A recent decision from one of New York’s trial courts of general jurisdiction could have a chilling effect on written communications between an insurer and its retained counsel during a claim investigation. In Otsuka America, Inc. v. Crum & Forster Specialty Insurance Co., 2019 WL 4131024, Judge Andrea Masley of the Supreme Court of the State of New York, New York County, ruled that several communications between Crum & Forster (CF) and its attorney (including the attorney’s coverage opinion letter), were not privileged and must be produced. The Court found that CF retained counsel, in part, to provide an opinion on whether the insured’s claim was covered. Determining whether a claim is covered is part of the regular business of…
Yearly Archives: 2019
New York Ruling Could Significantly Impact Disclosure of Communications Between Insurer and Counsel
Tagged with: Bad Faith, Discovery, Investigation, Loss Adjustment, Privilege, U.S. Legal System
Posted in Bad Faith, Discovery, Investigation, Loss Adjustment, Privilege, U.S. Legal System
Posted in Bad Faith, Discovery, Investigation, Loss Adjustment, Privilege, U.S. Legal System
New Texas Laws Take Aim at Common Practice in Storm-Related Repairs
Texas policyholders can no longer cut deals with storm repair contractors to pocket their deductibles for storm repairs. The Texas Legislature has amended the Texas Insurance Code and Texas Business & Commerce Code, targeting construction companies that offer “free roofs” and “waived deductibles” as enticements to policyholders. Previously, for example, contractors would reach an agreement to perform work for a policyholder, but waive or absorb the portion of the repair cost equal to the deductible. This waiver or absorption could occur through numerous paperwork tricks. Now, the policyholder must pay its deductible, otherwise the insurer can refuse to pay certain claims and the contractor can be charged with a crime. About The Author
Tagged with: Absorb, Deductible, Legislation, Roofer, Waive
Posted in Deductible, Flood, Hurricane, Waiver
Posted in Deductible, Flood, Hurricane, Waiver
Failure of Insured to Provide Requested Documents Triggers Appraisal Under First Party Insurance Policy
Those familiar with first party insurance policies have undoubtedly encountered a recurring issue with the interpretation of appraisal provisions – what does it mean to disagree on the amount of loss? In Valvano Realty Co. v. American Fire and Casualty Co., the United States District Court for the Middle District of Pennsylvania recently held that a disagreement on the amount of loss encompasses situations where an insurer claims it needs additional documentation before it can determine whether a disagreement exists. Valvano involved a December 18, 2015 fire at the Plaintiff’s property in Dickson City, Pennsylvania, which was insured by American. American’s adjuster, working with a retained construction consultant and structural engineer, determined the replacement cost value of the loss to…
Tagged with: Actual Cash Value, Arbitration and Appraisal, Coverage, Loss Adjustment, Replacement Cost, Valuation
Posted in Actual Cash Value, Arbitration and Appraisal
Posted in Actual Cash Value, Arbitration and Appraisal
Insured Made Whole After Subrogation Recovery
A property insurer, having paid for covered damage, can recover the loss by seeking reimbursement from its insured where the insured has recovered funds from a responsible third-party, or the insurer may pursue a claim directly against the third-party. If the insurer makes a direct claim against the responsible party, to what extent must the insurer allocate the money it recovers to reimburse the insured for its deductible? In an opinion issued on July 3, 2019, the Washington Supreme Court held that a fault-free insured must receive the full amount of its deductible before the insurer may allocate any of the recovered funds to itself. Daniels v. State Farm Mutual Automobile Insurance Co., Wash., No. 96185-9, 2019 WL 2909308 (July…
Pennsylvania Supremes to Decide Whether Actual Cash Value Includes General Contractor Overhead and Profit
Insurance companies may no longer be allowed to rely on clear policy language that expressly excludes general contractor overhead and profit (“GCOP”) from actual cash value payments. The Pennsylvania Supreme Court recently agreed to hear argument on the issue in Kurach v. Truck Insurance Exchange, Case No. 532 EAL 2018. The facts in Kurach are undisputed. The insureds, who admittedly chose not to repair the damage to their homes, filed a class action lawsuit against Truck for its alleged breach of contract by not including GCOP in its actual cash value payments. The policies at issue expressly provided that “actual cash value settlements will not include estimated general contractor fees or charges for general contractor’s services unless and until you…
Key Questions to Consider in Light of Operation Rubicon’s Investigation into Insurance Fraud in South Florida
Law enforcement in Miami-Dade County, Florida recently arrested nine individuals described by Florida Chief Financial Officer Jimmy Patronis as the “ringleaders of an elaborate fraud scheme” led by Barbara Maria Diaz de Villegas,[1] owner of the public adjusting company The Rubicon Group.[2] The arrests were the result of a year-long investigation, known as “Operation Rubicon,” to investigate insurance fraud, and demonstrate that efforts are being made to curb insurance fraud in South Florida. According to a February 2019 report from the Federal Trade Commission, Florida is ranked as the number one state for fraud and is home to 18 of the top 50 cities in the United States in terms of fraud reports.[3] The alleged fraud scheme involved public adjusters,…
Tagged with: Florida, Fraud, Insurance, Investigation, Miami, Public Adjuster, Rubicon
Posted in Water
Posted in Water
Free Ride on RCV? Not So Fast!
