What is the Duty to Cooperate in an Insurance Policy?

J.P. Gonzalez-Sirgo
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Founder of J.P. Gonzalez-Sirgo, P.A.

Not many policyholders are aware that they too are in a fiduciary relationship with their insurer. This means you owe your insurer the duty to cooperate with insurance investigations related to your claim. In broader and simpler terms, the insured must cooperate in connection with any claim of which insurer would have responsibility under their policy.  Ramos v. Northwester Mut. Ins. Co., 336 So.2d 71 (S.C. 1976).

What will happen if the insured fails to comply with their duty to cooperate? Failure to comply could result in the forfeiture of your claim in certain circumstances. Typically, a claim will be denied if the failure to cooperate was a material breach. If the breach did not involve a key condition or involved a minor deviation from the duty to cooperate, you still may be able to recover from your claim. Courts will look for a failure to cooperate that substantially prejudices one party when determining whether an insurer will be released from their liability.  This is only one way the materiality of a breach is assessed. Another common factor taken into consideration is the statutory regulations created by the legislation of your state and how the provisions in your policy fit into these laws.

Your failure to comply with the duty to cooperate found in your policy may be excused if the insurer does not act in good faith or negligently fails to carry out their fiduciary duties. The fiduciary duty goes both ways and is not the sole responsibility of one party. For example, lack of communication on the part of the insurance carrier may excuse an insured's failure to cooperate.  

An experienced insurance claims attorney can assist in disputing claims denied based on a failure to cooperate. Typically, this will be disputed by proving that it was not a material breach. 

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].

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