Is Mold Covered Under my Texas Homeowners Policy?

Oftentimes after a windstorm, flood, or plumbing leak, mold develops in a home. There are several standard insurance policies issued in Texas, and they all have some language that deals with mold. For example, a standard Texas Dwelling Policy—Form 3 specifically excludes mold damage, but covers an “ensuing loss” caused by water damage. These clauses seemingly contradict one another: how can there be no coverage for mold damage if it is an “ensuing loss” caused by water damage? In 2004, the U.S. District Court for the Eastern District of Texas discussed this issue in Malley v. Allstate Texas Lloyds.

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Ordinance or Law--An Additional Coverage Available Under Many Florida Residential Policies

Many residential insurance policies in Florida have additional coverage for “Ordinance or Law” or code upgrade coverage. I wanted to write about this additional coverage in the context of the Hurricane Law series because it is important to understand how this additional coverage kicks in during a typical residential hurricane claim. In South Florida, many property insurance claim issues remain from the 2005 and 2005 hurricanes. Many of the open disputes concern hurricane damage to residential roofs and whether they can be repaired or necessitate replacement. Of course there are many other issues still being litigated from the hurricanes of 2004-2005 in Florida, but this post will focus on the Ordinance or Law additional coverage in the context of a residential roof.

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Court Reduces Continuing Charges and Expenses From Net Profits When a Business Resumed Partial Operations After a Loss - Understanding Business Interruption Claims, Part 35

The Fifth Circuit Court of Appeals recently issued a 21-page opinion in the case of Consolidated Companies, Inc. v. Lexington Insurance Company, No. 09-30178, ___ F. 3d ___ (5th Cir. August 17, 2010). The opinion is dense, to say the least, but it resolves an issue that sometimes can make or break a settlement in business interruption claims.

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Insureds in Pennsylvania Win the Late Notice Battle but Bad Faith is Denied.

Usually, I write about cases involving public adjusters, but here is an interesting case where the insurance company’s adjuster helped the insureds.

Recently, a frequent allegation raised by the insurance companies seems to be “too little…too late.” Insurance policies typically include a condition that requires losses to be promptly reported.

Jeremy Tyler and Shaun Marker have addressed late reporting and late notice issues in great detail in their posts about hurricane losses. This week, I came across a case where the insureds were successful in overcoming the late notice/late discovery defense raised in a water damage claim in Pennsylvania. After reading the case, I reached out to some of the public adjusters in Pennsylvania and I learned a little more.

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How to Prepare for the Hurricane Season and Avoid Being Underinsured for Business Interruption Coverage

*(Note: Bob Glasser is a managing director at BDO Consulting, a division of BDO and Seidman, LLP, in the New York office. Mr. Glasser is a certified public accountant, a certified fraud examiner and a certified insolvency reorganization accountant, with more than thirty years of diverse financial management and accounting experience at public and private companies. Mr. Glasser leads the firm’s New York Insurance Claim Services practice).

Most CFOs and risk managers have an understanding of their property and liability insurance needs and dollar limits and are comfortable purchasing coverage that protects their companies from a loss due to an insured peril. However, it has been my experience that their comfort level drops dramatically when it comes to business interruption coverage and limits. The uncertainty surrounding business interruption coverage, extensions of coverage and respective limits of that coverage consistently results in many middle-market organizations finding themselves underinsured and short of cash when faced with a major loss. Even the fortunate CFOs and risk managers who have not experienced a major loss may eventually discover that they have been significantly overinsured for business interruption losses and paying unnecessarily higher premiums for their coverage. Of course, the more devastating situation is finding out after a shutdown of operations from a loss that company management has not mitigated the company’s risk of lost profits and now has insufficient coverage to protect profits and cash flow during a potentially long period of restoration.