Most property insurance policies condition the payment of replacement cost value (RCV) on the property first being replaced or repaired, and courts typically enforce that requirement. Replacement cost is not owed until the insured completes repair or replacement. Yet what property adjuster has never encountered an insured who attempts to claim reimbursement for items not damaged in the loss on the theory that such items are within the RCV estimate and are a part of the property’s “restoration”? A recent Washington Court of Appeals decision illustrates. In Mount Zion Lutheran Church v. Church Mutual Ins. Co., 2019 WL 2177893 Wash. App. (filed March 18, 2019; ordered published May 14, 2019), a fire damaged the interior of a church sanctuary. Church…
Tagged with: RCV, Repair, Replace, Replacement Cost
Posted in Direct Physical Loss or Damage, Uncategorized
Posted in Direct Physical Loss or Damage, Uncategorized
Texas Federal Court Holds that Named Storm Deductible Applies Even in the Absence of Wind Damage
Judge Nancy Atlas of the Southern District of Texas cut through competing arguments to resolve a high-profile dispute involving a Hurricane Harvey claim through Contract Interpretation 101. Lexington Insurance Company issued a policy to Pan Am Equities, Inc. (Pan Am) covering a property development in downtown Houston, Texas. The development sustained more than $6.7 million in flood damage due to Hurricane Harvey, a disaster that flooded homes and buildings across the city, but often left the structures undamaged by wind. This was the case with Pan Am’s downtown property development. The policy contained several different deductibles. As an exception to the general deductible, the policy had a $100,000.00 per occurrence Windstorm Deductible. The Windstorm Deductible was itself subject to an…
Collapse Coverage: Second Circuit Holds That Cracking Walls Do Not Constitute “Collapse”
Most homeowners’ policies – and property insurance policies in general – contain a limited coverage extension for “collapse.” The interpretation of that collapse coverage has been litigated around the country for decades, with different jurisdictions reaching considerably different results. The latest of these decisions, Valls v. Allstate Insurance Company, No. 17-3495-cv (2d Cir. 2019), comes out of the Second Circuit, deciding the case under Connecticut law. The case presented a single substantive question: does the “collapse” provision afford coverage for basement walls which had significant cracking but remain standing? Both the district court (D. Conn.) and the Second Circuit Court of Appeal concluded that it does not. In Valls, the plaintiffs owned a home in Connecticut which was insured by…
Florida’s “Assignment of Benefits” Bill: A Guide Through the New Statutory Framework
This week, after 7 years of failed efforts, the Florida Legislature passed a meaningful Assignment of Benefits (“AOB”) reform bill. Florida Governor Ron DeSantis announced yesterday that he would sign the legislation designed to cut back on abusive AOBs, a practice that has plagued the hurricane-prone state. In recent years, many contractors have taken advantage of Florida’s unique one-way attorney’s fee shifting statute for insurance coverage litigation. This rule has incentivized contractors to, via the assignment of benefits mechanism, charge property owners outlandish amounts and to then pursue needless, sometimes frivolous, and always expensive litigation against insurance companies. Florida H.B. 7065, expected to take effect July 1, 2019, makes several key statutory changes designed to curb AOB practices. We discuss…
Tagged with: 627.428, 627.7152, AOB, Assignment of Benefits, Attorney’s Fees, Florida, Florida Statutes, HB 7065, Insurance
Posted in Assignment of Benefits
Posted in Assignment of Benefits
