Many losses are a result of a chain of events. Some claims have one or two causes, others have many more. The important question to determine whether a loss is covered by a particular policy is what set the chain of events in motion. When analyzing a chain of events fact pattern, courts look at whether the initial event that started the chain is covered under the policy.
Continue Reading...Last week, many families in the Reno, Nevada, area were unable to celebrate Thanksgiving in their homes due to the epic wildfire which raged through Caughlin Ranch the week prior. News reports stated that the fire was the “perfect storm” of conditions where wind gusts up to 70 miles per hour resulted in flames up to 100 feet tall, which burnt through nearly 2,000 acres and destroyed 32 homes.
Senate Bill 425 was passed this past legislative term, adding a new chapter to the Texas Insurance Code. The new law requires the Texas Department of Insurance to approve certificates of insurance provided in connection with casualty and property policies. This new bill went into effect on September 1, 2011, and applies to certificates of insurance issued on or after January 1, 2012.
Continue Reading...Homeowners and businesses must be reminded that flood insurance is important, but excluded under most standard homeowners and commercial policies. This was demonstrated in a recent case from the Third District Court of Appeals, Intrepid Ins. Co. v. Prestige Imports, Inc., 2011 WL 4808798 (Fla. 3d DCA October 12, 2011). While the case did not involve a hurricane wind event, it presented a problem that policyholders sometimes face in windstorm claims. Did an excluded “flood” cause the damages, or any portion of the damages?
Continue Reading...“If the gloves don’t fit, you must acquit” – Johnny Cochran
Many forensic accountants have noted that the Generally Accepted Accounting Principles (“GAPP”) focus on business valuation formulas that are more suited for commercial transactions than for determining the amount of business income loss. Businesses also have different styles of bookkeeping, which can create challenges in finding the necessary data to support a claim.
Continue Reading...The Windstorm Insurance Network’s 13th Annual Conference is set for January 30 to February 2, 2012, at the beautiful Buena Vista Palace Hotel in Orlando, Florida. WIND® recently posted the schedule, and, as you can see, there are educational opportunities for every adjuster, novice or highly experienced, to learn and better their skills. Adjusters, agents, and attorneys can earn continuing education credit in an affordable and engaging seminar.
Continue Reading...The battle between policyholders and their insurance companies has been going on for many, many years. The 1972 case of Hanover Insurance Company v. Hallford is a finding of bad faith arising from a windstorm claim. In the underlying lawsuit, Mr. Hallford filed an insurance claim with his carrier, Hanover Insurance Company, for windstorm damage to his home. When the claim could not be resolved, Mr. Halford filed a lawsuit for the benefits for the damage to his home and personal property, additional living expense and he alleged bad faith. Although Mr. Hallford indicated that he was seeking damages in the total amount of $15,000, no other specified amounts were itemized in the complaint. Hanover defended the allegations, stating that Mr. Hallford had not given notice of the loss, had not filed a windstorm claim with Hanover before filing suit, and that Mr. Hanover breached the policy by failing to comply with policy provisions that required him to give immediate written notice of the loss and a submit a sworn proof of loss within 60 days of the date of the loss.
Continue Reading...Thanksgiving is officially here, and that means that millions of Americans will soon be gathering with their loved ones to the simple pleasures that accompany time spent together over a home-cooked meal. For many Americans, a juicy, fried turkey will be the centerpiece of this feast – but too often, carelessness turns a joyous celebration of thanks into a heartbreaking tragedy.
Continue Reading...The recent wild fires in Reno, Nevada, caused tragic losses of many homes and extensive loss to business property and business income. Commercial property policies with business interruption coverage vary widely with regard to coverage of business income loss due to order of civil authorities.
Continue Reading...California is prone to natural disasters. Just this last Sunday, Southern California was pummeled with rainstorms that drenched the area with intense downpours throughout the day. In Los Angeles County, evidence of this is all over as the affluent neighborhood of Hancock Park found itself underwater in various residential pockets. Even boutique stores along the famous Melrose Strip were flooded.
Continue Reading...Every policyholder’s first question after a loss is: does my insurance policy cover this? Some policyholders have a named peril policy insuring against certain risks that are enumerated within the policy itself. Others have an all-risk policy that insures against every peril that is not specifically excluded under the terms of the policy. Regardless of which policy you currently hold, the first step in determining whether coverage exists is determining the cause and origin of the damages.
Continue Reading...Florida Statutes authorize a civil lawsuit against an insurer when it does not attempt “in good faith to settle claims [and] it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.” Fla. Stat. § 624.155(1)(b)(1) (2011). In general terms, under Florida law, this “bad faith” lawsuit is not ripe for litigation until the insurance company is first held liable for benefits under the policy. Does this mean that a policyholder can’t sue for breach of contract and bad faith in the same lawsuit? Not necessarily, according to an opinion issued last week by Florida’s Fourth District Court of Appeal.
Continue Reading...Everybody at the Merlin Law Group has been blessed to have Kelly Kubiak working with them for ten years. Every policyholder she has represented has been fortunate she decided to take their case. Insurance companies are the worse for it.
