Author: Brandon McWherter

One of the questions we hear a lot from policyholders whose claims have been denied is, “Can I sue to recover my money?” The short answer to that question is “yes, but.” The simple truth is that many claim denials are appropriate, and in those cases any lawsuit that is filed would likely be unsuccessful.

Generally speaking, in order to win, a policyholder must be able to prove that the insurance company wrongfully denied the claim, failed to pay the appropriate amount, or engaged in unfair or bad faith claim practices. Because of this, we investigate cases thoroughly before filing suit and are careful to only prosecute the claims we feel will ultimately be successful.

Here’s a few examples of claims we’ve agreed to assist with over the last few weeks:

• Hail damage claims to metal roofs that the insurance company denied because the damage was “only cosmetic”
• A residential house fire in which the insurance company has only paid about half of the true value of the damaged residence
• Hail damage to HVAC units on the roof of a commercial building that the insurance company adjuster missed during his inspection
• Water damage to interior after an ice storm caused damage to an office building

Each insurance claim has its own set of facts, and those facts must be analyzed in light of the insurance policy that governs. Only then can the odds of success be determined, at which time an educated decision can be made as to how to best move forward. And if the policy doesn’t cover the loss, it then has to be determined whether the insured actually received the insurance coverage that was promised by the agent. Whatever the facts, we can help guide you through the process and aid you in deciding whether further action is warranted.

At the Gilbert Firm, we protect policyholders whose claims have been wrongly denied. If you think your insurance company has wrongfully denied or underpaid your claim, we want to help. Please call 888.996.9731 or fill out our contact form to make an appointment with Brandon McWherter, Clint Scott or Jonathan Bobbitt. We have offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville to better serve you.

One of the most often-overlooked pieces of the insurance claim process is the submission of a “proof of loss.” What is a proof of loss? It’s nothing more than a one-page document that, at the top, says “Sworn Statement in Proof of Loss,” and it is your claim. It is setting forth what you’re owed, and you give that to the insurance company; you swear to it, and that acts as the trigger for the insurance company’s obligation to pay.

Some insurance policies will say that a proof of loss has to be submitted within a certain period of days – 60 days – and if you miss that deadline, guess what? They raise problems. Some insurance policies say you have to submit it within 60 or 30 days, sometimes, from our request. And so, if you get that request, it’s very important that it be honored.

We here at the Gilbert Firm sit down with our clients, we put our team of people together, we hire the experts to put the claim package together, and we prepare that document for you. And when we submit it, that is what triggers the insurance company’s obligation to do something. / END TRANSCRIPT

From structural damage to contents losses to business interruption claim, your proof of loss is the official claim documents that is often required to make a claim for compensation with your insurance companies. Following the rules about submission – especially with regard to the deadline – is critical to getting the money you are owed. An insurance company will always prefer not to pay out a claim; missing a deadline could be just the excuse they need to deny yours, too.

That is why you want to work with an experienced team, like the one you’ll find at the Gilbert Firm. Our Tennessee insurance dispute lawyers have handled some of the most complex claims there are. Whether your home was damaged in a fire or by wind, or your business sustained losses because of natural disasters or even theft, you do have options. Contact Brandon McWherter or any member of our team by calling 888.996.9731, or by filling out our contact form. With offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville, we are always nearby when you need us the most.

On November 28, 2016, Gatlinburg and the surrounding areas experienced firsthand the devastation of the wildfires. The wildfires that ripped through the Smokies led to the deaths of 12 people, and injured almost 200 more. Close to 18,000 acres burned in two separate locations, and hundreds of people either lost their homes or businesses, or need to do substantial repairs and renovations.

Even those whose homes and businesses were untouched by the fires could have significant damage from the smoke and the soot. Yet many policyholders will face pushback and even denials if they try to recoup losses because of smoke, soot or ash-related damage, especially if the building was untouched by actual flames. But soot and ash can get into places in a building that aren’t quite visible, and make that building unsafe for living or working.

If your policy covers fire, and you wish to bring a claim for fire-related damage, there are a few things you can do to protect your home or business:

1. Document everything. Take as many pictures as you can of the damage done to the building and its contents. If, however, the property may be structurally unsound, or if there is a chance that the air could be contaminated and unsafe to breathe, do not go into the building. Ash can be particularly dangerous, as it may harbor burning embers.
2. Ask for help from emergency services. Your local law enforcement and fire departments can help you keep your property secure. Not only does your insurer want proof that your belongings were damaged by ash, smoke or soot; you want to ensure that anything valuable within your home is documented by the adjuster.
3. Ask your insurance carrier to hire a Certified Industrial Hygienist to test your home or business for remnants of soot, smoke or other contaminants. As a policyholder, you should want to have those tests performed, as they may be the only way to prove just how extensive the damage is. The CIH will take surface samples, but may take air samples as well.
4. Work with a professional cleaning crew. You do not want to attempt to clean your own home if it has sustained damage for smoke or soot. We recommended getting a number of estimates before choosing one company.
5. Review your claim. If your policy states that your property is to be returned to its pre-loss condition, then your insurer should pay for the costs associated with doing so. You may need to pay out-of-pocket for some costs, so you might want to review your policy with your agent. If it looks as though they may deny your claim, you might want to review it with your lawyer instead.

