Category: Insurance Disputes

Most of the claims that we handle involve disputes about how much is owed. Sometimes it’s if you’re owed anything at all, but most of the time it’s a dispute about how much. And so what we do here at the Gilbert Firm, is we have assembled a team of experts from all over the country, really – roofing experts, engineers, content specialist, accountants, lawyers, my own staff here – but we bring this team together, and we look at the claim as a whole, and we put a package together to make sure that we’re maximizing what you’re entitled to.

We’re not trying to inflate anything; we only want you to get what you’re owed, but we don’t want you to be underpaid. The insurance companies are often doing the exact opposite; they’re trying to pay the bare minimum. So, we are just here to make sure that you get the most possible bang for the claim that you’ve been forced to make because of this catastrophic loss.

The Gilbert Firm represents policyholders, workers, and students throughout Tennessee. To schedule a consultation time with Brandon McWherter, or to speak with a Tennessee insurance dispute lawyer in Nashville, Chattanooga, Memphis, Jackson or Knoxville, please call 888.996.9731, or fill out our contact form.

The documentation related to an examination under oath is going to be set out in the letter from the insurance company’s attorney, on what they want you to bring. That information can go as far as bank records, credit card statements, cell phone records, utility bills, tax returns. The first thing that an insured says is, “Oh my gosh, how am I going to get this stuff together? How am I going to produce it? What format do they want it produced in? How much is it going to cost me?”

At the Gilbert Firm, over the years, we’ve handled numerous examinations under oath, where clients have hired us to assist with that process. And so we use our experience and our resources to go out and gather those documents, and assist in gathering them, so that we can make sure that we fulfill the duties of the insured under the cooperation clause and produce all documents that we reasonably can.

The Gilbert Firm represents policyholders, workers, and students throughout Tennessee. To schedule a consultation time with Clint Scott, or to speak with a Tennessee insurance dispute lawyer in Nashville, Chattanooga, Memphis, Jackson or Knoxville, please call 888.996.9731, or fill out our contact form.

There are options other than filing a lawsuit. Oftentimes, when we get involved in a claim, we will present the claim, negotiate with the adjuster, negotiate with the opposing attorney, and try to get something worked out that’s satisfactory to the client before we even file a lawsuit. Sometimes we can avoid a lawsuit by going through what’s known as the appraisal process, which is a three person panel that is in most insurance policies, that allows that panel to set the amount of a loss, how much is owed. Sometimes we do file a lawsuit, but we don’t go to trial. Sometimes we mediate disputes; we have arbitration. There’s a variety of alternative dispute resolution procedures that we can look at to give consumers options – those that are perhaps scared of a trial, scared of that judge. We try to make it as easy on them as possible.

The Gilbert Firm represents policyholders throughout Tennessee. To learn more about the firm’s services, or to schedule an appointment with Brandon McWherter, please call 888.996.9731, or fill out our contact form. We have offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville for your convenience.

As the recent damage from Hurricanes Harvey and Irma show, the areas where homes can be flooded is expanding. Many home insurance property policies protect your contents if a fire or theft occurs, but homeowner policies do not normally cover your contents, cleanup costs, and repair or replacement costs if a flood damages your property. The causes of floods include more than just storms and hurricanes. Other causes include breaking dams or levees, melting snow/ice, broken pipes, and other natural and unnatural causes.

Homeowners can get flood insurance through the National Flood Insurance Program. The NFIP is governed by the Federal Emergency Management Agency (FEMA). Flood insurance generally covers your home or building up to a quarter of a million dollars. Many property owners hold the misperception that they cannot buy additional/private flood coverage beyond NFIP. Not true. Some private carriers allow you to purchase excess flood coverage and it’s important to thoroughly question your agent about your options.

One important point about the NFIP to keep in mind is that you must keep your flood insurance current in order to recover federal disaster assistance. And, policyholders will typically have to wait 30 days after they purchase flood insurance before the policy goes into effect. Some exceptions may apply to your situation so, again, be sure to get clarity.

Our experienced Tennessee insurance dispute attorneys understand when flood insurance, what you need to do if coverage is needed and how to prove your claim. At the Gilbert Firm, we fight to get you the full value of your loss. For strong advocacy from an attorney like Jonathan Bobbitt, Brandon McWherter or Clint Scott, please phone us at 888.996.9731 or fill out our contact form. We have locations in Nashville, Chattanooga, Memphis, Jackson, and Knoxville.

