With all of the recent publicity regarding insurance companies denying or limiting claim payouts on homeowners’ policies, many people are asking how they can protect themselves from being a victim of their own insurance company at a time when they most need the protection.
Here are a few thoughts on how to make sure you at least have adequate insurance. When you purchase insurance coverage for your home it is your intent to cover yourself for;
1) the cost of rebuilding your home,
2) the cost to replace your personal possessions within your home, and
3) the cost of having to live elsewhere while your home is being rebuilt.
First, decide how much it will cost to rebuild your home. This is not the price you paid for your home nor is it the amount of your mortgage. If you are unsure of how to determine this amount ask your agent since he has more expertise in this area. Give him the exact square footage of the residence, the specific location of the residence, the type of construction, whether the house is a custom home and any other unusual features of your home. Once your agent has this information, have the agent determine the cost per square foot to rebuild your home. In order to determine the amount of dwelling coverage you should carry just multiply the square footage by the cost per square foot. Always confirm in writing what figures the agent quoted you so that if the question of adequate coverage or co-insurance becomes an issue you are protected since you relied upon the agent’s expertise. However, beware that insurance agents typically under estimate the cost of rebuilding your home. Agents want to sell you insurance and to do so they believe they need to keep the premiums as low as possible which means keeping the coverage low.
In addition to determining how much coverage you need you must decide what kind of insurance to buy. A homeowners policy protects you against numerous perils, such as fire, windstorm, theft, etc. A fire policy is limited to protection only against fire. There are various types of homeowners policies and each type needs to be explored with your agent. Remember, policies that insure you for anything less than replacement cost will not cover the cost of rebuilding your home.
With regard to the amount of coverage you should carry for the personal possessions in your home, a typical homeowner policy will calculate that amount based upon a percentage of the dwelling coverage. Policies will vary as to whether the personal property coverage will be replacement cost or actual cash value (which applies depreciation). Immediately after you take out your policy and for every year thereafter, videotape the contents of your home (open drawers and videotape what is in them). When you have a loss, insurance companies will require you to file a proof of loss in which you will have to make a list of your personal property. A video recording will not only help you remember what was in your home but it will also prove to an insurance company that you had the item and the specifics of the item. Remember most homeowners' policies have a limit on items such as furs, jewelry, silverware, etc. If you want full coverage for those items ask your agent about a floater policy.
If you have a loss and are displaced from your home the additional living expense coverage on your policy will reimburse you for hotel bills, restaurant meals and other items that are over and above what you would have spent if you were living in your home. Additional living expense coverage is limited in your policy to a set maximum amount and limited in the time you are covered. Thus if you have 12 months of coverage and it takes 18 months to rebuild your house you will not have coverage for the last 6 months. Know your coverages and plan accordingly.
For more information on Homeowners Insurance and what you need to do when you have a loss see our insurance law website.
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Thursday, April 12, 2007
Tuesday, April 10, 2007
What Is ERISA
In 1974, Congress passed a law that regulates your employee benefits. Known as ERISA (the Employment Retirement Income Security Act) this law covers your retirement, disability, health, life and other employment-related benefits. It details the responsibilities of your employer regarding your employee benefit plan, and it outlines the steps you can take if you believe your rights are being violated. ERISA is a Federal law. State laws will not apply since they are preempted by ERISA. However, if you are employed by a governmental entity then ERISA does not govern your employment benefits. (State laws of insurance "bad faith" may then apply).
ERISA has a two-step claims procedure. You first must file a claim, with proof that you qualify for benefits, with the Plan's Administrator. Typically, your employer will provide you with the claim forms. Most disability, life and health Plans are underwritten by an insurance company. (Unum, Prudential, Met Life, Hartford, etc.). In these cases your claim will be reviewed by the insurance company (referred to as the Claim Administrator). Both the Plan Administrator (employer) and the Claim Administrator (insurer) have a fiduciary responsibility "to act solely in the interest of the [Plan] participants and beneficiaries." However it may be fatal to your claim to assume that the Administrator will assist you in proving your claim. You are responsible for proving your own claim.
If the Plan denies your claim, you have the right to an administrative appeal. The Claim Administrator will review your claim a second time. You have a right to obtain a copy of the administrator's file. Get it! This file will tell you what they have reviewed and what their own internal consultants (medical reviewers, vocational analysts, surveillance video) are saying about your claim.
The appeal process is a critical point in your claim. A time when you should at least talk to an attorney with expertise in ERISA. The reason being that if your appeal is also denied your remaining remedy is to file suit in Federal court. ERISA limits your rights in court. You have no right to a jury and virtually no right to perform discovery. Thus all of your discovery needs to be done during the administrative appeal process. When the judge reviews your case he will be limited to reviewing what is in the administrative file. You can not hold back the "good stuff" for trial. If it was not presented during the administrative review then the judge will not consider it. There are many things that can be done to bolster your claim. See the article, "Excuses...", for ideas.
