Insurance Bad Faith, Expert Witnesses, and Lawyers–Part I
Expert Witnesses (Sometimes Lawyers) in Insurance Bad Faith [IBF]Cases[1]:An Mostly Elementary Introduction to Some Fundamentals in Two Parts (Part One) Table of Contents I. Introduction(Part One) II. Insurance BadFaith (IBF)—Broad Characterization of Coverages (Part One) III. Types of Insurance Bad Faith (Part One) IV. Typical Issues and Conduct of Insurers &Adjusters in an IBF Case: Expert Witnesses(Part Two) V. Other Uses for Insurance Expert Witnesses(Part Two) VI. Qualifyingand Preparing Proposed Experts & Other Recommendations (Part Two) VII. Lawyers as Insurance Expert Witnesses (Part Two) VIII. ConclusionPart (Part Two) I. IntroductoryRemarks Widespread Error inNomenclature. One way to describeall acts of (at least) common law bad faith is to say that they lack bond fide or that each act whichconstitutes an act of insurance bad faith is one not characterized by bona fide. This is quite a popular namein various appellate courts around the country. This is by itself a mistake, however, since it is not terribly helpful. The Latin phrase being discussed originallyapplies to contracts, and it means “made in good faith, that is, without fraudor deception.” It also means an act whichis “sincere or genuine.” There are fivedistinct theses wrong here. (1)Insurance bad faith does not refer to contract formation. (2) Insurance badfaith cannot be defined in terms of its self, to wit, bona fide which is a phrase meaning “bad faith.” And (3) fraud anddeceit in an insurance adjustment process are by themselves insurance badfaith. A lack of sincerity in at least part of the adjustment practice is notsufficient to establish IBF. Imagine anadjuster posing as being attentive or loyal to an insured’s problem if he isnot. He still may do it right, even ifhe despises. An adjuster might act asthough he believed every word of a claimant, and yet believe that the claimantis a lying can of cheap and odor filled black shoe polish. Genuineness issomewhat similar, and my case it is even easier to make.[2] (5) The reader will see shortly that one ofthe names for insurance good faith is “good faith and fair dealing.”Bona fide obviouslymatches up the first phrase, but it doesn’t fit well with the second. Thus,one has to try again. Most courts havedone exactly that and often setting forth reasonable several-element standards. It is the name bona fide taken by itself that’s wrong and unhelpful; usually themore complex and more jury-understandable standards actually set forth bycourts are not consistent with the definition of bona fide to be found, for example, in any recent edition ofBLACK’S LAW DICTIONARY and THE OXFORD COMPANION TO LAW.B. Revision of Nomenclature. Here is one way the duty of good faith isthat the insurer must deal with the insured in a fair manner and process claimsin a good faith manner. As all readypointed the second conjunct of this definition is unhelpful, but the firstconjunct is extremely helpful. Thus allinstances of insurance good faith in the adjustment context require fairness orfaith dealing. Interestingly, therequirement of insurer bad faith is often actually called the “duty of goodfaith and fair dealing.” Sometimes the duty of good faith isformulated as something like this. Aninsurer has failed to adjust a claim in good faith if it has failed to provideor negotiate a settlement of a claim when it knew or should have known that thevalidity and/or value of the claim were reasonably clear. Insurer bad faith is not terriblyinteresting, when an insurer fails or refuses to “settle” a claim when it knowsthat it is valid and (roughly) its monetary value is not terribly interesting. C.Insurer Had Knowledge. Often an expert witness is not needed to prove the existenceof this knowledge. An expert may noteven be needed if the insurer denies that it had the requisite knowledge. Inthat type of case, the insured would have to prove that it probably had therequire knowledge; in that latter type of case some sort of expert testimonymay be required. It would be this noinsurer of even minimal competence could possible have failed to know thesignificant propositions.D. Insurers Should Have Had Knowledge. Expert testimony is much more required when the issue iswhether should have known some crucial proposition(s). In these types of cases, the testimony willbe much more probabilistic and sophisticated that regarding what even a near“idiot” insurance company would have to know. The kind of expert testimony required in the second type of context willhave to do what must be understand and believed because it isinsurance-adjustment-context-reasonable (“reasonable”) and because its oppositeis not reasonable, or is less reasonable, to a significant degree. This kind of testimony has many dimensionsand is much more interesting than “This insurer knew that it a claim was valid(a) because it admits that this is true, (b) has admitted that it is true, or(c) was and still is the greatest “idiot” insurance company in the history ofeconomies with the slightest component of free markets.” II.Insurance Bad Faith (IBF)—Broad Characterization of Foci Insurancerelated expert witnesses are usuallycalled only to testify on insurer bad faith matters, and not directly oncoverage or legal issues.