Kevin Pollack

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Collapse Claim Highlights the Importance of Retaining Experts Early in the Claim Process

A recent case filed in the Western District of Texas highlights the importance of retaining experts to assist in evaluating the cause of loss early in the claim process. In White Lodging Services Corporation et al v. Liberty Mutual Fire Insurance Company,1 a hotel development and management company filed suit against Liberty Mutual over a … Continue Reading

Business Interruption Claims – Calculating The Period of Restoration

Business interruption coverage provides protection against loss of income when a business suffers property damage from an insured peril (e.g., fire, water loss) that interrupts the operation of the business.1 A typical business interruption policy form provides that the insurer will pay the actual loss of business income the insured sustains during the necessary suspension … Continue Reading

Proof of Loss: Can an Insurer Deny Coverage and Later Argue the Claim is Barred Because the Insured Did Not Comply with the Proof of Loss Condition?

Insurers on occasion deny coverage or make claim decisions based on one ground, and then later, during litigation, seek to avoid liability based upon an entirely new defense theory. Although coverage decision letters regularly throw in boilerplate language seeking to avoid waiving coverage defenses, I was recently asked whether an insurer can deny coverage or … Continue Reading

Business Income and Extra Expense – Understanding the Differences

In addition to covering property damage, most first-party commercial insurance policies offer business interruption coverage. Business interruption coverage typically has two different built in coverages: business income and extra expense. Both are intended to assist businesses in the event a covered peril damages business property and impacts business operations.… Continue Reading

The Genuine Dispute Defense and Bad Faith

Insurers often seek to avoid liability for bad faith by asserting the “Genuine Dispute Doctrine.” Under the genuine dispute rule, an insurer’s coverage or claim decision may not be in bad faith when it mistakenly withholds policy benefits, if the mistake is reasonable and is based on a legitimate dispute as to the insurer’s liability.1… Continue Reading

Insurers Must Provide Complete Replacement Cost Estimates

The California Supreme Court issued a unanimous ruling yesterday requiring insurers to communicate “complete” replacement cost estimates to insureds.1 The ruling not only found the regulation requiring this action to be well within the Insurance commissioner’s authority, but found the basis for the regulation to be well founded. It is a wonderful victory for policyholders … Continue Reading

Exclusions in States That Have a Statutory Standard Form Fire Insurance Policy

Insurers often issue property insurance policies intended cover multiple perils (e.g. water damage and fire). While insurers often include a number of exclusions in their policies, in states with statutory standard form fire policies (such as California), insurers cannot apply exclusions that substantially vary from the terms and conditions in the standard form fire policy … Continue Reading

Examinations Under Oath – What You Need to Know

Most property and business policies contain a provision requiring the insured to submit to an examination under oath (known as an “EUO”) by the insurance company in connection with an insurance claim. It is similar to a deposition, with the policyholder providing sworn testimony under penalty of perjury. However, it is under a contractual policy … Continue Reading

Class Action Highlights Notification Requirements When Insurers Seek to Reduce Coverage Associated with “Renewals”

A recently filed proposed class action1 accusing California health insurance giant Anthem Blue Cross of using a "bait and switch" scheme that offered insurance policy "renewals" that did not clearly disclose major policy changes offers a great example of why the law requires insurers to notify insureds of reductions in insurance coverage.… Continue Reading

The Cooperation Clause – Do I have to Cooperate with the Insurer’s Investigation?

Public adjuster and policyholder advocates often get questions from insureds about the extent that insureds must cooperate with insurers during the investigation stage of a claim. As an example, some insureds have asked me whether they really must produce financial documents and receipts in a theft claim. Insureds often ask why the insurer is making … Continue Reading

“Commencing” Deemed Ambiguous in Property Insurance Policy

A federal District Court in Illinois has determined that the term “commencing” is ambiguous in a property insurance policy that provides coverage for “loss or damage commencing [d]uring the policy period…[w]ithin the…United States of America.”1 At issue in Temperature Service Company, Inc. v. Acuity, was whether property damage, that began before the policy period, but … Continue Reading

Do All Insurance Policies Require a Total Collapse to Trigger Collapse Coverage?

In California, if a property insurance policy does not specifically require a collapse to be complete or actual falling down to trigger coverage, then an imminent (i.e., impending) collapse will probably trigger coverage.1 However, on the flipside, if a policy does specifically require a collapse to be “complete” or “actual” falling down, then an imminent … Continue Reading

Florida District Court Decision on “Your Work” Exclusion in CGL Policy Is At Odds With Law of Numerous Jurisdictions

In Essex Insurance Co. v. DiMucci Development Corp. of Ponce Inlet Inc., U.S. District Judge Roy B. Dalton Jr. recently held that Evanston Insurance Company has no duty to defend a builder in a lawsuit alleging construction defects at one of its Florida condominium complexes based on an exclusion in the policy for damage to … Continue Reading

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 … Continue Reading
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