Zalma on Insurance
Education • Business
Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
Interested? Want to learn more about the community?
March 25, 2025
Can’t Change Definition of ACV by Class Action

ACV, by Definition, Requires Depreciation from Replacement Cost
Post 5027

See the full video at https://lnkd.in/gUwdsX7z and at https://lnkd.in/gxmkMQcB, and at https://zalma.com/blog plus more than 5000 posts.

This case is a putative class action concerning a commercial property insurance policy. Schoening Investment, LP alleges that The Cincinnati Casualty Company breached its insurance policy by undervaluing an actual cash value (ACV) payment for a covered partial structural loss to one of its properties in Schoening Investment, LP v. The Cincinnati Casualty Company, No. 1:24-cv-137, United States District Court, S.D. Ohio, Western Division (March 13, 2025)

Key Allegations:

Schoening contended that the policy does not allow Cincinnati Casualty to deduct any amount for depreciation from the ACV payments due for partial structural losses. Schoening specifically challenged whether the insurer is entitled to deduct depreciation from such payments at all.

Legal Standard:

This putative class action concerned a commercial property insurance policy and a not uncommon grievance-an insured’s belief that its insurance policy entitles it to more money from its insurer than it received. Specifically, Plaintiff Schoening Investment, LP alleges (on behalf of itself and a putative class of insureds in Kentucky and Arizona) that Defendant The Cincinnati Casualty Company breached its insurance policy by undervaluing an actual cash value (ACV) payment it made to Schoening after Schoening suffered a covered partial structural loss to one of its properties. (By partial structural loss, the Court (and Schoening) means structural damage where estimated repair costs are lower than estimated replacement costs.)

The Court applied Kentucky law, which holds that the interpretation of unambiguous terms in an insurance policy is a matter of law. The Court concluded that Schoening’s depreciation-based challenge fail under the unambiguous policy terms.

Schoening contended that Cincinnati Casualty breached its contract in one very specific way. According to Schoening, the policy at issue does not allow Cincinnati Casualty to deduct any amount for depreciation from the otherwise-applicable ACV payments that would be due for partial structural losses. All Schoening challenges here is whether the insurer is entitled to deduct depreciation from such payments at all.

Cincinnati Casualty contended that the policy terms are sufficiently unambiguous on the depreciation issue that the Court should dismiss the suit. The Court agreed with Cincinnati Casualty.

THE VALUATION PROVISION

The Policy informs the reader that phrases in quotation marks (like “Actual Cash Value”) “have special meaning,” as set forth in “Section G. Definitions.” According to the Definitions Section, “‘Actual cash value’ means replacement cost less a deduction that reflects depreciation, age, condition and obsolescence.”

LEGAL STANDARD

To survive a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), a complaint must present sufficient facts to state a claim to relief that is plausible on its face. A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.

THE UNAMBIGUOUS POLICY TERMS

Schoening asks the Court to manufacture a third valuation method for the Policy which it cannot do. Schoening seeks an ACV-based payment without a depreciation deduction that would mean that, even without selecting the optional replacement cost coverage, insureds covered under the Policy for full replacement cost or RCV.

Further, because the insureds who select the optional replacement-cost coverage can elect to receive ACV-based payments before making repairs Schoening’s reading of ACV would entitle them to receive full-replacementcost-based payments (i.e., without depreciation) without in fact making any repairs directly contravening the Policy wording.

All told, the Court found that, under the unambiguous Policy language, Cincinnati Casualty may deduct depreciation of materials from ACV calculations when evaluating partial structural loss claims.

The Optional Coverage under the Policy provides only two valuation methods-replacement cost and ACV. The latter, ACV, “means replacement cost less a deduction that reflects depreciation, age, condition and obsolescence.” Replacement cost (RCV) is payment “without deduction for depreciation.” Unless and until an insured repairs or replaces a covered property, the replacement-cost based measure is not available to that insured.

Court’s Decision:

The Court agreed with Cincinnati Casualty that the policy unambiguously allows the insurer to deduct depreciation from ACV-based payments for partial structural losses. Consequently, the Court granted the motion to dismiss Schoening’s complaint with prejudice.

ZALMA OPINION

Schoening’s proposed reading would effectively grant insureds who did not pay for nor select the replacement cost coverage, a cost greater than the premium when RCV is not selected, an entitlement to replacement cost coverage, contrary to the policy terms. Schoening tried, by filing a class action, to change the wording of the policy and give the class a benefit for which they did not pay. The court refused to rewrite the policy whose terms and conditions the plaintiff class accepted when it acquired the policy.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.

Subscribe to my substack at https://barryzalma.substack.com/subscribe

Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg

Go to the Insurance Claims Library – https://lnkd.in/gwEYk

00:08:27
Interested? Want to learn more about the community?
What else you may like…
Videos
Posts
March 28, 2025
Title Insurer Properly Denied Claim

If Pleadings and Policy Wording Established Claim Was Excluded is Sufficient to Reject Claim in Texas

Post 5032

Title Defects Assumed by the Insured Excluded

Read the full article at https://www.linkedin.com/pulse/title-insurer-properly-denied-claim-barry-zalma-esq-cfe-m4uxc, see the full video at and at and at https://zalma.com/blog plus more than 5000 posts.

In 2017 Yale Street Development LLC v. First National Title Insurance Company, No. 14-23-00688-CV, Court of Appeals of Texas, Fourteenth District (March 13, 2025) the court was faced with a denied title insurance claim related to a failed construction development project in Houston.

