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.  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 will be deemed to reflect the attitude and demeanor of the insurance company toward its policyholder.  

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

J.P. Gonzalez-Sirgo
J.P. Gonzalez-Sirgo, P.A.
Post A Comment