[3] Thus, this outline will appear to be simplerthan these types of discussions generally are. Then again, it will not be as boring as these “papers” and presentationsoften are. So, let’s begin with theunderlying substance: typical areas ofbad faith.A. FirstParty Coverage (FPC) involves insurance policies where the insuranceproceeds or benefits are to be payable to the insured(s) or beneficiariesdirectly and usually involve disputes between one or more insureds and one ormore insurers, e.g., property insurance, health insurance, or workerscompensation insurance.B. Third Party Coverage (“TPC”) occurring mostfrequently with liability insurance “LI”), involves insurance policies (or thatpart of them), where the insurance proceeds are to be paid, not directly to theinsured, usually but to third parties on behalf of the insured. The coverage is designed so that the insurer paysin the insured’s stead the damages owed or probably to be owed by the insuredto others for certain types of liabilities. Those covered liabilities of an insured must always arise under certainspecific circumstances. Most commonly when the injurious event was (1) not “fortuitous”or (what pretty much amounts to the same thing, (2) was an accident, or (3) wascertainly unintended, at least, usually. (4) Sometimes the act causing theinjury was intentional but had an injurious consequence which was bothunintended and unexpected. Whetherdamages arise from an accident, whether fortuity characterizes a casual event,or whether its one if its linguistic “cousins” apply, are jury issues. Still, an insurer’s decisions regarding theseissues can constitute bad faith; this too is a jury issue. As a general rule, the law of insurance badfaith has a much more diverse and complex relationship with FPC than it doeswith LC. (In at least some states forexample, common law insurer bad faith does not apply to LC at all, and inothers it does not apply to parts of LC.) III.Other Waysto OutlineTypes of IBF Types In this section I spell outadditional details generally outlined in the previous section. In this way, I focus a bit more on thefunctions of adjusters and experts on adjustment practiceA. Different Types of Bad Faith. I start with the claims adjustment processand insurer decision-making conduct. 1. Common Law IBF (CL/IBF) Issues: performanceof significant matter in the adjustment of a claim or claims, and whether itwas done or decided with or without a reasonable basis. a. If adenial is decided without a reasonable basis, the insurer is guilty of commonlaw bad faith.b. In provingor defending against allegations of commonlaw bad faith, reference needonly be to general principles of insurer performance and the acts or omissionsof the carrier and applied to the situation(s) in which those decisions, acts,or omission took place. Statutory badfaith is the opposite. c. This rulecan be understood as something starting with a negligence rule, namely that theinsurer failed to meet the industry-business adopted or prescribed standards ofcare for performance. Many applicationsof the negligence rule apply to bodily injuries and damage to physicalproperty. This is not really true,however. IBF is like or starts with thenegligence rule because it is actually very much like a rule of professionalmalpractice. It is as if there is such a thing as “adjuster malpractice.” There is another principle involved injudging malpractice however, as we shall see, and it is a breach of a fiduciary duty (as it may be for lawyers).d. Someobservers and a court here and there, have contended that IBF has only to dowith the insurer having been unreasonable with respect to discovering, analyzing,and coming to conclusions about the facts, and they try to say that there canbe no IBF when it comes to the language of the policy. This idea is non-sense. A person can make an unreasonable error ininterpreting language in a whole variety of different ways.e. Manystates have this rule CL/IBF, but some states don’t. Some