Author: Brandon McWherter

Being a homeowner isn’t always easy. There’s so much that goes into owning a home, including having an insurance policy that protects you from various dangers. But, does your insurance policy actually protect you? Many insurance policies have different riders that wind up costing the homeowners more than just their premium when damage is done to their property. For example, has your home been damaged by a flood, a storm, or a broken pipe? Are you under the belief that your policy will cover such damage? Depending on your policy, you may not be covered after all.

Burst pipes vs. slow leaks

Let’s begin with a claim dispute from Chesterfield, Virginia. The policyholder walked into her home one day and waded through water. The contractor identified three leaks in the home, one labeled as short-term (or new) and two labeled as long-term (or gradual).

Despite the homeowner’s policy covering water damage, the insurance company only issued a check for part of the claim. The company claimed that the damage to the home was considered gradual, because of the two long-term leaks – and that gradual wear and tear was not covered under the policy.

Is my water damage covered?

It’s important to know what your policy covers before you get into trouble. There are some claims that may be covered in full, such as roof leaks, burst pipes, water lines from appliances and compressor breaks.

You could also suffer water damage from a severe storm, such as a hurricane, which leads to one of the most common problem homeowners face: they have coverage for hurricanes through their policy, but the insurance company won’t pay in full because the policyholder isn’t covered for flood damage. You should look into flood coverage, as it may save you in the long run.

Pay close attention to the language of your policy

The terminology, or wording, used in the policy can be deceptive, too. Often, these policies are written in draconian “legalese,” and most policyholders don’t read their policies in their entirety, creating another way for the insurance company to deny a claim. Talk to your agent about your policy, and make sure to have the coverage you need.

Were you denied benefits by your insurance carrier because of one of the “loopholes” mentioned here? If so, it’s time to speak with an experienced Tennessee insurance dispute attorney from The Gilbert Firm about your situation. Brandon McWherter, Clint Scott and Jonathan Bobbitt provide residents of Tennessee with honest and trustworthy representation. Call the office at 888-996-9731 or fill out the contact us form found on the website to schedule an appointment.

A court decision in Tennessee regarding a homeowners’ insurance policy recently caught our eye. We thought it was a great opportunity to talk about the concept of misrepresentation and fraud.

In the case of Conley v Tennessee Farmers, Dolores Conley brought suit against her homeowners insurance company, requesting they pay her claim for damages after a house fire. Tennessee Farmers countered that because of Conley’s misrepresentation regarding a prior foreclosure, her policy was void. Tennessee Farmers alleged that misrepresentation concerning this foreclosure materially increased the risk of loss for the insurance company.

Conley explained that she was not involved in the foreclosure and her name was not on the loan for the property that went into foreclosure. However, the Court still held that misrepresentation voided the policy, because it increased the risk of loss, and whether or not she did it intentionally was irrelevant.

Understanding misrepresentation

This case is an interesting lesson in misrepresentation in insurance policy applications. In the insurance industry, misrepresentation is a false statement on an application for insurance coverage that, if told truthfully, would affect the company’s decision on issuing the policy.

Although misrepresentation doesn’t necessarily void a policy, Tennessee law (T.C.A. § 56-7-103 ) reads as follows:

• 56-7-103. Misrepresentation or warranty will not void policy Exceptions. No written or oral misrepresentation or warranty made in the negotiations of a contract or policy of insurance, or in the application for contract or policy of insurance, by the insured or in the insured’s behalf, shall be deemed material or defeat or void the policy or prevent its attaching, unless the misrepresentation or warranty is made with actual intent to deceive, or unless the matter represented increases the risk of loss.

The “unless” is the important part here. In the case above, the Court pointed out that the misrepresentation increased the risk of loss, rendering the policy void.

Whether a misrepresentation is innocent or fraudulent, it can result in a denial of benefits. It’s crucial you understand the terms of your policy and complete your application truthfully.

