Home Insurance Law How Worthwhile Is It To Not Pay Claims? An Instance of Why Insurers Need To Make Unhealthy Religion, Penalties For Delay, Fee of Prejudgment Curiosity, and Lawyer Charges Extinct

How Worthwhile Is It To Not Pay Claims? An Instance of Why Insurers Need To Make Unhealthy Religion, Penalties For Delay, Fee of Prejudgment Curiosity, and Lawyer Charges Extinct

How Worthwhile Is It To Not Pay Claims? An Instance of Why Insurers Need To Make Unhealthy Religion, Penalties For Delay, Fee of Prejudgment Curiosity, and Lawyer Charges Extinct


Consider what the price can be for someone to pay for a five-year authorized battle with an insurance coverage firm, realizing that the matter must acquire a trial court docket order after which win once more on attraction. How a lot cash does the insurance coverage business wrongfully pocket as a result of its wrongful cost selections go unchallenged? I’ll submit that it’s most likely far better than the loopy fraud statistics made by the insurance coverage business. In fact, there isn’t any insurance coverage business “Coalition Towards Unfair Claims Denial,” which screens its personal dangerous actors. These points are vital when enthusiastic about the scale of a typical loss and the insurance coverage business’s incessant lobbying to cut back penalties and accountability for good religion claims obligations.

I used to be enthusiastic about this whereas studying a State Farm case, which stands for the longstanding proposition that “incur” means a policyholder solely has to have a contract in order that the expense is “incurred” versus “cost,” which can imply that the cash has been paid.1 The case was over a dispute involving round $40,000. The water loss occurred in August 2018. After State Farm refused to pay for the water loss, the policyholder filed a lawsuit in February 2019. State Farm then demanded appraisal. State Farm’s appointed appraiser and the Umpire signed the award in March 2020.  State Farm then solely paid a bit greater than $1 thousand.

State Farm made the next shedding argument, which the appellate court docket didn’t settle for:

State Farm’s major argument is that the which means of ‘incur’ in its coverage contains an implicit, unwritten requirement that an insured should signal a restore contract that comprises no alternative for cancellation. State Farm concedes that this gloss on the which means of ‘incur’ will not be particularly set out in its coverage. Certainly, an insured would don’t have any warning that such a requirement exists till the denial of its declare on this foundation. As such, the plain which means of ‘incur’ as utilized in State Farm’s coverage doesn’t comprise even a touch that an insured’s contract should be non-voidable earlier than cost can be allowed. State Farm’s interpretation merely provides an undisclosed requirement that the coverage language doesn’t help.

The issue is that such a claims tradition is now prevalent in lots of insurance coverage firms. Anyone can simply begin to argue a large number of causes for non-payment or decreasing cost of each loss. Many of the insurance coverage firms with these claims cultures have claims administration targets, leakage targets, and different incentive-structured administration metrics to help the incessant nitpicking denials and tradition to pay as little as doable. These identical firms even have massive lobbying and propaganda budgets to stop legal guidelines that shield policyholders from such a claims tradition.

Let’s go one step additional—what number of water loss “tear out” claims does State Farm have yearly? It should be lots of of hundreds. Suppose this loss occurred in a state with no dangerous religion, no legal professional’s charges, and no prejudgment curiosity. How worthwhile is it for State Farm to take the identical shedding place, realizing nearly no one would be capable to rent an legal professional to take the matter on as a result of the price to take action would equal the quantity to be gained? What number of policyholders simply stroll away?

I additionally learn the policyholder appellate transient and famous that different trial court docket judges all through Florida had already dominated the identical means that the appellate court docket did on what the phrase “incur” means:

In instances all through the state, State Farm has invoked appraisal after which refused to pay the Tear Out quantity awarded to insureds throughout appraisal even after the insureds entered into contracts with a common contractor to carry out the Tear Out. Like on this case, trial courts have denied practically an identical arguments that State Farm doesn’t owe the Tear Out quantity and entered abstract judgment in favor of insureds requiring State Farm to pay the appraisal award quantity for Tear Out:

  • Burns v. State Farm Insurance coverage Co., 2018-CA-004156 (Polk County, Decide Steven L. Selph) (March 1, 2021);
  • Gant v State Farm Insurance coverage Co., 2D22-2590, 19-CA-004299 (Hillsborough County, Decide Rex M. Barbas) (July 15, 2022);
  • Hester v. State Farm Insurance coverage Co., 6D23-1022, 19-CA-001129 (Polk County, Decide James A. Yancey) (October 26, 2022);
  • Gordon v State Farm Insurance coverage Co., 2019-CA-000714 (Duval County, Decide Virginia Norton) (November 4, 2022);
  • McClendon v. State Farm, 1D22-4099, 16-2019-CA-002324 (Duval County, Decide Katie Dearing) (November 18, 2022).

How worthwhile is it to not absolutely and promptly pay claims? The aggressive insurance coverage business is aware of it is vitally worthwhile and even required now. The issue is that “dangerous actors” who promote on value are driving such a conduct. As soon as sufficient opponents are paying much less based mostly on a tradition of claims severity discount with no consequence, the in any other case good actors must sustain or lose market share. This idea will not be complicated economics.

For policyholders and people concerned about defending the rights of policyholders, we have to demand measures to stop this systemic dangerous religion claims tradition. I’ll write rather more about this concern as a result of it’s the main overreaching concern of the day that wants fixing earlier than the insurance coverage product loses all legitimacy.

Thought For The Day                            

Lowering claims frequency and severity can result in diminished insurance coverage premiums. It’s important to test how you’re doing at present regarding claims frequency and severity information.

—Bryson Insurance coverage Weblog

1 State Farm Ins. Co. v. James, 374 So.3d 934 (Fla. 5th DCA 2023).



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