Tendering an Insurance Claim

[Alaskan Sea-Duction]

I found this a good read. What happens when a vendor (mechanic) is injured on your boat. Did you know (at least in California) "the injured party and his attorney have no legal right to know the limits of your liability insurance, or even whether you are insured at all, unless they have filed a lawsuit."


https://www.thelog.com/ask-the-atto...ail&utm_term=0_85f388c485-32ef44f686-47817425

 

[slowgoesit]

Did something happen that suddenly made you decide to research this?!?

 

[ctjstr]

I found this a good read. What happens when a vendor (mechanic) is injured on your boat. Did you know (at least in California) "the injured party and his attorney have no legal right to know the limits of your liability insurance, or even whether you are insured at all, unless they have filed a lawsuit."

Here's the problem with that. The world of what happens with respect to policy limit issues can get complicated. Here's a run down, that I have been involved in more than once. I do this for a living.

I represent the guy hurt on your boat/car/house etc.
I write to your carrier asking for policy limit information. Your adjuster says no, I don't have permission, so I'm not telling. If the issue is important enough, the very next thing I do is draft the lawsuit, sent a courtesy copy to your carrier, and advise him to advise YOU that YOU are being sued because he wouldn't tell me the limits and advise him to pass THAT info on to you. So you get sued when in all probability that would not have happened if I'd been provided the information I asked for. So, you make the call, which works our better for YOU (not your carrier)?

As to why I want to know. If its a bad injury, it will take quite a bit of time, money and work for me to get the case resolved. I can spend hundreds of hours and spend tens of thousands of dollars working on it. If I don't know the limits, I have to assume they are high enough to cover the damages, so I do the work and spend the money. On the other hand, if I know you've got 100,000 in limits and way more in damages, I can save tons of time and money if I know in advance what those limits are and how to approach the carrier. To carry it further, and this is the important part for the insured, if the carrier refuses to tell me, I will on occasion work the case up and send a demand something like this. "dear carrier, enclosed are the docs that support our claim. I am hereby making demand for your policy limits, or xxxx dollars, whichever is less. You have 30 days to pay the policy limits or this demand is off the table, see you in court.
In that event, the carrier can be liable for the excess jury verdict over the limits, and if they are not, you are. There is really not a good reason to withhold the information in case of any significant injury, especially when you know it forces me to file a lawsuit, in which case I can get the limits disclosed almost immediately. This is all state specific, so may not be true for everyone, but in the states I am familiar with, it is.

toni

 

[BruceK]

I found this a good read. What happens when a vendor (mechanic) is injured on your boat. Did you know (at least in California) "the injured party and his attorney have no legal right to know the limits of your liability insurance, or even whether you are insured at all, unless they have filed a lawsuit."


https://www.thelog.com/ask-the-atto...ail&utm_term=0_85f388c485-32ef44f686-47817425

The part I find surprising is the insurance information is available after proceedings commence. Unless perhaps, the claimant is proceeding direct against the insurer because the insured is dead, or bankrupt, etc

 

[Alaskan Sea-Duction]

Seems I touched a never.

I found this interested as I didn't know about the 'Tender' part and that the injured party has no right to your policy info.

Face it insurance is a big part of cruising. Knowing your rights is important.

 

[ksanders]

What bothers me is that someone will claim "damages" to the point of insurance limits knowing that the insurance company will probably settle, making recovery easier.

Seems to me that ifv you are rightfully damaged you make your claim. Insurance coverage is between the insured and their carrier.

Just from the outside looking in, it seems like calims that just happen to be the insurance limits are falsely made up to be that ammount.

Take the idea of a worker getting hurt while working on your boat. Why is that automatically YOUR fault. What did YOU do that was negligent, and how did your negligence cause the persons injury.

 

[BruceK]

What bothers me is that someone will claim "damages" to the point of insurance limits knowing that the insurance company will probably settle, making recovery easier.

Seems to me that if you are rightfully damaged you make your claim. Insurance coverage is between the insured and their carrier.

Just from the outside looking in, it seems like claims that just happen to be the insurance limits are falsely made up to be that amount.

Take the idea of a worker getting hurt while working on your boat. Why is that automatically YOUR fault. What did YOU do that was negligent, and how did your negligence cause the persons injury.