states use this idea. f. In manystates who have adopted this rule, it applies only in cases of first partyinsurance “FPC”. This means that it doesnot apply across the board to liability insurance, except—maybe—to the duty todefend. A. Statutory Bad Faith—Specific Statutes[4]: Anumber of acts or omissions are explicitly required of insurers in connectionwith an insurance claim. E.g.: 1. Specific Acts: for example, misrepresentation, failure to settle in areasonable manner, giving erroneous reasons for denial, etc. 2. Certainacts must be performed “promptly” and reasonably understood in context. Often promptness is fixed to a specifiednumber of days. It is also, however,linked to having received needed and requested documents, etc. 3. In states at least insurers must provide insureds with the reasons orjustification for certain of its decisions, e.g., denial of a claim, substantialdelay of deciding a claim, the reasons it does or does not do something inadjusting a claim, or reserving its right(s) to do something (or several things)later. 4. IBF allegations and/or the defenses against them should referspecifically to the terms at issue in the relevant statute. The term “specific” does not require that thespecification be perfect—or even really—precise. Atthe same time the difference between the two types of IBF are recognized, it needsto be kept in mind that they have a similar spirit and virtually identicallypurposes. My creativity energy and my imagination is always more at home withthe common law because of its generality than it is with statutes because ofits being more specific. The reader might find that attitude helpful.IIIBad Faith and the Expert Witness A. Types of Actionable Insurer IBF Errors. A great many cases of insurer bad faithinvolve situations in which an insurer has significantly misconstrued, misunderstood,or misrepresented the meaning of its own insurance policy. B. The Idea of “Long Distance.” Alternatively,it could be that the insurer understood its policy, but its adjustment behaviorwas at a “long distance,” conceptually conceived, from what is required by themeaning of at least one relevant term in itspolicy. An insurer’s mistake is a “longdistance” from (i) what it ought to do or, (ii) how it should take its policylanguage to mean when it makes either a quite substantial error or makes anobvious and injury casing error, e.g. of money. These mistakes need not be deliberate (i.e., intentional), but they canbe. B. Another Source of “Long Distance.” Rulesand principles, if they exist in writing, for all of these various types of errors can often befound in records of various types of the insurance company. Usually they are tobe found in the records of insurer’s adjustment department, if they exist. If they existed in the past, but no longerexist, the chances are that the insurer destroyed them for some reason. It may be important for the policyholder topursue this topic, to the extent possible. The rules and/or principles are often called something like “AdjustmentGuidelines” or “Adjustment Manuals.” Policyholder lawyers should not set up their inquires to insist thatthese exact words or titles be used or counsel for the insurer will avoidproducing them. Interestingly,sometimes these manuals are designed to independent adjusters. Sometimes thesematters are handles in training and education sessions provided adjusters whenthey first enter the company or thereafter on a periodic basis. Sometimes the adjuster’s have kept the“textbooks” sometimes not. The chancesare that the insurer has them in its library, or something like it. Many big insurers have education departments. Sometimes they are kept in the generalcounsel’s office. Sometimes an outsideeducational or training firm is used. Such companies will almost certainly have the texts it used, and it willprobably have been approved by the insurer at some point. Experts often find these texts valuable. This true of experts on both sides of aninsurer-policyholder controversy.In anycase, often policies are standard form policies, so there may be well-establishedcase law on a good deal of the important language or topics. An expert witness on insurance adjustment should be readyto testify about the “distance” between the meaning of the terms of theinsurance contract and the conduct of the insurer in performing theinvestigation, its decision-making, the language, contents, and omissions inits—say—denial letter, the language, contents, and omissions in its reservationof rights letter, and so forth. Interestingly, to do this the expert will haveto testify to some degree about the law or about accepted law. If there