Florida Insurance News Reports on State Farms Slow March to Leaving
Yesterday, Chad Hemenway, associate editor of BestWeek, reported that State Farm and
Insurance Agents and Policyholders Need to Communicate and Share Information to Get Coverage Right
A recent Louisiana decision, Isidore Newman School v. J. Everett Eaves Inc., No. 2008-1368, 2009 La. App LEXIS 1469 (La. App. 4 Cir., Aug 5, 2009), underscores the need for insurance agents and policyholders to fully discuss insurance needs when selecting types and amounts of coverage. Insurance agents generally have a duty to exercise reasonable care and competence in obtaining and communicating information to policyholders. Interestingly, this case also demonstrates that business policyholders have a similar duty as well.
Continue Reading...First Party Claims Conference Three Weeks Away
Claims expert Charles Miller reminded me that the First Party Claims Conference is only three weeks away. Most claims conferences involve third party, worker compensation, medical and automobile claims. Few are devoted to first party property insurance claims and coverage issues.
Continue Reading...Texas Appraisers are Supposed to be Disinterested, Impartial and Not Biased: I Doubt This is Reality in Texas Appraisals
Texas hurricane claims are being resolved in a number of ways. Simple adjustment, mediation, litigation, and appraisal are the primary means to do so. Any TWIA policyholder thinking of invoking the administrative process should first consult an attorney as we warned in An Example of Why You Need to be Careful in Choosing How To Challenge TWIA. My perception is that many public adjusters are advising their clients (which is probably the unauthorized practice of law) to choose appraisal and entering the unknown post-State Farm v. Johnson era of Texas appraisals, as discussed in Appraisal in Texas is Still Going to be Debated and Part of the Wild West of Insurance Coverage Disputes.
Continue Reading...Insurance Agents and Policyholders Need to Schedule Jewelry for Better Coverage
Jewelry is something most adults purchase and accumulate and for which the value is far in excess of what standard policies cover. I thought about this after coming across a post, What Does it Mean to "Replace" a Lost Diamond Bracelet Under State Farm's Homeowner's Policy, by Mark Nation. Insurance agents study what their clients may need for insurance purposes. They should strongly urge that most of their clients schedule jewelry items because, chances are, policyholders are otherwise underinsured under most standard forms. Further, the perils to jewelry are extraordinarily limited under the standard form, so agents should be making certain that their clients are aware of and purchase the proper coverage for jewelry items that are valuable and emotionally important.
Continue Reading...Claims Management by Computer: Analytical Data Mining and Claim Oversight is a Trend
Claims management and operational review for claims efficiency are truly sciences. The study and management of these are becoming increasingly computerized and intertwined with analytical data mining. I had dinner with a public and independent adjuster this week, where we discussed the process of litigation case handling and standards within my own law firm. As we were analyzing my operation, I kept imagining how much more difficult and complicated it would be to manage an insurance claims organization, and how computers were changing the claims organization.
Continue Reading...Sworn Statements and Examinations Under Oath: National Perspectives of Where the Insurer Can Require the Policyholder to Provide the Statement
Bob Reynolds’ recent post, Where Do and Can Examinations Under Oath Be Held? Does a Policyholder Have to go to Timbuktu? is an excellent discussion on the state of Florida law on the subject. Bob has represented more policyholders in examinations under oath over the past twelve months than any attorney I know. He is also one of the best advocates I know at hearings before judges. I am happy that he is with us rather than doing insurance defense, which he did before he came to our firm.
Continue Reading...Matt Gaetz is a Policyholder's Advocate Running for Public Office
Imagine if we had truly knowledgeable advocates for insurance consumers in our legislatures. Many politicians advertise they are for policyholders as election day approaches, but they refuse to push any agenda other than the insurance industry’s the rest of the time. In Florida’s past legislative session, Florida Senator Don Gaetz, sponsored three significant pieces of insurance consumer legislation protecting the rights of policyholders regarding the fair treatment of claims. The person helping to write that legislation, his son Matt Gaetz, is now running for the Florida House of Representatives and he deserves support from those who want strong laws protecting Floridians from slow, frustrating, and wrongful insurance claim handling.
