Back in October of 2010, I had the privilege of attending the 15th Annual Insurance Law Institute in Austin, Texas. Over the course of the program, I listened to varying opinions on both sides of the insurance debate. Attorney James K. LaRoe, of Dallas, Texas, compiled a list of the top commercial hurricane damage claim disputes from a Texas perspective. Here, I present to you the top five commercial and hurricane Ike damage claims as presented by Mr. LaRoe.
1. Whether rain that entered and damaged the property was the result of physical damage to the property caused by wind.
2. Whether the property damage was caused by an excluded peril such as storm surge.
3. Whether the water damage was caused by both a covered peril and an excluded peril (known in the legal world as “concurrent causation”).
4. Whether a wind deductible applies and reduces the damage claim.
5. Whether the co-insurance applies, and, if so, how much does it affect the claim?
With this data, we are able to peer into the mind of the insurance defense lawyer. And, as you probably expected, insurance defense lawyers tend to have only one thing in mind: reducing the amount of the claim. I say “reducing the amount of the claim” instead of “eliminating the claim.” because when matters reach litigation, there is usually some real damage to a property that was caused by a covered peril. Sure, some insurance defense lawyers attempt to eliminate the entire claim via numbers one and two above, but usually those insurance defense lawyers are unsuccessful or the parties reach a settlement agreement prior to trial.
Unfortunately, litigating these disputes can take a substantial amount of time and expense. Policyholder advocates who truly have their clients’ best interests in mind try to obtain owed benefits without litigation first so their clients can fix their properties as best and quickly as possible. Even so, most claims can take anywhere from 6 months to 2 years to resolve.