Ch 2 · Anatomy of a Claim
Module 2.4
Common Perils Decision Tree
6 perils that drive 95% of claims. Per-peril exclusion + counter strategy + expert needs.
12 min read
What you'll learn
The 6 perils that drive 95% of FL property claims. Quick coverage analysis for each. The exclusion to watch + the counter strategy.
2.4.1 The 6 perils
| Peril | Frequency in FL claims |
|---|---|
| Water | 30-40% (highest) |
| Wind / hurricane | 20-30% |
| Fire / smoke | 5-10% |
| Hail | 5-10% |
| Theft | 5-10% |
| Vandalism | 1-5% |
Plus: mold (often follows water), sinkhole (specific FL counties).
2.4.2 Water — the most contested peril
Coverage analysis
Standard FL homeowner policy covers:
- Sudden + accidental water discharge from plumbing, appliances, etc.
Excludes:
- Continuous / repeated seepage over 14+ days
- Flood (need NFIP)
- Wear and tear
Common scenarios
| Scenario | Coverage likely? |
|---|---|
| Pipe burst | Yes (sudden) |
| Appliance failure (washer hose, water heater) | Yes (sudden) |
| Slow drip behind wall | Maybe (depends on duration evidence) |
| Long-term roof leak | No (gradual) |
| Slab leak | Sudden = yes; gradual = no |
| Storm surge | No (flood) |
| Tropical storm rain via broken roof | Yes (wind-driven rain via wind damage) |
Exclusion to watch
14-day continuous seepage rule — carrier characterizes leak as ongoing.
Counter strategy
- Plumber's report establishing recent failure
- Water bills showing sudden spike
- Time-stamped discovery photos
- IICRC S500 mitigation documentation
2.4.3 Wind / hurricane
Coverage analysis
Standard FL homeowner policy covers:
- Wind damage to dwelling + contents
Excludes:
- Flood / storm surge (need NFIP)
- Wear and tear (often invoked on roof claims)
- Sometimes: specific named-storm exclusions in certain zones
Common scenarios
| Scenario | Coverage |
|---|---|
| Roof tear-off from wind | Yes (subject to roof endorsement / hurricane deductible) |
| Tree falls on house | Yes |
| Wind-driven rain through broken roof | Yes (wind damage path) |
| Storm surge flooding | No (need NFIP) |
| Wind + flood combo | Anti-concurrent causation issue |
Exclusion to watch
- Hurricane deductible (% of Coverage A) — not exclusion but cost
- Wear-and-tear on older roofs
- Anti-concurrent causation w/ flood
Counter strategy
- NWS wind data
- Independent roofer / engineer
- Damage segregation (wind vs flood)
- Comparable claims in neighborhood
2.4.4 Fire / smoke
Coverage analysis
Almost always covered under standard policies. Includes:
- Fire damage
- Smoke + soot damage
- Water damage from firefighting
Common scenarios
| Scenario | Coverage |
|---|---|
| Kitchen fire | Yes |
| Electrical fire | Yes |
| Lightning strike fire | Yes |
| Vehicle fire damaging structure | Yes (if accidental) |
| Arson by insured | NO (intentional act) |
| Arson by third party | Yes (vandalism/fire) |
Exclusion to watch
- Intentional acts by insured
- Sometimes: specific arson investigation issues
Counter strategy
- Fire department report (cause)
- Document damage components separately (fire + smoke + water)
- ALE for uninhabitable
2.4.5 Hail
Coverage analysis
Covered under standard policies, but:
- Some policies have separate wind/hail deductible
- Some have cosmetic damage exclusion (newer endorsement)
Common scenarios
| Scenario | Coverage |
|---|---|
| Hail-bruised roof shingles | Yes |
| Hail-damaged AC unit fins | Yes |
| Cosmetic-only siding hail dings | Maybe (cosmetic exclusion) |
| Broken windows | Yes |
| Vehicle damage | Auto policy (not homeowner) |
Exclusion to watch
- Cosmetic damage exclusion
- Wear-and-tear on older surfaces
Counter strategy
- Independent roofer assessment
- Hail report (HailSTRIKE, NOAA hail records)
- Functional impact (not just cosmetic)
- Comparable claims from same hail event
2.4.6 Theft
Coverage analysis
Covered under Coverage C (personal property) — subject to:
- Sub-limits
- Police report requirement
- Cooperation/EUO requirements
- SIU (Special Investigation Unit) review
Common scenarios
| Scenario | Coverage |
|---|---|
| Burglary w/ forced entry | Yes |
| Theft w/o forced entry (unlocked) | Yes (subject to vacancy clause) |
| Insider theft (family member) | Often denied |
| Theft from vehicle (off premises) | Sub-limit applies |
| Theft from business location | Possibly Coverage C off-premises sub-limit |
Exclusion to watch
- Sub-limits (jewelry $1.5K, firearms $2.5K, money $200-500)
- Vacancy clause (60+ days)
- Lack of police report
- Insider/family theft
Counter strategy
- Police report
- Inventory reconstruction (Module 5.4)
- Schedule high-value items going forward
- Witness statements
2.4.7 Vandalism
Coverage analysis
Covered under standard policies — separate from theft sometimes.
Common scenarios
| Scenario | Coverage |
|---|---|
| Broken windows + spray paint | Yes |
| Damage during burglary | Yes (separate from theft) |
| Damage by tenant | Possibly (depends on policy) |
| Damage by insured / family | No (intentional) |
| Damage during civil unrest | Yes (usually) |
Exclusion to watch
- Intentional acts by insured
- Sometimes: vacancy clause if property unattended
Counter strategy
- Police report
- Photos pre + post
- Document damage components
2.4.8 The decision tree summary
For any new claim, use this quick tree:
1. What's the peril?
↓
2. Is it covered under the policy? (DICE check)
↓
3. What's the carrier's likely exclusion argument?
↓
4. Can you defend against the exclusion?
↓
5. Is the loss size > PA fee + risk?
↓
6. TAKE or WALK
2.4.9 The peril-specific expert needs
Match peril to expert:
| Peril | Primary expert |
|---|---|
| Water | Plumber + IICRC S500 mitigation |
| Wind / hurricane | Roofer + meteorologist if disputed; engineer if anti-concurrent |
| Fire / smoke | Fire department report + IICRC S700 restorer + electrician if relevant |
| Hail | Roofer + hail event verification |
| Theft | Police + inventory specialist for large losses |
| Vandalism | Police + repair contractors |
| Mold | IICRC S520 + mold inspector |
| Sinkhole | Geotechnical engineer |
Budget expert costs into your claim economics.
2.4.10 Action steps
- For every new claim: identify the primary peril + run the decision tree.
- Predict the carrier's exclusion argument based on the peril.
- Plan your counter-strategy before signing.
- Identify needed experts + budget.
- Walk if the math + likelihood don't work.
Chapter 2 complete. Next chapter: 3.1 Signing the Claim.
Educational. Not legal advice. Specific peril coverage varies materially by policy. Verify against your specific policy + current Florida law for any specific claim.