Author: Jonathan L. Bobbitt

Insurance companies have traditionally sought to minimize the amount they pay for any mold or black mold claims. Some insurers will try to pay a sparse amount or nothing at all for anything associated with mold cleanup, even when a water event that causes water damage is covered, but also leads to indoor mold contamination. A denial of a legitimate claim involving mold damage can certainly constitute an unfair or bad faith claim practice by your insurer.

How a mold claim can become an issue

A mold claim typically becomes an issue when it was not observed by the adjuster sent from the insurance company. Often, the insurer will later attempt to deny a claim for mold damages by asserting the mold existed prior to the covered loss, was the result of an improper loss mitigation technique, or resulted from a defect in construction. Sometimes insurance companies will deny the mold exists and is a problem even when it is a blatantly obvious issue.

A mold damage claim will typically be covered when some type of water peril that is covered by the insurance policy also causes the formation of mold. This is typically referred to as a covered peril. Mold that develops from a single event such as an ice storm or hurricane may be covered.

On the other hand, mold that develops from a chronic leaking pipe or other type of repeated or continuous water seepage may not be covered. Determining what moisture or water source caused the mold to develop is one of the major factors that influences whether a mold damage claim is covered. This determination can be made by experts in the mold inspection and remediation field.

Mold remediation cleanup costs are rising and as a result, insurance companies are entertaining different ways to avoid paying on mold damage claims. Some of the methods they employ include completely rewriting form policies to eliminate coverage for all types of mold – for instance they may reduce the amount covered for mold damage to between $1,000 and $10,000. Or, the insurer may litigate a mold damage claim under the existing insurance policy.

Filing your water damage claim

Once you have determined that water damage to some portion of your home is included under your insurance policy, there are certain steps you can take to help ensure your claim is approved. These include:

Documenting the damage quickly

Once you discover water damage, it is vital to contact your insurer as quickly as possible. Documenting the damage is also of crucial importance. Take pictures of the damaged areas, including every damaged item and the source of the water (i.e. hole in the roof or burst pipe). If you have any pictures of the area prior to the incident, show them to the assessor to provide a good before and after comparison.

Being prepared for questions from the adjuster

A representative from your homeowners’ insurance company will likely ask you an extensive list of questions about your claim to assist in the determination of what damage is covered under your policy. He or she can also accurately determine if the damage done is greater than the deductible stated in your policy.

If it is necessary to make certain repairs before the adjuster looks at the damage, be sure to take pictures before and after and retain any receipts for materials you purchase. All of these expenses may be reimbursed.

Considering getting a separate estimate of the damage and repair costs

In situations where water damage and mold are the issue, it can be quite helpful to have a contractor evaluate the damage separately and provide you with an independent estimate from the one you will receive from your insurance company. This estimate may be useful in the event that the insurance adjuster’s coverage is inadequate or does not cover the mold damage. The estimate can provide you with information useful in negotiating your offer upward or taking further legal action in pursuing your residential property claim.

At The Gilbert Firm, we have access to experts in mold detection and remediation to ensure your mold claim is not wrongfully denied. If you believe your insurance company is underpaying or denying your mold claim, call our experienced insurance dispute attorneys today at  888-996-9731 or complete a contact form to schedule a consultation with Clint Scott, Brandon McWherter, and Jonathan Bobbitt. We serve clients throughout Tennessee from our office locations in Nashville, Chattanooga, Memphis, Knoxville, and Jackson.

 

 

Residential and commercial real estate sales occur on a daily basis. Usually, the title transfer of the sale occurs without much fanfare regardless of whether the transaction involves a residential home or business real estate. The same is true when it comes to transferring insurance from the seller to the buyer. Up to the closing point, the seller generally insures the property. When closing occurs, the buyer generally insures the property.

An important question to ask is, can the sale of a property negatively affect an existing insurance claim on the property when it comes to the financial interests of the seller?

Hope for the policyholder seller

The Seventh Circuit Court has addressed this issue with a legal opinion that gives hope to the policyholder seller. The Court found that the sale of a property prior to the completion of repairs does not prevent the seller from eventually recovering the “replacement cost.”