are no guidelines or printed principal-books orpamphlets of any kind, this may be a problem for an insurer. If there are or were such things, and theyare not produced, that too will be a problem. Of course, if any of all this occurred in recent years, it will be inelectronic “storehouses” and will hence be “findable” and subject to productionin litigation.B. GeneralPrinciple of Common Law IBF—simply put—This principle is that an insurermay not make substantially unreasonable adjustment or claims decisions,as a result of which the policy holder is, in effect, deprived of money towhich it is entitled. (Of course, those involved believe or at leasthope that the coverage decision is the end of the “game.” Very, very often, the hope is satisfied.) In any case, the actions and/or decisionscannot be “unreasonable in a minor way” or “unreasonable in minor ways.” In addition, there must be an error as tocoverage, whether its existence or its amount. Thus, asjust indicated the policyholder must have been deprived of some or all proceedsunder the policy to which it was entitled. That policyholder may also beentitled to money damages as the result, having nothing to do with the natureand extent of coverage in of itself, but caused by the bad faith conduct,including omissions. Its damages may, inthe end, be far larger than the award of coverage to which the policyholder isentitled. Considerthe following illustration. What if aninsured hotel owner sustains $1m physical damage to its hotel as the result ofa storm but the insurer denies coverage on the ground that they physicalinjury is not the result of wind damageand the water damage it causes, but water damage by itself without there havingbeen preceding and causative wind damages. Now suppose the insurer is wrong, and did not perform anywhere near asatisfactory investigation, investigative reasoning, or inquiry into how statelaw works when an insurer, in effect, water over wind. So the insured gets its $1M, but it hasn’tbeen able to attract customers for 2 years, and it has lost $5M. The hotel might well recover the $1M incoverage and an additional $5M for theinsurer’s conduct, of course, plus interest and perhaps some of its attorneys’fees. Thus, bad faith claims can beextremely powerful. Adjustment actions or decisions can includemany various things, such as: 1. denialof coverage; 2. issuance of amounts of recovery under the policy; 3. calculation amounts of policy holder entitlement frominsurers, [5] 4. issuanceof a reservation or rights; 5. language of the reservation of rights communiqué (letter); 6. andso forth. If these acts ordecisions are manifestly unreasonable,[6] irrational,and/or falling way, way below the accepted standard of care generally acceptedin the “industry,” it is obvious there will be insurer bad faith. It must be remembered that adjusting a claimis not as simple as driving a motor scooter. The more complex the case, and hence the more the adjustment process,the less resemblance there is between the analogy used here—or anything like it—andthe “real thing” of the adjustment process. The same goes for situations in which the insured is, shall we say,unhelpful, uncooperative, deliberately difficult to deal with, and/or so forth. This is true in general and across the board. Still, if the insurer “screws” thepolicy holder or blunders into its equivalent, there is IBF.C. Epistemology. Many of the principles of soundadjustment are principles of epistemology, i.e., how we can know truths, whatare sound ways of discovering truth, what counts as truth in this or thatsituation? What is to done aboutinconsistent stories, especially when each of them is probably? What is to done about inconsistent butplausible disagreements as to the meaning of policy language? So hereare some epistemologically based principles of reasonable insurance adjustment:
1. Look for the truth as well ascoverage. Indeed, look hard for thetruth. 2. Empirical evidence must be thefoundations of denying a claim.3. All evidence must be sought in an energetic manner.4. All evaluations of empiricalmethodology and empirical evidence must be objective, and neither subjective orbiased in any direction.