Buying adequate insurance coverage is a fundamental step in ensuring the success of a business enterprise. Today’s entrepreneur must understand that the purchase of insurance is never a substitute for a risk management plan that will help the business maintain its daily operations after a catastrophic event.
Continue Reading...Handling a property damage insurance claim can be complex, time consuming and can turn your hair gray. For many, presenting a property damage claim is not something done on a regular basis. When faced with a claim, policyholders in most states have the right to hire a public insurance adjuster.
Continue Reading...It’s no secret that Citizens Property Insurance Corporation routinely treats policyholders like numbers on a page. Despite its title as the state’s largest property insurer, Citizens consistently gets the most complaints from policyholders, earning a reputation as the worst property insurance company in the state -- and in a state like Florida, that’s really saying something.
Continue Reading...This winter, the 2012 AAJ Winter Convention will be held at the Arizona Biltmore Resort and Spa, February 11–15, 2012. If you have not been to the Winter Convention before or have and are seeking a respite from dreary winter weather, this Convention is the place to learn from some of the best trial lawyers in the country. And, you can earn a year’s CLE credits.
Continue Reading...Insurance companies and insurance industry advocates consistently point to insurance fraud as a reason for higher insurance premiums. But, if insurance fraud is such a problem, why are property insurers still reaping massive profits? With profits like these, is there really justification for consistently raising premiums?
|
|
Revenues |
Profits |
||||
|
Rank |
Company |
Fortune 500 rank |
$ millions |
% change from 2009 |
$ millions |
% change from 2009 |
|
(mutual) |
37 |
63,176.7 |
2.8 |
1,762.8 |
129.9 |
|
|
(stock) |
7 |
136,185.0 |
21.1 |
12,967.0 |
61.0 |
|
|
17 |
104,417.0 |
1.2 |
7,786.0 |
N.A. |
||
|
82 |
33,193.0 |
6.8 |
1,678.0 |
64.0 |
||
|
89 |
31,400.0 |
-1.9 |
928.0 |
8.7 |
||
|
106 |
25,112.0 |
1.8 |
3,216.0 |
-11.2 |
||
|
117 |
22,383.0 |
-9.4 |
1,680.0 |
N.A. |
||
|
127 |
20,265.0 |
-2.3 |
959.0 |
33.9 |
||
|
145 |
17,946.1 |
2.2 |
2,637.4 |
-12.7 |
||
|
164 |
14,963.3 |
2.7 |
1,068.3 |
1.0 |
||
|
168 |
14,621.0 |
3.5 |
1,288.0 |
128.4 |
||
|
185 |
13,319.0 |
2.3 |
2,174.0 |
-0.4 |
||
|
285 |
8,527.7 |
-2.0 |
279.2 |
-35.2 |
||
|
358 |
6,491.8 |
0.6 |
487.1 |
89.6 |
||
Closely related to the fortuity doctrine, are the doctrines of known loss or loss in progress. Known loss is fairly simple and can often lead to allegations of fraud by the insured. If an insured knows of a loss and then procures insurance to cover it by concealing material information from the insurance company, the insurance company likely can raise the defense of fraud stemming from the insured’s concealment.
Continue Reading...Property policies usually include a mold exclusion. Water damage, however, is a commonly covered “cause of loss.” Mold growth and water infiltration have a close causal tie, and there has been a raging dispute in the industry over whether property policies respond to mold losses when water infiltration, a covered cause of loss, caused or contributed to the mold. The debate is complicated by fairly common exclusionary language that incorporates an “ensuing loss” exception:.
Continue Reading...We do not cover loss caused by:
***
(2) rust, rot, mold or other fungi. …***
We do cover ensuing loss caused by collapse of the building or any part of the building, water damage, or breakage of glass which is part of the building if the loss would otherwise be covered under this policy.
Recently I’ve been approached by several public adjusters regarding coverage limit and underinsured issues with their clients’ insurance policies after a loss. Specifically, I’ve been asked if an insured has any recourse when the insured’s policy falls short, leaving the insured effectively underinsured.
Continue Reading...As Chip Merlin wrote in his June 3, 2011, post Mediation Notice Lapse Prevents Appraisal Process, “insurers should follow Florida statutes and regulations. . . . Without accountability and consequences, laws are meaningless.” Florida’s Fourth District Court of Appeal recently held State Farm accountable for failing to comply with its statutory and administrative duties to inform its policyholder of an alternative mediation process. The consequence for State Farm was that it could not force its policyholder into the appraisal process. Gassman v. State Farm Florida Ins. Co., No. 4D11–360 (Fla. 4th DCA November 2, 2011).
Continue Reading...Early this week, another property insurance bill, SB 846, was filed in the Florida State Senate. Before you jump out the window, or turn off your computer in disgust, I have some GOOD news -- SB 846 is actually good public policy.
Continue Reading...Today, November 12, 2011, marks seven years since the passing of the lovingly remembered Katrina “Katie” Froeschle. Earlier this week, the American Association of Public Insurance Adjusters sent a call out to remember Katie Froeschle and support her foundation:
Continue Reading...Most policyholders understand that the policyholder and the insurance company have different obligations under an insurance contract. In breach of contract and bad faith cases, insurance companies commonly argue the policyholder did not comply with post loss obligations the insured was required to satisfy in accordance with the terms of the policy.
