Opinion ID: 218909
Heading Depth: 3
Heading Rank: 2

Heading: LOSS OF USE. If a loss caused by a Peril Insured

Text: against under Section I makes the residence premises wholly or partially untenantable, we cover: a. additional living expenses, meaning any necessary and reasonable increase in living expense you incur so that your household can maintain its normal standard of living. SECTION I – EXCLUSIONS: 1. The following exclusions apply to loss to property described under Coverage A (Dwelling) or Coverage B (Personal Property), but they do not apply to an ensuing loss caused by fire, smoke or explosion: .... c. We do not cover loss caused by windstorm, hurricane or hail to: ... (3) personal property contained in a building unless direct force of wind or hail makes an opening in a roof or wall and rain, snow, sand or dust enters through this opening and causes the damage. ... f. We do not cover loss caused by: ... (2) rust, rot, mold or other fungi. In 1999, hail and rain caused water damage to the roof and interior of the residence. Reverend Rooters filed a claim on or about May 4, 1999 with State Farm pursuant to subsection 1(c)(3) of the “Exclusion” provision, claiming that hail caused damage to the roof, water entered through the opening, and caused damage to the residence. In response, State Farm opened a claim (hereinafter the 1999 hail claim). State Farm paid Reverend Rooters approximately $19,000 for replacement of the roof, and repairs on the roof were completed. State Farm also issued Reverend Rooters another check for $331.00 of the $1,497.05 needed to repair the interior of the building. 3 Case: 10-10943 Document: 00511509610 Page: 4 Date Filed: 06/15/2011 No. 10-10943 Reverend Rooters passed away on June 28, 2001. In 2002, Mrs. Rooters (hereinafter Rooters) contacted State Farm and requested that the company conduct an investigation because, she alleged, the interior of the residence developed high concentrations of Stachybotrys, commonly known as black mold, and that State Farm still had not paid sufficient funds to repair the building’s interior. Accordingly, State Farm sent an adjuster to the premises, after which the 1999 hail claim was re-opened. State Farm then issued Rooters a check for $4,402.42 for mold abatement, but she did not cash the check because she alleges that no directions were given by State Farm about how to use the money. In 2003, Rooters paid for an environmental assessment of the interior of the building, which revealed high concentrations of black mold as well as other types of mold. She installed a new air conditioner on the day of the environmental assessment and awoke the next morning with her throat “closed up,” her ears hurting, and her eyes burning. She moved out in June 2003. Rooters claims that she was then forced to hire an attorney to obtain funds needed to initiate further repairs to the interior of the building. From 2004 through 2006, Rooters and her counsel corresponded with State Farm numerous times. State Farm issued multiple checks. However, Rooters had difficulty cashing the checks because they were paid to the order of two of the original beneficiaries of the insurance policy, Reverend Rooters and GCS. After several years, the issue was resolved, but Rooters paid a portion of the funds received from State Farm to pay her counsel. In sum, regarding the 1999 hail claim (including Rooters’s 2002 mold complaint), State Farm made payments as follows: (1) $52,049.85 pursuant to Coverage A of the policy for the dwelling; (2) $35,052.72 pursuant to Coverage B of the policy for personal property; and (3) $6,051.70 pursuant to the policy’s “Loss of Use” provision for additional living expenses. Thus, Rooters was paid a total of $93,154.27. Rooters does not dispute that these payments were issued. 4 Case: 10-10943 Document: 00511509610 Page: 5 Date Filed: 06/15/2011 No. 10-10943 On December 31, 2008, proceeding pro se, Rooters filed suit against State Farm in state court. State Farm removed the case to federal court and subsequently filed a motion for summary judgment. The district court summarily adopted the magistrate judge’s report and recommendation, granting summary judgment in State Farm’s favor. Rooters appealed.