Category: Insurance

Plant Company’s Growing Stock Ruined, Insurance Company Forced to Pay Claim
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Plant Company’s Growing Stock Ruined, Insurance Company Forced to Pay Claim | Evan Schwartz

A Michigan federal judge recently granted a large plant-growing company’s summary judgment motion in a case against its insurer over coverage for thousands of plants that died following a cooling system breakdown. Not surprisingly, the court based its ruling on the interpretation of the language of the insurance policy. The business and plaintiff in the case, Sawyer Nursery, has 300 greenhouses in Michigan and suffered a power outage that disabled the blower fans that keeps its plants from wilting.

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$300 Million—Plus Ruling Favors NJ Transit Against Insurer—Words Matter!
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$300 Million—Plus Ruling Favors NJ Transit Against Insurer—Words Matter! | Evan Schwartz

In light of the recent hurricanes that have decimated parts of the United States, Puerto Rico and the Caribbean, it is important to remember that ongoing battles that resulted from older natural disasters continue—in particular, from Superstorm Sandy.

Last month, a New Jersey judge ruled that the New Jersey Transit Authority is not subject to a $100 million cap for its flood losses suffered in connection with Sandy. This ruling is significant in that the damages exceed $400 million—more than $300 million of which has been in dispute.

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Long-Term Disability Buyouts—What You Need to Know
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Long-Term Disability Buyouts—What You Need to Know | Evan Schwartz

Lump sum buyouts of long-term disability policies can happen at any particular time during the course of a claim. Claimants need to know that there are opportunities available with some companies, but not with others, to receive buyouts.

•There are some long-term disability insurance companies who buy out claimants just to get them off the books, rather than continuing to pay their benefits.

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Cyber Fraud Insurance Coverage: More Coverage Than You Think!
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Cyber Fraud Insurance Coverage: More Coverage Than You Think! | Evan Schwartz

A recent decision by a New York federal judge in the burgeoning area of cyber coverage has significantly expanded the scope of covered losses that involve scams or theft by the hackers and scammers in cyberspace. The name of the case is Medidata Solutions v. Federal Insurance Company, and it was just decided in July of this year.

The officers and employees of Medidata were the targets of an email spoof, whereby scammers obtained access to the Google platform upon which this company operated. They were sent email messages that appeared to come from the president of the company, directing the key people in the company to wire transfer money in connection with a fictitious acquisition that was close to being finalized.

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Filing in Federal or State Court? The Answer May Significantly Affect Your Case
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Filing in Federal or State Court? The Answer May Significantly Affect Your Case | Evan Schwartz

When suing for long-term disability benefits, an important choice for your lawyer is whether to file the lawsuit in federal court or state court. New York State provides an interesting contrast for the purpose of evaluating this choice: Jury Unanimity In civil cases in New York State, a civil jury consists of six people—only five have to agree to meet the unanimity requirement. In federal court, complete unanimity is required—all jurors (usually 6 but sometimes more) have to agree whether or not the policyholder is totally disabled or disabled within the meaning of the policy.

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3 Components to Review in Long-term Care Insurance Policies
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3 Components to Review in Long-term Care Insurance Policies | Peter Gordon

I pride myself on having a network of experts that I can turn to when clients have issues in areas I am not familiar with. In order to share this information with others, I will be posting guest blogs from colleagues. The first one is from Barbara A. Brody, a Specialist in Medical Management and Health Care Solutions (www.BarbaraBrody.com).

Click here to read Peter Gordon's full article...

Is Prudential Not Paying Your Long-Term Disability Claim?
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Is Prudential Not Paying Your Long-Term Disability Claim? | Evan Schwartz

Prudential Life is an insurance company that sells a large number of group Long-Term Disability (LTD) insurance policies—and has only been selling group LTD insurance policies for a long time. In the last year, Prudential has really stepped up its claims scrutiny and has been denying and terminating LTD claims in far greater numbers than they have in the past. Because they only sell group disability insurance, the vast majority of policies they sell are governed by the Employment Retirement Income Security Act of 1974 or ERISA. I have previously blogged about ERISA and the difficulties that ERISA creates for claimants who have denied or terminated LTD claims.