There are usually deadlines both for submitting your claim and filing your appeal, although it may be possible to obtain a deadline extension. Make sure you comply with these deadlines.
It is highly recommended in these technical ERISA cases that you speak to an ERISA attorney early in your case. If you retain an attorney make sure he/she has specialized knowledge in ERISA and insurance company practices. An attorney can help you to fully document your claim by gathering all the documents, seek out additional experts or specialists, interview witnesses and compile legal and factual support for your claim. If you want to obtain more information about ERISA or wish to email or talk to an expert about your claim visit our web site at stennettcasino.com
ERISA has a two-step claims procedure. You first must file a claim, with proof that you qualify for benefits, with the Plan's Administrator. Typically, your employer will provide you with the claim forms. Most disability, life and health Plans are underwritten by an insurance company. (Unum, Prudential, Met Life, Hartford, etc.). In these cases your claim will be reviewed by the insurance company (referred to as the Claim Administrator). Both the Plan Administrator (employer) and the Claim Administrator (insurer) have a fiduciary responsibility "to act solely in the interest of the [Plan] participants and beneficiaries." However it may be fatal to your claim to assume that the Administrator will assist you in proving your claim. You are responsible for proving your own claim.
If the Plan denies your claim, you have the right to an administrative appeal. The Claim Administrator will review your claim a second time. You have a right to obtain a copy of the administrator's file. Get it! This file will tell you what they have reviewed and what their own internal consultants (medical reviewers, vocational analysts, surveillance video) are saying about your claim.
The appeal process is a critical point in your claim. A time when you should at least talk to an attorney with expertise in ERISA. The reason being that if your appeal is also denied your remaining remedy is to file suit in Federal court. ERISA limits your rights in court. You have no right to a jury and virtually no right to perform discovery. Thus all of your discovery needs to be done during the administrative appeal process. When the judge reviews your case he will be limited to reviewing what is in the administrative file. You can not hold back the "good stuff" for trial. If it was not presented during the administrative review then the judge will not consider it. There are many things that can be done to bolster your claim. See the article, "Excuses...", for ideas.
There are usually deadlines both for submitting your claim and filing your appeal, although it may be possible to obtain a deadline extension. Make sure you comply with these deadlines.
It is highly recommended in these technical ERISA cases that you speak to an ERISA attorney early in your case. If you retain an attorney make sure he/she has specialized knowledge in ERISA and insurance company practices. An attorney can help you to fully document your claim by gathering all the documents, seek out additional experts or specialists, interview witnesses and compile legal and factual support for your claim. If you want to obtain more information about ERISA or wish to email or talk to an expert about your claim visit our web site at stennettcasino.com
Sunday, April 8, 2007
Accidental Death Benefits Denied Because Insured Was Drinking and Driving
An accidental death insurance policy will pay benefits when the insured dies as a result of an accident. But when the insured dies in an auto accident with a high blood alcohol rate is that an accident? Metropolitan Life Insurance Company recently denied a widow life insurance benefits when her husband died in a single car accident while driving home from his brother's house. Met Life claimed that since decedent had been drinking beer before driving that the accident was not an accident under the law.
Met life interpreted "accident" to mean "not reasonably foreseeable." Met Life claimed that it was reasonably foreseeable that one would become involved in a serious accident when combining drinking with driving. Thus since the accident was reasonably foreseeable it was not an accident under the law. Met Life cited court decisions from Illinois (Cozzie v. Metropolitan Life, 140 F.3d 1104 (7th Cir. 1998)) and Wisconsin (Weatherall v. ReliaStar Life Insurance 398 F.Supp.2d 918 (W.D.Wis. 2005)) to support its position.
Fortunately, the auto accident occurred in California. In California, the courts recognize that accident insurance is purchased to protect insureds from their own miscalculations, misjudgements and careless conduct. Thus, California courts interpret the term accident to include accidents where the insured did not perceive the resulting death or injury to be a "substantially certain result of his conduct." (Padfield v. AIG Life, 290 F.3d 1121 (9th Cir. 2002)). The widow retained the law firm of StennettCasino who are attorneys experienced in handling life insurance and accidental death benefit claims. They pointed out the difference between Illinois and California law, and presented Department of Transportation statistics that illustrated that there is a less than 1% correlation between drinking and highway deaths. Since most drivers do not believe that combining drinking with driving is "substantially certain" to result in death then (at least in California) a resulting accident is an accident.
The widow in this case prevailed once the law was persuasively pointed out to Met Life. The accidental death benefits were paid. For more information visit our insurance law web site at StennettCasino.com.
Met life interpreted "accident" to mean "not reasonably foreseeable." Met Life claimed that it was reasonably foreseeable that one would become involved in a serious accident when combining drinking with driving. Thus since the accident was reasonably foreseeable it was not an accident under the law. Met Life cited court decisions from Illinois (Cozzie v. Metropolitan Life, 140 F.3d 1104 (7th Cir. 1998)) and Wisconsin (Weatherall v. ReliaStar Life Insurance 398 F.Supp.2d 918 (W.D.Wis. 2005)) to support its position.
