“Please do this, tell us that and please send us these documents.” Every day I hear this from potential clients, public adjusters representing policyholders, and restoration contractors asking what they have to do and provide. I often end up litigating the same issues in court. Insurance companies often leave the “please” out of the never-ending letters they send following a loss demanding information before paying money. Many insurance company adjusters seem a lot more allegedly concerned about thoroughly investigating a loss than they do about providing prompt payment.
Continue Reading California Policyholders Need to Cooperate with Their Insurers Following a Property Loss. What Does That Mean?

Insurance policies impose a duty on insureds to cooperate with the insurer’s investigation of a claim. An insured’s duty to cooperate encompasses the insured’s obligation to appear for an examination under oath (“EUO”), if requested, and to provide documentation verifying the loss. “Cooperation clauses” generally have been held to be material provisions of insurance policies with compliance therewith a condition precedent to coverage.
Continue Reading Can My Insurance Company Deny My Claim For Failure to Cooperate With Its Investigation?

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?

Recently, it seems like I have been privy to a relatively high number of insureds asked by their carrier, following a loss, to submit to an examination under oath (commonly referred to as an EUO). The most common question I received was, “Can I just choose not to answer or attend?” Although the choice is ultimately the insureds and the ramifications of refusal vary by justification, when dealing with Arizona insureds, I generally advise against such blanket refusals.
Continue Reading Refusing to Answer Questions at an EUO is Usually Not A Good Idea

Public adjuster and policyholder advocates often get questions from insureds about the extent that insureds must cooperate with insurers during the investigation stage of a claim. As an example, some insureds have asked me whether they really must produce financial documents and receipts in a theft claim. Insureds often ask why the insurer is making their lives so difficult during the investigation.

These questions have prompted me to write this blog addressing a clause in most property insurance policies known as the “Cooperation Clause.”

Continue Reading The Cooperation Clause – Do I have to Cooperate with the Insurer’s Investigation?

When submitting a claim to an insurance company, a policyholder has certain obligations that must be followed. The insurance policy contract lists the obligations. The policy document was written by the insurance company and approved (most of the time) by the insurance regulatory agency for the state where the property is located. Insurance contracts are usually “take it or leave it” when it comes to the wording of the provisions. An insured can buy endorsements to the policy, add additional insurance, and change deductibles but the language about the coverage and the explanation of what is excluded is not something an insured can make edits or changes to for the insurance company to consider and make part of the contract.

Continue Reading Insurance Company Has to Have Reasonable Requests Pursuant to the Policy

Earlier this week, I was in Austin, Texas, attending a deposition with Chip Merlin on a hail damage claim. Texas is known for their barbeque so we decided to try out The County Line BBQ on Lake Austin. If you are in Austin, I highly recommend it.

This led me to today’s blog topic – a property insurance case involving damage to a barbeque restaurant.

Continue Reading An Insured’s Duty to Cooperate in Pennsylvania

The lack of cooperation defense seems to be raised more often than it probably should in first-party property insurance claims. In Florida, and many other states, the insurance carrier has the burden to prove any lack of cooperation by the policyholder in a first-party property insurance claim substantially prejudiced it before any such breach would prevent recovery under the policy.

Continue Reading The Lack Of Cooperation Defense May Not Really Be As Broad As It Seems

At this point in their Hurricane Sandy insurance claims, many in New Jersey are being noticed to sit for an Examination Under Oath (EUO). Many wonder what an EUO is and if it is necessary for them to participate. An EUO is essentially a question and answer session where an attorney for the insurance carrier will ask you questions concerning your property and the loss claimed to that property. Virtually all insurance policies have a clause that requires you to cooperate with the insurance carrier’s investigation of your claim, which includes sitting for an EUO as often as they reasonably require. That begs the question, how do the courts of New Jersey deal with failure to participate in a requested EUO?

Continue Reading Are Examinations Under Oath Necessary in New Jersey?

Most policies contain a post-loss condition requiring the insured to show the insurer damaged property “as often as [the insurer] reasonably require[s].” It is rare to find a policyholder bothered by the fact that an insurance company over-inspected damages during claim adjustment. Sure, sometimes insurers request one inspection after another in an effort to exhaust an insured out of pursuing a claim; but, more commonly, insurers do not inspect damage enough during claim adjustment and attempt to unwind lackluster claim adjustment inspections with post-denial inspections.

Continue Reading Insurance Policy Conditions (a/k/a/ Land Mines): Part 7 – Damage Inspection