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State Continuing Education Credit

How to Properly Deny Claims

When insurers receive a claim or suit from an insured or third party, they must first make sure that subsequent actions by all parties are in accordance with the conditions required by the policy and applicable laws and regulations. Violating such conditions and guidelines can lead to unintended consequences. For example, courts could refuse to uphold claims denials and possibly recognize bad faith suits, instead. Or an insurance department could find that the insurer broke a law and subsequently impose regulatory penalties. This article discusses how to avoid such outcomes by discussing important, but basic, dos and don’ts, illustrated through real-life examples.

Andrew G. Sall

Andrew is a seasoned expert with over two decades of battle-tested experience under his belt.  Andrew’s success is no accident; it stems from a profound understanding of the idiosyncrasies of his clients’ businesses. He combines numerical precision with compelling narratives, a rare skill that transforms inadequate business income claim offers and outright denials into substantial…

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…

Richard Faber

Richard Faber is a highly experienced insurance professional who possesses a wide array of skills and a distinctive combination of experience, ranging from marketing, and consulting to managing/underwriting a staggering array of  risks. His background and extensive experience work together to make Richard a much sought after authority in his field. Richard began his career…

Thomas Quaka

Scott S. Margraves

EXPERT WITNESS | COVERAGE ANALYSIS Scott Margraves has over thirty-two years of “hands on” commercial property & casualty experience.  He is the Principal Consultant and Founder of Gulf Coast Risk Management, LLC (GCRM). GCRM provides research, analysis and advice to commerce, industry, government and individuals. Margraves operates COIs R Us, a certificate of insurance (COI)…

A Review of the Modern Claims Made Form

“Since its creation, “claims made” wording’s use has expanded outside of the “profession” and professional liability realm, finding use in diverse liability coverages. But the roots of “claims made” wording, and its most common use still, is found in covering the exposures created by a “professional’s” activities. As seen by the list of true “professions,” professionals are individuals who provide a service to society which, if done poorly, could cause extreme or irreparable personal or financial harm. …

The expansion of claims made policy forms beyond “professions” caused the basic “claims made” concept to diverge and evolve into two distinct forms. One evolutionary branch commenced in professional liability coverages (known also as “errors and omissions” coverages in this series) and the second branch grew out of the financial services industry and the need for directors and officers liability protection, fiduciary liability and employment practices liability (referred throughout this series as “executive liability” coverages).

Although both branches attach to the tree at the same point; greatly different “claims made triggers” have resulted. Additionally, coverage terms, conditions and definitions differ between the two branches.”

Vincent “Chip” Boylan

Property and Casualty Insurance Expert Witness with a 45 Year background as an Insurance Broker.  Expert witness since 1989 with a primary focus on 1) agent and broker standard of care; and 2) coverage issues. Topics addressed have included: Property/Crime; Business Interruption; General Liability; Executive & Professional Liability; Workers’ Compensation; Umbrella Liability; Automobile; and Homeowners.…

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