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Do You Have Claims-Made Professional Liability Coverage? Know Your Reporting Requirements
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Do You Have Claims-Made Professional Liability Coverage? Know Your Reporting Requirements | Evan Schwartz

Professional Liability Insurance (PLI) is generally sold as claims-made coverage—a unique type of time-limited coverage primarily for professionals. Typical examples of PLI coverage include:

•Legal malpractice for attorneys;

•Medical malpractice for physicians;

•Employer Practices Liability Insurance (EPLI);

•Directors and officers (of corporations) liability insurance;

•Media liability insurance;

•Brokers’ errors and omissions insurance; and

•Cyber-liability, technology errors, and omissions insurance coverage (this product is new).

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Insurance Bad Faith
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Insurance Bad Faith | Evan Schwartz

{2:00 minutes to read} The term “bad faith” is used when an insurance company unreasonably denies, delays, terminates, or underpays a claim. First-party bad faith specifically refers to the contract between you/your business and the insurance company (as opposed to the insurance company paying a claim made against you or your business from a third party). Examples of first-party bad faith could include your insurance company’s refusal to pay for: •Homeowner’s claims; •Business interruption claims; •Property damage suffered due to water or fire, etc.;

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Know Your Rights During An IME (Part 2)
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Know Your Rights During An IME (Part 2) | Evan Schwartz

My last article discussed the governance of an IME and how to prepare for one. This article shares my advice concerning what happens during an IME.   When it comes to physical versus mental or cognitive examinations, there are a lot of unresolved questions across the country. The answers vary, both under federal and state law. For example, do you have the right to: •Have a lawyer present during the IME? •Have a third party witness present, such as a spouse, sibling, nurse, or doctor, or lawyer?

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What is an IME & How Do I Prepare for One?
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What is an IME & How Do I Prepare for One? | Evan Schwartz

{3:55 minutes to read} In the world of claims or lawsuits against insurance companies, IME is an acronym for Independent Medical Examination. These examinations are never truly independent, however. IMEs are requested by insurance companies, and they have the power to hire someone who is more likely to give an outcome that’s favorable to them. That is who they typically hire. Especially in the context of long-term disability claims, the insurance companies themselves no longer call these examinations “independent.” Instead, they often use the acronym EME, which stands for Evaluative Medical Examination.

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Discretionary Authority Under ERISA
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Discretionary Authority Under ERISA | Evan Schwartz

{3:30 minutes to read} Discretionary authority can have, and has had, a devastating impact on the ability of people to get paid by their insurance companies.  Long-term disability policies, health insurance policies, and other types of coverage obtained through a private employer are typically governed by a federal law called ERISA—the Employee Retirement Security Act of 1974.

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Trigger of Insurance Coverage: A Basic Primer
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Trigger of Insurance Coverage: A Basic Primer | Evan Schwartz

{4:35 minutes to read} When you buy a policy and transfer risk to an insurance company in exchange for payment of a premium, the incidents, events, or circumstances covered by your policy are called triggers of coverage. The trigger of coverage depends on the type of policy you have. Conditions of Coverage People are often confused about the difference between when coverage is triggered and when conditions are met.

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Unum: The Insurance Giant Continues to Terrorize the Villagers
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Unum: The Insurance Giant Continues to Terrorize the Villagers | Evan Schwartz

{2:35 minutes to read} Still the largest disability insurer in both the United States and the United Kingdom, Unum Group has had a long history of allegations against it relating to its claim practices. Unum Group includes a series of companies that were acquired as a result of a merger between Unum Corporation and The Provident Companies of Chattanooga, Tennessee. Those companies primarily include:

•Unum US;

•Unum UK; and

•Colonial Life.

Underwriters primarily include:

•Provident Life and Accident Insurance Company; and

•The Paul Revere Life Insurance Company.

