Practicing solely in the field of first-party claims and studying, debating, and analyzing with others within Merlin Law Group raises the bar and makes our law firm members better at what we do. We also study other cases to learn winning techniques and what to avoid. Bad faith cases are never easy. But I was somewhat surprised while studying a recent Pennsylvania court’s decision to go out of its way to find delay and underestimating “reasonable.”1 I wonder if the court would have ruled the same way if an insurer stopped his paycheck and prevented him from making rulings for 17 months?
Continue Reading Pennsylvania Bad Faith Law and Learning From Others Cases

At the Spring 2021 Professional Public Adjusters Association of New Jersey meeting, I presented a course with Engineer Bill Halkiadakis entitled “How to Select and Use Engineering Experts in Property Claims.” The presentation included a case study on a claim where the insureds were renovating their property to add an additional story and a tarp was placed on the roof. While the tarp was on the roof and before the additional story was added, the tarp was blown off causing extensive damage to both the building and contents contained inside the residence. The carrier, Nationwide, applied coverage to the building component of the claim, but denied the contents portion.
Continue Reading Is a Tarp Considered a Roof? Western District of Pennsylvania Rules a Jury Should Decide

Greene v. USAA1 is probably the most cited case by first-party insurance carrier attorneys in Pennsylvania. It is an appellate level case that centered on whether an insurance carrier is required to replace a roof when the existing shingle is no longer in production, but shingles of “similar color, texture, function, and shape” are available. In Greene, the Superior Court of Pennsylvania (appellate) held that using shingles similar to the damaged shingles in function, color, and shape satisfied the insurer’s obligation to pay for repair or replacement with like construction.
Continue Reading Repair vs. Replacement in Pennsylvania

Below is testimony I elicited from a Nationwide Insurance representative during a recent deposition:

Q. Are you familiar with Overhead and Profit?

A. Yes.

Q. Okay. And when does Nationwide include overhead and profit in its estimates?

A. When it is reasonably necessary to assume that a general contractor is needed to facilitate the repairs.

Q. Okay. Now, going to the back of this estimate, it appears that Nationwide did not apply overhead and profit in terms of the estimate that It produced. Can you explain why Nationwide decided not to include overhead and profit on this estimate?
A. Can we – can I talk to counsel a second?

(A discussion between the attorneys was had wherein the witness was instructed to answer the question)

A. Okay. All right. It appears that we missed it.

Q. Okay.

A. Yeah There’s – there’s no reason why profit and overhead would not have been included on this estimate.

Continue Reading A Refresher on Overhead and Profit in Pennsylvania: Mee v. Safeco

What do I do and think about while waiting for crazy path Hurricane turned Tropical Storm Eta to flood my home in Tampa? How about being in New Jersey where my public adjuster friends will be meeting next week with what appears to be a ‘can’t miss” educational seminar.
Continue Reading Public Adjusters in New York, New Jersey, and Pennsylvania Must Attend the PPANJ Educational Meeting Next Wednesday, November 18

Shawnee Tabernacle Church (“Shawnee”) is a Congregation located in Monroe County, Pennsylvania. The church was insured by GuideOne Insurance (“GuideOne) with a policy that included the following language under the title “Pennsylvania Changes”:

Notice of Acceptance or Denial of Claim

Except as provided in 3 below, we will give you notice, within 15 working days after we receive a properly executed Proof of Loss that we:

A.) Accept your claim.

B.) Deny your claim; or

C.) Need more time to determine whether claim should be accepted or denied.

1) If we deny your claim such notice will be in writing and we will state any policy provision, condition or exclusion used as a basis of denial. If we need more time to determine whether your claim should be accepted or denied, the written notice will state the reason why more time is required.

2.) If we have not completed our investigation, we will notify you again, in writing, within 30 days after the initial notice as provided in i.e., above and thereafter every 45 days. The written notice will state why more time is needed to investigate your claim and when you may expect us to reach a decision on your claim.

3.) The notice procedures in 1 and 2 above do not apply if we have a reasonable basis, supported by specific information, to suspect that an insured has fraudulently caused or contributed to the loss by arson or other illegal activity; under such circumstances, we will notify you of the disposition of your claim within a period of time reasonable to allow full investigation of your claim, after we receive a properly executed Proof of Loss.

Continue Reading Pennsylvania Bad Faith Archives: Shawnee Tabernacle Church v. GuideOne Insurance

In Pennsylvania, construction is only able to continue for emergency repairs, construction of health care facilities, and for a select few companies that have been able to attain a waiver. In fact, Pennsylvania is the only state to shut down all active public and private construction sites.1
Continue Reading Builder’s Risk Policy – Why It Might Be a Good Time To Make Sure You Have One In Pennsylvania

Pennsylvania has followed five other states to propose legislation eradicating the “virus” exclusion for small businesses having commercial business income policies. Insurance company lobbyists are fighting this legislation in numerous ways. One is the argument that such legislation, if passed, would be unconstitutional.
Continue Reading Coronavirus Insurance Coverage Update April 8—Pennsylvania Files Proposed Legislation, An Official “Trickle” of Lawsuits is Filed and Is There A Test That Finds Covid-19 on Property?

The Western District of Pennsylvania recently had to answer the question of whether a raccoon’s actions in destroying a property can be considered vandalism or malicious mischief under an insurance policy. The trial court found that “raccoons and their companions in the animal kingdom cannot formulate the intent needed to engage in vandalism, malicious mischief, or any other criminal or actionable conduct.”1
Continue Reading Can a Raccoon Engage In Vandalism Under an Insurance Policy?

Merlin Law Group previously blogged about Konrad Kurach v. Truck Insurance Exchange,1 where an appeal was recently filed at the Pennsylvania Supreme Court on this question:

Did the Superior Court err as a matter of law in finding that the limitation of payment of General Contractors Overhead and Profit from actual cash value in a replacement cost policy, although violative of binding precedent, was nonetheless valid and enforceable?
Continue Reading United Policyholders Files Amicus Brief on Overhead and Profit in Pennsylvania