Explore Asheville continues to hear about the challenges our area’s businesses are experiencing with insurance claims following Helene—from business interruption claims to what weather conditions actually resulted in physical damages. To that end, Explore Asheville offered a free webinar with principals from a seasoned law firm, Gauthier Murphy & Houghtaling, who have extensive experience following named storms throughout the South. John Houghtaling, Kevin Sloan, and Pardis Moreland will lead the informative session.
Watch the recording of the webinar here.
This recap includes an overview of topics discussed during the webinar.
**This session is for informational purposes only and should not be considered advice from Explore Asheville and the Buncombe County Tourism Development Authority.**
When to Report a Claim
- Policies typically require prompt reporting. While most don’t have strict timeframes, check your policy. Delayed reporting requires a solid explanation, e.g., gathering info to confirm damages exceed the deductible or ensuring a legitimate claim.
Business Interruption (BI) Insurance
- Criteria: BI typically requires a covered physical cause of loss. Insurers calculate BI losses differently; provide clear narratives and financial documents. Control the narrative with examples like using a 6-month rolling average if year-over-year numbers don’t reflect your current growth.
- Involving Lawyers: Engage a lawyer from Day 1 or anytime thereafter. Choose one with first-party claim experience to help you build your claim.
- Approach with Insurers: Be “intelligently aggressive”—cooperative but proactive in sharing claim-supporting information. Help insurers understand your business nuances.
- “One way to be aggressive and everyone needs to take this to heart – the insurance company doesn’t know your business, you have to help them understand your business on a BI claim. They are going to get an accountant involved on their end to calculate your loss the way they want to calculate it, probably year over year and they take the same loss approach to every claim they get unless they’re told differently – businesses might be different – you might have just opened a year ago and weren’t profitable yet and the past 6 months you’re blowing and going and the insurer should use your past 6-month rolling average and not year over year- but if you’re approaching the carrier modestly and not telling them this, you’re not going to get what you want.”
Denied Claims
- This could be policy-dependent, but no formal “appeal” process exists. You can submit new information or, if warranted, file a lawsuit within the policy timeframe.
- “You can always submit new information to an insurance company to have them reconsider their decision, but the phrase “appeal” is not really applicable in the insurance claim world when dealing with losses at this stage right after an event happens. You will also have a timeframe within the policy to file a lawsuit, which isn’t an “appeal” but at least an option to litigate if the facts warrant.”
- For “bad faith” denials, limited options exist—hire a lawyer or proceed without one.
Utility Outages and Anti-Concurrent Causation
- Coverage depends on policy terms. Utility interruption without physical loss may not be covered unless you can prove physical damage caused the outage.
- “My understanding is you would have to be able to separate the two – i.e. if the policy excludes coverage from utility interruption and your property closes because your utilities go down, no coverage, but if you can show your building was damaged by a covered physical loss and that resulted in the closure, then there should be coverage theoretically, but the stronger the physical damage element and the more clear that damage is the more probability you would get coverage and avoid the anti-concurrent causation issue right?”
Expediting the Process
- Hire a lawyer to guide the process and advocate for your business.
Future Coverage Needs
- Work with your insurance agent to review policies thoroughly. Understand exclusions and coverages to avoid surprises during claims.
- “Get with your insurance agents – they’re selling you these policies to everyone, make sure you’re getting with them, make sure you’re reading cover to cover moving forward what is in your policy and if you don’t understand what you’re being sold get with an attorney who can help you look at it, get with an insurance agent who can help you look through it so you’re not surprised – it’s direct I think but it’s important advice right because even we on the panel are guilty of not reading what’s in our policies for our business or our homes so you’re not alone.”
Wind Damage & BI
- Generally speaking, wind damage must be a covered cause of loss to get BI. Policies may have sub-limits; consult your policy, agent, or lawyer for specifics.
Public Adjusters & State Adjusters
- Public adjusters help with claims but can’t assist if there are no covered losses. Broader area impact isn’t typically covered by insurance.
- Q: I had no covered losses. It has placed a strain on my business. Would a State Adjuster be able to help?
- A: “Look the unfortunate reality is if you have no covered losses, you’re going to have a tough time. The business may not do well because generally the area around the business is impacted, and just the sad reality is that likely isn’t an insurance issue, so it’s neither something a public adjuster nor an attorney generally can help with.”
Flood Insurance Timeline
- Payouts generally occur within 30-180 days, depending on circumstances.
Utility Outage Denials
- If denied due to missing peril coverage, review your policy’s specific terms to understand coverage limits and exclusions.