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Bracing for the Worst - Understanding Business Interruption Claims, Part 29

Yesterday, Rocco Calaci posted a blog entry announcing that La Niña conditions are already being observed. While I dare not attempt to explain the mechanics of these conditions, it is generally understood that La Niña is a climate phenomenon that is marked by an unusual cooling of the sea surface in the Pacific Ocean, which in turn affects wind and weather patterns globally. It is also generally said that these conditions foster more frequent and stronger storms in the Atlantic Ocean and the Gulf of Mexico. As a result, NOAA has forecasted 14 to 23 named storms, of which 8 to 14 are expected to be hurricanes and 3 to 7 major hurricanes during this season.

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Can "Real World Circumstances" Be Considered To Establish a Theoretical Period of Restoration? - Understanding Business Interruption Claims, Part 26

The “Period of Restoration” in a business interruption claim is a concept of time. The period, as defined in most ISO forms, begins at the time of “direct physical loss or damage” and ends on the earlier of “the date when the property should be repaired, rebuilt, or replaced with reasonable speed and similar quality.” […] or “the date when the business is resumed at a new permanent location.”

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Extra Expense and the Period of Restoration - Understanding Business Interruption Claims, Part 22

(Note: This Guest Blog is by Michelle Claverol, an attorney with Merlin Law Group in the Coral Gables, Florida, office. This is the part of a series she is writing on business interruption claims).

Most extra expense provisions state that coverage will be extended for necessary expenses that the insured incurs during the “period of restoration.”

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Accountants and Business Interruption Experts Will Play an Important Role Recovering BP Oil Spill Income Loss Claims

The tragedy of loss of human life and damage to the environment when discussing the BP Oil Spill cannot be overstated. The important role that accountants and business interruption experts will play helping prove financial loss cannot be overstated either. Experienced professionals like Bob Glasser, noted in yesterday’s Are Lawyers Pandering for BP Oil Spill Clients Going to Get Sued for Malpractice in Follow-up Class Actions? A Guest Blog Regarding Business Claims By Bob Glasser Explains and Guest Blogger Bruce Smith, who wrote The Forensic Accountant's Role In Business Interruption And Business Income Claims, should be in high demand from businesses and entities that lose revenue and income as a result of this oil spill. Attorneys presenting these lost income claims should consider hiring such individuals as consultants and financial expert witnesses.

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What if Code Upgrades Delay the Time to Complete Repairs? - Understanding Business Interruption Claims, Part 20

(Note: This Guest Blog is by Michelle Claverol, an attorney with Merlin Law Group in the Coral Gables, Florida, office. This is the part of a series she is writing on business interruption claims).

Complying with code upgrades often extends the period of time it takes to repair or replace the property after a loss. Depending on the type and nature of the code requirements, repairs could be extended for several months and depending on the type of policy this time delay may not be covered. Depending on the size of the business, this could translate into significant unrecoverable losses.

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The Duane Reade Saga -- Understanding Business Interruption Claims, Part 16

(Note: This Guest Blog is by Michelle Claverol, an attorney with Merlin Law Group in the Coral Gables, Florida, office. This is the part of a series she is writing on business interruption claims). 

New York-based drugstore chain, Duane Reade, must feel like it is Ground Hog Day every time their attorneys call to give status on their case against St. Paul Fire and Marine Insurance Company. Duane Reade, recently acquired by Walgreens, owns and operates 200 drugstores in and around New York City, including 124 in Manhattan. Duane Reade has been battling its carrier for almost 8 years in a protracted insurance coverage dispute arising from the September 11, 2001, destruction of its single most profitable store, formerly located on the main concourse of the World Trade Center. After a bench trial, four Federal District Court opinions, an appraisal and two appeals, the business interruption saga finally came to an end.

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Learning from Other's Mistakes -- Understanding Business Interruption Claims, Part 15

(Note: This Guest Blog is by Michelle Claverol, an attorney with Merlin Law Group in the Coral Gables, Florida, office. This is the part of a series she is writing on business interruption claims). 

