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Contract vs.Coverage Analysis

Ralph Korn, CPCU

I have over fifty years’ experience in insurance and risk management.  I am a graduate of Loyola University, Chicago.  My corporate experience includes Director of Insurance for Duplan Corporation, Risk Manager for E. & J. Gallo Winery and Vice President of Insurance for Greyhound Corporation.  In addition, I have over thirty-five years’ experience as an…

J. Eric Peterson, Jr.

I have been in the insurance industry for over 30 years, working as a Licensed Commercial Property and Casualty Insurance Broker, Licensed Property and Casualty Insurance Adjuster, Litigation Manager for wholly owned, Captive Insurance companies as well as handling Property and Casualty Insurance claims for two of the country’s top Third Party Administrative Companies. I…

Lezlee Liljenberg

Lezlee Liljenberg, entered the insurance business in 2004 as she started her first agency from ground zero, growing the business to over $6 million in revenue in less than 12 years. Ms. Liljenberg holds a BA in Journalism/Public Relations and a MA in Political Science/Public Administration from the University of Texas at Arlington.  She is…

Dr. Brenda Powell Wells

Brenda Powell Wells holds both a Bachelor of Business Administration and a Ph.D. in Risk Management and Insurance from the University of Georgia.  She holds the Chartered Property and Casualty Underwriter (CPCU), Accredited Advisor of Insurance (AAI) and Construction Risk Insurance Specialist (CRIS) designations.  She also holds a graduate certificate in Business Analytics from East…

Amy E. Johnson

Thomas Quaka

Scott S. Margraves

EXPERT WITNESS | COVERAGE ANALYSIS As the Principal Consultant of Gulf Coast Risk Management, I have over twenty-seven years of “hands-on” experience in the insurance industry and a Certified Insurance Counselor (“CIC”) since 1999.  Nationally recognized as one of the top insurance professionals in the United States in leadership and dedication to the insurance profession,…

Property & Casualty Insurance Procurement & Litigation (Ten Things Every Lawyer Should Know)

6. The insurance application process now requires more attention.
There was a time, in the not too distant past, when most applications for property and casualty insurance did not require the signature of the insurance buyer. Agents routinely completed applications and underwriters readily accepted them without anyone’s signature on the application. This custom and practice is no more. Insurance applications have become more than just tools to gather underwriting information to determine the eligibility of the applicant for coverage and for premium determination purposes. The necessity for thoroughness and precision has greatly increased. It is more than appropriate and appreciated by the underwriter for the applicant to provide supplemental answers and explanations along with the standardized application. These relatively recent changes in the usual and customary practices of making an application for insurance can make the difference between having a claim covered and not having it covered. An ambiguity or misunderstanding can become an allegation of misrepresentation, which can lead to no coverage at all, rather than just a possible increase in premiums. Policy rescission and voiding policies ab initio are on the rise, along with underwriters using application information as “Warrants” thereby making the application a part of the policy (which has always been the case with life insurance policy applications).
These developments make providing accurate information to underwriters more than just important. Accurate information becomes the basis for the existence of the contract itself and adds an increased threshold to the concept of “utmost good-¬‐faith” which is the traditional basis of all insurance relationships. However, “utmost good-¬‐faith” is a two-¬‐way street. Insurance companies sometimes attempt to deny coverage based on conditions and exclusions that are not, and never were intended, appropriate to the situation or the claim at hand. Some prohibitions were intended to exclude coverage because the hazard is better transferred by another type of policy, not to be used to exclude an otherwise covered claim. This type of unfair claims settlement practice is rare and usually caused by poor attention to detail in the filing of a claim and/or inexperienced claims adjusters. The insurance buyer needs to be equally diligent and vigilant as to the accuracy of applications of insurance and in the filing of a claim under an insurance policy.

Lesson: Insurance applications are more important than they once were. Plan and prepare in a careful, thorough manner before submitting an application for insurance or filing a claim.

Damian J. Arguello

Damian is an insurance coverage attorney and adjunct law professor whose legal practice focuses on representing and counseling commercial policyholders, business and trial attorneys, and insurance agents and brokers regarding insurance issues. In his consulting and expert witness practice, Damian also draws from his pre-law school experience as a claims adjuster for several insurance companies…

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