A Tale of Two Insurance Cases and Their Impact on Property Owners
Recent California appellate decisions in Gharibian v. Wawanesa General Insurance Company and 11640 Woodbridge Condominium Homeowners’ Association v. Farmers Insurance Exchange offer important insights into how courts interpret property insurance policies when damage occurs. Though both cases involved damage to homes, the courts reached different conclusions regarding the insurers’ obligations, underscoring the significance of specific policy language and the nature of the loss.
Gharibian v. Wawanesa General Insurance Company: Denial Upheld
Background
Following a wildfire approximately half a mile from their home, Hovik Gharibian and Caroline Minasian’s property was inundated with soot and ash debris. Their home suffered no direct burn damage. The homeowners submitted bids for professional cleaning and were paid over $20,000 by Wawanesa General Insurance Company, though they ultimately cleaned the property themselves. Dissatisfied, they sued Wawanesa for breach of contract and bad faith.
Policy Provision at Issue
The Wawanesa policy covered “direct physical loss to property”.
Court’s Reasoning and Ruling
The Second Appellate District affirmed the trial court’s summary judgment in favor of Wawanesa. The court held that Wawanesa owed no duty to compensate the homeowners for cleaning costs not covered under the policy. Inspectors for both Wawanesa and the homeowners confirmed that while soot and ash were present, neither had caused any physical damage to the property. The soot and ash could be removed by wiping, HEPA vacuuming, and power washing without residual damage. Therefore, there was no evidence supporting a claim for “direct physical loss to property”.
The court reasoned that because the policy did not cover cleaning services in the absence of direct physical loss, Wawanesa did not breach its policy. The prior payment for cleaning services did not alter the coverage provided under the policy. The court relied on the principle that “direct physical loss or damage to property requires a distinct, demonstrable, physical alteration to property”.
11640 Woodbridge Condominium Homeowners’ Association v. Farmers Insurance Exchange: Denial Reversed
Background
While the 11640 Woodbridge Condominium Homeowners’ Association (HOA) was having its building re-roofed, two rainstorms penetrated the partially constructed roof, leading to extensive interior damage. The roofer had removed approximately 80 percent of the existing roof membrane. The HOA filed a claim under its “all-risks” condominium policy with Farmers Insurance Exchange. Farmers denied the claim, citing policy exclusions for water damage and faulty workmanship, alleging the roofer’s work was negligent.
Policy Provisions at Issue
The “all-risks” policy covered all “direct physical loss of or damage to Covered Property… caused by or resulting from any Covered Cause of Loss,” unless specifically excluded:
- “Covered Property” included “additions under construction, alterations, and repairs to the building or structure,” if not covered by other insurance.
- The Water Damage Exclusion stated Farmers would not pay for loss from “Water,” but would pay for interior water damage from rain if “[t]he building or structure first sustains damages by a Covered Cause of Loss to its roof or walls through which the rain enters”.
- The Faulty Workmanship Exclusion precluded coverage for loss from “[f]aulty, inadequate or defective… workmanship, repair, construction [or] renovation”. However, it included a provision that “if an excluded cause of loss… results in a Covered Cause of Loss,” Farmers “will pay for the loss or damage caused by that Covered Cause of Loss”.
Court’s Reasoning and Ruling
The Second Appellate District reversed the trial court’s summary judgment for Farmers, finding triable issues of material fact:
- Regarding the Water Damage Exclusion, the court found that a roof under repair remains a “roof” within the policy’s meaning, and the HOA’s property was never without some form of roof. The policy’s inclusion of “alterations and repairs” as “Covered Property” supported this. The court reasoned that damage to the roof (potentially triggering the exception to the water exclusion) could result from the reroofing process itself or from weather acting on the incomplete roof, especially as the policy did not exclude losses from deliberate (non-faulty) re-roofing work.
- Concerning the Faulty Workmanship Exclusion, while the court agreed “workmanship” can refer to both process and product, Farmers had not established that the roofer’s alleged negligence was the sole cause of the HOA’s damages. Evidence suggested wind and rain also contributed to damaging the exposed roof layers. Farmers failed to prove that even with non-negligent work, no rain damage would have occurred. The ensuing loss provision could also allow coverage.