. I thought litigation where there is insurance might be very different USA vs Australia,but it seems not. And yes, the mechanic (unless actually employed by the owner), normally an independent contractor or employee of one, needs to establish that fault of the boatowner caused the injury.

 

[kthoennes]

So let me get this straight -- if I'm the insured -- the party being sued in other words -- you want to be able to compel my insurance carrier to disclose the policy limits (which is really one of the terms of a private contractual arrangement between me and my insurance company), so you can decide whether suing me is worth the time and effort? And you do know that settlement offer amounts and policy limits are usually separate, right? And if you do go to trial (in the U.S. at least) even the existence of insurance coverage, let alone the policy limits, can't be disclosed to a civil jury anyway, right?

I don't work for an insurance company and I'm no company advocate, but it's funny how common it is to think the insurance companies are just evil chiselers with bottomless pockets, and it seldom occurs to anybody that every damage award is ultimately paid by customers through their premiums.

 

[ghost]

We had to find out about this recently after my wife was rear ended by a pathetic druggie, car was on fire, vehicle totaled, she was injured and their insurance started by offering $3500 because “it was no big deal and most people don’t know how to evaluate damages”. Over a year later we finally settled on their insurance max as we decided going after the enabling parents was in this case not morally justified, even though they supplied the car after prior known issues. BUT, it took well over a year before we knew the damage liability would be capped. It IS a relevant thing to understand as unfortunately just having insurance is not enough, one also needs to know HOW and WHEN to use that insurance and same for engaging with legal help.

 

[wkearney99]

Just from the outside looking in, it seems like claims that just happen to be the insurance limits are falsely made up to be that amount.

This.

How much can we grab, and not what costs were actually incurred.

I know things are handled in a more nuanced way than just that.

But the way the comment was worded gave me ZERO sympathy for the plaintiff's side of it.

 

[kthoennes]

And just to be precise, liability and damage awards and recovery are not "capped" by insurance policy limits. You really mean money *from the insurance company* is limited. What would you prefer as the alternative, that we all walk around with - and pay the premiums for - potentially unlimited insurance policies? Again, I'm not an insurance agent or a lawyer and I have no dog on this debate, but insurance companies are not bottomless pools of money that drops out of the sky. Every award comes out of policy holders' pockets.

 

[SteveK]

Anyone ever asked by the agent if you want to increase your liability amount. That ask always made me pause, why would you want to cover me for more, more premium, more commission of course, but what other reason.

Not boat insurance related, insurance deductible limits are used to determine the quoted cost of a particular job. When the estimate approaches the limit 30-40% is added quote because now bottomless pit insurance company is going to pay. I have grown tired of fighting this trend because the insurance companies don't care, they just up premiums.

 

[O C Diver]

To add another twist, what if you have 2 policies. I carry $500,000 in boat liability insurance. Then I have an umbrella policy that's in the millions (picks up where the boat policy ends). I'm certainly not going to reveal the umbrella policy without advice of counsel and or the umbrella carrier.

What really annoys me is the fear that the insurance company might settle the bogus claim out of expediency, possibly resulting in higher premiums or cancellation.

Ted

 

[slowgoesit]

Bottom line: Insurance companies will do everything in their power to protect THEIR interests, not the interests of the insured. Many times they end up being the same, but that's not the insurance companies primary concern . . . .

 

[ksanders]

We had to find out about this recently after my wife was rear ended by a pathetic druggie, car was on fire, vehicle totaled, she was injured and their insurance started by offering $3500 because “it was no big deal and most people don’t know how to evaluate damages”. Over a year later we finally settled on their insurance max as we decided going after the enabling parents was in this case not morally justified, even though they supplied the car after prior known issues. BUT, it took well over a year before we knew the damage liability would be capped. It IS a relevant thing to understand as unfortunately just having insurance is not enough, one also needs to know HOW and WHEN to use that insurance and same for engaging with legal help.

I'm a bit less sympathetic I suppose.

If... and this is a big if my wife or I are ever injured through another's negligence we will not even be considering insurance caps.

We will attempt to recover what we were actually damaged, no more and no less.

frankly if that bankrupts someone I do not care. On the other hand if the person has insurance for a higher amount than we are damaged I do not care.

I think it is a reasonable expectation to be made whole if damaged by actual negligence of another, and I think it is not reasonable to attempt to claim negligence just because we might be able to get an insurance company to pay up.