“Experience is the name everyone gives to their mistakes” – Oscar Wilde

I picked up a couple of pointers worth sharing in an article published by the University Risk Management and Insurance Association titled, "Case Study-Business Interruption: An Exposure by Many Names," by William Austin, et al., (2005). The article examined a case study similar to what some academic institutions near the Gulf Coast experienced in the aftermath of Hurricane Katrina. The business interruption case study, however, was analyzed in a scenario where a catastrophic fire damaged a state of the art research facility at a higher education institution that thrived on revenue from its prestigious research and development programs.

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Post-Loss Market Earnings Ignored in Mississippi - Understanding Business Interruption Claims, Part 14

(Note: This Guest Blog is by Michelle Claverol, an attorney with Merlin Law Group in the Coral Gables, Florida, office. This is the part of a series she is writing on business interruption claims).  

Several weeks ago, in a blog titled To Consider the Economy, or Not to? ‘That is the Question’, I examined two diverging legal views regarding the use of post-loss market conduct in business interruption claims. In that blog, I borrowed information from an article published in the July/August 2009 issue of Coverage titled “Measuring Business Interruption Loss in Wide-Impact Catastrophes: Insurance Against Catastrophes or Only Against Insured Damage from Catastrophes?” by Richard Chattman and Gregory Miller and I explained that:

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Consequential Loss Exclusions - Understanding Business Interruption Claims, Part 13

(Note: This Guest Blog is by Michelle Claverol, an attorney with Merlin Law Group in the Coral Gables, Florida, office. This is the part of a series she is writing on business interruption claims).  

In general, business interruption insurance is intended to return to the insured's business the amount of profit it would have earned, had there been no interruption of the business or suspension of its operations. However, business interruption coverage ought not be used to put the insured in a better position than it would have occupied without the interruption. Most policies will therefore typically exclude coverage for any consequential (or remote) losses, delay, loss of use or loss of market, which do not directly flow from a covered loss.

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Strategies for Claim Resolution -- Understanding Business Interruption Coverage, Part 12

(Note: This Guest Blog is by Michelle Claverol, an attorney with Merlin Law Group in the Coral Gables, Florida, office. This is the part of a series she is writing on business interruption claims).  

In this business, everyone has their own style of “working a claim.” There are, however, healthy techniques of claim presentation that practitioners should follow to effectively present a business interruption claim.

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In Tough Economic Times, Extra Expense Coverage Should Survive Budget Cuts - Understanding Business Interruption Claims, Part 11

(Note: This Guest Blog is by Michelle Claverol, an attorney with Merlin Law Group in the Coral Gables, Florida, office. This is the part of a series she is writing on business interruption claims). 

In these tough economic times, many businesses are looking to cut expenses and trim their budgets. While it is tempting to reduce insurance coverage to minimize operating costs, business owners should not skimp on insurance protection to trim budgets, particularly when it comes to additional coverages like Extra Expense Coverage.

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Sinkhole Proposed Law Only Pays Policyholder 25% of Available Coverage--Lessons of How the Insurance Lobby Spins a Message

The poor policyholders whose homes cracked, popped, and dipped as a result of sinkholes induced by citrus farmers spraying their crops to prevent freezing damage should be happy it happened to them this year. Newly proposed anti-consumer sinkhole legislation would limit policyholders to 25% of their coverage limits for the most common sinkhole problems.

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Proposed New Senate Bill Filed: Policyholders Lose Prompt Replacement Cost Payments and Older Roof Insurance Coverage

If you are a policyholder, don’t expect prompt payment of replacement cost benefits and payments for damage to older roofs if Florida Senate proposed legislation passes. A proposed bill filed as a substitute that will be heard in the Florida Senate and Banking & Insurance this Wednesday was just released this afternoon. I have not had an opportunity to review it in detail, but a number of anti-consumer provisions are contained within this proposed legislation.

