The title of this post was my reaction after reading a statement from a Virginia court sent to me by Karl Dennison of Goodman, Gable & Gould (aka The Three G & # 39; s.) Insurance Companies Always Have Disputes about what is damaged and not damaged from a hailstorm. They always mention exclusions of pre-existing damage, pre-existing wear and tear and various other reasons for not paying all damages claimed from a hailstorm. If the appraisers were not allowed to resolve these controversies, almost no hailstorm loss would ever be resolved via an assessment that is usually, but not always, faster and cheaper than litigation.
The trial judge found out the facts:
On or about March 13, 2020, Craun was injured during a hailstorm … Craun filed a claim with his insurance company, Erie Insurance.
Craun claims that the amount covered by the insurance is $ 408,929.94. Erie maintains the amount covered by the insurance to $ 154,775.16. Craun strives to hand over the entire dispute to valuers in accordance with the standard language of valuers in the insurance required by VA Code § 38.2-2105, set forth in Section X, page 68 of 73 of the Insurance, which provides that if the parties cannot agree on the actual the cash value or the amount of the loss, either party may request an assessment in writing. Each page then names an appraiser, and the appraisers select a judge to make a binding decision.
Erie admits that part of the disputed amount disagrees with the actual cash value or loss amount and should be submitted for valuation. However, Erie claims that a significant portion of the amount claimed by Craun is excluded from coverage under the terms of the insurance as it cannot be attributed to the hailstorm on March 13, 2020. Such excluded items include wear, rot and other long-term wear. Since these objects are exceptions to the policy, Erie maintains that the objects should not be submitted during the assessment process according to the terms of the policy.
The court formulated the question and gave its answer as follows:
which the insurance company has judged to be excluded from coverage in accordance with the terms of the insurance. For the reasons stated here, the court concludes that the assessment mechanism does not apply to items determined by the insurance company to be excluded from coverage under the terms of the insurance.
In essence, the assessment will only determine part of the controversy which is a major waste of time and money because it leaves open objects with coverage and damages that then have to be resolved later in a lawsuit. The Virginia Court of Appeals noted that there is no precedent in Virginia appellate cases, but cited Texas precedents from the Johnson case that we discussed in Texas Court Rules in Appraisal Dispute — You Can & # 39; t Have Your Cake and Eat it, Too :
In Johnson the Texas Supreme Court resolved the division by defining the scope of assessments and the meaning of "loss amounts." The court ruled that a valuer could determine the amount of the loss. , even if the valuer may need to take a position on causation. Since then, courts have allowed appraisers to evaluate whether the damage was caused by a covered event or was the result of an uncovered cause of loss, pre-existing wear and tear.
Instead of following Johnson Virginia State Court overruled Texas precedent. The practical implication is that the insurer and the policyholder will not only have to value part of the damage, but they will then have to consider the remaining issues of coverage and loss amounts for the items that the insurance company objects to as a coverage issue. This seems very impractical, time consuming and costly.
Thought for the day
For a long time I thought it was all due to dedication, hard work, and visualizing that it went well – it worked for a while, but then it stopped. I have realized that you have to be more practical and mature to make things actually happen.