It is not uncommon that a homeowner may suffer hailstorm damage and receive an actual cash value payment, but not make all the repairs before the next hailstorm hits. This is the situation that arose in Selective Insurance Company of South Carolina v. Sela.1
Continue Reading Insurer Acted in Bad Faith Where it Could Identify No Specific Misrepresentations Made by the Insured

New Jersey Merlin Law Group attorney Jason Cieri was married last week. It was a fantastic wedding. It also provided me a chance to catch-up with some Jersey Shore public adjusters, discuss the upcoming PPAANJ seminar on November 14 and write this blog which includes a case discussion involving post loss misrepresentations made prior to an examination under oath.
Continue Reading Misrepresentations Made After Loss But Before An Examination Under Oath

It can be difficult after a fire for an insured to remember with 100% certainty what personal property they had in their home. Most likely, receipts and other purchase records have also been destroyed. As such, public adjusters in preparing estimates and/or proofs of loss are typically left to rely upon the insured’s memory. After all, who knows better than the insured what property was there before the fire? But what if there are inaccuracies in the proof or estimate….is that enough to cause the claim to be denied based on the concealment and misrepresentation clause?
Continue Reading Can Misrepresentations In a Proof of Loss Void Coverage?

Suspicion runs rampant with some insurance companies when it comes to alleged arson. Even if they cannot prove the policyholder had anything to do with a fire, some adjusters cannot help to look for other ways to deny an insurance claim. In Hayes vs. Metropolitan Property and Casualty Insurance Company,1 an insurer was held liable for bad faith denial of an insurance claim even though the policyholder did not win the breach of contract action because the policyholder failed to file his lawsuit within the one-year statute of limitations.
Continue Reading Bad Faith May Arise Out Of Wrongful Misrepresentation in Application Denial

In many jurisdictions, for an insurer to carry its burden of proving that coverage is void due to a material misrepresentation, the insurer must prove not only that the misrepresented fact was something that the insurer wanted to know, but that the misrepresentation affected the insurer’s investigation. In other words, that the misrepresentation was material. The question often becomes, how is materiality determined?
Continue Reading Jury Permitted to Determine if Misrepresentations by Insured Were Material

In the recent California case, Duarte v. Pacific Specialty Insurance Company, the appellate court examined an insured’s “misrepresentations” when applying for an insurance policy and concluded that the insurer had wrongfully denied coverage.1
Continue Reading When is a Misrepresentation Material for the Purpose of Insurance Coverage in California?