Continue Reading...When fortuity issues arise in insurance disputes, courts make a determination about the fortuity of the loss (as I wrote about in my previous post) and look to see how much control the insured had over the loss or damage. As one might expect, the general rule is the more control the insured has over the loss or damage, the less likely it is that a court will find coverage. In other words, if the insured makes every reasonable attempt to prevent a loss, but that loss ultimately still occurs, the loss is likely fortuitous.
Continue Reading...Cases around the country discuss property loss resulting from collapse. The issue is often litigated because collapse is usually a process that occurs over time and to various degrees. See Sherman v. Safeco Ins. Co. of Am., Inc., 716 P.2d 475, 476 (Colo. App. 1986) (where masonry work supporting the sill plate had cracked causing complete release of the sill plate, roof had fallen more than two and one-half feet producing a marked sag in the roof line, upper tiers of bricks on the two supporting walls had fallen out and the walls were bowed out, the condition was, as a matter of law, a “collapse” within the meaning of that term in the insurance policy).
Continue Reading...Over the last two weeks, Southern California was bombarded with short but very heavy rainstorms. It seems that the rains have come early this year and that we may be in for another uncharacteristically rainy season. Even more rain is anticipated for this coming weekend. In December 2010, Southern California was inundated with rain for weeks on end. A plethora of wind driven water damage claims arose from the 2010 rain, as well as claims for damage caused by falling trees and branches.
Continue Reading...After Hurricane Ike, many businesses had to cease their operations for until their damaged property was repaired. Fortunately, many had the appropriate insurance to cover their business losses. But even though many carried the appropriate amount of insurance, several struggled to obtain the full amount of the benefits they were owed. Insurers sometimes shortchange their customers by interpreting little-known policy language against the customer. Every now and then though, a policyholder challenges an insurer’s interpretation in court, and a judge determines which interpretation is correct.
Continue Reading...To make a claim for hurricane damage to property, you must first notify the insurance carrier of the damage. Most policies require the policyholder to provide this notice with some degree of expediency, usually “prompt” notice. Unfortunately, most policies do not define the term “prompt” and different circumstances could lead to varying interpretations of what “prompt” means. When disputes arise over whether notice was prompt, courts are often left to determine what the term means, again with varying results.
Continue Reading...More than three million customers across the Northeast lost power last weekend as wind and heavy snow uprooted some trees and sheared branches off others, snapping power lines as they fell. Connecticut Light and Power is still struggling to get service restored to hundreds of thousands of residents and business owners.
Continue Reading...Stephen Hadhazi has a website devoted to sharing his knowledge regarding vandalism losses with policyholders who have suffered losses. A licensed public adjuster in Texas, Florida, Hawaii, and Oklahoma, Stephen got his start working in the construction industry. Stephen explains,
Continue Reading...Like so many public adjusters, I began as a general contractor and an roofing contractor who performed work primarily on homes damaged by hail, wind, hurricanes, etc. In the course of doing business with adjusters from the insurance carriers over the years it was kind of a natural progression to eventually move into full time Public Adjusting. I suppose my passion for helping others in just natural. It is sort of who I am.
Many, if not all, policyholders’ advocates are aware of the recent legislative changes to Florida’s sinkhole statutes. One of our greatest concerns is the definitional change of the term “structural damage” and whether this change can be applied retroactively. Chip Merlin’s July 7, 2011, post highlighted a recent circuit court’s decision finding the new law’s definition of “structural damage” inapplicable to previous policies of insurance. On the very next day, July 8, 2011, the Florida Supreme Court addressed a similar retroactivity issue in Optical Corporation v. Spiewak.
Continue Reading...Tallahassee is buzzing – if you listen closely, you can hear it. As October winds to a close, the traffic on Interstate 10 is picking up, as is the mid-week crowd at Clyde’s & Costello’s. There’s only one thing that could mean – the 2012 legislative session is right around the corner.
Continue Reading...Wildfire insurance claims are raging in Texas. The Texas Association of Public Insurance Adjusters will talk about wildfire claims at its Fall Conference in Dallas on November 16 and 17. The speaker presenting this topic promises that the discussion will be practical, guaranteed not to put you to sleep, and worth hundreds of thousands of dollars in excess of the price of admission.
Continue Reading...California’s unfair competition or unfair business statute is found in Business & Professions Code section 17200 (the “Unfair Competition Law” or “UCL”). The UCL protects consumers and businesses from unfair competition described in Section 17200 as: “any unlawful, unfair or fraudulent business act or practice and unfair, deceptive, untrue or misleading advertising and any act prohibited by Chapter 1 (commencing with Section 17500) of Part 3 of Division 7 of the Business and Professions Code.”
Continue Reading...For the second straight term, a bill has been filed in the Florida Legislature designed to make changes to the well-settled legal principles that have successfully governed our state for many years and have held insurance carriers accountable when they act improperly.
Continue Reading...1-877-449-4700
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