insurance policy dispute

Insurance Coverage Disputes where the Focus is the Policy Language

Posted by David Adelstein on March 06, 2017
Standard of Review / Comments Off on Insurance Coverage Disputes where the Focus is the Policy Language

Insurance coverage disputes are fairly common between an insured and his/her/its insurer.   These are important disputes to an insured, particularly when they have been damaged and their insurer refuses to defend them from a third-party claim or otherwise denies coverage. An insured never wants to be in this position—understandably so. On the other hand, an insurance policy is not designed to cover every single risk under the sun as there are exclusions identified in policies for risks or perils that are not covered.   This ultimately means an insured needs to have an appreciation of those risks or perils not covered (in case he/she/it needs to procure another policy or a policy endorsement to cover certain risks or perils).

There are insurance coverage disputes where the primary focus is on the policy language. The material facts are not in dispute; the dispute is centered on whether the undisputed facts create coverage under the applicable policy. In this instance, the insurance coverage dispute is an issue for the court and not for a jury.

A recent case explains the appellate standard of review in insurance coverage disputes, particularly when the overriding issue has nothing to do with the facts and everything to do with the policy language:

We review the instant appeal from a final judgment interpreting the provisions of an insurance policy to determine coverage de novo. Where the facts are not in dispute and the language of an insurance policy is unambiguous and not subject to conflicting inferences, “its construction is for the court, not the jury.” Moreover, even where an ambiguity exists, if the facts are not disputed “it is within the province of the trial judge not the jury to resolve the ambiguity as a matter of law.” Here, because neither a factual dispute nor an ambiguity was demonstrated to exist, the coverage issue raised below should have been decided by the court below and on the record below….

Zurich American Ins. Co. v. Cernogorsky, 42 Fla. L. Weekly D476b (Fla. 3d DCA 2017) (internal citations omitted).

If you have questions regarding an insurance policy or you are involved in an insurance coverage dispute, do the prudent thing, consult an attorney that understands insurance.  Insurance is challenging, even for experienced practitioners, so do not assume you can navigate the complicated insurance waters solo.

Please contact David Adelstein at dadelstein@gmail.com or (954) 361-4720 if you have questions or would like more information regarding this article. You can follow David Adelstein on Twitter @DavidAdelstein1.

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