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The Hospitality Industry Has Significant Insurance Coverage Issues: Lessons Taught at the 2010 Hospitality Law Conference

I represented a Houston based hotel management company last spring regarding Hurricane Ike insurance claim disputes with eleven hotels they owned or managed in Texas. Some cases simply go right, and this one settled after two months. My client’s owners went out of their way to call to my attention that managers in the hospitality and real estate management business needed to be taught about the insurance claim game. The next thing I knew, they were putting a phone to my ear and I was talking to Stephen Barth of HospitalityLawyer.com.

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How does the Period of Restoration Affect the Valuation of a Business Interruption Claim? Florida Valuation Issues, Part 10

(Note: This Guest Blog is by Michelle Claverol, an attorney with Merlin Law Group in the Coral Gables, Florida, office. This is the tenth and final part in a series she is writing on valued policy laws).

In general, business interruption coverage is supposed to provide the capital needed to sustain a business while its operations are suspended as a result of damage caused by a covered peril.

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State Farm Florida Withdraws its Plan to Leave the State and Agrees to Non-Renew no More than 125,000 Residential Property Policies

The Florida Office of Insurance Regulation (OIR) has entered a Consent Order today resolving the attempt by State Farm to leave the Florida property insurance market.

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A Recent Florida Court Decision on Subrogation

On Target, Inc. v. Allstate Floridian Ins. Co., as Subrogee of Anthony and Nancy Podorski
No. 2D08-4887, ___ So. 3d ___
(Fla. 3rd DCA October 30, 2009)

Nancy and Anthony Podorski hired On Target, Inc., a leak detection service, to locate a leak under the floor of their home. The On Target technician who responded presented Mr. Podorski with a two-page form titled “Customer Information Card and authorization to proceed with the work.” The Customer Information Card authorized On Target to find the leak, provided general information about the nature and extent of the services provided by On Target, and the indemnification provision at issue in this case:

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Florida Rates Are Rising--Not So Fast!

Last week, I made a statement in my post, Are Wind Mititgation Credits Killing Profits of Florida Insurers, that everybody is predicting insurance rates are going up . Then, the St. Petersburg Times ran a story, Citizens Property Rates Headed Up, or Maybe Down, Depending on Where You Live.

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Are Wind Mitigation Credits Killing Profits of Florida Insurers?

It is hard to imagine any Florida property insurers not making a killing in 2009. With no hurricanes or significant tropical storms, the most financially devastating peril was eliminated. Yet, over 100 Florida residential property insurers reported losses.

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Senator Fasano Defends His View Regarding Opting Out of Sinkhole Coverages

I wonder how our clients, the Leeds, would feel if they had purchased only catastrophic sinkhole coverage or no sinkhole coverage, rather than the normal sinkhole coverage required when they purchased their "all-risk" insurance policy. Their home slowly but surely cracked, drooped, and sank over several years before it was condemned. If they "saved" money on their premium as Florida Senator Mike Fasano successfully pushed for in legislation, they would have lost the entire investment on their home. They would also still owe money on the mortgage, possibly causing bankruptcy.

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Mortgage Company Protections When an Insured Fails to Submit a Proof of Loss

(Note: This Guest Blog is by Corey Harris, an attorney with Merlin Law Group in the Tampa, Florida, office. This is the fourth of a twelve part series he is writing on proof of loss).

As I was watching one of the countless news reports detailing the current mortgage crisis and its effects on homeowners, I began to think of the insurance consequences of homeowners being forced to give up and hand over the keys to their houses. What would happen, I wondered, if a homeowner was to have a covered loss but fail to submit a proof of loss because of a pending foreclosure?

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"At War With The Weather" is a Must Read for Those Involved in the Debate of the Florida Property Insurance Market

My appointment by Florida's Governor Charlie Crist to the Citizens Mission Review Task Force afforded me the opportunity to learn about and have a small voice in the Florida insurance marketplace. At War With the Weather: Managing Large-Scale Risks in a New Era of Catastrophes is a significant academic work which our regulators and legislators must read and understand to fully appreciate the complexity of the property insurance issues in Florida and elsewhere. I wish it had been published while I was serving on that Committee. The historic lessons and current conclusions contained in this book are important to everybody living and working along Coastal areas.

