By: Ron Haynes
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Mass Torts Las Vegas – Storm Claims
I recently had the opportunity to be a presenter at the Mass Torts 2019 conference in Las Vegas speaking on Storm and Natural Disaster Claims. This was a unique opportunity because it allowed me to address attorneys from all over the nation who typically handle medical mesh, opioid or other mass tort litigation but have no experience with property claims. I was honored to be on a panel with one gentleman from Texas and another from a firm who typically handles flood. While property claims are specific to each State and each has unique laws, in general, the laws appear to be similar on most issues. I spoke on three major topics that a common areas of concern in property cases.
The first was the importance of knowing your policy. You should always request a certified copy of the policy from the carrier. Many of my clients believe that the insurance company has a copy of their exact policy in a computer somewhere and don’t realize that insurance companies don’t actually maintain the full copy. Instead, they issue a declaration page that lists each one of the forms that make up the policy. When you request a copy, the insurance company assembles the policy based on the forms listed in the declaration page. You can’t just rely on the declaration and summary sheet that most people receive when their policy is renewed. I have seen two many times policies that change from year to year with difference endorsements. The main section of the policy will stay the same but the endorsements are important because they can either add or take away from coverage. If you have a certified copy of the policy of insurance, the insurance company is representing that the policy you received is the true and correct policy. Make sure that you are requesting the certified policy which covers your date of loss. If clients are not represented when they call in the claim, many times they do not understand the significance of the date of loss and will pick the date they called in the claim or some other date that isn’t the actual date of loss. If the policy was just recently renewed, the insurance company could send the policy that was in full force and effect on the date the claim was called in gut the actual policy that would apply would be the previous policy that was in full force and effect when the loss occurred. It is important to make sure you have the correct policy that covers the correct date of loss.
Secondly, I spoke about complying with conditions or duties after the loss. Many clients and attorneys who don’t understand this area of the law think that you don’t have to comply with ever request from the insurance company and should just insist they should adjust the loss without any help. Many states including Florida have very clear law that if the named insured fails to cooperate with the insurance company following a loss, the claim can be denied even if you have a properly covered loss. The question becomes what exactly does a named insured have to do. If you have obtained a certified copy of the policy, the policy will spell out these conditions in the “Duties After Loss” section of the policy. These duties typically include submitting a proof of loss, displaying damaged property, preserving property, attending an examination under oath if requested and providing documentation. Some insurance companies place deadlines for compliance in these duties after loss so it is important to determine what the duties are early on and make sure you don’t miss any deadlines. Often times insurance companies request an examination under oath or recorded statement of the insured as part of the investigation of the claim. I would highly recommend retaining an attorney if this request is made. It has been my experience that often times if the insurance company is requesting an examination under oath, they are looking for support to deny the claim. Florida law holds that if you make a material misrepresentation during the examination under oath, your claim could be denied even if you have a valid claim. It is important to make sure you are prepared and speak to an attorney who is familiar with this process. You don’t have to hire an attorney for the entire claim. You have the option to retain an attorney just for the examination under oath process if you so choose. Christopher Ligori & Associates has represented many individuals in just the examination under oath process. If you successfully navigate this process, often times insurance companies will honor the claim.
Finally, I spoke on an issue which is coming up more and more here in Florida but which is universal to other states. Matching of materials during the rebuilding process has increasingly become an issue between the insurance company and individuals. Naturally when you have a loss and repairs are required, you want your house or commercial building to look like it did before the loss. This issue arises a lot with roofing materials, whether it is shingles or tile roofs. If the insurance company only wants to pay for a repair, it may leave your roof looking like it is pieced together, especially when the existing roofing material is older and weathered. Problems can also arise on the interior if you have tile or wood flooring. Many times tile cannot be matched because it is no longer manufactured and wood flooring cures and changes color due to sun light and other effects. Florida has a specific statute which requires the insurance company to match existing material but unfortunately this statute does not apply to commercial. However, there may be other avenues in a commercial policy. Christopher Ligori & Associates does free policy reviews for individuals or building owners if you are unsure what your policy provides and whether matching is required. I also addressed making sure you properly complete a proof of loss if one is requested. Many times the forms use terms like “actual cash value” and “replacement cost value”. It is very important that this form be completed correctly and accurately because you are swearing that the information contained in the form is true and correct and you will be held to the information on that form. If the form is incorrect, it could be a basis for denying the claim.
Insurance claims and policies are complicated. Unfortunately if you don’t get your claim correct the first time it can be very difficult to correct any mistakes on the back side. Don’t let a misunderstanding or a mistake lead to a denial of your claim. Call us at Christopher Ligori & Associates for a free policy or claim review.