Do you remember the post, Church Mutual Found To Be Systematically Underpaying Claims By a Federal Judge and Engle Martin Grossly Underestimated the Loss? Guess who was found guilty of engaging in unfair insurance claims practices last week? Church Mutual.1 Why would any church subject its parishioners to such unholy claim delays, denial, and underpayment?
Continue Reading Church Mutual Is Not So Holy When It Comes to Good Faith Claims Practices
Consider a scenario where a structure, such as a brand new home, is completely destroyed by a fire just a day after the homeowner moves in. In this instance, the replacement cost, which undeniably encompasses the general contractor’s overhead and profit, should be a direct reflection of the actual cash value. This is because, as per the given example, there has been no depreciation to the property.
The principle of indemnity has been a pivotal topic in insurance cases and treatises, especially in discussions about the meaning of ‘actual cash value’ in policies before the emergence of what are commonly referred to as so called ‘replacement cost’ policies, which dominate the market today. The term ‘so-called’ is deliberately used here to underscore a key aspect of most replacement cost policies: they typically pay only the actual cash value until the actual replacement occurs. This is highlighted in the paper, The Indemnity Principle: From a Financial to a Functional Paradigm, which delves into the historical inadequacies of actual cash value policies in fulfilling policyholders’ needs. It underscores the necessity for a new kind of insurance product, one that guarantees sufficient funds to cover the full cost of replacement or repair as needed. This paper noted:
Property loss prevention and associated laws are often perceived as modern endeavors designed to navigate the complexities of contemporary insurance risk management. However, these concepts are far from new. They are deeply rooted in American insurance history and have evolved to protect individuals and businesses from unforeseen losses. The essence of property loss prevention lies in the proactive measures taken to minimize risks and safeguard assets, a practice as old as property ownership itself.
Continue Reading Property Loss Prevention and Laws Are Not New Ideas But Necessary
A recent filing1 by my friend and colleague Jeff Raizner certainly brings home a concern that insurance companies and their lawyers want a stacked deck to win at any cost when it comes to arbitration. State legislators and insurance commissioners need to get control of surplus lines carriers. Otherwise, their state and federal anti-trust exemptions should be stricken. Making policyholders apply laws other than their forum state and arbitrated losses in faraway places is an abuse, as noted in Arbitration Clause Requiring New York Law and New York Arbitration Cited as Avoidance of Florida Lawsuit—Another Instance of Surplus Lines Insurer Abuse in Florida, and Surplus Lines Carriers Select Arbitration and Choice of Law in New York to Pay Less Coverage and Less on Claims.
Continue Reading Are Insurance Arbitrations Fixed for Insurance Companies?
If the facts are true, a lawsuit filed by Lloyd’s America against a Texas public adjuster1 will be placed in the truth is stranger than fiction category.
The insurance claims industry is in a constant battle to prevent policyholders and the public from knowing all the bad faith actions insurers do to delay, deny, and underpay claims. Like any bad actor, secrecy of the wrongful action is a core component to prevent accountability. We noted this motive for secrecy in Trade Secrets: Dynamite Discovery Decisions, Part 11.
Dan Ballard is at the Professional Public Adjuster Association of New Jersey (PPAANJ) Fall meeting, making a presentation about “Everything New Jersey.” One case he highlights in the presentation is from a hail damage case where “cosmetic damage” was an issue.1 The trial court ruled that the interpretation of the policy would be in favor of the policyholder, although the insurance company’s expert would be able to attempt to prove that hail had nothing to do with the loss:
Continue Reading Cosmetic Damage Hail Issues—Biased Engineering Reports and Bad Faith
Transparency is fundamental to fostering honesty in any industry, particularly in insurance, where trust is paramount. Advocating for fairer claims treatment raises a crucial question: why aren’t insurance companies required to disclose their claims files to their policyholders? If insurance adjusters are conducting their duties with integrity and in good faith, the sharing of these records should be standard practice. Such transparency would not only bolster trust between insurers and policyholders but also promote accountability. It would enable policyholders to have a clearer understanding of the claims process, strengthening the relationship and ensuring a more equitable and transparent claims resolution.
Continue Reading Laws Should Allow Policyholders to See the Insurance Claims File
There was no wind at the Sarasota Sailing Squadron yesterday morning. I was hoping for two more sailing races to improve my tied-for-6th place position when the race committee canceled any of those hopes. A couple of minutes later, attorney Jeff Carter texted me a photo from Panama City, Florida, of the St. Andrews Yacht Club ablaze. It burned down early Sunday morning. There is a piece of me that was lost in that fire. I am now left kicking myself for not doing something I tell everybody to do.
Continue Reading St. Andrews Bay Yacht Club Burns Down—A Lesson For All