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.
Here are a few claims reversals Lamb recently achieved for our nonprofit and human service clients:
|Client Type||Reason for Reversal||Recovery|
|Home Health Care Provider||GL 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 Institution||Denied property coverage due to flood exclusion. Proved Sewer Drain Backup Coverage was triggered by the flood.||$25,000|
|Homeless Shelter||Insured’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 Institution||Denied 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 Facility||Slip & 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 Provider||EPL 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 Provider||E&O billing claim denied due to various exclusions. Proved that policy explicitly provides coverage for billing disputes.||$10,000|
|Housing Authority||Claim 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 Authority||Carrier 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 Organization||Loss 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 Organization||Persuaded carrier to reevaluate two automobile total loss claims that were undervalued.||$7,500|
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.
Lamb Insurance Services
420 Lexington Avenue Suite 2620
New York, NY 10170
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