In Edgewood Manor Apartment Homes vs. RSUI Indemnity Company, the insured policyholder was the owner of an apartment complex who recaptured the “actual cash value” from the insurance company from damage caused by Hurricane Katrina. The insured then successfully sold the property before repairs were made. The terms of the sale included an assignment of the insurance claim to the buyer.

However, the Court ultimately determined that the assignment was not valid and that the insured seller held rights to the insurance claim and possessed a legitimate claim for the “replacement cost” after the buyer performed the repairs.

Establishing an insurable interest

One hurdle for the policyholder seller is to demonstrate that he or she has an insurable interest in the property. The Court’s decision explained that no state requires the insured to maintain an insurable interest during the course of residential or commercial property claim litigation. The existence of an insurable interest is determined either at the time of loss or at the time of the policy’s inception.

Recovering the replacement cost proceeds

The second challenge is to recover the proceeds of the “replacement cost.” In the Edgewood Manner case, the insurance company asserted that it was not responsible for paying any replacement cost because the insured seller sold the property prior to the completion of repairs. Regardless of that fact, the Court pointed out that nothing in the policy requires the insured party to perform the repairs on the property. Therefore, the insured party may sell the property and as long as the buyer completes repairs in a reasonable timeframe according to policy requirements, the seller can recuperate the replacement cost proceeds.

In summary, you have options when a commercial or residential property claim is pending during the sale of any property. The seller or buyer may recover replacement costs depending on the sales agreement and the policy. In addition, the sales price may or may not be modified to ensure the seller and buyer are in the financial position they would have expected to be in absent the insured event.

If you filed a claim against your commercial or residential insurance policy and received a denial, you may have grounds to file a lawsuit. Our Tennessee insurance dispute attorneys at The Gilbert Firm are here to help you receive the compensation you are owed based on your claim. To arrange a free consultation, call our office today at 888.996.9731 or complete our contact form. Our attorneys Clint Scott, Brandon McWherter and Jonathan Bobbitt are ready to fight for you. We serve clients in Tennessee from our offices in Nashville, Chattanooga, Knoxville, Memphis, and Jackson.

 

 

 

Insurance policy exclusions can dramatically affect insureds who think that they are protected completely when dealing with fire, storm, wind, hail, theft or other issues with their property. An insurance battle stemming from Hurricane Harvey in Texas was recently settled out of court for an undisclosed amount. The plaintiff, a woman who owns multiple commercial properties in Texas, sued Lloyd’s of London for failing to pay her claims. She claimed that winds of 125 MPH or more damaged roofing on her properties, causing damage inside her buildings.

The claims were denied due to damage being caused by anything but the wind, despite any evidence to the contrary. Exclusions like these can wreak havoc on policyholders, so it is important that you know what coverage you have and any exclusions that may apply.

What is an insurance exclusion?

Exclusions are typically found in policies which cover “risks of direct physical loss.” Basically, the policy will state that “all risks of direct physical loss” are covered “unless excluded”. This language enables insurance companies to narrow down what will and will not be covered by the policy. The most common exclusions we see include the following:

• Wear and tear/ deterioration
• Improper workmanship/materials/design
• Ordinance or law (but there may be a provision allowing for coverage relating to building code upgrades)
• Governmental action
• Intentional acts
• Earth movement
• Flood (sometimes, water)
• Fungus, wet or dry rot or mildew
• Slow leaks

(While not normally applicable, acts of war are usually excluded, too.)

Exclusions must be clearly written

Since an exclusion in an insurance policy does not cover certain items, the law requires that they be written clearly. This is where a lot of insurance companies get into trouble. If a policyholder misinterprets their policy language, or it is too difficult to understand, the insurer can wind up being held responsible for the damages the policyholder is seeking to recover.

How do exclusions hurt insureds?

