Insurance Dispute Lawyer Blog

The Berniard Law Firm, having already been involved with various clients with Chinese drywall in the Gulf Coast region, recently filed in federal court two claims against manufacturers and builders who were involved in the repair and manufacturing of their homes. Further, head attorney Jeffrey Berniard has been involved in the class action proceedings with the MDL established in New Orleans. That pre-trial matter has been proceeding at a very rapid pace as Judge Eldon Fallon, quite experienced with class actions and was selected because of his work in a previous matter involving the prescription drug Vioxx. For more information on Judge Fallon's work in the Vioxx matter and how he was chosen for his experience and expertise in the rapid development of class action pre-trial matters, read more here.

All of this involvement has led to a wealth of information that has been integral in establishing the advanced experience and approach the Berniard Law Firm has towards Chinese drywall. Mr. Berniard has been in attendance of each of the pre-trial hearings relating to the MDL Panel and has been active in helping advance the Plaintiff case in any way possible. To understand better the decisions made and the developments that come with these pre-trial hearings, refer back to our blog entry on this month's MDL hearing located here.

While this blog is intended to be a resource for individuals living in the Gulf Coast and beyond to understand the legal matters and situations going on day-to-day, the fact that builders as far away as Nevada have been accused of using Chinese drywall demonstrates that everyone need to be aware of the news and options going on with Chinese drywall.

For more information on Chinese drywall, feel free to peruse the section of this blog dedicated to the matter, located here. If you believe you may have Chinese drywall in your recently built or renovated home, contact us at the Berniard Law Firm and we will happy to help you with your home issue and pursue any legal case you may have.

Reported late last week, State Farm Florida is looking to shore up its finances and reduce discounts for customers... at the expense of those very customers. The Daytona Beach News-Journal reports

Trying to shore up its finances, State Farm Florida will eliminate or reduce some insurance discounts it offers to homeowners -- leading to an average premium increase of 28.4 percent.

The move, which comes as State Farm prepares to pull out of Florida's property-insurance market, will have widely varying effects on policyholders because they qualify for different levels of discounts.

Some will face large premium increases, while others will see little effect on their wallets.

But company and state officials said the biggest change will eliminate a discount customers receive when they go years without filing claims for fire, theft and other non-hurricane damages.

State Farm announced plans in January to leave the property-insurance market because it said its Florida subsidiary was losing money and in danger of eventually becoming insolvent. That decision came after regulators rejected a 47 percent rate increase.

With State Farm's exit plan already in place, this means customers of the insurance giant will face higher rates as they are indeed dumped by the company. Shopping around for another company, if they haven't begun to already, looks to be a fine plan for customers in Florida.

State Farm is looking to raise the rates of homeowners insurance in the state of Texas, appealing to the Department of Insurance for an increase up to 8.5%. The Lufkin Daily News reports

Insurance giant State Farm Lloyds filed with the Texas Department of Insurance on July 15 to increase its homeowners' insurance rates in Texas by an average of 8.5 percent starting on Oct. 1 for existing customers upon renewal and Sept. 1 for new customers. Angelina County's increase is below the state average at 5.7 percent. State Farm noted that 350,000 of its 1.2 million customers will see no change or a decrease in their rates as a result of the filing.

"We've seen major insurance carriers Allstate and Farmers raise their rates and now State Farm is completing the rate hike trifecta," said N. Alex Winslow, executive director of Texas Watch, a consumer rights group based in Austin.

State Farm Lloyds called 2008 "the worst catastrophic loss year in Texas history" with hurricanes Dolly, Ike and numerous spring hail storms across the state. The result: claims totaling $1.4 billion. Through May of 2009, State Farm paid $572.8 million in weather-related claims, already ranking 2009 second only to 2008 as the most costly of the last five claim years even prior to the start of hurricane season, the company said in a press release.

Texas residents can do little but wait and see as the state decides just how much State Farm can expect from policy holders that have lost a lot of their own money as well in these storms. Check back on this blog as time elapses to see what develops.

With hurricane season in full swing, it is important for home and property owners to be fully aware and clear about their insurance and coverage, or lack thereof, that it provides. Whether living in a flood plain or tucked safely in a non-flooding area, residents of the Gulf Coast can be affected all the same by a hurricane by the list of dangers such as wind or rain damage. Going through your policy and making sure the proper cover necessary to properly rebuild in the event of storm damage is there will help prevent nasty surprises should the unthinkable happen and serious destruction befalls you.

