Case Study:

Reversing Insurance Carrier Denial

Quick Facts

Community Type: Assisted Living

Number of Locations: 60

Resource: Claims Advocacy

Valued Client Since: 2012

Challenge

An upper Midwest campus of a client’s Assisted Living community includes an attached, enclosed parking garage. The client identified weather-related property damage to the parking structure, reported the event to the insurance carrier, and requested that repairs begin prior to the onset of inclement weather. The client sustained loss of rents for the garage and expressed concern about resident relocation from this area for safety reasons, if repairs were not underway prior to the weather changing. The insurance company hired structural engineers to investigate and based on this report, felt the damages were caused by a design defect and subsequently denied the claim.

Solution

An AssuredPartners Property Claims Manager, with over 30+ years of claims experience, facilitated a call between the client and insurance carrier to discuss the engineer’s findings. The Property Claims Manager identified crucial errors in the management of the claim, along with the lack of supportive evidence in the engineer’s report to substantiate a defect allegation. The adjuster failed to send out a reservation of rights letter as soon as they thought there was a coverage issue. This caused a potential delay and a tough decision for the client as they needed to get the building repaired due to safety concerns. If they chose to fight the denial, the client would have to refrain from altering the building so an expert of their own could inspect it. The delay by not sending the reservation of rights letter put them in a tough spot.If the building would’ve collapsed, the client could possibly blame the carrier. Ultimately, our Property Claims Manager was able to convince the carrier that the trigger of the claim was the weather, thus making it a covered loss based on the terms and conditions of the policy.

Value

The insurance carrier ultimately agreed to provide coverage and issued a payment, just shy of $1,000,000, so the client could begin repairs prior to the onset of inclement weather.