When I get hired on property damage cases, part of the materials I receive from the policyholder, or the public insurance adjuster, is a full or partial denial letter in which the carrier fairly specifically sets out reasons and quotes policy provisions supporting the denial of coverage. If I am hired on a case and I don’t see a denial letter or the reasons for the denial are not clear then I will ask the carrier to set out in writing the specific reasons for the denial and I ask them to cite policy provisions.
In Texas the general rule seems to be that either the insurance company or the policyholder may invoke the appraisal clause (before or after suit is filed). After the award both parties are generally bound by the award, unless they can prove the award was arrived at as a result of fraud or some other recognized basis for challenging the award. It is very difficult to set aside an award.1 I was recently asked by a policyholder about setting aside an unfavorable award in Oklahoma. The rules are different in Oklahoma because the appraisal award is only binding on the party who invoked appraisal. This rule was discussed in an interesting case out of the Oklahoma Supreme Court, Massey v. Farmers Insurance Group,2 where the Court answered a certified question from the U.S. Court of Appeals for the Tenth Circuit.
My last blog, The First Thing You Do Is Read the Policy, Part I: Limitations Clauses in Texas and the Spicewood Case, was the first in a series on “limitations clauses” in insurance policies. I imagined old Andy Griffith (à la Matlock) sitting around a cracker barrel in his blue seersucker suit telling young lawyers and public insurance adjusters, “The first thing you do is you read the insurance policy.”
The severe weather that has battered Texas and Oklahoma over the last several days has been front page news nationwide. The unprecedented rainfall has created large-scale flooding and damage in the region. On Thursday, FEMA responded by issuing a memorandum extending the time to file a proof of loss for an additional 180 days.1
Recently a reader came across my blog post discussing whether depreciation of labor is allowed in California when calculating ACV. In California, the answer is no. The reader wanted to know whether the same holds true for Oklahoma and, more specifically, on a roof replacement claim.
In Gutkowski v. Oklahoma Farmers Union Mutual Insurance Company,1 the insurance carrier (Farmers) found that the policyholder’s roof warranted a complete replacement due to hail damage. Farmers only agreed to pay for the "direct physical loss to the composition shingles," though, and not the "decking to which the composition singles were attached."2 Farmers argued that, pursuant to the applicable policy language, the decking surface did not sustain a direct physical loss as a result of the hail storm.
In this installment of my Oklahoma Coverage Series, I will address issues recently reported to us as being significant and frequent disputes between Oklahoma carriers and their policyholders relating to roof replacement claims.
In a recent news article published in The Oklahoman, the headline trumpeted “Oklahoma Led Nation In Natural Disaster Insured Losses In 2013.”1 Based on reports we receive, though, it seems an accurate subtitle would have read “But Was It Enough?” In this first installment of my Oklahoma Coverage Series, I’ll take a look at some disturbing trends being reported as to the manner in which some insurance carriers are treating Oklahoma policyholders.