CLAIMS GLOSSARY · FLORIDA & NEW JERSEY

Policy Exclusions

Also called: insurance exclusions, exclusion, some exclusions may apply, anti-concurrent causation, ensuing loss

By Nelson Avila, Licensed Florida Public Adjuster (License G332385) · Florida Certified Contractor
Homeland Public Adjusters · Last reviewed: October 2026

Definition

A policy exclusion is a provision that takes a cause of loss, a type of property, or a situation out of coverage that the insuring agreement would otherwise provide. Standard homeowners policies cover the dwelling against all risks except the listed exclusions (flood, earth movement, wear and tear, neglect, intentional acts, and others) and cover contents only for named perils. Most exclusions have exceptions, called ensuing-loss or give-back clauses, that restore coverage for the damage that follows.

Full guide: Claim Denied or Lowballed? Every Option Compared

The exclusions on nearly every property policy

Exclusion	What it removes	What is usually still covered
Flood / surface water / storm surge	Rising water from any outside source	Wind damage from the same storm; flood via NFIP or private flood policy
Earth movement	Sinkhole, settling, landslide, earthquake	Florida catastrophic ground cover collapse is required coverage; sinkhole by endorsement
Wear and tear, deterioration, rust, corrosion	Gradual damage from age	Sudden damage that results (a corroded pipe that bursts: the water damage, not the pipe)
Continuous or repeated seepage or leakage	Slow leaks over a period of time	Sudden discharge; often the resulting damage if hidden from view
Neglect / failure to protect property after a loss	Damage that grows because you did nothing	Damage before you could reasonably act; mitigation costs are covered
Faulty workmanship, design or materials	The defective work itself	Ensuing damage: the water loss caused by a badly installed window
Mold, fungus, rot	Mold as its own loss	Mold resulting from a covered water loss, up to a sublimit
Intentional loss	Damage caused on purpose by an insured	Damage by a third party (vandalism, arson by a stranger)
Ordinance or law	Cost to comply with code on the undamaged part	Restored by ordinance or law coverage (see the term)
Power failure off premises; war; nuclear; government action	Listed events	On-premises power surge from lightning is usually covered

Anti-concurrent causation

Most exclusions open with: “We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss.” That is the anti-concurrent causation clause. After a hurricane it is the sentence carriers use to call wind-and-surge damage “flood” and deny it. The counter is evidence that separates the wind damage (roof, openings, wind-driven rain, damage above the water line) from the flood damage, and a flood claim built to the same facts.

Ensuing loss: the exception that pays

Many exclusions end with “any ensuing loss not excluded is covered.” The defective pipe is excluded; the water damage it causes is an ensuing loss and covered. The rotten window frame is excluded; the interior damage from the rain that came through is covered. Carriers read exclusions broadly and give-backs narrowly; the policyholder is entitled to the opposite reading where the language is ambiguous.

Florida and New Jersey

Florida requires certain coverage that limits the earth-movement exclusion (catastrophic ground cover collapse under §627.706) and requires insurers to offer ordinance or law coverage (§627.7011(1)). It also lets carriers file forms with their own limitations, such as the limited water damage endorsement, which the Office of Insurance Regulation approves. New Jersey reads exclusions under the general rule that ambiguities go to the policyholder and that an insurer bears the burden of proving an exclusion applies. In both states the denial letter must state the policy basis; in Florida that is a statutory requirement under §627.70131.

How carriers use exclusions against you

Citing an exclusion without identifying the ensuing-loss exception next to it.
Calling a sudden event “wear and tear” because the component was old.
Using the anti-concurrent clause to deny all storm damage when only part was flood.
Applying a mold sublimit to the water damage and the rebuild, not just the remediation.
Denying for “neglect” when the damage was hidden.

Frequently asked questions

What does “some exclusions may apply” mean?

It means the policy has a list of causes and property types it does not cover, and the marketing sentence is not telling you which. The list is in the policy’s Exclusions section and in any endorsement that adds one.

Who has to prove an exclusion applies?

You prove a loss occurred within the coverage; the insurer then bears the burden of proving an exclusion applies. If an exception to the exclusion restores coverage, the burden on that exception varies by state, but ambiguity is construed in your favor.

Is mold excluded on my homeowners policy?

Mold as its own loss is excluded. Mold that results from a covered water loss is usually covered up to a sublimit, commonly $10,000 in Florida. The sublimit applies to remediation, not to the underlying water damage.

Can I buy back an exclusion?

Often yes: flood (separate policy), sinkhole, water backup, ordinance or law, equipment breakdown and scheduled personal property are all endorsements or separate policies that restore excluded coverage.

The IICRC S500 Standard for Professional Water Damage Restoration sorts a water loss two ways.

Read the definition ›

Ordinance or Law Coverage

Ordinance or law coverage pays the increased cost of repairing or rebuilding damaged property to comply with current building codes, including demolition of undamaged portions that code requires you…

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Date of Loss

The date of loss (DOL) is the date the damage occurred, which is the date the covered event happened, not the date you discovered it or reported it.

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Appraisal Clause and Umpire

The appraisal clause is a provision in most property policies that lets either the policyholder or the insurer demand appraisal when they disagree on the amount of a covered loss.

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If this is your loss, call Homeland before you talk to the insurance company: Florida (305) 783-3777, New Jersey (732) 517-3777, 24 hours. A licensed public adjuster reviews the claim for free and calls you back right away. No Recovery, No Fee.

Sources

This article is for general information only and is not legal or insurance advice. Statutes, regulations and policy wording change, and how they apply depends on your own policy and the facts of your claim. Homeland Public Adjusters is a public adjusting firm, not a law firm.

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