On the other hand, exclusions can hurt insureds when it comes to covered losses. An insured who has not read their policy, or has not asked for clarification of an exclusion, may very well find that they are not protected in certain loss events. For example, did you know that the neglect of your property could possibly void your homeowner’s policy? Look, let’s not forget that insurance companies do not make large profits by paying claims that they contend are not covered under their policies. It’s important to know what your policy says AND what it means.

When it comes to insurance disputes, the Gilbert Firm is highly experienced and respected all throughout Tennessee. Jonathan Bobbitt, Clint Scott, and Brandon McWherter work hard to make sure your insurance company pays your claim in a timely manner. Call us today at 888-996-9731 or complete the contact form to schedule a consultation in Nashville, Memphis, Chattanooga, Jackson or Knoxville.

 

 

The claims adjuster is an important cog in the insurance machine. This person is responsible for coverage determination, investigation /evaluation of the claim and damage, and ultimately determining how much of a financial obligation the insurance carrier has and will pay on your claim. Understanding what it is a claims adjuster does can make it easier to figure out if you are possibly being “lowballed” on the claim settlement offer.

The responsibilities of a claims adjuster

A claims adjuster has just about the same responsibilities no matter where they work, but some could be tasked with doing additional duties depending on their employer. At a minimum, a claims adjuster is often responsible for handling the following:

• Research the insurance policy
• Determining is coverage exists for the loss
• Investigate the claim
• Collect evidence to support or deny the claim
• Obtain property repair estimates
• Negotiate settlements with you, the customer
• Accept or Deny claims
• Understand costs of additional living expenses and construction costs
• Review estimates
• Order and review engineering reports

Am I being lowballed?

Would you know if you are being lowballed by the claims adjuster assigned to your case? More than likely you would have no idea. Candidly, it can be a really complicated process that, on its face, appears to be fair. So, why would an insured even consider questioning the offer in the first place? That’s why it’s vital to work with an experienced Tennessee insurance disputes attorney when filing a claim. If you believe you received an unfair offer from your insurance company, it’s best not to respond without speaking to an attorney experienced in the area.

If you suspect your claim is not being handled properly, contact the experienced Tennessee insurance dispute attorneys from the Gilbert Firm. We provide legal assistance for clients in Nashville, Chattanooga, Memphis, Jackson, and Knoxville. Call us at 888-996-9731 or complete a contact form to schedule a consultation with Clint Scott, Brandon McWherter, and Jonathan Bobbitt.

 

 

When you purchase an insurance policy, you’re ensuing that, in the event of a loss, there is a way for you to put your property back in pre-loss condition. Did you know that most states have a “Bill of Rights” for property owners which sets forth some basic rights to which a policyholder is entitled under their policy? For example, Tennessee has one that applies to homeowners’ claims of $20,000 or more. In Tennessee, all policyholders must be given a written statement of those rights from their insurer.

Under the law, and “at a minimum, the written statement… shall advise policyholders of their rights to:

1. Receive quality repair work to restore the damages to the policyholders’ property;
2. Have the repairs made by a contractor of the policyholders’ choice, understanding that the contractor is hired by the policyholder and that this contractor does not work for or at the direction of the insurance company;
3. Receive a copy of the insurance policy free of charge upon request;
4. Be informed of the need to file a proof of loss, if required;
5. Receive the name, phone number, and address of the claim representative handling the loss;
6. Receive a detailed estimate of the scope of damage and costs of repairs. Should the contractor selected by the policyholder have questions concerning the insurance company’s estimate, the policyholder or the policyholder’s contractor should contact the policyholder’s claim representative directly;
7. File supplemental claims as the need arises; and
8. File a complaint with the [state’s insurance] department by calling the policyholder service section at 1-800-342-4029, if the policyholder is unable to work out an agreement after speaking with the policyholder’s claim representative, agent, and the company.”

If you were not given a written statement of your rights when you filed your claim, you should request one from your insurance company. It can help protect you in case you need to make a claim.

I think my rights were violated; do I need a lawyer?

