Governor Gavin Newsom recently signed Senate Bill 240, which enacts new laws that regulate out of state independent adjusters. The law also addresses claim adjustment for declared emergencies. The new laws, described more fully below, became effective on October 3. 2019.
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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.
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We’ve all seen it before. The insured files a claim, the insurance company sends out an adjuster to adjust the loss, the loss is more complex, or a situation arises that the adjuster cannot handle so the insurance company forwards the claim to their legal department. At that point, an attorney becomes involved and the adjustment of the claim, as well as the communication between the parties is limited and calculated.
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Insurance is an important product. It is hard for all insurers to get clams handling right after a major disaster and claims accuracy is much less certain. That is what is taught and that is a fact. I could explain that problem and give a pass to the insurance industry and even try to help educate my policyholder friends through this understandable delay and inaccuracy which is almost inevitable.
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One of the strongest worded notices to insurance companies to pay promptly and do whatever it takes to help policyholders following a disaster came from Florida Insurance Commissioner David Altmaier in a December 19, 2018 memorandum entitled Hurricane Michael Claims Response.
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Crawford has acknowledged that the insurance industry it serves is not living up to its good faith claims obligation in a recent publication. Here is the confession about the 2017 Hurricane season which it reported in Today’s Large & Complex Claims Landscape: Preparing for the Perfect Storm:
To adequately respond to today’s evolving catastrophe landscape, insurers need to be prepared with contingency plans for their contingency plans to make sure the “perfect storm” of 2017 doesn’t happen again. Through streamlined, coordinated team response, expert scenario planning and the vast knowledgebase of worldwide claims expertise, insurers can rest easy knowing they’re getting the best possible resources working on the frontlines of catastrophe.
Back on March 29, 2019, every attorney in the Merlin Law Group Red Bank office attended the “Protection Gap in Property Insurance” seminar that was hosted by Professor Jay M. Feinman and held at Rutgers law school. This was the first time that I had observed Mr. Feinman speak on issues pertaining to insurance and I ended up buying one of his books, Delay, Deny, Defend, after the seminar.
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Every state has laws that prohibit unfair, discriminatory, or deceptive insurance practices. These regulations are normally encompassed as statutes or regulations enacted to protect insurance consumers. Pennsylvania has a statute enacted called the “Unfair Insurance Practices Act,”1 This law gives the consumer the right to file complaints against their insurance company to be investigated by the Insurance Department. However, this statute specifically prohibits a private cause of action against insurance companies by the public.
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The Texas Supreme Court recently answered the question above in two cases with different results depending on what type of insurance code violations the insured is alleging. The court addressed Texas Insurance Code chapter 542 violations (often called prompt payment of claims) in Barbara Technologies Corporation v. State Farm Lloyds.1
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Insurance companies are supposed to have insurance adjusters that are empathetic, professional and ethical when dealing with policyholders and claimants. The first chapter in the insurance treatise, Claims Handling Principles and Practices, has multiple lessons about these obligations. Claims adjusters should not make policyholders scream out of frustration about the service you receive.
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