Tim Engstrom from Southwest Florida's News-Press has more

Most homeowners - especially those outside high-hazard coastal zones - can find coverage, but it is likely to be with a newer, less-familiar company, said Randy Duncan, an agent with the Insurance Depot of Lee County in Cape Coral.

"The days of name-brand coverage are over," Duncan said. "All that really matters is whether the company is A-rated - can it cover its expenses in the event of a loss?"

There is no "hurricane insurance"; homeowners' insurance is actually a collection of insurance coverage that includes such hazards as windstorm, fire, lightning and more.

Duncan said homeowners frequently forget that their windstorm coverage typically carries a much higher deductible - based on a percentage of the insured value - than other coverage.

The article goes on, citing the need to reup your policy coverage in the event of home upgrades or additions, as well as keeping an extra copy of insurance documents with personal documentation in a safety deposit box or other "outside" storage area away from the home. Available here, the article is a good read for anyone living in the Gulf Coast to make sure they are up to task on their preparation and insurance values.

According to a report released this week, insurance policy holders in Florida and Louisiana, among other states, are paying some of the highest rates for homeowners policies that are vastly overrated. While states like Utah and Idaho have residents who are receiving a great value for their policies, this illustrates yet again a theme of insurance prices in the Gulf Coast being out of control.

The Times-Picayune reports

Louisiana is one of six states receiving an "F" on a newly released report card ranking states' insurance climates.

The report card, which was jointly released by The Heartland Institute and the Competitive Enterprise Institute, found that consumers in Louisiana, Florida, Hawaii, Maryland, Massachusetts and New York pay more for homeowners coverage that is inferior. Each of those states was awarded an F.

Arizona, Idaho, Utah and Vermont each earned "A" grades for their healthy insurance environment.

Again this is highly unacceptable and state and federal representatives of this state need to look for a way in which this tilted scale may be leveled in order to get some semblance of fairness, or even sanity, into the insurance sector of the Gulf Coast.

Today, according to the Atlantic Oceanographic and Meteorological Laboratory, marks the beginning of hurricane season.

The Atlantic hurricane season is officially from 1 June to 30 November. There is nothing magical in these dates, and hurricanes have occurred outside of these six months, but these dates were selected to encompass over 97% of tropical activity. June 1st has been the traditional start of the Atlantic hurricane season for decades. However, the end date has been slowly shifted outward, from October 31st to November 15th until its current date of November 30th.

Now, before it's too late, make sure your insurance premiums are up to date, your coverage is what you wanted and your home plan on emergency preparation is ready. For more information on how to be prepared for storms and hurricanes, check out our blog posts that go over a variety of ways to be prepared in the event of a disaster or tropical storm.

The Louisiana senate move forward with changes for Citizens insurance that will hopefully help home and property owners with their coverage and recovery in the event of a hurricane or natural disaster. NOLA.com reports:

The state-run insurer of last resort should have new guidelines to set rates and possibly slow the increase in premiums to homeowners, the Senate decided today.

Approved 30-2, Senate Bill 130 by Sen. Troy Hebert, D-Jeanerette, goes to the House Insurance Committee for more debate.
Hebert said if the bill had been in effect this year, the average 7 percent rate increase imposed May 1 by the Louisiana Citizens Property Insurance Corp., would have been about 3.2 percent.

Hebert's bill would require the reworking of the formula Citizens uses in setting rates. Under existing law, Citizens cannot charge competitive rates with private insurance companies in an area. It must add a 10 percent surcharge on top of the highest rate charged by private insurers in a parish.

With Louisiana, and any legislature in general, any progress is good progress. Hopefully rates will fall progressively with this new measure as coverage and damages require a full, multi-lateral effort amongst all involved.

While stories have been popping up progressively in the wake of Hurricanes Katrina, Gustav and Ike, one interesting development has been the efforts by lawmakers and citizens for preparedness should an unpredictable catastrophe befall their hometown. States along the Eastern Seaboard have been taking action instituting insurance measures and local disaster drills should an unexpected and devastating hurricane knock on their doorstep.

New Jersey is one of those states, taking it as far as to create a fund that would help make sure homeowners would be protected in the event of a cataclysmic storm:

Today, the Legislature will begin hearings on how to best protect New Jersey homeowners from the devastation of major hurricanes or other natural disasters. This is an important and timely step; the Atlantic hurricane season begins in less than a month and New Jersey is both exposed and vulnerable to those storms.

