“I have paid my premiums on time for twenty years and have never filed a claim. Now, it is difficult for me to tell who has caused me more damage — the storm or my insurance carrier.”
The above exclamation, or words similar to it, is something that I hear almost on a daily basis from Missourians who have had the misfortune of needing to file an insurance claim for damage to their homes and businesses. Do you really become “the enemy” of your insurance carrier when you file a claim? Do they really consider you more as an adversary than a customer?
I received an email today from an attorney representing an insurance carrier from out of state and who sells insurance policies in Missouri who provided a clear and convincing answer to those questions.
My client, a commercial business, had incurred extensive and obvious hail damage to multiple buildings and filed an insurance claim. Their insurance company hired an independent adjustment firm to inspect the damage who reported their observations to the carrier. The carrier, after receiving their report and photographs, decided to hire an engineer who regularly assists insurance carriers in denying coverage for hail damage to properties in Missouri.
With the hail damage being as obvious as it was, there was no legitimate reason to have an engineer look at the same dents, gouges, and tears that their independent adjuster had just seen and photographed. I suspected that the independent adjuster had actually recommended that the claim be paid against the carrier’s wishes, and I requested a copy of his report. Insurance companies almost always share their reports when their report supports a claim denial. For some reason, the carrier did not want to share this one and I was suspicious of their intention.
When I submitted a formal written request for a copy of the report from their independent adjuster that I believed supported my client’s claim for damages, I received a letter from the carrier’s attorney in response that confirmed my suspicions. In part, it read as follows:
“Under Missouri law, the relationship between an insured and the insurer with regard to first-party claims becomes adversarial when a claim is made on the policy. Therefore, the insurer is entitled to assert work product privileges to prevent access to materials found in the claim or investigative file.”
Because my client had filed a claim, he became an “adversary” to his insurance carrier and was not entitled to see documents in his file that might support his claim. In return for his annual premiums exceeding $80,000.00 per year, this is what his money bought for him. An adversarial relationship.
Of course, we’re suing. Soon, that report and all of the other documents in the file will be in the hands of his attorney. He will recover all of the money owed to him by his insurance carrier along with (most likely) punitive damages and his attorney fees. He is, indeed, an “adversary” to his insurance company – but not because he filed a claim. Rather, it was the insurance carrier that decided to vexatiously withhold money that was due to him under his contract rather than to pay him what he was entitled to. That action taken by them, and not his claim, is what made him an adversary … and a worthy one, at that.
