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Rate Evasion: The Steps to Take When Trying to Prove It

Rate evasion refers to when an individual materially misrepresents information on an insurance application and can lead to the insurer rescinding the policy. Courts have upheld policy voiding for undisclosed teenagers, medical conditions, lying about residency and many other issues. Courts have allowed voiding in just about all lines of insurance from auto to life. It rids the carrier of a dishonest insured and potentially avoids unreported claims. Investigating the application should be part of every SIU investigation.

The Fifth Amendment vs. an Examination Under Oath: Which Prevails?

Nearly all insurance policies require that an insured cooperate with their carrier during the investigation of a loss. Many policies also require the insured to submit to an Examination Under Oath (E.U.O.) should the carrier so elect. But what happens if the insured is under criminal investigation for the same circumstances as the loss? Can the carrier force the insured to testify at an E.U.O. during the pendency of a criminal proceeding despite the Fifth Amendment’s Constitutional protection against self-incrimination?

Avoiding Penalties for Late Payments

As an adjuster working on Virginia worker’s compensation claims, you are likely aware of the penalties that can accrue on compensation that is not timely paid. Under § 65.2-524 of the Virginia Workers’ Compensation Act (“the Act”), “[i]f any payment is not paid within two weeks after it becomes due, there shall be added to such unpaid compensation an amount equal to 20% percent thereof…” What does this mean?

Negligence and the Implied Warranty of Merchantability with Foreign Objects in Food

As an adjuster working on Virginia worker’s compensation claims, you are likely aware of the penalties that can accrue on compensation that is not timely paid. Under § 65.2-524 of the Virginia Workers’ Compensation Act (“the Act”), “[i]f any payment is not paid within two weeks after it becomes due, there shall be added to such unpaid compensation an amount equal to 20% percent thereof…” What does this mean?

Improper Removal to Federal Court Results in Sanctions

Removing a case to Federal Court is often one of the first important strategic moves a defendant can make in litigating a lawsuit. Knowing the inherent advantages that typically come with Federal Court, Plaintiffs will often plead the case in a way that precludes Federal Removal. Sometimes, the rush to Federal Court can backfire, and in the recent case of Scott Carmine v. Glen Poffenbarger, et al., Civil Action No. 1:18-cv-1288, Judge Anthony Trenga in Alexandria Division of the Eastern District of Virginia sanctioned the defendant for attempting to remove the lawsuit when such a move was not proper.

AI and the Insurance Industry- Benefits and Risks

The improvement in artificial intelligence (AI) over the last few years has impacted several industries including insurance. In a survey by Accenture “a full 75% of 550 insurance executives said they believe that AI will either significantly alter or completely transform the overall insurance industry in the next three years.” Machine learning algorithms are already playing a key role in product design, sales, services, fraud detection, risk evaluation and claims resolution.

Asleep at the Wheel, Part II: The Court of Appeals’ Decision in Norris and What It Means for You

Back in September, KPM’s Joe Smith updated you about the Commission’s recent decision of Norris v. ETEC Mechanical Corporation, JCN:VA00001317384 (June 25, 2018). Norris involved a claimant who sustained serious injuries in a car accident after he fell asleep at the wheel.

Since Joe’s update, the Court of Appeals reviewed the Commission’s decision in Norris. In the published decision of Norris v. ETEC Mechanical Corporation, Record No. 1054-18-2 (Dec. 28, 2018), the Court agreed with the Commission that Norris could not recover under the Workers’ Compensation Act.