MGW Law, LLP

Is criminal activity a reason to limit business property claims?

2026-10-27T06:37:23Z

Commercial real estate insurance can help to protect businesses from liability. Policies can also ensure that organizations have coverage to pay for repairs after major storms or other incidents leave a commercial facility damaged.

Occasionally, the origins of property damage are clearly human. Criminals attempting to rob a business, for example, might break windows, knock down walls or even drive their cars through a storefront facade in an attempt to access money or merchandise.

Can commercial insurance providers limit payouts when crime is the underlying cause of property damage?

Crime coverage is typically standard

While there may be a person to blame for crime-related property damage, that individual likely lacks the resources necessary to pay for repairs. Legal action against a criminal convicted of theft offenses and property damage crimes related to their attempt to access the commercial facility could result in a judgment in favor of the business, but collecting on that judgment could be difficult.

Thankfully, commercial real estate insurance policies generally include protection for crime-related incidents. While the insurance company might be able to subrogate the claim by taking independent legal action against the criminal or other potentially liable parties, the company typically cannot deny coverage or justify an unreasonably low settlement offer simply because criminal activity was the source of the property damage.

Reviewing commercial real estate insurance paperwork, police reports and other records of a criminal incident can help business leaders to secure the capital they need to repair their facilities. Negotiating a claim is likely to be complex and costly, so policyholders may need legal representation as they pursue the coverage they deserve, and that’s okay.

Can insurance deny my claim due to FEMA relief and vice versa?

2026-10-19T06:15:59Z

After a tornado, flood or other major disaster, homeowners may seek assistance from both their insurance company and the Federal Emergency Management Agency (FEMA). Unfortunately, navigating these two systems can be an understandably confusing endeavor. Can an insurer deny coverage because FEMA has assisted? Can FEMA refuse you needed assistance because you have insurance?

Each case is unique and dependent upon its distinct circumstances

Generally, private insurers cannot simply avoid their contractual obligations because a policyholder receives FEMA disaster assistance. If a loss is covered under the insurance policy, the insurer must evaluate the claim according to the policy's terms and applicable law. FEMA assistance does not automatically eliminate coverage. However, insurers may legitimately deny claims involving excluded damage, insufficient documentation or losses outside the policy's coverage. For example, standard homeowners insurance generally excludes flood damage, which may require separate flood insurance. Receiving FEMA assistance does not transform an excluded loss into a covered one. FEMA follows different rules. Federal disaster assistance is intended to address certain unmet needs rather than duplicate benefits available through insurance. If insurance covers a particular expense, FEMA generally cannot provide assistance for that same expense. This does not necessarily mean insured homeowners are ineligible for FEMA assistance. If insurance pays less than the actual eligible loss, excludes certain expenses or delays payment, additional FEMA assistance may be available depending on program requirements. Applicants may need to provide settlement documents, denial letters or other supporting information. Ultimately, understanding how FEMA assistance and private insurance interact can help disaster survivors protect their rights and avoid losing financial support when they need it most. Seeking legal guidance personalized to one’s circumstances is a great way to get started in this regard.

Is an insurance company unreasonably limiting temporary housing coverage?

2026-10-14T09:10:01Z

Living in a home seriously damaged by inclement weather can be challenging or outright unsafe. Especially once repairs begin, homeowners may need to make arrangements to stay elsewhere, such as a long-term stay hotel or a short-term apartment that does not require a year-long lease.

Depending on the scope of the damage and the repairs required, people may need to live elsewhere for weeks or even months while professionals restore their home to inhabitable condition. Homeowners may find that they struggle to secure the financial support they need when paying for alternate housing and other costs related to their temporary displacement.

Insurance companies want to limit losses

In a perfect world, a property owner facing a seven-month displacement based on the proposed construction timeline could obtain funds to pay for housing up front, which may give them more leverage when seeking a short-term lease and more stability while living somewhere other than their primary residence.

They should be able to rely on insurance to cover related additional living expenses (ALEs), such as animal boarding, take-out food and other costs directly associated with living in a temporary housing arrangement. Unfortunately, insurers might only approve housing costs in one-month or three-month increments, forcing policyholders to resubmit requests frequently until the completion of the work on their home.

There may also be disputes about what ALEs are eligible for payment and how much the insurance company can provide for those expenses, as well as how long the insurance company covers alternative living arrangements.

Working with a homeowners insurance attorney can help people handle negotiations and optimize the funds they receive when living elsewhere temporarily due to necessary home repair work inspired by turbulent circumstances.

Water damage could lead to a lowball offer

2026-10-07T10:03:14Z

Water damage is a top reason for property insurance claims. It could come from interior issues, like a broken pipe, or from external problems, such as a leak in a roof. But no matter how it starts, one thing to keep in mind is that water damage spreads quickly through a home. Even a small amount of water can be absorbed into various materials, such as drywall, paneling, carpet and more. Additionally, water always seeks the path of least resistance as it travels downward. Something like a leak in the roof is not just going to cause damage in the attic. That water could get into the ceiling, the light fixtures, the walls and even upper-level floors.