Many standard insurance policies cover fire damage, but that does not mean your insurer will want to pay. If you believe that your insurance dispute is an act of bad faith by your insurer, you should seek legal counsel immediately.

At the Gilbert Firm, we help policyholders who have had their claims denied for unfair or illegal reasons. Our Tennessee insurance dispute attorneys can review your claim, help you document your evidence, and fight on your behalf if your insurer isn’t holding up its end of the bargain. To speak with Brandon McWherter, Clint Scott or Jonathan Bobbitt, or to schedule an appointment at one of our offices in Nashville, Chattanooga, Memphis, Jackson or Knoxville, please call 888.996.9731, or fill out our contact form.

Let’s say that the worst has come to pass, and your home has sustained a significant amount of damage (as it would in a house fire). In order to make your home livable again, you need to hire a general contractor, who in turn is going to work with a plumber and an electrician in order to rebuild your home. When the bill comes due and your contractor submits it to your insurance company, the adjuster tells him or her that the company won’t pay for Overhead and Profit, or “O&P.”

Overhead and Profit, however, may recoverable if they are legitimate costs of doing business. In Parkway Assoc., LLC v. Harleysville Mut. Ins. Co., 129 Fed. Appx. 955 (6th Cir. 2005), the Court found that O&P are recoverable when the insured could “reasonably be expected to hire a contractor to repair [the] property.” As per the Tennessee Department of Commerce and Insurance’s Board of Licensing Contractors, it is reasonable to hire a contractor for any projects worth at least $25,000. In fact, the State requires that a contractor be licensed in order to even bid on projects that size. It is also reasonable when the work will require at least two additional subcontractors or tradesmen. Because Overhead and Profit are standard parts of any contractor’s bill, these should be covered by the insurance company.

What constitutes Overhead and Profit?

The contractor who works on your home repairs has expenses of his or her own. Overhead is the collection of expenses he or she has in running the business itself. That may include things like:

• Cost of materials
• Licensing costs
• Salaries and benefit plans for employees
• Rent for office space
• Marketing and advertising costs

Your contractor is also entitled to make a profit (the difference between how much the services and goods cost the contractor and how much those same good and services cost the customer); after all, he or she should not be expected to work for free.

Insurance companies may claim that these line items are actually included in the overall bid cost for the project: that is not always the case. As a policyholder, you pay premiums that include O&P, and as such, those costs should be covered. If they are not, you want an experienced Tennessee insurance dispute lawyer on your side to help.

The Gilbert Firm represents policyholders throughout the state whose insurance companies are giving them the run around when it comes to payment. We also protect contractors who have been denied Overhead and Profit by insurers. To learn more about our services, or to work with a skilled Tennessee insurance attorney like Brandon McWherter, Jonathan Bobbitt or Clint Scott, please call us at 888.996.9731, or fill out our contact form. We have offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville.

At what point in the claim process do I get involved? That varies – so much so, sometimes. I’ve got clients now, former clients that have another loss that have called me the day after. So sometimes it happens very, very quickly. On the other end of the spectrum, I’ll have lawyers who are handling cases for a policyholder that kinda get in over their head and call me after a lawsuit’s been filed. So I can get in at any given time.

But as a general rule, sooner is always better than later, because along the way there are gonna be pitfalls and roadblocks, and it’s so important to have someone qualified, that knows how to read a policy, that knows what the law is, to help guide you through that process and get it set up correctly on the front end, because sometimes, at the back end, it’s already too late.

You buy insurance because you expect it to protect you in the event of a loss. But what happens when your insurance company denies your claim, or lowballs the amount they are willing to pay out?

You have rights under the law, and a skilled Tennessee insurance dispute attorney can help you obtain the insurance payment you need and deserve. There are often limitations on how long you can wait before filing a claim – and how long you have may depend on the policy itself in some cases. That is why we say it is better to seek legal counsel sooner rather than later: you want to make sure all of your options are available to you.

