What is Concurrent Causation?

Why your insurance claim could be unexpectedly denied

As a roofing and construction company, we work closely with insurance companies daily to ensure fair reimbursement for homeowners’ repairs. Although this process usually runs smoothly, challenges sometimes arise when homeowners and insurers disagree. The difference of opinion between the two, could represent many thousands of dollars. A particularly sticky issue known as “concurrent causation” could lead your insurer to deny your claim. If you haven’t heard of it, take a minute to learn what it means and what you can do about it.

What concurrent causation means

Concurrent causation is a legal term in the insurance industry. It signifies that the damage to a property results from more than one cause (say, a tornado AND flooding). When one cause is covered by your insurance policy, and the other is not, it is particularly crucial. This may cause your insurance company to deny your claim – in full or in part – and only agree to pay for damages that are explicitly covered as written in the policy, in these cases. While it seems straightforward, determining the extent of which peril caused how much damage can get complicated. This process has been the source of many lawsuits between insurers (who feel they’re merely adhering to the stated policy) and homeowners (who feel they’re being treated unfairly).

A common North Texas example

In the Texas roofing business, we often see this scenario of concurrent causation. Let’s say a big hailstorm rolls through town and causes significant damage to your roof. A roofing contractor inspects your roof and recommends a full replacement ($20,000). But when you file an insurance claim, the insurance company tells you they will only reimburse you $3,000 – the amount required to repair the hail-damaged areas. They explain that your roof was old and not well maintained, and thus the majority of the damage was a matter of normal “wear and tear,” which the insurance will not cover. Their decision leaves you responsible for $17,000 in roof repairs.

So, who would be right in this situation? Although extremely difficult to determine, attempting to dispute the insurance company’s decision will undoubtedly require significant time and effort that may not amount to much. For this reason, concurrent causation becomes a source of contention between the policyholders and insurers.

Other debates regarding concurrent causation may arise regarding perils that aren’t covered by standard insurance policies. This can happen when damage by hail, wind rain coincides with flooding or mold in the home (the last two aren’t covered), and determining causation gets difficult.

What can homeowners do?

While you can’t completely insulate yourself from damaging storms, there are some things you can do to prevent problems with concurrent causation.

1. Maintain your home and make needed repairs promptly. This will help minimize the damage caused by storms and reduce the chance of the insurance company pinning the responsibility on you.

2. Keep meticulous records. Whenever you make home improvements, or when damage occurs to your home, take notes and photos, and keep your receipts. If you have a dispute with your insurer, you’ll need hard facts to make your case.

3. Review your insurance policy. Not all homeowners insurance policies are created equal. Some may have more restrictive language around concurrent causation and what they will or won’t cover. Know what yours says and consider shopping around.

4. Work with an experienced roofer. Companies like Peak Roofing and Construction have many years of experience dealing with insurance companies. We know what they’re looking for and can provide the evidence (assuming it exists) they require to approve your claim.

5. Involve an attorney. It’s probably a last resort, but if you feel strongly that your insurance company is unjustly denying your claim, there are attorneys that specialize in these types of cases. If you’re considering this route, it’s best that you involve a public adjuster before the attorney as it will cost less in the long run.

Confused about your insurance claim? Give us a call and we’ll help you sort it out.

Jeff Riss,
President, Peak Roofing & Construction