If you are a fan of John Grisham, you may remember the Rainmaker book and movie in which a young lawyer represents a family struggling with poverty in fighting a fictional health insurance carrier called Great Benefit. The insured in the movie dies of leukemia, but his death could have been prevented by a bone marrow transplant. Great Benefit repeatedly denied approval of the treatment for a succession of reasons, including dubbing the treatment as experimental, a pre-existing condition and various other bad faith reasons. Eventually, the insurance company sends a “smoking gun” letter that deems the repeated requests for coverage evidence that “[y]ou must be stupid, stupid, stupid”. It might be tempting to dismiss this as Hollywood dramatization. After all, no insurance company would actually treat a policyholder with such bad faith and disrespect, right? Wrong!
If the allegations in a complaint filed in the case of Fox Paper Ltd v. Hanover Insurance Co. are established, the case serves as an example of the rude and inappropriate way some insurance companies treat policyholders when they file a claim. The insured, who manufactures plastic utensils and paper plates, filed a claim for water damage under its commercial policy. When the claim was denied, the insured filed a lawsuit for breach of contract and insurance bad faith. In support of the insured’s claim, he allegedly provided information about water damage to the company’s warehouse above any flood water line. This information allegedly established that the damage was caused from water penetrating from above the building rather than from flooding.
Although insurance companies have a duty to conduct a reasonable investigation of a claim, the complaint filed by the policyholder indicates that the investigation performed by the insurer was a “sham”. The complaint also alleges that the insurance company’s attorney called the representative of the insured “an idiot” at an examination under oath (EUO). According to the court filings, the EUO was riddled with badgering and sarcasm by the insurance company’s attorney. The insurer’s attorney apparently called the insured an idiot after the insured failed to identify a particular picture with sufficient specificity to satisfy the attorney.
Although the insurance carrier’s attorney was the one who purportedly engaged in the egregious conduct, the attorney is the insurer’s representative and advocate. The conduct of the lawyer reflects to some extent the attitude and demeanor of the insurance company toward its policyholder. If the allegations in this lawsuit prove to be true, the lawsuit serves as compelling evidence that an insured cannot simply anticipate that his or her insurance company will act with respect, diligence and honesty in processing a claim.
If your home or business is damaged by a hurricane, lightning, wind, fire, theft or other covered peril, you might need legal representation to protect your interests when pursuing a claim. If you have questions about Miami-Dade insurance claims, you are welcome to contact my insurance claims dispute law firm. My law firm represents policyholders in claims disputes in Miami and throughout Florida. The Law Firm of J.P. Gonzalez-Sirgo, P.A. offers free consultations and case evaluations. No Recovery, No Lawyer Fees. Call 305-461-1095 or Toll Free 1-866-71-CLAIM.