A condominium made a claim arguing that unstable excavation material, which became heavy enough due to spring runoff, fell down a mountainside, causing damage to the condominium.1 The condominium made the following factual argument for coverage:   

Continue Reading The Specified Causes of Loss and Falling Objects—Can Debris Travelling Down a Mountain Be a Falling Object Triggering Coverage?

Property insurance adjusters sometimes ask me whether a loss comes within the “specified perils” coverage of the policy. What does “specified perils” mean?  When one goes to the International Risk Management Institute (IRMI) website, under “insurance definitions,” the term “specified perils coverage” is defined as the following:

Specified perils coverage is an obsolete auto physical damage term.

Continue Reading What Are the Specified Perils? What Is Falling Objects?

Dear Residents of Tree Oasis,

I hope this blog post finds you in good humor, as it is with great delight that I address a matter of utmost importance to Florida residents and others residing amongst the seemingly innocent vertical beings standing tall and proud: TREES.

Continue Reading Falling Objects Coverage – Are You Covered For That Tree Limb That Just Came Through Your Roof?

When an insured incurs expenses to prevent a potential loss, a situation arises that raises equitable and traditional insurance principles versus language not found in non-marine property insurance policies. This scenario, where the insured takes proactive steps to avert a loss that the insurer would have been liable for, raises a pivotal question: Should the insured be entitled to reimbursement for these preventative expenses?

Continue Reading Who Pays the Costs to Prevent a Loss?

Consider a scenario where a structure, such as a brand new home, is completely destroyed by a fire just a day after the homeowner moves in. In this instance, the replacement cost, which undeniably encompasses the general contractor’s overhead and profit, should be a direct reflection of the actual cash value. This is because, as per the given example, there has been no depreciation to the property.

Continue Reading Insurance Commissioners and Regulators Need to Protect Policyholders From Disappearing Actual Cash Value Benefits

Specialized and high-risk policies, like marine, aviation, and trucking, often contain requirements for qualifications and experience of the operator. These are often critical factors establishing coverage, which are raised after a loss occurs. These policies are not one-size-fits-all; they are tailored to specific risks and require operators to meet certain criteria to ensure that they are capable of managing those risks effectively. For example, an aviation policy might stipulate that the pilot must have a certain number of years and flying hours of experience, as well as specific certifications. Failing to meet these requirements could void the coverage, leaving the policyholder exposed to significant financial risks.  

Continue Reading Qualification and Experience Requirements of High Risk Property Insurance Policies

One of the craziest chapters ever written regarding insurance litigation involves Covid-19 first-party insurance cases. Judges, often without accepting any scientific evidence, simply ruled that Covid-19 does not cause physical damage. The Catch-22 issue is that the insurance industry wrote an endorsement to exclude Covid-19, and some insurers admitted that a covid type of scenario would be covered without a specific exclusion. 

Continue Reading Did a Major Insurer Admit in Its Claims Manual Coding That Covid-19 Causes Physical Loss?

Does an appraisal panel determine the amount of the loss before the coverage issues are litigated? This question is a common issue. The answer results in imperfect and prolonged proceedings, which result in delayed payment to the policyholder. Every state seems to have its own answer to the question. Courts struggle with how to handle these issues.  

Continue Reading What Comes First—The Appraisal or The Coverage Determination?

The insurance-to-value questions and concerns of underinsurance come up every time an insurance agent selling property insurance makes an application or oversees a renewal of a property insurance policy. Bill Wilson is an experienced insurance agent and insurance agent educator. When he talks insurance, those of us in the insurance business should listen.
Continue Reading The Underinsurance Gap: Who Is Truly in a Better Situation To Determine the Full Amount of Property Insurance Required on a Structure?

The recent Colorado wildfires have highlighted a countrywide claims issue for residential homeowners having total losses—most are far underinsured. Insurance agent commentator Bill Wilson recently published a blog on the topic: Another Cautionary Tale of Underinsurance. While there are myriad reasons for this epidemic of homes being underinsured to replacement value, Wilson’s post noted in part:

One would think that, among the parties involved in the insurance process – insureds, insurer, and if an agent was involved, the agent – someone would have questioned the large gap between purchase price and homeowners Coverage A limit.

The insurer is identified in the story and my first thought was that the insurer needs to reimagine their ‘You only pay for what you need’ sales pitch. Maybe, ‘We only pay for what you buy’ or ‘You only pay for what you mistakenly bought.’

Continue Reading The Wildfire Underinsurance Gap