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Florida Insurance News Reports on State Farms Slow March to Leaving

Yesterday, Chad Hemenway, associate editor of BestWeek, reported that State Farm and Florida’s Office of Insurance Regulation jointly moved to delay the administrative hearing that will address State Farm’s move to leave Florida’s property insurance market.  The saga continues....

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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.

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Catastrophic Sinkhole Coverage and the Problems of the New 2009 Florida Legislation

"Cheaper" insurance rates often mean far less coverage. In this world, you often get what you pay for. If there is ever a lesson to be learned about that, just ask those that live in the "Sinkhole Capital of the World," Pasco County, Florida. They can elect to get "Catastrophic Sinkhole Coverage" as ordinary coverage or get "Sinkhole Coverage" which is every bit as catastrophic where it counts--the ability to get back to where you started from--but covers damage from a slow moving sinkhole. The latter optional coverage is very expensive and covers Floridians from loss caused by most of the sinkholes that occur. The other coverage, which is much less costly, covers only very quick and substantial collapse sinkholes which happen once in a gazillion years to the properties owned by anybody. Guess which form the insurance industry wants to insure? BINGO!

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Insurance Agents, Adjusters and Attorneys Can Learn Important Coverage Topics Reading Chris Boggs' Articles

One of the more interesting aspects of my job as an advocate for policyholders is learning from non attorneys what insurance products mean at the point of sale and how they are supposed to work after the loss. This may seem a little curious to many, but if you think about it, why would anybody trust a judge’s ruling on a medical malpractice case to explain how to practice medicine? Judges are not trained in insurance. Attorneys who say they practice insurance recovery law, but learn insurance coverage and practice only by reading legal cases are too arrogant and ignorant to be in it for the policyholder. Maybe those types of attorneys can find their way to the insurer’s employ, so my job is made easier.

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Liberalization Clauses are Very Helpful to Policyholders, But A Florida Court Takes a Consevative View

Segal v. Hartford Ins. Co.,
No. 09-10588, 2009 U.S. Dist. LEXIS 13215
(11th Cir. June 18, 2009)

Most insurance policies contain a liberalization clause. Always look for them because a liberalization clause means that any change in the law broadening coverage would benefit the policyholder, even if the change happened in the middle of a policy period. One Florida court, however, recently took a narrower view on a liberalization clause's applicability.

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Insurance Agents and Brokers Should Be Concerned Writing Risks with 100 Percent Coinsurance to Avoid Error and Omission Claims

Coinsurance penalties are the last thing policyholders worry about following a loss. My experience has been that many field adjusters fortunately do not go through the costly calculations to accurately determine if a structure is underinsured. Thus, the penalties from being underinsured do not arise as often as they could.

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Mississippi Federal Court: An Insured Cannot Misrepresent if the Insured is Not Asked

Guideone Mut. Ins. Co. v. Rock,
1:06-CV-218, 2009 U.S. Dist. LEXIS 54717
(N.D. Miss. June 29, 2009)

On August 27, 2005, the Rocks' home and two vehicles were destroyed by a fire. The Rocks had a homeowner's and auto insurance policy with Guideone Mutual Insurance Company. Following the Rocks' loss, the Rocks filed claims with their insurer for damage to their home, damage to the contents of their home, and vehicle damage.

On July 31, 2006 Guideone denied the Rocks' insurance claims. Guideone denied the claims based on alleged material misrepresentations regarding Mr. Rock's criminal history on the homeowner's insurance policy application, and the Rocks' failure to comply with their contractual duties throughout the claim investigations, such as concealment regarding their claims, intentional acts, and failure to produce their children for examinations under oath.

