How Policy Analysis Can Determine Whether a Case Gets Taken
No one wants to hire an attorney to file a lawsuit, especially after an already long and arduous process. Sometimes, however, litigation is the necessary next step. As public adjusters, our goal is always to resolve a claim without reaching that point, but sometimes, despite our best efforts, an impasse with the carrier can occur. When it does, engaging counsel becomes essential to achieving a fair outcome for the policyholder.
“Litigation is never the first choice, but Premier Claims approaches every claim with that possibility in mind. Our responsibility is to ensure the policyholder’s position is strong long before a lawsuit is ever filed.”
When Litigation Becomes Necessary in a Property Insurance Claim
Before litigation can proceed, an attorney must be licensed in the jurisdiction where the loss occurred and must believe both the evidence and the policy language support the case. Insurance policies are often written in a way that makes advisory language appear enforceable. In this matter, counsel initially advised the claim would not be worth pursuing due to a cosmetic exclusion in the policy.
Why Insurance Language Matters More Than You Think
As the public adjuster, we owed a duty to our insured to investigate that conclusion further. Our role doesn’t end with scope or negotiation with the carrier; it extends into policy mechanics and interpretation. Upon review, we determined the cited language was not an operative exclusion at all. The introductory language to the notice was critical to understanding the language that followed.
Advisory Language vs. Operative Exclusions
Insurance policies often contain notices, advisory provisions, and endorsements that may appear to be exclusions but are not automatically enforceable. The structure of the policy determines what is binding and what is conditional.
Understanding Endorsements and the Schedule of Forms
The cosmetic exclusion in question was part of an endorsement that can alter roof valuation to actual cash value and/or add a cosmetic exclusion. For either to apply, the endorsement must be listed in the Schedule of Forms and Endorsements, and it must indicate which provision applies and to which property(ies).
The endorsement was neither scheduled nor included in the policy documents provided.
How Proper Policy Interpretation Changed the Outcome
Our associate attorney, Trevor Matulka, walked counsel through where the exclusion actually resided, the conditions required for it to apply, and why those conditions were not present in the policy. Once it was read in its proper structure, the premise that litigation wasn’t an option no longer held.
Litigation was no longer speculative; it was supported. As a result of our analysis, the attorney agreed to take the case, ensuring the policyholder could pursue this additional avenue to resolve their claim and ultimately, seek full indemnification under the policy.
Litigation Begins in the Policy, Not the Courtroom
Litigating a property insurance claim does not begin in the courtroom. It begins in the policy. Everything we do as public adjusters is intended to place the insured in the strongest possible position after a loss. When faced with an impasse with a carrier, the work we’ve done up to that point often determines whether a claim sees a courtroom at all.
Our job is to make sure that valid claims are paid properly, whether through negotiation or by making sure insureds do not lose their rights simply because a policy was not read all the way through.
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