Consumers are bombarded by insurance company advertisements loaded with puffery and bloated promises. While celebrity hucksters, jovial lizards with heavy accents, and emu sleuths might be amusing on TV, real world policyholders are left to discern fact from fiction when it comes to promotional statements in insurance company quotes.
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In a recent case,1 a federal appeals court addressed the issue of whether fire damage to a vacant dwelling from an arsonist was considered distinct from vandalism, so as to not implicate an exclusion within a homeowners insurance policy. In that case, Wells Fargo Bank owned an insurance policy on an abandoned house that an arsonist set ablaze. The insured sued its insurer after the insurer refused to indemnify the insured for the loss, relying on a policy provision exclusion for damage caused by “vandalism or malicious mischief” after the property had been vacant for more than thirty consecutive days.
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Chip Merlin frequently stresses the importance of reading the whole insurance policy when determining whether there is coverage for the relevant property damage. The failure to do so was highlighted in a recent case,1 where a Pennsylvania federal court stated it could not ignore the specific terms of an insurance policy merely because the
I often receive calls from policyholders asking how an insurance company can deny their claim based on an exclusion that isn’t defined in the policy. One of these terms is “surface water,” a common exclusion found in most policies. Recently, I had a client whose home’s gutter system malfunctioned during a rainstorm. Rather than channeling water to run from his roof, through the gutter system and out to the street, water was redirected at the side of the home. The water filled up a planter built in to the side of the house and eventually made its way into the home, damaging his flooring.
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In a recent decision,1 a federal court interpreting Pennsylvania law held that the discovery rule does not apply in insurance actions and the statute of limitations for an insured to bring suit against their insurance company begins to run on the date of loss and not the date the insured becomes aware of the loss.
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Excess insurance policies are often written to follow form, but then an excess carrier may issue a policy that does not follow the bid upon form. Insurance agents and excess lines brokers can certainly do a much better job at the point of sale by reading the policies they sell and broker so the insurance coverage for which they are arranging is actually sold.
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Victor Jacobellis left his job in San Francisco representing insurance companies to join Merlin Law Group and help policyholders obtain insurance coverage benefits. He asked me to speak with him about exceptions to exclusions of coverage which are often overlooked and lead to wrongful denials of coverage. The photo above shows yours truly speaking with Victor Jacobellis in Napa, California at the National Association of Public Insurance Adjusters Annual Conference on this important insurance topic.
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While the timeframe to file a legal action is generally defined under the Statute of Limitations, in some states an insurance policy can contractually establish a shorter period to file a legal action. In a recent California case, Keller v. Federal Insurance Company,1 the Ninth Circuit upheld a Legal Action Against Us clause, finding the homeowners waited too long to file a lawsuit.
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In a recent court opinion,1 the New Jersey Appellate Division interpreted a homeowner’s insurance policy’s water damage exclusion and determined whether damage from a broken municipal water main under a public street was covered under the policy. In that case, a homeowner brought an action against his insurer for breach of contract after the insurer disclaimed coverage on the basis that damage to his real and personal property resulting from a broken water main was excluded under the policy as flood, surface and ground water intrusion.
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Insurance companies and insurance agents know that their customers do not read their insurance policies. Proof is found by the Squaremouth Insurance Company offering a prize which could only be found if a policyholder read the insurance policy and won a secret contest. Here is the story:
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