My Red Bank colleague, Dan Ballard, and I recently gave a presentation about Misrepresentations & Mistakes at the 2020 Fall Conference of the Professional Public Adjusters Association of New Jersey (PPAANJ). During that presentation, I discussed New York case law providing that a homeowners insurance policy may be voided if the insured willfully and fraudulently places in the proof of loss a statement of property lost which the insured did not possess, or places a false and fraudulent value upon the articles which the insured did not own.
Continue Reading Incorrect Information Within Proof of Loss Not Enough To Void Insurance Policy

The National Flood Insurance Program is a tough federal insurance program. There is a recent case which was thrown out of court because the policyholder tried to do it himself. [1] It is another example that when FEMA officials say the government Is there to help with your flood claim, you will find out differently very quickly if you disagree with them on anything.
Continue Reading Policyholders Should Immediately Get Professional Help if they Have Any Problems with their National Flood Insurance Claim

Today‘s 2 p.m. EST Livestream features two former insurance company adjusters turned “good guy” policyholder attorneys. Merlin Law Group attorneys Javier Delgado and Etienne Font worked as insurance adjusters in a prior life. Their practical understanding and appreciating what insurance companies and independent adjusters have to do to resolve claims helps in their practice today

The term “replacement cost policy” is a misrepresentation by many insurance companies about the product they are now selling. Insurance regulators should not allow the general public to be duped into buying something which is obviously not what the insurance company is promising. Accordingly, I propose that we should consider that unless minimum standards within a policy are met, insurance companies selling any all-risk replacement insurance are required and must warn that they are selling a Non-Standard Non-Replacement Cost Policy. Insurance products that are deemed to be Replacement Cost Policies in the residential market should at least meet the criteria found in mortgage requirements for federal negotiable mortgages.
Continue Reading Homeowners Insurance Policies Differ—The Need For A Standard vs. Non-Standard Replacement Cost Policy Designation

Ejusdem generis is a Latin phrase that roughly translates as “of the same kind, class, or nature.” Its use is similar to that of noscitur a sociis,1 in that it usually involves a list of terms, but in this case one that ends in a catch-all category. Whether a particular object or event not specifically referenced in that list is subject to the exclusionary function of the listing depends on its similarity to the other items in the listing.2
Continue Reading What Is Ejusdem Generis and How Can it Help Clarify Ambiguous Policy Language If My Insurer Denies Coverage?

Generally, insurance policies in Texas are construed according to the same rules that govern the construction of contracts.1 Insurance policies must be interpreted by reading all sections of the document together.2 This stems from the primary concern of the courts—to enforce the parties’ expressed intent.3 “No one phrase, sentence, or section [of the policy] should be isolated from its setting and considered apart from the other provisions.”4 If part of a policy was read separately from the rest of the document, it would defeat the parties’ intent by excluding the other provisions.
Continue Reading Ambiguity in Texas Insurance Policies

One of my favorite aspects of being a first-party property insurance attorney is being able to pick apart an insurance policy and take a position on the way a certain provision should be interpreted.
Continue Reading Interpreting the Plain and Ordinary Meaning of an Ordinance or Law Insurance Provision; What Does it Mean to “Incur” and When Does this Happen?

Happy Thanksgiving!

Claims Journal published an article earlier this week, The Key to Winning COVID Business-Interruption Claims: Say the Virus is Present, quoting me from last Friday’s Forum at 2. I discussed the Chloe’s Café brief we filed in California,1 and provided a copy to the audience. The press and others must have watched the episode, and they noted:
Continue Reading Friday Forum at 2 Watched by Insurance Media Regarding Business Interruption and Civil Authority Claims

Note: This guest post is by Jamie Glass, a law clerk with Merlin Law Group in our Panama City office.

The local farmers’ market hosts an annual fruit salad competition. The rules of this completion require that only salads comprised completely of fruit may enter, specifically stating that “only apples, oranges, melons, grapes, cherries, and other fruits may be used.” A young, excited chef wishes to enter with her tomato and cucumber salad, but will she be able to? Using the ejusdem generis rule of construction, she can!
Continue Reading The Fruit Salad: Using Ejusdem Generis in Tennessee Insurance Policy Interpretation

Matching of damaged parts of a building is nothing new. This “Give Me Your Walls” episode from the classic Dick Van Dyke Show demonstrates a typical concern most property owners have about the aesthetics of matching property:

Some insurance companies are now selling “swiss cheese” and “cheap” insurance because they specifically say they will