Posted in Insurance Law

Property damage rarely has a single cause. A storm can bring wind and flooding, and a fire can lead to water damage from firefighting. When two causes combine and the policy covers only one, insurers sometimes deny the whole claim.

What Insurance Code Section 530 Says

Under Insurance Code section 530, an insurer is liable for a loss when a covered peril was the proximate cause, even if a peril the contract didn’t contemplate was a remote cause. The reverse also holds, since an insurer isn’t liable when the insured peril was only a remote cause.

Courts read this as a question of which cause was the dominant one, usually termed the efficient proximate cause. It isn’t always the last event in the chain, so the order of events has to be traced.

To find out which cause set the loss in motion, San Francisco homeowners with a denied claim can bring the file to a San Francisco insurance policy lawyer. The answer can change how well a denial holds up.

Exclusions Don’t Always Win

Many policies exclude losses from certain events, such as earth movement. Insurers have sometimes pointed to an exclusion even when a covered peril started the chain of events.

In Howell v. State Farm, the Court of Appeal held that a property insurer may not limit its liability this way when a covered peril was the efficient proximate cause. The court also found a triable question about whether a fire was the efficient proximate cause of a landslide.

One justice agreed with the result but disagreed that section 530 overrides policy language, reaching the same outcome through the parties’ reasonable expectations. The reasoning behind the rule isn’t uniform, so each claim needs careful analysis.

How a Claim Gets Built

Proving the dominant cause usually takes more than the policyholder’s account. Typical building blocks include:

• Photographs and video of the damage as it first appeared.
• Reports from contractors, engineers, or fire investigators.
• Weather records and timelines of events.
• The insurer’s own claim notes and denial letter.

Timing and sequence evidence carries real weight. A report that explains what happened first and what followed can shift the analysis.

Our insurance dispute attorneys work with policyholders to gather this kind of evidence while a denial is still being contested. Starting before the file goes cold preserves more options.

Reading the Denial Letter

A denial should explain why the insurer rejected the claim. Compare its reasoning with the policy language and the facts. Insurers sometimes cite an exclusion without addressing the cause of the loss, and that gap matters.

Policy wording drives the outcome, which is why reading the fine print before a claim is denied saves a lot of trouble. Reading it closely before a dispute arises gives a policyholder a head start.

If a denial seems wrong, the next move depends on the policy and the facts, and fighting a denied claim often starts with a written response and supporting documents. Deadlines in the policy still apply, so timing matters.

When Handling Crosses a Line

Denying a claim without a reasonable investigation can raise a separate issue. Insurers owe policyholders a duty of good faith, and whether they met it depends on what they did and when.

Conduct that falls short can amount to bad faith claims handling, which is separate from the coverage question itself. A denial can be wrong on coverage, on handling, or on both.

About Our Firm

The firm represents policyholders and has done so for more than 30 years. Attorney Bennett M. Cohen has represented plaintiffs against some of the largest insurers in the country.

The Law Office of Bennett M. Cohen takes on insurers over claims that were denied, delayed, or underpaid. We start with the denial letter and the policy.

Many disputes settle before a lawsuit is filed. Others do not, and the file is built with that possibility in mind.

Cases that can’t be resolved through negotiation may require insurance litigation in court, where the policy and the cause of loss are tested. A judge then decides how the statute and the policy language apply.

Questions Worth Asking First

Before accepting a denial, ask what caused the loss, which cause came first, and whether the exclusion the insurer cites really applies. Sometimes the answers change the outcome.

Questions like these often decide a coverage dispute. San Francisco policyholders who aren’t sure where they stand can reach out to a San Francisco insurance policy lawyer to talk through the denial and decide how to respond.