Tag Archives: Policy Language

Can an Insurer’s Pre-Sale Representations to a Prospective Insured Prevent Denial of Insurance Benefits After Loss?

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.… Continue Reading

Arson of Vacant House: Covered Fire Loss or Excluded Vandalism?

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 … Continue Reading

Court Does Not Pity the Fool Who Does Not Fully Read His Insurance Policy

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 insured … Continue Reading

When Can My Property Insurance Claim Be Denied Due to War or Other Undefined Terms?

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 … Continue Reading

Property Insurer Wrongly Denies You Coverage? Victor Jacobellis and Chip Merlin Discuss How Exceptions to Exclusions Win Coverage

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 … Continue Reading

Legal Action Against Us Clause

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 … Continue Reading

Broken Water Main Damage: Flood or Not Flood Under Homeowner’s Insurance Policy?

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 … Continue Reading

Church vs. Church – Court Uses Dictionary to Define “Decay”

Easthampton Congregational Church submitted an insurance claim to Church Mutual Insurance Company when their roof suddenly collapsed. Church Mutual denied coverage for faulty construction after they sent their engineer, Joseph Malo, out to inspect the property. Mr. Malo noted, and the insured agreed, there was “progressive failure of the fasteners used to attach the layers … Continue Reading

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

Wildfire Considered One Occurrence Despite Damaging Numerous Properties

A recent decision by the Supreme Court of Wisconsin1 might predict how other courts would analyze coverage under commercial general liability insurance policies for wildfires. In May 2013, a fire broke out on forest land owned by Lyme St. Croix Forest Company. The fire burned nearly 7,500 acres over the course of three days and … 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

Refusing to Answer Questions at an EUO is Usually Not A Good Idea

Recently, it seems like I have been privy to a relatively high number of insureds asked by their carrier, following a loss, to submit to an examination under oath (commonly referred to as an EUO). The most common question I received was, “Can I just choose not to answer or attend?” Although the choice is … 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
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