The recent Colorado wildfires have highlighted a countrywide claims issue for residential homeowners having total losses—most are far underinsured. Insurance agent commentator Bill Wilson recently published a blog on the topic: Another Cautionary Tale of Underinsurance. While there are myriad reasons for this epidemic of homes being underinsured to replacement value, Wilson’s post noted in part:

One would think that, among the parties involved in the insurance process – insureds, insurer, and if an agent was involved, the agent – someone would have questioned the large gap between purchase price and homeowners Coverage A limit.

The insurer is identified in the story and my first thought was that the insurer needs to reimagine their ‘You only pay for what you need’ sales pitch. Maybe, ‘We only pay for what you buy’ or ‘You only pay for what you mistakenly bought.’


Continue Reading The Wildfire Underinsurance Gap

Merlin Law Group attorneys Chris Mammel and Tamara Chen-See won an appraisal case pending before the 10th Federal Circuit Court of Appeals.1 The court ruled that the factual determination of damage to brick siding caused by a hailstorm is a factual matter for appraisal and not a coverage issue. The ruling was similar to the recent Connecticut Supreme Court holding involving matching noted in Matching is a Factual Determination and Can Be Resolved by Appraisal.
Continue Reading Insurers Cannot Escape Appraisal Arguing Factual Determinations of Damage Create Coverage Issues

United Policyholders (“UP”), a non-profit 501(c)(3) whose mission is to be a trustworthy and useful information resource and a respected voice for consumers of all types of insurance in all 50 states, launched its national Restoring the Insurance Safety Net Coalition (RISC) initiative in 2020. The purpose of this initiative is to reverse the trend of insurance policy re-writes that are shrinking coverage for damage to homes. One of its stated approaches is to identify wording that is causing protection gaps. I encourage you to read more about the initiative at uphelp.org/risc.
Continue Reading Beware of Avoidable Coverage Gaps with California FAIR Plan Companion Endorsements

As mentioned in my earlier blog post, How to File a Complaint with the Insurance Commissioner Office About Your Delaying, Denying, and Bad Treating Insurance Company, Article 27.164 of the Puerto Rico Insurance Code requires an insured to notify the Insurance Commissioner of any incompliance, delay, unpaid, under paid or unjust claim management by the insurer prior to filing suit in court. This law applies to Hurricane Maria claims and all insureds that did not file suit prior to the effective date of Article 27.164 must to comply with this new requirement.
Continue Reading Insurance Claim Notifications Prior to Filing Complaint

With cold temperatures gripping my home State of New Jersey, my mind (and research) brings me to warmer locations. In a recent case,1 a federal court in Georgia held that an insured’s 11-month delay in filing a claim after a loss was not justified and provided the insurer with a reasonable ground to deny the claim.
Continue Reading Is Eleven Months Too Long a Delay in Filing a Claim with an Insurer After a Loss?

Florida insurance companies have been notorious for increasing rates and filing news articles at the start of legislative sessions that support their legislative propaganda efforts. The typical scapegoats are lawyers and contractors. Somebody from the Attorney General’s office and newspaper reporters should call the lawyers for a contractor regarding a complaint1 filed and follow with an investigation about a lawsuit which states:
Continue Reading Lawsuit Alleges Field Adjusters Stated Under Oath That Florida Based Insurer Commanded That Reports Be Altered To Reduce Or Deny Claims—Did Insurers Do This To Dupe Florida Legislators?

What does it mean to be a Policyholder’s Advocate™? At Merlin Law Group, it means not only direct representation of policyholders whose claims have been delayed, denied, or underpaid, but also assistance through education, training, and community sharing that indirectly benefits policyholders. To accomplish the latter, Merlin Law Group is proud to sponsor events that indirectly assist policyholders by improving the insurance restoration industry. In other words, help those who help policyholders. To this end, Merlin Law Group is proud to continue our sponsorship of April Hall’s Storm Restoration Contractor Summit (“SRC Summit”) in 2022. As The Policyholder’s Advocate™, we support general contractors and the work they do for policyholders recovering from a storm or catastrophe.
Continue Reading Do Not Miss April Hall’s Storm Restoration Contractor Summit on January 21-23

The Connecticut Supreme Court ruled that matching is a factual determination rather than a legal coverage issue and can be resolved by the appraisal process.1 This is a huge win for policyholders. I want to give a big shout-out to Merlin Law Group attorney Shane Smith who volunteered her time to work on this case by filing an amicus brief2 on behalf of United Policyholders.
Continue Reading Matching is a Factual Determination and Can Be Resolved by Appraisal