A policyholder says a storm caused damage. The insurer responds that the storm caused none. Then the insurer argues there is no disagreement about the “amount of loss” because the dispute is really about “causation.” According to the insurer’s reasoning, appraisal never begins because the insurer says the answer is zero, and all about causation, which is a coverage issue.
That routine tactic took another hit in Village at Blacklick Creek Condominium Association v. Greater New York Insurance Company, 1 where a federal judge in Ohio recognized what many courts across the country have already concluded: causation is inseparably tied to the amount of loss. It follows another Ohio federal decision noted in State Farm Loses Causation Issue Regarding Appraisal—Understanding Appraisal in Ohio.
The ruling is significant because it directly confronts an issue insurers repeatedly use to avoid appraisal. If every disagreement over storm damage can be reframed as a “coverage dispute,” appraisal becomes meaningless. The policyholder pays premiums for a supposedly quick and inexpensive dispute-resolution process, only to be dragged into litigation before anyone even determines the scope of the damage.
The facts are familiar to anybody practicing in property insurance claims space. The condominium association alleged wind and hail damage from a 2022 storm. Greater New York Insurance denied the claim, asserting the roofs suffered from wear and tear rather than storm damage. The association invoked appraisal. The insurer refused.
The carrier’s position was that because it denied that the storm caused any damage, the dispute was not about the amount of loss. The insurer argued that there first had to be agreement that some covered damage existed before appraisal could proceed. That argument has gained traction in some courts because it sounds superficially logical.
If insurers can avoid appraisal merely by saying “the storm caused nothing,” then appraisal clauses are largely worthless in real-world property claims. Most roofs are not brand new. Most buildings have some pre-existing wear. Nearly every disputed property claim involves separating old damage from new damage. That is exactly why appraisers exist.
The court recognized this reality and relied heavily on the growing body of authority holding that determining the extent of storm damage necessarily involves determining causation. As the opinion explained, appraisers cannot determine the amount of loss without deciding what damage was caused by the covered peril and what damage resulted from something else.
Appraisal was never intended to function merely as a calculator after insurers concede coverage. Historically, appraisal was designed to resolve factual disputes over damage quickly and efficiently.
Judge Graham also understood something many courts miss. There is an enormous difference between factual causation and legal coverage questions. Whether hail damaged shingles is a factual determination. Whether the policy excludes cosmetic damage under a specific endorsement is a legal coverage issue. Courts decide legal questions. Appraisers decide factual damage issues. The distinction is not difficult unless somebody is trying very hard to blur it.
The opinion also dismantles one of the insurance industry’s favorite practical evasions. Insurers frequently argue that appraisers cannot “separate covered from uncovered damage.” Yet appraisers and adjusters perform precisely that function every single day. Roofing contractors, engineers, estimators, adjusters, and appraisers routinely evaluate what damage came from a storm and what did not. Pretending otherwise ignores how claims are actually adjusted in the real world.
One particularly important portion of the decision recognized the danger of allowing insurers to avoid appraisal simply by disputing causation. The court quoted Texas authority observing that such a rule would render appraisal clauses “largely inoperative.” 2 That observation is absolutely correct. Nearly every contested property claim contains a causation component.
What makes this ruling especially notable is that Ohio federal courts have been divided on this issue. Some courts adopted the insurer-friendly approach requiring an admission of at least some covered damage before appraisal could proceed. This decision firmly rejects that framework and instead adopts the more practical and policyholder-protective interpretation that causation disputes are part of the amount-of-loss determination.
That does not mean appraisers decide all coverage issues. The insurer still retains legal defenses after appraisal. The court made that clear. But factual questions concerning the extent and cause of physical damage belong in appraisal where the policy says they belong.
Insurance companies market appraisal as a fast and efficient alternative to litigation when they sell policies. Yet when large storm losses occur, some carriers suddenly portray appraisal as dangerously overbroad and inappropriate. Courts should remain skeptical whenever one side attempts to rewrite a policy provision only after a claim is submitted.
Thought For The Day
“Ohio is the heart of it all.”
— President Gerald Ford
1 Village at Blacklick Creek Condominium Ass’n v. Greater New York Ins. Co., 765 F. Supp.3d 698 (S.D. Ohio 2025).
2 State Farm Lloyds v. Johnson, 290 S.W.3d 886, 892–93 (Tex. 2009).