Hurricane Insurance Claims 101

Expanding in size, Hurricane Florence is continuing on a beeline toward Eastern North Carolina as an “extremely dangerous” Category 4 storm.

Catastrophic flooding and destructive winds are becoming very likely everywhere from the Triangle to the Coast.

Meteorologists are reporting that this storm may be comparable to Hurricane Hazel in the 1950s.

Nearly one in four homeowners and business owners in Eastern North Carolina can expect some level of property damage from Hurricane Florence.

In light of these odds, we have prepared the below tips for preparing for and making inevitable hurricane related insurance claims:

  1. Photograph the condition of your property before the storm.

Oftentimes, insurance companies will raise questions as to whether damage was storm related or pre-existing. If you have damage from a hurricane, you will want to be able to show your insurance company proof of your property’s condition immediately before the storm. This includes both real and personal property. Take your I-Phone and photograph the condition of the interior and exterior of your home or business. This includes furniture, fences, sheds, garages, attics, basements, trees and landscaping.

  1. Have copies of your insurance policies and/or declaration pages.

It is important to know what insurance coverages you have before a storm hits. Of equal importance, you need to review these documents to know how to quickly make an insurance claim if and when you sustain damage.  This should include but not be limited to any and all policies of car insurance, homeowners insurance, flood insurance, and business insurance that you have.

  1. If you have storm damage, make an insurance claim as soon as possible.

In catastrophes, insurance companies generally handle claims on a first come, first serve basis. If you call your insurance company immediately after the storm, you may experience long wait times, but be patient. It will pay-off in the speed at which your claim is adjusted. Likewise, don’t let someone put you or claim on the backburner. Be persistent in your communications. (As an aside, many companies now have apps or websites where you can make your insurance claims online, which may save you time on the phone.)

  1. Write down your claim number and keep it handy.

When you make an insurance claim, it is easy to overlook writing down your claim number. However, writing this number down and keeping it handy can save you a lot of time down the road. If you keep this number, insurance company representatives will be able to immediately find your claim each and every time you call.

  1. Keep Notes.

Take notes documenting every contact with your insurer, noting the person with whom you spoke, his or her contact information, the date that you spoke, and what you spoke about. After catastrophes, insurance companies are overwhelmed, and you should take the initiative in making sure your calls and correspondence make it to the right person and also that adjusters do what they promise. Additionally, if things go haywire with your insurance claim, it is important for your lawyer to get these notes down the road.

  1. Keep Receipts.

If you sustain storm damage, you have a duty to mitigate further damage to your home or business. This means you must make any and all reasonable temporary repairs to prevent further damage to your property. However, keep receipts for any expenses related to immediate repairs you had to make, as your insurer will generally be required to reimburse you for these expenses.

Likewise, keep receipts for any living expenses you incur (i.e. lodging & meals) if you could not return to your home in the wake of the storm. With wind claims, you should generally get reimbursed for such additional living expenses. If your claim is limited to flood insurance, additional living expenses might not be covered.

If you are a business owner, quickly develop a short-term plan for your business (i.e., open in temporary location, shut down etc.), and keep receipts/records for all purchases and services from the date of your loss until your claim is satisfactorily resolved.

  1. Photograph the condition of your property after the storm.

If you have storm damage, it is important that you photograph it, and that you photograph it before any temporary or permanent repairs are made to your home or business. Do not rely on the insurance company to document the damage to your property. Take the initiative and do it yourself. This instruction is not limited to real property and structures. If you have personal property that was damages in the storm, photograph that damage too.

  1. Know who you are dealing with.

When the insurance company sends out an adjuster, ask if he/she is an employee of the insurance company or an independent adjuster (I.A.). In catastrophes, insurance companies will oftentimes contract claims out to third-party companies. If you encounter an I.A., ask if they are authorized to make claim decisions and payments on behalf of your insurance company and ask for the name of the in-house company adjuster to whom the I.A. will be sending your information. If you have problems or issues with the I.A., having the contact information for the in-house company adjuster can be of great assistance.

  1. Flood versus Wind Damage

If you think you only have flood damage to your home or business, and you don’t have flood insurance, call your insurers anyway. Some homeowners and business policies that exclude damage related to flooding may cover damage from water and wind.

  1. Your vehicles should be covered.

Damage to your vehicles from downed trees and flooding should be covered by the comprehensive portion of your auto insurance. If your vehicle is damaged, promptly make a claim with your car insurance company and photograph its condition.

*Ask for help if you need it!

Most insurance claims are resolved on friendly and fair terms, but sometimes they are not. If you run into an adjuster who is making your life more difficult than it should be, arguing about what is or is not covered, or arguing with you or a contractor about the extent of damage to your home or business, call a lawyer immediately.

For a free consultation, you can reach me at [email protected] or (919) 821-7700.

Stay safe in the storm,

Robby Jessup

Robby JessupHurricane Insurance Claims 101
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Why Can’t The Jury Consider All Of My Medical Bills?

Prior to October of 2011, juries could consider the full amount of an injured person’s medical bills; however, that was changed when Rule 414 of the North Carolina Rules of Evidence was amended to read as follows:

“Evidence offered to prove past medical expenses shall be limited to evidence of the amounts actually paid to satisfy the bills that have been satisfied, regardless of the source of payment, and evidence of the amounts actually necessary to satisfy the bills that have been incurred but not yet satisfied. This rule does not impose upon any party an affirmative duty to seek a reduction in billed charges to which the party is not contractually entitled.” (2011-283, s. 1.1; 2011-317, s. 1.1.)

