Steven Plitt, Expert Witness Steven Plitt, Expert Witness
Insurance Bad Faith Claim Handling Expert Serving Clients Nationwide

May 2019 Archives

ADJUSTER'S FALSE REPRESENTATIONS CONSTITUTE CONSUMER FRAUD ACT VIOLATION IN NEW JERSEY

In Alpizar-Fellas v. Favero, 906 F.3d 910 (3rd Cir. 2018) (interpreting New Jersey law) the Court found that an adjuster's alleged fraudulent representations which induced the insured to sign a release that the insured did not understand gave rise to a private right of action under New Jersey's Consumer Fraud Act. 

WHEN DOES A STATUTORY BAD FAITH CLAIM ACCRUE UNDER DELAWARE LAW?

Delaware has a three-year statute of limitations period for the filing of a bad faith claim. In Homeland Ins. Co. of New York v. CorVel Corp., 197 A.3d 1042 (Del. 2018) the Court held that the limitations period began to run when the insured could plead a bad faith claim and not when the Court ultimately determined contested coverage.

TOO LATE!

The Colorado Supreme Court in Schultz v. GEICO Casualty Co., 429 P.3d 844 (Colo. 2018) recently held that later-developed evidence was irrelevant to a UIM claim because the denial had taken place prior to the development of that evidence. In this case, the insured, Charissa Schultz, needed multiple knee replacement surgeries after a motor vehicle accident caused by an underinsured motorist. After settling with the tortfeasor's insurer, GEICO paid its UIM policy limits two years after the tortfeasor payment. Schultz then sued GEICO, alleging unreasonable payment delay. During the processing of the UIM claim, GEICO requested an IME, which was objected to by Schultz. Schultz claimed that the request was made too late. However, the trial court ordered the IME to proceed.

9th Circuit Requires That Any Illness or Infirmity Causing or Contributing to Injury For Purposes of Accidental Death and Dismemberment Benefits Had to be a Substantial Cause of the Loss to Avoid Coverage

In Dowdy v. Metro. Life Ins. Co., 890 F.3d 802 (9th Cir. 2018), the insured sought benefits under an accidental death and dismemberment policy for an amputation of his leg resulting from a car accident. The leg was seriously injured as a result of the accident and was then later amputated. The policy provided that a covered loss was a loss that was a direct result of an accidental injury, independent of other causes. In deciding to deny the claim, Met Life relied upon a surgical report stating that due to comorbidities, as well as non-healing wounds and osteomyelitis, the patient had elected to undergo an amputation of the leg. Based upon the surgical report, Met Life concluded that the amputation was contributed to and complicated by the insured's diabetes and that, under the terms of the policy, a loss caused or contributed to by an illness or treatment for that illness was excluded from payment.

How Many Car Accidents Does It Take To Constitute An Occurrence?

An interesting case from the Fifth Circuit Court of Appeals considered the question of how many collisions constitute a single occurrence. In Evanston Ins. Co. v. Mid-Continent Casualty Co., 909 F.3d 143 (5th Cir. 2018) the Fifth Circuit Court of Appeals held that a series of automobile collisions constituted a single occurrence because each collision had a common cause and further, because there was no intervening event that was the immediate cause of damage. According to the Court, there was a single uninterrupted chain of events and therefore one accident.

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