Is the insurance really paying for everything?

The issue that this creates is that the damage goes far beyond the actual issue. Technically, a person may just have a small leak in the roof. But repairing that roof is just the first step. Depending on how much water got into the house, it could have ruined numerous parts of the home. The homeowner may actually have to replace ceilings, repaint, tear out walls, put up new drywall, replace carpeting and much more. Additionally, once water is within the closed system of the home, it can bring on many related issues. It can lead to rot and decay within the house. It promotes the growth of mold, which can start to spread through the home. In other words, even if a leak seems small, the water damage could be extensive. If the insurance company just offers to fix the roof itself, it could be a significant lowball offer. In reality, there could be tens of thousands of dollars of damage within the home that needs to be addressed, all because of that leak. If you believe that your insurance company is not paying out correctly or is even operating in bad faith, it is crucial that you understand all of your legal options.

Insurance delays may lead to problems for small businesses

2026-09-17T07:08:23Z

Small businesses usually have insurance that protects them from a variety of situations. When one of these businesses suffers a covered loss, they likely need their insurance to provide them with timely financial support so they can repair damage, replace property and keep operations moving forward. When the insurance payment is delayed, the small business owner may start to have financial difficulties. These can include an inability to cover basic expenses, such as rent, payroll, vendor bills, and taxes. Because small businesses often operate with a tiny profit margin, even small delays can have catastrophic financial consequences.

Addressing potential delays

Insurance delays can happen for a variety of reasons, such as the insurer needing more documentation or a dispute about the cause of the loss. It’s best to gather as much information as possible after the loss. This may include financial statements, repair estimates, inventory records, proof of ownership and photographs. Policy terms are another factor that might affect timing. Exclusions, waiting periods, deductibles and business interruption requirements can all impact when the small business owner may receive payment. If there were any misunderstandings about these terms, there may be an unexpected gap in the claims process.

Impact on recovery

A delayed or reduced insurance payment can lead the small business to have to limit services or make cuts to the company. If the recovery is too prolonged, the business may not be able to recover, which may lead to it closing. Small business owners must understand the scope of their insurance policies and the timeline for recovery. It’s also beneficial to conduct periodic checks on coverage amounts and terms to ensure it meets the business’s needs. Appeals of the insurance company’s decisions on payments may be necessary. Going through this process can be challenging but it may be a bit easier if someone is assisting the small business owner through the process.

Can insurance companies change the deductible during a claim?

2026-09-21T04:07:37Z

Numerous important figures influence insurance claims. Policy coverage limits set maximum amounts for the compensation people could secure. Deductibles determine how much policyholders must pay out of pocket for related expenses before the insurance company begins covering their losses. Sometimes, insurance companies do not outright deny claims but instead insist a deductible must be met before they honor the policy. If the claim is large, can the insurance company modify the deductible to limit losses given the scope of the damages incurred?

The deductible is set by the contract

The amount of the deductible paid before the insurance company covers losses is one of the most important considerations when determining how much the policy costs. People trying to reduce their annual premiums may choose to increase their deductible. Those who don’t want to worry about large deductibles when they file claims generally pay more for that protection. Insurance companies have an obligation to honor their policies as written until it is time for policy renewal. While a large claim might alter what an insurance company charges a policyholder and may force them into considering a larger deductible in the future, the insurance company cannot retroactively apply a higher deductible to a current claim. Attempts to deny coverage or deter policyholders from pursuing claims may constitute bad faith insurance practices. Misrepresenting the deductible and the policyholder’s financial obligations could be indicative of misconduct. Reviewing the policy paperwork and claims communications with a bad faith insurance lawyer can help people understand their options during disputed or delayed claims. Legal action is sometimes necessary to secure the compensation promised by insurance coverage.

How do insurance internal appeals and external reviews differ?

2026-10-01T14:01:03Z

A health insurance denial isn’t necessarily final. When an insurer refuses coverage for a needed surgery or other medical care, the patient may have the right to challenge the denial through an internal appeal, an external review or both. Internal appeals and external reviews have similar purposes, but they’re handled by different parties.

How is an internal appeal handled?

The denial notice should explain how to file an appeal and offer a deadline. For many health plans, patients have up to 180 days after receiving the denial to request an internal appeal. However, deadlines and procedures can differ. An internal appeal gives the insurer a chance to review its decision and reconsider the original denial. Someone who wasn’t involved in the initial decision should review the claim, the policy terms and any additional information the patient or medical provider submitted, such as:

Medical records and test results
A letter from the treating physician
Evidence that other treatments were ineffective
Medical research supporting the requested treatment
The insurer’s denial notice
Relevant language from the insurance policy

If the insurer still denies coverage for the medical services after its internal review, the claim may be eligible for an external review.