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Fireworks are Loved by Americans--and Insurance Companies Seeking Not to Pay Fourth of July Fires

Fire was the major peril insured by the insurance industry over a hundred years ago. In the tradition that is still commonplace today, insurers wrote specific exclusions into the insurance contracts which limited when they had to pay for loss caused by fire. I guess my friends along the coasts of Mississippi and Texas could relate when they found their all-risk insurance policies which cover hurricanes excluded damage from the waters that came with the hurricane.

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Federal Court Makes "Erie" Guess as to Louisiana's Valued Policy Law

Watson v. Allstate Ins. Co.
Slip Copy, No. 2:07-cv-3462, 2009 WL 1704730, 2009 U.S. Dist. LEXIS 50993,
(E.D. La., June 17, 2009).

Vivian Watson’s home was covered by an Allstate “Deluxe Homeowners” policy when Hurricane Katrina hit on August 29, 2005. Following Hurricane Katrina, Watson filed suit against Allstate in Federal District Court, alleging that her property suffered a total loss caused by wind, wind driven rain, flooding and waters entering New Orleans and surrounding parishes. She sought the full face value of the homeowner's policy for dwelling and other structures, personal property, and additional living expenses without deduction or offset, pursuant to Louisiana’s Valued Policy Law. Allstate filed a motion for partial summary judgment, arguing that Watson’s case should be dismissed because the damages were not caused exclusively by a covered peril (like most homeowners policies, Watson’s did not cover flood damage). 

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Insurance Industry Does Not Agree on State Farm Bailout Law

The Insurance Journal ran an article, Florida Domestic Insurers Urge Veto of 'Dangerous' Deregulation Bill, which indicates a significant portion of Florida's insurance industry opposes State Farm, State Farm agents, and the other big insurers trying to get a competitive advantage from this legislation. The article outlined many of the competing views and stated in part:

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Proposed Law Drops Sinkhole Coverage

One way to get cheaper rates is to buy an insurance policy that covers nothing. An article shows this is how the Florida legislature is tackling the insurance rate problem:

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Lessons for Policyholders Years After the Loss

I saw a number of property managers of former Community Association clients yesterday at the Community Associations Institute National Conference in New Orleans. We recalled the trials and tribulations of catastrophes long past. We consult with a number of them regarding their insurance programs and will sometimes have a conference with their insurance brokers and agents trying to anticipate coverage which would be needed in the event of another disaster.

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Three Factors Homeowners Must Consider When Updating their insurance for hurricane season

(Note:  This Guest Blog is by Ruck DeMinico, Knowledge Manager at Merlin Law Group). 

My wife and I were reviewing our homeowner’s policy this weekend, and she was unaware of a few things that all homeowners must know. I am sure there are many more people in her situation. While this blog may be elementary to those who work in insurance, on the off chance that a novice reads this blog, I would like to mention three of the most important things every homeowner should know when updating their insurance for the hurricane season.

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Damage Claims Rise From Spring Storms & Tornadoes in Mississippi, Louisiana and Alabama--When Should You Sign a Release?

(Note: This Guest Blog is by Deborah Trotter, an attorney with Merlin Law Group in the Gulfport, Mississippi office).

As homeowners, business owners, adjusters, and government and relief agencies begin to sort through the devastation left in the wake of the dangerous storms and tornadoes that tore through the southeast last week, the stark and solemn reality of the loss of life and property is overwhelming. So many families and communities are grieving tremendous losses.

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Spring Storms and Tornadoes in Mississippi Serve as a Reminder: Review and Update Your Policy for Overlooked Benefits

(Note:  This Guest Blog is by Deborah Trotter, an attorney with Merlin Law Group in the Gulfport, Mississippi office).

The spring storms and tornadoes that ripped through Mississippi, Alabama and Louisiana recently could be a preview of a devastating hurricane season. Policyholders should take the opportunity now to review their policy coverage.

One of the many things we learned from Hurricane Katrina, is that people often do not know the various insurance benefits available to them under their homeowners and/or business policies. And sadly, many insurance company adjusters do not feel obligated to inform policyholders of all of the policy benefits available to them.