At the Gilbert Firm, our Tennessee insurance dispute lawyers handle complex claims involving homes, condos, commercial properties, business and non-profit organizations. Whether you have been a victim of bad faith insurance practices, are faced with an insurance carrier that has breached its contract with you, or have been harmed by agent negligence or malfeasance, we can help. To make an appointment at one of our offices serving Nashville, Chattanooga, Memphis, Jackson or Knoxville, please call 888.996.9731, or fill out our contact form.

Imagine for a moment that a storm touches down in Tennessee and ravages your neighborhood. You put in a claim with your insurance company for the damage you sustained, dotting every “i” and crossing every “t.” Then the insurance company sends you some mail, and instead of the check you hoped for, you see a letter telling you that your claim was denied.

It happens to Tennessee homeowners all the time. We wanted to take a quick look at some of the more common reasons why an insurance company might deny a policyholder’s claim:

1. That damage isn’t covered. We have discussed policy exclusions before, and they remain one of the most common reasons why insurers deny claims. It is vitally important that you check your policy to ensure that any gaps or exclusions are covered by additional riders or policies. But remember, the insurance company bears the burden of proving the application of an exclusion.
2. The damage was too extensive. Every policy has limits. If the damage exceeded what your policy limits would cover, you’re likely to be “on the hook” for any additional damage over and above the limits. But, some policies provide extra coverage under limited circumstances. For example, many policies provide for an extra 20% of coverage if the existing limits are insufficient to make repairs.
3. There is a disagreement over the value of your loss. In this case, perhaps your claim was accepted, but the offer seems incredibly low: you say your damage was worth “X,” and the adjuster says it was worth “Y.” Under these circumstances, the insurance company has an obligation to pay what they admit they owe, but sometimes they will try to apply pressure to get you to sign a release. Don’t fall for it – insurance carriers must pay what they owe and leave the rest to fight about later.
4. There was another issue that could have led to the damage. If there is any kind of pre-existing damage or problem with your home, and the damage on your claim could have been caused by that pre-existing damage, your insurer may deny payment. The “wear and tear” exclusion is being utilized more and more to deny valid claims. These claims can be highly technical, and sometimes there can be coverage even if “wear and tear” or deterioration contributed to the damage.
5. There was an error on your original application. Even the smallest mistake can lead an insurance company to deny a claim. They may try to deny the claim if you failed to disclose a prior loss, criminal history, etc. The interaction between you and your agent on these topics can be critical.

Bad faith actions

There are also times when an insurance company’s denial of a claim is just flat out and plainly wrong. If the insurance company is “lowballing” you on purpose in order to avoid paying out a larger (more accurate) amount, or is purposely arguing for the application of an exclusion that is not applicable, you might have a claim for bad faith.

At the Gilbert Firm, we work hard on behalf of policyholders whose insurance agents and companies are giving them the run-around. Clint Scott, Brandon McWherter and Jonathan Bobbitt are skilled Tennessee insurance disputes attorneys who know what it takes to successfully prove bad faith. To make an appointment at one of our offices serving Nashville, Chattanooga, Memphis, Jackson and Knoxville, please call 888.996.9731, or fill out our contact form.

There are a variety of different coverages available under every policy. First, you should know that every policy is different. A homeowner’s policy is going to have dramatically different coverages than a commercial policy. Usually in a homeowner’s policy, you’ll have Coverage A, which is the dwelling, Coverage B, which is other structures (often times), Coverage C, which is contents, and then, in addition to that, there’s the lesser known coverages – the coverage for trees, shrubs and lawns. So when you have a fire loss, and every one of your shrubs has to be destroyed in order to rebuild, that’s covered.

There’s coverage for debris removal. There’s coverage for charges from fire departments for coming out and putting out the fire. There is a mix and multitude of coverages available in every policy, and it takes someone taking the time to dig through there to make sure that you take advantage of every coverage that you paid for. We’re not asking the insurance company to pay for anything that you don’t have, but it’s coverage that you paid good premiums for.

Are you covered for potential losses?

With so many different policies to choose from, it can be hard for Tennessee homeowners to know if they have the right coverage for their needs. You want to make sure that there are no gaps in your policy, and that you can purchase additional coverage for any exclusions, like floods. At the Gilbert Firm, we help our clients makes sense of the polices they have, and work with them to obtain compensation for damages when they are rightfully owed that compensation under their policy.

If your insurance company is giving you the run-around, or if you believe that your claim has been unfairly denied, you may be able to bring a bad faith action against your insurance company. Tennessee insurance dispute attorneys Brandon McWherter, Clint Scott and Jonathan Bobbitt help policyholders just like you every day. To learn more about our services, or to schedule a consultation at one of our offices in Nashville, Chattanooga, Memphis, Jackson or Knoxville, please call 888.996.9731 or fill out our contact form.