If you sustained a loss and submitted a claim through your insurance, and that claim was unfairly denied or delayed, or if you were given a lowball settlement offer, it may be time to seek legal counsel. An experienced Tennessee insurance dispute attorney will review your claim, your policy, and the offer from your insurance company, and determine whether or not you have been the victim of bad faith. If you have, you may be entitled to money for the damages you sustained, but also additional compensation in the form of statutory penalties and punitive damages.

To learn more about your options, or to reserve a consultation with Jonathan Bobbitt, Clint Scott, Brandon McWherter, or any of our Tennessee insurance dispute attorneys, please call the Gilbert Firm at 888.996.9731, or fill out our contact form. We maintain offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville, and serve insurance clients throughout Tennessee, and in Mississippi and Kentucky.

 

The protection you purchase with your insurance policy is supposed to be there when you need to access it for yourself or your loved ones. However, too often insurance companies fail to live up to their promises when accidents, storms, tragedy or disaster hits. A claim denial or delay can keep you from accessing the benefits you are owed under the terms of your policy. You might even experience a retroactive cancellation of your policy after you file a claim. Or, your insurer may fail to resolve your claim the way the policy dictates. These situations and others are at the core of insurance disputes and often involve bad faith on the part of the insurance company.

Having an experienced attorney handle your insurance dispute is often the only way to fully and properly resolve the claim and obtain the benefits you are owed.

Bad faith insurance actors

When an insurer issues an insurance policy, that company makes a promise that it will operate fairly and in good faith with you, its insured customer. Companies that fail to adhere to their policy terms may be acting in bad faith and can be held responsible for damages. It’s no secret that insurance companies save money when they are able to avoid paying out on customer claims. Unfortunately, many claims are wrongfully denied, and many of these claim denials are not disputed by the victims, enabling insurers to keep millions of dollars otherwise owed to their customers.

An attorney can enforce the insurer’s obligations

The good news is that legal help is available for insurance policyholders both at the outset of your insurance claim or even in the middle of an insurance dispute. If your insurance company denies your claim, refuses to fully pay your claim, or offers you a lowball settlement, you need an experienced lawyer in the area of insurance disputes to force the insurance company to meet its obligations. Please also remember that you do not have to wait until there is a dispute to hire a lawyer. There are cost effective ways to hire our firm to help you at the outset of your claim in order to hopefully avoid a dispute altogether.

Regardless of whether you purchase homeowners, disability, life or auto insurance, you deserve to receive 100 percent of the benefits of your policy if your claim is legitimate and covered. If the insurance company delays approval or payment of your claim or refuses to pay your claim outright, you may have a claim involving bad faith insurance.

Just some examples of insurance companies practicing bad faith insurance practices include:

• Unreasonable (lowball) settlement offer on a valid claim
• Failing to pay undisputed portions of the claim
• Failing to thoroughly and promptly investigate a claim
• Unreasonable denial of insurance benefits
• Unreasonable interpretation of policy language
• Canceling an insurance claim that should have been paid
• Hiring biased and outcome determinative experts to deny you claim
• Causing unreasonable delays in payments
• Refusing to reimburse you for your total loss or settle the case
• Failure to defend you (without proper reason) when you are sued under your liability coverage

The language of insurance policies can be confusing to even the most astute policyholder. Sometimes these policies contain loopholes that can prevent you from accessing the benefits you are owed. An experienced insurance lawyer can sort out the coverage you are actually owed for your losses and determine if the insurer has wrongly withheld your benefits.

At the Gilbert Firm, our Tennessee insurance dispute attorneys have extensive experience dealing with insurance companies that have not held up their end of the bargain with their customers. If you need help dealing with a difficult insurance company, we can help you obtain the justice you seek and the claim benefits you deserve. We serve our Tennessee clients from offices in Nashville, Jackson, Memphis, Chattanooga, and Knoxville; our Mississippi clients from offices in Tupelo and Jackson, and our Kentucky clients from our office in Louisville. To set up a free consultation, contact attorney Jonathan Bobbitt, Clint Scott or Brandon McWherter today – please call 888.996.9731 or send us a request through our contact form.