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The Importance of Understanding Your Business Interruption Insurance Coverage

(*Note:  This Guest Blog is by Ed Acle, an attorney in the Coral Gables office of Merlin Law Group).

Merlin Law Group often assists commercial policyholders with claims for business interruption insurance. Many policyholders, electing to save as much as they can on their premiums, often forego this type of coverage on their policies. Those that obtain business interruption (or “BI”) insurance often neglect to take full advantage of the full protections afforded by this coverage. This could have grave implications, as the accurate application of BI coverage on a claim can often make the difference between a business’s continued operation or the shuttering of its windows forever.

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Is National Flood Going To Be In Business?

An article in the Insurance Journal, National Flood Insurance Program Set to Expire Tomorrow, caught my eye. I think the threat of expiration is political gamesmanship, as indicated in the piece: 

“John Prible, government affairs for the Independent Insurance Agents and Brokers of America, says the omnibus bill funding is currently being debated in the Senate but there's "a little game of chicken" happening between the House and Senate on any changes that may be made to the omnibus bill in the Senate. The debate could potentially derail the bill, he said.”

I wonder whether Mississippi Congressman Gene Taylor will try to use this opportunity to get the Multiple Peril Insurance Act of 2009, into law. I am not holding my breath, but stranger things have happened in the political arena lately. Taylor’s website has a summary of what he hopes his proposed legislation will accomplish: 

“The Multiple Peril Insurance Act would allow coastal homeowners to buy comprehensive insurance and know that hurricane damage will be covered without lengthy legal disputes over how much damage was caused by wind and how much was caused by flooding.

After Hurricane Katrina, insurance companies overbilled taxpayers and underpaid homeowners by blaming flooding for some damage that had been caused by hurricane winds and wind-driven debris.

The bill will reduce future property damage by requiring participating communities to adopt International Building Codes.”

I recommend Slabbed’s excellent article, HR 1264 - One policy. One premium. One claims adjuster. Protecting America’s home & business owner. Protecting America’s taxpayers, which explains Taylor’s Bill.

State Farm's Departure is Problematic--What it Wants is Unclear

The Tampa Tribune ran a story, State Farm’s Exit From Florida Proving to Be a Problem for Some, which demonstrates problems consumers will have obtaining new coverage. The on-line edition of the story is somewhat entertaining because the comments show the disparate results of consumers who are shopping for insurance and confusion about underwriting. What is still unclear and troubling is exactly what State Farm hopes to gain from its announcement that it is leaving Florida. Certainly, it is losing revenue and access to a very large insurance market.

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Views From Hurricane Ike TWIA Insurance Adjusters

A Comment from a previous post, How Ike Insurance Claim Help is Supposed to Be, provided insight to the understanding of the claims process from two adjusters in the insurance industry. The comment is worthy of repeating here:

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The Devil is in the Details

State Farm has a method and reason for just about everything it does. As indicated in yesterday's post, its actions do not always reveal its strategy.

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State Farm's Power Play And Propaganda Ploy

State Farm is hard to figure out. They say one thing and often do another. When you finally get to the decision makers, there is usually some logic to why they do things despite disagreement from consumers or regulators. State Farm's announcement that it was leaving the Florida property market really has me wondering--"what's up?" From what I read and hear, I am not the only one.

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The Value Of Valuation Clauses--Gold Exists In The Small Print Of Your Property Insurance Policy

Kelly Kubiak burst into my office jubilant in her recent victory over Great American Insurance Company. She received an Order granting her Motion for Summary Judgment in a case where the central dispute involved the interpretation of the valuation clause of an insurance policy. We so often talk about the problems of causation that we fail to spend enough time talking about how many benefits insurance policies are supposed to provide. It has been our experience that many policyholders think they have obtained a fantastic settlement from their insurance company until we explain how much money was left on the table through lack of knowledge and experience.

