Why disclosing material facts is crucial in insurance

When Does a Restoration Contractor Become an Adjuster? Lessons from Wisconsin’s $6,000 Wake-Up Call The Wisconsin Office of the Commissioner of Insurance recently issued a final decision that should be read by all my friends in the insurance restoration contractor industry so this does not happen to you. The case involved a contractor who crossed the bright line between repair work and insurance claim negotiation and it ended with a $6,000 forfeiture, a public reprimand, and a clear message from regulators. The order tells a story that’s become all too common. An insurance restoration contractor, eager to “help” a homeowner, included an assignment of benefits clause in his contracts, advertised claim assistance, and even spoke directly with the insurer about claim amounts. In doing so, he wasn’t just fixing property but was adjusting a claim without a license. Worse, during a heated negotiation, he falsely claimed that the Insurance Commissioner had told him the insurer was “playing by its own rules.” That statement, deemed a fraudulent misrepresentation, earned him a $5,000 penalty by itself. This decision cuts deeper than a single case. It reminds us that adjusting a porperty insurance claim is not a casual act of customer service. Instead, it’s a regulated profession with defined boundaries. Insruance restoration contractors who insert themselves into claim negotiations risk more than fines; they undermine their credibility and expose themselves to penalties that could jeopardize your contractor license. I have long said that property insurance claims handling is not just about numbers. It’s about integrity and all of us in this field have to respect our legal lane. Whether you wear the hat of a contractor or a public adjuster, you must know where your role ends and where another begins. The Wisconsin Commissioner’s order is more than a penalty; it’s a warning shot to everyone in the claims business to respect the boundaries of our professions and the trust that comes with them.

Insurance Restoration contractors need to read this decision from Wisconsin discussing the line between a restoration contractor and adjuster in an insurance dispute.

As a leading insurance claim appraisal company within the state of Texas, My Claim Appraisal has provided our recommendations to the Texas Department of Insurance regarding the recent legislative changes involving the insurance claim appraisal process. Specifically, 28 TAC 5.9800, .9801, .9802, .9803, .9804, .9805. At My Claim Appraisal, our core perspective is that claim appraisal, when structured efficiently and correctly, serves as the most effective tool for Texas consumers, particularly the working class, to achieve the proper identification of their damage and the cost to repair those damages after they have submitted an insurance claim. By utilizing impartial parties, it is intended to be a faster and less expensive alternative dispute resolution mechanism than hiring a Public Adjuster or Attorney. The focus should be on ensuring this mechanism is functional, fast, and affordable, as intended by the Texas legislature. Attached is our recommendation to the Texas Department of Insurance surrounding the Residential Property Appraisal Process, sent by one of our Founders who is also a Texas resident and insurance policyholder. As with every recommendation we make as a company, our focus will always be on the policyholder, and what is best for the policyholder. Although some critics may disagree with our timeline recommendation, based on our company’s results, we know these timelines are achievable when the proper practices and processes are in place by companies and individuals that choose to be involved with the claim appraisal process. Our recommended timeline will directly benefit the policyholder by bringing a quick conclusion to a disruptive and stressful time of their lives. 

RIV (Reinstatement Value) insureds need protection   It is well known that RIV policies indemnify insureds more completely than market value policies. However, court cases indicate that insurers act unilaterally in such cases and prejudice their customers severely. One such recent case is United India v M/s Valley Iron & Steel (2025), decided by the Delhi High Court. In this case the insured sustained near total loss owing to a cloud burst in their area and the entire plant was submerged in mud and debris with damage all round. They had a RIV policy and as per the request of the surveyor, submitted a plethora of documents for assessing the loss on RIV basis. The insured started reinstatement but owing to various reasons the same could not be completed in 12 months and the insurer compelled a settlement of Rs. 10 crores on market value basis even though the claim was for Rs. 58 crores. The insured claimed that they were coerced into signing the discharge voucher. The insured made repeated pleas for on account payments, but they were not considered and as a result the reinstatement stopped and finally the claim had to be settled by Arbitrators for Rs. 33 crores on market value basis. In this regard the HC cited a similar case in the Madras High Court: Hefc Ergo General Insurance Co Ltd vs M/S Rohini Movie Park Rukmini (2019), where the HC stated in para 50: “In the given case, contention of the insurance company is in fact contrary to the public policy. The petitioner case is contrary to the written insurance policy. Taking advantage of the distress situation of its client, forcing the insured to receive compensation, is unreasonable and contrary to the own assessment of loss. Quoting depreciation and under-insurance, which is not applicable for Reinstatement Value policy is against law and public policy.” The HC also cited Renasa Insurance Company Ltd. v. Watson [2016] ZASCA 13 where it was held that “an insurer cannot take advantage of its own breach by withholding payment and thereafter insisting that the insured failed to reinstate within the stipulated period. The Court emphasised that insurers are expected, at the very least, to release the indemnity value to enable reinstatement, and failure to do so frustrates the very mechanism envisaged by reinstatement clauses.” Another case cited was Great Lakes Reinsurance (UK) SE v. Western Trading Ltd. [2016] EWCA, in which “the Court recognised that an insured cannot be said to have failed to act with “reasonable despatch” in reinstating property where liability is either denied or unreasonably delayed by the insurer.” (para. 98). It is clear that the IRDAI needs to encourage RIV policies but safeguard insured’s interests by a special Protection of Policyholder section for these policies highlighting the need for interim payments at least upto market value level and ensuring that the 12 month period in the clause is not used for arm-twisting the insured into a market value settlement etc.  