Comparative Analysis: Why the Different Outcomes?
The divergent outcomes in Gharibian and Woodbridge stem from several key distinctions:
Nature of the “Loss”:
- In Gharibian, the central issue was whether the presence of soot and ash, which could be cleaned without leaving lasting physical alteration, constituted a “direct physical loss”. The court found it did not.
- In Woodbridge, the interior water damage was undeniably a “physical loss”. The dispute was whether specific policy exclusions applied to negate coverage for this loss that occurred during active repairs.
Policy Language and Type:
- Gharibian involved a policy requiring “direct physical loss to property”. The insured had the initial burden to demonstrate that their claim fell within this basic scope of coverage. They failed to show a “distinct, demonstrable, physical alteration”.
- Woodbridge concerned an “all-risks” policy, which covers all risks of direct physical loss unless specifically excluded. Under such policies, the burden shifts to the insurer to prove that a specific exclusion applies. Farmers did not definitively establish that its relied-upon exclusions entirely precluded coverage.
Causation and Application of Exclusions:
- In Gharibian, because there was no initial covered “physical loss,” the analysis did not heavily focus on exclusions. The cleaning costs themselves were not a covered type of damage.
- In Woodbridge, the cause of the clear water damage was paramount. The court found triable issues regarding whether the water damage exclusion or the faulty workmanship exclusion applied. The policy covered “alterations and repairs”, and the court found it plausible that damage to the “roof” (even an incomplete one) during such covered work could trigger the exception to the water damage exclusion. Furthermore, the faulty workmanship was not proven to be the sole cause of the loss.
Condition of the Property:
- The Gharibian property was an intact home affected by external contaminants.
- The Woodbridge property was actively undergoing significant, intentional alteration (re-roofing), a state explicitly contemplated as covered under “alterations and repairs”. This made the structure inherently more vulnerable, a factor the policy appeared to address.
Implications for Property Owner Clients
These rulings provide valuable takeaways for property owners:
Regarding Gharibian v. Wawanesa:
- For coverage under policies requiring “direct physical loss,” the mere presence of contaminants like smoke, soot, or ash may not be sufficient if they do not cause a distinct, demonstrable physical alteration or damage to the property itself and can be removed by cleaning without residual harm.
- Property owners should meticulously document any actual physical changes or damage to their property, not just the need for cleaning or remediation of contaminants.
- An insurer’s voluntary payment for certain costs (like Wawanesa’s initial payment for cleaning) does not necessarily mean the underlying loss is covered by the policy or expand coverage beyond the policy’s terms.
Regarding Woodbridge HOA v. Farmers:
- This case is generally favorable for property owners undertaking repairs or renovations, particularly under “all-risks” policies. It affirms that a structure undergoing significant work, such as re-roofing, can still be considered to have a “roof” for policy purposes. Damage occurring during such active work is not automatically outside the scope of coverage.
- Exclusions for faulty workmanship may not bar coverage if the contractor’s negligence is not proven to be the sole cause of the loss, or if the faulty work leads to a separate “Covered Cause of Loss” (often termed an “ensuing loss”). The insurer bears the burden of proving the exclusion applies and negates all coverage.
- Policy language explicitly including “additions under construction, alterations, and repairs to the building or structure” as “Covered Property” can be vital in securing coverage for incidents during vulnerable construction periods.
- This decision highlights the broader protection potentially afforded by “all-risks” policies, where the onus is on the insurer to clearly exclude a cause of loss. If an all-risks policy does not specifically exclude damage that occurs due to deliberate, non-faulty work undertaken during repairs, coverage may be more likely.
Policy Terms and Loss Specifics: The Main Determinants in Coverage Disputes
The Gharibian and Woodbridge decisions demonstrate that the outcome of an insurance claim dispute often hinges on the specific wording of the insurance policy and the precise factual circumstances of the loss. Property owners should be aware that “direct physical loss” typically requires some form of tangible alteration. However, when undertaking repairs or construction, especially with an “all-risks” policy that contemplates such work, coverage for resulting damage may be available even if contractor work is a factor, unless an exclusion clearly and fully applies. Careful review of policy terms, particularly definitions of covered property and exclusions, remains vitally important.