The insurance company adjuster is ethically required to help the policyholder maximize benefits. A properly trained and motivated adjuster teaches the policyholder how the policy can be used to soften the financial blow caused by insured peril. One can imagine how much money is innocently not claimed or recovered when an adjuster does not understand the policy.

In Kelly’s case, the small business she represented had an adjuster fight with the owner over  “new” merchandise versus “used” merchandise. I wonder how many other insureds have been cheated as a result of Great American's obviously wrong interpretation of the valuation clause. Many policyholders do not realize the issue or simply fail to fight the issue by retaining an attorney. Unfortunately, this scenario is repeated far too often as many insurance company adjusters do not help the policyholder find ways to encourage payment of full policy benefits.

Have you ever heard of an insurance adjuster saying, “I think the policy can help you and pay you more if you would just….?” 

Responding to the Media About The Insurance Financial Crisis

The Tampa Tribune ran an editorial on January 12th regarding the Citizens Mission Review Task Force. As usual, I had something to say about their opinion, and wrote the the following reply, which was published in Sunday's paper:

Florida Dangerously Vulnerable

This is in response to the Jan. 12 editorial, "New Ideas Could Bring Sound Hurricane Coverage."

You raise some important points regarding the safety net of property insurance, and the Citizens Mission Review Task Force meetings also revealed issues that all Floridians must be made aware of.

First, dried up credit markets have left our current system dangerously vulnerable. In the event of a major hurricane season, it is unlikely that Florida would be able to raise the money needed to cover the debts of Citizens through bond sales.

Second, as you noted, Citizens rates are currently lower than being actuarial sound. Yet everybody wants rates to remain affordable. The task force recommended responsible, capped increases to prevent wallet shock.

Third, encouraging a private insurance market to replace those carriers that find Florida too risky is a viable long-term solution. The Legislature passed laws aiding and regulating these companies that often provide coverage at rates lower than Citizens, especially for policyholders who take advantage of the My Safe Florida Home program.

Finally, the best long-term solution is to harden structures. Yes, it is costly but offering premium discounts to homeowners who make improvements has to be encouraged, even if it takes a state and federal tax relief program too beneficial to pass up. That is something our federal and state leaders can start working on now.

We cannot afford to put our heads in the sand and hope Mother Nature will spare us for another season. We must act now for the long-term because there is no easy short-term solution to the very difficult situation we all face.

WILLIAM F. "CHIP" MERLIN

Tampa

The writer is founder of the Merlin Law Group and was appointed to the Citizens Property Insurance Mission Review Task Force by Gov. Charlie Crist in 2008.

The final meeting of the Task Force is scheduled in Jacksonville on Thursday, January 22nd. Our Report is due to the Florida Legislature by January 31.
 

Headlines And Reality

The Citizens Mission Review Task Force made a significant recommendation at its meeting on Tuesday. Prior testimony was that the average Florida rate hike, which would be approved by the Office of Insurance Regulation, would almost certainly be higher than 30%. We recommended to the Florida Legislature that they to pass a statute to cap that rate increase at 10%. Without this law, the rate would probably go up over 30% on a statewide basis.

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Actuaries Are Underwriters With No Personality

My Tuesday morning last week started with an early interview with a Tampa radio station, WFLA, regarding the Citizens Mission Review Task Force. Insurance rates, caps to rate increases, bankruptcy of the state, and hurricanes could only make the morning radio news in Florida. What happened to the debate about Sarah Palin's sexiness? Anything is more exciting than topics discussed by actuaries. 

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FTC Investigates Homeowner Insurers For Possible Discrimination

On December 23, The Federal Trade Commission issued Orders to nine homeowner carriers regarding their use of credit scores. The Order applies to the latest nine Homeowner insurance companies, which comprise over 60% of the homeowner insurance market share.

This investigation is important in the homeowner arena because of “redlining” laws that prohibit insurance companies from discriminating against potential policyholders based on race or ethnicity.

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