Keep away from Declare Denials: Key Policyholder Duties After a Loss

All insurance coverage insurance policies embody a piece putting particular duties and obligations on policyholders to behave in a sure means earlier than entitling them to coverage advantages for what ought to be a lined loss. If policyholders ignore such obligations, insurance coverage corporations can attempt to delay fee or, in additional excessive circumstances, even deny fee altogether for what would in any other case be a lined loss had the policyholder solely complied with their obligations beneath the coverage.

Most insurance coverage insurance policies embody a piece titled ‘Duties after Loss’ that goes over all the policyholder’s particular duties they need to adjust to after a loss. Typical duties for property claims embody:

• Promptly notifying the insurance coverage firm of the loss;
• Cooperating with the insurance coverage firm in its investigation of the declare, and;
• Defending/preserving the insured property after a loss.

You should definitely learn the precise language of your coverage to completely perceive your full listing of obligations, as these can differ between states, between insurance coverage corporations, and between insurance policies. Don’t fall sufferer to the concept that a policyholder’s duties after a loss stay stagnant between coverage renewals both. Insurance coverage corporations can replace these duties from yr to yr, so each policyholder ought to overview their ‘duties after a loss’ part every time they obtain a brand new coverage or renewal.

Why These Duties Matter

In the end, insurance coverage corporations place these post-loss obligations/duties on the policyholder to guard themselves. Insurance coverage corporations can use a policyholder’s non-compliance with a post-loss obligation as a motive to delay fee of a declare or in additional excessive instances, even deny the declare altogether. In impact, a policyholder’s compliance with a post-loss obligation is required earlier than a policyholder may even obtain fee for a loss.

Materials and Substantial Drawback to the Insurer

To argue a policyholder has voided protection for non-compliance with a post-loss obligation, a provider should present that the policyholder’s violation resulted in a “materials and substantial drawback to the insurer.” ¹ Such a “deprived’ evaluation can embody “whether or not the insurer has been in a position to full an affordable investigation with regard as to whether the insured’s declare is legitimate. If the insured’s refusal to cooperate prevents the insurer from finishing such an affordable investigation, prejudice ought to be discovered to exist. Particularly, it has been held that the insurer can deny protection, following an insured’s refusal to supply paperwork fairly requested by the insurer, on the premise that the insurer has been prejudiced as a result of the insured’s refusal prejudices the insurer by placing the insurer within the untenable place of both denying protection or paying the declare with out the means to analyze its validity.” ²

The Obligation to Cooperate

Amongst a policyholder’s post-lost duties/obligations, the responsibility to cooperate with the insurance coverage provider tends to be one of the essential. “The aim of a cooperation clause is to guard the insurer in its protection of claims by obligating the insured to not take any motion deliberately and intentionally that may have a considerable, antagonistic impact on the insurer’s protection, settlement, or different dealing with of the declare.” ³ This implies a policyholder mustn’t do something that hurts or stops the insurance coverage provider’s skill to analyze an energetic declare.

In my state of Colorado, courts implement the requirement that an insured should cooperate within the claims investigation by the provider as a situation precedent to protection beneath the insurance coverage coverage. ⁴ Whether or not a policyholder has sufficiently ‘cooperated’ with the provider beneath the coverage is a query of reality for the jury to determine. ⁵ In some instances, it’s potential to excuse a policyholder for a supposed violation of the cooperation clause if it’s proven that the policyholder’s failure “was resulting from some mistake and there was no train of unhealthy religion on [the policyholder’s] half.” ⁶ In the end, it’s higher and extra simple for a policyholder to not put themselves in a scenario in any respect the place such a argument would should be introduced.

Actual World Instance

In a 2024 United States District of Colorado case, policyholder plaintiffs had been in a position to overcome a protection movement for abstract judgment on a failure to cooperate argument by arguing substantial compliance with the coverage. ⁷ In that first-party property insurance coverage case, the provider repeatedly requested the policyholders present particular data on a number of home equipment throughout the dwelling that had been alleged to be broken in a loss. It’s undisputed that the policyholders by no means offered the requested supplies to the provider. Nevertheless, the policyholder plaintiffs argued they considerably complied (i.e., cooperated) with the provider’s request by offering what data they did have on the precise home equipment – together with estimates, photos, and reviews – regardless that this was not the precise supplies the provider requested. The policyholder plaintiffs additionally argued that the provider had sources out there to it to acquire the precise data it needed with out getting in from the policyholder plaintiffs immediately.

What’s extra, the provider introduced no proof that it ever knowledgeable the policyholder plaintiffs of the potential consequence of denying protection outright for the loss if the policyholder plaintiffs failed to supply the requested data. As an alternative, the provider solely introduced common proof of it being ‘deprived’ by the data not being offered slightly than it being ‘materially and considerably deprived.’ Due to this, the courtroom agreed with the policyholder plaintiffs that they introduced “proof that might lead an affordable jury to conclude they complied with the Coverage’s responsibility to supply documentation.” ⁸

Remaining Ideas

What’s clear is that understanding a policyholder’s obligations after a loss might be complicated. The perfect follow is for policyholders to do what they will to adjust to an insurance coverage firm’s request throughout its investigation of a declare. In any other case, a policyholder dangers inadvertently voiding protection beneath the coverage. If you’re undecided what you should do after experiencing a loss, think about speaking to an legal professional who’s skilled in property insurance coverage legislation. Insurance coverage is already difficult. By realizing your rights, your choices, and your duties when a loss happens, you may assist guarantee a easy course of when making a declare and belief that you’ll not be taking any motion that might inadvertently damage your declare within the course of.

¹ State Farm Mut. Auto. Ins. Co. v. Secrist, 33 P.3d 1272, 1275 (Colo. App. 2001).
² Walker v. State Farm Fireplace & Cas. Co., No. 16-CV-00118, 2017 WL 1386341, at *4 (D. Colo. Feb. 23, 2017).
³ Secrist, at 1275 (citing Am. Policyholder’s Ins. Co. v. Baker, 119 N.H. 958, 409 A.2nd 1346 (1979)).
⁴ Todd v. USAA Gen. Indem. Co., 713 F. Supp. 3d 1088, 1102 (D. Colo. 2024).
⁵ Todd, at 1105.
⁶ Farmers Auto. Inter-Ins. Exch. v. Konugres, 119 Colo. 268, 276, 202 P.2nd 959, 963 (1949).
⁷ Todd, at 1102.
⁸ Id.