Frozen Pipe Prevention and Water Damage Insurance Claims

With the recent biting cold, many property owners are taking steps to protect their investments to the best of their ability.  Some great information on how best to prevent disasters caused by freezing water pipes can be found in the Resource Links at the bottom of this article.

Recent research suggests a strong correlation between the loss of arctic sea ice and a particular pattern of the jet stream that causes the more frequent cold spells we feel here in Indiana.  But wherever you may fall on the never ending debate over global warming, one thing is beyond debate:  recent temperatures in Indiana have been unbearably and dangerously cold.  It is reasonable to expect that despite our best efforts a great deal of property damage will result from frozen and burst pipes.

Insurance claims involving frozen pipes, ice dams, and other cold-weather-related disasters can prove to be particularly frustrating for homeowners and businesses.  For example, many commercial policies include provisions that may limit or even exclude coverage for the catastrophic damage that can occur when pipes freeze, then burst.  If you have a dispute or potential dispute with your insurance company about coverage for frozen pipes or water damage, the time to seek advice and representation is now.  The property damage attorneys at Parr Richey are experienced with all aspects of these sometimes difficult claims and there is no fee charged for initial consultation.

The last time Indiana experienced the “polar vortex” the number of insurance claims for frozen and burst pipes skyrocketed.  Some estimated the cost to the US economy of such claims to exceed $5 billion.  Much of this loss is borne by individual homeowners and business owners who are not properly reimbursed for the loss and damage.  If you need help with your claim, Contact Us.

Resource links:

https://www.in.gov/oucc/2421.htm

http://disastersafety.org/wp-content/uploads/Freezing-Bursting-Pipes_IBHS-White.pdf

http://www.redcross.org/get-help/how-to-prepare-for-emergencies/types-of-emergencies/winter-storm/frozen-pipes

https://www.wikihow.com/Prevent-Frozen-Water-Pipes

Do You Have Flood Coverage?

Hurricanes Harvey and Irma have brought catastrophic flooding to parts of Florida and Texas, and the storm surge has affected other areas such as Charleston, South Carolina where high tides hit almost 10 feet on September 11th, about 3 feet above flood stage.  Flooding is everywhere in the news.

Water Main Break

Some water losses are not excluded in typical homeowners policies

What happens when you have a flood – particularly in areas not typically prone to flooding?  Do you have coverage under your homeowner’s insurance policy?

Probably not.  The typical homeowner’s policy excludes damage caused by what we typically consider to be a “flood”.  This includes water pushed over the land by waves or tides.  But flood insurance is available through the National Flood Insurance Program (“NFIP”).  There is a wealth of information available here. Unfortunately, not many affected homeowners are enrolled in NFIP.

Does this mean that if you suffer a water-related loss that you are automatically out of luck?  Not necessarily.  There may be many situations where damage that is covered by your policy occurs at or around the same time as the flood damage occurs, and it is necessary to carefully analyze the language in your policy to determine whether and under what circumstances there may be coverage for your water-related loss.  And, if the policy is unclear, that can benefit you as the policyholder.  For example, in Indiana, the law clear that ambiguities in insurance contracts are resolved in favor of the insuredSee Erie Ins. Exch. v. Sams, 20 N.E.3d 182, 187 (Ind. Ct. App. 2014) (citing Meridian Mut. Ins. Co. v. Auto-Owners Ins. Co., 698 N.E.2d 770, 773 (Ind. 1998)). This is particularly true with unclear provisions that limit or exclude coverage. Id. Where provisions limiting coverage are not clearly and plainly expressed, the policy will be construed most favorably to the insured. Id. This strict construal against the insurer is driven by the fact that the insurer drafts the policy and foists its terms upon the customer. Am. States Ins. Co. v. Kiger, 662 N.E.2d 945, 947 (Ind. 1996), reh’g denied. (quoting American Economy Ins. Co. v. Liggett, 426 N.E.2d 136, 142 (Ind. Ct. App. 1981)).

The bottom line is this:  If you have suffered a water-related loss, it may be important to seek a legal interpretation of your policy before communicating with the insurance company.

