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Case Study

CASE

Property Damage: Frozen Water

Synopsis of Complaint:

The consumer noticed water on the door jamb of their main floor office and went to the attic to investigate the source of the leak.

Upon inspection, they discovered hundreds of pounds of icicles throughout the attic. A contractor was hired to assess the cause of the damage and determined that a disconnected heat vent had allowed hot, moist air to escape into the attic. This warm air condensed and froze due to extremely cold outdoor temperatures, resulting in significant icicle formation over the insulation.

The consumer promptly reported the damage to their insurer, however, coverage was initially denied based on the contractor’s preliminary assessment, which suggested that the venting had been improperly installed. The contractor could not confirm whether the vent support had failed or had been missing entirely, as it was buried beneath a large accumulation of ice and insulation. Under the insurance policy, faulty workmanship is not a covered peril.

After the ice and insulation were removed, an HVAC specialist re-inspected the system and located the original vent support, confirming that the vent had in fact been properly installed. The specialist provided a formal report to the insurer. The consumer also obtained a copy of the original building permit from the municipality, verifying that the furnace installation met building code requirements at the time of construction.
Despite this, the insurer then denied the claim on the basis of “ongoing seepage and leakage.”

Review by GIO:

GIO reviewed the property policy wording along with documentation submitted by both the insurer and the consumer. The GIO appealed to the insurer on the grounds that the incident constituted a sudden, accidental, and fortuitous loss, not a case of gradual or continuous leakage.

Resolution:

Since there was no definitive evidence indicating when the vent had become disconnected, the insurer’s basis for denying the claim was not substantiated, and they ultimately agreed to provide coverage to the consumer.

GIO is an independent body set up to help Canadians find a fair resolution to disputes with insurance providers. GIO can provide advice on dealing with your insurance company as a first step. If you are not satisfied with the decision from your provider on your claim, GIO can help resolve your claim. 

If you’d like to submit a claim visit here.

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