The first thing every person representing an insurance company with respect to a potentially fraudulent claim must understand is that the insurance policy is the basis of any insurance fraud investigation. Without insurance, there can be no insurance fraud. The insurance agreement describes the parties' rights and obligations to the insurance policy. It contains in clear and unambiguous language weapons to defeat a fraudulent claim.
See the full video at https://youtu.be/YfEe1asnDJg
The construction of insurance contracts should be, but often not, regulated by the same construction rules that apply to all contracts. The courts claim that when interpreting an insurance contract, it gives the insurance terms their usual and generally accepted meaning. The court's primary objective is to implement the written expression of the insurance parties' intention.
Some rules that must be followed when interpreting or interpreting an insurance contract include:
- If the terms of the Police are ambiguous or uncertain in all respects, they must be interpreted in the sense that the promissory note (insurer) believed at the time of making it , that the promising (the insured) understood it.
- Whether the language of an insurance policy or contract is the subject of two or more reasonable interpretations is probably ambiguous.
- If an ambiguity constitutes an exclusive provision of an insurance policy, courts accept the construction requested by the insured as long as the construction is not unreasonable, even if the insurer's request appears to be more reasonable or a more accurate reflection of the insured's and insurer's intent.
- When reaching the conclusion that a police exclusion was ambiguous and that the policy therefore provided coverage, the courts should follow the firm rule that all ambiguities or uncertainties in an insurance must be resolved against the insurer and that if semantically permitted, the contract will be given such construction that will justifiably achieve its purpose of providing compensation for the loss to which the insurance relates.
- It is a supreme law that a contract should be interpreted against its founder. Maxim is sometimes called contra-preferendum
- Provisions that exclude coverage are interpreted strictly against the insurer.
- Uncertainties in insurance applications are usually interpreted against the insurer to avoid denial of coverage due to alleged erroneous representations.
- If the language of a contract is clear and unambiguous, it must be interpreted only with reference to the four corners of that document.
- When interpreting a policy, the provisions of an approval check the interpretation over the body or the declarations of an insurance when the two are in conflict.
The basic rules for the construction or interpretation of an insurance contract are all subject to a restriction that a court cannot and should not violate the simple terms of a contract by artificially creating ambiguity where none exists. In situations where reasonable interpretation benefits the insurer and everyone else would be strained and tough, there is no compulsion to torture or twist the language of the contract. An insurance company has the right to limit the coverage of an insurance issued by it and when it has done so, the limitation language must be observed.
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to working as an insurance consultant specializing in insurance coverage, handling insurance claims, cheating and insurance fraud almost equally for insurance policyholders. . He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims lawyer and more than 52 years in the insurance industry. He is available at http://www.zalma.com and firstname.lastname@example.org.
Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.
For the past 52 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurers and their staff to become insurance claims staff.
https://zalma.com/zalmas-insurance-fraud-letter-2/ Last read two issues of ZIFL here.
Go to Barry Zalma videos on Rumble.com at https://rumble.com/c/c-262921  Read posts from Barry Zalma at https://parler.com/ profile / Zalma / post
Listen to the podcast: Zalma om försäkring https://anchor.fm/dashboard/episodesZalma om försäkring
Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg/
Go to the Library for Insurance Claims – https://zalma.com/ blog / Insurance -claims libraries /
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