Category: Insurance Disputes

Preparing for an Examination Under Oath is probably the most important process, other than simply showing up. The lawyers that are hired have taken thousands and thousands of Examinations Under Oath over the years. They know what they’re looking for. They know what they’re asking – to create issues, so that your claim can potentially be denied. And so, preparing for the EUO is a process by which the Gilbert Firm is able to sit down with the insured, and work through the issues in their claim, talk about those issues, and explain what exactly is being asked by the insurance company. Not understanding a question that is asked by the insurance company’s attorney is the most dangerous thing that can happen, because the response that you give, while truthful, may give the wiggle room the insurance company wants when they’re looking to deny your claim.

What is an Examination Under Oath?

When you sustain a loss and make a claim with your insurance company for damages, you might be asked to submit to an Examination Under Oath, or EUO. If you’re asked, you have to say “yes,” or you risk having the claim denied altogether.

While the EUO is supposed to be used as a vetting tool for “suspicious” claims, more and more policyholders are being asked to submit. That’s why it is critical that you sit down with an experienced Tennessee insurance dispute attorney and go through the process first. The questions you’ll be asked can be really specific, because insurers want to avoid paying claims whenever they can. Preparing for the EUO can help ensure that you are compensated for the loss you sustained.

The Gilbert Firm fights on behalf of policyholders throughout the state. If you have been asked to submit to an Examination Under Oath, working with a skilled Tennessee insurance disputes attorney like Clint Scott, Brandon McWherter or Jonathan Bobbitt may be the difference between having your claim accepted or having it denied. To learn more about our services, or to schedule a consultation at one of our offices serving Nashville, Chattanooga, Jackson, Memphis or Knoxville, please call 888.996.9731 or fill out this contact form.

We recently ran across a news story out of Denver about a dispute between a homeowner and her homeowners’ association (HOA), over a particularly bright green paint. At the very end of the piece, the writer mentions that “the clock is ticking for [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][the homeowner] … who is in danger of losing her homeowner’s insurance. She has until the end of the month to get her house painted before her insurance is canceled.”

It may seem strange that a person could lose her homeowners’ insurance because of a poor paint choice, but it could conceivably happen. If you live in a condo, a multi-family home or a community where the HOA provides some level of insurance, and you are found in violation of an HOA regulation, that could affect your insurance policy. What we want to focus on here, though, is the importance of purchasing your own individual policy to protect you in the event of a problem.

HOA insurance and individual policies

More often than not, HOAs carry a master policy, often called a “walls out” or “studs out” policy, that can protect both the homeowner and the complex in the event of a fire or a storm (for example). The master policy would cover damage to things like:

• Foundations
• Elevators
• Stairs and stairwells
• Roofs
• Hallways
• Community areas (like the pool or clubhouse)
• Landscaping

The master policy is likely to exclude flood damage, because flood damage is often excluded from insurance policies.

Everything else – “walls in” – may not be covered, which leaves you on the hook for costs. For example, if a recent storm caused a leak in the roof, and rainwater damages the electrical wiring inside of your home, the HOA’s insurance should cover the costs associated with fixing the leak and the writing. But the toaster or microwave that shorts out as a result? That may not be covered by the HOA policy; you may need your own policy to collect for that type of damage. Insurance policies come in all shapes and colors, which is why it is important for you to have the right policy.

And if you do want to paint your house, make sure it is a color that your HOA will not object to you using.

At the Gilbert Firm, we understand that disputes often arise between homeowners and insurance companies. We understand the importance of identifying whose insurance is primary, and we know how to fight to protect our clients when they make claims for damage. To schedule a consultation with a Tennessee insurance dispute attorney like Clint Scott, Brandon McWherter or Jonathan Bobbitt, please call 888.9996.9731, or fill out our contact form. With offices serving Nashville, Chattanooga, Memphis, Jackson and Knoxville, we are always nearby when you need us.[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

Our neighbor two states over had an earthquake on Saturday: several of them, actually. One quake reached a 5.6 magnitude, and the effects could be felt in Memphis and Chicago. Tennessee is not usually a hotbed of serious earthquake activity, but that could be changing: we have had 11 in the first 13 days of September, the strongest of which was a 3.4 outside Tiptonville. Some experts believe we are due for a massive earthquake along the New Madrid Fault Line – the type of quake that could wipe out West Tennessee for up to two years.