Continue Reading...Sinkhole Case Trial Won For USAA Policyholder
Kelly and Craig Kubiak successfully presented a case to a jury this week involving a dispute with a long time USAA policyholder following a denial of her property insurance claim. The $245,000 jury verdict came after lengthy and contentious litigation with USAA. The opposing counsel and his law firm are one of the most successful in Florida. The most USAA ever offered in settlement to our client was fifty thousand dollars, so our client was thrilled and in tears following the jury’s verdict.
Continue Reading...Where Do and Can Examinations Under Oath Be Held? Does a Policyholder Have to go to Timbuktu?
(Note: This Guest Blog is the third of a thirteen part series on examination under oath).
“Sunshine State hereby requests you to submit to an examination under oath which will be held at the residence premises of the insured.” This is a common request to policyholders by Sunshine State. Of course, as a former insurance defense attorney I know that the carrier’s intention is to turn the EUO into a dog and pony show. That is, they will have the policyholder take defense counsel on a guided tour of the damage to the property, and if the policyholder fails to point out any of the covered loss, the carrier will hold that against the policyholder as if it were an intentional act of concealment.
Continue Reading...Sheila Birnbaum: The Attorney Behind State Farm's Katrina Scruggs Defense Explains How Major Corporations Can Use the Civil Justice System to Thwart Consumer Rights
I enjoy good lawyering. Corporate America has the best lawyers defending their actions and figuring out how they can be unaccountable for their bad acts. A formidable New York Ivy League trained lawyer, Sheila Birnbaum, is one of those lawyers. I give her, Corporate America, and especially State Farm, all the credit they deserve for showing that they can beat State Farm’s customers and their attorneys in the appellate courts of America. Birnbaum implied that large corporations have greater influence over federal courts of appeal in her webinar with the Washington Legal Foundation last year.
Continue Reading...Cooperation Clause Does Not Require the Policyholder's Slavish Obedience
It is curious how some insurance company claims managers allow their insurance defense counsel to treat their customers with an arrogant, demeaning tone, along with long requests for largely irrelevant lists of information following a loss. Any objection to the treatment is usually met with a threat the claim will be turned down for a failure to cooperate. The “threat” letter is usually in a similar tone requiring the policyholder to obey…or else. For insurance adjusters that do not act this way or allow their insurance defense counsel to do so, this treatment may shock you. Yet, many policyholder representatives see this as a growing trend in claims treatment following a loss.
Continue Reading...Florida Insurers Have A Strong Financial Incentive To Delay, Rather Than Deny, Claims
(Note: This Guest Blog is by Ruck DeMinico, Knowledge Manager with Merlin Law Group).
The recent case of North Pointe Insurance Company v. Tomas, No. 3D08-2245, 2009 Fla. App. LEXIS 12505 (Fla. 3d DCA August 26, 2009), illustrates why many insurers who wrongfully fail to pay a claim choose to unnecessarily delay payment rather than out right deny them.
Continue Reading...Federated's Claims Handling Problems
(Note: This Guest Blog is by Kelly Kubiak, an attorney with Merlin Law Group in the Tampa, Florida, Office).
Some insurance companies feel that although they may not have investigated a Florida loss promptly during the time period Florida suffered successive hurricanes, the companies have an excuse due to the vast amount of claims.
Continue Reading...An Example of Why You Need to be Careful in Choosing How To Challenge TWIA
Back in April, an attorney in our Houston, Texas, office, Javier Delgado, wrote a post for this blog warning TWIA policyholders to be careful when choosing how to challenge a TWIA determination of damage to property (Don't Be Fooled By Texas Windstorm Insurance Association's Misleading Letter).
Continue Reading...Alex Sink Reception on Monday
It is hard to imagine that I have insurance defense counsel friends going to a fundraiser for Alex Sink at an insurance company and then coming to my home next Monday for a fundraising reception we are hosting for her. Alex Sink has respect from many or she would not have that type of divergent support in her bid to become Florida's next Governor.