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What Did Sandy Teach Us About the Flood Exclusion?
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What Did Sandy Teach Us About the Flood Exclusion? | Evan Schwartz

{2:25 minutes to read} Recent storms such as Sandy and Irene have proven that the Northeast is extremely vulnerable to major flooding. They also made many people aware that most homeowners’ and business owners’ insurance policies have something called a flood exclusion. A flood exclusion means your insurance will not cover damage that was caused primarily by tidal flooding (water from an ocean, bay, or the like spilling over its ordinary containment and causing damage). This exclusion can exist for people both inside and outside “flood areas.”

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Under the Microscope: Examination Under Oath
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Under the Microscope: Examination Under Oath | Evan Schwartz

{4:48 minutes to read} An examination under oath—or EUO, as we call it in the business—is a tool that’s been in the insurance company arsenal for a hundred years. The concept arose to help insurance companies investigate suspicious claims and the potential for fraud, usually involving property or liability claims. An examination under oath is very much like a deposition, except that a lawsuit isn’t pending; instead, it occurs as part of the claims process with the insurance company.

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An Insurance Company’s Duty to Defend (Part 1)
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An Insurance Company’s Duty to Defend (Part 1) | Evan Schwartz

{6:70 minutes to read} There are a few things that you, as the insured, should know when the insurance company hires a lawyer on your behalf.  For liability claims that are covered by insurance, businesses and individuals have two types of protection: 1. The insurance company will hire and pay a lawyer to defend the insured when a claim is covered or potentially covered by the policy. 2. The insurance company will pay, or indemnify, the insured up to the limits of the policy’s indemnity limit that was purchased (the coverage limit).

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Professional Liability Insurance Policies & Notice
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Professional Liability Insurance Policies & Notice |Evan Schwartz

{5:00 minutes to read} While lawyers are busy helping and representing their clients, they often hurt themselves by not reading their insurance policies. It’s important for lawyers to realize what they are required to do as far as giving notice—and what will place them in jeopardy if they don’t. Most lawyers have what are called claims-made policies. These involve claims that are both made against them and reported to the insurance company during the policy period, which is typically one year.

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How to Determine a Date of Disability for an Insurance Claim
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How to Determine a Date of Disability for an Insurance Claim | Evan Schwartz

{3:20 minutes to read} When filing an insurance claim due to an injury or sickness, it can be challenging to determine the date of disability—i.e. when coverage was triggered. Clients, typically professionals, who experience injury or sickness which affects their ability to perform their job don’t always stop working. Many times, they will perform less of, or cease to perform one particular activity—even though that activity is an essential duty of their occupation.

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If You’re Seeking Insurance Proceeds, Don’t Forget These 3 Critical Responsibilities
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If You’re Seeking Insurance Proceeds, Don’t Forget These 3 Critical Responsibilities | Evan Schwartz

{6:50 minutes to read} When you submit a claim for insurance benefits under your policy, there are certain things you, as the insured, are required to do. There are things the insurance company is required to do as well. Let’s discuss generally what some of those things are. Notice of Claim When you have an insurance claim, the first step is to tell the insurance about it—we call that giving them notice, or “notice of claim.”

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Insurance 101: What Coverage Is Available & What Type Do You Need?
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Insurance 101: What Coverage Is Available & What Type Do You Need? | Evan Schwartz

{3:15 minutes to read} Most people will acquire insurance, either for themselves or their business, at some point during their lifetime. In general, there are two broad categories of insurance: first-party and third-party insurance. Within these two categories, there are many insurance products that provide coverage for various types of risks. First-Party Insurance First-Party Insurance — a contract between an individual or business and the insurance company — protects the property of the insured individual or their business in the event of a loss.

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What Disability Claimants Need to Know About ERISA
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What Disability Claimants Need to Know About ERISA | Evan Schwartz

{4:40 minutes to read} What is ERISA? The Employee Retirement Income Security Act of 1974, or ERISA, is a federal law designed to protect an employee’s trust fund benefits. It is primarily directed at defined benefit plans, 401Ks, deferred compensation plans, and any employee benefits furnished by an employer, but it also applies to employee-sponsored benefits funded by insurance companies, such as long-term disability, and health and life insurance benefits. Does it apply to my long-term disability benefit claim?