Weather events have caused a lot of damage here at home and to our neighbors over the last few years, and homeowners may be surprised by what their policies do not cover. Now is the time to review your policy for exclusions, and to consider purchasing additional insurance to cover you in the event of a problem.

Common exclusions in homeowner policies

You can buy two different types of insurance policies: all-risk, which covers every scenario except those that are specifically excluded, or named peril, which covers nothing but those perils named in the policy. An all-risk policy is, in our opinion, the better option, but you may need to buy additional plans in order to cover damage caused by:

• Water does a tremendous amount of damage, and Tennessee has seen an increased number of flash floods over the past couple of years. If you bought a home in a flood zone, chances are good that you had to purchase additional flood insurance right away – but if you weren’t required to buy it, now is the time to see if A) you need it, B) if it’s covered in your current policy (though it likely is not), and C) whether or not you can buy an additional plan to cover flooding.
• Sewer backups. If you have a septic system, you probably don’t have to worry about sewers – but a backup can do untold amount of damage to your home and your property. Talk to your agent about adding a rider for sewer issues, just in case.

Any of these things on their own would be bad enough – but when you mix in an earthquake, the chances of drainage problems, flooding and bursting pipes increases. If you do not have additional earthquake coverage, an insurance company might try to deny your claim because of something called “anti-concurrent causation.” Basically, if you sustain damage to your home because of two separate causes, and one of those events is not covered by your policy, your insurer might attempt to deny the entire claim.

There’s a lot more to insurance than simply writing the monthly check, so we urge you to review your policies now. If you submitted a claim to your insurance company and they denied it unjustly or unfairly, you may have legal recourse available to you. The Tennessee insurance dispute attorneys of the Gilbert Firm have the experience and skills to help policyholders whose claims have been wrongly denied. Please contact Jonathan Bobbitt, Brandon McWherter or Clint Scott to find out more. You can contact the firm through our form, or call 888.996.9731 to schedule a consultation in one of our offices serving Nashville, Chattanooga, Memphis, Jackson or Knoxville.

In 2013, a small company called Zenefits opened offices in New York and California. Over the past three years, it spread throughout the country. Zenefits, according to its own website, “integrates all of [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][a company’s] HR functions into an easy-to-use online dashboard;” in layman’s terms, the company sells cloud-based software that helps small to medium sized businesses manage their human resources departments. As part of the package, it also helps employers “manage all aspects of employee insurance online.”

This last part, about the insurance management, is what concerns us – specifically because in July, the state of Tennessee fined Zenefits $62,500 for violating insurance requirements. In a statement picked up by Reuters, Julie Mix McPeak, commissioner of the Tennessee Department of Commerce and Insurance, claimed “Under the company’s past leadership, compliance with insurance laws and regulations was almost an afterthought.”

Zenefits violated licensing rules here in Tennessee, and looks to have done the same in seven other states. The CEO, Parker Conrad, allowed his sales teams to act as insurance brokers, which means they were, essentially, selling insurance without a license. Buzzfeed reports that Tennessee regulators found “65 examples of employees selling insurance or otherwise acting as a broker in that state without a local license,” and 10 where the employees had no license at all.

Parker has since been let go, and the company has reported all potential licensing issues. They have also started requiring their brokers to finish 52 hours’ worth of coursework and instituted a new system to track compliance.

This story was an interesting one to watch develop, because the policies themselves were never called into question. But purchasing a policy from an unlicensed broker – one who is likely unable to explain any gaps in your coverage, or potential pitfalls you might face when making a claim – is a serious problem. If something goes wrong, or if the policy does not deliver what it promises, you may have a claim for broker negligence.