Tornado Damage Insurance Claims: The Twist May Be in the Policy Language

Indiana has just been clobbered – again – by fierce, widespread tornadoes. The website of the National Weather Service has excellent data you can review to track the history of the storms and the damage they caused in your area. For example, visit: http://www.weather.gov/ind/august242016severestorm track dataWhen the time comes to finalize your claim with your commercial or homeowners insurance carrier for the damage caused to your property by these strong storms, there are some common pitfalls to be aware of about what is or may be covered.

For example, depending on the scope or extent of the damage to your property, there may be additional dollars over and above the limits of your property coverage available to pay for the cost of debris removal. Policies provide this coverage in different ways and it is important to read and understand how your policy works when you are negotiating with your insurer. Here is one example of how a property policy may provide debris removal coverage:

Debris Removal Language

Language like this appears simple enough on first reading, but look again.  Let’s say you incurred expense removing debris following a storm, and assume the cost of removing the debris was actually more than the damage caused to your structure.  This policy appears to limit the available dollars for debris removal to 25% of the “amount we pay for the direct physical loss of or damage to Covered Property.”  The capital letters means “Covered Property” is defined somewhere else in the policy.  Defined as what?  The building?  The building and outbuildings?  It is important to know.  Also, when this policy provides 25% of the amount of direct loss or damage “plus” the “deductible in this policy applicable to that loss or damage” does that mean 25% of the deductible or 100% of the deductible?  Again — this is important to know when you are settling with your insurance company.

What if all you have is trees down, but (thankfully) they missed your house?  Homeowners policies often provide limited coverage for damage to trees and shrubs. The straight-line winds that accompanied recent storms brought down many, many trees – both living and dead – and the cleanup cost can be staggering. Yet, your homeowner’s policy from that “good neighbor” company that is “on your side” may only provide you with very limited policy proceeds for the cleanup of trees, and then only under very limited circumstances.

Here is some typical language from a standard homeowner’s policy:

We will also pay your reasonable expense, up to $1000, for the removal from the “residence premises” of:

1)  Your tree(s) felled by the peril of Windstorm or Hail or Weight of Ice, Snow or Sleet; or

2)  A neighbor’s tree(s) felled by a Peril Insured Against under Coverage C; provided the tree(s):

3) Damage(s) a covered structure;

4) Does not damage a covered structure, but:  a) Block(s) a driveway on the “residence premises” which prevents a “motor vehicle”, that is registered for use on public roads or property, from entering or leaving the “residence premises”; or  b) Block(s) a ramp or other fixture designed to assist a handicapped person to enter or leave the dwelling building.

The $1000 limit is the most we will pay in any one loss regardless of the number of fallen trees. No more than $500 of this limit will be paid for the removal of any one tree.

Say that again?!

If you need assistance untangling the language of your policy and working to resolve your claim with your insurance company, the policyholder attorneys of Parr Richey are always ready to help. Call Mike Schultz or Jim Buddenbaum toll free at 888-337-7766.

The Business Activity Exclusion

What happens if you operate a business – say an auto repair shop – as a means of making a living, and then suffer a fire loss to personal property located in that business? Assume the fire occurs as a result of working on a car in your repair shop, but that at the time of the fire you were not actually engaged in business; rather, you were working on your own car, or perhaps helping a friend to work on her car as a favor. Would the business activities exclusion in your homeowner’s insurance policy preclude you from recovering for the loss of your personal property?

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The rule in Indiana is that “an insured is engaged in a business pursuit only when he pursues a continued or regular activity for the purpose of earning a livelihood. American Family Mutual Ins. Co. v. Bentley, 352 N.E.2d 860, 865 (Ind. Ct. App. 1976) (emphasis added); see also Asbury v. Indiana Union Mut. Ins. Co., 441 N.E.2d 232, 239 (Ind. Ct. App. 1982) (same). Further, “[w]hether an activity is a ‘business’ or property is ‘business property’ under an insurance policy is almost always a factual question presented for determination by the trier of fact or jury.” Id., at 243. The question, then, should turn on what you were doing at the time, and not just on the fact that the loss occurred at your business.