What happens during an external review?

An external review sends the dispute to an independent third party that is not connected to the insurance company. The independent reviewer examines the medical evidence, the insurer’s reasoning and the terms of the health plan. If the reviewer overturns the denial, the insurer generally must follow that decision and cover the medical procedure. Not every dispute qualifies for external review. It’s commonly available for denials that involve claims of medical necessity, level of care, effectiveness of treatment, experimental treatments and questions about appropriateness of care. Denial notices should explain whether external reviews are available and how to initiate one. Insurance appeals can involve short deadlines and complicated plan language. If an insurer refuses to reverse an unsupported denial or fails to provide access to an external review, an attorney can help affected patients understand their rights and pursue the coverage they need.

Does suicide always prevent a life insurance policy payout?

2026-10-01T13:58:42Z

There are many ways for insurance companies to intentionally sidestep their obligations to policyholders. In some cases, they offer low settlements while people are desperate for financial relief. Other times, they may try to trick people into making statements that justify a reduced settlement or denied claim. Sometimes, professionals working for the insurance company may knowingly misrepresent policy terms to convince people that they do not deserve coverage. When grieving family members file a life insurance claim, insurance professionals may try to deny or reduce their claim. If suicide is the cause of death, do surviving family members lose the right to file a claim?

Suicide restrictions are common

Insurance companies lose money when they only collect life insurance premiums for a short amount of time before a policyholder dies. As such, certain elements of a policy’s coverage may not take effect immediately. Suicide exclusions are common in life insurance policies. However, contrary to what many people believe, it is not a permanent prohibition on coverage. Instead, there is a waiting period that applies. The policyholder generally needs to pay their premium for two to three years before coverage might be available to survivors after a suicide. The language included in every policy is different depending on the terms negotiated by the policyholder, state law and even company practices. Families who have just lost a loved one may need to assess a life insurance policy carefully with a legal professional. Having guidance may make it easier to recognize if coverage is available and negotiate with insurance providers that are eager to deny the claim.

Handling claims negotiations when roof issues cause mold growth

2026-10-01T13:57:13Z

Homeowners insurance and specialized supplemental policies may cover storm damage, including water damage caused by leaks in a roof. When hail, intense rainfall or strong winds damage a roof, the entire structure is potentially at risk. Property owners typically need to repair the roof and replace any property directly damaged. They can count on their insurance to help them address the damage and replace their lost property. In some cases, they may also need mold remediation services due to the water that gets into the property. Does homeowners insurance typically cover mold remediation as a side effect of storm damage?

Mold clean-up could be covered

Every insurance policy is different, and most policies that protect private property have numerous limitations written into them. Insurers often try to limit their liability by restricting coverage in some situations. Mold damage can be very costly to address, especially if it is widespread through the building and not localized to one area. Secondary or subsequent damage caused by storm damage may be eligible for insurance coverage in some cases. However, the timeline for mold development, the homeowner’s response to the initial damage and the details of the policy may all influence whether mold damage is eligible for coverage at all, and how much of the remediation costs are covered by the policy. People may need help documenting property damage, reviewing the coverage and negotiating with the insurance company. Working with an experienced homeowners insurance lawyer reduces the likelihood of homeowners losing the coverage for which they paid and facing major out-of-pocket expenses for interior mold issues caused by storm damage.

What should you know about roof damage insurance claims?

2026-09-17T07:07:47Z

Homeowners purchase insurance policies with the expectation that the policy will pay damages for covered calamities. Some of these revolve around natural disasters and inclement weather. One of these is roof damage, which may be the result of storms, winds, hail or objects like falling trees. Roof damage can lead to urgent questions about getting the damage repaired, insurance coverage and the entire claims process. Homeowners insurance may help to pay for these if the event was the result of a covered event.

What’s a covered event?

Coverage usually depends on the language within the policy and the cause of the damage. Damage from events like poor maintenance, normal wear and tear, earthquakes or flooding won’t be covered. It’s also possible that some wind or hail events won’t be covered.

What should homeowners do if roof damage is noted?

After a storm or other covered event occurs, checking the roof is one of the first things that must happen. Homeowners shouldn’t try to venture onto the roof because structural damage might be necessary. Photos and videos should be taken from safe areas that can help to document visible damage. Notifying the insurance company as soon as the damage is found is critical. Claims become harder to support as time moves on from the event. It’s also important for homeowners to mitigate the damage to the roof. This can include covering the damaged portions with a tarp to prevent the damage from worsening. Even with comprehensive documentation, the insurance company may still deny the claim. Homeowners should be prepared to appeal in these cases so they can receive the payment that enables them to repair or replace the roof as quickly as possible.