Property Insurance Claim Disputes 101: Conditions & Duties
As a homeowner, it can be difficult to keep up with all of the fine print that comes with home ownership, and your insurance policy is no exception! It is an extremely important, and often times overwhelming, contract that governs how your insurance company will be required to help you in the event you one day need coverage.
Every insurance policy places certain conditions and duties upon you as the insured. If you do not comply with the conditions and duties placed upon you, the insurance company may have grounds to deny you coverage. Reading your policy is the only way to truly know what specific conditions and duties apply to you. Some policies are termed “all-peril,” policies which provide coverage for sudden, accidental, and direct physical damage to covered property (subject to exclusions). Other policies only cover against losses specifically listed within the policy language. You should also keep in mind that every time you alter your coverage or renew your policy, there will likely be endorsements attached to the policy that could modify the coverage originally provided to you.
The good news is that most insurance policies have a core set of conditions and duties that are standard in just about every policy. Below is a general check list of your duties that should cover the basics in most situations:
- Timely payment of premiums
- Reasonable maintenance of the property
- Timely submission of a sworn statement, or "proof of loss"
- Cooperation with the insurance company’s investigation of your loss, to include:
- The production of certain documents
- An examination under oath
- Compliance with any other reasonable request from your insurance company
- Making your property available for inspection by the insurance company
Insurance companies also owe a core set of contractual and statutory obligations to you as the insured. Below is a general check list that covers most situations:
- Acknowledging a loss and acting promptly once a loss has been reported
- Conducting a reasonable investigation of the loss — i.e., conducting an in-person visit by an adjuster to document and establish the exact scope of loss
- Clearly explain the basis of any denial
- Acting in good faith to their insured — i.e., the insurer must not put its own interests ahead of the insured’s interests.
Most litigation related to these types of claims revolve around one question: what constitutes a “reasonable investigation” by the insurance company? Here is a common example often encountered:
An insurance adjuster conducts an in-person inspection to determine the exact scope of damages on a reported roof damage claim. After inspection, the insurance company denies coverage to the homeowner on the basis that the adjuster’s inspection report concluded that all damage found on the roof was the result of ordinary wear and tear (which was excluded under the terms of the policy).
It is then later discovered by the homeowner that the insurance adjuster never actually went onto the roof during the in-person inspection of the claim. In other words, the insurance adjuster never got on the roof, and thus, the insurance company had no reasonable basis for concluding that the damage on the homeowner’s roof was the result of ordinary wear and tear.
After bringing in the appropriate experts, the homeowner is able to prove that the damage on the homeowner’s roof was the result of a wind and hail storm and is then able to recover for the damage.
If you have reason to believe that your insurance company is putting its interests ahead of your own or is not acting with diligence and in good faith with regards to your claim, or if you have questions about the specific language in your insurance policy, please contact Heekin Law today for a free consultation and speak to an experienced attorney in our office.