Merlin Law Group attorney Drew Houghton brought an article, Discovery of Insurer Employee Incentive Plans: Rewarding Employees For Paying Insurance Claimants Less, to my attention. It was written by longtime colleagues Mike Abourezk and Marialee Neighbours. Their article is important and raises one of the fundamental ethical questions of claims management: The role of the claims professional regarding company profit. While insurance companies need to be profitable in the long run, I have yet to see a claims goal that rewards claims managers for making certain that the customer has not had benefits missed and not paid after a loss. Continue Reading Thoughts On Claims Incentive Goals—Where Is the Goal To Not Overlook All Damages?
A recent legal skirmish under a builders risk policy contains significant discussion about Georgia law allowing insurance companies to shorten the time to file a lawsuit. The trial court Order1 not dismissing the lawsuit despite a one-year limitation, and the brief of the policyholder are attached because they are worthy of study if you find yourself in a Georgia situation where the insurer is relying upon a statute of limitation defense. Continue Reading Georgia Allows Property Insurers to Shorten Statute of Limitations But There Are Exceptions
Exclusion provisions in a policy work to limit the range of coverage by restricting certain events or losses; often serving as a basis to deny a claim. Nevada case law has long held the burden is on the insured to prove a claim falls within the scope of coverage, and the insurer bears the burden to prove the applicability of an exclusion. However, for the first time the Supreme Court for the State of Nevada was faced with the question of who bears the burden to prove an exception to a policy’s exclusion provision, essentially restoring coverage.1 Continue Reading Nevada Insureds Bear Burden of Proving Exceptions to Exclusion Provisions
The genesis for this post is a jury trial that Merlin Law Group attorneys Mike Duffy, Jon Bukowski, and Larry Bache recently won. Jon Bukowski sent me a transcript of the closing arguments with a comment about Mike Duffy’s closing being “the best.” Continue Reading Insurance Company Lawyer Tells Jury Insurance Companies Cannot Be Expected to Know Building Codes
A recent Louisiana case1 demonstrates the difficulty of interpreting deductibles when sub-limits of a peril apply. The case is significant because many high limit commercial policies have similar deductible clauses, which courts have found ambiguous and afforded the policyholder a much greater recovery. Continue Reading Deductibles Can Be Confusing and Ambiguous
In a Puerto Rico Hurricane Michael case involving a Zurich Insurance Company providing a policy to a Louisiana policyholder, an alleged delayed payment resulted in attorneys for Zurich arguing that they could delay owed payments for various excuses. The first issue was what a proof of loss meant under Louisiana law. Continue Reading Proof Of Loss is Different Under Louisiana Law—Should You Be Insured by a Slow and Underpaying Insurance Company?
I was speaking with an attorney from Jefferson Parish in Louisiana about Hurricane Laura claims. He told me that the word that best fit insurance company payments for that storm is “putrid.” If that is the case, insurance companies that wrongfully delay payment of claims in Louisiana for greater than thirty days can be subject to an automatic penalty. Continue Reading Insurance Companies Have 30 Days to Pay or Be Subject to Penalties in Louisiana
We are happy to share with the insurance world a very positive development on COVID-19 Business Interruption cases – from Orange County, a conservative jurisdiction. The credit for this victory goes to our friends at Covington & Burling LLP, who we have been working closely with to advance justice for policyholders. A special shout-out is owed to Rani Gupta, Joan Li, David Goodwin, and Jad Khazem for this win, as the specific allegations of physical alteration were the driving force behind the victory and are instructive for future success. Continue Reading Court Rules in Favor of Goodwill on COVID-19 Business Interruption Matter
Insurance has been woven into the tapestry of human society dating back to ancient times. At its core, an insurance policy is a contract of indemnity between an insurance company and an insured. The policy is subject to the same rules that govern other contracts unless those rules are specifically modified by statute.1 Continue Reading Interpreting Insurance Contracts in Florida
The Certified Question: On July 2, 2020, a Ninth Circuit court of Appeals panel certified the following three-part question to the Nevada Supreme Court:
- Whether, under Nevada law, the burden of proving the applicability of an exception to an exclusion of coverage in an insurance policy falls on the insurer or the insured?
- Whichever party bears such a burden, may it rely on evidence extrinsic to the complaint to carry its burden, and if so,  is it limited to extrinsic evidence available at the time the insured tendered the defense of the lawsuit to the insurer?
The case out of which this certified question arises is Zurich American Insurance Co. v. Ironshore Specialty Insurance Company.1 Continue Reading Who Has the Burden to Prove an Exception to an Exclusion of Coverage in an Insurance Policy?