What is Estoppel and Waiver in the Insurance Coverage Context?

J.P. Gonzalez-Sirgo
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Before digging into these terms in the insurance context, it is important to understand the general meaning of these basic legal principles. Estoppel occurs when an individual is precluded from denying or alleging a fact as consequence of a previous act or failure to act on the individual’s behalf. While estoppel is typically the result of an action or series of events that may be involuntary, the concept of waiver is often a voluntary renunciation, repudiation, or surrender of a claim or right. However, this is not always the case. A waiver can be signaled by implications created by a party’s actions or can be voluntarily agreed to within a contract or orally in some circumstances. For example, breaching a covenant created by a contract can lead to the forfeiture of your initial rights. If the waiver of a right is not unconscionable then it may be included in contractual provisions to relieve liability from the contracting party or offer a conferred benefit to the party entering into the agreement for waiving a certain right.

Now that you have a better understanding of these legal principles, it is time that we apply them within the context of insurance coverage. Breaches that often lead to estoppel are breach of warranty, breach of condition precedent, and breach of condition subsequent. Estoppel can be used to assert a limitation of insurance coverage because of certain actions or failure to comply with your policy. This principle is often used in a defensive manner.

An insurer can be estopped from asserting a forfeiture of a policy by taking certain actions or failing to take certain actions. However, it may not be used in an affirmative fashion to expand coverage or place further restrictions. Generally, the same applies regarding affirmative use of waiver regardless of whether it is the insured or insurer asserting a waiver of their contractual right. Waiver still acts differently than estoppel because of its inapplicability when determining the existence or non-existence of coverage. Do not confuse this with the waiver of conditions which is not the same as waiving a forfeiture.

The scope of your policy explains and sets boundaries on what would be a material breach of your contract leading to estoppel or waiver of coverage. Previous interactions and business dealings between the insurer and insured can act as a waiver if neither party complied with a particular provision nor gave notice or acted to correct the error. All of these factors are still subject to state law making it important you contact an experienced insurance claims attorney to help you assess your policy and dispute unjustly denied claims.

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].

Source:

-Blacks Law Legal Dictionary

-Estoppel to Assert Limitation of Insurance Coverage, 26 Am. Jur. Proof of Facts 2d 137§ 1

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