In a 2012 decision the district court for the Northern District of Indiana rejected the argument that personal property that is the same as an insured’s business property automatically means a business exclusion applied to preclude coverage for the loss. In Bachman v. AMCO Insurance Company, 2012 WL 4322746 (N.D.Ind. Sept. 20, 2012), the insured sued AMCO for breach of contract after the insurance company applied a $10,000 limitation in its policy applicable to property located in the residence premises used mainly for “business” purposes. Following a theft, the insured, who sold sports cards out of his home, made a claim under his homeowner’s policy for some $150,000 worth of Fleer basketball cards. The cards had been purchased with money from his business, but the insured considered the particular cards stolen to be his “personal collection”. Id. at *1-2. The insured even admitted that he considered his personal collection to be “investments” that he planned to sell one day when he was “ready to retire.” Id., at *1.

The insurance company argued that the $10,000 business property limitation in its policy applied to the stolen basketball cards and, “[r]elying on excerpts from [the insured’s] examination under oath, . . . contend[ed] that the subject property was business property because it was stored in a manner indistinguishable from the business inventory and was acquired with resources from [the business] with the intention of eventually being sold through the company.” Id., at *5. The insurance company relied on Asbury v. Ind. Union Mut. Ins. Co. (and two other cases) to support its argument. Id.

The district court first noted that the cases relied on by the insurance company (including Asbury) “actually support the denial of summary judgment.” Id. The district court went on to reason as follows:

To the extent that AMCO argues that the Fleer basketball cards automatically fit within the business property limitation at issue simply because Mr. Bachman operated a sports memorabilia business out of his home on a consistent basis at the time of the burglary, the argument cannot result in the granting of summary judgment in AMCO’s favor. No one disputes that Spectator Sportscards, Inc. constituted a “business” and that Mr. Bachman regularly and continually sold sports memorabilia from his home office to third persons for the purpose of earning a livelihood. . . . However, the limitation in AMCO’s policy plainly depends on the use of the property at issue.

Id., at *7 (emphasis in original; internal citation omitted).

Issues like this can arise in many contexts.  The application of exclusions in policies is not necessarily simple or obvious, and sometimes the coverage is actually more broad than it seems.  If you have suffered a loss and are involved in a dispute with your insurance company about what is covered and what is excluded by your policy, whether it is a homeowners policy or a commercial policy, you should contact an attorney with experience reading and interpreting the coverages, conditions, limitations and exclusions. Sometimes the insurance company takes a position that looks correct at first glance, but they may not be looking at the whole picture.

The Importance of Preserving Evidence after an Explosion or Fire

In the aftermath of a catastrophic explosion or fire, it is not surprising when victims or their family members do not think about the need to preserve evidence.  But in those cases where there is litigation to determine who or what may bear fault for causing the incident the efforts, or lack of efforts, to preserve and protect the evidence taken in the immediate aftermath of the fire or explosion will prove to be critical to the parties.  Test Data

Preserving the evidence is in everyone’s interest because the ultimate goal of any litigation is to determine the truth of what happened.  If it can be shown that the evidence was in the control of one party or another and the party in control failed to take appropriate steps to preserve the evidence so that other interested parties could examine it, the party in control may be accused of “spoliation” of evidence.  In that case, the court may ultimately instruct the jury that had the evidence been preserved and made available it would have been adverse to the party who could have preserved it — the so-called “adverse inference instruction”.

An enormous amount of information can be gleaned from what may appear to be unlikely sources.  Care must be taken to preserve even some materials that may seem to be inconsequential.  For example, lithium ion batteries such as those used in phones, tablets and laptops have a very high energy density. Although the electronic circuitry in chargers are supposed to prevent overcharging, those circuits can fail allowing the batteries to overheat and catch fire.  Yet, some fire investigators, focused on more obvious causes, can miss this evidence, which gets scooped up with all the other fire debris after the initial scene investigations have been concluded.

It is important for the victims of fires and explosions to have their own experts and investigators review the scene and not rely solely on those sent to the scene by their insurance company.  It is also important to act quickly, before the critical evidence is gone.