However, it’s not uncommon for claims to be wrongfully denied for misrepresentation. Maybe the questions on the application were confusing or vague. Perhaps your agent didn’t ask you all of the questions. An experienced Tennessee insurance dispute attorney can work with you to find out why.

If you have any questions or concerns about your policy or need legal assistance, the Tennessee insurance dispute attorneys at The Gilbert Firm can help. Talk to Brandon McWherter, Clint Scott, or Jonathan Bobbitt for smart and honest representation. Call us today at 888.996.9731, or fill out our contact form. We maintain offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville.

More and more people are working from home these days, whether it’s full-time for a brick-and-mortar company, as telecommuters, or as independent business owners. Because of the increase in work-at-home employees, it’s important to look at how insurance policies protect your home-based business property in the event of damage. 2018 was filled with horrific catastrophes including massive wildfires, floods, hurricanes, tornadoes and crippling blizzards. Would your home-based business survive if a weather event or other catastrophe caused damage to your home?

Business interruption insurance

Imagine if your home suffers a fire. The homeowners’ insurance you have on the home will cover the damage left behind by the fire, even if it’s not a total loss, but the income you miss out on due to being unable to work will typically not be covered by a normal homeowners’ policy. If you have business interruption insurance, the lost income as a result of the fire will be covered.

Business interruption insurance is an important coverage all businessowners should consider, no matter whether the business is home-based or the more traditional brick-and-mortar style. Business interruption (“BI”) coverage is routinely packaged into a broader businessowners form that covers business personal property, equipment, inventory, etc. BI coverage helps cover the income you will lose if you need to close your business for an extended period for various reasons. But when buying BI coverage, be sure to ask questions to make sure the coverage is properly tailored for your particular enterprise. For example, things like co-insurance, whether or not payroll costs are covered, the limits of the coverage, etc. can all have a dramatic increase on whether the policy will actually serve the intended goal of putting the business in the place it would have been had there been no loss at all.

There are exclusions and specific items that are not covered by business interruption insurance. For example, practically all policies limit coverage to losses of income that result from a risk that is covered by the underlying policy, i.e., wind, hail, fire, etc.  The fine print is also important, and it is critical to gain a good understanding from your agent about what is covered and what is not covered. For example, if you own a home-based business that sells product stored off-site, would your BI coverage kick-in to cover a loss of income caused by a fire to your product that was damaged by fire while in a warehouse owned by someone else? If you don’t ask and explain the nature of your business to your broker, you might be in for surprise.

Is business interruption coverage worth it?

Business interruption coverage may be a vital component to the continued the health and success of your home business in the aftermath of a catastrophe. But, it’s not for everyone. If you are a life coach and can continue your work in other locations, maybe it’s not a big deal for you.

Did you have to close your home-based business for an extended period due to some type of weather event? Did a fire or flood stop you from working?  Did your insurance carrier fail to properly pay your BI claim?   If so, it may be time to speak to an experienced Tennessee insurance dispute attorney from The Gilbert Firm about your situation. Call the office at 888-996-9731 to speak with Brandon McWherter, Clint Scott or Jonathan Bobbitt today. Complete the contact form found on our website to schedule an appointment.

When you buy an insurance policy for your property – no matter whether that property is commercial or residential – that policy is most likely going to have an appraisal clause. Although few people take advantage of the appraisal process, nearly all insureds have the option of using appraisal to resolve disputes over the “amount of loss.”

When a property owner sustains damage because of, for example, a hail storm, the insurance company will typically send someone to inspect the damage and prepare an estimate. The policyholder might think the damage is worth X; the insurance company believes it is worth Y. At this time, either the policyholder or the insurance company may invoke the policy’s appraisal clause. When people hear the word “appraisal,” they usually think of a real estate appraiser, but in the insurance context it is more appropriate to think of an appraiser as a damage assessor. Pursuant to the appraisal clause, both the policyholder and the insurance company must select an appraiser to value the amount of the loss, and those two individuals will attempt to reach an agreement on the replacement cost value and actual cash value (replacement cost minus depreciation) of the loss.

