Reasonable Expectations – North Carolina

The reasonable expectations doctrine could be outcome determinative in coverage disputes in the Tar Heel State. Two doctrines courts often consider when analyzing policy interpretation are the doctrines of (1) contra proferentem and (2) the insured’s “reasonable expectations.” North Carolina state courts embrace the doctrine of contra proferentem while its adoption of the reasonable expectations doctrine is more limited. The doctrine of contra proferentem is one of contract interpretation and construes any ambiguity in the contract against the party who drafted the contract. North Carolina state courts apply this principle in policy interpretation. Courts look to the plain meaning of the contract. Strict construction applies unless there is an ambiguity. In the property insurance context, North Carolina state courts use this rule to interpret policy terms liberally in favor of the policyholder and strictly against the insurance company since the insurance company chose the language in the policy. Continue Reading

All Acquisition Costs Should Be Included For Replacement Cost Values

Insurance company adjusters often leave off the reasonably expected acquisition costs when determining replacement cost. While the actual pricing can become theoretical, the bottom line is that these acquisition costs can be a material cost and every adjuster should include them when determining the top line replacement cost value. Continue Reading

Hurricane Michael Policyholders, Public Adjusters, Contractors, and Agents Warning About Some Policies With One Year Limitations To File Arbitration

Lloyd’s of London

Hurricane Michael policyholders, public adjusters, contractors and agents must check their policies to make certain that there is not a one-year deadline to start arbitration. The above photo is Lloyds at London. Lloyds is a place where surplus lines insurers do business and it is not an insurance company. Many of the Lloyds Underwriters have placed obscure arbitration provisions into their policies which mandate that New York law with a one-year limitation to start the arbitration. Continue Reading

The Joy of Being a Policyholder Attorney

I recently had my second child. So, when my paralegal, Regina, came in my office the other day with a large box I assumed that it was more gifts over and above the abundance of gifts that Chip, the Tampa office, and the Red Bank office had already showered my growing family with. Although I was correct as to the contents, the box was from a client whose case I had recently settled. Continue Reading

California Insurers Are Violating Replacement Cost Estimate Laws

Many policyholders do not have enough insurance to replace their buildings or homes after a total loss. Often these policyholders were assured by their agents or insurance companies at the point of sale that their limits were sufficient. And many times these assurances were based on estimates that fell below the minimum standards set by law. Continue Reading

Hurricane Michael Claims Deserve Continued Attention By Florida Insurance Regulators

From left to right, JL Evans, Donice Krueger, Chip Merlin, Ron Delo, James and Rene Howard

Hurricane Michael insurance claims continue to take up a lot of time with Merlin Law Group attorneys. The photograph above is from dinner last night in Panama City, Florida, where the issues and problems of getting insurance claims resolved fully were the hot topic of discussion. Hurricane Michael has a lot of slow and low paying claims where insurers are wrongfully reporting to the Office of Insurance Regulation that the claim is administratively “closed” when it is anything other than being over from the policyholder’s view. Continue Reading

The Seventh Circuit Court of Appeals Weighs In On “Matching”

Last year in one of my blogposts, I wrote about Windridge of Naperville Condominium Association v. Philadelphia Indemnity Insurance Company,1 and the issue whether appraisal is appropriate to resolve a dispute over the cost of repairing physically undamaged siding of townhome buildings to remedy a mismatch with repaired damaged siding. There, a federal district court in Illinois denied the Association’s motion to compel appraisal on the “matching” issue, reasoning it was a question of coverage, not loss amount, and thus inappropriate for appraisal. This coverage issue was subsequently resolved in favor of the Association, the district court concluding that Philadelphia must replace or pay to replace the siding on all four of the townhome buildings’ elevations if no siding is available that matches the undamaged siding on the north and east elevations, as claimed by the Association.2 Continue Reading

Pretrial Motion Practice in Federal Court

Image by Nick Youngson

This blog post will describe the difference between pre-trial case dispositive motions and motions that impact the admissibility of evidence at trial. I recounted in a previous post that (1) motions to dismiss and (2) motions for summary judgment are case dispositive motions. That means that if either party ultimately wins the motion, the claim or a portion of the claim is definitively won by the moving party unless the court grants leave to fix the identified issue. Motions in limine and Daubert motions, however, concern what evidence is admissible at trial. Continue Reading

Insurance Agents Play An Important Role In Everyday Life

Brent Winans, Jessica Kirkwood-Alley, David Thompson, and Chip Merlin

David Thompson of the Florida Association of Insurance Agents (FAIA) is a premier insurance agent educator who spends most of his time on the road teaching insurance agents how to ply their trade. This morning, I was on a panel moderated by Thompson, with insurance agent defense attorney Jessica Kirkwood-Alley and insurance expert Brent Winans. The topic was how insurance agents can avoid errors and omissions claims. Continue Reading

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