 

[BruceK]

To add another twist, what if you have 2 policies. I carry $500,000 in boat liability insurance. Then I have an umbrella policy that's in the millions (picks up where the boat policy ends). I'm certainly not going to reveal the umbrella policy without advice of counsel and or the umbrella carrier. Ted

In Australia there is law surrounding "Dual Insurance", where for one reason or another,an insured has 2 policies covering the same risk, in whole or part. Policies commonly had a clause saying that if there was other insurance, the policy would not operate. So,if you had 2 policies, neither operated, you were uninsured! Even the Courts recognized that was madness, and came up with a method of attributing the loss to both policies, quite complex in some cases. I was involved in one case which helped clarify the conflict and resulting mess.

 

[BruceK]

Anyone ever asked by the agent if you want to increase your liability amount. That ask always made me pause, why would you want to cover me for more, more premium, more commission of course, but what other reason...

Don`t know about Canada, but from what I`ve read on TF, the US public liability cover amount is $.5-1M range. In Australia it`s usually $10M Aud.

Every instance is individual, but it sounds like good advice given in the interests of ensuring the insured was properly protected by adequate cover if standard cover is the modest amount above.

 

[Art]

Seems pretty simple, for self protection, I guess...-

Make sure the mechanic has their own minimum $500K insurance for any injury they may incur on my boat. Easy to say... not always available.

 

[ghost]

I'm a bit less sympathetic I suppose.



If... and this is a big if my wife or I are ever injured through another's negligence we will not even be considering insurance caps.



We will attempt to recover what we were actually damaged, no more and no less.



frankly if that bankrupts someone I do not care. On the other hand if the person has insurance for a higher amount than we are damaged I do not care.



I think it is a reasonable expectation to be made whole if damaged by actual negligence of another, and I think it is not reasonable to attempt to claim negligence just because we might be able to get an insurance company to pay up.

Trust me when I say that moral decisions were a part of our considerations. That said, no, we were/are very likely a long way from being made whole. When you settle, you don’t just have to consider what you know now, you have to consider what you don’t or won’t know until long after the settlement is done. My wife has permanent damage. We can only guess how that will further materialize some day, but little to no doubt it will. You won’t be going back later for the extra. The max liability barely covered her car replacement and current medical expenses. I can only tell you it changes how you look at it when it is not just theory. Especially when somebody uses the term “accident”, which I personally can’t call this level of stupidity. But it’s done and now we forever live with the consequences of someone else’s decisions.

To the insurance companies, it’s a game, it’s an equation, it’s some office workers bad day or simply the thrill of trying to spar with someone else. We don’t do this regularly and will never equal those who do it every day as their job. Learn what you can, because when it matters, you realize you are already behind the eight ball and probably already made tactical mistakes.

 

[ctjstr]

So let me get this straight -- if I'm the insured -- the party being sued in other words -- you want to be able to compel my insurance carrier to disclose the policy limits (which is really one of the terms of a private contractual arrangement between me and my insurance company), so you can decide whether suing me is worth the time and effort? And you do know that settlement offer amounts and policy limits are usually separate, right? And if you do go to trial (in the U.S. at least) even the existence of insurance coverage, let alone the policy limits, can't be disclosed to a civil jury anyway, right?

I don't work for an insurance company and I'm no company advocate, but it's funny how common it is to think the insurance companies are just evil chiselers with bottomless pockets, and it seldom occurs to anybody that every damage award is ultimately paid by customers through their premiums.

Has nothing to do with being chiselers. its about risk. One of the first thing the carrier does, or tries to, is assign an amount as a reserve for the claim. So, barring unforeseen circumstances, they have at least some idea what their exposure is. They also know that as cases develop, the damages can often get higher the longer the case goes unresolved. So they will settle. Closed head injuries are a perfect exampple. They often do not show up for a while, but when they do, they can add enormous sums to the value of the case. Same with disc problems or joint replacements. So they will often try and get a case resolved by paying the limits knowing that if it goes on too long, they can have much higher exposure. They choose not to take that risk. just like I will sometimes resolve a case quickly at a lower number that I might otherwise have thought, if I suspect that my client is going to make a terrible witness, or is doing something else that will eventually make his case worse. Its risk on my side as well.

