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August 18, 2016  

 
 Q&A of the Week
Appraisal and Disposal of Damaged Contents

A New Jersey subscriber recently asked the following question:

A fire loss lead to substantial damage to the insured's structure and contents. The contents were disposed of after the insurer provided their spreadsheet to the insured. The insured then invoked appraisal because they disagree with item prices and overall settlement offered from the insurer on the contents. Can the insurer deny the appraisal because the items were disposed of? Please note, the insured possesses pictures of the damaged property, and there is no difference over scope, only the prices of each item.


ANSWER: One of the duties after a loss is to show the damaged property as often as the carrier reasonably requires. The policy clearly states that failure to comply with duties can be cause for denial of a claim if the failure to follow the duties is prejudicial to the carrier. However, an appraisal is not dependent on the duties; the appraisal is an option if the insured and the carrier disagree on the amount of loss. The exact wording is "If you and we fail to agree on the amount of loss, either may demand an appraisal of the loss" (emphasis added). Nothing in the policy states that the carrier can refuse an appraisal for anything—if either party demands it, the other party must comply. It is an issue of fact as to whether the lack of the actual damaged property prejudices the carrier; the appraisers or umpire should speak to that.
 Read More
 
 What's New This Week in FC&S
Liability Associated with Pokémon Go

Summary: In the recent fad of playing a new game called Pokémon GO in smartphone application format many insurance questions arise. Read More
 
 Litigation Watch
Cross Utility Vehicle as a Motor Vehicle

The underinsured motorist (UIM) carrier brought an action against the insured for a declaratory judgment that the policy excluded coverage since the insured was driving his cross utility vehicle that was not a covered auto as defined in the policy. This case is Progressive Preferred Insurance Company v. Reece, 2016 WL 3176482.

Reece owned and operated a 2012 John Deere 855-D cross utility vehicle and was driving it down the highway. He hand-signaled a left turn and was turning when Askren attempted to pass in her Chrysler Sebring. The Askren vehicle collided with the left rear corner of the cross utility vehicle, causing injury to Reece. Reece was offered $50,000, the liability limit on the Askren vehicle; his injuries were in excess of $150,000.
 Read More
 
 Fraud of the Week
Health Insurance Fraud – Arizona
AMOUNT: Unknown


An ongoing investigation is occurring due to allegations of widespread fraud, theft, and waste being uncovered in the group homes in Prescott Arizona. Read More
 
   
 FC&S Ask the Experts
Did you realize that the Q&A section of FC&S is made up of questions submitted by subscribers like you?

Paid subscribers to FC&S Online or print FC&S Bulletins are invited to submit insurance coverage questions to the editors. We'll provide a personalized opinion within five business days. (We'll let you know if it will be longer than that. Sometimes we have to gather research or other supporting materials).

Who knows? Your question may be featured (anonymously) in the online Q&A of the Week or as an FC&S update.

Submit your coverage interpretation question right to the editors of FC&S for quick and reliable information. Ask our expert staff a question by clicking here.
 
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FC&S editors regularly conduct web-based demos of the service. Feel free to contact Christine Barlow, cbarlow@alm.com, to set one up! They only take 30 minutes, a small investment of time that will help you learn all that FC&S Online has to offer.
 
 Contact Us
As always, your comments and questions are welcome.

Contact us at:
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Phone: 800-543-0874
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The Zalma Insurance Claims Library
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Construction Defects Coverage Guide
Your single-source for identifying, insuring, investigating, prosecuting, and defending cases that result from construction defect claims. More Info
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FC&S Team
Kelly Maheu, J.D.
Publisher
  Diane W. Richardson, CPCU
Consulting Editor
Christine G. Barlow, CPCU
Managing Editor, FC&S
  Diana B. Reitz, CPCU, AAI
Consulting Editor
David D. Thamann, J.D., CPCU, ARM
Managing Editor, FC&S Bulletins
  Emily Brunner
Online/Print/Production Editor
Susan L. Massmann, CPCU
Managing Editor, Electronic Publications
  Tosha Brinkman
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Barry Zalma, Esq., CFE
Contributing Editor
  Donna Cozatchy
Creative Director
Hannah Smith, J.D.
Staff Writer
 
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