Appraisal Award Must be Rejected if Appraiser Has a Financial Interest in a Potential Award
Post 5019
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New England Property Services Group, LLC appealed from a January 23, 2024 order denying the plaintiff’s motion to reconsider a denial of the plaintiff’s petition to confirm an appraisal award. The Superior Court granted the defendant, Vermont Mutual Insurance Company’s (defendant),cross-petition to vacate the award based on partiality on the part of the plaintiff’s appraiser.
In New England Property Services Group, LLC v. Vermont Mutual Insurance Company, No. 2024-67-Appeal, Supreme Court of Rhode Island (March 10, 2025) the Supreme Court Applied state law.
FACTS
Brandy Hamel and Scott Parker (the insureds) made claim to Vermont Mutual for loss caused by wind damage to the insured’s property located in Greenville, Rhode Island. The insureds engaged plaintiff to complete the repairs at their home in exchange for the assignment of their insurance claim to plaintiff. The defendant processed the claimed loss and provided an estimate to plaintiff. The plaintiff disagreed with the estimate and invoked the appraisal process established in the insurance agreement.
THE APPRAISAL CLAUSE
The appraisal clause in the contract allows the determination of loss by submitting the dispute over the amount to a panel of three appraisers.
Steven Ceceri (Ceceri), the principal of plaintiff, was appointed by plaintiff as its appraiser for the dispute. The defendant appointed Vincent Cicci (Cicci) as its own appraiser. According to the terms of the appraisal clause, Ceceri and Cicci were to agree on a person to serve as appraisal umpire. The two men could not agree, and Felix Carlone (Carlone) was appointed as umpire by the Superior Court.
The appraisal concluded with an award signed by Ceceri and Carlone, with Cicci refusing to sign, according to defendant, because he believed that the award was not supported by the facts presented. Plaintiff filed a petition to confirm the appraisal award under Rhode Island’s Arbitration Act in the Superior Court. The defendant filed a cross-petition to vacate the award arguing that Ceceri was ineligible to serve as appraiser for plaintiff because of his financial interest in a potential award.
The Superior Court entered an order granting defendant’s cross-petition to vacate the appraisal award and denying plaintiff’s petition to confirm the appraisal award.
After defendant objected, the Superior Court denied plaintiff’s motion. The hearing justice determined that the omission of the term “disinterested” from the insurance contract did not negate the categorization of the appraisal process as an arbitration. Specifically, he declared that plaintiff “continuously promoted” the appraisal proceedings as arbitration throughout the process.
DISCUSSION
The plaintiff asserts that the public policy is efficient resolution of insurance disputes that have been served by the appraisal proceeding. The plaintiff further avers that Rhode Island has not universally equated appraisal with arbitration and that the Arbitration Act does not apply to this appraisal proceeding.
The Supreme Court concluded that it is well settled in New Hampshire that when the language of a statute is clear and unambiguous, the Supreme Court must interpret the statute literally and must give the words of the statute their plain and ordinary meanings.
The Arbitration Act has no requirement that the arbitrators be disinterested; rather, they are only prohibited from engaging in partiality or corruption. Since the Plaintiff, sitting as an appraiser, had a financial interest in the outcome he was engaging in partiality or corruption.
The Supreme Court concluded that plaintiff’s actions revealed his willingness to use every judicial avenue available to derive an unfair advantage if it were permitted to now claim that the appraisal proceeding is not arbitration after previously attempting to confirm the appraisal award in the Superior Court under that same theory. The Supreme Court affirmed the order of the Superior Court.
ZALMA OPINION
The New York Standard Fire Insurance Policy has been the foundation for insurance policies insuring against the risk of lost to real or personal property and, followed and adopted across the country. It, and almost all property policies, contain an appraisal clause as a prompt means of conflict resolution. In this case, one of the appraisers had an assignment of the insured’s claims against the insurer and was interested in the result of the appraisal. The Supreme Court found that the appraisal is subject to New Hampshire’s Arbitration Act as an arbitration and affirmed the Superior Court because of the plaintiff’s appraiser’s interest in the proceeds.
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Concurrent Cause Doctrine Does Not Apply When all Causes are Excluded
Post 5119
Death by Drug Overdose is Excluded
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Southern Insurance Company Of Virginia v. Justin D. Mitchell, et al., No. 3:24-cv-00198, United States District Court, M.D. Tennessee, Nashville Division (October 10, 2024) Southern Insurance Company of Virginia sought a declaratory judgment regarding its duty to defend William Mitchell in a wrongful death case pending in California state court.
