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Exceptions & Estoppel in insurance



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Although the terms "waiver" and " estoppel "are usually lumped together, there are completely different terms that, when applied. They may lead to similar conclusions of a trier, but they are different.

A waiver is a "voluntary waiver or waiver – express or implied – of a legal right or benefit." 201 The person who finds himself having waived a right must do so consciously, with knowledge of the existing right and the intention to waive the right.

Estoppel, on the other hand, demands that a court create a bar that "prevents one from asserting a claim or rights that contradicts what one has said or done before or what has been legally established to be true."

In order to establish estoppel the insured or insurer must provide evidence that:

  1. there must be a false statement;
  2. it must be made with knowledge of facts;
  3. the other party must have been ignorant of the truth ;
  4. it must have been done with the intention of being acted upon by another party; and
  5. the other party must have been prompted to act on it. available to the insurer, the right to exercise the right of subrogation where, after a loss is paid, the insurer may step into the shoes of the insured and claim damages from the n responsible for the loss. The insurance contract often allows the insured to waive the insurer's right to subrogate to a certain class of persons, such as landlords, contractors, property owners or tenants, before a loss.

    The insurer should notify the insured of its intention to declare the insurance invalid, or forfeited, as a result of the insured's incorrect presentation, concealment and / or fraud as soon as possible. The message should be clear enough for the insured to know clearly that there is no coverage and the reasons why the insurer takes the position that the contract is invalid.

    As this is a drastic measure, it should not be done without the advice of a competent coverage adviser, even in jurisdictions that find an insurance immediately invalid in the event of fraud by the insured. The adjuster should also request that the coverage adviser assist in preparing the letter to the insured and notify the insurer's decision to invalidate the coverage. The cost to the insurer is well worth avoiding any claims of exemption or estoppel defense.

    Every insurance claimant must understand the importance of waiver, the effect of the estoppel doctrine and how each concept is important for the investigation of an insurance claim.


    © 2021 – Barry Zalma Barry Zalma, Esq., CFE, now limits his practice to serving as an insurance consultant specializing in insurance coverage, insurance claims management, bad faith insurance and insurance fraud almost as much for insurers and insurers.

    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 and claims management attorney and more than 54 years in the insurance industry.

    He is available at http://www.zalma.com and zalma@zalma.com. Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award. For the past 53 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 insurance companies and their indemnity staff to become insured.

    Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma ; Go to Barry Zalma videos on Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to Insurance Claims Library-https: //zalma.com/blog/insurance-claims-library/ T the last two issues of ZIFL are available at https://zalma.com/zalmas-insurance-fraud- letter -2 / podcast now available at https://podcasts.apple.com/us/podcast/zalma-on-insurance/id1509583809?uo=4


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