The Senate Commerce Committee will hear testimony on the "New Jersey Consumer Catastrophe Preparedness and Protection Act" (S2089), sponsored by Senate Majority Leader Steve Sweeney (D-Gloucester). It would use private insurer dollars to create a fund that would stand behind the traditional insurance market to cover the most extreme losses from truly massive hurricanes -- not the routine storms that sweep across beachfront properties, but those whose devastation would stretch far beyond our coastal communities and well into many of our urban centers.
Because the fund would be a pubic-private partnership, private insurer dollars that are deposited into the fund, as well as the fund's investment income, would be exempt from state and federal taxes. Mandatory annual deposits combined with tax-free investment income would help the fund to grow year after year.

A portion of the investment income, but not the principal deposits, would by law be annually appropriated for preparation and planning so that damages from storms could be minimized. A portion would be used to enhance first-responder training and equipment so that lives could be better protected when the unthinkable does happen. A portion would also be dedicated to improve consumer and homeowner education so that residents can be informed and prepared in the event of a massive natural event.

It's good to see that the lessons of the past will not be forgotten so easily, even in states that did not face such hardships directly.

While a tropical storm can pop at any point that the water and air temperatures are "right," June 1st is commonly considered to be the beginning of "Hurricane Season."

Things to consider now, or at least before June 1st, are your preparedness for a large tropical storm or hurricane, the storage of important documentation relating to insurance and your home and/or property, evacuation plans and various other steps. Feel free to browse our section on storm and hurricane preparedness tips, located here, and make sure you complete your checklist before storm season gets here.

In the event a storm does cause damage to your home and you feel the insurance companies are not giving you the covered financial restitution you feel you deserve, contact a legal professional immediately. The Berniard Law Firm prides itself on taking on insurance companies and defending Gulf Coast residents against bullying or undercutting insurers.

A recent New York Times article helps highlight just how far behind insurance companies are to innovations of modernity and innovation. Highlighting the cases of several cancer patients who were forced to go out-of-pocket to receive convenient oral treatments rather than in-house intravenous, etc., care, the NYT highlights how insurance companies rely on redtape and a lack of federal demand to innovate to demonstrate how the average citizen who, until they fall into crisis, believe they are fully covered suddenly are required to provide their own money for reasonable remedy:

Pills and capsules are the new wave in cancer treatment, expected to account for 25 percent of all cancer medicines in a few years, up from less than 10 percent now.

The oral drugs can free patients from frequent trips to a clinic to be hooked to an intravenous line for hours. Fewer visits might save the health system money as well as time. And the pills are a step toward making cancer a manageable chronic condition, like diabetes.

But for many patients, exchanging an I.V. bag for a pill is a lopsided trade because the economics and practice of cancer medicine have not caught up with the convenience of oral drugs.

Too often individuals appealing to their insurance company for help when necessary are finding that there is little to no interest on the part of these companies to modernize or "go the extra step" to provide the care they should provide. Through governmental complacence and a lack of oversight to the processes occurring in coverage, insurance companies have consistently red flagged and prevented proper restitution or remedy to claimants who have a full right to proper care. This practice extends beyond pharmaceuticals and the healthcare industry and into various other insurance industries, including property and homeowners.

By refusing to accept low-end bargaining from insurance companies and seeking legal advise on the rights provided by the contractual arrangement between policy holder and provider, citizens can protect themselves from needing to pay out-of-pocket for the results they deserve. While necessary governmental oversight over the insurance companies may be too far into the future to rely upon, everyday people can make sure that, should a form of tragedy befall on them that they believe their insurance provider is bound to provide, they have the legal support they deserve.

Per The New York Times, "After the 9/11 terror attacks, thousands of people faced a weighty and uncomfortable decision. Congress had created a special fund to compensate survivors and victims' families, but said that those who received compensation from it could not sue airlines or airport security firms, among other entities."

While many families who lost a loved on in the attacks "sought compensation from the fund" a "new court report suggests that the small minority who went their own way and sued made out better financially: 93 of the 96 claims have been settled, for an average of $5 million, or more than twice the average payment from the special fund."

This correlation can be found now in settlement struggles between people still fighting with their insurance companies with Ike and Gustav hurricane claims who did it without legal assistance. Insurance companies very often "lowball" or under-appreciate the value of homes and property damaged in incidences. With legal assistance, experts and courtroom litigants, individuals run a much better chance of receiving higher compensation. While, in this case, it was the government pressuring settlement, insurance companies have a proven trackrecord of manipulating and exerting pressure on their clients to accept their offers rather than pursue legal assistance. However, in the event your property or home is damaged under insured events, seek a legal expert who can get you the financial settlement you deserve.

