Scott was driving and David was his passenger when they had a car accident. Both of them submitted medical payments claims to AMICA Mutual Insurance Company. AMICA responded by requesting that each submit to a medical examination. Unfortunately, neither of them could find the time to do so. Consequently, neither received any payment from AMICA.

However, Scott and David did find the time to contact an attorney and sue AMICA in an attempt to receive their benefits. The appellate court agreed with AMICA and determined that the insurance company is not required to pay policy benefits unless its terms and conditions are complied with.

Click here for more details on this court case.

Every insurance policy has terms and conditions that specifically state what the named insured must do in order to receive the benefits provided by the policy. If the named insured does not comply with these requirements, payments can be delayed or even denied. Are your insureds aware of what they must do following an accident?

Click here for the PF&M analysis of the
Duties After An Accident or Loss Section of the ISO Personal Auto Policy.

Most insureds don’t discover the true value of their insurance coverage until they have a loss. If the claim handling was satisfactory to them, they are more likely to listen to coverage recommendations and count on your expertise.

Click here for a letter (or an email) you might send
to schedule a time to review coverages.

Scott and David didn’t really understand that most insurance companies verify that a covered loss has actually occurred before they pay it. Others apparently believe that the insurance company has all the rights and that they must simply accept the offer it makes to them. The insurance policy is actually a well-balanced product where both parties have responsibilities as well as rights. Have you considered adding a newsletter article or its equivalent on your website explaining what to expect following a loss?

Click here for an emarketing article you might
want to use on your website or as a newsletter article.

ACORD has withdrawn ACORD 80–Homeowners Application and ACORD 84–Dwelling Fire Application as of September 30th, 2008. . ACORD 88–Personal Insurance Application – Applicant Information Section and ACORD 89–Residential Section used in combination replace both forms.

The December PF&M Update includes an analysis of the 06/07 edition of the ISO Commercial Property Coverage Forms filed effective 11/08 in many states. Pay particular attention to CP 12 32–Limitation on Loss Settlement–Blanket Insurance (Margin Clause). This new endorsement changes the way blanket coverage is written. As a result, some of your clients may be quite unhappy.

Have you found what you need in the Producer OnLine? Is there a classification
to add to the Producer's Commercial Lines Risk Evaluation System or a subject that you would like to see covered in PF&M?  Contact us now.

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