What Makes a "Complete" Roof?

The Utah Court of Appeals ruled last week that a homeowners’ insurance policy did not cover water damage where the house did not have a “complete” roof.1

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The Neglect Exclusion Does Not Apply to Pre-Loss Neglect

Homeowner and commercial property insurance policies typically exclude loss or damage caused by or resulting from neglect.1 Under the ISO Homeowners 3-Special Form,2 neglect means “neglect of an ‘insured’ to use all reasonable means to save and preserve property at and after the time of a loss.” Under the ISO Commercial Property Causes of Loss-Special Form,3 neglect means “neglect of an insured to use all reasonable means to save and preserve property from further damage at and after the time of loss.” As both forms clearly and unambiguously state, the exclusion does not apply to pre-loss neglect. Rather, it applies only to neglect of an insured at and after the time of loss.4

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Well...Another Bad Faith Case in Massachusetts

Shaun Harrington was subcontracted to install a well on the McLaughlins’ property (sorry for the bad pun in the title). Unfortunately, in July and August of 2003, this well starting pumping salt water onto the McLaughlin’s irrigation system causing extensive damage.

A claim was submitted to Harrington’s insurer, American States Insurance Company (ASIC) on November 3, 2003. After not hearing back from ASIC’s adjuster for quite some time, the McLaughlins’ insurance agent called the ASIC’s adjuster, Dresner, on January 26, 2004 inquiring about the status of the claim. After the adjuster spoke with Rachel McLaughlin, Dresner documented the call, sent a letter requesting documents from Harrington and then took no further action until the McLaughlins’ agent called ASIC on February 19, 2004. When Rachel McLaughlin spoke to another adjuster at ASIC during Dresner’s absence, they verbally denied coverage stating the plants may have been damaged by other causes. The adjuster for ASIC was verbally abusive to McLaughlin and when pressed why ASIC had not sent an adjuster out to the property to adjust the damages, the adjuster for ASIC said they had no intention of doing so.

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Does My Business Have Insurance Coverage for Losses Attributed to the Zika Virus?

As most of you know, there is a spreading concern about the presence of the Zika virus in South Florida. In fact, the Centers for Disease Control and Prevention has issued travel warnings pertaining to the regions where the Zika virus has been confirmed.

The first CDC travel advisory related to South Florida advised pregnant women to avoid the Wynwood, Midtown and Edgewater areas in Miami, Florida—areas known for popular art districts, restaurants, and shopping.

On Aug. 19, 2016, Florida Governor Rick Scott confirmed the Florida health department’s findings that there are five new local cases of Zika and a new “transmission zone” in Miami Beach. Consequently, the CDC has issued an additional travel advisory pertaining to specific areas in Miami Beach.

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Five Ways to Help Louisiana Flood Victims

Last week, Shane Smith posted FEMA’s announcement of the availability of two advance payment options by WYO carriers and the NFIP direct serving agent for those victims of the Louisiana flooding with coverage.

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Court Holds Damages Consequential to Subcontractors Faulty Workmanship is an "Occurrence" and "Property Damage" Under Plain Language of Standard Form Commercial General Liability Policy

New Jersey has joined a growing number of jurisdictions in ruling that damages from a subcontractor’s faulty workmanship may trigger coverage under a Developer/General Contractor’s Commercial General Liability (“CGL”) policy. On August 4, 2016, the New Jersey Supreme Court rendered a unanimous decision affirming the Appellate Division’s holding that consequential damages stemming from a subcontractor’s faulty work constitute “property damage” caused by an “occurrence” as defined by the policy.1

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Florida Peninsula Policy Changes in Response to Assignment of Benefits

Last week Florida Peninsula announced to its policyholders that all renewal policies on or after July 1, 2016, will include new language regarding water losses:

  • Out-of-pocket insurance expenses incurred by you will be limited to $3,000 or 1% of Coverage A, whichever is greater for the first 72 hours on all water mitigation services.
  • No further money will be paid for out-of-pocket expenses until 72 hours after the claim is reported to Florida Peninsula Insurance.
  • The above amount may only be exceeded with carrier approval. The limit can be exceeded if we fail to respond within 48 hours.
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Panama Canal Expansion Expected to Expand Shipping from Asia to the East Coast: What Law Will Govern if My Shipment is Lost?

If you ship goods between Asia or South America and the United States, you are no doubt aware of the “Third Set of Locks Project,” which doubled the capacity of the Panama Canal by adding a new lane of traffic and increasing the width and depth of the existing lanes and locks, allowing larger ships to pass. The new Panamax ships are about one and a half times larger than the previous Panamax ships, and can carry over twice as much cargo.

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Louisiana Flood Insurance Claims - Secrets That Flood Adjusters Will Not Tell You

“I am here to help you and get you everything you deserve to get.” That is the script and the first lie Louisiana flood insurance adjusters will say. They will not tell this dirty secret to any flood policyholder, but it is being played out by the thousands of claims of desperate people in Louisiana who paid their premiums and are hoping for relief. Everybody in the National Flood Insurance Program knows it, but nobody will say it is true for risk of losing lots of money.

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Former Director of Hi-Rise Engineering is Indicted in New York

Former director of Hi-Rise Engineering, Matthew Pappalardo was indicted on a 50-count indictment stemming from Hi-Rise’s role in altering their engineering reports to defraud policyholders from monies owed due to Superstorm Sandy damage. Contained within the indictment were 25 counts of Forgery in the second degree, in violation of Penal Law Sect. 170.10(1) and 25 counts of the Unauthorized Practice of a Profession in violation of Education Law Sect. 6512(1).

A person is guilty of forgery in the second degree when, with intent to defraud, deceive or injury another, he falsely makes, completes or alters a written instrument which is or purports to be, or which is calculated to become or to represent if completed. . . .[an] instrument which does or may evidence, create, transfer, terminate or otherwise affect a legal right, interest, obligation or status. . . .

A person violates Education Law Sect. 6512(1), while not being authorized to practice under said law, practiced or offered to practice or held himself out as being able to practice the profession of engineering, a profession in which a license was a prerequisite to the practice of the acts, or aided or abetted an unlicensed person to practice the profession of engineering. . . .

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FEMA Issues Bulletin to Allow Advanced Payments

As a result of the devastation from the severe storms affecting Louisiana, Mississippi, Arkansas and Texas, FEMA is making an effort to ensure accurate and prompt settlement of NFIP policyholders’ claims.

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9th Circuit to Interpret Meaning of "Direct Supplier" In Context of a Commercial Property Loss Claim

Commercial property insurance policies often include damages sustained by a “direct supplier.” As an example, an insured that sells motorcycles, might rely on a particular motor cycle part supplier to provide parts used in their motorcycles. If the motorcycle part supplier sustains a loss, it could impact the insured’s business.

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Don't Gamble With Policy Provisions, Make Certain to Mind Your D.I.C.E.

As part of a larger discussion with public adjusters addressing fresh perspectives on claim presentation a few weeks ago, my colleague Mike Poli revealed a perfect tool to make certain policy provisions remain understood: D.I.C.E. (Declarations Page. Insuring Agreement. Conditions. Exclusions).

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Will Policyholders be refunded by State Farm?

California Insurance Commissioner Dave Jones must decide whether to approve an order signed by an administrative judge ordering State Farm pay its policyholders.

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Allstate New Jersey Skates on Late Payment Claim

On July 19, 2016, U.S. District Court Judge Susan Davis Wigenton, dismissed Florence Hanson’s Complaint against Allstate New Jersey Insurance Company for violating the New Jersey’s Insurance Trade Practices Act, citing a lack of subject matter jurisdiction.

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