An example of what i said earlier: I have a case for a fellow that was a passenger in a van, so he is fault free. As a result of the wreck, he has medical bills close to 250k. I know the policy limits are less than 100k. The way I work on the case differs knowing that. For example, I will not hire an economist to calculate wage loss. I will not hire a life care planner to calculate the cost of his future care. I won't worry about some sort of forensic medical expert to review and explain the treatment and bills. I also know that unless the carrier is the village idiot, they will pay the policy limits because if they do not, I'll be forced to hire those experts, at a cost of 30k or so and no way will I be willing to accept the policy limits. They had their chance and turned it down, so now they will likely pay what a jury awards.

there can be excesses on both sides. I'm an expert at what I do, but so are insurance adjusters and their lawyers. If I were to bet, I'd wager that insurance companies short change claimants far more often than us unscrupulous lawyers take advantage of the poor insurance industry. For every "frivolous" claim made, there are just as many "frivolous" defenses thrown up to reduce claims. Its just the way the system works. Its adversarial, no matter how much we wish it weren't.

 

[BruceK]

Most cases involve negotiation. But once, in the case of a claim by family(dependents) arising from the death of a worker, the family`s lawyer put an offer, the insurer I was acting for said "we don`t chisel widows and orphans, if that`s what they want, we`ll pay it", and we did. Biggest difficulty was the family`s lawyer, a decent and earnest guy, chiding himself for not asking enough if his first offer was met in full. I explained the insurers somewhat atypical attitude and that he`d got the figure just right, no more no less.
Insurer attitudes vary, some are fair, some are awful. I`ve even said once, if the claims manager wants to make that offensive offer(a one way ticket to an overseas country) he can come here and do it himself, because I`m won`t.

 

[Steve DAntonio]

All of this is an excellent reminder to thoroughly review your insurance policy, and if you are unable to fully understand it (pretty common), take it to an attorney who specializes in insurance litigation to explain any shortcomings. I recommend this approach for many of my clients, to ensure they aren't under insured or unnecessarily exposed. It's a small but worthwhile investment. Problems often arise after a claim, wherein the boat owner/insured, often says, "I didn't know that about my policy". Avoid being that person by having your policy professionally reviewed, preferably by an attorney who specializes in representing plaintiffs in insurance claims.

In many cases, I'm also guiding my clients to an attorney who specializes in this type of law, in the case of a damage loss claim, as these can be very complex issues to navigate. I find adjusters almost always amend their initial proposal after the right language is used by the insured, when he or she is being guided by an attorney.

 

[Seevee]

Help me out here a bit...


Why are we so hell bent on "insurance"? Why are we not more concerned about our actions that could cause injuries?



Seems to me, to pay damages, one has to be negligent. If a mechanic comes onto your boat, he should know the risks of being hurt. If one is a reasonable boater and takes reasonable precautions, why would he be negligent? If he stores an open can of gas in the engine room and it explodes when he drops his cigarette, perhaps he's negligent. If the mechanic slips, falls into a hole or wrenches is back, HE'S negligent. The boat owner didn't cause that.


I could argue stronger for being a good steward of your boat, and back up with good asset protection. And a good liability policy (which is your first line of defense).


I'm not a subscriber of disclosing policy limits. I've seen that backfire a few times. Gut feeling, if there's no money for the lawyer, why would he even take the case and that's what we want to have happen.


Comments?


Toni?

 

[ksanders]

Has nothing to do with being chiselers. its about risk. One of the first thing the carrier does, or tries to, is assign an amount as a reserve for the claim. So, barring unforeseen circumstances, they have at least some idea what their exposure is. They also know that as cases develop, the damages can often get higher the longer the case goes unresolved. So they will settle. Closed head injuries are a perfect exampple. They often do not show up for a while, but when they do, they can add enormous sums to the value of the case. Same with disc problems or joint replacements. So they will often try and get a case resolved by paying the limits knowing that if it goes on too long, they can have much higher exposure. They choose not to take that risk. just like I will sometimes resolve a case quickly at a lower number that I might otherwise have thought, if I suspect that my client is going to make a terrible witness, or is doing something else that will eventually make his case worse. Its risk on my side as well.

