We would be happy to review your policy to see if further legal action is warranted. In fact, we have successfully handled numerous cases that other lawyers have turned away after insurance companies deny coverage. Call the attorneys at Rittgers & Rittgers today.

1 Hartong v. Makary, 665 N.E. 2d 704, 706 (Ohio App. 1995)

2 Affiliated FM Ins. Co. v. Owens-Corning Fiberglas Corp., 16 F.3d 684, 686 (6th Cir. 1994).

3Buckeye Union Ins. Co. v. Price, 39 Ohio St.2d 95, 311 N.E.2d 844 (1974) 

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