Last week I received a favorable decision and order for one of my insurer clients from the United States District Court for the Southern District of New York in a number-of-families homeowners policy application misrepresentation case. My client had ...
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Coverage Counsel - 5 new articles

4 + 2 ≠ "Residence Premises"

Last week I received a favorable decision and order for one of my insurer clients from the United States District Court for the Southern District of New York in a number-of-families homeowners policy application misrepresentation case. My client had denied coverage for the Brooklyn, NY fire loss based, in part, on the application misrepresentation but did not rescind the homeowners policy (that's a thing). I conducted the policyholder's EUO and defended the policyholder's subsequent breach of contract action.


The Decision & Order begins:
The material facts, which cannot be disputed, are simple: In his insurance application, plaintiff stated that his property had three units, with three families living in them. The policy that Nationwide issued to him covered "one, two, three or four-family" dwellings. In fact, plaintiff's building had at least six units, rented to unrelated tenants. After the fire, Nationwide discovered the additional units and denied coverage. As explained below, Nationwide was entitled to do so and consequently will be granted summary judgment.
And adds:
Plaintiff contends that the language of the Policy is ambiguous, preventing the Court from granting...

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Scope of Appraisal vs. Appraisal of Scope -- New York

There has been a good deal of conflicting case law over the years over what kinds of property loss disputes are and are not amenable to the appraisal process. This post discusses four of those court decisions and concludes with what I think is the current state of the law in New York on the proper scope of property loss appraisals.

425 West Main Associates LP v. Selective Insurance Company of South Carolina

(Supreme Court, Genesee Co., 2018)

The policyholder, 425 West Main Associates LP commenced this special proceeding to compel an appraisal of its reported roof damage/loss claim. The policyholder claimed that on March 8, 2017, the roof of its commercial premises was damaged as a result of wind and weight of ice and snow, which resulted in further damage to the interior of the premises.

425 West Main hired National Fire Adjustment Company, Inc. (NFA) to assist in determining the damage and submitting claims to its insurer, Selective Insurance Company, for replacement of the roof and repair for the interior of the building. After NFA's analysis, 425 West Main claimed damages of more than $530,000.00.

425 West Main's wind damage claim was tendered to Selective on March 22,...

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Discord and Discourse With a Florida Public Adjuster About His "5 Ways to Trick an Insurance Claims Adjuster"


Florida public adjuster Mike Keeler believes his own messaging. At least he seems to do so.

I was looking for content for my "So, You're About to Be Deposed (Or Violently Overthrown): How Should You Prepare and What Should You Expect" presentation tomorrow at NEIASIU's 15th Annual Joint Training Seminar in Massachusetts, when I came YouTube returned this video (click the image above to view) in my "depositions of insurance adjuster" search results.

Those of you who know me know I couldn't resist--both watching the video and dropping a comment onto it.

"Trick No. 4", according to Mike is:

If they ask you for a recorded statement, all right, when you're going through a recorded statement they usually try to pin you down as to what happened. You play dumb. When did this happen? Um, and let's say the claim was two months ago. Well, I don't remember. I just know I have a leak. And why did you wait two weeks to report it? Well I was trying to attend to the leak. You keep everything simple. Keep everything very simple. Brief. Use I don't remember exactly. When they ask for a time, I don't remember exactly, maybe sometime in the afternoon. I, I really don't know. All right so you use...

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New York's Comprehensive Insurance Disclosure Act -- CIDA Light 2.0 -- Passes and Is Signed

In the beginning the NYS legislature created CPLR § 3101(f). And 3101(f) thusly provided:

Contents of insurance agreement. A party may obtain discovery of the existence and contents of any insurance agreement under which any person carrying on an insurance business may be liable to satisfy part or all of a judgment which may be entered in the action or to indemnify or reimburse for payments made to satisfy the judgment. Information concerning the insurance agreement is not by reason of disclosure admissible in evidence at trial. For purpose of this subdivision, an application for insurance shall not be treated as part of an insurance agreement.
And all was good.

But the personal injury plaintiff attorneys, always wanting more, cried out to their Legislature, "Defendants and their attorneys should be required to disclose more about the contents of their insurance agreements, the applications for those agreements, the limits of those agreements, any payments made under those agreements, and the persons who oversee the third-party claims made under those agreements!"

And so it came to pass that on the last day of creation in 2021, the Legislature approved ...

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Wordle in 4 and Writing My AI-in-Insurance-Fraud Session Title & Description

Couldn't sleep. Woke at 3:30, did my Wordle (in 4), read the Russia-Ukraine news, and got up at 4:15.

Made my first cup of coffee of the day and wrote the title and description of a session Joe Stephenson and I will be co-presenting in Orlando next week:

Session Title:
The Bullseye of AI: Precogging the Risks of Using AI in Insurance Fraud Prevention and Detection

Session Description:
Agatha, Arthur and Dash saw this coming, this use of AI by insurers. We’ve heard that AI offers the promise, or at least the potential, of these learning and discerning machines assisting insurers in the prediction, prevention and detection of insurance fraud. But at the intersection of meta and data there lies risks of present and future legislative and litigation challenges, like state and federal privacy acts, BIPA laws, algorithmic accountability acts and, of course, the closely following VC-litigation-funded class action litigation. In this session (and while not outside lying horizontally in the pool), insurtech/legal precogs Joe and Roy will outline, discuss and likely debate some of those risks and challenges.

Btw, but for the several consonant blends that work with "oke", I would've...

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