Fortunately, the auto accident occurred in California. In California, the courts recognize that accident insurance is purchased to protect insureds from their own miscalculations, misjudgements and careless conduct. Thus, California courts interpret the term accident to include accidents where the insured did not perceive the resulting death or injury to be a "substantially certain result of his conduct." (Padfield v. AIG Life, 290 F.3d 1121 (9th Cir. 2002)). The widow retained the law firm of StennettCasino who are attorneys experienced in handling life insurance and accidental death benefit claims. They pointed out the difference between Illinois and California law, and presented Department of Transportation statistics that illustrated that there is a less than 1% correlation between drinking and highway deaths. Since most drivers do not believe that combining drinking with driving is "substantially certain" to result in death then (at least in California) a resulting accident is an accident.
The widow in this case prevailed once the law was persuasively pointed out to Met Life. The accidental death benefits were paid. For more information visit our insurance law web site at StennettCasino.com.
Excuses Used By Insurance to Deny Disability Claims
Every denial of disability benefits includes the language "your medical records do not support a claim for disability as defined in the Plan." What does that mean and what can you do about it? Plenty. First you must understand that there are two issues presented in that often used excuse to deny benefits. The definition of disability in the Plan and your medical records. (The issues are the same in an ERISA Plan, Governmental Plan and Individual Plan).
How is "disability" defined in your Plan? You must read it to know. For example is it "the inability to perform the material duties of your own occupation" or "the inability to perform the material duties of any occupation"? If it is "your own occupation" then get a copy of the job description from your employer. If it is incorrect or incomplete then tell the Plan. Once the job duties are defined then determine how your illness/injury prevents you from performing those duties. If your job requires you to sit at a computer terminal 7 hours a day and you can only sit 2 hours a day then make sure your medical records reflect that fact.
How do you control what is in your medical records? The doctor performs the examination orders the diagnostic tests and makes the diagnosis. But the diagnosis alone does not necessarily define what your limitations are in a work setting. One person with a bulging disc may not even know he has a problem while another with the same diagnosis may be totally disabled. Each person is unique and each person reacts differently. To determine how an injury/illness affects you the doctor has to rely on what you tell him.
Do not just tell the doctor that your back hurts and you cannot work. Tell the doctor that your job requires you to sit at a computer 7 hours a day and you can only sit for 30 minutes before the pain gets so bad that you need to lay down for 20 minutes to lessen the pain. Every time you see the doctor and he asks "how are you doing" give him something interesting to write in the medical record so that it supports your inability to perform the material duties of your occupation. Tell him that you really want to return to work but at work you have to get on your knees all the time and you cannot do that yet. Tell him it bothers you that you cannot invite friends over for dinner because you cannot sit at the dinner table long enough to be social. Tell the doctor how your injury/illness affects your life. Let the medical record support your disability
There are many other methods to fully document your disability as well as many other excuses insurers like Unum, Prudential, Hartford, Met Life, Reliance Standard and others use to deny disability claims. Please visit our insurance disability web site at StennettCasino.com for additional information or to contact a disability attorney who can answer your questions whether you are dealing with an ERISA disability plan or a private disability plan.
How is "disability" defined in your Plan? You must read it to know. For example is it "the inability to perform the material duties of your own occupation" or "the inability to perform the material duties of any occupation"? If it is "your own occupation" then get a copy of the job description from your employer. If it is incorrect or incomplete then tell the Plan. Once the job duties are defined then determine how your illness/injury prevents you from performing those duties. If your job requires you to sit at a computer terminal 7 hours a day and you can only sit 2 hours a day then make sure your medical records reflect that fact.
How do you control what is in your medical records? The doctor performs the examination orders the diagnostic tests and makes the diagnosis. But the diagnosis alone does not necessarily define what your limitations are in a work setting. One person with a bulging disc may not even know he has a problem while another with the same diagnosis may be totally disabled. Each person is unique and each person reacts differently. To determine how an injury/illness affects you the doctor has to rely on what you tell him.
Do not just tell the doctor that your back hurts and you cannot work. Tell the doctor that your job requires you to sit at a computer 7 hours a day and you can only sit for 30 minutes before the pain gets so bad that you need to lay down for 20 minutes to lessen the pain. Every time you see the doctor and he asks "how are you doing" give him something interesting to write in the medical record so that it supports your inability to perform the material duties of your occupation. Tell him that you really want to return to work but at work you have to get on your knees all the time and you cannot do that yet. Tell him it bothers you that you cannot invite friends over for dinner because you cannot sit at the dinner table long enough to be social. Tell the doctor how your injury/illness affects your life. Let the medical record support your disability
There are many other methods to fully document your disability as well as many other excuses insurers like Unum, Prudential, Hartford, Met Life, Reliance Standard and others use to deny disability claims. Please visit our insurance disability web site at StennettCasino.com for additional information or to contact a disability attorney who can answer your questions whether you are dealing with an ERISA disability plan or a private disability plan.
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