Continue Reading...State Farm Agents are Fighting State Farm for Economic Survival
State Farm has a tremendous agent organization. Some of the best trained and motivated personal lines agents are found at State Farm. Amy Bach, of United Policyholders, sent a comment to yesterday afternoon's post, McCarty Claims State Farm Trying to Work Out Deal and Expects Property Insurance Rates to Go Up, which asked:
Continue Reading...Will more State Farm agents start diverging from the company line a la United Farmers Agents Association?
McCarty Claims State Farm Trying to Work Out Deal and Expects Property Insurance Rates to Go Up
I would pay to be a fly on the wall during the discussions the Florida Office of Insurance Regulation is having with State Farm regarding its withdrawal from the Florida property insurance market. As I noted in State Farm Must Love the Clash, many of us suspect that State Farm’s bullying and threatening tactics demonstrate that it does not want to leave Florida, but uses such tactics to get what it wants from Florida’s politicians and regulators.
Continue Reading...What Happens if A Policyholder Does Not Attend an Examination Under Oath?
(Note: This Guest Blog is the second of a thirteen part series on examination under oath).
“I don’t want to sit for an examination under oath…” If I had a nickel for every time a client said that to me, I’d probably own my own plane. For policyholders who have never been involved in a deposition or EUO, the proposition of sitting in a room, swearing an oath to tell the truth, and being questioned by an attorney while a court reporter writes down every word can be very daunting. So this begs the question—“Is it possible to avoid an EUO?”
Continue Reading...Coverage Issue of "Matching" Roof Tiles or Shingles Shows How to Use the Search Function of this Blog
I received a comment to my post, Cosmetic Damage is "Physical Damage" and Recoverable Under a Property Insurance Policy, asking the following:
Continue Reading...What about matching of the roof tiles or shingles?
The new ones are always going to be different. But, the insurance companies are not paying for the entire roof.
In this case the purpose of insurance of "to put the insured in the same position they were before the loss" is not true as long as the insurance companies continue to pay part of the roof.
Your opinion, please.
Thank you.
Cosmetic Damage is "Physical Damage" and Recoverable Under a Property Insurance Policy
Yesterday’s post, Physical Damage is Needed to Collect for Loss of Warranty, may lead some to think that property insurance policies require “structural” or a “functional” destruction before coverage is not afforded. This simply is not true. Alterations to the physical appearance of a structure or personal property are covered so long as the cause is a covered peril.
Continue Reading...Physical Damage is Needed to Collect for Loss of Warranty
I was asked twice on Friday at our seminar in Houston whether a policyholder could collect for the loss of their roof warranty. I felt the questions were valid because Hurricane Ike has caused many to lose warranties on their roofs as a result of wind speeds being in excess of allowable warranty requirements. In essence, policyholders suffer financial damage because they no longer have warranties on roofs due to the physical wind speed event of an act of God, Hurricane Ike.
Continue Reading...Texas Department of Insurance Actively Seeks Information Regarding TWIA Claims Misconduct
The seminar our firm hosted for public adjusters went extremely well, with very practical information exchanged between adjusters, engineers, and attorneys. The Texas Department of Insurance had an attorney from its enforcement division attend. I felt it was a significant learning experience for her as well. Most people do not understand how complicated evaluating damage and investigating coverage matters can be. I am certain anybody not familiar with claims handling who attends one our claims seminars quickly appreciates that insurance adjusting is a demanding job....if done correctly and ensuring that full benefits are paid promptly.
Continue Reading...September Issue of Consumer Reports Has Article With Useful Tips On Homeowner Insurance
A Texas Department of Insurance Investigator Will be at Tomorrow's Public Adjuster Seminar
A Texas Department of Insurance (TDI) attorney familiar with the ongoing investigation will be at the Public Adjuster Seminar we are hosting tomorrow in Houston.
