Insurance Dispute Lawyer Blog

In a very well written and important Times-Picayune article, writer Rebecca Mowbray reports that the recent problems being caused by Chinese drywall in courtrooms goes beyond simple construction or building code and law and into the depths of federal laws regarding international products. Because of this faulty imported wallboard, Mowbray points out, huge problems in the law and remedy for faulty products have been exposed. While many have followed this matter for its importance to builders and homeowners, business and legal experts now see it as a crucial, highly important matter that demonstrates work needs to be done on the United States' federal legal system.

The article explains

International trade agreements treat health and safety standards as barriers to commerce, and make it possible for manufacturers to hawk products that fall short of the importing country’s standards. Meanwhile, foreign companies that sell products in U.S. markets aren’t required to participate in litigation in American courts, and even if they did, there’s no means of enforcing U.S. legal judgments against them.

As a result, many of the foreign companies named in the consolidated Chinese drywall litigation in New Orleans are expected to blow off the proceedings, as illustrated Sept. 24 when U.S. District Judge Eldon Fallon held manufacturer Taishan Gypsum Co. Ltd. in contempt of court for failing to respond. Others, such as the German company Knauf Gips, have argued that the proper venue is the International Court of Justice in The Hague.

While a bit lengthy, the article is a very good read for those wishing to understand why it may be quite some time before any legal resolution results from the proceedings in this matter. Anyone with more questions about Chinese drywall litigation can read the various blog posts we have posted on the matter here. To find out more from an attorney, feel free to contact our offices to speak to a legal expert on the matter.

In order to be best prepared for hurricanes or to better understand your hurricane insurance provisions, having a glossary of key terms used in hurricane reports is a good idea. Courtesy of the Texas Department of Insurance and the National Oceanic and Atmospheric Administration, here is a list of helpful terms used commonly and their definitions:

Tropical disturbance: A moving area of thunder storms in the Tropics that maintains its identity for 24-hours or more. A common phenomenon in the tropics.

Tropical depression: Rotary circulation at surface highest constant wind speed 38 miles per hour (33 knots).

Tropical storm: Distinct rotary circulation, con stant wind speed ranges 39-73 miles per hour (34-63 knots).

Hurricane: Pronounced rotary circulation, con stant wind speed of 74 miles per hours (64 knots) or more.

Small craft cautionary statements When a tropical cyclone threatens a coastal area, small craft operators are advised to remain in port or not to venture into the open sea.

Gale Warnings may be issued when winds of 39 54 miles an hour (34-47 knots) are expected.

Storm Warnings may be issued when winds of 55 73 miles an hour (48-63 knots) are expected. If a hurricane is expected to strike a coastal area, gale or storm warnings will not usually precede hurricane warnings.

A Hurricane Watch is issued for a coastal area when there is a threat of hurricane conditions within 24-36 hours.

A Hurricane Warning is issued when hurricane conditions are expected in a specified coastal area in 24 hours or less. Hurricane conditions include winds of 74 miles an hour (64 knots) and/or dangerously high tides and waves. Actions for protection of life and property should begin immediately when the warning is issued.

Flash Flood Watch means a flash flood is possible in the area; stay alert.

Flash Flood Warning means a flash flood is imminent; take immediate action.

The San Francisco Gate features an article that helpfully and articulately describes the difference between property and disaster insurance. Embedded within the article are links to other articles that help outline the grey area that can often exist on the issue. While this blog has tried to explain this in the past, every article an insurance policyholder in the Gulf Coast can read on the topic is worthwhile as recent years have shown insurance nightmares can easily spring up.

An excerpt:

The key today, with so many options, is to first assess exactly what you need and then work with an insurance agent to figure out the best package: one that covers your most significant risks. It's not an either/or scenario that you want, but a combination of policies that provides protection without duplicating coverage. It is common for business owners to fail to look closely at what is covered by their property insurance and buy another policy that covers many of the same risks. Conversely, many policyholders mistakenly assume disasters such as flooding are covered under one of their policies and don't discover until they're underwater that neither their property insurance nor their disaster insurance covers flooding.

The article in its entirety may be read here.

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 wrap up of this blog's glossary of insurance terms, ranging from the letter S to Z:

Screening. Physical examination and health history taken by an insurer before the applicant is given the policy applied for.

Settlement option. One of the several ways, other than immediate payment in a lump sum, in which the insured or beneficiary may choose to have a life insurance policy paid.

Short-term disability income insurance. The provision to pay benefits to a covered disabled person as long as he/she remains disabled from their occupation up to a specified period not exceeding two years.

