Wear and Tear, Pre-Existing Damage, and Maintenance Exclusions in Florida Residential Property Claims

When an adjuster writes that a roof failed from "age and deterioration" or that interior staining is a "long-term maintenance issue," that adjuster is invoking an exclusion. Under Florida law that label carries a consequence the denial letter rarely spells out: on a standard open-peril homeowners policy, the insurer, not the policyholder, carries the burden to prove the loss falls within the exclusion. This article covers how Florida treats wear and tear, deterioration, faulty workmanship, pre-existing damage, and the "constant or repeated seepage" water exclusion in first-party residential claims, with emphasis on roof and water losses where these denials cluster. It explains who proves what, how the concurrent cause doctrine lets a covered windstorm carry an otherwise excluded maintenance cause into coverage, how anti-concurrent-cause language changes that result, and the statutory claim-handling clocks, tightened by the Senate Bill 2-A reforms effective December 16, 2022, that frame every denial.

Scope: Florida residential property only, HO-3 style open-peril dwelling coverage (ISO form HO 00 03 and carrier forms that track it). It does not address commercial property, NFIP flood, sinkhole and catastrophic ground cover collapse mechanics under sections 627.706 through 627.7074, or the calculation of statutory bad-faith damages. Analysis is current as of June 14, 2026, and reflects the statutory text in the 2025 Florida Statutes and the Senate Bill 2-A amendments (chapter 2022-271, Laws of Florida) effective December 16, 2022.

The rule that decides these claims: burden of proof on an open-peril policy

Almost every wear-and-tear fight turns on allocation of proof, and Florida settled that allocation forty years ago. On an open-peril ("all risk") policy, the insured bears the initial burden to prove that a physical loss occurred to covered property while the policy was in force. Once the insured makes that showing, the burden shifts to the insurer to prove the loss arose from an excluded cause. See Hudson v. Prudential Property & Casualty Insurance Co., 450 So. 2d 565, 568 (Fla. 2d DCA 1984). Hudson reversed a defense verdict because the trial court's instruction forced the insureds to prove their home was damaged by a covered sinkhole rather than requiring Prudential to prove its earth-movement exclusion. The procedural posture matters: this was a jury-verdict reversal on an instruction error, which is why Hudson is cited for the proposition that misallocating the exclusion burden is itself reversible.

That allocation is not a technicality. Wear and tear, deterioration, faulty workmanship, and pre-existing damage are exclusions or coverage limitations. They are the insurer's affirmative case. An adjuster who closes a file on "maintenance" has not defeated coverage; the carrier has assumed the burden of proving, with admissible evidence, that the excluded cause produced the loss.

Florida construes the exclusions the insurer must carry against the insurer. Exclusionary clauses are read narrowly, and any ambiguity is resolved in favor of coverage; the carrier is responsible for clearly stating what it has excluded. Whether a given loss falls within an exclusion is a question of law. The Florida Supreme Court applied those principles in Fayad v. Clarendon National Insurance Co., 899 So. 2d 1082 (Fla. 2005), quashing a Third District affirmance of summary judgment for the insurer and holding that an earth-movement exclusion reaches only natural events, so damage from man-made blasting was covered. Fayad is about earth movement, not wear and tear, but its interpretive rules are general and are the rules every Florida court applies to maintenance and deterioration exclusions. Note one point from Fayad that recurs below: a "regardless of any other cause" lead-in broadens an exclusion's reach, which is the doctrinal seed of anti-concurrent-cause language.

Concurrent causation: when a covered storm carries an excluded cause into coverage

The reason adjusters cannot simply point to old shingles and stop is the concurrent cause doctrine. In Sebo v. American Home Assurance Co., 208 So. 3d 694 (Fla. 2016), the Florida Supreme Court held that when two or more independent perils converge to produce a loss and no single peril can be identified as the sole or efficient proximate cause, coverage may exist so long as a covered peril is one of the concurrent causes, even if another concurrent cause is excluded. The Court quashed the Second District's contrary application of the efficient proximate cause doctrine. The doctrine traces to Wallach v. Rosenberg, 527 So. 2d 1386 (Fla. 3d DCA 1988), which first rejected the rule that any excluded concurrent cause defeats the whole claim.

