Property Insurance Claims

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Fire claims can be disastrous. In addition to the fire itself, catastrophic damage is caused by the smoke, power surge, fire department activity, and the thousands of gallons of water used to extinguish a fire. 

Fire claims are equally complicated. They involve complex issues involving reconstruction, codes, additional living expenses, temporary repairs, water remediation, and contents claims. When dealing with a fire claim, the devil is in the details. An insurance company's adjustment of a fire claim can differ from a homeowner's assessment by tens of thousands of dollars to hundreds of thousands of dollars.

Businesses are faced with additional challenges, taking into account relocation and loss of business. Fire claims should not be handled alone. It is essential to have a professional assist you. Contractors are not trained to handle insurance claims, and you should not rely on your contractor to negotiate your claim for you. They are not licensed to do so and do not have a firm understanding of policy interpretation or coverage.

If a fire occurs, it should be reported immediately.  If immediate work is required before the insurance company adjuster can arrive, everything should be properly photographed and documented.  Failure to do so could result in an unnecessary investigation and raise suspicions as to material aspects of the loss being covered up.

Contact us today for assistance.  Do not delay and do not go at it alone. 

Whenever the wind blows fierce, there is always the potential for damage to buildings, whether the damage is caused by blowing debris, a tree fall, or the force of the wind itself.  Wind damage can be significant, there could be concealed damage, or a dispute over the causation of the loss itself.  Disputes often arise over the issue of repair vs. replacement and the issue of potential hidden damage.

In New York, some policies even have high deductibles for windstorm claims, by way of endorsement,  for every windstorm damage claim, while most homeowner's policies have  significant catastrophic windstorm deductible for storms classified above a certain level.  While policies vary, a policy may contain sub-limits for tree removal, mold remediation, and other aspects of the loss related to the wind damage.

Claimed damage to a roof, for example, is very typically an area of dispute, with insurance companies often taking the position that the damage is minimal, or the the roof can be easily fixed or "patched."  The insurance company's position however may be in direct conflict with what you are entitled to under the policy.  

Even if there are no issues as to coverage, a claims professional is advised.  Statistics have shown that an insured who is represented will recover substantially more than one unrepresented.  Our office can assist immediately, 24/7 and help with claim submission, obtaining estimates, emergency remediation, alternative living, and peace of mind.

As the weather gets colder, frozen pipes and related water damage claims become quite frequent.  Given that water expands when it freezes, if the weather drops and heat becomes inadequate, a pipe can freeze and break and the results can be catastrophic.

Not all frozen pipe claims are covered however, and a claim must be approached very carefully.  Certain provisions in homeowner insurance policies set forth very specific requirements in order for a frozen pipe claim to be covered.  While each policy form may vary, there are certain common themes among frozen pipe insurance coverage clauses.  These commonalities include reasonable efforts to maintain heat, turning off the water and draining the pipes and appliances, and certain occupancy/vacancy provisions.

If you have had a frozen pipe claim, it is always advised to seek professional assistance, ideally immediately after the loss and before the claim is submitted.  Quite often, homeowners or business owners submit a claim and unwittingly provide incorrect information, if believed to be true by the insurance company, could result in a denial. 

Even if there are no issues as to coverage, a claims professional is advised.  Statistics have shown that an insured who is represented will recover more than one unrepresented.  Get the representation you need and deserve.

Water damage claims are amongst the most common insurance claims.  They may range from a common broken pipe to more complex losses involving structural damage, earth movement, or even broken water main lines off the property.  Insurance carriers are quite strict with regard to their interpretation  of the policy, and may result in a denied water damage claim.

While each insurance policy in New York may have slight variations, it is always important to havie a claims professional, such as an insurance lawyer or public adjuster assist you in handling the claim.  Very often, homeowners or business owners submit a claim and unwittingly provide incorrect information, which, if documented by the insurance company could result in a denied claim and the need to pursue legal action.  

Agulnick Kremin carefully analyzes your relevant policy provisions to determine whether ambiguity in the language exists and whether significant precedent precludes the insurer from asserting certain exclusions.  

​Our office can assist immediately, 24/7 and help with claim submission, obtaining estimates, emergency remediation, alternative living, and piece of mind

Collapse claims are very complicated types of insurance losses from the perspective of causation.  In many home and business owner policies, collapse is a peril that is an excluded cause of loss.  Some policies do have an endorsement which provides for such extra coverage, however, those endorsements which provide coverage for collapse limit that coverage to certain underlying causes.  

Once an insurance claim for collapse is submitted, you should expect in most cases for the insurance company to dispatch an engineer to inspect the loss and "determine the cause", and provide the insurance company with their conclusion.  The engineer assigned should not be expected to have your best interests in mind, as they are retained by the insurance company.  They do not work for you and their focus may be to establish that an excluded cause was involved.

