Public adjusters sometimes find themselves in disputes with their own clients. Public adjusters should be paid fees for services they perform as promised in their contracts. Failing to provide those services or performing services which harm rather than help the policyholder will invariably cause the policyholder client to rightfully challenge those fees. Continue Reading Public Adjuster Not Entitled to Fee When it Fails to Prove What Amounts Were Owed

As mentioned previously in my blog post, Accord & Satisfaction: Will My Insurance Claim Be Dismissed If I Deposit A payment (July 21, 2019), many policyholders in Puerto Rico that received payments deposited them without being aware of the consequences of accord and satisfaction. This has also been a common issue on many complaints filed in court and the reason many cases are being dismissed. Fortunately, The Appellate Court (Panel V) on October 24, 2019, just reversed the decision in Negron v. MAPFRE PRAICO Insurance Company, regarding Accord and Satisfaction. Continue Reading Merlin Law Group (PR) LLC, Wins Accord and Satisfaction Appeal

On October 2, 2019, the U.S. District Court for the Middle District of Florida ruled that a dispute between an insurance company and its policyholder should proceed to appraisal despite insurance company’s allegations that it had discovered what it called evidence of fraud. Continue Reading An Insurer’s Potential Fraud Claim Against Insured Was “No Reason to Stop or Stay Appraisal,” Court Rules

On Saturday October 12, 2019, several decks of upper floors of the Hard Rock Hotel & Casino under construction just off Canal Street in New Orleans suddenly collapsed. As emergency personnel were engaged in the immediate efforts to rescue and aid the crews working at the hotel site, the City of New Orleans was busy implementing its emergency response teams. Continue Reading New Orleans Hard Rock Hotel & Casino Construction Collapse Triggers Time Element Coverages

The United States District Court for the District of Minnesota in Selective Insurance Company of South Carolina v. Sela,1 recently addressed whether the implied covenant of good faith includes a broader obligation to act “reasonably” and “properly” in making a decision about whether to pay benefits. Sela had submitted a claim for hail damage to his home. Selective investigated the claim and filed suit alleging that Sela made fraudulent misrepresentations and was not entitled to coverage. Sela counterclaimed for breach of contract, breach of the implied covenant of good faith and fair dealing, and bad faith, pursuant to Minn. Stat. §604.18. Continue Reading Does the Implied Covenant of Good Faith and Fair Dealing Impose a Broad Duty on Insurers to Act “Reasonably” or “Properly” in Handling Claims?

Chip Merlin and FAPIA Executive Director Nancy Dominguez

The largest public adjuster conferences are with the Florida Association of Public Insurance Adjusters (FAPIA). Nancy Dominguez is the Executive Director pictured with me at this past weekend’s conference. Two major themes resonated at the conference—insurance protection gaps and forgotten catastrophe-victim policyholders. Continue Reading Insurance Protection Gaps and Forgotten Policyholders are Major Topics at FAPIA

A judge agreed with my view posted in, Did Florida Mistakenly Place an Insurer Into Insolvency, Try to Disqualify the Law Firm That Pointed Out the Mistake and Harm 91,000 Policyholders By Quick and Unnecessary Non-Renewals?

The Florida Department of Financial Services and the Office of Insurance simply made a mess of Florida Specialty Insurance Company’s financial problems and cancellation of policies. Continue Reading Judge Calls Out Florida Department of Financial Services and Office of Insurance Regulation for Improper Liquidation and Unlawful Cancellation of Policies

The answer to the above question on Certificates of Insurance1 is found in another long-awaited answer to a certified question2 that was tendered nearly a year ago from the Ninth Circuit Court of Appeals to the Washington Supreme Court in T-Mobile USA v. Selective Insurance Company of America. The question certified was:

Under Washington law, is an insurer bound by representations made by its authorized agent in a certificate of insurance with respect to a party’s status as an additional insured under a policy issued by the insurer, when the certificate includes language disclaiming its authority and ability to expand coverage? Continue Reading Can a Certificate of Insurance Change the Terms of An Insurance Policy?

In California, a carrier’s bad faith liability includes conduct beyond what is set out in the Insurance Code (statutory) and the Fair Claims Settlement Practices Act regulations. Bad faith conduct is also expressed through case law. Some of this additional bad faith conduct is summarized below. Effectively communicating an insurer’s bad faith conduct is essential to resolving insurance disputes. When you see bad faith conduct, a best practice is to bring the conduct to the carrier’s attention and explain why such conduct is prohibited. Continue Reading Prohibited Insurer Conduct and Unfair Acts Expressed Through California Case Law – Another Quick Guide to Holding an Insurer Accountable