At the Gilbert Firm, we provide comprehensive counsel to policyholders and employers who have been harmed by such practices. To schedule an appointment with Tennessee insurance disputes attorney Clint Scott or Brandon McWherter, please call 888.996.9731 or fill out our contact form. We maintain offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville for your convenience.

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Commercial property is, by and large, pretty expensive. For many small business owners, buying a piece of property that hasn’t budged on the market for a while can look like a good bargain, since you are more likely to negotiate a better selling price. All of that is well and good, until a pipe springs a leak or the ceiling caves, or you find some other damage that leaves you at a loss.

When you purchase a building that has been unoccupied for an extended period of time, you must purchase an insurance policy that fits your needs, and understand what is and is not covered in that policy.

We have discussed exclusions before, but the average exclusions for a policy may differ when it comes to commercial property. This is also true for buildings that have been abandoned or vacant for more than 60 days. Your policy may not cover you for:

• Previously damaged areas. While no insurance policy is going to cover you for damage that already exists, your policy may have a clause that allows it to deny claims if the damaged property, once fixed, becomes damaged again. For example, let us say there is a leak in one pipe in the building. You fix the pipe and the damage to the supports and dry wall, and then find that another leak springs up in the same exact place. Your policy may not cover that claim, since the damage occurred again.
• Animal damage. It is unlikely that an insurance policy covers the mice that chew your wires, or any other examples of damage done by critters who have taken up residence in or around your building.
• Electronic data. If you are the victim of a security breach, any data that is lost or stolen is may not be covered. You can purchase additional coverage for cyber security, and if you run any part of your business online, you absolutely should make that purchase.
• Damage to the land. This is a tricky one for a lot of commercial property owners, but it works like this: when you buy a property, the land upon which your building sits might not be covered.

It is possible to purchase additional coverage for your property, and your agent should explain clearly and carefully what types of coverage you need. For example, if you buy a building in a flood zone and your agent fails to disclose that you need flood insurance, you may be able to make a case for an agent negligence claim. Before you buy any property, though, you should sit down with your agent to talk about your needs, and to ensure that your policy is sound.

The Gilbert Firm upholds the rights of policyholders throughout the state. If you believe your insurance agent acted negligently, or if your claim has been denied under what appears to be suspicious or unfair reasons, you’ll need a skilled Tennessee bad faith attorney to help you. Please call 888.996.9731, contact Clint Scott or Brandon McWherter, or use our contact form to schedule your consultation at one of our offices in Nashville, Chattanooga, Memphis, Jackson or Knoxville to find out more.

There is a dangerous new issue in the insurance world regarding arbitration clauses. Though most insurance policies usually do not have forced arbitration clauses, recent news from Texas makes it apparent that at least some carriers are trying to go that route. As Tennessee is one of the many states with no statutes in place “prohibiting or restricting the use of arbitration in insurance contracts,” it is possible that your insurer may try to put one in place eventually.

When you purchase your policy, you agree to pay a certain premium for insurance coverage. This guarantees (at least hypothetically) that your insurer will provide coverage in the event of a claim. So if you submit a claim under your homeowners’ policy after a storm damages your home, and your insurance carrier refuses to pay, or tries to pay you less than what the damage is worth, then you could come see one of our attorneys, and we would either negotiate a better settlement, or take the insurer to court. It depends on the exact circumstances of your case. Either way, you are well within your legal rights to choose either of these options.

But those premiums can be difficult to pay – especially when you have a mortgage payment on top of it – for some homeowners. The insurance company then offers you another option: lower premiums in exchange for agreeing to arbitration in lieu of a right to a jury trial should a dispute arise. With a mandatory arbitration clause, however, you are denied your right to pursue justice in court. While arbitration can sometimes be used to reach a successful resolution, it also subjects the parties to a final decision that cannot be appealed under most circumstances.

