Businesses forced closed by COVID-19 and denied coverage by their insurers received a legal boost this month. In a recent North Carolina ruling, the court held that a commonly worded business interruption policy covered losses arising from closures mandated by COVID-19. Continue Reading Court Finds Coverage for Restaurants’ COVID-19 Business Interruption Claims
On September 30, 2020, the Puerto Rico Court of Appeals revoked the rulings held on two (2) Accord and Satisfaction cases. The first case, Victor Cruz Perez v. Universal Insurance Company,1 was reversed due to the insurer’s failure to prove that all elements of Accord Satisfaction had been fulfilled. Continue Reading Puerto Rico Court of Appeals Revokes Two Accord & Satisfaction Rulings on Hurricane Maria Claims
Florida law distinguishes between insurance agents and insurance brokers.1 In Essex Ins. Co. v. Zota, the Florida Supreme Court defined an insurance broker as an individual who “represents the insured by acting as a middleman between the insured and the insurer, soliciting insurance from the public under no employment from any special company…[and] places it with a company selected by the insured.”2 If the insured has no preference as to the company, the broker can select the company.3 An insurance agent, on the other hand, is someone who “represents an insurer under an exclusive employment agreement by the insurance company.”4 Continue Reading When Can an Insurance Carrier be Liable for the Actions of its Agents?
Wildfires have erupted across Colorado, forcing thousands of Coloradans to evacuate to safety from the Cameron Peak, CalWood, Lefthand Canyon, and East Troublesome Fires. Accordingly, the Colorado Division of Insurance (DOI) issued a news release to give insurance advice to those effected on evacuation, filing insurance claims, and financial preparedness. The consumer advisory provides practical insurance tips, insurance evacuation and claims advice, and guidance on returning home after the fire. Continue Reading Colorado Wildfires – Colorado Division of Insurance Advisory to Impacted Coloradans
Picture this. You have retained counsel to assist in enforcing your claim under your insurance policy. After a favorable appraisal, and payment of that award by the insurer, you receive a notice of nonrenewal stating that the insurer is electing not to renew the policy as “the risk no longer complies with underwriting guidelines.” Continue Reading Policyholders’ Potential Bad Faith Claim for a Retaliatory Nonrenewal
Civil Authority and Ingress/Egress Coverage Bibliography
Robert M. Horkovich, et al., Insurance Coverage for Businesses Affected by Civil Unrest. Risk Management (June 15, 2020).
Shannon O’Malley. Commercial Property Insurance Coverage and Coronavirus. Zelle LLP (Mar. 11, 2020).
Jonathan McBride. Civil Authority Coverage For Coronavirus Claims. Zelle LLP (Mar. 20, 2020).
Douglas Berry. COVID-19—When Civil Authorities Take over, Are You Covered? IRMI (Mar. 2020).
White Paper: Shutdowns by Civil Authority. Risk & Insurance (Feb. 2019).
Clark Schirle. Civil Authority and Ingress/Egress Coverage. The Brief (Winter 2018).
Matt Weaver et. al., September 11, 2001, and the Impact of Actions by Civil Authorities Lessons Learned. Brief 20 (Fall 2016).
Albert Risk Management Consultants. The Next Level of Business Income Coverage. IRMI (Nov. 2011).
Jennifer Cook. Civil Authority Order Provisions in Business Interruption Insurance Policies. 2007 Paul Cordish Memorial Award Winner, 2nd Place.
Douglas Berry. Business Interruption for Denial of Access to Insured Property. IRMI (Oct. 2001).
Jon Held is one of the best advocates I have ever seen and heard argue about keeping the amount owed to policyholders down. He is a brilliant businessperson and has built an exceptional insurance consulting company regarding virtually every aspect of the insurance claims valuation process. I called his company a “surrogate” for claims adjusters and the insurance industry media took notice.
The Claims Journal noted this in, Growing Use of ‘Unlicensed Surrogates’ Worries Policyholder Attorney. The article noted the “tit for tat” between Jon Held and me over this issue:
Merlin specifically mentioned two companies that perform many of the functions traditionally done by licensed claims professionals: J.S. Held and Ladder Assist. In his blog, Merlin said J.S. Held is an ‘amazing advocate for the insurance industry.’
