What should I include in a Notice of Claim letter to the Insurance Company?

Had an accident? A fire? Someone’s sued you? You need notify your insurance company. The repercussions of when you do this is a topic for a different post, but do it as soon as you can. What do you tell the insurer? There are differing opinions on this. In this post, I’ll let you know what I put into a notice of claim letter to insurance companies.

The short answer—it depends. It depends on the policy(ies) at issue, the type of claim, the type of policy, the coverage problems at issue, etc. If you’re really concerned, talk to an attorney.

That being said, here are some guidelines to include in your notice letter.

First, if you know the policy(ies) numbers that are implicated, you should include those. I suggest you also state “and any other applicable policies.”  You may not know initially which policies are actually triggered and at issue at the start.

Second, it is helpful to identify the person or entity covered under the policy. This, (along with the policy number(s)) assists the insurer figure out the policies that are at issue.

Third, you should include description of the claim. If you’ve been sued, I wouldn’t characterize the lawsuit. Doing so could impact the coverage analysis. Just inform the insurer that you’ve been sued and attach a copy of the complaint. If there’s been an accident, I’d follow the same guidance. Just say you’ve been in or had an accident. You can identify when, where, and the contact information of others involved. You can attach a police report if available. I wouldn’t address who you think was at fault.
 

I think it is a good idea in your notice to request a “Certified” copy of any applicable policies. In Indiana, insurers have an obligation to do provide you a copy. If they do not, they could lose their coverage defenses.

If you already have a lawyer, a contractor, etc. involved, let the insurer know who you’re using. Request the insurer to advise you if they suggest someone else. I’d also state that you’ll forward the insurer their bills. This helps minimize a potential subsequent argument that you didn’t use the right person/organization.

I would send this letter certified mail so that you have proof you sent it and when the insurer received it.

Finally, I would also send notice to your insurance agent/broker. Ask them to pass the notice letter along to any potential insurer. I’d also ask them for copies of the policies as well.

Good luck. As always, this is not legal advice.

Insurance Coverage for Brown Recluse Spider Infestations

Everyone shutters when they hear Brown Recluse Spiders. They’re hideous. As the comedian Ricky Gervais so eloquently notes: "They're always ready!"

 

 

Can you imagine if you found one in your house?

 

What would you do if your home was infested with them—hundreds of them? Most would say, CALL THE EXTERMINATOR ASAP. Pretty good advice, but I’d recommend calling your insurance company first. Insurance coverage likely exists—despite what your insurance company and/or your agent says.  Depending on your policy, your insurance company should pay to exterminate the spiders and provide you a place to live in the meantime.

These mass infestations are rare, but they do occur. They occur frequently enough that I’ve had multiple matters dealing with this issue. This can be a traumatic time for a family, especially if there are children and individuals with compromised immune systems living in the home.

I wouldn’t be a bit surprised if your insurance company denies your claim. Don’t worry—there’s hope.  The insurer will likely at least raise two issues. First, it will say there’s no coverage because there is no “direct physical loss.” Second, it will deny the claim based on the “insect” exclusion. Neither of these defenses works.

Taking the latter first, spiders are not insects. This is something we learn in grade school. While some folks may have forgotten it, it is common knowledge that spiders are not insects. Everything from children’s books and dictionaries to scientific research papers note the distinction. Spiders have eight legs and two body parts. Insects have six legs and three body parts.

Insurers also argue that an infestation is not a “direct physical loss.”  They claim that because there is no physical damage to structure there is no “direct physical loss.” Courts around the country have held, in a variety of situations, that there does not need to be physical damage to structure to have “direct physical loss.” I have been successful convincing a court and insurer this is the case on two separate occasions, both of which involved brown recluse spiders.

Of course, depending on the facts of your cases, there may be other issues. At a minimum, be prepared to address these two arguments from the insurance industry. Go and fight the good fight.

As always, this is not legal advice and I am not your attorney.