The Claim Attorney - Blog #Exclusion

When "fore" may equal 1

Sat, 15 Nov 2025 22:20:13 +0000

Introduction

If you live next to a Texas golf course, you may be all too familiar with the sound of golf balls striking your roof. Over a season, or over many years, these repeated impacts can cause fractured shingles, cracked tiles, punctured underlayment, or long-term water intrusion.

But here is the question most homeowners struggle with:

Does each golf-ball strike count as a separate insurance claim and separate deductible?Or can all the damage be treated as one “occurrence” under your Texas homeowners policy?

Texas law and standard Texas HO-3 homeowners policies provide a strong argument that repeated golf-ball strikes from the same source are one occurrence—meaning one deductible, not dozens.Below is a comprehensive explanation of the governing law, policy language, and strategic guidance for homeowners dealing with this issue.

1. The Policy Language: “Occurrence” and the Section I Deductible

Most Texas HO-3 homeowners policies define an occurrence as:

“an accident, including continuous or repeated exposure to substantially the same general harmful conditions.” —Texas HO-3 Form, USAA.HO-3RTX.07.08, Definition of Occurrence.

This definition explicitly groups together:

continuous exposure

repeated exposure

substantially the same harmful conditions

Golf balls repeatedly leaving the same tee box or fairway and impacting the same roof slope are “repeated exposure to substantially the same general harmful conditions.”

The Deductible Is Applied Per Loss (Per Occurrence)

Texas HO-3 forms also state:

“We will pay only that part of the total of all loss payable under Section I that exceeds the deductible amount shown in the Declarations.” —Texas HO-3 Form, Section I – Conditions, Deductible clause.

This language means:

the deductible applies once per covered loss, not per incident

insurers must first determine whether the roof damage is one loss or multiple losses

Nothing in the policy requires the deductible to reset for each roof impact. To the contrary, the policy’s own aggregation clause (“continuous or repeated exposure”) is designed to combine these impacts into a single occurrence.

2. Texas Uses the “Cause Test” to Count Occurrences

Texas courts consistently apply the cause test (also called the causation rule):

The number of occurrences is determined by the number of causes of the injury, not the number of injurious effects.
Here are the leading cases:
Maurice Pincoffs Co. v. St. Paul Fire & Marine Ins. Co. 447 F.2d 204, 206–07 (5th Cir. 1971)
The seminal Texas case adopting the cause test.
Courts look to the underlying cause, not the number of injuries.
H.E. Butt Grocery Co. v. Nat’l Union Fire Ins. Co. 150 F.3d 526, 531–32 (5th Cir. 1998)
Reaffirmed Texas’s cause test.
Multiple assaults were multiple occurrences because each assault was aseparate immediate cause.
Negligent supervision was not the cause; the assaults were.
Foust v. Ranger Ins. Co. 975 S.W.2d 329, 332–33 (Tex. App.—San Antonio 1998, pet. denied)
Herbicide overspray over a large area was one occurrence because there was a single spraying operation—a single continuous cause.
Lafarge Corp. v. Hartford Cas. Co. 61 F.3d 389, 395–97 (5th Cir. 1995)
A continuous emission causing widespread dust damage was one occurrence.
Matador Petroleum Corp. v. St. Paul Surplus Lines Ins. Co. 174 F.3d 653, 657–58 (5th Cir. 1999)
A continuous release of oil and gas was treated asone occurrence.
Key Takeaway Under Texas Law
If one continuous hazard produces multiple injuries, Texas courts treat the entire series as one occurrence. Repeated golf-ball impacts from the same hole, creating the same hazard, causing damage to the same roof are, functionally, one continuing cause.

3. Cases Supporting “Continuous or Repeated Exposure” as One Occurrence

Several Texas courts recognize that an occurrence includes ongoing harmful conditions and repeated exposures.

Dorchester Dev. Corp. v. Safeco Ins. Co. 737 S.W.2d 380, 383 (Tex. App.—Dallas 1987, no writ)

“Occurrence” includes continuous or repeated exposure to conditions.

Ongoing water intrusion fit the definition.

