2020 has been quite a year for us in Georgia and throughout the world. With so few insurance claims, insurance companies have been sending rebates to their insured in droves. Yet, curiously, insurance companies are relying on exclusions and policy language to void coverage and wrongfully deny claims.
Policy exclusions are contained in the body of the insurance policy itself. Even if the insured can show that other requirements are met, and the loss should be covered, the large insurance companies such as Allstate, State Farm, GEICO and others are trying to rely on exclusions to take otherwise valid coverage away.
If this fails, they drop down and ague not coverage based on rules of construction. This end play by the insurance company can be successfully challenged in litigation if the policy language is ambiguous. Under well established Georgia law, if policy language is ambiguous, it is construed against the insurance company, mainy because they wrote the policy. As has been explained repeatedly by Georgia Appellate Courts, contract construction involves 3 steps: (1) the court must decide whether the language is clear and not ambiguous. If ti is, the court simply enforces the contratual term, as written; (2) If the court decides that the language is ambiguous, the court must apply the rules of contract construction to resolve the ambiguity; and (3) if the ambiguity remains after applying the rules of construction, then it is a jury question. Importantly, courts in Georgia construe insurance contracts in accordance with the reasonable expectations of the insured (who, obviously expect to be insured for losses) and any ambiguity is construed in favor of the insured and against the insurance company.
The insurance company bears the burden to prove that an exclusion, exception or limitation to coverage applies, and these limiting clauses are strictly construed against the insurer. This is done for good public policy reasons. As a general rule, insurance policies are entered into to cover losses. Any attempts by the insurance company to side-step this responsibility is met with consternation by the courts and all attempts are made to provide coverage to the insured who are current with their premiums and who have suffered a loss and made a timely and proper claim. Exclusion fly in the face of this preference for coverage, so these and other policy language that is trying to be relied on to deny coverage is considered suspect by the court. While it is not impossible for the insurance company to prevail in this strategy, they must tread lightly and overcome some pretty serious legal burdens though.
Robert J. Fleming is a partner in the law firm of Katz Wright & Fleming, LLC in Atlanta, Georgia and Decatur, Georgia. He is a personal injury attorney who has been handling wrongful death, dental malpractice, professional negligence, car accidents and insurance disputes for individuals and families who have been severely injured or died as a result of negligence for over 25 years. He practices in the Atlanta, Georgia area including handling lawsuits in Fulton, DeKalb, Clayton, Gwinnett, Cobb counties in Georgia and nearby cities such as Alpharetta, Chamblee, College Park, Conyers, Duluth, Decatur, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Roswell, Sandy Springs, and Stone Mountain. If you or a family member would like to discuss your case in complete confidence, contact Robert J. Fleming directly on (404) 525-5150 or contact us online. We are here to help.