by Chris Bantly » Tue May 12, 2009 05:35 pm
I read an article today that I found incredibly interesting, and I thought I would get the input of some of the adjusters on the board. A woman experienced a home invasion with a fairly large loss (jewelry, silver, money, etc.) She stated that she had never had a claim in the past, and that she had been an excellent customer (never any late payments, etc.) When the police arrived and found the front door wide open, they searched the property to make sure it was safe. There were no signs of forced entry and no borken windows / latches / etc. The only two ways that somebody could have entered the home would be if the front door was unlocked or if the burglar had found the spare key hidden in a fake rock (and then replaced it).
The woman stated in the article that her insurance company was refusing to pay because her negligence caused the loss. She further stated that she was told that because she played a major role in causing the loss, she would have her claim denied.
Has anyone ever dealt with anything like this?
The woman stated in the article that her insurance company was refusing to pay because her negligence caused the loss. She further stated that she was told that because she played a major role in causing the loss, she would have her claim denied.
Has anyone ever dealt with anything like this?
Posted: Tue May 12, 2009 06:15 pm Post Subject:
I'll bet any amount that this information is either incorrect or there is a lot of information missing. There is no exclusion for the insureds negligence on the home owners policy. If there was, 90% of all claims would be denied! :lol:
As an instructor used to ask us in class.... "do we pay for stupidity?" Yup, all of the time!
Posted: Tue May 12, 2009 08:26 pm Post Subject:
I would agree to the fact that a lot of information is missing.
Homeowner’s policies have a limit on the amount of
jewelry covered for theft. Typically the limit is $1,000 on jewelry that is not specifically insured. If you insure your valuable jewelry, the company will pay a reasonable replacement cost for each of the items scheduled without a deductible for theft.
Posted: Tue May 12, 2009 09:21 pm Post Subject:
The woman stated in the article that her insurance company was refusing to pay because her negligence caused the loss. She further stated that she was told that because she played a major role in causing the loss, she would have her claim denied.
I'm throwing up a giant b.s. flag on that one.Has anyone ever dealt with anything like this?
Only NEVER...you know though many years ago, (like 20), some of the auto policys in MO had an exclusion surrounding breakins to vehicle and vehicle theft, if it wasn't forced (ie if you left the keys in the car) it was excluded...Now I don't know how long that was on the books when I came to the biz (1986 or 1987 I can never remember that :roll: :oops: )... it was being fazed out at renewals then...I'd have to know the state this happened in and see the policy that allowed a denial for that claim, ON THOSE GROUNDS...I don't buy it for a second....and am just as sure as I can be that 'somethin's missin' here'....wonder if the actual claims dept told her that or an agent? Was this article in something you could link us to?
As Todd said, and all adjusters know we DO insure stupidity...that's one of the first things you learn when you become and adjuster.. :wink:
Posted: Tue May 12, 2009 09:45 pm Post Subject:
It was in a FA journal that my past employer got me a subscription to (and it has never stopped). It was in an editorial section where she actually wrote in as a question for Insurance Q & A. I wish she would have posted it on here!
Posted: Tue May 12, 2009 10:14 pm Post Subject:
Well, I'll bet (since it was in that type of venue-question/answer) there's a WHOLE lot more to that story... :wink:
Posted: Wed May 13, 2009 02:09 am Post Subject:
First off, negligence deals with third parties ALWAYS. You cannot be "negligent" under the property portion of your homeowner's policy. Are there exclusions in property contracts that get the company out of certain "stupid acts" of the insured? You betcha, but it has nothing to do with the pure definition of negligence.
Property policies pay for "stupid" all the time. When I was adjusting, we used to have a weekly "contest" for the dumbest move on the part of an insured, and there were plenty of them. I react to "stupid" in the same way I act when people say "insurance doesn't pay for acts of God." That, arguably, is one of the stupidest things I hear. Ok...let's see...WHAT DO YOU THINK A HURRICANE, or an EARTHQUAKE or a FLOOD or a TORNADO or a WINDSTORM is??? Gee...acts of God maybe? Do we pay for those losses? Every day we pay for those losses.
I got a hunch on the matter at hand here...I have a feeling that the coverage was excluded because the insurer discovered the the loss was perpetrated by an INSURED which is absolutely excluded. The "lack of forcible entry" is NOT a barrier to coverage.
Lori brought up a memory. Back in the day, auto insurance DID have an exclusions regarding theft or interior damage/theft of the car that there had to be "visible signs of forced entry" in order to pay for these type of comprehensive losses. How many times have thieves used "slim-jims" to get into a car and leave no sign of forcible entry whatsoever? All the time. Then they came out with an amendatory endorsement that removed the forcible entry requirement, as each state in turn struck down the exclusion.
Homeowner policies are the same way. I have NEVER seen a claim denied (echoing Lori's sentiments) on the grounds stated in this thread. Yup...there's more to it!
InsTeacher 8)
Posted: Fri May 22, 2009 05:29 am Post Subject:
I've heard of that happening but it has never happened to me.
The insurance companies sometimes deny you for the lamest reasons.
I dont get it.
Just be cautious to wut insurance compnay u pick.
Posted: Tue May 26, 2009 04:49 am Post Subject:
The insurance companies sometimes deny you for the lamest reasons.
Lamest reasons? Is that the same as insurance companies are finding loop holes to deny my claim, or they are finding words in the “fine print” to deny my claim.
I can’t say how many auto or homeowner policies I've read, but I am still looking for that “fine print”. It seems like all the print is about the same size except for the headers for the different sections.
Loop holes = Limitations and exclusions?
Lamest reasons = Insured didn’t read the policy and thus didn’t read the “fine print” which included the exclusions and limitations.
Rant complete
Posted: Tue May 26, 2009 12:46 pm Post Subject:
Thanks Das...was heading that way myself...
The insurance companies sometimes deny you for the lamest reasons.
No claim is EVER denied for a 'lame' reason..it's denied for a legal reason...ie, policy not in force (there's the lamest of all!)....claim (for whatever reason) is excluded...coverage excluded...point is these companys are governed folks...a carrier cannot EVER deny a claim for a 'lame' reason.Posted: Wed May 27, 2009 06:19 am Post Subject:
I have a feeling that the coverage was excluded because the insurer discovered the the loss was perpetrated by an INSURED
Is it synonymous to insurance fraud?
IMO if the insurance companies keep denying claims for the reason of negligence of the insured no claim will be paid. You can always find certain amount of human negligence in every situation.
Now, the insurance company can deny paying for the damages that you have suffered in hurricane stating that you should have applied your wits in not buying house in a hurricane prone area. Does it happen this way? No!
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