TABLE
OF CONTENTS............................................................................................................................
1
INTRODUCTION.....................................................................................................................................3
Reopen
Old and Denied Claims........................................................................................................
4
My
Favorite Denied Claim Story........................................................................................................4
About
the Adjuster’s Attitude and Morale.........................................................................................5
BATTLE PREPARATIONS....................................................................................................................
5
“Battle
Gear”.....................................................................................................................................
5
General
Battle Principals..................................................................................................................
6
“Negligence”
(by the insurer, their vendors and others).........................................................................
7
“Estoppel”.........................................................................................................................................
7
YOUR
FIRST MOVES..............................................................................................................................
8
Your
Right to Know versus Attorney Client Privilege and Attorney
Work Product.......................... 9
About
Experts ..................................................................................................................................10
INSURER’S
FAVORITE DENIAL TECHNIQUES.......................................................................................
11
Delay................................................................................................................................................
11
Unreasonable
Demands...................................................................................................................
11
Examination
Under Oath (as a denial technique)................................................................................
11
Declaratory
Relief Action.................................................................................................................
12
“ENTIRE
POLICY VOID” DENIAL..........................................................................................................
12
“POLICY
OUT OF FORCE” (for alleged non payment of premium)............................................................
12
BUILDING
STRUCTURE or OTHER ITEM “NOT
SCHEDULED” (on an existing policy)...............................
13
YOUR
ADDITIONAL “TO DO” LIST.......................................................................................................
13
“BREACH
OF CONTRACT” (for alleged arson, fraud, misrepresentation,
missing or faulty “Proof of
Loss”, “failure
to cooperate” by the insured)...
SELECTED
“EXCLUDED PERIL” DENIED CLAIMS..................................................................................
15
MOLD................................................................................................................................................
15
WATER
DAMAGE................................................................................................................................
16
CAUSE
OF THE LOSS (how
to recover lost dollars from “cause of loss” not being covered)....................... 17
CONCURRENT
CAUSE OF LOSS NOT COVERED......................................................................................
17
“VACANT
STRUCTURE”.......................................................................................................................
17
CODE
IMPROVEMENTS – (how to get coverage without an
endorsement)..............................................
17
SPECIAL
ITEMS OF CONCERN (that help set up a denial)...................................................................
19
‘Proof
of Loss’ (form)........................................................................................................................
19
Tape
Recorded Statement...............................................................................................................
20
READING
YOUR POLICY (the quick and easy way)..............................................................................
21
Special
Considerations When Reading Your Policy..........................................................................
22
About
Policy Form Numbers and Edition Years................................................................................
23
“BURDEN
OF PROOF” (is it on you or the insurer?).............................................................................
23
USING
THE LAW TO HELP YOU..............................................................................................................
23
HARD BALL TACTICS.............................................................................................................................
25
1. Small
Claims Court......................................................................................................................
25
2. Better
Business Bureau Sponsored Arbitration.........................................................................
26
3. News
Media.................................................................................................................................
26
4. Picketing.....................................................................................................................................
26
5. Other
Guerilla tactics..................................................................................................................
26
6. Litigation.....................................................................................................................................
26
PROFESSIONAL
HELP (Public Adjusters).............................................................................................
27
FINAL
NOTE...........................................................................................................................................
27
APPENDIX..............................................................................................................................................
28
These
appendix documents are samples of insurance claims documents
that I have critiqued. My notes are handwritten in the margins
as well as in blue text boxes. My notes are followed by my
initials “rc”. These documents may not be the latest versions
and should only be used as a guide to show you how to critique
your own unique documents.
A
- Policy Cancellation Documents Critiqued.......................................................................................
A1
- Insurance policies are overridden by State Law................................................................................
A2
- “Certification Page” sample of a certified policy................................................................................
A3
- Sample document request letter to insurer......................................................................................
A4
- Case study “Number 1”, policy wrongly cancelled, insurer
had incorrect mail address (5 pages).
A5
- Case study “Number 2”, policy wrongly cancelled, insurer
had incorrect mail addresses on both insured and mortgagee
(9 pages)
A6
- Sample letter seeking attorney to litigate........................................................................................
A7
- Case study “Number 3”, building wrongly not listed on
policy, insurer had insufficient address, inspection, etc
inc. sample documents and correspondence (16 pages)............
A8
- Case law regarding cancellation notices (6 pages)............................................................................
B
– Insurer’s Expert Report Documents Critiqued..............................................................................
B1
- Sample structural engineer report critiqued and correspondence
(13 pages)......................................
B2
- Sample mold engineer report rejected by Insurer (8 pages).............................................................
B3
- Sample mold engineer report critiqued (30 pages)..........................................................................
C
– Proof of Loss and Release Forms Critiqued.................................................................................
C1
– Proof of Loss
Forms with Releases incorporated on one paper, deceptive practice
(8 pages)..............
C2
– Proof of Loss form with no release................................................................................................
D
– Declaratory Relief Actions Critiqued............................................................................................
D
- 1 Sample Declaratory Relief action used properly (3
pages)...............................................................
D
- 2 Sample Declaratory Relief action used improperly by
insurer (7 pages)...........................................
D
- 3 Sample attorney “set up” letter to insurer for Declaratory
Relief (10 pages).....................................