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Home / Insurance / Should late announcements of windstorms and hail demands be a valid defense when the insurer is not affected? | Legal insurance blog for property insurance

Should late announcements of windstorms and hail demands be a valid defense when the insurer is not affected? | Legal insurance blog for property insurance



Insurance bulletins often overlook pearls that protect policyholders. Various insurance departments regularly issue bulletins to the insurance companies regarding claims handling. The Arkansas Department of State issued a bulletin last week indicating that insurers should stop denying windstorms and hail damage when there is a valid reason for the policyholder not to have reported the loss in time.

The bulletin should be read in full, but it states in part:

Although a requirement in an insurance to claim wind or hail damage within 365 days from the date of loss may be reasonable in most cases, there are situations where the policyholder may does not identify wind and hail damage within this time frame without his or her own fault. It is the department's position that an insurance company must recognize exceptions from good reasons to a time limit for claims in a policy for wind and hail claims.

In particular, the department's position that a wind and hail claim is reported later than 365 days after the loss date can be denied based on an insurance provision that requires a claim to be reported within such time, but that the policyholder must be given the opportunity to refute the denial by there was good reason for the delay in the reporting. [1

9659004] The Department also acknowledges that there should be a definitive limitation on such claims and will consider that denials of claims reported more than 24 months after the due date are reasonably denied under insurance regulations. This time will be considered reasonable given the inherent difficulties of adjusting receivables for losses that occur years before a claim is made.

I can imagine how this plays out in the field:

Adjuster – “Lady, why did you wait 20 months to report your hail injury? ”

Policyholder -“ I did not know that hail damaged my roof. "

Rules -" Did you know there was a hailstorm? "

Policyholder -" You hear and see hail at any time, but how do you know it caused any damage? It's not like an airplane broke through my living room and left a hole in the ceiling for anyone to see. ”

Adjuster —-“ How do you know this particular hailstorm caused the damage? Could it have happened three years ago? "

Policyholders -" Well, I saw that my neighbors started getting roofing companies on their roofs at about the same time a little more than a year ago or so. One of them at the mall told me that hail had damaged the roof. That's why I called my insurance agent. "

Adjuster -" So you noticed that your neighbors got work on their roofs, but you never inspected your own roof?

Policyholder – “How would you expect me to do that? And why would I do that? It did not leak! "

Adjuster -" So it does not leak now? "

Policyholder -" No, you idiot. If it leaks, I would have told you that was why I reported the claim to the agent. Anyone could have put two and two together and thought that the hail damaged my roof at the same time as my neighbors got their roofs fixed and paid for by their insurance companies. I told you that all my neighbors had their roofs fixed, and anyone could imagine that hail does not happen in just one house like fire; it spreads over a block. I'm 67 years old and do not climb a ladder that inspects anything. I have never been on top of a house and never on a roof in my life. I could fall off and kill myself. Just because I'm older does not mean I'm stupid. You never ask me all these questions when I pay my premiums. Why do not you take your ass up there and look at my roof? "

Adjuster -" Sorry, I did not mean to make you angry. I send out an expert roofing technician from HAAG or Rimkus directly. They know exactly what to do. "

Of course, everyone who does hailstorm work knows how this story normally ends. The policyholder receives a letter of five pages two months later with reference to all kinds of policy language that she has never read. The letter quotes the engineer's finding that the engineer could not find hail damage that caused any "functional damage" to the roof, and the minimal cosmetic hail damage may have occurred from a number of storms that were greater than 24 months before the reported loss occurred. (Isn't it amazing how HAAG and Rimku's engineering reports match the exact exceptions in the insurance language and claim bulletins? It's almost as if the engineers knew what the insurance language stated when they wrote their reports for their insurance company customers.) [19659004] Arkansas Insurance Commissioner McCall was appointed this year by one of my favorite governors, Asa Hutchinson. I twice sat across from Arkansas Governor Hutchinson at Republican Governors Association dinners and was very impressed. McClain should be commended for issuing this bulletin, which protects policyholders.

This is common sense and fresh air. It argues fairness justice rather than permitting technical defense that prevents the property insurance product from doing what it is supposed to do – paying for covered losses caused by covered risks.

This post also explains why attorneys from Merlin Law Group have an advantage when we are fighting insurance companies. Keeping track of insurance bulletins and examining them is something few law firms do. In fact, most lawyers who do not regularly practice in this field have no idea that insurance commissioner bulletins exist.

Merlin Law Group Knowledge Manager Ruck DeMinico is a lawyer specializing in the art of investigating insurance law. He keeps our company informed about this development that would otherwise be missed. He is also the final editor of this blog behind the scenes and keeps us on schedule so that we can share with you these property insurance laws.

Cheers for Ruck!

Thought for the day

Being from the heart of America, I do not think one should have to go to Washington to seek justice.
—Asa Hutchinson


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