Post Claims Underwriting
Firemans Fund Insurance Co. vs. City of Lodi, CA
Year: 2000
Court: U.S. Court of Appeals, 9th Circuit
Case Number: 99-158902
Issue:
  • Post Claims Underwriting
State:
  • California

UP supports lower court decision and educates the court on insurance company tactics, post claims underwriting, etc.
Hailey vs. California Physicians’ Service dba Blue Shield of California
Year: 2006
Court: California Court of Appeal, 4th District, Division 3
Case Number: GO35579
Issue:
  • Post Claims Underwriting
State:
  • California

Health and Safety Code section 1389.3 was designed to stop the practice of post-claims underwriting. Blue Shield should not be allowed to engage in post-claims underwriting and rescind its policy when it fails to sufficiently investigate and turns a blind eye to information it either…
Nieto, Julie vs. Blue Shield of California Life & Health Insurance Company
Year: 2009
Court: California Supreme Court
Case Number: B214669
Issue:
  • Post Claims Underwriting
State:
  • California

If the Court of Appeal decision cannot be reconciled with California public policy and is inconsistent with all other California authority, which has strongly condemned unlawful post claims underwriting.
Sigelman et al. vs. Lawyers Mutual Insurance Company
Year: 2007
Court: California Court of Appeal, 4th District, Division 1
Case Number: D050783
Issue:
  • Post Claims Underwriting
State:
  • California

Letter Brief supporting petition for review. Malpractice insurer rescinded policy for alleged misrepresentation in the application. The policy had been in force for seventeen years. Trial court entered judgment in favor of the policyholder. The Appellate Court reversed.
Southern Realty Management Inc. et. al. vs. Aspen Specialty Insurance Co. et. al.
Year: 2010
Court: U.S. Court of Appeals, 11th Circuit
Case Number: 10-11513-G
Issue:
  • Post Claims Underwriting
State:
  • Georgia

Issues involve: (1) whether insurance company must be prejudiced in order for there to be material breach of the cooperation clause such that it bars coverage and (2) whether the insurance company’s denial of claim constitutes impermissible post-loss underwriting.
Kerrigan v. Metropolitan Life Insurance Company
Year: 2014
Court: New York Court of Appeals
Case Number: 111775/2003
Issue:
  • Post Claims Underwriting
State:
  • New York

“Post-claims underwriting” describes the scenario where an insurer waits until after the insured makes a claim to investigate whether the insured is eligible for coverage based on the risk he or she presents. Post-claims underwriting (also referred to as “post-loss underwriting” or “retroactive underwriting” in…
Massachusetts Mutual Life Ins. Co. v. San Francisco Superior Court
Year: 2018
Court: California Court of Appeal, First Appellate District, Division Two
Case Number: A153198
Issue:
  • Post Claims Underwriting
State:
  • California

UP wrote in opposition to a writ sought by the insurance company that would overturn a trial court ruling that held that an insurance company may not rescind a long term care insurance policy after the contestability period based on impermissible application questions. The trial…
Rosalin Rogers and Mark L. Thompson v. Catlin Ins. Co. LTD (UK)
Year: 2017
Court: Colorado Supreme Court
Case Number: 2016SC916
Issue:
  • Post Claims Underwriting
State:
  • Colorado

Many states have enacted statutes requiring and incentivizing insurance companies to promptly pay policy benefits owing to policyholders (and those who stand in their shoes). In Colorado, insurers who fail to promptly pay benefits owed or improperly deny coverage are liable not only for the…