If the two appraisers are unable to agree, a third neutral party, called “the umpire,” comes in and resolves the appraisers’ disagreements. The umpire is the third member of a three-person appraisal panel. In most policies, an agreement between any two of the three members of the appraisal panel becomes binding as to the amount of the loss.

How is an appraiser different from an adjuster?

An insurance adjuster is the person who inspects your property to determine how much damage has been done, and what that damage is worth.  Remember that insurance adjusters usually work for the insurance company – not the policyholder (public adjusters are the exception; they work for policyholders). Although insurance adjusters are supposed to accurately value the loss, they often leave things out which can leave the policyholder in a lurch when it comes time to make repairs.

An appraiser is the person who comes in after the adjuster has offered a settlement, if the insured feels the payment offered is inappropriate. Adjusters assess the damage, investigate the cause and extent of the loss, take statements, make recommendations for payment, and interpret the policy. On the other hand, appraisers serve the singular purpose of determining the amount of the loss in the context of the insurance policy’s appraisal clause when the insurance company and insured are unable to agree.

Appraisal can be an awesome tool for insureds because it takes the decision-making power out of the insurance company’s hands as it relates to the amount of the loss. By the same token, insurance companies can invoke appraisal too. However, appraisal does have its limitations because appraisers are not authorized to make coverage decisions, i.e., determine whether damage is covered by the policy.

Why you might need a lawyer to uphold your rights as a policyholder

Our firm has represented clients in countless claims involving appraisals.  Sometimes we conclude appraisal is the best option to quickly resolve a dispute. In those cases, we will help our clients screen and select an independent and impartial appraiser and guide the insured through the process. In other cases, we are hired because the insured has already demanded appraisal, but the insurance company has refused to allow the claim to go to appraisal based on assertions of “coverage questions.”  Additionally, we are often called upon to represent clients who have received an appraisal award, but the insurance company refuses to pay it. The scenarios are endless, but whatever the facts may be, call us for a no obligation consultation and we’ll point do our best to get your claim heading back in the right direction.

Dealing with property loss is frustrating; choosing the right attorney to fit your needs should not be. The Gilbert Firm has been protecting commercial and residential policyholders for years. To speak with an insurance dispute lawyer like Brandon McWherter, Clint Scott or Jonathan Bobbitt, please call 888.996.9731, or to fill out our contact form. We maintain offices across Tennessee, with satellite offices in Mississippi, for your convenience.

There are primarily three different types of adjusters. There are independent adjusters who work for the insurance company. They’re not employed by the insurance company, but they work only for them, not for the policy holder. There’s in-house adjusters, who’re actually employed by the insurance companies. Then the third type are public adjusters, and public adjusters are those who work for the policy holder. So they help fight for those people to make sure that the amount of the loss is set correctly.

I work with public adjusters all over the southeast. I’ve worked with dozens and dozens of them, and I welcome any public adjusters who have cases that they want to run by me, and be pleased to talk with you.

The Gilbert Firm is proud to represent policyholders and public adjusters on residential and commercial claims. To speak to an experienced Tennessee insurance dispute attorney like Brandon McWherter, please call us 888.996.9731, or fill out our contact form. We have offices are based in Nashville, Chattanooga, Memphis, Jackson, and Knoxville, Tennessee.

Let’s start with the basics. If you, as a homeowner, sustain property damage or losses because of a covered event (like a fire, for example), you will need your home fixed. You choose a contractor or restoration company to do the work – but the check from the insurance company has not come through yet, and you need them to start right away. So, what can you do?

You can sign an “assignment of claim,” which assigns your rights (as the policyholder) to benefits and proceeds from the loss, to the company or contractors. In the simplest of terms, the assignment of claim allows your contractor to get paid directly from the insurance company.

However, many contractors and purchasers of the damaged property have found themselves in a tight spot over the years, because of something called the anti-transfer clause. As explained on the Tennessee Insurance Litigation Blog, the anti-transfer clause “usually reads something like this: ‘Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured.’” Sometimes, the insurance company requires their written consent before an assignment of claim can be made.

