What Are Common Home Insurance Exclusions?
Flood, earthquake, and normal wear top the list. Mold, sewer backup, and pest damage are often limited too.
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If the adjuster's decision turns on an exclusion, check the denial letter for the exact policy language and section it cites, then pull up your own policy and read that clause yourself. Insurers can't deny a claim on an exclusion that isn't written into your contract. Water damage is where this gets tricky, since a burst pipe is usually covered but water that seeps in gradually or backs up through a sewer line often isn't, unless you added that coverage separately. Your declarations page shows what endorsements you paid for.
Two policies at renewal time rarely exclude the same things the same way. One insurer may sell sewer backup or water backup coverage as a standard add-on, another may charge more for it or leave it off entirely, and that difference only shows up when you compare what's actually written into each contract. If this claim turned on an exclusion you didn't know was there, checking what other policies would have covered costs nothing.
What happens if part of the damage is excluded and part isn't?
Most claims involving an exclusion aren't a flat yes or no. A pipe bursts and soaks the drywall, the flooring, and the subfloor, and over the following weeks mold starts growing in the wall cavity. The water damage from the burst pipe is covered. The mold that grew afterward might be covered, excluded, or covered up to a set dollar limit, often far less than what remediation actually costs. Adjusters are supposed to separate these causes and pay for the covered part even when they deny the rest. If your estimate treats the whole repair as one number, ask for a breakdown that shows what's being paid for which cause of loss.
The wording of the exclusion matters as much as its existence. Some mold exclusions are absolute. Others only exclude mold that results from a cause that was itself excluded, like a slow, hidden leak you should have caught. If the mold grew out of a sudden, covered event like a burst pipe, the exclusion may not apply the way the denial letter suggests. Read the clause the adjuster cited, not just the summary in the letter, and check whether it has conditions attached.
Anti-concurrent causation clauses complicate this further. These say that if an excluded peril, like flood or earth movement, contributes to the damage at all, the insurer can deny the entire claim even if a covered peril was also involved. Wind tears off part of a roof, then rain gets in and floods the attic. If the insurer argues flood contributed to the loss, some policies let them deny the wind damage too, even though wind is normally covered on its own. These clauses are enforceable in most states but not all. How they're worded varies, so this is worth checking against your own policy rather than assuming the worst.
When a claim is split this way, ask the adjuster in writing to itemize what's being paid, what's being denied, and the exact exclusion or clause behind each denied item. A partial denial is still something you can appeal piece by piece. You don't have to accept the whole decision just because part of it is correct.
Can you push back on a partial denial instead of accepting it?
Yes, and treating a partial denial as one decision is usually a mistake. If the itemized breakdown shows the insurer paid for the drywall but denied the mold remediation, those are two separate findings, and you can appeal the mold denial without reopening anything already settled. Most insurers have an internal appeals process for exactly this, and the denial letter should say how to start one along with any deadline attached to it.
The strongest appeals bring something the adjuster didn't have the first time. A contractor's written opinion on how the damage happened, a plumber's report showing the pipe failure was sudden rather than gradual, or photos time-stamped before the mold spread all do more than a phone call insisting the decision was wrong. If the dispute is about timing, whether the leak was sudden or had been seeping for weeks, that question usually gets settled by someone who inspected the pipe or the wall cavity, not by rereading the policy again.
Some states require insurers to pay the undisputed part of a claim promptly even while the rest is under appeal, so if part of your estimate was approved, ask when that payment is issued separately from the denied portion. If the appeal stalls or the second answer still doesn't match the policy language you read yourself, a public adjuster or an attorney who handles property claims can review the file, and in some states you can also file a complaint with the state insurance department, which keeps a record of how the insurer handled the claim.
None of this requires accepting the first number as final. Insurers write denial letters quickly and sometimes cite the wrong clause or skip the exception built into their own exclusion. Checking the language yourself, and asking for the denial broken down by cause of loss, is often the difference between losing the whole claim and losing only the part that was genuinely excluded.
Before you accept the decision
Find the exact clause the denial cites in your own policy and check it for exceptions. If any part of the damage was approved, ask when that payment arrives separate from the appeal.
