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Home / Insurance / Caselaw, Statutes and Dissertations All Agree: Insurers Have an Obligation to Thoroughly Examine Every Claim in Good Faith | Legal insurance blog for property insurance

Caselaw, Statutes and Dissertations All Agree: Insurers Have an Obligation to Thoroughly Examine Every Claim in Good Faith | Legal insurance blog for property insurance



Under each agreement, the parties involved in the relationship have obligations and obligations they owe each other.

In most insurances, the policyholder has obligations such as the obligation to mitigate further damages and the obligation to send a notice in due time. of the claim. On the other hand, the insurer also has its own obligations and obligations. One of the most important tasks that the insurer has is the obligation to fully investigate the claim in good faith. Although failure to properly and thoroughly investigate a claim is not a cause in itself in most jurisdictions, it is extremely relevant evidence to be used to arouse disbelief in an insurance company.

As one author puts it: [1

9659004] Purchasing such insurance provides security and safety if the insured is unable to work. In order to protect these interests, it is essential that an insurance company fully investigates possible grounds that may support the insured's claims, and it cannot reasonably and in good faith deny payments to its insured without thoroughly examining the grounds for its denial. 1

Statutes, case law and dissertations will all say the same thing: An insurance company that is faced with a claim owes the insured an obligation to investigate the claim completely and fairly.

In Florida, § 624,155 governs claims for damages. Section 624,155 provides that an insurance company has acted in bad faith if it “[n] has not tried [ed] in good faith to resolve claims when in any case it could and should have done so if it had acted fairly and honestly against its insured and with due regard to [the insured’s] interest. ”§ 624.155 (1) (b). Although this does not explicitly state that an insurer must examine the claim in good faith, it can easily be suggested; and caselaw helps clarify that.

Several district courts now apply a set of circumstances when determining whether the Florida Statute 624,155 was violated. And looks at the following factors in total:

  1. whether the insurer could obtain a reservation for the right to refuse coverage if a defense was provided;
  2. attempts or measures taken by the insurer to resolve the coverage dispute quickly or in such a way as to limit any damage to the insured;
  3. the content of the coverage dispute or the importance of legal authority in the coverage issue;
  4. the insurer's diligence and accuracy in examining facts particularly relevant to coverage; and
  5. attempts by the insurer to resolve claims before the coverage dispute. 3

Other legal dictations have extended this duty of investigation and have argued that the insurer is obliged to examine a claim objectively, not just to prove that there is no coverage. 4 In addition, an insurance company may not jump to a conclusion on the basis of specific or certain evidence and then conduct a temporary investigation. 5

Couch on Insurance a popular secondary source for insurers and lawyers, describes the obligation to investigate:

An insurer's duty to investigate is usually interpreted as requiring sufficient investigation to determine coverage in accordance with the policy in question. The obligation therefore requires the insurer to investigate before denying or resolving a claim and before deciding on its obligation to defend. Insurers are also responsible for asking about the existence of other insurers or whether there is an obligation to defend. The survey must also be reasonable, both in terms of depth and timeliness. These requirements are often defined by statutes. 6

Although each jurisdiction may have its own statute or way of interpreting the scope of the obligation and whether it may be its own legal cause or not, all jurisdictions agree that an insurer facing a claim is in fact the insured owes an obligation to investigate the claim completely and fairly.

The traditional and long-standing obligation to fully investigate an insurance claim is extremely practical and important for the relationship between an insurer and a policyholder. As previously explained, the purchase of insurance is to provide security and safety for a policyholder. If the policyholder can not be sure that the insurer is not fully examining his claim, the insurance contract is not doing its job to provide that security and safety.

As a real estate insurance law firm, a lot of our cases would not come to us if the insurer would simply do a thorough and complete investigation. Throughout the discovery process, however, it soon becomes apparent that some insurers simply do not follow these guidelines in good faith, thorough investigations described in applicable statutes, cases and dissertations.
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1 46 ] Am. Jur. Evidence of facts 3d 289 (Originally published 1998).
2 State Farm Mut. Car. Ins. Co. v. Laforet 658 So. 2d 55, 62 (Fla. 1995).
3 Robinson v. State Farm Fire & Casualty Co. 583 So.2d 1063, 1068 (Fla. 5th DCA 1991); State Farm Mut. Car. Ins. Co. v. Laforet 658 So. 2d 55, 63 (Fla. 1995).
4 See Mariscal vs. Old Republic Life Ins. Co. 42 cal. App. 4th 1617, 50 cal. Rptr. 2d 224 (cal. App. 2 dist., February 29, 1996); Commonwealth Lloyd & # 39; s Ins. Co. v. Thomas 825 SW2d 135 (Tex. App. Dallas 1992), judgment revoked for other reasons, 843 SW2d 486 (Tex. 1993) and granted writing, (January 20, 1993).
5 See Capstick v. Allstate Ins. Co. 998 F.2d 810 (10th Cir. 1993).
6 § 198: 28. Scope of the duty; intrusion or fulfillment, 14 Couch on Ins. § 198: 28.


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