The initial presentation of a collapse can be the difference between a covered loss and a denied insurance claim.  A couple of incorrect words in a report could set a denial in motion.  It is often suggested to consult with your own engineer so that you can dispute the carrier's claim, should they attempt to deny it.  

If a collapse occurs, it should be reported immediately.  If immediate work is required to prevent further damage or danger to life before the insurance company adjuster can arrive, everything should be properly photographed and documented.  Failure to do so could result in an unnecessary investigation and raise suspicions as to material aspects of the loss being covered up.

Agulnick Kremin are your New York Examination Under Oath Lawyers (EUO) .  We have extensive experience with the EUO process and can help you through the many pitfalls. Our New York examination under oath attorneys will guide you through the process and handle of the logistics, from scheduling the location to the post examination procedure related to your insurance claim.  Our attorneys will help ensure compliance with all of the insurance company's demands and safeguard our clients' rights during the actual EUO.

Insurance companies often undertake comprehensive investigations when faced with a significant payment on an insurance claim. The investigation sometimes includes an EUO, which a policyholder is required to appear at, if requested. The legal basis for an EUO can be found in the binding language of a policy.  

Examinations Under Oath are most often coupled with the requirement that the insured produce a multitude of documents, all claimed to be related to the insurance companies investigation of the claim.  An insureds failure to appear or provide all of the requested documents, or respond appropriately if such documents cannot be provided, may form the basis for a denial under the Cooperation Clause.  EUO demand letters may also include a demand for a Proof of Loss, which must be submitted within very strict time limits.

If you have received a demand for an EUO, or a demand for a Proof of Loss, you should contact an experienced insurance attorney without delay.  Hourly and contingency payment arrangements are available.  Good representation can make the difference,  Contact us for a free consultation today.  Our insurance claim lawyers serve Long Island, the New York City area and surrounding counties.

Protective Safeguards requirements are extremely important components of many insurance policies.  Protective Safeguards are considered warranties under an insurance policy and essentially act as a condition precedent to coverage for related loss.  With Protective Safeguard requirements, the devil is in the details and the failure to comply can result in a loss being uncovered.  

Some common protective safeguards required in insurance policies are fire suppression system, "Ansul" system for restaurants and cooking establishments, and burglar alarm.  Many require supervisory service and central station monitoring.  It is important that every policyholder know exactly what protective safeguards are required before there is a loss.  However, it is possible in many situations to overcome a denial on such grounds and for that reason it is essential to consult with an attorney with specific experience with PS cases, and whose prior cases have been cited as authority throughout New York.

The typical exclusionary language for protective safeguard provisions is as follows:

The endorsement also adds the following language to the Exclusions section of the Commercial Property Conditions Form:

We will not pay for loss or damages if, prior to the loss, you:
Knew of any suspension or impairment in any protective safeguard listed in the Schedule above and failed to notify us of that fact; or
Failed to maintain any protective safeguard listed in the Schedule above, and over which you had control, in complete working order.
If part of an Automatic Sprinkler System is shut off due to breakage, leakage, freezing conditions or opening of sprinkler heads, notification to us will not be necessary if you can restore full protection within forty-eight hours. 

Prior to the issuance of any insurance policy, insurance companies require the completion of an insurance application.  Insurers look at the application and determine whether the risk is one that their underwriting department is willing to approve for coverage.  Each insurer has written underwriting guidelines, which in conjunction with the guidelines makes a determination as to the issuance of a policy,

When a loss occurs, insurance companies often investigate not only the occurrence and the circumstances surrounding the loss, but they also investigate the responses on the application.  When an insurer discovers what it claims to be a misrepresentation, the insurer may attempt to rescind the policy, void ab initio (meaning now for then). If this happens, you must seek legal counsel.  The insurer will actually return all premiums to you, but do not cash those checks unless you are accepting the rescission.  If the premium checks are cashed, the insurer will claim an accord and satisfaction.  

Agulnick Kremin is very familiar with the latest law pertaining to insurance policy rescission, having successfully handled many such matters, and prevailed at litigation.  For example, AK recently obtained a decision in the Second Circuit Court of Appeals which declared certain application questions to be ambiguous as a matter of law, precluding the insurer's ability to rescind.  AK has employed a number of strategies to overcome rescissions, including ambiguity, waiver, and estoppel.  Furthermore, misrepresentations must be material, and that materiality is often unsupported by the written underwriting guidelines relied upon by an insurer.

Contact Agulnick Kremin today to see how we can help with your rescinded policy, or provide the counsel necessary to avoid rescission in the first place.