Pilgrim Enters., Inc. v. Maryland Casualty Co. 24 S.W.3d 488, 501 (Tex. App.—Houston [1st Dist.] 2000, no pet.)

Applied the same “continuous or repeated exposure” language.

Reinforced that repeated exposure may be aggregated into one occurrence.

Lennar Corp. v. Great Am. Ins. Co. 200 S.W.3d 651, 673–76 (Tex. App.—Houston [14th Dist.] 2006, pet. denied)

Recognized that ongoing construction-defect damages occur over time but may fall under one occurrence if caused by a single continuous condition.

Analogy to Golf-Ball Strikes

Ongoing water intrusion = ongoing golf-ball intrusion.

Both involve:

one source

one mechanism

repeated exposure

continuing damage over time

Thus, courts already accept the legal framework needed for golf-ball roof damage to be treated as one occurrence.

4. Distinguishing the Few Cases That Favor Multiple Occurrences

Insurers often cite cases involving clearly separate causes. They are distinguishable.

Goose Creek Consol. ISD v. Continental Casualty Co. 658 S.W.2d 338, 340–41 (Tex. App.—Houston [1st Dist.] 1983, no writ)

Two fires at different locations = two occurrences.

H.E. Butt Grocery (above)

Each assault was its own cause, so multiple occurrences.

U.E. Texas One-Barrington, Ltd. v. General Star Indem. Co. 332 F.3d 274, 276–78 (5th Cir. 2003)

Separate plumbing leaks in different structures were separate occurrences.

Why These Are Not Like Golf-Ball Roof Damage

Different buildings

Different causes

Different times

Different mechanisms

Golf-ball roof cases involve:

one location

one hazard

one line of play

one mechanism of impact

one policy period

Thus, the insurer’s “multiple occurrences” cases do not apply.

5. Applying Texas Law to Golf-Ball Roof Damage

The cause is the continuing hazard created by the golf course layout, not each golfer's swing.

The ongoing condition is:

a tee box oriented toward your home

a fairway aligned in a way that sends mishits toward your roof

predictable flight paths creating ongoing exposure

This is exactly the type of repeated exposure Texas HO-3 policies group into one occurrence.

The Homeowner’s Argument

The policy defines occurrence to include “continuous or repeated exposure to substantially the same general harmful conditions.”

My roof experienced repeated exposure to golf balls from the same hole.

Texas counts occurrences by cause, not by impact.

The cause is one continuing hazard.

Therefore, all damage within the policy year is one covered loss subject to one deductible.

6. Practical Steps One Might Use When Filing the Claim

Document the Pattern

Photograph clusters of impacts.

Collect golf balls (logos help tie them to the course).

Keep a log of when you hear/see impacts.

Note the consistent direction of flight.

File One Claim for the Policy Year

Tell the carrier:

you discovered cumulative damage

impacts came from one continuing hazard

policy language groups this exposure into a single occurrence

Use an Expert

Have a roofer or engineer confirm:

the impacts came from a consistent direction

impacts were caused by high-velocity projectiles

damage is consistent with repeated golf-ball strikes

the damage is functional, not merely cosmetic

7. Conclusion

Under Texas law and Texas HO-3 policy language, repeated golf-ball strikes are very often one occurrence, not many. Texas courts focus on the cause, and a home repeatedly struck because of its position next to a golf hole is experiencing one continuous hazard.

For many homeowners, this means:

one deductible

one claim

coverage for the full roof damage discovered during the policy period

If your insurance company is trying to classify each golf-ball strike as a separate deductible event, you may have strong grounds to challenge that decision.

Need Help With a Texas Homeowners Claim?

If you’re dealing with repeated golf-ball damage—or any roof or property claim, my office can help you understand your rights, challenge improper deductible stacking, and force carriers to follow Texas law and the policy language they wrote.

Schedule a consultation today.

Get Started Now

Wear and Tear in Insurance Claims: What Carriers Don’t Want You to Know

Thu, 05 Sep 2024 21:09:09 +0000

📘 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.

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.

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.

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.

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.

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

GET YOUR FREE CLAIM REVIEW

⚖️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.

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