Category: Insurance Disputes

If you ever wanted to see an illustration of the how the vagaries of insurance terminology can be used against even large companies, look no further than a recent ruling against First Tennessee Bank. In order to understand why that ruling matters to policyholders, we need to look at the original case against the bank.

It began 2012, when the US Department of Housing and Urban Development initiated an investigation into First Tennessee Bank’s lending practices under the Fair Housing Act. This exploration proceeded for a year, and in 2013 it became clear that First Tennessee Bank was in violation, and liable for up to $1.19 billion in damages. During this period, the bank had its own Errors and Omissions insurance policies in place, as well as no fewer than seven redundant policies for the same coverage.

By 2014, the US Department of Justice made First Tennessee Bank an oral settlement offer of $610 million, later confirmed via email. Through counter offers and various proposals, in 2015, First Tennessee reached a settlement agreement for $212.5 million. At this point, the insurers who covered First Tennessee Bank’s Errors and Omissions policy would be expected to pay the full amount.

However, during the period when it became clear that damages would need to be paid, First Tennessee Bank informed its insurers only in vague terms. The insurers, having not been officially or fully notified in a timely fashion of the potential claim, declined to pay the damages First Tennessee Bank now owed, leading to the present suit.

The results all come down to paperwork and timing

The case at hand thus hinged on what a “claim” actually was, whether the First Tennessee Bank’s notice met that definition, and whether that notice or the future claim met the time requirements set out in the Errors and Omissions policy in order to assure payment. The judge ruled that while First Tennessee Bank did send a notification, it was too vague to constitute actual notice of an impending or current claim and thus the bank’s insurers did not have to pay on the policy.

While these types of disputes may be more familiar between insurance companies and individual policyholders, seeing how the same factors play out on a corporate scale can help consumers better understand their rights and responsibilities as policyholders. (Or, at the very least, let you know that you are not alone when it comes to being denied a claim.) The takeaway lesson is that timeliness of notification of insurance claims is a potential issue, no matter if the client is an individual or a large business. However, when a policyholder has properly submitted a claim and faces rejection or lack of payment, legal assistance may be needed.

The Gilbert Firm provides counsel to families who have been denied or had their insurance claims unnecessarily delayed. To speak with an experienced Tennessee insurance lawyer such as Clint Scott, Brandon McWherter or Jonathan Bobbitt, please call 888.996.9731, or fill out our contact form. We maintain offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville.

You know, listen, we all love our insurance agents; but the truth is they make mistakes, and sometimes those mistakes can cause problems on a claim that perhaps you’ve been paying premiums on for years. An insurance agent should help you obtain sufficient coverage. They should be sure to explain exclusions that may apply to your claim. They should be sure that the time frame of your coverage is what you need to cover the type of loss, or type of risk that you may have. And then certainly, if they’re going to assist you in filling out an application, or asking you questions that they can fill out your application, they’ve got to be sure that they do that very thoroughly, and put in all of the accurate and correct information; otherwise a policy holder could have a claim denied for failure on the front end of the process.

If your insurance claim has been denied, the Gilbert Firm can protect your rights. We help policyholders throughout Tennessee who have been denied a claim because of an act of agent negligence. To work with a Tennessee insurance dispute attorney like Jonathan Bobbitt, please call 888.996.9731, or fill out our contact form. We maintain offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville.

In a recent appellate case, Freeze v. Tenn. Farmers Mut. Ins. Co., the Tennessee Court of Appeals again analyzed the effect of misrepresentations in applications for insurance. The Court began by referencing Tenn. Code Ann § 56-7-103), which provides that misrepresentations on an application will not void the policy unless the misrepresentation is made with actual intent to deceive, or unless the matter represented increases the risk of loss. The latter, whether the misrepresentations increases the risk of loss, was the focus of the Freeze court.

Tennessee courts have previously noted that a misrepresentation in the application increases the risk of loss “when it is of such importance that it naturally and reasonably influences the judgment of the insurer in making the contract.”