In a committee meeting relating to the insurance industry, witnesses recently laid before the Senate statistics and numbers that would imply an insurance agency, UnitedHealth Group, went to so far as to defraud through underpayment one in three of their clients:

CQ Healthbeat (3/27) reports, "UnitedHealth Group officials are in for an unpleasant experience at a Senate hearing next week - if a set-up session on Thursday was any indication." At a Senate Commerce, Science and Transportation Committee hearing today, witnesses "described how health insurers routinely defrauded millions of patients who sought out-of-network care by paying less than the insurers owed for medical bills." A witness told the panel, which will hear from United representatives next Tuesday, that "the practice could have potentially affected as many as one in three insured Americans and lasted for at least a decade." Committee Chairman John D. Rockefeller, IV (D-WV), "declined to say what types of changes should be included in health overhaul legislation," saying, "I want to make sure exactly what it is we need to do...just in the saying of it, I could do damage to health reform."

This system of underpayment should come as no surprise to residents of the Gulf Coast, who found that their property insurers consistently undercut them by offering the bare minimum to their claims. The insurance agency at large is notorious for trying to bolster their bottom line by offering far less than the fair market or genuine value is to the damaged, insured homes or property of their clientele. It is becoming ever more important to attain legal support in the event you believe your insurance agency is acting in bad faith with their offer to your claim, whether it be health insurance or property damage or any type of issue with an insurer.

The Times Picayune reported yesterday

Louisiana has the third-highest homeowners insurance premiums in the nation, according to the first assessment of prices after Hurricane Katrina by the National Association of Insurance Commissioners.

The cost appears to be a Gulf Coast epidemic as Texas claims the number one spot, followed closely by Florida:

The most expensive property insurance market in the country in 2006 was Texas, where premiums increased 2.7 percent in 2006 to an average of $1,409 per home. But the NAIC cautions against comparing Texas to any other market because the Texas data comes from a different source than most other states, and the homeowners policies are slightly different.

The explanation (or excuse?) for this is simple: the weather and risk level of the Gulf Coast places the financial burden on citizens to properly maintain insurance on their homes and property. While this demands constant vigilance on the part of state government and the citizenry to make sure insurance companies do not overstep what is necessary for them to remain successful and in business, it, in the least, requires policy holders to make sure they get their "bang for their buck" and get the best service and response they deserve from their insurance company.

Always make sure your provider is conforming to deadline requirements should you make a claim and, in the event they act in bad faith, contact an attorney immediately.

Continue reading "Report: Louisiana, Texas most expensive places for homeowners insurance" »

While a recent string of fires in Pineville and Alexandria this week have led officials to warn Louisiana residents about fire safety and the like, it also serves as a reminder about insurance coverage. Not knowing if your home or property is covered in the event of a fire can lead to, at best, a lot of stress. At worst it can lead to a complete loss in the event of devastation.

Precautionary tips on how to prevent fires in your home or property include:

Remain in the kitchen while cooking

Keep flammable objects away from cooking surfaces

Never leave BBQ grills unattended

Keep space heaters 3 feet or more from objects that may burn

Never leave a trash or leaf fire unattended

Have your chimney or furnace regularly checked and maintained

Douse cigarette or cigar butts with water before throwing away

Do not plug in an excessive amount of electronics to the same outlet

These are just some of the things you can do to prevent fire. However, to prevent a complete loss in the event of a fire, review your insurance policy and make adjustments as necessary to protect your home and property.

When going about shopping for the right policy or making sure your policy protects you in the ways you need, it is important to understand insurance terms used. In educating yourself about the legal jargon employed by the insurance companies, you can be better prepared to combat an unfair claim payment or prevent your policy from being hijacked by vague language.

Below, courtesy of the University of Illinois, is a glossary of insurance terms, ranging from the letter G to I:

Grace period. A period (usually 30 to 31 days) following the premium due date, during which an overdue premium may be paid without penalty. The policy remains in force throughout the period.

Group insurance. Insurance issued to an employer for the benefit of employees or to members of an association.

Guaranteed insurability. An option that lets the policyholder buy more life insurance at stated times in the future without a medical exam.

Guaranteed renewable. A policy that is always renewable as long as premiums are paid. A company may raise premiums for all policyholders within a particular group.
Guaranty fund. A state fund to pay claims of insurers when a company is insolvent.

