Claims Under Your Homeowner’s Policy
What are Homeowner’s Policies?
Homeowners policies are typically “all risk” policies which provide a broad range of coverage for property damage to your home as well as liability coverage for claims made against you or a family member for something you were alleged to have done that caused loss and damage to someone else or their property. Property damage to your home could include fire or some other cause of physical damage. Liability coverage include the insurer paying the costs of defending the claim made against you as well as any damages payable to the injured party.
In the event that you have a claim, typically the 1st step is to contact your insurance broker or the insurance company that sold you the policy. The purpose of your contacting them is to report the claim and obtain their assistance in assigning adjuster to assist you in dealing with the loss or damage. For example, in the case of a fire, arrangements would be made for alternate accommodation.
Depending on the nature of the claim, the insurer may retain an insurance adjuster to investigate the claim. The insurance adjuster is typically asked by the insurer to determine whether there is coverage under the policy as well as advise the insurance company as to the nature and extent of the damage and the estimated repair costs in the case of property damage. While insurance adjusters typically perform their obligations professionally, they are hired by or work for the insurance company, not by you.
If in the course of the investigation of your claim by the insurer, usually by the adjuster, you are asked to sign a non-waiver agreement or served with a reservation of rights letter, this means that there may be a coverage issue under your policy in connection with your claim. In those circumstances it is wise to seek advice as to what the potential problem is and what can be done to deal with it as soon as possible.
If coverage is denied, you should seek legal advice to determine whether the denial of coverage is justified or not. The limitation period, that is the period of time in which you have to bring a legal action to contest a denial of coverage, is now 2 years from the date of denial.
Problems that can arise in the course of your property damage claim relate primarily to whether the claim is covered or the valuation of the claim i.e. the extent of the damage or what options are available to you under the policy if the claim is for a total loss. If you and the insurance company disagree as to the value of the property insured, the nature and extent of repairs or replacements required or whether or not they were adequate, the recently amended Insurance Act of British Columbia contains provisions to resolve the disagreement as between you and the insurer. That process can be invoked by you or the insurance company. We can explain this process, your rights, and see you through the appraisal process. in some cases suing the insurance company the only option we have considerable experience in that process.
In regards to liability claims, that is claims made against you or members of your household, the most common problem is coverage – that is whether or not the claim is covered and whether the insurer has a duty to defend the claim. The “duty to defend” is an important part of your policy as it obligates the insurer to pay legal fees associated with your defense which can be considerable.
If your claim is denied, coverage issues are raised or you are offered far less than you think the damage to your home is worth, you should consult with one of our lawyers who can explain the claims process, evaluate your insurance coverage, advise you as to your rights and the appropriate steps to take, and answer any questions you may have.
Wrongful Denials Under Life Insurance Policies
We have life insurance policies so that if something happens to us our family members will have sufficient funds to carry on without us. In some cases, life insurance companies deny coverage and refuses to pay benefits to the designated beneficiary or there is a dispute as to the beneficiary designation under the policy which delays payment pending the resolution of the beneficiary issue.
Denials of coverage under life insurance policies usually fall into one of 2 categories. The 1st is a dispute over the cause of death including that the claim is excluded under the policy because of the cause of death. The 2nd, and more common reason for a denial of coverage, is that the insured misrepresented a fact at the time that they made the application for the insurance. Those of you who have completed life insurance applications know that they provide a form with a great many questions as to your previous health history and health status. As well, during the application process you may be examined or interviewed by a nurse who asks further questions and records the answers. If there is a misstatement as to prior health history, which can simply be a forgotten event or condition, the insurer may deny coverage on the basis that the deceased misrepresented his or her health history and had they been aware of the true facts they would not have sold the policy or they would have charged a higher premium.
If an insurer communicates any difficulties with coverage or beneficiary designation, legal advice should be sought as typically the monies payable under life insurance policies are considerable and the issue as to whether an insurer can rely on an alleged misrepresentation can be complex.
Business Insurance Policies
There is an increasing volume of coverage denials.
Businesses typically have what are referred to as comprehensive general liability policies which provide coverage for both commercial property and liability risks. Specialized businesses such as developers, construction and technology companies have additional coverages/policies depending on the size and the nature of the business include coverages specifically related to inventories, errors and omissions, fidelity bonds and other specialized coverages.
Property coverages include damages to plant and equipment caused by a variety of risks as well as business interruption coverage to cover losses sustained by the business as a result of damage which affects your ability to conduct business. There are a number of levels of business interruption coverage and a number of disputes typically arise in the compensation for that coverage.
Liability coverages provide for defense costs and indemnity for any monies that have to be paid to a person or company claiming against your business that is covered under the policy. Coverage under these policies can include liability arising from a wide variety of circumstances including your products and completed operations. Coverage issues that arise under this policy can relate to a failure to report a potential claim or the application of one of the many exclusions contained in the policy.
Companies purchase directors and officer’s liability insurance to protect the organization’s top management from claims made against them in respect of the services they perform as directors and officers.
If your business’ claim is denied, or the insurer is investigating the claim on a reservation of rights basis or otherwise indicated there may be a coverage or other issue in regards to your claim or a claim made against you or your business, please contact us to discuss your case. What we do is ask the right questions and analyze your insurance policy and provide straightforward advice as to the extent of the problem and options to solve the problem.
Mortgage Insurance, executor insurance, professional liability insurance
We can assist clients in the formulation and presentation of their claim in order to facilitate a fair settlement and avoid to the extent possible disputes over valuations and coverage.
We assist clients in the course of the insurance company’s claims investigation process to assist in meeting policy requirements as well as reducing the likelihood of coverage issues arising as a result of the manner in which the claims investigation process was conducted.
For more information, we invite you to contact Ross McLarty or Robert Lo to discuss how we can assist you.