Insurance Denied Your Water Damage Claim? Understanding “Wear and Tear” vs. Sudden Damage

The following article is general information, and is not legal advice. The law and each case is nuanced, and you should consult an attorney before relying on any legal principles outlined in this article.

Water damage claims are among the most common—and most contested—homeowners insurance claims. A frequent frustration: the insurer points to a “maintenance,” “gradual seepage,” or “wear and tear” exclusion to deny coverage, even when you experienced a sudden leak or burst. Here’s how these provisions really work, what “sudden and accidental” means, and how to respond if your claim was wrongly denied in Oregon.

The “Wear and Tear” Exclusion—What It Actually Means

Most policies don’t cover ordinary deterioration: aging roofs, corroded pipes, failed seals, rot, rust, and similar long-term conditions. Insurers legitimately treat those as the homeowner’s maintenance responsibility.

But that’s only half the story. Many policies also promise coverage for sudden and accidental water damage—for example, a burst pipe or an appliance failure that releases water unexpectedly. In those situations, the resulting water damage to walls, flooring, or personal property is typically covered even if an older part failed. (Repairs to the worn part itself may be excluded.)

“Ensuing Loss” (Resulting Loss) Clauses—Why They Matter

Policies often include an ensuing loss (or “resulting loss”) clause. In plain English: even if an excluded condition (like wear and tear) plays a role, you can still have coverage when a separate, covered peril ensues and causes the damage—such as water suddenly escaping and damaging the structure. Courts and commentators explain that ensuing-loss language exists so exclusions don’t swallow the basic coverage the policy is supposed to provide. See Penn State Law: The “Ensuing Loss” Clause in Insurance Policies: The Forgotten and Misunderstood Antidote to Anti-Concurrent Causation Exclusions. 

That is why denial letters that simply say “wear and tear” aren’t the end of the analysis. The key question is what actually caused the water damage and whether a covered, sudden event set things in motion.

How Insurers Commonly Overreach

It’s not unusual to see denial letters broadly citing “wear and tear,” “repeated leakage,” or “maintenance” when the facts show a discrete incident—like a fitting that failed or a line that ruptured—produced sudden water release and interior damage. Industry disputes (and litigation) frequently turn on whether leakage was gradual over months (typically excluded) versus abrupt (generally covered for the resulting damage).  

Often damage will occur after a storm or freeze, but the insurance company might take the position that “wear and tear” was responsible.  Engrav Law Office has litigated several of these claims and has fought the insurance companies on blanker assertions that damage was from wear and tear. 

In Oregon, denial letters must also specifically reference the policy provisions the insurer relies on—and denials must be in writing. If your letter is vague or cites the wrong sections, that’s a red flag. See OAR 836-080-0235(1). 

What to Do Right Away if Your Water Damage Claim Is Denied

1. Talk to a coverage attorney. A focused review of the policy, the facts, and Oregon law often changes outcomes—especially when the record shows a sudden event and properly mitigated damages.  Engrav Law Office will provide a free consultation in regard to a potential coverage issue with your policy.  We take select cases on a contingency fee percentage, meaning you don’t pay us unless we prevail on your claim.  Even if we don’t take your case, we’re happy to provide the consult and be helpful if we can be. 
2. Get and keep the denial in writing. Oregon rules require written denials that cite the exact policy language at issue. File the letter and any claim notes you receive.
3. Document the event and the damage. Photos, videos, and timelines matter. Save plumber invoices, mitigation company reports, and any moisture readings.
4. Seek an independent opinion. Ask a licensed plumber, mitigation contractor, or building consultant to put in writing what failed and when (e.g., “sudden failure on [date]”). Independent reports can rebut “gradual” narratives.
5. Preserve the failed part. If a fitting, valve, or section of pipe is replaced, save it—it could be crucial evidence.
6. Appeal internally, in writing. Point to the sudden and accidental nature of the event and the policy’s resulting loss coverage.
7. Escalate if necessary. You can file a complaint with the Oregon Division of Financial Regulation (DFR), which investigates unfair claim practices and can pressure insurers to comply with the law. See DFR Website.