Earlier this month, a California appellate court held that a policyholder can assert a negligent misrepresentation claim against an insurance adjuster.1

In the underlying bad faith suit, the homeowners (the Bocks) sued Travelers for lowballing their claim for property damage caused by a large tree limb crashing into the home and damaging among other things, the chimney, the windows and the home’s interior. As part of the lawsuit, the homeowners also sued the claims adjuster (Hansen) individually for negligent misrepresentation. At the initial pleadings stage, the lower court held that as a matter of law the claims adjuster could not be held liable for negligent misrepresentation. Consequently, the claims adjuster was able to obtain a dismissal. The appellate court said, not so fast. In reversing the judgment that was in favor of the claims adjuster, the appellate court found that when supported by appropriate facts, an insurance company’s agents and employees do have a duty to the policyholder and can be held personally liable for committing an independent tort in the course of handling a claim.

The misrepresentation at issue, at least as alleged by the homeowners, was the claims adjuster informing them that their policy did not cover the cost of the clean up when in fact it did. What I actually found more interesting was the other alleged conduct of the adjuster:

  • When the adjuster arrived at the home to inspect the loss, he told the homeowners that he only had minutes to review the damage, and in fact spent no more than ten to fifteen minutes at the home.
  • Before the adjuster took pictures of the damage, he pushed several branches out of the living room window. When the adjuster was asked why he had not taken the pictures first, he ignored the homeowner as told her to “clean up the mess” and demanded that she clean up the living room.
  • The adjuster also removed the tree limbs leaning against the chimney before taking any pictures.
  • In addition to telling the homeowners that cleanup was not covered under the policy and that they should contact “friends and family members with chainsaws” to clean up the limbs and the mess in the house and backyard.

Assuming that the above is what actually happened, does anyone think that this is a proper claims investigation?


1 Bock v. Hansen, No. A136567, 2014 WL (Cal. App. Apr. 2, 2014).

 

  • Not at all proper, but 100% believable. The adjuster may say he simply wanted a clear photo of the damage, but ZERO excuse for not taking photos of the limbs in place first. This is similar to adjusters and engineers who avoid marked damage on roofs and focus 95% of attention on material and installation defects, nail pops, scuff marks, and everything else not related to the damage being claimed, just so they can later support their denial. Can carrier-side adjusters (and experts/consultants) be similarly sued in FL and other states?

  • What I see is spoliation and/or fraud. I also see that the case could be interesting in that the cause of action against an individual could defeat diversity in Federal Courts. I do not know the law in CA, but we have sued individual adjusters for intentional torts in FL. I do not believe we have been able to sue individuals under a negligence theory. I know at least one FL case prohibits it. Nevertheless, thank you for the information as I will be looking at the case for the reasoning. There is no reason Florida law cannot change. This issue is one that would be beneficial in the process. We all know I.A.s who are really decent folk, but whose job has been chipped away.

  • Adrian Arkin

    P.S. After reading the decision, it appears that the Court likened the negligent misrep claim to an intentional tort. Thus, and similar to Florida law, individual adjusters are not immune to being sued for intentional torts.

  • Chip Merlin

    Mark,

    I agree. There should have been photos of the tree taken from every angle.

    A common adjustment occurrence we find is that some adjusters and especially insurance company experts and vendors take a lot of pictures where damage did not occur and few pictures of damage. This is simple dishonesty because it misrepresents the damage and proof of it.