Frequent readers of our blog know that property insurance losses center on the insurance policy. The Policy provisions are the most fundamental and are always important in a breach of contract case. Despite the importance of the policy, you would think that insurance company adjusters, independent adjusters, and the representatives working on insurance claims would also have the insurance policies at their fingertips when working on a claim, but that is often not the case.
While we have found adjusters rarely consult the subject policies (or even have access to them), it may be because the insurance companies often don’t express the importance of the insurance policy provisions when handling claims, or they have trained the adjusters to use the policy as a sword. In two recent depositions, carrier representatives have testified that a certain policy provision is a reason for non-payment and as part of their argument, but they never mentioned this specific language or requirement to the policyholder. The letters sent from the insurance company did not reference or quote this so-called reason for not paying more on the claim. In one case, the insurance company didn’t even know if it actually mailed a letter to the insureds after the claim.
The representatives have taken the position that:
- The insureds should have read their policy
- The insureds should know what provisions are in their insurance policy
- The insureds should have asked for another copy of their policy
- The company didn’t have to proactively offer a copy of the policy or the important terms.
Did these representatives have an expectation that insureds memorize every random portion of their insurance policy before a loss? Did this insurance company expect the insured to retain the policy portions that came in the mail piecemeal for the last eleven years and be able to understand how the various provisions were to be interpreted? Did the insurer expect that an insurance policy was not damaged or destroyed in a fire loss.
My hunch is that it was a lawyer who “found” the policy provision that the company would rely upon once the claim was in litigation. Had this language been relied upon during the claim process it would have been brought to the insureds attention, but since the policy language wasn’t found in the final claim letter or any emails between the parties, this seems to be a new reason to attempt to avoid payment.
Since many carriers are inadequately adjusting claims, especially in the wake of catastrophes, an insured may decide to be proactive when faced with an insurance claim. Making a request for a complete copy of the insurance policy is a good way to start. Some companies now allow you to download your policy from a portal and some agents can send you complete insurance policies in just a few clicks via email. No matter how you acquire the operative insurance policy (the one in effect for the claim you are dealing with now) you need to make sure you have the complete policy. Often, homeowners think they have a copy of the entire insurance policy but when a lawyer or a public adjuster takes a glance, it is clear that forms with vital information are missing, and all the insured has is his or her renewal documents.
United Policyholders offers help insureds who want to make sure they have a full and complete policy. United Policyholders is a great organization we have posted about in
- Rutgers Law School and United Policyholders Launch Essential Protections for Policyholders Project
- Empowering the Insured – United Policyholders Website Provides Claims Handling Tip
- United Policyholders Continues its Good Work
UP’s sample letter will help you get a certified copy of your insurance policy. Reasons to have the complete certified copy are many but will help greatly when trying to respond to the insurance company’s requests during a claim.
Having your Policy—the contract that binds you and the insurance company—won’t always solve your problems but this is the document that matters most. But now you have to read it and understand what you just read! This can be a stressful and confusing process, but you don’t have to go it alone. Dedicated adjusters can be hired specifically to help you understand the policy or you can ask a qualified lawyer handling first party property loss for policyholders when you need help. Without a doubt it is better to seek assistance with the duties and obligations during a claim process than be confused or travel down the wrong path because you are not understanding the process.