If you have questions regarding the need to preserve or protect evidence after a fire or explosion, contact an experienced attorney for help.

2013 Homeowners Complaint Index

Here is the 2013 Homeowners Complaint Index published by the Indiana Department of Insurance.

NAIC # Company Premium No. of Complaints
1 19232 Allstate Insurance Company 49,211,663 6 1.76 (Complaint Index)
2 17230 Allstate Property And Casualty Insurance Company 63,755,595 2 0.45
3 10111 American Bankers Insurance Company of Florida 3,506,013 3 12.34
4 19941 American Commerce Insurance Company 3,110,081 1 4.64
5 23450 American Family Home Insurance Company 2,269,193 1 6.35
6 19275 American Family Mutual Insurance Company 75,501,268 8 1.53
7 43494 American Hallmark Insurance Company of Texas 460,836 1 DNC
8 38652 American Modern Select Insurance Company 4,539,677 1 3.18
9 18988 Auto-Owners Insurance Company 19,206,416 1 0.75
10 16713 Buckeye State Mutual Insurance Company 2,678,583 1 5.38
11 20230 Central Mutual Insurance Company 7,390,404 1 1.95
12 10921 CSAA Fire & Casualty Insurance Company 19,757,111 2 1.46
13 26271 Erie Insurance Exchange 59,073,698 4 0.98
14 21652 Farmers Insurance Exchange 21,983,950 4 2.62
15 11185 Foremost Insurance Company 10,394,742 1 1.39
16 14044 Goodville Mutual Casualty Company 1,037,642 1 13.90
17 13927 Homesite Insurance Company of the Midwest 16,391,117 3 2.64
18 29068 IDS Property Casualty Insurance Company 5,619,059 1 2.57
19 21679 Illinois Farmers Insurance Company 15,751,815 1 0.92
20 22624 Indiana Farmers Mutual Insurance Company 42,139,265 2 0.68
21 22659 Indiana Insurance Company 3,718,841 4 15.51
22 42404 Liberty Insurance Corporation 18,668,543 3 2.32
23 23035 Liberty Mutual Fire Insurance Company 19,117,960 2 1.51
24 34339 Metropolitan Group Property And Casualty Insurance Company 5,960,626 1 2.42
25 26298 Metropolitan Property And Casualty Insurance Company 16,107,103 1 0.90
26 21687 Mid-Century Insurance Company None 1 DNC
27 14621 Motorists Mutual Insurance Company 6,543,729 1 2.20
28 23779 Nationwide Mutual Fire Insurance Company 18,376,547 2 1.57
29 23787 Nationwide Mutual Insurance Company None 1 DNC
30 27740 North Pointe Insurance Company -564 1 DNC
31 32700 Owners Insurance Company 25,760,073 2 1.12
32 34690 Property And Casualty Insurance Company Of Hartford 9,344,419 2 3.09
33 32905 Property-Owners Insurance Company 23,979,960 1 0.60
34 92334 Rochester Farmers Mutual Insurance Company None 1 DNC
35 24740 Safeco Insurance Company Of America 11,741,202 2 2.46
36 41297 Scottsdale Insurance Company None 1 DNC
37 19259 Selective Insurance Company Of South Carolina 12,577,813 2 2.29
38 24988 Sentry Insurance A Mutual Company 2,912,786 1 4.95
39 23388 Shelter Mutual Insurance Company 12,214,763 3 3.54
40 19070 Standard Fire Insurance Company 9,475,629 1 1.52
41 25143 State Farm Fire and Casualty Company 465,414,630 23 0.71
42 28188 Travco Insurance Company 28,653,143 3 1.51
43 27998 Travelers Home And Marine Insurance Company 1,109,317 1 13.00
44 15288 United Farm Family Mutual Insurance Company 139,970,753 9 0.93
45 18600 USAA General Indemnity Company 5,190,564 1 2.78
46 44393 West American Insurance Company 3,560,948 1 4.05
47 92279 Widner Mutual Fire Insurance Association None 1 DNC
Subtotal Premium and Complaints 1,264,176,913 117
115 Companies with Zero Complaints 422,946,767
Total Premium and Complaints 1,687,123,680 117

For further explanation of this information, visit the Indiana Department of Insurance Website.