This clause routinely allows insurers to deny payments to contractors – but it shouldn’t, when an assignment of claim is made post-loss.

Pre-loss vs. post-loss assignments

The Courts of Tennessee have routinely ruled on behalf of contractors and purchasers who were assigned the claim after the loss occurred. That is because the original assignee – the homeowner – was approved by the insurance company in the first place, and because the damage occurred regardless. There was no additional risk for the insurance company. Therefore, even if the contractor has a long and storied history of rule-breaking (or even criminal activity), the homeowner can assign the claim however he or she chooses; after all, the loss already happened.

Where insurance companies can (and do) have a leg-up is for pre-loss assignments. The insurance company underwrote the risk on Bob and Jane Homeowner because it felt confident enough to do so. Bob and Jane cannot assign their policy to another person without the approval of the insurer, even when no loss has occurred.

Even if there is an anti-transfer clause in your policy, the chances are very good that a post-loss assignment cannot be legally denied by your insurer. If it is, seek out a lawyer to help you dispute the denial.

One last note for policyholders

In some cases, the insurance company may decide that the amount of your loss is worth less than what the contractor is charging you for the renovations. If this happens, you could be on the hook for the remainder of the costs., depending, of course, on the language of the deal with your contractor.

Because of this risk, you should contact an attorney before making any decisions. Get informed about your rights from the start, and let your lawyer address any potential hiccups along the way. If your insurer lowballs your claim, your attorney can handle the dispute, to ensure that you are compensated fairly.

At the Gilbert Firm, we have spent years fighting against unfair insurance claims policies in Tennessee and Mississippi. Let Brandon McWherter, Jonathan Bobbitt and Clint Scott  put their knowledge and experience to work for you. Please call 888-996-9731 or fill out our contact form to schedule a consultation at once of our offices in Nashville, Chattanooga, Memphis, Jackson, and Knoxville.

If your claim has been denied, the first thing you need to do is talk to a lawyer. Call us. We’d be happy to take a look at it.

Your claim can be denied for a variety of reasons, and there’s no way to know if the reason that’s been given is a legal one, unless you have a lawyer take a look at it. Perhaps your claim has been denied in a fire case because they’ve accused you of arson. Perhaps you’ve had a roof claim and they say that your roof was just old, and you don’t deserve a new roof. There’s so many types of losses and so many different bad reasons given to deny claims. It’s hard to give a general answer on, “What do you need to do next?” except for call someone who knows what they’re doing, let them explain their options to you, and we’d be happy to do that for you.

The Tennessee insurance dispute attorneys of the Gilbert Firm are proud to represent policyholders. To speak to an experienced insurance dispute attorney like Brandon McWherter, please call us 888.996.9731, or fill out our contact form. We have offices are based in Nashville, Chattanooga, Memphis, Jackson, and Knoxville, Tennessee.

One of the most common questions that we get is, “How do you charge for your time?” And that’s a fair question. If I was a consumer, I would want to know that too. We charge based on contingency fee, so we get a percentage of whatever we get for you. Sometimes it’s low, sometimes it’s high. It depends on the amount of the claim; it depends on the complexity of the case; it depends on when you call me. If I’m getting a claim before any claim decision has been made that’s moving along in the ordinary course and someone just needs help presenting their claim, then the contingency fee might be one number. If it comes after a denial and after partial payment has been made, and so we’re fighting about a smaller amount, and that portion is being denied, then it could be a totally different number. But that’s how we get paid, and we only get paid when you get paid.

At the Gilbert Firm, our insurance dispute attorneys help policyholders throughout Tennessee. To speak to an experienced insurance dispute attorney like Brandon McWherter, please call us 888.996.9731, or fill out our contact form. We have offices are based in Nashville, Chattanooga, Memphis, Jackson, and Knoxville, Tennessee.