[7]5. Determine what are the mostappropriate and best methods for obtaining appropriate and needed empiricalinformation?6. Determine the right method fordealing with evenly but clearly conflicting empirical evidence. (Of course, in many situations there isexactly only one way to do this.)7. Determine how conflicting stories should be dealt with. Maybe determinewhat other back-up evidence should be devised and use.8. Determine what experts, if any,need to be used.9. Determine the logical reason which should be used in making coveragedecisions.10. Determine what sort of dialogues,“round table discussions,” objective reviews, and so forth, should beperformed.11. At some point, and perhaps at an early point in the reasoning process,determine how long a reasonable adjustment should take. 12. At every stage an adjustment process is slowed down or blocked, a newschedule should be devised, checked, reviewed, shared, and so forth. a. Oftenproblems of scheduling and rescheduling should be discussed, etc., with thepolicyholder. b. Determinea reasonable temporal decision-making process, if at all possible, which can bedecided by both the insurer and the policyholder. (It is amazing how frequently exactly this isnot done.)[8]Of course, after all thisepistemological work has been performed, appropriate behavior and actions mustfollow. Equally, “of course,” is thefact that in many types of at least simple adjustments, all of thesepropositions have been thought out well in advance. Nevertheless, whether there is any need forany of these must be considered on every adjustment. It doesn’t take very long in many simple case. D. CommonLaw Bad Faith vs. Negligence 1. Asalready asserted, common law IBF is NOT identical to negligence, inadvertence byitself is not enough; it is not a sufficient condition for there being IBF. (Somemight say that it is nothing like negligence at all.) Here are different approaches. One can lighta match negligently, call somebody by the wrong name, or misspell a wordnegligently. One can even drive a car ina sloppy or inattentive way. Such errors do not constitute acts performed in badfaith. IBF requires seriousness,relevance (or materiality), and guilt laden diversion from honorable practice. Accidental blunders are not IBF if they arecorrected. Curiously, the extent of aninjury caused is not relevant to whether an event has been caused by negligentconduct. The same may not be true ofIBF, at least in the practical world. 2.Common law bad faith requires a complex system deliberate, purposeful conductby the insurer into which IBF actions must fit. This is something close to the immediately preceding remarks. IBF is relatively complex over-all conduct whichis to be pursued integral to the complex framework. 3. Someone might analogize bad faith insurerconduct to gross negligence, although that isn’t quite right either.[9] Actual recklessness is not required forIBF. Maybe something close to it may besufficient, though not necessary, condition. 4. In contrast to IBF, negligent acts must bealmost completely an unintentional performance or one not explicitly motivatedby its actor-oriented self-interest, evil, or close-to-evil’s, distant cousins. (Here “performance,” also includesomissions.) 5. Still, even an excessive lack ofintentionality—something like intensely ignoring something relevant—can itself bea symptom of IBF, since adjusters—given that the insurer, insurer’s employees and its independent contractoradjusters—are supposed to treat policyholders, and their interests, as at leastequal to the insurer, together with its interests. All adjusters are supposedto be thorough, careful, objective, rational, and equality-committed. 6. Of course, all of thetypes of conduct just listed require that the adjuster pay close and careful attention to what s/he is doing. This entails that very speedy adjustment can becontrary to principle, even if conclusions turn out to be correct. Why? We’ll see presently. g. Still, IBF has aconnection to negligence. An act (oromission) constitutes bad faith only if it is at least negligent or worse. This principle is necessary for IBF, but it is not sufficient. Thus, negligence, recklessness, or problematic and disturbing intentionalityare necessary conditions, under normal conditions, of insurer bad faith, butnone of them are not sufficient conditions. Materiality and injury-or-damages are also necessary. b. Probably, an expert will (or shouldbe) permitted to testify about these matters. 