But during a telephone interview on Friday, Merlin said that good work isn’t good news for policyholders.
He said insurers ‘are providing the authority and certainly all the expertise determinations, to—essentially—people who aren’t licensed.’
‘It’s the job of adjusters to ensure that that they pay every single penny that (policyholders) are entitled to,’ Merlin said. Vendors ‘are not going to tell you all the benefits that you may have coming to you.’
For example, Merlin said a policyholder who suffered damage to a custom home may be entitled to have an architect oversee the contractor’s work. Policyholders whose homes are destroyed may be able to change the design of the structure by contributing their own funds to the reconstruction. Policyholders may not learn that they have that flexibility if the insurer sends out a vendor instead of a licensed adjuster, he said.
Jonathan Held, chief executive officer J.S. Held, said he appreciates Merlin’s plug for his company. The admiration is mutual. Held said Merlin is a friend.
Friend or foe, I am typically saying “no, no, no” to the low evaluations of damage made by JS Held. But this misses the point.
Insurance adjusters, whether company or independent, are supposed to make certain that policyholders are aware of all of their rights, are getting monies owed as quickly as possible, and softening the blow of the loss. Claims management is supposed to have a sufficient number of adjusters who, with adequate authority based on training, experience ,and trust, approve benefit monies so that the policyholder’s anticipation of prompt payment is delivered. That is good faith claims handling.
What I described is not what is happening. It is not JS Held’s fault. It is the “bean counters” fault. They make claims delay. They desire that claims expenses are reduced by not training claims adjusters so that they can have authority and can be trusted by their own peers.
I did not just make this up. Read the three-part series run by the insurance industry Claims Journal that made these articles about this topic in:
- Outsourcing Claims Functions
- Trend of Claims Outsourcing Driven by Finance Execs, New Managers
- Risks of Claims Outsourcing Include Vendor Control, Brain Drain
For policyholders, we just want the insurance industry to train people to take care of them and understand how the product is supposed to help the policyholder and provide prompt payment rather than a fight. The industry sells a product that they should understand requires them to promptly help the policyholders get all the benefits they deserve.
Does anybody disagree with my last sentence? If not, why is this not happening?
On another note, Steve Badger has had so much trouble with me that he wants an even bigger show stomping yours truly and has added Jon Held to his side while adding Jonathan Wilkofsky to my side as we debate trends in the appraisal process at the upcoming Windstorm Insurance Conference. This is a highlight fight to the death you do not want to miss, even if it turns out to be virtual.
We will discuss these topics shortly on Tuesday at 2 with Chip Merlin. I have two guests and hope you can join us. Here is the link for this afternoon’s session.
Thought For A Tuesday Afternoon
Creativity is a highfalutin word for the work I have to do between now and Tuesday.
Like the 50 states, the U.S. Virgin Islands allows policyholders to recover through multiple avenues, in the event of an insurance company’s refusal to pay a valid claim. Similarly, the USVI also allows a policyholder to bring a bad faith claim in addition to a breach of contract claim. Continue Reading Insurance Bad Faith in the Virgin Islands: How To Properly Plead Insurance Claims Misconduct in The Virgin Islands
Deductibles are an issue in all property insurance claims. Policyholders hate to pay them but love the discount in policy price when a higher deductible is part of the policy. I wrote about a new deductible financing product in High Deductible? Try FundMyDeductible.com. Some questioned whether this was proper and what the insurance industry response would be. Continue Reading Insurance Industry Adopting Deductible Financing and Deductible Payments Over Time
Auto-Owners has begun a sad trend of suing its insureds and alleging that the insured’s contractors and/or public adjusters are fraudulently inflating prices. Auto-Owners is levying these accusations even though its insureds’ contractors and/or public adjusters are also using Xactimate to estimate the costs of repair to reach a lump sum agreement. In taking this drastic step, Auto-Owners and its attorneys confusingly assert Xactimate results is fair and reasonable pricing for them, but results in fraud when its insureds’ contractors and/or public adjusters produce an estimate utilizing the same software. This trend is both shocking and concerning for Auto-Owners’ insureds. Continue Reading Auto-Owners Utilizes Xactimate to Draft Claims Estimates, But Argues Fraud When its Insureds Do the Same