An example of what i said earlier: I have a case for a fellow that was a passenger in a van, so he is fault free. As a result of the wreck, he has medical bills close to 250k. I know the policy limits are less than 100k. The way I work on the case differs knowing that. For example, I will not hire an economist to calculate wage loss. I will not hire a life care planner to calculate the cost of his future care. I won't worry about some sort of forensic medical expert to review and explain the treatment and bills. I also know that unless the carrier is the village idiot, they will pay the policy limits because if they do not, I'll be forced to hire those experts, at a cost of 30k or so and no way will I be willing to accept the policy limits. They had their chance and turned it down, so now they will likely pay what a jury awards.

there can be excesses on both sides. I'm an expert at what I do, but so are insurance adjusters and their lawyers. If I were to bet, I'd wager that insurance companies short change claimants far more often than us unscrupulous lawyers take advantage of the poor insurance industry. For every "frivolous" claim made, there are just as many "frivolous" defenses thrown up to reduce claims. Its just the way the system works. Its adversarial, no matter how much we wish it weren't.

That is a wonderful explanation, and a sad example of an accidents results.

Here is a question... and this is important.

If you have a case like the one you described and the at fault party has significant assets like a house, boat, or other non protected assets is there a real risk of a injured party suing for their actual damages Vs their policy limits?

 

[Wataworld]

Workers Compensation

I am wondering if Florida is the only state with Workers Compensation Insurance. The original Post was about a mechanic who entered the boat why would he be entitled to any of the boat owners policy. Now his employer might be liable let's say the mechanic hurt his back and the employer new the job would take two people to resolve the repair,. No fault of boat owner.
Gregg Ditzian

 

[ancora]

To sum up...you pay for "insurance" but you are not insured.

 

[ctjstr]

That is a wonderful explanation, and a sad example of an accidents results.

Here is a question... and this is important.

If you have a case like the one you described and the at fault party has significant assets like a house, boat, or other non protected assets is there a real risk of a injured party suing for their actual damages Vs their policy limits?

sorry this took a while to respond. The answer is yes. if the injuries are bad enough and insurance "light" enough, you can bet there is a good chance that the claimant will have an asset search done, and perhaps make a claim. In 40 plus years, I've done it maybe a couple times, very rarely.
toni

 

[ctjstr]

I am wondering if Florida is the only state with Workers Compensation Insurance. The original Post was about a mechanic who entered the boat why would he be entitled to any of the boat owners policy. Now his employer might be liable let's say the mechanic hurt his back and the employer new the job would take two people to resolve the repair,. No fault of boat owner.
Gregg Ditzian

No, most states I know of there is workers comp. It protects the EMPLOYER, not third parties. So, if joe is working for acme marine, who sends him out to work on my boat, and joe gets hurt, yes, he'll be covered by workers's comp, but if he can make the case that I did something negligent, he can sue me. If he's been covered by workmens comp, and IF I recover from the at fault boat owner, I have to reimbursed workmen's comp according to their statutory schedule.

 

[ctjstr]

Help me out here a bit...


Why are we so hell bent on "insurance"? Why are we not more concerned about our actions that could cause injuries?



Seems to me, to pay damages, one has to be negligent. If a mechanic comes onto your boat, he should know the risks of being hurt. If one is a reasonable boater and takes reasonable precautions, why would he be negligent? If he stores an open can of gas in the engine room and it explodes when he drops his cigarette, perhaps he's negligent. If the mechanic slips, falls into a hole or wrenches is back, HE'S negligent. The boat owner didn't cause that.


I could argue stronger for being a good steward of your boat, and back up with good asset protection. And a good liability policy (which is your first line of defense).


I'm not a subscriber of disclosing policy limits. I've seen that backfire a few times. Gut feeling, if there's no money for the lawyer, why would he even take the case and that's what we want to have happen.


Comments?


Toni?

its never that simple. Yes, as the owner most often you don't owe unless you do something negligent, or leave something in a dangerous condition. EG, the workman slips on some water in the galley that you shoudl have spotted and cleaned up, you could be liable. To make it worse, there can be cases of "strict liability", where all you have to do is prove you've been injured, and if so, the property owner is liable simply because its a known dangerous condition that he has a responsibility to inspect and keep clean. Floors in front of the veggie aisle where the veggies get sprayed every half hour or so. If I fall on one of those areas, its almost strict liability. The owner has a duty to inspect and clean,, or warn, regardless if he knows there is a wet spot. That its often wet and he didn't inspect it enough. That's why you see so many "wet floor"signs everwhere.