The clauses that decide claims
A policy is not a list of things that are covered. It is four structures that interact — and most disputes live where two of them meet.
Read these in order. The causation rule overrides the rest; the exclusions remove causes; the limits cap categories; the conditions set the deadlines you have to meet while all of that is being argued.
| Order | Structure | Why it comes first |
|---|---|---|
| 1 | Causation (anti-concurrent) | Decides which cause controls when two arrive together — it can override a covered peril |
| 2 | Exclusions | Removes causes of loss entirely, then partially re-includes some with a sub-limit |
| 3 | Special limits | Caps specific categories — jewelry, money, silverware, business property |
| 4 | Conditions | Sets proof-of-loss and cooperation deadlines, which can end a claim regardless of coverage |
Why the order matters
Take the most common mistake: someone reads that wind is covered and that flood is not, and concludes a hurricane claim should be paid for the wind portion. The causation clause is read first, and it can produce the opposite result. Starting from the peril list rather than the causation rule is how people end up surprised by a denial.