One item of particular interest to contractors is the inclusion of overhead and profit in insurers’ payment of insurance losses. In Tennessee and in many other states, the general standard is that insurance companies must include overhead and profit in their calculation of the amount of loss when the job is of a type that a person would reasonably be expected to utilize the services of a contractor. Although many insurers have adopted a custom or practice of limiting the payment of overhead and profit to jobs involving three trades or more, there is no such requirement in the law.

For example, in a commercial roofing project that involves only one trade (roofing), it seems obvious that a reasonable property owner would be expected to hire a properly licensed and bonded general contractor to perform the work. Safety, supervision, accuracy, and timeliness are critical, and it is also crucial that the contractor performing the work be properly insured as required by the contractor licensing statutes and regulations. When a non-licensed contractor is hired to perform the work, the owner puts all of this risk.

In our view, ten percent overhead and ten percent profit is the minimum amount due. This is just made a part of the underlying replacement cash value of the loss, and courts have clarified that overhead and profit must be considered when calculating actual cash value of the loss as well.

Another factor relevant to overhead and profit are state licensing laws. For example, in Tennessee, the Contractors Licensing Act requires that any person performing work above $25,000 (with certain limited exceptions) be licensed as a contractor. Accordingly, because the law requires a contractor’s license to perform work over $25,000 and because overhead and profit must be paid when it is reasonably expected that the owner would utilize the services of a contractor, then of course it necessarily follows that overhead and profit is due and owing by the insurance company in claims exceeding that amount. In fact, our firm is presently involved in a class action against a major insurer in Tennessee regarding this very issue.

At the Gilbert Firm, our Tennessee insurance lawyers fight to show that your loss is covered and to maximize the amount of the recovery. We are experienced insurance and trial litigators. To talk with a skilled insurance conflict lawyer like Brandon McWherter, Jonathan Bobbitt or Clint Scott, please phone us at 888.996.9731 or use our contact form. We have offices based in Nashville, Chattanooga, Memphis, Jackson, and Knoxville.

Overhead and profit is an issue that comes up quite often in the claims process. The question is this: Am I entitled to get overhead and profit for my project? Not always, but if you are reasonably likely to hire a general contractor to perform the work of your project, then you’re entitled to overhead and profit.

Many times, an insurance company may try to hold back the overhead and profit, or they may suggest to the policyholder that unless you have three trades or more, then we don’t pay overhead and profit – and it’s simply not true. Again, the test is: Is the policyholder reasonably likely to hire a general contractor to perform this work.

If so, then you’re entitled to overhead and profit, and a policyholder should look very closely at their estimates to make sure that that’s included, and that’s something that we can help with here at the Gilbert Firm.

The Gilbert Firm represents policyholders throughout the state. To learn more about the Firm’s services, or to schedule an appointment with a Tennessee insurance dispute lawyer like Jonathan Bobbitt, please call 888.996.9731, or fill out our contact form. We maintain offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville for your convenience.

An examination under oath is a formal proceeding that insurance companies use to investigate an insured’s claim. The insured should review any request for an examination under oath (EUO) with an experienced Tennessee insurance lawyer, because the insurance company will often try to use the EUO to deny a claim, reduce the amount that should be paid, or even to charge a policyholder with fraud.

EUO requirements

An EUO begins with a formal notice by the insurance company that usually includes the following:

• The identity of the person who will be examined – usually the policyholder
• The identity of the person conducting the examination
• Where and when the examination will be conducted
• A list of documents the person being examined must bring

Sometimes, a policyholder or named person can be required to submit to multiple EUOs during the insurance company’s investigation. The EUO is conducted before a court reporter, and the person being examined takes an oath that they will tell the truth. No matter how many times you are asked to submit, you must comply; otherwise, you risk having your claim denied for non-cooperation.

Why do insurance companies order EUOs?

The purpose of an EUO should be to help the insurance company determine the validity of the claim, what other witnesses the insurance company may want to speak to, and what evidence of value there is. EUO’s were commonly used during Hurricane Katrina, for example, and will likely be used by the property victims of Hurricanes Harvey and Irma.

An EUO should be used to help clear up any concerns your insurer has, and ideally expedite your payment. Insurers usually request one if they feel there are too many “red flags” in your claim. Sometimes the EUO request is done in good faith, but sometimes the motives are less “friendly.” This is why your will want to work with a lawyer before you submit to questioning.

While your attorney cannot actively participate in the examination under oath with you, he or she can prepare you for what is to come. Our insurance dispute attorneys help you gather and present your documentation and evidence of your loss, review the types of questions you are likely to be asked, and ensure that the process of meeting with the insurance company goes smoothly.

