Merlin The Moose is a client favorite at the Chicago Merlin Law Group office. We won him at a charity auction last year. He also led me to some creative research uncovering a problem with market conduct studies and the transparency of property insurance claims procedures many insurers keep hidden from their customers and insurance regulators.

Moose v. Nationwide Mutual Insurance Company1 involved a relatively common action which many long-time insurance agents bring against their captive insurers after the management of the captive insurers change the rules of their relationship. Nationwide Mutual argued the following in the case:

The interest of the policyholders, agents, employees, and the public are best served through policyholder ownership and control of the business. Such control helps to develop and maintain financial soundness of the Companies and provide high quality insurance service at the lowest possible cost. It is, therefore, a policy that the policyholders, through the Companies, shall maintain ownership and control of the business and all policyholder information and such ownership rights shall not be vested with either agents or employees.2

if this is so, why shouldn’t the policyholders be provided all the written claims guidelines which the insurance company is instructing its adjusters to use while adjusting their own property insurance claims? Nationwide and many other insurance companies argue these are “top secret” and never provide them. Yet, the National Flood Insurance Program actually publishes the guidelines for their customers and others to analyze. Citizens Property Insurance Corporation used to publish theirs as well.

Insurance companies are subject to market conduct studies by insurance regulators. Most would think these regulators would not only want to review closed claim files but ask for any documents showing an emphasis, changes to and the actual written claims procedures and directives which insurance company adjusters are being required to follow.

If we had this transparency, wrongful claims practices, like the Farmers “Bring Back a Billion” claims initiatives in the late 1990s may never have come into being for fear of regulatory fine and public embarrassment.

Could you imagine a manufacturer of a product not providing the service and product manual to its customers? No way. Yet, this is exactly what is happening when we allow a property insurance company and claims management to initiate claims procedures which are not in good faith but in only the insurance company’s financial interest.

Quote of The Day

“If you want to go foraging into the wilds of Canada without proper gear, you deserve what you get, even if that happens to include being attacked by an undead moose.”
—Mira Grant
1 Moose v. Nationwide Mut. Ins. Co., No. 5:08CV77, 2011 WL 4368351 (W.D.N.C. Sept. 19, 2011).
2 Id. at *9.