Insurance Policy Conditions (a/k/a/ Land Mines): Part 18 – Who Is “You”?

My previous seventeen posts in this blog series have discussed what you are required (or not required) to do under various post-loss / pre-suit insurance policy conditions. This post discusses the extent of “you.” Is “you” just you, or does “you” include your spouse, your family members, your public adjuster, and others? Who is “you” largely depends on the language of the insurance contract.

The “Conditions” section of most policies has a subsection entitled “Your Duties After Loss.” Most policies define “you” and “your” as “the ‘named insured’ shown in the Declarations and the spouse if a resident of the same household.” Take note of the oft-overlooked latter half of that definition and cooperate with the insurer (despite knee jerk reactions to the contrary) when it burdens your spouse with post-loss / pre-suit conditions … the machismo or chivalry can wait for car doors, water puddles, and restaurant bills.

Are we there yet? Is it just you and your spouse that the insurer gets to pick on? Not necessarily – more and more policies these days are pulling others into the post-loss / pre-suit conditions mix. For example, some policies include language like this: “Anyone you hire in connection with your claim … must … [s]ubmit to examinations under oath and recorded statements, while not in the presence of any other ‘insured,’ and … sign the same.” This could include the likes of public adjusters, damage mitigation specialists, and contractors.

Are we there yet? Is it just you, your spouse, and anyone you hire in connection with your claim that the insurer gets to pick on? Not necessarily – some policies require any “insured” to comply with various post-loss / pre-suit conditions. And “insured” is sometimes defined to include “residents of your household who are: a. Your relatives; or b. Other persons under the age of 21 and in the care of any person named above.”

In sum, think twice (maybe even thrice) before telling an insurer to “take a hike, only I am subject to post-loss / pre-suit policy conditions.”

To read previous posts in my series on insurance policy conditions, click here.