Cooperation Clause

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Every once in a while, Colorado federal district court judges decide to provide more clarity on legal defenses asserted by insurers. One such recent case is a great case study regarding the evolving standard relative to an insurer’s ability to assert a failure to cooperate defense in litigation. In Excel Construction Group v. GuideOne Mutual Insurance Company,1 the trial court recently evaluated the failure to cooperate defense for defenses asserted before the enactment of C.R.S. § 10-3-1118. Excel was filed by a contractor by assignment of an insurance claim. Excel filed a lawsuit against a church facility’s insurer for breach of contract damages and a violation of Colorado’s insurance bad faith statute, C.R.S. § 10-3-1115 and 1116, in the federal district court of Colorado on December 31, 2020.   …

Continue Reading Does an Insured Have to Respond to an Insurer’s Document Request or Else Risk Legal Action Asserting a Failure to Cooperate as an Absolute Bar to Insurance Recovery?

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

Almost all property insurance policies require that the insured “assist and cooperate” in an insurer’s investigation. If an insured fails to “cooperate,” an insurer may have the right to deny a claim. However, the insurer cannot demand that an insured cooperate with every request. This blog discusses what requests you should ensure an insured cooperates with, what lack of cooperation may be grounds for a denial, and how to manage an insurer’s overbroad and unreasonable request. Most of the principles here are not unique to California and can serve as a general guide almost everywhere else.
Continue Reading What Constitutes Cooperation with an Insurer’s Claim Investigation in California – Ensuring Compliance and Avoiding Unnecessary Harassment

“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