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January 21, 2016  

 
 Q&A of the Week
Claim Made Years after Death of Insured

A Pennsylvania subscriber recently asked the following question:

I am handling a claim for a daughter who lost her mother multiple years ago. The daughter informed her mother's agent of her mother's passing and has since kept up with the premiums. She had a covered loss happen and now the insurance company is trying to deny the claim because she never had the policy put in her name. Shouldn't coverage still be provided since the premiums were still being paid?

ANSWER: You have a few different things working here. The ISO HO 00 03 05 11 insures the legal representative or those in custody of the property until the legal representative is appointed. Was the estate settled and the house put in the daughter's name? Who was the executor of the estate? Technically the legal representative is covered for the premises and property. Did the agent notify the company of the death of the first named insured? You may have an agent's E&O issue if he did not notify the company. Technically notification to the agent is notification to the company, but he still has to do his duty and advise the carrier of the change and advise the insured to follow through on titling the property. The policy does not state that the coverage upon the death of the insured terminates at the end of the policy term, although in most cases the estate is settled and names changed on property and the like.
Without the property being in her name, unless she is the appointed legal representative, they can deny the claim, although they have been collecting premium on this for years; if they deny the claim, they should at least refund the premium. It really sounds like there is an E&O issue here with the agent not advising his insured or the carrier.
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 What's New This Week in FC&S
ISO Homeowners Comprehensive Form, HO 00 05

Insurance Services Office (ISO) introduced form HO 00 05 10 00, which provides open perils coverage for personal property as well as buildings, in the 2000 forms revision. Read More
 
 Litigation Watch
Duties of the Insurer

The insured dump truck owner brought an action against its excess liability insurer, alleging that the insurer breached its policy and duty of good faith and fair dealing by not proactively investigating claims against the insured and by refusing to tender its policy limits to spur settlement negotiations in an underlying action. This case is SRM v. Great American Insurance Company, 798 F.3d 1322 (2015). Read More
 
 Fraud of the Week
Staged Accident—Spain
AMOUNT: $377,021


Insurance fraud is not limited to the United States. 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.
 
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The Zalma Insurance Claims Library
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FC&S Team
Kelly Maheu, J.D.
Publisher
  Diane W. Richardson, CPCU
Consulting Editor
Christine G. Barlow, CPCU
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  Diana B. Reitz, CPCU, AAI
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David D. Thamann, J.D., CPCU, ARM
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  Tosha Brinkman
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Barry Zalma, Esq., CFE
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  Donna Cozatchy
Creative Director

 
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