Continue Reading...Umpire and Appraiser Information Sharing
I sometimes get unique ideas from public adjusters. Today, I received one regarding the website, UmpireBook.com, that I want to share with you. Here is the email:
Continue Reading...An Invitation To Jim Oliver and TWIA To Attend Our Hurricane Ike Seminar This Friday In Houston
As a follow-up to my post on Saturday, TWIA Insurance Claims Under Investigation by Regulators and Media--An Invite to TWIA Claims Executives to a Public Meeting in Houston Next Friday Regarding Those Accusations, where I extended an open invitation to Texas Windstorm Insurance Association (TWIA) executives and claims managers to attend the seminar my firm is presenting this Friday in Houston, I sent a letter to Jim Oliver, General Manager at TWIA.
Continue Reading...Examinations and Sworn Statements Under Oath: What Are They and Their Relevance to Insurance Coverage From a Historical Study of Older Cases
(Note: This Guest Blog is the first of a thirteen part series on examination under oath).
“The insurer has requested that you submit to today’s Examination Under Oath in order to assist them in illuminating all facts and circumstances involved in this claim so that they may make an informed assessment of your loss.”
Before I was struck from my horse by a white light and a booming voice demanding, “Bob! Bob! Why do you persecute the policyholders?” thus facilitating my shift to the path of righteousness, that was the line I used to give policyholders at the beginning of the record for every EUO I’ve ever conducted when I used to represent the insurance companies. Back then I was a fraud specialist, so most claims I handled for the insurers involved the taking of EUOs. But, to be candid, I had never given much thought about the legal basis of EUOs, nor the basis of the carriers’ right to take such examinations.
Continue Reading...Are There Going to Be Any Hurricanes in 2009?
I get asked that question quite often. Doing what I do for a living, given my last name, and having proven my prognostication prowess (with money backing up my opinion) by opening our Texas office BEFORE the first of two major hurricanes to hit Texas, I can understand why many come to me for that answer rather than professional meteorologists and psychics. I am not betting on any “major” hurricanes this year. El Niño seems to be preventing tropical storms from making the trek across the Atlantic Ocean. Upper level wind shear has been destroying the movement towards the coastal United States and Gulf regions. Let’s hope it stays that way. And, as I suggested in May with a post, Weak El Nino and Cooler Tropical Waters Lead to Predictions of Fewer Hurricanes, who really knows?
Continue Reading...TWIA and Its Customers Prepare to Go Before the Texas Insurance Commissioner
The Houston Chronicle ran an article by Purva Patel today, See what blew in with Ike: a battle, which explains the lifted shingle issue at the heart of numerous Hurricane Ike Claims. It is not clear at this time how Texas Insurance Commissioner Mike Geeslin will resolve the issue, but consumer advocates hope Geeslin will prove to take a stand for his constituents, as did his counterpart in Florida, Kevin McCarty.
Continue Reading...A Few Quick Comments on How Policyholders Can Use Their Insurance Coverage Attorneys More Wisely
This post is a result of three different ideas that have been swirling as I imagine different methods to re-invent myself and my law firm’s efficiency. Our seventeen lawyer firm will hold a meeting in early October where these issues will be discussed in depth. First, I have been frustrated by one corporate client simply not using my talents and experience to quickly add value to their situation. Their executives seem to believe they know it all and are better than the hired help. This is not uncommon in some corporate environments. Second, there is one person with a very small claim who obviously wants to be a client of our firm. We keep turning her down or sending her to other firms that take smaller cases but settle for pennies on the dollar rather than fight for maximum value. Third, I keep thinking about a remarkable speech by Barry Schwartz entitled, Talks “Barry Schwartz on Our Loss of Wisdom.” If you think this post does not apply to you, do yourself a favor and click to Schwartz—it is very meaningful. As a matter of fact, to shorten this post, everybody should click on Schwartz and then come back to here.
Continue Reading...TWIA Insurance Claims Under Investigation by Regulators and Media--An Invite to TWIA Claims Executives to a Public Meeting in Houston Next Friday Regarding Those Accusations!
I have been involved in a lot of disputed property insurance claims in many venues over the past twenty-five years where emotions run high, but the Texas Windstorm Insurance Association (TWIA) is the blue ribbon winner in Texas for policyholders that hate how they have been treated. And, it is not just limited to the customers of TWIA. A number of independent adjusters representing TWIA are ready and willing whistleblowers in lawsuits against TWIA regarding these practices. They are upset as well.