Translate that to a roof claim. A hailstorm strikes a roof that already shows granule loss and some deterioration. The carrier denies on wear and tear. If wind or hail and deterioration each contributed and neither is the clear proximate cause, the concurrent cause doctrine can pull the loss into coverage despite the wear-and-tear exclusion. That is exactly the scenario in Jones v. Federated National Insurance Co., 235 So. 3d 936 (Fla. 4th DCA 2018), a hail claim on a damaged roof. The Fourth District reversed a defense verdict and remanded for a new trial because the jury instruction applied efficient proximate cause uniformly without first letting the jury decide whether a single efficient cause even existed. Jones is the most useful single decision in this area for two reasons developed below: its exclusion-by-exclusion treatment of anti-concurrent-cause language, and the burden-shifting framework it laid out for instructing juries.

Anti-concurrent-cause language changes the answer

Carriers can contract around the concurrent cause doctrine. An anti-concurrent-cause (ACC) provision states that a loss is excluded if an excluded peril contributes to it "directly or indirectly," "regardless of any other cause or event contributing concurrently or in any sequence." Where that language attaches to an exclusion, an excluded concurrent cause defeats coverage for that loss. The Fifth District enforced exactly that result in Liberty Mutual Fire Insurance Co. v. Martinez, 157 So. 3d 486 (Fla. 5th DCA 2015), reversing a summary judgment for the insureds and directing judgment for the carrier because subsurface water pressure, an excluded cause, concurrently produced the damage and the policy's water exclusion carried ACC language. Martinez predates Sebo, but the two are consistent. The policy in Sebo contained no anti-concurrent-cause language, and the Court grounded its result in the specific terms of that policy; nothing in Sebo disturbs a carrier's ability to contract around the concurrent cause doctrine, which is why Martinez and Jones remain the governing authority on ACC clauses after Sebo.

Here is the trap for adjusters and the opportunity for coverage counsel, both visible in Jones. Policies do not always apply ACC language uniformly to every exclusion. In Jones, three exclusions ("neglect," "existing damage," and "weather conditions") carried ACC lead-ins, but the "faulty, inadequate or defective design" and "wear and tear, marring, deterioration" exclusions did not. Because the wear-and-tear and design exclusions lacked ACC language, the concurrent cause doctrine remained available as to those causes, and the trial court erred by applying efficient proximate cause across the board. The lesson is that ACC analysis is exclusion-specific. Reading the policy's lead-in once and assuming it governs the whole Section I exclusions block is how carriers lose these cases, and how counsel wins them.

The exclusions themselves, and the ensuing-loss carve-back

The standard HO-3 special form excludes wear and tear, marring, deterioration, mechanical breakdown, latent defect, and faulty workmanship or design, alongside the water exclusions discussed below. These are real exclusions and they defeat coverage when the carrier proves the excluded cause produced the loss and no covered concurrent cause is in play. The point of the doctrine above is not that wear and tear never excludes; it is that the carrier must prove it, and that a covered concurrent peril can survive it absent ACC language.

The form also gives back coverage in two ways that matter in water claims. First, many forms cover sudden and accidental discharge or overflow of water from a plumbing system even when the discharge results from deterioration of the system, "unless the loss is otherwise excluded." Second, the water exclusions are themselves limited in scope. The Third District parsed both features in Cheetham v. Southern Oak Insurance Co., 114 So. 3d 257 (Fla. 3d DCA 2013), reversing judgment for the insurer. The court held that the surface-water, below-ground-water, and sewer-or-drain-backup exclusions address water originating outside the residence premises plumbing system, so a deteriorated pipe inside the system that caused waste water to back up into the home was a covered loss, not an excluded one. Cheetham is a clean illustration that "deterioration" in the chain of causation does not automatically trigger an exclusion when the policy separately covers accidental discharge from the plumbing system.

