It is not uncommon in a condominium complex for a unit to be damaged due to a failure in a neighboring unit. With units tightly packed together, water can quickly flow from one unit to another, causing damage along the way. Determining the cause of damage is often the first step in evaluating an insurance claim. If evidence relating to the cause of the damage, such as maintenance records or a breached window or door, is owned and controlled by a third-party, when is there a duty imposed on the third-party to preserve the potential evidence?
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Almost every federal court requires parties to mediate their case before trial. The purpose of mediation is to place all interested parties in the same room to determine whether an amicable resolution of the case is possible.

A mediator is an individual who works with the parties to highlight strengths and weaknesses of the parties’

Photograph taken during the Waldo Canyon Fire

After a fire loss you would expect your insurance company to complete a full and fair adjustment of the damages, right? So did the Normans, however, as admitted by a corporate representative of State Farm, “had State Farm not received additional information [from an industrial hygienist], the payments made in July 2012 would have been the settlement of the Normans’ claim” stemming from smoke and soot damage to their home as a result of the infamous Waldo Canyon fire of 2012 in Colorado.1 Eventually State Farm did pay a lot more in covered damages in May of 2013.
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The National Association of Insurance Commissioners (NAIC) drafted a model law named the “Unfair Claims Settlement Practices Act.” These standards include fair and rapid settlement of claims as well as the procedures and practices constituting unfair claim adjustment practices. Section 9 of the Model Act outlines language pertaining to the replacement of undamaged items when the damaged items cannot be replaced in a way that achieves a reasonably uninform appearance.
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The Florida Third District Court of Appeal recently found that when a policyholder failed to substantially comply with a post-loss obligation, the insurance company is presumed to have been prejudiced by the breach.1 The burden then shifts to the policyholder to show that the failure to comply with a post-loss obligation did not prejudice the insurance company. The question remains: What have courts found to satisfy a policyholder’s burden of showing that reporting a claim late did not prejudice the insurance company?
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Policyholders who have delayed and underpaid insurance claims from Hurricane Michael may think about taking a page from the “how to file a complaint” playbook from an Old Mutual policyholder who sent the dead body to the claims department to collect on a funeral insurance policy.
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Governor Gavin Newsom recently signed Senate Bill 240, which enacts new laws that regulate out of state independent adjusters. The law also addresses claim adjustment for declared emergencies. The new laws, described more fully below, became effective on October 3. 2019.
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(NOTE: This guest post is by Barry Zalma, Esq., CFE.1 Barry Zelma is a prolific writer and scholar in the field of insurance. I have purchased numerous publications from Barry. I am currently reading a book on legal ethics he wrote, The Little Book on Ethics For The American Lawyer, which may be his finest work and that is saying a lot after reading his treatises on insurance law and adjustment. I encourage you to read this very thorough post and consider purchasing Zalma’s publications for your reference library. – Chip Merlin.)

A Policyholders Lawyer’s Take on the Obligation to Read

In its blog the Merlin Law Group cites a small portion of a lengthy Hastings Law Journal article written by Professor Chuck Knapp.2 Dr. Knapp did not like the use, by appellate courts, of the concept that there is a duty to read (DTR) an insurance policy.

The blog post by Chip Merlin proposed that Dr. Knapp’s proposals would allow the court to rewrite the terms and conditions of the policy. Dr. Knapp did not do that but spent many pages explaining why the word “duty” should not be used and the exceptions available to the courts when interpreting an insurance contract as well as other contracts.
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