Property insurance is a type of insurance policy that provides financial protection for the policyholder’s property against various perils such as fire, theft, floods, earthquakes, and other specified events. This coverage extends to both personal property (such as household items) and real property (such as buildings or land). Property insurance can be purchased by individuals, businesses, and other organizations to safeguard their assets from potential risks.
Property and casualty insurance claims involve the process of filing a claim with an insurance company to receive compensation for damages or losses covered under a property and casualty insurance policy.
These claims can be made for various reasons, such as theft, accidents, or natural disasters that cause damage to the insured property or for liability coverage in case the policyholder is found responsible for causing damage to someone else’s property or person.
What Is Casualty Insurance?
Casualty insurance is a broad category of insurance coverage that protects policyholders against liability for injuries or damages to third parties or their property. This insurance can cover a wide range of situations, such as auto accidents, professional liability, and workers’ compensation claims.
The main difference between property and casualty insurance is that property insurance focuses on protecting the policyholder’s own property, while casualty insurance protects the policyholder from liability for harm caused to others or their property.
What Are Some Common Property and Casualty Insurance Disputes?
There are many types of property and casualty insurance disputes that can arise, including:
Claim Denial
A policyholder’s commercial property suffers damage due to flooding from heavy rains. The insurance company denies the claim, stating that the policy does not cover flood damage as it is considered an excluded peril. The policyholder disputes the denial, arguing that the policy should cover the loss.
Valuation Disputes
A policyholder’s manufacturing facility is damaged in a fire. The insurance company estimates the cost of repairs to be $200,000, while the policyholder’s independent assessment suggests a repair cost of $300,000. The two parties are in a dispute over the actual value of the damaged property and the cost of repairs.
Policy Interpretation
A policyholder’s restaurant suffers a loss of income after a power outage forces it to close temporarily. The policyholder files a claim for business interruption coverage, but the insurance company argues that the policy only covers income losses caused by physical damage to the property. The policyholder disputes this interpretation, claiming that the policy should cover the loss of income resulting from the power outage.
Bad Faith Claims
A policyholder’s warehouse is damaged in a severe storm. The policyholder submits a claim for the damages, but the insurance company takes an unreasonable amount of time to investigate and process the claim. The policyholder alleges that the insurer is acting in bad faith by delaying payment and not properly handling the claim.
Coverage Disputes
Disagreements may arise over whether a specific event or circumstance falls within the scope of the policy’s coverage. For example, a policyholder files a claim after their commercial building is vandalized.
The insurance company argues that the damage was caused by wear and tear, which is not covered under the policy, while the policyholder insists that the damage was due to vandalism, which is covered.
Exclusions and Endorsements
Disputes may occur when policyholders and insurance companies disagree on the applicability of policy exclusions or endorsements (additional coverages added to the policy). For example, a policyholder believes their policy’s mold endorsement covers the cost of mold remediation after a water leak, but the insurance company claims that the endorsement only covers mold damage resulting from specific covered perils.
Deductible Disputes
Conflicts can arise over the appropriate deductible amount to be applied to a claim. For example, a policyholder believes their $5,000 deductible should be applied to a $50,000 claim for storm damage, while the insurance company insists that a separate, higher deductible for windstorm damage applies.
Causation Disputes
Disagreements may emerge over the cause of the damage or loss, which can impact whether the claim is covered under the policy. For example, a policyholder’s commercial property suffers damage from a combination of heavy rain and a leaking roof. The insurance company asserts that the majority of the damage was caused by the pre-existing leak, which is not covered under the policy, while the policyholder contends that the rain was the primary cause, which is covered.
How Are Property Insurance and Casualty Insurance Disputes Resolved?
Commercial property and casualty insurance disputes can be resolved through various methods, such as:
Negotiation
A policyholder’s commercial building suffers significant water damage due to a burst pipe. The insurance company initially offers a lower settlement amount than the policyholder believes is necessary for repairs. Through negotiation, the policyholder and the insurance company discuss the costs of repair, present their evidence, and ultimately agree on a higher settlement amount that satisfies both parties.
Mediation
After a storm damages a policyholder’s warehouse, the insurance company and the policyholder cannot agree on the extent of coverage for the damages. They decide to engage in mediation, where a neutral mediator helps them communicate and explore possible resolutions. By working together, the policyholder and insurance company eventually reach an agreement on the coverage amount and the necessary repairs.
Arbitration
A policyholder files a claim for loss of income after a fire forces their retail store to close for several months. The insurance company disputes the amount of income lost and suggests a lower figure. The policyholder and insurance company agree to resolve the dispute through arbitration. The arbitrator hears arguments from both parties and reviews their evidence before making a binding decision on the appropriate compensation for the policyholder’s lost income.
Litigation
A policyholder believes their insurance company is acting in bad faith by delaying payment on a valid claim for damages to their office building. The policyholder and insurance company are unable to resolve the dispute through other means, so the policyholder files a lawsuit against the insurer. In court, both parties present their cases, and a judge or jury ultimately decides whether the insurance company acted in bad faith and, if so, awards damages to the policyholder.
Appraisal
Appraisal is a process where each party selects a qualified appraiser, and those appraisers then select an impartial umpire. The appraisers evaluate the claim and provide their estimates, and if they disagree, the umpire steps in to determine the final value of the claim.
To illustrate, if there is a dispute over the value of damaged property after a fire, the appraisers will assess the damage and attempt to come to an agreement on the value. If they cannot agree, the umpire will make the final decision.
Regulatory Intervention
In some cases, policyholders can seek assistance from state insurance regulators or departments to resolve disputes. For instance, if an insurance company is not responding to a policyholder’s claim in a timely manner, the policyholder can file a complaint with the state insurance department, which may investigate and take action against the insurer if necessary.
Settlement Conferences
Settlement conferences are formal meetings between the parties involved in a dispute, usually facilitated by a judge or a court-appointed neutral party. During the conference, the parties discuss the issues, present their positions, and explore potential resolutions.
For example, if a policyholder and insurance company cannot agree on a settlement amount after a natural disaster, they may participate in a settlement conference to discuss their differences and attempt to reach a compromise.
Collaborative Law
Collaborative law is an alternative dispute resolution process where the parties involved, along with their respective attorneys, work together to resolve the dispute without going to court. The parties agree to openly share information and work cooperatively to reach a mutually acceptable resolution.
For example, if a policyholder and an insurance company have a disagreement over policy coverage, they may choose to engage in a collaborative law process to reach an agreement on coverage and compensation.
Do I Need a Lawyer for Help with Property and Casualty Insurance Claims?
It is advisable to consult with an experienced insurance attorney when dealing with property and casualty insurance claims. An attorney can help you understand your rights, review your policy, and represent you in negotiations or legal proceedings.
Use LegalMatch’s reliable platform to help you find a qualified insurance lawyer who can effectively handle your property and casualty insurance claim.
