Insurance companies and their experts have a long and growing checklist of excuses not to pay hailstorm losses. Many of those excuses center on allegations that the observed damage was not caused by the particular hailstorm being adjusted. When insurers say the alleged hailstorm damage occurred outside the policy time frame, can the matter still be appraised?
Does an appraisal panel determine the amount of the loss before the coverage issues are litigated? This question is a common issue. The answer results in imperfect and prolonged proceedings, which result in delayed payment to the policyholder. Every state seems to have its own answer to the question. Courts struggle with how to handle these issues. …
Appraisal panels have few rules to follow about what they can and cannot consider in determining the amount of the loss. In a case recently decided,1 a policyholder refused to continue in an appraisal because the panel was presented evidence of a subsequent loss. The policyholder argued that this breached the appraisal agreement. …
My bet is that virtually all property insurance adjusters will say “yes.” Yet, in a recent Order in a pending case in Wisconsin,1 State Farm has currently won an argument that the method of repair is a coverage issue and not an issue for an appraisal panel.
Continue Reading Does Appraisal Determine the Method of Repair?
In a recent decision by the United States District Court for the Eastern District of Wisconsin, a federal judge issued an order denying the property owner’s request for appraisal, holding that the insurance policy’s appraisal provision is “limited to disputes over valuation, not causation or coverage.”1…
Continue Reading Wisconsin Federal Court Limits Appraisal to Valuation Only
The Townes of Cedar Ridge Condominium Association (“Cedar Ridge”) was damaged as a result of a March 2019 hailstorm. Cedar Ridge informed its insurer, Travelers Indemnity Company of America (“Travelers”), which inspected the complex and concluded that some gutters, downspouts, air conditioning units, and one shingle on one roof had sustained hail damage. As a result, Travelers issued payment for $17,140.88 for the damages it found were covered and denied the remainder of the claim.
Continue Reading Insurer’s Declaratory Judgment Action After Denial Ruled Untimely
Merlin Law Group attorneys Chris Mammel and Tamara Chen-See won an appraisal case pending before the 10th Federal Circuit Court of Appeals.1 The court ruled that the factual determination of damage to brick siding caused by a hailstorm is a factual matter for appraisal and not a coverage issue. The ruling was similar to the recent Connecticut Supreme Court holding involving matching noted in Matching is a Factual Determination and Can Be Resolved by Appraisal.
Continue Reading Insurers Cannot Escape Appraisal Arguing Factual Determinations of Damage Create Coverage Issues
Tennessee is a beautiful state. The powers that be even gave me a license to ply my trade in the Volunteer State. I was recently researching whether causation can be determined by an appraisal panel in Tennessee.
Continue Reading Causation in Appraisal—What is The Causation Rule in Tennessee Appraisals?
Occasionally, an attorney representing an insured will run into a Motion to Compel Appraisal filed by the carrier’s attorney. Upon receipt of the motion, a few considerations must be made with the most important being:
- Is the demand for appraisal timely? and
- Is appraisal proper considering the “amount of loss”?
Continue Reading Amount of Loss: Appraisal Considerations in New Jersey
Appraisal provisions in property insurance policies are intended to provide an alternative dispute resolution process for resolving property insurance claim disputes involving the amount of loss. The amount awarded by the appraisal panel is, with limited exceptions, binding on both parties under the terms of the policy. While the appraisal process is intended to bring finality to a dispute, what happens when the appraisal panel fails to consider certain items due to limitations or restrictions on the scope of the appraisal or unanticipated factual issues not considered by the panel? Such a situation poses the question of whether Colorado appraisal awards preclude any further breach of contract claims for unanticipated circumstances.
Continue Reading Subsequent Claims for Items Not Considered by Appraisal Panel