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Homeowners Insurance – Your Children May Not Be Covered!

This week I started thinking about families and how they are affected by the definitions of words in insurance policies.

We all know that the divorce rate in the United States is high. We know many divorced people who have children. We also know that many divorced people who have children remarry.

Old understandings of what defines family are in flux. But policy terminology can’t keep up with this change, and your family may be affected when making a claim.

Today, let’s take a look at how family structure can affect homeowner, condo or renter insurance coverage.

Here are situations where family structure can become a coverage issue:

1. You and your spouse separated. She still lives in the house you jointly own, but you have rented an apartment.
2. You and your spouse share custody of the children.
3. Your second wife’s 22-year-old unmarried daughter lives with you. She has a bichon frize that bites the mailman and the mailman sues you.
4. Your elderly parents move in with you.
5. (Actual case where I worked) Your wife’s college roommate moved to Atlanta from California looking for a job. You accept her understanding is only three months. The following month, the mother of your roommate in California has a stroke and she also moves into your home.

Join me as we review the Insurance Services Office’s (ISO) HO-3 All Risks Homeowners Policy, HO-6 Condominium Policy, and HO-4 Renters Insurance Policy. ISO is the standard language for almost all policies.

First, we have to lay some groundwork by making sure we all understand some definitions of words in the policy. You might think this stuff is boring, but know this: If an insurance company takes the time to define a particular word, that word has a special meaning. If you or your circumstances do not qualify for this definition, you will not be covered.

In all three policies, “insured” means you and your household residents:

– your relative: or

– Other persons under the age of 21 who are in the care of any of the above.

“You” and “Your” refer to the “named insured” appearing on the statement and its spouse (if resident in the same household).

The terms “resident”, “family”, “relative” and “cared for by” are not defined in the policy. So the court has a lot to say about the definitions of these terms. I could list court cases, but I don’t want to bore you. Let me know if you need specifics and I’ll provide them.

Let’s expand on each of the examples above.

1. You and your spouse separated. She still lives in the house you jointly own, but you have rented an apartment. The policy has both of your names on it, but you don’t live there. You do not qualify as a “resident”. If you file a claim, even during legal separation, the insurance company may deny you coverage because you didn’t live there.
2. You and your spouse are divorced and have joint custody of the children. The kids shuttle back and forth between your house and your ex-husband’s. One of the children caused serious injury to another neighbor child in your home. Under the liability section of the policy, the insurer is responsible for providing the legal defense of claims and any lawsuits. But is the child an “insured”? The insurance company could argue that the child spends more time per week at your ex-spouse’s residence than at yours and deny coverage to you. This could expose you to a large lawsuit settlement and possibly bankrupt you. But take heart.There was a court case where the court ruled that the children had dual residency,And it was decided that the child was covered by two homeowners policies.
3. Your second wife’s 22-year-old unmarried daughter lives with you. She has a bichon frize that bites the mailman and the mailman sues you. Daughter was deceived? Well, she’s a relative, so she’s covered up. What about a dog bite lawsuit? Congratulations, you’re covered again. The policy states that dog bites are covered. However, if the daughter has a boyfriend with her, anything the boyfriend does that causes damage is not covered.
4. Your elderly parents move in with you. However, they are healthy and financially self-sufficient. They spend 7 months of the year at their Florida home during the winter and use your address as their legal address. They are not “under your care”. Are they covered under your policy? Yes, they qualify as “insured persons” because they are relatives. However, in the case of a claim, the insurance company may argue that they are not “residents”.
5. (Actual case where I worked) Your wife’s college roommate moved to Atlanta from California looking for a job. You accept her with the understanding that it will only take three months for her to find a job and find an apartment. The following month, the mother of your roommate in California has a stroke and she also moves into your home. One morning, after you and your wife leave, your roommate is up and ready to go to the bathroom. She lit a candle and placed it on top of the fiberglass garden tub. She forgot to blow out the candles and was away for hours, while her mother in a wheelchair was home alone. Candles ignite fiberglass tub, causing $135,000 fire. Mom got out safely. In this claim, the insurance company actually referred the claim to their Special Investigations Unit (SIU) in an attempt to prove that the homeowner set the fire. The insurance company took more than three months to investigate, during which time they would not tell the homeowner anything. The insurance company recorded statements from the homeowner, his wife and roommate… none of them were home when the fire broke out. The insurance company never asked for any information from the mother, who was actually inside the house when the fire broke out. Additionally, they will not pay the homeowner any additional living expenses. They refused to insure the roommate and her mother’s personal property destroyed in the fire because they did not qualify as “insured persons.” The delay nearly bankrupted the homeowner. On behalf of the homeowners, we have finally reached a settlement for them after months of tough negotiations.

So you can see that words that are not defined in the policy can cause headaches and even lawsuits. Having custody of your children does not necessarily mean they qualify as residents. Being a resident of a residence does not automatically make a person eligible for coverage as a resident of a household.

Do you have a story of how the definition of an insurance term got you in trouble or caused an insurance company to deny your claim? Let’s discuss it in the blog.

Thanks for reading this article, and here’s to a clear definition!

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