Skilled Nursing Care. Daily nursing and rehabilitative care that can be performed only by or under the supervision of, skilled medical personnel.

Stock life insurance company. A life insurance company owned and controlled by stockholders who share in the surplus earnings. The company issues, in general, nonparticipating life insurance.

Stop-loss Provision. A provision under which an insured pays a certain amount of coinsurance after which the insurance company pays 100 percent of the remaining covered expenses.

Surgical schedule. A list of maximum amounts payable under an insurance policy for specific types of surgery.

Subrogation. The legal process by which an insurance company seeks to recover a claim it has paid from another company or person who is legally liable for it.

Term life insurance. Insurance protection that pays death benefits to survivors but no cash value buildup.

Term rider. Term insurance that is added to a whole life policy at the time of purchase or later.

Title insurance. Insurance the seller or buyer buys to protect the lender, buyer, or both from the risk that a claim against the property is not discovered at the time of the title search.

Total disability. The insured is unable to perform the duties of any occupation for which she or he is suited through experience, education, or training.

Umbrella liability policy. A special liability insurance policy that provides further payment for liability claims after the liability coverage from other policies is used.

Underwriting. Classifying applicants for insurance according to their degrees of insurability so that the appropriate premium rates may be charged.
Uninsured motorist insurance. Insurance to protect one's own bodily injury losses if ever hit by an uninsured motorist or a hit and run driver.

Universal life insurance. A flexible premium life insurance policy under which the policyholder may change the death benefit from time to time (with satisfactory evidence of insurability for increases) and vary the amount or timing of premium payments. Premiums (less expense charges) are credited to a policy account from which mortality charges are deducted and to which interest is credited at rates that may change from time to time.

Variable life insurance. This is a life insurance contract under which a portion of the premium is invested in mutual funds. The value of the accumulated funds varies on a daily basis based on the performance of the mutual funds. The policy has level death benefits.

Viatical settlement. A transaction in which a life insurance policyholder who is terminally ill sells his or her rights to the policy in exchange for immediate payment of a portion of the death benefits.

Waiver of premium clause. A policy provision that continues the policy without premium payment while the subscriber is ill or disabled.

Whole life insurance. A cash value life insurance policy that provides level protection for a level premium as long as premiums are paid and includes a savings feature.

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 O to R:

Optionally renewable. An insurance policy renewable at the discretion of the company.

Out of pocket payments. The percentage of medical expenses not paid by insurance company. Only approved, allowable expenses apply toward out-of-pocket.

Outline of coverage. A description of policy benefits, exclusions, and provisions that makes it easier to understand a particular policy and compare it with others.

Paid-up insurance. Insurance on which all required premiums have been paid.
Partial disability rider. A policy addition that will pay disability benefits for a period of time when the insured is partially disabled.

Participating policies. Life insurance policies that pay dividends.
Participation limits. The maximum monthly benefit from all sources of which an insurer will write a portion.

Peer review committees. Groups of physicians or other medical providers who advise insurers, patients, and physicians in disputes regarding what is a "reasonable and customary fee" for services rendered by medical providers other than those on the committee.

Period of confinement. The time during which you receive care for a covered illness. The period ends when you have been discharged from care for a specified period of time, usually six months.

Personal liability. Responsibility for the damage or loss to someone's property or bodily injury of someone.

Personal property. Property not considered real property, such as automobiles, clothing, and furnishings.

Policy. The printed legal document stating the terms of the insurance contract that was issued to the policyholder by the company.
Policyholder. The person who owns an insurance policy.

Preadmission Testing (PAT). Laboratory and other prescreening tests and examinations prior to being admitted to a medical facility as an inpatient.
Preexisting condition. A medical condition that the insured has prior to the effective date of the policy.

Preferred Provider Organization (PPO). A prepaid health insurance plan where several hospitals and doctors agree to provide services at a discounted rate.

Premium. The charge for insurance protection.

Private Mortgage Insurance (PMI). Insurance that protects the lender from financial loss when the mortgager defaults. Allows a homebuyer to obtain a mortgage with little or no down payment.

Reasonable and Customary Charge. Health care fees consistent with average rates or charges for identical or similar services in a specified geographic area.

Reinstatement clause. A clause that lets the policyholder reinstate an insurance policy upon completion of reinstatement application accepted by the company and payment of back premium. The customer should check with the insurance company to see that the cash value of the policy was not reduced.

Renewable term insurance. Term insurance providing the right to renew at the end of the term for another term or terms, without a medical exam. The premium rates increase at each renewal as the age of the insured increases.

Replacement value. The claim settlement method in which the insured receives the full cost of repairing or replacing the damaged or lost items/property up to the policy limits.