KEY POINTS
1. Motion for Judgment on the Pleadings: The Plaintiff moved for judgment on the pleadings, which was granted in part and denied in part.
2. Duty to Defend: The court found that the Plaintiff has no duty to defend William Mitchell in the California case due to a specific exclusion in the insurance policy.
3. Duty to Indemnify: The court could not determine at this stage whether the Plaintiff had a duty to ...
GEICO Sued Fraudulent Health Care Providers Under RICO and Settled with the Defendants Who Failed to Pay Settlement
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Post 5119
Default of Settlement Agreement Reduced to Judgment
In Government Employees Insurance Company, Geico Indemnity Company, Geico General Insurance Company, and Geico Casualty Company v. Dominic Emeka Onyema, M.D., DEO Medical Services, P.C., and Healthwise Medical Associates, P.C., No. 24-CV-5287 (PKC) (JAM), United States District Court, E.D. New York (July 9, 2025)
Plaintiffs Government Employees Insurance Company and other GEICO companies (“GEICO”) sued Defendants Dominic Emeka Onyema, M.D. (“Onyema”), et al (collectively, “Defendants”) alleging breach of a settlement agreement entered into by the parties to resolve a previous, fraud-related lawsuit (the “Settlement Agreement”). GEICO moved the court for default judgment against ...
ZIFL – Volume 29, Issue 14
Post 5118
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You can read the full 20 page issue of the July 15, 2025 issue at https://lnkd.in/giaSdH29
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
This issue contains the following articles about insurance fraud:
The Historical Basis of Punitive Damages
It is axiomatic that when a claim is denied for fraud that the fraudster will sue for breach of contract and the tort of bad faith and seek punitive damages.
The award of punitive-type damages was common in early legal systems and was mentioned in religious law as early as the Book of Exodus. Punitive-type damages were provided for in Babylonian law nearly 4000 years ago in the Code of Hammurabi.
You can read this article and the full 20 page issue of the July 15, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/07/ZIFL-07-15-2025.pdf
Insurer Refuses to Submit to No Fault Insurance Fraud
...
Rulings on Motions Reduced the Issues to be Presented at Trial
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CASE OVERVIEW
In Richard Bernier v. State Farm Mutual Automobile Insurance Company, No. 4:24-cv-00002-GMS, USDC, D. Alaska (May 28, 2025) Richard Bernier made claim under the underinsured motorist (UIM) coverage provided in his State Farm policy, was not satisfied with State Farm's offer and sued. Both parties tried to win by filing motions for summary judgment.
FACTS
Bernier was involved in an auto accident on November 18, 2020, and sought the maximum available UIM coverage under his policy, which was $50,000. State Farm initially offered him $31,342.36, which did not include prejudgment interest or attorney fees.
Prior to trial Bernier had three remaining claims against State Farm:
1. negligent and reckless claims handling;
2. violation of covenant of good faith and fair dealing; and
3. award of punitive damages.
Both Bernier and State Farm dispositive motions before ...
ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional
See the full video at https://lnkd.in/gK_P4-BK and at https://lnkd.in/g2Q7BHBu, and at https://zalma.com/blog and at https://lnkd.in/gjyMWHff.
Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ You can read the full issue of the May 15, 2025 issue at http://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-05-15-2025.pdf
This issue contains the following articles about insurance fraud:
Health Care Fraud Trial Results in Murder for Hire of Witness
To Avoid Conviction for Insurance Fraud Defendants Murder Witness
In United States of America v. Louis Age, Jr.; Stanton Guillory; Louis Age, III; Ronald Wilson, Jr., No. 22-30656, United States Court of Appeals, Fifth Circuit (April 25, 2025) the Fifth Circuit dealt with the ...
Professional Health Care Services Exclusion Effective
Post 5073
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This opinion is the recommendation of a Magistrate Judge to the District Court Judge and involves Travelers Casualty Insurance Company and its duty to defend the New Mexico Bone and Joint Institute (NMBJI) and its physicians in a medical negligence lawsuit brought by Tervon Dorsey.
In Travelers Casualty Insurance Company Of America v. New Mexico Bone And Joint Institute, P.C.; American Foundation Of Lower Extremity Surgery And Research, Inc., a New Mexico Corporation; Riley Rampton, DPM; Loren K. Spencer, DPM; Tervon Dorsey, individually; Kimberly Dorsey, individually; and Kate Ferlic as Guardian Ad Litem for K.D. and J.D., minors, No. 2:24-cv-0027 MV/DLM, United States District Court, D. New Mexico (May 8, 2025) the Magistrate Judge Recommended:
Insurance Coverage Dispute:
Travelers issued a Commercial General Liability ...
