We are discussing a recent U.S. Supreme Court decision regarding the proceeds from a life insurance policy. The insured was covered under the Federal Employees’ Group Life Insurance plan, and when he passed away in 2008 his widow discovered that the named beneficiary on the policy was his ex-wife. The insurer distributed the proceeds to the ex-wife, and the widow sued.
This is not a typical insurance claim story. The insurance company, in fact, barely makes an appearance. Nor is it a story about Florida. What it is is a story about the power of the insurance contract.
To some, particularly citizens in the state of Florida, the Affordable Care Act seems to be working. Federal officials have mandated various insurance companies provide health insurance rebates to insured individuals-millions of dollars in fact. But why?
We all know that the insurance industry is highly regulated. States exercise a good deal of control over what insurance companies charge (rates and premiums) and how they manage their finances to make sure they have enough money set aside (reserved) to pay the claims they are obligated to pay their policyholders.
A little more than a year ago, the Florida Office of Insurance Regulation issued an order allowing commercial property insurance companies to use new forms without first obtaining the OIR’s approval. The “fast-track” process will become state law on July 1.
We are finishing up our discussion of anti-concurrent causation clauses, but we would like to reserve the right to revisit the issue. A state that was hit hard by Superstorm Sandy is considering legislation that would address, among other things, anti-concurrent causation clauses in homeowners insurance policies. The insurance industry calls the proposal “misguided, if well-intentioned.”
If things happen in threes, and your homeowners insurance policy has an anti-concurrent causation clause in it, you had better hope all three of those things are covered. If not, your insurer will deny the claim. Homeowners hit by Superstorm Sandy learned this lesson the hard way, and state legislatures and regulators are looking into how to rein in insurers’ vigorous enforcement of ACC clauses.
We are continuing our discussion of anti-concurrent causation clauses in homeowners insurance policies. ACC clauses have garnered attention in the past few months as states less well-versed in insurance than Florida dealt with the aftermath of Superstorm Sandy. Homeowners were surprised to learn that their insurance policies included a kind of all-or-nothing coverage provision.
With hurricane season looming over Florida homeowners, it may be time for us to learn something from other states with less major storm experience. When Superstorm Sandy hit Mid-Atlantic and New England states last year, homeowners and commercial property owners learned the hard way that anti-concurrent causation clauses in insurance policies are valid and enforceable. At least one of those states has passed a law requiring insurers to explain the ACC clause in a separate notice to each and every new and renewing policyholder.
We are wrapping up our discussion of a number of lawsuits, one filed here in Florida, against life insurance companies. The plaintiffs accuse the insurers of holding on to death benefits when the companies know or should know that the insured has passed away.
