Oklahoma Insurance Law : Oklahoma Insurance Lawyer & Attorney : Buckman & Roach Law Firm : Tulsa Bad Faith Insurance & Declaratory Judgment Commentary

An insurance agent was held responsible for failure to obtain workers' compensation coverage.  In a blog post by Tred Eyerly, a summary of the decision is set forth.  Essentially, the agent held herself out as an expert on insurance for certain types of automotive dealerships.  The plaintiffs purchased insurance without specifying any particular type of coverage needed and allowed the agent to select the coverages purchased.

Although the agent was aware California required mandatory workers' compensation coverage, the initial policy provided no such coverage.  One year later, the policy was renewed with another insurer and again no workers' compensation coverage was obtained.

Later, an employee was severely burned in a fire at the dealership.  When he learned there was no workers' compensation coverage available, he sued and obtained a judgment for $11 Million, $6.8 Million of which the dealership was responsible.

The dealership then sued the insurance agent for negligence.  There was a factual dispute over whether or not workers' compensation coverage was discussed and the documentary evidence tended to show the conversation never happened.  Judgment was entered against the insurance agency for $5.8 Million, the outstanding amount of the judgment after one insurer tendered payment of $1 Million in partial satisfaction simply to extricate itself from the situation.

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Cancellation of a homeowners' insurance policy requires compliance with terms and conditions of the policy. It may sound simple, but we have seen several full blown lawsuits arise over the years where the manner in which the policy was cancelled before a loss occurred was challenged. The starting point is a review of the requirement and the procedure for cancellation inside the insurance policy as well as a review of the Oklahoma statutes. The statutory fire policy provides five days' written notice of cancellation with or without tender of the excess premium pro rated for the remaining time not used. The notice of cancellation is required to state that the excess premium (if not tendered) will be refunded on demand.

Some insurance policies provide for a greater notice period than the statutory five days. An insurance company should comply with its own policy terms and conditions for cancellation and provide the additional time per the policy. Some policies prescribe notice of cancellation by registered mail which is not the same as certified mail. In these cases, the insurer should use the procedure for registered mail.

We saw an interesting blog not long ago by Jason W. Anderson commenting on a Washington Supreme Court decision.  The insurer attempted to cancel a policy by using certified mail as opposed to regular mail. The State of Washington has a statutory requirement for notice of cancellation and the question was whether certified mail was the equivalent of mailing under the statute.

The court decided certified mail was not the equivalent of regular mail and the policy was never actually cancelled. The court found there were some practical differences between regular mail and certified mail in that there is a greater imposition placed upon the insured as it requires the policy holder to be at home to receive the letter or actually travel to the post office to retrieve it. A cancellation notice sent by regular mail would arrive without the hassle and aggravation of signing for the certified envelope or going to the post office to pick it up.

In summary, when there is an issue of cancellation involved, the insurer should follow the applicable regulations as well as the insurance policy guidelines. When the applicable regulation and the policy provide different notice requirements, then the insurer should follow the insurance policy (provided it doesn't attempt to give less notice than the statute).  If in doubt, consult with an attorney who practices in areas of insurance coverage.

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Coverage decisions tend to be expensive one way or the other.  If an insurance company determines coverage exists, then it has to pay for the underlying claim.  If the claim was not really covered by the terms of the insurance policy, then the company has incurred an expense that was unnecessary and which adversely impacts the year end financial picture.  Decisions to deny coverage, when in fact it exists, is even more expensive.  There is the litigation expense plus the potential bad faith claim. 

Christopher J. Boggs wrote a commentary about what his 19 years of experience in the insurance industry had taught which he was kind enough to share. 

• Only good lawyers realize they don't know everything about the law
• Someone who truly understands insurance can explain its concepts in simple language.  The person with no idea how it works masks his ignorance with $10.00 words and legalese
• There is ALWAYS more than one possible answer to a coverage question.  One is just more correct than the others based upon the particular situation
• Only "newbies" know everything about insurance
• Regardless of how much I know (or think I know) about insurance, there is always MUCH more to learn.  It is NEVER okay to guess at the answer to a coverage question
• It's perfectly acceptable to say, "I don't know", as long as you follow it up with "but I'll find out and get right back to you."

The only other thing I have to add from my 25 years of coverage analysis is the answer is always simple - just ask either side!  They always know the answer!

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Most homeowners' insurance policies provide disputes over the value of the claim can be taken to appraisal and the amount determined by disinterested parties. The appraisal clause has its roots in the statutory fire policy addressed in earlier posts. The statutory provision provides for appraisal upon the request of either party to the claim. The insurer can request appraisal or the insured can request it. The process is one in which each side selects a competent and disinterested appraiser to determine the extent of the loss. Before the appraisers ever meet to appraise the damage, they select a competent and disinterested third person to serve as an umpire for the resolution of any disputes between the appraisers. If the two appraisers cannot agree upon an umpire, there is a provision made for appointment of the umpire by the court.

Initially, it is the job of the appraisers to try to reach an agreement as to the amount of the claim. The umpire is supposed to resolve any dispute upon which an agreement cannot be reached by the appraisers.  In many cases, the umpire is never actually utilized as the two appraisers are able to reach an agreement. In other situations, the dispute is so contentious that the decision of the appraisers and the umpire is rejected by one or both parties and suit filed.

