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 … Continue Reading
A Nebraska court recently ruled that an insured was entitled to bad faith damages after the court found that an insurance application was ambiguous in its language.… Continue Reading
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. … Continue Reading
A court in Georgia found coverage for a loss based on the presence of a semicolon. In the case Lee v. Mercury Insurance Company,1 the court found coverage for a home destroyed by fire based on the potential ambiguity created by a semicolon.… Continue Reading
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 insurers investigate insurance claims and suspect that something about the claim is not quite right, they often assign special investigation units evaluate whether the claim lacks merit or is otherwise fraudulent. In Young v. Progressive Casualty Insurance Company,1 a federal district court in California recently upheld an insurer’s denial of its insured’s claim for … Continue Reading
Fireworks will literally be exploding outside of my home next to Channelside in Tampa. The video above depicts the view from my master bedroom. So long as those fireworks are blowing up outside of my home and over Tampa Bay, my insurance company has no problem. The question is at what point do fireworks inside … Continue Reading
After a claim is made, and despite the obligation to objectively, fairly, and reasonably investigate a claim with an eye toward providing coverage and without putting the insurance company’s interests ahead of their insured’s, some insurers actively look for ways to deny coverage. One of the ways some insurers do this is by using the … Continue Reading
On November 22, 2016, Judge Berle M. Schiller from the District Court for the Eastern District of Pennsylvania issued his Opinion and Order in Payne v. Allstate Insurance Company, granting summary judgment to Allstate and awarding them $25,000 in damages, after finding that the Plaintiff made material misrepresentations while securing the homeowners policy.… Continue Reading
A recent case out of the 8th Circuit Court of Appeals dealt with material misrepresentations.1 In 2006, an insured’s home was destroyed by fire. He submitted a claim and it was paid, so he rebuilt. State Farm subsequently cancelled his policy. He then went to an independent insurance agency to obtain a new policy. He … Continue Reading
A recent Florida case involved insureds whose home was insured by Citizens. On May 25, 2012, the home was damaged by water escaping from a broken plumbing system.1 Citizens’ adjuster inspected the home and noticed that the driveway and interior flooring had been trenched and the underground plumbing system had been removed by a plumbing … Continue Reading
Often, when a property insurance claim is reported (even one undisputedly covered) one of the first things many carriers will do is review the application for the policy to see if the insured answered questions either incorrectly or incompletely. This is because Section 627.409 of the Florida Statute allows insurers, in certain limited circumstances, to … Continue Reading
In Georgia, an insurance company does not have to prove fraud in order to prevent recovery under a policy; the standard is actually much lower for insurance companies. A carrier can prevent recovery by showing a policyholder has misrepresented, omitted, concealed, or made an incorrect statement about a material fact when buying insurance.1… Continue Reading
Five tips to make sure your insurance coverage is not voided: When you are shopping for insurance coverage be sure to carefully read the underwriting section of the application. Don’t assume your insurance agent has filled out the correct information for personal questions, including your financial background and prior insurance. Don’t assume your insurance agent … Continue Reading
The information in an application for insurance is extremely important; it contains information which the insurance company uses to determine if it will extend coverage, what type and how much coverage, and is used to determine the level of risk. The accuracy of that information is important. There are different burdens of proof that an … Continue Reading
One of the trickiest parts of property insurance claims is the contents portion of the claims. Even if the insured saved receipts to prove the age and cost of personal property,those receipts are often stored in the same general place as the personal property and suffer the same fate as the personal property. Accordingly, policy … Continue Reading
Insurance applications are important in the insurance marketplace. Applications are part of the risk analysis insurers make in determining whether they will issue a policy. There is exhaustive case law on issues of misrepresentations, ambiguities, and incomplete applications. The issue I want to discuss is whether an insurer can waive its right to deny a … Continue Reading
Last month, the Florida Senate Appropriations Committee unanimously passed Senate Bill 708. If the bill becomes law, part of the language would curb Universal Property Insurance Company, and all insurance companies in the state, from alleging certain application misrepresentations. Currently, Florida residential property insurance companies have 90 days to perform underwriting on an insurance risk … Continue Reading
You don’t have to have a law degree or be an insurance guru to see through one of the recent arguments People’s Trust has been using when denying insurance claims. Buying insurance with People’s Trust is very different than the way insurance is purchased with other Florida carriers. The basic process is different because People’s Trust … Continue Reading
I have often written about how the specific words matter in insurance policies during coverage evaluations. Well this simple motto also carries over to the application, which is often the first document submitted by a policyholder to an insurance carrier to obtain a policy. If the language of the application and policy is drafted by … Continue Reading
In North Carolina, when an insurance carrier alleges that a policy should be voided because of an application misrepresentation, the allegation is that an insured made a representation that is false and material, and the policy may be voided even if the statement was not fraudulent.1… Continue Reading
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. … Continue Reading
Despite the many authorities obligating insurers to treat their insureds fairly, to thoroughly investigate claims and to timely pay claims, it should come as no surprise that insurers look for reasons to keep their money by delaying or denying claims. One method used by insurers with increasing frequency to avert payment on the claim is … Continue Reading
Suffering a fire loss to your home can be devastating. I have listened to policyholders questioned in trial and deposition about these types of claims. Sometimes, insureds have lost everything but the clothes on their backs, and many times in cases of a total loss, the policyholders will describe the items that can’t be replaced- … Continue Reading
