After Sandy, victims tackle insurance maze

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Superstorm Sandy may be gone, but a new tempest is brewing as property owners try to recoup losses from their insurance companies.

Policyholders, who believe they have full coverage are about to discover gaping holes over the next few weeks, thanks to a complex maze of exemptions and legalese, said J. Robert Hunter, director of insurance at the Consumer Federation of America.

Insurance companies tend to pay for a lot of small losses soon after a disaster, he said, but later on in the process, when faced with big-ticket claims, they dig in their heels.

"It takes about three weeks for these things to start happening," Hunter said. "You'll hear moaning."

Deborah Brenner, co-owner of Cafe Portofino in Piermont, saw her business interrupted and the loss of thousands of dollars in equipment to Sandy's storm surge over the banks of the Hudson River.

Initial indications on insurance coverage from fellow business owners don't look encouraging, she said. Brenner is still waiting for a final decision from her insurance company.

"What we're hearing from people is insurance is trying to put most of the onus on individuals," Brenner said. "We pay our insurance premiums every month and now that we need it, they don't seem to want to pay much out."

What kind of potholes will home and business owners be hitting?

• Replacement-cost shortfall: After storms like Sandy, the cost of materials and labor climb, meaning the dollars allocated under a policy might fail to cover the full cost of replacing or repairing a house or business. After Hurricane Katrina, "people were short by 50 percent because of a demand surge in the cost of goods and materials," Hunter said.

• Rich man, spore man: Unless the property owner bought a special rider, they probably don't have mold coverage.

• Spotty flood coverage: Virtually all homeowners' policies, save a handful on the high end, exclude flood coverage, said Ronald Brunell, a principal in the B&B Coverage insurance agency with offices in Elmsford and Valley Stream. Homeowners can buy a flood policy through the federal National Flood Insurance Program, but the top coverage -- $250,000 on a house and $100,000 on personal property -- may not be enough for people who were wiped out. "You can buy excess flood insurance, but it is extraordinarily expensive," Brunell said. Even with a flood policy, personal property, except boilers and other appliances, is not covered if the flood is in the basement.

• Wind plus water equals nothing: Many insurance policies include "anti-concurrent causation clauses." These say that if two events, like winds and floodwaters, damage a property and the owner has coverage on only one, the insurer does not have to pay a dime. "People don't believe there's a trapdoor in the back of their policies," Hunter said.

• No FEMA funds for businesses or vacation homes: Damages to businesses and secondary or vacation homes are not eligible under the disaster assistance program of the Federal Emergency Management Agency. FEMA, however, may provide assistance in arranging Small Business Administration loans to businesses, renters and homeowners.

• No power to the people: Neither generators nor gasoline to power them is covered, even in blacked out areas, said Arlene Lester, public affairs specialist at insurer State Farm.

• Business income up in smoke: When calamity strikes a region, businesses -- whether a retail store or a doctor's office -- can lose income. If there's no direct physical damage to the building from a covered peril, however, business income does not apply, Brunell said. Even if coverage is in effect, the payout can be difficult to assess. "The hardest kind of loss to recover is business interruption," said Emily Canelo, executive vice president at Endurance, a Bermuda-based insurance and reinsurance firm.

• That tree isn't mine: If a tree falls, it is considered an act of God, Brunell said. Whoever owns the property where it falls is responsible, even if it stood on a neighbor's property. "It doesn't promote neighborly" relations, Brunell said.

Yet another potential trap involves the hurricane deductible, which typically ranges from 2-10 percent of the building's insured value. On a $500,000 home, for instance, a 5 percent deductible would amount to $25,000.

When Sandy made landfall in New Jersey on Oct. 29, the National Weather Service declared that her reduced wind speeds made her a post-tropical cyclone. Gov. Andrew Cuomo and others seized on that to proclaim that insurance companies' hurricane deductible would not apply. Most insurance companies have so far fallen into line with Cuomo's declaration.

Luckily, not all insurance claims are painful.

Thomas Hughart, owner of the 1700s-era Ambler House in Bedford said the initial claims process on damage to his driveway, house and barn has been smooth.

"Food in the refrigerator and freezer is covered, interior damage to the ceiling in a bedroom is covered. The driveway will be covered, less the deductible, which I paid," he said.

Still, sometimes the best insurance is a good neighbor.

Lawyer Susan Perone was stuck at her West Nyack house after her neighbor's tree knocked loose a live power line and fell across her driveway, blocking access to her garage and cars.

Her neighbor wasn't covered for the tree removal, she said, but agreed to pay for it regardless.

With Timothy O'Connor, Sarah Armaghan

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