When the SIU Goes Too Far: The Role of the Arson Investigation in Civil Fire Cases

When the SIU Goes Too Far:

The Role of the Arson Investigation in Civil Fire Cases

 1.  Overview

Residential and commercial property insurance policies always exclude coverage for fire losses in the event the fire was deliberately set by the insured or at the insured’s direction. The language of the exclusion appears in various familiar forms: Regardless of the form, the importance of the exclusion cannot be overstated. If the insurance company has a reasonable, good faith basis to believe that the fire was intentionally set, it can deny the claim.

2.  The Role of the Duty of Good Faith and Fair Dealing

Arson investigations do not occur in a vacuum, and it is not (or at least it should not be) the goal of an arson investigation to simply build a case against the insured. Rather, the goal should be to discover what really happened – fairly and objectively. An arson investigation is nothing more than a coverage investigation, and it is well-established that the duty of good faith and fair dealing governs an insurer’s behavior during a coverage investigation.

An insurer has a duty to deal with its insureds in good faith, and a cause of action exists for the breach of that duty. Erie Ins. Co. v. Hickman, 622 N.E.2d 515, 519 (Ind. 1993); County Line Towing, Inc. v. Cincinnati Ins. Co., 714 N.E.2d 285, 291 (Ind. Ct. App. 1999), trans. denied. This duty to deal in good faith with insureds “. . . includes an obligation to refrain from causing an unfounded delay in making payment; making an unfounded refusal to pay policy proceeds; exercising an unfair advantage to pressure an insured into settlement of his claim; and deceiving the insured.” Id. “. . . [A]n insurer which denies liability knowing that there is no rational, principled basis for doing so has breached its duty.” Becker v. American Family Ins. Group, 697 N.E.2d 106, 108 (Ind. Ct. App. 1998). In order to find that an insurance company committed bad faith in a particular case, a jury ultimately must find from the evidence that the company had “a state of mind reflecting dishonest purpose, moral obliquity, furtive design, or ill will.” Colley v. Indiana Farmers Mut. Ins. Group, 691 N.E.2d 1259, 1261 (Ind. Ct. App. 1998).

“Indiana has long recognized that there is a legal duty implied in an insurance contract that the insurer must deal in good faith with its insured. This duty is breached when an insurer fails to settle a claim that could not in good faith be disputed.” Liberty Mutual Insurance Co. v. Parkinson, 487 N.E.2d 162, 164 (Ind. Ct. App. 1985). The duty to act in good faith includes, but is not limited to, four types of obligations: “to refrain from (1) making an unfounded refusal to pay policy proceeds; (2) causing an unfounded delay in making payment; (3) deceiving the insured; and (4) exercising any unfair advantage to pressure an insured into a settlement of his claim.” Erie, 622 N.E.2d at 519.

The ultimate claim decision is only one of the four (4) types of obligations described in Erie, and as the Indiana Supreme Court has made clear, a claim for bad faith may lie even if there is a good faith coverage dispute. In Monroe Guaranty Insurance Company v. Magwerks Corporation, 829 N.E.2d 968 (Ind. 2005), the Indiana Supreme Court held that an insurance company’s “conduct leading up to and including the issuance of the denial letter” may rise to the level of bad faith. Id. at 977. The Magwerks case stands for the proposition that even if there is a “good faith dispute over whether coverage did or not exist”, a claim for breach of the duty of good faith and fair dealing must still be submitted to the jury if there is evidence that the conduct of the insurance company leading up to the denial breached the duty. Id.

The public policy interest served by allowing bad faith claims against insurance companies to be heard is to discourage insurers from denying legitimate claims on the theory that they would only be liable for contract damages. Patel v. United Fire & Cas. Co., 80 F.Supp.2d 948, 959 (N.D. Ind. 2000). “. . . [T]he goal of Erie is to permit plaintiffs in bad faith actions to recover damages beyond those traceable to the contract, including punitive damages.” Id.

