What is Business Interruption Insurance? Does it Apply to the Covid 19 Shutdowns?

Mark Wolfe, Attorney at Law
mark@brwlawyers.com

Business Interruption Insurance or also known as Business Income Insurance is an added coverage found in a business property insurance policy or as part of a comprehensive business operations policy.  Business interruption insurance can compensate businesses for lost revenue, rent and lease payments, mortgage payments, other loan payments and taxes. Employee payroll may be covered, along with costs of having to relocate temporarily or permanently to new premises.

The key is that this coverage is derivative from a covered loss under the insurance policy and it is an “add-on” coverage that is paid for in the premium package. It is generally not a stand alone coverage. The business must suffer a covered peril that results in an interruption to normal operations so as to trigger this coverage, if it is part of the policy.

A similar example of a derivative coverage that can be “added on”can be found in your automobile policy. As part of the collision coverage or comprehensive coverage you may have added “rental car insurance” for an additional premium cost. If your car is damaged in an accident (collision coverage) or burns up in a fire (comprehensive coverage), your rental car insurance will pay for a rental car until the property loss is adjusted and paid.  If your car becomes un-driveable for some other reason not covered under the auto-insurance policy you can not use your car rental coverage.

This is also the way business interruption insurance works. If it has been added-on to the policy, the loss must be derived from a covered loss. Herein is the problem for many business owners suffering under the Covid 19 business shut down, the loss is most likely not from a covered peril. In fact, some business insurance policies have specific exclusions for damages related to or caused by a communicable diseases or pandemic.

However, if you are not sure whether or not you have this type of coverage or even if you don’t think you have a viable claim, you may want to consult with an experienced insurance claim lawyer. Business insurance policies are complex and they vary greatly from business to business. They can often be vague or ambiguous in definitions of covered losses and benefits. These uncertainties under a policy may work to the claimants advantage so as to allow a business interruption claim.

If you would like a free consultation with Mark about your potential insurance claim, please email him at mark@brwlawyers.com or send a text to 251 533-9548 (cell). You can also call Mark directly at 251 410-7761.

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

What to Do When You Win the Lottery!

CONGRATULATIONS! I know it’s hard to believe that you’ve actually won the lottery and I hope your hands are still shaking from excitement as you read this! Now, let’s take a deep breath and review some basic strategies before you do something you might forever regret! Such as telling your dim-wit, debt laden Bro-in-Law about your good fortune.

#1. KEEP YOUR MOUTH SHUT! There are some very important things you should do and consider before telling the world that you’re now a financial peer with Bill Gates and Warren Buffett.

#2. ENDORSE & SECURE YOUR WINNING TICKET. Lottery tickets are considered a presentation instrument. So if you lose it without having endorsed it, you may be SOL! Leave room on the endorsement section because you may have to add another entity (see Rule 5). Photograph/photo copy the endorsed winning ticket and then promptly put it in a fire proof safe or safe deposit box. [Also, don’t forget Rule 1, or your neighbor who never returned the rake he borrowed will be on your front door step graciously returning your rake AND now requesting to “borrow” some cash.]  

#3. FIND OUT HOW LONG YOU HAVE TO CLAIM YOUR PRIZE & WHETHER IT CAN BE CLAIMED ANONYMOUSLY. There are deadlines ranging from three months to a year to claim your prize. Find out asap how much time you have to get your affairs in order before claiming the winnings.  Some States allow you to claim a prize anonymously but many require public disclosure. Also, some Lottery Rules require winners to appear at press conferences and participate in public events or announcements. [Are you still good with Rule 1? Because if not, here come all of your co-workers and their tales of financial woes.]

#4 CHANGE YOUR PHONE NUMBER. On the off chance you’ve disregarded Rule 1 but even if you have not, it’s still a good idea because sooner or later your loser Bro-in-Law is going to find out about your winnings and he has some “really boss ideas” on how to invest your money for you!  

#5. GET LEGAL ADVICE ASAP. Now you can finally tell someone about your new found wealth! The attorney-client privilege will prevent your lawyer from disclosing that you are client and/or the nature and extent of his or her representation. If you want to remain anonymous a lawyer can help you determine if the funds can be claimed by an innocuous charity or foundation that you establish and/or maybe negotiate for your privacy with the Lottery. Some lotteries will allow you to remain anonymous but you have to give up some of the winnings to do so. Even if you can’t remain anonymous a lawyer can tell you how to set up various entities to help shelter and protect your winnings from the vultures. A lawyer can also work with a tax advisor and financial consultant to help establish short term and long term priorities for your wealth.
#6.  MAKE YOUR LAWYER THE “BAD GUY.” Sooner or later, it’s likely your family, friends and co-workers will learn of your lottery good fortune. Also, there’s a good chance you’ll be contacted by legitimate and illegitimate strangers seeking financial assistance. Instead of you having to be the bad guy saying “no,” just tell them the lawyer has everything tied up in long term CITs…Charitable Investment Trusts and he or she is responsible for managing your money and all inquires for funds should go through him or her. You can let your lawyer know who you want to help and to what extent and let him or her make the delivery. 
Again Congratulations on winning the Lottery. Understand, your financial good fortune will bring a side effect of stress and concern.  Following these simple guidelines will help reduce that stress and enable you to enjoy your winnings to the fullest. 

