Victor Jacobellis left his job in San Francisco representing insurance companies to join Merlin Law Group and help policyholders obtain insurance coverage benefits. He asked me to speak with him about exceptions to exclusions of coverage which are often overlooked and lead to wrongful denials of coverage. The photo above shows yours truly speaking with Victor Jacobellis in Napa, California at the National Association of Public Insurance Adjusters Annual Conference on this important insurance topic.
This blog has over 30 posts regarding ensuing loss provisions. Here are some of the highlights:
- Whipped Cream, Honey and Covered Ensuing Loss Delights
- Wear and Tear Exclusions Versus Depreciation For Resulting Damage To Worn and Torn Older Parts of a Structure
- Recent New York Case Involving An Exception To An Exclusion
- Snow is Causing Roofs to Fall — Is There Coverage After the Insurer’s Engineer Says the Roof was of Faulty Design?
- Defective Construction and Ensuing Loss Provisions
- Ensuing or Resulting Loss, and the Burden of Proving Causation Explained Simply
I often call ensuing loss clauses the “Lazarus clauses” of property insurance policies. This is because insurers may claim that a loss is not covered citing an exclusion but fail to note the broad grants of coverage afforded by the ensuing loss provisions which are extraordinarily important to making the insurance product work as intended. Victor Jacobellis made the following slide for our presentation:
During our speech, I highlighted and stressed that all public adjusters should read Bill Wilson’s weekly blog posts about insurance coverage. In Claim Declination and Reservation of Rights Letters, Wilson noted:
My experience has been that claim denials that cite exclusions while ignoring exceptions to the exclusions, as in the last two examples, are very common. Often the exception is placed at the end of a series of exclusions, so one reason for the frequency of these types of improper denials could be simply overlooking them, not that this is a valid excuse.
The practical tips from the speech were as follows:
- Read the entire policy. This cannot be stressed enough.
- Do not accept coverage denials as being correct just because the insurance company cites lots of reasons for the denial.
- Do not overlook all the important exceptions to coverage found in the policy.
- Critically reevaluate each limitation for additional grants of coverage for in other parts of the policy. (Again, you have to read the entire policy to find them.)
- Use the research function of this blog, search FC&S, IRMI and other treatise material regarding the language the insurer is relying upon.
If all else fails, do not hesitate to call Victor Jacobellis or one of the other Merlin Law Group attorneys dedicated to helping policyholders denied or delayed insurance benefits.
Thought For The Day
All people have had ill luck, but Jairus’s daughter and Lazarus had the worst.
—Mark Twain