Water claims and the "constant or repeated seepage over 14 days" exclusion

The most common maintenance denial in water claims invokes the exclusion for loss caused by "constant or repeated seepage or leakage of water ... over a period of 14 or more days." Carriers read it to bar the entire claim whenever an expert opines the leak persisted two weeks or longer. The Fifth District rejected that reading in Hicks v. American Integrity Insurance Co. of Florida, 241 So. 3d 925 (Fla. 5th DCA 2018). A refrigerator supply line leaked for roughly five weeks while the insured was away. The carrier denied the whole loss; the trial court granted summary judgment for the carrier. Reversing, the court held that an exclusion for seepage "over a period of 14 or more days" does not unambiguously exclude losses caused by seepage over a period of thirteen days or less. The practical effect is that the exclusion is durational. It does not erase a loss that began accruing before day fourteen, and the carrier bears the burden to separate excluded from non-excluded damage rather than denying in full.

The wording controls, which the Fourth District underscored in Feldman v. Citizens Property Insurance Corp., No. 4D22-865 (Fla. 4th DCA Aug. 30, 2023), an authored opinion reversing a defense verdict in part. Feldman holds two useful things. First, on the insured's threshold burden, an undisputed physical loss during the policy period (a ceiling collapse) entitled the insured to a directed verdict on that initial question; the fact that the damage was not "new" did not negate the timing. Second, the court distinguished Hicks because the Citizens policy's seepage exclusion did not contain the "14 days or more" durational language, so Hicks's thirteen-day reasoning did not compel the insured's requested instruction. The case remained for a jury on whether the long-term seepage exclusion precluded coverage. Together, Hicks and Feldman tell adjusters and counsel to read the exact seepage wording: the durational defense to a full denial exists where the policy uses the "14 or more days" formula, and weakens where it does not. Practitioners should confirm Feldman's permanent reporter citation before relying on it in briefing; as of this writing the opinion still carries only its docket number, without an official Southern Reporter cite.

There is no clean interdistrict conflict rejecting Hicks where the "14 or more days" language appears. Feldman did not reject Hicks; it distinguished it on policy text. Under Florida's stare decisis rules a district court of appeal decision binds all circuit and county courts in the absence of interdistrict conflict, so Hicks governs trial courts statewide on policies using that durational phrasing unless another district squarely disagrees.

Roof claims: age, valuation, deductibles, and matching

Roof denials raise the wear-and-tear question in its starkest form because every roof ages, and a roof near the end of its service life invites an "age and deterioration" denial regardless of what a named storm did. Jones is the controlling template: the carrier must prove the wear-and-tear or deterioration exclusion, and absent ACC language on that specific exclusion, hail or wind acting concurrently with deterioration can carry the loss into coverage.

Three statutory features shape the dollars once coverage attaches. First, valuation. Under section 627.7011, Florida Statutes, a replacement-cost dwelling policy must initially pay at least actual cash value less the deductible, with the holdback released as repairs are performed, except that on a total loss the insurer must pay replacement cost without depreciation holdback. Where a roof deductible under section 627.701(10) applies, the insurer may limit the roof payment to ACV until it receives reasonable proof the policyholder paid the roof deductible. ACV depreciation is where age and wear quietly re-enter a covered roof claim, so the depreciation methodology, not just the coverage decision, is a litigable point.

Second, underwriting by roof age. Section 627.7011 prohibits a carrier from refusing to issue or renew a homeowners policy solely because of roof age if a roof inspection shows at least five years of remaining useful life, for policies issued or renewed on or after July 1, 2022. That provision constrains pre-bind appetite decisions; it does not convert an aged-roof claim denial into a coverage grant, and the two should not be conflated.