False Claims Act – Whistleblower Claims

by Mark Wolfe, Attorney at Law In 1863 the U.S. Government enacted the False Claims Actscales and gavel (FCA) as a way to stop and discourage fraud by companies who were selling war supplies to the Union Army during the civil war. It authorizes private citizens with “inside information” to bring a lawsuit on the government’s behalf against a person or business who has fraudulently or wrongly caused the Federal government to suffer a financial loss.

To encourage courageous individuals to step forward and report fraud the FCA provides that the individual who first comes forward and files the claim is rewarded with anywhere from 15- 30% of the government’s recovery! It also allows the person reporting the fraud or initiating the claim investigation to remain anonymous during the preliminary investigation and prevents retaliation once the action is formally started in Court.

These type of claims and cases have been increasing and in 2011, the Federal government recovered over $3 billion and paid almost $530 million to the individual whistleblowers who initiated these actions. Some examples of these type claims include:

– Billing for goods or services that were not provided or that were unnecessary.

– Falsifying certifications, test results, research data, safety reports, and/or product quality.

– Securing contracts through misrepresentation, kickbacks or bribes.

– Misuse or misappropriation of Federal grant funds.

– Duplicate or multiple billing for the same goods or services.

Many States, and some larger municipalities, have also enacted similar FCA laws to protect State and local governments from fraud. Alabama has not enacted FCA laws; however, if a State agency receives Federal funds it is possible a FCA claim can be maintained if the fraudulent loss is passed through the State agency back to the Federal funding. Initial reporting requirements for these type claims can be complex and tedious and may require further investigation and analysis before being presented to the Federal government for review. If you have inside knowledge or information about fraud against the Federal government and want legal help and guidance for the claim, we can help. Consultations are free and confidential. Call 433-7766 or e-mail me at mark@brwlawyers.com 

    REQUIRED DISCLAIMERS Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free Background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

Alabama Workers Compensation Information

Alabama Workers Compensation Information

The Mobile Alabama law firm of Boteler, Finley & Wolfe has a free publication available for injured workers who have questions about Alabama Workers Compensation laws and benefits. On the Job Injuries: A Guide for Injured Workers – Alabama edition provides detailed information about many aspects of the Workers Compensation laws in Alabama. Written by top rated personal injury attorney Mark Wolfe, the guide provides a quick and easy to read summary of Alabama workers compensation laws as well as practical pointers and suggestions. Below is an Annotated table of Contents for this free publication. To get your copy call Boteler, Finley & Wolfe toll free at 1 866 975-7766 or for a digital version complete with resource hyperlinks, e-mail Mark Wolfe at mark@bfw-lawyers.com and put Guide for Injured Workers in the subject line. FREE CONSULTATIONS ALSO AVAILABLE.

On the Job Injuries: A Guide for Injured Workers – Alabama edition  Annotated Table of Contents

CH I. A Quick Summary of Alabama Workers Compensation Laws. Provides a quick and easy to read summary of Alabama workers compensation laws to help injured workers get a basic understanding of the wage and medical benefits available to them after being injured on the job.

CH II. On the Job Injury – Defined. Covers the basic definition of an “on the job injury” and discusses reporting requirements for an on the job injury. This section also provides practical advice and recommendations to help report and document an on the job injury.

CH III. Benefits Available to Injured Workers. Discusses the difference between a scheduled and non-scheduled injury. Discusses the lost wage benefits available to injured workers and how benefits are calculated. It reviews the medical benefits afforded to injured workers. Also, discusses and reviews death benefits available to family members. Covers vocational retraining benefits.

CH IV. Occupational Disease, Exposure Claims and Repetitive Injury Claims. Covers the definition of occupational disease and exposure claims and which includes injuries such as repetitive motion injuries. Defines legal and medical causation for these claims.

CH V. Injured Workers Rights. Discusses some of the basic rights of injured workers under the Alabama Workers’ Compensation Act.

