Mar 292020

Probably one of the most unpopular posts I will ever make… Unfortunately, the truth is normally unpopular.

An insurance policy is a contract. One that is executed in anticipation of a future loss, thus written “prior” to an event occurring.

That being the case, that policy/contract dictates the terms that it will pay out on, and specifies the items it will exclude. This is the way coverage is decided.

“Does the policy provide it?”

Oftentimes, in our specific profession, we argue coverage against insurance carriers who would benefit to claim that it did not exist. So this is not a new procedure in the claims process, it is actually business as usual. What is not, is COVID 19 and the effects it is having on even sane, rational folks.

Why would I use those terms? Well, to hear some folks talk about what insurance should cover, and if it doesn’t cover, that our government should “Force” them to cover it…

That is a horrific thought process and path that any “sane/rational” person would avoid at all costs.


Simple. If the government can force carriers to cover something that was not in their contract, that same government can force you into the same scenario… Affordable Care Act for instance. We were forced to buy a product that does not work, and is extraordinarily expensive. Many, many folks who supported it, only did so until it hit their own pocketbook… When that happened, the next logical thing occurred…

Support was withdrawn.

I believe a carrier should pay every cent they owe.

I do not believe they should pay a single penny they do not. I do not believe we should even be talking about making them something they do not, and I especially do not believe the government should be involved in the act of forcing them to do anything above and beyond the contract they sold. If anything close should occur, it should be forcing them to honor what actually is in the policy.

So we are clear.

  1. If there are no virus exclusions, and the insured has coverage in their policy, then they should pay what they owe without a fight.
  2. If there are triggers for coverage, such as Direct Physical Damage that occurs, and the claim qualifies, they should pay what they owe without a fight.
  3. If there are legitimate coverage issues, we need to resolve them.

As PIA’s/Attorney’s it is our job to root these facts out, and find coverage where coverage is available.

We should not be standing on the corner hawking fear for referrals.

Before anyone begins to holler, I will allude to John Houghtailing, and the way he masterfully went about doing just that, the correct way. He sued the carrier to obtain a declaratory judgement in what is considered the first lawsuit of its kind. [Cajun Conti, LLC, et al. v. Certain Underwriters at Lloyd’s London, et al., Civil District Court for the Parish of Orleans, Louisiana].

I say this is masterful and cite it for one reason. He didn’t tell anyone what he could do… He showed them, and then publicized.

#ProtectTheInsured means the good, the bad, and the ugly. And yes, sometimes it means protect them from themselves. As we move forward, and this continues to unfold, we will be here for the legitimate claims, and to decry or denounce what we believe to be erroneous, even if it helps the carriers. Our intent was never to harm them, simply to make them pay what they owed… not a penny more, not a penny less. Exactly what we teach at Public Adjuster Boot

Cal Spoon


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