Hands tied legally?

Enough emphasis cannot be placed on the time limitations that surround your insurance claims. There are rules and guidelines that need to be followed in a specific format, and failure to do so can significantly impact your case.

Case example

In the case of L'Espérance v. Economical Mutual Insurance Group, we take a look at this real life case where time is of the essence, and discuss its outcome.

In June of 2011, an individual (the plaintiff in this case) informed their insurance company that their vehicle was stolen. The following day, the police informed the individual that the vehicle was found destroyed by fire in a removed location, and the plaintiff then updated the insurance company on the police's findings.

Mid-August of that same year, a Proof of Loss statement was made available to the insurance company and within the same week they requested that the plaintiff be examined under oath (via the Statutory Condition) . For reasons unknown, this examination did not start until almost eight months later the following year." 

It was noted that the insurance company was still "investigating" the claim which by then had passed the twelve month claiming period. The plaintiff's hands were tied legally because he or she could not bring forth a claim until the examination under oath of the sworn proof of loss statement was rectified.

Only in August of 2012 did the insurance company let the plaintiff definitively know that the claim was being denied based on the belief that it was fraudulent and had gone pass the time limitation requirement.

Because of these events, the plaintiff decided within the same month to file suit for breach of contract as well as bad faith. The plaintiff started the claim over a year after the theft and destruction of the vehicle occurred.

The issue at hand is whether the plaintiff's claim that he was "led on" by the insurance company is justifiable in determining the lateness of the filing of the claim. The plaintiff could not file the claim while the investigation into the proof of loss statement was ongoing and the insurer did not express their stance until after the allotted time period ended.

Their investigation implied that the claim was being scrutinized and this should require that the matter be dealt with in a manner that adheres to the rules and guidelines concerning time limits entailed in the contract between insurers and insured. The insurance company's response was that it was the plaintiff's right to ensure that the claim was being investigated in a timely manner.

Their claim was that they were acting well within their rights and assessing the case in a strategic manner that did not have to be divulged with the plaintiff. The Judge ruled that while the insurance company has every right to investigate claims to determine validity, in this case the length of time taken forced the plaintiff to file his or her claim after the allotted time period.

Since the time when the claim could be filed was solely dependent on rectifying the examination under oath procedure which they failed to carry through, they could not now try to debunk the claim based on the time limitations contained within the Insurance Act.

The issue of bad faith is linked closely with the breach of contract.  In this case, the deliberate wrong that the defendant is being accused of can only be assessed after the basic two year period entailed in the Limitation Act 2002.

Deciding whether or not the blame lies with the insurers for not addressing the issue in a timely fashion, or the plaintiff's lack of insistence and follow-up on the claim cannot be decided with a summary judgment but only through trial.

While the insurance company has a responsibility to ensure that their customers are rightfully compensated based on their policies, it is also in the hands of the insured customers to take an interest in how their claims are being handled, especially when it comes to the time constraints surrounding the claim.

An experienced and professional lawyer from Gluckstein Lawyers can help ensure that you are capably represented to ensure your rightful compensation.

Call us today for a free initial consultation and let us help you get your life back.