As a former federal lawyer, the purpose of this blog series is to help educate policyholders on what they can face with federal court insurance cases. Today, I only explain some ways an insurer can handle an insured's complaint in a federal court.
A complaint is a formal document that claims how the insurance company violates the policy or law. The complaint is written in separate paragraphs, identifying what the insurer did wrong and explaining what relief the insured requests.
Federal rules require the insurer to respond to the complaint. Insurers have several options.
First, they can respond to the complaint. In the answer, the insurers must either acknowledge whether the insured's claims are true or deny them. Insurers always deny that they acted incorrectly. After acknowledging or denying claims, insurers can submit affirmative defense. Confirmatory defense is the reason why the insurance company claims that they are not liable for the amount requested by the insured. When an insurance company responds to the complaint, the submissions are closed and the case continues to be detected according to the case management plan.
Second, insurers can submit a proposal for departure. The most common movement to reject claims that the complaint does not contain any requirement as to which relief can be granted. This movement claims that even if the complainant's claims were true, the assured did not assure the insurer that violated the policy or law. In response, it has insured options. If it is the first intention to dismiss, the insured can only change the complaint of course to correct the perceived errors identified by the insurer. This makes the insurer's proposal to reject the moot. Changing the complaint is a good option for insurance, as it can help strengthen the complaint against future arguments that the insurer can make later in the procedure. Change also saves court time and can prevent very unpleasant exercise which can delay the progress of the case.
The insured can also respond in contrast to the decision to dismiss. In the answer, the insured essentially explains the judge why the insurance company's arguments are incorrect. The insured will identify the law that the court should apply and point out the complainant's claims that support how the insured claims the insurer violates the law.
Except in very tight circumstances, the Court does not consider evidence to be decisive. Instead, the court looks at the allegations in the complaint, accepts these claims as true and makes a judgment as to whether the insured has a credible claim. No evidence is required and the court does not consider evidence and documents not related to the complaint.
If a decision of termination is granted, federal courts generally offer the insured the opportunity to file a modified complaint that corrects the deficiencies noted by the court. Sometimes the change requires something as little as adding to a date or additional claims. When the change is complete, the process begins completely.
Third, insurers are increasingly applying contractual provisions to force assessment or arbitration. If the insurance contract contains appraisal or arbitration, the insurer may invoke these provisions and essentially request that the court interrupt all proceedings and refer the case to a panel for decision on the damage the insured is due to. The court may issue a stay and require the attorneys to send status updates on the progress of the case. Even if the courts have consistently enforced these provisions, the insured may claim that they should not be enforced on the basis of the insurer's conduct or any other law.