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Fraud in the Insurance Claims Process
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Fraud in the Insurance Claims Process | Evan Schwartz

{3:00 minutes to read} In a recent blog, we talked about fraud during the underwriting process — the formation of the insurance contract. When fraud is committed during the claims process and involves property, casualty or liability insurance, the entire claim will be forfeit. This applies to, among others:

  • Professional liability policies;
  • General liability policies;
  • Commercial liability policies;
  • Homeowner’s policies;
  • Automobile insurance policies;
  • Employment Practices Liability Policies (EPLI); and
  • Errors and Omissions policies (E&O).

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The Pain of Discipline vs the Pain of Regret
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The Pain of Discipline vs the Pain of Regret | Michael Fliegelman

{5:42 minutes to read} Today, I have a very special guest joining us, Mr. Mark Bullock. He shared with me a story that made me think about a concept that I learned many years ago; the pain of discipline versus the pain of regret. Elder care is a huge problem for many families. Once somebody has gone through this kind of process, they look at the decisions pertaining to insurance very differently. Mark is going to share a little bit about his family situation and how it has been affected by these issues.

Click here to read Michael Fliegelman's full article...

Commercial Property Insurance: Basic, Broad or Special
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Commercial Property Insurance: Basic, Broad or Special | Seth Jonas

Seeing an insurance broker as opposed to an agent has many advantages, especially when shopping for commercial property insurance. There are three types of commercial property insurance, referred to as Basic Form, Broad Form and Special Form. These policies differ in the items that are covered, so achieving the best outcome takes experience and practical knowledge.

Click here to read Seth Jonas' full article...

Is life insurance a part of your retirement plan? It should be.
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Is life insurance a part of your retirement plan? It should be | Michael Fliegelman

{3:12 minutes to read} Today I want to talk about qualified plan accounts as an approach to purchasing life insurance as part of your retirement plan. Qualified plans include:

  • 401(k);
  • Profit-sharing;
  • Money purchase; and
  • Defined benefit plans.
As people get older and accumulate wealth, these qualified plan accounts could potentially represent a very attractive way for an individual to purchase life insurance.

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Insourcing vs. Outsourcing: Become the Ultimate Advisor
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Insourcing vs. Outsourcing: Become the Ultimate Advisor |  Kellan Goldberg

{3:20 minutes to read} The scope of what an advisor does is mind boggling. Essentially, they are small business owners with an endless list of responsibilities and clients who have unbelievably high expectations. It is impossible to accomplish all of the daily tasks alone and do them well, but advisors are almost forced to do so because clients and regulators expect this of them. So how can an advisor stay on top of everything while maintaining a healthy balance in their lives?

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The Cost of Waiting to Review Insurance
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The Cost of Waiting to Review Insurance | Kellan Finley

{4 minutes to read} When reviewing insurance needs - whether it’s life insurance, disability, long-term care or even annuities - advisors need to consider possible costs in delaying a regular review of their client’s products. There are two main costs of waiting that are commonly understood:

  • As clients get older, premiums go up. Waiting until a year or two to make the same change to insurance will result in higher premiums. While these costs will not increase astronomically, premiums are always a consideration.

Click here to read Kellan Finley's full article...

Is Your Business Under-Insured?
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Is Your Business Under-Insured? | Seth Jonas

Business owners know that having the right insurance policies in place is vital, but not everyone realizes the importance of having enough insurance. Estimating the insurance needs of a new business entity does not go easily with running a business. There are so many different factors to consider that the best course of action is often to get the regular help of a professional – someone with years of experience getting coverage for all different types of start-up companies.

Click here to read Seth Jonas' full article....

“Health Insurance” Not Necessarily Good For Patients’ Health
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According to the Hippocratic Oath, a doctor must first do no harm.  But the influence of health insurance companies on modern doctors raises the question of exactly who doctors are bent on not harming: their patients, or their corporate benefactors.  This subject was the topic of a recent, disturbing op-ed piece in the NY Times, which is entitled “How Medical Care Is Being Corrupted.” The authors, both Harvard physicians, warn that:  

Click here to read Andrew Barovick's full article...