After filing a claim, insurance companies will at times request a substantial amount of information, leaving many Coloradans feeling overwhelmed. However, a failure to respond to the requests (aka “failure to cooperate”), could cost an insured their owed insurance claim benefits. Recently the United States District Court, District of Colorado, discussed this issue in its review of a Motion for Summary Judgment in Cribari v. Allstate Fire & Casualty Insurance Company.1
As Magistrate Judge Neureiter discusses, the Federal District of Colorado has determined that a failure to cooperate may constitute a breach of insurance policy requirements if it causes a material and substantial disadvantage to an insurance carrier in its investigation and adjustment of an insurance claim. But, what is a failure to cooperate and what is a material and substantial disadvantage?
In Cribari, plaintiff was injured in a car accident and filed suit seeking underinsured motorist benefits from her insurance carrier, Allstate, as well as claims for bad faith and unreasonable delay and denial of insurance benefits. Allstate raised a failure to cooperate defense against plaintiff’s legal claims and sought Summary Judgement, stating that she did not fulfill the requests for information that it had sent to her during the claim investigation.
While this case arises from an uninsured motorist benefits, the discussion on the duty to cooperate is applicable in home and commercial property insurance claims as well.
In its defense, Allstate claimed that the plaintiff failed to cooperate because she had not provided all records requested that it alleges were necessary to make the insurance claim decision, and she did not provide certain medical records until after filing a lawsuit. In response to this defense, plaintiff stated that she had substantially complied with all requests made by her insurer by offering a number of the requested documents and records and by providing alternative methods in gathering additional information and records—even going as far as offering to arrange a meeting between her medical doctor and Allstate.
Ultimately, Allstate’s Summary Judgement was denied as the Magistrate determined a number of factual questions should be presented to a jury, leaving a decision on the adequacy of plaintiff’s participation in this case to be determined as well. However, the Magistrate’s assessment was insightful, and I wanted to share a few takeaways that I found beneficial.
First, when you receive requests from your insurance company, do not ignore the request. Like in Cribari, while plaintiff had not provided every document that Allstate requested, she provided a substantial number of documents, and the court viewed that effort favorably.
Second, if you do not fully understand or agree with a request, ask your insurance company to explain what they are looking for and/or seek assistance from an attorney, but do not ignore the request.
The insurance company requests need to be appropriately limited to information that will assist it in making a claims decision, which does not open the door to an investigation of every aspect of your life. Again, like in Cribari, plaintiff offered alternative methods to obtaining information such as meeting with plaintiff’s doctor and provided alternative records to that specifically requested by Allstate, which the court again viewed favorably. Finally, at its simplest level, the duty to cooperate means keeping the channels of communication active and open and documenting your efforts.
The insurance claims adjustment process can be long and time-consuming. After all the time and effort it is likely to require from an insured, do not give your insurance carrier a reason to deny your claim that is entirely unrelated to your loss. Communicate regularly, provide responses, and/or consult legal assistance if the requests become too much to handle.
1 Cribari v. Allstate Fire & Cas. Ins. Co., No. 16-2450, 2019 WL 1296581 (D. Colo. Mar. 21, 2019).