When Appraisers Fail to Agree on Umpire Court Must Appoint One When a claim for damages due to a hurricane was disputed the parties demanded appraisal and appointed their respective appraisers. However, the appraisers could not agree on an umpire for reasons unclear and bad faith litigation ensured. Because of the inability of the appraisers […]
Insurer May Never Subrogate Against its own Insured Zurich American Insurance et al sued their coinsurers – Appellant Certain Underwriters at Lloyd’s, London Subscribing to Policy Number B12630308616 (Lloyd’s) and Defendant Arch Insurance Company (Arch) – seeking a declaratory judgment that Lloyd’s is barred under New York law from bringing a common law indemnification or […]
Fraudster Must Serve Time and Lose His Residence to Pay Restitution Armando Valdes appealed his 60-month sentence for health care fraud after he pleaded guilty. Valdes’s conviction and sentence arose out of his scheme to submit millions of dollars in fraudulent medical claims to United Healthcare and Blue Cross Blue Shield for intravenous infusions of […]
The Christmas Gift of Insurance Fraud The story that follows is fiction based, in part, on a true case worked on by me. Any similarity to real people is unintentional. It is meant only to educate fraud professionals about how some unscrupulous people use the crime of insurance fraud for fun and profit during the […]
When used in contract law, the word condition refers to an event, the occurrence or non-concurrence of which alters the previously existing relations of the parties by creating or extinguishing a legal duty. A condition is different from a promise or warranty. When used in an insurance policy the condition imposes duties on the insured […]
What is a Condition? Subscribe to my Substack, Excellence in Claims Handling for $5 a month or $50 a year where you can read this and others here. In AIG Centennial v. Fraley-Landers, 450 F.3d 761 (8th Cir. 2006) the Eighth Circuit found that Arkansas law does not require any showing of prejudice to the […]
Appraisal Required to Resolve Extent of Loss υ In an insurance dispute stemming from Hurricane Ian The parties agreed that their case should go to appraisal to determine the extent of the loss. When an insurance policy contains an appraisal provision, “the right to appraisal is not permissive but is instead mandatory, so once a […]
Important Requirements to Make Insurance Policies Work Certain policies contain the term “warranty.” This is a word of great power. Generally, a warranty can be defined as follows: “warranty” in insurance law is a statement or condition forming part of a contract whereby insured agrees that certain acts have been or shall be done, and […]
Fraud in Inception Allows Insurer to Rescind Lamin Fatty appealed the trial court’s order granting summary disposition to Farm Bureau on the basis of finding Fatty’s fraud was grounds for contract rescission and reimbursement of benefits paid. In Lamin Fatty v. Farm Bureau Insurance Company Of Michigan, No. 363888, Court of Appeals of Michigan (November […]
Courts May Never Assume They Must Deal in Facts Team Industrial Services, Inc. (Team) found it had incurred a $222 million judgment against it in a wrongful-death lawsuit arising out of a steam-turbine failure in June 2018 at a Westar Energy, Inc. (Westar) power plant. Team sought indemnity for the judgment from Westar, Zurich American […]
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