Conditions Precedent

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As the effects vary from state to state, it is important to be aware of what can happen if there is a delay in providing a proof of loss or notice to a carrier in an insurance claim. Some states are more lenient and follow the notice-prejudice rule.1 “The notice-prejudice rule requires that the insurance company can assert late notice as a defense to overage only if the late notice has caused actual prejudice to the insurer.”2 Some states, on the other hand, are much stricter on complying with any deadlines for notice or proof of loss. What can happen in Arkansas if a proof of loss is late?…

Continue Reading Late Proof of Loss in Arkansas

A recent case1 shows that every technical step regarding proof of loss requirements in the flood claims process has to be followed, even if the steps are meaningless. Federal law regarding flood claims is draconian. It is the worst law against policyholders. Attempts at legal reform of the claims processes have fallen on deaf ears. It is a “heads I win, tails you lose” situation if a flood policyholder challenges any claims decision.
Continue Reading Federal Flood Claim—File a Timely Proof of Loss Even If Claim Denied

Examinations under oath are important to recovery. Reasonable production of relevant documents that are part of a cooperative investigation is important as well. Failure to provide an examination under oath and documents is a one-way street to help an insurer deny recovery.
Continue Reading Failure to Provide an Examination Under Oath and Documents Can Result in Lost Benefits

Last week the United States District Court for the Southern District of Indiana granted Travelers Indemnity Company’s Motion for Summary Judgment allowing them to dodge hail damage claims made by policyholder Mapleton at Countryside Condominium Association Inc. (“Mapleton”).1 Mapleton brought suit against Travelers for breach of contract and bad faith following two hailstorms impacting their buildings in June 2016 and April 2017. The hailstorms caused damage to the condominium’s siding estimated at $2.58 million.
Continue Reading Court Finds Hailstorm Claims Made “Unreasonably Late”

Defendant Insureds, Lonergan Law Firm, PLLC, et al. (“Lonergan”), recently appealed to the Fifth Circuit Court of Appeals a Northern District of Texas ruling against it, which found it failed to meet a material condition of the policy by not sending its Notice of Claim (“Notice”) to the Claims Department. Landmark American Insurance Co. (“Landmark”) filed suit against its insureds seeking to avoid liability for coverage by arguing that, even though it received notice via a Claim Supplement during the policy period, the insureds failed to send the notice to the location mandated by the Policy.1…
Continue Reading Notice of Claim: Precatory “Please” Does Not a Mandatory “Shall” Make

In Northgate Country Club Management, LLC v. Philadelphia Indemnity Insurance Company,1 the Honorable Sim Lake, Senior Judge for the United States District Court for the Southern District of Texas, reaffirmed this past week the critical rule that in a FEMA flood case, the requirement for a policyholder to file a proof of loss cannot be waived even by a carrier that participates in a claim. With the hurricane and tropical season upon us along the Gulf Coast, a reminder of this mandatory rule is relevant.
Continue Reading Can the Proof of Loss Requirement Be Waived in a Flood Case?

In a recent case, a federal appeals court held that named insureds’ son and daughter-in-law were required to submit to an examination under oath (“EUO”) because they resided in the insureds’ house, and that their failure to do so precluded recovery on the insurance claim.1…
Continue Reading Are My Children and Their Spouses Required to Submit to an Examination Under Oath for My Property Damage Claim?

While the timeframe to file a legal action is generally defined under the Statute of Limitations, in some states an insurance policy can contractually establish a shorter period to file a legal action. In a recent California case, Keller v. Federal Insurance Company,1 the Ninth Circuit upheld a Legal Action Against Us clause, finding the homeowners waited too long to file a lawsuit.
Continue Reading Legal Action Against Us Clause

In Florida, an insurer’s denial of coverage constitutes a waiver of its right to require an insured to comply with policy conditions before filing suit.1 But, what if insured requests an insurer to reconsider its coverage denial before filing suit? Does the request to reconsider nullify the insurer’s previous denial of coverage requiring the insured to comply with policy conditions never initially invoked or requested?
Continue Reading Compliance with Policy Conditions After a Denial of Coverage

The purpose of a sworn proof of loss is to enable the insurer to properly investigate the circumstances of a loss while the occurrence is fresh in the minds of the witnesses, to prevent fraud, and to enable it to form an intelligent estimate of its rights and liabilities so it may adequately prepare to defend any claim. But, if that information is not submitted in the form requested by the insurance company, has an insured still complied with the proof of loss requirement?
Continue Reading Is Substantial Compliance with a Proof of Loss Enough?