![]() |
| Expert Registration |
Article Abstract: Insurance policies may be rescinded by insurance companies in the event of material misrepresentation or concealment of facts by the insured, unless there is a satisfactory answer to each of the following questions: Is the fact known to the insured? Is it false? Is the falsity material? Is it reasonable to rely on it? Did the insurer rely on it? About The Author: This author's company offers property and casualty insurance and reinsurance services, including arbitration, company startup and runoff, expert witness and litigation support, feasibility studies, product research and development, policy reviews and underwriting audits. These are some of the keywords associated with this expert's work experience and/or field of study: Expert Witnesses, Legal Experts, Consultants, Consulting, Forensic, Litigation, Arbitrations, Depositions, Trials, Mediations, Courts, Forensics, Civil Cases, Law Suits, Testify, Testimony, Torts, Laws, Lawyers, Attorneys, Malpractice, Industry Standards, Training, Supervision, Management, Managers, Insurer, Insured, Rescission, Insurance Policy Rescission, Property Insurance, Casualty Insurance, Misrepresentations, Material Facts, Relying on Materially False Facts, Concealment, Insurance Claims, Underwriting Information, Insurance Policies, Policy Applications, Non-Renewals, Policy Terminations, Cancellations, and Insurance Applications.
This expert will consult with attorneys / clients that are located in: AK (Alaska), AL (Alabama), AR (Arkansas),
AZ (Arizona), CA (California), CO (Colorado), CT (Connecticut), DC (District of Columbia), DE (Delaware), FL (Florida),
GA (Georgia), HI (Hawaii), IA (Iowa), ID (Idaho), IL (Illinois), IN (Indiana), KS (Kansas), KY (Kentucky), LA (Louisiana),
MA (Massachusetts), MD (Maryland), ME (Maine), MI (Michigan), MN (Minnesota), MO (Missouri), MS (Mississippi), MT (Montana),
NC (North Carolina), ND (North Dakota), NE (Nebraska), NH (New Hampshire), NJ (New Jersey), NM (New Mexico), NV (Nevada),
NY (New York), OH (Ohio), OK (Oklahoma), OR (Oregon), PA (Pennsylvania), PR (Puerto Rico), RI (Rhode Island),
SC (South Carolina), SD (South Dakota), TN (Tennessee), TX (Texas), UT (Utah), VA (Virginia), VT (Vermont), WA (Washington),
WI (Wisconsin), WV (West Virginia), & WY (Wyoming).
Rescission of an insurance policy is serious business. Such action could result in serious financial difficulties to insureds, especially if it occurs after a major loss. Furthermore, costly and protracted litigation almost inevitably follows to contest the rescission. Fortunately, insureds and their brokers can minimize the potential for rescission by simply exercising greater care to ascertain the accuracy of underwriting information, and by providing all material information to insurers. Also, rescission decisions are made by insurers only if they are convinced that they have adequate justification for them. An insurer may rescind its policy in the event of material misrepresentation or concealment of a fact by the insured. Misrepresentation is false statement of a fact by the insured. Concealment is the neglect to reveal a fact that the insured knows and ought to communicate to the insurer. Misrepresentation or concealment is material if it affects the underwriting decision of the insurer. For example, the premium would have been higher had the insurer been aware of the true and complete facts. Property-casualty policies typically include conditions pertaining to the subject of rescission, such as:
In most cases, rescission is based on materially misrepresented facts in the policy application, or in underwriting information provided by the insured or its broker. However, unless there is a satisfactory answer to each of the following questions, the rescission is not justifiable:
If the insurer possesses a fact that differs from what the insured had provided, then it must attempt to reconcile it before proceeding further with consideration of rescission.
The insurer must have incontrovertible evidence to demonstrate that the fact obtained from the insured is false.
Materiality is determined within the context of probable and reasonable influence on the insurer by the false fact. Consequently, if the insurer's underwriting decision is not affected, then the falsity cannot be deemed material.
The insurer cannot reasonably rely on a fact received from the insured alone if it is aware of a conflicting fact.
There must be clear evidence to demonstrate that the insurer did rely on materially false facts when making its underwriting decision. State insurance codes and legal precedents also have an impact on the insurer's decision-making process concerning rescission. For example, the California Insurance Code allows policy rescission even in cases of unintentional misrepresentation or unintentional concealment, and it provides that materiality is to be determined solely by the probable and reasonable influence of the facts on the insurer. Also, case law precedent prevents insurers from relying solely on representations contained in the policy application or underwriting information if an inspection of the insured's property is conducted. A policy may be rescinded even after a loss that would otherwise be covered by the policy. Since rescission could have severe negative financial impact on the insured, the insurer must be certain that the reasons for rescission are based on solid grounds and able to withstand potential legal challenge. In a 2001 case, an insurer rescinded their policy following a major fire loss, alleging material misrepresentation and concealment by the insured, pertaining to several matters, including square footage of the premises. The pre-trial discovery proceedings included examination of ambiguous questions contained in the insurer's application form, and the accuracy of the inspection report provided by an independent inspection company retained by the insurer. Major weaknesses emerged in the insurer's justifications for its decision to rescind the policy, including:
Based on the above points, it was not reasonable for the insurer to rely on the square footage information provided by the insured, and the insurer's contention that it did rely on the square footage data provided by the insured was questionable. Although this case was resolved and the insured received payment for its claim, the pre-trial discovery process took over a year, with detrimental financial consequences to the insured.
|
| Expert Registration |
| E-Mail: questions@expertnetwork.com |