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Bad-faith analysis

Fair claims practices and standards of care.

Whether the handling of a claim met the state’s fair claims practices statutes and regulations, the industry standard of care, and the carrier’s own claim-handling guidelines.

Property & Catastrophe Fair claims practices and standards of care Coverage and policy interpretation

About this practice area

The rules a claim is handled under.

Most states have adopted a version of the NAIC’s model Unfair Claims Settlement Practices Act. It lists practices an insurer may not engage in: misrepresenting policy provisions, failing to acknowledge and act promptly on claims, failing to adopt reasonable standards for prompt investigation, refusing to pay without a reasonable investigation, and failing to affirm or deny coverage within a reasonable time, among others. State regulations add specific deadlines and documentation requirements.

In many states these statutes do not by themselves give a policyholder a right to sue, but they are widely treated as evidence of the standard a reasonable insurer is expected to meet. Alongside them sit the industry’s customary practice and the carrier’s own claim manuals, guidelines, and training materials.

The analysis follows the claim file step by step: when the claim was reported and acknowledged, what was investigated and when, how it was evaluated, what the policyholder was told, and when and how much was paid, each measured against the standard that applied at that point in the claim.

A claim file laid against a solid graduated rule, the standard of care; each entry threads to its mark on the rule, and the one that falls late is flagged amber

Engagements

Measured against the standard.

Every engagement below turned, in whole or in part, on whether the claim was handled the way the rules and the industry required.

Testifying expert · Report

Claims handling and coverage in a major class action

80,000page record

68-pagereport, 327 citations

Fair claims practices

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Retained by a multi-national insurance conglomerate to review the 80,000-page record and issue a report on the claims handling and coverage issues presented by a major class action lawsuit against the policyholder. Allegations included bad faith, breach of contract, and failure to defend. Using case management software GIC was able to draft a 68-page report containing 327 citations to the record.

Also listed under: Claims Handling Review

Testifying expert · Report

California wildfire and mudslide losses at a luxury resort

250,000+pages in the record

Business incomeand extended business income

Property & Catastrophe

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Engaged by a five-star luxury resort for a breach of contract and bad-faith litigation in California arising from wildfires and mudslides. The losses arise from building, building personal property, business income, and extended business income coverages. The record consists of in excess of 250,000 pages.

Also listed under: Business Interruption Analysis

Testifying expert · Report, Deposition

Texas ice storms, February 2021: property damage and business income

2021Texas ice storms

Business incomeproperty and contents claims

Property & Catastrophe

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Engaged by an entertainment concern which suffered major damage and loss during the Texas ice storms of February 2021. This policyholder is contesting the carrier’s refusal to pay the benefits for property damage, business personal property, and loss of business income.

U.S. District Court, Western District of Texas, Waco Division

Also listed under: Business Interruption Analysis · Testimony record

Testifying expert · Report

Workers compensation bad-faith allegations against a TPA (South Dakota)

42-pagereport, 118 citations

16 daysfrom retention to report

Defense of TPAs, agencies, and counsel

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Engaged by a major claim third party administrator to address allegations of bad faith for their handling of a South Dakota workers compensation claim. Mr. Bingham’s 42-page report contained 118 citations. This report was completed 16 days from the date of retention.

Also listed under: Defense of TPAs, Agencies, and Counsel

Testifying expert · Report, Deposition

Major fire and business interruption at an entertainment venue

Business incomeproperty and contents claims

Property & Catastrophe

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Engaged by an entertainment concern which suffered major structural damage, including substantial business interruption claims due to a major fire. This policyholder is contesting the carrier’s refusal to pay the benefits for property damage, business personal property, and loss of business income.

U.S. District Court, Western District of Kentucky, Paducah Division

Also listed under: Business Interruption Analysis · Testimony record

Testifying expert · Report

Fire and business interruption loss from civil disturbance (Chicago restaurant)

Federalcourt report

Settledat mediation

Property & Catastrophe

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Retained by a Chicago restauranteur in bad-faith litigation with a major property insurer over a fire and business interruption loss stemming from civil disturbance. In addition to a report for the Federal Court, GIC assisted in the examination of carrier staff focusing particularly on deviations from the Illinois Fair Claim Practices Act and usual, customary, and ordinary practice. Case was settled at mediation.