CH VI. Hiring an Attorney. Discusses factors for injured workers to consider such as when to consult with an attorney and when to consider hiring an attorney to assist with a workers compensation claim. Also covers the prescribed contingency fees authorized for attorneys under the Alabama Workers Compensation Act.

CH VII. Practical Pointers and Suggestions. Provides injured workers with some practical suggestions related to workers compensation claims.

CH VIII. Resources and References. Provides injured workers with helpful resources and references related to a job related injury claim.

To get your copy call Boteler, Finley & Wolfe toll free at 1 866 975-7766 or for a digital version complete with resource hyperlinks, e-mail Mark Wolfe at mark@bfw-lawyers.com and put Guide for Injured Workers in the subject line. FREE CONSULTATIONS ALSO AVAILABLE.

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Required Disclaimers:

Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

Is Your Homeowners Insurance Company Really on Your Side?

When you purchase a homeowners insurance policy, you make a substantial financial commitment to your insurer. In return, you expect it to hold up its end of the bargain and provide coverage for certain types of damage to your home. Sadly, homeowners insurance companies often act against their policyholders’ interests. Here are just a few recent examples: Hurricane Katrina In the wake of Hurricane Katrina, thousands of policyholders’ claims were denied on the premise that their homes were exclusively damaged by water. Since flood damage isn’t covered by many policies, this was enough to ruin many hardworking homeowners. In cases that clearly involved wind damage, insurers went even further and argued that standard homeowners policies were insufficient to cover “dual damages.” Many residents successfully sued to have these decisions reversed. Hurricane Sandy While standard homeowners insurance policies don’t cover flood damage, homeowners who had supplemental flood insurance policies were sure that they’d be covered after Hurricane Sandy. Unfortunately, tens of thousands of claims in New York and New Jersey were denied on the basis that flood-related damage was caused by groundwater rather than surface floods. Many policyholders who sought advice from licensed attorneys in the wake of the storm were able to challenge these questionable denials of coverage. Northridge Earthquake In some cases, insurers resort to outright fraud. After a major earthquake in the Los Angeles area, some policy issuers simply forged homeowners’ signatures on coverage waivers to avoid paying claims. Needless to say, this was not an acceptable maneuver. Many homeowners who enlisted the help of trained legal professionals were able to mount successful court challenges to their insurers’ underhanded tactics. “Mundane” Denials In all of the situations that we described above, insurance companies were motivated by the threat of heavy financial losses to disregard their policyholders and deny legitimate claims. Unfortunately, the same principles apply to individual claims. Since burst pipes, tree damage and other “mundane” issues don’t make headlines, insurance companies might actually be more inclined to deny individual homeowners’ claims on such matters. Homeowners insurance companies deny all manner of claims, but the most commonly ignored include water damage and structural problems like roof deterioration or “settling.” For water-related claims, insurance companies often attempt to argue that the source of a damaging inundation is external and thus isn’t covered by traditional homeowner’s insurance. For structural problems caused by storms or faulty construction, insurers may point to the policy’s vaguely defined “wear and tear” clause. If you’re fed up with homeowner’s insurance companies that don’t respect their policyholders, you need an experienced attorney who knows the insurance business through and through. Learn more about your options at our website or call us at 866-975-7766.

How Can an Honest Disability Claim Be Denied?

If you become unable to work due to a mental or physical health condition, you may be entitled to file a disability claim online or at your nearest Social Security Administration office. There’s a tremendous amount of publicly available literature about the filing process, but ensuring that your honest disability claim is accepted might not be as easy as it sounds. We’ll discuss why some honest claims are denied and offer some friendly advice about fighting for your right to disability insurance. What Are the Basic Criteria for a Legitimate Disability Claim? While claims for disability insurance are always evaluated on a case-by-case basis, there are a few key criteria that applicants are expected to meet. These usually include: •    An inability to perform Substantial Gainful Activity (SGA) or earn more than $1,040 per month at a regular job •    A qualifying medical condition that prevents reasonable work activity •    Doctor-prescribed restrictions on physical activity, including limitations on standing, lifting or walking •    An inability to fulfill the duties of the applicant’s most recent job Why Some Claims Are Denied Honest disability claims can be denied for a variety of reasons. In far too many cases, applicants simply aren’t aware that they have to file specific pieces of paperwork or meet specified deadlines. In others, they change residences and can’t be reached by Social Security Administration employees. Other common reasons include: •    Past criminal convictions •    Missing or incomplete records •    Misunderstandings that result in a failure to meet therapy guidelines •    A disability that’s determined to be temporary If your disability claim has been denied for any of these reasons, a trained legal professional can help you navigate the treacherous waters of the appeals process. How to Appeal Appealing a denied disability claim is much easier with proper representation. You’ll need to inform the proper authorities of your desire to appeal within 60 days of receiving your denial. Additionally, you’ll need to attend a special hearing and speak directly with a judge. If your initial appeal is denied, you can lodge another appeal with the state’s Appeals Council or take the matter to federal court. Success Rates and the Benefits of Professional Representation In Alabama, just 30% of initial disability claims are approved. Upon appeal, approval rates roughly double. This underscores the importance of hiring a legal professional to guide you through the claims and appeals processes. Our team of disability insurance specialists knows the ins and outs of Alabama’s confusing legal framework and is proud to fight for their clients’ rights. For more information about contesting a denied disability claim or any of the other services that our Mobile, AL law firm offers, visit our homepage or call 866-975-7766.

Should I Participate in a Mass Tort Case?

If you’ve suffered property damage, personal injury or other losses as a result of a large-scale disaster, defective product or toxic incident, you may have grounds to join a mass tort case against the liable party. Although the mass tort process generally isn’t time-consuming or arduous for individual plaintiffs, it can seem confusing. We’ve compiled a helpful “cheat sheet” that outlines the advantages of participating in mass tort cases. Mass Torts vs. Class Action Lawsuits It’s understandable to confuse mass torts with class action lawsuits, but the two forms of litigation aren’t identical. The key difference lies in their structure: Whereas a class action lawsuit is a single action that’s joined by hundreds or thousands of participants, a mass tort case is a collection of individual actions with similar characteristics. For this reason, mass torts are often called “multidistrict legal actions” or variations thereof. Characteristics and Promotion Mass tort cases generally stem from complaints about one of these three broad issues: •    Defective machinery or consumer products •    Large-scale disasters like plane crashes or building fires •    Toxic events like oil spills or waste dumping incidents Regardless of the exact complaint, a judge must determine that each individual claim is similar enough to warrant the formation of a mass tort. Once a given case is certified, it must be promoted in local or national media in accordance with certain guidelines. Preparing for Your Case To prepare for your case, compile any documents that might strengthen your claim. These include: •    Hospital bills •    Termination letters •    Worker’s compensation forms •    Pay stubs •    Testimony from witnesses or others involved in the case As a rule, you should never divulge specific information about your case without your attorney’s consent. It’s never a good idea to attempt to enter a mass tort case without the help of a legal professional. Time Commitment and Results Even though mass tort cases are structured as streamlined collections of individual legal actions, they generally don’t require their participants to appear in court on a daily basis. Trained legal representatives can handle the pre-trial and trial phases of each mass tort without direct input from their clients. As such, mass tort participants generally don’t need to devote huge amounts of time to their cases. Since judgments in these cases may run into the tens of thousands or hundreds of thousands of dollars, many participants are happy to invest some of their time in the outcome. Do you feel as if you’re entitled to compensation under a pending mass tort case but wonder whether it would be worthwhile for you to participate? Many regular folks are understandably nervous to “put themselves out there” in a legal action that can stretch on for months or years. Before you make any decisions, contact us at 866-975-7766 or visit our homepage for more information.

Life Insurance Claims: Important Information for Beneficiaries and Claimants

IMPORTANT INFORMATION ABOUT LIFE INSURANCE CLAIMS©
By: Mark Wolfe, Attorney at Law
Mobile, Alabama
mark@bfw-lawyers.com

While most of us hope that a life insurance claim arising from the death of a loved one will be a simple and hassle free process, the fact is many life insurance claims are initially denied. These denials can be for many reasons. Some times the reasons for such a denial are legitimate, but many times they are wrong. In fact many insurance industry experts say that up to 40% of life insurance claim denials are done so wrongly.

This article will help you with some basic information about life insurance claims and locating policies. Then the article reviews common reasons why life insurance claims are initially denied and concludes with important information for claimants if the claim is denied.

I. LIFE INSURANCE CLAIMS & LOCATING OTHER POLICIES

Notify the Company of the Claim. While this is a very basic step it can be a little difficult if the policy is older. Mergers and acquisitions of life insurance companies can make locating the correct successor or remainder company a little difficult. However, internet searches can usually help you quickly identify the correct company name and location for claim notification. Also, many life insurance agents or attorneys who handle life insurance claims have this information available or access to the correct resources to help identify where and how the claim should be submitted.

