📘 The Policyholder’s Playbook: Wear and Tear in Real Claims
HERE IS THE SECRET. INSURANCE POLICIES ARE WRITTEN BY ATTORNEYS AND IF THEY ARE AMBIGUOUS, IT IS LIKELY INTENTIONAL!
What “Wear & Tear” Really Means
Insurance companies often deny claims by citing “wear and tear.” In plain English, that’s just the natural aging of your property. Think:
Paint fading over time
Small cracks in walls from settling
Roof shingles naturally losing granules
Most policies exclude normal wear and tear. That’s fair enough — insurance isn’t meant to be a maintenance contract.
But here’s the catch: policies do cover sudden and accidental damage. If a storm rips shingles off, hail strikes your roof, or a pipe bursts, that’s new damage — even if your property is old.
Paint fading over time
Small cracks in walls from settling
Roof shingles naturally losing granules
How Insurers Misuse the Exclusion
In practice, insurance companies often stretch the “wear and tear” excuse to deny valid claims. They’ll look for any way to blame a problem on age, maintenance, or neglect.
From my own experience handling claims, I’ve seen:
Creased shingles blamed on “high nailing” instead of wind damage.
Obvious storm creasing written off as “vandalism” or “wear and tear.”
Broken windows blamed on anything but the actual storm — I’ve heard excuses ranging from thermal stress to “pre-existing weakness.”
The reality: these denials aren’t always honest assessments. They’re tactics to save the carrier money.
Creased shingles blamed on “high nailing” instead of wind damage.
Obvious storm creasing written off as “vandalism” or “wear and tear.”
Broken windows blamed on anything but the actual storm — I’ve heard excuses ranging from thermal stress to “pre-existing weakness.”
What Denial Letters Look Like
Most homeowners and business owners don’t know how to read a denial letter. Carriers use coded phrases like:
- “Long-term seepage”
- "Normal wear and tear"
- “Marring, deterioration, or defect”
- “No evidence of a storm-created opening”
- "Long term seepage"
- "No storm created opening"
These are red flags. They signal the insurer is leaning on exclusions instead of acknowledging new, covered damage. Seek a professionally immediately.
Real-World Examples
1. Cheetham v. Southern Oak Ins. Co. (2013)
What happened: The Cheethams’ home suffered water damage after a deteriorated pipe broke. The insurer denied coverage, pointing to the wear-and-tear and water damage exclusions.
Court’s view: The appellate court said exclusions are interpreted strictly against insurers. It found the policy ambiguous and ruled that because the damage came from the home’s own plumbing system, the loss was covered
Cheetham v. Southern Oak Ins.
Takeaway for homeowners: Even if damage starts with “deterioration” (wear and tear), if it causes an accidental water discharge, coverage may still exist. Don’t accept “pipe was old” as the final word.
What happened: The Cheethams’ home suffered water damage after a deteriorated pipe broke. The insurer denied coverage, pointing to the wear-and-tear and water damage exclusions.
Court’s view: The appellate court said exclusions are interpreted strictly against insurers. It found the policy ambiguous and ruled that because the damage came from the home’s own plumbing system, the loss was covered
Cheetham v. Southern Oak Ins.
Takeaway for homeowners: Even if damage starts with “deterioration” (wear and tear), if it causes an accidental water discharge, coverage may still exist. Don’t accept “pipe was old” as the final word.
2. Dodge v. People’s Trust Ins. Co. (2021)
What happened: The Dodges’ cast iron pipes corroded, causing water damage. The insurer said corrosion = “act of nature” and capped coverage at $10,000 under a water damage endorsement.
Court’s view: The appellate court agreed — rust and corrosion were considered natural processes (an “act of nature”), so the $10,000 sub-limit applied
Dodge v. People's Trust Ins.
Takeaway for homeowners: Corrosion and long-term deterioration are often limited by sub-limits, even if sudden water damage occurs. Watch out for endorsements that quietly cap your payout.
What happened: The Dodges’ cast iron pipes corroded, causing water damage. The insurer said corrosion = “act of nature” and capped coverage at $10,000 under a water damage endorsement.
Court’s view: The appellate court agreed — rust and corrosion were considered natural processes (an “act of nature”), so the $10,000 sub-limit applied
Dodge v. People's Trust Ins.
Takeaway for homeowners: Corrosion and long-term deterioration are often limited by sub-limits, even if sudden water damage occurs. Watch out for endorsements that quietly cap your payout.