Given these authorities, it is clear that even if an insurance company has a legitimate basis for conducting an arson investigation as part of its coverage determination, it must always consider its duty to the insured while handling the investigation in the context of the pending claim. The investigation should not result in undue delay in making the claim decision; it should not involve any deception of the insured or unfair or oppressive conduct. And, importantly, an insurance company cannot insulate itself from bad faith liability by conducting an investigation in a manner that is calculated to construct a “pretextual basis” for denial of the claim. See, e.g., State Farm Fire & Cas. Co. v. Simmons, 963 S.W.2d 42, 44; 1998 Tex. LEXIS 30, **6 (Tex. 1998). The goal must always be the truth and to find coverage for the insured if possible, not to manufacture a pretextual basis to deny – or delay payment of – the claim.

3.  Arson Immunity Statute

The operative provisions of the Arson Immunity Statute provide:

(c) A person who acts without malice, fraudulent intent, or bad faith is not subject to civil liability for filing a report or furnishing, orally or in writing, other information concerning a suspected, anticipated, or completed fraudulent insurance act if the report or other information is provided to or received from any of the following:

(1) The department or an agent, an employee, or a designee of the department.

(2) Law enforcement officials or an agent or employee of a law enforcement official.

(3) The National Association of Insurance Commissioners.

(4) Any agency or bureau of federal or state government established to detect and prevent fraudulent insurance acts.

(5) Any other organization established to detect and prevent fraudulent insurance acts.

(6) An agent, an employee, or a designee of an entity referred to in subdivisions (3) through (5).

(d) This section does not abrogate or modify in any way any common law or statutory privilege or immunity.

I.C. § 27-1-3-22 (c) and (d) (Emphasis added). A corollary of this provision is that if the information is provided in bad faith or while the person is acting maliciously or with fraudulent intent then the immunity does not apply. It is here where the pitfalls are found.

4.  Pitfalls and Pretext

Unfortunately, many fire investigations still result in a finding that the fire was “incendiary” based on what one renowned fire investigator, Gerald Hurst, Ph.D., has called “garbage fire forensics.” These findings include, but are certainly not limited to:

  • The investigator claims to be able to tell from the burn pattern on the floor that an accelerant was poured;
  • The investigator claims the fire burned too hot, or too smoky, or too quickly not to have been accelerated;
  • The investigator finds that all electrical causes were eliminated in a totally burned building;
  • The investigator states that the insured behaved unnaturally during or after the fire.

Any decision to deny a claim based on a report containing such bogus claims is likely to be challenged in court, and the reliance may be used to claim the insurance company acted in bad faith. The “science” behind these bogus findings has long-since been debunked, and the insured will argue that it is not reasonable for the insurance company to rely on any report containing such nonsense as an allegedly good faith basis to deny a claim.

Another common error occurs when the insurance company SIU investigator seizes the opportunity to have the state or local authorities investigate the insured with the hope that the authorities will make a determination that the fire was incendiary, thus giving his or her employer a basis to deny the claim.

It is common and expected for SIU investigators to work closely in tandem with the State Fire Marshal when investigating “suspicious” fires. But this situation is fraught with peril for the insurance company. The duty of good faith and fair dealing requires that the insurance company keep the insured’s interests in mind at all times, including during the arson investigation. Yet the overwhelming temptation during an arson investigation seems to be to provide enforcement officials with only those materials that tend to prove the insured’s guilt. If the insurance company’s investigator influences the authorities to change their conclusion or adopt the investigator’s conclusion as to the origin and cause of the fire, and if the insurance company’s investigator routinely works primarily for insurance companies, and if the investigator turns out to have missed important evidence or used inappropriate methodology, it is an easy argument for the insured to make that the investigation was merely an attempt to manufacture a claim defense. In a phrase, the SIU went too far.

For further information about the proper role of the arson investigation in the context of an insurance claim, contact Mike Schultz or Jim Buddenbaum at Parr Richey Obremskey Frandsen & Patterson LLP.  www.parrlaw.com  (317) 269-2500.