Continue Reading...Is Your College Kid's Stuff Covered Under a Homeowner's Policy?
Seems like yesterday when my son, Chase, was swinging on jungle gyms. It is hard to imagine that this day is finally here when he is off to college. With all the little odds and ends to take care of, I wondered whether all his electronic gadgets are covered under my homeowner’s policy. After doing some reading, I am calling my agent and reading my policy when I get home from Philadelphia.
As usual, I like to check the FC&S Bulletins for some general information with these practical questions. While I have suggested that all policyholder attorneys and public adjusters subscribe to this publication, insurance agents and brokers can get some great ideas as well because the coverage topics are very “main street” rather than some of the exotic situations my clients bring to our firm.
Continue Reading...Florida Public Adjusters File Lawsuit to Overturn 48 Hour Solicitation Ban and Fee Caps
A lawsuit was filed by three public adjusting firms seeking to enjoin the State of Florida from enforcing the 48 hour solicitation ban and the fee caps public adjusters may charge to policyholders. The mastermind behind the lawsuit is lawyer turned public adjuster, Pat Catania of East Coast Public Adjusters. The lawsuit is not a surprise. Many public adjusters have been complaining that their business has been significantly impacted by these laws as insurance restoration companies act as surrogate public adjusters since the 48 Hour Ban does not prohibit insurance contractors from actively soliciting work from policyholders immediately after a loss.
Continue Reading...Texas Association of Public Insurance Adjusters (TAPIA) to Have Introductory Meeting Sept 11 Following Adjusting Seminar
Mary Fortson has been quite busy working with Jim Beneke and Art Jansen reinstating the non-profit and corporate status of TAPIA for the past several months. With that accomplished, there will be an introductory meeting to which all licensed Texas public insurance adjusters are welcome and encouraged to attend immediately following the Merlin Law Group Hurricane Ike--What a Difference a Year Makes Seminar on September 11, 2009.
Continue Reading...The Examination Under Oath: A Thirteen Part Series on Everything You Need (and Would Ever Want) to Know About Examinations Under Oath and Sworn Statements Under Oath Given Pursuant to a Property Insurance Claim
Starting next Wednesday, we will start a weekly series regarding examinations under oath which are sometimes called sworn statements under oath.
Continue Reading...Tropical Storm Erika? - Rocco Calaci Gives His Plain-Talk Interpretation of the National Hurricane Center Bulletin
(*Chip Merlin's Note--Rocco Calaci has been a noted meteorology expert witness in the Katrina Legal Wars. After meeting him at a recent FAPIA Convention, I invited him to write a series of guest blogs. Click here to read his previous guest blogs)
(*Note from Rocco Calaci: I started issuing a "plain talk" interpretation of National Hurricane Center bulletins at the beginning of the 2008 hurricane season. I remind everyone that this is strictly a courtesy, I have no affiliation with any government agency, this is not a commercial service and the information is not for any type of decision. It is strictly FYI).
***
There is an area of disturbed weather moving across the Atlantic and approaching the Lesser Antilles. This area may become Tropical Storm Erika in the next day or so.
Continue Reading...Matching Coverage Disputes and Disagreements are Routine and Not Going Away--Don't Miss Our September 11 Seminar in Houston Which Covers This Topic
Insurance claim denials and disputes involving “matching” are frequent. I received this recent comment on the topic of matching:
Continue Reading...Hey Chip
Back on 5/17/09, Cat adjuster posted a comment regarding matching of aged paneling and tile floors. You advised that maybe the adjusters were relying on Texas Case Law regarding causation. In my experience, the adjusters and appraisers I am dealing with in Texas simply don't feel they owe for match. For instance, I am dealing with an adjuster who agrees that the siding on this Galveston Home was discontinued in the 1930's and is obviously unavailable and can not be matched. He agrees to replacement of the two damaged sides, but insists the carrier does not owe for match of the two remaining sides.
I have argued that failure to replace all 4 sides will not completely indemnify the Insured. He is not moving at all. I have not found any case law or statutes dealing directly with this issue.
Any thoughts??