Underinsurance. We wring our hands over this in the insurance industry. It happens in all types of insurance - both commercial and private lines. But do we really understand what it is, why it happens and - importantly - the role of the broker? Case study here of where it happened - and the broker was deemed "at fault" for not providing the right advice. This example is a business case - but arguably the risks for a personal lines broker are even higher, as a personal lines customer would be expected to have a much lower level of basic understanding. One of the biggest issues is ensuring the policyholder correctly declares the sum to be insured. That is the responsibility of the policyholder. But the broker needs to ensure they have made the policyholder fully aware of this responsibility, and the risk if not done correctly. One way of doing this for personal lines clients is to (strongly) suggest they get a valuation - maybe even providing a recommendation to someone like Rachel Doerr who can do it for you. Even a MNW client should strongly consider a walk-through valuation. And many commercial businesses should consider valuations for assets - there's been a spate of trophy thefts from golf clubs recently, with quite a few of those clubs finding they don't have the cover they need... https://lnkd.in/eEfgixc3

Morrison Mahoney Partner Cara Joyce recently argued successfully at the Connecticut Supreme Court, prevailing on behalf of her insurance agency client. Cara had previously obtained summary judgment at the trial court stage and prevailed before the Appellate Court in relation to this matter as well. Plaintiffs’ homeowner’s insurance claim was denied by the insurer after a house fire because their policy had non-renewed days prior when they failed to replace a portion of missing siding on the house that was identified in an inspection. The insurance company had notified the agency of the inspection results and asked the agency to pass the information about the needed repairs on to the plaintiffs. The agency sent the plaintiffs a certified letter informing them of this, per Connecticut’s statutory requirements. Plaintiffs never claimed the letter, the policy non-renewed, and ~10 days later, their house burned down in an accidental fire. The insurance company declined to cover the claim, as the policy had non-renewed. Plaintiffs claimed they were never informed of the inspection results by the agency. They sued the insurance company and the insurance agency, claiming that the insurance agency had a duty to inform them of the impending non-renewal. All defendants obtained summary judgment, which was affirmed on appeal. The Appellate Court concluded that most of the plaintiffs’ claims were unpreserved and affirmed the trial court that the insurance agency had no duty to inform them of the non-renewal. The Supreme Court granted certification to the insurance agency only, and in a 4-2 decision with two judges dissenting, the Supreme Court affirmed the lower courts’ rulings in favor of the insurance agency defendant. The Supreme Court agreed that the plaintiffs’ claims of a long-standing relationship with the insurance agency did not provide an exception to the general principle that an insurance agency’s duty ends when they have procured the policy they were requested to procure. This win limits our client’s duty and confirms that they have no ongoing duty unless special circumstances exist. Great work, Cara! Read more here: https://lnkd.in/eP8fBtTj

⚠️ An Open Message to All RSA (Now Intact Insurance UK) Policyholders On 6 October 2025, RSA quietly announced that its UK operations have “transitioned” to a new brand, Intact Insurance UK. At first glance, this looks like a simple rebrand. A fresh name, a new logo, and the usual marketing language about “expertise, trusted partnerships, and a new way to keep business moving.” But behind the polished press release lies a more serious question every policyholder should ask: What exactly has changed, and what hasn’t? Because a name change does not erase corporate history. It does not rewrite how customer complaints were handled. It does not undo how claims were delayed, documents fabricated, or cases mishandled. And it certainly does not wipe away accountability. RSA’s record with consumers and the Financial Ombudsman Service tells a long story, one of obstruction, data concealment, and unresolved disputes that remain active to this day. Those same files, staff, and policies have now been folded into Intact Insurance UK. So, to every existing RSA policyholder, and to anyone considering a policy under the new name, you have the right to know: Are your data and claim records being transferred transparently? Will ongoing complaints be handled under the same standards and case numbers? Is Intact assuming full liability for RSA’s unresolved obligations? Before celebrating a “fresh identity,” policyholders deserve full disclosure. A change in branding should not be used to obscure a history of misconduct or avoid regulatory scrutiny. If Intact Insurance UK truly wants to “keep business moving,” it should start by honouring every existing claim and releasing a public statement confirming continuity of responsibility for all RSA cases. Until then, remember: A company can change its name overnight. Accountability cannot.

