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Monday, April 15, 2024

Can the Late Discover Prejudice Rule Result in Claims Gamesmanship?


The Colorado Supreme Courtroom not too long ago adopted the discover prejudice rule1 as famous in Colorado Supreme Courtroom: Late Discover, No Prejudice, No Drawback:

The notice-prejudice rule, nevertheless, requires the insurer to show that the delay in notification materially prejudiced its place earlier than it will probably deny protection based mostly on a late discover. Primarily, this rule shifts the main target from strict adherence to contractual deadlines to a extra equitable consideration of whether or not the insurer was really harmed by the late discover. The notice-prejudice rule beforehand utilized solely to uninsured/underinsured motorist and third-party legal responsibility insurance policies in Colorado.

Following a LinkedIn remark by insurance coverage protection legal professional Steve Badger criticizing the choice, I wrote a response in The Doom and Gloom Assumes a Costume of Plume—The Insurance coverage Business Must Cease Being So Detrimental and Watch Out for Its Prospects. On the finish of that submit, I famous:

There may be one other side of the case that may result in wrongful gamesmanship, which I’ll describe in an upcoming submit.

It can be crucial for everyone to know what the insurance coverage trade and Steve Badger complain about regarding late discover of claims. Steve Badger contends {that a} late discover of declare ought to end in denial reasonably than cost as a result of he believes that the apply of submitting claims lengthy after an occasion, equivalent to a hurricane or hailstorm, results in gamesmanship within the claims course of, which is usually brought on by roofers and AOB attorneys. The insurance coverage trade’s place is {that a} late discover of injury inherently makes it harder for insurers to analyze and precisely assess the harm. Accordingly, the “responsibility after loss” to carry out the rapid discover of loss is materials and vital from the insurer’s view.

The trade view is that the delay might be exploited by contractors to inflate the price of repairs, and make claims for losses that aren’t brought on by the occasion claimed, which inherently will increase adjustment and claims bills simply to analyze claims not discovered worthy of cost and drives up premiums to pay for elevated severity and frequency of claims in comparison with historic severity and frequency actuarial outcomes. Since I’ve spent fairly a little bit of time with Steve Badger discussing and debating these points, I imagine his place is probably going fashioned by his broader issues concerning the integrity of the insurance coverage claims course of. Not like my apply, the place I see insurance coverage firm claims abuses, insurance coverage protection attorneys work on claims despatched to them by insurers that they imagine are merely unfit. Badger actually exhibits examples of those in his public feedback.

My view is {that a} policyholder who makes a declare late ought to be capable to accumulate if the late discover has not prejudiced the insurance coverage firm.  My weblog submit supplied an instance, which I imagine occurs on a regular basis as a result of we’ve represented quite a few policyholders in the same situation. Nevertheless, the late discover rule within the trendy claims period can result in a possible draw back that promotes gamesmanship.

The gamesmanship is way simpler to perform in states which have an extended statute of limitations and disallow a shortened statute of limitations. Florida is a superb instance of such a state. The end result has led to statutory reforms disastrous for policyholders in response to perceived and precise situations of claims gamesmanship methods.

In Florida, the insurance coverage trade supplied quite a few examples of contractors offering incentives to policyholders to entice the investigation of a doable declare to roofs the place the storm occurred years earlier than. Gross sales groups of roofers have been skilled on learn how to method policyholders to make such claims and promising one thing too good to be true—“You don’t have anything to lose, allow us to make the declare for you with an AOB, and let’s see if the insurer pays for the substitute of your roof.  We are going to even discover and rent attorneys to assist out for free of charge to you.”

This situation with AOB attorneys, together with extraordinary gross sales ways by some within the building restoration trade and a five-year statute of limitations, killed the Florida insurance coverage market. Insurance coverage firm claims managers have been besieged with an historic rise within the frequency of late reported property claims. They made new claims processes, which have been rather more tough for all claimants. Good or dangerous claims have been caught on this new situation of claims processing. Claims funds have been rather more tough, and property insurance coverage litigation elevated. I might write a e book on the Florida instance of gamesmanship.

Except you reside beneath a rock within the property insurance coverage discipline, the Florida situation is understood to many. It’s what Badger and the insurance coverage trade concern. That was a part of why I wrote the submit concerning the trade overreacting to a rule of legislation that appears very equitable to many. Certainly, the unfairness rule is frequent in most states and has labored with little gamesmanship ever occurring.

I usually remind many within the insurance coverage trade that they’ve this tendency to overreact to at least one case or occasion of fraud. They complain about an occasion of fraud as whether it is regular for everyone to be doing it, and make up statistics that aren’t supported. They appear to be in a jihad in opposition to the folks buying the insurance coverage product as quickly as they’ve a loss. I said this in Badger Traps and How Contractors Can Keep away from Being Accused of Insurance coverage Fraud:

One of many outstanding features of property insurance coverage declare dealing with is how usually some insurance coverage firms get right into a ‘holy conflict’ about insurance coverage fraud. Each Steve Patrick and Steve Badger will inform anyone that’s listening that neither promotes fraud by the insurance coverage firm, the policyholder, the contractor or the general public adjuster. Certainly, every says fraud needs to be known as out regardless of who’s doing it. I’ve actually heard them say the identical factor about fraud in several speeches, in several components of the nation.

The underside line is that the case permits Colorado policyholders who reported their property loss late a method to nonetheless accumulate if the insurer has not been prejudiced. Whereas there may be some elevated likelihood of some examples of “gamesmanship” that occurred in Florida, Colorado legislation is totally different than Florida. Colorado permits for a shortened statute of limitations and case legislation permitting insurers to particularly stop AOBs of their property insurance coverage insurance policies.

Thought For The Day 

Braveness is resistance to concern, mastery of concern, not absence of concern.

—Mark Twain


1 Gregory v. Safeco Ins. Co. of Am., 2024 CO 13, — P.3d —, 2024 WL 1040531 (Colo. Mar. 11. 2024).



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