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Can my insurance company deny my claim that I did not cooperate with its investigation? | Legal insurance blog for property insurance



Insurance entails an obligation for the insured to cooperate with the insurer's investigation of a claim. An insurance's obligation to cooperate includes the insured's obligation to register for an investigation under oath ("EUO") at any time and to provide documentation confirming the loss. "Cooperation clauses" have generally been considered as essential provisions in insurance policies that meet these conditions that cover coverage.

In order to be released from liability under the insurance, the insurer must generally prove more than the breach of the co-operation provision. For example, in my home state of New Jersey, coverage can only be forfeited because there was a material and intentional breach of the insured's obligation to cooperate with the insurer's investigation that significantly diluted the insurer's ability to evaluate the claim. 1

Courts interpreting this standard have found that policyholders' failure to produce income tax registers and business books for companies controlled by them at the request of insurers was a material breach of policy that excludes theft and arson policies.

In a recent case 2 an appeals court in New York found that a lower court erred in rejecting an insured claim for breach of the terms of the policy. In that case, the insured's personal property was destroyed by a fire on the property. The insurer waived coverage for the insured's personal property on the grounds that the plaintiff did not follow the policy of cooperation. More specifically, the insurer claimed that the insured did not provide the requested purchase documents to support much of the insured's claims for lost content. In response, the insured claimed that he could not reconstruct old invoices without knowing the date of purchase of each item. In the end, the court found that there was no innocent and intentional refusal by the insured to comply with the policy cooperation clause.

In summary, after a loss, an insured would produce documents in response to specific, material and reasonable requests from insurers or risk losing coverage under the insurance. If you believe your claim was incorrectly denied due to an alleged failure to cooperate with your insurance company after a claim, contact your local Merlin Law Group attorneys.
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1 DiFrancisco v. Chubb Ins. Co. 283 N.J. Super. 601 (App. Div. 1995).
2 Jahinger vs. Tri-State Consumer Ins. Co. 2020 WL 7759483 (N.Y.S.3d 2020).


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