At the Gilbert Firm, our Tennessee insurance dispute attorneys like Clint Scott, Jonathan Bobbitt and Brandon McWherter explain the importance of examinations under oath. We represent you at the exam and work to pursue strong and just negotiated settlements of your claims.. For help now, please call us at 888.996.9731 or make an appointment through our contact form. We have locations in Nashville, Chattanooga, Memphis, Jackson, and Knoxville.

All I do are insurance claims. I work for the policyholder: for the person who suffered a loss, who’s not being paid enough, who’s not being paid at all, whose claim has not been denied. That’s all we do. We handle property claims primarily: homeowners, commercial, industrial, churches, non-profits – the whole gamut. From the small $25,000 house that the elderly lady lives in that’s had a fire loss that’s really struggling, to the multi-million-dollar condominium complexes.

And we help people present their claim. We help people litigate their claim if necessary, but we just try to get them to the result that serves the basis for them even having insurance in the first place: to put them back where they were prior to the loss event. Sometimes it’s hail, sometimes it’s fire, sometimes it’s wind, sometimes it’s a collapse. It can be a variety of things, but that’s what we do: help people who have suffered a loss to get what they deserve.

The Gilbert Firm represents policyholders throughout Tennessee. To learn more about the Firm’s services, or to schedule an appointment with Brandon McWherter, please call 888.996.9731, or fill out our contact form. We have offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville for your convenience.

The Gilbert Firm can help any policyholder insured – whether it’s a personal property claim, whether it’s a structure homeowner’s claim, or a commercial claim – prepare for the Examination Under Oath by assisting and gathering the documents, getting the Examination Under Oath scheduled at a time and a date that works for the insured, and going over and analyzing the claim with the insured to make sure the insured knows what’s at issue, what the questions that will be asked are, what the nature of those questions are, and making sure that the insured understands what’s being asked of them, so that the answers they give are not only truthful, but they’re responsive to the questions and don’t allow the insurance company the wiggle room they often look for to get out of paying claims.

The Gilbert Firm helps Tennessee policyholders who are struggling to have their claims paid. To speak with an experienced Tennessee insurance lawyer such as Clint Scott, please call 888.996.9731, or fill out our contact form. We maintain offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville.

Let’s say that your home is damaged in a storm. You need to replace a part of your roof as well as a section of vinyl siding. The company which originally manufactured these products is no longer in business, or has discontinued the line – which means that the front of your home will feature two different shades of siding, and your roof might end up looking like a chess board.

Or, at least, it could have, had the Tennessee Commissioner of Insurance not confirmed, in new Rules which go into effect October 9, 2017, that insurers must pay for matching when it comes to replacing your damaged property. The Rule says:

“When the policy provides for the adjustment and settlement of first party losses based on replacement cost, the following shall apply:

. . .

(b) When a loss requires replacement of items and the replaced items do not match in quality, color or size, the insurer shall replace items so as to confirm to a reasonably uniform appearance according to the applicable policy provisions.  This applies to interior and exterior losses. The insured shall not bear any cost over the applicable deductible, if any.”

0780-01-05-.10(1)(b)

In layman’s terms, the Rule confirms our previous assessment of the law – if the replacement “parts” do not match in color, size or quality, then the whole must be replaced. To use our earlier example, then, the insurance company would have to pay for a brand-new roof or siding in its entirety, with no additional costs to the policyholder (outside of the cost of the deductible).

If matching was the law, then why pass a new Rule?

So why pass a new Rule if this was already the practice? Because the practice wasn’t uniformly followed. Generally speaking, insurers had no difficulties matching to replace losses inside the home, like replacing the entire carpet in a room when only a section was damaged. However, the cost of re-carpeting a 11’ x 12’ room is significantly lower than the cost of replacing an entire roof, and insurers often disputed claims for more expensive replacements.

The new Rule uses the word “shall,” which is clearer. It also specifies that the Rule applies to both interior and exterior losses, which helps policyholders, too. For those who might think the “reasonably uniform appearance” clause is still ambiguous, rest assured: the Rule only applies to replacements, not repairs, so there should be no outstanding arguments.

If, however, a dispute does arise, you may need the help of a skilled Tennessee insurance dispute attorney. The Gilbert Firm represents policyholders throughout the region who have had their claims unfairly denied or disputed by insurers. To work with an experienced lawyer such as Brandon McWherter, Jonathan Bobbitt or Clint Scott, please call 888.996.9731, or fill out our contact form. We maintain offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville.