Gilman and Pastor, LLP has substantial experience in numerous areas of insurance litigation on behalf of both plaintiffs and defendants. We represent purchasers and policyholders, including business and consumers who have been victimized by unfair and deceptive practices or insurance bad faith.
Examples of such unsavory practices are the following:
Vanishing premiums which do not vanish
Failing to protect an insured’s interests in bad faith
Misrepresenting an insurance policy as a retirement or investment product
Insurance Litigation Our attorneys have extensive experience litigating insurance claims on behalf of homeowners and business owners against their insurance companies. We have represented in the past, and currently represent businesses and individuals in a wide array of insurance cases, including:
1. Hurricane Property Damage
We have handled claims involving the improper calculation of deductibles, determining coverage, and cases where the insurance company simply refuses to pay the right amount.
2. Sinkhole Damage
There are generally two kinds of sinkhole claims: (1) the insurance company denies that there is sinkhole activity; and (2) the insurance company acknowledges that sinkhole motion exists, but then fails or refuses to adequately or timely pay to repair the damage.
3. Life Insurance
While life insurance carriers actively advertise for, and promote, their life insurance coverage, and then willingly accept premium dollars for many years – decades or more – they too often fail to pay on the claim in the consumer’s time of need. Claims denial is common.
4. Long Term Disability (LTD) Insurance
Consumers pay their LTD premiums, and then, suddenly, when they need that become disabled and need that coverage the most, the LTD carrier refuses to honor and pay the claim.
5. Health Insurance
Health insurance companies, in their efforts to maximize profits and to cut costs, often delay or deny treatment for valid health insurance claims. These insurance companies simply deem innovative, progressive treatment as “experimental” and excluded under the policy. They also engage in “rescission," which is their concerted effort to retroactively cancel the policyholder’s coverage by claiming the insured lied on the on an insurance application form.
6. Denial of Warranty Claims
When a consumer buys a home, a car, appliance, or other costly product, he or she also purchases additional insurance protection – called a warranty – to protect the consumer against costs of repair or replacement if the purchase turns out to be defective or fails. Many builders, car dealers, and electronics chains, sell these warranties at an additional cost over and above the product’s purchase price. Unfortunately, many warranty companies fail to honor their warranty obligations to repair or replace the defective product. There are several variations of this warranty denial: (1) claiming the product or defect is not covered; or (2) claiming no coverage exists because the item is “out of warranty” or outside the warranty period.
7. Vehicle Property Damage
Vehicle crashes, accidents, theft, fire, or adverse weather conditions can result in substantial vehicle property damage. Auto insurance companies often fail or refuse to cover the full extent of the property damage. For profit’s sake, insurance companies try to pay consumers the very least amount of money possible for vehicle property damage. Insurance companies are required, however, in virtually every State, to honor the terms of their policies. If they fail to honor their policies terms, in many case insurance companies can be sued for bad faith.
More often than not, auto insurance companies attempt to repair the damaged vehicle instead of declaring the vehicle a “total loss,” or “totaling” the vehicle. Not only does this improper tactic greatly diminish the vehicle’s value, but may also place the consumer at risk of operating a defective and unsafe vehicle.
8. Fire Insurance
Fire insurance protects against fire damage to homes and businesses. When a substantial claim is made under a fire insurance policy, insurance companies often seek to deny coverage on several grounds: (1) arson; (2) electrical fire; (3) appliance and product malfunctions. Insurance companies also often refuse to pay the correct for repair, replacement, relocation, or rebuilding.
9. Water Damage
Water damage to the home is caused by many sources: broken washer lines/hoses, broken refrigerator water lines, broken ice machine hoses, or leaking roofs. Insurance companies may be held liable for failing to pay a water damage claim, or when they fail to pay the correct amount.
10. Flood Damage Claims
Water damage in the form of flooding often ruins a home. After the water has been removed, there is often mud residue and toxic mold which take hold of the structure itself, rendering the home uninhabitable. Major appliances and electronics, including washer, dryer, refrigerator, furnace, water heater, televisions, computers, and other related products and irreparably damaged and require replacement. Carpeting and drywall have to be replaced. The damage to the structure itself – called structural damage – may be insurmountable to repair, meaning relocation or rebuilding are the last available options.
Most homeowner, condo owner, and business insurances cover water damage, but exclude “flood” damage. Because of this standard exclusion, insurance companies often attempt to delay or deny claims for water damage by simply categorizing the damage as flood damage. There are strict legal definitions that apply to these situations, and quite often the insurance company’s claim denial based on claiming the damage is flood-related can be defeated in court.
11. Employee Retirement Income Security Act (ERISA) Disability Claims
Consumers whose disability insurance is issued through their employer often fall under the federal employee benefit law known as ERISA. Consumers who have become disabled need their private disability insurance to cover their new and increasing financial needs. This is why the consumer purchased the private disability insurance in the first place: peace of mind. Unfortunately, insurance companies often fail to provide compassion or an adequate legal basis for denying valid disability claims by their insureds for coverage under long-term and short-term disability policies. Special rules for ERISA claims apply, so our attorneys knowledgeable in ERISA law can help.
12. Hail Damage
Hail damage to homes and business is often covered in homeowner and business insurance policies. Often, the insurance company claims the roof damage or other proiperty damage caused by hail was pre-existing, or was not the result of hail damage. Where these claims have been wrongfully denied, then the insurance company is often liable to the policyholder for the claim as well as attorneys’ fees and costs.
