Instead of sending a full and adequate amount of insurance proceeds, is your insurance company sending over just a small offer hoping it “settles” the claim and that you accept it and go away? Continue Reading
Next up in our whirlwind 50-state tour of claims handling requirements is the Tar Heel State. Unlike our previous stops in New Jersey and Pennsylvania, North Carolina has relatively few explicit claims handling requirements. This may be why North Carolina ranked dead last in a 50-state ranking of insurance regulations as pointed out by my colleague, Nicole Vinson.
North Carolina General Statute § 58-63(11) requires that an insurance carrier act openly and honestly with insureds during the claim process. The North Carolina Statutes provide some specific acts that are compulsory or are barred. For instance, a carrier must acknowledge and act upon communications regarding claims reasonably promptly. N.C. Gen. Stat. § 58-63(11)(b). The insurance carrier must affirm or deny coverage of the claims within a reasonable time after the claimant provides a proof of loss. N.C. Gen. Stat. § 58-63(11)(e). The carrier must settle claims promptly after liablity has become reasonably clear. N.C. Gen. Stat. § 58-63(f). They must not attempt to settle a claim for less than what a reasonable man would believe was appropriate. N.C. Gen. Stat. § 58-63(11)(h). If a claim is denied, or a claim is partially paid as a result of a compromise settlement, the insurance carrier must also promptly provide a reasonable explanation for the denial or the offer of compromise. N.C. Gen. Stat. § 58-63(11)(n). Finally, once a decision has been made to pay a claim, the payment must be mailed or delivered within ten days. 11 N.C. Admin. Code 4.0421(1).
As you can see, the North Carolina statutes use terms like “reasonable” and “promptly,” which means that the facts are going to be considered. Accordingly, insureds in North Carolina need to stay on top of their insurance claims and respond as soon as possible to all communications from the insurance carrier. This will help to define what “reasonable” and “promptly” mean in that claim.
Finally, whenever I get to thinking about North Carolina, I inevitably turn to one of my favorite movies, Bull Durham. This might be one of the best scenes in a sports film:
Insurance policies containing conditions pertaining to an insured’s obligation to submit a notice and proof of loss are “meant to give the insurer the necessary facts to facilitate an investigation of a claim and to protect it against fraudulent and excessive claims.”1 Continue Reading
With a new year upon us, it is a good time to look at your insurance documents and make sure all of your files are organized for the upcoming year.
It is not uncommon for a family or an individual to make a move from one house to another, and not consider the best adjustments that must be made for property insurance. Continue Reading
On November 22, 2016, Judge Berle M. Schiller from the District Court for the Eastern District of Pennsylvania issued his Opinion and Order in Payne v. Allstate Insurance Company, granting summary judgment to Allstate and awarding them $25,000 in damages, after finding that the Plaintiff made material misrepresentations while securing the homeowners policy. Continue Reading
The “water damage” exclusion, which applies to a loss caused by “water which backs up through sewers or drains” plagued New Yorkers for decades, until Pichel v. Dryden Mutual Insurance Company, 117 A.D.3d 1267 (3rd Dept. 2014). In Pichel, the insured was an owner of an apartment building and brought an action against its property insurer after a denial of coverage for a flood that occurred in the basement apartments from waste water entering the buildings through toilets, bathtubs, condensation drains, and laundry room drains. The insurer cited the water damage exclusion which excluded coverage for “water which backs up through sewers or drains.” Continue Reading
As promised in my recent post regarding the Gatlinburg fires, today we are looking at the claims handling guidelines provided by the Tennessee code. The Tennessee code has general requirements that require insurance carriers to develop standards and practices for the prompt and proper handling of claims in the Unfair Claims Settlement Practices Act.1 Continue Reading
The most important question asked following a loss will always be “am I covered for this”? As a gentle reminder to our readers, the best way to determine whether you have coverage is to read the policy, and not just the declarations page, because sometimes the answers lie in the policy itself. Continue Reading
State Farm Mutual Automobile Insurance Company is the parent of the State Farm family of companies. It is listed as the 35th largest company in the Fortune 500. Big companies sometimes have big problems. State Farm had a one billion dollar judgement problem that now may be a seven billion dollar problem.
There have been many cases recently decided in Texas Federal District Court on the issue of fraudulent joinder and remand of cases where in-state insurance adjusters are defendants in first-party property damages cases. I think all will agree that these cases are all over the board.