Pontiff’s Visit to Philadelphia (Part III) – Top Five (5) Last Minute Tips for Landlords/Owners

It’s just a few days away! The papal visit is expected to bring more than 2 million visitors to the Philadelphia area. Our last two articles (here and here) dealt with the positive economic impacts for the region and managing the masses during this event. Here are five (5) tips that should be at the top of the list for landlords and owners of commercial, retail and multi-family properties.

Review your Leases. With an event of this magnitude, it is a good time to take a last minute look at your leases to ensure all items are appropriately addressed. For instance, does your lease have certain notice requirements for limiting access to parking areas designated for tenants and their customers? If you plan on sectioning off certain parking areas, did you send notice out in time? Sometimes leases will have a provision that allows you to circumvent certain notice requirements, if actions are done for health and safety reasons.

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New Insurance Offering: Ebola Business Interruption Coverage

The insurance industry is reacting to the recent realities that the Ebola virus has the potential to have an impact on U.S. based businesses. NAS Insurance Services recently announced that it will offer Ebola Business Interruption Coverage in conjunction with Prospect Insurance Brokers Ltd and the Ark Syndicate at Lloyd’s of London. This coverage is intended to fill a gap that exists in current Commercial Business Owner policies. Read More about New Insurance Offering: Ebola Business Interruption Coverage

Beware of Time Limits for Homeowners to Sue Their Insurance Carriers

Most homeowner’s policies issued in New Jersey contain statutes of limitation for filing a lawsuit against an insurance carrier where the homeowner (insured), disagrees with the insurance carrier’s claim payment amount, or refusal to make any payment on a claim.

In a recent unpublished United States District Court opinion, Turkmany v. Excelsior Insurance, the court reaffirmed the New Jersey Supreme Court’s holding in other cases, by ruling that the limitations period to bring suit against an insurance carrier begins to run once the insurer “flatly states that the insured will not be paid any additional funds on a claim.”

The court sought to clarify when the insured is entitled to “tolling” of the statute of limitations, the time during which the insured is granted additional time to file a lawsuit. For example, if a policy has a 1 year statute of limitations and a loss occurs on January 1 of given year, and the homeowner files a claim with the carrier on February 1, but the carrier takes until December 1, (10 months later), to issue a formal written denial of the claim, the homeowner is given the benefit of that additional 10 months to file a lawsuit. In other words, the Plaintiff will have 1 year and 10 months to file a lawsuit (in this example, November 1 of the following year).

This concept arises out of the court’s recognition that the homeowner should not be penalized for time spent by the insurance company in deciding whether to pay the claim, and should be given the benefit of the full amount of time set forth in the policy. This is most typically one or two years, although in the absence of a statement in the policy, a six-year statute would apply in New Jersey. However, given that almost all homeowner’s policies have a one or two-year limitation period stated in the form policy language, it is extremely rare that a homeowner would get the benefit of six years.

This opinion breaks no new ground, but, rather, reaffirms in slightly stronger and more clear terms, how a court might view computing the time allowed for the homeowner to sue the carrier. There has been discussion, in prior decisions, regarding an insured’s reasonable expectations, when the insurance carrier either doesn’t respond to the insured within the limitation period or provides an equivocal response – without specifically addressing whether additional monies will be paid out under the policy.

This opinion provides some guidance in that regard. The bottom line is that insureds should be diligent about putting the carrier on notice of a claim, in timely presenting proofs, and by filing suit promptly against the carrier, if necessary, to avoid statute of limitation bars. Similarly, insurance carriers must be prompt in their responses and definitive, regarding payment of claims, so that everyone knows what to expect in terms of time limitations.

Honesty Required When Homeowners Bring a Fire Loss Insurance Claim

Insureds filing a fire loss claim against their homeowner’s insurance carrier for property damage and loss of personal property must not conceal or misrepresent any material fact or circumstance in presenting the claim.

In a recent unreported Appellate Division case in New Jersey, Masaitis v. Allstate, plaintiffs (the homeowners) sued Allstate for significant fire loss damages to property and contents. Allstate counterclaimed, alleging that the plaintiffs misrepresented their losses in making the claim. Although Allstate also alleged arson, that issue was considered and rejected by the jury, who concluded Allstate had not proven the plaintiffs committed arson. Regardless, the jury was very skeptical about the proofs presented by the plaintiffs, and held that the plaintiffs fraudulently claimed loss of items they could not prove they had ever owned, let alone had lost in the fire.

