Insurance claims adjusting is not easy business. Quality adjustment which vets claims quickly and gets the money to policyholders fairly, promptly and fully is challenging work. I have repeatedly indicated this in numerous blogs. Continue Reading Two Views Of Claims Management: Prompt and Full Payment vs. Overpayment Caused By Fraud

California has an insurer of last resort for fire coverage, the FAIR Plan, which I explained in detail in a previous post, What Is The California FAIR Plan? In late 2019 in the wake of hundreds of thousands of non-renewals, California Insurance Commissioner Ricardo Lara ordered the FAIR Plan to start selling more comprehensive policies that cover more perils than just fire. The order was set to take effect in 2020. However, in December 2019, the insurance industry filed a lawsuit to bar its enforcement. Continue Reading California Court Blocks Insurance Commissioner’s Order That FAIR Plan Expand Coverage Options

One of the first topics anybody should consider before claiming an insurance agent is negligent is the specific state law on the topic. Since virtually all states require people that sell any type of insurance to be licensed, many find it surprising that some states only impose a duty of care as an “order taker” rather a “professional advisor.” So, in Massachusetts, what duty does the law impose? Continue Reading Are Insurance Agents McDonald’s Order Takers or Professional Advisors? The Massachusetts View

Public adjuster Paul Yemm of Action Adjustment Service was elected President of the American Association of Public Insurance Adjusters (AAPIA). An AAPIA press release announced his election: Continue Reading Paul Yemm is The New President of the American Association of Public Insurance Adjusters

Insureds have the right to clearly understand the reason why their claim has been denied, delayed, or underpaid. Insurers have the duty to explain how they determined their adjustment and payments. Continue Reading What Constitutes a Promptly Reasonable and Proper Explanation From My Insurance Company?

Merlin Law Group Attorney Mary Fortson celebrated her 20th year in our firm last week. In the summer of 2008, she met with Texas public adjusters Art Jansen and Jim Beneke about re-establishing the Texas Association of Public Insurance Adjusters (TAPIA). Today, TAPIA has 100 paid members. Continue Reading Texas Association of Public Insurance Adjusters Conference Features Adjustment Issue of Storm, Flood, and Water Claims

The Supreme Court of Iowa in three opinions1 this week affirmed various rulings which held that 33 Carpenters’ contractual assignment was unenforceable, as it was operating as an unlicensed public adjuster. I wrote about the lower appellate court decision in, Contractor Acted as an Unlicensed Public Adjuster, Notwithstanding Assignment of Claim and Benefits. Continue Reading Court Affirms Contractor Acted as Unlicensed Public Adjuster

A few years ago, I asked Merlin Law Group attorney Doug Grose, “How did we end up in arbitration in London, England with policy delivered in Texas, a loss in Houston, Texas and our client from Houston, Texas?” He told me there was an arbitration provision and the federal court ordered us to go to arbitration in London because that is where the policy required the arbitration take place. I asked Doug: ”Geez, forgetting the extraordinary increased cost to our client do this, what chance do you think we have in arbitration in London against Certain Underwriters at Lloyd’s of London?” Continue Reading Choice of Law and Arbitration Provisions in Texas—Beware of These Provisions Which May Apply Laws of Another State

The Win The Storm conference was abuzz about a trio of Iowa cases that ruled void residential restoration contracts.1 The primary lesson to insurance restoration contractors is the promises made in contracts and found in advertisements may lead to contracts being found void pursuant to laws in many states. Contractors can expect insurance companies and possibly their own customers to challenge Assignment of Benefits and other construction contracts where insurance restoration contractors promise to provide services which constitute public adjusting. Continue Reading Restoration Contractors Need To Be Careful About the Wording of Contracts and Website Advertisements or Risk Not Getting Paid

Effective communication with an insurance company is one of the best tools available to successfully resolve claims. I have heard time and time again from insurance adjusters and defense attorneys that poor communication is one of the chief reasons that claims are undervalued and low settlement values are assigned. I outline some basic tips for effective advocacy. Continue Reading Effective Communication with Insurers – When You Have Good Facts and Law, Focus on the Good Facts and Law