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  • Writer's picturePeter Lamont, Esq.

Navigating Insurance Denials and Reservation of Rights: A Primer for Small Business Owners

As a small business owner, your business insurance policy is the bedrock of your risk management strategy. It provides essential protection against a plethora of potential damages, losses, and liabilities. However, there can be circumstances where an insurance company may deny coverage under a business policy, leaving you vulnerable. Understanding insurance denials, along with concepts like policy exemptions and reservation of rights, is vital. Moreover, appreciating the role of an attorney in these contexts can significantly enhance your ability to protect your interests effectively.

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Why an Insurance Company May Deny Coverage in a Business Policy

In essence, an insurance policy is a contract between your business and the insurance company. You pay premiums, and in return, the insurer commits to paying for certain types of losses as specified in the policy. However, insurance companies may deny coverage for a multitude of reasons.

One of the most common grounds for denial is a misrepresentation or nondisclosure. If an insurance company determines that you provided incorrect or incomplete information at the time of policy issuance or renewal, they may deny a claim or even rescind the policy altogether.

Another frequent reason for denial is non-compliance with policy conditions. Insurance policies often stipulate certain duties that the policyholder must fulfill, such as notifying the insurer in a timely manner after a loss, protecting the property from further damage, and cooperating in the claim investigation. Failure to meet these conditions can result in a denial of coverage.

Understanding Exemptions

Insurance policies typically include certain exemptions, also known as exclusions, which are specific situations or circumstances that the policy does not cover. These exemptions are usually explicitly stated in the policy and may range from specific perils, such as war or nuclear risk, to certain types of property or activities.

For instance, many business policies exclude coverage for losses resulting from intentional or dishonest acts by the insured. This reflects the fundamental insurance principle that coverage should not encourage wrongful conduct.

Exemptions are an essential part of your policy, and understanding them is crucial. When a claim is denied due to an exemption, it's not the insurer refusing to honor the contract; it's the insurer adhering to the contract's terms.

Reservation of Rights

A reservation of rights is a statement from an insurer indicating they may not cover all or part of a claim, even while they are investigating or defending the claim. It's essentially a way for insurers to keep their options open.

The purpose of a reservation of rights letter is to avoid a legal doctrine known as "waiver and estoppel." This doctrine prevents insurers from denying coverage for a claim if they have not reserved their rights and have taken actions that suggest they will provide coverage. A reservation of rights allows an insurer to defend a claim or continue investigating it without implicitly agreeing to cover the loss.

The Role of an Attorney

In situations where there are personal claims against you, or if your insurance carrier denies coverage, the assistance of an attorney is invaluable. An experienced attorney can help you understand your policy, assess the validity of the denial, and formulate an effective response.

Should you be personally named in a claim, an attorney can help defend your interests and provide guidance on potential personal liability. In the event of an insurance denial, an attorney can review your policy, identify any areas of contention, and engage in negotiations or litigation with the insurance company to seek the coverage you are owed.

Ultimately, insurance is a complex field with numerous nuances. As a small business owner, understanding the basics of how your policy works, including why a claim may be denied, the implications of exemptions, and the meaning of a reservation of rights, is of utmost importance, and the guidance of an attorney can provide invaluable assistance.

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About Peter Lamont, Esq.

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As with any legal issue, it is important that you obtain competent legal counsel before making any decisions about how to respond to a subpoena or whether to challenge one - even if you believe that compliance is not required. Because each situation is different, it may be impossible for this article to address all issues raised by every situation encountered in responding to a subpoena. The information below can give you guidance regarding some common issues related to subpoenas, but you should consult with an attorney before taking any actions (or refraining from acts) based on these suggestions. Separately, this post will focus on New Jersey law. If you receive a subpoena in a state other than New Jersey, you should immediately seek the advice of an attorney in your state as certain rules differ in other states.



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