Although the fire marshal concluded the cause of origin could not be determined, there were apparently substantial proofs submitted to the jury, challenging the plaintiffs’ credibility regarding motive – based, in part, on their pets, vehicles, and expensive items of personal property, having been removed from the property prior to the fire and having presented conflicting testimony regarding at least one of the plaintiff’s whereabouts at the time of the fire.

Ultimately, the homeowners were found to have violated a New Jersey statute, which allows an action by an insurance carrier, against someone who knowingly files a statement of claim containing any false or misleading information. If the insurance company can prove a claim under the statute, they are entitled to reasonable investigation expenses, costs of suit and attorneys fees. Here the jury awarded over $800,000 to the insurance company.

The take away is that insureds must be honest in presenting claims to the insurance carrier following a property casualty loss. Often insureds are traumatized; the fire loss scene is chaotic; and proofs are hard to come by, depending upon the seriousness of the damage to property and the ability to reconstruct damaged items after the fact.

Notwithstanding, insureds must be straightforward in presenting claims and must not use a serious property loss to serve as a smokescreen for trying to inappropriately gain. Insurance companies are adept at investigating and approach losses with a skeptical, if not jaundiced, view of their insureds, as they sift through the evidence and form opinions regarding not only the cause of loss, but the quality of the proofs. This case is a sobering reminder that this process is a two-way street, requiring scrupulous honesty by all involved.

Senior Citizen Life Insurance Policies and Designating a Third Party to Receive Notice

A recent unpublished decision by a N.J. federal district judge addressed whether an insurance company can be forced to pay out $300,000 on a life insurance policy purchased by a senior who stopped paying premiums before his death.  Smith v. Conseco.

The New Jersey legislature enacted a statute, effective in 2000, requiring insurers to remind senior citizen policyholders of their right to designate a third-party to receive notice from the insurance company of an attempt to cancel the policy, as a means of protecting seniors whose diligent record keeping may have fallen off with age.

Unfortunately, the legislature provided only that the Department of Banking and Insurance may fine an insurance company $1,000 to $2,000 for failing to honor this legal obligation. The Smith case addressed whether the beneficiary of a life policy has a private right of action against the insurance company for failure to provide the required notice, forcing them to pay out the full life insurance policy benefit.

The law provides that every insurer shall permit its senior citizen insureds to “designate a third party to whom the insurer shall transmit a copy of notices of cancellation, lapse, nonrenewal and conditional renewal with respect to a policy of personal lines insurance.”  The senior citizen must notify the insurer that a third-party has been so designated, and the insurance carrier must then notify both the insured and the third-party designee of changes in coverage status.

The judge recognized that although there are a few reported cases in New Jersey, where the courts have found a private right of action, in somewhat analogous circumstances, absent specific intent expressed by the legislature, the court was reluctant to read a private right of action into the statute or code.

This is an area where adequate safeguards and protections to an insured would seem to require modification of the statute to expressly provide for a private right of action.  Perhaps an enterprising legislator would take up this cause.  As this case points out, having the insurance carrier exposed to a $2,000 fine ultimately does nothing for a beneficiary who is denied the intended benefit of a $300,000 life insurance policy, presumably as a result of inadvertent inattention by a senior citizen insured.  Here, the decedent had faithfully paid premiums for almost 20 years, before discontinuing payments.

The take away is that seniors are wise to designate a third-party to receive notifications, so that if things fall through the cracks, there is a second pair of eyes looking out for inadvertent lapses in coverage, not intended by the insured.  This also serves as a cautionary tale for those of us who are trying to keep an eye out for seniors in our lives, whose attention to the increasingly complex “paperwork” of daily life, is not as keen as once it was.

Reprieve For Community Associations Located In High Risk Flood Areas

In response to concerns raised by the public, legislators, the Community Associations Institute and others, Congress recently passed the Homeowner Flood Insurance Affordability Act of 2014. Signed by President Obama into law, the legislation forestalls significant increases in flood insurance premiums that were set to have taken effect.

The Impact of “Tolling” on Sandy Suit Deadlines

With the anniversary of Superstorm Sandy fast approaching, policyholders who sustained damage during the storm who have not yet settled their insurance claims, may be running up against some contractually imposed deadlines. Most insurance policies limit the time period within which an insured is permitted to file suit against an insurer for the insurer’s failure to provide benefits under the policy. Insurance policies are considered contracts, and normally in New Jersey an aggrieved party has up to six years to sue for an alleged breach of contract. However, parties are free to enter into contracts that contain terms which restrict rights that would otherwise be available to one party or the other. In the insurance context, policy provisions which limit the time period within which an insured is permitted to sue are found in virtually all policies.

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