Residual disability benefits. Disability insurance policy benefits paid when the disabled individual returns to work and is able to earn only a portion of the former benefits. The benefits paid will bring the individual's total income up to the former benefit level.

Rider. An amendment to a policy that modifies the policy by expanding or restricting its benefits or excluding certain conditions from coverage. An example of a rider is additional insurance for valuables such as jewelry.

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 J to N:

Lapsed policy. A policy terminated for non-payment of premiums. Level premium life insurance. Life insurance for which the premium remains the same from year to year.

Liability coverage. Insurance protection that pays for claims or judgments brought against the insured.

Life expectancy. The average number of years of life remaining for a group of persons of a given age according to a particular mortality table.

Limited payment life insurance. Cash value life insurance on which premiums are paid for a specified number of years but the insurance remains in force for life.

Loan value. The amount which can be borrowed at a specified rate of interest from a cash value life insurance policy. If the policyholder dies with the debt partially or fully unpaid, then the amount borrowed, plus any accrued interest, is deducted from the policy's face amount.

Long Term Care. A comprehensive range of medical, personal, and social services delivered over time to meet the needs of chronically ill or disabled persons.

Major medical insurance. Health insurance to cover medical expenses over and above that of a basic health insurance policy.

Managed care. Prepaid health plans that provide comprehensive health care to members.

Market value policy. A homeowner's insurance policy that pays to replace, repair, or rebuild damaged property up to the maximum of the policy, which is set at the property's market value. Materials used in making the repairs will be similar to, but not the same as, the original materials.

Medicaid. A medical insurance program for low-income individuals that is paid by federal and state funds.

Medical payments. Coverage under a homeowner's policy that pays for some medical expenses for injuries to others caused by the insured, a family member, or pet.

Medical payments insurance. Insurance coverage under an auto policy to pay for the insured's medical and funeral expenses after an automobile accident.
Medicare. A federal government health program available to people over 65 and some other citizens meeting specified requirements.

Medigap insurance or Medicare supplement. Medicare supplement insurance, or Medigap (sometimes called MedSup), is private insurance that supplements or fills in many of the gaps in Medicare coverage. While MedSup policies typically cover Medicare's deductibles and co-insurance amounts, they do not pay benefits for long-term care.

Mortality table. A statistical table showing the death rate at each age, usually expressed as so many per thousand.

Mutual life insurance company. A life insurance company whose board of directors is elected by its policy owners. The company issues, in general, participating policies.

National Association of Insurance Commissioners (NAIC). NAIC is a national organization of the 50 state insurance commissioners for exchanging ideas, information, and coordinating regulatory activities. NAIC has no legal power but exerts a strong influence through its recommendations.

No-fault insurance. Auto insurance that covers certain losses of the insured without considering who is at fault in the accident.

Noncancelable. A policy that guarantees the premium will remain the same and the policy stay in force as long as the premium is paid.

Nonforfeiture table. A cash value life insurance policy table listing the insured's options to take the policy as extended term insurance, as cash, or as reduced paid-up life insurance.

Nonparticipating policies. Life insurance policies that do not pay dividends.

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 D to F:

Deductible. The amount of covered charges an individual must pay before the insurance company begins payments. Insurance company can only require individual to pay 50% of the basic health services.

Depreciation. The decrease in the value of the property due to use, deterioration, or the passage of time.

Disability. Physical or mental handicap resulting from sickness or injury. It may be partial or total.

Disability income insurance. Insurance that provides periodic payments to replace income when an insured person is unable to work as a result of illness, injury, or disease.

Discharge planning. Under managed care, facilitates the transfer of a patient to a more cost-effective care facility after it is deemed that the patient no longer needs to remain in the hospital.

Dividend. A return of part of the premium to policyholders of insurance from a participating company when earnings exceed costs.

Double indemnity. An insurance policy clause that pays the beneficiary double the actual value of the contract in case of accidental death.

Dread disease insurance. A health insurance policy that protects against medical expenses resulting from a certain dreaded disease such as cancer.

Eligibility period. A specified length of time, frequently 31 days, following the eligibility date during which an individual member of a particular group is eligible to apply for insurance under a group life or health insurance policy without a medical exam.

Elimination period. The period of time before insurance benefits begin. Endorsement. A policy feature that increases the coverage of a standard insurance policy.

Endowment insurance. A plan of life insurance that pays a definite sum of money to the policyholder after a specified number of years. If the policyholder dies before the end of that time, the policy pays a beneficiary.

Exclusions. Specific conditions or circumstances listed in the policy for which the policy will not pay claims or benefits.