Last month, a team member watched me review an insurance policy starting from the last page. "That's... different," she said. Let me explain why we do this; and what it catches. Years ago, I noticed a pattern. The most restrictive definitions, the narrowest interpretations, the clever exclusions - they lived in the back half of policies. Page 200 had the teeth. Page 1 had the smile. So we flipped our process. We now read every policy three times. First pass: backwards, definitions first. Second pass: forwards, coverage grants next. Third pass: diagonal - following every cross-reference, every "subject to," every "as defined in Section." It sounds excessive. Until you see what it finds. Last week, page 3 promised broad professional services coverage. Page 187 defined professional services to exclude "administrative acts." Page 94 defined administrative acts to include "processing applications." For an MGA that processes applications all day, that's no coverage at all. The traditional front-to-back reading would see the promise before the restriction. Our backwards approach sees the restriction first, then questions the promise. The insurance market has evolved. Policies have become three-dimensional documents; meaning changes based on which angle you approach from. Reading backwards isn't about being contrarian. It's about seeing what's actually there, not what you expect to find. Our team member now reads backwards too. She found a seven-figure gap in her first review. The client had been told their coverage was "comprehensive" by the prior broker. It was. If you only read forwards. Perspective changes everything. In insurance, the ending often rewrites the beginning. By the way… Every week we share curated insights that cut through insurance chaos and help you make the best policy decisions: Join here: https://lnkd.in/garzxSxG

#MissionIndia2047🇮🇳 #InsuranceForAll🤗 🤗Utmost Good Faith 👍 *2nd of 7 Principles of Insurance which affect Insurance Claim* **Uberrimae Fidei**, or the principle of "utmost good faith," is a foundational concept in insurance law that requires both parties in an insurance contract—the insurer and the insured—to act honestly and disclose all material facts related to the policy. Here’s an overview of the principle and its impact: ### Overview of Uberrimae Fidei 1. **Definition**: - Uberrimae Fidei means that both parties must engage in utmost good faith, fully disclosing all relevant information that could influence the terms of the insurance contract. 2. **Application**: - This principle applies to all types of insurance, including life, property, and marine insurance. It mandates that the insured must provide accurate information about the risk being insured. ### Impact of Uberrimae Fidei 1. **Trust and Transparency**: - The principle fosters trust between insurers and policyholders. It encourages open communication, which can lead to better risk assessment and tailored coverage. 2. **Reduction of Fraud**: - By requiring full disclosure, uberrimae fidei helps prevent fraudulent claims and misrepresentation. Insurers can make informed decisions based on accurate information. 3. **Contract Validity**: - If either party fails to uphold the principle of utmost good faith, the contract may become void. For instance, if an insured fails to disclose a pre-existing condition in a life insurance policy, the insurer may deny claims based on that information. 4. **Claims Handling**: - The principle affects how claims are processed. If the insurer finds that the insured did not act in good faith, it may refuse to pay the claim, even if the event occurred. 5. **Legal Consequences**: - Breaches of this principle can lead to legal disputes. Insurers may take legal action against policyholders for misrepresentation, which can undermine the insured’s ability to claim benefits. 6. **Risk Assessment**: - Insurers rely on accurate disclosures to assess risk. This principle helps them set appropriate premiums and coverage limits based on the true nature of the risk involved. ### Conclusion Uberrimae Fidei is crucial for maintaining the integrity of the insurance industry. It ensures that both parties are protected and that the insurance system functions effectively. By promoting transparency and honesty, it ultimately supports a more ethical and fair insurance environment. *||Food 4 Thought||* 👉Everyone plan wealth but overlook two vital questions:👇 - If I’m not around, is my family protected? 🤔 - When I stop working, will income continue??🤔 👉For Free Consultation and Unbiased Advice at your convenience Watsapp at 👇 +91 9336377772 (INDIA)🇮🇳 +973 39269573(BAHRAIN)🇧🇭 #NRI #Expats #Indiansabroad #NonResidentsIndian #GCCExpats #UAEExpats #Bahrain #Insurance #MutualFund #MetLifeGulf

Encouraging to see Florida's leadership making bold moves that both protect consumers and support a healthier insurance market. Lower auto insurance rates paired with improved carrier profitability is a rare win-win. Smart regulatory reform can drive real results, and Florida is setting an example worth watching. California should pay attention!