Insurance Claims in North Carolina

Most people in North Carolina have some sort of insurance. By law, persons operating vehicles are required to have liability coverage. The owners of the cars might also have collision coverage. Most homeowners have homeowner’s insurance, and many renters have renter’s insurance. Many people also have health coverage, whether provided by their employer or purchased directly by the individual. Businesses often have a general liability policy. These and other policies give rise to numerous claims and numerous insurance disputes every year in North Carolina.Governmental supervision: Insurers are subject to oversight by the North Carolina Department of Insurance (“DOI”). A consumer (or “inured”) can file a complaint against an insurer with the DOI. The DOI is not likely, however, to become heavily involved in a routine dispute between an insured and the insurer. Many statutes (within Chapter 58) regulate the insurance companies, as well as regulations promulgated by the N.C. DOI.Terms of coverage: The scope of coverage afforded under an insurance policy is determined primarily by the terms of the policy, and also by the applicable North Carolina General Statutes and any regulations by the DOI. When disputes are litigated in the courts, any precedential cases will also affect the interpretation of the policy. Health (and other) policies subject to ERISA may be subject to federal law, which preempts state law.Duties during claims handling process: Policies typically have provisions that give various rights to the insurer in the claims-handling process. The insured often must submit a “proof of loss” form, in which the loss is described to the insurer. The insured often must produce documents, and must submit to an “examination under oath,” at which the insurer’s lawyer can ask questions of the insured to investigate the claim. If the insured fails to comply with these provisions, then he can lose coverage. (Duties of the insurer are addressed below, in connection with the insurer’s potential liability for bad faith and treble damages.)Resolution of the claim outside court proceedings: Some aspects of the insurance claim might be subject to arbitration or appraisal (rather than court action). For example, the standard fire insurance policy in North Carolina, governed by statute, provides that the parties can use an appraisal process to value property (N.C. General Statute 58-44-16). A standard underinsured motorist policy in North Carolina contains a provision which allows the insured to demand arbitration.Resolution of the claim in a court proceeding: Where, however, the insurer and the insured cannot agree on coverage, and the dispute is not subject to arbitration or appraisal, they might have to take their dispute to court. The insured can file a lawsuit for breach of contract, and the insurer can file a suit for declaratory relief. In North Carolina, such suits are often filed in Superior Court in state court. They can also be filed in (or removed to) federal court if diversity jurisdiction is met. (There have, however, been a couple of decisions in our Circuit rejecting such disputes on the abstention doctrine.)Punitive Damages: In addition to seeking to recover the amount due under the insurance policy, the insured can also pursue a claim for “punitive” damages if the insurer denied the claim in “bad faith.” Punitive damages in this state are governed by statute, and also by case law addressing this claim. According to one case, the insurer is not liable for punitive damages if its position is “neither strained nor fanciful.” Punitive damages are capped by statute in North Carolina, to the greater of $250,000 or three times the actual damages (whichever is greater).Treble damages for Unfair Conduct: The policyholder can also assert a claim to recover “treble” (i.e. tripled) damages where the carrier’s conduct is unfair or deceptive. Such a claim is often based on the insurer’s violation of a provision in the statutes mandating that insurers handle a claim in various ways, including that they conduct a reasonable investigation, promptly investigate the claim, and provide an explanation of the denial to the policyholder. (N.C. Gen. Stat. 58 63 15.)Coverage disputes in North Carolina can quickly become very complicated, and the policyholder and often the insurer may need the services of an attorney experienced in insurance matters.

Business Insurance Explained

If you have just started a new enterprise or have been asked to look after the company’s insurance renewals, business insurance can at first seem a daunting proposition. After all, much of the language and industry jargon such as endorsements, indemnity levels and excess periods can at first appear alien.Then there is the question of knowing what covers to get.With the responsibility of ensuring that the business activities and property are completely covered from risks that the firm might face, a new small businessman may well also be confused by the plethora of covers, plans and policies that are available today.Business insurance is however fairly simple even for newbies, if you break it down from the top.There are basically two types of risk that a business may face in daily operations, these being business property risks and business liability risks.All business insurance policies contain elements of the two risks either separate or combined under a single plan. If you need cover for business buildings and premises contents, you will need property insurance. If you need cover for the work you do, you will require liability insurance. Most businesses need elements of both.Business property buildings insurance protects all risks to a business premises covering loss,material damage and consequential loss to all buildings, outbuildings, fixtures and fittings on the premises. The premiums are calculated on rebuilding costs of the business property and will also contain elements of public liability to protect a business against claims from the public of for example, a wall falling on a passer-by.Property contents insurance covers loss or damage to the contents of the business premises. Business contents policies typically have provision to cover items such as furniture, tables and desks, computer equipment, telecommunications equipment, business electronic equipment, data, tools, machinery, stock, high risk stock, raw materials, fabricated, assembled, manufactured or stored goods and anything used in the daily operation on the business premises. Freight, cargo and goods in transit cover options provide insurance for the businesses property away from the premises.Business property insurance polices are typically marketed by the type business property they provide insurance for. For example office insurance, shop insurance, hotel insurance and pub insurance are popular commercial property insurance schemes which contain all the relevant covers for each use of the property type.Much commercial property is either rented or leased, in particular offices and shop space. Business insurance provides specialist cover for property owners of these types of premises with a let property insurance policy, which is tailor-made for business landlords.Liability Insurance protects a business against all liabilities that the enterprise might be liable for as it carries out its daily actions. Liabilities are events which occur that could lead to claims against the proprietor, trader, owner, partnership or company. Liability insurance cover protects the company profits against all damages and costs incurred resulting from the claim.Business Liability Insurance includes Public Liability Insurance, Employers Liability, Products Liability, Directors and Company Officers Liability and Professional Indemnity Insurance.Public Liability protects the business profits against claims from members of the public and this cover forms the basis of a standard business insurance contract.If you employ staff you will require by law Employers liability insurance which protects your business against claims resulting from accidents and injuries to paid employees and sub contractors whilst anywhere at work.If you sell or provide goods or parts your business will need Products liability insurance.This cover is usually automatically included in for example, a shop insurance policy.Nearly all business insurance polices sold, in particular those online, are what is known as combined business insurance or trade packages that have been specifically designed for particular trades or professions. Find one that is suitable for your particular company by carrying out a search for your trade, service or profession insurance. These combined business insurance policies contain all the covers you will need in your line of work, ensuring that if a claim against your company is made, you will be covered.The company owners or directors can also purchase Directors & Officers Insurance or D & O insurance as it is often called, which covers them personally against both civil and criminal liabilities resulting from business activities.Additionally professional services should purchase Professional Indemnity insurance which covers the service against the liability of any advice that might be given professionally and later turns out to be negligent.