Claims Adjusters

News & Analysis as of

District of Colorado: Insureds Have No Obligation To Hire Public Adjusters To Recover Amounts Due Under A Policy

Norman v. State Farm Fire & Cas. Co., No. 13-CV-01643-PAB-CBS, 2014 WL 6478046 (D. Colo. Nov. 19, 2014). District of Colorado holds that insured has no duty to hire own adjuster in order to receive payment, and denies...more

Checklist of Affirmative Defenses for NC Comp Claims

Although arguably the most important determination an adjuster makes when a claim is filed is whether or not the claim is compensable, before even contemplating that question, the adjuster should consider whether or not the...more

FLSA Insurance-Adjuster Overtime Exception Buried In Appropriations Bill

Section 111 of the recently-enacted "Department of Labor Appropriations Act, 2015" directs that the federal Fair Labor Standards Act "shall be applied as if" there is an overtime exclusion for certain workers who are employed...more

And Another Texas Court Realizes What The Hail Is Going On?

Another Texas court -- this time in the Valley -- has realized What The Hail Is Going On? Nino vs. State Farm Lloyds is identical to thousands of hail damage lawsuits presently pending in the Valley. Most of these...more

With Respect to Discoverability, Indiana Federal Court Distinguishes Between Pre-Suit and Post-Suit Reserves

In May, we reported on a Third Circuit decision holding that loss reserve information was generally irrelevant and not discoverable. In October, a federal court in Indiana came to the same conclusion with respect to...more

Texas Supreme Court Denies Policyholder’s Discovery Regarding Claims Handling

It is rare to see a state’s highest court address a discovery issue. But the Supreme Court of Texas did just that recently in In re National Lloyds Insurance Co., holding that a policyholder’s demands for discovery about how...more

New York Appellate Court Dismisses Claims Against Reinsurer And Its Claims Administrator

In what began as a dispute between OneBeacon America Insurance Company and its insured, Colgate, over OneBeacon’s asserted right to control the defense of claims against Colgate in connection with numerous personal injury...more

Lawful Shmawful: Ninth Circuit Ignores Lawful Written Policy and Uses Statistical Sampling to Certify Class Based on Alleged...

On September 3, 2014, the U.S. Court of Appeals for the Ninth Circuit upheld certification of a class of approximately 800 nonexempt insurance claims adjusters who claimed they worked overtime without compensation despite the...more

Claims Handlers: It’s Time to Adjust Our Claims!

Many insurers have a longstanding practice of paying claims adjusters a set weekly salary, regardless of the number of hours they actually work. The practice has support in federal labor regulations; the regulations...more

Federal Courts Continue To Find Claims Adjusters Exempt

We have previously discussed how, over the past 10+ years, courts have increasingly recognized that insurance claims adjusters are exempt under the Fair Labor Standards Act (FLSA). The recent cases of Estrada v. Maguire Ins....more

Estimates vs. Bids: Determining Insurer Obligation

The typical property insurance claim begins with notification of a loss from the insured or its broker. Thereafter, the carrier sends out an adjuster to investigate the loss and determine whether, and to what extent, coverage...more

Dr. Dettling Talks About Shoulder/Knee Work Injuries

Orthopedic surgeon James Dettling, M.D. specializes in shoulder and knee injuries. About half his patients are injured workers treating under a Nevada workers' comp claim. He and long-time medical assistant, Patrick...more

California Court Holds An Adjuster May Be Personally Liable For Misrepresentations Made To The Insured

Earlier this month, an intermediate level California court rejected arguments that an insurance company’s adjuster owes no independent duty to the policyholders and cannot be liable even for “appalling” misconduct if he is...more

New York District Court Grants Summary Judgment Against FLSA Class of Insurance Claims Adjusters

In a number of cases, the plaintiffs’ strategy in collective active litigation under the Fair Labor Standards Act may fall into a familiar pattern: file the case, do minimal discovery, move for conditional certification under...more

The CGL “Business Risk” Exclusions

I recently came upon an interesting case from the United States Court of Appeals for the First Circuit that examined the complex and confusing Commercial General Liability (CGL) “business risk” exclusions. Oxford Aviation,...more

The Non-Response (De Facto) Denial

Injured workers have the right to file an appeal if the claims adjuster does not respond to a written request within 30 days. Attorneys are usually the only ones that know that when the adjuster fails to respond, it is...more

No Administrative Exemption Under California Law Where Worker Did Not Receive Fixed Salary

Negri v. Koning & Associates, No. H037804 (May 16, 2013): In a recent decision, a California Court of Appeal held that an insurance claims adjuster was not an exempt employee under the administrative exemption of Industrial...more

PK Law Attorney Brian S. Goodman Contributes Tips for the Proper Handling and Presenting of Property Insurance Claims After...

NAPIA Offers Tips for the Proper Handling and Presenting of Property Insurance Claims After Oklahoma Tornadoes - Potomac Falls, Virginia (May 22, 2013) – The devastating tornadoes that ripped through the suburbs of...more

The First 30 Days of Your Nevada Work Comp Claim

The first 30 days of a serious job injury claim are confusing and scary. Here are a few important tips...more

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