Insurance Claims

The firm has extensive experience with all types of insurance including property and casualty (liability), disability, life, and health insurance. While Jim and Bill have defended insurers and insurance brokers, more often they represent insured clients who are suing or being sued by insurers or third parties. They also work with and advocate for public insurance adjusters and insurance advisors. The expertise they have gained representing all sides involved in insurance disputes gives them great insight into the tactics which their adversaries are likely to employ, enabling Jim and Bill to be well-prepared to exploit the weaknesses of their opponents’ cases. As a result, the partners are uncommonly effective client advocates before administrative bodies, arbitrators, and referees – and through all levels of the judicial system.

Jim is acknowledged for his success, breadth of experience, and eagerness to litigate against very difficult adversaries. He is intimately familiar with property and casualty insurance policies and has sued and defended many parties in cases involving personal and commercial policies. Jim has represented many clients seeking to recover for property losses, as well as clients pursuing or defending against liability claims. He has also handled claims involving insurance premiums and premium audits. Jim frequently represents building owners who have sustained losses from fire, water, theft, collapse, and other hazards. He has represented clients before the Massachusetts Division of Insurance, as well as in references (arbitration proceedings under Massachusetts property policies) to determine the amount of loss sustained.

Jim enjoys complex insurance matters. His breadth of experience includes occasional adversary proceedings in the bankruptcy courts involving insurance proceeds and premiums, and non-competition claims among insurance agencies or between agencies and departing personnel. Both Jim and Bill relish insurance cases where they can demonstrate that their adversaries have acted in bad faith. These occasions allow the potential for judgments or settlements in excess of the original loss, regardless of the policy limits.

Jim’s notable cases include:

$275K fire insurance settlement for manufacturer despite policy limit of $21,000 for location of fire
When a warehouse fire caused $400,000 damage, Jim’s client obtained more than $170,000 from his primary insurer, which insured the building in which the fire occurred. Unfortunately, the amount of insurance was insufficient, and Jim’s client had an ongoing relationship with its insurance broker. Faced with limited options, Jim focused on a policy issued by a secondary insurer, covering a small amount of property ($21,000) in a separate building in a different location. The secondary insurer sought to limit its payment to the $21,000 specified for the location of the fire. Jim’s careful reading of the policy revealed an additional grant of coverage in the amount of $500,000, which applied to property “not at premises listed in the description of premises . . . at any location” – a phrase he reiterated throughout negotiations, the grant of partial summary judgment in his client’s favor, mediation, and successful settlement.

$250K liability insurance settlement for knee injury in which client initially sought only $10K
A partner in a video production company suffered a fracture to his tibial plateau when he was struck – as a pedestrian – by a car when crossing the street en route to a meeting. The minimal driver’s insurance was insufficient to make the client whole. The client came to Jim seeking to recover the $10K limit of “underinsurance” proceeds under the automobile policy of his common-law wife. That claim was unsuccessful because even though he was a “household member,” he was not related to his common-law wife by “blood, marriage, or adoption” under Massachusetts law. Undaunted, Jim discovered another policy covering the video partnership’s van that provided $100K in underinsurance coverage. Jim sued for the policy limit, plus additional amounts for bad faith. After Jim obtained summary judgment in favor of his client, the insurer settled for $250K, far in excess of the client’s medical expenses and lost earnings.

$200K settlement for $80K damage from insurer which wrongfully denied original claim
An indoor chemical spill caused $80K damage which the insurer refused to cover, citing the policy’s pollution exclusion. Jim questioned the applicability of the pollution exclusion since the spill was contained inside the building and the chemical was a principal raw material of the business, not a “pollutant.” Jim also noted that the policy provided an exception for pollution caused by certain specified causes of loss, including water from a pipe – and in this case, the chemical etched through a large water pipe, resulting in a liquid spill of water-borne chemical. Jim prevailed at summary judgment, setting the stage for a trial to determine multiple damages and attorneys’ fees due to bad faith. As a result, the parties ultimately settled for two and half times the claim’s original value.

$95K settlement above policy limit for an insurer’s bad faith adjustment of a house fire
Mindful that insurers are obligated to adjust and pay claims fairly and promptly, when an insurer refused to settle with homeowners following the total loss of their house and possessions, Jim prosecuted a bad faith claim against the insurer. In addition to recovering the full value of the policy, the homeowners received an additional $95K from the insurer to settle the bad faith action. Further, Jim brought a claim against the insurance broker (now defunct) for failure to procure adequate limits of insurance, and then brought a claim against another broker which had promised to procure malpractice (errors and omissions) coverage for the original broker. Jim obtained a settlement from the second broker and is seeking to assess additional damages against the principal of the defunct first insurance broker.