Health insurance. Insurance to pay for medical losses to individuals.

Health Maintenance Organization (HMO). An organization that provides a wide range of comprehensive health care services to members who prepay of a fixed periodic fee for the service.

Home health care. Includes a wide variety of services that bring care to the home: skilled nursing care, physical and occupational therapy, speech therapy, personal care, and the assistance of home health aides (sometimes referred to as homemakers) with chore services.

Home inventory. A list of personal possessions, along with the date purchased, the purchase price, and any information that would help identify an item in case of loss.

Homeowners insurance. Coverage for your place of residence and its associated financial risks. Insurance to pay for losses of personal or real property and for losses resulting from perils specified in the insurance contract.

Hospice. A center for the care of terminally ill individuals who do not require the specialized technology available in hospitals. The hospice center may be within the hospital structure.

Hospitalization policy. A policy that covers the hospital expenses incurred in an in-patient hospital stay.

Indemnity income policy. An insurance policy that pays income to the insured during hospitalization.

Industrial life insurance. Life insurance issued in small amounts, usually less than $1,000, with premiums payable on a weekly or monthly basis.

Inflation guard endorsement. A special endorsement that increases the face amount of a homeowner's policy on a regular basis to compensate for the increasing costs of home construction.

Insured. The individual who is insured against loss for health, auto, life, home, etc.

Insurability. Acceptability to the company of an applicant for insurance.

Insurance commissioner. The central figure in regulation of the insurance industry in each state who exercises judicial power in interpreting and enforcing insurance code.

Insurance examiner. The representative of a state insurance department assigned to audit and examine the affairs of an insurance company.

Issue limits. The maximum disability benefit an insurer will pay any one individual.

In further developments to State Farm's desired exit from providing insurance to customers in Florida, the state's insurance regulators have begun investigating and questioning just how reasonable the insurer's claims are.

Insurance regulators question State Farm's dire claim By Paige St. John

State Farm, Florida's second-largest home insurer, pleads poverty as it attempts to exit the state and send more than 700,000 customers scrambling for coverage.

Company officials say they are losing $20 million a month. After being denied a 47 percent rate increase late last year, continuing to operate in Florida "would have resulted in insolvency," said State Farm Florida CEO James Thompson.

But a review of the company's regulatory filings suggests a different picture:

Over the past decade, State Farm Florida collected $2.6 billion more in premiums than it paid out in claims. State Farm says all that money has been used to pay expenses.

In the past four years, State Farm Florida has moved $2 billion out of Florida to its parent company for reinsurance, paying its parent to assume nearly all of its hurricane risk.

The full text of the article may be read here.

Should an insurance claim go to court, there is a strict process and shifting burden of proof when damage comes to your property. Whether dealing with a questionable cause to damage or if an exclusion prevents you from making a claim, the court takes a different approach that is necessary to understand when building your case.

While an insurance company policy often means to people a specific protection that seems simple enough, this is not the case. It is in fact the responsibility of the insured to prove whether or not a policy affords coverage for an incident. This burden of proof is heavily relied upon by insurance companies because, if it is not met, the insured is left out in the cold, regardless of how expensive premiums were or how confident they were in the the policy's protection.

With this basis of a burden of proof on the insured to demonstrate the damage incurred is covered by their policy, this is not the case for policy exclusions. In regards to exclusions, it is the insurance company's burden to prove that the exclusion is applicable to the incident in question.

Here is an example of how these burdens can play out:
A homeowner in Lafayette has windstorm protection. A heavy storm rolls through and a tree branch knocks in the roof. As the storm rages, the kitchen begins to fill with water. In the aftermath, the insurance company refuses to pay for the water stains and various other rain-based damages that come from the storm. The burden of law falls upon the homeowner to prove, through expert testimony and a fact pattern, that the tree branch was knocked down by the wind and that the water damage would have never occurred had the wind not damaged the tree and so on. However, if the insurance company maintained an exclusion that they would not insure tree damage from branches that hang within 5 feet of the home, it would be their responsibility to prove that the tree was, in fact, within the prevented distance.

As you can imagine, it is essential to have the best legal team possible to meet the burden of proof or disprove that of the insurance company's.

Continue reading "The Burden of Proof in an Insurance Claim" »

An insurance agency has a specific duty to settle and pay a claim that meets the required standards for an insured damage. This duty is set into motion when the claimant submits what is considered a "satisfactory proof of loss." In Louisiana, the courts have held that satisfactory proof of loss is to be considered with reference to the relevant law and the policy itself.