The effect on homeowners

Remember how we said that homeowners’ policies usually don’t contain these clauses? Texas Farm Bureau is trying to change that. In this letter to the Texas Commissioner of Insurance, David Mattax, The Office of Public Insurance Counsel asks the Commissioner to not approve the company’s Endorsement No. HO-802, “’Mandatory Mediation-Arbitration Endorsement’… for use in the Texas insurance marketplace.” Farm Bureau is trying to push through policies with mandatory arbitration clauses – even homeowners’ policies. Given Tennessee’s lack of regulation in the realm of arbitration clauses, homeowners here could see a similar push for arbitration by insurance companies as well. And as the insurance company is likely to be in charge of picking an arbiter, the chances are good that homeowners won’t get a fair shake if a dispute arises.

So far, this hasn’t been an issue in Tennessee, but the winds of change are blowing. Now is probably the right time to double check your insurance policies, to make sure that you understand everything they say. If you notice any discrepancies or changes to your policy that you never agreed to, speaking with a skilled Tennessee insurance attorney is a smart move.

The Gilbert Firm proudly represents policyholders throughout Tennessee. If you believe your insurance company is acting in bad faith, or that you have been sold a different policy than the one you agreed to buy, we may be able to help. Please contact Brandon McWherter, Clint Scott, or one of our offices in Nashville, Chattanooga, Memphis, Jackson or Knoxville to learn more about our services.

We all grumble a little bit about paying our insurance premiums, until we get hurt or sick – and then those premiums don’t seem so bad. HealthCare.gov tells us that the average cost of a 3 day stay in a hospital is about $30,000, or $10,000 a day. So when you are seriously injured or ill, knowing that your health insurance will pick up the majority of that cost can ease some of your worries.

Unless your health insurance never receives a bill from the hospital – which is exactly what happened to a young woman in North Carolina, and the reason we wanted to talk about a controversial insurance practice taking place in states across the country.

In sum, this is what happened. Jessica Mounce was rear-ended by another car, and she “flew to the other side of the highway” as a result, as she told WSOCTV. She went to the hospital, but the hospital never billed her health insurance company. Instead, they went after Jessica herself, even putting a lien against her and threatening her with collections.

To understand why the hospital is allowed to do this, you need to know more about balance billing.

How health insurance pays a hospital bill

Insurance policies vary from customer to customer, but one of the things they do have in common is how they work with hospitals and doctors. This is called “balance billing,” and in very, very general terms, it works like this.

Let us say that ABC Hospital charges $200 to fix a broken leg. XYZ Insurance Company tells the hospital that they would love to contract with them, but they are only willing to pay $150 for a broken Leg. ABC Hospital agrees. Then, XYZ Insurance company tells you that they will only pay (based on your policy) for 50% of the costs to fix your broken leg – in this example, $75. You agree to this.

You break your leg, go to ABC Hospital, who then bills XYZ Insurance Company for $150. XYZ covers $75, so the hospital bills you for the additional $75. In that way, the total cost of $150 is paid in full.

Now, if you’re wondering what happened to that other $50 – it’s gone. The insurance won’t pay for it, so hospitals are supposed to chalk that up as the cost of doing business; after all, by accepting the insurance and whatever the policy will pay, the hospital stands to gain more patients and thus more revenue.

What the hospital did instead

Instead of billing Jessica’s healthcare insurance provider, the hospital – looking to recoup all of its money – sought payment from the auto insurance carrier for the driver that hit Jessica, placing a lien on any settlement or recovery, and threatening to turn her over to collections. They never billed her healthcare provider at all. If it seems unfair, it is – but it also may be perfectly legal in most states. WSOCTV reports that there are lawsuits pending in similar cases in Colorado, Ohio, Missouri, Arkansas and North Carolina right now, and there could be more in other states, too. Indiana, on the other hand, has passed laws that prohibit hospitals from not going through a person’s healthcare insurance provider first.

We urge you to review both your health insurance and auto insurance policies to make sure you have enough coverage, and to make sure that your health insurance is billed for any medical treatment that you receive. At the Gilbert Firm, we protect policyholders at risk of being taken advantage of. To make an appointment with Clint Scott or Brandon McWherter, please call 888.996.9731, or fill out our contact form. With offices in Nashville, Chattanooga, Memphis, Jackson and Knoxville, you can always find an experienced Tennessee bad faith attorney nearby when you need help.