3. Sebo v. American Home Assurance Co. (2016)
What happened: Sebo’s $8 million Naples home was destroyed by a mix of defective construction, rain, and Hurricane Wilma. The insurer denied coverage, saying defective construction (excluded) caused much of the loss.
Court’s view: The Florida Supreme Court applied the Concurrent Cause Doctrine (CCD). When multiple causes (some excluded, some covered) combine, coverage applies if at least one covered peril contributed — unless the policy clearly says otherwise
Sebo v. Am. Home Assur. Co.
Takeaway for homeowners: If storm damage and wear and tear both play a role, you may still be covered. Insurers can’t automatically deny just because wear and tear was involved.
What happened: Sebo’s $8 million Naples home was destroyed by a mix of defective construction, rain, and Hurricane Wilma. The insurer denied coverage, saying defective construction (excluded) caused much of the loss.
Court’s view: The Florida Supreme Court applied the Concurrent Cause Doctrine (CCD). When multiple causes (some excluded, some covered) combine, coverage applies if at least one covered peril contributed — unless the policy clearly says otherwise
Sebo v. Am. Home Assur. Co.
Takeaway for homeowners: If storm damage and wear and tear both play a role, you may still be covered. Insurers can’t automatically deny just because wear and tear was involved.
Steps Policyholders Should Take
1. Document Everything – Take photos, videos, and keep repair/maintenance records.
2. Get a Second Opinion – Hire a contractor, public adjuster, or attorney to inspect.
3. Request the Denial in Writing – Force the carrier to spell out their reasons.
4. Challenge the Denial – Many claims denied under “wear and tear” are later overturned.
5. Remember Burden of Proof – Once you show a loss occurred, it’s the insurer’s job to prove an exclusion applies.
Document Everything – Take photos, videos, and keep repair/maintenance records.Get a Second Opinion – Hire a contractor, public adjuster, or attorney to inspect.
Request the Denial in Writing – Force the carrier to spell out their reasons.
Challenge the Denial – Many claims denied under “wear and tear” are later overturned.
👉 Bottom line: Don’t just take the carrier’s word for it. If they say “wear and tear,” you may still have a valid, covered claim.
⚖️ Legal Corner: Lessons on Wear and Tear
⚖️Legal Corner
Cheetham v. Southern Oak Ins. Co., 114 So. 3d 257 (Fla. 3d DCA 2013)
Facts: The insureds’ home suffered water damage when a deteriorated pipe burst. The insurer denied coverage, citing wear-and-tear and water damage exclusions.
Issue: Does the wear-and-tear exclusion bar coverage for water damage from a burst pipe?
Holding: The court found the exclusions ambiguous and ruled the policy covered the loss.
Reasoning: Exclusions are strictly construed against the insurer; ambiguities favor the policyholder.
Takeaway: Even if a pipe is old, a sudden break causing water damage may still be covered.
Dodge v. People’s Trust Ins. Co., 321 So. 3d 831 (Fla. 4th DCA 2021)
Facts: Corroded cast iron pipes caused water damage. The insurer applied a $10,000 sub-limit under a Water Damage Endorsement, arguing corrosion was an “act of nature.”
Issue: Does corrosion-related water damage fall under the endorsement’s sub-limit?
Holding: The court upheld the sub-limit. Corrosion was deemed a natural process and therefore subject to the endorsement.
Reasoning: Clear policy language limited the payout; courts enforce unambiguous sub-limits.
Takeaway: Corrosion and wear-and-tear losses may be limited by hidden policy endorsements.
Sebo v. Am. Home Assur. Co., 208 So. 3d 694 (Fla. 2016)
Facts: A luxury home suffered damage from defective construction, rain, and Hurricane Wilma. The insurer denied coverage, pointing to the construction defect exclusion.
Issue: When both covered and excluded causes contribute to a loss, does coverage exist?
Holding: The Florida Supreme Court applied the Concurrent Cause Doctrine (CCD): coverage exists if a covered peril contributes, unless the policy clearly avoids CCD.
Reasoning: Many losses have multiple causes. Without clear anti-concurrent cause language, insurers cannot escape coverage.
Takeaway: Even if wear and tear contributed, coverage may still apply when a storm or other covered peril also caused the damage.
👉 Final Takeaway
Carriers often misuse “wear and tear” to avoid paying. But Florida law shows:
Burst pipes may still be covered.
Corrosion may be capped, but only if endorsements clearly limit it.
Mixed causes (wear + storm) may still result in coverage under CCD.
If your claim was denied for “wear and tear,” contact The Claim Attorney today for a free claim review.