BACKGROUND:

In 2015, Terry Fisher created 829 Yale St. LLC to construct a mid-rise condominium development at 829 Yale Street in Houston. Fisher obtained loans from Steadfast Funding and D&A Alvarez Group to complete the project. 829 Yale conveyed its title to Jetall Companies, Inc. to...

00:07:41
placeholder
March 27, 2025
Guilty Paying Kickbacks and Cappers to Defraud Insurers

Lawyer Convicted of Workers’ Compensation Fraud

Post 5031

Read the full article at https://www.linkedin.com/pulse/guilty-paying-kickbacks-cappers-defraud-insurers-zalma-esq-cfe-9uybc, see the full video at https://rumble.com/v6r8bl0-guilty-paying-kickbacks-and-cappers-to-defraud-insurers.html and at https://youtu.be/ZXEaXW1pGZs and at https://zalma.com/blog plus more than 5000 posts.

In The People v. Jon Woods, G061948, California Court of Appeals, Fourth District, Third Division (March 18, 2025) a jury convicted Jon Woods of 37 felony counts of workers’ compensation fraud.

Woods was a worker’s compensation attorney who had made business arrangements that involved unlawful kickback and referral fees.

Woods contended that the Williamson rule (In re Williamson (1954) 43 Cal.2d 651, 276 P.2d 593) precluded convictions on counts 5 through 37. The Williamson rule states that where the Legislature has defined a specific crime with a lesser punishment, the conduct described by that crime may not be charged as a more general ...

00:08:07
March 26, 2025
Fortuity Required for Defense

Tortious Interference Requires Intent to Harm

Defamation is a Covered Personal Injury Tortious Interference with Business Is Not

Post 5031

Read the full article at https://lnkd.in/g2MGe_8W, see the full video at https://lnkd.in/g3dDf3_9 and at https://lnkd.in/gRBCMG7b and at https://zalma.com/blog plus more than 5000 posts.

Robert Hole, M.D., appealed from the March 3, 2023 order granting plaintiff State Farm Fire and Casualty Company’s motion for summary judgment denying Dr. Hole coverage under the policy issued by State Farm.

In State Farm Fire And Casualty Company v. Dr. Robert Hole, M.D., and Dr. Michael Russonella, D.O., and North Jersey Orthopaedic And Sports Medicine Institute, LLC, No. A-2522-22, Superior Court of New Jersey, Appellate Division (March 21, 2025) a lawsuit filed against Dr. Hole by Michael Russonella, D.O. that alleged Dr. Hole made false statements regarding Dr. Russonella’s alleged misconduct at St. Mary’s Hospital in Passaic.

Dr. Hole sought coverage from his insurer, State Farm, to...

00:07:57
March 13, 2025

Read the full article at https://www.linkedin.com/pulse/duties-liabilities-insurance-brokers-barry-zalma-esq-cfe-mmpbc, if you Subscribe to “Excellence in Claims Handling” at https://barryzalma.substack.com/subscribe for only $5 a month or $50 a year.

Duties and Liabilities of Insurance Brokers

Posted on March 12, 2025 by Barry Zalma

Excellence in Claims Handling

This blog post is just a taste of the full article that is only available to subscribers to Excellence in Claims Handling. Anyone can subscribe to “Excellence in Claims Handling” at https://barryzalma.substack.com/subscribe for only $5 a month or $50 a year.

Cases in which insurance brokers’ liability is in question depend in part on whether brokers are seen to be serving a fiduciary role or simply acting as a conduit between the insured and the insurer.

A person or an entity is a fiduciary with respect to a plan to the extent:

he exercises any discretionary authority or discretionary control respecting management of such plan ...

post photo preview
March 12, 2025

Read the full article at https://www.linkedin.com/pulse/duties-liabilities-insurance-brokers-barry-zalma-esq-cfe-mmpbc, if you Subscribe to “Excellence in Claims Handling” at https://barryzalma.substack.com/subscribe for only $5 a month or $50 a year.

Duties and Liabilities of Insurance Brokers

Posted on March 12, 2025 by Barry Zalma

Excellence in Claims Handling

This blog post is just a taste of the full article that is only available to subscribers to Excellence in Claims Handling. Anyone can subscribe to “Excellence in Claims Handling” at https://barryzalma.substack.com/subscribe for only $5 a month or $50 a year.

Cases in which insurance brokers’ liability is in question depend in part on whether brokers are seen to be serving a fiduciary role or simply acting as a conduit between the insured and the insurer.

A person or an entity is a fiduciary with respect to a plan to the extent:

he exercises any discretionary authority or discretionary control respecting management of such plan ...

post photo preview
February 25, 2025
Adjusting Liability Claims

The Basics Needed by a Liability Adjuster

Post 5003
Posted on February 25, 2025 by Barry Zalma

See the full video at and at

Adjusting liability insurance claims requires skill, patience, knowledge of insurance, basic knowledge of tort and contract law, and knowledge and experience as an investigator. The liability claims adjuster is faced with the following basic obligations:

  • To understand the law of torts as applied in the state where the adjuster works.
  • To understand the law of contracts as applied in the state where the adjuster works.
  • To understand sufficient medical terminology to be able to evaluate claims of injury.
  • To understand the costs to repair or replace damaged real or personal property.
  • To understand how to read and apply the terms and conditions of a liability insurance policy.
  • To understand how to thoroughly investigate all claims assigned.
  • To conduct an investigation of every claim ...
post photo preview
placeholder
See More
Available on mobile and TV devices
google store google store app store app store
google store google store app tv store app tv store amazon store amazon store roku store roku store
Powered by Locals