Third, matching. Section 626.9744 requires that, unless the policy provides otherwise, when a loss requires replacement of items that do not match adjoining undamaged items in quality, color, or size, the insurer must make reasonable repairs or replacement of items in adjoining areas, considering cost, achievable uniformity, and remaining useful life. On a tile or shingle roof where only one slope is damaged and the product is discontinued, matching can drive the loss toward a full replacement. The "unless otherwise provided by the policy" clause is doing heavy lifting after the 2022 and 2023 reforms, because carriers have increasingly added matching-limitation endorsements that the statute expressly permits. Pull the endorsement schedule before assuming the statutory matching obligation applies.

The statutory clocks that frame every denial

Maintenance and wear-and-tear disputes play out inside a set of deadlines that tightened sharply between 2021 and 2022. Getting the triggers right is half the analysis, because a deadline without its trigger date is half a fact.

The presuit notice in section 627.70152 is a condition precedent to suit, served on the Department of Financial Services on the department's form, and a court must dismiss a suit filed without it. It cannot be served until the insurer has made a coverage determination under section 627.70131, which links the litigation clock to the claim-handling clock. The five-year suit limitation in section 95.11 runs from the date of loss for a breach of a property insurance contract; note that the 2023 tort reform restructured section 95.11's subsection lettering, so confirm the current subsection when you cite it.

The notice deadlines are the most consequential change for stale roof and water claims, and the version that applies depends on the policy:

Which row governs turns on the operative policy and the date of loss, and the applicability trigger has itself generated litigation, so do not assume the one-year window applies to a loss under an older policy form.

A burden-shifting framework for the claim file

Jones did more than reverse; it set out the analytical sequence Florida courts use when covered and excluded perils both appear. Adapted as a working framework for evaluating a wear-and-tear or maintenance denial, it runs as follows.

1. Confirm the policy is open-peril and that the insured can show a physical loss to covered property during the policy period. If the insured cannot establish a loss within the policy period, the claim fails at the threshold, before any exclusion analysis. This is the insured's burden, and pre-existing damage attacks it directly.

2. Ask whether a single sole or efficient proximate cause can be identified. If one can, coverage turns on whether that single cause is excluded. The insurer must prove the exclusion; if it cannot, the insured recovers.

3. If no single efficient proximate cause can be identified and the relevant exclusions lack anti-concurrent-cause language, the concurrent cause doctrine applies. The insurer carries the initial burden of production to show an excluded risk was a contributing cause. If it fails, the insured recovers.

4. If the insurer produces that evidence, the burden of production shifts to the insured to show a covered risk was also a concurrent cause. If the insured then makes that showing, the insurer bears the ultimate burden to prove the insured's claimed covered cause was either not a real contributing cause or was itself excluded.

5. Run steps 2 through 4 exclusion by exclusion, because ACC language may attach to some exclusions and not others within the same policy. Where ACC language attaches, an excluded concurrent cause defeats coverage for that loss and the efficient proximate cause analysis governs instead.

This framework, adapted from the sequence the Jones court itself laid out and reorganized for the claim file, can be lifted directly into a coverage memo or a reservation of rights, because it identifies precisely which party must come forward with what, and when.

Settled law and open questions

Settled: on an open-peril policy the insurer bears the burden to prove a wear-and-tear, deterioration, faulty-workmanship, or maintenance exclusion (Hudson). Exclusions are construed narrowly against the carrier and whether a loss falls within one is a question of law (Fayad). The concurrent cause doctrine governs when independent perils converge with no identifiable sole proximate cause and the policy lacks ACC language (Sebo, Wallach, Jones). Parties may contract around that doctrine with ACC provisions, which Florida courts enforce (Martinez). A "14 or more days" seepage exclusion is durational and does not bar loss accruing in the first thirteen days (Hicks).

Open or fact-dependent: whether ACC language reaches a given loss is exclusion-specific and frequently litigated, because carrier forms vary and do not always apply the lead-in uniformly (the live issue in Jones). The depreciation methodology used to compute ACV on a covered but aged roof remains a recurring valuation dispute rather than a settled formula. Whether the one-year notice window in section 627.70132(2) applies to a particular claim depends on the policy's effective date and has produced its own body of trial and appellate litigation. And the reach of carrier matching-limitation endorsements under the "unless otherwise provided by the policy" clause of section 626.9744 is still developing, with sparse appellate authority interpreting the matching statute itself.

