On this blog, we often try to educate homeowners so they can be protected. In the past, we have urged homeowners to read their homeowner insurance policies and to ask questions if there are terms or provisions they do not understand. Well, here is another important tip: Obtain a copy of your policy from your insurance company at least once a year. Why? It is the best way to confirm that you have valid insurance coverage.


Continue Reading Homeowners: Where is Your Copy of Your Homeowners Insurance Policy?

Steve Badger gets the 2014 Insurance Defense Attorney Macho Man Award. His works, What The Hail Is Going On In Texas?,1  and The Emerging Hail Risk: What The Hail Is Going On?,2 have envious insurance defense attorneys complaining that they have been slow to address the needed “tough guy” for the insurance industry, and others questioning if Badger is being fair to customers of the insurance industry. He also has addressed the issue in a seminar – stay tuned.


Continue Reading Is Steve Badger’s View of Hail Damage Claims Fair and Balanced?

All adjusters are called upon to make good faith evaluations of loss. The obligation of all adjusters is to make certain that the policyholder receives the full amount of benefits owed under the policy. When disagreements occur over the value of loss, appraisals and umpires often become involved. The recent arrest of a public adjuster I posted about in Public Adjuster Arrested For Intentionally Inflated Fire Claim Denies Allegations, involves all these issues.

Continue Reading Public Adjuster Arrest, Umpire Ethics, and Good Faith Opinions–An Intriguing Story

When a policyholder disputes a property damage claim, insurance company representatives often dig in their heels and try to stand firm on the denial or the low valuation. Insurance companies frequently allege various unsupported reasons and defenses to avoid paying what is due. Some insurance companies accuse consumers of insurance fraud even when the facts don’t support an allegation under Florida’s law. Does this mean that insurance fraud doesn’t happen? Absolutely not. Fraud is a real and there is a need for Florida’s fraud task force to handle actual insurance fraud, but a very small number of the insurance fraud reported to the State of Florida relates to property damage claims.


Continue Reading Florida Updates Website for Reporting Suspected Insurance Fraud

Most policies contain a “Concealment or Fraud” condition that reads along these lines: “With respect to all persons insured under this policy, we provide no coverage for loss if, whether before or after a loss, one or more persons insured under this policy have: a. Intentionally concealed or misrepresented any material fact or circumstance; b. Engaged in fraudulent conduct; or c. Made false statements; relating to this insurance.” Insurers sometimes argue an insured’s intent to defraud should not be assessed by the court or jury in deciding whether the insurer’s fraud-based claim denial was appropriate; insurers sometimes argue that even accidental misrepresentations, mistakes, or the like bar coverage. Wrong, in my opinion.


Continue Reading Insurance Policy Conditions (a/k/a/ Land Mines): Part 21 – “Intent” and the Fraud Condition

Most policies contain a “Concealment or Fraud” condition that reads along these lines:

With respect to all persons insured under this policy, we provide no coverage for loss if, whether before or after a loss, one or more persons insured under this policy have: a. Intentionally concealed or misrepresented any material fact or circumstance; b. Engaged in fraudulent conduct; or c. Made false statements; relating to this insurance.

Just about every fraud-based claim denial that I have come across (at the claim and/or litigation stage) lacks specificity, i.e., fails to explain how the insured defrauded the insurer. Do not let the insurer get away with that at either the claim stage or the litigation stage.


Continue Reading Insurance Policy Conditions (a/k/a/ Land Mines): Part 16 – Specificity of Fraud-Based Claim Denial

Insurers often employ the phrase “insurance fraud” in conjunction with claim denial, legislative lobbying, and premium increase requests. But does the usage rate of this phrase correlate with the rate at which insurance fraud is actually committed? Put differently, is insurance fraud as rampant as insurers rampantly contend? Nope! A renowned, well-respected claims practice expert summed the situation up nicely at a deposition I defended not so long ago:


Continue Reading Is Insurance Fraud As Rampant As Insurers Rampantly Contend?