Audit, Compliance and Risk Blog

Part II: Ten Commandments Claims Adjusters Should Follow

Posted by Barry Zalma on Sun, Jul 08, 2012

Here is Part II of my Ten Commandments of insurance claims which should be followed by all claims people working to fulfill the promises made by an insurer in an insurance policy. They are intended to provide direction to every person involved in claims handling, for the benefit of insurers, and the public.

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Tags: California Legislation, Insurance Claims

Part I: Ten Commandments Insurance Claims Adjusters Should Follow

Posted by Barry Zalma on Thu, Jul 05, 2012

The following are the first 5 of my Ten Commandments of insurance that should be followed by all claims adjusters working to fulfill the promises made by an insurer in an insurance policy. They are intended to provide direction to every person involved in insurance claims, for the benefit of insurers, and the public. 

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Tags: California Legislation, Insurance Claims

Insurance Claim: Tragic Shooting Not 'An Occurrence' in Policy

Posted by Barry Zalma on Mon, Jun 18, 2012

If a person fires bullets at a car and unintentionally kills someone seated inside, does that constitute an 'occurrence’ for the purpose of insurance coverage? One Mississippi case follows the thread of that question. This year an appeals court was asked to determine whether a shooting that caused the “accidental death” of a person is an “occurrence” as defined in a home insurance policy, and/or whether an illegal act exclusion should apply. Here is a brief summary of the case.

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Tags: Business & Legal, Insurance, Insurance Claims

Intentional Harm: Language of Abuse in Insurance Policy Key to Ruling

Posted by Barry Zalma on Mon, Jun 11, 2012

Situations can arise whereby an insurance policy holder is accused of abuse. But policies that stipulate there is no insurance coverage for abuse can still be subject to challenges—and where a child is involved, the stakes are high. The following case was heard in the Wisconsin appeals court that tested the clarity of the abuse exclusion in a home insurance policy.

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Tags: Business & Legal, Insurance, Insurance Claims

Disability Benefits Denied: Claimant Can Work in ‘Own Occupation’

Posted by Barry Zalma on Mon, Jun 04, 2012

Disability insurers are often chastised for not accepting an insured’s disability claim and denying them insurance benefits. At the same time, some individuals attempt to recover from their disability insurer even when they are able to perform the duties of their occupation. And when contracts are written in such a way that even the most erudite advocate cannot determine their meaning unequivocally, it is no wonder so many such cases end up in litigation, as in the following case from Arkansas.

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Tags: disability claim denied, Corporate Governance, Health & Safety, Insurance Claims, Disability benefits

The Need for Competent and Experienced Claims People

Posted by Barry Zalma on Mon, May 07, 2012

When two parties in a claim cannot agree, appraisal is often the quickest and fairest method of determining loss value.  But if the appraisers are not able to agree on the value they can choose an umpire to help resolve the dispute, after which an award can be paid out.  But in innumerable cases the parties refuse to accept a win, and insist on moving for a new trial to appeal the case.

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Tags: Business & Legal, Insurance, Insurance Claims