But That Roof was So Old!

Homeowner was an elderly widow in Texas who was not keen on moving into a retirement home, so she continued to live in her house by herself. As she got older, a lot of normal maintenance started to get ignored, including the roof – The shingles were old and looked like they were about to fall off any day. One day a windstorm came through the area, and sure enough, 20-30 shingles blew off. She called her insurance company. The adjuster reviewing the file thinks, wind is a covered cause of loss, but wear and tear and deterioration are not. He is wondering what to do when there are multiple contributing factors.

Notable Timestamps

[ 00:15 ] - The homeowner failed to maintain the roof, and then it was damaged in a windstorm. Both factors contributed to the loss, but only one (wind) is covered, and the other (wear and tear) is not.

[ 01:04 ] - The PLRB podcasters discuss how long their roofs have left before they'll need to be replaced...

[ 02:50 ] - There can be coverage for a roof even though it's past its useful life. It still performs a valuable function. ACV would be low, but replacement cost would replace old with new.

[ 03:44 ] - The question is whether it's functioning as a roof. If there are gaping holes, or damage to the point where it's value-less, it may not be covered.

[ 04:06 ] - Some carriers have endorsements clarifying when a roof's useful life (and coverage) ends.

[ 04:35 ] - The Anti-Concurrent Causation Preface: "Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss." When this is present and applicable, one exclusion's application means no coverage for the entire claim.

[ 05:45 ] - Ususally, the Anti-Concurrent Causation Preface does not precede the wear & tear exclusion. Without that clause, the exclusion would only apply if wear & tear were the proximate cause.

[ 08:00 ] - Tim makes the bold claim that Texas is the #2 state, after Ohio of course. Outside of Texas, under the majority rule, proximate cause means the dominant and sufficient cost. If the shingles were hanging on by a thread, wear & tear would be the proximate cause even if wind knocked them off. On the other hand, if the shingles weren't that bad and a 70-mph gust tore them off, the proximate cause would likely be wind.

[ 09:25 ] - The crew selects Houston as their favorite Texas destination. In Texas, when covered and non-covered perils combine to create a loss, the insured is entitled to recover that portion of the damage caused SOLELY by the COVERED peril. Failure to do so results in NO coverage. This sounds a lot like the Anti-Concurrent Causation Preface, even though it's not coming from the policy but from Texas case law.

[ 10:30 ] - It's the insured's burden to establish what damage is caused SOLELY by the covered peril. If there's a non-covered peril contributing to the loss in any way, it won't be covered, at least in this unique jurisdition.

[ 11:50 ] - A creative public adjuster brings up the Ensuing Loss clause. Losses that ensue from wear & tear can be covered... but Tim's not buying this argument. If the wear & tear causes a leak which leads to damage, that's one thing, but to consider the shingle damage as an ensuing loss of the wear & tear of the shingles themselves... it's a little close.

[ 13:08 ] - If spot repair can be effective, it's an option. But issues like matching, difficulty accomplishing the repair, and local ordinances or laws can mean a full replacement.

[ 14:07 ] - What if the only issue with spot repair is the rotted decking under the shingles? Mike had relevant personal experience to share.

[ 15:33 ] - Tim provides a recap of the scenario and the points above.

Your PLRB Resources

Coverage Question - Roof Damage Caused By Combination of Wear and Tear Plus Freezing/Thawing  - https://search.plrb.org/?dn=74356&src=gsa

Coverage Question - Windstorm Damage v Wear/Tear Shingles - https://search.plrb.org/?dn=20790&src=gsa
Annotation - Texas Ensuing - Resulting Loss - https://search.plrb.org/?dn=45283&src=gsa

PLRB’s state-by-state on proximate cause laws - https://www.plrb.org/property-lines/#

Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/container.cfm?conlink=sec/cq/default.cfm) at no additional charge to you or your company.

Subscribe to this Podcast

Your Podcast App - Please subscribe and rate us on your favorite podcast app

YouTube - Please like and subscribe at @plrb

LinkedIN - Please follow at “Property and Liability Resource Bureau”

Send us your Scenario!

Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.

Legal Information

The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License.
Font: Metropolis by Chris Simpson. SIL OFL 1.1.
Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription).
Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).