13. Toxic Mold Attorneys
Toxic mold claims originate when a home is subject to water damage or intrusion from the elements, faulty workmanship, burst pipes, roof leaks, or other sources of water entering the home. Water intrusion in the home often results in the growth of toxic mold, which takes thrive in moist environments. When water damage leads to mold, then the homeownwer’s insurance policy is often required to pay for resulting repairs, clean-up, and replacement of affected structures.
14. Home Owner Insurance (HOI)
Homeowners’ insurance (HOI) protects the home itself as well as the contents, or personal property inside the home. Most consumers have paid their HOI premiums for years, even decades, without filing a single claim. When a home and/or its contents are damaged or destroyed in a hurricane, tropical storm, thunderstorm, lighting strike, fallen tree, or even an errant vehicle, then a HOI generally covers the claim, including repair, replacement, and rebuilding. Insurance companies are increasingly refusing to pay valid claims, delay paying the claim, or underpaying the claim. Because an insurance policy is a contract between a homeowner and an insurance company, the insurance company must abide by the terms of its contract. Where the insurer wrongfull delays or denies paying a valid claim, it can be held liable not only for breach of contract, but also for bad faith.
In addition, the firm has considerable experience in construction structural equipment accidents, medical malpractice, and premises liability.
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Gilman and Pastor has Successfully Defended Large Corporate Interests
Gilman and Pastor has defended large insureds’ claims for products liability and has provided representation for Ford, GMAC, American Druggists, and Charles of the Ritz, to name a few, including numerous insurance companies.
$150 Million Recovery in Michaels v. Phoenix Home Life Mutual Insurance Company
Gilman and Pastor was actively involved in the prosecution of litigation involving the sales, marketing, and operations of life insurance by Phoenix Home Life Mutual Insurance Company. After extensive litigation, a recovery was obtained that was valued in excess of $150 Million.
$100 Million TransAmerica Occidental Life Insurance Recovery
Gilman and Pastor was actively involved in the prosecution of litigation involving the sales, marketing, and operations of life insurance by TransAmerica Occidental Life Insurance. After extensive litigation, a recovery was obtained that was valued in excess of $100 Million.
$125 Million Manufacturers Life Insurance Recovery
Gilman and Pastor was actively involved in the prosecution of litigation involving the sales, marketing, and operations of life insurance by Manufacturers Life Insurance Company. After extensive litigation, a recovery was obtained that was valued in excess of $125 Million.
$100 Million Sun Life Assurance Company Recovery
Gilman and Pastor was actively involved in the prosecution of litigation involving the sales, marketing, and operations of life insurance by Sun Life Assurance Company. After extensive litigation, a recovery was obtained that was valued in excess of $100 Million.
$350 Million John Hancock Mutual Life Insurance Recovery
Gilman and Pastor was actively involved in the prosecution of litigation involving the sales, marketing, and operations of life insurance by John Hancock Mutual Life Insurance Company. After extensive litigation, a recovery was obtained that was valued in excess of $350 Million.
Gilman And Pastor LLP Has Won An Important Decision Involving The Statute Of Limitations In Litigation Against Berkshire Life Insurance Company.
The United States Court of Appeals for the First Circuit issued a decision Wolinetz v. Berkshire Life Insurance Company, No. 01-1217 (1st Cir. March 18, 2004) recognizing that an insured who purchased a vanishing life insurance policy based upon fraudulent representations was within his rights to bring a lawsuit for fraud ten years after purchasing the policy when the company intentionally failed to disclose the true basis for the decline in performance of the policy.
The plaintiff had alleged that Berkshire Life sold insurance policies by using projections of policy performance which it knew or should have known were unreasonable, and without disclosing material, adverse facts which made it impossible for the policy to perform as illustrated. A lower court had held that the statute of limitations barred the claims, based on Berkshire’s arguments that the insured’s knowledge that the policy was underperforming was enough to put him on notice of fraud. Gilman and Pastor attorney Douglas M. Brooks argued to the appeals court that Berkshire concealed the true cause of the policy’s underperformance – that Berkshire Life’s illustrated dividend scales were artificially inflated to begin with -- and Berkshire Life knew when it sold he policy that dividend reductions would be necessary.
The United States Court of Appeals for the First Circuit, which has jurisdiction over all of the federal courts in Massachusetts, Maine, New Hampshire, Rhode Island and Puerto Rico, agreed and held that the issue of when the statute of limitations began to run should have been left to the jury. The First Circuit sent the case back to the United States District Court for the District of Massachusetts, stating that the plaintiff did not have “sufficient storm warnings to alert a reasonable person to the possibility that there were misleading statements or significant omissions involved in the sale” of the insurance policy.
Brooks said “this decision vindicates the principle that corporations who knowingly sell defective products but conceal these crucial facts from consumers should be held accountable, even if the injuries are not discovered until many years after they sell the product. This principle applies not just to insurance policies, as in this case, but to any defective products which might cause physical or economic harm to a consumer, from drugs to defective product.”
$180 Million Settlement of New England Mutual Life Insurance Company
Our firm successfully achieved settlement valued at $180 Million in our representation of the policy holders of New England Mutual Life Insurance Co. concerning deceptive sales and marketing practices of life insurance policies.