Face amount. The amount that a life insurance policy will pay at death or when the policy matures.

FAIR Plan. A program to provide homeowners insurance coverage to individuals who have been refused coverage by at least three insurance companies.

First-dollar Coverage. A hospital or surgical policy with no deductible.

Floater endorsement. An addition to a policy that adds coverage for specific personal property item(s) that are movable (such as jewelry).

Free-look period. The time you have to look at a policy and return it to the insurer for a full refund.

Full replacement policy. A homeowners policy that pays to replace, rebuild, or repair damaged property at the cost of replacing the property (up to the policy maximum).

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 from the letter C:

Case management. An approach designed to provide effective treatment to meet the specific needs of people with serious medical problems. Benefits not traditionally covered (for example, medical equipment) may be provided to promote cost-effectiveness.

Cash value (Cash surrender value). The amount available in cash to be borrowed against or obtained in cash if a life insurance policy is canceled.

Catastrophic. Caused by a great and sudden misfortune such as a serious accident or illness.

Chore Services. Minor household repairs, cleaning, meal preparation, and yardwork.

Chronic illness. An illness marked by long duration or frequent reoccurrence such as arthritis, diabetes, heart disease, asthma, and hypertension.

Claim. A formal notice to an insurance company requesting payment of an amount under the terms of a policy.

Coinsurance. A clause or provision that requires the insured to share in a certain percentage of medical expenses such as 80/20 or 90/10 (the insurance company pays 80%/90%; the insured pays 20%/10% of expenses), sometimes called co-insurance.

Collision insurance. Insurance to pay for damages to one's own car in case of an accident.

Comprehensive auto insurance. Insurance to cover losses resulting from a stolen car or for repairs if the car is hit by a falling object or damaged by fire, flood, or vandals.

Comprehensive major medical insurance. A policy offering the coverage of both a basic and a major medical health insurance policy. It is characterized by a low deductible amount, a coinsurance feature, and high maximum benefits.

Convertible term insurance. Term insurance giving the consumer the right to exchange it for cash value insurance without a medical exam.

Coordination of Benefits (COB). The specific term used to describe how benefits will be paid when a consumer has more than one health insurance policy. The two policies combined cannot pay more than 100 percent of total allowable expenses.

Co-payment. An amount insured must pay in order to receive a service, which is not fully prepaid.

Cost sharing. Policy provisions that require individuals to pay, through deductibles and co-insurance, a portion of their health insurance expenses.

Covered expenses. Those specified expenses paid for under the terms of a specific policy.

Credit life insurance. Term life insurance issued through a lender or lending agency to repay the lending institution if the borrower dies.

Custodial Care. Assistance with bathing, dressing, eating, taking medicine, and similar personal needs. People without medical skills or training can provide custodial care.

Customary and reasonable. A charge that does not exceed the regular or normal charge for a given service in a locality where it is provided.

Understanding Terms Used in Insurance Claims

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 A to B:

Actuary. A person professionally trained to apply probability and statistics to the practical problems of insurance and related fields.

Accident insurance. A form of health insurance that insures against financial loss resulting from an accident.

Accidental death and dismemberment insurance. Insurance that pays the insured in the event of death or loss of limb or eye resulting from an accident.

Actual cash value. A claim settlement method in which the insured receives payment based on the current replacement cost of a damaged or lost item, less depreciation.
Acute care. Care that is usually short term and recuperative.

Adjustable life insurance. Insurance that lets the policyholder change the plan of insurance, raise or lower the face amount of the policy, increase or decrease the premium and lengthen or shorten the protection period.

Agent. A representative of one or more companies who sells insurance. Annuity. A contract that provides an income for a specified period of time.

Application. A signed request for insurance, giving information about the prospective policyholder.

Appurtenant structures. Buildings not attached to a house.

Assigned benefits. An arrangement whereby your physician accepts payment directly from the insurance company.

Assigned risk pool. A state program through which people, unable to get auto insurance elsewhere due to poor driving or accident records, can buy coverage at higher rates.

Automatic premium loan. A provision in a life insurance policy that any premium not paid by the end of the grace period (usually 31 days) is automatically paid by a policy loan if there is sufficient cash value.

Automobile insurance. Insurance that pays for loss to individuals or property from an auto accident, theft, or other perils specified in the insurance contract.

Beneficiary. The person named in a life insurance policy to receive the insurance proceeds at the death of the insured.

Blue Cross. An independent, mutual for profit membership corporation providing coverage for hospital care.

Blue Shield. An independent, mutual for profit membership corporation providing coverage for surgical and medical care.

Broker. A person who represents insurance buyers, not companies.