May 6, 2008
Supreme Court: Shouldn't the burden of proof be with the drafter?
Analysis of:
Supreme Court Weighs Insurer's Conflict of Interest in Claim Denial | www.insurancejournal.com
This analysis is solely the work of the author. It has not been edited or endorsed by GLG.
Implications: The burden of proof may shift to insurers when insureds submit claims.Will the review of insurance claims be subjective or objective?
Analysis: The rule has long been that when the insured submits a claim the burden of proof is with the insured. Many feel this process makes little sense if the general rule is that in a contract of adhesion any ambiguities should go against the drafter. Some may feel one has nothing to do with the other. The reality is insurance companies do have an interest in protecting what funds are paid out and the more that is paid out affects the bottom line. The general theory is that they are only obligated to pay what they are legally obligated to. Common sense then dictates if they are going to decide what gets paid, and it affects their profits, the insurer should bear the burden of showing why it is not covered and allow this function to be determined by a third party. State Farm certainly ended up with some issues relative to inherent conflicts. http://aminthemorning.blogspot.com/2008/01/gao-flood-insurers-have-inherent.html. Problem is, if insurers out source this function will it not only be more expensive to the insured but will the third party be any more objective if their profit is derived from the insurer? One thing seems axiomatic, more & more insureds will likely receive more benefits. What a novel concept, getting what you pay for.
Analysis: The rule has long been that when the insured submits a claim the burden of proof is with the insured. Many feel this process makes little sense if the general rule is that in a contract of adhesion any ambiguities should go against the drafter. Some may feel one has nothing to do with the other. The reality is insurance companies do have an interest in protecting what funds are paid out and the more that is paid out affects the bottom line. The general theory is that they are only obligated to pay what they are legally obligated to. Common sense then dictates if they are going to decide what gets paid, and it affects their profits, the insurer should bear the burden of showing why it is not covered and allow this function to be determined by a third party. State Farm certainly ended up with some issues relative to inherent conflicts. http://aminthemorning.blogspot.com/2008/01/gao-flood-insurers-have-inherent.html. Problem is, if insurers out source this function will it not only be more expensive to the insured but will the third party be any more objective if their profit is derived from the insurer? One thing seems axiomatic, more & more insureds will likely receive more benefits. What a novel concept, getting what you pay for.
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