What You Need to Do. Once you’ve contacted the company you must complete the claim form. Many of these claim forms can now be downloaded from the company’s web site. At the very least you will have to submit a copy of the death certificate and the company may require additional records related to the claim. Always reference the claim number or policy number (or both) on all documents or material submitted. Until the claim is paid in full: Keep copies of all correspondence and documents sent to the life insurance company. Keep all letters and material sent from the life insurance company. If a claim is denied, make sure you understand and comply with the requirements for an appeal. (IMPORTANT: Please make sure to read more about appealing a denial below.) Why are so many life insurance claims denied? Most life insurance claims adjusters recognize that many life insurance claimants do not question or challenge a denial of life insurance benefits. This means that if there is a “close call” on whether or not benefits should be paid, they automatically opt for denial first in hopes the claimants will just “go away.”

Locating Additional Policies. It’s a fact, many life insurance benefits go unclaimed because beneficiaries do not realize a policy exists. Below are some tips for locating additional life insurance policies.

1. Review the decedent’s check book or bank statements looking for premium payments,

2. Review the decedent’s tax returns for the last several years to see if interest or cash dividends from a life insurance policy were listed. There should be a corresponding 1099-INT from the life insurance company. These payments will be reported directly on form 1040, 1040A and 1040EZ or on Schedule B if an itemized tax return was filed,

3. Contact the decedent’s employer and/or former employers to see if any type of life insurance was offered through the company’s benefit plan program and if the decedent purchased a life insurance policy or was provided a life insurance policy through employment,

4. Review all disability policies for the decedent to see if death benefits are also provided,

5. Review any known life insurance policy to see if additional benefits such as double indemnity for accidental death may apply.

6. Check with the decedent’s auto insurance company or homeowner insurance company. Many of these companies will also offer life insurance policies for their customers.

II. DENIAL OF BENEFITS AND APPEALS

Standard life insurance claim denials. Many times if a basic life insurance claim is denied, it is done so based upon a process known as “retroactive underwriting.” This is a claim investigation technique that allows the insurance company to more fully and completely examine the deceased’s prior medical history. These prior medical records are reviewed thoroughly to see if the deceased left out or failed to disclose a pre-existing medical condition when completing the life insurance application. This “failure to disclose” is then used as grounds to deny the life insurance benefits. However, most claimants are not aware that such a denial must have materially effected the underwriting risk associated with issuing the policy. Simply put, the company must be able to legitimately argue that “but for” the undisclosed prior medical condition, the policy would not have been issued or the rates for the policy would have been significantly different. The issue of “material risk” is a complex issue that is often legally debatable.

Accidental death or double indemnity benefits. Some companies issue stand alone accidental death life insurance policies or some standard life insurance policies have a “double indemnity clause” which pays twice the face value of the policy if the death is caused by an accident. Yet the policy language concerning the term “accidental death” is often drafted so vaguely that it gives the company lots of “wiggle” room to initially deny accidental death benefits. Terms like “sole and only proximate cause of death”often involve complex medical and legal analysis but give the company a very legalistic sounding excuse not to pay.

BEFORE YOU FILE AN APPEAL OF A DENIAL. If you have questions about the denial of any life insurance benefits, make sure you fully understand your rights and obligations under the policy. Most life insurance policies allow claimants to file an appeal of the decision to deny benefits. Yet many times claimants are unaware of the potential consequences of simply “appealing” the denial. Generally, once a company has denied the life insurance claim, the claimant has the burden of identifying specific reasons for the appeal and providing supporting documents or records to support the appeal. If the life insurance policy in question has been provided through the decedent’s employment or through a group, the failure to comply with the appeal requirements can be extremely detrimental. In one recent example a Federal Court determined that the claimant’s failure to submit any “new evidence” during the appeal process provided for in the plan, precluded the claimant from presenting that new evidence at trial. [See Hancock v. MetLife, 590 F.3d 1141 (10th Circuit 2009).]

NOTE: If the claim is denied consider consulting immediately with an experienced life insurance claims attorney in your State. Note: Most attorneys who handle life insurance claims for beneficiaries do not charge for a consultation and work on a contingency fee (no benefits = no fees). Also, many times an experienced attorney can help resolve a denied claim before having to resort to filing a lawsuit.

III. CONCLUSION

While life insurance claims should be simple and easy, they can often times become arduous and legally complex. The simple fact is insurance companies do not like to pay claims and have tremendous resources to fight claims. With many claimants of life insurance benefits in a state of grief and mourning, the insurance company knows it has the upper hand and this often results in the wrongful denial of life insurance benefits. If you believe your claim for life insurance benefits has been wrongfully denied, please consider consulting with an experienced attorney who knows and understands this area of the law.

Note from the author: If you are reviewing this publication or link during a time of loss, please accept my condolences and sympathy for your loss. I pray that you find comfort and understanding for your loss and that the passage of time will replace the sorrow of your loss with the joy and blessing of the memories of moments shared. – Mark