Also listed under: Business Interruption Analysis

Other matters

Residential hail and wind bad-faith claimsTestifyingProperty & CatastropheRead moreShow less

Retained by a top tier personal lines insurer on multiple residential hail/wind claims where policyholders are alleging bad faith and breach of contract. Mr. Bingham has authored reports for both state and Federal courts and has given or is in the course of giving depositions.

Court of Common Pleas, Warren County, Ohio

Also listed under: Testimony record

Uninsured/underinsured motorist claim: bad faith and breach of contractTestifyingFair claims practicesRead moreShow less

Retained by a major personal lines carrier on an uninsured/underinsured claim where the policyholder was alleging bad faith and breach of contract. This state court case was settled upon production of Glynloen’s report.

Notice and reporting under a claims-made policyTestifyingCoverage and policy interpretationRead moreShow less

Engaged by a major carrier to offer expert opinions in support of claim denial asserting breach of contract, specifically notice and reporting issues on a claim made policy. Mr. Bingham’s report cited in detail the breaches, offered a timeline, and described the usual, customary, and ordinary practice for insurance carriers.

Also listed under: Claims Handling Review

Review of a claims department’s staffing, procedures, and settlement practicesTestifyingCarrier claims-practice reviewsRead moreShow less

Completed reviews and expert reports assessing propriety of Subject Company’s claim department’s staffing, claims handling policies & procedures, and overall fairness of Company’s claim settlement practices.

Also listed under: Carrier claims-practice reviews & audits · Reserve adequacy studies · Claim audits and file scoring

Failure to settle multi-fatality death claimsTestifyingFair claims practicesRead moreShow less

Retained by decedent’s estate in a bad-faith/breach-of-contract action against a self-insured for failure to settle death claims resulting from a driving while intoxicated accident involving multiple fatalities; Expert opinion report; sworn deposition.

U.S. District Court, District of South Carolina

Also listed under: Defense of TPAs, Agencies, and Counsel · Testimony record

Illinois Fair Claim Practices Act and standards of care in a hospitality bad-faith caseTestifyingFair claims practicesRead moreShow less

Retained by a Chicago based hospitality and entertainment operator to offer opinions in an insurance bad-faith litigation. Mr. Bingham opined on breaches of the Illinois Fair Claim Practices Act as well as industry standards of care and best practices.

Also listed under: Business Interruption Analysis · Claims Handling Review

Personal articles policy bad-faith claim (Texas)TestifyingFair claims practicesRead moreShow less

Retained as an expert on a Texas bad-faith claim controversy arising from a personal lines personal articles policy. Expert’s report tendered.

Insurance agency accused of negligence and bad-faith claims conductTestifyingClaims handling reviewRead moreShow less

Retained as expert for an Insurance Agency by their E&O carrier to defend against allegations of negligence, violations of the State Insurance Code, and “bad faith” claims conduct.

Also listed under: Claims Handling Review

Property & Catastrophe

First-party property losses: hail & wind, fire, winter storm, wildfire & mudslide, tornado, and civil unrest, often with business-interruption components and claim records that run to hundreds of thousands of pages.

View Property & Catastrophe →

Coverage and policy interpretation

Disputes that turn on what the policy says and how the carrier applied it: notice under claims-made forms, deductibles & waived conditions, the duty to defend, an agent’s representation of policy terms, and which insurer bears the extra-contractual exposure.

View Coverage and policy interpretation →

Fair claims practices and standards of care.

The rules a claim is handled under.

Measured against the standard.

Claims handling and coverage in a major class action

California wildfire and mudslide losses at a luxury resort

Texas ice storms, February 2021: property damage and business income

Workers compensation bad-faith allegations against a TPA (South Dakota)

Major fire and business interruption at an entertainment venue

Fire and business interruption loss from civil disturbance (Chicago restaurant)

Other matters

Elsewhere in Bad-Faith Analysis.

Property & Catastrophe

Coverage and policy interpretation

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