Tag Archives: Policy Language

Appraisal: Competent, Disinterested and Impartial. Are appraisers and Umpires Ever Actually Any of the Three?

Recently, I presented at the Professional Public Adjusters Association of New Jersey educational conference on the area of insurance appraisal to roughly 30 public adjusters. During my preparation, I reviewed current and past appraisal provisions contained within standard insurance policies. In my research, I found some very interesting differences contained within insurance policy appraisal provisions … Continue Reading

Federal District Court Weighs in on Whether Labor Can Be Depreciated in Arriving at an Actual Cash Value Loss Settlement

Whether labor can be depreciated in arriving at an actual cash value property loss settlement has been a hot topic of debate over these past five years. A federal district court in Ohio recently weighed in on the issue in ruling on motions to dismiss two putative class action lawsuits, one against State Farm Fire … Continue Reading

Chocolatier Gets Sweet Revenge on Chubb

In a Second Circuit decision, the court of appeals revived Madelaine Chocolate Novelties Inc.’s Superstorm Sandy claim against Chubb for property damage and business interruption for an additional $49 million in coverage. In overruling the lower court, the appellate court found that the lower federal court failed to properly evaluate all the relevant policy provisions.1… Continue Reading

Appellate Court Disagrees with Sister Court on Assignment of Benefits

In December of last year, my colleague Ashley Harris discussed Security First Insurance Co. v. Florida Office of Insurance Regulation,1 where the Florida Fifth District Court of Appeal (Fifth DCA) upheld the Office of Insurance Regulation (“OIR”) prohibition of proposed language in an insurance policy that would require “all insureds, all additional insureds and all … Continue Reading

What Constitutes an “Abrupt Collapse”?

Most property insurance policies provide additional coverage for direct physical loss of or damage to covered property caused by or resulting from an “abrupt collapse.”1 In Hoban v. Nova Casualty Company,2 a California federal district court recently addressed the meaning of the phrase “abrupt collapse,” which the commercial insurance policy at issue defined as “an … Continue Reading

Carriers Fail to List or Mention the Important Print in a Policy Once Dollars are at Stake

Frequent readers of our blog know that property insurance losses center on the insurance policy. The Policy provisions are the most fundamental and are always important in a breach of contract case. Despite the importance of the policy, you would think that insurance company adjusters, independent adjusters, and the representatives working on insurance claims would … Continue Reading

Bigwigs Versus Actual Wigs – Who Wins?

In a recent unpublished Appellate Division case in New Jersey,1 AIG was held not responsible for a wig and beauty distributor’s business loss claim. Beauty Plus, a wholesale distributor of human hair wigs and other beauty products had a shipment of 487 cartons of human hair wigs stolen from their Moonachie, New Jersey, warehouse back … Continue Reading

Follow-Up: My Insurance Claim Was Denied Because My Water Leak Lasted Over a Period of 14 Days or More – Was the Denial Proper?

In March, I posted a blog on the Hicks v. American Integrity Insurance Company opinion,1 in which a Florida court ruled that policy language stating: “we do not insure…for loss…caused by…constant or repeated seepage or leakage of water…over a period of 14 or more days,” did not preclude coverage for damage caused during the first … Continue Reading

Policy Conditions “Conformity to State Law” May Extend the Period Time to File Suit.

Some insurance policies will contain a clause within the conditions section entitled “Conformity to State Law.” This provision contains language similar to: “Conformity to State Law. When a policy provision is in conflict with the applicable state law of the State in which this policy is issued, the law of the state will apply.”… Continue Reading

When the Insurance Company Labels Your Loss a Collapse, Can It Still Deny Your Collapse Claim?

At least one Michigan court has ruled that even when the execute general adjuster calls a building’s damage a collapse and labels it as a “cave in,” the denial will stand where the policy language supports an exclusion.1 This case arises out damages that occurred to a large commercial shop that repairs commercial trucks. There … Continue Reading

Texas Insurance Appraisal: Who is Grading Insurance Company Papers and the Policies They Sell?

It is no secret that there are problems with the appraisal process. The ever-growing issues with appraisal include, but certainly are not limited to, exorbitant expenses pushed onto policyholders and insurance companies, gamesmanship, and the never-ending questions of: When is appraisal appropriate What can be addressed and assessed within appraisal, and Whether a policyholder’s claims … Continue Reading

Post-Loss List Created Solely From Memory Can Satisfy the Insured’s Duty to Furnish an Inventory

When personal contents or business personal property are damaged or lost in a covered event, most policies require the policyholder to provide an inventory of the damaged or lost items to the carrier. But often, the carrier and the policyholder clash on the level of specificity required and whether the policyholder has submitted adequate proof … Continue Reading

Freezing Exclusion – What Does It Really Mean to Use Reasonable Efforts to Maintain Heat in the Building?

Whether residential or commercial, most property coverage policies exclude loss caused by freezing, unless the insured either: Uses reasonable or best efforts to maintain heat in the building; or drains the plumbing lines. Application of this freezing exclusion, however, often turns on interpreting or defining what the terms “reasonable,” “best efforts,” and “building” mean.… Continue Reading

Replacement is Not Always a Prerequisite for an Insured to Claim Replacement Cost Benefits

Replacement cost insurance generally allows recovery for the actual value of property at the time of loss, without deduction for deterioration, obsolescence, and similar depreciation of the property’s value. Depending on the circumstances, the difference between the actual cash value and the replacement cost value of a loss can be significant.… Continue Reading
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