It is important to remember in Oklahoma that the party invoking the appraisal process is usually bound by the decision of the appraisers, while the non-requesting party has the right to litigate the amount of the award.  You will want to carefully consider the aspect of the appraisal provision before actually making demand for the procedure.

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Oklahoma insurance law attorneys agree there are a number of reasons why a policy may be voided by an insurance company.  Fraud by the applicant or policy holder is the most common reason an insurance company would rescind or void an insurance policy.  Rescission is defined as:

1. A party's unilateral unmaking of a contract for a legally sufficient reason, such as the other party's material breach, or a judgment rescinding the contract; voidance.  Rescission is generally available as a remedy or defense for a nondefaulting party and is accompanied by restitution of any partial performance, thus restoring the parties to their precontractual positions. -- Also termed avoidance.  Black's Law Dictionary (8th ed. 2004)

According to Oklahoma statute 15 O.S. § 235, a party seeking to rescind or void a contract (which includes an insurance policy) must:

• act promptly upon discovering facts which entitled him to do so
• restore to the other party everything of value

In other words, experienced Oklahoma insurance attorneys advise their insurance company clients wanting to rescind a policy on the grounds of fraud to act quickly and also to return all premiums paid.  Sneed v. State ex rel. Department of Transportation, 1983 OK 69, 683 P.2d 525 and Berlands's Inc., of Tulsa v. Northside Village Shopping Center, 1972 OK 152, 506 P.2d 908.

As a caveat fancy legal wording for caution or warning), accusing a policyholder of fraud needs to be done carefully.  In Oklahoma, an insurer really should consult with competent legal counsel before doing so.

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It has come as a surprise to many an attorney that Oklahoma has a one year statute of limitation in which to file a lawsuit for a claim involving a fire loss. The one year limitation is set forth by statute in the statutory fire policy. This rule is a significant exception to the typical five year statute of limitations for a written contract. The one year time period has been given the approval of the Oklahoma Supreme Court since 1916 in the case of Wever v. Pioneer Fire Ins. Co., 1915 OK 1046, 153 P. 1146. www.oscn.net/applications/oscn/deliverdocument.asp

Legal writers have observed over the years this one year statute of limitation may not be valid under Oklahoma’s Constitution. The Supreme Court has held in other cases that special legislation designed to protect a certain industry or class of individuals is unconstitutional. The one year requirement in which to file a suit involving a fire loss under a homeowners’ policy has been considered the law for close to 100 years and is recognized by most Oklahoma attorneys as the required time period.

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The Oklahoma legislature in 36 O.S. § 4803 has adopted a statutory version of a fire policy sometimes referred to as the "New York Standard Fire Policy". The statute requires all insurance companies issuing homeowners' policies in Oklahoma to have the minimum coverage required by the statute unless special approval has been received from the insurance commissioner allowing them to sell something less than the minimum requirement. Typically, obtaining the commissioner's approval for a nonstandard policy form is difficult unless the insurer is enlarging or expanding the available coverage.

Section 4803 provides for many of the defenses that are normally used by insurers in denying claims.  Fraud by insureds upon Oklahoma insurance companies is a valid concern.  There is provision for denial for fraud or concealment on the part of the insured. The statute also provides that bills, currency, deeds, evidences of debt, money, or securities are not covered by the insurance policy unless specifically provided by the insurance contract.

The statutory insurance policy provides there is no coverage for certain types of perils such as military invasions, rebellions, insurrections, civil war, neglect on the part of the insured to use all reasonable means to save and preserve property, and further that the insurer is not responsible for theft losses.

The statute sets minimum time periods in which the policy can be cancelled and the type of notice that must be given to an insured as well as a mortgage company before coverage is actually cancelled. In the event of a claim, it requires the insureds to tender a proof of loss within 60 days of the event and allows the mortgage company to submit the proof of loss if the policy holder does not take timely action.

The statute also makes provisions Oklahoma insurance attorneys use in taking examinations under oath, inspection of damaged property, and require preparation of a complete inventory detailing the quantities, cost, and actual cash value of the items claimed.  

Most homeowners' policies provide more coverage than the statutory minimum. For instance, the typical homeowners' policy will have coverage for theft, wind storm, liability coverage, and contain other clauses that give greater protection to a homeowner than the statutory framework enacted many years ago.  Questions about the minimum required coverages under a homeowners' policy should be reviewed by a competent attorney knowledgeable about Oklahoma insurance laws.

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Some people, including insurance adjusters, forget an insurance policy is a legally binding contract.  Claim representatives who adjust a lot of liability and third-party claims sometimes tend to confuse the issue of coverage under a policy with liability for the accident.  These issues are not related.

One reason insurance policies don't seem like binding contracts is because the insurance policy is signed with a preprinted signature by an officer of the company. The policy holder or insured does not have to sign the agreement so it is not what people typically think of as a contract. 

Another reason maybe that insurance policies are contracts the courts call “contracts of adhesion”. In other words, the terms of the agreement are usually not negotiated like a typical business deal. The insurance company drafts and prepares the policy and the insured either buys the coverage or does not.

Regardless of whether people think of insurance polices as contracts, courts consider them valid and binding to the extent the agreement does not violate regulations of the insurance department, statutes of the jurisdiction where the policy is issued, and controlling case law interpreting insurance policies. As such, the first step in trying to decide whether there is coverage for any given situation is to read the policy.

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