In other words, if the insurance carrier had known the truth, would it have decided that the risk of having to pay for an insurance loss was too great to offer coverage?

In ruling that the insureds’ insurance policy was void as a result of misrepresentations, the Freeze court made three findings that essentially affirm dozens of prior appellate cases:

• First, it determined that whether the misrepresentation increased the risk of loss was a question of law (not fact) for the Court to decide.
• Second, whether the applicant actually read the application before it was signed was not determinative. If the applicant signed the application, he/she is presumed to have read it.
• That misrepresentations of any of the following did “increase the risk of loss.”
  • Are there any pending legal actions?
  • Has the applicant been charged or convicted of felony crimes?
  • Has the applicant been charged or convicted of arson, fraud, theft, or drug related crimes?

Although there is certainly nothing earth-shaking about the Freeze opinion, there are a couple of things that are worth noting. First, just because the insured is presumed to have read an application, the policyholder may still have options for recovering against an insurance agent if the agent caused the application to be incorrect. For example, if the agent told the applicant that he did not have to disclose a pending legal action and the applicant relied on that advice, then the agent is exposed to liability if a claim is later denied. Further, an agent’s knowledge is imputed to the insurance company. Second, not every felony or other crime is “material.” For example, if a 55-year-old applicant was charged with theft when he or she was 18, then a court might determine that such was not “material.” In the Freeze case, neither of these nuances were present as the insured had numerous criminal charges that were very recent and even some that were actively pending, none of which were disclosed.

Insurance companies will try every argument they can to defeat your claim. The Gilbert Firm understands the law and keeps current with the most recent court decisions. Our Tennessee insurance dispute attorneys help policyholders contest improper denials, and work to get our clients the benefits to which they are entitled. For help with your insurance policy claim, please call 888.996.9731, or use our contact form to get answers and strong representation from Brandon McWherter, Clint Scott or Jonathan Bobbitt. We have offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville.

An examination under oath, or an EUO, is something that an insurance policy gives the insurance carrier the right to do. It gives them the ability to investigate your claim, where they’re going to sit down, most likely with a lawyer. That lawyer for the insurance company’s going to ask a series of questions to the insured or the policy holder to investigate the claim.

At the Gilbert Firm, we help our clients prepare for EUOs, so they can feel confident when they speak to insurers about their claims. To learn more about what we do, or to schedule an appointment with an experienced Tennessee insurance dispute attorney, please call 888.996.9731, or fill out our contact form. We maintain offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville, for your convenience.

Contents coverage brings with it several issues that seem to arise. Number one is the inventory. The insurance company will inevitably ask the insurer to write out what they have and what they had at the time of the loss, and place a value on it and approximate the age. Oftentimes, the insurance company doesn’t really give any specifics or any guidance to the insurer. To the insurer, it’s lost as to how to do it. Filling out that inventory form and doing it accurately, or the best that you can, is a big step. There’s also always the issue with fire loss that the items aren’t there anymore. So trying to remember what was actually included in the business or the home, so that everything can be listed on the personal property inventory form, is another important issue that arises. Valuation is something that comes up. Insurance companies, without given guidance, leave the insurer to try to guess, and so sometimes it’s necessary to go on the Internet and try to figure out what the replacement cost is of the item.

At the Gilbert Firm, we help Tennessee policyholders obtain compensation after a loss. Our skilled insurance dispute attorneys help protect you when your insurer refuses to pay your claim, or offers you less than you should be given. To learn more about our services, please call 888.996.9731, or complete our contact form.

Water damage is a leading cause of property damage claims, right behind fire damage. It can be caused by a burst pipe, a sprinkler systems malfunction, a tree limb that crashes through a window in a storm, water overflow from a neighbor’s property, and so on. The cost to repair the damage can be steep, and most homeowners will look to their insurance policies to see if the repairs will be covered.

