Farmers Insurance COVID-19 Denials Lawsuit Investigation

In California, Farmers Insurance Group also sells policies under the following names:

• Farmers Insurance Exchange (#R 201)
• Fire Insurance Exchange (#1267-4)
• Truck Insurance Exchange (#1199-9)
• Mid-Century Insurance Company (#1428-2)
• Civic Property and Casualty Company (#4241-6)
• Exact Property and Casualty Company (#4240-8)
• Neighborhood Spirit Property and Casualty Company (#4242-4)

After faithfully paying thousands of dollars in premiums for policies that are supposed to cover income lost in the event of a disaster, many small business owners are being told by Farmers that their policies won’t cover losses from pandemic-related closures.

However, the legal landscape on this issue is not as cut and dried as Farmers would like you to think. Depending on the specific wording of your policy, there are several different ways you might be covered for pandemic-related losses.

• loss of access as physical loss: some courts have found that loss of the ability to use your property can count as physical loss
• civil authority orders: some courts have found that in some policies, the clause for covering losses from government-mandated closures does not require physical damage to the property
• reasonable expectations doctrine: some courts use this doctrine to rule in favor of more coverage rather than less, because this legal principle says it’s not just the text of the contract that matters, but also the reasonable expectations of the policy holder
• virus exclusions: in the past several years, some insurers have unilaterally put in a clause attempting to excluding losses from virus, but according to the reasonable expectations doctrine, if the clause is written in an ambiguous way, or if the policy still covers losses from government-mandated closures, then a policyholder may still be covered for losses from COVID-19

The bottom line is, each specific policy and situation is different. If you want to do all you can to get coverage, it’s worth having one of our attorneys take a closer look.

We recently filed a class action lawsuit against insurance providers The Hartford and Sentinel for denying coverage to Washington, D.C. restaurants suffering losses from coronavirus stay-at-home orders.

Read more here: The Hartford Class Action Lawsuit Complaint

When insurance companies deny their claims, small business owners often file lawsuits to force their insurance company to pay. For example, two restaurants in Napa Valley also recently Hartford for failing to pay claims under the restaurants’ business interruption insurance. According to the complaint, the two restaurants’ insurance plans specifically covered business losses due to an order by civil authority that prevents access to the building, such as the shelter-in-place orders adopted in Napa and various other parts of the country.

A Louisiana restaurant, Oceana Grill, also reportedly sued its insurance carrier, Lloyd’s of London, to proactively require the carrier to provide coverage under an “all risk” insurance policy for losses stemming from government-ordered closures due to COVID-19. According to The National Law Review,

In its Complaint, Oceana argued that because their policy did not exclude losses that arise as a result of a virus or global pandemic, the restaurant is entitled to coverage.

In Illinois, six bar and restaurant groups filed a suit in federal court against their insurance provider, Society Insurance, for allegedly wrongfully denying payouts related to COVID-19 losses because the businesses supposedly did not suffer property damage or loss. An owner of one of the Chicago restaurant groups was quoted by Eater Chicago as saying,

We’ve been paying our policies every month… For them to come out and find a way not to pay, it’s outrageous.

Learn more about how businesses are dealing with COVID-19 losses in our Business Interruption Insurance Article.

California Insurance Commissioner Ricardo Lara issued a notice requiring insurance companies to fairly investigate all business interruption claims resulting from COVID-19 losses. The Journal quotes the commissioner as saying,

I want to be absolutely clear that insurance companies need to fairly investigate all business interruption claims as they would during any disaster… Policyholders deserve all the services, coverage, and benefits they are due under their policy.

The Commissioner’s Notice emphasizes that no insurer, agent, or representative may dissuade policyholders from filing a notice of claim, or refuse to open an investigation on claims under Business Interruption Insurance. If you believe your insurer did not conduct a fair investigation into your claim stemming from COVID-19, you may have legal recourse.

The Notice also describes the rules and procedures that insurers must follow when a business wants to file a claim on its business interruption insurance:

1. Policyholders send a Notice of Claim: The California Fair Claims Settlement Practices Regulations says that insurers are obligated to accept any communication from the policyholder or its representative as a notice of claim if the communication indicates that the policyholder desires to make a claim, and the communication reasonably suggests that a response is expected.
2. Insurers acknowledge notice: With few exceptions, insurers are required to acknowledge a notice of claim immediately, but within no more than 15 calendar days of receiving the notice.
3. Insurers provide next steps: The insurer must provide the policyholder with the necessary forms, instructions, and assistance, and specific the information needed in connection with the proof of claim.
4. Insurer conducts fair investigation: The insurer is required to “conduct and diligently pursue a thorough, fair, and objective investigation of the reported claim” before deciding whether or not to accept or deny the claim.
5. Insurer accepts or denies: The Notice states that the insurer must accept or deny the claim within 40 days after the receipt of the proof of claim. If the claim is denied, the insurer must provide, in writing, a list of all the legal and factual basis for the denial.

Jason Gibbs

A founding partner at Gibbs Law Group, Eric has negotiated groundbreaking settlements that resulted in meaningful reforms to unlawful business practices. He was recently recognized as California Lawyer Attorney of the Year and was named to the Top Plaintiff Lawyers in California for 2019.

Andre Mura

Andre represents plaintiffs in high-stakes complex litigation and appeals in state and federal courts throughout the country. He has authored briefs filed in the U.S. Supreme Court and received the California Lawyer Attorney of the Year Award in 2019.

Amy Zeman

Amy Zeman represents clients in a wide variety of complex litigation, with experience working closely with class representatives and consumer contacts. She uses her prior career experience as an accounting/ compliance manager in the financial services sector to identify and investigate fraud claims.

Aaron Blumenthal

Aaron Blumenthal represents consumers, employees, and whistleblowers in class action and other complex litigation.

Andrew Friedman

Andrew is a Partner at Cohen Milstein and the Co-Chair of the firm’s award-winning Consumer Protection practice group. Mr. Friedman is a nationally recognized leader in the area of complex, multi-state lawsuits against major insurers, credit card companies, and other manufacturers and service providers.

Geoffrey Graber

Geoffrey leads Cohen Milstein’s Business Interruption Insurance team. As a Partner and a member of the Consumer Protection practice group, he specializes in complex litigation involving false advertising, fraud, and other forms of unfair business practices at the hands of insurance companies, banks, health care companies, and others.

Victoria Nugent

Victoria is a Partner at Cohen Milstein and Co-Chair of the firm’s Public Client practice. She represents clients in civil law enforcement investigations and litigation involving consumer protection, fraud, and other areas of enforcement.

 

Eric A. Kafka

Eric is a member of Cohen Milstein’s Consumer Protection practice. He also serves on Public Justice’s Class Action Preservation Committee.

 

Karina G. Puttieva

Karina is a member of Cohen Milstein’s Consumer Protection practice and focuses on litigating class actions on behalf of consumers who have been harmed by large corporations.