Is Your Insurance Broker Challenging Carrier Claim Denials And Getting Wrongfully Denied Claims Reversed?

Lamb Insurance Services’ Client Advocacy Group is constantly reviewing our clients’ claim outcomes. This in-house department reviews the basis and policy wording of carrier denials to determine whether the claim was wrongfully denied and should be corrected.

Claims Reversals from LAMB Insurance

Defending Your Mission – In the past 3 years, Lamb has returned over $6 million to our clients.

Here are a few claims reversals Lamb recently achieved for our nonprofit and human service clients:

Client TypeReason for ReversalRecovery
Home Health Care ProviderGL claim denied due to disputed location of slip & fall. Proved that property was insured and carrier was required to defend and indemnify.$500,000
Religious InstitutionDenied property coverage due to flood exclusion. Proved Sewer Drain Backup Coverage was triggered by the flood.$25,000
Homeless ShelterInsured’s retaining wall collapsed. Carrier denied coverage based on the Earth Movement Exclusion. Successfully argued that coverage is provided via the policy’s Underground Water Seepage Coverage.$25,000
Educational InstitutionDenied Legionnaires’ Disease claim due to Communicable Disease Exclusion. Proved carrier was in violation of New York law by failing to timely copy claimant on disclaimer.$600,000
Assisted Living FacilitySlip & Fall claim denied because property manager was not an insured under tenant's GL policy. Proved that lease is "Insured Contract" so property manager's demand for defense and indemnification is insured under the policy.$125,000
Healthcare ProviderEPL claim denied due to Labor Relations Exclusion. Proved that this was a retaliation claim and covered by the retaliation exclusion to the Labor Relations Exclusion.$50,000
Home Health Care ProviderE&O billing claim denied due to various exclusions. Proved that policy explicitly provides coverage for billing disputes.$10,000
Housing AuthorityClaim was incorrectly classified as having a $250,000 Retention and Sublimit. We correctly had it reclassified subject to a $50K Retention and a $1M limit of liability.$825,000
Housing AuthorityCarrier claimed five separate $75K retentions applied to five sexual harassment claims. Proved all five claims were interrelated acts so only one $75K retention applied to the claim.$300,000
Youth OrganizationLoss of revenue at two facilities due to COVID outbreak. Carrier refused to cover loss incurred by one facility because the Department of Health only ordered one of the two to close and disinfect. Explained to carrier that the two facilities were interrelated and the only way to adequately disinfect the one facility was to close and disinfect both.$25,000
Social Services OrganizationPersuaded carrier to reevaluate two automobile total loss claims that were undervalued.$7,500

Does your insurance agency have this type of clout? Or expertise? Or willingness?

The in-depth knowledge and understanding required to reverse these wrongfully denied claims is just one more reason Lamb exceeds our clients’ expectations every day. And why we have maintained a better than 95% client renewal rate.

Learn how we can properly insure your business.

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Lamb Insurance Services
420 Lexington Avenue Suite 2620
New York, NY 10170

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