After Hurricane Georges hit Puerto Rico in September of 1998, many policyholders considered that their claims were unfairly denied due to the ambiguous language in their policies. The main issue was that the policies did not have a specific deductible language for hurricane damage. If the policy did not have specific deductible language for hurricane, the insurance companies would apply the wind damage deductible but, in some claims, they applied the deductible classified under “basic damages.” Many of the policyholders filed complaints in the Insurance Commissioner’s Office against the insurance companies for the ambiguity in the language related to hurricane damage deductible. Some of those cases were then appealed. Below is what the Court of Appeals of Puerto Rico held in United Surety & Indemnity Company v. Insurance Commissioner of Puerto Rico,1 regarding this issue. Continue Reading Is it Correct for Your Insurance Company to Consider Windstorm Damage Synonymous with Hurricane Damage?
A policy is a contract and should represent the clear intent of both parties under the agreement. But what happens if what was intended to be covered under a policy is not actually described in the policy? Continue Reading Can An Insurance Claim Be Denied If The Policy’s Property Description Does Not Match The Property That Has Been Under The Same Insurance For Years?
The response is no, you can’t individually request reconsideration on behalf of your Condominium or as an individual for a decision made by a Board of Directors of a Condominium if you are not a named insurer under the policy. Continue Reading Can I Request An Insurance Company Reconsider Their Hurricane Insurance Claim Offer That Was Accepted By The Board Of Directors Of My Condominium?
La Gobernadora de Puerto Rico decretó una Orden de Cierre el pasado 16 de marzo de 2020, como medida de prevención para evitar contagios por el Coronavirus. Muchos negocios y empresas público/ privadas con excepción de aquellas ya señalados por la Gobernadora se verán afectadas. Continue Reading ¿Cómo Afectará La Orden De Cierre En Puerto Rico Mi Reclamación Al Seguro?
The Governor of Puerto Rico decreed a “Closure Order” or lockdown beginning on March 16, 2020, as a preventive measure to avoid contagions by the coronavirus. Many businesses and public/private companies, with the exception of those already indicated by the Governor, will be affected. Continue Reading How Will The Lockdown Order In Puerto Rico Affect My Insurance Claim?
Insureds have the right to clearly understand the reason why their claim has been denied, delayed, or underpaid. Insurers have the duty to explain how they determined their adjustment and payments. Continue Reading What Constitutes a Promptly Reasonable and Proper Explanation From My Insurance Company?
In the last two weeks, Puerto Rico has experienced earthquakes that have caused significant damage to homes and buildings, especially in the southwest area of the island closest to the earthquake epicenters. Many of these properties have collapsed and others are under dangerous conditions. The government has asked the people to abandon homes that are not safe, and the Governor declared a State of Emergency due to the seismic activity continues in Puerto Rico. Continue Reading Can My Insurance Company Deny Coverage If I Vacate My House After an Earthquake?
As Hurricane Maria insurance claims continue to be litigated, we begin to see how trial courts in Puerto Rico are evaluating case by case the insurance code’s amendments such as the appraisal process. It has been a year since Puerto Rico’s Insurance Code was amended and one of the significant changes made was under law 242-2018,1 which added an “appraisal process” as an alternative to solve insurance claims. These and other amendments were discussed in my blog published on December 5, 2018, “Puerto Rico Approves Amendments to the Insurance Code to Protect Policyholders and Improve Claim Handling Procedures.” Continue Reading Can I Litigate An Insurance Claim During An Appraisal Process In Puerto Rico?
Mientras se continúan litigando muchas de las reclamaciones al seguro por los daños ocasionados por el Huracán María, observamos como los tribunales comienzan a evaluar y aplicar en cada caso las enmiendas realizadas al Código de Seguros de Puerto Rico tales como el nuevo proceso de “appraisal”. Ya ha pasado un (1) año desde la enmienda al Código de Seguros de Puerto Rico que incluyó como uno de sus cambios significativos bajo la ley 242-2018,1 el proceso de “appraisal” como alternativa para solucionar reclamaciones al seguro. Ésta enmienda junto a las demás fueron discutidas dentro de mi “blog” publicado el 5 de diciembre de 2018, titulado “Puerto Rico Aprueba Enmiendas Al Código de Seguros Para Proteger A Los Asegurados Y Mejorar Los Procedimientos Para Solucionar Reclamaciones”. Continue Reading ¿Puedo Radicar Acción Judicial Sobre Una Reclamación Al Seguro Tras Haber Iniciado Un Proceso De Appraisal?
The Puerto Rico Insurance Code provides that the right of subrogation is “[t]he right of an insurer to recover damages who has been called to pay an insured under his policy.”1 Under this law, this right arises once the insurance company makes a payment to the insured. The Supreme Court of Puerto Rico has expressed that this provides a legal replacement mechanism whereby an insurance company replaces the insured person in the exercise of the actions or rights that it has against the person causing damage.2 In other words, the right of subrogation of the insurance company arises when it pays the insured; it is the payment that makes the insurer a creditor through subrogation.3 Continue Reading When Does a Subrogation Clause Apply?