Practical takeaways by role

For coverage counsel: the denial letter's "maintenance" label is the carrier's burden, not the insured's, so frame the case around Hudson and force the carrier to prove the exclusion with evidence. Then run the Jones framework exclusion by exclusion and identify any exclusion that lacks ACC language, because that is where the concurrent cause doctrine survives and a covered storm can carry the loss. On water claims, read the seepage wording for the "14 or more days" phrase and invoke Hicks to defeat a full denial of a partly recent loss.

For underwriting and rate filings: ACC language is the single most outcome-determinative drafting choice in these claims, and uniform application of an ACC lead-in across every Section I exclusion, rather than to some exclusions and not others, is what separates Martinez from Jones. Matching-limitation endorsements and roof deductible structures under sections 626.9744 and 627.701(10) materially affect severity on aged-roof exposures and should be modeled accordingly, and the roof-age underwriting limits in section 627.7011 constrain non-renewal appetite for roofs with remaining useful life.

For claim handling and reserving: an "age and deterioration" or "long-term leak" conclusion does not close the file, it opens the carrier's affirmative case, so the inspection and engineering record must separate covered from excluded causation rather than asserting it. The 60-day pay-or-deny clock in section 627.70131(7)(a) and the 7-day acknowledgment requirement run regardless of how confident the maintenance theory is; missing the 60-day clock is a violation of the Insurance Code that starts interest running on any late payment from the date of notice under section 55.03, although by the statute's own terms it does not by itself create a private cause of action. A denial that cannot survive the concurrent cause framework should be reserved as a contested coverage exposure, not a clean decline. Reserve seepage claims for the non-excluded portion when the "14 or more days" exclusion is in play, because Hicks forecloses treating the whole loss as excluded.

Sources

Primary sources (statutes):

• Fla. Stat. § 627.70132 (notice of property insurance claim)
• Fla. Stat. § 627.70131 (insurer's duty to acknowledge and investigate; pay-or-deny)
• Fla. Stat. § 627.70152 (presuit notice; suits arising under a property insurance policy)
• Fla. Stat. § 627.7011 (replacement cost and law and ordinance; ACV holdback; roof-age underwriting)
• Fla. Stat. § 627.701 (roof deductible, subsection (10))
• Fla. Stat. § 626.9744 (matching; claim settlement practices)
• Fla. Stat. § 95.11 (limitations; breach of property insurance contract runs from date of loss)

Case opinions:

• Fayad v. Clarendon National Insurance Co., 899 So. 2d 1082 (Fla. 2005)
• Sebo v. American Home Assurance Co., 208 So. 3d 694 (Fla. 2016)
• Hudson v. Prudential Property & Casualty Insurance Co., 450 So. 2d 565 (Fla. 2d DCA 1984)
• Wallach v. Rosenberg, 527 So. 2d 1386 (Fla. 3d DCA 1988)
• Cheetham v. Southern Oak Insurance Co., 114 So. 3d 257 (Fla. 3d DCA 2013)
• Liberty Mutual Fire Insurance Co. v. Martinez, 157 So. 3d 486 (Fla. 5th DCA 2015)
• Hicks v. American Integrity Insurance Co. of Florida, 241 So. 3d 925 (Fla. 5th DCA 2018)
• Jones v. Federated National Insurance Co., 235 So. 3d 936 (Fla. 4th DCA 2018)
• Feldman v. Citizens Property Insurance Corp., No. 4D22-865 (Fla. 4th DCA Aug. 30, 2023)

General legal analysis, current to June 14, 2026 — not advice on a specific claim. The recent Florida reforms apply differently by policy issuance and date of loss, so verify the current statute and the cited opinions before relying on them.