This reminds me of a well-known phrase my mother used to say to ensure I knew I could never get away with well-organized mischief without her knowing. The saying goes: “You can’t pull the wool over the wool puller’s eyes.” Many carriers try their darndest to do just that: pull the wool over their own policyholders’ eyes without raising an eyebrow. Not that policyholders are the wool pullers, but you catch my drift.
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I’ve said it before, and I will say it again. My favorite policy exclusions carriers cite to deny property damage claims are wear, tear, and deterioration, improper workmanship, and construction defect. Do you know whether your state is a concurrent causation state? This could mean the difference between coverage and no coverage for a loss.
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The reasonable expectations doctrine could be outcome determinative in coverage disputes in the Tar Heel State. Two doctrines courts often consider when analyzing policy interpretation are the doctrines of (1) contra proferentem and (2) the insured’s “reasonable expectations.” North Carolina state courts embrace the doctrine of contra proferentem while its adoption of the reasonable expectations doctrine is more limited. The doctrine of contra proferentem is one of contract interpretation and construes any ambiguity in the contract against the party who drafted the contract. North Carolina state courts apply this principle in policy interpretation. Courts look to the plain meaning of the contract. Strict construction applies unless there is an ambiguity. In the property insurance context, North Carolina state courts use this rule to interpret policy terms liberally in favor of the policyholder and strictly against the insurance company since the insurance company chose the language in the policy.
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My primary role as an attorney at Merlin Law Group is to represent the best interests of policyholders and get all benefits owed following a loss. But, I call it like I see it when approached with debatable inquiries from contractors and restoration companies.
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Prompt-pay laws are important to a policyholder’s rights to recover insurance benefits following a wrongful denial or delay in payment of a property damage claim. Prompt-pay laws vary from state to state. The implementation of statutory prompt-pay laws is critical to a policyholder’s recovery following a devastating loss.
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“The Department of Insurance was created to protect the insurance consumers, public interest, and insurance marketplace by ensuring the solvency of insurers, enforcing and implementing the insurance laws of the state, and regulating the insurance industry in an efficient, courteous, responsive, fair, and equitable manner.”
—The South Carolina Department of Insurance Mission Statement
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Michigan policyholders are entitled to timely payment of property insurance benefits. Many insurers take extraordinary measures to delay, deny, and underpay claims leaving policyholders in vulnerable positions. An insurance company’s statutory responsibility to pay interest on delayed claim payments incentivizes insurers to promptly settle viable property insurance claims.
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Fees may not be recoverable under a condominium association policy to an insured condominium association or its property management company after a loss. The Board should carefully consider fee percentages agreed upon in a management agreement to assist the association through a property insurance claim.
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In two recent blog posts, I discussed Florida statutory interest which imposes a statutory duty on insurance carriers to pay interest on delayed payment of insurance proceeds.1 If you missed either blog post, then you find them here:
Possibly. Many policies exclude or limit coverage for interior water damage unless there is evidence of a wind-created opening in the roof, outside wall, door or window where rain entered the home or business. I often see carriers deny coverage in a manner similar to the below scenario:
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