3. Different Standard of Care thanNegligence. a. Here is a different approach to what hasnow been discussed for a while. In the negligence context, actors owe eachother only the duty of ordinary care. Insurers, because they have a special relationship with each of theirinsureds, owe each of their insureds the dutyof good faith and fair dealing. Generally,as already indicated, in many, and perhaps most states, this means that an insurer must treat the insured’s interestson a par with its own, or at leastequal to its own. Quite frequently, findingsof IBF involve an insurer not following this important principle. Adherence is often a matter of perspective,which is easily lost in the heat of the moment. In any case, if a policy holder wants to prove IBF this is key principleto emphasize, of course, among several others. b. Significantly,an expert witness should be allowed to testify as to whether an insurer objectivelyacted in good faith. This is not simplya matter of law. c. With two exceptions, IBF does not applyto LI. Often, generally speaking, as alreadyobserved, the standard common law of insurer bad faith does not apply to the“we the insurer will pay specified losses” parts of the policy. (i) First Exception: Unreasonably wrongful failure or deliberatefailure to provide a defense to the insured, if called for in the policy.[10] As a general rule, the duty to defendrequires notice from an insured. Oncenotice is provided the insurer must treat the duty to defend as FPC (or itsequivalent).[11] (ii) Second Exception: IBF in LI situationscan be created by unreasonably wrongful failure or wrongfully deliberatefailure or refusal to settle a covered case against an insured, after areasonable demand has been made to settle within policy limits.[12] (Often this is called a “Stowers Demand.”[13] This name originates from a Texas case, but it is used by at least someinsurance adjusters, examiners, and more senior claims department people allover the country.) (iii) Experts on LI claims practice and related decision-making are usuallypermitted to testify about whether an insurer made a reasonable “Stower’s decision” and is therefore not“guilty” of IBF. Thus, the Stowers situation is distinct from mostdimensions of insurer conduct pertaining to liability policies.(iv) If an LI insurer has erroneouslydenied coverage and the insured has received a “Stowers demand” and settled it for amounts beyond policy limits, isthe insurer liable for the whole sum? Would it matter if the settlement sum was reasonable? What if it was unreasonable? What if the underlying case was tried? Suppose the verdict and/or judgment exceededpolicy limits. Would the nature andstructure of the underlying case matter? Insurance experts should be able to testify as to parts of all this.(v) Would it matter whether or notthe insurers denial was reasonable or not? Some experts should be able to testify about some of this at least.(vi) Suppose an insurer indicatedthat it would defend under a Reservation of Rights but the insured rejectedthat “offer” of defense? It is saying, “You defend me without a reservation ofany rights, or I will go forward without you.”[14] 4. FPC mostly focuses on “property damages,”and/or what used to be called “Business Interruption Insurance,” and which isnow “officially” called “Loss of Business Income Insurance”[15] is entirely different, although the latter isusually tied to the former. There areexceptions; there is FPI which is not tied to “property damage.” a. Here is examples of first party insurancewhich concerns property but not “property damage:” (i) insuranceupon art work which is designed to deal with the risk of its being stolen, orsold to the policyholder fraudulently;[16] (ii) insurance upon making a motion picturewhen one of the actors drops out;[17](iii)insurance triggered by a kidnapping of a business worker and his/her familywhile in a foreign country;(iv) Thereare other FPC business insurance which are rather esoteric. Here are four of them: b.Disability, health, and accidental insurance all focus on “bodily injury,” andthey are first party insurance.c. How shouldwe think about life insurance?d. How shouldwe think about insurance on jet airplanes which cover not only the plane butalso those who are killed when the plane crashes.
[1] Thisis a revised version of a speech-paper distributed at a Continuing LegalEducation program held in the winter of 2011 at South Texas School of Law.There have been no changes in the fundamental dimensions of the applicable law. [2]Then again, an adjuster can be genuine (and/or sincere, for that matter) and beguilty of bad faith. I “saw” this notlong ago. The adjustment was passingthrough difficult stages: data collection and recollection, sworn proof aftersworn proof, equivocal indicators from the insurer, and statement from theinsurer which the policyholder took to be devious. At one point he said the the adjuster, “I amthrough with your shell games.” Theadjuster replied, “I will engage in shell games with you as often as I please.”Now there’s an adjuster who should be sacked forthwith. Imagine how dreadful if a coverage litigatorsaid something like this in a deposition?