In the case of Louisiana, the relevant general substantive law states that reporting requirements are inherently minimal and do not have a high threshold to satisfy. The Second Court of Louisiana has gone so far as to hold that there is no specific or particular form required for such a claim and, in some cases, may even just be simple verbal notification to the insurance agency itself. The basic purpose of the notification requirement by law is to alert the insurer of the facts of the event upon which the claim is being made.

However, when dealing with the proof of loss itself, insurance agencies often place very strict or rigid requirements for the actual means in which a claim is fully reported or demonstrated. While insurance companies may allege certain requirements such as filling out your claim with only their forms, these requirements are subject to the court's review. Supporting this idea, courts will more often than not prevent insurers from restricting payouts on the basis of a technicality. The fact judicial discretion can settle this issue and that it is not explicitly clear by the word of law, though, makes this an important issue to always be ahead of.

When dealing with an insurance company, it is important to remain vigilant not only with paying premiums on time and following your end of the agreement to the most minor detail, but also with any claim process that should develop. By filling out a claim exactly as proscribed by the insurance agency as well as notifying them of any impending claim when the damage occurs, you begin setting yourself up for a solid claim defense should it be necessary. If the insurance company denies your claim on the grounds that the proper procedure was not followed, however, contact an attorney immediately to review your case.

Continue reading "Settlements and Payments of Claims" »

There are a multitude of different insurance policies available for homeowners to protect their home or property from all the damages that can occur in life. Along with windstorm and flood policies, there are also insurance provisions that home owners hope will protect them no matter what happens. One such example is the "all risk" policy.

An "all risk" policy is oftentimes purchased by homeowners in the hopes that it will work, as it seems to describe, to protect the owner from anything that might happen. On the surface, an all risk policy sells itself as a wide umbrella of protection that secures its validity by appearing to be all that could be assumed from its name. However, such policies also showcase just how intricate and complex the specific coverage can be and just how vague insurance companies can make coverage in order to charge high premiums and prevent payouts.

An all risk policy covers all risks unless a risk is specifically included so as not to be covered. These exclusions serve to insulate the insurance company from various different calamities that they refuse to protect claim-holders from and often relate to elements of the environment that home or property owners assume the risk of damage incurring from.

For example, damage from "surface water" may very well be one of those items an all risk policy excludes. The courts in the state of Louisiana have held that surface water may be defined by policies as bodies of water that collect and build on the surface of the ground. It does not include rainwater, overflowing a rooftop and seeping into a home.

If you feel your all risk policy covers a damage and you are not receiving the adequate policy coverage you deserve, it is essential to go back over your policy and closely examine all inclusive and exclusive language. In the event you feel that your policy covers the damages that should fall under your all risk insurance plan, call the Berniard Law Firm.

Continue reading "Understanding insurance terms: "All Risk" Policy" »

When dealing with insurance plans and the intricate clauses involved, it is important to fully understand the language used. In utilizing terms like these, insurance companies embed vague, variable levels of damage responsibility so as to skirt responsibility in the event damage comes to your home under what is supposed to be a covered incident. What exactly is a direct loss? What is the proximate cause of a damage? The following will hopefully help you better understand your policy and how to go about receiving the compensation you deserve when damage comes onto you:

Direct loss or proximate cause relates to the dominate and efficient cause of your property loss. In proving the proximate cause of a harm, the courts have held that, through eye witness and/or expert testimony, the insured must prove that the related incident the plan covers was the "dominate and efficient" cause of the loss. As such, it relates to a factual, not subjective, determination by the court or jury.

For example, should your claim relate to wind damage, it would be necessary to prove in court that the proximate cause of your damage to be the wind involved in the related storm. To proceed, you would then bring in an expert on wind damage to tell the court that, were it not for the extreme winds involved in the event that caused damage, your property would not be harmed.

Understanding proximate cause is extremely important because it can cause an extreme hardship to individuals who are unable to prove it when making their claim. For instance, if it can be proven that flood damage would have occurred even without the strong wins, the court or jury may deny the claim in court, alleging the damage would instead only be covered by flood insurance.

Because proximate cause is not a concrete idea and has vagueness that can lead to compelling arguments affecting the outcome of a case, it is essential to have legal representation that is able to effectively litigate in your favor. Proving proximate cause requires careful, well-developed arguments from your attorney and, perhaps most importantly, a compelling testimony from an expert on your side.

Continue reading "Understanding terms: "Direct Loss" and "Proximate Cause"" »