Said slightly differently, evidence of medical expenses is limited to the amounts actually paid to satisfy the bills, and the amounts actually necessary to satisfy the bills not yet paid. This rule has become to be known as “Billed vs. Paid.”

This is important because the State Health Plan, Private Health Insurance, Medicaid, and Medicare all receive significant discounts when paying medical bills.

Before October of 2011, evidence of payments made by health insurance, Medicare or Medicaid were not admissible in trial and were not to be considered by a jury in determining damages for medical expenses.

Now, Plaintiffs generally can only present to a jury the amounts paid by health insurance or other collateral sources to satisfy medical bills.

To illustrate this with an example, Bob is crossing in a crosswalk, when a vehicle suddenly runs a red light and breaks Bob’s legs.  Bob is insured with Blue Cross Blue Shield of North Carolina.  Bob incurs $50,000 in medical bills at a local hospital for reconstructive surgery to his legs.  Blue Cross Blue Shield of North Carolina receives 50% off Bob’s medical bills pursuant to its provider agreement with the local hospital.  Therefore, under Rule 414, Bob can only present $25,000 of medical expenses to the jury.  Before October of 2011, Bob could present the full $50,000 of bills to the jury.

You may think that Rule 414 will not affect the pre-litigation value of a claim because it is a Rule of Evidence. This is not the case. The insurance companies calculate medical damages in settlement negotiations in the same way that the courts do during trial. They are adjusting what you may ultimately recover in Court, so they are using Billed vs. Paid. Over the past 6 years, Billed vs. Paid has significantly reduced the average value of personal injury claims.

Robby JessupWhy Can’t The Jury Consider All Of My Medical Bills?
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Contributory Negligence: The All or Nothing Doctrine

Currently, only three States in the United States follow the doctrine of “Contributory Negligence,” and North Carolina is one of them.

What this doctrine says is that if an injured or wrongfully deceased person is found to be even as little as 1% at fault for his or her injuries or death, then the plaintiff gets nothing from the defendant, despite the fact that the defendant was still 99% at fault for the subject injuries or death.

Most people believe that the doctrine of “Contributory Negligence” is unfair, and as a result, the vast majority of states have implemented a “Comparative Negligence” system.

With “Comparative Negligence,” a plaintiff’s total amount of recovery is decreased according to the percentage of fault assigned to the injured or deceased person. Whether the plaintiff is denied recovery once he or she (or his or her decedent) has reached a certain percentage of fault depends on which type of “Comparative Negligence” system the State has adopted. In pure “Comparative Negligence” jurisdictions, plaintiffs are entitled to recover some damages, even if they are assigned the greater portion of fault for causing the accident. For example, if the plaintiff is found to be 90% at fault and the defendant is found to be 10% at fault, the plaintiff still can recover 10% of the total damages from the defendant. Thirteen states have pure “Comparative Negligence” rules. Thirty-three states have a modified “Comparative Negligence” rule. Twelve of the states follow a 50% rule in which plaintiffs are barred recovery if they are found to be 50% or greater at fault for their injuries. Twenty-one states follow a 51% rule in which plaintiffs are not barred recovery unless they have been found 51% or greater at fault for their injuries.

In rare North Carolina cases, the “Contributory Negligence” defense can be overcome. If the plaintiff can prove that the defendant’s willful and wanton acts caused the injury, then the defendant cannot prevent the plaintiff from recovery. Likewise, if the plaintiff can show that the defendant had the last clear chance to avoid an accident and did not do so, then the defendant can still be held accountable even if a plaintiff is found to be one or more percent at fault.

Robby JessupContributory Negligence: The All or Nothing Doctrine
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You Can’t Say “Insurance” In The Courtroom

After an automobile negligence trial, jurors always ask, “[w]hy didn’t you tell us whether the Defendant had insurance?”

Generally, in North Carolina civil trials, lawyers are not allowed to present evidence as to whether or not the Defendant is insured.

Rule 411 of the North Carolina Rules of Evidence provides that evidence that a person was or was not insured against liability is generally not admissible.

In Fincher v. Rhyne, 266 N.C. 64 (1965), our Supreme Court stated: “[w]here testimony is given, or reference is made, indicating directly and as an independent fact that the defendant has liability insurance, it is prejudicial, and the court should, upon motion therefor aptly made, withdraw a juror and order a mistrial.”

Our Supreme Court explained its rationale as follows: “[t]he existence of insurance covering defendant’s liability in a negligence case is irrelevant to the issues involved. It has no tendency to prove negligence or the quantum of damages. It suggests to the jury that the outcome of the case is immaterial to defendant and the insurer is the real defendant and will have to pay the judgment. It withdraws the real defendant from the case and leads the jury to regard carelessly the legal rights of the real defendant. No circumstance is more surely calculated to cause a jury to render a verdict against a defendant, without regard to the sufficiency of the evidence, than proof that the person against whom such verdict is sought is amply protected by indemnity insurance.”

Needless to say, most individuals I represent don’t like this logic. For the most part, the reason my clients are mad and suing is not because someone hit them with a car, but because Allstate, State Farm or some other insurance company treated them unfairly after the accident. My clients want juries to hear about the years of delay and heartache insurance adjusters have put them through.

There are a number of States where juries are told about the existence of insurance in automobile negligence cases; although this is the exception and not the rule. What do you think about this?

Robby JessupYou Can’t Say “Insurance” In The Courtroom
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