Common types of water damage

When you call in a repair company, in addition to assessing the structural and personal property damage, the professional should look for problems that often arise in the aftermath of water damage, including:

• Mold damage can cause serious health conditions, including respiratory infections, asthma, and bronchitis. The mold needs to be inspected at a laboratory to determine its type. The sooner water damage is treated, the better. Mold damage increases the more that water stays in or about the home.
• Wood and other materials that decompose can attract termites, carpenter ants, and fungi. Wood rot is common in water damage cases, and can make your home structurally unsound.
• Warping. Any water that sits can warp floorboards or walls. Homeowners may not even realize they had water damage until they see warping.

What happens when you make a claim?

If you make a claim for water damage, your insurance company should send out a competent adjuster or engineer to perform an inspection. It is important that you notify your insurance company as soon as you discover the damage and work with them to get someone to your property to mitigate the damage quickly. Before beginning any restoration work, you should seek professional help to ensure that the scope of work being given by the insurance company will actually repair all damage and restore your property to pre-loss condition.

You should be aware that insurance companies often wrongfully deny water damage claims relying on a multitude of exclusions found in various policies. Often times, the insurer will try to claim that the damage already existed, or that it occurred through some fault of your own (like an unrepaired, pre-existing leak). Another tactic is to claim that you lack the proper coverage – for example, like saying that flooding caused by storms cannot be covered because you don’t have flood insurance. When policyholders have their claims denied for these reasons, they should seek counsel from an insurance disputes attorney.

At the Gilbert Firm, our Tennessee insurance dispute lawyers review insurance policies, work with policyholders to determine the value of the damage, and bring claims against insurance companies who have wrongfully denied payment.

For strong legal advocacy, please phone 888.996.9731, or use our contact form to make an appointment with Clint Scott, Brandon McWherter or Jonathan Bobbitt. We maintain offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville for your convenience.

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.

You buy homeowners’ insurance for the same reason you buy any kind of insurance policy: to protect you in the event of a misfortune of some kind. While there is no such thing as a “one size fits all” insurance policy, homeowners’ usually covers the following:

• Structural damage. First and foremost, your policy covers physical damage to the home – plumbing, electrical wiring, roofing, walls, etc. – if the cause is covered. House fires, storm damage (like excessive wind or hail), theft: these are typically part of a policy. The outside of your home, such as a patio and your siding will also be covered.
• Contents loss. These are your possessions found inside your home. Your furniture, your jewelry and your clothing should all be covered by your homeowners’ insurance. There may be special limits on certain types of contents such as jewelry, so talk to your agent to make sure you have all of the coverage you need.
• Additional structures. If you have a shed or a fence that is damaged, your policy may cover these structures as well.
• Loss of use coverage (additional living expenses). If the damage to your home is so severe that you cannot live in it during the repair process, your policy may cover your additional living expenses, such as the cost of an apartment or rental.
• Liability protection. If someone is hurt or injured on your property, your homeowners’ policy should cover the expenses associated with that claim. How much liability protection you have depends on the policy you choose, however, so you want to make sure you are fully covered.

Do you need additional insurance past your basic plan?

Every homeowner is different, which means every homeowner’s policy should be different. You want to make sure that your agent helps you identify any gaps in your insurance from the beginning, so you are covered no matter what happens. For example, if you live on a river that tends to flood, you will want flood insurance. If you are an art collector, then your basic insurance policy is likely not enough to cover the full amount of that collection in the event of a house fire or a break-in.

It is your agent’s job to review your plan with you, and to make sure you have what you need in terms of homeowners’ insurance. He or she should identify and inform you about any gaps in coverage, or any potential problems. If he or she does not alert you to these issues, or fails to recommend the right or appropriate policy for your needs, you may be able to make a claim for damages based on agent negligence.

If you believe that your claim has been denied unfairly, or that your agent or insurer has acted in bad faith, the Gilbert Firm may be able to help. Our Tennessee insurance dispute attorneys protect policyholders throughout the state. To schedule a consultation with Clint Scott, Brandon McWherter or Jonathan Bobbitt, please call 888.996.9731, or fill out our contact form. We have offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville for your convenience.

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.