[3] Asa general rule, when testifying before a jury, experts on insurance—insurerconduct, for example—are not asked or allowed to testify as to the precisecontent of cases or statutes, per se. (Sometimes, when an expert is testifying before a judge only, theopposite may be true when the expert is acting as an explanatory witness abouthow insurance policies work; this is also frequently the case indepositions.) It often helps for theexpert to have the short relevant sections of the pertinent statutes or lawphotocopied and on hand, as well ad a summary of the most recent pronouncementof—the elements of common law bad faith(either off to the side or in “the” stack to be used anyway, or in one’spocket). The same is true for lists ofall of those who are part of the cast of character in the pending case, as wellas the lawyers examining the expert witness. [4] See for example §§ 54l.060 and 542 ofthe Texas Insurance Code. This law is derived to some degree from modelstatutes, and many states have statutes like those of Texas and/or which aredrawn in whole or in part from the rule just mentioned. [5] This oneapplies to both small amounts and most interestingly to complex commercialcases. [6]This one might be described in the following slang, “Wow; Unreasonable,” “By God! Unreasonable,” “Intolerably unreasonable,” and so on. [7]Here is amazing story which is difficult to believe. My deposition was taken on April Fool’s Dayin 2011. I asserted that in anadjustment process insurance carriers had a duty to be empirically-oriented,objective, and logical in their reasoning. Deposing counsel actually asked me what was my “authority” formaking that assertion. [8] Ofcourse, complex adjustment processes will resemble construction projects. They will never run on schedule. But if everyone has laid out the plan andeveryone is working according to the plan agreed upon, bitter complaints andbad faith suits are less likely., [9] Recklessis still classifiable as unintentional, even though it is close tointentional. Reckless conduct issomething like negligent conduct performed in the context of a flagrantdisregard of other’s rights, “I don’t give a damn,” or even worse, “F-them, Ido as I see fit without paying any one’s interests, except under my ownnarcissistic conceptions.” [10]And it is called for in most liability insurance policies. Sometimes liabilities are also called“indemnity” policies. Ignore thisdifference, except in some rare situations. Be sure adjusters and experts know what they are talking abouthere. Perhaps the expert cannot testifyas to the semantic difference. Semantics differences can be treated as matters of law. This strikes me as unjustified. The usage andthe evolution of meaning is a historical matter, as a rule. If an insurer has actually issued a real“indemnity” contract of insurance, this fact must be, and probably will be,clearly indicated in the policy. In anycase an expert can testify to an insurer’s mistake in confusing the two terms,if it has influenced its behavior or indicates that the insurers’ rationale isunreasonably defective as to generally applicable knowledge. (From now on we will refer to all adjustersand all experts as “he.” It is notSexist in the slightest. It is simplethat the word “he” is shorter and easier to type.) In any case, observation in this footnoteapplies across the board. Thus,explaining how an insurer misused the phrase “surety bond”—which is or is closeto a type of insurance–indicates that the insurer is ill informed, and thismay indicate something indicative of bad faith or something dangerously closeto it. [11] Totrigger the obligations of an insurer, notice is always required. Under many or most circumstances, notice mustcome from the insured, or someone very close to that policyholder. [12] Atleast most jurisprudence (and therefore its courts) rejects the idea thatinsurers have a duty to make the settlement offer themselves. An expert should not this mistake. This is true though that some believe thatthis rule is a mistake—a legal mistake and a relatively “ancient,” uselessanomaly, which is nothing but insurer protective. [13] G.A.StowersFurniture Co.v. Am. Indem. Co., 15 S.W.2d 544 (Tex. Comm’n App. 1929,holding approved).[14] Iregard this as almost always as a bad idea for policyholder, even if it will not end up being a lack ofcooperation on the part of the insured. [15]Experts better know the accepted vocabulary difference and the unreasonablenessof an adjuster misusing these phrases. [16] Ofcourse, this insurance involves, it just isn’t tied to physical damage/injuryto tangible property. [17] Ofcourse this also looks like business interruption insurance.
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